Monitoring
Patients with diabetes benefit from monitoring at least every 3 months if their diabetes is not well controlled and every 6 to 12 months otherwise.[30] Blood pressure, weight, and activity level should be monitored at each visit and healthy lifestyle modifications encouraged.[30]
Joint American Heart Association and American College of Cardiology guidelines recommend that all patients with signs or symptoms suggestive of peripheral arterial disease (PAD) (e.g., calf claudication; decreased or absent pedal pulses; non-healing wounds) should have an ankle-brachial index (ABI) measured, with or without ankle pulse volume recordings and/or Doppler waveforms.[29] Screening with resting ABI is also considered reasonable in patients with any of the following characteristics: age ≥65 years or older; age 50-64 years with risk factors for atherosclerosis (e.g., diabetes, smoking history, dyslipidaemia, hypertension), chronic kidney disease, or family history of PAD; age <50 years with diabetes and one additional risk factor for atherosclerosis; patients with known atherosclerotic disease in another vascular bed (e.g., coronary, carotid, subclavian, renal, mesenteric artery stenosis, or abdominal aortic aneurysm).[29] The American Diabetes Association recommends screening for PAD using ABI in asymptomatic patients with diabetes who have any of the following characteristics: age ≥50 years; diabetes with duration ≥10 years; comorbid microvascular disease; clinical evidence of foot complications; or any end-organ damage from diabetes.[30] See Diabetes-related foot disease.
In patients on lipid-lowering therapy, a lipid profile should be checked: at initiation of statins or other lipid-lowering therapy, 4-12 weeks after initiation or a change in dose, and annually thereafter.[30]
Serum creatinine/estimated glomerular filtration rate and potassium should be checked within 7-14 days of initiation of treatment with an ACE inhibitor, angiotensin-II receptor antagonist, aldosterone antagonist, or diuretic, as well as following uptitration of dose and then at least annually.[30]
Screening for heart failure in patients with diabetes is important for starting therapy early and optimising prognosis. The American Diabetes Association recommends annual screening of asymptomatic adults with diabetes for heart failure.[30] Opportunistic screening for atrial fibrillation is recommended by the European Society of Cardiology in all patients with diabetes aged under 65 years; systematic screening should be considered for those aged 75 years and over or at high stroke risk.[7]
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