The more patients know about diabetes, the better prepared they are to engage in self-management. It is important for patients to understand how other conditions can exacerbate or be affected by diabetes and that self-management of diabetes is critical for their overall health.
Diabetes can affect several aspects of a patient’s overall health that can and should be measured over time.
Eye health – Diabetic retinopathy is a specific and usually asymptomatic complication of diabetes. Uncontrolled blood glucose leads to damage of the small capillaries in the eye, causing fluid buildup in the retinal tissue that can impair vision.1 Patients should be screened for diabetic retinopathy with a dilated eye exam shortly after being diagnosed with type 2 diabetes, and annually thereafter.2
Glucose levels – Self-monitoring of blood glucose (SMBG) allows a patient to evaluate their response to therapies and determine if their glycemic targets are being met. For adults (non-pregnant), preprandial blood glucose levels should be between 80 and 130 mg/dL (4.4 and 7.2 mmol/L) and peak postprandial blood glucose levels should be <180 mg/dL (<10 mmol/L).2
HbA1C – A1C levels serve as a measure of average glycemia over several months prior to the test and are strong predictors of complications related to diabetes. For adults (non-pregnant), the A1C goal should be <7%. Certain patients may benefit from an A1C goal of <6.5% if this can be achieved without significant hypoglycemia or other adverse effects. Less stringent A1C goals (such as <8%) may be appropriate for some other patients based on their health condition.2
Blood pressure – In patients with diabetes, hypertension is associated with increased rates of cardiovascular events and mortality. Patients with hypertension should be treated to achieve a systolic blood pressure <140 mm Hg and a diastolic blood pressure <90 mm Hg. Lower systolic and diastolic goals may be appropriate for certain patients.2
Lipids – Lipid abnormalities are known risk factors for cardiovascular disease, independent of having diabetes. Patients with elevated triglyceride levels (≥150 mg/dL [1.7 mmol/L]) or low HDL cholesterol (<40 mg/dL [1.0 mmol/L] for men; <50 mg/dL [1.3 mmol/L] for women) should be treated with intensive lifestyle therapy and glycemic control. Patients with increased cardiovascular risk (e.g., LDL cholesterol ≥100 mg/dL [2.6 mmol/L]) may warrant treatment.2
Kidney function – Kidney disease in patients with diabetes is the leading cause of end-stage renal disease. Urine albumin-to-creatinine (UACR) ratios should be measured annually for all patients with type 2 diabetes. Patients with UACR ratios between 30 and 299 mg/g that have persisted in 2-3 specimens within a 3- to 6-month period should be treated to slow the progression of diabetic kidney disease. Patients with estimated glomerular filtration rates (eGFR) of <60 ml/min/1.73 m2 should be evaluated for chronic kidney disease.2
Foot health – Early recognition and management of risk factors for diabetic complications in the foot can prevent or delay adverse outcomes. All adults with diabetes should have a comprehensive foot exam annually, including a medical history, an inspection of the skin and musculoskeletal condition of the foot, a vascular assessment, and a neurological exam of the foot.2
Patients may benefit from seeing whether their “numbers” in each of these areas—from the eyes to the feet—are within the recommended goal range and how they change over time. Tracking their measurements and exams may:
The Head to Toe Health Tracker tool helps patients understand what aspects of their health are affected by diabetes and what their goals should be for keeping themselves healthy. It also provides a way for them to track their progress across clinic visits. You may suggest that patients share their numbers with family members or caregivers to give them an idea of how the patient is doing.
Download and print the brochure for the patient to keep and bring with them to each visit, where you can fill in the results of the indicated exam or test. The Head to Toe Health Tracker is available in both English and Spanish and includes entries for recording the dates and results for A1C level, blood pressure, LDL cholesterol, HDL cholesterol, and triglycerides. The tracker also records the dates and results of annual eye exams, foot exams, and kidney function tests.
Encourage your patients to bring their Head to Toe Health Tracker with them to each office visit with you and any specialists they see. At each visit, make a photocopy of the tracker to keep in the patient’s chart. This way you have a record of the measurements even if the patient’s copy is lost. You may need to print a new Head to Toe Health Tracker brochure for your patient after the first one is filled.