Complications of diabetes can involve multiple systems throughout the body, such as the cardiovascular, cerebrovascular, nervous system, kidney, eye, oral cavity, and skin, and can be very harmful to patients. Therefore, it is extremely important to be well screened. The serious complications of diabetes are daunting and can affect the quality of life and survival of the patient, and are responsible for the disability and death of diabetic patients.
From a therapeutic point of view, the aim of diabetes treatment is not only to reduce sugar, but also to avoid or treat complications of diabetes as early as possible; and there is nothing that patients worry more about and want to know more than whether they have complications of diabetes. Therefore, screening for complications in patients with diabetes is an indispensable “must”. So, what are the items that need to be checked?
A. Screening for atherosclerosis risk factors
Chronic complications of diabetes are the result of a variety of cardiovascular risk factors including high blood sugar.
For this reason, it is necessary to conduct a comprehensive screening of various risk factors leading to atherosclerosis, including: blood glucose (including fasting blood glucose and postprandial blood glucose), blood lipids (total cholesterol, triglycerides, LDL-C and HDL-C), blood pressure, body mass index (BMI, normal not more than 24kg/m2 ) and abdominal circumference (<90cm for men; <80cm for women), uric acid electrolytes, blood rheology, etc., to clarify whether there are disorders of glucolipid metabolism, hypertension, hyperlipidemia, hyperuricemia, etc.
Screening for diabetic eye disease
Test visual acuity, lens, and dilated pupil to check the fundus. For those with suspicious fundus lesions or those with pre-proliferative or proliferative retinopathy, further fundus fluorescence imaging should be done.
Screening for diabetic nephropathy
24-hour urine albumin quantification or random urine albumin to creatinine ratio (UmAlb/Ucr), urine routine, blood creatinine and urea nitrogen measurement, and renal ultrasound can be done.
In the early stage of diabetic nephropathy, patients usually only show increased urine microalbumin quantification (<30mg/24h in normal people) or urine albumin to creatinine ratio (normal value <30mg/g), while urine routine, serum creatinine and urea nitrogen can be normal, and the latter only starts to appear abnormal as the disease progresses.
IV. Screening for cardiovascular complications
Commonly used clinical tests include general electrocardiogram and cardiac ultrasound. If necessary, 24-hour ambulatory electrocardiogram and 24-hour ambulatory blood pressure examination are feasible to clarify whether the combination of cardiovascular disease and cardiac insufficiency.
V. Screening of diabetic neuropathy
The screening mainly includes “vegetative neuropathy” and “peripheral neuropathy”.
If the patient’s resting heart rate exceeds 90 beats per minute or has postural hypotension (difference between standing and lying blood pressure: ≥30 mmHg in systole or ≥20 mmHg in diastole), the patient has cardiac autonomic neuropathy.
The presence of peripheral neuropathy can be determined by examining the tendon reflexes of the extremities, nylon filament touch or tuning fork vibration sensation, as well as nerve conduction velocity determination and pain threshold determination.
VI. Screening of diabetic foot disease
1.Ask the patient if there are any sensory abnormalities such as numbness, pain and anterograde sensation in the hands and feet.
2.Check the foot appearance and arterial pulsation: whether there is foot deformity, whether the skin color is normal, whether there is callus, breakage and ulcer, whether there is dorsalis pedis artery, posterior tibial artery pulsation is weakened, etc.
3, suspected lower limb ischemia, feasible lower limb vascular Doppler ultrasound examination, determination of “ankle-brachial index” (abbreviation: ABI, representing the ratio of ankle artery systolic pressure to brachial artery systolic pressure, the normal value should be greater than 0.9; if the ABI is less than 0.9, it indicates that the lower limb arterial vascular sclerosis; if the ABI is less than 0.6, it indicates that the lower extremity vascular lesions are more serious).
VII. Screening of oral diseases
Check for tooth decay, gingivitis, periodontal abscess, alveolar bone resorption, loose teeth, orofacial infection, oral mold infection, palatal inflammation, etc.
VIII. Screening for depression
For those diabetic patients who are depressed, uninterested in anything, lethargic all day long, few words, and teared up, they should be alerted to whether they are suffering from depression and be clearly diagnosed through special psychological tests.
IX. Screening for type 1 diabetes
For adolescents with high blood glucose and patients suspected of having possible type 1 diabetes, they need to be checked for islet cell antibodies, insulin antibodies and glutamic acid decarboxylase antibodies as well as blood insulin or C-peptide levels.
X. Other
Complete chest X-ray and abdominal ultrasound to clarify the presence of lung infection, tuberculosis, fatty liver or other concomitant diseases.
In addition, after completing the screening for complications, for patients with type 2 diabetes without complications, annual screening is recommended in principle. patients with type 1 diabetes should be screened once a year after 3 to 5 years if the first screening is normal. For those with existing complications, further examinations or a decision on the timing of their review will be made depending on the situation, along with more targeted and enhanced treatment.