Diabetes Mellitus Referral Access Criteria

• New diagnosis of any type of diabetes = polyuria and/or polydipsia and random BSL >11.1mmol/L or HbA1c >6.5% or OGTT with fasting BSL >7mmol/L or 2 hours >11.1mmol/L
• In a patient with known diabetes (of any type) with any of the following:
  • Suspected DKA such as hyperglycaemia with vomiting, abdominal pain, severe lethargy and positive ketones
  • Severe hypoglycaemia (coma, convulsions, altered consciousness)
  • Persistent vomiting with hypoglycaemia or hyperglycaemia or inability to tolerate PO fluids

• Nil

To contact the relevant service, see Clinician Assist WA: Acute Paediatric Assessment (external site)

• Polydipsia or polyphagia
• Polyuria or nocturia or enuresis or glycosuria
• Weight loss
• Excessive fatigue
• Symptoms of ketoacidosis:
  • Rapid, deep breathing
  • Abdominal pain
  • Vomiting
• Thrush
• UTI

This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.

• Relevant history, onset, duration and severity of symptoms
• Current medication list
• Any known allergies
• Familial history of diabetes and obesity
• Report presence or absence of concerning features:
  • Polyuria
  • Recent weight loss
  • Recent onset enuresis

• Nil

• Ketosis on urine or blood testing (along with high blood glucose or glucosuria in urine)

• Mode of presentation (insidious or acute)
• Past medical history (inclusive of pregnancy, birth, immunisation and development history)
• Familial history of polycystic ovary syndrome and other endocrine conditions

• Height/weight/head circumference and growth charts with prior measurements if available
• Other physical findings inclusive of CNS, birthmarks or dysmorphology

• Other relevant laboratory tests or medical imaging

Category 1

Appointment within 30 days

• Unstable known diabetes transferring care

Category 2

Appointment within 90 days

• Stable known diabetes transferring care

Category 3

Appointment within 365 days

• No defined category 3 criteria

• Nil

• All newly diagnosed or suspected diabetes should be seen as an emergency as soon as the diagnosis is suspected. Other than point of care testing of blood glucose level (e.g. fingerpick BSL or immediate dipstick for glycosuria), do not wait for test results to become available before referring for emergent assessment.
• The statewide diabetes service at Perth Children’s Hospital will offer healthcare services to patients under 16 years of age with newly diagnosed diabetes. For those diagnosed with diabetes before age 16, outpatient care will generally continue until age 18, or on completion of secondary school.
  • For school-aged patients aged 16 to 18 with a new diagnosis of diabetes, referral to acute adult services is required. The diabetes service will consider accepting cases in exceptional circumstances upon discussion with the endocrinologist on-call.
• In rural and remote areas, it is preferable that local health professionals, who have access to the specialist paediatric diabetes team, provide ongoing support and partner in care where possible.
• Youth in regional and remote areas of WA will be assigned where possible to their nearest subspecialty diabetes clinic, all of which will be administered and staffed by the Diabetes Service at PCH
• See Clinician Assist WA: Diagnosing Diabetes in Children and Adolescents (external site)
• See PCH: Diabetes – For health professionals (external site) for more information.