Curriculum standards

Insulin dose adjustments (irrespective of insulin delivery method)

• Safe dose adjustment in response to:
  • alcohol and recreational drug use
  • blood glucose levels
  • concurrent treatments that impact blood glucose (e.g. glucocorticoids and parenteral nutrition etc.)
  • exercise
  • intravenous insulin regimens:
    • dosing
    • indications
    • initiation
    • transition to subcutaneous
  • nutrition and fasting
  • peri-operative and peri-procedures
  • pregnancy, lactation, labour, and postpartum
  • sick days
  • titration

Lifestyle management

• Counselling and best evidence-based lifestyle advice for individuals to prevent the development of Type 2 diabetes or to manage all forms of established diabetes:
  • alcohol, recreational drugs, smoking, and vaping
  • carbohydrate counting
  • contraception and pre-conception planning, management during pregnancy and postpartum
  • education and employment
  • nutrition and diet
  • physical activity and reducing sedentariness
  • weight management

Pharmacological management

• Apply up to date, evidence-based best practice and clinical judgement to individualised medication management plans
• Action profiles of various insulins and combination regimens:
  • effects of concurrent drug therapies on glycaemia
  • evidence-based use of pharmacotherapy for non-glycaemic benefits in diabetes populations, e.g. cardiovascular or renal benefits
• Knowledge of the pharmacological therapy indicated for:
  • gestational diabetes mellitus
  • MODY
  • pancreatectomy or endocrine pancreatic insufficiency
  • type 1 diabetes mellitus and LADA
  • type 2 diabetes mellitus
• Mechanism of action of major non-insulin drug classes in glycaemia
• Principles of pharmacology:
  • drug distribution, metabolism, and excretion
  • drug interactions, precautions, and contraindications

Screening

• Depression, accelerated cognitive decline, and dementia
• Diabetes complications screening (incorporating allied health and other health professionals wherever indicated) at appropriate intervals for microvascular and macrovascular disease burden
• Diabetes distress, particularly for people living with type 1 or LADA diabetes
• Diagnostic criteria
• Hypertension and dyslipidemia
• Individualised glycaemic targets determined by:
  • complications and comorbidities profile
  • duration of disease
  • goals
  • hypoglycaemia risk
  • patient preferences
• Metabolic syndrome and associated fatty liver disease (MAFLD)
• Monitoring glycaemia
• Obstructive sleep apnoea (OSA)
• Referral and use of allied health and multidisciplinary professionals in providing holistic team care
• Screening and managing referrals for associated conditions
• Screening for other autoimmune conditions, such as:
  • Addison's disease
  • coeliac disease
  • pernicious anaemia
  • thyroid dysfunction

Hyperglycaemic emergencies

• Diabetic ketoacidosis
• Hyperglycaemic hyperosmolar state

Hypoglycaemia

• Acute and preventive management of hypoglycaemia
• Acute hypoglycaemic emergencies
• Investigations and work up of hypoglycaemia in non-diabetes cases
• Mechanisms and associated diseases, including insulinoma, dumping syndrome, nesidioblastosis, post-bariatric surgery
• Recognition and management of hypoglycaemia unawareness

Euglycaemic diabetic ketoacidosis

• Pregnancy-induced
• SGLT2i-induced
• Starvation
• Type 1 diabetes

Advanced technology and devices

• Blood glucose monitoring systems:
  • benefits, limitations, and data interpretation (time in range, GMI)
  • bolus calculators for multiple daily injection (MDI)
  • continuous glucose monitoring (CGM) systems:
    • used with MDI therapy and insulin pumps
    • principles, benefits, and limitations of closed loop technology
    • glucose data interpretation (self-monitored blood glucose readings, continuous glucose monitoring)
  • finger prick meters – glucose and ketones
• Calculation and adjustment of:
  • basal insulin dose/ratios
  • carbohydrate ratio
  • insulin sensitivity factor
• Indications and suitability of CSII converting insulin doses from MDI to CSII
• Insulin delivery devices:
  • insulin pen devices for MDI therapy
  • insulin pumps and features/functions
• Interpretation of insulin pump data
• Principles of continuous subcutaneous insulin infusion (CSII, ‘insulin pump’) therapy, such as:
  • basal infusion rates
  • pump specific attributes including suspend and exercise

Cardiovascular risk mitigation

• Blood pressure:
  • individualised target setting
  • investigation for underlying secondary causes of hypertension where appropriate
  • monitoring including home, clinic, and 24-hour ambulatory monitoring
• Clinical assessment and comprehensive diabetes physical examination
• Impact of alcohol on diabetes monitoring and management
• Lipid management and targets in diabetes cohort
• Smoking cessation/avoidance
• Weight management

Hypoglycaemia

• Dynamic tests – indications, performing tests, and interpretation:
  • mixed-meal test
  • 72-hour fast

Investigations

• Gastric emptying study
• Genetic screening:
  • rare or suspected inherited forms of diabetes
• Endogenous insulin reserves (when indicated), e.g. paired C-peptide and glucose
• Limitations and interferences in pathology results, such as:
  • fructosamine
  • HBA1c
  • lipid studies
• Nerve conduction studies
• Pancreatic autoimmunity (when indicated or suspected)
• Urine albumin/creatinine ratio
• Use of decision support tools to facilitate clinical decisions such as cardiovascular disease calculator

Evidence based clinical practice

• Beta cell transplantation, including whole pancreas or islet cell transplantation
• Evidence for best practice (e.g., AnnADA guidelines supplement, diabetes care) and application of this using clinical judgement and individual circumstances in partnership with patients
• Fitness to drive according to guidelines

General management considerations

• Educate, support, and empower people to self-manage their diabetes
• Environmentally sustainable practices in clinical care
• Impact of:
  • cultural, health literacy, social, geographic and financial barriers to accessing comprehensive diabetes care
  • diagnosis of diabetes and of living with diabetes on an individual, their family, their life, and their life stages
  • hypoglycaemia unawareness on patients, their family, and carers
  • socioeconomic determinants of health on health outcomes
• Equitable access to comprehensive diabetes care delivery for individuals, such as:
  • appropriate multicultural resources
  • including multidisciplinary involvement
  • use of telehealth and other digital health tools
• Recognise the impact of management in the presence of comorbidities including:
  • atherosclerotic
  • cardiac failure
  • chronic kidney disease
  • cognitive decline
  • obesity
  • seizure disorders

Health needs of specific groups

• Diabetes in youth:
  • common risk-taking behaviour in young people and its effects on diabetes
  • impact of practitioner’s behaviour on young people
  • physiological, psychological and social factors affecting glycaemic levels in adolescence
  • potentially negative effects of adolescent behaviour on diabetes and the impact it may have on family and personal relationships
  • young people transitioning from paediatric to adult diabetes care
• Older people and people living with significant disability or life-limiting comorbid conditions:
  • adjust management and therapeutic targets based on individual needs and the principles of hypoglycaemia harm mitigation
  • ensure careful utilisation of health service resources
  • potential effects of these comorbidities on diabetes treatments and glycaemia
  • specific social and medical needs of people with diabetes living in residential/nursing care, and those with neurological or cognitive disabilities including additional levels of supervision to ensure safety
  • work with multidisciplinary teams and family members who can support people living in the community
• Management of glycaemia:
  • for people with type 1 or LADA diabetes, manage insulin delivery and insulin pump therapy in all stages of pregnancy, in labour and postpartum
  • indications and safety of medication use prior to conception, in pregnancy and with lactation
  • monitoring advice
  • nutrition and exercise advice
• Pre-conception, pregnancy, and lactation
  • gestational diabetes:
    • diagnostic criteria and screening strategies, including progression of complications
    • glycaemic, blood pressure and weight management goals prior to and throughout pregnancy
    • impact of intercurrent illness and events on glycaemia, such as administration of glucocorticoids, and how to adjust insulin doses in these situations
    • monitor for risks, including progression of maternal complications on fetal development and growth
  • recognise the need for pre-pregnancy assessment, counselling, and family planning in women of reproductive age
• Recognise concerns and anxieties of parents and carers