langcare-diabetes-panel

name: langcare-diabetes-panel description: > Reviews diabetes-related laboratory results against ADA Standards of Care including HbA1c, fasting glucose, lipid panel, renal function, and urine albumin. Tracks glycemic control trends and flags overdue monitoring. Use when asked to review diabetes labs, A1c trends, diabetes panel, glycemic control, or diabetic monitoring.

Diabetes Panel Review

When to Use This Skill

Use when a clinician needs a focused diabetes laboratory review with ADA guideline-based interpretation, trend analysis, and gap identification.

Clinical Workflow

1. Use fhir_read to retrieve Patient demographics (age for A1c target individualization)
2. Use fhir_search to pull HbA1c results (LOINC 4548-4) over the past 2 years for trending
3. Use fhir_search to pull fasting glucose, random glucose, lipid panel, renal function (creatinine, eGFR), urine albumin/creatinine ratio
4. Use fhir_search to pull active Condition resources for diabetes type, complications (retinopathy, nephropathy, neuropathy)
5. Use fhir_search to pull active MedicationRequest resources for diabetes medications
6. Evaluate against ADA Standards of Care (see references/ada-standards.md): A1c target, lipid goals, renal monitoring, eye exam status
7. Calculate time since last A1c, last lipid panel, last urine albumin -- flag if overdue
8. Present structured diabetes dashboard with trends, goal attainment, and recommended actions

FHIR Resources

• Observation -- HbA1c (4548-4), glucose (2345-7), lipids (57698-3), creatinine (2160-0), eGFR (33914-3), urine albumin/Cr (14959-1)
• Condition -- Diabetes type, complications
• MedicationRequest -- Diabetes medications (metformin, insulin, GLP-1 RA, SGLT2i, sulfonylureas)
• Procedure -- Dilated eye exam (SNOMED 252891009)

FHIR Query Examples

Pull A1c Trend (2 years)

fhir_search(resourceType="Observation", queryParams="patient=[patient-id]&code=4548-4&date=ge[2-years-ago]&_sort=date")

Pull Urine Albumin

fhir_search(resourceType="Observation", queryParams="patient=[patient-id]&code=14959-1&_sort=-date&_count=3")

Clinical Guidelines

• ADA Standards of Medical Care in Diabetes (updated annually)
• KDIGO guidelines for diabetic kidney disease
• ACC/AHA lipid management in diabetes

Interpretation Guide

• A1c targets: <7.0% for most adults, <8.0% for elderly/high hypoglycemia risk, <6.5% for newly diagnosed without hypoglycemia risk
• A1c monitoring frequency: every 3 months if above target, every 6 months if stable at target
• Lipid goals with diabetes: LDL <100 (no ASCVD), <70 (with ASCVD or high risk)
• Urine albumin staging: <30 mg/g normal, 30-300 moderately increased (microalbuminuria), >300 severely increased (macroalbuminuria)
• Annual screening requirements: urine albumin, lipid panel, comprehensive metabolic panel, dilated eye exam

Safety

• Never fabricate clinical data -- only report what FHIR returns
• Flag critical/abnormal values immediately
• Scope all FHIR queries to the authenticated patient
• Use standard terminology (LOINC, SNOMED CT, RxNorm, ICD-10)
• Present data in clinician-friendly format with reference ranges