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 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
    • 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 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