| Intervention | Frequency | Notes |
| History and physical examination | ||
| Height, weight, and BMI | Every visit | |
| Smoking cessation counseling | Every visit | For smokers only. |
| Blood pressure | Every visit | Individualize goal blood pressure (eg, <130/80 mmHg if at high cardiovascular risk; <140/90 mmHg if at lower risk).* |
| Dilated eye examination | Annually¶ | Begin at onset of type 2 diabetes, 3 to 5 years after onset of type 1 diabetes. Examine yearly (or more frequently) if retinopathy present, every 2 to 3 years if there is no evidence of retinopathy. |
| Comprehensive foot examination | Annually | Every visit if peripheral vascular disease or neuropathy. |
| Dental examination | Annually | Periodontal disease is more severe and may be more prevalent in patients with diabetes. |
| Laboratory studies | ||
| Lipid profile | Initially, as indicated | In people <40 years of age without dyslipidemia and not on cholesterol-lowering therapy, testing may be infrequent (eg, every 5 years). |
| A1C | Every 3 to 6 months | Goal ≤7% (may be lower or higher in selected patients). |
| Basic metabolic profile | Annually | Includes electrolytes, BUN, creatinine, calcium, and glucose. In the presence of chronic kidney disease, may need to measure more often. |
| Urinary albumin-to-creatinine ratio | Annually | Begin 3 to 5 years after onset of type 1 diabetes and at diagnosis in patients with type 2 diabetes; protein excretion should also be monitored if persistent albuminuria is present. |
| Vaccinations | ||
| Pneumococcus | ||
| 1 dose, ages 19 to 64 years | Once the patient is ≥65 years (and ≥1 year after PCV13 and >5 years after previous dose of PPSV23), give a second dose of PPSV23. Revaccinate every 10 years. |
| 1 dose at age ≥65 years | Once the patient is ≥65 years (and ≥1 year after PPSV23), give PCV13. |
| Influenza | Annually | |
| SARS-CoV-2 (COVID-19) | 3-dose series | Follow changing guidelines, with type 2 diabetes having markedly increased risk of complications from COVID-19 risk and type 1 diabetes having lesser increased risk of complications from COVID-19. |
| Hepatitis B | 3-dose series | Administer to unvaccinated adults who are ages 19 to 59 years. For older patients, administer based upon risk of acquiring hepatitis B, including the need for assisted blood glucose monitoring and the likelihood of an adequate immune response to vaccination. |
| Provide other routine vaccinations for adults with diabetes according to age-related recommendations. | ||
| Education, self-management review | ||
| Annually | More often at onset of diabetes and when there is a change in regimen. | |
BMI: body mass index; A1C: glycated hemoglobin; BUN: blood urea nitrogen; ASCVD: atherosclerotic cardiovascular disease.
* When manual auscultatory method is used to measure blood pressure. High cardiovascular risk includes those with existing ASCVD or 10-year ASCVD risk ≥15%. Lower cardiovascular risk includes those with 10-year ASCVD risk <15%.
¶ Less frequent screening (every 2 to 3 years) may be appropriate for some patients (eg, patients with little or no retinopathy and near-normal A1C levels).