RetourUrgent (same day) referral should be assured if one of the following is detected:
- urine ketones ≥ 2 or no improvement in glycaemia ≥ 18 mmol/L after management with metformin and/or gliclazide;
- suspicion of ketoacidosis or hyperosmolar hyperglycaemic state;
- hypoglycaemia unresolved by treatment;
- clinical suspicion of type 1 diabetes in a newly diagnosed patient;
- symptoms or signs of coronary heart disease and stroke;
- recent deterioration of vision;
- blood pressure > 200/> 110 mm Hg
- blood pressure > 180/> 110 mm Hg with headache, shortness of breath, blurred vision, changed mental state, nausea, vomiting, reduced urine output;
- infected foot ulcer with or without symptoms of systemic infection or gangrene;
- critical limb ischaemia; or
- anuria or estimated glomerular filtration rate < 30 mL/min per 1.73 m2
Non-emergency referral should be done if one of the following is detected:
- glycaemia treatment goal is not achieved despite compliance to treatment with oral medication (and insulin);
- estimated glomerular filtration rate 30–59 mL/min per 1.73 m2 ;
- moderately or severely increased albuminuria;
- symptoms and signs of peripheral vascular disease;
- blood pressure > 130/80 mm Hg despite treatment with two medications; or
- total cholesterol > 8 mmol/L (310 mg/dL).
Reference
Diagnosis and management of type 2 diabetes (HEARTS-D). Geneva: World Health Organization; 2020 (https://apps.who.int/iris/handle/10665/331710, accessed 11 September 2024). Licence: CC BY-NC-SA 3.0 IGO
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