1.3 The diabetes annual review
The function of the diabetes annual review is to identify risk factors. The GP or a doctor in the hospital diabetes team may perform this review, while other members of the team, for example the practice nurse in the GP surgery, or the diabetes care technician in the diabetes clinic, carry out many of the tests.
Although some of the risk factors can be identified by physical tests (examples include blood tests to check cholesterol level, or measuring blood pressure), much of the information required to judge risk factors (such as dietary and smoking history, or home blood glucose monitoring results) is obtained by careful discussion between the health care professionals and the person with diabetes. (See Case Study 2.)
Case Study 2
Janet has had Type 2 diabetes for four years. She takes her diabetes tablets regularly each day, tries to eat a healthy diet, and usually has a brisk walk on most days. She checks her blood glucose level with a meter several times a week, and feels satisfied that her diabetes control is within the target range she agreed with the doctor. She has arrived for her annual review with a urine test, her medications, and her blood glucose record book. She had some blood tests taken two weeks ago so the results would be available to discuss with her doctor. Although she feels well, she is keen to find out if her diabetes is as well controlled as she thinks it is.
You can see then, that an annual review is a team effort, with the person with diabetes as the focus (Figure 2).
Activity 1 Sharing personal information
It is important that people with diabetes feel able to share information with their health care team, about their lifestyles and the difficulties they may be facing as they try to make changes.
Describe to someone the food you ate yesterday. Make a note of their reactions to what you had eaten and any responses they give. Did the person react in a non-judgemental way or did you feel they disapproved of any of the foods you ate? How did you know? Did they use words like ‘naughty’ or did you notice a change in their facial expression?
We've suggested discussing food for this activity because diet can be an emotive subject, with many people having a reasonable knowledge about what they should be eating, and feeling guilty if they are not using this knowledge. Hopefully, every health care professional, when asking the patient to share honest information, will ensure privacy and confidentiality and receive information in a non-judgemental way. Comments like ‘what?!’ and ‘really?’ express disbelief and incredulity, and therefore are judgemental. If you have diabetes this may discourage you from sharing information, which may create barriers to having useful conversations with health professionals.
Apart from diet, information on many of the risk factors mentioned above needs to be obtained through discussion with the person with diabetes and/or their partner or carer. This process is described as taking the patient's history. It includes collecting information on smoking history and units of alcohol consumed, family history of diabetes and related diseases like heart problems, and the amount of exercise taken weekly. It is often done formally and noted in the medical records by a doctor, but is also done informally, for example by the nurse or diabetes care technician asking how someone is managing with dietary changes when weighing them at the clinic. Some information can be more difficult to obtain, particularly if it relates to stressful situations at home that may impact on other risk factors like adherence to a healthy diet or number of cigarettes smoked. This information may be offered later when a trusting relationship has developed between the health care professional and the person with diabetes.
What could prevent you giving information to a doctor or nurse at the clinic?
You may have thought of several factors, but probably a lack of privacy and trust will be among them. You may not want to discuss the number of cigarettes you smoke for example, if you think the doctor will reprimand you.