Quality Standards for Diabetes Care Toolkit

Implementation advice

Correct diagnosis of a possible uncommon cause of diabetes allows for individualised and appropriate treatment resulting in reduced complications and more effective response to treatment (Juszczak et al 2014).
Joint clinics are one of the most effective settings for clinicians to look after people with dual conditions where members of both the specialist diabetes team and condition specialist work together to look after the individual. This enables the health professionals to manage the complex needs of both conditions and allows all to learn from each other and provide a consistent approach (Tzoulis et al 2014).
People with diabetes receiving corticosteroid treatment or those who develop diabetes as a result of corticosteroids can be particularly difficult to manage due to the fluctuations in therapy requirements and circadian glycaemic pattern (Burt et al 2011). Prescribers of corticosteroids should work in partnership with diabetes expert teams at the commencement of treatment to enable early, appropriate and frequent anti-diabetes medication changes as needed for the individual (Stevens et al 2011). This includes all those prescribing corticosteroids across the disciplines including, but not limited to, neurological, respiratory, haematology, oncology and palliative care.
In remote locations, care is likely to be provided by a locally based physician and these practitioners should have ready access to the facilities and advice provided by specialist diabetes teams. For complex individuals, annual reviews should take place with the specialist team (International Society for Pediatric and Adolescent Diabetes 2000). This model of shared care should strengthen rather than weaken the relationship between the person with diabetes and their local provider (Cystic Fibrosis Association of New Zealand 2011).
Specialist teams from district or regional centres might organise outreach clinics where people with diabetes have difficulty travelling. The specific role of this diabetes team is to provide specialised hospital medical care, expert comprehensive ambulatory care of diabetes and associated conditions, expert advice on issues related to diabetes (exercise, travel and sickness), and screening for complications (International Society for Pediatric and Adolescent Diabetes 2000).
Telemedicine consultations with diabetes specialist services should be considered as they can remove barriers associated with location to accessing these services (Levin et al 2013). Ideally, there should also be specialist telephone support available 24 hours a day (International Society for Pediatric and Adolescent Diabetes 2000).