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
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