Complications of diabetes

Complications of diabetes are common, particularly those at high risk and include:

Onset of diabetes at a young age
Advancing age
Long duration of diabetes
Suboptimal glycaemic control
Pre-existing complications or comorbidities e.g. established cardiovascular disease, microalbuminura and/or reduced eGFR
Māori or Pacific people ethnicity
Non-European ethnicity
Lower socioeconomic status
Hypertension
Dyslipidaemia
Smoking
Obesity
Reduced adherence or attendance

These complications should be screened for at least annually in all patients with diabetes

Weight and waist circumference and consider treatment for obesity if required
Blood pressure and management of hypertension if above BP targets
A neurovascular examination of the feet and ensuring foot cares if increased risk
Smoking cessation and reduced alcohol intake/recreational drug use if required
Ensuring retinal photoscreening is up to date and appropriate management of diabetic retinopathy
HbA1c and optimisation of glycaemic control if above target (consider revising targets if change in clinical cirumstances)
Urinary albumin:creatinine ratio and serum eGFR and management of diabetic renal disease if either abnormal
Liver function tests and if abnormal consider screening for fatty liver disease
Non-fasting lipid studies and management of dyslipidaemia if present
Assessment of cardiovascular risk using a validated cardiovascular risk calculator
Calculating cardiovascular risk is important in patients with diabetes because:

Most patients with diabetes die from macrovascular disease
To aid decision making on antiplatelet and blood pressure and lipid lowering therapy

NB: Cardiovascular risk calculators typically underestimate risk in younger patients and/or those with a strong family history of cardiovascular disease
Consideration of antiplatelet therapy if high cardiovascular risk
Ensuring adequate contraception and that pregnancies are planned in women with diabetes of reproductive age
Screening for commonly associated comorbidities with diabetes including depression and erectile dysfunction, and that recommended cancer screening is up to date

Type 2 Diabetes Management Guidelines