Diabetes Complication Screening: What Tests Should You Do Every Year?

This is a very common and very important doubt.

Diabetes complications usually do not give symptoms early. Because of this, we do planned screening, not random or expensive full body testing.

Instead of “all tests”, diabetes care focuses on targeted screening of key organs.

There are four main areas we screen regularly:

1. Eyes.
2. Kidneys.
3. Nerves and feet.
4. Heart and blood vessels.

Eye screening - Diabetic retinopathy

Why this matters

Diabetic eye disease can start without affecting vision. Many patients see well but still have damage.

What test is needed

• Dilated retinal examination by an ophthalmologist
• Or retinal photography where available

When to do it

• Type 2 diabetes: at the time of diagnosis, then usually once every year
• If retinopathy is already present, follow the eye doctor’s advice (often yearly or more frequently).^[1]

Kidney screening - diabetic nephropathy

Why this matters

Kidney damage from diabetes is often silent until advanced stages.

Minimum tests required

• Urine albumin-to-creatinine ratio (UACR).
• Blood creatinine with eGFR.

How often

• At least once every year in all adults with diabetes.
• More frequently if urine albumin is detected or kidney function is reduced.^[1]

Nerve damage and foot screening

Important point

Neuropathy is not only pain. Loss of sensation is more dangerous because wounds may go unnoticed.

What doctors check

• Foot inspection (skin, cracks, infections, deformities).
• Sensation testing using 10 g monofilament.
• Vibration or pinprick testing.
• Foot pulses and footwear advice.

When to screen

• Type 2 diabetes: start at diagnosis, then yearly.
• Type 1 diabetes: start 5 years after diagnosis, then yearly.^[4]

Heart and stroke risk screening

What is essential (low cost, high value)

• Blood pressure at every visit.
• Lipid profile (cholesterol test) periodically.
• Weight, waist circumference.
• Smoking and tobacco use assessment.

What is NOT routinely needed

• Treadmill test, CT angiography or echo without symptoms are not done routinely
  These are ordered only if symptoms or high-risk features are present.^[3]

HbA1c and glucose monitoring

Why this matters

HbA1c reflects average sugar control over 3 months and predicts complication risk.

Frequency

• Stable control: usually every 6 months.
• Recent diagnosis or medication changes: every 3 months.^[5]

Simple, affordable annual diabetes screening checklist

For most patients, this is the minimum yearly screening package:

1. Dilated retinal eye examination.
2. Urine albumin-to-creatinine ratio.
3. Serum creatinine with eGFR.
4. Foot and nerve examination.
5. Blood pressure measurement.
6. Lipid profile.
7. HbA1c.

This approach detects complications early without unnecessary expense.

Type 1 vs Type 2 diabetes - screening start points

Warning signs - do not wait for annual screening

Seek medical care urgently if there is:

• Sudden vision loss or floaters.
• Chest pain, unexplained breathlessness.
• One-sided weakness or speech difficulty.
• Foot wounds, black discoloration, fever.
• Recurrent severe low sugars.

Simple takeaway for patients

You do not need a “full body checkup.” You need regular, focused screening of eyes, kidneys, nerves, feet, and heart risk factors. Early detection prevents disability.