Guidelines for Frequency of
Lab Tests & Examinations
Clinic visit at least every 3 months for those who are not meeting LDL cholesterol, blood glucose, or blood pressure goals; on new therapy; on insulin therapy; or with evidence of progression of microvascular or macrovascular diseaseAt least every 6 months for those who are meeting blood glucose and blood pressure goals, are not on new therapy, and do not have evidence of progressionof microvascular or macrovascular disease.
- Hemoglobin A1c Same as for clinic visit above
- Blood Glucose Patient self-monitoring blood glucose (SMBG) records are acceptable (Appendix I) If patient is not self-monitoring blood glucose, test when fasting at each clinic visit and correlate with A1C
- Blood Pressure 1 Check and record at every visit
- Foot Exams 2 Screen feet annually: foot inspection, 10g monofilament exam, and 1 of 3 other neurosensory tests (pp 31-32; Appendix D)If High Risk: Visually inspect at every visit
- Dilated Eye Exam 3,4 Annually for most patients with non-proliferative diabetic retinopathy (NPDR) or microaneurysms, biennially for patients in good control and with a normal exam with advice from an ophthalmologist or optometrist (see Appendix F)
- Microalbumin/Creatinine Ratio 4,5 Annually for patients without chronic kidney disease diagnosis
- Serum Creatinine Annually, more often if chronic kidney disease diagnosis
- Fasting Lipid Profile Annually (non-fasting may be acceptable6)
- Influenza Vaccine Annually
- Pneumococcal Vaccine See page 39
- Self-managementEducation 1. Upon diagnosis2. When there are significant changes in therapy, the patient is not meeting targets, for pre-pregnancy counseling, or newly-diagnosed gestational diabetes3. Annually reassess need for education
- Dental Exam Every six months for preventive care
- Tobacco Use During each visit; advise quitting and refer to cessation services (see Appendix G)
- See section on hypertension (pgs. 18-26)
- Refer to “Feet Can Last a Lifetime” packet for additional foot screening information (www.ndep.nih.gov).
- Exception: Examine when planning pregnancy if possible and in first trimester with close follow-up
- Exception: Screen in first trimester in pregnancy
- See section on nephropathy (pgs. 33-35)
- Van Dieren et al. Non-fasting lipids and risk of cardiovascular disease in patients with diabetes mellitus.
Jan;54(1):73-7. Epub 2010 Oct 20.ReferenceDOI 10.1007/s00125-010-1945-z