Diabetes Overview

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Diabetes Overview

• Managing Diabetes in Primary Care

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Diabetes Mellitus

• Diabetes mellitus is a condition in which there
  is a chronically raised blood glucose
  concentration
• It is caused by an absolute or relative lack of
  insulin i.e. insulin is not being produced from
  the pancreas or there is insufficient insulin or
  insulin action for the bodys needs

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Prevalence

• 1.3 million in UK
• 2.5 population diagnosed
• Missing Million
• DUK reckon up to 2 more diabetics undiagnosed
• Prevalence rises with age
• 1 in 20 over 65
• 1 in 5 over 85

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Sociology

• European perspective
• Britain among worst rates of Diabetic
  complications in Europe (renal failure,
  amputation, blindness)
• Ethnicity
• T2DM up to 6 more common in people of South
  Asian descent
• T2DM up to 3 more common in people of African or
  Afro-Caribbean descent
• Social Class
• morbidity is up to 3.5 more in poorest than
  richest in our society

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Gender Variation

• Prevalence higher in men than women
• Risk of dying higher in women than men

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Definitions

• World Health Organisation
• Diabetes
• fasting plasma glucose gt7.0
• 2-h post-glucose load gt11.1
• Impaired Glucose Tolerance
• fasting lt7.0 and
• 2-h post-glucose load gt7.8
• Impaired Fasting Glucose
• fasting 6.1 7.0

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Classification

• Type 1
• insulin-dependent
• Type 2
• non-insulin-dependent

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Type 1 Diabetes

• Presents in childhood or early adult life
• accounts for 15 cases in England
• pancreatic ßislet cells destroyed autoimmune

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Type 2 Diabetes

• Often presents after age 40
• 85 of cases in England
• insulin resistance
• gradual onset
• tiredness, frequent urination, increased thirst,
  weight loss
• may be detected routinely
• medical examination

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Complications

• Microvascular
• Cardiovascular
• Other

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Microvascular

• eye
• retinopathy
• maculopathy
• nephropathy
• neuropathy
• feet/ulceration
• postural hypotension
• abnormal sweating
• diarrhoea
• erectile dysfunction

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Cardiovascular

• CHD
• angina
• myocardial infarction
• heart failure
• Stroke/TIA
• PVD
• claudication
• foot ulcers

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Other

• cataract
• infections
• UTI
• candidal
• skin
• soft tissue problems
• frozen shoulder, trigger finger
• skin problems
• necrobiosis lipoidica diabeticorum
• mental health problems

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Management Options

• Diet
• Oral Hypoglycaemics
• Insulin
• T1DM
• T2DM

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Management of T1DM

• Insulin
• Pre-mixed biphasic
• Basal Bolus
• Insulin Pump

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Management of T2DM

• Diet
• low fat
• high (complex) carbohydrate
• Lifestyle modification
• smoking cessation
• reduce alcohol
• reduce obesity
• exercise

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Management of T2DM (2)

• Glycaemic control
• sulphonylureas
• biguanides (metformin)
• secretagogues (Repaglinide)
• thiazolidinediones
• Hypertension control
• ACEI
• Lipid control
• statins

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Organised Diabetic Care

• Practice Clinic
• Nurse Specialist
• GP Specialist
• Call/Recall
• Specialist Care
• Liaison Nurse
• Screening Services
• Retinopathy
• Podiatry