Multidisciplinary diabetes care

Principles

Multidisciplinary diabetes care is a team approach to providing diabetes support, education and care. Multidisciplinary diabetes care:

• Demonstrates shared leadership, accountability and responsibility for individualised planning of services and support to improve the quality of life for the person with diabetes
• Is comprehensive, holistic and integrated across the lifespan needs of people with diabetes
• Is a collaborative team effort of health care professionals who are respectful and accepting of each other’s discipline specific skills, training, attributes and contribution to diabetes care
• Supports shared decision-making by valuing and respecting the contributions of each member of the diabetes team; the person with diabetes, their family or carer and other health care professionals

Core components

• A focus on continuity of care
• Development of pathways and protocols for treatment and care
• Development of appropriate referral networks, including appropriate pathways to meet psychosocial needs
• Development of multidisciplinary team audit mechanisms
• The person with diabetes must consent prior to their case being discussed by the diabetes team

What can it achieve?

• Improved coordination of services
• Improved treatment planning and thus improved outcomes for people with diabetes and their families and carers
• Better detection and management of the psychosocial and emotional needs of people with diabetes and their family or carers
• Improved information sharing between the diabetes team member

Who are the members of the diabetes team?

Who participates depends on the type of diabetes, the services available in the particular location, the health care setting (primary care or tertiary sector), and the stage of diabetes and the needs of the person with diabetes.

In addition to the person with diabetes and their family or carer, the following are commonly long term members of the diabetes team:

• General Practitioner
• Endocrinologist/Pediatrician
• Credentialled Diabetes Educator (CDE)
• Dietitian
• Podiatrist

Other health care professionals that frequently participate include:

• Practice Nurse
• Specialist medical practitioners such as Ophthalmologist and Obstetrician
• Exercise Physiologist
• Optometrist
• Psychologist and/or social worker

Loooking for diabetes education services?

To locate diabetes education services in your area, please click here to return to the ‘Find a CDE’ search function on this website. To locate specialist diabetes centres and services, please visit the National Association Diabetes Centres (NADC) page by clicking here.