What is the best way to present a complex diabetic patient in a structured manner?

From the Guidelines

The best way to present a complex diabetic patient is to use a comprehensive medical evaluation and assessment approach, as outlined in the Standards of Medical Care in Diabetes-2022, which includes a thorough initial evaluation, follow-up visits, and ongoing management guided by the assessment of diabetes complications and shared decision making to set therapeutic goals. This approach ensures that all aspects of diabetes management are addressed, including diabetes history, family history, personal history of complications and common comorbidities, high blood pressure or abnormal lipids, macrovascular and microvascular complications, hypoglycemia awareness, presence of hemoglobinopathies or anemias, and last dental visit and dilated eye exam 1.

Key Components of the Comprehensive Medical Evaluation

• Initial visit: comprehensive diabetes medical evaluation, including diabetes history, family history, personal history of complications and common comorbidities, and high blood pressure or abnormal lipids
• Follow-up visit: interval medical history, assessment of medication-taking behavior and intolerance/side effects, physical examination, laboratory evaluation, and assessment of risk for complications
• Ongoing management: guided by the assessment of diabetes complications and shared decision making to set therapeutic goals, with a focus on patient-centered collaborative care and a multidisciplinary team approach 1

Structured Presentation Approach

The SOAP format (Subjective, Objective, Assessment, Plan) can be used to present a complex diabetic patient, with special attention to diabetes-specific elements, including:

• Subjective: symptoms, medication adherence, hypoglycemic episodes, diet compliance, exercise habits, and self-monitoring data
• Objective: vital signs, BMI, physical exam findings, and laboratory results
• Assessment: summarize glycemic control status, complications, comorbidities, and identify key issues requiring attention
• Plan: detail specific medication adjustments, lifestyle modifications, education needs, referrals, and follow-up timing 1

Importance of Patient-Centered Care

Patient-centered care is essential in the management of complex diabetic patients, with a focus on patient engagement, shared decision making, and a multidisciplinary team approach 1. This approach ensures that the patient's individual needs are addressed, and that they are empowered to take an active role in their care. By using a comprehensive medical evaluation and assessment approach, and presenting the patient in a structured and organized manner, healthcare providers can ensure that all aspects of diabetes management are addressed, and that the patient receives high-quality, patient-centered care.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Presenting a Complex Diabetic Patient

To present a complex diabetic patient in a structured manner, consider the following key points:

• Initial Management: The initial management of diabetes involves controlling hyperglycemia, correcting fluid and electrolyte imbalances, and avoiding hypoglycemia 2.
• Patient Assessment: A thorough physical examination is essential to identify patients at risk for complications of diabetes and to classify the type of diabetes 3.
• Disease Knowledge: Assessing the patient's baseline disease knowledge is crucial, including their understanding of the disease, its risk factors, signs/symptoms, related complications, and suitable diet 4.
• Treatment Approach: A patient-centered approach to treatment is recommended, with consideration of the patient's individual needs and goals 5.
• Audit and Evaluation: Regular audit and evaluation of diabetes care are necessary to identify areas for improvement and to ensure optimal patient outcomes 6.

Key Components of Presentation

When presenting a complex diabetic patient, include the following key components:

• Medical History: A detailed medical history, including the patient's diagnosis, treatment, and any complications 2.
• Physical Examination: A thorough physical examination to identify any signs of complications or comorbid conditions 3.
• Laboratory Results: Relevant laboratory results, such as blood glucose levels and lipid profiles 5.
• Treatment Plan: A clear treatment plan, including any medications, lifestyle modifications, and monitoring requirements 2.
• Patient Education: An assessment of the patient's understanding of their disease and treatment, and any educational needs 4.