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Diabetes – When to Refer

When to Refer

At diagnosis or during routine follow-up

The European AIDS Clinical Society (EACS) recommends that people living with HIV who are diagnosed with diabetes should receive a consultation with a specialist in diabetology.

The following referrals should also be considered at diagnosis and as needed throughout treatment:

  • lifestyle modification: dietician and smoking cessation clinic if relevant1–3
  • diabetes self-management education2,3
  • dilated eye examination (repeated annually)2–4
  • dental examination (repeated annually)2,4
  • family planning in women of reproductive age2,4
  • mental health professional when indicated,2,4 for example when there is evidence of gross non-compliance, eating disorder, cognitive dysfunction, addiction, adjustment disorder, major depression, anxiety disorder or personality disorder

Emergency referrals

Patients with diabetes are at increased risk of a number of complications that may require urgent specialist intervention, and clinicians should refer to relevant guidelines such as those published by the International Diabetes Federation (IDF) or the American Diabetes Association (ADA) for guidance.

The IDF guidelines recommend that immediate specialist medical attention may be required for the following conditions:4

  • immediate medical care for marked hyperglycaemia accompanied by ketosis, vomiting, or alteration in level of consciousness2
  • referral the same day (diabetic retinopathy) for sudden loss of vision or evidence of retinal detachment
  • referral within a week (diabetic retinopathy) for evidence of pre-retinal and/or vitreous haemorrhage; new vessel formation or rubeosis iridis
  • referral within 24 hours for foot ulceration or infection
  • immediate medical care for diabetic ketoacidosis or non-ketotic hyperosmolar state due to loss of glycaemic control that may be precipitated by illness, trauma or surgery