Surveillance for complications of diabetes: don't wait for symptoms before intervening.

Surveillance and treatment of diabetes-related complications should be part of routine care of all patients with diabetes. The natural history and screening recommendations for diabetic retinopathy, nephropathy, and neuropathy must be understood, since even advanced disease can be asymptomatic. Most adults require yearly ophthalmologic evaluations and determinations of albuminuria. Regular foot examinations by the patient and physician are required, with special attention to identifying patients with increased susceptibility to neuropathic ulcer and lower extremity amputation (ie, the "high-risk foot"). Cardiac autonomic neuropathy has become easier to diagnose, and its presence has several implications. Measurement of lipid levels and glycosylated hemoglobin and assessment of nutritional health should also be included in evaluation. Although understanding and prevention of diabetes complications are improving, the impact of end-organ damage remains a major problem. Early diagnosis and treatment often improve outcome and should dramatically decrease the burden of diabetes in our society.