What questions should be included in a focused diabetes history of established type 2 diabetes mellitus (DM)?

Updated: Oct 23, 2019
  • Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD  more...
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Answer

In patients with known type 2 diabetes, inquire about the duration of the patient's diabetes and about the care the patient is currently receiving for the disease. The duration of diabetes is significant because the chronic complications of diabetes are related to the length of time the patient has had the disease.

A focused diabetes history should also include the following questions:

  • Is the patient's diabetes generally well controlled (with near-normal blood glucose levels) - Patients with poorly controlled blood glucose levels heal more slowly and are at increased risk for infection and other complications

  • Does the patient have severe hypoglycemic reactions - If the patient has episodes of severe hypoglycemia and therefore is at risk of losing consciousness, this possibility must be addressed, especially if the patient drives or has significant underlying neuropathy or cardiovascular disease

  • Does the patient have diabetic nephropathy that might alter the use of medications or intravenous (IV) radiographic contrast material

  • Does the patient have macrovascular disease, such as coronary artery disease (CAD) that should be considered as a source of acute symptoms

  • Does the patient self-monitor his or her blood glucose levels - If so, note the frequency and range of values at each time of day

  • When was the patient's hemoglobin A1c (HbA1c; an indicator of long-term glucose control) last measured, and what was it

  • What is the patient’s immunization history - Eg, influenza, pneumococcal, hepatitis B, tetanus, herpes zoster

As circumstances dictate, additional questions may be warranted, as follows:

  • Does the patient give a history of recent polyuria, polydipsia, nocturia, or weight loss - These are symptoms of hyperglycemia

  • Has the patient had episodes of unexplained hypoglycemia - If so, when, how often, and how does the patient treat these episodes

  • Does the patient have hypoglycemia unawareness (ie, does the patient lack the adrenergic warning signs of hypoglycemia) - Hypoglycemia unawareness indicates an increased risk of subsequent episodes of hypoglycemia

  • Regarding retinopathy, when was the patient's last dilated eye examination, and what were the results

  • Regarding nephropathy, does the patient have known kidney disease; what were the dates and results of the last measurements of urine protein and serum creatinine levels

  • Does the patient have hypertension (defined as a blood pressure of >130/80); what medications are taken

  • Does the patient have CAD

  • Regarding peripheral vascular disease, does the patient have claudication or a history of vascular bypass

  • Has the patient had a stroke or transient ischemic attack

  • What are the patient's most recent lipid levels; is the patient taking lipid-lowering medication

  • Does the patient have a history of neuropathy or are symptoms of peripheral neuropathy or autonomic neuropathy present (including impotence if the patient is male)

  • Does the patient have a history of foot ulcers or amputations; are any foot ulcers present

  • Are frequent infections a problem; at what site


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