Key guideline – RACGP handbook (online version), 

Local pathway – Health Pathways

Key organisations – Diabetes Australia, National Diabetes Services Scheme (NDSS)

Screening 

– ATSI > 18yr HbA1c

– High risk : AUSDRISK score 12 or more, CV event, gestational DM, PCOS, antipsychotic meds -> use HbA1c or FBG

– Adults over 40yrs – use AUSDRISK

HbA1c most useful unless – hemolysis, blood loss, transfusion, iron deficiency, severe CKD, pregnancy/post-partum -> then use FBG

Diagnosis

– HbA1c > 48 (6.5%) on 2 occasions if asymptomatic

– FBG (at least 8 hours) > 7.0 on 2 occasions

Consider type 1/2/MODY/LADA

– if suspicion of non-type 2 check blood ketones, c-peptide, GAD antibody

Initial assessment of newly diagnosed type 2 DM

– Education – signpost to Diabetes Australia  search ‘Type 2 diabetes and me’ – series of short videos or ‘just diagnosed’

– Gather information – BMI, BP, lipids, urine ACR, GFR, smoking status

– Screen for complications – eyes (optometrist), feet (low risk – pulses, sensation, ulcers/skin; high risk – refer high risk foot clinic or podiatry), nephropathy

– Consider a 3‑ to 6‑month trial of intensive lifestyle modification without medications in newly diagnosed patients with all of:

* HbA1c near target (HbA1c < 7.5%)

* Clearly modifiable risk factors for diabetes (weight, diet)

* No signs or symptoms of end organ damage

– Offer GPMP/TCA to arrange referral to diabetes educator, dietician, podiatrist

Weight loss measures

– options beyond Diabetes Australia education -> referral to dietician, VLED (baker heart and diabetes institute have meal plans), medication (BMI > 27 – orlistat, GLP-1s), referral to bariatric surgery (BMI > 35)

Use Diabetes Cycle of Care (to guide reviews)

Box 1. Medicare Benefits Schedule (MBS) diabetes ‘cycle of care’ minimum requirements2

At least six-monthly:

Measure weight, height and body mass index (BMI)

Measure blood pressure

Assess feet for complications

At least annually:

Review and discuss diet, physical activity, smoking status, medications (need for more frequent review should be individualised, as outlined in Table 1)

Assess diabetes management by measuring HbA1c

 Review and discuss complication prevention – eyes, feet, kidneys cardiovascular disease (CVD)

Measure total cholesterol, triglycerides and high-density lipoprotein (HDL) cholesterol

Assess for microalbuminuria

At least every two years:

Comprehensive eye examination (more frequently for those at high risk)

Subsequent reviews

– Glycaemic targets – see Algorithm (Aug 2022)