Local Clinical Guidelines

Abnormal Hba1c – non-diabetic

First Hba1c 42-47: add “non-diabetic hyperglycaemia” code as a Major Problem then task secretaries to send new “at risk of diabetes” letter to patient

If 48 or above, arrange repeat Hba1c and TSH 1 month later via the recall system.

If 2nd hba1c is 48 or above, or the patient is symptomatic with a raised Hba1c:

• 1) Code “Type II Diabetes Mellitus” as major problem
• 2) Arrange a follow up phone call with the patient with yourself to break the diagnosis
• 3) Book 30 minute F2F appointment with diabetes nurse for introductory chat
• 4) Send task to secretaries to refer to retinopathy

Abnormal Hba1c – diabetic

If Hba1c is 58 or above (75 or above with moderate or severe frailty), ensure patient has a diabetes nurse appointment to discuss (if not, arrange one). If over 90, discuss with a member of the diabetes team on the same day.

Abnormal GFR or ACR

ACRs and GFRs are interchangeable in the NICE CKD guideline, so either being abnormal should trigger this process.

First abnormal result (GFR less than 60, ACR 3 or more) check for acute illness, AKI, nephrotoxic drugs and action if appropriate. Then send “Low GFR 1 letter (blood test in 2 weeks)”

Second abnormal result – check for acute illness, AKI, nephrotoxic drugs, then send “low GFR 2 letter (blood test in 2months)”

Third abnormal result – check at least 3 months between abnormal results, then code appropriate CKD category and ask secretaries to post “new CKD letter”.

Safeguarding Leads

Safeguarding Lead: Dr Philip Williams

Deputy Safeguarding Leads: Dr Catherine McParland, Mrs Liz Smith