Review
The perfect diabetes review

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Abstract

Background

Diabetes is a chronic multi-system disease that needs specialised annual review that is thorough, efficient and beneficial to the patient's needs.

The diabetes review clinic in the UK has varying formats and contents. In the main, the goal should be to review the patient holistically as diabetes can affect every body system. By assessing the patient's glycaemic control and screening for potential complications we run the best chance of limiting the severity of disease progression. There are many differing opinions as to how best it should be performed. Recent research has shown that Diabetologists may be failing their patients in that they are not adequately screening or assessing for diabetic complications, such as erectile dysfunction, as suggested by the national institute for health and clinical excellence (NICE) guidelines.

Conclusions

We propose a basic summary of the essential areas which must be included in a diabetes review. However, we understand that this may prove unwieldy and logistically difficult in a busy clinic/practice setting.

Introduction

There is no consensus as to the best way to perform a diabetes review. There are many differing opinions as to what factors need to be included in the consultation and also the best way of achieving good care and outcomes. Indeed, one of our own recent studies demonstrated that we are significantly failing to follow the NICE guidance in investigating erectile dysfunction for example in the diabetes clinic [1].

Essentially the diabetes review clinic provides an opportunity to holistically assess and manage the patient with diabetes on an annual basis, screening for and aiming to reduce complications and provide ongoing support.

The problem, especially for trainees in diabetes, is that the format and the content vary so wildly between centres. Outlined below is our summary of the important areas that need to be touched upon. It may seem like common sense but we wish to maximise the efficacy of such clinics.

Section snippets

Background

It is important to be aware of and keep up to date with the patient's basic information such as type of diabetes and duration of disease, current medications, pre-existing complications and treatments of, a full list of all co-morbidities and their smoking status.

Observations

A battery of basic tests should be performed as part of the patient's check up. They should include; urinalysis, blood pressure, body weight and BMI, visual acuity and neurothesiometry if available.

Blood and urine tests

All patients should have up to date

Plan and recommendation

A final resting place for a summary of the major issues and the actions required to ameliorate them.

Discussion

The diabetes review clinic has different formats and varying effectiveness depending on where it takes place. In the main, the goal should be to review the patient holistically as diabetes can affect every body system. By assessing the patient's glycaemic control and screening for potential complications we run the best chance of limiting the severity of disease progression [17]. In recent years in the UK, diabetes reviews have been moved in to the community and often performed as a box

Conflict of interest

None.

Acknowledgements

Many thanks to Dr. Andrew Gorsuch, Dr. Umesh Dashora, Dr. Derek Lington and Dr. Jeremy Bending.

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