04/22/23 1

Primary Care Diabetes

Dr Bruce Davies

www.bradfordvts.co.uk

04/22/23 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.

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Topics of Discussion Detection Education & counselling Components of continuing care Aims Management Who to refer CDM and future NSF Audit

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Detection – How / When

Symptoms New patient checks 75+ checks Medicals Systematic Opportunistically ANC Other risk factors

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Diagnostic Criteria

Random glucose > 11mmol

Fasting glucose > 7mmol

2 hours after 75g glucose orally > 11mmol

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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

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Education BDA A on going process Not one off Need more information as

and when they can use it

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Education

Partnership with health professionals –

Full multidisciplinary teams

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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

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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

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Time and Resources Annual check takes about

30 minutes Most practices use a

practice nurse

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Aims Patient takes pragmatic

responsibility for own health

Minimise symptoms Glycaemic control Weight Blood pressure Cholesterol

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Who to Refer?

Acutely unwell at diagnosis Insulin treatment required Child Pregnant or pre-conceptual Complications Patient request

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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 ?

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Maybe Not!

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Mea Culpa I’ve forgotten to test these

peoples urine on more than one occaision

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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?

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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?

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Homework What drugs when? Treatment of cholesterol? Treatment of BP Treatment of complications

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CDM and Future NSF Small annual fee per GP for

“systematic care” + Audit NSF next year will make it better

defined and ? Bigger fee

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Audit Heaps of possibilities. Diagnosis. Follow-up. Monitoring. How well controlled. Etc.Etc.

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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