Table 5—

Components of the comprehensive diabetes evaluation

Medical history
  • Age and characteristics of onset of diabetes (e.g., DKA, routine laboratory evaluation)

  • Prior A1C records

  • Eating patterns, nutritional status, and weight history; growth and development in children and adolescents

  • Diabetes education history

  • Review of previous treatment programs

  • Current treatment of diabetes, including medications, meal plan, and results of glucose monitoring and patient’s use of data

  • Exercise history

  • DKA frequency, severity, and cause

  • Hypoglycemic episodes

    • Any severe hypoglycemia: frequency, severity, and cause

  • History of diabetes-related complications

    • Microvascular: eye, kidney, nerve

    • Macrovascular: cardiac, CVD, PAD

    • Other: sexual dysfunction, gastroparesis

Physical examination
  • Blood pressure determination, including orthostatic measurements when indicated

  • Fundoscopic examination

  • Thyroid palpation

  • Skin examination (for acanthosis nigricans and insulin injection sites)

  • Neurological/foot examination examination

  • Inspection

  • Palpation of DP and PT pulses

  • Presence/absence of patellar and Achilles reflexes

  • Determination of proprioception, vibration, and monofilament sensation

Laboratory evaluation
  • A1C

  • Fasting lipid profile, including total LDL and HDL cholesterol and triglycerides

  • Liver function tests

  • Test for microalbuminuria

  • Serum creatinine and calculated GFR

  • Thyroid-stimulating hormone

  • Screen for celiac disease in type 1 diabetes and as indicated in type 2 diabetes

Referrals
  • Eye exam, if indicated

  • Family planning for women of reproductive age

  • MNT

  • Diabetes educator if not provided by physician or practice staff

  • DP, dorsalis pedis; PT, posterior tibial; PAD, peripheral arterial disease.