Quality Standards for Diabetes Care Toolkit

Introduction

People with diabetes are at increased risk of developing microvascular and macrovascular complications (see Standards 9, 10, and 11). Appropriate screening for the detection of complications is important to ensure the right management occurs. The majority of this care can be provided in primary care but there will be circumstances where the person will require expert/specialist help and advice. This may be episodic or ongoing.
Due to the polypathological nature of diabetes and the subsequent polypharmacy, the impact of diabetes complications and their management can be wide-ranging across all body systems.
The following list is provided to illustrate this; however, it is not exhaustive:

hyperglycaemia (leading to diabetic ketoacidosis or hyperosmolar, hyperglycaemic nonketotic syndrome)

hypoglycaemia – mild and severe and hypoglycaemia unawareness

obesity and related health issues

fatty liver

skin and musculoskeletal disorders such as: adhesive capsulitis, carpel tunnel syndrome

macrovascular disease such as: hypertension, dyslipidaemia, cerebrovascular, peripheral vascular, peripheral ulcers

microvascular disease such as: nephropathy, retinopathy, maculopathy, cataracts and glaucoma, periodontal disease, neuropathy

autonomic neuropathies such as: postural hypotension, gastroparesis, gustatory sweating, neurogenic bladder, sexual dysfunction, hypoglycaemia unawareness

peripheral neuropathy leading to pain management, neuropathic ulcers, Charcot foot.

Co-existing conditions, such as:

obstructive sleep apnoea

gout

polycystic ovary syndrome

gastro-oesophageal reflux

depression/anxiety/distress

coeliac disease

primary hypothyroidism

pernicious anaemia

anaemia of chronic disease

Addison’s disease.
Conditions or their treatments commonly contributing to hyperglycaemia, such as:

chronic obstructive pulmonary disease and asthma

cancer, cystic fibrosis

Cushing’s syndrome

pancreatitis

hemochromatosis.