Diabetes is a metabolic disorder syndrome that can cause damage to multiple organs, including the heart, brain, kidneys, eyes, and nerves. Therefore, when you go to the hospital to see a diabetic, in addition to a clear diagnosis, you should further clarify whether the combination of hypertension, hyperlipidemia, obesity and other metabolic disorders, the presence of various acute and chronic complications caused by diabetes, and the severity of the disease. Once all these problems are clearly identified, the purpose of our visit to the doctor is achieved, and at the same time, a comprehensive basis for future systematic treatment is provided.
In order to systematically understand the changes in the disease and the comorbidities/complications at the time of illness, it is recommended that some of the following tests are optional.
1.Examinations related to diagnosis and typing
(1) Blood glucose: fasting and 2-hour postprandial blood glucose. Fasting blood glucose ≥7.0mmol/l (126mg/dl) and/or 2 hours postprandial blood glucose ≥11.1mmol/l (200mg/dl) can be diagnosed as diabetes mellitus.
(2) Oral glucose tolerance test (OGTT test): It is an important test to diagnose “impaired glucose regulation” and diabetes mellitus.
(3) Islet function: including insulin release test (IRT) and C-peptide release test (CPRT). It is used to understand the degree of islet function failure and help determine the clinical classification of diabetes.
2. Tests that respond to the average level of blood glucose control
(1) Glycosylated hemoglobin (HbA1c), normal value is 4% to 6%, reflecting the overall blood glucose level in the past 2 to 3 months.
(2) Glycated serum protein (GSP): It is the combination of albumin and glucose in plasma, which can reflect the overall blood glucose level in the past 2 to 3 weeks.
3.Exams related to metabolic disorders and complications
(1) Urine routine: including urine sugar, urine ketone body, urine protein, white blood cell and other indicators, which indirectly reflect the blood sugar level and complications.
(2) Blood lipid: diabetic patients are often combined with disorders of lipid metabolism, and lipid-regulating drugs should be reasonably selected according to the test results to correct abnormalities of lipid metabolism.
(3) Blood pressure and blood viscosity: high blood pressure, high blood lipids, high blood viscosity and high blood glucose are the four invisible “killers” of diabetic patients, which must be paid attention to at the initial diagnosis.
4. Complications/comorbidities-related tests
(1) Body mass index (BMI). It can be used as a reference for calculating daily caloric intake to guide clinical drug selection.
(2) Liver and kidney function. To understand the disease and guide the safe use of medication.
(3) Eye examination. To facilitate early detection of diabetic retinopathy.
(4) Neurological examination. Early detection of diabetic peripheral neuropathy.
(5) Electrocardiogram and cardiac ultrasound. To understand the presence of coronary artery disease and cardiac insufficiency.
(6) Lower extremity vascular ultrasound and angiography. To understand whether there is atherosclerosis or stenosis of the lower extremities.
(7) Chest X-ray. To determine whether there is concurrent tuberculosis or lung infection.
(8) Bone density examination. To understand whether there is osteoporosis.
5.After the diagnosis of diabetes, in order to monitor the changes of the disease, according to the “China Type 2 Diabetes Prevention and Control Guidelines”, it is recommended that the frequency of examination should be arranged in this way
(1) Blood glucose (fasting and postprandial), weight, blood pressure, glycated hemoglobin, and urine routine must be measured at each visit.
(2) Quarterly eye (visual acuity and fundus), foot (dorsalis pedis artery pulsation, neuropathy), weight, blood pressure, glycosylated hemoglobin, and urine routine should be checked.
(3) Annual examination of eyes, feet, weight and body mass index, blood pressure, glycosylated hemoglobin, urine routine, urine albumin, blood lipids (cholesterol/high/low density lipoprotein cholesterol, triglycerides), creatinine/urea nitrogen, liver function, and electrocardiogram. If conditions allow, urine microalbumin should be tested.