It is estimated that approximately 257,000 people have diagnosed diabetes in New Zealand. An annual diabetes review allows for assessment of glycaemic control and earlier detection of, and intervention for, diabetes related complications. It also creates an opportunity to regularly review and assess individual treatment plans and enable support if required. Additionally, the information gained from diabetes follow-up provides up to date data for diabetes registers, which in turn drives improvements in diabetes service delivery.
Each DHB is responsible for their own diabetes care improvement package, which is a community and primary care-based programme and therefore services and initiatives differ between regions.
Regular checks for the management of diabetes
The New Zealand quality standards for diabetes care state that: “People with diabetes should be offered, as a minimum, an annual assessment for the risk and presence of diabetes-related complications and for cardiovascular risk. They should participate in making their own care plans, and set agreed and documented goals/targets with their health care team.”
The table below suggests the assessments that should be conducted at least annually. The frequency of these may vary depending on the individual patient’s risk of complications.2,5
| Assess at least Annually | If moderate to high risk of complications | |
| HbA1c |  | 3 monthly |
| Blood Pressure | at every visit | |
| Lipid profile | | |
| Feet | | 3 monthly |
| Retina check | | |
| Albumin / Creatinine ratio | | 6 monthly |
| eGFR | | |
| BMI / Weight | | |
| Teeth and gums | | |
| Healthy lifestyle advice | |
Increasing uptake of the annual diabetes review
Strategies to increase the number of people with diabetes who receive annual follow-ups include:
- Text alert reminders: Text alerts will be sent when your Annual diabetic review is due. Please be proactive and respond to the txt by booking an appointment.
- This will be followed by our nurse calling you on your phone to request you to get your annual diabetic review done.
Useful links
Symptoms and complications of Diabetes