The HCAs Role in Diabetes Management in Primary Care

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The HCAs Role in Diabetes Management in Primary
Care

• Linda Goldie
• Clinical Director
• Primary Care Training Centre

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What is diabetes?

• A condition where the amount of glucose in the
  body is too high because the body is unable to
  deal with it.
• www.diabetes.org.uk

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Its a big problem!

• 2 million people in the UK have diabetes and the
  numbers are growing!
• 70,000 more diagnosed this year
• 750,000 unaware they have it!

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Complications linked to diabetes

• Heart Disease
• Stroke
• Kidney Failure
• Blindness
• Nerve damage
• Peripheral Vascular Disease

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What can the HCA do?

• Diabetes care involves the multidisciplinary care
  team.
• Lets look at a patient!

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What information and care does Jim need?Who
will do it?
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What is diabetes?

• Verbal and written information on what diabetes is

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What type of diabetes do you suspect Jim has?

• Type 1 ?
• OR
• Type 2 ?

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Type 1 Diabetes

• No insulin production
• Young
• Sudden onset ill
• Slim?
• Insulin needed for survival

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Type 2 Diabetes

• Not enough insulin produced or
• the body is resistant to the insulin produced
• Older
• Family History
• Race
• Overweight/obese
• Increased waist circumference

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Waist circumference
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Obesity Increases Lifetime Diabetes Risk
Lifetime Risk at Age 45 (Total Population)
Narayan et al. Diabetes Care 2007301562-1566
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Obesity Increases Lifetime Diabetes Risk
Lifetime Risk at Age 18 (Total Population)
Narayan et al. Diabetes Care 2007301562-1566
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Insulin resistance precedes Type 2 diabetes by up
to 20 years1
gt 90 of Type 2 diabetes patients are insulin
resistant2
1. Warram JH et al. Ann Intern Med 1990 113
909915. 2. Haffner SM et al. Diabetes Care 1999
22 562568.
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Healthy Lifestyle

• Diet
• Alcohol
• Physical Activity
• Smoking

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Key Points

• BOGH picture

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Weight reduction

• Increase fruit and veg
• Reduce fats and sugars
• Careful with alcohol!
• EAT LESS!
• Pharmacological interventions

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Is this the role of a HCA?

• Almost certainly yes!
• Everyone working in primary care should be giving
  health promotion messages
• BUT
• be aware of your limitations

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Exercise
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Physical Activity

• Jim doesnt need to put on lycra and aim to be
  like these guys!
• Just be more active!

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Stop Smoking!

• Smoking cessation advice

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What would Jim say if told to eat this with this
warning?
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• My Ase!!

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So why do this?
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Smoking cessation

• Support and encouragement essential!
• If you are trained to give this advice then do it!

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At Clinic -

• Height and Weight BMI
• Waist circumference
• Women 80 cms
• Asian Men 90 cms
• White/Black 94 cms

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Measuring waist circumference
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Avoiding complications

• Blood pressure
• Blood tests
• HbA1c to assess diabetes control
• Cholesterol and Lipids
• Renal function
• Urine test
• protein

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• The HCA can play a valuable role doing these
  tasks within the diabetes clinic

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Medication advice

• Tablets to reduce blood glucose level
• Tablets (statins) to reduce cholesterol
• Tablets (aspirin) to reduce clotting
• Tablets (ace inhibitors) to protect the kidneys
• Tablets to reduce blood pressure

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Medication advice

• Normally left to the doctors and nurses

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Further checks

• FEET
• EYES
• HBGM Results

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Podiatry

• General condition
• Basic advice
• Pulses
• Sensation

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EYES

• Visual Acquity
• Retinal photography

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Home Blood Glucose Monitoring

• How to test
• When to test
• What to do with the results

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Further information

• Employment
• Driving
• Insurance
• Travel

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Employment

• Will Jim be able to continue to work or continue
  to seek employment with diabetes?
• Some jobs may be affected for example HGV
  drivers
• PSV drivers

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Driving

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Driving Information

• No problems generally
• If insulin treated in the future safety issues
  need to be addressed related to blood glucose
  testing

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Insurance

• Need to inform relevant companies
• Car
• Travel
• Life on new policies otherwise no disclosure
  needed

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Travel advice

• General healthcare advice
• Travel vacs
• Insurance
• Sexual health
• Diabetes related advice
• Medication/storage
• Flying/time zones
• Foot care

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HCA as part of the multi-disciplinary diabetes
team

• Patient
• Doctor
• Nurse
• DSN
• Dietitian
• Podiatrist
• Optometrist
• Pharmacist

• THE HEALTH CARE ASSISTANT!

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Thank you for listening and participating

• Linda Goldie
• lgoldie_at_primarycaretraining.co.uk
• www.primarycaretraining.co.uk