Diabetics universally recognize that it is not high blood sugar itself that poses the greatest threat, but rather the potential complications it spawns. Prolonged hyperglycemia can inflict damage upon both macro- and microvasculature, giving rise to multifaceted lesions throughout the patient's body. It is the early detection and prevention of these complications that every individual living with diabetes fervently seeks, hence the critical role played by routine health screenings. As diabetes patients, we must acquaint ourselves with the key assessments that demand our regular attention.
Regular Urine Protein Monitoring
Diabetic Nephropathy stems from the metabolic disarray of diabetes, compounded by extensive glomerular nodular sclerosis in the kidneys. Primarily driven by diabetic microvascular disease, its early manifestation is characterized by a subtle elevation in urinary albumin excretion (microalbuminuria), which progressively evolves into macroalbuminuria, heightened serum creatinine levels, and ultimately, renal failure.
Detecting trace albumin in urine constitutes the most prevalent means of diagnosing diabetic nephropathy in its nascent stages. Methods for urine collection include:
- Spot urine sample – Measuring albumin-to-creatinine ratio at any given time point.
- 24-hour urine collection – Quantifying the total amount of albumin over a day.
- Timed urine collection (4 hours or overnight) – Assessing urinary albumin excretion rate. Abnormal results should be retested within 3 months for confirmation, following the specific hospital guidelines.
Type 2 diabetes patients should have urine microalbumin assessed at diagnosis, while those with Type 1 diabetes should be tested after a disease duration of ≥5 years. Subsequently, annual checks are advised to promptly identify diabetic nephropathy. If urinary albumin excretion rate increases, repeat the examination 2 to 3 times within 3 to 6 months.
Periodic Eye Examinations
Diabetic Retinopathy is a distinctive microvascular complication of diabetes, with risk factors encompassing diabetes duration, hyperglycemia, hypertension, and dyslipidemia. Its early stages may present minimal or no symptoms, underscoring the importance of proactive fundus examinations. Patients diagnosed with diabetes after an extended pre-diagnosis period are more likely to exhibit retinopathy at diagnosis. Thus, patients with Type 2 diabetes should undergo their initial fundus examination and accompanying ocular assessments soon after diagnosis.
Diabetic patients without retinopathy are advised to have an eye exam every 1 to 2 years, those with mild disease annually, and those with severe disease every 3 to 6 months. Pregnant women require more frequent evaluations. Eye examination components include visual acuity, intraocular pressure, angle, and fundus assessment (noting microaneurysms, intraretinal hemorrhages, hard exudates, cotton wool spots, intraretinal microvascular abnormalities, venous beading, neovascularization, vitreous hemorrhage, preretinal hemorrhage, fibroplasia, etc.). Venous beading, characterized by localized dilation of retinal veins resembling beads on a string, is a hallmark feature of diabetes.
Self-Monitoring of Blood Pressure
Hypertension is a frequent comorbidity or complication associated with diabetes. In Type 1 diabetes, hypertension often exacerbates renal function decline, whereas in Type 2 diabetes, it typically reflects the coexistence of multiple cardiovascular and metabolic risk factors. The concurrence of diabetes and hypertension significantly amplifies the risk of cardiovascular disease, stroke, nephropathy, retinopathy, and mortality in diabetic patients. Conversely, effectively managing hypertension can dramatically reduce the likelihood of developing and advancing diabetes-related complications.
For patients with diabetes and hypertension, the target systolic blood pressure is <130 mmHg, and diastolic blood pressure should be maintained at <80 mmHg.
Diabetic patients should self-monitor their blood pressure at home on weekdays. Upon reaching a reading of 120/80 mmHg or above, they should initiate lifestyle interventions to lower blood pressure and avert hypertension onset. Individuals with blood pressure ≥140/90 mmHg might consider commencing antihypertensive medication, while those with readings of ≥160/100mmHg or exceeding the target by 20/10mmHg should promptly begin drug therapy, potentially employing combination treatments if necessary.
Procedure for Self-Measuring Blood Pressure:
For those not meeting the standard, it is recommended to measure blood pressure once in the morning and evening, repeating each measurement 2 to 3 times, for seven consecutive days. The average blood pressure of the subsequent six days will serve as a reference for physician-guided management. For those already within the standard range, weekly measurements are suggested. Ensure standardized blood pressure measurement by resting quietly for at least 5 to 10 minutes, sitting down, securing the cuff to the upper arm, placing it on a table, remaining silent, motionless, and refraining from talking during the measurement. Allow a 1-minute interval between two pressure readings. Accurately record blood pressure measurements and provide them to healthcare professionals as a reference for treatment during follow-up visits.
Regular Lipid Profile Checks
Common lipid abnormalities in Type 2 diabetes involve elevated triglycerides and decreased high-density lipoprotein (HDL) cholesterol, both strongly linked to an augmented risk of cardiovascular disease in these patients. Studies have demonstrated that statins can mitigate the risk of macrovascular disease and mortality in diabetes patients by reducing total cholesterol and low-density lipoprotein (LDL) cholesterol levels.
Diabetic patients should have their lipid profile checked once at diagnosis and annually thereafter, inclusive of LDL cholesterol, total cholesterol, triglycerides, and HDL cholesterol. Patients receiving lipid-lowering therapy should have their lipid levels checked according to the evaluation of treatment efficacy, necessitating increased frequency of monitoring.
Liver Function Tests
Diabetic patients with fatty liver often experience impaired glucose and fatty acid absorption, leading to blocked lipoprotein synthesis. Consequently, a substantial portion of glucose and fatty acids is converted into fat in the liver, resulting in its accumulation and the development of fatty liver. Liver function tests serve to detect the presence of liver disease, assess the extent of liver damage, and determine the underlying cause.
Normal liver function is also a criterion for selecting medications suitable for diabetic patients. The liver is the primary site for drug metabolism in the human body, neutralizing drug toxicity through oxidation, reduction, hydrolysis, conjugation, and other processes, enabling drugs to enter the bloodstream and exert their effects. Most medications, including hypoglycemics, require liver metabolism to be efficacious. Drugs are metabolized by the liver without directly impairing liver function; therefore, as long as diabetics have normal liver function, they need not worry about the impact of medications on the liver. However, in patients with abnormal liver function, the drug may inadvertently affect the liver during metabolism. In cases of overtly abnormal liver function, switching to insulin therapy is advisable.
Type 2 diabetes patients should have their liver function checked at diagnosis and then annually.
Kidney Function Assessments
The kidney plays a crucial role in drug metabolism and elimination in the human body. When diabetic patients encounter kidney issues, they may experience kidney function impairment. Regular kidney function checks help in timely detection of diabetic nephropathy. In the event of renal insufficiency in diabetic patients, certain oral hypoglycemics tend to accumulate in the bloodstream, heightening the risk of adverse reactions like hypoglycemia. Patients with renal dysfunction should opt for a safer hypoglycemic regimen under medical guidance.
Individuals with Type 2 diabetes should have their kidney function evaluated at diagnosis and then annually.
Electrocardiogram (ECG)
An ECG is a widely employed clinical tool for evaluating heart conditions. It aids in diagnosing arrhythmias, myocardial ischemia, myocardial infarction and its localization, identifying heart enlargement and hypertrophy, and assessing the influence of drugs or electrolyte imbalances on the heart. Type 2 diabetes patients require an ECG at diagnosis and then annually to facilitate early detection of cardiac disease.
Thyroid-Stimulating Hormone (TSH)
Diabetes and thyroid disorders are the two most prevalent ailments in the endocrine and metabolic system, with a complex interplay often resulting in their coexistence. Hypothyroidism is characterized by reduced body metabolism due to diminished synthesis and secretion of thyroid hormones or inadequate physiological effects. Both Type 1 diabetes and hypothyroidism are autoimmune diseases. Type 1 diabetes patients are predisposed to developing hypothyroidism, with most cases presenting no typical symptoms. A minority may exhibit features like painless goiter, weight gain, growth retardation, fatigue, anorexia, constipation, cold intolerance, somnolence, and bradycardia. The combination of Type 1 diabetes and hypothyroidism can lead to suboptimal glycemic control, heightened insulin resistance, and a heightened risk of cardiovascular disease. Hence, it is recommended that Type 1 diabetes patients have their TSH checked annually, and Type 2 diabetes patients undergo TSH testing every 3 to 5 years.