Management of type 2 diabetes: A handbook for general practice

Assessment of the patient with type 2 diabetes

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Last revised: 17 Sep 2020

A detailed assessment of the person with diabetes should be made at diagnosis. The aim of the assessment is to provide a whole-of-person evaluation to determine and understand which factors are affecting the patient’s health and quality of life.
Individualised planning for ongoing care should also be developed at this stage, including negotiated goals and expectations.

This assessment should include:

  • a full medical and psychosocial history
  • appropriate physical assessment
  • assessment for complications and cardiovascular risk status
  • investigations where required.

A comprehensive list of assessment components, including intervals of assessment, is provided in tables 1–3. Refer also to Box 1 for the Medicare Benefits Schedule (MBS) diabetes ‘cycle of care’ minimum requirements. Suggestions for which members of the multidisciplinary team should carry out components of assessment are shown in Table 4.

Aboriginal and Torres Strait Islander point1

In Aboriginal and Torres Strait Islander patients, the development of rapport may take precedence over a detailed assessment in a single consultation. An assessment could be done over several visits.

Developing a doctor–patient (or patient–healthcare worker) relationship based on trust and respect is the best way of overcoming cultural barriers and ensuring effective care in the long term.

The purpose of ongoing structured assessment is to determine the impact of care and diabetes on the life of the person with diabetes. Ongoing assessment appointments should include:

  • a history and examination to assess the impact of clinical management (Table 1)
  • review and re-evaluation of the person’s diabetes goals, individualised targets and risk factors (Table 2)
  • refining of the management plan (including a review of medication using the principles of the ‘review rule’ (refer to the section ‘Medical management of glycaemia’).

Specific areas for ongoing or intermittent review might include:

  • patient support, such as structured education about self-management (eg with a credentialled diabetes educator)
  • emotional issues, including diabetes-specific distress and/or depressive symptoms
  • need for allied health/specialist intervention (eg psychologist, accredited practising dietitian)
  • pregnancy planning and contraception
  • other diabetes-related issues (eg risks and complications) identified earlier
  • medication/therapy
  • review every three or six months, following the principles of the ‘review rule’ (refer to the section ‘Medical management of glycaemia’)
    • adjust agent, dose, combination or de-prescribe
    • if necessary, specifically ask about symptoms of hypoglycaemia
  • complication management – is specific intervention/support/referral indicated?

Measure glycated haemoglobin (HbA1c) on an individual basis:

  • three-monthly in newly diagnosed patients, patients undergoing therapeutic changes or those whose HbA1c is outside their individualised target range
  • less frequently, if appropriate, in stable patients who have reached agreed targets.

Base further investigations on re-evaluated clinical symptoms and history.

Routine investigations are best organised before the review appointment.

The annual review is an opportunity to coordinate care. It may involve:

  • detailed assessment
  • updating the problem priority list
  • re-establishing goals
  • checking agreed arrangements for management.

Additionally, general practitioners (GPs) should:

  • renew team care planning with identified specific interventions
  • work with the patient to identify therapeutic management changes and additional education goals
  • organise appropriate referral where clinically necessary. Some patients may require ongoing specialist or other allied health reviews.

Box 1. Medicare Benefits Schedule (MBS) diabetes ‘cycle of care’ minimum requirements2

At least six-monthly:

  • Measure weight, height and body mass index (BMI)
  • Measure blood pressure
  • Assess feet for complications

At least annually:

  • Review and discuss diet, physical activity, smoking status, medications (need for more frequent review should be individualised, as outlined in Table 1)
  • Assess diabetes management by measuring HbA1c
  •  Review and discuss complication prevention – eyes, feet, kidneys cardiovascular disease (CVD)
  • Measure total cholesterol, triglycerides and high-density lipoprotein (HDL) cholesterol
  • Assess for microalbuminuria

At least every two years:

  • Comprehensive eye examination (more frequently for those at high risk)
 Medical history and ongoing assessments for the person with type 2 diabetes

Table 1.

 Medical history and ongoing assessments for the person with type 2 diabetes
 

 Medical examinations to assess the person with type 2 diabetes

Table 2.

 Medical examinations to assess the person with type 2 diabetes

 Investigations for diabetes and multimorbidity

Table 3.

Investigations for diabetes and multimorbidity
 

 Suggested actions and health professionals to provide treatment or service

Table 4.

Suggested actions and health professionals to provide treatment or service
 
  1. McBain-Rigg KE, Veitch C. Cultural barriers to health care for Aboriginal and Torres Strait Islanders in Mount Isa. Aust J Rural Health 2011;19(2):70–74.
  2. Department of Health. MBS Online: Medicare Benefits Schedule – Item 2517. Canberra: DoH, [date unknown] [Accessed 1 April 2020].