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Inappropriate referrals put Type 1 patients at risk

12 February 2015

At Diabetes UK we have been alerted to reports of an increasing number of Type 1 patients admitted in DKA despite a diagnosis in primary care, because the patient was treated in the same way as a Type 2 diagnosis, rather than thethat’s needed for Type 1.  Diabetes UK would like to address confusion around referring patients with Type 1 diabetes.

Type 1 diabetes accounts for about 10 per cent of all adults with diabetes and is treated by insulin injections, a healthy diet and regular physical activity. Type 1 diabetes can develop at any age but usually appears before the age of 40, and especially in childhood. It is the most common type of diabetes found in childhood.

Type 2 diabetes usually appears in people over the age of 40, though in South Asian people, who are at greater risk, it often appears from the age of 25. It is also increasingly becoming more common in children, adolescents and young people of all ethnicities. Type 2 diabetes accounts for between 85 and 95 per cent of all people with diabetes.  Initially patients may require only a lifestyle change, but as the diabetes progresses patients will require more medical interventions and some Type 2 patients do require treatment with insulin.

In Type 1 diabetes the signs and symptoms are usually very obvious and develop very quickly, typically over a few weeks, especially in children.  The classic symptoms are increasedand; and in this situation, the adult/child may appear extremely unwell and fasting blood glucose levels will be elevated well above 7mmol/l. Leaving Type 1 diabetes untreated can lead to serious health problems, including, which can result in a. The symptoms are quickly relieved once insulin is initiated and the diabetes is brought under control.

In Type 2 diabetes the signs and symptoms may not be so obvious, as the condition develops slowly and may only be picked up in a routine medical checkup. The symptoms may be similar to Type 1 diabetes, but develop over months or even years, and the blood glucose levels may not appear to be so high.

GPs and practice nurses have a pivotal role to play in ensuring that all people with diabetes receive effective diabetes care. GPs and other members of the primary healthcare team are responsible for ensuring that all people with diabetes registered to their practice are receiving planned diabetes care. It is often the GP who makes the initial diagnosis of diabetes and who is responsible for agreeing with the person with diabetes where they will receive each element of their diabetes care and who will provide this.

At Diabetes UK in response to the reports of patients with Type 1 diabetes not receiving appropriate referrals from General Practice on diagnosis, we are making this recommendation. In order to ensure patients are receiving the best care, the following referral should be made.

If the patient, whether adult or child presents with Type 1 symptoms it is vital that you carry out a blood glucose testand, if it indicates Type 1 diabetes, you follow local referral pathways. Typically patients are referred to the local diabetes specialist team in secondary care where, if necessary, they will be admitted and commence the correct care. This will include starting insulin therapy. It is not appropriate for these newly diagnosed Type 1 patients to be cared for in primary care with Type 2 therapies. It is important to remember the related risks in this situation and refer accordingly.

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