Management Of Diabetes

What’s Been Changed in This Document?

This document has been revised several times since September 2002: in February 2008, in April 2009, in

November 2010, and now in June 2012.

June 2012 Revisions:

The June 2012 revisions, highlighted in yellow throughout the document, include the following:

 A new section on Diabetic Periodontitis has been added to Section 11, Medical Management of

Diabetic Complications. Non-dentists should be aware of the bidirectional relationship between

periodontal disease and glycemic control.

 Statistics from the CDC’s 2011 National Diabetes Fact Sheet now introduces Section 11 to highlight

the seriousness of diabetic complications.

 The importance of periodic finger sticks at Health Services is reinforced in Section 9, Blood Glucose

Monitoring.

 Under Hypertension in Section 11, the recommendation, “If targets are not achieved, a thiazide

diuretic should be added,” has been deleted.

 In Appendix 2, Recommendations for Diabetes Chronic Care Monitoring, a note has been added

regarding screening for microalbuminuria: “Abnormal results should be repeated at least 2–3 times

over a 3–6 month period to appropriately diagnose, because of the potential for false positives.”

 All technical information has been reviewed by BOP pharmacists, and the updates are highlighted in

yellow.

 The nutritional information for diabetic inmates has been updated. The Diabetes Food Pyramid has

been replaced; patients are counseled to choose from the heart-healthy food options on the BOP

National Menu, and the BOP National Carbohydrate Counting Menu available on Sallyport. See

Food Selection under Lifestyle Intervention in Section 5, and the new inmate handout in Appendix 12,

Eating to Manage Your Diabetes in the Bureau of Prisons.

 The three Inmate Handouts have been revised and grouped together as Appendices 10–12.

November 2010 Revisions:

The following BOP recommendations were changed to align with the American Diabetes Association’s

Standards of Medical Care in Diabetes – 2010.

 The recommendations for aspirin therapy in diabetic patients have been changed. See the discussion of

aspirin therapy in Section 11.

 Criteria for diagnosing diabetes now includes hemoglobin A1C testing, with a cut point of >6.5%.

An A1C of 5.7–6.4% is considered a sign of pre-diabetes (see Table 1). Based on the results of multiple

randomized trials and correctional considerations, the BOP recommends A1C <7.0–7.5% as a reasonable

treatment goal for diabetic inmates (see Section 6, Type 2 Diabetes Treatment).

April 2009 Revisions:

The April 2009 version of Management of Diabetes was a targeted update to make these guidelines consistent

with the updated BOP guidelines on Preventive Health Care. Both guidelines were changed in 2009 to be in

line with the following U.S. Preventive Services Task Force recommendation:

There is only one group of asymptomatic, otherwise low-risk individuals for whom routine

diabetes screening is warranted. Those with a blood pressure greater than 135/80 (treated or

untreated) should be screened every 3 years. Federal Bureau of Prisons Management of Diabetes

Clinical Practice Guidelines June 2012

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Otherwise, glucose screening should be performed as clinically indicated, i.e., in association with management

of hyperlipidemia, cardiovascular disease, peripheral vascular disease, history of gestational diabetes, or

history of polycystic ovary disease.

February 2008 Revisions:

 The criteria for diagnosis of diabetes, impaired fasting glucose (IFG) and impaired glucose tolerance

(IGT), were revised (Table 1). A new term, “pre-diabetes,” was applied to IFG and IGT.

 The screening criteria for diabetes were revised (Section 3). Obtaining a capillary blood glucose from

insulin dependent diabetics at intake is emphasized (in Section 5).

 Lifestyle interventions were recommended. The benefits of lifestyle intervention for inmates with

IFG/IGT in preventing or delaying the onset of type 2 diabetes are emphasized. The role of exercise as a

diabetes treatment intervention is more strongly emphasized. BOP institutions should consider

implementing structured exercise programs for diabetic inmates. The American Diabetes Association

“Food Pyramid” was included, but has now been replaced with more current information (see

Appendix 12).

 Treatment goals were revised (Appendix 3), including an A1C goal of <7%.

Note: The 2008 A1C goal has been superseded by the November 2010 recommendations.

 Early intervention for type 2 diabetes is emphasized. Recommendations for treatment of type 2 diabetes

were changed (Section 6).

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