1. Carlson, Elizabeth A.

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ACP Diabetes Care Guide: A Team-Based Practice Manual and Self-Assessment Program. (2007) Philadelphia: American College of Physicians


In 2007, the American College of Physicians distributed the ACP Diabetes Care Guide: A Team-Based Practice Manual and Self-Assessment Program. This comprehensive publication can be obtained free by contacting The American College of Physicians at 800-523-1546 extension 2600. This guide was developed in response to the increasing numbers of Americans with diabetes (1 in 14) and the estimate that another 40% of the population are at risk for developing the disease (p. 1). As stated in the introduction, "this guide [horizontal ellipsis] presents innovative ways to incorporate collaborative care into a variety of clinical settings" (p. 2). The component of the publication that makes me recommend this guide in particular is the ACP Diabetes Care Guide Toolkit located at the end of the publication. The tools are listed in the order in which they are presented in the care guide needed to meet your goals. The tools are identified by a stylized wrench in the margin, making them easy to find and use. How to incorporate the tools into your practice is discussed in the relevant chapters.


There are 17 chapters grouped into six categories. Specific steps in developing a comprehensive diabetes care approach are given along with the tools needed to meet your goals.


Chapter 1: Improving the Quality of Care in Your Practice: A Team-Based Approach begins with an assessment template specific to chronic illness care (diabetes). This assessment enables you to determine the current level of support for chronic illness in your institution or practice. For example, under the step "Track your progress in improving care," the following tools are cited and available in the guide and online: Standing Orders, Diabetes Care Flow Sheet, Diabetes History and Self-Management Checklist, Diabetes Eye Exam Report, and Drugs for Primary or Secondary Prevention of Cardiovascular and Kidney Disease Checklist. An online template is available that enables you to enter your monthly numbers for your diabetes population to generate graphs and track progress. In addition, the use of evidence-based guidelines is supported by the tools offered that incorporate current diabetes care guidelines. A tool is also available that organizes specific responsibilities and to whom they have been assigned (Implementing Clinical Guidelines).


Chapter 1 also provides a brief explanation of the PDSA (Plan, Do, Study, Act) cycle that can be used for rapidly testing a change-by planning it, trying it out, observing the results, and acting on what is learned. A Web site is included for more comprehensive information on the PDSA cycle.


Chapter 2: Patient Engagement and Self-Management uses Glasgow's "5 As" model-Assess, Advise, Agree, Assist, Arrange-for self-management in patients with newly diagnosed diabetes. Concrete examples of what questions to ask and how to proceed are provided. Tools to help the patient in their self-management are provided. Chapters 3, 4, and 5 provide information on screening and diagnosis, prevention of diabetes, and monitoring glycemic control. Chapter 7 discusses oral diabetes drugs and management issues. Chapter 8 presents material on insulins and the new injectables.


Chapters 9, 10, and 11 present comorbidities such as obesity, hyperlipidemia and hypertension, and depression and cognitive dysfunction, respectively. Chapter 12 addresses complications of diabetes. Once again, resources are available from the toolkit for patient use, and flowcharts and recommendations for the clinician are included.


The management of diabetes in special populations is the next section. Diabetes in women of childbearing age (chapter 13), the elderly (chapter 14), and specific ethnic groups (chapter 15) are discussed. Although not specific to diabetes, a Web site is given that proves to be a useful resource for clinicians providing care to persons of specific ethnic groups.


Chapter 16 discusses emergencies in diabetes with specific information provided as to what to tell your patient about hyperglycemia and how to prepare for emergencies. Chapter 17 concerns the care for the hospitalized patient with diabetes and the issues unique to this population.


The appendices in the guide are every bit as useful as the didactic materials presented. The pages on resources are comprehensive including telephone numbers, general information Web sites, online books and guidelines, clinical trial information, quality improvement programs, and even monofilament suppliers. Suggested readings related to each chapter are listed. As noted initially, the ACP Diabetes Care Guide Toolkit makes this a worthwhile publication alone. The final item to round out this extremely useful publication is the companion CD-ROM that allows you to test your knowledge by answering 81 multiple-choice questions. And as a bonus, although the questions are modeled after the ones used for internal medicine's certifying examination, by completing and submitting the test online, nurses can obtain 15 continuing education units.


I highly recommend this publication because of the many resources it offers.