Type 2 diabetes is about much more than blood sugar. The damage it can do over the years shows up in the heart, kidneys, eyes, nerves and feet, and much of it is silent until late. The way to stay ahead of it is to track a short list of numbers and checks, year after year.

The figures below come from the American Diabetes Association’s Standards of Care in Diabetes 2026, published in December 2025, and from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Your own goals may differ, and that is a conversation to have with your doctor.

A1C: your three-month average

The A1C blood test reflects your average blood glucose over roughly the past three months. The ADA says that an A1C goal below 7 percent is appropriate for many nonpregnant adults who do not have troublesome low blood sugars. Goals are often relaxed for older adults, people with many other conditions, or anyone prone to hypoglycemia, because lows carry their own risks.

How often to test: at least twice a year if you are at goal and stable, and about every 3 months if you are not at goal or your treatment has just changed. People who wear a continuous glucose monitor also get a “time in range” number, and the ADA suggests more than 70 percent time in range as a goal for many adults. If you have been told you have prediabetes rather than diabetes, our article on prediabetes and A1C covers that stage.

Blood pressure and cholesterol

Diabetes raises the risk of heart attack and stroke, so the ADA’s heart recommendations matter as much as the sugar ones. Its 2026 standards say blood pressure should be checked at every routine visit, and that the treatment goal is below 130/80 if it can be reached safely, with a top number under 120 encouraged for people at high heart or kidney risk. Home readings help; see our guide to home blood pressure monitoring.

For cholesterol, the same section recommends a moderate-intensity statin, along with lifestyle changes, for people with diabetes aged 40 to 75 who do not already have heart disease. LDL cholesterol is rechecked 4 to 12 weeks after starting or changing a statin, then yearly. Our article on statins explains the benefits and the side effects people worry about.

The NIDDK sums this up as the diabetes ABCs: A1C, blood pressure, cholesterol, and stop smoking.

Kidneys: two tests every year

Kidney disease from diabetes affects 20 to 40 percent of people with diabetes, according to the ADA, and it usually causes no symptoms early on. That is why the ADA recommends that everyone with type 2 diabetes have two tests at least once a year:

  • Urine albumin-to-creatinine ratio (UACR), a simple urine test that picks up small amounts of protein leaking through the kidneys.
  • eGFR, an estimate of kidney filtering calculated from a blood creatinine test.

Both matter, because either one can be abnormal while the other looks fine. When kidney disease is found, there are now medicines that slow it down. The ADA recommends an SGLT2 inhibitor for people with type 2 diabetes and chronic kidney disease whose eGFR is 20 or higher, to slow kidney decline and lower heart risk. Our article on eGFR and kidney labs walks through the numbers.

Eyes and feet

Diabetes can damage the retina without blurring vision until it is advanced. The ADA recommends a dilated eye exam by an ophthalmologist or optometrist at the time of diagnosis, then yearly. If one or more yearly exams show no retinopathy and blood sugar is at goal, every one to two years may be enough. Retinal photography read remotely, including FDA-approved AI systems, is also an accepted screening method.

Feet need attention because nerve damage can take away the warning of pain. The NIDDK advises checking your own feet every day, asking your care team to look at them at each visit, and having a thorough foot exam, including feeling and pulses, at least once a year.

Putting it together

A simple yearly checklist covers most of it: A1C two to four times, blood pressure at every visit, a lipid panel, UACR and eGFR, a dilated eye exam, and a foot exam. Add vaccines and a medication review, and you have the core of good diabetes care. Call your doctor promptly for blood sugars that stay much higher than usual, frequent lows, a foot sore that is not healing, or new changes in vision. Confusion, fainting, or a low you cannot bring up are reasons to call 911.

Because Dr. Shtern is board-certified in both Internal Medicine and Nephrology, the kidney side of diabetes is part of everyday care at Legacy Medical. Our chronic care and kidney care pages describe how ongoing conditions are followed. If you would like to talk it over first, the first visit is a complimentary meet and greet.

This article is general information, not advice for your situation. Members can call the office with questions about their own care.