Target organ compromise
Retina
The fundus study should be performed at diagnosis of DM2. If normal, it should be repeated annually; if altered, the patient should be referred to a specialist.
Renal compromise
Assessment of plasma creatinine and calculation of glomerular filtration should be performed at diagnosis of DM2 and, if normal, should be repeated annually. Determination of proteinuria is performed at diagnosis of DM2; if negative, a microalbuminuria test is requested. Urinary albumin excretion (UAE) is quantified with the albumin/creatinine ratio in a random urine sample. UAE values between 30 and 300 mg/g should berepeated; microalbuminuria is diagnosed when 2 out of 3 samples continue to be altered. If the UAE values are <30 mg/g, the check-up can be performed annually.
Neuropathy and arteriosclerosis of the lower limbs.
The clinical examination is conducted with exploration of feet and testing of tactile and vibratory sensitivity, reflexes and peripheral pulses. This examination is conducted at the patient's diagnosis; if no alterations exist, it should be systematically repeated once a year. In this examination, it is advisable to include the orthostatism test.
Detection and prevention of cardiovascular disease (CVD)
DM in general is a risk factor for
CVD and DM2 is associated with other factors which form part of the pre-diabetic status and
which exert negative interrelations leading to a more precocious and severe CVD. Detection
and control of these factors forms part of the treatment of DM; the most important are arterial
hypertension and dyslipidemia.
Arterial hypertension
Diabetic patients have a high risk of CVD starting from the prehypertension stage, which also contributes to microvascular damage. Its optimized treatment reduces micro- and macrovascular complications of DM. It is essential to guarantee detection, control and treatment of hypertension. The goals to be achieved are < 130/ 80 mm Hg and, in nephropaths, < 125/75 mm Hg.
Dyslipidemia
Lipid alterations are a known risk factor for CVD and are more aterogenic in DM. The most important goal is to correct LDL cholesterol. Added to this is the so-called “aterogenic” dyslipidemia of the diabetic and pre-diabetic patient: elevated triglycerides, low HDL cholesterol and small, dense particles of LDL cholesterol. This explains why detection and treatment of lipid alterations is a main part of the check-up and follow-up of DM2. Lipid profiles should be included in the initial evaluation of DM2. If the result is normal, it should be repeated once a year. The goals to be achieved are: triglycerides <150 mg/dl, HDL >40 mg/ dl in men, >50 in women and LDL <100 in primary CVD prevention and <70 in secondary CVD prevention.With the aim of achieving an optimal metabolic control and prevention of micro- and macroangiopathic complications, all patients should be encouraged to adhere to a healthy diet, low in cholesterol and saturated fatty acids and high in dietary fiber. Additionally, regular physical activity for 150 minutes per week, fractionated in 5 days, should be promoted.
