Diabetic Standards of Care

What immunizations are there specific guidelines for in ADA?

COVID, Hep B, Influenza, Pneumonia, RSV, Tdap, Zoster

What is the ADA recommendation for influenza vaccine?

recommended for all DM annually; usually trivalent vaccine (NOT live)

What is the ADA recommendation for Hep B vaccine?

recommended for all adults (<59) can be given if warranted at least 60 years old

What is the ADA recommendation for COVID vaccine?

all people 6 months and older; initial vaccine and boosters

What is the ADA recommendations for RSV vaccine?

all adults at least 60 years old; 1 dose

What is the ADA recommendations for Zoster vaccine?

at least 60 years old; 2 doses of Shingrix

What is the ADA recommendations for Tdap vaccine?

every 10 years

What are the ADA recommendations for pneumococcus vaccines?

recommended for all DM > 19

if last was PCV13,15 give PPSV 23 at least 1 year later

if PCV 20 do NOT use PPSV23

If last was PPSV23 give PCV 15 or 20 at least 1 year later

Which vaccine isn’t in the AACE guidelines as of now?

RSV

What screenings should be done for T1DM?

autoimmune disease: autoimmune thyroid disease, celiac disease

What screenings need to be done for T2DM?

bone health, cognitive impairment/dementia, dental care, disability, low testosterone in men, female sexual dysfunction, metabolic dysfunction-associated steatohepatitis (MASH)

When should you follow AACE targets and goals?

if patients are <65 and without clinical ASCVD

When should you follow ADA targets and goals?

if the patients is at least 65 years old OR any age with clinical ASCVD

What is the AACE A1C goal?

less than 6.5%

What is the AACE FBG goal?

< 110 mg/dL

What is the AACE PPG goal?

<140 mg/dL

What is the ADA A1C goal?

<8.0%

What is the ADA FBG goal?

80-130 mg/dL

What is the ADA PPG goal?

< 180 mg/dL

What are tighter goals used for?

to prevent CVD/ prevent long term micro & macro vascular complications

What are looser goals used for?

to avoid hypoglycemia

What additional recommendations exist for all individuals with diabetics?

monitor for signs of over basalization

glucagon prescription

assess for financial obstacles

use lower-cost medications and consider cost-related barriers

what diet/eating plan is suggested for diabetics?

mediterranean or DASH

What is the ADA recommendation regarding smoking cessation?

avoid use of cigarettes, other tobacco products, or e-cigs

What is the AACE recommendation regarding smoking cessation?

no specific recommendations; encourage smoking cessation

How often should urinary albumin be monitored if they have CKD?

1-4 times per year depending on stage

When should T1DM have an initial eye exam after the onset of diabetes?

within 5 years

When should T2DM have initial eye exam?

at the time of diagnosis

What factors are associated with the at-risk foot?

poor glycemic control, peripheral neuropathy, PAD, foot deformities, prior ulceration, amputation, smoking, retinopathy, nephropathy