Comprehensive Workup for Newly Diagnosed Diabetes Mellitus
The recommended workup for newly diagnosed diabetes mellitus should include laboratory testing for glycemic control (HbA1c), assessment of complications (microvascular and macrovascular), evaluation of comorbidities, and screening for cardiovascular risk factors. 1
Initial Laboratory Assessment
Glycemic Evaluation
- HbA1c: If not available within past 3 months 1
- Fasting plasma glucose: Confirm diagnosis if not already established 1
- Consider OGTT: If diagnosis is uncertain or for gestational diabetes screening 1
Metabolic Evaluation
- Lipid profile: Total cholesterol, LDL, HDL, and triglycerides 1
- Liver function tests: To assess for NAFLD and baseline before medication 1
- Serum creatinine and estimated glomerular filtration rate (eGFR): To assess kidney function 1
- Urinary albumin-to-creatinine ratio: To screen for early diabetic nephropathy 1
- Serum potassium: Especially if planning ACE inhibitors or ARBs 1
- Thyroid-stimulating hormone: Particularly in type 1 diabetes due to increased risk of autoimmune thyroid disease 1
- Vitamin B12 levels: If patient will be started on metformin 1
Complication Screening
Microvascular Complications
- Comprehensive eye examination: Referral to ophthalmologist for dilated fundoscopic exam 1
- Comprehensive foot examination:
- Visual inspection for skin integrity, calluses, deformities, ulcers
- Vascular assessment (pedal pulses, consider ABI if diminished)
- Neurological assessment (10-g monofilament exam, vibration or pinprick sensation) 1
Macrovascular Risk Assessment
- Blood pressure measurement: Assess for hypertension 1
- Orthostatic blood pressure: When indicated 1
- Cardiovascular risk assessment: Based on lipid profile, blood pressure, smoking status, family history 1
Additional Assessments
Physical Examination
- Height, weight, and BMI calculation: Assess for obesity 1
- Waist circumference: To evaluate for central obesity 1
- Skin examination: Check for acanthosis nigricans (insulin resistance marker), insulin injection sites if applicable 1
- Thyroid palpation: Especially for type 1 diabetes 1
Psychosocial Assessment
- Screen for depression and anxiety: Common comorbidities in diabetes 1
- Assess for disordered eating: Particularly important in younger patients 1
- Evaluate social determinants of health: Food security, housing stability, transportation access, financial security 1
Vaccination Status
- Review vaccination history: Particularly important as diabetes increases risk of infections 1
- Ensure up-to-date on recommended vaccines: According to CDC guidelines for people with diabetes 1
Type-Specific Considerations
For Type 1 Diabetes Suspicion
- Islet autoantibodies: Consider testing for GAD65, insulin autoantibodies, IA-2, IA-2b, and ZnT8 antibodies 1
- C-peptide levels: To assess endogenous insulin production 1
For Gestational Diabetes
- 75-g OGTT: For diagnosis at 24-28 weeks gestation 1
- Risk assessment: Early screening for high-risk individuals (obesity, prior GDM, family history) 1
Management Planning
Medication Considerations
- Assess contraindications to first-line therapies: Particularly metformin (kidney function, liver disease) 1
- Consider insulin needs: Especially for symptomatic patients or very high glucose levels 1
Education and Support
- Diabetes self-management education: Essential at diagnosis 1
- Nutritional counseling: Referral to registered dietitian 1
- Physical activity assessment and recommendations: Aim for at least 150 minutes/week of moderate-intensity activity 1
Follow-up Planning
- Establish monitoring schedule: HbA1c testing every 3 months until target achieved, then at least twice yearly 1
- Blood glucose monitoring plan: Determine frequency based on medication regimen and glycemic control 1
- Complication screening schedule: Annual eye exams, foot exams, kidney function tests 1
Common Pitfalls to Avoid
- Incomplete complication screening: Ensure comprehensive assessment of all potential complications
- Overlooking comorbidities: Screen for common comorbidities like hypertension, dyslipidemia, and NAFLD
- Inadequate education: Ensure patients receive proper education about their condition and self-management
- Focusing only on glucose control: Address all cardiovascular risk factors comprehensively
- Missing type-specific workup: Consider specific tests based on suspected diabetes type
This comprehensive approach ensures proper diagnosis, early detection of complications, and appropriate treatment planning for patients with newly diagnosed diabetes mellitus.