Summary of recommendations

Recommendation 

Grade 

References 

Recommended as of:

General population of normal risk 

Assessing the risk of diabetes is recommended every 3 years for those in the general population aged >40 years without specific risk factors. Use a validated screening tool to assess the risk of diabetes, such as the Australian type 2 diabetes risk assessment tool (AUSDRISK). 

Conditionally recommended 

¹ 

Aboriginal and Torres Strait Islander people 

All adults aged 18 years and over should be screened on an opportunistic basis and/or annually. 

1. Measure fasting blood glucose (FBG) or glycated haemoglobin (HbA1c): A laboratory test is preferable, but fingerprick testing is an alternative. If an FBG is impractical, perform a random (non-fasting) venous test or an HbA1c (which is not affected by fasting status). 

2. Perform an oral glucose tolerance test (OGTT) in those with equivocal results (FBG 5.5–6.9 mmol/L, or random glucose 5.5–11.0 mmol/L*). 

Children/adolescents with the following additional risk factors should be screened** from the age of 10 years (or at the onset of puberty, whichever occurs first): 

• overweight or obesity (body mass index*** [BMI] ≥85th or ≥95th percentile, respectively, and/or waist circumference to height ratio >0.5) 
• maternal history of diabetes or gestational diabetes (GDM) 
• first-degree relative with type 2 diabetes 
• signs of insulin resistance (acanthosis nigricans) 
• other conditions associated with obesity and metabolic syndrome (eg dyslipidaemia, polycystic ovary syndrome [PCOS]) 
• use of psychotropic medication. 

*Impaired fasting glucose (IFG) = fasting glucose 6.1–6.9 mmol/L; impaired glucose tolerance (IGT) = non fasting glucose ≥7.8 to <11.0 mmol/L. 

**Repeat annually if HbA1c <5.7%; repeat in six months if HbA1c 5.7–6.4%. 

***BMI should be calculated using age- and gender-appropriate calculator/percentile growth charts. 

Recommended (Strong) 

² 

High-risk population* 

In asymptomatic adults at high risk* of developing type 2 diabetes, screen using fasting blood glucose (FBG) or glycated haemoglobin (HbA1c) every 3 years (every 12 months for people with impaired glucose tolerance [IGT] and impaired fasting glucose [IFG]**) 

*Adults at high risk of developing type 2 diabetes include people with any one of the following: 

• overweight or obesity and age ≥40 years 
• overweight or obesity, age 18–40 years and hypertension 
• overweight or obesity, age 18–40 years and clinical evidence of insulin resistance (acanthosis nigricans, dyslipidaemia) 
• a first-degree relative with type 2 diabetes 
• a history of a cardiovascular event (eg acute myocardial infarction, angina, peripheral vascular disease or stroke) 
• certain ethnicities (Aboriginal and Torres Strait Islander***, South Asian, South-east Asian, North African, Latin American, Middle Eastern, Māori or Pacific Islander people [includes individuals of mixed ethnicity]) 
• a history of GDM 
• PCOS 
• taking antipsychotic medication. 

An AUSDRISK score ≥12 also indicates high risk. 

**IFG = fasting glucose 6.1–6.9 mmol/L; IGT = non fasting glucose ≥7.8 to <11.0 mmol/L. 

***Aboriginal and Torres Strait Islander people refer to recommendation above 

Conditionally recommended 

¹ 

Individuals with impaired glucose metabolism, defined by fasting glucose, OGTT or HbA1c should be screened: 

• with FBG or HbA1c* 
• every 12 months. 

*If impaired glucose metabolism was diagnosed only on the two-hour plasma glucose of the OGTT, consider using the OGTT for subsequent screenings. 

B
C 

^{3, 4} 

Recommendation 

Grade 

References 

Recommended as of:

Intensive lifestyle changes, including weight loss, may achieve diabetes remission (defined as glycated haemoglobin [HbA1c] levels remaining below 6.5% [48 mmol/mol] for at least three months in the absence of glucose-lowering medications). 

*Consensus-based recommendation formulated by the RACGP Diabetes Expert Advisory Group. 

Consensus* 

14/11/2024

Low-calorie (800–850 kcal/day)** diets with meal replacement products for three to five months aimed at achieving >15-kg body weight loss, followed by structured food reintroduction and increased physical activity for weight loss maintenance, should be recommended as an option to potentially induce type 2 diabetes remission to selected non-pregnant adults with a body mass index (BMI) between 27 and 45 kg/m2, type 2 diabetes duration <6 years, HbA1c <12% and not using insulin. 

**3,344–3,553 kJ/day. To convert from calories (kcal) to kilojoule (kJ), multiple calories by 4.18 (1 calorie = 4.18 kJ). 

A, Level 1A 

¹ 

14/11/2024

Bariatric surgery*** should be recommended to non-pregnant adults with type 2 diabetes and a BMI ≥35 kg/m2 as an option to potentially induce type 2 diabetes remission. 

***Metabolic surgery; refer to ‘Weight management interventions for type 2 diabetes’, which explains the different types of surgeries. 

A, Level 1A 

¹ 

14/11/2024

If type 2 diabetes remission criteria are met, HbA1c (or, if HbA1c unreliable, fasting plasma glucose or an oral glucose tolerance test) should be performed at a minimum interval of every six months to assess persistence of diabetes remission or relapse of diabetes. 

D, Consensus 

¹ 

14/11/2024

Recommendation 

Grade 

References 

People with impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) should be referred to lifestyle intervention programs to: 

• achieve and maintain a 7% reduction in weight 

• achieve a moderate-intensity physical activity to at least 150 minutes per week 

A 

¹ 

14/11/2024

People with glycated haemoglobin (HbA1c) 6.0–6.4% may also benefit from a structured weight loss and exercise program to reduce their risk of developing type 2 diabetes 

D, Consensus 

² 

14/11/2024

Recommendation 

Grade 

References 

For people aged 18–30 years with early-onset type 2 diabetes, due to the complexity of management and higher risk of complications, consider timely referral to an endocrinologist or non-general practitioner specialist with an interest in diabetes through a shared care arrangement. 

Consensus  

¹ 

14/11/2024

Recommendation 

Grade 

References 

Counsel youth with type 2 diabetes to engage in 60 min/day or more of moderate- or vigorous-intensity aerobic activity, with vigorous muscle-strengthening and bone-strengthening activities at least three days/week. Sedentary behaviours, especially prolonged screen time, should be avoided. 

B 

^1,2 

14/11/2024

Counsel most adults with type 2 diabetes to engage in 150 minutes or more of moderate- to vigorous-intensity aerobic activity per week, spread over at least three days/week, with no more than two consecutive days without activity. Shorter durations (minimum 75 min/week) of vigorous-intensity or interval training may be sufficient for younger and more physically fit individuals. 

B 

² 

14/11/2024

For all people with diabetes, evaluate baseline physical activity and time spent in sedentary behaviour. 

B 

² 

14/11/2024

Counsel that prolonged sitting should be interrupted every 30 minutes for blood glucose benefits. 

C 

² 

14/11/2024

Recommend flexibility training and balance training two to three times/week for older adults with diabetes. Yoga and tai chi may be included based on individual preferences to increase flexibility, muscular strength, and balance. 

C 

² 

14/11/2024

Recommendation 

Grade 

References 

All people who smoke should be offered brief advice and medications to quit smoking 

Recommended (Strong) 

¹ 

14/11/2024

Recommendation 

Grade 

References 

People with diabetes drink no more than 10 standard drinks per week 

B 

^{1, 2} 

14/11/2024

Recommendation 

Grade 

References 

In people with overweight or obesity with diabetes, a nutritionally balanced, calorie-reduced diet should be followed to achieve and maintain a lower, healthier body weight. 

A, Level 1A 

^1-3 

14/11/2024

An intensive healthy behaviour intervention program, combining dietary modification and increased physical activity, may be used to achieve weight loss, improve glycaemic control* and reduce cardiovascular disease (CVD) risk. 

*glycaemic management

A, Level 1A 

^2-4 

14/11/2024

Obesity pharmacotherapy should be considered for people with diabetes and overweight or obesity along with lifestyle changes. Potential benefits and risks must be considered. 

A 

⁵ 

14/11/2024

People who achieve weight loss goals should be offered long-term (≥1 year) weight maintenance support which should, at minimum, involve monthly contact, ongoing monitoring and self-monitoring of weight and regular physical activity (200–300 min/week). 

A 

^5,6 

14/11/2024

Consider metabolic surgery as a weight and glycaemic management approach in people with diabetes with  body mass index (BMI) ≥30.0 kg/m2 who are otherwise good surgical candidates. 

A 

^5,7 

14/11/2024

Metabolic surgery should also be considered for people with type 2 diabetes and BMI 30.0–34.9 kg/m2 if hyperglycaemia is inadequately managed despite optimal treatment with either oral or injectable medications. 

Consensus 

^5,7

14/11/2024

Recommendation 

Grade 

References 

Glycated haemoglobin (HbA1c) measurement should be used to assess long-term blood glucose control.

A

14/11/2024

A reasonable HbA1c goal for many non-pregnant adults is <7% (53 mmol/mol) without significant hypoglycaemia is appropriate.

A

² 

14/11/2024

Less stringent HbA1c goals may be appropriate for individuals with limited life expectancy or where the harms of treatment are greater than the benefits. 

B

14/11/2024

Self-monitoring of blood glucose (SMBG) is recommended for people with type 2 diabetes who are using insulin and sulfonylureas due to hypoglycaemia risk.;

B

⁴

14/11/2024

Targets for SMBG levels are 4.0–7.0 mmol/L for fasting and preprandial, and 5.0–10.0 mmol/L for two-hour postprandial. 

B, level 2

⁵

14/11/2024

Consider intermittent real-time continuous glucose monitoring (CGM) for people with insulin-treated type 2 diabetes if they have: 

• recurrent or severe hypoglycaemia 

• impaired hypoglycaemia awareness 

• a condition or disability (including a learning disability or cognitive impairment) that means they cannot self-monitor their blood glucose by capillary blood glucose monitoring but could use a CGM device (or have it scanned for them). 

Conditional recommendation 

³ 

14/11/2024

In adults with type 2 diabetes using basal bolus insulin therapy who have not achieved their HbA1c target, who are willing and able to use CGM, real-time CGM may be used to reduce HbA1c and duration of hypoglycaemia. 

A, Level 1A 

⁵ 

14/11/2024

Recommendation 

Grade 

References 

Recommended as of:

Glucose-lowering medication in people newly diagnosed with type 2 diabetes

A person-centred approach should be used to guide the choice of glucose-lowering medication. Considerations include comorbidities (atherosclerotic cardiovascular disease, heart failure, chronic kidney disease), hypoglycaemia risk, impact on weight, cost, risk for side effects and individual preferences.

E

¹

14/11/2024

Healthy behaviour interventions should be initiated at diagnosis.

B, Level 2

²

14/11/2024

If glycaemic targets are not achieved within three months using healthy behaviour interventions alone, anti-hyperglycaemic therapy should be added to reduce the risk of microvascular complications.

A, Level 1A

²

14/11/2024

Metformin should usually be selected before other agents due to:

• low risk of hypoglycaemia and weight gain
• long-term experience with this agent.

 

A, Level 1A
D, Consensus

²

14/11/2024

Individuals with metabolic decompensation (eg marked hyperglycaemia, ketosis or unintentional weight loss) consider receiving insulin with or without metformin to correct the relative insulin deficiency.

D, Consensus

²

14/11/2024

Advancing treatment

Dose adjustments to, and/or addition of, glucose-lowering medications should be made in order to attain target glycated haemoglobin (HbA1c) within 3–6 months.

D, Consensus

²

14/11/2024

If glycaemic targets are not achieved, other classes of glucose-lowering agents should be added or substituted to improve glycaemic control**.
**glycaemic management

Consensus

²

Recommendation 

Grade 

References 

Continuous glucose monitoring (CGM) should be considered for continual* or intermittent use in all individuals with type 2 diabetes on intensive insulin therapy (multiple daily injections [MDIs] or insulin pumps), subject to individual factors and the availability of resources. 

*‘Continual use’ refers to the use of CGM in a consistent manner based on the optimal number of recommended sensors, subject to patient factors and availability of resources. 

A 

¹ 

14/11/2024

Recommendation 

Grade 

References 

Calculate cardiovascular disease (CVD) risk level using the Australian absolute cardiovascular disease risk calculator (Aus CVD Risk Calculator)*. 
Age ranges for assessing CVD risk in people without known CVD are as follows: 

• All people aged 45–79 years 

• People with diabetes aged 35–79 years 

• Aboriginal and Torres Strait Islander people aged 30–79 years. Assess individual CVD risk factors in Aboriginal and Torres Strait Islander people aged 18–29 years** 

*The updated Aus CVD Risk Calculator can be accessed here. When using the calculator within electronic medical records, verify the version to ensure it is not outdated. 
**Refer to the National Aboriginal Community Controlled Health Organisation (NACCHO)–Royal Australian College of General Practitioners (RACGP) National guide to preventive healthcare for Aboriginal and Torres Strait Islander people. 

Conditional 

Conditional 

Consensus  

¹  

14/11/2024

For Aboriginal and Torres Strait Islander people, consider reclassifying estimated CVD risk to a higher risk category after assessing the person’s clinical, psychological and socioeconomic circumstances, and community CVD prevalence.* 

Refer to the NACCHO-RACGP National guide to preventive healthcare for Aboriginal and Torres Strait Islander people. 

Conditional, moderate 

¹ 

14/11/2024

In people whose estimated CVD risk is close to the threshold for a higher risk category, consider reclassifying estimated CVD risk to a higher risk category for the following groups: 

• Māori people 

• Pacific Islander people 

• people of South Asian ethnicity (Indian, Pakistani, Bangladeshi, Sri Lankan, Nepali, Bhutanese, or Maldivian ethnicities) 

Conditional, moderate 

¹ 

14/11/2024

People with pre-existing CVD are at high risk of another CVD event. 

Consensus 

² 

14/11/2024

Managing CVD risk 

For people at high risk of CVD* (estimated 5-year risk ≥10% determined using the Australian cardiovascular disease risk calculator), prescribe lipid-modifying medicines to reduce CVD risk, unless contraindicated or clinically inappropriate. Explain the potential benefits and harms of treatment to the person and encourage shared decision-making. Encourage, support and advise a healthy lifestyle. 

* For people at intermediate or low risk of CVD, refer to the Australian guideline for assessing and managing CVD risk. 

Strong

¹

14/11/2024

For people at high risk of CVD* (estimated 5-year risk ≥10% determined using the Australian CVD risk calculator), prescribe blood pressure-lowering medicines to reduce CVD risk, unless contraindicated or clinically inappropriate. Explain the potential benefits and harms of treatment to the person and encourage shared decision-making. Encourage, support and advise a healthy lifestyle. 

* For people at intermediate or low risk of CVD, refer to the Australian guideline for assessing and managing CVD risk. 

Strong 

¹

14/11/2024

We recommend the addition of an sodium–glucose cotransporter 2 inhibitor (SGLT2i) to other glucose-lowering medication(s) in adults with type 2 diabetes who also have CVD, multiple cardiovascular risk factors* and/or kidney disease. 

*We define multiple cardiovascular risk factors as men 55 years of age or older or women 60 years of age or older with type 2 diabetes who have one or more additional traditional risk factors, including hypertension, dyslipidaemia or smoking. 

Strong 

³ 

14/11/2024

We recommend the addition of a glucagon-like peptide-1 receptor agonist (GLP-1RA) to other glucose-lowering medication(s) in adults with type 2 diabetes who have CVD, multiple cardiovascular risk factors* and/or kidney disease, and are unable to be prescribed an SGLT2i due to either intolerance or contraindication. 

*We define multiple cardiovascular risk factors as men 55 years of age or older or women 60 years of age or older with type 2 diabetes who have one or more additional traditional risk factors, including hypertension, dyslipidaemia or smoking. 

Strong 

³ 

14/11/2024

Antihypertensive medication

Antihypertensive therapy is strongly recommended in patients with diabetes and systolic blood pressure ≥140 mmHg. 

Strong; Level I evidence 

⁴

14/11/2024

For people with diabetes and hypertension, blood pressure targets should be individualised through a shared decision-making process that addresses cardiovascular risk, potential adverse effects of antihypertensive medications and individual preferences

B

⁵

14/11/2024

In patients with diabetes and hypertension, any of the first-line* antihypertensive drugs that effectively lower blood pressure are recommended. 

*Angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ARB) agents.⁵ 

Strong; Level I evidence 

⁴ 

14/11/2024

In patients with diabetes and hypertension, chronic kidney disease or comorbidities of heart disease, a blood pressure target of <140/90 mmHg is recommended. 

Strong; Level I evidence 

⁴

14/11/2024

For individuals with hypertension and a history of transient ischemic attack (TIA) or stroke, a blood pressure target of <140/90 mmHg is recommended. 

Strong; Level I evidence 

⁴

14/11/2024

Lipid-lowering medications 

All adults with type 2 diabetes and known prior CVD (except haemorrhagic stroke) should receive the maximum tolerated dose of a statin, irrespective of their lipid levels. 

Note: The maximum tolerated dose should not exceed the maximum available dose (eg 80 mg atorvastatin, 40 mg rosuvastatin). 

A 

² 

14/11/2024

In people with type 2 diabetes and known prior CVD, fibrates should be commenced in addition to a statin or on their own (for those intolerant to statin) when fasting triglycerides are greater than or equal to 2.3 mmol/L, or high-density lipoprotein (HDL) cholesterol is low†. 

Note: When used in combination with statins, fenofibrate presents a lower risk of adverse events than other fibrates combined with statins. 
†HDL <1.0 mmol/L (based on the cut-offs reported in the ACCORD and FIELD studies). 

B 

² 

14/11/2024

In individuals with atherosclerotic CVD (ASCVD) or other cardiovascular risk factors on a statin with controlled low-density lipoprotein (LDL) cholesterol but elevated triglycerides (135–499 mg/dL [1.5–5.6 mmol/L]), the addition of icosapent ethyl can be considered to reduce cardiovascular risk. 

A 

⁵ 

14/11/2024

For people with diabetes and ASCVD, treatment with high-intensity statin therapy is recommended to target an LDL cholesterol reduction of ≥50% from baseline and an LDL cholesterol goal of <55 mg/dL (<1.4 mmol/L). Addition of ezetimibe or a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor/PCSK9 targeted therapies with proven benefit in this population is recommended if this goal is not achieved on maximum tolerated statin therapy. 

B 

⁵ 

14/11/2024

Antithrombotic medication 

All adults with type 2 diabetes and known prior CVD should receive long-term antiplatelet therapy unless there is a clear contraindication. 

A 

² 

14/11/2024

Use aspirin therapy (75–162 mg/day) as a secondary prevention strategy in those with diabetes and a history of ASCVD*. 

*Based on a clinical history of atherosclerotic disease not imaging retinopathy risk reduction. 

A 

⁵ 

14/11/2024

For individuals with ASCVD and documented aspirin allergy, clopidogrel (75 mg/day) should be used*. 

*Based on a clinical history of atherosclerotic disease not imaging retinopathy risk reduction. 

14/11/2024

Recommendation 

Grade 

References 

Recommended as of:

Individuals with type 2 diabetes should be screened and evaluated for retinopathy by an optometrist or ophthalmologist at the time of diagnosis. 

B

¹

14/11/2024

• blood glucose
• blood pressure
• lipid levels.

Recommendation 

Grade 

References 

Recommended as of:

All people with diabetes should be screened for diabetic peripheral neuropathy, starting at diagnosis of type 2 diabetes and at least annually thereafter. 

D 

^1,2 

14/11/2024

Assessment for distal symmetric polyneuropathy should include a careful history and assessment of either temperature or pinprick sensation (small-fibre function) and vibration sensation using a 128-Hz tuning fork (for large-fibre function). All people with diabetes should have annual 10-g monofilament testing to identify feet at risk for ulceration and amputation. 

B 

¹ 

14/11/2024

The following agents may be used alone or in combination for relief of painful peripheral neuropathy: 

• anticonvulsants 

  • pregabalin 

  • gabapentin 

  • valproate 

• antidepressants 

  • amitriptyline 

  • duloxetine 

  • venlafaxine 

• topical nitrate spray 

In people not responsive to the above agents, opioid analgesics (tramadol, tapentadol ER, oxycodone ER) may be used.* 

*Prescribers should be cautious when prescribing opioid analgesics due to the risks of abuse, dependence and tolerance, and adhere to prescribing guidelines 

A, Level 1 

B, Level 2 

B, Level 2 
 

B, Level 2 

B, Level 2 

B, Level 2 

² 

14/11/2024

People with type 2 diabetes should be treated with intensified glycaemic control* to prevent the onset and progression of neuropathy. Optimise blood pressure and serum lipid control* to reduce the risk or slow the progression of diabetic neuropathy. 

*management  

B 

Recommendation 

Grade 

References 

Assess all people with diabetes and stratify their risk by enquiring about previous foot ulceration and amputation, visually inspecting the feet for structural abnormalities and ulceration, assessing for neuropathy using either the Neuropathy Disability Score or a 10-g monofilament, and palpating foot.

C

^1,2

14/11/2024

In people stratified as having low-risk feet (where no risk factors or previous foot complications have been identified), foot examination should occur annually. 

Consensus 

¹ 

14/11/2024

Repeat screening once every 6–12 months for those classified as International Working Group on the Diabetic Foot (IWGDF) risk 1 , once every 3–6 months for those classified as IWGDF risk 2  and once every 1–3 months for those classified as IWGDF risk 3 . 

Strong; low 

² 

14/11/2024

Pressure reduction, otherwise referred to as ‘redistribution of pressure’ or ‘off-loading’, is required to optimise the healing of plantar foot ulcers.  

B 

¹ 

14/11/2024

People with diabetes-related foot ulceration are best managed by a multidisciplinary foot care team. 

C 

¹ 

14/11/2024

Dressings should be selected principally on the basis of exudate control, comfort and cost. 

Strong; low 

² 

14/11/2024

Non-viable tissue should be debrided. 

A, Level 1 

³ 

14/11/2024

Recommendation 

Grade 

References 

Recommended as of:

At least once a year, assess urine albumin to creatinine ratio (uACR) and estimated glomerular filtration rate (eGFR) in all patients with type 2 diabetes, regardless of treatment. 

B 

¹ 

14/11/2024

To prevent the onset and delay the progression of chronic kidney disease (CKD), people with diabetes should be treated to optimise blood glucose levels and blood pressure. 

A, Level 1A 

² 

14/11/2024

Treatment for hypertension should include drug classes demonstrated to reduce cardiovascular events in people with diabetes. 

Angiotensin-converting enzyme inhibitors (ACEi) or (ARBs) angiotensin receptor blockers (ARBs) are recommended first-line therapy for hypertension in people with diabetes and coronary artery disease. 

A 
 

A 

³ 

14/11/2024

Multiple-drug therapy is generally required to achieve blood pressure targets. However, combinations of ACEi and ARBs and combinations of ACEi or ARBs with direct renin inhibitors should not be used. 

A 

³ 

14/11/2024

We recommend that treatment with an ACEi or an ARB be initiated in patients with diabetes, hypertension and albuminuria, and that these medications be titrated to the highest approved dose that is tolerated. 

1B 

² 

14/11/2024

We recommend the addition of a sodium–glucose cotransporter 2 inhibitor (SGLT2i) to other glucose-lowering medication(s) in adults with type 2 diabetes who also have kidney disease. We recommend a glucagon-like peptide-1 (GLP-1) receptor agonist if the patient is unable to be prescribed an SGLT2i due to either intolerance or contraindication. The evidence base for this recommendation includes studies on people with kidney disease who had an eGFR of 30 mL/min/1.73 m2 of body surface area or higher, although a few studies included participants with lower eGFR. 

Recommended 

⁴ 

14/11/2024

For people with type 2 diabetes and chronic kidney disease CKD with albuminuria treated with maximum tolerated doses of ACEi or ARB, addition of finerenone is recommended to improve cardiovascular outcomes and reduce the risk of chronic kidney diseaseCKD progression.

A 

³ 

14/11/2024

For people with type 2 diabetes and diabetic kidney diseaseCKD, use of an SGLT2i is recommended to reduce CKD progression and cardiovascular events in individuals with eGFR ≥20 mL/min/1.73 m2 and urinary albumin ranging from normal to 200 mg/g creatinine. 

B 

¹ 

14/11/2024

For cardiovascular risk reduction in people with type 2 diabetes and diabetic kidney disease CKD, consider use of an SGLT2i (if eGFR is ≥20 mL/min/1.73 m2), a GLP-1 agonist or a non-steroidal mineralocorticoid receptor antagonist (if eGFR is ≥25 mL/min/1.73 m2). 

A 

¹ 

14/11/2024

Recommendation 

Grade 

References 

Individuals treated with combinations utilising insulin or sulfonylureas should be asked about symptomatic and asymptomatic hypoglycaemia at each encounter. 

C 

¹ 

14/11/2024

Glycaemic goals for some older adults might reasonably be relaxed as part of individualised care, but hyperglycaemia leading to symptoms or risk of acute hyperglycaemia complications should be avoided in all people with diabetes.  

C 

¹ 

14/11/2024

Recommendation 

Grade 

References 

Recommended as of:

Routinely monitor people with diabetes for diabetes distress. 

B

^1,2

14/11/2024

Providers should consider assessment for symptoms of diabetes distress, depression, anxiety, disordered eating and cognitive capacities using patient-appropriate standardised and validated tools when there is a change in disease, treatment, or life circumstance; including caregivers and family members in this assessment is recommended. 

B 

^1,2 

People with diabetes with any of the following should be referred to a mental health professional and to do a care plan: 

• significant distress related to diabetes management 
• persistent fear of hypoglycaemia 
• psychological insulin resistance 
• psychiatric disorders (ie depression, anxiety, eating disorders). 

D, Consensus 

^1,3 

Collaborative care by interprofessional teams should be provided for people with diabetes and depression to improve: 

• depressive symptoms 
• adherence to antidepressant and non-insulin glucose-lowering medications 
• glycaemic control*. 

*Glycaemic management 

A, Level 1 

^3-6

Psychosocial interventions should be integrated into diabetes care to improve adaptation to living with diabetes and engagement in self-management, including: 

• motivational interviewing 
• cognitive behaviour therapy 
• acceptance and commitment therapy 
• stress management strategies 
• coping skills training 
• family therapy 
• case management 
• mindfulness interventions 

^3,4,7-9

Recommendation 

Grade 

References 

Recommended as of:

In addition to focused attention on achieving glycaemic targets, standard preconception care should be augmented with extra focus on nutrition, diabetes education and screening for diabetes comorbidities and complications. 

B 

¹ 

14/11/2023

Preconception counselling should address the importance of achieving glucose levels as close to normal as is safely possible, ideally glycated haemoglobin (HbA1c) <6.5% (48 mmol/mol), to reduce the risk of congenital anomalies, pre-eclampsia, macrosomia, preterm birth and other complications. 

A 

¹ 

Potentially harmful medications in pregnancy (eg angiotensin-converting enzyme [ACE] inhibitors, angiotensin receptor blockers, statins) should be stopped prior to conception and avoided in sexually active individuals of childbearing potential who are not using reliable contraception. 

B 

¹ 

Women on metformin planning a pregnancy may continue on these agents if glycaemic control* is adequate until pregnancy is achieved. 

*management 

C, Level 3 

² 

The decision to continue insulin analogues that have little available safety data in pregnancy, and metformin, should be individualised, but neither medication should be ceased abruptly in early pregnancy due to the imperative to maintain euglycaemia. Cessation should depend on the risks and benefits of continuation. While metformin crosses the placenta, there has not been any evidence that it is teratogenic. 

Other non-insulin glucose-lowering agents should be ceased prior to or as soon as pregnancy is detected.  

Consensus  

³ 

Folic acid 2.5–5 mg daily in total, taking multivitamin supplementation into account, commenced ideally three months prior to conception and continued until 12 weeks gestation. Total daily doses of folic acid >5 mg are not recommended given the potential for harm. 

Consensus 

³ 

Prior to conception, women with diabetes should be referred to a multidisciplinary team which is experienced in the care of women with diabetes as this has been shown to improve pregnancy outcomes. This team may consist of an obstetrician, endocrinologist/diabetes physician, credentialled diabetes educator, accredited practising dietitian, lead maternity carer (New Zealand) and other health specialists as required. In rural areas where distance is a barrier to antenatal attendance, the local healthcare team should contact the nearest expert diabetes in pregnancy multidisciplinary team for access to telehealth options. 

Consensus 

³ 

Recommendation 

Grade 

References 

In the first trimester, all women not known to have diabetes should be assessed for risk of hyperglycaemia.  

Consensus 

^1,2

14/11/2024

Between 24 and 28 weeks’ gestation, recommend testing for gestational diabetes (GDM) to all women previously diagnosed in the current pregnancy. Women considered as moderate or high risk but with normal early pregnancy glucose testing should have a repeat pregnancy oral glucose tolerance test (POGTT) at the usual time of 24–28 weeks gestation. However, a POGTT should be performed at any earlier time during pregnancy, if clinically indicated. 

Consensus 

^{2, 3}

14/11/2024

Pregnant women with GDM should be offered dietary advice and blood glucose monitoring, and be treated with glucose-lowering therapy depending on target values for fasting and postprandial targets.  

A 

^{4, 5} 

14/11/2024

Pregnant women with other forms of diabetes such as type 2 diabetes or gestational diabetes, and experiencing severe hypoglycaemia regardless of awareness OR if have unstable blood glucose should also be offered continuous glucose monitoring (CGM). 

High-level 

⁵ 

14/11/2024

Postnatal education and support are important in preventing or delaying the onset of diabetes in the future, and women should be encouraged to attend postnatal testing. 

Consensus 

² 

14/11/2024

Women diagnosed with GDM should have a 75 g two‐hour oral glucose tolerance test, preferably at 6–12 weeks postpartum, with classification according to World Health Organization criteria. 

Consensus 

³

14/11/2024

The Australasian Diabetes in Pregnancy Society (ADIPS) guideline is under review. Information will be updated once the 2024 guideline has been published. 
The Australian Clinical Practice Guidelines: Pregnancy Care are being actively updated. 

Recommendation 

Grade 

References 

Recommended as of:

Consider the assessment of medical, psychological, functional (self-management abilities) and social domains in older adults to provide a framework to determine targets and therapeutic approaches for diabetes management.

B

¹

14/11/2024

Screen for geriatric syndromes (ie polypharmacy, cognitive impairment, depression, urinary incontinence, falls, persistent pain, and frailty) in older adults, as they may affect diabetes self-management and diminish quality of life.

B

¹

14/11/2024

Overtreatment of diabetes is common in older adults and should be avoided. Deintensification (or simplification) of complex regimens is recommended to reduce the risk of hypoglycaemia in older adults, if achievable within the individualised HbA1c target.

B

¹

14/11/2024

For older adults in residential aged care facilities, individualised care plans should be developed and agreed upon by the individual, their general practitioner (GP) and facility staff. This will provide clarity regarding aims of care and metabolic targets, and facilitate screening for diabetes-related complications and annual reviews.

Consensus*

14/11/2024

*Consensus-based recommendation formulated by the RACGP Diabetes Handbook Expert Advisory Group.

Recommendation 

Grade 

References 

Recommended as of:

Determine a blood glucose and glycated haemoglobin (HbA1c) range that is appropriate for the individual, aligns with the individual’s advance care plan and avoids hypoglycaemia and symptomatic hyperglycaemia. 

Consensus* 

14/11/2024

*Consensus-based recommendation formulated by the RACGP Diabetes Handbook Expert Advisory Group. 

Recommendation 

Grade 

References 

Recommended as of:

Sick day management

Sick-day management plans are an integral component of diabetes education. The development of a sick-day management plan along with education on sick-day management should be provided at diagnosis and reviewed or updated at regular intervals.

Consensus

^1–3

14/11/2024

Sleep and diabetes

Consider screening for sleep health in people with diabetes, including symptoms of sleep disorders, disruptions to sleep due to diabetes symptoms or management needs and worries about sleep. Refer to sleep medicine specialists and/or qualified behavioural health professionals as indicated.

B

⁴

14/11/2024

Planning surgical procedures

When commencing a person with diabetes on sodium–glucose cotransporter 2 inhibitors (SGLT2i), clinicians should inform them about the risk of diabetic ketoacidosis (DKA) associated with clinical procedures, ideally with written information and management plans. It is advisable to document that the advice has been provided.

Consensus

⁵

14/11/2024

Dementia and cognitive decline

Screening for early detection of mild cognitive impairment or dementia should be performed for adults 65 years of age or older at the initial visit, annually, and as appropriate.

B

⁶

14/11/2024

Dementia and cognitive decline

In the presence of cognitive impairment, diabetes treatment plans should be simplified as much as possible and tailored to minimise the risk of hypoglycaemia.

B

⁷

14/11/2024