Overview
The Diabetes Program was the second state-wide disease management program developed by the Community Care networks.
The program provides resources for clinicians as they follow evidence based clinical practice guidelines in the diagnosis and treatment of patients with Diabetes. The 2009 American Diabetes Association Clinical Practice Recommendations are used as the basis of the program. Click here for a summary of the adult and child guidelines.
In addition, case managers can work intensively with high risk diabetic patients to promote self management and focus on the importance of dietary changes, exercise, adherence to prescribed medications, and recognition of warning signs of worsening symptoms.
Tools and Resources
Diabetes Flow Sheets – Adult, Child
Referral Resource
WakeMed Adult Diabetes Medical Referral Form
WakeMed Children Diabetes and Endocrinology Center
WakeMed ENERGIZE referral
WakeMed ENERGIZE lab form
Rex Diabetes Education Center
Duke Raleigh Hospital Diabetes Center
Johnston Memorial Diabetes Education
Patient Education
Control of ABC’s of Diabetes
Hyper-Hypo Glycemia – English, Spanish
First Steps for Health Eating- English, Spanish
Smoking Cessation Resources
Measures
As part of the Continuous Quality Improvement activities, measures are tracked to guide network and practice level priorities and resources. These include:
- 1 or more measurement of HbA1c per year
- A1c control (good) – Most recent HbA1c <7% (patients > 18 yrs)
- A1c control (poor) – Most recent HbA1c >9% or no test in past year (patients > 18 yrs)
- Lipid Management (good) – Most recent LDL-C is < 100mg/dl (patients > 18 yrs)
- Lipid Management (poor) – Most recent LDL-C is > 130 mg/dl or no test in past year (all ages)
- BP control (good) – Most recent BP <130 systolic and <80 diastolic (patients > 18 yrs)
- BP control (poor) – Most recent BP > 140 systolic or >90 diastolic (all ages)
- Foot exam in past year (patients > 18 yrs)
- Aspirin use address (patients >40 yrs)
- Claim for an eye exam (patients > 10 yrs)
- Nephropathy Screen (patients > 10 yrs)
- Smoking status addressed and cessation advice given to smokers (patients > 10 yrs)
