Question

What are pertinent assessments for a diabetic patient?

Answer 1

Aims of assessing the patient with diabetes. ... To detect any complications of diabetes and treat them as appropriate. To educate and reinforce healthy lifestyle advice. To assess the patient's overall health and to treat any associated or coincidental illness, physical or mental.

• Weight, abdominal circumference, height and BMI.
• Urinalysis for ketones, protein and nitrite (evidence of infection).
• Inspect injection sites of patients with type 1 diabetes, looking for evidence of lipoatrophy and lipodystrophy/lipohypertrophy.
• Cardiovascular:
  • Check pulse and blood pressure.
  • Listen for carotid bruits and to heart sounds/lung fields if there is any history consistent with cerebrovascular or cardiac illness.
  • Palpate and record the peripheral pulses of the feet.
• Eyes:
  • Ensure regular attendance and appropriate follow-up for diabetes eye screening.
  • Inspect eyes, looking for any evidence of xanthelasmata, cataract formation or ophthalmoplegia.
  • Check visual acuity, with distance vision glasses, if worn.

  • checklist for a routine, annual or opportunistic review of the patient with diabetes

    See also the separate Diabetes Education and Self-management Programmes article.

    When, how and who?

    Patients with diabetes frequently attend their healthcare practitioners, either specifically for diabetes-related issues, for complications of their chronic illness, or for unrelated problems. They may see their GP, practice nurse, hospital diabetologist, diabetes specialist nurse, dietician and many others, from time to time. Each visit can be viewed as an opportunity to assess and improve the patient's understanding of their illness, and their ability to control the disease.

    This article provides a summary of the areas of assessment relevant to type 1 diabetes and type 2 diabetes, which will need to be adapted, depending on an individual patient's type of diabetes.

    Aims of assessing the patient with diabetes

  • To educate the patient and enable them to monitor and manage their diabetes as well as possible.
  • To assess any problems in glycaemic control and address them to improve it.
  • To detect any complications of diabetes and treat them as appropriate.
  • To educate and reinforce healthy lifestyle advice.
  • To assess the patient's overall health and to treat any associated or coincidental illness, physical or mental.
  • To provide support and advice to the patient on how to cope with living with a chronic illness and how they can best alter their lifestyle to maintain their health.

  • A checklist for a routine, annual or opportunistic review of the patient with diabetes

    History

    There is much to cover if all the information below is to be discussed at the review:

  • Education and self-management:
    • How is the patient coping with self-care and self-management of their diabetes?
    • Does the patient consider that they eat a healthy diabetic diet and do they feel sufficiently informed about how to manage their diet and its relationship to their insulin regimen?
    • Have they received, or would they like to receive, any educational input to help them improve their understanding of their condition and its self-management? For example, Dose Adjustment for Normal Eating (DAFNE), Diabetes Self Management for Ongoing and Diagnosed (DESMOND), dietetic input, exercise and activity programmes.
    • Is the patient a smoker? If so, what help would they like to become a non-smoker and are they aware of the importance of stopping smoking?
  • Complications:
    • Has the patient had any hospital admissions in the preceding year for diabetic decompensations such as hypoglycaemia, diabetic ketoacidosis (DKA) or hyperosmolar hyperglycaemic state?
    • Has the patient had any treatment or hospital admissions for complications of their diabetes in the preceding year? For example, angina/myocardial infarction, cerebrovascular event/transient ischaemic attack (TIA), diabetic nephropathy, diabetic retinopathy, diabetic neuropathy or diabetes foot problems.
    • Has the patient had any symptoms of cardiovascular, cerebrovascular, renal, ophthalmological or neurological complications of diabetes?
    • Has the patient had any problems with sexual function? Ask specifically about erectile dysfunction.
    • Has the patient been otherwise well, or had any other illness of note over the preceding year for which they have consulted their doctor .
    • How has their mood been? Has there been any problem with, or treatment for, depression?
  • Treatment:
    • How is the patient coping with and complying with their medication regimen for diabetes? Have there been any problems with injection of insulin? Have there been any problems with timing of insulin or oral medication? Do they miss injections or medication regularly?
  • Monitoring:
    • Are there any problems with the equipment that they have to monitor their capillary glucose? When did they last calibrate their glucose monitoring equipment?
    • Do they have their records of their blood glucose monitoring?
  • Pregnancy and pre-pregnancy
    • Are they pregnant or planning on having any children? It is essential to ensure effective pre-pregnancy care and care during the pregnancy.

  • Examination

  • Weight, abdominal circumference, height and BMI.
  • Urinalysis for ketones, protein and nitrite (evidence of infection).
  • Inspect injection sites of patients with type 1 diabetes, looking for evidence of lipoatrophy and lipodystrophy/lipohypertrophy.
  • Cardiovascular:
    • Check pulse and blood pressure.
    • Listen for carotid bruits and to heart sounds/lung fields if there is any history consistent with cerebrovascular or cardiac illness.
    • Palpate and record the peripheral pulses of the feet.
  • Eyes:
    • Ensure regular attendance and appropriate follow-up for diabetes eye screening.
    • Inspect eyes, looking for any evidence of xanthelasmata, cataract formation or ophthalmoplegia.
    • Check visual acuity, with distance vision glasses, if worn.
    • Carry out ophthalmoscopy, preferably with dilated eyes, unless this has already been done as part of the patient's diabetes ophthalmological screening and digital retinal photography programme.
  • Neuropathy:
    • Examine the legs for evidence of diabetic amyotrophy.
    • Check peripheral limb sensation.
    • Check ankle and knee reflexes using a tendon hammer.
    • Inspect footwearnd the feet carefully for any evidence of peripheral neuropathy causing deformity and ulceration, or hypoperfusion due to peripheral vascular disease.