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 and medication adherence, meal plan, physical activity patterns, and readiness for behavior change

  • 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 UAE 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 years

Referrals

  • Eye care professional for annual dilated eye exam

  • Family planning for women of reproductive age

  • Registered dietitian for MNT

  • DMSE

  • Dentist for comprehensive periodontal examination

  • Mental health professional, if needed

  • ↵* See appropriate referrals for these categories.