screening and eligibility for dpp clinical guidelines

Screening and Eligibility for DPPScreening and Eligibility for DPPClinical GuidelinesClinical Guidelines

EligibilityEligibility

• Impaired Fasting Glucose (IFG) = Impaired Glucose Tolerance (IGT)= Prediabetes

• Individuals eligible for SCREENING – follow Core Element guidelines

At Risk for DiabetesAt Risk for Diabetes

• Family member with type 2 diabetes (parents or siblings with diabetes)

• Overweight– BMI ≥25 kg/m2

• Age ≥ 35• Habitual inactivity (no regular physical activity, less than 30

minutes 3 times a week)• Previous diagnosis of Prediabetes (IFG or IGT)• Prior GDM or delivery of a baby weighing > 9 lbs• History of Polycystic Ovarian Syndrome• Any other component of Metabolic Syndrome (ATP III)

ScreeningScreening

• Remember – there will be many more individuals who are eligible for screening than are eligible for participation

• Exclude eligible individuals from participation in this project who have any of the exclusion diagnoses/conditions:

Exclusion CriteriaExclusion Criteria

– Current diagnosis of pregnancy (reconsider participation 6 weeks after delivery, suspend participation if becomes pregnant during project)

– Active alcohol or substance abuse by provider judgment that would affect successful participation

– End Stage Renal Disease on dialysis– Previous diagnosis of diabetes (not eligible for

diabetes prevention)– Current diagnosis of cancer undergoing treatment that

prohibits participation – provider judgment

Community ScreeningCommunity Screening

Do Random Blood Sugar (RBS) AND ADA Risk Test

• (+) Screening = RBS > 100 OR ADA Score ≥ 10 = Refer to Clinic/schedule for OGTT if agrees to participate

• (–) Screening = Provide education/information and offer f/u

Clinic ScreeningClinic Screening

2 hour OGTT AND ADA Risk Test (if not already done)

• Do not use Fasting Blood Sugar (FBS) testing in place of 2 hr OGTT

2 hour OGTT2 hour OGTT

• Only 1 OGTT result necessary for diagnosis of Prediabetes

• If individual has a previous diagnosis of Prediabetes AND:

1. OGTT done < 6 months before baseline assessment = do a FBS to ensure not progressed to Diabetes

2. OGTT done > 6 months before baseline assessment = REPEAT 2 hour OGTT

2 hour OGTT results2 hour OGTT results

NORMAL PRE-DM DIABETES

(presume)

FBS < 100 100 – 125 125

2 hr BS < 140 140 – 199 200

• One or more abnormal result in the Pre-diabetes range = Pre-diabetes

Diagnosing Pre-diabetesDiagnosing Pre-diabetes

• Diagnosis must be made by a Licensed Independent Practitioner

• Notification of individual can be delegated to a clinical staff/project staff member – RN, RD, etc.