Quality Health Care and You - Diabetes

Quality Diabetes Care Goals

The key to quality diabetes care is making sure you’re keeping important health measures in the safety zone and getting the routine care you need to prevent complications. Health measures that are important to the best diabetes care include:

You can learn more about each of these measures and how they relate to diabetes by clicking on the links above. Talk to your doctor to be sure you’re getting the tests and care that are right for you.

Sugar Control and Hemoglobin A1C

What it is
Everyone's blood contains a sugar called glucose, the main source of fuel to give your body energy. There are two basic ways of measuring blood sugar. The first is direct measurement. The second is a test call Hemoglobin A1c (although they are many names for the same test). The A1c provides an indication of what your glucose has been on the average for the previous few months. It is different from testing your sugar level at one specific moment (like a regular glucose test done at home with the strips).
How it Relates to Diabetes
The best way to avoid or put off the complications of diabetes (damage to kidneys, eyes, nerves, and blood vessels) is to keep your blood glucose as close to normal as possible. As a bonus, you will feel better!
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The A1c level that is appropriate for you is a very individual decision. Some organizations such as the American Diabetes Association have recommended that the target level should be less than 7%. However, it is important to recognize that sometimes this cannot be achieved safely so that different levels would be considered acceptable. Your health care provider should be watching your glucose control with this specific A1c test, so make sure you have it done at least twice a year, or even every 3 months, or so.

Blood Pressure Control

What it is
As the heart pumps blood through the arteries and circulatory system of the body, it creates a certain amount of pressure on the walls of the arteries. This is called blood pressure.
How it Relates to Diabetes
A whopping 70% of diabetics have high blood pressure, which is a form of cardiovascular disease and the leading cause of early death among diabetics. Sadly, at least 65% of people with diabetes die from some form of cardiovascular disease, commonly heart disease or stroke.
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Your health care provider should check your blood pressure at every visit. If they don't, ask them to do it – it only takes a minute. To lower the risk of developing cardiovascular disease, it has been recommended by the American Diabetes Association that diabetics should keep their blood pressure below 130/80 mmHg. If you have high blood pressure, talk to your doctor about how it can be lowered using a combination of diet, exercise and medications. Medications can be very effective at lowering blood pressure. The two common classes are called "ACE inhibitors" (such as lisinopril, trandolapril, enalapril) or "angiotensin receptor blockers or ARBs" (such as valsartan, losartan, or candesartan).

Cholesterol Control

What it is
Everyone has a certain amount of cholesterol – and it’s not always a bad thing. Cholesterol is a waxy, fat-like substance found in all the cells of the body, including blood. There are two kinds of lipoproteins which carry cholesterol through your body: LDL (Low-Density Lipoproteins) or "bad cholesterol" and HDL (High-Density Lipoproteins) or “good cholesterol”.
How it Relates to Diabetes
Diabetics tend to have more cholesterol abnormalities. These variances can increase your risk for cardiovascular disease. By managing your cholesterol, especially lowering LDL cholesterol, you reduce your chance of developing cardiovascular disease and early death. In fact, diabetics who lower their LDL cholesterol can reduce their risk of heart attack by up to 42 percent!
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Your health care provider should check your blood fat levels at least once a year. Here’s what the results should say:

LDL (bad) cholesterol should be less than 100

If you are at high risk for cardiovascular disease, some organizations have recommended that LDL should be less than 70.

HDL (good) cholesterol should be more than 40 for men and more than 50 for women.

Triglycerides should be less than 150

Total cholesterol should be less than 200

Sometimes diet and exercise aren't enough to bring cholesterol back to normal, and medication may be needed. Statin drugs are one way your health care provider may try to lower your LDL if it is too high.

Weight Control and Body Mass Index (BMI)

What it is

BMI is a measure of the amount of fat in your body. The results are based on height and weight. This test works for both adult men and women.
How it Relates to Diabetes
Being overweight (along with high blood pressure and high cholesterol) increases your risk for cardiovascular disease.
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Make sure that your health care provider checks your weight and calculates your BMI at every visit. If they don’t, ask them to do it – it only takes a minute. A BMI below 18.5 is considered underweight, 18.5 to 24.9 is normal, 25 to 29.9 is overweight, and 30 or above is considered obese. If you are overweight, it is critical that you begin a plan with your health care team to lose weight (and reduce your risk of cardiovascular disease). Start small - set reasonable goals and make small changes in diet, portion size, and your activity level.

Not Smoking

What it is
Nicotine is one of the most addictive substances known. Most people are exposed to it through smoking, which is very damaging to the body.
How it Relates to Diabetes
Smoking has many bad health effects for everyone. For people with diabetes, who already have a host of health concerns, smoking intensifies the health risks they face, especially when it comes to the risk of developing cardiovascular disease. Smoking raises blood pressure levels, whether you’re diabetic or not.
With 70% of diabetics already diagnosed with high blood pressure, smoking only makes it harder to control your diabetes. Smoking also constricts blood vessels. This can cause circulation problems in your feet and can contribute to a heart attack or stroke. If that wasn’t enough, nicotine also raises blood sugar levels. It is not yet known whether nicotine addiction causes diabetes, but research on this is currently underway.
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Stop Smoking! There’s no way around it. Make a plan to quit – start by setting a quit date. Ask your family, friends and co-workers for support. There are medications out there that can help you, so get help from your doctor if you feel you want it. Keep trying even if you’re not successful the first time. Don’t give up – your health depends on it!

Screening for Kidney Disease

What it is
People with diabetes are at a higher risk for kidney disease. This is because when there is too much sugar in the blood, the kidneys try to clean it out. Unfortunately, the sugar that the kidneys clean out begins to slowly kill the cells in the kidney.
To measure how well the kidneys are working, your healthcare provider should do a microalbuminuria test, which looks for small quantities of protein called albumin in a urine sample. High levels of the protein albumin in the urine indicate the start of a condition called microalbuminuria. Usually, this test is for a person who’s been diabetic for several years and may show whether or not you are at risk for developing kidney disease.
How it Relates to Diabetes
Damage to the cells and blood vessels in the kidneys affects their ability to filter out waste. Waste in the blood will stay in the body instead of being excreted with urine. If the damage goes on long enough, in some cases this can lead to kidney failure. When the kidneys fail, every few days a person has to have his or her blood filtered through a machine (a treatment called dialysis), or get a kidney transplant.
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Your microalbumin (a protein in the urine) should be less than 30 mg/24 hours. Your health care provider should check this at least once a year. Your doctor can also do a yearly blood test to measure your kidney function.

Eye Examination

What it is
At a complete eye exam, called a dilated eye exam, the eye doctor widens the pupil of the eye with eye drops to allow a closer look at the inside of the eye. This exam may not be part of an eye exam for a new pair of eyeglasses or contact lenses. Be sure to ask your eye doctor for a dilated eye exam.
How it Relates to Diabetes
Diabetes that isn't controlled may cause blindness. High blood glucose and high blood pressure cause small blood vessels to swell and leak liquid into the retina of the eye, blurring the vision. This can eventually lead to blindness. People with diabetes are also more likely to develop cataracts – a clouding of the eye’s lens, and glaucoma – optic nerve damage.
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Be sure to have a dilated eye exam with an optometrist or ophthalmologist once a year. Having your regular doctor look at your eyes is not enough.

Foot Examination

What it is
Your health care provider will have you take off your socks and shoes. They look over your feet to see if you have cuts or breaks in the skin, or have an ingrown nail. They will ask you if your foot has changed color, shape, or just feels different (for example, becomes less sensitive or hurts). Your health care provider may trim your corns and calluses or toenails if you are unable to do so safely.
How it Relates to Diabetes
People with diabetes are more likely to have foot problems. This is because of the damage that is done to your blood vessels and nerves when blood sugars are not properly managed. Some of the problems people with diabetes may develop include: nerve damage, circulation problems, and infections. These can cause serious foot problems for people with diabetes. Apart from people who have injuries, diabetes is the leading cause of amputation.
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People with diabetes should have their doctor check their feet once a year with a special tool to make sure they have feeling. Also, keep track of any changes in color, shape, or feeling in your feet and report them to your health care provider immediately.

Vaccine to Prevent Pneumonia

What it is
Vaccination is giving a person a shot that helps them to be at least partly immune to certain germs. The pneumonia shot helps prevent pneumonia caused by certain kinds of bacteria.
How it Relates to Diabetes
People with diabetes are more likely to develop infections and do much worse when they do get them. People with diabetes are much more likely to have complications when they get the flu or pneumonia. So it's important that you get all of the vaccines you need. Vaccination lowers the risk of catching some diseases caused by germs.
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Every year your health care provider should give you a flu shot. You should only get a pneumonia shot once, after you've been diagnosed.

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Last Reviewed: Jun 05, 2008

David C Aron, MD, MS
Professor of Medicine, Epidemiology and Biostatistics
Associate Chief of Staff, VA Medical Center
Division of Endocrinology
School of Medicine
Case Western Reserve University