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, medication adherence and barriers thereto, 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, and 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 |
| • TSH 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 |
| • DSME |
| • Dentist for comprehensive periodontal examination |
| • Mental health professional, if needed |
*
See appropriate referrals for these categories.