Annual diabetes review

A structured annual diabetes review for all patients with type 2 diabetes continues to be a quality standard of care as outlined by Te Whatu Ora. The annual diabetes review should include assessment and optimisation of management if above target(s) (NB: Should consider revising targets if change in clinical circumstances). Goals and targets of management should be documented
To be effective, any abnormal findings or results above target on the annual diabetes review need to be acted on as outlined below.
- NB: Components of the 'annual diabetes review' may be performed at different times throughout the year, but all components should be performed at least once per year

The 'annual diabetes review' should include as a minimum:

Ongoing review of HbA1c and optimisation of glycaemic control if above target. Consider revising targets if change in clinical circumstances
- NB: HbA1c should be performed 3 monthly if above target with ongoing changes in treatment regimen and 6 monthly if reached target
Screening for depression and diabetes distress using tools such as the PHQ-9
Weight and waist circumference and consider treatment for obesity if required
Blood pressure and management of hypertension if above BP targets
- Blood pressure should me measured at least 3 monthly until target
A neurovascular examination of the feet and ensuring foot cares if increased risk
Ensuring retinal photoscreening is up to date and appropriate management of diabetic retinopathy
An examination of the teeth and gums and referral to dental care if significant dental/periodontal disease
Smoking cessation and reduced alcohol intake/recreational drug use if required
Urinary albumin:creatinine ratio and serum eGFR and management of diabetic renal disease if either abnormal
Liver function tests and if abnormal consider screening for fatty liver disease
Non-fasting lipid studies and management of dyslipidaemia if present
- Lipid studies should be measured at least 3 -6 monthly until target
Assessment of cardiovascular risk using a validated cardiovascular risk calculator
- Calculating cardiovascular risk is important in patients with diabetes because:
  - Most patients with diabetes die from macrovascular disease
  - To aid decision making on antiplatelet and blood pressure and lipid lowering therapy

The currently recommended cardiovascular risk calculator for type 2 diabetes is the PREDICT calculator that is already embedded in most practice management systems but may also be found on the NZSSD website

NB: Cardiovascular risk calculators typically underestimate risk in younger patients and/or those with a strong family history of cardiovascular disease
Consideration of antiplatelet therapy if high cardiovascular risk
Ensuring adequate contraception and that pregnancies are planned in women with diabetes of reproductive age
Screening for commonly associated conditions with diabetes such as erectile dysfunction, and ensuring that recommended cancer screening is up to date

Common associated conditions with diabetes

Recurrent skin and genitourinary infections
Dental and periodontal disease
Other features of metabolic syndrome e.g. gout, polycystic ovarian syndrome
Mental health e.g. depression, dementia and disordered eating
Cardiac e.g. congestive heart failure and atrial fibrillation
Musculoskeletal e.g. frozen shoulder and myopathy
Dermatological e.g. diabetic dermopathy and acanthosis nigricans
Gastrointestinal e.g. fatty liver disease and diarrhea
Solid cancers e.g. breast, bowel, lung, pancreas, ovarian cancers etc.

Type 2 Diabetes Management Guidelines

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