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Falkland Surgery PPG Open Evening on Diabetes


Title: Early Intervention in Diabetes Author: BSS Last modified by: Tim Created Date: 7/7/2008 3:51:52 PM Document presentation format: On-screen Show (4:3) – PowerPoint PPT presentation

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Learn more at: http://www.falklandsurgery.co.uk


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Title: Falkland Surgery PPG Open Evening on Diabetes

Falkland Surgery PPG Open Evening on Diabetes
  • Tim Walter - GP
  • Jackie Winterbourne - Practice Nurse
  • - Falkland Surgery
  • Janet Grimes Diabetes Educator/Specialist Nurse
  • NHS Berkshire West

  • TW - Introduction to Diabetes at Falkland Surgery
    diagnosis, prevalence, risk factors
  • JG - Education programmes after diagnosis etc.
  • JW- Conversion from oral treatment to insulin

Earlier Intervention in Diabetes
  • Tim Walter

  • Falkland Surgery population of 14,400
  • Main demographic is of an average age split but
    higher than average elderly population c.f.
    locally (75yrs)
  • Some pockets of deprivation
  • High level of employment

Diagnosis Trends
  • 2000 194 patients registered with DM
  • 2005 306 patients registered
  • 2008 435 patients registered
  • 1.3 / 2.1 / 3.0 of population
  • National prediction 3.6 in 2007 still a way to

Trends in detail
  • 2000 Type 1 DM 44 Type 2 DM 150
  • 2005 Type 1 DM 56 Type 2 DM 250
  • 2008 Type 1 DM 66 Type 2 DM 369
  • Therefore the massive increase in DM is
    predominantly in the Type 2 group
  • NB Caveats, re recording etc

  • Demographics
  • Ageing population
  • Trend nationally towards obesity
  • Clinical
  • Better detection
  • Lower thresholds Fasting BS of 7.8 down to 7
  • Type 2 DM is associated with age, ethnicity,
    family history, weight/obesity and sedentary

Actions we are taking to prevent epidemic
  • Weight clinics
  • Exercise referrals
  • Earlier screening and detection
  • Public education and involvement

Weight Clinic
  • Currently piloting a weight clinic Julie
  • Weekly clinic with interventions, advice,
    encouragement, medication if appropriate
  • Part of the Greenham project
  • However we need to audit results to prove its
    effectiveness, September 08 and review

Exercise referrals
  • Ongoing work done via Northcroft Centre with
    April Peberdy for any patient with a need
  • Exercise on prescription
  • Something like 70 of early detected raised
    BS/DM can be managed by diet and exercise (but
    it takes effort)

Early Detection
  • Computer system analyses and flags up patients
    with previously raised sugar levels. Work done
    in University of Warwick, published in BMJ and we
    have been running this for about 2 years
  • Random BSs over 11, fasting over 7 without codes
    to indicate diagnosed already
  • Retest to assess risk
  • Looked at 12 patients with potentially missed DM,
    9 were subsequently confirmed
  • Ongoing process as new patients arise
  • Second group with random BS over 7

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National Initiatives
  • We need to see co-ordinated education and action
  • Publicity on healthy living
  • Labelling
  • Role models
  • Newspapers/Magazines/Advertising
  • Prevention better than cure
  • However this costs money now, but wont show
    results for many years

Further interventions
  • We are starting people on medication earlier and
    more aggressively not only for the DM but also
    statins, aspirin, antihypertensive medication
  • Converting to Insulin earlier and more frequently
    (see later) as patients with Type 2 live longer

Recent NICE guidelines - 1
  • Patient education
  • Offer structured education to every person and/or
    their carer at and around the time of diagnosis,
    with annual reinforcement and review. Inform
    people and their carers that structured education
    is an integral part of diabetes care.

Recent NICE Guidelines - 2
  • Setting a target HbA1c
  • When setting a target HbA1c
  • involve the person in decisions about their
    individual HbA1c target level, which may be above
    that of 6.5 set for people with type 2 diabetes
    in general
  • encourage the person to maintain their
    individual target unless the resulting side
    effects (including hypoglycaemia) or their
    efforts to achieve this impair their quality of
  • offer therapy (lifestyle and medication) to
    help achieve and maintain the HbA1c target level
  • inform a person with a higher HbA1c that any
    reduction in HbA1c towards the agreed target is
    advantageous to future health
  • avoid pursuing highly intensive management to
    levels of less than 6.5.

Recent NICE Guidelines - 3
  • Self-monitoring
  • Offer self-monitoring of plasma glucose to a
    person newly diagnosed with type 2 diabetes only
    as an integral part of his or her self-management
    education. Discuss its purpose and agree how it
    should be interpreted and acted upon.

Recent NICE guidelines - 4
  • Starting insulin therapy
  • When starting insulin therapy, use a structured
    programme employing active insulin dose titration
    that encompasses
  • structured education
  • continuing telephone support
  • frequent self-monitoring
  • dose titration to target
  • dietary understanding
  • management of hypoglycaemia
  • management of acute changes in plasma glucose
  • support from an appropriately trained and
    experienced healthcare professional.

  • Massive rise in Diabetes diagnosed through better
    detection but unfortunately also through higher
  • Provision of lifestyle interventions (weight /
    diet / exercise)
  • Still a way to go but somehow we need to prevent
    problems arising
  • Please put us out of a job!
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