DM Monitoring: Physical Exam

Question 1

What is the frequency for checking height, weight, and BMI of DM patients? For which group is this especially important?

Answer 1

Frequency:
- every visit

Adolescents:
- to monitor for growth and pubertal development

Question 2

How often should DM patients’ blood pressure be checked? What should their BP goal be?

Answer 2

Frequency: Every visit

Goal: < 140/90 mmHg
OR
< 130/80 mmHg if “easily achieved”

Question 3

How often should a foot exam be performed on diabetic patients?

Answer 3

• Every 3 months
• Every visit if:
  • PVD or
  • neuropathy

Question 4

What elements should be included with a foot exam performed on diabetic patients?

Answer 4

Inspection and palpation of pulses with ABI, if indicated:
- dorsalis pedis
- posterior tibial

Assess reflexes:
- patellar
- Achilles

Determination of:
- proprioception
- vibration
- monofilament sensation

Question 5

How often should a dilated eye exam be performed on diabetic patients?

Answer 5

TIDM: 5 years after diagnosis
T2DM: annually at onset

Ask patient to bring a copy of the report to PCP appointment

Question 6

How often should a fundoscopic exam be performed on diabetic patients?

Answer 6

At diagnosis

NOTE: Fundoscopic exam does NOT substitute for dilated eye exam

Question 7

How often should thyroid palpation be performed on diabetic patients and how should it be evaluated?

Answer 7

• at diagnosis
• annually

Evaluation is per clinical judgment

Question 8

How often should skin examination be performed on diabetic patients and which conditions might be expected?

Answer 8

Frequency:
- at diagnosis
- annually

Conditions:
- acanthosis nigricans
- fungal infections

Question 9

How often should a dental examination be performed on diabetic patients and why?

Answer 9

Frequency: annually

Why: periodontal disease is more severe in patients who have DM