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Components of a diabetic follow up in family medicine

In family medicine in Ontario, diabetic patients generally have routine 3 month follow ups with their family doctor. 1-2 weeks before their appointment the patient is requested to get their HbA1c blood work completed so that it may be reviewed and discussed during the appointment. Patients are also requested to have their cholesterol (lipid profile) and albumin-creatinine ratio (degree of protein leakage) checked once per year as well to assess cardiovascular and renal co-morbidity.

  • Diabetic blood work
    • HbA1c every 3 months
    • Lipid profile (LDL most valuable) and ACR (albumin to creatinine ratio) every year

What happens during the appointment?

Obviously this varies based on which doctor you work with. Different doctors practice differently.

SOAP note template for diabetic follow-up

  • RFR: diabetic follow-up
  • S:
    • Symptoms of high or low sugars (most concerned for low sugars)
      • Shaky
      • Anxiety
      • Sweating
      • Irritability
      • Fast pulse
    • Dizziness (clarify what they mean by dizzy)
    • Diabetic medications: options include metformin, SGLT-2 inhibitors, DPP-4 inhibitors, GLP-1 agonists
    • Blood pressure medications
    • Cholesterol medications
  • O:
    • Home sugar measurements range from…
      • Ask them how often they check and when do they check (ideally in the morning before breakfast)
    • Home blood pressure measurements range from…
      • Make sure patients are checking their blood pressure twice and that they are reporting the second value
      • Ask them how often they check
      • If home blood pressure measurements differ from clinic measurements ask them to bring their cuff into the clinic for a back to back comparison
    • Clinic blood pressure measurement in sitting relaxed position
      • For diabetics, blood pressure should be less than 130/80 mmHg
      • If blood pressure is high in clinic, measure it again and report both readings in the SOAP note
  • AP:
    • Describe whether diabetes is well controlled based on most recent HbA1c
    • Describe whether blood pressure is under control based on clinic measurement and home blood pressure readings
    • Provide medication renewals if necessary
    • Provide lab work requisition for HbA1c, and lipid profile and ACR if necessary