Table 2.

Schedule of care

Component of care	Details of evaluation
Medical and family history
Diabetes history	Date of diagnosis Presentation at onset Islet autoantibodies (date) C-peptide (date) Episodes of DKA or Level 3 hypoglycaemia Hypoglycaemia awareness
Family history	Type 1 diabetes or type 2 diabetes in first-degree relatives Other autoimmune disorders
Personal history of chronic complications	Microvascular: retinopathy, macular oedema, laser/injection therapy, date of last retinal evaluation (exam or photos); peripheral neuropathy, autonomic neuropathy; nephropathy Macrovascular: heart, cerebrovascular and peripheral arterial disease Foot ulcers or amputations
Personal history of common comorbidities	Autoimmune disorders: thyroid, coeliac, othersa Hypertension Lipid disorder Overweight and obesity Eating disorders Hearing loss Sleep disorder Dermopathy Fractures Joint and soft tissue disorders: cheiroarthropathy, trigger finger, capsulitis, carpal tunnel syndrome Dental and gum health
Other	Pregnancy and contraception history Immunisation history
Additional behavioural factors	Diet and nutrition: use of carbohydrate counting, weight history Physical activity Smoking, alcohol, substance use Sleep
Diabetes management
Current insulin regimen	MDI: pens, including connected insulin pens; syringes; needles Insulin pump (type/model): settings; backup injection plan
BGM	Type of meter/strips Frequency of use Mean (SD), range Pattern
CGM	Type/model Data sharing; if yes, with whom Glucometrics Pattern
Other	Other diabetes medications Glucagon prescribed Ketone testing supplies prescribed (where available) Software/app use
Psychosocial issues	Monitor psychological wellbeing: diabetes-specific distress; depressive symptoms; anxiety symptoms Consider, also, the potential presence of fear of hypoglycaemia and disordered eating Screen for social determinants of health and social support Assess cognitive status
DSMES	Assess and plan for meeting individual needs Consider contraception and pregnancy planning
Physical examination	Height Weight, BMI: every visit Blood pressure and pulse: at least once a year Skin including injection/infusion sites: every visit if skin complaints or erratic glucose readings, otherwise annual Cardiovascular: annual; more often if previous abnormality or symptoms Feet: every visit if peripheral vascular disease, neuropathy, foot complaints or history of foot ulcer, otherwise annual
Laboratory testing	HbA1c every 3–12 months Creatinine: annual; may be more often if kidney disease Urine albumin/creatinine ratio: annual Lipid panel: frequency dependent on the presence of previous lipid abnormality or treatment ALT and AST: at least once and as indicated clinically Serum potassium: if taking ACE-I, ARB or diuretic TSH, vitamin B12, vitamin D, coeliac screen: at least once and as indicated clinicallya
Goals setting	Individualised, attainable, realistic: behavioural considerations (diet and nutrition, activity, smoking cessation) Glycaemic: HbA1c, TIR, hypoglycaemia
Treatment plan	Formulate treatment plan with shared decision-making
Referrals	As needed: podiatry, cardiology, nephrology, ophthalmology, vascular surgery, gynaecology, others

^aIndividuals with type 1 diabetes are also at increased risk for the development of other autoimmune diseases, including autoimmune thyroid disorders, pernicious anaemia, coeliac disease, collagen vascular diseases and Addison’s disease [291, 292]. The optimal frequency of screening for these conditions in adults has not been established

ACE-I, ACE inhibitor; ALT, alanine aminotransferase; ARB, angiotensin II receptor blocker; AST, aspartate aminotransferase; TSH, thyroid stimulating hormone