Tayside Diabetes MCN Handbook 
Management of Newly Diagnosed Type 2 Diabetes

1.    Confirm Diagnosis 

• See Handbook Section on Diagnosis of Diabetes
• IF PATIENT HAS PRESENTED WITH OSMOTIC SYMPTOMS (POLYURIA/POLYDIPSIA OR WEIGHT LOSS) PLEASE FOLLOW SPECIFIC GUIDANCE IN MANAGEMENT OF NEWLY DIAGNOSED PATIENTS WITH OSMOTIC SYMPTOMS    

2.    Register with SCI-DC

• See Tayside Diabetes MCN Website www.diabetes-healthnet.ac.uk [SCI-DC - Clinical Information - Data Entry Forms Screen - Diabetes Administration Form].

3.    Retinopathy Screening

• Once the patient has been registered with SCI-DC, he/she will automatically receive an appointment to attend for retinal photography within 3 months of this registration.

4.    Provide initial support and information about the nature and management of Type 2 diabetes. Including:

• provide appropriate written material see Patient Information Leaflets including "Patients Newly Diagnosed With Type 2 Diabetes – What Care Should You Have?" 
• informing the patient of the availability of further information on the Tayside diabetes MCN website.

5.    Refer for Education/Lifestyle Support/Remission

• Offer the patient an opportunity to enrol in the Oviva Diabetes Support Programme emphasising the important benefits. For details and referral information see Type 2 Diabetes Education and Support.
• Discuss opportunity for remission see Type 2 education and remission overview

6.    Check Baseline Measures

• BMI, Blood Pressure, Urinalysis for protein / microalbumin/ketones and Bloods (HbA1c, Creatinine /   eGFR, Lipid profile).

7.     Identify and address other risk factors

• Identify and address other risk factors for vascular disease including smoking cessation and exercise

8.    Management of Cardiovascular Risk

• Consider commencement of aspirin, statin and ACEI or ARB where appropriate. For further information see Management of Cardiovascular Risk

9.    Management of Glycaemic Control

• Consider allowing 3 month trial of dietary and lifestyle modification prior to commencing oral hypoglycaemic therapy. Use Metformin as the first line option unless this is contraindicated. For further information see Pharmacological management of glycaemic control in people with Type 2 diabetes

10.    Foot Screening & Risk Assessment

• Use the Foot Screening Tool, found by clicking on "Foot" icon within Patient’s SCI-DC patient Summary Data Screen. Consider referral to Community or Specialist Podiatry if the calculated level of foot risk is moderate or high.

11.   Consider referral to Specialist Consultation Service (Hospital Diabetes Clinic) 
In the following circumstances:

• Definite or likely Type 1 diabetes (urgent telephone referral to on-call Paediatric or Adult Diabetes Team)
• Patients with low or low normal BMI
• All children
• Patients who are pregnant or planning a pregnancy
• Pre-existing Chronic Renal Impairment. For information on referral guidelines see Screening and Management of Kidney Complications
• Seriously consider if patient under age of 40 at diagnosis of Type 2 diabetes (especially if strong family history of diabetes)
• Wherever there is a specific clinical concern about an individual patient.

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