Is Diabetes really that complicated

1. Is Diabetes really that complicated? Dr Jon Tuppen GPSI Diabetes

2. Consider this case ? DOB 14.5.57 14 May 2007 15:28   Smoker (137R.) "6-7 a day“ had a routine taxi driver medical examination - letter from Dr. Coull, had high B.P readings - 175/120, and 2+ of sugar in urine, no symptoms, not on any medication @ present, going through very stressful period . o/e - B.P - 175/112, H.R - regular, Chest - HS - normal, no murmur advice to get bloods done including fasting glucose, Hba1c, repeat B.P readings on 2 different occasions with nurse 1 wk apart, ECG , start on lisinopril tablets 5mg & r/w in 3-4 wks time. Smoking cessation advice (Ua1Nz)  what would you have done from here? What is the diagnosis?

3. Bloods Serum glucose level (44f..): 6.60 mmol/L Serum creatinine level : 120.00 umol/L Serum cholesterol level : 6.00 mmol/L Serum sodium level : 139.00 mmol/L Serum albumin level (XE2eA): 46.00 g/L Serum globulin level (XE2eB): 25.00 g/L ALT/SGPT serum level (44G3.): 88.00 iu/L

6. Would you like anything else?

7. So what happened??

8. Next contact was……..

9. Risk ? What risk?

10. Is it important what style we use to deal with patients?

11. We know what works…..The evidence base for all long term conditions  Describe….. But this is what I’d call a complex intervention. All three components have to be in place all together to get the improved outcomes. So we have the problem. We have the context and we have the evidence base and we now have for Year of care to put it into praticeDescribe….. But this is what I’d call a complex intervention. All three components have to be in place all together to get the improved outcomes. So we have the problem. We have the context and we have the evidence base and we now have for Year of care to put it into pratice

12. And in diabetes…The % of adults who report they…… More specifically in diabetes this is ……….. So the headline message might be that while we have world class attention to ticking the boxes less than half of all the consultations in England are effective in addressing the critical issues of support for self management and the patient engagement, which Wanless said was the key feature in our being able to sustain the service. If you want to know where your PCT figures on this slides for every SHA and PCT in England are on the NDST website. Because the range of effective consultations is vast from less that a third to as many as two thirds , suggesting that doing what we do now but systematically would make a huge difference to a lot of people. More specifically in diabetes this is ……….. So the headline message might be that while we have world class attention to ticking the boxes less than half of all the consultations in England are effective in addressing the critical issues of support for self management and the patient engagement, which Wanless said was the key feature in our being able to sustain the service. If you want to know where your PCT figures on this slides for every SHA and PCT in England are on the NDST website. Because the range of effective consultations is vast from less that a third to as many as two thirds , suggesting that doing what we do now but systematically would make a huge difference to a lot of people.

16. Personalised Care Planning and the Patients’ Prospectus

17. This slide shows the key messages about what care planning is and the links to the Patients’ Prospectus and what we expect people to be offered. The Year of Care approach can support us in achieving the offer of quality care planning for people with LTCs. It fits with this national approach to care planning – i.e. embedding a holistic process that is centred around the person with a focus on goal setting, information and support for self care – rather than a bureaucratic tick in the box exercise. We look forward to seeing the evaluation of the YOC pilots which will be helpful to link with our central monitoring of the uptake and impact of care planning. This slide shows the key messages about what care planning is and the links to the Patients’ Prospectus and what we expect people to be offered. The Year of Care approach can support us in achieving the offer of quality care planning for people with LTCs. It fits with this national approach to care planning – i.e. embedding a holistic process that is centred around the person with a focus on goal setting, information and support for self care – rather than a bureaucratic tick in the box exercise. We look forward to seeing the evaluation of the YOC pilots which will be helpful to link with our central monitoring of the uptake and impact of care planning.

18. Task: Design from scratch a diabetic system for your practice and consider how it integrates with other parts of local diabetes care Consider things like Admin Who does what When will be it be held Where will be it be held Audit Who else do you need to involve? Education of workforce Who has main responsibility? etc Consider from the patients side What will you want ? What information do you need? What will you main concerns be? Time commitment on diabetes care Impact on work/ family / insurance etc