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CLINICALPATHWAYTYPE2DIABETESDIAGNOSISOFDIABETESFBG>7.0mmol/LORcasualPG>11.1mmol/LontwooccasionsORonceinthepresenceofsymptomsOR75gmOGTT2hrplasmaglucose>11.1mmol/l1.ReferpatienttoaDiabetesEducationCentre2.GivepatientaprescriptionforBloodGlucoseMeter(Recommendmonitoringfasting&2hrpcmainmeal2to3days/week)3.GivepatientBasicNutritionGuidelines:Eat3meals/day;watchportionsizes;eliminatejuiceandregularpop(substitutewithwater,dietpop),limitsodium,alcoholandcaffeine,reducefat.4.Encouragepatienttoexercisefor30minutes,5daysaweek.(ConsiderexerciseECGforpreviouslysedentaryindividuals)5.Encouragepatienttoquitsmoking6.FormostNormalRange(ifcanTargetspatientsbeachievedsafely)FBS4–7<62hrpcBS5–105-8HbA1C<7<67.Ifpatienthassymptomsofhyperglycemia,itmaybeappropriatetomovetofollow-uproutineat1month8.Diabetesisaprogressivedisease–regularpre-bookedfollowupisimperative9.Considerreferraltoendocrinologistatanytimeifgoalsarenotmetorcomplicationsarepresent10.TargetA1Cshouldbeachievedin6to12months11.AggressivelyaddressBP,Lipids,KidneyFunction(seechartpage2)FOLLOW-UP–2-3MONTHSHbA1C,LipidProfile,Urinemicroalbumin(CopytoDEC)TargetBP<130/80YESNOInitiateContinueIndividualizedTargetsPharmacologicLifestyleAchieved?TherapyManagementMildtoModerateMarkedhyperglycemia(A1C>9.0)Hyperglycemia(A1C<9.0)Non-overweight(BMI<25)Overweight(BMI>25)Start2agentsfrom StartInsulin*1or2agentsfromBiguanidesaloneorindifferentclasses:(seeInsulindifferentclasses:combinationwith1of: BiguanideInitiationOptions Biguanide Thiazolidinediones Secretagogues*page2) Thiazolidinediones Secretagogues* Thiazolidinediones Secretagogues* Insulin* Insulin* Insulin* Alpha-glucosidase Alpha-glucosidase Alpha-glucosidaseinhibitorinhibitorinhibitor*Advisepatientofsigns,symptoms&treatmentofhypoglycemiaRecommendedPatientLiterature:“GettingStarted”bookletfromtheDiabetesEducationCentreCLINICALPATHWAY(416)521-4081orliteraturefromCDATYPE2DIABETESFOLLOW-UP--3MONTHSContinueAdd
