Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • diabetic ketoacidosis
  • diabetes and severe vomiting
  • acute severe hyperglycaemia
  • acute severe hypoglycaemia
  • hyperosmolar hyperglycaemic state (HHS)
  • diabetic foot ulceration, refer to Vascular High-Risk Foot — adult CPC
  • newly diagnosed type 1 diabetes, call endocrinology registrar or consultant on call
    • present to diabetes medical specialist service within 24 hours. If no medical specialist service is available, present to an emergency department.

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network 

Southern Adelaide Local Health Network

Inclusions

  • consider referring to diabetes nurse educator and dietitian
  • monogenic diabetes
  • secondary diabetes
  • specific education requirements e.g., technology, insulin use
  • type 1 diabetes
  • type 2 diabetes, complicated or uncontrolled

Exclusions

  • diabetic foot ulceration, refer to Vascular High-Risk Foot — adult CPC
  • pre-diabetes
  • stable existing type 2 diabetes
  • newly diagnosed type 2 diabetes and not acutely unwell
  • dietary advice for weight reduction, high cholesterol, hypertension or cardiovascular disease (CVD) for individuals with diabetes
  • impaired glucose tolerance or impaired fasting glucose
  • depression screening tool e.g. Patient Health Questionnaire-9 (PHQ-9)
  • type 2 diabetes managed with dietary measures
  • type 2 diabetes well controlled/responding to dietary and medical management with a glycated haemoglobin (HbA1c) less than 8% without associated medical complications
    • unless identified as high-risk including Aboriginal and Torres Strait Islander

Triage categories

Category 1 - appointment clinically indicated within 30 days

  • diabetes with advanced complications:
    • stage 3 chronic kidney disease (CKD)
    • retinopathy: pre-proliferative/proliferative or maculopathy
    • autonomic complications
    • symptomatic vascular disease
  • existing diabetes with recent unintentional weight loss greater than 5% of body weight within the preceding 3 to 6 month period
  • major hypoglycaemic episode (assistance has been required by a third party) OR recurrent severe hypoglycaemia
  • newly diagnosed gestational diabetes mellitus (GDM) refer directly to the obstetric medicine clinic instead
  • newly diagnosed type 1 diabetes
  • poorly controlled diabetes with recent deterioration despite escalation of therapy
    • glycated haemoglobin test (HbA1c) greater than 10% (or 86mmol/mol)
    • vulnerable patient e.g. Aboriginal and Torres Strait Islander
  • post diabetic ketoacidosis (DKA) or hyperosmolar hyperglycaemic state (HHS) admission
  • pregnancy in patient with existing diabetes, refer directly to the obstetric medicine clinic instead
  • recent acute coronary syndrome with poor diabetes control HbA1c greater than 9%

Category 2 — appointment clinically indicated within 90 days

  • diabetes requiring optimisation in the presence of uncontrolled risk factors for chronic vascular disease (CVD)
  • diabetes with advanced comorbidities:
    • cirrhosis
    • congestive heart failure
  • diabetes with disordered eating
  • existing type 1 diabetes with newly diagnosed coeliac disease
  • pre-pregnancy planning
  • private or commercial driver’s licence who require a new or renewal of conditional licence
  • stable type 1 diabetes
  • undifferentiated diabetes type requiring diagnosis
  • unsatisfactorily controlled diabetes with recent deterioration despite escalation of therapy:
    • glycated haemoglobin test (HbA1c) 64-86mmol/mol or 8 to 10%

Category 3 — appointment clinically indicated within 365 days

  • self-management education or difficulties in managing diabetes in the absence of adequate community resources

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • past medical/surgical/cancer history, including osteoporosis
  • current medications and dosages
  • use/frequency of alcohol, tobacco, and other drugs
  • allergies and sensitivities
  • onset, duration, and progression of symptoms
  • management history including:
    • treatments trialled/implemented prior to referral
    • presence of any complications and details when screening last performed
    • specific educational requirements e.g. insulin use
  • physical examination results
  • height/weight
  • body mass index (BMI)

Pathology

  • glycated haemoglobin test (HbA1c%)
  • lipids plus high-density lipoprotein (HDL)
  • serum biochemistry including renal function
  • urine albumin to creatinine ratio (ACR)

Recurrent hypoglycaemia, or type 1 diabetes/autoimmune

  • coeliac screen
  • morning cortisol (8.00 to 9.00 am)
  • thyroid function test (TFT)

Unsure of diabetes type

  • serum antibodies to glutamic acid decarboxylase (anti-GAD) and insulinoma-associated protein-2 (IA2) antibody
  • paired C-peptide and blood glucose
  • ferritin, iron studies

Peripheral neuropathy

  • vitamin B12

Additional information to assist triage categorisation

  • driver’s licence status

Clinical management advice

Please ensure that recent pathology results are available. Consider providing the patient with a repeat pathology form at the time of referral.

Patients who have previously received care from a specialist should be encouraged to return to their care for additional assessment if needed.

Referrals are subject to the evaluation of the triaging clinician. If you believe your patient necessitates specialist assessment but may not meet the provided criteria, feel free to connect with the specialist team to discuss your concerns.

Clinical resources

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • impact on employment
  • impact on education
  • impact on home
  • impact on activities of daily living
  • impact on ability to care for others
  • impact on personal frailty or safety
  • identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery, where surgery is a likely intervention.
  • Choice to be treated as a public or private patient.
  • Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.