Diabetes Mellitus Algorithm G: Glycemic Control

Patient with diabetes mellitus (DM) [A]
Assess glycemic control [B]
Determine glycemic control target by: Determining recommended target using risk stratification criteria [C] and
Determine glycemic control target by: Adjusting the glycemic target according to patient factors [D] and
Determine glycemic control target by: Setting a target range after discussion with patient [E]
Is patient high-risk? [F] Consider referral for comprehensive evaluation and treatment of DM Box 6 yes to box 12
Is patient on medication therapy? Box 6 yes to box 12
Does patient require insulin? [G] Institute / adjust insulin. Consider referral [H]
Assure appropriate intervention to address patient adherence [I] Box 8 to box 11
Initiate / adjust therapy (Refer to Table G2) [J]
Box 10 to box 11 Reinforce self management education. Consider referral for diet and DM education. See Module M
Sequential Treatment for Type 2 DM: 1. Lifestyle modification, diet and exercise 2. Monotherapy with oral agent or insulin 3. Combination (add second oral agent) 4. Insulin with daytime oral agent 5. Insulin alone 6. Referral Continue DM management. Return to Module D
Box 6 yes to box 12
Determine if there are side effects or contraindications to current treatment [K]
Is HbA<sub>1</sub>c level above target range? Are there problems with patient adherence? [L] Provide appropriate intervention to address patient adherence [I]
Box 13 no to box 20 Box 14 no to box 16 Provide appropriate intervention to address patient adherence [I]
Continue current treatment or, adjust therapy if there are side effects or contraindications to current therapy [J] Should glycemic control target by adjusted? [M] Box 15 to box 16 and box 16 yes to box 17
Box 20 to box 19 Box 16 no to box 18 Adjust target level
Adjust medication therapy as indicated; consider side effects and contraindications [J] Box 17 to box 18
Reinforce self-management and education. Follow up [N]
Continue DM management. Return to Module D