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In addition to regular appointments and exams with their primary care provider, diabetic patients also require extra exams by specialists to evaluate diabetes-specific complications.

• Ophthalmology referrals - Patients with type 1 diabetes should have a dilated eye exam conducted by an ophthalmologist or optometrist experienced in identifying diabetic retinopathy within 3-5 years of their diagnosis. Patients with type 2 diabetes should have a dilated eye exam as soon as possible after their diagnosis because they often have had unrecognized disease for years prior to diagnosis. Patients with diabetes are recommended to have an annual dilated eye exam to identify early signs of retinopathy. Risk of progression is particularly concerning for women who are pregnant. For this reason, women who learn they are pregnant or planning on becoming pregnant should make appointments to see their eye specialist for a comprehensive eye exam and followed throughout their pregnancy and immediate postpartum period to evaluate for the development or progression of diabetic retinopathy.

• Foot care specialist referrals – Patients suffering from peripheral neuropathy need regular foot exams provided by their primary care provider. But under some circumstances, patients may need additional assistance with their foot care. Consulting a podiatrist or other foot care specialist can be indicated if a diabetic patient suffers from any number or foot problems, ranging from severe calluses and ulcers to bony deformities of their feet. In particular, patients who smoke or suffer from peripheral vascular disease are most often in need of this type of help. Specialists who deal with foot care are able to help these patients by trimming toenails, removing calluses, providing wound care, and fitting them with specially designed shoe inserts to maintain proper foot positioning.

• Dental referrals – Patients with diabetes are urged to visit their dentist every 6 months, which is the same as recommendations for the general population. However, a careful dental exam by a dentist offers another opportunity to check overall oral health, as well as for specific complications of diabetes such as candidiasis in the oropharynx.
  
  
• Nephrology referrals – Kidney function can be monitored by any primary care physician. However, if the patient’s kidney function deteriorates (e.g., estimated GFR less than 60 ml/min), hematuria, suspected renovascular disease, significant proteinuria (urine albumin/creatinine >300 after initiation of therapy), or unable to achieve BP goal (<130/80) for whatever reason, a nephrology consult may be indicated.