By Helen d'Emden
Diabetes Queensland Credentialled Diabetes
You are likely to be aware of team care arrangements with your
GP and the Annual Cycle of Care to inform the range of medical
checks recommended to help prevent or delay complications
associated with diabetes.
These are great initiatives designed to provide the best
evidence-based care possible.
However, it can be hard work finding the time and money to see
all the suggested providers - a diabetes medical specialist, a
diabetes nurse educator, dietitian, podiatrist and perhaps a
Your GP is invaluable to help with your day-to-day medical needs
for diabetes and other health conditions and liaises with any
medical specialists on your behalf.
Australian and International Diabetes Guidelines suggest
individuals with type 1 diabetes are best supported by a
multidisciplinary healthcare team experienced in diabetes
management, who have access to resources, support and education
from a tertiary centre diabetes team.
A tertiary centre is a hospital that provides health
care from specialists in a large hospital setting after
referral from a primary care provider, such as your GP.
For those living in rural and remote regions, telehealth
medicine is increasingly utilised and helps to provide access to
such teams too.
If you have type 1 diabetes, you can seek a referral from your
GP to a multidisciplinary diabetes service for a face-to-face or
At these centres, you will have access to a wider
multidisciplinary team such as a diabetes nurse educator, dietitian
and perhaps a podiatrist and/or psychologist.
This means that you may be able to see multiple providers,
sometimes several at the one visit, and these appointments are
covered under Medicare.
Staff at these centres can help with education on blood glucose
meters, continuous glucose monitors, and insulin pumps, or how best
to manage multiple daily injections of insulin.
Staff are understanding of the stress associated with diabetes
management and may be able to help you in a number of ways or
refer to a mental health practitioner who understands diabetes.
For those on insulin injections, the OzDAFNE (Dose Adjustment
for Normal Eating) program is offered at several tertiary centres
throughout Queensland and Diabetes Queensland is starting to
present OzDAFNE in regional centres around the state.
Once a referral to a multidisciplinary centre is received you
are likely to get your initial appointment within 90 days if you
have stable diabetes but within 30 days if you have one of the
- Poorly managed diabetes with recent deterioration despite
escalation of therapy (HbA1c >86mmol/mol or 10%)
- Major hypoglycaemia episode (assistance has been required by a
third party) or multiple episodes of hypoglycaemia
- Existing type 1 diabetes with newly diagnosed coeliac
- Existing diabetes with recent unintentional weight loss (>
5% of body weight over a month period)
- Diabetes requiring optimisation in the presence of severe
vascular complications, for example, stage 3 chronic kidney
disease, proliferative retinopathy or gastroparesis
- Pregnancy in patient with existing diabetes. For optimum care,
patient should be seen within 1 week
- Diabetes with disordered eating
- Diabetic foot ulcer
Once you have your initial appointment, the diabetes team will
organise regular ongoing appointments at the centre or in a shared
care arrangement with your general practitioner.
Consider your options and make sure you access the best care
possible for your diabetes management. Discuss this with your