diabetes overview managing diabetes in primary care
TRANSCRIPT
Diabetes Overview
Managing Diabetes in Primary Care
James Street Family Practice, Louth
GP Registrar Tutorial
Diabetes Mellitus
Diabetes mellitus is a condition in which there is a chronically raised blood glucose concentration
It is caused by an absolute or relative lack of insulin i.e. insulin is not being produced from the pancreas or there is insufficient insulin or insulin action for the body’s needs
James Street Family Practice, Louth
GP Registrar Tutorial
Prevalence
1.3 million in UK 2.5% population
diagnosed “Missing Million”:
DUK reckon up to 2% more diabetics undiagnosed
Prevalence rises with age
1 in 20 over 65 1 in 5 over 85
James Street Family Practice, Louth
GP Registrar Tutorial
Sociology
European perspective Britain among worst rates of Diabetic complications in Europe
(renal failure, amputation, blindness)
Ethnicity T2DM up to 6* more common in people of South Asian descent T2DM up to 3* more common in people of African or Afro-
Caribbean descent
Social Class morbidity is up to 3.5* more in poorest than richest in our society
James Street Family Practice, Louth
GP Registrar Tutorial
Gender Variation
Prevalence higher in men than women
Risk of dying higher in women than men
James Street Family Practice, Louth
GP Registrar Tutorial
Definitions
World Health Organisation Diabetes
fasting plasma glucose >7.0 2-h post-glucose load >11.1
Impaired Glucose Tolerance fasting <7.0 and 2-h post-glucose load >7.8
Impaired Fasting Glucose fasting 6.1 – 7.0
James Street Family Practice, Louth
GP Registrar Tutorial
Classification
Type 1 insulin-dependent
Type 2 non-insulin-dependent
James Street Family Practice, Louth
GP Registrar Tutorial
Type 1 Diabetes
Presents in childhood or early adult life accounts for 15% cases in England pancreatic ß–islet cells destroyed autoimmune
James Street Family Practice, Louth
GP Registrar Tutorial
Type 2 Diabetes
Often presents after age 40 85% of cases in England insulin resistance gradual onset
tiredness, frequent urination, increased thirst, weight loss
may be detected routinely medical examination
James Street Family Practice, Louth
GP Registrar Tutorial
Complications
Microvascular Cardiovascular Other
James Street Family Practice, Louth
GP Registrar Tutorial
Microvascular
eye retinopathy maculopathy
nephropathy neuropathy
feet/ulceration postural hypotension abnormal sweating diarrhoea erectile dysfunction
James Street Family Practice, Louth
GP Registrar Tutorial
Cardiovascular
CHD angina myocardial infarction heart failure
Stroke/TIA PVD
claudication foot ulcers
James Street Family Practice, Louth
GP Registrar Tutorial
Other
cataract infections
UTI candidal skin
soft tissue problems frozen shoulder, trigger finger
skin problems necrobiosis lipoidica diabeticorum
mental health problems
James Street Family Practice, Louth
GP Registrar Tutorial
Management Options
Diet Oral Hypoglycaemics Insulin
T1DM T2DM
James Street Family Practice, Louth
GP Registrar Tutorial
Management of T1DM
Insulin Pre-mixed “biphasic” Basal Bolus Insulin Pump
James Street Family Practice, Louth
GP Registrar Tutorial
Management of T2DM
Diet low fat high (complex) carbohydrate
Lifestyle modification smoking cessation reduce alcohol reduce obesity exercise
James Street Family Practice, Louth
GP Registrar Tutorial
Management of T2DM (2)
Glycaemic control sulphonylureas biguanides (metformin) secretagogues (Repaglinide) thiazolidinediones
Hypertension control ACEI
Lipid control statins
James Street Family Practice, Louth
GP Registrar Tutorial
Organised Diabetic Care
Practice Clinic Nurse Specialist GP Specialist Call/Recall
Specialist Care Liaison Nurse
Screening Services Retinopathy Podiatry