Table 7—

Components of the comprehensive diabetes evaluation

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

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

  • Diabetes education history

  • Review of previous treatment regimens and response to therapy (A1C records)

  • Current treatment of diabetes, including medications, meal plan, physical activity patterns, and results of glucose monitoring and patient's use of data

  • DKA frequency, severity, and cause

  • Hypoglycemic episodes

    • Hypoglycemia awareness

    • Any severe hypoglycemia: frequency and cause

  • History of diabetes-related complications

    • Microvascular: retinopathy, nephropathy, neuropathy (sensory, including history of foot lesions; autonomic, including sexual dysfunction and gastroparesis)

    • Macrovascular: CHD, cerebrovascular disease, PAD

    • Other: psychosocial problems,* dental disease*

Physical examination
  • Height, weight, BMI

  • Blood pressure determination, including orthostatic measurements when indicated

  • Fundoscopic examination*

  • Thyroid palpation

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

  • Comprehensive foot examination:

    • Inspection

    • Palpation of dorsalis pedis and posterior tibial pulses

    • Presence/absence of patellar and Achilles reflexes

    • Determination of proprioception, vibration, and monofilament sensation

Laboratory evaluation
  • A1C, if results not available within past 2–3 months

If not performed/available within past year:
  • Fasting lipid profile, including total, LDL, and HDL cholesterol and triglycerides

  • Liver function tests

  • Test for urine albumin excretion with spot urine albumin-to-creatinine ratio

  • Serum creatinine and calculated GFR

  • Thyroid-stimulating hormone in type 1 diabetes, dyslipidemia or women over age 50

Referrals
  • Annual dilated eye exam

  • Family planning for women of reproductive age

  • Registered dietitian for MNT

  • Diabetes self-management education

  • Dental examination

  • Mental health professional, if needed

  • *

    * See appropriate referrals for these categories.