Assessment for complications

After a diagnosisThe process of determining which condition a patient may have. of diabetes, it is important to have regular screening for any complications.

This is because detecting the onset of any complications at an early stage allows early treatment that may prevent their progression.

Screening for complications is best done in a systematic way and may be most convenient as a 'one-stop' programme[1]. It should look for:

  • Cardiovascular disease
  • Disease of the retina in the eye (retinopathy)
  • Kidney problems (nephropathy)
  • Disease of the nervous system and peripheral arteries (neuropathy and peripheral arterial disease).

Learn more about the complications of diabetes.

The tests more commonly used to assess for each of these complications are summarized below.

Cardiovascular disease

  • Blood pressure should be checked each year, or more often if it is poorly controlled[2]
  • Blood lipidOne of a group of compounds that are an important energy source. testing should be done every year[2]
  • Any symptoms, for example, anginaA central chest pain caused by insufficient oxygen supply to the heart., should be fully investigated early on[1]
  • High-sensitivity C-reactive proteinA protein found in the blood. Raised levels suggest tissue damage or necrosis (death of cells). (abbreviated to hsCRP) is a bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. test that gives a measure of inflammationThe body’s response to injury.. High levels, combined with high glucoseA simple sugar that is an important source of energy in the body. levels, suggest an increased risk of bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. clots.[3]

Disease of the retina (retinopathy)

  • Eyes should be checked annually. The level of vision should be assessed whilst any prescription lenses or glasses are being worn, to assess 'corrected visual acuity'[1]
  • Retinal photography may be carried out - your doctor will probably give you eye drops to dilate your pupils first[1]
  • Fluorescein angiographyX-ray imaging of the blood vessels following the injection of a dye to improve visibility. is a special test that can assess for leakage or blockage of the small bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. vessels of the retina.[4]

Kidney problems (nephropathy)[1]

  • Tests should measure urine albuminA type of chemical called a protein, formed in the liver., a type of protein that suggests the presence of kidney disease or infectionInvasion by organisms that may be harmful, for example bacteria or parasites.
  • Serum creatinineA product of the breakdown of creatine in muscle (creatine itself is fromed from the breakdown of protein). should also be assessed. This gives an indication of how effectively the kidneys are working
  • Trends in urine albuminA type of chemical called a protein, formed in the liver. over time may also be important.

Disease of the nervous system and peripheral arteries (neuropathy and peripheral arterial disease)[1]

  • Any symptoms suggestive of disease of the nerves or bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. vessels should prompt early investigation
  • Assessment for foot ulceration, deformity, neuropathy (nerveBundle of fibres that carries information in the form of electrical impulses. problems), poor oxygen supply and infectionInvasion by organisms that may be harmful, for example bacteria or parasites..

Choosing treatments

References

  1. Prevention and early detection of vascular complications of diabetes. Marshall SM and Flyvbjerg A. BMJ. 2006;333:475-80.
  2. ABC of diabetes: cardiovascular disease, hypertensionHigh blood pressure., and lipids. Watkins PJ. BMJ. 2003;326:874-6.
  3. Abstract 1366: effects of hs-CRPAn abbreviation for C-reactive protein, found in the blood. Raised levels of this protein suggest tissue damage or necrosis (death of cells). and hyperglycemia on tissue factor isoform expression and procoagulant activity in diabetes type-2. Rauch U, Kaiser H, B Szotowski et al. Circulation. 2006;114:II 260.
  4. ABC of diabetes: retinopathy. Watkins PJ. BMJ. 2003;326:924-6.