What does a diabetes care assessment include?

The core of clinical frontline diabetes care evaluation is centered around three aspects: the effect of sugar control, the risk of complications, and the patient's actual compliance conditions. It is by no means as simple as just measuring fasting blood glucose.

Last week, I picked up Aunt Zhang, who was just diagnosed with type 2 diabetes, at the community health service center. The first thing she said when she came in with the physical examination report was, "I just have high blood sugar, why do I need so many evaluations?" ”Just enough to string these assessment contents into actual scenarios.

The first thing we pay attention to is the overall state of glucose metabolism, not a single blood glucose value. We will ask about fasting and 2-hour postprandial blood glucose fluctuations in the past two weeks, and whether she has had any hypoglycemic reactions such as palpitation, hand tremors, and sweating. Combined with the glycated hemoglobin value for three months, we can judge her overall glucose control level during this period. Aunt Zhang said that she often had dark eyes after dancing in the square a while ago, and it took her 10 minutes to calm down. She had always thought it was due to insufficient blood supply to the brain due to her age, but it was actually unnoticed hypoglycemia after exercise. If she hadn't asked about this and directly prescribed anti-diabetic drugs at regular dosages, she might be in danger.

Understanding the current sugar metabolism is only the first step. Next, we need to investigate the hidden damage that high sugar has caused to the body. We will measure the temperature of her feet, use 10g nylon wire to measure the tactile sensitivity of the soles of her feet, and ask her if she has had blurry vision or foamy urine recently. These are early signs of diabetic foot, retinopathy, and kidney disease. Aunt Zhang said that the fine print on her mobile phone has been blurry recently, so we quickly made an appointment for her to undergo a fundus screening. Fortunately, it was only mild retinopathy, which can be reversed by timely sugar control. If this part had not been assessed, the damage would have been irreversible by the time she felt her vision was significantly reduced.

The indicators have been clearly laid out, but if the patient cannot implement the follow-up care plan at all, it will be in vain. So we will also find out about her daily life: does she like to drink sticky rice porridge, does she have the habit of eating pickles with steamed buns, how many times does she dance square dances a week, is there anyone living at home who can help remind her to test her blood sugar, and we will even ask about her medical insurance reimbursement status to avoid prescribing anti-diabetic drugs and blood glucose meters that she cannot afford. Aunt Zhang lives alone, and she never knew how to operate the blood glucose meter her children bought for her before. We specially recorded a 1-minute short video of the operation for her and saved it on her phone. We also wrote the time for measuring her blood sugar and taking medicine in big letters and posted it on her refrigerator, just to prevent her from forgetting it.

There are still some differences in the industry on whether mental status should be included in routine assessments. Many grassroots organizations feel that patients do not need to ask more questions if they do not take the initiative to say they are not in good mood, so as not to cause resistance. However, nearly 30% of the patients we contact have anxiety after diagnosis. Not sleeping well and worrying all the time will keep blood sugar high, so we will all chat more and ask how the sleep has been recently and whether there have been times when we can't feel energetic. When Aunt Zhang was first diagnosed, she was always worried that she would be blind or have her limbs amputated in the future. She was so worried that she could not sleep all night long. We invited her into the community's diabetes friends group and let old diabetes friends who have controlled diabetes for more than ten years chat with her. She gradually relaxed and her blood sugar was much more stable than before during the recheck.

In fact, to put it bluntly, diabetes care assessment is never about filling out forms through procedures. It is about understanding the actual situation of each patient and setting up a sugar control framework that is most suitable for him. Only then can subsequent care measures be implemented. Otherwise, no matter how standard the plan is, it will be useless if the patient cannot implement it.