The number of people with diabetes in the UK is almost 1.8 million and this is continuing to rise, according to recent figures. But only about half of these are currently diagnosed. It is obviously essential to ensure that these people are diagnosed as early as possible and then managed appropriately to ensure they receive the best possible care to minimise long-term complications. In this article, we review how to diagnose diabetes accurately, based on good practice recommended in standard two of the National Service Framework (NSF) for Diabetes. What should we be measuring in people who present with the classic symptoms and in those who do not to ensure an accurate diagnosis of diabetes?
Healthy eating for type 2 diabetes: let’s go shopping
People with diabetes used to be advised to watch their carbohydrate – particularly sugar – intake. But dietary recommendations have developed over the past few years so that they are now similar to the healthy diet that we should all be eating. Are there any remaining differences in what we should be telling patients with diabetes about their diet? Fewer than you might think. In this article we take a ‘supermarket tour’ that explains what patients with diabetes should be putting in their trolleys and what they should be leaving on the shelves.
Changing practice in hypertension: ASCOT win for newer antihypertensives
The British Hypertension Society Guidelines published last year were widely welcomed as a major step forward in the management of patients with high blood pressure. In common with all recent guidelines they were based on a review of all relevant evidence, mainly gained from clinical trials. However, medicine is never static and research is ongoing. A major study – ASCOT – has provided new information about the benefits of newer combinations of antihypertensives compared to older drugs. What did the study show and how should we act on the results to improve outcomes for our patients?
Isolated systolic hypertension
Isolated systolic hypertension (ISH) – an increase in the higher of the two numbers when blood pressure (BP) is measured – is the commonest type of high BP in older people over the age of 60. The systolic pressure used to be dismissed as less important than the lower number – diastolic BP – but studies have shown that it is associated with increased risk of cardiovascular disease. ISH accounts for up to 75% of the overall incidence of uncontrolled hypertension in the elderly and appears to be more common in women than men.
How to score top marks for secondary prevention of coronary heart disease
In this second article in our series on the Quality and Outcome Framework (QOF), we will discuss how to maximise points in the secondary prevention of coronary heart disease (CHD) and heart failure. This will include lipid management and smoking cessation.
One year on: boldly going where no primary care nurse has gone before
Welcome to the first year anniversary issue of the British Journal of Primary Care Nursing (BJPCN). It has been an eventful year for primary care nurses, with new challenges coming from all directions. In each issue of the journal we have tried to provide practical information and tools to help you find your way through the expanding universe of primary care in cardiovascular disease and diabetes – to boldly go where no primary care nurse has gone before!
Aspirin in patients with diabetes
Patients with diabetes are at high risk of cardiovascular disease and aspirin is an important part of prevention strategies. Although it is effective and relatively well-tolerated, studies have shown that many patients with diabetes are not taking aspirin. In this article, we review why aspirin should be considered in patients with diabetes, the benefits it might achieve and areas where caution is required.
Making sense of the Quality and Outcome Framework of the new GP Contract
The Quality and Outcome Framework (QOF) of the new GP Contract will be the biggest experiment in improving the quality of care for patients anywhere in the world. By April 2005, we will see how well Primary Care can deliver. In this series, we provide a step-by-step guide on how your practice can get QOF points, including practical information on what data to collect and how to record it. Over the coming months, we will be discussing the best ways to maximise the quality of care and will concentrate on the cardiovascular and diabetes elements of the QOF. We will discuss the setting up of registers, practical tips, examples from practices that are delivering well, how to check how well you are doing from your own IT system and from Quality Management Analysis System and, of course, how to deal with exception reporting and the PCT QOF visit.
Oily fish and cardiovascular disease
The management of cardiovascular disease (CVD) in primary care has been transformed in recent years, particularly with extensive use of statins in secondary prevention. But what about the less high-tech approach of getting patients to eat more healthily? Dietary advice has traditionally been offered primarily to those needing to lose weight or lower their lipid levels. But more recently, systematic reviews have shown good evidence that dietary changes can reduce mortality and morbidity in addition to modifying some risk factors in patients with coronary heart disease. Evidence to date suggests similar benefits of healthier eating are likely in primary prevention. In this new series – Food for Thought – we sort the wheat from the chaff when it comes to dietary advice for patients with cardiovascular disease. This article will focus on the benefits of oily fish, with the good news that simply increasing oily fish intake achieves major benefits.
Practical approaches to empowering people with cardiovascular disease or diabetes
For people with long-term conditions, self-care can have as much, if not more, influence on their health than prescribed medication and treatment. Yet, in many cases, healthcare professionals become frustrated when attempts to improve peoples’ self-care behaviours prove unsuccessful. This article looks at some of the reasons why it can be difficult to encourage people with diabetes or cardiovascular disease to look after themselves effectively; what types of practice can help us to increase people’s success in managing long-term conditions; and how we can incorporate empowering techniques in our day-to-day consultations.
Sex after an MI
Rehabilitation after a myocardial infarction (MI) includes all aspects of a patient’s life – medical, physical and social. Sexual functioning is an important part of most people’s lives. Fears about whether having sexual intercourse could trigger another heart attack is the question many post-MI patients want to ask but embarrassment may stop them. Giving accurate information about sex after an MI is just as much a part of patient education as telling them about cholesterol and blood pressure and can go a long way to helping recovery and preventing further problems such as sexual dysfunction.
Stroke and TIA
Stroke is common, affecting around one in four people over the age of 45 at some time in their lives. Increasing age is a major risk factor for stroke, so the numbers of people suffering a stroke will increase with the ageing population. Primary care teams have a central role in providing effective secondary prevention, but because patients often fall between primary and secondary care, things may be missed. Taking a systematic approach to assessing risk factors, such as blood pressure, and treating them effectively can significantly reduce further stroke risk.
