GuidelinesOther guideline
Organisation of Diabetes Care
Organisation of Diabetes Care
Requirements for a diabetic clinic
(See Strength of Recommendations Taxonomy (SORT) for explanation of Grade A-C)
| SEMDSA 2017 Recommendations | |
| Patients with diabetes should be seen by dedicated staff at a clinic/facility with adequate space and resources (equipment and medication) |
C |
| The diabetes consultation should be a structured one The use of standardised diabetes consultation templates is encouraged to ensure that essential assessments / processes of care are not omitted |
C |
| At each visit, the patient should have a history taken, undergo a clinical examination and have blood taken for biochemical evaluation |
- |
| The complexity of each will be dependent on whether it is an initial consultation, follow-up consultation or an annual review |
C |
REQUIREMENTS FOR A DIABETIC CLINIC
- Dedicated, appropriately trained staff
- Adequate space:
- For individual consultation
- For group education
- Protocols covering:
- Screening
- Regular care, including referrals
- Equipment:
- Tape measure (waist circumference)
- Scale
- Height measure
- Accurate sphygmomanometers, with two cuff sizes
- Monofilament and 128 Hz tuning fork
- Glucometers in good working order
- HbA1C testing equipment, to enable testing on site
- Educational material
- Regular supply of medication
- Register with recall system for non-attenders
- Annual audits of:
- Numbers of patients receiving designated processes of care
- Numbers of patients reaching targets for glycaemia, blood pressure (BP) and lipids
- History, clinical examination, investigations: What to do when
|
History
|
Initial
|
3-6 monthly visit
|
Annually
|
|
Symptoms of hyperglycaemia, and duration of symptoms
|
X
|
X
|
X
|
|
Relevant family history
|
X
|
-
|
X
|
|
Other risk factors (e.g. gestational diabetes, high birth weight)
|
X
|
-
|
X
|
|
Relevant medical history
Co-morbid conditions
Symptoms of complications
Cardiovascular, neurological, bladder function, sexual function (i.e. erectile dysfunction), feet, visual, infection
|
|
|
|
|
X
|
-
|
X
|
|
|
X
|
X
|
X
|
|
|
-
|
-
|
-
|
|
|
|
|
|
|
|
Drugs
Current
Side-effects and adherence
Allergies
|
|
|
|
|
X
|
-
|
X
|
|
|
X
|
X
|
X
|
|
|
X
|
-
|
X
|
|
|
Hypoglycaemic symptoms
|
X
|
X
|
X
|
|
Vaccinations
Pneumococcal (date)
Influenza (date)
|
|
|
|
|
X
|
-
|
X
|
|
|
X
|
-
|
X
|
|
|
Lifestyle
Weight history
Physical activity
Eating pattern
Smoking
Alcohol
|
|
|
|
|
X
|
X
|
X
|
|
|
X
|
X
|
X
|
|
|
X
|
X
|
X
|
|
|
X
|
X
|
X
|
|
|
X
|
X
|
X
|
|
|
Psychosocial
Occupation
Family and community support
Depression
|
|
|
|
|
X
|
-
|
X
|
|
|
X
|
-
|
X
|
|
|
X
|
X
|
X
|
|
|
Home monitoring chart (if relevant)
|
X
|
X
|
X
|
|
Examination
|
Initial visit
|
3-6 monthly visit
|
Annually
|
|
Weight
|
X | X | X |
|
Height
|
X | - | X |
|
BMI (kg/m2 )
|
X | X | X |
|
Waist circumference (cm)
|
X | X | X |
|
Blood pressure
|
X | X | X |
|
Feet - detailed examination§
|
X | - | X |
|
Monofilament assessment
|
X | - | X |
|
Vibration sensation assessment
|
X | - | X |
|
Ankle jerks
|
X | - | X |
|
Evaluation for peripheral arterial disease
|
X | - | X |
|
Oral cavity
dental caries
gum disease
|
|||
| X | - | X | |
| X | - | X | |
|
Eye examination
Visual acuity
Retinal examination* |
|||
| X | - | X | |
| X | - | X | |
| Cardiovascular examination | X | - | X |
| Injection sites if appropriate | X | X | X |
|
§ See: The Prevention and Treatment of Foot Problems in Diabetes
*The preferred method for screening for retinopathy is retinal imaging using non-mydriatic fundus photography, (the images can be interpreted remotely by those with the expertise); dilated fundoscopy can be used in the absence of a retinal camera by those clinicians who have the necessary expertise to diagnose diabetic retinopathy, and in patients where dilatation of the pupil will not hamper driving or returning to work |
|||
| Investigations | Initial visit | 3-6 monthly visit | Annually |
|
Blood
Glucose
HbA1c
Lipids (TC, HDLc, TG, LDLc)
Creatinine and calculation of eGFR
Potassium
HIV
|
|||
| X | - | - | |
| X | X | X | |
| X | - | X | |
| X | - | X | |
| X | - | X | |
| X | - | - | |
|
Urine
Dipstix Glucose
Ketones
Protein
Albumin/creatinine ratio
|
|||
| X | X | X | |
| X | X | X | |
| X | X | X | |
| X | - | X | |
|
ECG
|
X | - | X |
|
Continuous glucose monitoring*
|
X | X | X |
|
*Refer to: Glycaemic Targets
|
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| Other important tasks | Initial visit | Every visit | Annually |
|
Diabetes educator*
|
X | X | X |
|
Education: Self-management and lifestyle adjustment, including smoking cessation
|
X | X | X |
|
Setting goals
|
X | X | X |
|
Preconception counselling and family planning
|
X | X | X |
|
Medication revision/adjustment
|
X | X | X |
|
Immunisations
|
X | - | X |
|
Testing for autonomic neuropathy
|
X | - | X |
| *Any healthcare worker who has completed, with competence, a South African Nursing Council or SEMDSA-approved diabetes educators course | |||
Authors: Naomi S. Levitt and Joel A. Dave