Annual Review Guidelines

It is generally understood that the annual review takes place in general practice.

Clinical Assessment

• General health and well being
• Glycaemic control: self-monitoring results; symptoms of hypoglycaemia and hyperglycaemia
• Evaluate knowledge of diabetes and self-management skills
• Lifestyle issues including diet, smoking, alcohol consumption and physical activity
• Enquire about symptoms of diabetic complications, including
  • problems with vision
  • chest pain and shortness of breath
  • claudication
  • symptoms of neuropathy, including impotence
• Ensure eye screening has occurred

Examination

• weight and body mass index (BMI)
• blood pressure
• foot examination (see guidelines)
• inspection of injection sites in insulin-treated patients
• further clinical examination, as indicated

Investigations

• Urinalysis for proteinuria - if protein detected, arrange an MSU. Measure 24 hour urinary protein if persistent proteinuria. Measure microalbuminuria if dipstick protein negative
• Blood test for HbA1c, IPA (renal and liver function tests) and fasting serum lipid profile (HDL, LDL and total cholesterol, serum triglycerides) and glucose.
• Further investigations as indicated eg FBC, Thyroid function tests

Management

• If necessary modify treatment for
  • Glucose
  • Blood pressure
  • lipids
• Negotiate individual management targets for glucose, lipid and blood pressure control in addition to lifestyle issues
• Aspirin therapy if indicated
• Referral to dietitian, podiatrist, specialist diabetes clinic or other specialist, as indicated
• Education re: knowledge of diabetes, its complications and footcare
• Contraception and plan for future pregnancies where appropriate
• Ensure appropriately up to date with influenza and pneumococcal immunization
• Future reviews

Recording of annual review findings

• Written and/or computerised medical record

Record agreed targets and management plan in patient held records

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