Follow-up visits should be agreed individually with the patient, considering aspects such as the duration and type of treatment of diabetes, and any other diseases.
More extensive and comprehensive examinations should be carried out annually.
Treatment should be guided using a coaching approach supporting self-care.
Consult also local policies and guidelines on diabetes management.
Aims
Treatment aims at preventing and slowing down the development of organ changes and complications and ensuring smooth everyday life, good functional ability and quality of life. Targets of treatment include
Dietary habits, quantity and quality of dietary fat, protein and carbohydrates
Exercise
Weight
Use of tobacco products
Intoxicant abuse
Symptoms
Physical performance
Chest pain, dyspnoea on exertion
Intermittent claudication, pain in lower extremities
Vision changes
Self-monitoring
Individual self-monitoring of blood glucose (e.g. paired pre- and post-meal [at 2 hours after starting the meal] blood glucose tests at breakfast and the main meal of the day on the preceding 2-3 days, preferably combined with keeping a food and exercise diary)
Hypoglycaemia, strong blood glucose excursions
Any treatment-related problems
Blood glucose monitoring at home in the morning and in the evening twice at intervals of 1-2 minutes on 4 days before seeing the doctor
Every 1-3 years or more frequently, as necessary, if there are changes
Mild changes can be monitored by the responsible physician; otherwise, the patient should be monitored by an ophthalmologist.
Oral and dental health
Laboratory tests
Basic blood count with platelet count and HbA1c
Plasma creatinine, urine albumin/creatinine ratio
Lipids (cholesterol [total, HDL and LDL], triglycerides) every 1-3 years
ECG every 1-3 years
Plasma potassium and sodium in patients on blood pressure medication
TSH (in patients with type 1 diabetes every 5 years)
Transcobalamin II-bound vitamin B12 in patients on metformin every 3-5 years
Transglutaminase antibodies in patients with type 1 diabetes every 5 years until the age of 20 and subsequently if there are abdominal symptoms consistent with coeliac disease or if there is anaemia
ALT, TSH, as necessary, if there is hypoglycaemia or abnormally high lipid values, serum cortisol, if Addison's disease is suspected
Temperature, interdigital spaces, pulses, ulceration, monofilament test (picture 1), malpositions, shoe fit
Assessment of driving health
Driving health should be followed up regularly in patients with diabetes. Check local regulations and policies.
Treatment plan
Review pharmacological and non-pharmacological treatment, and make changes, as necessary.
Determine individually when and whom the patient should see for the following check-up/contact, and what tests should be done before this.
References
[Type 2 diabetes]. A Current Care Guideline. Working group appointed by the Finnish Medical Society Duodecim, the Finnish Society of Internal Medicine, and the Medical Advisory Board of the Finnish Diabetes Association. Helsinki: Finnish Medical Society Duodecim, 2024 (accessed 27 May 2024). Available in Finnish at http://www.kaypahoito.fi/hoi50056/.
[Insulin-dependent diabetes mellitus]. A Current Care Guideline. Working group appointed by the Finnish Medical Society Duodecim, the Finnish Society of Internal Medicine, and the Medical Advisory Board of the Finnish Diabetes Association. Helsinki: Finnish Medical Society Duodecim, 2022 (accessed 27 May 2024). Available in Finnish at http://www.kaypahoito.fi/hoi50116/.