John E. Anderson, MD, prepared useful practice aids pertaining to type 2 diabetes for this CME activity titled "Realizing Your Patient’s Potential: Embracing the Guidelines to Appropriately Individualize Care for Patients With Type 2 Diabetes." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2UlgLL0. CME credit will be available until April 16, 2020.

1. This Practice Aid has been provided as a quick reference to help learners apply the information to their daily practice and care of patients.
Decision Cycle for Patient-Centered
Management of Type 2 Diabetes1
1. American Diabetes Association. Diabetes Care. 2019;42(Suppl 1):S1-S193.
PRACTICE AID
Access the activity, “Realizing Your Patient’s Potential: Embracing the Guidelines to Appropriately
Individualize Care for Patients With Type 2 Diabetes,” at PeerView.com/UQE40.
Assess key patient
characteristics
Consider factors that
may impact choice
of treatment
Shared decision-making
to create a
management plan
Agree on a
management plan
Implement a
management plan
Routine monitoring
and support
Review and agree on
a management plan
Goals of
Care

2. Access the activity, “Realizing Your Patient’s Potential: Embracing the
Guidelines to Appropriately Individualize Care for Patients With Type 2
Diabetes,” at PeerView.com/UQE40.
Assessing Patient Characteristics: Key
Components of the Comprehensive
Diabetes Medical Evaluation1
This Practice Aid has been provided as a quick reference to help learners apply the information to their daily practice and care of patients.
PRACTICE AID
Psychosocial conditions
• Screen for depression, anxiety, and disordered eating; refer for
further assessment or intervention if warranted
• Identify existing social supports
• Consider assessment for cognitive impairmenta
Diabetes self-management education and support
• History of dietitian/diabetes educator visits/classes
• Assess diabetes self-management skills and barriers
• Assess familiarity with carbohydrate counting (type 1 diabetes)
Pregnancy planning
• For women with childbearing capacity, review contraceptive needs
and preconception planning
Behavioral
and
Diabetes
Self-
Management
Skills
Initial
Visit
Every
Follow-Up
Visit
Annual
Visit
Diabetes history
Components of the Comprehensive Diabetes Medical Evaluation at Initial, Follow-Up, and Annual Visits
• Characteristics at onset (eg, age, symptoms)
• Review of previous treatment regimens and response
• Assess frequency/cause/severity of past hospitalizations
Family history
• Family history of diabetes in a first-degree relative
• Family history of autoimmune disorder
Personal history of complications and common comorbidities
• Macrovascular and microvascular
• Common comorbidities (eg, obesity, OSA)
• Hypoglycemia: awareness/frequency/causes/timing of episodes
• Presence of hemoglobinopathies or anemias
• High blood pressure or abnormal lipids
• Last dental visit
• Last dilated eye exam
• Visits to the specialist
Interval history
• Changes in medical/family history since last visit
• Eating patterns and weight history
• Physical activity and sleep behaviors
• Tobacco, alcohol, and substance use
• Current medication regimen
• Medication-taking behavior
• Medication intolerance or side effects
• Complementary and alternative medicine use
• Vaccination history and needs
• Assess use of health apps, online education, patient portals, etc
• Glucose monitoring (meter/CGM): results and data use
• Review insulin pump settings and use
This
Visit
Lifestyle
Factors
Past Medical
and Family
History
Medications
and
Vaccinations
Technology
Use

3. Access the activity, “Realizing Your Patient’s Potential: Embracing the
Guidelines to Appropriately Individualize Care for Patients With Type 2
Diabetes,” at PeerView.com/UQE40.
Assessing Patient Characteristics: Key
Components of the Comprehensive
Diabetes Medical Evaluation1
This Practice Aid has been provided as a quick reference to help learners apply the information to their daily practice and care of patients.
ABI: ankle-brachial pressure index; ACE: angiotensin-converting enzyme; ARB: angiotensin receptor blocker; CGM: continuous glucose monitors; OSA: obstructive sleep apnea; PAD: peripheral
arterial disease.
a
At 65 years of age or older. b
Should be performed at every visit in patients with sensory loss, previous foot ulcers, or amputations. c
May also need to be checked after initiation or dose changes
of medications that affect these laboratory values (ie, diabetes medications, blood pressure medications, cholesterol medications, or thyroid medications). d
In people without dyslipidemia and
not on cholesterol-lowering therapy, testing may be less frequent. e
May be needed more frequently in patients with known chronic kidney disease or with changes in medications that affect
kidney function and serum potassium.
1. American Diabetes Association. Diabetes Care. 2019;42(Suppl 1):S1-S193.
PRACTICE AID
Initial
Visit
Every
Follow-Up
Visit
Annual
Visit
• Height, weight, and BMI; growth/pubertal development in children
and adolescents
• Blood pressure determination
• Orthostatic blood pressure measures (when indicated)
• Fundoscopic examination (refer to eye specialist)
• Thyroid palpation
• Skin examination (eg, acanthosis nigricans, insulin injection
or insertion sites, lipodystrophy)
• Comprehensive foot examination
– Visual inspection (eg, skin integrity, callous formation, foot deformity
or ulcer, toenails)b
– Screen for PAD (pedal pulses; refer for ABI if diminished)
– Determination of temperature, vibration or pinprick sensation, and
10-g monofilament exam
• A1C, if the results are not available within the past 3 months
• If not performed/available within the past year
– Lipid profile, including total, LDL, and HDL cholesterol and triglyceridesc
– Liver function testsc
– Spot urinary albumin-to-creatinine ratio
– Serum creatinine and estimated glomerular filtration ratee
– Thyroid-stimulating hormone in patients with type 1 diabetesc
– Vitamin B12 if on metformin (when indicated)
– Serum potassium levels in patients on ACE inhibitors, ARBs, or diureticse
d
Physical
Examination
Laboratory
Evaluation
American Diabetes Association Standards of Medical Care App
• Download on the App Store for IOS
• Download on Google Play for Android
This
Visit

4. This Practice Aid has been provided as a quick reference to help learners apply the information to their daily practice and care of patients.
1. Unger J. Diabetes Metab Syndr Obes. 2012;5:57-74.
PRACTICE AID
Access the activity, “Realizing Your Patient’s Potential: Embracing the Guidelines to Appropriately
Individualize Care for Patients With Type 2 Diabetes,” at PeerView.com/UQE40.
• When did the event(s) occur? (daytime versus overnight)
• Under what circumstances did they occur? (missed meal, following exercise, excess medication)
• What were the symptoms?
• What was done? (eg, carbohydrates ingested, follow-up blood glucose monitoring)
• What was the blood glucose reading?
• Did they require assistance from another person in order to reverse the hypoglycemia?
• With whom and how did they treat the hypoglycemia?
• How soon did hypoglycemia resolve? (blood glucose levels rose to 3.9 mmol/L [70 mg/dL])
• Did the hypoglycemic event reoccur later within a 24-hour period?
• How fearful is the patient or the family of hypoglycemia?
• Do they test their glucose level before driving?
• Does the patient “stack insulin” (re-bolus rapid insulin analog within 3 hours of a similar injection)?
• At what glycemic level does the patient perceive hypoglycemia? (If 50 mg/dL, patient may have hypoglycemia-associated
autonomic failure.)
• Does the patient understand the consequences of hypoglycemia? (Some patients prefer being “low” rather than “high” because they
fear the consequences of acute or chronic hyperglycemia.)
Talking With Patients About
Hypoglycemic Events1

5. This Practice Aid has been provided as a quick reference to help learners apply the information to their daily practice and care of patients.
Diabetes Management Resources
VA: Veterans Affairs.
PRACTICE AID
Access the activity, “Realizing Your Patient’s Potential: Embracing the Guidelines to Appropriately
Individualize Care for Patients With Type 2 Diabetes,” at PeerView.com/UQE40.
Resource URL
American Association of Clinical Endocrinologists and American College of Endocrinology
Comprehensive Type 2 Diabetes Management Algorithm 2019
https://journals.aace.com/doi/pdf/10.4158/CS-2018-0535
American Diabetes Association (ADA) and the European Association for the Study of
Diabetes (EASD) Consensus Statement—2018
http://care.diabetesjournals.org/content/diacare/41/12/2669.full.pdf
ADA Standards of Medical Care—2019 https://professional.diabetes.org/content-page/practice-guidelines-resources
ADA Standards of Medical Care in Diabetes—2019
Abridged for Primary Care Providers
http://clinical.diabetesjournals.org/content/diaclin/early/2018/12/16/cd18-0105.full.pdf
ADA Standards of Medical Care App https://professional.diabetes.org/content-page/standards-care-app-1
US Dietary Guidelines (MyPlate) https://health.gov/dietaryguidelines/2015/resources/2015-2020_Dietary_Guidelines.pdf
VA MOVE!® Coach app https://mobile.va.gov/app/move-coach
Osteoarthritis Education https://arthritisaustralia.com.au/
Mayo Clinic Diabetes Decision Aids
Downloadable brochures and instructions: https://shareddecisions.mayoclinic.org/decision-aid-
information/decision-aids-for-chronic-disease/diabetes-medication-management/
Video demonstration: https://www.youtube.com/watch?v=SYTPqceFgSw
Medication availability
https://info.mmitnetwork.com/formulary-search
https://lookup.decisionresourcesgroup.com/
https://mobile.va.gov/app/ask-a-pharmacist
https://www.goodrx.com/