Diabetes

Guidelines for preventive activities in general practice

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Table of contents

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

Prevalence and context of the condition

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

Table of recommendations

Screening

Recommended as of: 28/06/2024

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 obesity^A, age 18–40 years with one or more additional risk factors and increasing body mass index (BMI) overweight or obesity^A, 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

Recommended as of: 28/06/2024

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

Further information

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.

Considerations for Aboriginal and Torres Strait Islander peoples

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.

Resources

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