**13. Physical examinations of diabetic patients**

Either complete physical examination or brief physical examination will be performed at the time points specified in the Time and Events Table.

The complete physical examination will include evaluation of the following organ or body systems:


occur more frequently than in non diabetic population, but it seem to be more severe probably because in diabetic patients leukocyte function is impaired and subsequently accompanied by poor control. Also this population is particularly prone to four unusual infections with strong relationship with diabetes –focus on skin, urinary tract, lungs, and bloodstream. *Malignant external otitis*, usually due to *Pseudomonas aeruginosa* tends to appear in older population and is characterized by severe pain in the ear, fever, and leukocytosis. The facial nerve becomes paralyzed in 50% of the cases, but other crucial nerves can be involved. *Emphysematous cholecystitis* tends to affect diabetic men and diagnosis is established when gas is seen in the

Hypertriglyceridemia is common in diabetics and is related to overproduction of VLDL (*Very Low Density Lipoprotein*) in the liver and to a defect of metabolization on the peripheral tissues. The latter is due to a deficiency of lipoprotein lipase, an insulin-dependent-enzyme. It is important to know that some patients have high level of lipids profile even when diabetic disease is controlled; probably these cases have a primary familial hyperlipoproteinemia, a circumstance independent of DM. Of course, these patients must be treated for lipids disorder –hypertriglyceridemia and lipids hypercholesterolemia with HMG-CoA reductase inhibitors such as lovastatin, pravastatin, simvastatin, fluvastatin, atorvastatin, rosuvastatin, as mode of action that reduces cholesterol synthesis and increases LDL receptors; ezetimibe reduces the absorption of lipids from diet at the intestinal level; and fibric acid derivatives –↓ LPD and tryglyceride, hydrolysis, VLDL synthesis, ↑ LDL catabolism. Patients can also suffer from a variety of skin lesions: necrobiosis lipoidica diabeticorum, candida albicans, vaginal monilia‐ sis, in women, hypertrophy of fat, bullosis diabeticorum, diabetic dermopathy, atrophy of adipose tissue, Dupuytren's contractures, and schleroderma. Additional illnesses such as the

Either complete physical examination or brief physical examination will be performed at the

The complete physical examination will include evaluation of the following organ or body

gallbladder wall or during non invasive imaging examination.

prevalence of eating disorders can be seen particularly in young women.

**13. Physical examinations of diabetic patients**

time points specified in the Time and Events Table.

**•** Skin (including injection site)

**•** Head, eyes, ears, nose, and throat

**•** Lymph nodes (neck, axilas, inguinal)

systems:

140 Treatment of Type 2 Diabetes

**•** Thyroid

**•** Respiratory system

**•** Abdomen (liver, spleen)

**•** CV system, BP

The brief physical examination will include evaluation of the following organ or body systems:

