Check for diabetes complications

Perform a careful history and physical examination in all patients with hyperglycemia to evaluate for the complications of diabetes.

In the patient history, document key items regarding risk factors for diabetes, history of diabetes, and complications of diabetes, including:

• Medication history, including the use of antihyperglycemic agents in the past, including during hospitalizations
• Cardiovascular risk factors
• Diet and exercise
• Infections, particularly fungal infections, recurrent urinary tract infections, or non-healing skin infections
• Other endocrine disorders, including thyroid and adrenal disorders
• Visual disturbances
• Neuropathic pain, especially in the feet

In the physical exam, document key items that are manifestations of diabetes or its complications, including:

• Height and weight for calculation of BMI
• Blood pressure and pulse
• Skin exam for acanthosis nigricans or striae
• Eye exam for retinopathy, macular edema, glaucoma, cataracts (dilated exam should be done by specially trained personnel or by an ophthalmologist)
• Thyroid exam
• Cardiac exam
• Foot exam including sensory exam

This content is from ACP Smart Medicine, the College's new Web-based clinical decision support tool developed specifically for internal medicine physicians. Information about ACP Smart Medicine is online.