Diabetes referral pathways (Guidelines)

Who can refer:

• Healthcare professionals
• Self-referral from people with diabetes

Appropriate referrals:  

• People with type 2 diabetes needing to commence on injectable therapies to manage their diabetes (insulin and / or GLP-1 RA).
• People with type 2 diabetes already on insulin needing additional support to improve their glycaemic control.
• New diagnosis of type 1 diabetes LADA.
• Guidance for people with established type 1 diabetes on how to improve their glycaemic control.
• Diabetes management advice / commencement of therapy for steroid induced diabetes, MODY, pancreatic pathology or other forms of diabetes in people over 21 years.

Referral form: 

• Community Diabetes Nurse Referral Form - SE, Mid and West Highland.
• Community Diabetes Nurse Referral Form - North Highland: Caithness and Sutherland.

Who to refer to an Adult (>16) Diabetes, Consultant led, Outpatient Clinic

• All patients with type 1 diabetes (T1DM) aged over 16
  Any new suspected T1DM should be a same day discussion with community DSNs or acute medical admissions if suspected ketoacidosis.
• Individuals with suspected diabetes secondary to pancreatic pathology requiring insulin, eg post-pancreatectomy, cystic fibrosis
• Patients with diagnostic uncertainty eg ?MODY, ?underlying LADA / T1DM
• Young patients under 35 with type 2 diabetes (T2DM)
• Any female with diabetes (T1DM, T2DM or other) considering pregnancy
• Individuals with T2DM not meeting their individualised HbAc1 target despite maximal tolerated oral agents.
  Likely to be triaged to DSN-led insulin or GLP-1 RA initiation
• Individuals with T2DM on insulin for consideration of an alternative insulin regimen or with concerning hypoglycaemia.
• Active foot ulceration (for triage to MDT foot clinic)
• Concerns regarding worsening complications, eg progressive proteinuria.

Referrals should include appropriate clinical information with a sentence stating a clear reason for the referral in all referral letters.

Clinicians MUST ensure any appropriate pre-referral assessments have been completed, according to local pathways (provided access to diagnostics is available to primary care teams), eg most recent HbA1c.

• DSN: Diabetes Specialist Nurse
• GLP-1 RA: glucagon-like peptide-1 receptor agonist
• HbA1c: Glycolated haemoglobin
• LADA: Latent autoimmune diabetes in adults
• MDT: Multidisciplinary team
• MODY: Maturity-onset diabetes of the young
• T1DM: Type 2 diabetes
• T2DM: Type 1 diabetes