Targets and Priorities

 Topics

  1. Assess Safety 
  2. Assess Diabetes Targets 
  3. Set Priorities 

 Related: 

 

1. Assess Safety 

  • We advise you to include a safety assessment in your appointment "agenda". See Agenda Setting for more details. 
  • The key safety concerns we have identified are as follows: 
    • Psychosocial 
    • Hypoglycemia
    • Hyperglycemia (DKA, HHS)  
    • Pregnancy 
    • Signs of Vascular Event 
    • Foot Wound 
  • Visit our Safety Checklist page for questions to ask, what to do in case of urgent concern and resources. 

2. Assess Diabetes Targets 

Diabetes targets have been simplified by Diabetes Canada into the ABCDES3 as shown in table below. The table below can also be accessed in the Diabetes Canada 2018 Quick Reference Guide.

 


A-    A1C 


A1c target usually < 7.0%. Click here for table with individualized A1c and blood glucose targets. 

These are based on Diabetes Canada's modified Clinical Frailty Score.

 


B-    Blood Pressure 
 


Target < 130/80 mmHg 

  


C-   Cholesterol 



LDL < 2.0 or > 50% reduction from baseline

Alternate targets include: apo B < 0.8 g/L and non-HDL-C < 2.6 mmol/L

Some physicians are not using LDL targets alone. They are assigning medications based on risk factors present, as does the Diabetes Canada Reducing Vascular Risk Tool.

 


D -    Drugs for Cardiovascular Disease Risk Reduction 



Diabetes Canada: Reducing Vascular Risk Tool to help assess whether the following medications are advised: 


ACE inhibitor/ARB 
Statin
ASA
SGLT-2 /GLP-1 


 


E-    Exercise and healthy Eating 
 


Aerobic exercise: At least 150 minutes of moderate to vigorous activity/week
Resistance exercise: 2-3x/week

Healthy Eating assessment: See our webpage on Nutrition (currently in development). Consider referral to a Registered Dietitian (Diabetes Services Calgary). 

 


S-    Screening for Complications 
 


ECG every 3-5 years if ˃40 or diabetes complications.

Retinal exam every 1-2 years or as advised by eye specialist.

Urine Albumin/Creatinine ratio and eGR annually.
ACR target < 3.0,  eGFR > 60. (Ckdpathway.ca tool)

Foot exam at least once a year (see our Foot Care page). 

 


S-   Smoking Cessation 


Assess if currently smoking and ask permission to advise on cessation. Smoking cessation resources on our Topics Catalogue

 

S-   Self Management, Stress, and other barriers 


Using appropriate client centered counseling is key when assessing all diabetes targets. Click on Client Centered Counseling for information on "Assessing Conviction/Confidence" and "Goal Setting".

Stress management resources can be found on our Topics Catalogue.  

We encourage you to create your own question to help assess stress level and other psychosocial barriers. See Safety Checklist - Psychosocial - for the example: "What, if anything, is getting in the way of you taking care of your health?"