Screening and Eligibility for DPP Clinical Guidelines Presentation: Screening & Eligibility Klamath Tribe

Eligibility Impaired Fasting Glucose (IFG) = Impaired Glucose Tolerance (IGT)= Prediabetes Individuals eligible for SCREENING – follow Core Element guidelines

At 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.

Screening 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 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 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 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 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 results NORMALPRE-DMDIABETES (presume) FBS< – 125  hr BS< – 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-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.