7
Table 7. Components of the Comprehensive Diabetes Evaluation
Î Medical 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 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: coronary heart disease (CHD), cerebrovascular disease,
peripheral artery disease (PAD)
▶ Other: psychosocial problems,
a
dental disease
a
Î Common comorbidities (Table 6)
Î Physical examination
• Height, weight, BMI
• Blood pressure determination, including orthostatic measurements when indicated
• Fundoscopic examination
a
• 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
Î Laboratory evaluation
• A1c, if results not available within past 2-3 months
• If not performed/available within past year:
▶ Fasting lipid profile, including total low-density lipoprotein cholesterol
(LDL-C) and HDL-C and triglycerides
▶ Liver function tests
▶ Test for urine albumin excretion with spot urine albumin-to-creatinine ratio
▶ Serum creatinine and calculated glomerular filtration rate (GFR)
▶ Thyroid-stimulating hormone in type 1 diabetes, dyslipidemia, or women over
age 50 years
Î Referrals
• Annual dilated eye exam
• Family planning for women of reproductive age
• Registered dietitian for medical nutrition therapy (MNT)
• Diabetes self-management education (DSME)
• Dentist for comprehensive periodontal examination
• Mental health professional, if needed
a
See appropriate referrals for these categories.
