GUIDELINES ON THE CARE OF DIABETIC NEPHROPATHY, RETINOPATHY AND FOOT DISEASE

Diabetes mellitus is a common disease frequently managed by family phy sicians. Because of its high prevalence and associated comorbidity, di abetes mellitus has received a great deal of attention from several sp ecialty organizations. The American Diabetes Association, the American Board of Family Practice and the Centers for Disease Control and Prev ention have published specific practice guidelines and recommendations for the care of diabetic patients. These recommendations include annu al comprehensive foot examinations, yearly ophthalmologic screening fo r retinopathy, and urinalysis for microalbuminuria. The use of angiote nsin converting enzyme inhibitors is advocated for the majority of dia betic patients with proteinuria or hypertension. Based on recent evide nce, improved glycemic control is also increasingly advocated. Complia nce with practice guidelines by primary care physicians has historical ly been poor. Mechanisms such as the use of patient problem lists and diabetic flow sheets can serve as reminders to physicians and can faci litate closer adherence to practice guidelines.