Diabetes Clinical Guidelines

Introducing the PHS/PCHI Clinical Guidelines Update for the Treatment of Type 2 Diabetes in the Non-Pregnant Adult

July, 2012

Dear Colleagues:

Three years have passed since our last set of diabetes guidelines from PHS/PCHI – and, as I noted last time, once again there has been a lot of progress in the interim. This progress enhances the ability of our diabetic patients to live full and better lives – but we also know that the progress makes it more complicated to deliver the very best care. The role of surgery, the potential impact of life style changes, the ideal use of oral versus insulin therapy – all hugely important topics.

Fortunately for me and other PCHI physicians, we have access to a team of community and academic physicians, including a variety of specialists, who have reviewed all of the most recent literature and have updated the guidelines for our everyday use. There are so many issues that come up for all of us in the management of our diabetic patients -- we need to manage blood glucose with a growing number of medications available to us, and we need to manage blood pressure, lipids, and pay attention to preventative measures. I really appreciate that all of these topics and then some are right here at my fingertips and, thanks to this update, I can be confident that I am basing my decisions on the most current information available to us.

The "new and improved" guidelines incorporate the recommendations from the Diabetes Care Redesign team. The FAQs in the previously posted edition have been replaced with an overview of the work of Care Redesign, bariatric surgery, and a more in-depth discussions of various aspects of diabetes care, such as self monitoring of blood glucose (with frequency suggestions, based on the patient's current treatment approach). A template for physicians to assist with basal insulin initiation and titration, as well as various patient education handouts that are intended to provide support for patients starting on insulin have also been included in this version of the guidelines. Also attached is a list of diabetes teaching groups throughout our network who are here to help us.

Please keep in mind that each patient is unique and may not fit within the recommended guidelines. Using your good clinical judgment is still number one, however we think the guidelines will be useful when you are adjusting medications, ordering labs, starting patients on insulin, and managing other aspects of patient care.

Please bookmark PCHInet (http://www.pchinet.com => Medical References => Diabetes Guidelines) and/or Virtual Diabetes Center (http://vdc.partners.org) for electronic access to these guidelines. I hope you will visit the site often when you see patients with diabetes.


Thomas H. Lee, M.D.
CEO, Partners Community HealthCare, Inc.