Note: a multifactorial intervention targeting hyperglycemia and cardiovascular risk factors in individuals with diabetes is most effective. Both individual measures of diabetes care, as well as comprehensive measures of performance on broader sets of measures, are recommended. A randomized controlled trial has shown a 50% reduction in major cardiovascular events through a multifactorial intervention targeting hyperglycemia, hypertension, dyslipidemia, microalbuminuria, aspirin and ACE inhibitor use in individuals with microalbuminuria (Gaede, 2003).
Goals for A1c, low-density lipoprotein and other diabetes measures should be personalized, and lower goals for A1c and low-density lipoprotein than those included here in the priority aims and measures may be clinically justified in some adults with T2DM. However, efforts to achieve A1c below 7% may increase risk of mortality, weight gain, hypoglycemia and other adverse effects in many patients with T2DM. Therefore, the aims and measures listed here are selected carefully in the interests of patient safety.
- Diabetes Optimal Care: Increase the percentage of patients ages 18-75 years with T2DM mellitus who are optimally managed.
- Management of T2DM in high-risk patients (Trial measure): Decrease the percentage of adult patients ages 18-75 with T2DM mellitus with poorly controlled glucose and cardiovascular risk factors.
- Lifestyle modification and nutrition therapy – increase the percentage of patients ages 18-75 years newly diagnosed with T2DM who are advised about lifestyle modification and nutrition therapy.
- Medication Management – increase the percentage of patients with T2DM who are on appropriate medication management.