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Annual Diabetic Review: ADR (What is reviewed? (Weight and height, Blood…
Annual Diabetic Review: ADR
Lipid profile
High-density lipoprotein [HDL] - good cholesterol target >1
Low density lipoprotein [LDL] - bad cholesterol target <2
Triglycerides target < 1.7
Total cholesterol target <4
Provides information on overall health and wellbeing as well as risk of cardiovascular disease and stroke.
These are reviewed by the Doctor prior to review and the primary care nurse can map the results over time if there is a concern information would be gathered about specific diet and lifestyle change and referral to the Doctor for a more in-depth review would be made.
HbA1c: (goal <55mmol/mol
).
This test measures average blood glucose level across 2-3 months. Creates a snapshot of long term blood glucose control. Also used to diagnose Diabetes.
Hb is short for Haemoglobin which is protein in blood that carries oxygen around the body. Glucose sticks to Hb in blood becoming HbA1c. Increased glucose in blood means increased attachment to haem and increased HbA1c.
Difference between Blood glucose levels [BGL] and HbA1c levels is that BGL tests glucose levels in blood present time. HbA1c is an average of BGL results over a time which can indicate whether treatment needs to be adjusted.
Kidney function test
Blood test which measures levels of Urea, creatinine and electrolytes
Indicated to measure kidney functioning. Assess whether medications are causing kidney damage and hydration or presence of kidney damage or disease.
Creatinine: a waste by-product generated by muscles which passes into blood stream and is normally excreted in urine. increased creatinine levels indicate decreased kidney function.
Urea: produced as protein is broken down by the body. More than 90% of urea is eliminated by the kidneys. A high level in blood indicates dehydration and decreased kidney function.
Electrolytes: sodium, potassium, chloride and bicarbonate in abmoral levels in the blood can indicates kidney function problems.
Estimated glomerular filtration rate or eGFR: A more accurate measure of how well the kidneys are functioning to filter the blood.
Goal of annual diabetic review by primary nurse
Assess patient wellbeing
Assess effectiveness of interventions
Provide patient education
Encourgae and facilitate self management of chronic condition
Regular review supports prevention rather than cure of adverse outcomes
Enhance patient provider relationship through building rapport
What is reviewed?
Weight and height
Blood pressure
HBA1c
Total cholesterol
HDL Cholesterol
LDL Cholesterol
Triglycerides
Microalbuminuria
Eye examination - 2 yearly
Foot check - sensation and pulses
Insulin review if prescribed - BGL, abdomen check, if units increased by nurse this is by 2 with follow up phone call and review of TD BGL measurements every 3 days.
Foot check - sensation and pulses
Diabetic feet should be checked annually, more often for those at an increased risk of foot complications
Education should be provided about footwear and hygiene
Referral to podiatrist, vascular specialist, diabetes nurse specialist if concerned
Peripheral neuropathy and arterial disease common complications of diabetes. Increase risk of ulcers, infection and amputation.
assessing temperature, skin integrity, sensation, colour. Asking questions about pain when walking, numbness, tingling, un-healing wounds or infection.
Absense of pedal pulses can indicate neuropathy
References:
Diabetes New Zealand. (2020).
Annual Diabetes Check Up
.
https://www.diabetes.org.nz/diabetes-check-ups
Health Navigator New Zealand. (2020).
What is the HbA1C test?
.
https://www.healthnavigator.org.nz/health-a-z/h/hba1c-testing/
Health Navigator New Zealand. (2020).
High Cholesterol
.
https://www.healthnavigator.org.nz/health-a-z/h/high-cholesterol/?tab=9971
Health Navigator New Zealand. (2020).
Kidney function blood test
.
https://www.healthnavigator.org.nz/health-a-z/k/kidney-function-blood-test/
Bpac NZ. (2010).
Screening and management of "The Diabetic Foot"
.
https://bpac.org.nz/bpj/2010/october/diabeticfoot.aspx