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Diabetes care in Reading, Wokingham and West Berkshire

Tier 4 complex care service provision

Secondary or complex care service provision for Tier 4 diabetes patients

Tier 4: complex care

Referrals will be triaged to the tier 4 team for:


  • Type 1 insulin initiation /  Type 1 diabetic annual reviews
  • Known adrenal or pituitary condition
  • Diabetes secondary to pancreatic disease
  • Joint Renal/Diabetes care – (not at present but criteria to be looked at)
  • Terminal illness under hospital care
  • Severe known autonomic neuropathy
  • Active foot problems including infection, ulceration, charcot
  • Insulin Pumps
  • All Diabetic Pregnancy.
  • Young adult clinic
  • Type 1 Diabetic full care package (contract to be defined)
  • Persistently raised HbA1c and active retinopathy, amputation
  • Obesity


Provision of structured patient education