Patients with diabetes mellitus (DM) constitute an important stratum of patients, since diabetes takes the third place in the world in morbidity and mortality after cardiovascular diseases and oncology. About this tells Nadezhda Lebedeva , endocrinologist FGBU “Polyclinic № 3”, a. M. N.
In Moscow, many training programs and schools for patients have been created today . At the same time, on an outpatient appointment, I regularly come across the fact that people do not take medical recommendations too seriously and often don’t know what kind of research and how often they need to perform about diabetes mellitus (DM).
Since a regular examination for complications of diabetes will allow them to be identified and prevented in time, slow down development, let us designate a list of what a patient with diabetes should do every year .
At least 1 time per year, patients with type 1 and type 2 diabetes should undergo general blood and urine tests, take an ECG and perform an chest x-ray as part of a therapeutic screening to assess overall health.
At least once a year, patients need to undergo a biochemical blood test: total protein, AST, ALT, lipid spectrum – total cholesterol (cholesterol), LDL, HDL, triglycerides, total bilirubin, urea, creatinine, potassium, sodium, GFR calculation. In the presence of complications of diabetes, biochemistry should be taken more often and a more complete list of indicators should be monitored . It is important to keep in mind that the target (recommended) level of LDL in patients with diabetes is lower than in people without diabetes: in the medium-risk group <2.5 mmol / l, in the high- risk group < 1.8 mmol / l, in the group very high risk < 1.4 mmol / L. To which group of risk of vascular complications do you belong, determine at the appointment with your attending endocrinologist.
Screening for the detection of microangiopathies (damage to small vessels): patients with type 2 diabetes should be tested immediately, at the time of diagnosis, with type 1 diabetes, it is recommended to pass no later than 5 years after the onset of the disease. In the absence of previously microvascular changes – examination of the fundus with mydriasis (dilated pupil) and urinalysis for microalbuminuria (MAU) – 1 time per year, in the presence of diabetic retinopathy, the frequency of examination is prescribed by an ophthalmologist, in the presence of MAU – urinalysis for MAU – 1 every 6 months
A survey to identify the macrovascular complications of diabetes – coronary artery disease (CHD), cerebrovascular disease (CVD) and diseases of lower limb arteries: 1 times a year – consultation of the cardiologist and an electrocardiogram, and for patients with type 2, in addition to this – the removal of ECG exercise test. Patients with type 2 diabetes, because they all belong to the group of high and very high risk of vascular I would recommend immediately after the diagnosis execute ECHO CG (echocardiography, ie, ultrasound of the heart), duplex scanning of brachiocephalic artery (BCA USDS) and lower limb arteries. In general, how much you now need to conduct these examinations and how often to be observed further, the appropriate specialists will tell you: a cardiologist, neurologist and surgeon. In young patients with type 1 diabetes, macroangiopathies do not develop so quickly, therefore, the passage of examination data is only according to the indications of specialists.
Measurement of blood pressure (BP) – at each visit to the doctor, as well as independently, at home – 2 times a day (morning and evening), with a note in the diary. Target (recommended, optimal) level of blood pressure in diabetics: less than 130/80 mm Hg , at the age over 65 years old, an increase in blood pressure to 140/80 mm Hg is permissible . If you have been prescribed medications for pressure, then they should definitely include drugs from the groups of ACE inhibitors or ARBs, it is very important to check, because these drugs have nephroprotection – they protect the kidneys in diabetes. In connection with the fact that all patients with type 2 belong to the group with high and very high risk of vascular complications, usually in a permanent appointment is the appointment of antiplatelet agents (do not allow to form clots) and statins (cholesterol-lowering, and with them the risks of heart attacks, strokes ) Young patients with diabetes mellitus 1 belong to the group with an average risk of cardiovascular complications, therefore, the appointment of antiplatelet agents and statins is usually postponed to a later age, but the solution to this issue, as well as the appointment of any treatment, is decided on an face- to -face appointment .
You’ve probably heard that diabetes wounds heal worse? Therefore, it is necessary to reduce the risk of their formation and timely identify. Patients with diabetes should carefully monitor their legs. So, examination of the legs, feet for wounds, cracks, discoloration of the fingers should be carried out not only at each visit to the doctor, but also regularly independently. The foot area (except the interdigital spaces) should be moistened daily by applying a cream with a high urea content to the skin . When carrying out care it is impossible to injure the skin with sharp objects (tweezers and scissors) – only a nail file can be used .
The sensitivity of the foot of patients with type 2 diabetes and type 1 diabetes should be assessed at least 1 time per year, and in case of type 1 diabetes, it is permissible to begin to check for distal polyneuropathy 5 years after the debut of diabetes. According to indications , a neurologist is examined . Patients should not forget that there is also a motor and autonomous form of neuropathy (cardiovascular, gastrointestinal and urogenital), the latter is more common in patients with type 1 diabetes, but it can also be in type 2 diabetes, and in the presence of complaints from the gastrointestinal tract, urinary tract systems or hearts (first of all, orthostatic hypotension), it is imperative to voice them at an appointment with an endocrinologist and a neurologist, so that if you suspect these types of neuropathy, undergo studies prescribed in such cases.
To evaluate the compensation of carbohydrate metabolism patients diabetes have 1 every 3 months to take a blood test for glycated hemoglobin. It is important to know that for most adult patients with diabetes, the target (optimal, acceptable) HbA1c level is less than 7.0%, however , the targets are somewhat individual, depending on the patient’s age and the presence of diabetes complications. Be sure to check with your endocrinologist what your targets for glycated hemoglobin and glycemia are.
Patients must understand their responsibility and personal contribution to diabetes control. You yourself should conduct self-monitoring of glycemia at home , with diabetes 1 – daily, at least 4 times a day, with diabetes 2 – depending on what therapy you are on – from 1 time per week on a diet to 4 times a day on insulin therapy . Patients on insulin should at least once every 6 months show the endocrinologist an examination of the injection sites of insulin and equipment ( whether you are administering the insulin correctly ).
According to the testimony, the doctor will install a device for continuous monitoring of glycemia. Now there are non-contact glucometers that allow you to measure sugar level every minute without a finger puncture, but require periodic calibration (checking indicators) using a conventional glucometer.
In the presence of complications of diabetes, severe combined pathology, the appearance of additional vascular risk factors, the question of the frequency of examinations is decided on an individual basis, at an appointment with the attending physician.