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How to make the most of your annual cycle of care

The Annual cycle of care is a checklist which allows your GP to review your health condition and your risk of diabetes-related complications by performing different health checks. Diabetes educator SALLY KWONG explains.

Weight, waist and BMI

Maintaining a healthy weight is important for your health, as it will have a positive impact on your blood glucose management, blood pressure and your cholesterol. Body Mass Index (BMI) is a way of checking whether your weight is within the recommended healthy range. Research shows that waist circumference is an important indicator of your health risk. Reducing your weight by as little as 5-10% can significantly help in reducing your blood glucose levels, blood pressure and cholesterol levels. How often? At least every 6 months.

Blood pressure

This measures the pressure in your arteries as your heart pumps blood around the body. High blood pressure can increase the risk of stroke, heart disease and kidney disease. Your GP or practice nurse can monitor your blood pressure during your visit. Alternatively, you can either get your measurement done in your local pharmacy or monitor it at home using a blood pressure monitor.
How often? At least every 6 months.


This measures the amount of glucose that was carried by the haemoglobin in your blood, and gives an overall picture of your blood glucose management in the past 3 months.
How often? At least every 6-12 months.


There are different types of fats in our blood and some are better for our health than the others. Lipids are fatty, waxy, or oily compounds that are essential to many body functions and serve as the building blocks for all living cells. Getting them checked measures your total cholesterol, triglycerides, HDL, LDL and cholesterol. Elevated lipids levels can increase the risk of cardiovascular disease.
How often? At least every year.

Kidney health

Kidneys can be damaged without you knowing it, due to the lack of presenting symptoms. Having blood glucose and blood pressure above target over time, can increase the risk of kidney damage. The only way to detect early sign of kidney damage is to check if microalbumin (a type of protein) presents in urine, as well as monitoring your kidney function through blood test.
How often? At least every year.

Eye check

Blood glucose above target over time can damage the small blood vessels at the back of our eyes, which can irreversibly cause blindness. Therefore, it is important to have a comprehensive eye examination check by your optometrist.
How often? At least every two years, or more often if needed.

Foot check

It is important to look after your feet every day by checking for any wounds or sores, washing, drying and moisturising them. Your GP, nurse and podiatrists will also check your feet by looking at the skin and nails, as well as performing different tests to check for any abnormal sensation, pulse and circulation of your feet.
How often? At least every 6-12 months, or more often if needed.

Medication review

Your GP reviews your medication annually, making sure the medications that you take do not interact. If you would like to know more details about your medication, you can also request a medication review by an accredited pharmacist at your home – which may be covered by Medicare. Speak to your GP or your local pharmacy.
How often? At least every year.

Healthy eating

Eating a well-balanced diet is beneficial for weight management. Also, it offers extra benefits in blood glucose and cholesterol management. Your dietitian can help you with designing a personalised healthy eating plan, and you may be eligible for a Medicare rebate. Ask your GP for a referral.
How often? At least every year.

Physical activity

Being physically active can not only improve your physical well-being, but also your emotional health. It helps to keep your blood glucose levels within target naturally, due to the muscle cells picking up glucose in the blood. If you are finding it difficult to get started or to persist, maybe due to your other medical conditions, an exercise physiologist will be able to help. You may be eligible for a Medicare rebate, speak to your GP about it.
How often? Find an activity schedule that works for you.

Stopping smoking

Smoking can cause damage to blood vessels and allows plaque build up. This plaque causes the walls of the arteries to stiffen and thicken. Over time, this results in a range of possible cardiovascular complications – including stroke and heart attack. Once you stop smoking, your circulation will start improving in two weeks’ time. Rather than going “cold-turkey”, there are different aids available to help you more easily and effectively quit smoking. Your GP and pharmacist can help you.
How often? As soon as possible.

Emotional health

Living with diabetes can be challenging and stressful. Your emotional well-being is as crucial as your physical well-being. It is important to look after your mental health every day. Speak to your family, friends, support person or health care professionals about your feelings so they can assist you to find the support you need.
How often? Whenever needed.

GP management plan

You may think it will be expensive to follow the annual cycle of care – visiting different health professionals throughout the year. The good news for people living with diabetes is that your GP can write a personalised GP management plan for you. This allows you to have up to five visits to see a diabetes health professional under Medicare rebates annually.

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