Diabetes is a condition that changes over time. Your medications, lifestyle, and management plans may need adjusting as your body and circumstances change. The start of a new year is a great opportunity to check in with your GP and get your diabetes annual cycle of care underway. Whether you’ve been living with diabetes for years or were recently diagnosed, regular health checks are essential to staying well and preventing complications.

Your Annual Cycle of Care Checklist

Here’s a guide to the key checks and reviews you should aim to complete each year:

Check	How often	Target
HbA1c	At least every 6–12 months	53mmol/mol (7%) or less
Blood pressure	At least every 6 months	130/80 to 140/90 mmHg or less
Foot assessment	Yearly (low risk) or every 3–6 months (high risk)	Daily self-checks are essential and a professional diabetes foot assessment should be undertaken every 6-12 months
Eye test	At least every 2 years	Eye test by an optometrist who will refer you to an eye specialist doctor if needed
Kidney health	At least every year	Normal urine albumin and kidney function
Dental health	At least every year	See your dentist to assist with healthy teeth and gums
Cholesterol (blood fats)	At least every year	– Total cholesterol less than 4 mmol/L – LDL less than 2 mmol/L – HDL 1 mmol/L or above – Triglycerides less than 2mmol/L
Weight	Every 6 months	Healthy BMI (18.5–24.9) or as advised. Note: these are European targets, BMI for Islander people are generally higher, and lower for those of Asian descent
Waist circumference	Every 6 months	< 94 cm (men), < 80 cm (women). Note: these are European targets
Healthy eating review	At least every year	Dietitian support for following a healthy eating plan
Physical activity review	At least every year	At least 30 minutes of moderate physical activity, five or more days a week. Muscle strengthening exercises 2-3 sessions a week. Minimise time spent sitting
Medication review	At least every year	You are entitled to a yearly review with your chosen pharmacist; this is called a Home Medicines Review
Smoking	At least every year	Stop smoking, seek support if needed
Diabetes self-management	At least every year	Education to build confidence in managing diabetes
Emotional health	As needed	Maintain support for mental wellbeing

What is being checked and why

HbA1c

This shows your average blood glucose levels over the past three months. Keeping your HbA1c in your target range can make you feel better and prevent diabetes-related complications.

Blood pressure

Research shows that keeping your BP in target can reduce your risk of damage to your heart, kidneys, eyes, and nerves.

Foot assessment

This will assess your circulation, sensation, skin,  toenails and physical foot structures. You will usually see a podiatrist for this service. They can also provide advice on the management of foot issues, such as bunions, corns, and callouses.

Eye exam

Damage to your eyes, including the small blood vessels at the back of your eyes can occur without warning and without any obvious symptoms. It is important to see an optometrist or ophthalmologist (eye specialist) for an eye test.

Kidney health

Kidney issues often go unnoticed which is why it’s a good idea to have your urine and your blood tested to measure your kidney function.

Dental health

It is important to see a dentist regularly, even if you have dentures, as problems with teeth and gums, such as gingivitis, can impact blood glucose levels. Ill-fitting dentures or problems with teeth may also affect the types of foods you can eat, which in turn can also affect your glucose levels.

Blood fats (cholesterol)

Healthy cholesterol levels can reduce your risk of diabetes-related complications, including heart disease.

Weight

Maintaining a healthy weight, or reducing your weight if you carry excess weight, can help you better manage your diabetes. You may choose to review your body mass index (BMI) which compares your weight to height. Not everyone likes to use this measurement; speak with your health team to understand your ideal weight range.

Waist circumference

Measure your waist mid-way between the top of your hip bone and your lowest rib. Excess abdominal fat (fat around our organs) can contribute to poor health.  The above are average targets for people from European backgrounds; again, speak with your health professional for what is right for you.

Healthy eating review

A healthy eating plan can help you reach or maintain a healthy weight, cholesterol level, and blood glucose level. You can make this plan with your dietitian.

Physical activity review

Regular physical activity has a big impact on your health. An exercise physiologist is the allied health member who can assist you with your activity needs. This is by helping you develop a personal activity plan that bears in mind any physical limitations and preferences.

Medication review

Taking medications correctly is very important, this includes any over the counter or non-prescription medication. Your pharmacist can review your medications and supplements to check for safety and potential interactions. You are entitled to a yearly review with your chosen pharmacist; this is called a Home Medicines Review.

Smoking

We know smoking damages blood vessels and causes a number of cancers. If you smoke, please consider quitting. See your GP or call Quitline on 13 78 48.

Diabetes management

Your diabetes educator can provide education and support by sharing tools to help you better self-manage. Advice can include information on how to manage sick days and hypoglycaemia (low blood glucose levels); how to inject diabetes medication; travel advice; support around pregnancy; mental health, and many more topics.

Emotional health

Emotional health is crucial to your self-management. If you are feeling anxious, distressed, burned out, or depressed, see your GP and speak to people you trust such as family, friends, and health professionals. 

Getting started

1. Book an appointment with your GP to discuss your diabetes management and specialist services that could help. Your GP can refer you to many free public services, such as your local diabetes education centre and also create your GP Chronic Condition Management Plan (GPCCMP).
2. Plan how you might like to use your five Medicare-subsidised visits. Discuss with your GP which allied health professional(s) could help you the most.
3. Schedule your annual checks for the rest of the year, blood tests including HbA1c and cholesterol, blood pressure, foot, dental, and eye tests.

Why it matters

Diabetes complications such as heart disease, kidney damage, vision loss, and nerve problems can be prevented or delayed with regular care.

If you’ve been putting off your check-ups or haven’t had a GP care plan before, now is the time to act. The GPCCMP is designed to make managing your diabetes simpler, more flexible, and more effective. See your GP to create your plan and receive your health professional referrals.

Need help?

For more information or support, call Diabetes Australia on 1800 177 055 or the NDSS Helpline on 1800 637 700 and ask to speak with a health professional.

By Monica McDaniel-Wong, Credentialled Diabetes Educator