Primary Care Diabetes - PowerPoint PPT Presentation

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Primary Care Diabetes

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... widow who attends often because of her angina and COPD. She is getting more tired and feels it ... The government should have better diet and exercise policies? ... – PowerPoint PPT presentation

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Title: Primary Care Diabetes


1
Primary Care Diabetes
www.bradfordvts.co.uk
  • Dr Bruce Davies

2
Introduction - Diabetes
  • 2 of UK population.
  • 66 have been diagnosed.
  • Each GP will find 2-3 new cases per year.
  • 20-30 cases per GP on their lists.
  • 5-10 of NHS budget.
  • Childhood DM doubling every 10 years.

3
Topics of Discussion
  • Detection
  • Education counselling
  • Components of continuing care
  • Aims
  • Management
  • Who to refer
  • CDM and future NSF
  • Audit

4
Detection How / When
  • Symptoms
  • New patient checks
  • 75 checks
  • Medicals
  • Systematic
  • Opportunistically
  • ANC
  • Other risk factors

5
Diagnostic Criteria
  • Random glucose gt 11mmol
  • Fasting glucose gt 7mmol
  • 2 hours after 75g glucose orally gt 11mmol

6
Education
  • Lifelong disease
  • Knowledge is power
  • 3 times more likely to die prematurely
  • Reactions vary to what is really bad news
  • Lifestyle changes are needed
  • Specialist health education material
  • Specialist educators

7
Education
  • BDA
  • A on going process
  • Not one off
  • Need more information as and when they can use it

8
Education
  • Partnership with health professionals
  • Full multidisciplinary teams

9
At Diagnosis
  • Full examination
  • Explanations
  • See a dietician /- follow-up
  • See a chiropodist /- follow-up
  • Monitoring education
  • Implications for driving, insurance, DVLA, script
    charges etc
  • BDA
  • Education about lifestyle

10
Once Reasonably Controlled
  • At least annual review
  • Eye surveillance
  • Education when necessary
  • Formal medical review
  • Weight
  • Urine
  • Bloods (HbA1, cholesterol)
  • Review of control
  • Blood pressure
  • Legs and feet
  • Discuss any problems

11
Time and Resources
  • Annual check takes about 30 minutes
  • Most practices use a practice nurse

12
Aims
  • Patient takes pragmatic responsibility for own
    health
  • Minimise symptoms
  • Glycaemic control
  • Weight
  • Blood pressure
  • Cholesterol

13
Who to Refer?
  • Acutely unwell at diagnosis
  • Insulin treatment required
  • Child
  • Pregnant or pre-conceptual
  • Complications
  • Patient request

14
Real Life
  • Mrs A is a 68 year old widow who attends often
    because of her angina and COPD. She is getting
    more tired and feels it is due to old age.
  • Must be the angina or breathing getting worse ?

15
Maybe Not!
16
Mea Culpa
  • Ive forgotten to test these peoples urine on
    more than one occaision

17
Questions
  • No evidence that self blood monitoring does any
    good
  • Some evidence of harm!
  • Control of BP in diabetics may be better for long
    term outcome than blood sugar!
  • How can compliance be improved?

18
Questions
  • Many type 2 diabetics would be better off not
    knowing their diagnosis?
  • The government should have better diet and
    exercise policies?
  • Hospital care is better than practice care?
  • Primary care is better?

19
Homework
  • What drugs when?
  • Treatment of cholesterol?
  • Treatment of BP
  • Treatment of complications

20
CDM and Future NSF
  • Small annual fee per GP for systematic care
    Audit
  • NSF next year will make it better defined and ?
    Bigger fee

21
Audit
  • Heaps of possibilities.
  • Diagnosis.
  • Follow-up.
  • Monitoring.
  • How well controlled.
  • Etc.Etc.

22
References
  • Gallichan M. Self-monitoring by people with
    diabetes evidence based practice. BMJ
    1997314964-7
  • UKPDS 33. Lancet 1998352837-53
  • Diagnosis and classification. Diabetes care
    1997201183-97
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