section name header

Information

Editors

MerjaK.Laine

Regular Check-Ups of Patients with Diabetes

Essentials

  • 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.

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
    • 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.

History

  • 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

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

Clinical examination

  • 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

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/.