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Type 2 Diabetes Referral Guidelines
Prediabetes and Type 2 diabetes present with elevated blood glucose. Unlike patients with Type 1 diabetes who have deceased insulin production, patients with prediabetes and Type 2 diabetes have high insulin levels in order to overcome underlying insulin resistance.
Prediabetes and diabetes are not completely separate entities, but more of a spectrum of the same condition cause by insulin resistance and relative beta cell failure. Patients with prediabetes are able to have increased insulin production, which allows them to maintain blood glucose below diabetes range. Overtime the beta cells fail, insulin production decreases and blood glucose rises progressively into the diabetes range.
Risk factors include being overweight or obese, a family history of diabetes, a mother with gestational diabetes during the child’s pregnancy, an at-risk ethnic background and signs of insulin resistance such as acanthosis nigricans.
Diagnosis is made based on blood glucose levels and HbA1c.
An initial screening is recommended for children with BMI above the 85th percentile with a fasting or random blood glucose and/or HbA1c. Screening is recommended yearly or sooner if BMI is increasing or if there are symptoms of diabetes (polyuria/polydipsia, unexplained weight loss, fatigue).
Initial management includes weight management, which is crucial in the treatment of prediabetes and diabetes. Providers should encourage families to follow standards for exercise and nutrition, or refer to a nutritionist if needed.
Metformin is the first line of therapy for patients with prediabetes who fail lifestyle intervention and for those with Type 2 diabetes.
- Refer to a dietician if FGB <99 and HbA1c <6.0%
- Refer to a prediabetes clinic, non-urgent appointment, if FBG 100-125 and HbA1c 6.0-7.0%
- Refer to Type 2 diabetes clinic, expedited appointment will be given, if FBG ≥126, random BG ≥200, HbA1c ≥7.0%
- If blood glucose is more than 200, check for urine ketones, and call office department for urgent referral.
Fax lab results and growth chart to 202-476-4095 with contact information for the family. Our office will contact the family to set up the appointment.
If an expedited appointment is required, call at 202-476-5000 and ask for the endocrinologist on call.
A patient should expect to meet with endocrinologist and dietitian at their visit. They may also meet with a diabetes educator.
If required, an appointment with a psychologist will be scheduled.
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