Type 2 diabetes

​​​​​​​​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 (even if glucose is normal) (i.e. clinical dehydration, rapid or laboured [Kussmaul] breathing, recurrent vomiting, reduced level of consciousness, haemodynamically compromised with tachycardia or hypotension, urine ketones +++, or > 1.5 mmol/L blood ketones)
  • 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)
  • Pregnant patient with persistent blood glucose level of > 10.0 mmol/L and/or blood ketones > 0.6 mmol/L unresponsive to initial management
  • Pregnant patient with persistent blood glucose level of < 3.5 mmol/L (confirmed by finger prick test, where possible) unresponsive to initial management
  • 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 diagnosed active Charcot neuro-osteo-arthropathy (i.e. unilateral foot condition with features of peripheral neuropathy, hyperaemia, increased foot skin temperature by
    2 degrees or above, restricted joint range of motion, changes in foot shape, oedema, pain and/or bounding pulses)
    Note: same-day referral to a high-risk foot service (or similar service to manage Charcot foot)
  • Suspected or symptomatic hyperosmolar hyperglycaemic state (HHS) (i.e. polyuria, polydipsia, altered mental state, dehydration) with acute illness and/or persistent hyperglycaemia
  • Unable to tolerate oral fluids and blood glucose levels continue to drop during sick day management
  • Unresolved severe hypoglycaemia despite treatmentNote: patient also should be referred to a medical practitioner for review of diabetes type, ongoing management and driving safety

When public outpatient services are not routinely provided

  • Prediabetes care
  • Private driver's licence holders who require a new or renewed conditional licence
    Note: commercial driver's licence assessments may be considered on a case-by-case basis where there are specific clinical concerns that require specialist diabetes input
  • Routine care or ongoing review for uncomplicated type 2 diabetes, including, but not limited to:
    • Routine podiatry care, including annual diabetes-related neurovascular foot assessment
    • Routine clinical psychology care
    • Routine medical nutrition therapy
    • Routine diabetes education
      Note: these services can be subsidised by the five (5) allied health services accessible through a General Practitioner Chronic Condition Management Plan (GPCCMP). Get Healthy Service is also available for free health coaching to reach healthy eating and active living goals.
  • Stable, well-controlled type 2 diabetes where HbA1c is at individualised target without undue risk of hypoglycaemia
  • Stable, well-controlled type 2 diabetes where referral is solely for weight loss
  • Severe clinical obesity seeking access to bariatric surgery
    Note: exception is referral to a specific obesity management service

Note: refer to your local HealthPathways for more information on specific services and models of care available within your respective region

Criteria to access public outpatient services

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

  • Hypoglycaemic unawareness and frequent hypoglycaemia (i.e. > 3 hypoglycaemic episodes per week) despite adjustment of therapy
  • Inadequately controlled type 2 diabetes with recent glycaemic deterioration despite escalation of therapy as indicated by any of the following features:
    • HbA1c > 12.0% (or > 108 mmol/mol)
    • Persistent blood glucose levels > 17.0 mmol/L
  • New diabetes-related foot ulcer
    Note: referral to high-risk foot service is indicated, where available
  • Post discharge for a hyperosmolar hyperglycaemic state (HHS) or diabetic ketoacidosis (DKA) admission
  • Pregnant with newly diagnosed or existing type 2 diabetes
    Note: for optimum care, patient should be reviewed within 1 week
  • Recent, severe hypoglycaemic episode (level 3) where assistance has been required from a third party
  • Type 2 diabetes commencing steroid therapy in the context of new chemotherapy or new pulse steroids for autoimmune or inflammatory conditions​
​Category 2
Recommended to be seen within 90 calendar days.
  • Inadequately controlled type 2 diabetes with recent glycaemic deterioration despite escalation of therapy
    as indicated by any of the following features:
    • HbA1c 10.0-12.0% (86-108 mmol/mol)
    • Average blood glucose level > 14.0 mmol/L
  • Pre-conception planning with existing type 2 diabetes
  • Rapid progression of type 2 diabetes complications requiring adjustment of treatment
    Note: include details of complications in referral
  • Type 2 diabetes awaiting a major surgical procedure with HbA1c > 9.0%
  • Type 2 diabetes planned for organ transplantation
  • Type 2 diabetes following new organ transplantation independent of HbA1c
  • Type 2 diabetes commencing steroid therapy in any other context as specified in Category 1

Category 3
Recommended to be seen within 365 calendar days.

  • Aged < 25 years at time of diagnosis with type 2 diabetes
  • Diagnosed type 2 diabetes with Aboriginal and/or
    Torres Islander descent
  • HbA1c > 8.0% despite triple therapy or insulin therapy
  • Problems related to insulin therapy (e.g. > 10.0% increase in total body weight, insulin allergy)
  • Self-management education or difficulties in managing type 2 diabetes in the absence of adequate primary care services


Note: commercial driver's licence assessments may be considered on a case-by-case basis where there are specific clinical concerns that require specialist diabetes input​

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
  • Patient health summary (such as relevant medical history, relevant investigations, current medications and dosages, immunisations, allergies and/or adverse reactions), including specifically:
    • Any diabetes complications (e.g. severe hypoglycaemia events or diabetic ketoacidosis, cardiovascular disease, kidney disease, retinopathy, cerebral vascular disease, foot disease, neuropathy, anxiety, depression) and complications screening outcomes
    • Contraception, pregnancy intention and obstetric history (for women of reproductive age)
    • HbA1c level within the last 3 months
    • Height, weight and body mass index (BMI)
    • Most recent laboratory measures (preferably within the last 6 months):
      • Full blood count (FBC)
      • Electrolytes, urea and creatinine (EUC)
      • Liver function tests (LFTs)
      • Lipids (total cholesterol, LDL, HDL, triglycerides)
      • Urine albumin: creatinine ratio​

If available

  • Details of relevant medical management (including the course and outcome of treatment)
  • Driving licence status (i.e. nil, private or commercial)
  • Medication history (including non-prescription medicines, herbs and supplements)
  • Past surgical and cancer history, including if osteoporosis is present
  • Previous HbA1c results and diabetes complications screening in younger years
  • Physical examination findings
  • Resting electrocardiogram (ECG)
  • Ferritin or iron studies
  • Results of depression screening (PHQ-2)
  • Blood vitamin B12 level (if peripheral neuropathy is present)​​

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