Toolkit for Implementing the Chronic Care Model in an Academic Environment
Glycemic Control Algorithm 2
The Planned Visit Notebook includes a step-by-step description for a diabetes planned visit. The Glycemic Control Algorithm is a flowchart that takes a health professional through the steps for one part of the diabetes planned visit.
Text Description
The Glycemic Control Algorithm for DM2 begins with a text box that reads:
| Assess A1c result Note: A1c result should be no older than 3 months |
| Recheck in 3 months |
|
Planned Visit—complete assessment of glycemic control program (see Module 4 Podcast) Is patient amenable to additional oral agents therapy? See Oral Agent Classes and medication based on current efficacies of meds and a conservative estimate of potential for lifestyle change (See Module 1 Podcast) |
|
Currently on Secreatagogue 1st option—Titrate to maximal effective dose of secreatagogue ( A1c < 8.0) 2nd option—Add sensitizer (TZD or Metformin) unless contraindicated—work up to maximal dose as the clinical situation warrants 3rd option—Add other sensitizer unless contraindicated work up to maximal dose as clinical situation warrants (for example start with 500 mg Metformin up to 2000mg daily dose) with quarterly reassessments. 4th option—consider alpha-glucosidase inhibitors vs insulin |
|
Already on Sensitizer 1st option—Titrate to maximal effective dose of A1c <8.0 2nd option—Add secreatogogue (Meglinitide, Sulflonylureas) 3rd option—Add additional sensitizer unless contraindicated 4th option—consider alpha-glucosidase inhibitors vs insulin |
|
Not amenable to addition of further oral agents If patient is here—call Dr. Salem or contact Faculty for insulin order at that visit Return visit or recontact in 1 week |
There are two reference tables:
Table 1
| Oral Agent Classes/MEDS | Potential % decline A1c | |
|---|---|---|
| Solo | Combined | |
| Sulfonlureas | 2% | 1% |
| Metformin | 2% | 1% |
| Meglinitides | ||
| Prendin | 2% | 1% |
| Starlix | 1% | .5% |
| TZDs | 2% | 1% |
| Alpha Glucosidase Inhibitors | 1% | .5% |
| Medication | Maximum Effective Dose |
|---|---|
| Amaryl | 4 mg daily |
| Gulcotrol | 10 mg daily |
| Diabeta | 10 mg daily |
| Prandin | 4 mg tid |
| Starlix | 120 mg tid |
| Actos | 45 mg daily |
| Avandia | 8 mg daily |
| Precose | 150 mg tid |
| Glyset | 150 mg tid |
| Metformin | 2000 mg total daily |
The following notes are at the bottom of the algorithm:
Notes:
- If option is available—have patient call in the nurse line with home blood sugar logs weekly to make adjustments more rapidly. When at goal, recheck A1c in 3 months.
- Any patient who has additional OA prescribe should be seen/contact within 2 week to insure adherence/tolerability of meds and to access the current HGM results and status. Option to increase oral agent dose(s) that that point.
- Review of HGM status include w/each reassessment, tailored recommendations for frequency of HGM given with each med change.
- Team meeting optional at any point for lack progress—as determined by nurse practitioner.
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