Required: Body System: Session Topic: Educational Format Faculty Expertise Required

2019 AAFP FMX Needs Assessment
Body System: Endocrine

Session Topic: Diabetes Treatment Update
Educational Format Faculty Expertise Required
Expertise in the field of study. Experience teaching in the
field of study is desired. Preferred experience with audience
Interactive
REQUIRED response systems (ARS). Utilizing polling questions and
Lecture
engaging the learners in Q&A during the final 15 minutes of
the session are required.
Expertise teaching highly interactive, small group learning
environments. Case-based, with experience developing and
Problem- teaching case scenarios for simulation labs preferred. Other
Based workshop-oriented designs may be accommodated. A typical
OPTIONAL
Learning PBL room is set for 50-100 participants, with 7-8 each per
(PBL) round table. Please describe your interest and plan for
teaching a PBL on your proposal form.
Learning Objective(s) that will close Outcome Being

Professional Practice Gap
the gap and meet the need Measured
 Physicians have statistically 1. Evaluate current standards of care Learners will
significant and meaningful (screening, prevention, diagnosis, submit written
gaps in the medical skill treatment, management) for patients commitment to
necessary to efficaciously with diabetes, or who are at risk for change statements
manage treatment; and developing diabetes, for on the session
management of those at risk opportunities to update standards in evaluation,
for developing diabetes, accordance to current research and indicating how
such as patients who are evidence-based guidelines. they plan to
obese, have hypertension, 2. Apply a patient-centered approach to implement
hyperlipidemic and have a incorporate guideline presented practice
history of prediabetes. recommendations for intensifying recommendations.
 Patients fail to direct therapy to achieve glycemic control.
ambitious and timely 3. Use medication which allow patients
therapeutic interventions
to achieve their individualized
which have been
metabolic targets without weight
demonstrated to reduce the
risk and/or progression of
gain or increasing their risk of
long term diabetes related developing treatment emergent
complications. hypoglycemia.
 Physicians have knowledge 4. Encourage patients to remain
gaps related to utilizing a adherent to their prescribed
patient-centered approach to behavioral and pharmacologic
care that involves the entire therapeutic interventions
care team to help make the
office visit with the
physician more efficient;
recognizing latent
autoimmune diabetes in
adults (LADA);
©AAFP. All rights reserved. This document contains confidential and/or proprietary information which may not be
reproduced or transmitted without the express written consent of AAFP. Last modified 6-28-18
understanding and adhering

to current screening and
evaluation guidelines; being
up to date on current
guidelines for medications
and therapeutic approaches;
improving efforts toward
patient education and
counseling for prevention in
pre-diabetic patients,
including effective use of
group visits; effective
control and maintenance of
patients receiving treatment;
and having an awareness of
current guidelines for
gestational diabetes.
 Physicians are often not
aware of updated clinical
guidelines and results of
clinical interventions from
retrospective studies that
prove such
recommendations to be
effective.
 Physicians do not routinely
use clinical guidelines (from
the American Diabetes
Association or the
American Association of
Clinical Endocrinologists)
in managing care for
patients with diabetes, and
often do not provide optimal
coordination of care with
specialists.
 Over 60 % of patients will
discontinue their prescribed
medications, including
insulin, oral agents and
GLP-1 RAs within 6
months. Poor adherence
results in higher A1Cs and a
greater risk of
microvascular and
macrovascular
complications
 Cardiovascular outcome
studies have now been
published which suggests
patients with known
cardiovascular disease or
those who are at high risk
for developing CV disease
may benefit from certain
therapeutic agents
ACGME Core Competencies Addressed (select all that apply)
X Medical Knowledge Patient Care
X Interpersonal and Communication Skills Practice-Based Learning and Improvement
Professionalism Systems-Based Practice
Faculty Instructional Goals
Faculty play a vital role in assisting the AAFP to achieve its mission by providing high-
quality, innovative education for physicians, residents and medical students that will
encompass the art, science, evidence and socio-economics of family medicine and to support
the pursuit of lifelong learning. By achieving the instructional goals provided, faculty will
facilitate the application of new knowledge and skills gained by learners to practice, so that
they may optimize care provided to their patients.
 Provide up to 3 evidence-based recommended practice changes that can be
immediately implemented, at the conclusion of the session; including SORT taxonomy
& reference citations
 Facilitate learner engagement during the session
 Address related practice barriers to foster optimal patient management
 Provide recommended journal resources and tools, during the session, from the
American Family Physician (AFP), Family Practice Management (FPM), and
Familydoctor.org patient resources; those listed in the References section below are a
good place to start
o Visit http://www.aafp.org/journals for additional resources
o Visit http://familydoctor.org for patient education and resources
 Provide updates on new treatment therapies, changes to therapies, or warnings
associated with existing therapies. Provide recommendations regarding new FDA
approved medications; including safety, efficacy, tolerance, and cost considerations
relative to currently available options. Include relevant FDA REMS education for
any applicable medications.
 Provide an overview of current updates on diabetes topics in general and their
immediate impact to patient care, including recommendations for implementation.
 Describe the best evidence for screening for and prevention of type 2 diabetes.
 Outline the diagnostic criteria for type 2 diabetes.
 Summarize initial testing and treatment of a patient with newly diagnosed type 2
diabetes.
 Describe goals for blood pressure, cholesterol, and A1c levels based on best evidence
for patient-oriented outcomes.
 Summarize drug treatment for glucose control for patients with type 2 diabetes.
 Discuss potential benefits and adverse effects of combination drugs for glucose control.
 Describe alternatives to traditional individual office visits for optimizing diabetes care.
 Summarize team-based care in the provision of diabetes education and other diabetes
services.
 Describe ways to incorporate technology in the care of a panel of patients with diabetes
including ambulatory glucose monitoring and continuous glucose sensing.
 Summarize options for organizing and billing for group visits for diabetes.
 Provide recommendations regarding guidelines for Medicare reimbursement.
 Provide recommendations to maximize office efficiency and guideline adherence to the
diagnosis and management of diabetes.
 Provide an overview of newly available treatments, including efficacy, safety,
contraindications, and cost/benefit relative to existing treatments.
 Provide instructions regarding the incorporation and use of the PCMH/ACO/Primary
Care Core Measure Set into practice.
Needs Assessment
* Note – for the purposes of this session, the scope and focus is intended to provide an overview
of current updates on diabetes topics in general and their immediate impact to patient care,
including recommendations for implementation.
According to the 2017 National Diabetes Statistics Report from the Centers for Disease Control
and Prevention (CDC), 30.3 million people have diabetes (9.4% of the US population); including
23.1 million diagnosed people, and 7.2 million (23.8% of people with diabetes) undiagnosed
people.1 Data from the 2015 National Ambulatory Medical Care Survey indicates that family
physicians make a diagnosis of diabetes mellitus during more than 19 million office visits.2
Additionally, 84.1 million adults aged 18 years or older have prediabetes (33.9% of the adult US
population), including 23.1 million adults aged 65 years or older. Data from the SEARCH for
Diabetes in Youth Study3,4 indicated:
 During 2011–2012, the estimated annual number of newly diagnosed cases in the United
States included:
o 17,900 children and adolescents younger than age 20 years with type 1 diabetes.
o 5,300 children and adolescents age 10 to 19 years with type 2 diabetes.
o Among children and adolescents younger than age 20 years, non-Hispanic whites
had the highest rate of new cases of type 1 diabetes compared to members of
other U.S. racial and ethnic groups.
o Among children and adolescents aged 10 to 19 years, U.S. minority populations
had higher rates of new cases of type 2 diabetes compared to non-Hispanic whites
Diabetes was the seventh leading cause of death in the United States in 2015. This finding is
based on 79,535 death certificates in which diabetes was listed as the underlying cause of death
(crude rate, 24.7 per 100,000 persons). Diabetes was listed as any cause of death on 252,806
death certificates in 2015 (crude rate, 78.7 per 100,000 persons).5
Family physicians providing care for a broad spectrum of patients, from birth to geriatric care,
can be challenged to remain up to date on evidence-based guidelines and recommendations,
especially when those guidelines are updated, vague or contradictory. Physicians need
continuing medical education that will help them to apply the most current and clinically relevant
evidence-based recommendations to practice.
Data from a recent American Academy of Family Physicians (AAFP) CME Needs Assessment
survey indicate that family physicians have statistically significant and meaningful gaps in the
medical skill necessary to efficaciously manage treatment; manage diabetes complications
(addressed in other CME sessions); and in managing those at risk for developing diabetes, such
as patients with metabolic syndrome.6 Additionally, CME outcomes data from several 2012-
2017 AAFP FMX (formerly Assembly) sessions focused on diabetes topics suggest that
physicians have knowledge and practice gaps with regard to utilizing a patient-centered approach
to care that involves the entire care team to help make the office visit with the physician more
efficient; recognizing latent autoimmune diabetes in adults (LADA); understanding and adhering
to current screening and evaluation guidelines; being up to date on current guidelines for
medications and therapeutic approaches; improving efforts toward patient education and
counseling for prevention in pre-diabetic patients, including effective use of group visits;
effective control and maintenance of patients receiving treatment; and having an awareness of
current guidelines for gestational diabetes.7-12
More than 90 % of patients with diabetes are managed by primary care physicians; however,
some family physicians may not be aware of updated clinical guidelines and results of clinical
interventions from retrospective studies that prove such recommendations to be effective.13,14
Research suggests that primary care physicians do not routinely use clinical guidelines in
managing care for patients with diabetes, and often do not provide optimal coordination of care
with specialists.15 For example, the Diabetes Control and Complications Trial (DCCT) reported
that intensive diabetes therapy aimed at lowering glycemic levels reduces the risk of diabetic
retinopathy, nephropathy and neuropathy.16 Additionally, consensus from a number of
organizations, including the Joint National Committee on the Prevention, Detection, Evaluation
and Treatment of High Blood Pressure, the American Diabetes Association and the National
Kidney Foundation, supports aggressive blood pressure targets in patients with diabetes, which
may require pharmacologic therapy.17 Family physicians can also help patients make numerous
lifestyle modifications, including smoking cessation, alcohol restriction, dietary modification
(often with sodium restriction), physical activity and weight loss, all of which can decrease
patients’ risk of complications from diabetes and improve their overall health. Current data
suggests that physicians achieve the standard care for chronic diseases and preventive care only
50 percent to 60 percent of the time; therefore, physicians may need continuing education to
assist them in developing and maintaining team-based chronic disease care strategies.18,19
Despite potential risks and established clinical guidelines, recent data suggest that some patients
are not being managed optimally for diabetes.20 There are several evidence-based clinical
performance measures for adult diabetes, including those defined by the National Diabetes
Quality Improvement Alliance. Many family physicians traditionally have relied on the
American Medical Association (AMA)-convened Physician Consortium for Performance
Improvement (PCPI) list of clinical performance measures for adult diabetes; however, many
physicians continue to need education and strategies to assist them with consistent
implementation of these measures into practice.
A review of the recent literature reveals a number of updates with regard to diabetes care and
management, including (but not limited to):
 ACOG Releases Guideline on Gestational Diabetes21
o Screening for gestational diabetes usually occurs at 24 to 28 weeks' gestation, but
early screening is recommended in women with risk factors.
o Gestational diabetes should be treated with nutrition therapy.
o If medications are needed, insulin and oral medications are equally effective and
appropriate for first-line therapy.
o Women with gestational diabetes should be screened again at six to 12 weeks
postpartum.
 FDA approval of diabetes treatments22-26
o Invokana to treat type 2 diabetes (first in a new class of diabetes drugs
o Tanzeum (albiglutide) to treat type 2 diabetes
o Afrezza (insulin human) Inhalation Powder to treat diabetes
o Trulicity (dulaglutide) to treat type 2 diabetes
o FDA has recently approved SGLT2 inhibitors for diabetes; however, the FDA has
also issued a warning that the type 2 diabetes medicines canagliflozin,
dapagliflozin, and empagliflozin may lead to ketoacidosis27
o Empagliflozin now has an indication to reduce cardiovascular risk in patients with
type 2 diabetes
o Tresiba (insulin degludec injection); Novo Nordisk; For glycemic control in
adults with diabetes mellitus, Approved September 2015
o IGlargine 300 (Toujeo) approved as a new concentrated basal insulin
o Combination therapies using GLP-1 RAS and basal insulin (IDegLIra and
IGlarlexisenatide)
o Disposable patch pumps designed to provide easy access to basal-bolus therapy
for patients with type 2 diabetes
o Libre Pro sensor which monitors interstitial glucose levels every 15 minutes for 2
weeks. Data may be downloaded and used by clinicians to intensify diabetes
interventions.
o Steglatro (ertugliflozin); Merck; For the treatment of type 2 diabetes mellitus,
Approved December 2017
 Currently recruiting diabetes-related medical trials28

 Semaglutide, a once weekly GLP-1 RA which improves fasting, postprandial glucose
levels as well as A1C. In addition, this drug reduces CV risk by 26 %29
 Both SGLT1 inhibitors and GLP-1 RAs have been shown to reduce progression to
nephropathy30
 Culturally appropriate health education for people in ethnic minority groups with type 2
diabetes mellitus31
 Reminder systems for women with previous gestational diabetes mellitus to increase
uptake of testing for type 2 diabetes or impaired glucose tolerance32
 Intensive glucose control versus conventional glucose control for type 1 diabetes
mellitus33
 Surgery for weight loss in adults34
 AACE/Obesity Society/ASMBS Clinical practice guidelines for the perioperative

nutritional, metabolic, and nonsurgical support of the bariatric surgery patient35
 Outpatient glycemic control with a bionic pancreas in type 1 diabetes36
 Effect of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers
on all-cause mortality, cardiovascular deaths, and cardiovascular events in patients with
diabetes mellitus: a meta-analysis37
 Physical activity and sedentary behaviors associated with risk of progression from
gestational diabetes mellitus to type 2 diabetes mellitus: a prospective cohort study38
 Glycemic Control in Type 2 Diabetes (Drug Treatments)39
 Findings from recent studies do not support the hypothesis that diabetes, or treatment of
diabetes is associated with risk of thyroid cancer among postmenopausal women.40
 US Food and Drug Administration (FDA) revised its labeling of metformin, which
previously had identified metformin as contraindicated in women and men with serum
creatinine levels ≥1.4 mg/dL (124 micromol/L) and ≥1.5 mg/dL (133 micromol/L),
respectively [25]. The use of metformin is contraindicated in patients with an eGFR <30
mL/min, and the initiation of metformin is not recommended in patients with an eGFR
between 30 and 45 mL/min. For patients taking metformin whose eGFR falls below 45
mL/min, the benefits and risks of continuing treatment should be assessed, whereas
metformin should be discontinued if the eGFR falls below 30 mL/min. For patients with
eGFR between 30 and 60 mL/min, we typically reduce the metformin dose by half (no
more than 1000 mg per day), although there are no data to support this approach.41,42
 Not all individuals with diabetes should be unconditionally assumed to be a risk
equivalent of those with prior CHD.43
 A recent study suggests that patients with type 2 diabetes who are at high risk of
cardiovascular events while taking standard therapy, those taking liraglutide had lower
rates of cardiovascular events and death from any cause than did those in a placebo
group.44
 Recent studies suggest a possible increased risk of hospital admission for heart failure in
those patients with type 2 diabetes treated with DPP-4 inhibitors and with cardiovascular
diseases or multiple risk factors for vascular diseases at baseline. Although the effect is
small if it exists, and the associated confidence interval includes no effect, our results
suggest the advisability of caution in the use of DPP-4 inhibitors for patients with type 2
diabetes who are at high risk for heart failure.45
 While intranasal glucagon remains investigational and is not commercially available, in a
recent randomized trial comparing intranasal (3 mg) and intramuscular (1 mg) glucagon
in 77 patients with type 1 diabetes and hypoglycemia (induced in a controlled setting by
administering insulin), successful reversal of hypoglycemia occurred in 98.7 and 100
percent of intranasal glucagon and intramuscular glucagon visits, respectively.46
 While not yet available in the United States, recent randomized trials involving patients
with new or established type 2 diabetes, have shown that among patients with type 2
diabetes and a recent acute coronary syndrome, treatment with lixisenatide resulted in
rates of major cardiovascular events, including heart failure and death from any cause,
that were similar to those observed with placebo.47
Physicians may improve their care of patients with diabetes, or at risk of developing diabetes, by
engaging in continuing medical education that provides practical integration of current evidence-
based guidelines and recommendations into their standards of care, including, but not limited to
the following:48-57
 The AAFP recommends screening for gestational diabetes mellitus (GDM) in
asymptomatic pregnant women after 24 weeks of gestation. (2014).
 The AAFP concludes that the current evidence is insufficient to assess the balance of
benefits and harms of screening for GDM in asymptomatic pregnant women before 24
weeks of gestation. (2014).
 The AAFP recommends screening for type 2 diabetes in asymptomatic adults with
sustained blood pressure (either treated or untreated)) greater than 135/80 mm Hg. (2008)
 The AAFP concludes that the current evidence is insufficient to assess the balance of
benefits and harms of screening for type 2 diabetes in asymptomatic adults with blood
pressure of 135/80 mm Hg or lower. (2008).
 The guideline, Management of Newly Diagnosed Type 2 Diabetes Mellitus in Children
and Adolescents, was developed by the American Academy of Pediatrics and endorsed
with qualifications by the American Academy of Family Physicians.
o Insulin therapy should be initiated for children and adolescents with T2DM who
are ketotic or in diabetic ketoacidosis and in whom the distinction between T1DM
and T2DM is unclear.
o Insulin therapy should be initiated for patients who have random venous or
plasma blood glucose (BG) concentrations ≥ 250 mg/dL or whose HbA1c is >
9%.
o In all other instances, a lifestyle modification program and metformin should be
initiated as first-line therapy at the time of diagnosis of T2DM.
o HbA1c concentrations should be monitored every 3 months and treatment
intensified if treatment goals for BG and HbA1c concentrations are not being met.
o Patients should be advised to monitor finger-stick BG concentrations if they are
taking insulin or other medications with a risk of hypoglycemia, are initiating or
changing their diabetes treatment regimen, have not met treatment goals, or have
intercurrent illnesses.
o Nutritional counseling may incorporate the Academy of Nutrition and Dietetics'
Pediatric Weight Management Evidence-Based Nutrition Practice Guidelines.
o Children and adolescents with T2DM should be encouraged to engage in
moderate-to-vigorous exercise for at least 60 minutes daily and to limit
nonacademic screen time to less than 2 hours per day.
 The guideline, Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus, was
developed by the American College of Physicians and endorsed by the American
Academy of Family Physicians.
o Pharmacologic therapy should be added in individuals diagnosed with type 2
diabetes when lifestyle modifications, including diet, exercise, and weight loss,
have failed to adequately improve hyperglycemia.
o Monotherapy with metformin should be the initial pharmacologic therapy for
most patients with type 2 diabetes.
o A second agent should be added to metformin to treat patients with persistent
hyperglycemia when lifestyle modifications and monotherapy with metformin fail
to control hyperglycemia.
 The guideline on Management of Overweight and Obesity in Adults was developed by

the American College of Cardiology, the American Heart Association, and the Obesity
Society, and was endorsed by the American Academy of Family Physicians.
o *Note: This topic is covered by other sessions
 Metformin should be used as first-line therapy to reduce microvascular complications,
assist in weight management, reduce the risk of cardiovascular events, and reduce the risk
of mortality in patients with type 2 diabetes mellitus.
 Patients with prediabetes or new-onset diabetes should undertake extensive lifestyle
changes to slow the progression of type 2 diabetes.
 Patients with existing cardiovascular disease, two or more cardiovascular disease risk
factors, or duration of diabetes of 10 years or more should have higher A1C goals
because of a lack of benefit and the potential for increased risk of mortality compared
with lower A1C goals.
 Self-monitoring of blood glucose levels for patients taking noninsulin therapies does not
significantly affect glycemic control.
 Screening for GDM should occur after 24 weeks of gestation in all women without
known diabetes mellitus.
 USPSTF recommendation based on systematic reviews and meta-analyses
 Initial management of GDM involves dietary changes, increased physical exercise, and
blood glucose self-monitoring.
 Target glucose values in women with GDM are ≤ 95 mg per dL (5.3 mmol per L) with
fasting, ≤ 140 mg per dL (7.8 mmol per L) one-hour postprandial, or ≤ 120 mg per dL
(6.7 mmol per L) two-hour postprandial.
 Pharmacologic therapy with metformin (Glucophage), glyburide, or insulin is appropriate
for women with GDM whose glucose values are above goal despite lifestyle
modifications.
 Treatment of impaired fasting glucose and impaired glucose tolerance with
pharmacologic interventions, lifestyle interventions, or both decreases progression to
diabetes mellitus.
 Patients 40 to 70 years of age who are overweight or obese should be screened for type 2
diabetes. Persons with abnormal results should be referred for intensive behavioral
counseling interventions that focus on physical activity and a healthy diet.
 If initial screening results for type 2 diabetes are normal, screening may be repeated
every three years.
 Diagnosis of type 2 diabetes can be made using fasting plasma glucose, A1C testing,
random plasma glucose testing, or an oral glucose tolerance test. Women with GDM
should be screened at six to 12 weeks postpartum, and every three years thereafter, for
abnormal glucose metabolism.
 The US Preventive Services Task Force (USPSTF) has issued new recommendations for
diabetes screening. Previously, the USPSTF only recommended screening for diabetes in
adults with hypertension, but the new guideline recommends screening for diabetes as
part of cardiovascular risk assessment in adults aged 40 to 70 years with body mass index
(BMI) ≥25 kg/m2 [18]. The USPSTF suggests screening every three years based on
limited evidence. We agree with the new USPSTF guideline and also suggest diabetes
screening for adults with hypertension or hyperlipidemia. A fasting plasma glucose
(FPG) and/or a glycated hemoglobin (A1C) are the preferred screening tests.
 For most persons with diabetes, A1C should be at 7% or lower to decrease the occurrence
of microvascular disease.
 An angiotensin-converting enzyme inhibitor or angiotensin receptor blocker should be
used to treat hypertension.
 Patients should receive a high-intensity statin if they have at least a 7.5% risk of
atherosclerotic CVD.
 A dosage of 75 to 162 mg per day of aspirin is an option in persons with a 10-year risk of
CVD of 10%.
 Clinicians should minimize the use of concomitant medications that may cause weight
gain when treating patients with insulin therapy for type 2 diabetes mellitus.
 Consider initiating basal insulin to augment therapy with one or two oral agents or one
oral agent plus a GLP-1 receptor agonist when the A1C is 9% or more, especially if
symptoms of hyperglycemia or catabolism are present. Or, consider the addition of basal
insulin to augment therapy with two oral agents with or without GLP-1 receptor agonists
when the A1C is more than 8%.
 Consider initiating insulin replacement therapy when the blood glucose level is 300 to
350 mg per dL (16.7 to 19.4 mmol per L) or more or the A1C is more than 10% to 12%.
Also consider adding rapid-acting insulin in those patients taking basal insulin who are
already on augmentation therapy but not attaining A1C goals.
 Insulin analogues may be used to reduce the risk of hypoglycemia.
 The A1C goal should be individualized based on age, life expectancy, comorbid
conditions, duration of diabetes, risk of hypoglycemia, adverse consequences related to
hypoglycemia, or patient motivation and adherence.
 Intensive control of type 2 diabetes (A1C goal below 7%) significantly decreases the
need for photocoagulation treatment of diabetic retinopathy but increases hypoglycemia
and mortality risk.
Best Practice Recommendations from Choosing Wisely:48
 Do not medicate to achieve tight glycemic control in older adults. Moderate control is
generally better.
 Do not use sliding scale insulin for long-term diabetes management for individuals
residing in the nursing home.
Faculty should also be prepared to discuss key points for practice from the new 2018 ADA
Updates of Medical Care for Patients with Diabetes Mellitus.57
These recommendations are provided only as assistance for physicians making clinical decisions
regarding the care of their patients. As such, they cannot substitute for the individual judgment
brought to each clinical situation by the patient's family physician. As with all clinical reference
resources, they reflect the best understanding of the science of medicine at the time of
publication, but they should be used with the clear understanding that continued research may
result in new knowledge and recommendations. These recommendations are only one element in
the complex process of improving the health of America. To be effective, the recommendations
must be implemented. As such, physicians require continuing medical education to assist them
with making decisions about specific clinical considerations.
The American Academy of Family Physicians Academy has participated in the Core Measures
Collaborative (the Collaborative) convened by America’s Health Insurance Plans (AHIP) since
August 2014. The Collaborative is a multi-stakeholder effort working to define core measure sets
of various specialties promoting alignment and harmonization of measure use and collection
across both public and private payers.
Participants in the Collaborative included Centers for Medicare and Medicaid Services (CMS),
the National Quality Forum (NQF), private payers, provider organizations, employers, and
patient and consumer groups. This effort exists to decrease physician burden by reducing
variability in measure selection, specifications and implementation– making quality
measurement more useful and meaningful for consumers, employers, as well as public and
private clinicians.
With significant AAFP input, a PCMH/ACO/Primary Care Core Measure Set has been
developed for primary care. The goal of this set is to decrease burden and allow for more
congruence between payer reporting programs.58
Resources: Evidence-Based Practice Recommendations/Guidelines/Performance Measures

 Type 2 Diabetes Mellitus: Outpatient Insulin Management48
 Diabetes Mellitus: Screening and Diagnosis50
 AAP Management of newly diagnosed type 2 Diabetes Mellitus (T2DM) in children and
adolescents14
 ADA Standards of medical care in diabetes57
 ACOG Gestational diabetes mellitus21
 Management of Blood Glucose with Noninsulin Therapies in Type 2 Diabetes53
 Screening, Diagnosis, and Management of Gestational Diabetes Mellitus52
 Pharmacologic management of hypertension in patients with diabetes17
 Glycemic Control in Type 2 Diabetes (Drug Treatments)39
 Preventing CVD in Adults with Type 2 Diabetes Mellitus: An Update from the AHA and
ADA49
 Adding health education specialists to your practice59
 Envisioning new roles for medical assistants: strategies from patient-centered medical
homes60
 The benefits of using care coordinators in primary care: a case study61
 An organized approach to chronic disease care18
 Patient-physician partnering to improve chronic disease care19
 Group visits for chronic illness care: models, benefits and challenges.62
 Keys to high-functioning office teams63
 Registries made simple64
 AMA PCPI Approved Quality Measures20
 Engaging Patients in Collaborative Care Plans65
 The Use of Symptom Diaries in Outpatient Care66
 Health Coaching: Teaching Patients to Fish67
 Medication adherence: we didn't ask and they didn't tell68
 Encouraging patients to change unhealthy behaviors with motivational interviewing69

 Integrating a behavioral health specialist into your practice70
 Simple tools to increase patient satisfaction with the referral process71
 Documenting Diabetes Mellitus under ICD-1072
 FPM Toolbox – Disease Management: Diabetes73
 FamilyDoctor.org. Diabetes Overview (patient education)74
 FamilyDoctor.org. Gestational Diabetes | Overview (patient education)75
References
1. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017.
In. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health
and Human Services; 2017.
2. National Center for Health Statistics. National Ambulatory Medical Care Survey. 2015;
https://www.cdc.gov/nchs/ahcd/ahcd_products.htm. Accessed Apr, 2018.
3. Mayer-Davis EJ, Lawrence JM, Dabelea D, et al. Incidence Trends of Type 1 and Type 2
Diabetes among Youths, 2002-2012. The New England journal of medicine.
2017;376(15):1419-1429.
4. Pettitt DJ, Talton J, Dabelea D, et al. Prevalence of diabetes in US youth in 2009: the
SEARCH for diabetes in youth study. Diabetes care. 2014;37(2):402-408.
5. Centers for Disease Control and Prevention. About Underlying Cause of Death 1999–
2015. 1999-2015. Accessed Jan, 2018.
6. AAFP. 2012 CME Needs Assessment: Clinical Topics. In: American Academy of Family
Physicians; 2012.
7. American Academy of Family Physicians (AAFP). 2017 AAFP FMX CME Outcomes
Report. In. Leawood KS: AAFP; 2017.
8. American Academy of Family Physicians (AAFP). AAFP FMX CME Outcomes Report.
In. Leawood KS: AAFP; 2016.
9. American Academy of Family Physicians (AAFP). AAFP FMX CME Outcomes Report.
In. Leawood KS: AAFP; 2015.
10. American Academy of Family Physicians (AAFP). 2012 AAFP Scientific Assembly:
CME Outcomes Report. In. Leawood KS: AAFP; 2012.
11. American Academy of Family Physicians (AAFP). 2013 AAFP Scientific Assembly:
CME Outcomes Report. In. Leawood KS: AAFP; 2013.
12. American Academy of Family Physicians (AAFP). AAFP Assembly CME Outcomes
Report. In. Leawood KS: AAFP; 2014.
13. Davidson JA. The Increasing Role of Primary Care Physicians in Caring for Patients
With Type 2 Diabetes Mellitus. Mayo Clinic Proceedings. 2010;85(12 Suppl):S3-S4.
14. Copeland KC, Silverstein J, Moore KR, et al. Management of newly diagnosed type 2
Diabetes Mellitus (T2DM) in children and adolescents. Pediatrics. 2013;131(2):364-382.
15. Beaser RS, Okeke E, Neighbours J, Brown J, Ronk K, Wolyniec WW. Coordinated
primary and specialty care for type 2 diabetes mellitus, guidelines, and systems: an
educational needs assessment. Endocrine practice : official journal of the American
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2019 AAFP FMX Needs Assessment

Body System: Endocrine

Learning Objective(s) that will close Outcome Being

understanding and adhering

 Currently recruiting diabetes-related medical trials28

 AACE/Obesity Society/ASMBS Clinical practice guidelines for the perioperative

 The guideline on Management of Overweight and Obesity in Adults was developed by

Resources: Evidence-Based Practice Recommendations/Guidelines/Performance Measures

 Encouraging patients to change unhealthy behaviors with motivational interviewing69

College of Endocrinology and the American Association of Clinical Endocrinologists.

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