Diabetes care is most effective when it is structured, evidence-based, and tailored to the needs of each patient. PEP Health, in alignment with the Australian Diabetes Educators Association (ADEA), offers a suite of patient support pathways designed to guide diabetes care teams and empower patients at every stage of their journey.
Here’s how these pathways can help your team deliver comprehensive, patient-centred diabetes care.
Overview of PEP Health Diabetes Support Pathways
PEP Health’s pathways are built on the ADEA’s referral and care models, ensuring best-practice, multidisciplinary support for people with diabetes.
Each pathway is structured to provide:
- Clear stages from diagnosis to ongoing management
- Patient-reported outcome measures (PROMs) and experience measures (PREMs)
- Resources for both patients and clinicians
- Linkages with national programs like the National Diabetes Services Scheme (NDSS)
- Regular review and goal-setting to support self-management
3 Steps to Better Patient Support
Now you can support patients with three simple steps.
- Add patient details
- Select the Patient Support Pathway
- Send the invitation to the patient.
Or, to make things even easier, simply give the patient a Pathway Code so they can register themselves—no administrative work required. You can send the Pathway Code to patients by text message, email, include it in a brochure, or display it on a poster in the waiting room.
Eight off-the-shelf ADEA-aligned pathways
The Pathways Library offers eight patient support pathways based on ADEA’s trusted referral and care models. When you assign a pathway to a patient, the system automatically:
- Sets up all patient communications
- Creates a checklist for practitioners
- Starts collecting important patient data
- Provides one place to track patient progress
- Enables the sharing of files and reports between all care team members
1. Pre-Diabetes Check Pathway
- Focus: Early identification and intervention for individuals at risk of developing diabetes.
- Features: Risk assessment, lifestyle modification advice, and regular monitoring.
- Goal: Prevent or delay the onset of diabetes through proactive education and support.
- More pathway details
2. Type 1 Diabetes – Adults
- Stages: Diagnosis, Education, Management
- Features: Baseline and review surveys, insulin and blood glucose diaries, mental health support, and information on the NDSS.
- Tools: Diabetes Distress Scale (DDS), WHO Wellbeing Index, ICHOM outcome measures.
- Goal: Equip adults with knowledge and tools for self-management, while supporting mental and physical health.
- More pathway details
3. Type 1 Diabetes – Children & Adolescents
- Stages: Diagnosis, Education, Management
- Features: Age-appropriate education, family-centric support, regular assessments, and integration with paediatric diabetes teams.
- Tools: Baseline and review surveys, blood glucose and insulin diaries, DDS, WHO Wellbeing Index.
- Goal: Support young people and their families through initial diagnosis, ongoing education, and management, with a focus on holistic wellbeing.
- More pathway details
4. Type 2 Diabetes – Adults
- Stages: Diagnosis, Education, Management
- Features: Information on medication, lifestyle changes, mental health, and regular monitoring.
- Tools: BMI calculator, DDS, ICHOM outcome measures, WHO Wellbeing Index.
- Goal: Empower adults to manage their diabetes through education, regular reviews, and multidisciplinary support.
- More pathway details
5. Type 2 Diabetes – Children & Adolescents
- Stages: Diagnosis, Education, Management
- Features: Tailored education for young people, family involvement, and regular check-ins with the care team.
- Goal: Foster early understanding and self-management skills, with ongoing support from a multidisciplinary team.
- More pathway details
6. Type 2 Diabetes – Starting Insulin
- Focus: Guidance for patients and care teams during insulin initiation and stabilisation.
- Features: Education on injection technique, monitoring, and regular follow-up.
- Goal: Ensure safe and confident transition to insulin therapy, with ongoing support from diabetes educators and the broader care team.
- More pathway details
7. Gestational Diabetes
- Focus: Support for women diagnosed with gestational diabetes, from diagnosis through pregnancy and postpartum.
- Features: Education on blood glucose monitoring, nutrition, and the importance of follow-up after pregnancy.
- Goal: Promote healthy outcomes for both mother and baby, with clear pathways for ongoing care.
- More pathway details
8. Diabetes Distress Scale (DDS) Pathway
- Purpose: Assess and address the emotional burden of living with diabetes.
- Features: Easy delivery of the DDS-17 survey, automated reminders, and follow-up based on results.
- Goal: Identify and manage diabetes-related distress, supporting mental health as a core component of diabetes care.
- More pathway details
PEP Health’s support of Diabetes Educators
The PEP Health platform offers a robust suite of features that streamline and enhance the delivery of diabetes support pathways for patients and care teams. With a singular, comprehensive view of each patient, care teams can quickly assign the most appropriate care pathway in just three steps, ensuring timely and tailored intervention. Automated communications, notifications, and data collection are seamlessly aligned with each care pathway, reducing administrative burden and keeping patients engaged and informed throughout their care journey.
Collaboration is at the heart of the platform, with built-in support for multidisciplinary teams. Secure file sharing between patients and all care team members enables holistic, coordinated diabetes management. Integration with Apple HealthKit and Google CareKit allows for automatic syncing of health data, empowering patients to track their progress and enabling clinicians to monitor outcomes in near-real time.
Configurable flags make it easy to isolate and manage specific patient cohorts, facilitating targeted interventions and research. The platform’s turnkey operation means organisations can create an account and begin supporting patients almost immediately, without complex setup or training.
For research and quality improvement, PEP Health enables de-identified data collection and export, supporting ongoing evaluation and innovation in diabetes care. Both clinicians and administrators benefit from a centralised dashboard, while patients have access to a dedicated mobile application for both Apple and Google devices, ensuring accessibility and engagement across the care continuum.
How to Integrate PEP Health Pathways
- Initial Assessment: Use baseline surveys and PROMs to understand patient needs.
- Education: Provide tailored information at each stage, including self-management skills and mental health resources.
- Ongoing Management: Schedule regular reviews, monitor progress, and adjust care plans as needed.
- Emotional Support: Incorporate tools like the DDS to address psychological well-being.
- Team Collaboration: Refer to and involve appropriate specialists as the patient’s needs evolve.
PEP Health’s patient support pathways, grounded in ADEA’s best-practice models, offer a structured, evidence-based approach to diabetes care. By integrating these pathways, care teams can deliver personalised, holistic support, empowering patients to manage their diabetes and improve their quality of life at every stage.
For more information or to access these pathways, visit the other parts of this website or contact our friendly support staff.
Organisations: We’re offering a free 30-minute, no-obligation call for organisations interested in supercharging their patient communications and keeping their multidisciplinary care teams in the loop with patient progress. Check our calendar here for a free spot.
Diabetes care team members: Health professionals can use the PEP Health platform for free. Talk with us now to find out how.
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