Components of the initial visit
| Medical history |
| • Symptoms, results of laboratory tests, and special examination results related to the diagnosis of diabetes |
| • Prior A1C records |
| • Eating patterns, nutritional status, and weight history; growth and development in children and adolescents |
| • Details of previous treatment programs, including nutrition and diabetes self-management education, attitudes, and health beliefs |
| • Current treatment of diabetes, including medications, meal plan, and results of glucose monitoring and patients’ use of data |
| • Exercise history |
| • Frequency, severity, and cause of acute complications such as ketoacidosis and hypoglycemia |
| • Prior or current infections, particularly skin, foot, dental, and genitourinary infections |
| • Symptoms and treatment of chronic eye; kidney; nerve; genitourinary (including sexual), bladder, and gastrointestinal function (including symptoms of celiac disease in type 1 diabetic patients); heart; peripheral vascular; foot; and cerebrovascular complications associated with diabetes |
| • Other medications that may affect blood glucose levels |
| • Risk factors for atherosclerosis: smoking, hypertension, obesity, dyslipidemia, and family history |
| • History and treatment of other conditions, including endocrine and eating disorders |
| • Family history of diabetes and other endocrine disorders |
| • Lifestyle, cultural, psychosocial, educational, and economic factors that might influence the management of diabetes |
| • Tobacco, alcohol and/or controlled substance use |
| • Contraception and reproductive and sexual history |
| Physical examination |
| • Height and weight measurement (and comparison to norms in children and adolescents) |
| • Sexual maturation staging (during pubertal period) |
| • Blood pressure determination, including orthostatic measurements when indicated, and comparison to age-related norms |
| • Fundoscopic examination |
| • Oral examination |
| • Thyroid palpation |
| • Cardiac examination |
| • Abdominal examination (e.g., for hepatomegaly) |
| • Evaluation of pulses by palpation and with auscultation |
| • Hand/finger examination |
| • Foot examination |
| • Skin examination (for acanthosis nigricans and insulin-injection sites) |
| • Neurological examination |
| • Signs of diseases that can cause secondary diabetes (e.g., hemochromatosis, pancreatic disease) |
| Laboratory evaluation |
| • A1C |
| • Fasting lipid profile, including total cholesterol, HDL cholesterol, triglycerides, and LDL cholesterol |
| • Test for microalbuminuria in type 1 diabetic patients who have had diabetes for at least 5 years and in all patients with type 2 diabetes. Some advocate beginning screening of pubertal children before 5 years of diabetes. |
| • Serum creatinine in adults (in children if proteinuria is present) |
| • Thyroid-stimulating hormone (TSH) in all type 1 diabetic patients; in type 2 if clinically indicated |
| • Electrocardiogram in adults |
| • Urinalysis for ketones, protein, sediment |
| Referrals |
| • Eye exam, if indicated |
| • Family planning for women of reproductive age |
| • MNT, as indicated |
| • Diabetes educator, if not provided by physician or practice staff |
| • Behavioral specialist, as indicated |
| • Foot specialist, as indicated |
| • Other specialties and services as appropriate |
| Medical history |
| • Symptoms, results of laboratory tests, and special examination results related to the diagnosis of diabetes |
| • Prior A1C records |
| • Eating patterns, nutritional status, and weight history; growth and development in children and adolescents |
| • Details of previous treatment programs, including nutrition and diabetes self-management education, attitudes, and health beliefs |
| • Current treatment of diabetes, including medications, meal plan, and results of glucose monitoring and patients’ use of data |
| • Exercise history |
| • Frequency, severity, and cause of acute complications such as ketoacidosis and hypoglycemia |
| • Prior or current infections, particularly skin, foot, dental, and genitourinary infections |
| • Symptoms and treatment of chronic eye; kidney; nerve; genitourinary (including sexual), bladder, and gastrointestinal function (including symptoms of celiac disease in type 1 diabetic patients); heart; peripheral vascular; foot; and cerebrovascular complications associated with diabetes |
| • Other medications that may affect blood glucose levels |
| • Risk factors for atherosclerosis: smoking, hypertension, obesity, dyslipidemia, and family history |
| • History and treatment of other conditions, including endocrine and eating disorders |
| • Family history of diabetes and other endocrine disorders |
| • Lifestyle, cultural, psychosocial, educational, and economic factors that might influence the management of diabetes |
| • Tobacco, alcohol and/or controlled substance use |
| • Contraception and reproductive and sexual history |
| Physical examination |
| • Height and weight measurement (and comparison to norms in children and adolescents) |
| • Sexual maturation staging (during pubertal period) |
| • Blood pressure determination, including orthostatic measurements when indicated, and comparison to age-related norms |
| • Fundoscopic examination |
| • Oral examination |
| • Thyroid palpation |
| • Cardiac examination |
| • Abdominal examination (e.g., for hepatomegaly) |
| • Evaluation of pulses by palpation and with auscultation |
| • Hand/finger examination |
| • Foot examination |
| • Skin examination (for acanthosis nigricans and insulin-injection sites) |
| • Neurological examination |
| • Signs of diseases that can cause secondary diabetes (e.g., hemochromatosis, pancreatic disease) |
| Laboratory evaluation |
| • A1C |
| • Fasting lipid profile, including total cholesterol, HDL cholesterol, triglycerides, and LDL cholesterol |
| • Test for microalbuminuria in type 1 diabetic patients who have had diabetes for at least 5 years and in all patients with type 2 diabetes. Some advocate beginning screening of pubertal children before 5 years of diabetes. |
| • Serum creatinine in adults (in children if proteinuria is present) |
| • Thyroid-stimulating hormone (TSH) in all type 1 diabetic patients; in type 2 if clinically indicated |
| • Electrocardiogram in adults |
| • Urinalysis for ketones, protein, sediment |
| Referrals |
| • Eye exam, if indicated |
| • Family planning for women of reproductive age |
| • MNT, as indicated |
| • Diabetes educator, if not provided by physician or practice staff |
| • Behavioral specialist, as indicated |
| • Foot specialist, as indicated |
| • Other specialties and services as appropriate |