State of Florida

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State of Florida

• Diabetes Medical Practice Guidelines
• Larry Deeb, MD

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Notice on Practice ParametersState of Florida,
Agency for Health Care Administration

• These practice guidelines are endorsed by the
  Florida Agency for Health Care Administration
  for
• Information
• Education
• Review by medical community, other professionals
  and the public

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Notice on Practice ParametersState of Florida,
Agency for Health Care Administration

• Use these guidelines along with your best medical
  judgment
• Guidelines are not fixed protocols
• They identify typical courses of intervention
• Some patients may require more or less treatment
• Those that fall above or below guidelines should
  be closely monitored and properly documented.

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Introduction to Guidelines

• Diabetes is a chronic illness that requires
  continual medical care and education to prevent
  acute complications and long-term medical
  problems.
• The 1996 Florida Legislature required all
  insurance policies and HMOs to provide coverage
  for the treatments suggested in the guidelines.

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Introduction to Guidelines

• The Guidelines were developed by
• Florida Agency for Health Care Administration
  (AHCA)
• Florida Department of Health (DOH)
• American Diabetes Association
• Endocrinologists
• Internists
• Dieticians
• Diabetes self-management experts
• Other experts in diabetes management

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Introduction to Guidelines

• In 2001, revisions were made to the original
  guidelines to reflect the most current medical
  standards used in treatment of Type 1 and Type 2
  diabetes in adults and children.
• Practitioners should remember
• Each patient has individual medical and
  psycho-social needs.
• A critical element of success is the patients
  participation in a comprehensive self-management
  care and education program.

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Florida Diabetes Practice Guideline
AlgorithmCritical Parameters for the Treatment
of Diabetes
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Florida Diabetes Practice Guideline
AlgorithmCritical Parameters for the Treatment
of Diabetes
Annual implies that the service could be
delivered in more than one session during a
12-month period.
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Florida Diabetes Practice Guideline
AlgorithmCritical Parameters for the Treatment
of Diabetes
Annual implies that the service could be
delivered in more than one session during a
12-month period.
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Florida Diabetes Practice Guideline Algorithm

• Criteria for the diagnosis of Diabetes mellitus
• Symptoms of diabetes plus random plasma glucose
• gt/ 200mg/dl (11.1 mmo1/1) or
• Fasting plasma glucose (FPG) on two occasions
• gt/ 126mg/dl (7.0 mmo1/1)
• Two-hour plasma glucose (PG)
• gt/ 200mg/dl during an OGTT

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Florida Diabetes Practice Guideline
Algorithm Diabetes Self-Management Training

• A minimum of 10 to 12 hours of instruction should
  be provided to all patients within 12 weeks of
  the initial diagnosis.
• Diabetes overview
• Medication
• Monitoring and use of results
• Nutrition
• Prevention, detection and treatment of acute and
  chronic complications

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Florida Diabetes Practice Guideline
Algorithm Diabetes Self-Management Training

• Exercise and activity
• Stress and psycho-social adjustmentspecial
  areas of concern that impact the target audience
  (children, adolescent, young adults and older
  adults)
• Foot, skin and dental care
• Use of health care systems and community resources

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Florida Diabetes Practice Guideline
AlgorithmSpecial Situations

• Children with diabetes
• Preconception counseling
• Gestational Diabetes

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Florida Diabetes Practice Guideline
AlgorithmChildren with diabetes

• Use of pediatric specialists
• Need for team approach
• School situations
• Recognition of Type 2

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Florida Diabetes Practice Guideline
AlgorithmPreconception Counseling

• Discussion of planned pregnancy
• Gycemic goals
• Potential complications

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Florida Diabetes Practice Guideline
AlgorithmGestational Diabetes

• Detection and diagnosis
• Complete risk assessment on first visit
• Women considered at low risk require no glucose
  testing
• Average risk should have testing completed
  between 24 and 28 weeks gestation
• Those with clinical characteristics consistent
  with high-risk should have test completed as soon
  as possible. If initial test negative, retest
  between 24 and 28 weeks gestation

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Florida Diabetes Practice Guideline
AlgorithmGestational Diabetes

• Diagnosis of gestational diabetes
• Determined by evaluating the results of the 100-g
  oral glucose tolerance during pregnancy that is
  interpreted using diagnostic criteria of
  OSullivan and Mahan
• Two or more of the venous plasma glucose values
  must be met or exceeded
• Fasting 95 mg/dl
• 1 hour 180 mg/dl
• 2 hours 155 mg/dl
• 3 hours 140 mg/dl

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Patient Chart Flow Sheet Diabetes Mellitus
Management Based on Floridas Medical Practice
Guidelines
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Patient Chart Flow Sheet Diabetes Mellitus
Management Based on Floridas Medical Practice
Guidelines
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Patient Chart Flow Sheet Diabetes Mellitus
Management Based on Floridas Medical Practice
Guidelines
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Patient Chart Flow Sheet Diabetes Mellitus
Management Based on Floridas Medical Practice
Guidelines