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Table 1

The 25 essential clinical care practices taught in the simulated program

Glycemia practiceHypertension practiceLipid practice
Early drug initiation after medical nutrition therapy failure Initiation of BP medication, new diagnosis Initiation of statin above goal 
Initiation of additional oral drugs or exenatide beyond metformin and sulfonylureas Appropriate use of home BP measurements Use of fibrate for high triglyceride 
Initiation of insulin or exenatide Initiation of combo drugs for stage 2 hypertension Use of fibrate for low HDL 
Change to updated insulin regimen (basal bolus insulin regimens) Adding drug classes as needed Titrating statin or ezetimbe to achieve LDL goals 
Initiation of metformin as insulin sensitizer Initiation of fourth drug class Titrating lipid drugs, fear of myalgias 
Initiation of thiazolidinedione as insulin sensitizer Titration of drugs Reassessing lipids ≤3 months after adjusting lipid medications 
Initiation of prandial insulin Target systolic BP Yearly monitoring of lipids 
Titration of basal insulin Importance of treatment in the elderly Monitoring liver enzymes tests 
Titration of prandial insulin More frequent visit intervals for patients not at goal  
10 Titration of insulin in large enough amounts Monitoring potassium and creatinine after starting or increasing an ACE inhibitor or angiotensin receptor blocker  
11 Use of SMBGs and pattern recognition Use of ACE inhibitor or angiotensin receptor blocker for congestive heart failure  
12 Optimal metformin dosing   
13 Optimal sulfonylurea dosing   
14 Optimal insulin dosing   
15 Optimal thiazolidinedione dosing   
16 Timely visit intervals   
17 Avoid severe hypoglycemia (<60 mg/dl)   
18 Address mild hypoglycemia (60–69 mg/dl)   
19 Avoid fear of low normal glucose levels (70–89 mg/dl)   
20 A1C frequency ≤3 months if not at goal   
21 A1C frequency ≤6 months at goal   
22 Metformin/creatinine contraindications   
23 Metformin/heart failure warnings   
24 Thiazolidinedione/heart failure warnings   
25 Educator referrals for patients not at goal   
Glycemia practiceHypertension practiceLipid practice
Early drug initiation after medical nutrition therapy failure Initiation of BP medication, new diagnosis Initiation of statin above goal 
Initiation of additional oral drugs or exenatide beyond metformin and sulfonylureas Appropriate use of home BP measurements Use of fibrate for high triglyceride 
Initiation of insulin or exenatide Initiation of combo drugs for stage 2 hypertension Use of fibrate for low HDL 
Change to updated insulin regimen (basal bolus insulin regimens) Adding drug classes as needed Titrating statin or ezetimbe to achieve LDL goals 
Initiation of metformin as insulin sensitizer Initiation of fourth drug class Titrating lipid drugs, fear of myalgias 
Initiation of thiazolidinedione as insulin sensitizer Titration of drugs Reassessing lipids ≤3 months after adjusting lipid medications 
Initiation of prandial insulin Target systolic BP Yearly monitoring of lipids 
Titration of basal insulin Importance of treatment in the elderly Monitoring liver enzymes tests 
Titration of prandial insulin More frequent visit intervals for patients not at goal  
10 Titration of insulin in large enough amounts Monitoring potassium and creatinine after starting or increasing an ACE inhibitor or angiotensin receptor blocker  
11 Use of SMBGs and pattern recognition Use of ACE inhibitor or angiotensin receptor blocker for congestive heart failure  
12 Optimal metformin dosing   
13 Optimal sulfonylurea dosing   
14 Optimal insulin dosing   
15 Optimal thiazolidinedione dosing   
16 Timely visit intervals   
17 Avoid severe hypoglycemia (<60 mg/dl)   
18 Address mild hypoglycemia (60–69 mg/dl)   
19 Avoid fear of low normal glucose levels (70–89 mg/dl)   
20 A1C frequency ≤3 months if not at goal   
21 A1C frequency ≤6 months at goal   
22 Metformin/creatinine contraindications   
23 Metformin/heart failure warnings   
24 Thiazolidinedione/heart failure warnings   
25 Educator referrals for patients not at goal   

MNT, medical nutrition therapy; TZD, thiazolidinedione; HDL, high-density lipoprotein cholesterol; LDL, low-density lipoprotein cholesterol; SMBG, self-monitored blood glucose; ACE, angiotensin-converting enzyme inhibitor; ARB, angiotensin-receptor blocker; TG, triglyceride.

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