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Latest Updates & News on Current Position Statements & Guidelines

ALERT - Periprocedural Diabetic Ketoacidosis (DKA) with SGLT2 Inhibitor Use

Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are oral medications approved for the management of blood glucose levels in type 2 diabetes.  Over the last few years there has been an increasing number of reports of patients with type 2 diabetes who are taking SGLT2i developing severe diabetic ketoacidosis (DKA) requiring ICU/HDU admission, particularly during the peri-operative period. Sometimes this DKA is associated with near normal or only mildly elevated blood glucose levels (i.e. euglycaemic ketoacidosis [euDKA]).  The risk is increased if the patient has been fasting or has very restricted dietary intake, has undergone bowel preparation, including for colonoscopy and/or a surgical procedure, is dehydrated or has an intercurrent illness such as active infection. 

Please download a recent Australian article outlining the risk of euDKA in patients with type 2 diabetes undergoing colonoscopy and the alert on periprocedural diabetic ketoacidosis (DKA) with SGLT2i use developed by ADS, ADEA, DA, NZSSD and ANZCA. View the Alert & full article (Posted: September, 2020)

A position statement on Gestational Diabetes in Australia

The Gestational Diabetes in Australia Position Statement has been developed by Diabetes Australia in collaboration with the Australian Diabetes Society, the Australian Diabetes Diabetes Educators Association and the Australasian Diabetes in Pregnancy Society to inform women who may be at risk of, or who develop, gestational diabetes mellitus (GDM) and also to inform the community, policy makers and health care providers. It is not intended as a clinical guidance document for health professionals.
This position statement addresses the diagnosis, management and post-pregnancy care of women who develop GDM. It provides an overview of key issues relating to GDM and its impact and makes recommendations about the care and support women should receive. 
There are three main types of diabetes affecting women in pregnancy: 

1. pre-existing type 1 diabetes 

2. pre-existing type 2 diabetes 

3. gestational diabetes (GDM) which is first detected during pregnancy and is different to type 1 diabetes or type 2 diabetes 

This position statement only addresses GDM, people with diabetes should always consult a health care professional before making decisions about their diabetes careaa

Download the Gestational Diabetes in Australia Position Statement.

A position statement on screening and management of prediabetes in adults in primary care in Australia

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

ADS summary of the Prediabetes Position Statement - pdf (Posted June, 2020)

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

Periprocedural Diabetic Ketoacidosis (DKA) with SGLT2 Inhibitor Use

Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are oral medications that promote glucose excretion in the urine for the treatment of type 2 diabetes. Note that SGLT2i are not approved for use in the management of type 1 diabetes in Australia or New Zealand, although they are sometimes used off-label in this setting - PDF (Posted: January, 2020)

ALERT - Diabetic Ketoacidosis (DKA) with SGLT2 Inhibitor Use, Particularly Perioperatively

Sodium-glucose co-transporter-2 inhibitors(SGLT2i) are being used with increasing frequency due to their effectiveness and also the cardiorenal benefits being demonstrated in clinical trials. Indeed the latter has also led to non-endocrinologists, especially cardiologists and renal physicians commencing the agents. In addition, it is clear that even bowel preparation, not just surgery per se, has been a precipitating factor in a number of cases. Physicians, surgeons, anaesthetists, emergency departments andprimary care providers all need to beaware of the risks of diabetes ketoacidosis with these agents - PDF (Posted: August, 2019)

Use of "Biosimilar" Insulins for Diabetes Position Statement

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.

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

ADS Consensus Position Statement on: Utilising the Ambulatory Glucose Profile (AGP) combined with the Glucose Pattern Summary to support Clinical Decision Making in Diabetes Care

The ADS ‘AGP Plus’ Working Party
Chair: Prof Stephen Twigg
Members: A/Prof Neale Cohen, Ms Natalie Wischer, A/Prof Sof Andrikopoulos

Consensus
The Ambulatory Glucose Profile (AGP) enables retrospective analysis of dense data, trends and patterns for persons with diabetes and their health care team to help achieve appropriate glucose targets and to minimise hypoglycaemia and hyperglycaemia.

Preamble
An Australian Diabetes Society ‘Standardisation of AGP Profile Workshop’ was held on April 13th 2018, to identify the clinical effectiveness of glucose profiling in diabetes with a focus on retrospective, summary methods of reporting. This document reflects the main outcomes of that Consensus Workshop, leading to this consensus position statement with a practical focus.

Download the 'ADS Consensus Position Statement on: Utilising the Ambulatory Glucose Profile (AGP) combined with the Glucose Pattern Summary to support Clinical Decision Making in Diabetes Care' - PDF (Posted: June, 2020)

Emergency Management of Hyperglycaemia in Primary Care

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:

  • Identifying clinically important patient presentations and risk factors

  • Ensuring management of hyperglycaemic emergencies is optimised to prevent serious outcomes

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

ALERT - Severe Euglycaemic Ketoacidosis with SGLT2 Inhibitor Use in the Perioperative Period

There have been a number of reports of severe euglycaemic ketoacidosis in patients with type 2 diabetes who are taking sodium-glucose co-transporter-2 inhibitors (SGLT2i) during the perioperative period. SGLT2i's are oral medications that promote glucose excretion in the urine for the treatment of type 2 diabetes. Please read the alert for further information about the symptoms and recommendations for practice. If you do have a case of euglycaemic ketoacidosis with SGLT2i inhibitor treatment in your patients with diabetes please ensure that this is reportedas an adverse drug reaction - PDF (Posted: February, 2018)

ADS Position Statement on 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
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.

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)

ADS Position Statement on Insulin-requiring Diabetes and Recreational Diving

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

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.

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

ADS T2D Treatment Website (A New Blood Glucose Management Algorithm for Type 2 Diabetes)

This website follows the release of a revised position statement by the ADS entitled, ‘A new blood glucose management algorithm for type 2 diabetes’.

This initiative involved the support of groups including the National Association of Diabetes Centres (NADC), Diabetes Australia (DA), the National Prescribing Service (NPS) and the Royal Australian College of General Practitioners (RACGP).  

Please visit http://t2d.diabetessociety.com.au to access the T2D treatment website.

ADS Position Statement on A New Blood Glucose Management Algorithm for Type 2 Diabetes

The ADS has updated the Type 2 Diabetes Management Algorithm to reflect the new studies reported at the European Society of Cardiology 2020. As of 1 July 2020, the Pharmaceutical Benefits Scheme listed semaglutide (ozempic) for the management of type 2 diabetes in combination with metformin or sulfonylurea or as triple therapy with metformin and sulfonylurea. 

Download the updated Blood Glucose Treatment Algorithm for Type 2 Diabetes Evidence Table - PDF (Posted: 03 September, 2020)

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)

Australian Obesity Management Algorithm

Obesity is a complex and multi-factorial chronic disease with genetic, environmental, physiological and behavioural determinants that requires long-term care. In 2014-15, 63.4% of Australians aged 18 years and over were above normal weight, with 27.9% being obese. Obesity is associated with a broad range of complications including type 2 diabetes, cardiovascular disease, dyslipidaemia, sleep apnoea, osteoarthritis, and certain types of cancers, which significantly impair quality of life. Obesity and its related complications place a considerable financial burden on Australia. In 2014-15, the direct and indirect costs of obesity were estimated at $ 8.65 billion.

This statement has been developed by a working group with representatives from the Australian Diabetes Society, the Australian and New Zealand Obesity Society and the Obesity Surgery Society of Australian and New Zealand.

The aims of the document are to:

1) Assist general practitioners (GPs) in treatment decisions for non-pregnant adults with obesity

2) Provide a practical clinical tool to guide the implementation of existing guidelines for the treatment of obesity in the primary care setting in Australia.

Download the full version of the Australian Obesity Management Algorithm - PDF (Posted: October, 2016)

HbA1c for Diagnosis of Diabetes Mellitus

Guidance concerning the use of glycated haemoglobin (HbA1c) for the diagnosis of diabetes mellitus Postion 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.

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:

  • HbA1c ≥6.5% (48 mmol/mol)
  • Fasting glucose ≥7.0 mmol/L
  • Random glucose ≥11.1 mmol/L
  • On a 75 g oral glucose tolerance test: fasting glucose ≥7.0 mmol/L or 2 hr glucose ≥11.1 mmol/L

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.

Psychological Care for People with Diabetes: A Position Statement of the American Diabetes Association

Complex environmental, social, behavioral, and emotional factors, known as psychosocial factors, influence living with diabetes, both type 1 and type 2, and achieving satisfactory medical outcomes and psychological well-being. Thus, individuals with diabetes and their families are challenged with complex, multifaceted issues when integrating diabetes care into daily life.

Download the full version of the 'Psychological Care for People with Diabetes: A Position Statement of the American Diabetes Association' - PDF (Posted: December, 2016)

ADS Position Statement on Insulin Glargine (Lantus ®) and a Possible Link with Cancer

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

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Guidelines endorsed by the Australian Diabetes Society

Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations

The ADS has recently endorsed international guidelines that recommend metabolic surgery for patients with type 2 diabetes and class III (BMI ≥40 kg/m2) obesity and patients with type 2 diabetes with class II (BMI 35.0–39.9 kg/m2) obesity who have had inadequate glycaemic control with lifestyle and pharmacotherapy.

Download the full version of the 'Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations' Guidelines - PDF (Posted: October, 2019)

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Australian Diabetes Society Position Statement & Guidelines

ADS Position Statement on A New Blood Glucose Management Algorithm for Type 2 Diabetes

This position statement developed by the Australian Diabetes Society outlines the risks, benefits and costs of the available therapies and suggests a treatment algorithm incorporating the older and newer agents. Summary of this ADS Position Statement is as follows:
  • Lowering 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 each person with diabetes. This should start with selecting appropriate glucose and glycated haemoglobin targets, taking into account life expectancy and the patient's wishes. For most people, early use of glucose-lowering therapies is warranted.
  • A range of recently available therapies has added to the options for lowering glucose levels, but this has made the clinical pathway for treating diabetes more complicated.

Download the full version of the ADS A New Blood Glucose Management Algorithm for Type 2 Diabetes Position Statement - PDF (Posted: December, 2014)

The Position Statement was also published in the MJA (Med J Aust 2014; 201 (11): 650-653.). You can read the MJA article online.

Download the updated Blood Glucose Treatment Algorithm for Type 2 Diabetes Evidence Table - PDF (Posted: 17 July, 2018)


ADS Guidelines for Routine Glucose Control In Hospital

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.

Download the ADS Guidelines for Routine Glucose Control in Hospital - PDF

 

ADS Peri-Operative Diabetes Management Guidelines

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. 

Download the ADS Peri-operative Diabetes Management Guidelines - PDF


National Evidence Based Clinical Care Guidelines for Type 1 Diabetes in Children, Adolescents and Adults

The Australian Diabetes Society (ADS) and the Australasian Paediatric Endocrine Group (APEG) have completed the National Evidence Based Clinical Care Guidelines for Type 1 Diabetes in Children, Adolescents and Adults and is approved by the NHMRC under section 14A of the National Health and Medical Research Council Act 1992.

Download the National Evidence Based Clinical Care Guidelines for Type 1 Diabetes in Children, Adolescents and Adults - PDF

Download the National Evidence Based Clinical Care Guidelines for Type 1 Diabetes in Children, Adolescents and Adults (Technical Report) - PDF

Download the National Evidence Based Clinical Care Guidelines for Type 1 Diabetes in Children, Adolescents and Adults (Press Release Document) - PDF

(Please Note: Only electronic PDF copies are available)

 

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

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.

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NHMRC Clinical Practice Diabetes Guidelines

The National Health & Medical Research Council (NHRMC) Clinical Practice Guidelines Portal can be accessed at http://www.clinicalguidelines.gov.au

All publications relating to Diabetes can be viewed and downloaded from the National Health & Medical Research Council (NHMRC) website at: http://www.nhmrc.gov.au/guidelines/publications/subject/Diabetes

  • 2009 National Evidence Based Type 2 Diabetes Guidelines

During 2009, five Diabetes Type 2 Guidelines were approved by the Chief Executive Officer (CEO) of NHMRC under Section 14A of the NHMRC Act, namely:

  • National Evidence Based Guideline for Diagnosis, Prevention and Management of Chronic Kidney Disease in Type 2 Diabetes
  • National Evidence Based Guideline for Case Detection and Diagnosis of Type 2 Diabetes 
  • National Evidence Based Guideline for Patient Education in Type 2 Diabetes
  • National Evidence Based Guideline for Blood Glucose Control in Type 2 Diabetes
  • National Evidence Based Guideline for the Primary Prevention of Type 2 Diabetes

These Guidelines comprise a suite of Type 2 Diabetes Guidelines developed under a funding agreement between the Department of Health and Ageing and the Diabetes Australia Guideline Development Consortium. The most recently finalised Guideline the National Evidence Based Guideline for the Primary Prevention of Type 2 Diabetes, was approved by the NHMRC CEO on 10 December 2009.

The five Guidelines in the series, when combined, present a comprehensive set of evidence-based guidelines for the
prevention, diagnosis and management of Type 2 Diabetes.

The five diabetes guidelines above can be viewed or downloaded at:-
http://www.nhmrc.gov.au/publications/synopses/di16to19syn.htm

  • Management of Diabetic Retinopathy
    The Australian Diabetes Society is delighted to announce that the updated Guidelines for the Management of Diabetic Retinopathy are now available and can be viewed or downloaded from the NHMRC website under publications.  The website address is http://www.nhmrc.gov.au/guidelines/publications/di15 . The review, conducted between 2004 and 2007, updates the 1997 guidelines with additional literature from 1996 to the end of August 2007. The ADS would like to thank A/Prof Justin O’Day for his leadership and chairing this working party that included the following members:  Dr Ralph Audehm, Dr Daryl Guest, Mr Robert Guthrie, Prof Janet Hiller, A/Prof Jill Keeffe, Mr John Kilmartin, Dr Mark McCoombe, Dr Andrew Magennis, Ms Tracy Merlin, Prof Paul Mitchell, Dr Peter Montgomery, Dr Pat Phillips, and Prof Tien Wong.

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Australian Diabetes Society Position Statement Archives

The Australian Diabetes Society has published the following position statements prior to 2001:

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Statement of Consent

The information contained in the ADS Position Statement & Guidelines section and elsewhere on this website is for general information only. It is designed to be educational and is not intended to be and is not a complete or definitive statement on any area of medical practice or procedure. The Society, its directors and other officers make no express or implied warranties, as to suitability for a particular purpose or otherwise, with respect to any information included on this website. Rapid advances in medicine may cause information contained in this website to become outdated or subject to debate. Visitors to this website who are not medical practitioners qualified in the field should seek further professional advice before any action is taken in relation to the matters described or referred to on this website.