Table 8

Components of the comprehensive diabetes evaluation

Medical history
  • Age and characteristics of onset of diabetes (e.g., DKA, asymptomatic laboratory finding)

  • Eating patterns, physical activity habits, nutritional status, and weight history; growth and development in children and adolescents

  • Diabetes education history

  • Review of previous treatment regimens and response to therapy (A1C records)

Current treatment of diabetes, including medications, meal plan, physical activity patterns, and results of glucose monitoring and patient's use of data
  • DKA frequency, severity, and cause

  • Hypoglycemic episodes

    • Hypoglycemia awareness

    • Any severe hypoglycemia: frequency and cause

  • History of diabetes-related complications

    • Microvascular: retinopathy, nephropathy, neuropathy (sensory, including history of foot lesions; autonomic, including sexual dysfunction and gastroparesis)

    • Macrovascular: CHD, cerebrovascular disease, PAD

    • Other: psychosocial problems*, dental disease*

Physical examination
  • Height, weight, BMI

  • Blood pressure determination, including orthostatic measurements when indicated

  • Fundoscopic examination*

  • Thyroid palpation

  • Skin examination (for acanthosis nigricans and insulin injection sites)

  • Comprehensive foot examination:

    • Inspection

    • Palpation of dorsalis pedis and posterior tibial pulses

    • Presence/absence of patellar and Achilles reflexes

    • Determination of proprioception, vibration, and monofilament sensation

Laboratory evaluation
  • A1C, if results not available within past 2–3 months

  • If not performed/available within past year:

    • Fasting lipid profile, including total, LDL- and HDL cholesterol and triglycerides

    • Liver function tests

    • Test for urine albumin excretion with spot urine albumin/creatinine ratio

    • Serum creatinine and calculated GFR

    • TSH in type 1 diabetes, dyslipidemia, or women over age 50 years

Referrals
  • Annual dilated eye exam

  • Family planning for women of reproductive age

  • Registered dietitian for MNT

  • DSME

  • Dental examination

  • Mental health professional, if needed

  • * See appropriate referrals for these categories.