Paediatric diabetes (Diabetes and Endocrinology)

PAEDIATRIC

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • New diagnosis of type 1 diabetes = polyuria and/or polydipsia and random BSL >11.0.
    • Ketoacidosis in a person known to have diabetes with any of the following:
    • systemic symptoms (fever, lethargy) or
    • vomiting or
    • inability to eat (even if not vomiting) or
    • abdominal pain or
    • headache
      • Refer to local HealthPathways or local guidelines
      • All newly diagnosed/ suspected type 1 diabetes must be seen as an emergency as soon as the diagnosis is suspected. Do not wait for test results to become available except near patient testing of blood sugar level.
      • To avoid delay in diagnosis, physicians need to take due care in their detection of diabetes in a patient and in defining its clinical sub‐type, since delayed diagnosis of type 1 diabetes in a child or adolescent is associated with an increased risk of DKA and subsequent morbidity and mortality.
      • 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 education. If the child/adolescent/family is unable to access these health professionals, support with education should be provided by the experienced health professional at the provincial or tertiary diabetes centre, via videoconference or phone.
      • Groups for whom inpatient management is necessary at diagnosis include
        • individuals with diabetic-related ketoacidosis, significant comorbidities, inadequate social support, or mental health issues
        • children under 2 years of age
        • those in geographically remote areas
        • non-English speakers
      • Explain to children and young people with type 1 diabetes and their family members or carers (as appropriate) that an HbA1c target level of 48 mmol/mol (6.5%) or lower is ideal to minimise the risk of long-term complications.
      • Refer to local/regional diabetes education/dietetic services.  Registration with NDSS (National diabetes services scheme).
      • Develop an individualised management plan, which includes planned interaction with local diabetes educators, dietetic inputs, caregivers, local health team and visiting specialists where necessary.
      • Provide ongoing clinical advice and support to local health team and family
      • Refer/explain to children and young people with type 1 diabetes and their family members or carers (as appropriate) how to find information about government and benefits available.
      • Disability benefits. It is important to monitor the school performance of children who developed diabetes before age 5–7 years, and those with a history of significant hypoglycaemic episodes or chronic poor blood glucose control.
      • Offer children and young people with type 1 and type 2 diabetes and their family members or carers (as appropriate) timely and ongoing access to mental health professionals with an understanding of diabetes because they may experience psychological problems (such as anxiety, depression, behavioural and conduct disorders and family conflict) or psychosocial difficulties that can impact on the management of diabetes and wellbeing.
      • Encourage children and young people with type 1 diabetes to wear or carry something that identifies them as having type 1 diabetes (for example, a bracelet).
      • In the majority of cases, it is thought inappropriate for children to wait more than 6 months for an outpatient initial appointment
      • Next of kin or person(s) who is legally responsible for patient consent, with the exception of children under guardianship orders with the Department of Child Safety, Seniors and Disability Services, should be present at the first outpatient appointment.
      • If you have a reason to suspect a child in Queensland is experiencing harm, or is at risk of experiencing harm, you need to contact Child Safety Services
      • Statement of intent – the prioritisation of health services for children and young people in the child protection system
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Suspected type 2 diabetes where
    • child/adolescent assessed to be well and without ketosis. Health care provider confident of type 2 diagnosis
    • unstable known type I diabetes transferring care
  • A child currently in out of home care (OOHC), or at risk of entering or leaving OOHC, where they have previously been on a waiting list for this problem and were removed without receiving a service.
Category 2
(appointment within 90 calendar days)
  • Pre-existing and stable type I diabetes in a person transferring care
Category 3
(appointment within 365 calendar days)
  • No category 3 criteria

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • History of the presentation including reasons why this is thought to be type 2 diabetes rather than type 1 (e.g. strong family history of type 2, obesity, evidence of insulin resistance [e.g. acanthosis nigricans])
  • Report presence or absence of concerning features:
    • polyuria or polydipsia
    • recent weight loss
    • recent onset enuresis
    • ketosis on urine or blood testing.
  • HbA1c, FBC, ELFTs, CRP, TFT
  • Plasma glucose (fasting)
  • Ketones (blood or urine) – if positive send direct to emergency
  • Confirmation of OOHC (where appropriate)

NB follow up/review patients will have pathology attended to in the clinic, the patient is not required to get blood tests prior to attending on an ongoing referral

3. Additional referral information Useful for processing the referral

Highly desirable information – may change triage category

  • Mode of presentation, whether insidious or acute
  • Other past medical history
  • Family history, especially of diabetes, PCOS and other endocrine conditions
  • Height/weight/head circumference and growth charts with prior measurements if available

Desirable Information - will assist at consultation

  • Birth history
  • Immunisation history
  • Developmental history
  • Medication history
  • Allergies
  • Significant psychosocial risk factors (especially parents' mental health, family violence, housing and financial stress, department of child safety involvement)
  • Other physical examination findings inclusive of CNS, birthmarks or dysmorphology
  • Any other relevant laboratory tests or medical imaging

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • To establish a diagnosis
    • For treatment or intervention
    • For advice and management
    • For specialist to take over management
    • Reassurance for GP/second opinion
    • For a specified test/investigation the GP can't order, or the patient can't afford or access
    • Reassurance for the patient/family
    • For other reason (e.g. rapidly accelerating disease progression)
    • Clinical judgement indicates a referral for specialist review is necessary

    Clinical modifiers

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    Other relevant information

    • Willingness to have surgery (where surgery is a likely intervention)
    • Choice to be treated as a public or private patient
    • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 2 December 2024

© State of Queensland (Queensland Health) 2023

Except as permitted under the Copyright Act 1968, no part of this work may be reproduced, communicated or adapted without permission from Queensland Health. To request permission email ip_officer@health.qld.gov.au1.