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Primary Care Diabetes

Primary Care Diabetes

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Primary Care Diabetes

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

  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 > 11mmol • Fasting glucose > 7mmol • 2 hours after 75g glucose orally > 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 • I’ve 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 1997;314:964-7 • UKPDS 33. Lancet 1998;352:837-53 • Diagnosis and classification. Diabetes care 1997;20:1183-97