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Edited and written by Yimaitong, please do not reprint without authorizati.
From the top of the mouth to the bottom of the feet, the skin and the heart are examined from the outsi.
A "perfect" physical examination for diabetes should include these 9 items! Diabetic complications such as "sugar heart", "sugar kidney", and "sugar foot" are an important health burden for patien.
A complete physical examination can help detect the clues of diabetic complications in the early stage of the disease, so as to intervene as soon as possib.
Eye exams ➤Type 1 diabetes: First visit within 5 years of diagnosis, then at least every 1-2 years; ➤Type 2 diabetes: Check at diagnosis, then at least every 1-2 yea.
Diabetic retinopathy (DR) is the leading cause of blindness in people with diabet.
In the early stage of DR, the symptoms are often not obvious, and obvious symptoms will not appear until macular edema or proliferative retinopathy, which highlights the importance of early screeni.
Considering the course of disease, blood sugar control, hypertension, hyperlipidemia, nephropathy, and neuropathy will all contribute to the occurrence of DR, ophthalmological examination should be an essential item for high-risk patien.
Oral exams are recommended at every vis.
There is increasing evidence that oral health and diabetes have a close "two-way" relationship: oral disease increases the difficulty of blood sugar control, which in turn increases the risk of oral disease, and curing periodontal disease helps improve blood sug.
contr.
This close relationship underscores the need for people with diabetes to undergo oral exa.
If the patient is found to be accompanied by early symptoms of periodontitis/gingivitis such as bad breath, swollen gums, bleeding, e.
, it is recommended to go to the dentist for further evaluation and manageme.
Skin examination is recommended at every vis.
Data show that 30% to 91% of people with diabetes experience at least one skin disease complication in their lifeti.
Common skin diseases ➤Acanthosis nigricans: Acanthosis nigricans is a common disease characterized by dark red velvet-like plaques in the armpits, groin, and back of the ne.
There is usually no noticeable sensation, but in rare cases there may be pain, odor, or infiltrati.
Acanthosis nigricans is divided into benign and malignant, both of which have similar clinical and histological manifestatio.
Benign acanthosis nigricans commonly occurs in patients with type 2 diabetes and obesi.
In addition, patients with insulin resistance, polycystic ovary syndrome, lipodystrophy, acromegaly, and Cushing's syndrome may also develop acanthosis nigrica.
➤ Diabetic skin disease: Also known as tibial plaques or hyperpigmented pretibial plaques, it affects about half of people with diabetes, especially those with complications from microangiopat.
Diabetic dermatosis presents as multiple insensitive, round, dark red to pink papules or plaques, mostly on the pretibial sk.
Lesions develop within 1 to 2 weeks into well-circumscribed, atrophic brown spots and plaques that are finely sca.
➤Vitiligo: Vitiligo is a chronic depigmented skin disease that can occur anywhere on the body, especially the face, genitals, and han.
Skin lesions range in size from a few millimeters to a few centimeters and usually have a well-defined bord.
Patients with type 1 diabetes were more likely to develop vitiligo than those with type 2 diabetes (6% .
4.
➤ Psoriasis: Psoriasis is a relatively common chronic inflammatory skin disease with systemic manifestations that presents with itchy, scaly manifestations, most commonly on the knees, elbows, trunk, and sca.
Injection site reactions If the rotation is not appropriate, fat changes may occur at the insulin injection site, manifesting as small dimples or pits, also known as lipodystrophy, which may lead to insufficient insulin absorption and poor blood sugar contr.
In addition, the advent of new devices such as continuous glucose monitoring sensors and insulin pumps has increased the likelihood of allergic skin reactions, lipodystrophy, and skin infections, mainly manifested as hives, eczema, skin redness, and uneven fat distributi.
To a large extent, it has become an obstacle to the use of the device, and it is also the main reason for discontinuati.
Fungal infections Diabetic patients may develop recurrent fungal infections such as tinea corporis and onychomycos.
➤ Tinea corporis: Appears as annular plaques or plaques that appear as pruritic, round, oval, erythematous, or hyperpigmented, scaly lesions that spread centrifugal.
➤Onychomycosis: is a common fungal infection of the nai.
Bacterial infection In diabetic patients, staphylococcus and beta-hemolytic streptococcus infections are the most common bacterial skin infections, severe gangrene and even necrotizing fasciitis can occ.
➤ Gangrene: Commonly seen in diabetic foot infections, it is divided into dry gangrene and wet gangrene: Dry gangrene is characterized by a hard and dry skin texture with clear boundaries between healthy tissue and necrotic tissue, usually affecting the distal ends of the toes and fingers; wet gangrene is manifested as Wetness, severe swelling, and blisters are a surgical emergen.
➤ Necrotizing fasciitis: It is a surgical emergency and can manifest as erythema, edema, severe pain, twist lines, skin bullae, necrosis, or ecchymos.
Systemic symptoms include fever, tachycardia, and hypotensi.
Thyroid examination ➤Type 1 diabetes: expected at the time of diagnosis, and then once a year; ➤Type 2 diabetes: once a ye.
In outpatient settings, simple palpation of the thyroid can reveal diffuse enlargement involving the isthmus and lateral lobes of the thyroid, and goiters suggest Hashimoto's thyroiditis (the most common autoimmune thyroid disease) and Grave's disease (a hyperthyroid conditio.
autoimmune cause.
Physicians should consider the need for further biochemical evaluati.
The 2020 ADA guidelines recommend that patients with type 1 diabetes should be screened for autoimmune thyroid disease at the time of diagnosis of diabet.
Thereafter, it is assessed annual.
For people with type 2 diabetes, annual thyroid evaluation is recommend.
Blood pressure is recommended to be checked at every vis.
Data show that 20% to 60% of diabetic patients may be accompanied by hypertensi.
Hypertension is closely related to the increased risk of macrovascular and microvascular diseas.
Rational antihypertensive treatment can help reduce cardiovascular risk and protect renal functi.
Therefore, the patient's blood pressure should be measured at each vis.
Setting of blood pressure goals The 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines for hypertension and the American Diabetes Association (ADA) standard of care for diabetes recommend: ➤ For diabetes with vascular sclerosing cardiovascular disease (ASCVD) or 10 For patients with an annual ASCVD risk equal to or greater than 15%, the blood pressure target can be set to <130/80mmHg under the premise of safety; ➤ For patients with diabetes and hypertension with a low 10-year cardiovascular risk (less than 15%) , the blood pressure target can be set to <140/90mm.
Standardized process of blood pressure detection Before the test, rest for at least 5 minutes, the patient is sitting, the arm is flush with the heart, and the appropriate cuff size should be selected according to the circumference of the upper arm, and the measurement should be repeat.
Other modalities of blood pressure monitoring, such as home blood pressure self-monitoring and 24-hour ambulatory blood pressure monitoring, can help avoid the white coat effe.
Body mass index and waist circumference are recommended at every vis.
Overweight/obesity is an important risk factor for the occurrence and development of diabet.
The risk increases with the increase of obesity, and weight loss brings many benefi.
In the process of diagnosis and treatment, it is recommended to regularly track the patient's weight and waist circumference, and make recommendations for clinical manageme.
Body mass index Body mass index (BMI) = weight (kg)/height (m) squared Table 1 BMI index and obesityWaist circumference to prevent abdominal obesity, it is recommended that the waist circumference of men should not exceed 85 cm; the waist circumference of women should not exceed 80 .
Cardiovascular examination Cardiovascular complications are the leading cause of death in patients with diabet.
On physical examination, patients with tachycardia, irregular heart rate, third or fourth heart sound, heart murmur (eg, mitral regurgitation or ventricular septal defect), hyper/hypotension, lower extremity edema, and jugular venous pressure Elevated levels suggest cardiovascular disea.
In addition, abnormal pulse may suggest peripheral arterial disease (PA.
The manifestations of PAD include abnormal pulse, audible noise, unhealed lower extremity wounds, delayed capillary return, cold extremities and lower extremity gangrene, e.
Patients with the above symptoms are recommended to undergo ankle brachial index (ABI) testing to further screen for P.
Foot exam ➤Type 1 diabetes: First exam within 5 years of diagnosis, then year.
In the presence of paresthesias, foot ulcers, or amputation, examinations are recommended at each visit; ➤ Type 2 diabetes: examinations at diagnosis, then year.
In the presence of paresthesias, foot ulcers, or amputation, examination at each visit is recommend.
Elliott Joslin pointed out in 1934 that "diabetic gangrene is not born, it is bor.
The lifetime risk of foot ulcers in people with diabetes is as high as 34%, and it greatly increases the risk of dea.
The risk of foot ulcers is further increased in the presence of diabetic retinopathy, kidney disease (especially dialysis),e.
The patient's basic medical history, such as history of foot ulcers or amputations/toes, and foot and leg discomfort, including numbness, tingling, limping, and rest pain, should be carefully ask.
The foot should be evaluated, such as a thorough examination of ulcerated or abnormal erythematous areas (including interdigital spaces) and the presence of calluses, nail dystrophy, paronychia, and local or global skin temperature differences between the feet, Consider referral to a podiatrist for treatment if necessa.
Mental Status Assessment Maintaining mental health is an important condition for achieving diabetes treatment goals, but people with diabetes often face a higher risk of depressi.
Routine assessment of depression, anxiety, eating disorders, and cognitive abilities using rating scales is recommended, with particular attention to emotional changes since the patient's vis.
Table 1 Inspection items and frequency
From the top of the mouth to the bottom of the feet, the skin and the heart are examined from the outsi.
A "perfect" physical examination for diabetes should include these 9 items! Diabetic complications such as "sugar heart", "sugar kidney", and "sugar foot" are an important health burden for patien.
A complete physical examination can help detect the clues of diabetic complications in the early stage of the disease, so as to intervene as soon as possib.
Eye exams ➤Type 1 diabetes: First visit within 5 years of diagnosis, then at least every 1-2 years; ➤Type 2 diabetes: Check at diagnosis, then at least every 1-2 yea.
Diabetic retinopathy (DR) is the leading cause of blindness in people with diabet.
In the early stage of DR, the symptoms are often not obvious, and obvious symptoms will not appear until macular edema or proliferative retinopathy, which highlights the importance of early screeni.
Considering the course of disease, blood sugar control, hypertension, hyperlipidemia, nephropathy, and neuropathy will all contribute to the occurrence of DR, ophthalmological examination should be an essential item for high-risk patien.
Oral exams are recommended at every vis.
There is increasing evidence that oral health and diabetes have a close "two-way" relationship: oral disease increases the difficulty of blood sugar control, which in turn increases the risk of oral disease, and curing periodontal disease helps improve blood sug.
contr.
This close relationship underscores the need for people with diabetes to undergo oral exa.
If the patient is found to be accompanied by early symptoms of periodontitis/gingivitis such as bad breath, swollen gums, bleeding, e.
, it is recommended to go to the dentist for further evaluation and manageme.
Skin examination is recommended at every vis.
Data show that 30% to 91% of people with diabetes experience at least one skin disease complication in their lifeti.
Common skin diseases ➤Acanthosis nigricans: Acanthosis nigricans is a common disease characterized by dark red velvet-like plaques in the armpits, groin, and back of the ne.
There is usually no noticeable sensation, but in rare cases there may be pain, odor, or infiltrati.
Acanthosis nigricans is divided into benign and malignant, both of which have similar clinical and histological manifestatio.
Benign acanthosis nigricans commonly occurs in patients with type 2 diabetes and obesi.
In addition, patients with insulin resistance, polycystic ovary syndrome, lipodystrophy, acromegaly, and Cushing's syndrome may also develop acanthosis nigrica.
➤ Diabetic skin disease: Also known as tibial plaques or hyperpigmented pretibial plaques, it affects about half of people with diabetes, especially those with complications from microangiopat.
Diabetic dermatosis presents as multiple insensitive, round, dark red to pink papules or plaques, mostly on the pretibial sk.
Lesions develop within 1 to 2 weeks into well-circumscribed, atrophic brown spots and plaques that are finely sca.
➤Vitiligo: Vitiligo is a chronic depigmented skin disease that can occur anywhere on the body, especially the face, genitals, and han.
Skin lesions range in size from a few millimeters to a few centimeters and usually have a well-defined bord.
Patients with type 1 diabetes were more likely to develop vitiligo than those with type 2 diabetes (6% .
4.
➤ Psoriasis: Psoriasis is a relatively common chronic inflammatory skin disease with systemic manifestations that presents with itchy, scaly manifestations, most commonly on the knees, elbows, trunk, and sca.
Injection site reactions If the rotation is not appropriate, fat changes may occur at the insulin injection site, manifesting as small dimples or pits, also known as lipodystrophy, which may lead to insufficient insulin absorption and poor blood sugar contr.
In addition, the advent of new devices such as continuous glucose monitoring sensors and insulin pumps has increased the likelihood of allergic skin reactions, lipodystrophy, and skin infections, mainly manifested as hives, eczema, skin redness, and uneven fat distributi.
To a large extent, it has become an obstacle to the use of the device, and it is also the main reason for discontinuati.
Fungal infections Diabetic patients may develop recurrent fungal infections such as tinea corporis and onychomycos.
➤ Tinea corporis: Appears as annular plaques or plaques that appear as pruritic, round, oval, erythematous, or hyperpigmented, scaly lesions that spread centrifugal.
➤Onychomycosis: is a common fungal infection of the nai.
Bacterial infection In diabetic patients, staphylococcus and beta-hemolytic streptococcus infections are the most common bacterial skin infections, severe gangrene and even necrotizing fasciitis can occ.
➤ Gangrene: Commonly seen in diabetic foot infections, it is divided into dry gangrene and wet gangrene: Dry gangrene is characterized by a hard and dry skin texture with clear boundaries between healthy tissue and necrotic tissue, usually affecting the distal ends of the toes and fingers; wet gangrene is manifested as Wetness, severe swelling, and blisters are a surgical emergen.
➤ Necrotizing fasciitis: It is a surgical emergency and can manifest as erythema, edema, severe pain, twist lines, skin bullae, necrosis, or ecchymos.
Systemic symptoms include fever, tachycardia, and hypotensi.
Thyroid examination ➤Type 1 diabetes: expected at the time of diagnosis, and then once a year; ➤Type 2 diabetes: once a ye.
In outpatient settings, simple palpation of the thyroid can reveal diffuse enlargement involving the isthmus and lateral lobes of the thyroid, and goiters suggest Hashimoto's thyroiditis (the most common autoimmune thyroid disease) and Grave's disease (a hyperthyroid conditio.
autoimmune cause.
Physicians should consider the need for further biochemical evaluati.
The 2020 ADA guidelines recommend that patients with type 1 diabetes should be screened for autoimmune thyroid disease at the time of diagnosis of diabet.
Thereafter, it is assessed annual.
For people with type 2 diabetes, annual thyroid evaluation is recommend.
Blood pressure is recommended to be checked at every vis.
Data show that 20% to 60% of diabetic patients may be accompanied by hypertensi.
Hypertension is closely related to the increased risk of macrovascular and microvascular diseas.
Rational antihypertensive treatment can help reduce cardiovascular risk and protect renal functi.
Therefore, the patient's blood pressure should be measured at each vis.
Setting of blood pressure goals The 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines for hypertension and the American Diabetes Association (ADA) standard of care for diabetes recommend: ➤ For diabetes with vascular sclerosing cardiovascular disease (ASCVD) or 10 For patients with an annual ASCVD risk equal to or greater than 15%, the blood pressure target can be set to <130/80mmHg under the premise of safety; ➤ For patients with diabetes and hypertension with a low 10-year cardiovascular risk (less than 15%) , the blood pressure target can be set to <140/90mm.
Standardized process of blood pressure detection Before the test, rest for at least 5 minutes, the patient is sitting, the arm is flush with the heart, and the appropriate cuff size should be selected according to the circumference of the upper arm, and the measurement should be repeat.
Other modalities of blood pressure monitoring, such as home blood pressure self-monitoring and 24-hour ambulatory blood pressure monitoring, can help avoid the white coat effe.
Body mass index and waist circumference are recommended at every vis.
Overweight/obesity is an important risk factor for the occurrence and development of diabet.
The risk increases with the increase of obesity, and weight loss brings many benefi.
In the process of diagnosis and treatment, it is recommended to regularly track the patient's weight and waist circumference, and make recommendations for clinical manageme.
Body mass index Body mass index (BMI) = weight (kg)/height (m) squared Table 1 BMI index and obesityWaist circumference to prevent abdominal obesity, it is recommended that the waist circumference of men should not exceed 85 cm; the waist circumference of women should not exceed 80 .
Cardiovascular examination Cardiovascular complications are the leading cause of death in patients with diabet.
On physical examination, patients with tachycardia, irregular heart rate, third or fourth heart sound, heart murmur (eg, mitral regurgitation or ventricular septal defect), hyper/hypotension, lower extremity edema, and jugular venous pressure Elevated levels suggest cardiovascular disea.
In addition, abnormal pulse may suggest peripheral arterial disease (PA.
The manifestations of PAD include abnormal pulse, audible noise, unhealed lower extremity wounds, delayed capillary return, cold extremities and lower extremity gangrene, e.
Patients with the above symptoms are recommended to undergo ankle brachial index (ABI) testing to further screen for P.
Foot exam ➤Type 1 diabetes: First exam within 5 years of diagnosis, then year.
In the presence of paresthesias, foot ulcers, or amputation, examinations are recommended at each visit; ➤ Type 2 diabetes: examinations at diagnosis, then year.
In the presence of paresthesias, foot ulcers, or amputation, examination at each visit is recommend.
Elliott Joslin pointed out in 1934 that "diabetic gangrene is not born, it is bor.
The lifetime risk of foot ulcers in people with diabetes is as high as 34%, and it greatly increases the risk of dea.
The risk of foot ulcers is further increased in the presence of diabetic retinopathy, kidney disease (especially dialysis),e.
The patient's basic medical history, such as history of foot ulcers or amputations/toes, and foot and leg discomfort, including numbness, tingling, limping, and rest pain, should be carefully ask.
The foot should be evaluated, such as a thorough examination of ulcerated or abnormal erythematous areas (including interdigital spaces) and the presence of calluses, nail dystrophy, paronychia, and local or global skin temperature differences between the feet, Consider referral to a podiatrist for treatment if necessa.
Mental Status Assessment Maintaining mental health is an important condition for achieving diabetes treatment goals, but people with diabetes often face a higher risk of depressi.
Routine assessment of depression, anxiety, eating disorders, and cognitive abilities using rating scales is recommended, with particular attention to emotional changes since the patient's vis.
Table 1 Inspection items and frequency
