Management of type 2 diabetes: A handbook for general practice

Assessment of the person with type 2 diabetes

Management of type 2 diabetes: A handbook for general practice
Download PDF

Assessment of the person 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 their 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 diabetes ‘cycle of care’ minimum requirements. Suggestions as to which members of the multidisciplinary team should perform components of assessment are provided in Table 4.

Aboriginal and Torres Strait Islander people 

In supporting an Aboriginal and Torres Strait Islander person with diabetes, the development of rapport may take precedence over a detailed assessment in a single consultation. An assessment could be done over several visits.1 

Developing a clinician–person with diabetes relationship based on trust and respect is the best way of overcoming cultural barriers and ensuring effective care in the long term. 

Refer to the National Aboriginal Community Controlled Health Organisation (NACCHO) and The Royal Australian College of General Practitioners National guide to  preventive healthcare for Aboriginal and Torres Strait Islander people.2 

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, particularly focusing on the risks of cardiovascular, renal and diabetes complications (Table 2) 
  • refining of the management plan (including a review of medication using the principles of the ‘review rule’; refer to ‘Medical management of glycaemia’). 

Specific areas for ongoing or intermittent review might include: 

  • diabetes literacy and glycaemic management, such as structured education about self-management (with a credentialled diabetes educator [CDE]) 
  • emotional issues, including diabetes-specific distress and/or depressive symptoms 
  • the need for allied health/specialist intervention (eg psychologist, accredited practising dietitian [APD]) 
  • 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 ‘Medical management of glycaemia’) 
    • ask about adherence and side effects; consider the choice of therapies, dose, combination or deprescribing 
    • if necessary, specifically ask about symptoms of hypoglycaemia 
  • complication management – is specific intervention/change to glycaemic or other therapeutic management needed/referral indicated? 

Measure glycated haemoglobin (HbA1c) on an individual basis: 

  • three-monthly in newly diagnosed people, people undergoing therapeutic changes or those whose HbA1c is outside their individualised target range 
  • less frequently, if appropriate, in people with stable blood sugar levels who have reached agreed targets 
  • review the use of self-monitoring of blood glucose (SMBG) or continuous glucose monitoring (CGM; if used) and target ranges. 

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

Routine investigations are best organised before the review appointment. 

The annual review (Box 1) is an opportunity to coordinate care. It may involve: 

  • detailed assessment and review for specific complications or onset of multimorbidity 
  • updating the problem priority list 
  • re-establishing goals 
  • checking agreed arrangements for management. 

In addition, general practitioners (GPs) should: 

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

Box 1. The diabetes cycle of care3 

At least six-monthly: 

  • Measure weight, height, weight circumference and body mass index 
  • Measure blood pressure 
  • Assess diabetes management by measuring HbA1c (funded by the Medicare Benefit Schedule for up to four measurements per year) 
  • Assess feet for complications 

At least annually: 

  • Review and discuss diet, physical activity, smoking status, medications (the need for more frequent review should be individualised, as outlined in Table 1) 
  • Sick-day management and, when indicated, glucose monitoring 
  • Review and discuss complication prevention – eyes, feet, kidneys, cardiovascular disease 
  • Measure total cholesterol, triglycerides and high-density lipoprotein cholesterol (interval may be less [eg six monthly] if adjusting therapy) 
  • Assess for microalbuminuria 

In addition, consider assessment for: 

  • Psychosocial issues or other individual specific concerns and include assessment for diabetes distress or depression 
  • Review vaccination status and provide guidance of appropriate preventive activities 

At least every two years: 

  • Undertake a comprehensive eye examination (more frequently for those at high risk) 

Table 1. Medical history and ongoing assessments for the person with type 2 diabetes4 

Components for assessment 

Assessment interval 

Initial 

Ongoing 

Annual 

Diabetes-specific assessment 

Age/year of diagnosis 

      

Symptoms 

  • Hypoglycaemia 
  • Hyperglycaemia 
    • Polyuria, polydipsia, polyphagia, weight loss, nocturia 
  • Sequelae of hyperglycaemia and complications of diabetes 
  • Malaise/fatigue 
  • Neurological and autonomic symptoms 
  • Altered vision 
  • Bladder and sexual dysfunction 
  • Foot and toe numbness and pain 
  • Recurrent infections (especially urinary and skin with delayed wound healing) 
  • Gastrointestinal dysfunction (eg gastroparesis and nausea) 
  • Poor dental hygiene and gingivitis (refer to ‘Managing multimorbidity in people with type 2 diabetes’) 
  

Three-monthly or individualised 

  

Predisposing factors 

Pancreatic disease, Cushing’s disease, obstructive sleep apnoea 

Medications (eg corticosteroids, antipsychotics; see below) 

Autoimmune diseases (eg hypothyroidism or hyperthyroidism) 

  

Individualised

  

Other medical history 

Gestational diabetes 

      

Other secondary causes (eg pancreatic disease) 

      

Multimorbidities 

  • Overweight and obesity 
  • Hypertension 
  • Hyperlipidaemia 
  • Cardiovascular disease 
  • MALFD 
  

Three-monthly or individualised 

  

Complications 

  • Eye

For those at high risk, refer to ‘Defining and diagnosing type 2 diabetes’ 

    

Every two years; more frequently for those at high risk 

Complications 

      

Family history 

Haemochromatosis 

      

Gestational diabetes 

  

Individualised 

  

Psychosocial history

Lifestyle 

  • Physical activity 
  • Smoking 
  • Diet 
      

Emotional and mental health 

  

Individualised 

  

Medications 

Past and current medications 

Complementary therapies 

  

Individualised 

  

Other therapy, glucose monitoring and technology 

  • Role of routine and non-routine SMBG 
  • Use of technology
  

Individualised 

  

Immunisations* 

As per the National Immunisation Program/ATAGI 

  

Individualised 

  

Pregnancy and contraception 

Pregnancy planning 

Contraceptive use 

  

Individualised 

  

Other* 
 

Individualised 

  

*For more information, refer to the discussion of immunisations in ‘Managing risks and other impacts of type 2 diabetes’. 

ATAGI, Australian Technical Advisory Group on Immunisation; MALFD, metabolic-associated fatty liver disease; NDSS, National Diabetes Services Scheme; SMBG, self-monitoring of blood glucose. 

 

Table 2. Medical examinations to assess the person with type 2 diabetes4 

Components for examination 

Examination intervals 

Initial 

Ongoing 

Annual 

Physical 

General 

  • BMI 
  • Waist circumference (cm) 
  • Blood pressure 
  • Central and peripheral vascular systems 
  

Individualised 

  

Complications of diabetes 

  • Feet: Stratify the risk of developing foot complications (refer to ‘Complications: Diabetes-related foot care’) 
  • Peripheral nerves: Tendon reflexes, sensation (touch [eg 10-g monofilament] and vibration [eg 128-Hz turning fork]), existence of peripheral neuropathic changes 
  • Heart: consider ECG if arrhythmia detected (eg atrial fibrillation in those aged >65 years) 
  • Sexual dysfunction: Both male and female sexual dysfunction 
  • Eyes: Such as acuity, cataract, retinopathy (refer to ‘Complications: Diabetes-related eye disease’) 
  • Skin: Lipohypertrophy or dystrophy, acanthosis nigricans, mycotic infections 
  

Individualised 

 

(eyes every 2 years) 

Psychological 

Depressive symptoms 

  • Patient Health Questionnaire (PHQ)-2 
  • If PHQ-2 score ≥3, progress to PHQ-9 Diabetes distress 
  • Problem Areas in Diabetes (PAID) 
  • Diabetes Distress Scale (DDS) 
  • Cognitive assessment when indicated 

Refer to ‘Type 2 diabetes and mental health’ 

  

Individualised 

  

BMI, body mass index; CVD, cardiovascular disease; ECG, electrocardiogram 

 

Table 3. Investigations for diabetes and multimorbidity4 

Components for examination 

Assessment interval 

Initial 

Ongoing 

Annual 

 HbA1c 

Note: variance factors may affect the accuracy of this result. Refer to ‘Diagnosing type 2 diabetes’. 

  

Three to six monthly 

  

Lipids 

LDL-C, HDL-C, TC, TG 

Absolute CVD risk assessment if needed for primary CVD prevention 

  

Individualised 

  

Urinalysis 

Urine ACR at least annually: 

  • Microalbuminuria ACR ≥2.5 mg/mmol (men) or ≥3.5 mg/mmol (women), or albumin concentration ≥20 mg/L 

  • Proteinuria (macroalbuminuria) ACR ≥25 mg/mmol (men) or ≥35 mg/mmol (women) 

  

Individualised if abnormal 

  

eGFR 

Normal levels are reported as >90 mL/min/1.73 m2; refer to the section ‘Complications: Diabetes-related chronic kidney disease’ for criteria of CKD stages 

  

Individualised if abnormal 

  

Other as appropriate for symptomatic presentation or existence of comorbidity or multimorbidity (eg vitamin B12 deficiency if on prolonged metformin therapy) 

 

 

 

ACR, albumin-to-creatinine ratio; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; TC, total cholesterol; TG, triglyceride. 

 

Table 4. Suggested actions and health professionals to provide treatment or service 

Suggested actions 

Suggested team resource: Who?* 

Ask 

Symptoms 

GP 

Goal-setting supporting self-management, including lifestyle factors, health literacy and adherence, medication tolerance 

GP/practice nurse/CDE 

Complication concerns (eg chest pains, palpitations, neuropathy symptoms, sleep disorders) 

GP/practice nurse/CDE 

Glycaemic management – if self monitoring 

GP/practice nurse/CDE 

Assess (inclusive within an annual cycle of care) 

Risk factors for modification 

GP/practice nurse/CDE 

Weight, height 

GP/practice nurse/CDE 

Cardiovascular disease risk assessment, including blood pressure 

GP/practice nurse/CDE 

Foot examination 

GP/podiatrist/practice nurse/CDE

The presence of other complications, especially hypoglycaemia risk with insulin or sulfonylureas 

GP/practice nurse/endocrinologist/CDE 

Psychological status 

GP/psychologist/CDE 

Eye examination 

GP/optometrist/ophthalmologist 

Dental review 

GP/dentist 

Medication review 

GP/credentialled pharmacist 

Consider other assessments where appropriate (eg cognitive impairment, obstructive sleep apnoea) 

GP/endocrinologist/other specialist (where indicated) 

Advise 

Review smoking, nutrition, alcohol, physical activity (SNAP) profiles, including specific issues 

GP/practice nurse/CDE 

Nutrition 

GP/APD 

Physical activity levels 

GP/AEP/physiotherapist 

Pregnancy planning and contraception, including NDSS six-month blood glucose strip access 

GP/endocrinologist/obstetrician/CDE 

Driving 

GP/endocrinologist/other specialist/CDE 

Immunisation 

GP/practice nurse/CDE 

Sick-day management 

GP/practice nurse/CDE 

Medication issues 

GP/pharmacist/CDE/endocrinologist 

Self-monitoring of blood glucose 

GP/CDE/practice nurse 

Insulin/injectable management 

GP/CDE/accredited nurse practitioner/endocrinologist 

Assist 

Register for NDSS/review NDSS resources 

GP/practice nurse/CDE/nurse practitioner 

General practice management plan and chronic disease management plan 

GP/practice nurse 

Cultural and psychosocial issues 

GP/Aboriginal and/or Torres Strait Islander health workers and practitioners*/interpreter service/social worker/CDE/psychologist 

Arrange 

Addition to the practice’s diabetes register and recall 

GP/practice nurse/practice staff 

Organise reviews, including pathology, vaccination and annual cycle of care 

GP/practice nurse 

Driver’s licence assessment 

GP/practice nurse/endocrinologist (when indicated) 

*An Aboriginal and/or Torres Strait Islander health worker and/or practitioner is recommended to assist with all actions supporting Aboriginal and Torres Strait Islander people. 

AEP, accredited exercise physiologist; APD, accredited practising dietitian; CDE, credentialled diabetes educator; GP, general practitioner; NDSS, National Diabetes Services Scheme. 
  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. National Aboriginal Community Controlled Health Organisation and The Royal Australian College of General Practitioners (RACGP). National guide to preventive healthcare for Aboriginal and Torres Strait Islander people. 4th edn. RACGP, 2024.
  3. National Diabetes Services Scheme (NDSS). Your diabetes annual cycle of care fact sheet. NDSS, 2021 [Accessed 2 September 2024].
  4. American Diabetes Association Professional Practice Committee. 4. Comprehensive medical evaluation and assessment of comorbidities: Standards of care in diabetes – 2024. Diabetes Care 2023;47(Supplement_1):S52–76. doi: 10.2337/dc24-s004.
This event attracts CPD points and can be self recorded

Did you know you can now log your CPD with a click of a button?

Create Quick log


 

Related documents

Advertising