Bay Navigator

Diabetes

Referral Acceptance

Diabetes services are offered in both Primary and Secondary Care in the Bay of Plenty.

Type 1 diabetes diagnosed in children is managed predominently in Secondary Care by the Paediatric Department.

Gestational diabetes, and pregnant women with diabetes, are managed in Secondary Care by multi-disciplinary teams including obstetricians, diabetologist, midwives and specialist diabetes nurses.

Type 2 diabetes is predominently managed in Primary Care. Support is available through a range of community-based specialist diabetes nurses. In addition complex patients can be referred to the secondary service for assessment by a diabetologist or specialist diabetes nurse.

Diabetes referrals are prioritised by Senior Medical Officers based on the information contained within. Additional information should be attached where available. The priorisation tool used to triage referrals can be found below under Access Criteria.

All accepted referrals will be seen within a maximum waiting time of 4 months, unless there is a clinical reason for delay.

Referral acceptance is as follows:

First Specialist Assessments

Wait Times

Waiting priority 1

Accepted

Waiting priority 2

Accepted

Waiting priority 3

Accepted

Waiting priority 4

Declined

Access Criteria

National Access Criteria for First Assessment (ACA)
Bay of Plenty Variation (April 2014)

Note: Access criteria that determine prioritisation primarily on the referral diagnosis have their limitations and this is acknowledged.  For those referrals in which the referring doctor has not been able to make a confident diagnosis it may be difficult, or impossible, to apply these ACA criteria.  It is therefore stressed that these are guidelines only and that clinical judgement must be applied in all cases in which they are used.

REFERRAL GUIDELINES: Diabetes

Category

Examples (not an exhaustive list)

1. Immediate

  • Diabetes patients with significant clinical risk

2. Urgent

 

  • Newly diagnosed Type 1 Diabetes
  • Some of them (un-complicated) may be able to be managed in the community with diabetes nurse/dietitian support.
  • Type 2 DM - associated with significant hyperglycaemia, BS ≥ 25 mmol/L, ketonuria, significant complications at the time of diagnosis.
  • Hypoglycaemic unawareness in Type 1 DM / significant unexplained hypoglycaemia

3. Semi-urgent

 

  • Diagnosis is not clear: e.g. MODY, LADA
  • Diabetes associated with cystic fibrosis, transplant diabetes or pancreatic disease associated diabetes
  • Poor glycaemic control after optimising medical, nutritional and lifestyle therapy HbA1C ≥ 10% (86 mmol/mol)

4. Routine

 

  • Symptomatic peripheral neuropathy
  • Mild to Moderate micro albuminuria not improving with appropriate therapy; Eg BP control, ACE/ARB therapy

Note: Some of the patients with poor glycaemic control, hypoglycaemia may be directly referred to Diabetes Nurses. Please refer to diabetes nurse referral criteria.

The following criteria referred directly to appropriate services

1. Serum creatinine ≥ 200 umol/L and Diabetic nephropathy or Proteinuria ≥ 1g/24 hrs, Rapid decline in serum creatinine, presence of casts/ red cells in urine.

1. Renal Services

2. Acute visual loss / visual issues (high risk diabetic retinopathy)

2. Ophthalmology Services

3. Diabetic foot ulceration. Associated Cellulitis, systemic infections, infections not responding to oral antibiotics, radiological evidence or bone involvement, gangrene.

3. Vascular Surgery/Podiatry

4. Symptomatic peripheral vascular disease and associated complications.

4. Vascular Surgery/Podiatry

5. Pregnancy diabetes.

5. Diabetes Pregnancy team