T2DM Office-Visit Checklist

DIAGNOSTIC CRITERIA
Prediabetes
*A1c 5.7% - 6.4%, or
*FPG 100 mg/dL to 125 mg/dL, or
*2-hr 75g OGTT 140 mg/dL -199 mg/dL

Type 2 Diabetes
*A1c > 6.5%, or
*FPG >126 mg/dL (minimum 8 hr fast), or
*2-hr 75g OGTT >200 mg/dL, or
Random plasma glucose >200 mg/dL with classic symptoms of
hyperglycemia or hyperglycemic crisis

Consider metformin, especially if BMI >35, <60 years of

age, and prior gestational diabetes
*Test should be repeated to confirm. Preferably the same test; however if results of 2 different tests are above the threshold, the
diagnosis is confirmed.
Checklist Item
GOALS
At goal
At goal
At goal

BP at goal of < 130/80 mm Hg

LDL at goal of <100 or <70 mg/dL
Goal is:
A1c at goal
Goal is:

At goal

Capillary plasma glucose

70-130 mg/dL preprandial
<180 mg/dL postprandial
DRUG THERAPY FOR PRIMARY PREVENTION
Indicated
ACE-I / ARB
Yes
No
Comments:
On Therapy
Yes
No
Indicated
Statin
Yes
No
Comments:
On Therapy
Yes
No
Indicated
Aspirin
Yes
No
Comments:
On Therapy
Yes
No
LABS
Up to Date

Description

<70 mg/dL if CAD + additional risk factors such as smoking, metabolic

1
syndrome, etc, or history of ACS
Most patients goal of <7%
Optional goals of <6.5% or <8% based on duration of diabetes,
hypoglycemic risk, life expectancy, complications, comorbidities,
and ease of control
Postprandial = 1-2 hours after beginning meal

Indicated if: diagnosis of HTN or evidence of microalbuminuria

(>30 g/mg)

Indicated if:
LDL above goal
Regardless of LDL if patient has overt CVD
Patients without CVD if > age 40 with 1 or more CVD risk factors
Indicated if:
10 year risk >10% (includes most men > age 50 or women > age
60 who have at least one other major risk factor (family history
of CVD, hypertension, smoking, dyslipidemia, or albuminuria)
Risk vs Benefit if 10-year risk 510%
Not recommended for low CVD risk (10-year CVD risk <5%)

A1c

Every 3 months unless at goal. If at goal, test at least twice annually.

Fasting lipid profile

Annually

Liver Function Tests

Baseline (prior to statin initiation) and as needed based on symptoms of

2
liver disease

Due:
Needs ordered
Up to Date
Due:
Needs ordered
Up to Date
Due:
Needs ordered

LABS (cont)
Up to Date

UAE with spot urine albumin-tocreatinine ratio

Annually (confirmed by 2/3 abnormal within 3-6 months)

Normal <30 g/mg
Microalbuminuria 30-299 g/mg
Macroalbuminuria >300 g/mg

Serum creatinine and calculated

GFR

Annually

Thyroid-stimulating hormone in
type 1 diabetes, dyslipidemia, or
women > age 50

Annually if indicated

Due:
Needs ordered
Up to Date
Due:
Needs ordered
Indicated
Due:
Needs ordered
IMMUNIZATIONS
Up to Date
Due
Up to Date
Due

Up to Date
Due
Not Indicated
EXAMS/REFERRALS
Up to Date

Annual Influenza
Pneumococcal polysaccharide
Age:
Last administered:
Hepatitis B

One time before age 64 plus one-time revaccination after age 64 if last
vaccine was > 5 years prior

Recommended in those < age 60. Over age 60 depending on need for
3
assisted glucose monitoring, risk, and likelihood of immune response

Annual dilated and comprehensive

eye exam

Less frequent (every 2-3 years) optional following >1 normal exams

Annual comprehensive foot

examination

To include pedal pulses, and testing for loss of protective sensation (10-g
mono-lament plus testing any one of the following: vibration using 128Hz tuning fork, pinprick sensation, ankle reexes, or vibration perception
threshold)

Due:
Needs ordered
Up to Date
Due:

Needs ordered
EDUCATION DISCUSSION POINTS
Exercise
At least 150 min/week of moderate-intensity aerobic physical activity (30 min / 5 days per week)
Resistance training at least twice per week
Hypoglycemia (BG < 70 mg/dL)
Treatment: 15-20 g of glucose
Glucagon for those at risk of severe events
Smoking cessation
Foot self-care
Self-monitoring blood glucose
Glucometer teaching & recommended frequency
Nutrition
All recommendations taken directly from the American Diabetes Association Standards of Medical Care in Diabetes- 2012, except as
noted:
1. Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines.
Circulation. 2004;110:227-239.
2. FDA Expands Advice on Statin Risks. FDA's MedWatch Safety Alerts: February 2012. Available at:
http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm298416.htm#1. Accessed May 14, 2012.
3. Centers for Disease Control and Prevention. Recommended adult immunization scheduleUnited States, 2012. MMWR 2012;61.
Available at http://www.cdc.gov/vaccines/recs/schedules/default.htm. Accessed May 14, 2012.