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Strictly defined, the ADA refers to assessing cognitive, emotional, and social factors that may interfere with management of the disease. It is appropriate to ensure that the patient understands the disease and the rationale for the different modes of monitoring and treating it. Assessing for any history or current symptoms of mood disorder (such as depression) that may be affecting compliance is recommended. You should not limit your questioning to, “How has your mood been lately?”  Remember to also obtain information about the patient’s energy level, sleep, and any weight change. These will clue you in not only to depression but also the possibility of thyroid dysfunction—a common problem in adults.

It is essential to ask about smoking and drug and alcohol usage.  Smoking cessation is a very important issue and one in which you can actively participate.  A more complete discussion of smoking cessation is included under the menu link for Counseling.

When assessing alcohol usage, assess frequency, amount, and type. For additional information on screening for at-risk drinking (heavy drinking) and alcohol use disorders (abuse or dependence) and use of the AUDIT as a screening tool. Also, ethanol use can contribute to high triglycerides and low HDL, particularly in individuals with diabetes.