Management of type 2 diabetes: A handbook for general practice

Introduction

Management of type 2 diabetes: A handbook for general practice
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Introduction 

Diabetes is a national health priority. The Australian National Diabetes Strategy 2021–2030, released by the Australian Government in November 2021, has been developed in consultation with key stakeholders and people with diabetes.1 It outlines a ‘roadmap’ to address diabetes in Australia. Implementation of these priorities will impact primary care across a range of outcomes, along with the inevitable burden of rising numbers of people affected by diabetes and those at risk of developing this disease.

Almost 1.5 million Australians with diabetes have registered with the National Diabetes Services Scheme (NDSS), with more than 85% having type 2 diabetes.2 The number of people with type 2 diabetes is growing, most likely the result of rising overweight and obesity rates, lifestyle and dietary changes and an ageing population. If trends continue, the number of people in Australia diagnosed with diabetes may increase to 3.6 million by 2050.3

General practice plays a central role in the early identification and optimal management of people with type 2 diabetes, which can significantly reduce the risk of coronary artery disease, stroke, kidney failure, limb amputations and vision loss associated with the condition. General practice maintains a primary role from identifying those at risk, right through to caring for patients at the end of life. These guidelines give up-to-date, evidence-based information tailored for general practice to support general practitioners (GPs) and their teams in providing high-quality clinical management tools. 

In developing the 2024 edition of Management of type 2 diabetes: A handbook for general practice, The Royal Australian College of General Practitioners (RACGP) has focused on factors relevant to current Australian clinical practice. The RACGP has used the skills and knowledge of your general practice peers who have an interest in diabetes management and are members of the RACGP Specific Interests Diabetes Network. 

This publication has been produced in accordance with the rules and processes outlined in the RACGP’s conflicts of interest policy.

This edition represents 25 years of a successful relationship between the RACGP and Diabetes Australia. We acknowledge the support and contributions of the experts, writers, reviewers (listed under ‘Acknowledgements’) and RACGP staff in the development of these guidelines.

This handbook has been designed to provide pragmatic, evidence-based recommendations for use in general practice, and adopts the most recent recommendations from organisations including Diabetes Canada, the American Diabetes Association (ADA) and other relevant sources. 

The table of recommendations include the reference or source and the grade of each recommendation. In cases where graded recommendations are not available or current, the expert advisory group has considered the results of systematic reviews and primary research studies to formulate the overall recommendation.  A ‘consensus-based recommendation’ denotes a recommendation that was formulated in the absence of high-quality evidence; the RACGP Diabetes Handbook expert advisory group reached a consensus expert opinion to include the point in the resource. 

In each section, where possible, information is presented as: 

  • recommendations 
  • ​clinical context (or what you need to know) 
  • in practice (or what you can do). 

When addressing the recommendations in this handbook to provide care needs for people living with diabetes, implementation of person-centred care is essential. Management that follows this principle incorporates an individual’s experience of care and treats them as partners in their own healthcare.5 

In practice, this means providing care that is ‘respectful of and responsive to individual patient preferences, needs and values, and ensures that patient values guide all clinical decisions’.6 As a result, the person with diabetes is more likely to engage actively in self-management and achieve optimal health outcomes.7 

Patients and their carers should be offered a structured, evidence-based education program at the time of diagnosis, with an annual update and review.8 Providing education to people with diabetes about their condition and its treatment, including education to support self-management, is an integral part of diabetes care.9,10 More information is available from Diabetes Australia and Australian Diabetes Educators Association (ADEA). ADEA has developed a person-centred care toolkit to support health care professionals.

For examples of a structured, person-centred care plan, refer to the section ‘Assessment of the patient with type 2 diabetes’.

Evidence-based, structured self-management training programs are available through the National Diabetes Services Scheme (NDSS).

Note that although many of the assessments discussed in this handbook are performed informally during a routine consultation, systems should be developed within the practice to allow appropriate assessment, review and management of individual patients. These are discussed in an article by Borg et al. (2019)11 and on the International Consortium for Health Outcomes Measurement (ICHOM) website. 

Information specific to Aboriginal and Torres Strait Islander people is highlighted throughout the text. GPs are also encouraged to refer to the type 2 diabetes topic in the National Aboriginal Community Controlled Health Organisation (NACCHO)–RACGP National guide to preventive healthcare for Aboriginal and Torres Strait Islander people, which includes strengths-based practical recommendations to support the prevention of type 2 diabetes. 

Recommendations in some areas of diabetes care are different for Aboriginal and Torres Strait Islander people. It is therefore important to identify, record and report the Aboriginal and Torres Strait Islander status of patients. 

The RACGP has a position paper outlining the processes of identification. 

  1. Department of Health and Aged Care. Australian national diabetes strategy 2021–2030. Australian Government, 2021) [Accessed 5 September 2024].
  2. National Diabetes Services Scheme (NDSS). Diabetes data snapshots. NDSS, June 2024 [Accessed 5 September 2024].
  3. Diabetes Australia. The state of the nation 2024: The diabetes epidemic in Australia. Diabetes Australia, 2024 [Accessed 5 September 2024].
  4. Australian Institute of Health and Welfare (AIHW). Diabetes: Australian facts. AIHW, 2024 [Accessed 5 September 2024].
  5. Johnson B, Abraham M, Conway J, et al. Partnering with patients and families to design a patient- and family-centered health care system: Recommendations and promising practices. Institute for Patient- and Family-Centred Care, 2008.
  6. Institute of Medicine Committee on Quality of Health Care in America. Crossing the quality chasm: A new health system for the 21st century. The National Academies Press, 2011. doi: 10.17226/10027.
  7. Silverman J, Kurtz S, Drapper J. Skills for communicating with patients. 2nd edn. Radcliffe, 2005.
  8. National Institute for Health and Clinical Excellence (NICE). Type 2 diabetes in adults: Management. NICE guideline NG28. NICE, 2015.
  9. Steinsbekk A, Rygg LØ, Lisulo M, Rise MB, Fretheim A. Group based diabetes self-management education compared to routine treatment for people with type 2 diabetes mellitus. A systematic review with meta-analysis. BMC Health Serv Res 2012;12(1):213. doi: 10.1186/1472-6963-12-213.
  10. Loveman E, Frampton GK, Clegg AJ. The clinical effectiveness of diabetes education models for type 2 diabetes: A systematic review. Health Technol Assess 2008;12(9):1–116. doi: 10.3310/hta12090.
  11. Borg S, Eeg-Olofsson K, Palaszewski B, Svedbo Engström M, Gerdtham UG, Gudbjörnsdottir S. Patient-reported outcome and experience measures for diabetes: Development of scale models, differences between patient groups and relationships with cardiovascular and diabetes complication risk factors, in a combined registry and survey study in Sweden. BMJ Open 2019;9(1):e025033. doi: 10.1136/bmjopen-2018-025033.
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