Referrals

Type 2 diabetes complex escalation referral checklist

Referral checklist for persistent glycemic instability or advanced cardiorenal diabetes complexity.

Last reviewed 2026-02-07|diabetes | endocrine | complex care

At a glance

Fast checkpoints for point-of-care decisions.

Minimum pre-referral workup

Include latest A1C trend, home glucose patterns, and hypoglycemia episodes.
Summarize medication trials, dose changes, intolerance, and adherence barriers.
Provide renal function, urine ACR, blood pressure, weight trend, and cardiovascular comorbidity context.

Urgency tier and escalation triggers

Urgent escalation for severe recurrent hypoglycemia, ketosis concern, or marked symptomatic hyperglycemia.
Expedited referral for persistent poor control despite sequential evidence-based therapy steps.
Routine referral for optimization of complex regimens or difficult treatment decisions.

Referral packet essentials

Current medication list including non-diabetes agents that influence glycemia.
Relevant lab/imaging data with dates.
Clear target question (insulin strategy, cardiorenal optimization, diagnostic uncertainty).

Pre-referral optimization tasks

Confirm workup completeness, urgency tiering, and referral packet quality before submission.

Verify baseline investigations are complete and recent.

Include latest A1C trend, home glucose patterns, and hypoglycemia episodes.
Summarize medication trials, dose changes, intolerance, and adherence barriers.
Provide renal function, urine ACR, blood pressure, weight trend, and cardiovascular comorbidity context.

Separate urgent pathways from routine referral flow.

Urgent escalation for severe recurrent hypoglycemia, ketosis concern, or marked symptomatic hyperglycemia.
Expedited referral for persistent poor control despite sequential evidence-based therapy steps.
Routine referral for optimization of complex regimens or difficult treatment decisions.

Include all mandatory data to reduce rejected referrals.

Current medication list including non-diabetes agents that influence glycemia.
Relevant lab/imaging data with dates.
Clear target question (insulin strategy, cardiorenal optimization, diagnostic uncertainty).

Address interim safety, optimization, and follow-up steps before handoff.

Jump to

Include latest A1C trend, home glucose patterns, and hypoglycemia episodes.
Summarize medication trials, dose changes, intolerance, and adherence barriers.
Provide renal function, urine ACR, blood pressure, weight trend, and cardiovascular comorbidity context.

Urgent escalation for severe recurrent hypoglycemia, ketosis concern, or marked symptomatic hyperglycemia.
Expedited referral for persistent poor control despite sequential evidence-based therapy steps.
Routine referral for optimization of complex regimens or difficult treatment decisions.

Current medication list including non-diabetes agents that influence glycemia.
Relevant lab/imaging data with dates.
Clear target question (insulin strategy, cardiorenal optimization, diagnostic uncertainty).