Takeaway
- During the ongoing COVID-19 pandemic, the Association of British Clinical Diabetologists, Diabetes UK, and the Primary Care Diabetes Network advise stratifying care of adult patients with diabetes based on risk.
- Recommendations should be undertaken holistically, including comorbidities, ethnicity, and socioeconomic deprivation.
Proposed risk stratification
- REVIEW URGENTLY (within 3 months, virtually or in-person):
- HbA1c >10% (86 mmol/mol);
- BP >160/100 mmHg;
- Complete hypoglycemia unawareness (Gold score 7) or reported severe hypoglycemia in past year;
- Hospital admission for diabetic ketoacidosis, hyperosmolar hyperglycemic syndrome, or unstable cardiac/cerebrovascular disease in past year;
- Recently discharged with treatment changes;
- Estimated glomerular filtration rate (eGFR) 2 or renal function decline >15 mL/minute/year;
- Active diabetic foot disease; and
- Other factors: severe mental illness, learning difficulties, frailty, women planning pregnancy.
- REVIEW as PRIORITY (within 6 months):
- HbA1c: 8.5%-10% (70-86 mmol/mol);
- BP: 140-160/90 mmHg or total cholesterol >5 mmol/L;
- Impaired hypoglycemia awareness (Gold score 4-6), or >5 episodes/week or >20% time
- HbA1c
- eGFR 45-30 mL/minute/1.73 m2, albumin-to-creatinine ratio >30;
- Age
- No diabetes review for >18 months.
- In the ROUTINE category:
- Others may be postponed until mid-2021.
- Give patient educational resources and instructions about what to do if parameters change.
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