ADS Position Statements/Guidelines - Type 2 Diabetes Mellitus

Resources for Diabetes Health Professionals 

Australian Type 2 Diabetes Glycaemic Management Algorithm

Summary
The blood glucose management algorithm for type 2 diabetes outlines the risks, benefits and costs of available therapies and provides an approach for how to incorporate older and newer agents. Control of blood glucose levels in people with type 2 diabetes has clear benefits for preventing microvascular complications and potential benefits for reducing macrovascular complications and death. Control of blood glucose levels in people with type 2 diabetes has clear benefits for preventing microvascular complications and potential benefits for reducing macrovascular complications and death. Treatment needs to be individualised for the person with diabetes. This should start with selection of the appropriate blood glucose and HbA1c targets, taking into account life expectancy and the wishes of the person with diabetes. A range of recently available therapies have added to our range of options for controlling blood glucose levels but has made the clinical pathway for managing diabetes more complicated. To assist with clinical decision making, in 2014 the Australian Diabetes Society council appointed an expert working group to draft a Position Statement with a focus on the results of recent randomised clinical trials. The original statement was reviewed by the ADS council (September 2014) and then sent to all ADS members for comment before publication in the Medical Journal of Australia (December 2014). In light of new randomised clinical trial evidence the statement and algorithm is updated as required.

Algorithm Evidence Table
Download the updated Australian Type 2 Diabetes Glycaemic Management Algorithm - PDF (Posted: 04 August 2022

Position Statement
Download the updated (December, 2016) full version of the 'A New Blood Glucose Management Algorithm for Type 2 Diabetes ADS Position Statement ' - PDF (Posted: December, 2016). The Position Statement was also published in the MJA (Med J Aust 2014; 201 (11): 650-653.). You can read the MJA article online. Website: Please visit http://t2d.diabetessociety.com.au to access the T2D treatment website.


 

ADS-ADEA-APEG Consensus Statement: Management of Type 2 Diabetes in Young Adults (aged 18-30 years)

Summary The Australian Diabetes Society together with the Australian Diabetes Educators Association and Australasian Paediatric Endocrine Group have written the first ever Australian consensus statement on the management of type 2 diabetes in young adults. The consensus statement provides advice on screening, diabetes type, psychological care, lifestyle, glycaemic targets, pharmacological agents, cardiovascular disease risk management, comorbidity assessment, contraception and pregnancy planning, and patient-centred education. Special considerations for Aboriginal and Torres Strait Islander Australians are highlighted separately. The article is published in the MJA.  Consensus Statement: Please download the joint full version of the 'ADS-ADEA-APEG Consensus Statement: Management of Type 2 Diabetes in Young Adults (aged 18-30 years)' - PDF (Posted: 18 April, 2022)

Please view the consensus statement via MJA Management of type 2 diabetes in young adults aged 18–30 years: ADS/ADEA/APEG consensus statement | The Medical Journal of Australia (mja.com.au)


Diabetes and Ramadan Position Statement

Authors: Sara Baqar, Jenny Sheen, Sofianos Andrikopoulos, Elif Ekinci

Summary:
The Australian Diabetes Society has developed a position statement for the management of diabetes during Ramadan for people living with both type 1 diabetes and type 2 diabetes. Position Statement: Please download the joint full version of the 'ADS Diabetes and Ramadan Position Statement' - PDF (Posted: 11 April, 2022)


Periprocedural Diabetic Ketoacidosis (DKA) with SGLT2 Inhibitor Use In People with Diabetes

Summary   The ADS together with ADEA and ANZCA have made an update to the Alert - 'Periprocedural Diabetic Ketoacidosis (DKA) with SGLT2 Inhibitor use in People with Diabetes' incorporating recently published data and clinical evidence. Please download published article in Diabetes Care, Capillary Ketone Concentrations at the Time of Colonoscopy: A Cross-Sectional Study With Implications for SGLT2 Inhibitor–Treated Type 2 Diabetes | Diabetes Care | American Diabetes Association (diabetesjournals.org) and the alert on periprocedural diabetic ketoacidosis (DKA) with SGLT2i use in people with diabetes developed by ADS, ADEA, DA, NZSSD and ANZCA. Alert
 View the updated Alert (Posted: July, 2022) 


Type 2 Diabetes Remission

Summary
Diabetes Australia’s Position Statement on Type 2 diabetes remission was jointly developed by a working group from representatives of the Australian Diabetes Society (ADS), the Australian Diabetes Educators Society, provides up-to-date, practical advice and information to people with diabetes and the community about possible remission of type 2 diabetes. It is not intended to be a scientific or fully detailed report for health professionals. People with type 2 diabetes who want to attempt diabetes remission need to do so in close consultation with their diabetes healthcare team, as intensive dietary and weight changes need careful management, monitoring and support. People who do not achieve or sustain remission should not feel that they have ‘failed’. The health benefits of weight loss and a reduction in HbA1c are significant even if remission does not occur, as these reduce the risk of developing diabetes-related complications and may lead to reducing or stopping glucose-lowering medications.  Position Statement
Download the full version of the 'Type 2 Diabetes Remission Position Statement ' - PDF (Posted: October, 2021)


Screening and management of prediabetes in adults in primary care in Australia

Summary
A joint Position Statement by the Australian Diabetes Society, Australasian Diabetes Educators Association, Dietitians Association of Australia, Exercise and Sports Science Australia and the Pharmaceutical Society of Australia. Prediabetes has a high prevalence, with early detection essential to facilitate optimal management to prevent the development of conditions such as type 2 diabetes and cardiovascular disease. Prediabetes can include impaired fasting glucose, impaired glucose tolerance and elevated HbA1c. ADS summary of the Prediabetes Position Statement - pdf (Posted June, 2020)

Position Statement
This Position Statement outlines the approaches to screening and management of prediabetes in primary care - PDF (Posted: May, 2020) 

A Position Statement on Screening and Management of Prediabetes in Adults in Primary Care in Australia - Updated (Posted July, 2020)

Posted: May, 2007 You can read the MJA article online.


Use of "Biosimilar" Insulins for Diabetes 

Summary
This Position Statement represents the collective views of the Australian Diabetes Society, the Australian Diabetes Educators Association and Diabetes Australia.

The Therapeutic Goods Administration (TGA) recently approved the first “biosimilar” insulin product for use in Australia – Basaglar Insulin. A “biosimilar” is a copy of a biological molecule that has already been approved for use and has a demonstrated similarity in physiological characteristics, efficacy and safety.

Position Statement
Download the full version of the 'Use of “biosimilar” Insulins for Diabetes Position Statement ' - PDF (Updated: June, 2019)


Emergency Management of Hyperglycaemia in Primary Care

Summary
Emergency management of hyperglycaemia in primary care was developed by the RACGP and the Australian Diabetes Society (ADS) to raise clinical awareness of hyperglycaemic emergencies in primary care by:

This document should be read in conjunction with the relevant management flow charts (Figures 1 and 2), which provide information for the management of hyperglycaemic emergencies before patients arrive at hospital. This position statement should integrate with, but not replace, existing sick day, ambulance and hospital-based management protocols. Clinicians should consult existing local/regional or health pathways/protocols for inpatient management.

It is important to note this statement does not replace existing diagnostic guidelines for routine (non-emergency) presentations, and should not be used for evaluating hyperglycaemia associated with pregnancy where specialist advice on assessment and management must be sought. 

Position Statement
Download the jointly-produced RACGP and Australian Diabetes Society clinical Position Statement which aims to assess and manage hyperglycaemic emergencies and prevent adverse outcomes - PDF (Posted: May, 2018)


Insulin Glargine (Lantus ®) and a Possible Link with Cancer

Position Statement
Download the full version of the 'ADS Position Statement on Insulin Glargine (Lantus®) and a Possible Link with Cancer - PDF (Posted: October, 2017)


The Prevention and Management of Type 2 Diabetes in the context of serious Mental Illness

Authors: Roger Chen, Timothy Lambert, Jen Kinsella, Leon Chapman, Maarten Kamp, Jennifer Conn

Summary
The Australian Diabetes Society (ADS) has released a new Position Statement aimed at improving the management and health outcomes of people living with serious mental illness and type 2 diabetes. A working party, supported by funding from the National Diabetes Services Scheme, was established to provide recommendations for the improvement and to better monitoring of the overall cardiometabolic health, particularly diabetes and diabetes risk, of individuals with serious mental illness.

Position Statement
Download the full version of 'The prevention and management of type 2 diabetes in the context of psychotic disorders ADS Position Statement ' - PDF (Posted: October, 2017)


Insulin-requiring Diabetes and Recreational Diving

Authors: Mervyn Kyi, Barbora Paldus, Natalie Nanayakkara, Michael Bennett, Rebecca Johnson, Catherine Meehan, Peter Colman

Summary
In 2015 the Australian Diabetes Society commissioned a working group to review and revise its Position Statement on scuba diving in persons with diabetes. The working group consisted of endocrinologists with an interest in type 1 diabetes, diving medical specialists, a recreational diver with diabetes and an advocate for people with type 1 diabetes. A thorough literature review was performed and all available evidence was summarised and a new Position Statement was drafted. The new Position Statement was submitted to the ADS Council for approval. The scope of this document is restricted to recreational (not professional) diving in line with the available evidence. It is also targeted at insulin-requiring (both type 1 and type 2) diabetes, as traditionally this group has been excluded from recreational diving. This document updates the ADS Position Statement in line with current evidence.

Position Statement
Download the full version of the 'Insulin-requiring diabetes and recreational diving ADS Position Statement ' - PDF and Appendices - PDF (Posted: December, 2016)


HbA1c for Diagnosis of Diabetes Mellitus

Summary
Guidance concerning the use of glycated haemoglobin (HbA1c) for the diagnosis of diabetes mellitus Position Statement

The use of glycated haemoglobin (HbA1c) for diagnosis of diabetes mellitus has been accepted by Medicare for reimbursement. The Position Statement "Guidance concerning the use of glycated haemoglobin (HbA1c) for the diagnosis of diabetes mellitus" has also been published in the MJA on 20 July 2015. Click here to view the document in MJA.(https://www.mja.com.au/journal/2015/203/2/guidance-concerning-use-glycated-haemoglobin-hba1c-diagnosis-diabetes-mellitus)

Like any test, the use of HbA1c for the diagnosis of diabetes mellitus has its strengths and weaknesses. It is important for practitioners to be aware of its potential short comings as well as correctly interpreting a positive and a negative result. The aim of this position paper is to provide a succinct summary of how to optimally use the test to diagnose patients. The test represents an important advance and it is hoped that the guidance provided by this Position Statement will assist health practitioners to use the test effectively.

Position Statement
Download the full version of the 'Guidance concerning the use of glycated haemoglobin (HbA1c) for the diagnosis of diabetes mellitus ADS Position Statement ' - PDF (Posted: July, 2015)

Download the Press Release Statement on 'Guidance concerning the use of glycated haemoglobin (HbA1c) for the diagnosis of diabetes mellitus ADS Position Statement ' - PDF (Posted: July, 2015)

View and download the new HbA1c Conversion Table

ADS Recommendations for the use of HbA1c for the Diagnosis of Diabetes

HbA1c is now acceptable as a diagnostic test for diabetes. The threshold for diagnosis is at an HbA1c level of 6.5%. The existing glucose criteria for the diagnosis of diabetes remain valid as well.

The criteria for the diagnosis of diabetes are now:

In an asymptomatic patient the test should be repeated for confirmation of the result and diagnosis. An abnormal result on 2 different diagnostic tests is also acceptable. For full details of the recommendation of HbA1c for the diagnosis of diabetes, including situations where the HbA1c is unreliable, go to https://www.mja.com.au/journal/2012/197/4/role-hba1c-diagnosis-diabetes-mellitus-australia.


ADS Guidelines for Routine Glucose Control In Hospital

Summary
The 2012 ADS Guidelines for Routine Glucose Control in Hospital have been developed over the last year, and cover a range of areas including general hospital wards, myocardial infarction, stroke, steroid-induced hyperglycaemia, enteral and parenteral feeding, insulin pump therapy, end of life situations, the optimal means for achieving glucose control, routine measures in hospital, and how to follow-up patients with newly discovered hyperglycaemia. The guidelines were informed by systematic reviews and evidence where there was any; otherwise they were based on consensus.

The Writing Party comprised David Chipps, Shirley Cornelius, Barbara Depczynski, Kristine Heels, David O’Neal, Jennifer Wong, Sophia Zoungas, and Wah Cheung.

Position Statement
Download the ADS Guidelines for Routine Glucose Control in Hospital - PDF (Posted: 2012)


ADS Peri-Operative Diabetes Management Guidelines

Summary
These guidelines have been developed by an ADS working group and are primarily intended to provide assistance for those practitioners whose primary focus is not diabetes or who do not have the support of local diabetes expertise in their management of patients with diabetes undergoing surgical procedures. 

Position Statement
Download the ADS Peri-operative Diabetes Management Guidelines - PDF (Posted: July, 2012)


ADS Position Statement on the Individualisation of HbA1c targets for Adults with Diabetes Mellitus

Summary
The Australian Diabetes Society has produced a Position Statement regarding the individualization of HbA1c targets, for adults with diabetes mellitus. This has been published in the Medical Journal of Australia, in the issue of September 21, 2009. A more comprehensive document with further background documentation can also be downloaded here and you can read the MJA article online.


Prediabetes: A Position Statement from the ADS & ADEA

Posted: May, 2007 You can read the MJA article online.