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Diabetes Mellitus

Emergency department referrals

Phone on call Diabetic and Endocrinology Registrar via:

  • Royal Brisbane & Women’s Hospital switch - (07) 3646 8111
  • The Prince Charles Hospital switch - (07) 3139 4000
  • Redcliffe Hospital switch – (07) 3883 7777
  • Caboolture Hospital switch – (07) 5433 8888

and send patient to the Department of Emergency Medicine (DEM) at their nearest hospital.

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

  • Diabetes-related ketoacidosis
  • Diabetes and severe vomiting
  • Acute severe hyperglycaemia
  • Acute severe hypoglycaemia
  • Hyperosmolar hyperglycaemic state (HHS)
  • Foot ulcer with infection and systemically unwell or febrile
  • Invasive infection or rapidly spreading cellulitis of the foot (defined by peripheral redness around the wound >2cm)
  • Acute foot ischaemia
  • Wet gangrene foot
  • Newly diagnosed type 1 diabetes, please contact the on-call registrar or consultant immediately. The client should be referred to a diabetes specialist service within 24 hours. If a specialist service is not available, the client should present to the nearest emergency department.

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

  • Pregnancy in patient with existing diabetes. For optimum care, patient should be seen within 1 week.
  • Newly diagnosed GDM. For optimum care, patient should be seen within 1 week.
  • Elevated HbA1c (>85mmol/mol or 10%) with recent deterioration despite escalation of therapy
  • Major hypoglycaemia episode (assistance has been required by a third party) or multiple episodes of hypoglycaemia
  • Existing type 1 diabetes with newly diagnosed coeliac disease
  • Existing diabetes with recent unintentional weight loss (> 5% of body weight over a month period)
  • Diabetes requiring optimisation in the presence of severe vascular complications, for example stage 3 CKD, proliferative retinopathy, gastroparesis
  • Diabetes with disordered eating
  • Diabetes related foot ulcer – refer to high-risk foot criteria
  • Post DKA admission. For optimum care, face to face or telephone review should be seen within 1 week.

Category 2

Appointment within 90 days is desirable

*The following category 2 cases can be referred to local/regional general physician if endocrinologist access is not locally available.

  • Diabetes requiring optimisation in the presence of uncontrolled risk factors for chronic vascular disease (CVD)*
  • Unsatisfactorily controlled diabetes with recent deterioration despite escalation of therapy (HbA1c 64-86mmol/mol or 8-10%)*
  • High-risk (but currently not ulcerated) foot in client with diabetes*
  • Pre-pregnancy planning
  • Suspected monogenic diabetes
  • Private or commercial driver’s licence who require a new or renewal of conditional licence (not available at all sites)
  • Stable type 1 diabetes
  • For consideration or commencement of continuous glucose monitoring or continuous subcutaneous insulin infusion pump. (NDSS | Access subsidised continuous glucose monitoring (CGM) and flash glucose monitoring (Flash GM) products)

Category 3

Appointment within 365 days is desirable

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

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

  • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Not an exhaustive list

 

Referral requirements

A referral may be rejected without the following information.

Essential Referral Information

  • Type of diabetes and duration of disease
  • Details of all treatments offered and efficacy
  • Medication history
  • Presence of any complications and details when screening last performed
  • Height, weight, BMI
  • BP
  • History of smoking
  • HbA1c (current and previous results)
  • FBC, ELFT, fasting lipids – cholesterol LDL HDL Tg results
  • Urine albumin: creatinine ratio

Additional Referral Information (Useful for processing the referral)

  • Details of family history of diabetes
  • Copy of GPMP/TCA
  • Ankle brachial pressure index (ABPI)
  • Commercial driver’s licence requirements
  • Results of depression screening (PHQ-2):
    • over the last 2 weeks, how often have you been bothered by any of the following problems?
    • little interest or pleasure in doing things?
    • feeling down, depressed, or hopeless?
  • If Type 1 diabetes: TSH, anti-transglutaminase antibodies, IgA for coeliac disease within the last 5 years
  • If peripheral neuropathy: B12 folate

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • 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

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can’t order, or the patient can’t afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

  • 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

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

  • 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.)
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