Referral Protocols for Diabetes Complications and Comorbidities for Smartphone Application for Diabetes Care Program, Guatemala

Routine Referrals (Within 1–2 Weeks)Urgent Referrals (Within 1–2 Days)Emergency Referrals (Same Day)
  • Stage I hypertension (BP 140-160/90–100 mm Hg)

  • Noninfected diabetic ulcer

  • Need for renal function testing

  • A1c ≥ 9% despite maximal doses of metformin and glyburide for ≥3 months

  • A1c ≥ 9% for 3 consecutive checks

  • A1c above glycemic target, but <9% for 4 consecutive checks

  • Recent chest pain, moderate risk of CAD

  • Blood in stool or possible melena

  • Patient has other symptoms not addressed by the program protocols

  • Stage II hypertension (BP 160–200/100–120 mm Hg)

  • Possibly infected diabetic ulcer, no signs of systemic infection

  • Worsening vision

  • FBG detectable, but ≥400 mg/dL

  • A1c ≥ 14%

  • Patient cannot tolerate minimum doses of metformin and/or glyburide

  • Current chest pain, moderate risk of CAD

  • Severe hypertension (BP ≥ 200/120 mm Hg)

  • Fasting blood glucose undetectable high

  • Postprandial/random blood glucose undetectable high with mental status changes

  • Hypoglycemia associated with altered mental status

  • Persistent hypoglycemia despite treatment in the field

  • Current chest pain, high risk of CAD

  • Possibly infected diabetic ulcer with signs of systemic infection

  • Abbreviations: A1c, hemoglobin A1c; BP, blood pressure; CAD, coronary artery disease; FBG, fasting blood glucose.