Table 5—

Components of the initial visit

Medical history
• Symptoms, results of laboratory tests, and special examination results related to the diagnosis of diabetes
• Prior A1C records
• Eating patterns, nutritional status, and weight history; growth and development in children and adolescents
• Details of previous treatment programs, including nutrition and diabetes self-management education, attitudes, and health beliefs
• Current treatment of diabetes, including medications, meal plan, and results of glucose monitoring and patients’ use of data
• Exercise history
• Frequency, severity, and cause of acute complications such as ketoacidosis and hypoglycemia
• Prior or current infections, particularly skin, foot, dental, and genitourinary infections
• Symptoms and treatment of chronic eye; kidney; nerve; genitourinary (including sexual), bladder, and gastrointestinal function (including symptoms of celiac disease in type 1 diabetic patients); heart; peripheral vascular; foot; and cerebrovascular complications associated with diabetes
• Other medications that may affect blood glucose levels
• Risk factors for atherosclerosis: smoking, hypertension, obesity, dyslipidemia, and family history
• History and treatment of other conditions, including endocrine and eating disorders
• Family history of diabetes and other endocrine disorders
• Lifestyle, cultural, psychosocial, educational, and economic factors that might influence the management of diabetes
• Tobacco, alcohol and/or controlled substance use
• Contraception and reproductive and sexual history
Physical examination
• Height and weight measurement (and comparison to norms in children and adolescents)
• Sexual maturation staging (during pubertal period)
• Blood pressure determination, including orthostatic measurements when indicated, and comparison to age-related norms
• Fundoscopic examination
• Oral examination
• Thyroid palpation
• Cardiac examination
• Abdominal examination (e.g., for hepatomegaly)
• Evaluation of pulses by palpation and with auscultation
• Hand/finger examination
• Foot examination
• Skin examination (for acanthosis nigricans and insulin-injection sites)
• Neurological examination
• Signs of diseases that can cause secondary diabetes (e.g., hemochromatosis, pancreatic disease)
Laboratory evaluation
• A1C
• Fasting lipid profile, including total cholesterol, HDL cholesterol, triglycerides, and LDL cholesterol
• Test for microalbuminuria in type 1 diabetic patients who have had diabetes for at least 5 years and in all patients with type 2 diabetes. Some advocate beginning screening of pubertal children before 5 years of diabetes.
• Serum creatinine in adults (in children if proteinuria is present)
• Thyroid-stimulating hormone (TSH) in all type 1 diabetic patients; in type 2 if clinically indicated
• Electrocardiogram in adults
• Urinalysis for ketones, protein, sediment
Referrals
• Eye exam, if indicated
• Family planning for women of reproductive age
• MNT, as indicated
• Diabetes educator, if not provided by physician or practice staff
• Behavioral specialist, as indicated
• Foot specialist, as indicated
• Other specialties and services as appropriate