Treated suboptimally, type 2 diabetes can have devastating complications, including cardiovascular disease, kidney disease and sight loss.1 A crucial part of diabetes care is the clinical review, which everyone with type 2 diabetes should undergo at least annually.1
Diabetes UK (DUK) has reinforced the need for annual screening for kidney disease and function for everyone with diabetes, which should include both a blood test for serum creatinine and calculation of eGFR, and a urine test for albumin excretion. However, urine testing for albumin remains the least frequently completed care process in diabetes.2
The National Diabetes Audit (NDA) showed that, in 2017-18, 4 in 10 people with type 2 diabetes did not receive all the recommended health checks.*3
TABLE 1. PERCENTAGE OF PEOPLE WITH DIABETES RECEIVING RECOMMENDED HEALTHCARE CHECKS IN 2017-183
Healthcare check completed | Type 1 | Type 2 |
All 8 healthcare checks* | 42% → | 58% ↓ |
HbA1c | 85% ↑ | 95% → |
Blood pressure | 91% ↑ | 96% → |
Cholesterol | 80% ↑ | 93% → |
Kidney function | 83% ↑ | 95% ↑ |
Urinary albumin | 51% ↓ | 66% ↓ |
Foot exam | 74% ↑ | 86% → |
Body mass index (BMI) | 82% → | 95% ↑ |
Smoking review | 90% ↑ | 95% ↑ |
↑ Improved since 2012-13; ↓ Deterioriated since 2012-13; → Remained the same |
*The NDA is unable to collect data on eye screening so the report covers eight of the nine recommended health checks
In terms of kidney function, NICE recommends that monitoring should take place more frequently (Figure 3) for patients with or at risk of CKD, i.e. people with:
Guide to frequency of monitoring (times per year) by GFR and albuminuria category | Persistent albuminuria categories Description and range |
||||||
A1 | A2 | A3 | |||||
Normal to mildly increased | Moderately increased | Severely increased | |||||
<30mg/g <3mg/mmol |
30-300mg/g 3-30mg/mmol |
>300mg/g >30mg/mmol |
|||||
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G1 | Normal or high | ≥90 | 1 if CKD | 1 | 2 | |
G2 | Mildly decreased | 60-89 | 1 | 2 | |||
G3a | Mildly to moderately decreased | 45-59 | 1 | 2 | 3 | ||
G3b | Moderately to severely decreased | 30-44 | 2 | 3 | 3 | ||
G4 | Severely decreased | 15-29 | 3 | 3 | 4+ | ||
G5 | Kidney failure | <15 | 4+ | 4+ | 4+ |
Adapted from NICE CG1824
Each review should prompt the clinician to consider the patient’s current medication, and if and how it might need to be adjusted if renal function has changed. Reviews should include lifestyle advice such as smoking cessation, weight management and encouragement to follow a healthy eating and physical activity programme.5
Job code: UK/DIA-19020d DOP: June 2020