How to access evidence-based care if you live with t1
Thursday, 16 May 2019
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 psychologist.
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 telehealth consult.
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 following concerns:
- 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 disease
- 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 GP.
By Helen d’Emden, Diabetes Queensland Credentialled Diabetes Educator