Table 7

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, medication adherence and barriers thereto, meal plan, physical activity patterns, and readiness for behavior change
 • 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, and 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-to-creatinine ratio
 • Serum creatinine and calculated GFR
 • TSH in type 1 diabetes, dyslipidemia or women over age 50 years
Referrals
 • Eye care professional for annual dilated eye exam
 • Family planning for women of reproductive age
 • Registered dietitian for MNT
 • DSME
 • Dentist for comprehensive periodontal examination
 • Mental health professional, if needed
  • * See appropriate referrals for these categories.