TABLE 4.

Components of the Comprehensive Diabetes Medical Evaluation*

Medical history
  • Age and characteristics of onset of diabetes (e.g., diabetic ketoacidosis [DKA], asymptomatic laboratory finding)

  • Eating patterns, nutritional status, weight history, sleep behaviors (pattern and duration), and physical activity habits; nutrition education and behavioral support history and needs

  • Complementary and alternative medicine use

  • Presence of common comorbidities and dental disease

  • Screen for depression, anxiety, and disordered eating using validated and appropriate measures**

  • Screen for diabetes distress using validated and appropriate measures**

  • Screen for psychosocial problems and other barriers to diabetes self-management such as limited financial, logistical, and support resources

  • History of tobacco use, alcohol consumption, and substance use

  • DSME and DSMS history and needs

  • Review of previous treatment regimens and response to therapy (A1C records)

  • Assess medication-taking behaviors and barriers to medication adherence

  • Results of glucose monitoring and patient’s use of data

  • DKA frequency, severity, and cause

  • Hypoglycemia episodes, awareness, frequency, and causes

  • History of increased blood pressure and abnormal lipids

  • 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

  • For women with child-bearing capacity, review contraception and preconception planning

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 and 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 eGFR

    • ○ Thyroid-stimulating hormone in patients with type 1 diabetes

  • * The comprehensive medical evaluation should all ideally be done on the initial visit, but if time is limited different components can be done as appropriate on follow-up visits.

  • ** Refer to the ADA position statement “Psychochsocial Care for People With Diabetes” for additional details on diabetes-specific screening measures.