Table 4

Children and adolescents*

Clinical evaluationInitialAnnualQuarterly follow-up
BMI percentileXXX
Blood pressureXXX
General physical examXX
Thyroid examXXX
Injection/infusion sitesX (if already on insulin)XX
Comprehensive foot examIf needed, based on ageBeginning with older teens with diabetes since childhood
Visual foot examXIf needed, based on high-risk characteristics
Retinal exam by eye care specialistX§In some cases, may be done every 2 years (see ADA Standards of Care)
Depression screenXXX
Hypoglycemia assessmentXXX
Diabetes self-management skillsXXX
Physical activity assessmentXXX
Assess clinically relevant issues (e.g., alcohol, drug, and tobacco use; use of contraception; driving)XAs needed for teensAs needed for teens
Nutritional knowledgeXXAs needed
Query for evidence of other autoimmune diseaseXAs neededAs needed
Immunizations as recommended by CDCXXAs needed
Laboratory assessmentsInitialAnnualFollow-up
A1CXXEvery 3 months
Creatinine clearance/estimated glomerular filtration rateXX
Lipid panel||Once glycemia is stableXAs needed based on treatment
TSHXXAs needed based on treatment
Frequency of testing varies based on clinical symptoms, presence of antibodies, and/or if on treatment
Antithyroid antibodies (antithyroid peroxidase and antithyroglobulin antibodies)XRepeat as clinically indicated
Frequency of testing is unknown; test if symptoms are present or for periodic screening
Celiac antibody panelXRepeat as clinically indicated
Frequency of testing is unknown; test if symptoms are present or for periodic screening
Urine albumin-to-creatinine ratioStarting 5 years after diagnosisXAs needed based on treatment
Islet cell antibodies: GADA/IA2A/IAA/ZnT8X
May be needed in new-onset patients to establish diagnosis
C-peptide levelsX
Occasionally needed to establish type 1 diabetes in a patient on insulin or to verify type 1 diabetes for insurance purposes—always measure a simultaneous blood glucose level
  • * Assumes a patient has a health care provider to manage the nondiabetes-related health assessments and to perform annual evaluations.

  • Patient may opt out of measurement if psychologically distressing.

  • Foot inspection should be done at each visit and self-exams taught if high-risk characteristics are present. Comprehensive foot exam includes inspection, palpation of dorsalis pedis and posterior tibial pulses, presence or absence of patellar and Achilles reflexes, and determination of proprioception, vibration, and monofilament sensation.

  • § Within 5 years after diagnosis.

  • || If triglycerides are elevated in a nonfasting specimen, measure a direct LDL cholesterol level.