Editors

MerjaK.Laine

Regular Check-Ups of Patients with Diabetes

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.
See also articles Initial examinations and follow-up of type 1 diabetes Follow-Up of Type 1 Diabetes, Comprehensive treatment and follow-up of type 2 diabetes Comprehensive Treatment and Follow-Up of Type 2 Diabetes and Lifestyle guidance in the treatment of type 2 diabetes Lifestyle Education in Type 2 Diabetes.
Consult also local policies and guidelines on diabetes management.

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
- hyperglycaemia
- dyslipidaemia
- hypertension
- overweight and obesity
- insufficient physical activity
- use of nicotine products.
Apply a coaching approach supporting self-care!
For aims in type 1 diabetes (T1D) and type 2 diabetes (T2D), see Tables Type 1 Diabetes: Treatment and Comprehensive Treatment and Follow-Up of Type 2 Diabetes, respectively.

The patient's own assessment of the situation, how they are coping with treatment, mood Recognition and Diagnostics of Depression Planning the Treatment of Patients with Depression, lifestyle
Other diseases and medications
Lifestyle
- 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
Fundus photography Diabetic Retinopathy
- 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

Basic blood count with platelet count and HbA_1c
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

Weight, height and BMI Bmi
Blood pressure should be measured, as necessary.
- Possibility of orthostatic hypotension, particularly in elderly patients and those with autonomic neuropathy
Auscultation of the heart and arteries
Inspection of injection sites in patients receiving injection therapy
Examination of feet Treatment of the Diabetic Foot Diabetic Neuropathy
- Temperature, interdigital spaces, pulses, ulceration, monofilament test (picture 1), malpositions, shoe fit

Driving health should be followed up regularly in patients with diabetes. Check local regulations and policies.

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.

[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/.