Once someone is diagnosed with T2DM, aside from discussing the above important points with regards to lifestyle advice, treatment options and risk of complications, there is usually a plan put in place for monitoring. The main objectives for monitoring are:
1. Monitoring for risk of complications
This would include regular eye checks, foot checks and kidney health checks, all done through the NHS.
2. Monitoring sugar levels
As many of the complications are more likely with higher sugar levels, it is sensible to agree to set a treatment target to aim towards, in order to reduce the chance of these complications occurring. NICE recommends a target HbA1c of 48 mmol/mol for people who aren’t at risk of getting a hypo – i.e. if they are managing their Diabetes through lifestyle changes alone, or with only using metformin and no other medication. For these people, and also for those who aren’t pregnant or planning a pregnancy, NICE doesn’t recommend routinely monitoring snapshot blood sugar levels. The HbA1c is the superior test here.
If someone is taking other medication that can cause hypo’s, NICE advises a target of 53 mmol/mol. The advantage of a less-strict target here means that someone is less likely to try to have super-tight sugar control – something that is often associated with getting a hypo.
NICE also recommends checking the HbA1c every 3 – 6 months to start with, until it is stable and the treatment hasn’t changed, then swapping to every 6 months.
3. Other Risk Factors for Complications
Diabetes is not the only condition that can lead to some of the above complications. High blood pressure, raised cholesterol and smoking can all be linked with the Macrovascular Complications, as well as damage to the kidneys and sexual function. Hypertension can also cause eye damage. For this reason, it is worth assessing the smoking status, blood pressure and cholesterol levels of someone with Diabetes regularly.
If someone with Diabetes is found to have high blood pressure, because of the significant damage that can occur with both, usually more aggressive treatment is used to get the blood pressure to a lower target than someone without Diabetes.
4. Damage from medication
While generally the medication used to treat Diabetes should do far more good than harm, it is generally sensible to check routinely that all is as it should be. For instance, there are reports that high doses of metformin taken long-term may reduce the absorption of Vitamin B12, so it would be sensible to check B12 levels periodically for someone who might be at risk of B12 deficiency (e.g., someone with a vegan diet).
We also know that, if the kidneys aren’t working well, someone could develop a serious condition called lactic acidosis while taking metformin. For this reason, kidney function is usually monitored prior to starting this medication as well as regularly afterward.