Glycemic Control Algorithm 1

Toolkit for Implementing the Chronic Care Model in an Academic Environment

The Planned Visit Notebook includes a step-by-step description for a diabetes planned visit. The Glycemic Control Algorithm is a flowchart that takes a health professional through the steps for one part of the diabetes planned visit.

Glycemic Control Algorithm for DM1: Goal A1c greater than 7.0. For details, see Text Description below.

Text Description

The Glycemic Control Algorithm for DM1 begins with a text box that reads:
Algor Assess A1c result
Note: A1c result should be no older than 3 months
Two arrows lead from it. The one to the left is labeled "A1c <7.0" and points to a box that reads:
Recheck in 3 months
The one to the right is labeled "A1c >7.0" and points to a box that reads:
Planned Visit—complete assessment of glycemic control program (see Module 4 Podcast)
—Advise relevant lifestyle changes
Two arrows lead from this box to two boxes below it. The box to the left reads:

Group 1: Control goal attainable by dosage changes within current regime (generally A1c 8.0 or less)

NP with endocrinologist/staff oversight adjust doses makes HGM recommendations

Contact patient in 1 week (visit or otherwise to assess effectiveness of changes), then no less often than monthly. Change as necessary with staff oversight.

Recheck A1c in 3 months

The box to the right reads:

Group 2: Control goal is not attainable by dosage changes within current regime (generally A1c >8.0)

Contact endocrinologist for change in regimen or arrange a team meeting. Initiate a regime as soon as possible, including that day.

Contact patient in 1 week (visit or otherwise to assess effectiveness of changes) and make further recommendations with staff oversight.

Recheck A1c in 3 months

A note at the bottom of the algorithm reads:

Note: Team Meetings option at any point for scope of changes necessary, lack of progress not limited to adherence issues, or nurse practitioner wishes. Team meeting optional at any point for lack progress—as determined by nurse practitioner.

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Page last reviewed January 2008
Internet Citation: Glycemic Control Algorithm 1: Toolkit for Implementing the Chronic Care Model in an Academic Environment. January 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/chroniccaremodel/chronic2a7.html