Management of Type 2 Diabetes
The Diabetes Cycle of Care (CoC) was introduced in October, 2015 and shortly afterwards A Practical Guide to Integrated Type 2 Diabetes Care (ICGP, 2016) guidelines were launched. ECAD has developed a care pathway, described below, for Community Healthcare East (CHE), based upon these national guidelines. A schematic version is available here. It begins with screening for diabetes and refers to pages 2-4 of A Practical Guide to Integrated Type 2 Diabetes Care (ICGP, 2016) for guidance on who should be screened, conducting screening and interpreting results. Click here to see ECAD’s quick reference guide to using the Hba1c blood test to diagnose Type 2 diabetes and interpreting results of Hba1c, Fasting Plasma Glucose (FPG) and two hour Post Prandial (PP) glucose on the Oral Glucose Tolerance Test (OGTT).
People are identified as either having Pre-Diabetes or Type 2 Diabetes
The pathway recommends referral to our Pre-Diabetes structured education programme. People with a diagnosis of Pre-Diabetes may also undertake the PHEW structured education programme for weight management.
People with Pre-Diabetes attend their GP annually for re-assessment of their glucose status and management of any cardiovascular risk factors they may have.
Type 2 Diabetes
When diagnosed with Type 2 Diabetes:
- Enter patient's name on to the practice diabetes register which may be useful in organising diabetes care. It contains the minimum required information and has a 12 month calendar incorporated for planning diabetes reviews
- Register for the Diabetes Cycle of Care (CoC) if medical card holder or GP visit card holder and review twice yearly with a minimum of 4 months between visits
Complete Long Term Illness (LTI) form
- A HCP needs to register patients with the National Retina Screen Programme for annual retinal screening www.retinascreen.ie Free phone 1800 45 45 55
Review twice yearly as per the Diabetes Cycle of Care (CoC)
- Provide patient with a Diabetes Passport
- Recommend DISCOVER DIABETES to those suitable for group education. Provide with X-PERT flyer and contact details for self-referral to the programme. www.hse/go/diabetes or contact Rosin Kavanagh on 01 2744324 or 01 2744360
- If unsuitable for DISCOVER DIABETES, refer to Community Dietitian for one to one consultation
- If weight management issues, consider referral to the PHEW programme. Contact 01 2744360
- Identify risk stratification of feet annually i.e. low, moderate or high risk and refer accordingly as per A Practical Guide to Integrated Type 2 Diabetes Care (ICGP, 2016), Appendix p56-62 and the Model of Care for the Diabetic Foot (HSE, 2011). Provide with Low Risk, Moderate Risk or High Risk information booket according to risk stratification
- Where chiropody / podiatry is required and patients are eligible, complete HSE Chiropody Card Application Form
- Complete Referral Form to Foot Protection Team at St. Columcille’s Hospital (SCH) or St. Vincent’s University Hospital (SVUH) if high risk of active foot disease i.e. charcot foot, ischaemia or active foot ulcer
- Where patients have Complicated Type 2 Diabetes refer to Community Diabetes Nurse Specialist (DNS) and / or local diabetes centre i.e. SCH, SVUH or St. Michael’s Hospital (SMH)
- For support in managing Type 2 diabetes please contact a Community Diabetes Nurse Specialist (DNS)