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CLINICAL PRACTICE GUIDELINES
This Sample Diabetes Patient Care Plan is designed to assist you in recording appropriate informationregarding the management of your patients with diabetes, and incorporates key concepts from the current Canadian Diabetes Association Clinical Practice Guidelines. Other patient care plans may be available. It is important to use a care plan that best suits your practice needs.
CLINICAL PRACTICE GUIDELINES
Name: __________________________________ Date of diagnosis: ____________________ Type of DM: ________________ Risk factors: ❑ Overweight ❑ Sedentary ❑ Family history ❑ Ethnicity ❑ IGT/IFG ❑ Smoker ❑ CVD ❑ Hypertension ❑ Dyslipidemia ❑ GDM/Macrosomia ❑ PCOS/Acanthosis nigricans ❑ Schizophrenia ❑ Medications Complications/Comorbidities (date of Dx): ❑ Retinopathy _________ ❑ Nephropathy _________ ❑ Neuropathy _________ ❑ Foot disorders _________ ❑ CVD _________ ❑ ED _________ ❑ Other _________ Referrals (date): ❑ Dietitian ________ ❑ DEC ________ ❑ Endo ________ ❑ Cardiol ________ ❑ Podiatrist ________ ❑ Ophthal/Optom _________ ❑ Nephrol _________ ❑ Psychol/Social worker _________ ❑ Other _________ Lifestyle: ❑ Smoking ❑ Exercise ❑ Diet Drug plan: ❑ Formulary ❑ 3rd party ❑ Self A
P
P
E
N
D
IC
E
S
rly BP ≤130/80
rte A1C
a
u Preprandial (4–7) (4–6)
Q Postprandial (5–10) (5–8)
) Random ACR
d
te Serum creatinine
ica Creatinine clearance
d
in Foot care: Lower
lly extremity exam
ica Neuropathy: 10-g
clin at great toe
s
a
r Retinopathy: Refer for
(o dilated eye exam
lly
a
u
n
n
A Erectile dysfunction
Psychosocial: Anxiety,depression, economic CLINICAL PRACTICE GUIDELINES
Management of hyperglycemia in type 2 diabetes
Clinical assessment and initiation of nutrition therapy and physical activity Mild to moderate hyperglycemia (A1C <9.0%) Use insulin alone or in combination with: Timely adjustments to and/or additions of oral antihyperglycemic agentsand/or insulin should be made to attain target A1C within 6 to 12 months *When used in combination with insulin, insulin sensitizers may increase the risk of edema or congestive heart failure.The combination of an insulin sensitizer and insulin is currently not an approved indication in Canada.
**If using preprandial insulin, do not add an insulin secretagogue.
†May be given as a combined formulation: rosiglitazone and metformin.
Antihyperglycemic agents for use in type 2 diabetes
Drug class, generic name (trade name)
gliclazide (Diamicron®, Diamicron® MR, generic)glimepiride (Amaryl™) Combined formulation of rosiglitazone and metformin glyburide (Diabeta®, Euglucon®, generic) (note: chlorpropamide and tolbutamide are still available in Canada, but rarely used)

Source: http://sma.sk.ca/data/1/rec_docs/45_Can_Diabetes_Assoc_Guidelines_Care_Plan.pdf