Primary Care Clinics of North America 34 (2007) pdf

[...]... ARB, if tolerated, to persons who have evidence of early nephropathy Ask about symptoms suggestive of neuropathy; check sensation of feet using either monofilament or tuning fork Glycemic control Patient education Foot care Ophthalmologic (eye) care Cardiovascular care Urinary (renal) care Sensory care 24 MISER renal disease), and S (sensation) The primary care physician also must remember to address appropriate... Smoking cessation counseling MANAGEMENT OF TYPE 2 DIABETES MELLITUS 23 demonstrated that the quality of care provided to patients who have diabetes is suboptimal [122,123] The chronic care model is a framework for enhancing health care delivery to persons with chronic disease and focuses on six areas of care: community resources and policies, the organization of health care, self-management support, delivery... information about the importance of patient education can be found on the home pages of the ADA (http://www.diabetes.org) and the American Association of Diabetes Educators (http://www.aadenet.org) Each year, Diabetes Care publishes established guidelines as to what should be included in this personalized education [80] Self-management support involves a collaborative effort of primary care physicians helping... health care organizations The National Committee for Quality Assurance (http://www.ncqa.org), in conjunction with the ADA, developed a set of indicators to assess quality of care delivered to individuals with diabetes These indicators (Table 7), known as the Diabetes Quality Improvement Project, govern 20 public and private health care organizations Chronic care model Because of the complexity of the... recommendation for foot examinations has become the standard of care in most diabetes quality -of -care guidelines, the actual frequency and components of that examination have not been well studied In a population-based, case-control study of Pima Indians with T2DM, MANAGEMENT OF TYPE 2 DIABETES MELLITUS 25 Mayfield and colleagues [126] found that the risk of amputation for persons with one or more foot examinations... 2002;92(4):543–8 [34] American Diabetes Association Economic costs of diabetes in the US in 2002 Diabetes Care 2003;26:917–32 [35] Gilmer TP, O’Connor PJ, Manning WG, et al The cost to health plans of poor glycemic control Diabetes Care 1997;20(12):1847–53 [36] Harris MI, Eastman RC, Cowie CC, et al Racial and ethnic differences in glycemic control of adults with type 2 diabetes Diabetes Care 1999;22(3):403–8... with diabetes Diabetes Care 2003;26(Suppl 1):S83–6 [57] American Diabetes Association Treatment of hypertension in adults with diabetes Diabetes Care 2003;26(Suppl 1):S80–2 [58] Taskinen MR Diabetic dyslipidemia Atheroscler Suppl 2002;3(1):47–51 [59] American Diabetes Association Smoking and diabetes Diabetes Care 2003;26(Suppl 1): S89–91 [60] Carman TL, Fernandez BB Jr A primary care approach to the... Clinicians must examine the feet carefully, looking between the toes and unroofing calluses, which may hide ulcerations They also should inspect shoes for areas of inadequate support or improper fit If ulcerations ´ are discovered, aggressive treatment requires adequate debridement, often under the care of a foot care specialist Two recent reviews outline the appropriate care for individuals who develop... subjects with T1DM, aged 13 to 39 years, who were followed for an average of 6.5 years [73] The major purpose of the trial was to determine whether intensive therapy, defined as three or more daily injections of insulin or the use of an insulin pump with a HbA1c goal of less than 6.05%, prevents the development of or delays the progression of retinopathy, nephropathy, and neuropathy compared with conventional... verapamil and diltiazem), diuretics, and atenolol may be substituted [168] Primary care physicians should consider enlisting the assistance of a nephrologist when individuals develop evidence of chronic kidney disease Sensory (neuropathy) care Good glucose and BP control prevent the development of and delay the progression of neuropathy [73,130] The ADA recommends that all patients who have T2DM be . Preface Guest Editors In these two issues of the Primary Care Clinics of North America, we are pleased to offer you Evidence-Based Approaches to Common Primary Care Dilemmas. During the past decade,. 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.pop.2007.01.001 primarycare.theclinics.com Prim Care Clin Office Pract 34 (2007) 1–38 for its management [2]. Type 1 DM (T1DM), formerly known. Elsevier Inc. All rights reserved. doi:10.1016/j.pop.2007.04.001 primarycare.theclinics.com Prim Care Clin Office Pract 34 (2007) xi–xii death in the United States, coronary artery disease. We