Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
You should consider referring a patient with Type 1 Diabetes to a specialist for further management in several key situations, depending on their age and clinical needs:
- For children and young people (aged 12 months to 17 years) with suspected Type 1 Diabetes, an immediate (same-day) referral to a multidisciplinary paediatric diabetes team is required to confirm diagnosis and provide immediate care NICE NG18. This team will also provide an ongoing integrated package of care NICE CKS.
- For adults (aged 18 years and onwards) with a new diagnosis of Type 1 Diabetes, the diabetes specialist team should develop and explain a plan for their early care NICE CKS. An individual care plan should be set up by the diabetes specialist team, with arrangements for implementation and a review in the following weeks NICE CKS.
- For ongoing management across all ages, patients with Type 1 Diabetes require an ongoing integrated package of care provided by a multidisciplinary diabetes team NICE CKS,NICE CKS. This includes regular contact with the diabetes team, such as attending clinic four times a year for young people, to help maintain optimal blood glucose levels NICE NG18,NICE CKS.
- For specific advanced treatments or complex issues, specialist referral is necessary. This includes considering referral for islet or pancreas transplantation NICE NG17. Additionally, the specialist team manages advanced therapies such as continuous subcutaneous insulin infusion (insulin pump) therapy or hybrid closed-loop systems NICE NG17. If an adult patient has erratic and unpredictable blood glucose control (hyperglycaemia and hypoglycaemia at no consistent times), the specialist team will assess factors like injection technique, self-monitoring skills, and mental health before changing an optimised insulin regimen NICE NG17.