What areas should a doctor check for each type 1 office visit?
John Harding, Dexter, New York
Sue Kirkman, MD, responds
Timely question! The American Diabetes Association recently published the first-ever position statement— a medical guideline—on treatment of type 1 diabetes in all age groups. Prior position statements have been limited to specific groups (such as children or pregnant women with type 1) or specific issues (such as driving and diabetes or employment discrimination).
What to Know
Medical visits for type 1 have typically focused on the “ABCs” (A1C and blood glucose patterns, blood pressure, cholesterol or cardiovascular risk) and screening for complications of diabetes. The position statement reminds us to also address emotional health (how diabetes is impacting your daily life), whether you are having low blood glucose (hypoglycemia), and whether you might have other autoimmune problems such as thyroid disease or celiac disease. Other recommendations include checking on self-management skills (after all, 99 percent of diabetes care is done by you between doctor visits) and figuring out how your provider can best support you in areas such as exercising and following a healthy diet.
It obviously takes time to assess and discuss all these issues, and fitting it all into a short clinic visit can be a challenge. Preparing ahead of time for your visit can make it a meaningful experience for you and your health care providers.
Also, the focus on more than just labs and medical issues means that team care works best for people with type 1. In some clinics, that includes your diabetes doctor as well as certified diabetes educators, registered dietitians, and often others, such as psychologists and exercise physiologists. The team approach extends to “beyond the walls” team members: eye doctors, ob-gyns for women of childbearing years, and your primary care clinician. And, of course, the most important team member is you, the person with diabetes.
For your next diabetes visit, bring a checklist adapted from the type 1 position statement, which you can download at diabetesforecast.org/type1. Knowing what you should expect at your doctor visits—and speaking out about your needs—is a great step to take!