RUNNING A DIABETIC

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• RUNNING A DIABETIC
• CLINIC IN PRACTICE
• Dr Stephen Newell
• Susan Neal, Nurse-practitioner

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• DIABETICS AT NSMC
• 12,500 patients
• Register of 403 (3.2 of list)
• Type 1 40 (10)
• Type 2 357(90)
• Approx 40 Type 2 are insulin treated

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• WORKLOAD
• 344 patients attend practice diabetic clinic
• Type 1 31(78) seen in last 15m
• Type 2 317(90) seen in last 15m
• Other 60 mixture of hospital/recidivists/houseboun
  d
• 896 dedicated diabetic or DC/CVS appts (17 appts
  weekly)
• 2/3 appts annually on average
• 4 clinicians

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• A PATIENT TO ILLUSTRATE THE POINTS

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• FEMALE
• BORN 1955
• OBESE
• POSSIBLE ANGINA 1991
• FH OF DM (MOTHER)

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• WHAT ARE THE REQUIREMENTS?
• PROTOCOL FOR ALL NURSES AND DOCTORS
• AGREED APPROACH TO MANAGEMENT
• EFFECTIVE USE OF IT Protocol must include
  consistent IT entries

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• TARGETS FOR BP CONTROL
• TARGETS FOR HbA1c LEVELS
• AGREEMENT ON OTHER INVESTIGATIONS
• PROTOCOL MUST FIT WITH NSF NEW CONTRACT

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• STEPPED APPROACH TO MEDICATION
• NOT MAKING THINGS DIFFICULT
• EXPERTISE AND CONFIDENCE CAN BE DEVELOPED IN
  HOUSE
• APPROPRIATE USE OF EXPERTS DSNs, HOSPITAL
  CLINICS, DIETICIANS

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• DISEASE REGISTER IS COMPUTER BASED
• ADMINISTRATIVE USE OF REGISTER FOR REPORTS AND
  RECALL
• AUDIT QUALITY OF OF CARE BEING DELIVERED

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KEEP IT SIMPLEBUILD UP FROM BASICSBE PREPARED
TO ASK FOR ADVICE