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'Referral advice' recommendation details

Type 2 Diabetes - newer agents (partial update of CG66)

Guidance ID NICE 'referral advice' recommendation 'Referral advice' category
CG87 In type 2 diabetes, refer to an ophthalmologist in accordance with the National Screening Committee criteria and timelines if any of these features is present: - referable maculopathy - exudate or retinal thickening within one disc diameter of the centre of the fovea - circinate or group of exudates within the macula - any microaneurysm or haemorrhage within one disc diameter of the centre of the fovea, only if associated with deterioration of best visual acuity to 6/12 or worse - referable pre-proliferative retinopathy (if cotton wool spots are present, look carefully for the following features, noting that cotton wool spots themselves do not define pre-proliferative retinopathy): - any venous beading - any venous loop or reduplication - any intraretinal microvascular abnormalities - multiple deep, round or blot haemorrhages or any unexplained drop in visual acuity. Urgent
CG87 If gastroparesis is suspected, consider referral to specialist services if: - the differential diagnosis is in doubt - persistent or severe vomiting occurs. Time frame not specified
CG87 In type 2 diabetes, arrange emergency review by an ophthalmologist for: - sudden loss of vision - rubeosis iridis - pre-retinal or vitreous haemorrhage retinal detachment. Arrange rapid review by an ophthalmologist for new vessel formation. Urgent
CG87 In patients with type 2 diabetes with erectile dysfunction, following discussion, refer to a service offering other medical, surgical, or psychological management of erectile dysfunction if phosphodiesterase-5 inhibitors have been unsuccessful. Follow up
CG87 Investigate unexplained discrepancies between glycated haemoglobin (HbA1c) and other glucose measurements. Seek advice from a team with specialist expertise in diabetes or clinical biochemistry. Time frame not specified
CG87 Agree referral criteria for specialist renal care between local diabetes specialists and nephrologists. Time frame not specified
CG87 In patients with type 2 diabetes, persons with unexplained bladder-emptying problems should be referred to the appropriate secondary care services for investigation for the possibility of autonomic neuropathy affecting the bladder. Time frame not specified

This page was last updated: 22 August 2012

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.