U.S. Department of Health and Human Services

National Diabetes Education Program

Diabetes Management

Early identification, management, and ongoing comprehensive diabetes care can prevent or control acute diabetes complications such as hypoglycemia and hyperglycemia as well as chronic diabetes microvascular and macrovascular complications. Comprehensive care includes management of blood glucose, blood pressure, lipids, and comorbidities. With proper medical management, education, self-care, and attention to behavioral, social, and environmental factors, people with type 1 and type 2 diabetes can live long, active, and productive lives. The health care team needs to work in partnership with the patient, discussing options and individualized goals, to create a specific, personalized diabetes management plan.

Clinical Information Systems – for Diabetes Management

Electronic health record offerings

Buyer Zone: search for EHR and compare free electronic medical record price quotes.

Center for Health IT, American Academy of Family Physicians

EHR Outlook, an online resource.
How EHR templating helps me provide better diabetes care

Electronic health records, American College of Physicians:

EMRConsultant, a comprehensive EMR/EHR matching system.

Fierce EMR, a free EMR weekly newsletter.

HealthITBuzz, Office of the National Coordinator for Health Information Technology (ONC).

MedlinePlus Connect, a free service that allows health organizations and health IT providers to link patient portals and electronic health record systems to MedlinePlus, an authoritative up-to-date health information resource for patients, families, and health care providers (National Library of Medicine).

Community Resources – for Diabetes Management

Diabetes Disorder Resource Center – National Association of Managed Care Physicians: www.namcp.org/_vti_bin/shtml.dll/diabetes/diabetes_PD.html

School Resources

Helping the Student with Diabetes Succeed: A Guide for School Personnel , National Diabetes Education Program

Toolkit for Preferred Provider Organizations (PPOs) – Talking with payers, providers and patients about diabetes: Helps PPOs of any business model talk with key stakeholders about the importance of diabetes and identify resources for each audience to improve care quality.

Tools for faith leaders, New York State Health Foundation

Web based education module for medical students and residents, Columbia University


Reducing disparities in diabetes, University of Michigan DRTC.

Decision Support – for Diabetes Management


Management of hyperglycemia in type 2 diabetes: with a table for the initiation and adjustment of therapy for hyperglycemia (2012), American Diabetes Association and the European Association for the Study of Diabetes.

Clinical practice guideline for the management of diabetes mellitus (2010), Veterans Administration / Department of Defense.

Glycemic control in type 2 diabetes (2009), American Association of Clinical Endocrinologists/American College of Endocrinology.

Oral pharmacologic treatment of type 2 diabetes mellitus: a clinical practice guideline (2012), American College of Physicians.

AIDA On-Line: Simulate the effects of changes in insulin and diet on the blood glucose profiles of various example 'virtual diabetic patients'. Simulations can be run without charge with all results being displayed in your Web browser window.

Care guide

Diabetes Care Guide – American College of Physicians: (requires online registration or membership)

Empowerment tools

Support Behavior Change – How to motivate your patients, National Diabetes Education Program.

Forums Online

Diabetes Forum – for people with diabetes and the health care team.

Medscape diabetes and endocrinology news

Online physician communities – search the internet to find more

Practice guidelines

Guidelines for developing a comprehensive diabetes care plan (2011), American Association of Clinical Endocrinologists.

Evidence-based practice reports, Agency for Healthcare Research and Quality.

Clinical practice recommendations: position statements, technical reviews, committee reports & consensus statements, positions statements, and standards and review criteria (January each year), American Diabetes Association.

Guiding Principles for Diabetes Care , National Diabetes Education Program

Guideline search, National Guidelines Clearinghouse: www.guideline.gov/search/search.aspx?term=diabetes

Clinical practice guideline for the management of diabetes mellitus (2010) Veterans Administration /Department of Defense: www.healthquality.va.gov/diabetes/DM2010_FUL-v4e.pdf

Management tools

Depression care:


The Patient Health Questionnaire (PHQ-9) is a nine-item depression assessment tool: www.cqaimh.org/tool_depscreen.html. The first two questions, known as the PHQ-2, have been validated as a screening tool and are regularly administered to high-risk groups (e.g., those with chronic illnesses, those with a history of depression). [Kroenke K, Spitzer RL, Williams JB: The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care 2003; 41(11): 1284-92.]

The PHQ-2 addresses depressed mood and loss of interest or pleasure in previously enjoyable activities. Patients with positive screening results should complete the PHQ-9. Staff members can assist in identifying patients due for screening, administering the questionnaires, and scoring and reporting results to the physician.

A screen should be considered positive if the patient answers “yes” to either of the first two questions. Items are scored on a Likert scale from 0 to 3 (0 = Not at all, 1 = several days, 2 = more than half the days, 3 = nearly every day). Add items for a score ranging from 0 to 27.

Scores of 0–4 suggest negligible depressive symptoms, 5–9 mild, 10–14 moderate, 15–19 moderately severe, and 20–27 severe. The likelihood that the patient has true depression increases as the PHQ-9 score increases, but it is still important that the provider evaluate the diagnosis as well as develop a treatment plan in collaboration with the patient.

Patient Health Questionnaire Mood Scale (PHQ)-9 Screening Tool for Use in Primary Care

Step one: Two-question basic screening—Over the last two weeks, how often have you been bothered by any of the following problems:

• Having little interest or pleasure in doing things?

• Feeling down, depressed, or hopeless?

Step two: If the response to either question is “yes,” administer the seven remaining items:

• Trouble falling or staying asleep, or sleeping too much,

• Feeling tired or having little energy,

• Poor appetite or overeating,

• Feeling bad about yourself, that you are a failure, or that you have let yourself or your family down,

• Trouble concentrating on things, such as reading the newspaper or watching television,

• Moving or speaking so slowly that other people could have noticed. Or, the opposite, being so fidgety or restless that you have been moving around a lot more than usual, and,

• Thoughts that you would be better off dead or of hurting yourself in some way.

Source: www.ihs.gov/MedicalPrograms/Diabetes/HomeDocs/Tools/BestPractices/2011_BP_DepressionCare_508c.pdf

Glomerular Filtration Rate Calculators, National Kidney Disease Education Program

Slide Presentations, various diabetes-related topics, National Diabetes Education Program

Risk calculators for diabetes

American Diabetes Association tools

Framingham Heart Study Risk Score Profiles


Challenges of managing diabetes – 7 part video, AmericanAcademy of Family Physicians

Foot examination video, American College of Physicians Foundation and Abington Memorial Hospital – (Purchase)

Video news reports based on new clinical research from Annals of Internal Medicine, American College of Physicians.

Video series topic search, AmericanAcademy of Family Physicians.

Patient Self-management Support – for Diabetes Management

Applications (Apps) (costs may apply)

Diabetes apps – 2012 http://forecast.diabetes.org/magazine/features/2012-diabetes-software-apps

Mayo clinic blog: Managing diabetes with diabetes apps: www.mayoclinic.com/health/diabetes-apps/MY01863

Empowerment tools

Diabetes HealthSense – National Diabetes Education Program: many resources to help patients with or at risk for diabetes live well and meet goals.

Forums Online

Diabetes Forum – for people with diabetes and the health care team www.diabetesforum.com/

Videos and Podcasts

ACP self-care videos: www.acpfoundation.org/materials-and-guides/video/

Hispanics and diabetes in English or Spanish, American College of Physicians Foundation: www.acpfoundation.org/materials-and-guides/video/

Video HEALTH TiPS: Six diabetes-related videos for patients covering insulin use, hypoglycemia, foot care, taking blood pressure, and preparing for a visit to the doctor, American College of Physicians Foundation and Abington Memorial Hospital

Podcasts, National Diabetes Education Program: http://ndep.nih.gov/resources/podcasts/

Videos for patients, National Diabetes Education Program: http://ndep.nih.gov/resources/index.aspx?ToolType=17

Practice Redesign – for Diabetes Management

Cost of diabetes assessment tools

Forms for patient or practice management

Checkup questionnaire, Diabetes registry sample spreadsheet, Encounter form, Flow sheet; Patient-physician partnership agreement, and Reminder letter for diabetes checkup (AAFP Family Practice Toolkit): www.aafp.org/online/en/home/publications/journals/fpm/fpmtoolbox.html#Parsys9810

Diabetes portal – American College of Physicians http://diabetes.acponline.org/index.html



Journal articles

Canadian Family Physician Improving diabetes care in my practice www.cfp.ca/content/53/11/1897.full

Diabetes Care Improving Diabetes Care in Practice Findings from the TRANSLATE trial, 2008 care.diabetesjournals.org/content/31/12/2238.full.pdf

Effects of quality improvement strategies for type 2 diabetes on glycemic control: a meta-regression analysis. JAMA. 2006 Jul 26;296(4):427-40.

Measuring program impact

Improving diabetes prevention and management http://nyshealthfoundation.org/priority-areas/improving-diabetes-prevention-and-management


Survey instruments for diabetes patients and health professionals www.med.umich.edu/mdrtc/profs/survey.html

Patient satisfaction survey (PACIC) www.improvingchroniccare.org/index.php?p=Survey_Instruments&s=165

Team care

TEAM care www.teamcarehealth.org/Home.aspx

Team Care Guide – How to develop or expand your team, National Diabetes Education Program

Transitions from Pediatric to Adult Health Care , National Diabetes Education Program