Prevention of type 2 diabetes

1. Prevention of type 2 diabetes Aimee Black Population Health Consultant General Practice Victoria

2. Background to the Prevention of Type 2 Diabetes Program The National Type 2 Diabetes Prevention program is an initiative of the Council of Australian Governments Part of the National Reform Agenda Federal and state strategies have been allocated funding, planned and implementation has begun in some areas

3. Commonwealth commitment Commonwealth Government commitment: $103.4M Development of an Australian type 2 diabetes risk assessment tool - AUSDRISK New Medicare item number to assess risk in 40-49 yo’s Patients at high risk can be referred by their GP to a local accredited Lifestyle Management Program (LMP) Development of national LMP standards for accreditation Divisions network funded to purchase and/or provide LMPs

5. Purpose: To support general practice to address the health needs of patients 40-49 years of age who are at ‘high risk’ of developing type 2 diabetes. Patient eligibility: 40-49 years of age At “high risk” of diabetes as defined by the NRAT Has not already developed diabetes Has not had an item 717 claimed in the past 3 years MBS Item 713 – diabetes risk review

6. MBS Item 713 – diabetes risk review • Components of check • Review of the factors underlying the NRAT ‘high risk’ score • Updating patient history • Examinations and investigations • Initiating interventions where possible • Providing advice and information • Considering referral to an LMP

7. Review of the factors underlying the AUSDRISK ‘high risk’ score • Contemplative or Ready? • Discuss the individual elements of risk (weight, physical activity) • What have they tried in the past? • What has succeeded and what hasn’t • So what are they going to do? • What changes are they willing to make? • How can you help them with these changes?

8. Motivational interviewing • Lifescripts DVD • Professor John Litt provides a brief overview of Motivational Interviewing technique • Case studies of how MI is used in a general practice consultation

9. Relationship between MBS items • A GP cannot conduct an item 713, if a previous 713 has been conducted within the previous 3 years. • A person who has previously accessed a 45-49 year health check (item 717), can only become eligible for a type 2 diabetes risk evaluation (item 713) when 3 years have elapsed. • A previous item 713 does not preclude an eligible person from accessing item 717 in relation to the risk of developing other chronic illnesses

10. Item 717 – 45-49 health check 3 years 1 day Item 713 – Diabetes risk review Relationship between item #s

11. Refer Refer Refer! LMP/Life! • Detailed studies in America, Finland and China have consistently shown that programs which actively support behavioural change (improved nutrition and physical activity) in people with pre-diabetes, can prevent more than half of the expected progression to type 2 diabetes. • Local LMP providers are delivering LMPs

12. More information • AGPN: http://www.agpn.com.au/site/index.cfm?display=35338 • DoHA: http://www.health.gov.au/internet/main/publishing.nsf/Content/Diabetes-Risk_Evaluation • Life!: http://www.goforyourlife.vic.gov.au/hav/articles.nsf/pages/Life_Taking_Action_on_Diabetes_Program?Open