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Table 5—

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 
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