DM Full Guideline (2010) - VA/DoD Clinical Practice Guidelines Home

Version 4.0
Evaluation
Component
VA/DoD Clinical Practice Guideline
for the Management of Diabetes Mellitus
History-Patient/Family Physical Examination Laboratory
Coronary and
Peripheral
Arterial
Disease/
Dyslipidemia
Neurovascular
Selfmanagement
education
Other
Educational Assessment
Atherosclerotic disease:
• Myocardial infarction (MI)/angina
• Stroke
• Transient ischemic attack (TIA)
• Claudication
• Surgical history of
revascularization
Atherosclerotic risks other than
diabetes:
• Smoking history
• Family history
• Previous diagnosis of
hyperlipidemia; triglycerides
Current and previous medications:
• Aspirin
• Estrogen therapy
• Hypolipidemics
Sensory state of:
• Hands and feet
Knowledge, understanding and self -
described behaviors of :
• Use of medication
• Goals of treatment
• Diet and self-management skills
• What to do in case of complications
• Dental history and oral exam
• Dental and gingival health
• Infections
• Insulin injection sites
• Immunizations: flu and pneumovax
• Cardiac examination:
• Heart
• Peripheral circulation
including pulses and
bruits
• Cutaneous or tendinous
xanthomata
• Interosseous muscle
wasting
• Deep tendon reflexes
Observation:
• Home glucose
monitoring, if indicated
• Foot self-examination
• Oral examination
• Electrocardiogr
am (EKG)
• Fasting lipid
profile, if not
done within the
last year
• Other
modalities as
indicated
The patient’s general knowledge and ability to adequately self-manage his or her diabetes can be assessed by asking
questions such as:
• Is there anything you do or have been advised to do because of your diabetes that you have difficulty with
or are unable to do?
• Do you know what to do when your sugar is high/low (describe both hyperglycemia and hypoglycemia
symptoms)? Who and when do you call?
• Do you remember your target goals: HbA 1 c, low-density lipoprotein (LDL), weight, exercise, and BP?
N/A
• Which food affects your blood sugar the most—chicken breast, salad, or potato?
The patient’s inability to answer these questions indicates a possible deficiency in knowledge and self-management
skills. (See Module M: Self-Management and Education for additional assessment tools.
Patients with DM who have more immediate medical or psychiatric problems should still undergo an educational
needs assessment. This evaluation will determine whether they have sufficient skills to manage their glycemic
control during a period of concurrent illness, with a goal of avoiding symptomatic hypo- or hyperglycemia.
N/A
N/A
N/A
N/A
Module D: Core Page 19