Diabetes  |  Type 2 Pathway - Referrals


Type 2 Pathway - Referrals

Diabetes Management

Type 2 diabetes in the absence of complications should be managed in primary care.

When there is difficulty with glycaemic control people with type 2 diabetes should be referred to a community diabetes nurse specialist.


Referral to secondary care is appropriate if adequate glycaemic control is still not achieved.

Specific indications for referral to Hospital Based Diabetes Services include:

  • Type 2 DM - associated with significant hyperglycaemia BS ≥ 25 mmol/L, ketonuria, significant complications at the time of diagnosis.
  • Diagnosis is not clear: e.g. MODY, LADA.
  • Diabetes associated with cystic fibrosis, transplant diabetes or pancreatic disease associated diabetes.
    • Symptomatic significant peripheral neuropathy.

The hospital based services is run by the SMO and a team of diabetes specialist nurses. Patient's referrals are triaged to see the most appropriate member of the team.

Referral to other Specialities:

Renal Referral

  • Patients with an eGFR < 30ml/min/1.73m2
  • Diabetic nephropathy or Proteinuria ≥ 1g/24 hrs
  • Rapid decline in serum creatinine
  • Presence of casts/ red cells in urine

Mark referrals Renal Referral and send to the BOPDHB referral centre

Ophthalmology Referral

  • All patients with diabetes
  • Urgent referral for acute visual loss

Urgent referrals should be made following discussion with the on-call Ophthalmologist.

Routine referrals including for retinal screening should be marked Ophthalmology Referral and send to the BOPDHB referral centre

Vascular Referral

Referral criteria for vascular review

Criteria for referral to a vascular surgeon for a patient with a diabetic foot complication includes the following:

  • Foot lesion (ulcer, gangrene) or suggestion of rest pain with peripheral arterial disease
  • Deteriorating ulcer with known peripheral arterial disease or absent pedal pulses
  • Ankle Brachial Index <0.5 or absolute ankle pressure <50 mmHg
  • New foot lesion with previously treated peripheral arterial disease
  • Symptomatic intermittent claudication at <200 m
  • Acute diabetic foot sepsis
  • Osteomyelitis of forefoot or metatarsals
  • Acute osteomyelitis

Mark referrals Vascular Referral and send to the BOPDHB referral centre

Podiatry Referral

Diabetes in Pregnancy

Referral all women who have diabetes and are pregnant, whether this developed pre or post conception

Mark referrals Diabetes in Pregnancy Team and send to the BOPDHB referral centre

Dietition Referral

Last updated : Wednesday, July 26, 2017
Next review date : Thursday, July 26,2018

Disclaimer: This site is intended to be flexible and frequently updated. While every effort has been made to ensure accuracy, all information should be verified.