Guidelines for preventive activities in general practice

Metabolic

Diabetes

      1. Diabetes

Metabolic | Diabetes

Screening age bar

0–9 10–14 15–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69 70–74 75–79 ≥80

Diabetes is a common condition, with approximately 1 in 20 Australians having diabetes. The prevalence of diabetes increased 2.8-fold between 2000 and 2020.1 Type 2 diabetes is comparatively more prevalent in lower than higher socioeconomic groups and in people living in remote and very remote areas than in those living in urban areas.1 In 2020, approximately one in six pregnant women had gestational diabetes.1 Aboriginal and Torres Strait Islander Australians were 2.9-fold more likely than non-Indigenous Australians to have diabetes.2 The prevalence of diabetes increases with age, and is 1.3-fold more common in men than in women.1 Type 2 diabetes occurs in 11.8% of general practice encounters and 5.5% of patients in general practice.3

Screening

Recommendation Grade How often References
General population of normal risk
Assessing the risk of diabetes is recommended 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 Every 3 years. 4, 5
High-risk population*
In asymptomatic adults at high risk* of developing type 2 diabetes, screen using fasting blood glucose (FBG) or glycosylated haemoglobin (HbA1c).
    
*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 diabetes
  • a history of a cardiovascular event (eg acute myocardial infarction, angina, peripheral vascular disease or stroke)
  • a high-risk ethnicity/background (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 gestational diabetes mellitus (GDM)
  • polycystic ovary syndrome (PCOS)
  • taking antipsychotic medication.
An AUSDRISK score ≥12 also indicates high risk.  
Conditionally recommended Every 3 years (every 12 months for people with impaired glucose tolerance [IGT] and impaired fasting glucose [IFG])
Annually for Aboriginal and Torres Strait Islander people
5,6,7,8
An oral glucose tolerance test (OGTT) is recommended for people who have previously had an intermediate hyperglycaemia result, such as FBG (5.5–6.9 mmol/L).
 
Further information regarding the screening and diagnosis of type 2 diabetes in asymptomatic people is provided in figure 1, Management of type 2 diabetes: A handbook for general practice.
Conditionally recommended Re-test every 1–3 years, depending on result (see figure 1, Management of type 2 diabetes: A handbook for general practice) 4
Highest-risk population
In asymptomatic adults at very high risk** of developing type 2 diabetes, screen using FBG or HbA1c.
 
**Adults at very high risk of developing type 2 diabetes include those with any one of the following:
  • impaired fasting glucose
  • impaired glucose tolerance
  • overweight or obesityA, age 18–40 years with one or more additional risk factors and increasing body mass index (BMI)
  • overweight or obesityA, age ≥40 years and increasing BMI.  
A BMI ≥25 kg/m2; specific cut-off points recommended for South Asian and South-east Asian people are BMI >23 kg/m2 for overweight and BMI >27.5 kg/m2 for obesity.
Conditionally recommended Every 3 years, earlier if BMI is increasing

Every 12 months for people with IGT and IFG
8

Preventive activities and advice

Recommendation Grade How often References
People should follow a diet in line with the Australian dietary guidelines to help prevent diabetes. Practice point N/A 9
People at high risk of developing type 2 diabetes may also benefit from a structured weight loss, healthy diet and exercise program to reduce their risk of developing the condition. Even modest weight loss (5–10%) may provide clinical benefits, and with further weight loss there are further improvements. Practice point N/A 4
All people who smoke should be offered advice to quit smoking. Recommended (strong) N/A 10

Screening using AUSDRISK has the advantage of identifying patients without diabetes who are at high risk for preventive activities. Those with an HbA1c 6.0–6.4% (42–46 mmol/mol) should be considered at higher risk of developing diabetes and screening should be repeated in 1 year. Screening in those with an HbA1c ≥6.5% (48 mmol/mol) should be repeated to confirm the diagnosis of diabetes. Although it does not require a fasting test, HbA1c may be inaccurate if the person has haemoglobinopathies or other conditions.4 

For further information see Preventing progression to type 2 diabetes in Management of type 2 diabetes: A handbook for general practice.

Recommendations in some areas of diabetes care, including a lack of accuracy of AUSDRISK scores, are different for Aboriginal and Torres Strait Islander people. Aboriginal and Torres Strait Islander people should be screened annually with blood testing (FPG, random venous glucose or HbA1c) from 18 years of age.4,11

For specific recommendations for Aboriginal and Torres Strait Islander people, please refer to Type 2 diabetes prevention and early detection in the National Guide to a preventive health assessment for Aboriginal and Torres Strait Islander people.

Evidence-based recommendations for management of patients with type 2 diabetes:
Management of type 2 diabetes: A handbook for general practice | RACGP and Diabetes Australia
 
Further information on the identification and management of hyperglycaemic emergencies:
Emergency management of hyperglycaemia in primary care | RACGP and Australian Diabetes Society (ADS)
 
Further information on the management and support of patients during COVID-19:
Diabetes management during coronavirus | RACGP
 
Guidance for GPs on managing diabetic patients who fast during Ramadan:
Diabetes management during Ramadan | RACGP
 
Guidance and flow charts for the emergency management of children with diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS):
Guideline for the early recognition of hyperglycaemia in children under 16 | Clinical Excellence Queensland
 
Evidence-based recommendations the amount and kinds of foods to eat for health, wellbeing and prevention of chronic disease:
Australian dietary guidelines | National Health and Medical Research Council
 
To assess and manage cardiovascular risk in people with diabetes aged 35–79 years without known atherosclerotic cardiovascular disease (CVD):
Australian CVD risk calculator (AusCVDRisk), a risk assessment, communication and management tool for health professionals

  1. Australian Institute of Health and Welfare. (AIHW). Diabetes: Australian facts. AIHW, 2023 [Accessed 2 August 2023].
  2. Australian Bureau of Statistics (ABS). National Aboriginal and Torres Strait Islander Health Survey. ABS, 2019 [Accessed 2 August 2023].
  3. NPS MedicineWise. General practice insights report July 2019–June 2020 including analyses related to the impact of COVID-19. NPS MedicineWise, 2021 [Accessed 31 January 2024].
  4. The Royal Australian College of General Practitioners (RACGP). Management of type 2 diabetes: A handbook for general practice. RACGP, 2020 [Accessed 31 January 2024].
  5. Chen L, Magliano DJ, Balkau B, et al. AUSDRISK: An Australian type 2 diabetes risk assessment tool based on demographic, lifestyle and simple anthropometric measures. Med J Aust 2010;192(4):197–202. doi: 10.5694/j.1326-5377.2010.tb03507.x.
  6. Australian Government Department of Health and Ageing (DoHA). Background to the Australian type 2 diabetes risk assessment tool. DoHA, 2010 [Accessed 31 January 2024].
  7. Martin A, Neale EP, Tapsell LC. The clinical utility of the AUSDRISK tool in assessing change in type 2 diabetes risk in overweight/obese volunteers undertaking a healthy lifestyle intervention. Prev Med Rep 2018;13:80–84. doi: 10.1016/j.pmedr.2018.11.020.
  8. Wong J, Ross G, Zoungas S, et al. Management of type 2 diabetes in young adults aged 18-30 years: ADS/ADEA/APEG consensus statement. Med J Aust 2022;216(8):422–29. doi: 10.5694/mja2.51482.
  9. National Health and Medical Research Council (NHMRC). Australian dietary guidelines. NHMRC, 2013 [Accessed 31 January 2024].
  10. The Royal Australian College of General Practitioners (RACGP). Supporting smoking cessation: A guide for health professionals. 2nd edn. RACGP, 2019 [Accessed 31 January 2024].
  11. National Aboriginal Community Controlled Health Organisation; The Royal Australian College of General Practitioners (RACGP). National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people. 3rd edn. RACGP, 2018 [Accessed 31 January 2024].
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