What does the annual cycle of care involve?
The health checks included in the cycle of care include:
❏ HbA1c: a blood test to measure your average blood glucose levels over the past 2-3 months. Keeping blood glucose levels in your target range can help to reduce the risk of developing diabetes-related complications. It is recommended that you have this checked at least every 6-12 months.
❏ Blood pressure: is a measure of the force of circulating blood on the walls of your blood vessels. High blood pressure increases the risk of heart disease, stroke, eye damage and kidney damage. This means that managing blood pressure is just as important as managing blood glucose levels for preventing diabetesrelated complications. It is recommended that you have this checked at least every 6 months.
❏ Blood fats: a blood test to measure the different fats in your blood, including LDL cholesterol, HDL cholesterol and triglycerides. As with high blood pressure, high blood fats can increase the risk of heart disease, stroke and other diabetes-related complications. It is recommended that you have these checked at least every year.
❏ Kidney health: An annual urine test, the urinary albumin to creatinine ratio (UACR), shows whether small amounts of protein are passing into the urine. This can indicate very early signs of kidney damage, when treatment can often slow or prevent further damage. A blood test to check kidney function, called estimated glomerula filtration rate (eGFR), is also recommended.
❏ Foot checks: An initial foot check should be done by your doctor, diabetes educator, practice nurse or podiatrist. If your feet are found to be low risk, then it is recommended that you have an annual foot check. If assessed as high or intermediate risk, then you will need more regular checks: at least every 3-6 months for intermediate risk and at least every 1-3 months for high-risk feet. ❏ Eye checks: A visit to an ophthalmologist or optometrist is recommended at least every two years to check your eyes through dilated pupils. They will check for diabetes-related eye damage (retinopathy), as well as cataracts, glaucoma and other eye disorders that occur more frequently in people with diabetes. If any problems are detected, you may need more regular visits.
❏ Weight, waist measurement and body mass index (BMI): Carrying extra weight, especially around the middle, can make it harder to manage your blood glucose levels, blood pressure and blood fats, so it is important to keep a check on these. It is recommended that you have these checked at least every 6 months.
❏ Lifestyle habits: During your annual review, your GP should also ask about your lifestyle habits, including your current eating habits, activity levels, smoking status, and alcohol intake. Following a healthy eating plan, exercising regularly, limiting alcohol intake and quitting smoking (if you smoke) are important parts of managing your diabetes and overall health.
❏ Medication review: As part of the annual cycle of care, your GP will review your medications to ensure that you are taking the right dose and combination of medications that are safe and effective for managing your current health conditions. This will include your diabetes medications but also medications to treat other health risk factors such as high cholesterol and blood pressure. If you are taking multiple medications to manage your diabetes and other health issues, you may be eligible for a Home Medicines Review (HMR), MedsChek or Diabetes MedsChek. These are Medicarefunded programs designed to help people living at home to maximise the benefits of their medications and prevent medication-related problems.
❏ Diabetes self-management: A range of health professionals are available to support you in managing your diabetes, but most of the day-to-day management is up to you. It is therefore important that you learn about diabetes and the various aspects of self-management, from lifestyle changes to monitoring and medications, so you can become an expert in the management of your condition. Your GP can refer you to a diabetes educator who can review your overall diabetes management, provide education and support, and help you develop an individualised diabetes management plan.
❏ Emotional health: Diabetes doesn’t just impact your physical health, but can also affect your emotional health. If living with diabetes is causing anxiety or distress, your doctor can help you find the support you need. This may include referral to a mental health professional, such as a psychologist or counsellor.
As part of the annual cycle of care, your GP may refer you to other health professionals, such as a diabetes educator, dietitian, podiatrist, ophthalmologist, exercise physiologist or endocrinologist, to help you in managing your diabetes and reducing the risk of complications.
They might also prepare a GP Management Plan (GPMP) and Team Care Arrangement (TCA) which provide an organised approach to your health care and help coordinate the care you need from your GP and the other health care providers. If you have both a GPMP and TCA, you may be eligible for
Medicare rebates for certain allied health services if they are directly related to the management of your diabetes. This could include a diabetes educator, dietitian, exercise physiologist and/or podiatrist. The current rebate is $56 per consultation for up to five consultations per calendar year. However, if you are seeing more than one allied health professional, these visits need to be split between them. For example, you could have two consultations with a diabetes educator, one with a dietitian, one with an exercise physiologist and one with a podiatrist.