Screening for diabetes-related complications
Diabetes-related complications are complex but with effective screening they can be delayed and potentially avoided. Complications primarily arise from prolonged high blood glucose levels, which damage blood vessels and nerves.
This article summarises some of the key diabetes screening checks that make up the Annual Cycle of Care (ACC). As the year draws to a close, now is a great opportunity to encourage your clients to schedule their annual cycle of care checks. Most people living with diabetes have a GP Management Plan, which provides up to five Medicare-subsidised visits to allied health professionals each year. This plan resets at the beginning of the calendar year, making now the ideal time to start booking appointments for 2025.
Note – the following list is not exhaustive as sustained high glucose levels can affect any part of the body reached by blood flow.
Annual Cycle of Care
- Blood Glucose (HbA1c): Every three months to yearly
- Emotional wellbeing check-in: At every visit
- Kidney function: Yearly
- Blood fats check: Yearly
- Blood pressure: Every 6 months
- Eye examination: Every 2 years
- Foot assessment: Every 6 months
- Medication review: Yearly
- Dietary intake: At least yearly
- Physical activity review: At least yearly
- Smoking status check: Every visit if applicable
Key checks explained
Blood Glucose (HbA1c)
The HbA1c check measures average blood glucose levels over the last 10-12 weeks. Recommended every three months unless their GP suggests otherwise. At a minimum, it should be performed every 12 months.
The higher HbA1c, the greater the risk of developing diabetes-related complications. Red blood cells survive in the body for 8-12 weeks before they are renewed. This is the reason HbA1c tests are done at a minimum of three months apart.
Goal for HbA1c for people living with diabetes is: 7% or 53 mmol/mol or less. Higher HbA1c levels increase the risk of complications.
Emotional wellbeing
Emotional wellbeing is an important cornerstone of diabetes management. Diabetes distress, feelings of overwhelm, anxiety, trauma and depression can greatly impact the ability to manage diabetes. Emotional wellbeing check-ins should occur regularly throughout the year and referrals made to counsellors or psychologists where needed. Peer support groups may also make a difference.
Kidney function
A yearly urine test detects early signs of kidney disease. Early detection allows interventions to slow or even reverse kidney damage.
Blood fats
Safe ranges of cholesterol and triglycerides in the blood reduce the risk of diabetes-related complications.
Goals for blood fats for people living with diabetes are:
- Total cholesterol < (less than) 4mmol/L
- Triglycerides < 2mmol/L
- LDL < 2mmol/L
- HDL > (greater than) 1mmol/L
Blood pressure
Maintaining a range of 130/80–140/90 mmHg or less reduces the risk of heart, kidney, and eye disease.
Eye check
Eye examinations (sometimes called diabetic retinopathy screenings) identify and prevent damage to the small blood vessels in the back of the eyes. This examination can detect early damage from high glucose levels, potentially preventing vision loss if treated early.
Foot care
A foot check (sometimes called a diabetic foot assessment) is recommended to be performed twice a year to check the blood supply and sensation in both feet. Some people will require more regular checks by a Podiatrist. Daily foot care at home is important for preventing complications such as ulcers or infections.
Medication review
If your client is taking a lot of medications an annual Home Medicines Review (HMR) is recommended. They will need to obtain a referral from their GP to a pharmacist who will then arrange a home visit to check the medicines they are taking are appropriate for their diabetes, and any other conditions they may be managing.
Diet
Annual consultations with a dietitian help refine food choices to support blood glucose management and overall health. A referral to a dietitian can be provided by their GP.
Physical activity
Physical activity, whether structured or informal (e.g. gardening, housework, walking), is good for managing diabetes and general wellbeing. The GP can assist with a referral to an Exercise Physiologist.
Smoking status
Quitting smoking can significantly reduce the risk of diabetes-related complications. Support is available through Quitline 13 78 48.
Who can perform annual cycle of care checks?
Many of the checks in the ACC can be performed without a GP present. For example, the pathology tests can be done by a health practitioner or nurse. They, along with diabetes educators, can also perform foot checks and measure blood pressure. An optometrist is qualified to provide a diabetes eye check, and a podiatrist visit is recommended at least once every 12 months.
A GP will need to provide advice regarding a medication review of medications and checking all the items are complete.
715 Health Assessment
Aboriginal and Torres Strait Islander people of all ages can get their free 715 health check at Aboriginal Medical Services and bulk-billing clinics. This health check helps identify whether they are at risk of illnesses or chronic conditions.
For more information on diabetes for the health workforce and or people living with or at risk of diabetes, please head to the Diabetes Australia website here OR call the NDSS Helpline on 1800 637 700 to speak with a health professional.
Interested in learning more about diabetes-related complications?
Our Chronic Complications and Prevention course bite provides practical guidance on managing diabetes, helping you support your patients with confidence. By completing the course you can:
- Describe the chronic complications of diabetes such as microvascular, macrovascular, oral and mental health complications.
- Describe the Annual Cycle of Care (ACC), how it reduces the risk of chronic complications, and which tests and reviews are involved.
Enrol today and gain valuable knowledge, CPD points, and practical skills to enhance your professional practice.