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 Follow-Up of Type 1 Diabetes, Treatment and follow-up in type 2 diabetes Comprehensive Treatment and Follow-Up of Type 2 Diabetes and Lifestyle education in type 2 diabetes 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?

Fasting blood glucose and HbA_1c
Plasma total cholesterol, LDL and HDL cholesterols, triglycerides
ECG (exercise stress test Exercise Stress Test if there are symptoms of coronary heart disease Chronic Coronary Syndrome (Coronary Heart Disease))
Plasma creatinine, eGFR Gfr Calculator, urinary albumin excretion
- Single specimen (albumin/creatinine ratio) or timed overnight excretion
- 24 h albumin excretion if the patient has macroalbuminuria
- Treatment of nephropathy Diabetic Kidney Disease (Diabetic 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

Weight, height and BMI 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 Diabetic Retinopathy
- 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 Treatment of the Diabetic Foot Diabetic Neuropathy
- Temperature, interdigital spaces, pulses, ulcerations, monofilament test 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.