programmes, monitoring and reporting across PHNs and the health system more generally for: Eye damage and blindness Cardiovascular disease and strokes Kidney damage and failure Amputations Mental health Impaired growth and development in children. Table 3 provides an overview of key diabetes-related complications, including their assessment, frequency, diagnosis and referral pathways. It also demonstrates the wide range of components and services that are needed to deliver optimal diabetes care. Table 3: Overview of the complexity of the management of chronic diabetes complications Complication Assessment Frequency Means of Referral Measuring Pathways Eye Retinopathy Visual acuity Every 2 years Fundus Retinopathy Cataract (1 year for examination requires access Glaucoma Fundus Indigenous to laser therapy Visual loss examination people) Fundus and specific Blindness photography medications More frequently if Includes access abnormalities to present or an optometrist Kidney Albuminuria Urine At least Urine and Access to Chronic kidney examination annually blood test dialysis and disease for albuminuria transplantation More where indicated Measurement frequently if of creatinine abnormalities Access to and calculation present nephrologist of eGFR Foot Neuropathy Foot At Foot Includes access Peripheral vascular examination annually inspection by to podiatrist and disease and tests of doctor, multidisciplinary Foot deformity sensation and More podiatrist or foot care team Ulcer circulation frequently if diabetes Amputation abnormalities educator present disease Blood lipids Annually Clinical Includes access Cardiovascular disease Coronary artery Blood pressure examination to cardiologist disease CVD risk and relevant Heart failure assessment Blood test tests (e.g., stress Stroke tool test, Atrial fibrillation angiography) Mental health Depression Assessment of On diagnosis Clinical Multidisciplinary Anxiety mental status and when examination team including required psychologists, psychiatrists and social workers Growth and Poor growth Growth Annually Clinical Includes access development Delayed puberty examination to in children multidisciplinary paediatric diabetes team Key issues Clinical Guidelines: Diabetes management has attracted a plethora of research, and the
programmes, monitoring and reporting across PHNs and the health system more generally for: Eye damage and blindness Cardiovascular disease and strokes Kidney damage and failure Amputations Mental health Impaired growth and development in children. Table 3 provides an overview of key diabetes-related complications, including their assessment, frequency, diagnosis and referral pathways. It also demonstrates the wide range of components and services that are needed to deliver optimal diabetes care. Table 3: Overview of the complexity of the management of chronic diabetes complications Complication Assessment Frequency Means of Measuring Referral Pathways Eye Retinopathy Cataract Glaucoma Visual loss Blindness Visual acuity Fundus examination Every 2 years (1 year for Indigenous people) More frequently if abnormalities present Fundus examination Fundus photography Retinopathy requires access to laser therapy and specific medications Includes access to or an optometrist Kidney Albuminuria Chronic kidney disease Urine examination for albuminuria Measurement of creatinine and calculation of eGFR At least annually More frequently if abnormalities present Urine and blood test Access to dialysis and transplantation where indicated Access to nephrologist Foot Neuropathy Peripheral vascular disease Foot deformity Ulcer Amputation Foot examination and tests of sensation and circulation At annually More frequently if abnormalities present Foot inspection by doctor, podiatrist or diabetes educator Includes access to podiatrist and multidisciplinary foot care team Cardiovascular disease disease Coronary artery disease Heart failure Stroke Blood lipids Blood pressure CVD risk assessment tool Atrial fibrillation Annually Clinical examination Blood test Includes access to cardiologist and relevant tests (e.g., stress test, angiography) Mental health Depression Anxiety Assessment of mental status On diagnosis and when required Clinical examination Multidisciplinary team including psychologists, psychiatrists and social workers Growth and development in children Poor growth Delayed puberty Growth Annually Clinical examination Includes access to multidisciplinary paediatric diabetes team Key issues Clinical Guidelines: Diabetes management has attracted a plethora of research, and the