Components of the Comprehensive Diabetes Evaluation

Medical history
• Age and characteristics of onset of diabetes (e.g., diabetic ketoacidosis, asymptomatic laboratory finding)
• Eating patterns, physical activity habits, nutritional status, and weight history; growth and development in children and adolescents
• Presence of common comorbidities, psychosocial problems, and dental disease
• Diabetes education history
• Review of previous treatment regimens and response to therapy (A1C records)
• Current treatment of diabetes, including medications, medication adherence and barriers thereto, meal plan, physical activity patterns, and readiness for behavior change
• Results of glucose monitoring and patient’s use of data
• Diabetic ketoacidosis 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, cerebrovascular disease, and peripheral arterial disease
Physical examination
• Height, weight, BMI
• Blood pressure determination, including orthostatic measurements when indicated
• Fundoscopic examination
• 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
Laboratory evaluation
• A1C, if results not available within past 3 months
• If not performed/available within past year
  ○ Fasting lipid profile, including total, LDL, and HDL cholesterol and triglycerides, as needed
  ○ Liver function tests
  ○ Test for urine albumin excretion with spot urine albumin-to-creatinine ratio
  ○ Serum creatinine and calculated glomerular filtration rate
  ○ TSH in type 1 diabetes, dyslipidemia, or women over age 50 years
• Eye care professional for annual dilated eye exam
• Family planning for women of reproductive age
• Registered dietitian for medical nutrition therapy
• Dentist for comprehensive periodontal examination
• Mental health professional, if needed