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In established cases, patients should be examined every 3 months for macrovascular and microvascular complications.They should undergo funduscopic examination for retinopathy and monofilament testing for peripheral neuropathy.

Other organ systems should be assessed as indicated by the patient’s clinical situation.Examiners who are not ophthalmologists tend to underestimate the severity of retinopathy, which cannot be evaluated accurately unless the patients’ pupils are dilated.The dorsalis pedis and posterior tibialis pulses should be palpated and their presence or absence noted.This is particularly important in patients who have foot infections: poor lower-extremity blood flow can delay healing and increase the risk of amputation.Documenting lower-extremity sensory neuropathy is useful in patients who present with foot ulcers because decreased sensation limits the patient’s ability to protect the feet and ankles.An explosive onset of symptoms in a young lean patient with ketoacidosis always has been considered diagnostic of type 1 DM.

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