Please register or login to view the chart

Diabetes-Referral guide

Manage in primary care –Impaired GTT  Impaired fasting glucose New diagnosis type 2 diabetes Minor self-treated hypoglycaemia Transient hyperglycaemia Well controlled diabetes ( diet or treated ) Stable micro-macro vascular complications

Referral to secondary care – Routine All with type 1 diabetes – managed in secondary care Age < 25 yrs Patient not achieving target HbA1c despite optimum management in general practice or
Worsening glycaemic control Erratic glycemic control Assessment for insulin initiation or intensification / change GLP-1 – assessment and initiation Patient on GLP-1 and considering GLP-1 initiation Considering or already on insulin pump Blood pressure – uncontrolled despite optimum management as per NICE guideline Diabetes complications as
Neuropathy – GI tract , hypotension , erectile dysfunction
Diabetes arthritis e.g carpal tunnel syndrome
Isolated nerve palsy e.g 3rd N , foot drop
Progressive mico-macro vascular complications despite max Rx
Retinopathy requiring laser treatment or grade >= 3 PCOS ( with or without diabetes ) Obesity management e.g bariatric surgery Secondary diabetes e.g
○ steroid use
○ acromegaly
○ psychoses treatment
○ pancreatitis Complex medical co-morbidities

Referral- Urgent- Hyperglycaemia and symptomatic Suspected ketoacidosis or non-ketotic hyperosmolar coma Severe hypoglycaemia
episode requiring 3rd party assistance or Health care professional help Children with newly diagnosis or suspected diabetes New diagnosis of Type-1 diabetes Infected , necrotic or gangrenous foot , ulceration or suspected charcot foot ( inflammatory syndrome characterized by varying degrees of bone and joint disorganization secondary to underlying neuropathy , trauma and perturbations of bone metabolism ) CKD 
 ○ creatinine > 150 or CKD 3
 ○ proteinuria : UACR >= 30 mg / mol
 ○ optimise risk factors then renal angle
 ○ rapidly declining kidney function
 ○ anaemia or bone disease
 ○ on dialysis ( likely to under specialist care already ) Worsening claudication symptoms 

Women with pre-existing diabetes who become pregnant ( refer on 1st contact ) Women who develop gestational diabetes ( refer 1st contact if not done already by e.g midwife ) Acute visual loss

Diabetes structured programme- XPERT- written by Dr Trudi Deakin ,according to their website it is based on the theories of patient empowerment , discovery , learning and patient centered care. They offer 4 programmes X-PERT Prevention of Diabetes ( X-POD ) , X-PERT diabetes , X-PERT Insulin , X PERT Weight DAFNE -dose adjustment for normal eating ( type 1 diabetes ) DESMOND – Diabetes Education and self-Management for Ongoing and Newly Diagnosed. Offers 6 programmes GERTIE- George Eliot Type 1 Diabetes Education programme BERTiE – for Type 1 diabetics SEREN structured education programme for children and young people with diabetes in Wales EPP Cwmru – offers diabetes self management programme via Scottish Diabetes patients – access via


  1. Rogers, Lee C et al. “The Charcot foot in diabetes.” Diabetes care vol. 34,9 (2011): 2123-9. doi:10.2337/dc11-0844
  2. Care Sep 2011, 34 (9) 2123-2129; Early referral for foot ulcers is vital, finds audit of diabetes care BMJ 2016; 352 (Published 31 March 2016) BMJ 2016;352:i1820
  3. Management and referral checklist for patients with diabetes : A guide for Lamberth GP Practices NHS England Diabetes Care- Alphabet Approach


Related Charts:

Add Your Comments

Your email address will not be published.

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

A4 Medicine  - Search Less and Learn More

Welcome to the A4 medicine community where we are constantly working to provide exceptional educational material to primary health care professionals. Subscribe to our website for complete access to our A4 Charts. They are aesthetically designed charts that contain 300 (plus and adding) common and complex medical conditions with the all information required for primary care in one single page that can help you in consultation/practice and exam.

Additionally, you will get complete access for our Learn From Experts : A4 Webinar Series in which domain experts share the video explainer presentation on one medical condition in one hour for the primary care. And you will also get a hefty discount on our publications and upcoming digital products.

We are giving a lifetime flat 30% discount to our first thousand users, discount code already applied to checkout.