The following summarizes tests that can be used to detect complications of diabetes, including tests performed during a physical exam. A physical exam assesses overall health status. Doctors focus on the eyes, blood vessels, heart, lungs, nerves, abdomen, and feet.
Diabetes complications and their screening methods and treatment goals
- Hyperglycemia: Glycosylated hemoglobin A1c (HbA1c) tests are performed every 3 to 6 months to examine the long-term stability of blood glucose levels. Target Levels: Most non-pregnant adult patients with type 1 and type 2 diabetes and children with type 2 diabetes: less than 7%; patients with type 1 diabetes under age 18: less than 7.5%. (Individual targets may be lower or higher than this, depending on health status and age.)
- Hypertension: Every 3 to 6 months, measure blood pressure at the time of the visit. If visits are less frequent, measure blood pressure at least once a year. Target level: Most people: below 120/80 mm Hg. Hypertension: 140/90 mm Hg and above. If high pressure is 140 or higher, or low pressure is 90 or higher, or both, you have hypertension. (Individual targets may be lower or higher than this value, depending on health status and age.)
- Kidneys: Check albumin in the urine annually. The metabolic waste creatinine in the blood is also checked. The glomerular filtration rate (GFR) is usually calculated using a formula that includes the individual’s age, sex, race, and blood creatinine level. Examines whether kidney disease is progressing. Target levels: Albumin in urine: less than 30 mg/g; GFR: 90 mL/min and above.
- Both eyes: Annual dilated pupil examination (funduscopy) by an ophthalmologist. Some physicians may recommend less frequent eye exams (e.g., every 2 years) if diabetic retinopathy is not indicated. Examine for retinopathy (damage to the back of the eye). Goal: No retinal damage.
- Foot: Every 3 to 6 months, remove your socks at the time of your visit so that you can remind yourself and your doctor to check your feet. Have a more comprehensive foot exam once a year. Examine whether a foot ulcer has occurred; whether the patient has lost sensation. Goal: No foot ulcers or loss of sensation.
- Dental: Two dental exams per year. Examine the patient for gum disease. Goal: Healthy teeth and gums.
- Thyroid: If the patient has hypercholesterolemia or is a woman over 50 years of age, the doctor may recommend a blood thyroid stimulating hormone (TSH) test. Goal: Normal thyroid stimulating hormone (TSH) levels.
- Liver: Your doctor may recommend liver function tests, especially if the patient is taking medications that may affect the liver. Goal: Normal liver function.
- High cholesterol: If the patient is initially diagnosed with diabetes, or if the patient is 40 years of age or older, the doctor may recommend checking cholesterol levels. Cholesterol levels, in combination with other methods, can help patients understand their risk of heart attack or stroke. Goal: Treating cholesterol is not just about lowering the amount of cholesterol, but lowering the risk of a heart attack or stroke.