Other diabetes mellitus types

​​​​​​​Emergency

If any of the following are suspected, seek emergency medical advice or refer the patient to the emergency department (via ambulance if necessary)

  • Acute, severe diabetes-related end-organ complication (e.g. suspected acute coronary syndrome, cerebrovascular event, infected foot ulcer with systemic features, new vision loss, or renal failure)
  • Clinical features suggesting diabetic ketoacidosis or euglycaemic ketoacidosis (i.e. clinical dehydration, rapid or laboured [Kussmaul] breathing, recurrent vomiting, reduced level of consciousness, or haemodynamically compromised with tachycardia or hypotension)
  • Diabetes-related foot ulceration with absent pulses
    Note: refer to a vascular surgeon or high-risk foot service
  • Diabetes-related foot ulceration with features of severe or systemic infection
    Note: refer immediately to emergency department and/or high-risk foot service
  • High ketones unresponsive to initial management (i.e. moderate or greater result on urine testing or > 1.5 mmol/L on finger prick blood test)
  • Recurrent, persistent vomiting for > 4 hours preventing oral intake and hydration
  • Severe hypoglycaemia requiring third party assistance including that occurring with loss of consciousness
    Note: referral to endocrinologist or diabetes service is indicated for rapid access outpatient appointment within 24 hours. If no medical-led specialist outpatient service is available, present to an emergency department.
  • Suspected or symptomatic hyperosmolar hyperglycaemic state (HHS) (i.e. polyuria, polydipsia, altered mental state, dehydration) with acute illness and/or persistent hyperglycaemia
  • Suspected or diagnosed active Charcot neuro-osteo-arthropathy (i.e. clinical signs of inflammation, particularly redness, heat and/or swelling, in the neuropathic foot)
    Note: same-day referral to a high-risk foot service (or similar service to manage Charcot foot)​

When public outpatient services are not routinely provided

  • ​Prediabetes, obesity or metabolic syndrome without diabetes​
    ​

Criteria to access public outpatient services

CategoryCriteria
Category 1
Recommended to be seen within 30 calendar days.

  • Atypical diabetes with suspected severe insulin deficiency as indicated by any of the following features:
    • Low C-peptide
    • Moderate to severe ketosis
  • Acute drug-induced diabetes, especially in the context of new chemotherapy or new pulse steroids for autoimmune or inflammatory conditions
  • Diabetes arising from checkpoint inhibitors
  • HbA1c > 12.0% (> 108 mmol/mol) or persistent blood glucose levels > 17.0 mmol/L
  • New onset diabetes after transplantation (NODAT)
  • New onset Type 3c diabetes (including pancreatic cancer, post-pancreatitis, cystic fibrosis or haemochromatosis)
  • Recent post-total pancreatectomy or Whipple's procedure
​Category 2
Recommended to be seen withinn 90 calendar days. 
​
  • Chronic drug-induced diabetes (i.e. chronic hyperglycaemia in the context of relatively stable corticosteroid use) with HbA1c > 10.0% (> 86 mmol/mol) or average blood glucose > 14.0 mmol/L
  • Malnutrition-related diabetes (Type 5 diabetes)​

Category 3
Recommended to be seen within 365 calendar days.

  • Chronic drug-induced diabetes (i.e. chronic hyperglycaemia in the context of relatively stable corticosteroid use) with HbA1c 8.0-10.0% (64-86 mmol/mol) despite triple therapy or insulin therapy
  • Diagnosed other diabetes mellitus type with Aboriginal and/or Torres Islander descent
  • Longstanding Type 3c diabetes in whom management review is required due to sub-acute comorbidity or instability
  • Monogenic diabetes (e.g. Maturity Onset Diabetes
    in the Young (MODY), mitochondrial diabetes)
  • Undifferentiated or atypical diabetes type requiring diagnosis​

Information to include within a referral

Required

  • Reason for referral
  • Details of the presenting condition, including symptoms and their duration, and date of diabetes diagnosis
  • Additional information including: HbA1c, renal function, steroid regimen and family history
  • Patient health summary (such as relevant medical history, relevant investigations, current medications and dosages, immunisations, allergies and/or adverse reactions), including specifically:
    • Other concerning features associated with atypical diabetes
    • Details of chemotherapy regimen, including steroid regimen (if applicable)
    • Details of transplant (if applicable)
    • Any genetic testing (if applicable)​​

If available

Nil.

Important information for referring health professionals

If there is a change to a patient’s condition while waiting for their appointment, referring health professionals may further investigate and manage the situation, or send an updated referral to the outpatient service. Where there are significant concerns about a patient's condition, referring health professionals may check HealthPathways for urgent/same day advice or contact the relevant clinical team. 

Current as at: Monday 23 March 2026
Contact page owner: System Purchasing