Components of the Comprehensive Diabetes Medical Evaluation

Medical history
• Age and characteristics of onset of diabetes (e.g., DKA, asymptomatic laboratory finding)
• Eating patterns, nutritional status, weight history, and physical activity habits; nutrition education and behavioral support history and needs
• Presence of common comorbidities, psychosocial problems, and dental disease
• Screen for depression using PHQ-2 (PHQ-9 if PHQ-2 positive) or EPDS
• Screen for DD using DDS or PAID-1
• History of smoking, alcohol consumption, and substance use
• Diabetes education, self-management, and support history and needs
• Review of previous treatment regimens and response to therapy (A1C records)
• Results of glucose monitoring and patient’s use of data
• DKA frequency, severity, and cause
• Hypoglycemia episodes, awareness, and frequency and causes
• History of increased blood pressure, increased lipids, and tobacco use
• 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
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, 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 estimated glomerular filtration rate
  ○ Thyroid-stimulating hormone in patients with type 1 diabetes or dyslipidemia or women aged >50 years
  • DD, diabetes distress; DDS, Diabetes Distress Scale; DKA, diabetic ketoacidosis; EPDS, Edinburgh Postnatal Depression Scale; PAID, Problem Areas in Diabetes; PHQ, Patient Health Questionnaire.