Headings
Interval history · Glucose readings · Medications and adherence · Hypoglycemia · Foot exam · Eye and kidney screening · Results reviewed · Assessment · Plan
When to use it
Use this for routine type 2 or type 1 diabetes visits where glucose control and complication screening drive the note. It gives dedicated space for meter or sensor readings, hypoglycemia events, the foot exam and eye and kidney checks, so nothing on the yearly checklist is missed. It goes deeper on one condition than a general chronic disease follow-up.
Example
Fictional example
Interval history
L.K., 58, type 2 diabetes for 9 years. Walking 3 days a week. Lost 4 lb since last visit.
Glucose readings
Fasting 130 to 165 on meter. Two readings above 220 after large dinners.
Medications and adherence
Metformin 1000 mg twice daily. Empagliflozin 10 mg daily. Misses evening metformin about twice a week.
Hypoglycemia
None reported.
Foot exam
Pulses intact. Monofilament sensation normal. Callus left first toe, no ulcer.
Eye and kidney screening
Retinal exam in May, no retinopathy. Urine albumin to creatinine ratio 18.
Results reviewed
A1c 7.9, up from 7.4. eGFR 78.
Assessment
Type 2 diabetes above goal, partly from missed doses.
Plan
Switch to metformin extended release 2000 mg with dinner. Increase empagliflozin to 25 mg. A1c in 3 months.