Assessment of the patient with type 2 diabetes

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.

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.