What is the recommended follow-up protocol for a patient with newly diagnosed diabetes mellitus (DM)?

From the Guidelines

The recommended follow-up protocol for a patient with newly diagnosed diabetes mellitus (DM) should include comprehensive medical evaluations and assessments of comorbidities, with initial and follow-up visits tailored to the patient's specific needs, as outlined in the 2022 standards of medical care in diabetes 1.

Key Components of Follow-Up Visits

• Initial visits should include a comprehensive medical evaluation, such as height, weight, and BMI measurement, blood pressure determination, and orthostatic blood pressure measures when indicated, as well as screenings for depression, anxiety, and disordered eating 1.
• Follow-up visits should focus on monitoring glycemic control through A1C testing, adjusting medications as needed, and performing comprehensive foot examinations, including visual inspection and screenings for peripheral arterial disease (PAD) 1.
• Annual visits should include a review of the patient's medication regimen, lifestyle modifications, and laboratory results, such as lipid profiles, liver function tests, and serum creatinine and estimated glomerular filtration rate (eGFR) 1.

Laboratory Monitoring and Medication Adjustments

• Regular laboratory monitoring should include HbA1c testing every 3-4 months, annual lipid panels, and kidney function tests (eGFR and urine albumin-to-creatinine ratio) 1.
• Medication adjustments should be made as needed to achieve optimal glycemic control, with consideration of the patient's age, comorbidities, and diabetes type 1.
• Patient education should cover proper glucose monitoring technique, medication administration, hypoglycemia recognition and management, dietary guidance, and foot care, with individualized guidance based on the patient's specific needs and regimen 1.

From the Research

Follow-up Protocol for Diabetes Mellitus

The follow-up protocol for a patient with newly diagnosed diabetes mellitus (DM) is crucial for managing the condition and preventing complications. The recommended follow-up protocol includes:

• Regular monitoring of blood glucose levels to assess glycemic control 2
• Adjustment of medication and insulin doses as needed 2
• Lifestyle modifications, such as dietary changes and exercise, to improve glycemic control and overall health 2
• Regular check-ups with a healthcare provider to monitor progress and address any concerns 3

Telephonic Consultation and Follow-up

Telephonic consultation and follow-up have been shown to be effective in improving glycemic control and patient compliance in patients with DM 3. The study found that:

• Weekly telephonic consultation improved glycated hemoglobin (HbA1c) levels and lipid profiles in patients with DM
• Patients who received weekly telephonic consultation had better treatment satisfaction and adherence to medication and lifestyle modifications
• Telephonic consultation can be a useful measure to improve follow-up and management of patients with DM, especially for those who have difficulty attending regular clinic visits

Medication Management

Medication management is an essential part of the follow-up protocol for patients with DM. The choice of medication depends on the type of DM, patient characteristics, and other factors. Studies have compared the effectiveness of different medications, such as:

• Glimepiride and rosiglitazone in patients with type 2 DM 4
• Metformin and glipizide in patients with type 2 DM 5
• These studies found that different medications have different effects on glycemic control, weight, and lipid profiles, and that the choice of medication should be individualized based on patient characteristics and needs

Screening and Diagnosis

Screening and diagnosis of DM are critical for early detection and treatment. The American Diabetes Association recommends:

• Screening for type 2 DM annually in patients 45 years and older, or in patients younger than 45 years with major risk factors 6
• Using a fasting plasma glucose level of 126 mg per dL or greater, an A1C level of 6.5% or greater, or a random plasma glucose level of 200 mg per dL or greater to diagnose DM 6
• Confirming the diagnosis with repeat testing on a subsequent day, unless a single random plasma glucose level of 200 mg per dL or greater is accompanied by typical signs and symptoms of hyperglycemia 6