Table 5—

Components of the comprehensive diabetes evaluation

Medical history
  • Symptoms, results of laboratory tests, and special examination results related to the diagnosis of diabetes

  • Prior AIC 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

  • Assessment for mood disorder

  • 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, if clinically indicated

  • 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