Making Best Practice, Every Day Practice
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More than 4.9 million people in the UK have diagnosed diabetes and by 2030 Diabetes UK estimate there will be 5.5 million people with diabetes.
The care of patients with diabetes – particularly type 2 diabetes which counts for about 90% of patients seen in primary care – is a significant challenge.
Our resources focus on:
Detection of pre-diabetes conditions frequently associated with obesity and metabolic disorders
Early diagnosis of type 2 diabetes
Interventions to reduce the risks of cardiovascular and renal disease (the cardio-renal syndrome)
Glycaemic control with established therapies including metformin
The roles for newer agents including SGLT2 inhibitors and DDP-4 inhibitors
Importance of lipid (cholesterol) management and antihypertensive therapy
Additional contributions discuss:
The initiation and intensification of insulin in people with type 2 diabetes
Diagnosis and management of people with type 1 diabetes
Prevention of hypoglycaemia
People from ethnic minorities may not get the diabetes care they need because of issues associated with language, literacy and culture, warned a recent Audit Commission report on diabetes – Testing Times. This article explores these issues and gives some insight into the challenges of looking after South Asians – Bangladeshis, Pakistanis, Indians and Sri Lankans – with diabetes, as well as offering some pointers to improve their care and treatment.
Most patients with type 2 diabetes require many tablets to control their diabetes and prevent cardiovascular complications. Patients are often prescribed two or three antidiabetic agents, two or three antihypertensives, one or more lipid-lowering tablets and low-dose aspirin. Research has warned that fewer than 50% of patients take their prescribed diabetes medication adequately. The consequence of this poor adherence is increased risk of cardiovascular complications. How do we help patients to take their tablets and so improve their health and long-term outcomes?
Insulin pumps – small devices that deliver insulin at regular intervals and on demand – are proving increasingly popular with patients with type 1 diabetes who find their glucose levels difficult to control with injections or who have other complications. They can offer significant benefits in terms of overall glucose control and patient’s quality of life. In this article we review how insulin pumps have developed over the last 40 years, how modern pumps are used, which patients should be considered for their use and cost issues associated with these devices.
There are several blood tests that can be used to measure blood sugar levels, including random blood sugar, fasting blood sugar, glycosylated haemoglobin (HbA1C) and the glucose tolerance test (GTT). This article provides a ‘whistle-stop’ tour updating you on what information each of these tests provides, what test to use when and how to explain the procedures and results to your patients.
Gestational diabetes – glucose intolerance occurring during pregnancy – is relatively common, affecting around four in every hundred pregnancies. A lot of research has linked low birth weight in babies born to mothers with diabetes to increased risk of vascular disease in later adult life. But much less attention has been focused on the mother’s subsequent health risks after having gestational diabetes. In this article, we review the increased risk of diabetes and vascular disease in later life in women suffering gestational diabetes and how to improve follow-up and prevention.
Diabetes is the leading cause of blindness in the UK in people of working age. Diabetic retinopathy occurs when blood vessels in the retina become blocked, leaky, or grow haphazardly. There are usually no obvious symptoms, making the condition difficult to detect until it is well advanced. However, irreparable damage has been done by this time. This article outlines the importance of screening for early detection of retinopathy, and reviews the targets set in the National Service Framework (NSF) for Diabetes Priorities document (2003) regarding annual retinal screening tests.
IIn this, the fifth article in our series on the Quality and Outcomes Framework (QOF), we review how to score top points for diabetes. This is an area that has been managed almost wholly in Primary Care for many years. Virtually all practices now have a diabetes clinic, which generally has extensive nurse involvement – with many being nurse-led. Practices are doing extremely well in this area and many are achieving a very high percentage of points. Figures for practices in England showed that on average they scored 93.2% of the QOF points for diabetes. This article offers some pointers on how to keep up the good work.
Monitoring blood glucose levels is a central part of managing diabetes effectively. Inadequate monitoring can put a patient at risk of both short- and long-term complications. Maintaining near normal blood glucose levels helps to prevent immediate problems such as hypoglycaemia and hyperglycaemia and longer-term microvascular complications, including retinopathy, renal disease and neuropathy. There are many different ways in which diabetes can be monitored; this article focuses on self blood glucose monitoring.
MODY (maturity onset diabetes of the young) is a rare, genetic form of diabetes characterised by three main features: a young age of onset (<25yrs in at least one family member), non-insulin-dependent diabetes and autosomal dominant inheritance. MODY accounts for 1% of patients with diabetes in the UK – approximately 20,000 cases. It is often misdiagnosed, which can have major implications for patient management and investigating family members. In this article we review what causes MODY, how it is diagnosed and how to manage patients and their families.
Primary care nurses can target efforts to prevent type 2 diabetes by measuring patients’ waist circumference, according to a new definition of metabolic syndrome announced recently by the International Diabetes Federation. The definition focuses on excess abdominal fat – which results in people being ‘apple’ shaped – as a key contributor to the development of the dangerous mix of impaired glucose control, hypertension and hyperlipidaemia that sets people on the road to type 2 diabetes. Just looking at people’s body shape as they come into the surgery, measuring their waist size and taking steps to reduce it where indicated, can help in the ongoing fight against the disease.
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