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Diabetes Mellitus: The Rule of Three’s

A Model to Facilitate Comprehensive Care for Patients with Type 2 Diabetes Mellitus

Micro-Vascular Complications    

1. EYES (Retinopathy)
Annual visit with Ophthalmologist    

2. KIDNEYS (Nephropathy)
Annual screen for Microalbuminuria
ACE-Inhibitor for HTN, and/or
     microalbuminuria
Follow Renal Function (Creatinine)

3. FEET (Neuropathy)
Patient Education: Foot Care
Inspect Patient’s Feet
Podiatry as needed    

Blood Sugar Control

1. HEMOGLOBIN A1C
Check every 3-6 months
Goal is less than 8
Avoid being over-aggresive
w/hypoglycemic agents

2. LIFESTYLE
Nutrition
Activity

3. MEDICATIONS
Metformin First-Line 
A variety of oral &
injectable agents
Insulin

Macro-Vascular Complications

1. HYPERTENSION
Systolic BP < 140
Lower threshold if increased CV risk
Diastolic BP < 90

2. LIPIDS
Follow 2013 AHA/ACC Guidelines:
Emphasize level of risk instead of LDL
Engage in shared decision making
w/the patient

3. CAD/CVA PREVENTION
Smoking Cessation, Nutrition, Activity
Stress ↓: Yoga, Meditation, Therapy
Consider aspirin if increased CV risk

 

Author(s): Wayne Altman, M.D.
Created: Thursday October 25, 2012
Modified: Friday May 11, 2018

Copyright Information: Copyright 2012, Tufts University

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