Oxfordshire Children’s Diabetes Service
Children’s Hospital, Oxford OX3 9DU
Horton Hospital, Banbury OX16 9AL
Your Annual Review
There are two parts to an annual review.
 The first is to check if any of the complications of diabetes have developed.
 The second is to check for any associated conditions, which are more common in children with
diabetes.
1. There are four ways in which we look for complications of diabetes, but since these really do not
occur in children under the age of 12 years, we only do these at 12 years and above, apart from
checking the lipid levels in all children at their first annual review.
a. foot problems - we will ask you if you have any problems with your feet and provide you with
an information leaflet about how to look after your feet. If you or we have any concerns that
there might be worries about your feet, we will look at them with shoes and socks off and
examine for nerve or circulation problems.
b. eye checks - you will first have a test of your vision, then you will usually have drops put in your
eyes followed by a photograph taken. This is to look at the tiny blood vessels at the back of the
eye, where diabetes can cause small leakages and swellings in the blood vessels. Around 5%
of the non-diabetic population have some changes, so if you receive a letter saying that there
are background changes in one eye, this is unlikely to be due to the diabetes, particularly if
your blood glucose control has been good. Even if there are changes in both eyes, this can
reverse with good blood glucose control, so don’t panic, and just work to improve the HbA1c
level. Generally there is no specific treatment for background changes, they will just be
checked the following year.
c. blood tests - here we look at the amount of fats (lipids) in the blood. It is rare to find any
abnormality in the lipid level before you are 12 years old so we only check this once at your first
annual review. However, many young people over 12 with diabetes have high lipid levels,
particularly if their blood glucose control has not been good, so we check these annually after
you are 12 years of age. This is important as these lipids are linked with furring up of the large
blood vessels, and later heart disease and strokes. We will let you know if these are too high.
d. urine tests - from the age of 12, you will be sent 3 urine bottles in which to catch the first urine
test of the day on three consecutive mornings, and you will be asked to bring them to clinic.
We examine the urine for tiny amounts of protein (microalbuminuria), which are the first signs
of diabetic kidney disease.
2. The associated conditions which we look for are coeliac disease and thyroid problems, and these
are both tested for by blood tests which we do in all children, regardless of their age.
a. Coeliac disease - this is a condition where the gut becomes damaged because of gluten which
is contained in some grains, especially wheat. The damaged gut is then unable to absorb food
properly into the body. If untreated, it can cause poor growth, anaemia, thinning of bones and
other problems. If the blood test is positive, you will be phoned to be told and will then be
asked to come up for a repeat test. The condition is confirmed by an examination of the bowel
which will be explained to you, and is done as a day case in hospital. About 8% of children in
the clinic have coeliac disease as well as diabetes.
b. Thyroid problems - this is usually an underactive gland, but some children may have an
overactive gland. If the blood test is abnormal, we will telephone you to let you know. The
treatment of an underactive thyroid gland is very simple, and is with small tablets once a day.
Please email any comments you may have about this document to: Mary.Cheeseman@ouh.nhs.uk
Paediatric Diabetes Team, May 2013
Review May 2016