What referrals are needed for a patient with newly diagnosed diabetes?

Essential Referrals for Newly Diagnosed Diabetes Patients

Patients with newly diagnosed diabetes should be referred to a diabetes care team including an endocrinologist, certified diabetes educator, registered dietitian nutritionist, and mental health professional to optimize outcomes and reduce morbidity and mortality. 1, 2

Primary Referrals (Essential)

1. Endocrinologist

• Type 1 diabetes: Immediate referral to pediatric endocrinologist for children or adult endocrinologist 2
• Type 2 diabetes: Consider referral especially for complex cases or when glycemic targets are not met with initial therapy 1

2. Certified Diabetes Educator

• Immediate referral for diabetes self-management education and support (DSMES) 1
• Provides essential "survival skills" education including:
  • Blood glucose monitoring techniques
  • Recognition and treatment of hypoglycemia and hyperglycemia
  • Medication administration (especially insulin if prescribed)
  • Sick-day management
  • Basic meal planning 1

3. Registered Dietitian Nutritionist (RDN)

• Referral for medical nutrition therapy (MNT) at diagnosis 1
• Individualized nutrition planning can reduce A1C by 0.3-2.0% in type 2 diabetes and 1.0-1.9% in type 1 diabetes 1
• Essential for weight management in patients with overweight/obesity 1

4. Ophthalmologist/Optometrist

• Type 1 diabetes: Initial dilated eye exam within 5 years of diagnosis
• Type 2 diabetes: Initial dilated eye exam shortly after diagnosis 2

Secondary Referrals (Based on Specific Needs)

1. Mental Health Professional

• Screen for depression, anxiety, and disordered eating at diagnosis 1
• Refer if positive screening or history of mental health conditions 1
• Mental health support improves adherence and outcomes 2

2. Nephrologist

• Refer patients with advanced kidney disease (eGFR <30 mL/min/1.73 m²) 2
• Consider earlier referral for rapidly progressing kidney disease

3. High-Risk Obstetrics

• All women with pre-existing diabetes who become pregnant
• Women diagnosed with gestational diabetes 2

4. Podiatrist

• Patients with foot deformities, neuropathy, or history of foot ulcers

Structured Follow-up Plan

Initial Period (First 3 months)

• Primary care physician: Every 2-4 weeks until stable
• Diabetes educator: 2-3 sessions within first month
• Dietitian: Initial assessment and follow-up within 4-6 weeks

Maintenance Period

• Primary care physician: Every 3 months if not meeting goals, every 6 months if stable
• HbA1c testing: Quarterly if not meeting goals or therapy changes; biannually if stable 1
• Annual comprehensive assessment for complications

Discharge Planning Considerations

For hospitalized patients with newly diagnosed diabetes, discharge planning should include:

• Scheduling follow-up appointments with primary care and specialists before discharge
• Ensuring patients have necessary supplies (glucose meter, strips, medications)
• Providing prescriptions for insulin, oral medications, and testing supplies 1
• Arranging for home health services if needed 1

Common Pitfalls to Avoid

1. Delayed education: Diabetes self-management education should begin immediately upon diagnosis, not delayed until complications develop 1

2. Inadequate coordination: Ensure communication between all team members through shared medical records and care plans

3. Insufficient mental health support: Depression and anxiety are common in diabetes and significantly impact outcomes 1

4. Overlooking insurance coverage: Verify coverage for specialist visits, diabetes education, and supplies before making referrals

5. Neglecting family involvement: Include family members/caregivers in education sessions to improve support and outcomes 1

The coordinated care approach with appropriate referrals has been shown to significantly reduce diabetes-related complications, hospitalizations, and mortality while improving quality of life.