Diabetes is very common. The estimated prevalence in the USA is about 7.5% of the population, and this is rising with the increased prevalence of obesity in the Baby Boomers and younger populations. Diabetes, if not managed, is associated with severe multi-system complications such as heart attack, stroke, end-stage kidney disease requiring dialysis, retinopathy, , blindness, foot ulcers and amputations. These complications alone currently account or about 14% of the US health care expenditures.
Diabetes is a disease that simply needs to be controlled. With tight control, most if not all of the complications can be avoided. The following are the recommended “tune upsâ€:
Ophthalmologic Exam – This should be done at the time of diagnosis and then yearly. For Type I Diabetes which may be diagnosed in childhood, within 5 years of the diagnosis or age 10 (which ever comes first), then yearly.
Foot Examination – This should be done yearly. Advice about prophylactic foot care includes avoiding going barefoot – even at home. Test water temperature prior to stepping into a hot bath. Trim toe nails to the shape of the toe and do not cut the cuticles. Wash and check feet daily. Shoes should be snug and not too tight and customized for misshapen feet or if ulcers are noted. Socks should fit and be changed daily.
Fasting lipid profile – Yearly, unless there are abnormalities. If abnormal and/or on medication, labs are done as often as every 3 months.
HgbA1C – Every 3-6months, depending on how well controlled the Diabetes is. In general the goal is an AIC of <7%.
Urine Microalbumin – Yearly
Serum Creatinine – This kidney function test should be done initially and as often as every 3 months depending on medications and renal function.
Blood pressure should be checked on every visit and should be kept below 130/80 and below 120/75 if there is kidney impairment.
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