PARTNERSHIP HEALTHPLAN OF CALIFORNIA
GUIDELINE/ PROCEDURE
Guideline/Procedure Number: MPXG5002 (previously XG100502)
Guideline/Procedure Title: Clinical Practice Guidelines for Diabetes
Mellitus
Original Date: 04/19/2000 – Medi-Cal
04/21/2010 – Healthy Kids
Lead Department: Health Services
☒External Policy
☐ Internal Policy
Next Review Date: 06/18/2015
Last Review Date: 06/18/2014
Applies to:
☒ Medi-Cal
☒ Healthy Kids
☐ Employees
Reviewing
Entities:
☒ IQI
☐P&T
☒ QUAC
☐ OPERATIONS
☐ EXECUTIVE
☐ COMPLIANCE
☐ DEPARTMENT
☐ BOARD
☐ COMPLIANCE
☐ FINANCE
☒ PAC
☐ CREDENTIALING
☐ DEPT. DIRECTOR/OFFICER
Approving
Entities:
☐ CEO
☐ COO
Approval Signature: Robert Moore, MD, MPH
Approval Date: 06/18/2014
I.
RELATED POLICIES:
A. N/A
II.
IMPACTED DEPTS:
A. ..
III.
DEFINITIONS:
A. N/A
IV.
ATTACHMENTS:
A. N/A
V.
PURPOSE:
Diabetes is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin
secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated with long-term
damage, dysfunction, and failure of different organs, especially the eyes, kidneys, nerves, heart, and blood
vessels. (Diabetes Care, January 2012; 35(Supplement 1)
VI.
GUIDELINE / PROCEDURE:
A. KEY POINTS IN DIAGNOSIS AND MANAGEMENT
1. Diagnosis Criteria for the diagnosis of diabetes
a. A1C> 6.5%;or
b. Fasting plasma glucose > 126 mg/ dL; or
c. 2-h plasma glucose > 200 mg/dL during an oral glucose tolerance test
d. In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma
glucose > 200 mg/dL;
e. In the absence of unequivocal hyperglycemia, the result should be confirmed by repeat testing
2. Treatment. The glycemic goal in adults is the lowering of Hemoglobin A1C to below or around 7%,
with the exception of patients with limited life expectancy, repeated episodes of severe
hypoglycemia, advanced cardiovascular disease, advanced kidney disease and advanced neuropathy,
for whom the goal is between 7-8%. The principles of treatment consist of lifestyle changes
(physical activity, nutrition, smoking cessation), pharmacotherapy, appropriate weight loss, diabetes
self-management education, depression screening, management of co-morbidities (hypertension,
dyslipidemia), screening for and treatment of complications of diabetes (CHD, nephropathy,
retinopathy, neuropathy, foot care)
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Guideline/Procedure Number: MPXG5002 (previously
Lead Department: Health Services
XG100502)
☒ External Policy
Guideline/Procedure Title: Clinical Practice Guidelines for
Diabetes Mellitus
☐ Internal Policy
Original Date: 04/19/2000 – Medi-Cal Next Review Date: 06/18/2015
04/21/2010 – Healthy Kids
Last Review Date: 06/18/2014
Applies to: ☒ Medi-Cal
☒ Healthy Kids
☐ Employees
B. PHC FORMULARY AND MEDICATIONS
1. Oral Hypoglycemics;
a. Formulary -No TAR required; glimepiride (Amaryl), tolbutamide (Orinase), glyburide
(Micronase, DiaBeta), glipizide (Glucotrol), metformin (Glucophage, Glucophage XR),
acarbose (Precose), nateglinide (Starlix), miglitol (Glyset)
b. Formulary – STEP required; alogliptin (Nesina), Alogliptin-metformin ( Kazano), linagliptin
(Tradjenta), linagliptin-metformin (Jentadueto),rosiglitazone (Avandia),
rosiglitazone/glimepiride (Avandaryl), saxagliptin (Onglyza), saxagliptin-metformin
(Kombiglyze XR), sitagliptin (Januvia), sitagliptin/metformin (Janumet, Janumet XR),
pioglitazone (Actos), pioglitazone/metformin (Actoplus Met), pioglitazone/glimepiride
(Duetact),
2. Insulin; Insulin (vials), Insulin (PFS, Pen, or CRT), Insulin Pump
C. INDICATORS MONITORED BY PHC: These indicators will be monitored for measurement of
adherence to this guideline.
1. Quality Improvement Program for 2014-2015
a. A1C testing
b. LDL testing
c. Retinal eye exam
d. A1C good control (< 9%)
e. Blood pressure< 140/90
f. Nephropathy screening test or evidence of nephropathy
VII.
REFERENCES:
A. PHC has adopted the diabetes guidelines entitled American Diabetes Association Clinical Practice
Recommendations published in Diabetes Care, January 2014; 37(Supplement 1). A copy of the
guideline is available at http://care.diabetesjournals.org/content/37/Supplement_1/S1.full.pdf+html
VIII.
DISTRIBUTION:
A. HS Department UM Staff
B. PHC Provider and Practitioner Manuals
C. PHC Department Directors
IX.
POSITION RESPONSIBLE FOR IMPLEMENTING PROCEDURE:
X.
REVISION DATES:
Medi-Cal
12/19/01; 09/18/02; 09/15/04; 11/17/04; 03/21/07; 04/21/10; 06/20/12; 06/18/14
Healthy Kids
06/20/12; 06/18/14
PREVIOUSLY APPLIED TO:
PartnershipAdvantage
MPXG5002 - 03/21/2007 to 01/01/2015
Healthy Families
MPXG5002 - 05/18/2007 to 03/01/2013
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