Annual follow-up for diabetes - Quick Reference

This is a Quick Reference article. See also the main articles Primary and follow-up examinations in type 1 diabetes , Treatment and follow-up in type 2 diabetes and Lifestyle education in type 2 diabetes .

History

• Lifestyle
  • Dietary habits, amount and quality of fat in the diet
  • Physical exercise
  • Smoking
  • Alcohol use
• Symptoms
  • Chest pain or dyspnoea on exertion?
  • Claudication or pain in the lower extremities?
  • Changes of vision?
• Home monitoring and medication in use
  • Occurrence of hypoglycaemias or large fluctuations in blood glucose?
  • Mapping of possible problems associated with the care
  • ASA, medication for hypertension, dyslipidaemia?

Laboratory investigations

• Fasting blood glucose and HbA_1c
• Plasma total cholesterol, LDL and HDL cholesterols, triglycerides
• ECG (exercise stress test if there are symptoms of coronary heart disease )
• Plasma creatinine, eGFR , urinary albumin excretion
  • Single specimen (albumin/creatinine ratio) or timed overnight excretion
  • 24 h albumin excretion if the patient has macroalbuminuria
  • Treatment of nephropathy consists of effective treatment for hypertension, good blood glucose control, cessation of smoking, avoidance of dietary protein, treatment of dyslipidaemia (statin therapy is initiated if the patient is diagnosed with microalbuminuria or proteinuria).
  • If nephropathy advances in spite of intensified treatment, consultation with a nephrologist is warranted.
• ALT if the patient uses drugs that affect the liver or there is a suspicion of fatty liver

Clinical examination

• Weight, height and BMI
• Blood pressure (target 130/80 mmHg); also measured with the patient standing if he/she is on antihypertensive medication
• Auscultation of the heart and arteries
• Examination of injection sites in patients on insulin
• Ocular fundus photography
  • Performed every 1 to 3 years
  • The interval may be long (every 3 years) if the blood glucose control is good (HbA_1c < 7.5 % [58 mmol/mol]) and the previous fundus photography showed normal findings.
  • Mild changes may be followed up by the patient's own doctor, otherwise the follow-up is the responsibility of an ophthalmologist.
• Examination of the feet
  • Temperature, interdigital spaces, pulses, ulcerations, monofilament test , foot deformities, shoe fit
  • A podiatrist takes part in the treatment and patient education.
  • Skin infections are treated early and effectively; lower limb ischaemia and Charcot's arthropathy must be identified.