Prevention of Microvascular and Macrovascular complications

In both type 1 and type 2 diabetes it has been shown that improved glycaemic control can limit development and progression of complications. The ideal targets recommended are as follows:

  • HbA1c value of less than b7.0%
  • BMI value of less than 25
  • Total cholesterol value of less than 5 mmols
  • Blood Pressure 130/80

These are only RECOMMENDED targets. Individual, realistic targets should be set for each patient to current health/social status.

Home Assessments by District Nurses

Prior to home assessments each patient should have a care plan developed with the assistance of the GP. Identification of risk factors and treatment options may influence frequency of routine assessments. Clear parameters should be set for each individual. The Tayside Diabetes Handbook provides specific information and management pathways for any problems that may arise.

Annual Review

All patients should have an annual review. The assessment includes the following:

  • Height and weight
  • Foot assessment
  • Check visual acuity (may be able to attend eye van)
  • Review alcohol, smoking, coronary heart disease risk factors
  • HbA1c
  • Urea, electrolytes and creatinine levels
  • Total cholesterol, HD1 and triglycerides
  • Urinalysis for proteinuria MSU if protein detected
  • Urine sample for microalbumin
  • Home monitoring, self management skills
  • Diet and exercise
  • Inspection of injection sites if using insulin
  • Education, inform about Diabetes UK
  • Review medication and treatments options
  • Identify complication risks and refer as necessary
  • Plan future reviews

 

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Routine Review/Assessment

In general, reviews can take place in 6-12 monthly for uncomplicated patients. However increased risk factors and evidence of the complications of diabetes may necessitate more frequent reviews. A routine assessment should include:

  • Weight
  • Urinalysis for proteinuria send MSU if protein detected
  • HbA1c
  • Treatment review
  • Blood Pressure
  • Home monitoring and lifestyle discussion
  • Foot assessment
  • Further examinations as required where risk factors and complications are identified

Data gathered by District Nurses should be added to the DARTS Clinical Management System. Contact the DARTS administrator in your Practice or contact Karen Hunter at karen.hunter@tuht.scot.nhs.uk

Frail, Elderly and Partially Sighted People

Many of these people will require assistance with most aspects of diabetes care including administration of insulin or oral medication.

  • Blood glucose monitoring
  • Regular check of injection sites
  • Foot assessments particularly those at high risk
  • Closer monitoring during illness
  • Ensure adequate diet/food provision, may require changes in treatment regimes to accommodate lifestyle and social service support.

 

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