Table 5


Clinical evaluationInitialAnnualFollow-up
Blood pressureXXX
General physical examX
Thyroid examXIf indicated
Injection/infusion sitesXXX
Comprehensive foot examXX
Visual foot examAs needed—at each visit, if high-risk foot
Retinal exam by eye care specialist§Starting 5 years after diagnosis; earlier if visual symptoms and/or true date of diagnosis is unknownIn some individuals, screening may be done every 2 years (see ADA Standards of Medical Care)
Depression screenXX
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 neededAs needed
Nutritional knowledgeXXAs needed
Query for evidence of other autoimmune diseaseXAs needed based on clinical scenarioAs needed based on clinical scenario
Immunizations as recommended by CDCXXAs needed
Laboratory assessmentsInitialAnnualFollow-up
A1CXXEvery 3 months
Creatinine clearance/estimated glomerular filtration rateXX
Fasting lipid panel||XXAs needed based on treatment
TSHXXAs needed based on treatment
Frequency of testing varies based on clinical symptoms, presence of antibodies, or if on treatment
Antithyroid antibodiesX
Frequency of testing is unknown; test if symptoms are present or for periodic screening
Celiac antibody panelX
Frequency of testing is unknown; test if symptoms are present or for periodic screening
Urine albumin-to-creatinine ratioXX
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, determination of presence or absence of patellar and Achilles reflexes, and determination of proprioception, vibration, and monofilament sensation.

  • § In some instances, the test may not need to be done yearly.

  • || If a patient is unable to undertake a fasting test due to hypoglycemia, measure a direct LDL cholesterol level.