TABLE 4.
Components of the Comprehensive Diabetes Medical Evaluation
| Medical history |
| • Age and characteristics of onset of diabetes (e.g., DKA, asymptomatic laboratory finding) |
| • Eating patterns, nutritional status, weight history, and physical activity habits; nutrition education and behavioral support history and needs |
| • Presence of common comorbidities, psychosocial problems, and dental disease |
| • Screen for depression using PHQ-2 (PHQ-9 if PHQ-2 positive) or EPDS |
| • Screen for DD using DDS or PAID-1 |
| • History of smoking, alcohol consumption, and substance use |
| • Diabetes education, self-management, and support history and needs |
| • Review of previous treatment regimens and response to therapy (A1C records) |
| • Results of glucose monitoring and patient’s use of data |
| • DKA frequency, severity, and cause |
| • Hypoglycemia episodes, awareness, and frequency and causes |
| • History of increased blood pressure, increased lipids, and tobacco use |
| • Microvascular complications: retinopathy, nephropathy, and neuropathy (sensory, including history of foot lesions; autonomic, including sexual dysfunction and gastroparesis) |
| • Macrovascular complications: coronary heart disease, cerebrovascular disease, and peripheral arterial disease |
| Physical examination |
| • Height, weight, and BMI; growth and pubertal development in children and adolescents |
| •Blood pressure determination, including orthostatic measurements when indicated |
| •Fundoscopic examination |
| •Thyroid palpation |
| •Skin examination (e.g., for acanthosis nigricans, insulin injection, or infusion set insertion 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 the past 3 months |
| •If not performed/available within the past year |
| ○ Fasting lipid profile, including total, LDL, and HDL cholesterol and triglycerides, as needed |
| ○ Liver function tests |
| ○ Spot urinary albumin–to–creatinine ratio |
| ○ Serum creatinine and estimated glomerular filtration rate |
| ○ Thyroid-stimulating hormone in patients with type 1 diabetes or dyslipidemia or women aged >50 years |
DD, diabetes distress; DDS, Diabetes Distress Scale; DKA, diabetic ketoacidosis; EPDS, Edinburgh Postnatal Depression Scale; PAID, Problem Areas in Diabetes; PHQ, Patient Health Questionnaire.