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Diabetes Follow Up Visits

Type 1 Diabetes - Follow-up Care - Lehigh Valley Health Network - A Passion For Better Medicine

Type 1 Diabetes - Follow-up Care - Lehigh Valley Health Network - A Passion For Better Medicine

Type 1 diabetes follow-up care requires both supervised medical care, and importantly, self-managed care to keep tabs on this chronic condition. Treatment involves insulin injections up to several times a day and monitoring of blood sugar levels during the day. The levels are checked by pricking an approved area of skin and placing a drop of blood on a special test strip. The blood glucose level is displayed on the meters screen. To maintain steady sugar levels, you should eat a well-balanced diet with enough calories to prevent hypoglycemia (low blood sugar) but not enough calories to cause an excessive and abnormal increase in blood glucose. In addition to a healthy diet, frequent checks of blood sugar levels and use of insulin, you also will need to: Exercise to lower and help the body use blood sugar. Self-monitor ketone levels in the urine several times a day, as directed by your doctor. Check hemoglobin A1c levels regularly (with an HbA1c test). A crucial part of diabetes self-management is glucose monitoring. When you meet with the certified diabetes educator at Lehigh Valley Health Network, you will learn how to do this frequent glucose checking and about the devices that make it simpler. Careful monitoring is the only way to make sure the blood sugar level remains within target range. A range of 70-130 milligrams/deciliter before meals is suggested for most individuals with diabetes. Your doctor will tell you what your target range should be. Its also helpful to use a logbook to record your glucose test results, when medicine was taken and how much, as well as details like what you ate, how long you exercised and any significant events of the day such as high or low blood sugar levels and how the problem was treated. Better equipment now available makes testin Continue reading >>

Pre-visit Planning For Three-month Diabetes Follow-up Visits

Pre-visit Planning For Three-month Diabetes Follow-up Visits

Pre-Visit Planning for Three-Month Diabetes Follow-Up Visits A primary care practice site in western North Carolina manages approximately 200 patients with diabetes per month. There were no pre-planned, tools in place to appropriately monitor, educate, and manage the Diabetes Mellitus (DM) population. A pre-planned standardized process was implemented to gauge its effectiveness using the American Diabetes Associations (ADA) clinical standards and national diabetic guidelines as a template. A methodology was used to develop a packet for providers and ancillary staff. The packet included tools for providers to organize patient information, devise treatment plans, establish goals of care, and monitor patient preparation. The intention was to improve patient adherence to blood glucose logs and encourage self-management practices. Three educational sessions were held to described how to use the packet within the process change. Guiding frameworks were Nola Penders Health Promotion Model (HPM) and E.H. Wagners Chronic Care Model (CCM). The Plan-Do-Study-Act (PDSA) tool was utilized weekly during the three-month implementation phase to monitor progress toward completion of project goals. The new practice change decreased behavioral and environmental barriers. There was a decrease in missed appointments from 17% to zero percent, and an increase in patient adherence from 11% to 23%. The practice changes also uncovered a 34% staff compliance rate, which was attributed to time management issues, individual resistance to change, and staffing fluctuations. Continue reading >>

Future Visits: American Diabetes Association

Future Visits: American Diabetes Association

How often you should return to your diabetes doctor depends on many things. If you take insulin for your diabetes or if you're having trouble managing your glucose levels, you should see your doctor at least four times a year. Otherwise, you should see your doctor two to four times a year. You may need to visit your doctor more often if you have complications or if you are starting a new medicine or insulin program. Your doctor will advise you about when to return. He or she should also tell you other times to call or come back. For example, your doctor may want you to call if you've had nausea or vomiting that make you unable to eat, or if you've had a fever for more than a day. You will need to stay in touch with your doctor by phone every week or even every day if you are making big changes in your diabetes care plan. When you return, expect the doctor and other members of your health care team to give you a physical examination, take a medical history, run laboratory tests, and fine-tune your treatment program. These later visits are not as in-depth as your first visit, although you should get a complete physical examination once a year. Also, your doctor may order new tests, do other examinations, or refer you to a specialist depending on test results and your needs. This checklist will help you make sure your health care team does a good job at your follow-up visits. They should: ask about times you've had high or low blood glucose levels ask what adjustments you've made to your diabetes care plan ask what problems you've had in following your diabetes care plan ask about symptoms that might indicate you are getting a diabetes complication ask what other illnesses you had since your last visit take blood for glycated hemoglobin measurement once a year, take a uri Continue reading >>

Deductibles Reduce Diabetes Follow-up Visits In Lower-income Insured Patients

Deductibles Reduce Diabetes Follow-up Visits In Lower-income Insured Patients

Deductibles Reduce Diabetes Follow-up Visits in Lower-Income Insured Patients For low-income patients with diabetes, high deductibles decrease specialty visits, potentially resulting in patients forgoing needed medical services. HealthDay News - Lower-income patients with diabetes and private insurance with a low (LD) or high deductible (HD) have reduced medical service use, according to a study published in Diabetes Care. David L. Rabin, MD, MPH, from the Georgetown University School of Medicine in Washington, DC, and colleagues used the 2011 to 2013 Medical Expenditure Panel Survey to compare demographic characteristics, medical service use, diabetes care, and health status among 1461 privately-insured adult respondents with diabetes (aged 18 to 64 years) by lower and higher income and deductible vs no deductible (ND), LD, and HD. The researchers found that privately-insured lower-income respondents with an LD reported significant decreases in service use for primary care, check-ups, and specialty visits (27%, 39%, and 77% lower, respectively) compared with those with diabetes with ND; among respondents with an HD the decreases were 42%, 65%, and 86%, respectively. Significant decreases were seen in specialty and emergency department visits for higher-income respondents with an LD (28% and 37% respectively). Diabetes care measures were similar by income and insurance, and no changes were seen in physical health status. "Private insurance with a deductible substantially and problematically reduces medical service use for lower-income insured respondents with diabetes who have an HD; these patients are more likely to report forgoing needed medical services," the researchers wrote. Continue reading >>

What Screening And Follow-up Are Appropriate For Patients With Diabetes?

What Screening And Follow-up Are Appropriate For Patients With Diabetes?

What Screening and Follow-Up Are Appropriate for Patients With Diabetes? Q.What are the basic history elements of an office visit for a person with diabetes? A.Any office visit of a patient with diabetes should include an assessment of lifestyle, diet, and behavioral changes. According to the American Diabetes Association (ADA),1 an evaluation of the level of patients engagement should include their understanding of their diabetes, as well as review the symptoms and the details of self-management, including glucose self-monitoring. Each visit also should include attention to complications and comorbidities of diabetes, particularly the incidence and severity of hypoglycemia, such as addressing hypoglycemic events that may occur while the patient is driving an automobile. The clinician should inquire about the results of the patients most recent dilated eye examination.2 For persons with type 1 diabetes (T1D), this examination should be first performed within 5 years after onset. For those with type 2 diabetes (T2D), it should be done at the time of initial diagnosis, and for pregnant women it should be done either before onset or during the first trimester. Persons with T1D or T2D should be monitored at least annually unless there has been no evidence of retinopathy at 1 or more normal annual examinations; otherwise they should be monitored a minimum of every 2 years. Depending on the degree of retinopathy, pregnant women may need monitoring during each trimester and for 1 year following delivery. The history should address existing complications and comorbidities, as well as address preventive strategies such as vaccinations and aspirin therapy. Clinicians should inquire about smoking history and counsel about cessation when needed. Patients should avoid electronic ci Continue reading >>

Structured Nursing Follow-up: Does It Help In Diabetes Care?

Structured Nursing Follow-up: Does It Help In Diabetes Care?

Structured nursing follow-up: does it help in diabetes care? 1Department of Family Medicine Central District, Clalit Health Service, Rehovot, Israel 2Department of Family Medicine Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel 1Department of Family Medicine Central District, Clalit Health Service, Rehovot, Israel 2Department of Family Medicine Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel 1Department of Family Medicine Central District, Clalit Health Service, Rehovot, Israel 2Department of Family Medicine Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel 1Department of Family Medicine Central District, Clalit Health Service, Rehovot, Israel 2Department of Family Medicine Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel 1Department of Family Medicine Central District, Clalit Health Service, Rehovot, Israel 2Department of Family Medicine Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel 3Family Medicine Department Hadassah Medical School, The Hebrew University, Jerusalem, Israel Received 2013 Dec 3; Accepted 2014 Aug 7. Copyright 2014 Shani et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( ) applies to the data made available in this article, unless otherwise stated. This article has been cited by other articles in PMC. In 1995 Clalit Health Services introduced a structured follow-up schedule, by primary care nurses, of diabetic patients. This was supplementary care, given in addition to the family physician Continue reading >>

Diabetes - Tests And Checkups

Diabetes - Tests And Checkups

See your diabetes doctor for an exam every 3 to 6 months. During this exam, your doctor should check your: Blood pressure Weight Feet See your dentist every 6 months, also. Your doctor should check the pulses in your feet and your reflexes at least once a year. Your doctor should also look for: If you have had foot ulcers before, see your doctor every 3 to 6 months. It is always a good idea to ask your doctor to check your feet. An A1c lab test shows how well you are controlling your blood sugar levels over a 3-month period. The normal level is less than 5.7%. Most people with diabetes should aim for an A1C of less than 7%. Some people have a higher target. Your doctor will help decide what your target should be. Higher A1C numbers mean that your blood sugar is higher and that you may be more likely to have complications from your diabetes. Continue reading >>

Making Diabetes Checkups More Fruitful

Making Diabetes Checkups More Fruitful

Pre-planning can turn scattered encounters into efficient, productive visits. This content conforms to AAFP CME criteria. See FPM CME Quiz. High-quality diabetes care is hardly a lone endeavor. Instead, it is a combination of forces: a physician and staff who are knowledgeable about the disease and current treatment guidelines, a patient who is involved and empowered to improve his or her own health, and a practice whose systems are designed in such a way that they help, not hinder, the care process. This third element, practice systems, may well be the richest area of improvement for most medical practices. One case in point is Family Care Network, a northwest Washington group without walls, which recently embarked on an ambitious 13-month diabetes quality improvement project. Very quickly, the group realized that its patient encounters, crucial to the delivery of high-quality diabetes care, were not living up to their full potential. As in many practices, patients arrived for their visits without having had the necessary lab work or other services performed in advance. As a result, the physicians did not have complete information to guide the visit, while patients gave very little thought to what they would like to accomplish regarding their disease. Post-visit, practices were left with tremendous follow-up work that included making phone calls to obtain or communicate the elusive test results. In short, visits were unplanned and participants were largely unprepared. The solution to this problem for Family Care Network's three pilot sites was to implement a fairly simple system called pre-planning. Pre-planning involves creating systems within a practice to ensure that the staff, physician and patient are all prepared for the visit. Instead of the patient showing up Continue reading >>

Diabetes Follow-up - Diabetes Management - Healthcommunities.com

Diabetes Follow-up - Diabetes Management - Healthcommunities.com

To prevent or delay the development of complications from type 1 or type 2 diabetes, you need to take a proactive role in the management of your health care. This includes making regular visits to your primary care physician and other professionals on your health care team. How frequently you see each member of your team varies, but, in general, individuals with diabetes should have a comprehensive physical once a year and have their diabetes assessed at least every six months. During these visits, you may undergo tests and exams that indicate how well you are maintaining your health and if any complications of diabetes are emerging or progressing. Individuals with diabetes should know about the tests and exams their doctors perform, the goal for each test and exam, and how often each is typically done. According to our sister publication, Diabetes Focus, Summer 2014, the U.S. Food and Drug Administration (FDA) has begun cracking down on illegally sold diabetes products. Steer clear of items that claim to "lower blood sugar naturally," "replace your diabetes medicine," or "relieve symptoms of diabetes." They may contain harmful ingredients or be unsafe, the FDA says. If you experience any adverse health effects from such products, report them online at www.fda.com/Medwatch/report.htm or call 1.800.FDA.1088 (1.800.332.1088). Publication Review By: Written by: Christopher D. Saudek, M.D.; Simeon Margolis, M.D., Ph.D. Continue reading >>

The Three Phases Of The Diabetes Care: Pre-visit, Intra-visit, Post-visit

The Three Phases Of The Diabetes Care: Pre-visit, Intra-visit, Post-visit

The Three Phases of the Diabetes Care: Pre-visit, Intra-visit, Post-visit Diabetes care can be organized into three phases: pre-visit, intra-visit, and post-visit. Opportunities exist during each phase to introduce practice changes that can help engage and support patients in their diabetes care and management. Health care teams can optimize diabetes encounters by taking a planned, continuous improvement approach to visits, which includes pre-visit preparation (by both patients and practices), intra-visit coordination (among practice team members), and post-visit follow-up (among the practice team and with patients). Pre-planning for diabetes visits helps ensure that both patients and practice staff are prepared for diabetes visits.1 Ideally, pre-visit preparation starts at the end of the current visit. Patients schedule appointments for their next visit, which, if not at goal, may be in three months, and arrangements are made for A1C labs to be drawn just prior to the next visit or at point-of-care, along with other labs (e.g., lipids), to ensure an opportunity for timely treatment adjustments. This way, the provider and patient have all the relevant information at hand to review, discuss, and adjust therapies (e.g., increase medication doses) at a face-to-face visit. Compared with trying to coordinate a time to review the lab results a few days later, this approach saves time and allows for better communication between the patient and provider. The process of pre-visit preparation involves the following steps: Proactively identify patients who are due for diabetes visits. Practice teams now have access to sophisticated tools that allow them to systematically identify patients who are due for routine diabetes visits and may benefit from additional medical care, like i Continue reading >>

Summary Of Guidelines For Patients With Diabetes: Checklist For Your Doctor Visits

Summary Of Guidelines For Patients With Diabetes: Checklist For Your Doctor Visits

Every person with diabetes should visit a doctor at least every three months. Regular checkups allow your doctor to track your condition and, if necessary, make changes in your treatment plan. But what should happen during those checkups? Do you wonder why your doctor orders certain tests? Or what the numbers mean? The American Diabetes Associations guidelines cover all aspects of diabetes care, including doctors' visits. This summary of the ADA's recommendations will help you know what to expect from your next visit. If you still wonder why your doctor has ordered a test -- or not ordered a test -- be sure to ask the doctor directly. When tests should be done The ADA has different guidelines for what should happen on diagnosis, at each visit, every three months, and once a year. 1. When you are diagnosed with diabetes, your doctor should provide a pneumococcal vaccine for protection against pneumonia, unless you have already been vaccinated. This vaccination does not have to be renewed each year. When you turn 65, however, you should receive another vaccine if you haven't had one in the last five years. 2. At each visit, a doctor should do the following: Ask about your self-monitoring of blood sugar. Ask about frequency and severity of episodes of hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar). Check your weight. Measure your blood pressure. Carefully inspect your legs and feet (including between the toes) for sores. Ask about your medication use. Answer questions about the disease and educate you about self-care. Check on any diabetic complications, including symptoms of nerve damage such as numbness. Ask about your use of tobacco and/or alcohol. Ask you about any lifestyle changes and discuss the consequences. Talk to you about possible stress, de Continue reading >>

Routine Follow-up Visits To Your Physician

Routine Follow-up Visits To Your Physician

Routine Follow-up Visits to Your Physician Abstracted from Dr. Bernsteins book Diabetes Solution Taking responsibility for the care of your own diabetes may free you from habits that have been with you for many years. It also requires the establishment of new habits, such as exercise and blood sugar self-monitoring, that are easier to abandon than to follow. Once your blood sugars have become controlled, it may only take a few months for you conveniently to forget about the pain you used to have in your toes, or the parent or friend who lost a leg or vision due to complications of diabetes, and so on. As time goes on, you will find that with diabetes, as with life in general, you will gradually tend to do what is easiest or most enjoyable at the moment. This backsliding is quite common. When I havent seen a patient for six months, Ill usually take a meal history and find that some of the basic dietary guidelines have been forgotten. Concurrently blood sugar profiles, glycosylated hemoglobin levels, lipid profiles, and even fibrinogen levels may have deteriorated. Such deterioration can be short-circuited when I see patients every two months. We all need a little nudge to get back on track, and it seems that a time frame of about two months does the trick for most of us. I was not the first diabetologist to observe this, and your physician may likewise want you to visit him at similar intervals. Dosage requirements for insulin or ISAs(insulin sensitizing agents) may change over time, whether due to weight changes, to deterioration or improvement of beta cell output, or just to seasonal temperature changes. So theres an ongoing need for readjustment of these medications. Again, two month intervals are appropriate. What are some of the things that your physician may want Continue reading >>

The Importance Of Follow-up

The Importance Of Follow-up

Once you give patients a diagnosis of diabetes, you likely tell them about the importance of self-care and direct them to take their medication, monitor their blood glucose, exercise and lose weight if needed. But research shows patients with diabetes have a spotty record of following their doctors’ advice, even after they are told it’s important. Consider: Medication – only 77 percent of patients with diabetes take insulin as prescribed and 85 percent take other medications as prescribed Monitoring – fewer than half – 45 percent – monitor their blood glucose as told Exercise and weight loss – only 24 to 27 percent of patients follow the instructions closely The truth is it takes time to educate patients about self-care and help them make significant changes. That’s time you don’t often have. But diabetes educators do – and they’ll keep you in the loop on your patients’ progress. Diabetes education is a collaborative process between the educator and the patient that usually includes up to 10 hours of counseling in the first year after diagnosis to address a variety of topics in depth – from healthy eating and exercise to monitoring and medications to problem-solving. Because behavior change is difficult and can take time, it’s important that you not only refer your patients with diabetes to a diabetes educator, but follow up with them to be sure they are continuing their education. Having a patient work with a diabetes educator and supporting that interaction will ensure better outcomes for the patient. Read some success stories. Continue reading >>

Follow-up Report On The Diagnosis Of Diabetes Mellitus

Follow-up Report On The Diagnosis Of Diabetes Mellitus

In 1997, an International Expert Committee was convened to reexamine the classification and diagnostic criteria of diabetes, which were based on the 1979 publication of the National Diabetes Data Group (1) and subsequent WHO study group (2). As a result of its deliberations, the Committee recommended several changes to the diagnostic criteria for diabetes and for lesser degrees of impaired glucose regulation (IFG/IGT) (3). The following were the major changes or issues addressed. 1) The use of a fasting plasma glucose (FPG) test for the diagnosis of diabetes was recommended, and the cut point separating diabetes from nondiabetes was lowered from FPG ≥140 mg/dl (7.8 mmol/l) to ≥126 mg/dl (7.0 mmol/l). (All glycemic values represent venous plasma.) This change was based on data that showed an increase in prevalence and incidence of diabetic retinopathy beginning at approximately a FPG of 126 mg/dl, as well as on the desire to reduce the discrepancy that existed in the number of cases detected by the FPG cut point of ≥140 mg/dl and the 2-h value in the OGTT (2-h plasma glucose [2-h PG]) of ≥200 mg/dl (11.1 mmol/l). 2) Normal FPG was defined as <110 mg/dl (6.1 mmol/l). 3) The use of HbA1c (A1C) as a diagnostic test for diabetes was not recommended. The primary reason for this decision was a lack of standardized methodology resulting in varying nondiabetic reference ranges among laboratories. 4) Although the OGTT (which consists of an FPG and 2-h PG value) was recognized as a valid way to diagnose diabetes, the use of the test for diagnostic purposes in clinical practice was discouraged for several reasons (e.g., inconvenience, less reproducibility, greater cost). The diagnostic category of impaired glucose tolerance (IGT) was retained to describe people whose FPG wa Continue reading >>

Evidence-based Guidelines To Determine Follow-up Intervals: A Call For Action

Evidence-based Guidelines To Determine Follow-up Intervals: A Call For Action

The American Journal of Managed Care > January 2014 Published on: January 10, 2014 Evidence-Based Guidelines to Determine Follow-up Intervals: A Call for Action Emilia Javorsky, MPH; Amanda Robinson, MD; and Alexa Boer Kimball, MD, MPH Evidence-based guidelines are needed to determine appropriate follow-up intervals for chronic medical conditions to maximize the quality of patient care and minimize unnecessary costs. Although there are nearly 1 billion outpatient follow-up visits annually in the United States, few data exist documenting evidence-based follow-up intervals for the most common and costly chronic conditions. Evidence-based follow-up intervals must be established based on healthcare outcomes. Evidence-based follow-up intervals have the potential to reduce healthcare costs per person and improve access without compromising or restricting care. Public concern regarding access to care combined with increasing pressure to curtail healthcare costs has prompted physicians to think critically about how best to manage chronic disease. Perhaps surprisingly, Americans face long wait times compared with other industrialized nations. A 2010 Commonwealth Fund study of 11 industrialized countries found waiting times were longer in the United States than in all the other countries except Canada, Norway, and Sweden.1 Moreover, the study showed that only 57% of patients were able to access a same-day or next-day appointment when they were sick or needed care, compared with top-ranking Switzerland, where 93% of patients described being able to secure an appointment under these conditions. Similarly, 19% of patients in the United States waited 6 or more days for an appointment compared with only 2% of patients in Switzerland.1 Several specialties face a shortage of providers, Continue reading >>

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