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, physical activity habits, 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/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.