Evidence Based Management

The American Diabetes Association (2014) recommends that providers monitor the glycosolated hemoglobin at least twice a year in diabetic patients.  An A1C goal of 7% or under is recommended for those patients without complications and frequent hyperglycemia.  Patients who have already experienced complications, have frequent hypoglycemic episodes, or has a decrease life expectancy may have an A1C goal of 8% or less.

The clinical practice recommendations published by the American Diabetic Association (2014) recommend initial therapy with metformin.  The provider should prescribe metformin at an initial dose of 500mg to 1,000 mg per day.  This can be titrated by increasing the dose by 500mg to 1,000mg per week as tolerated, until a maximum dose of 2,500mg per day is reached.  Lifestyle changes, such as the ADA controlled carbohydrate diet, along with frequent exercise, can increase the patient’s sensitivity to insulin.

Qi et al (2014) reported that frequent consultation and education in a primary care setting showed significant improvement in diabetic management. In the study, the practitioners delivered six teaching sections on health issues and four times face-to-face counseling in one year to patients with diabetes.  The fasting plasma glucose decrease from 8.53 mmol/L to 7.11 mmol/L (p < 0.001).

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