New Australian Diabetes Society guidelines for management of diabetes and its complications during the COVID-19 pandemic highlight the services that must continue to be provided face to face.

Although diabetes out-patient clinics have been closed or reduced, the ADS says telephone/telehealth services cannot replace some aspects of care for urgent or immediate conditions that require emergency treatment or admission for inpatient management.

In its guidelines released on 3 April, the ADS highlights conditions including:

• Severe hypoglycaemia,
• Diabetic ketoacidosis (DKA),
• Hyperosmolar hyperglycaemic state (HHS),
• Severe/systemic foot infections, gas gangrene or acute limb-threatening ischaemia.

And while outpatient services may be provided by different service models, face-to-face consultations may still be needed for diabetes specialists, diabetes nurses, dietitians, psychologists, podiatrists.

The ADS says that some routine diabetes reviews may be provided via telehealth, there is a need to identify high risk patients who may still require face-to-face visits. Outpatient clinics may still be needed for:

• Inter-disciplinary diabetes foot services,
• Pregnancy and diabetes services,
• Insulin starts,
• The combination of requiring insulin treatment, having increased risk of hypoglycaemia and lack of ability or facility to download meters or other diabetes technology (insulin pumps, continuous glucose monitoring, flash glucose monitoring) for remote review.

“These need to be assessed in the light of local decision-making processes and should be focussed on those required to avoid hospital emergency department attendances where possible,” the guideline states.

The ADS has also developed a joint statement with the Australasian Diabetes In Pregnancy Society (ADIPS), Diabetes Australia (DA) and the ADEA  to guide health professionals with the diagnosis of gestational diabetes during the COVID-19 pandemic.