Screening and Eligibility for DPPScreening and Eligibility for DPPClinical GuidelinesClinical Guidelines

Presentation: Screening & Eligibility Klamath Tribe

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)

* The clinical measures listed on these documents were used by the programs over the past 10 years and were current at their time of use. However, these example documents are not intended to serve as current clinical guidelines. Programs using these documents will need to ensure the clinical measures are current for their intended use.

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

* The clinical measures listed on these documents were used by the programs over the past 10 years and were current at their time of use. However, these example documents are not intended to serve as current clinical guidelines. Programs using these documents will need to ensure the clinical measures are current for their intended use.

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

* The clinical measures listed on these documents were used by the programs over the past 10 years and were current at their time of use. However, these example documents are not intended to serve as current clinical guidelines. Programs using these documents will need to ensure the clinical measures are current for their intended use.

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

* The clinical measures listed on these documents were used by the programs over the past 10 years and were current at their time of use. However, these example documents are not intended to serve as current clinical guidelines. Programs using these documents will need to ensure the clinical measures are current for their intended use.

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.