Review Article

Expert Consensus on Telemedicine Management of Diabetes (2020 Edition)

Table 2

Conditions that require referral for an offline or emergency visit.

ItemContentGrade of recommendation and level of evidence

HypoglycemiaRecurring hypoglycemia: random blood glucose <3.9 mmol/L, associated with other symptoms such as hunger, cold and clammy extremities, palpitation, and sweatingStrong recommendation, C
Severe hypoglycemia: random blood glucose <2.8 mmol/L, irrespective of symptoms or not
Diabetic ketoacidosis or hyperglycemic stateDry mouth, polydipsia, nausea, vomiting, hyperpnea, and consciousness disordersStrong recommendation, C
Two or more times of fasting blood glucose ≥16.7 mmol/L or random blood glucose >20 mmol/L
Chronic diabetic complications requiring emergency treatment [6](1) Patients having difficulties in online visit for diagnosis, treatment regimen formulation, and efficacy assessment of chronic diabetic complications (retinopathy, nephropathy, neuropathy, diabetic foot, or peripheral vascular disease)Strong recommendation, C
(2) Patients requiring emergency aid and treatment due to severe target organ damage caused by chronic diabetic complications (acute cardiocerebrovascular disease, renal insufficiency caused by diabetic nephropathy, severe vision loss caused by diabetic retinopathy, intermittent claudication and ischemic symptoms caused by diabetic peripheral vascular disease, and diabetic foot)
Other stress conditionsInfection, fracture, trauma, foot ulcer, edema (continuous nonremission), blindness, cardiocerebrovascular emergency, and comaStrong recommendation, C