Diagnosis and Assessment Table 8. Components of the Comprehensive Diabetes Evaluation
ÎMedical history > Age and characteristics of onset of diabetes (eg, diabetic ketoacidosis [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
> History of diabetes-related complications ▶ Microvascular: retinopathy, nephropathy, neuropathy (sensory, including history of foot lesions; autonomic, including sexual dysfunction and gastroparesis)
▶ Hypoglycemia awareness ▶ Any severe hypoglycemia: frequency and cause
▶ Macrovascular: coronary heart disease, cerebrovascular disease, peripheral artery disease
▶ Other: psychosocial problems,a ÎPhysical examination dental diseasea
> Height, weight, BMI > Blood pressure determination, including orthostatic measurements when indicated > Fundoscopic examinationa > 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
ÎLaboratory 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 glomerular filtration rate ▶ Thyroid-stimulating hormone in type 1 diabetes, dyslipidemia, or women age > 50 years
ÎReferrals
> Annual dilated eye exam > Family planning for women of reproductive age > Registered dietitian for medical nutrition therapy > Diabetes self-management education (DSME) > Dentist for comprehensive peridontal examination > Mental health professional, if needed
a See appropriate referrals for these categories. 4
