Quality Standards for Diabetes Care Toolkit

Implementation advice

The Australian Clinical Management Care Guidelines for type 1 diabetes state that education (see Standard 1) and psychological support (see Standard 4) are an essential component of standard diabetes care and recommend ‘intensified education and psychological support programs should be considered when treatment goals are not being met’(p 7). The practice points for this are:

educational and psychological interventions should be culturally, developmentally and age appropriate

the multidisciplinary diabetes health care team should aim to maintain consistent contact with people with diabetes and their families/whānau or carers

it is important for the multidisciplinary diabetes team to provide preventive interventions for patients and families/whānau (include training parents in effective behaviour-management skills) at key developmental stages, including after diagnosis and before adolescence. The aim of these interventions is to emphasise appropriate family/whānau involvement and support in diabetes management, effective problem-solving and self-management skills, and realistic expectations about glycaemic control (Delamater 2009)

diabetes care teams should have appropriate access to mental health professionals to support them in the delivery of psychological support

flexible intensive insulin therapy programs, such as DAFNE, aim to provide dietary freedom for people with type 1 diabetes (www.apeg.org.au/portals/0/guidelines1.pdf).

The Institute for Clinical Systems Improvement (ICSI) (https://www.icsi.org/_asset/3rrm36/Diabetes-Interactive0412.pdf algorithms) suggest the following for when treatment goals are not met:

Recommendations

If patients are having difficulty achieving treatment goals, consider a modification of treatment goals. In addition, evaluate for potential contributing issues such as adherence, depression and obstructive sleep apnoea (see Standards 1 and 4).

A referral to an extended care team clinician can be helpful; this could be as an endocrinologist or other specialist, diabetes educator (diabetes nurse specialist in New Zealand), dietitian or pharmacist.

Modify treatment based on appropriate related guideline

Prevention and management of obesity (mature adolescents and adults) (see Standard 2)

Hypertension diagnosis and treatment (see Standards 5 and 6)

Lipid management in adults (see Standards 5 and 6)

Major depression in adults in primary care (see Standard 4).