Annual Cycle of Care

What is the cycle of care?

The diabetes Annual Cycle of Care is a checklist that helps you review your diabetes management and general health.

If you’re living with type 1 or type 2 diabetes you can reduce your risk of developing complications by keeping your health on track. This includes keeping your blood pressure, blood glucose levels and blood fats as close to normal as possible. It’s also important to have regular dental checks and pay attention to other parts of your body that can warn you when you may be at risk, such as your feet, kidneys and eyes.

Some things, such as your blood glucose levels, you can check for yourself. Others like your teeth, feet, kidneys and eyes will need to be checked by healthcare professionals.

We call these checks your Annual Cycle of Care. We recommend you make appointments with each member of your healthcare team at least once a year. To make these appointments easy to remember we recommend you put them in your calendar for the same date each year.

At our Annual Cycle of Care events our trained health professionals will check your:

  • HbA1c (three month average of your blood glucose levels)
  • Cholesterol levels
  • Kidney health
  • Foot health
  • Blood pressure
  • BMI

Blood Glucose Levels (BGL)

Self-monitoring of your BGL’s enables you to check your own levels as often as needed or as recommended. Regular testing can reinforce your healthy lifestyle choices as well informing you of your responses to other influences. Your diabetes health professional will help you decide how many tests are needed and the levels to aim for. More about blood glucose monitoring.

HbA1c (Glycosylated haemoglobin)

The HbA1c test shows an average of your blood glucose level over the past 10-12 weeks. It does not show the highs and lows but gives an overall picture of your blood glucose management. High blood glucose levels can contribute to the development of long-term complications of diabetes. The general target level is 7% (53 mmol/mol) or lower.

Blood Pressure (BP)

This is the measurement of the pressure at which your heart pumps blood around the body. High blood pressure can increase the risk of heart disease, stroke and kidney disease. You should have your blood pressure checked regularly (at least every doctors visit) and treated if necessary. For someone with diabetes, the target BP is less than 130 over 80. (130/80).

Cholesterol (blood fats-lipids)

This is a type of fat in the blood. Cholesterol problems are common in people with diabetes and too much fat increases the risk of heart disease and stroke. Your target total cholesterol level is less than 4 mmol/L.

There are two types of cholesterol:

  • Low-density lipoproteins (LDL’s) called bad cholesterol and high-density lipoproteins (HDL’s) called good cholesterol. LDL can narrow or block your blood vessels. Keeping your LDL low helps protect your heart. Your target level is below 2 mmol/L.
  • HDL helps remove deposits from your blood vessels and stops them getting blocked. Your target level is 1mmol/L or above.

Triglycerides are another type of fat in your blood. Your target level is less than 2 mmol/L. Your cholesterol level should be tested every 12 months.


Diabetes can cause eye problems and may lead to blindness. Complications can include cataracts, glaucoma and retinopathy. Many people don’t notice any problems with their sight until retinopathy is well advanced.

You can reduce the risk of eye damage by keeping your blood glucose levels, HbA1c and blood pressure at recommended levels and if you notice any changes in your vision, speak with your doctor or eye specialist immediately. Your eyes should be checked every one-two years.


People with diabetes can develop a number of foot problems such as changes to the skin, calluses, foot ulcers and nerve damage (neuropathy), which can lead to amputation. For these reasons it is important to take good care of your feet.

Your doctor or podiatrist should perform a complete foot exam at least annually. You can prepare by taking off your socks and shoes while you wait. You should check your feet every day as instructed by your podiatrist or educator.


Over time, people with diabetes face increased risk of damage to their kidneys (nephropathy). An early sign of kidney problems can be detected through a urine test for microalbumin. Finding out early that kidneys are beginning to have a problem is simple and painless. Your urine should be checked yearly for microalbumin.

Other management goals

Other checks include: Healthy eating, weight management, stopping smoking, moderate alcohol consumption (two or less standard drinks a day for men, one for women) and physical activity (at least 30 minutes most days a week) and a review of your medications and diabetes management plan.

Annual cycle of care podcast series

A series of 10 podcasts focusing on the importance and components of the annual cycle of care is available on the NDSS website. Topics include eye health, kidney health, HbA1c and what support is available for managing diabetes.

Listen now

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