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Diabetes Prevention and Early Detection

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... identify individuals who should seek and be offered weight management program ... Increased physical activity and weight loss can reduce risk of type 2 diabetes ? ... – PowerPoint PPT presentation

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Title: Diabetes Prevention and Early Detection


1
Diabetes Prevention and Early Detection
Module 3.1
  • Best Practice Guidelines
  • An overview

2
Presentation purpose
  • Target audience
  • Health professionals and project workers on DPMI
    projects
  • Aim
  • To aid in planning of stages 2 and 3 of DPMI
    projects
  • Objectives
  • Provide an overview of the prevention of diabetes
  • Discuss type 2 diabetes risk factors and
    screening
  • Discuss prediabetes and implications in practice
    and for the projects
  • Discuss IGT/IFG diagnosis, communicating risk to
    consumers and best practice care projects.

3
Prevention of diabetes
  • Recommendations to reduce risk of type 2 diabetes
  • Regular physical activity
  • Interventions to reduce obesity
  • Waist circumference, body weight and body mass
    index (BMI) identify individuals who should seek
    and be offered weight management program
  • Individuals at risk should have dietary intake
    assessed and receive individualised dietary
    advice and continued dietetic support
  • Evidence Based Guideline for the Prevention of
    Type 2 Diabetes. Australian Government NHMRC
    www.diabetesaustralia.com.au/education_info/nebg.h
    tml

4
Prevention of diabetes
  • Recommendations to reduce risk of type 2 diabetes
  • Identification of women with GDM would allow
  • Postnatal clinical interventions in those with
    diabetes
  • Option to use preventive methods to reduce the
    risk of Type 2 diabetes
  • Diet and exercise education in children should
    include
  • Parental involvement
  • Behavioural techniques
  • Evidence Based Guidelines for the Prevention of
    Type 2 Diabetes. Australian Government NHMRC
    www.diabetesaustralia.com.au/education_info/nebg.h
    tml

5
Screening for diabetes and risk factors
  • Active case detection and diagnosis of Type 2
    diabetes should be considered for the following
    reasons
  • Type 2 diabetes is serious and costly
  • Natural history includes asymptomatic phase which
    is not benign and during which it can be
    diagnosed
  • Early treatment reduces morbidity from long term
    complications
  • Case detection and diagnosis has a favourable
    riskbenefit ratio
  • NB Overall prevalence does not justify universal
    testing of the entire Australian adult population
    but rather opportunistic case detection.
  • Evidence Based Guideline for the case Detection
    and Diagnosis of Type 2 Diabetes.
  • Australian Government NHMRC www.diabetesaustral
    ia.com.au/education_info/nebg.html

6
Opportunistic case detection
  • Test high risk individuals
  • People with IGT or IFG
  • Aboriginal and Torres Strait Islanders aged 35
    years and over
  • Certain high risk non-English speaking background
    groups aged 35 years and over
  • (specifically Pacific Islander people, people
    from the Indian subcontinent or of Chinese
    origin)
  • People aged 45 years and over who have either or
    both of the following risk factors
  • Obesity (BMI 30 )
  • Hypertension
  • All people with clinical cardiovascular disease
    (myocardial infarction, angina or stroke
  • Women with polycystic ovary syndrome who are
    obese.
  • Evidence Based Guideline for the case Detection
    and Diagnosis of Type 2 Diabetes.
  • Australian Government NHMRC www.diabetesaustral
    ia.com.au/education_info/nebg.html

7
Evidence Based Guideline for the case Detection
and Diagnosis of Type 2 Diabetes. Australian
Government NHMRC www.diabetesaustralia.com.au/ed
ucation_info/nebg.html
8
Definition
  • Pre diabetes includes both
  • Impaired Glucose Tolerance
  • Impaired Fasting Glucose

9
Pre diabetes
  • 16 of population have pre diabetes
  • AusDiab Study (Dunstan et al, 2002)
  • Pre diabetes associated with
  • Increased risk of microvascular complications
  • Increase risk of microalbuminuria and neuropathy
  • (lower prevalence than diabetes but higher than
    general population)
  • Increase risk of cancer breast, colon, liver
    and pancreas.
  • Increased risk of developing diabetes
  • Need to consider age how relevant is IGT or IFG
    in a person 75 years old?

10
Does pre diabetes predict diabetes?
Progression of IGT/IFG to diabetes in 11 year
follow up
Presentation Stephen Twigg. Pre diabetes
Symposium ADS ADEA Annual Scientific Meeting
Sydney 2004
11
Interventions
  • Increased physical activity and weight loss can
    reduce risk of type 2 diabetes ?Reduce
    cardiovascular risk
  • Need to focus on follow up and review given high
    risk of developing diabetes
  • Need to encourage ongoing review and management
    of CVD risk factors

12
Communicating risk to consumers
  • Is it a condition vs risk factor?
  • What is the name of the condition? Will the name
    influence how seriously consumers view it i.e.
    pre diabetes vs impaired glucose tolerance.
  • No label may mean not taken seriously
  • No label may mean no intervention. No follow up
  • Implications for individuals if labelled with a
    condition where approx 1/3 will revert back to
    normal.

13
How is pre diabetes managed in general practice?
  • Mapping exercise (Div of GP Perth)
  • GP audit.
  • Nearly 1/3 of patient with prediabetes had not
    had a blood glucose test in the past 12 months
  • Waist circumference was only recorded for 10
    patients
  • 50 had their weight recorded
  • Lipids and BP were recorded in almost all
    patients ( not sure how often)
  • Presentation by A Derbyshire. ADS ADEA Annual
    Scientific Meeting Sydney 2004

14
Primary care management of Type 2 diabetes
  • GP Focus Groups
  • GPs reluctant to pursue aggressive case finding
  • GPs dont involve other HPs in management of pre
    diabetes
  • Most follow up is oppurtunistic
  • No recall systems
  • Patient characteristics such as motivation, lack
    of understanding were seen as the greatest
    barriers to managing pre diabetes in GP practice
  • Presentation by Kaye Neylon ADS ADEA Annual
    Scientific Meeting Sydney 2004

15
Group education for Impaired Glucose Tolerance -
does it work?
  • ACT Diabetes Service
  • Referred clients (n34) with IGT/IFG attended 2
    group ed sessions (1 hr nutrition/ 1 hr
    information) asked to identify possible lifestyle
    modifications.
  • Responses
  • - 79 exercise - 59 weight loss,
  • - 5 smoking cessation - 5 stress reduction.
  • 6 month telephone follow up (78 response)
    reported lifestyle changes implemented and
    maintained
  • - 68 exercise - 56 dietary changes
  • - 50 weight loss - 5 stress reduction
  • - 0 smoking cessation.
  • Presentation by W.R Mossman ADS ADEA Annual
    Scientific Meeting Sydney 2004
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