Produced by The Alfred Workforce Development Team on behalf of DHS Public Health - Diabetes Prevention and Management Initiative June 2005 Diabetes Prevention and Early Detection Best Practice Guidelines An overview Module 3.1

DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Presentation purpose Target audience Health professionals and project workers on DPMI projects Aim To aid in planning of stages 2 and 3 of DPMI projects Objectives Provide an overview of the prevention of diabetes Discuss type 2 diabetes risk factors and screening Discuss prediabetes and implications in practice and for the projects Discuss IGT/IFG diagnosis, communicating risk to consumers and best practice care projects.

DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Prevention of diabetes Recommendations to reduce risk of type 2 diabetes  Regular physical activity  Interventions to reduce obesity Waist circumference, body weight and body mass index (BMI) identify individuals who should seek and be offered weight management program  Individuals at risk should have dietary intake assessed and receive individualised dietary advice and continued dietetic support Evidence Based Guideline for the Prevention of Type 2 Diabetes. Australian Government NHMRC

DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Prevention of diabetes Recommendations to reduce risk of type 2 diabetes  Identification of women with GDM would allow: Postnatal clinical interventions in those with diabetes Option to use preventive methods to reduce the risk of Type 2 diabetes  Diet and exercise education in children should include: Parental involvement Behavioural techniques Evidence Based Guidelines for the Prevention of Type 2 Diabetes. Australian Government NHMRC

DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Screening for diabetes and risk factors Active case detection and diagnosis of Type 2 diabetes should be considered for the following reasons:  Type 2 diabetes is serious and costly  Natural history includes asymptomatic phase which is not benign and during which it can be diagnosed  Early treatment reduces morbidity from long term complications  Case detection and diagnosis has a favourable risk:benefit ratio NB Overall prevalence does not justify universal testing of the entire Australian adult population but rather opportunistic case detection. Evidence Based Guideline for the case Detection and Diagnosis of Type 2 Diabetes. Australian Government NHMRC

DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Opportunistic case detection Test high risk individuals  People with IGT or IFG  Aboriginal and Torres Strait Islanders aged 35 years and over  Certain high risk non-English speaking background groups aged 35 years and over (specifically Pacific Islander people, people from the Indian subcontinent or of Chinese origin);  People aged 45 years and over who have either or both of the following risk factors: Obesity (BMI = 30 ) Hypertension; All people with clinical cardiovascular disease (myocardial infarction, angina or stroke Women with polycystic ovary syndrome who are obese. Evidence Based Guideline for the case Detection and Diagnosis of Type 2 Diabetes. Australian Government NHMRC

DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Evidence Based Guideline for the case Detection and Diagnosis of Type 2 Diabetes. Australian Government NHMRC

DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Definition Pre diabetes includes both  Impaired Glucose Tolerance  Impaired Fasting Glucose

DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Pre diabetes 16% of population have p re diabetes AusDiab Study (Dunstan et al, 2002) Pre diabetes associated with  Increased risk of microvascular complications  Increase risk of microalbuminuria and neuropathy (lower prevalence than diabetes but higher than general population)  Increase risk of cancer – breast, colon, liver and pancreas.  Increased risk of developing diabetes Need to consider age: how relevant is IGT or IFG in a person 75 years old?

DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Does pre diabetes predict diabetes? Progression of IGT/IFG to diabetes in 11 year follow up Presentation Stephen Twigg. Pre diabetes Symposium ADS & ADEA Annual Scientific Meeting Sydney 2004

DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Interventions Increased physical activity and weight loss can reduce risk of type 2 diabetes ?Reduce cardiovascular risk Need to focus on follow up and review given high risk of developing diabetes Need to encourage ongoing review and management of CVD risk factors

DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Communicating risk to consumers Is it a condition vs risk factor? What is the name of the condition? Will the name influence how seriously consumers view it i.e. pre diabetes vs impaired glucose tolerance. No label may mean not taken seriously No label may mean no intervention. No follow up Implications for individuals if labelled with a condition where approx 1/3 will revert back to normal.

DPMI Workforce Development – The Alfred Workforce Development Team June 2005 How is pre diabetes managed in general practice? Mapping exercise (Div of GP Perth) GP audit. Nearly 1/3 of patient with prediabetes had not had a blood glucose test in the past 12 months Waist circumference was only recorded for 10% patients 50% had their weight recorded Lipids and BP were recorded in almost all patients ( not sure how often) Presentation by A Derbyshire. ADS & ADEA Annual Scientific Meeting Sydney 2004

DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Primary care management of Type 2 diabetes GP Focus Groups  GPs reluctant to pursue aggressive case finding  GPs don’t involve other HPs in management of pre diabetes  Most follow up is oppurtunistic  No recall systems  Patient characteristics such as motivation, lack of understanding were seen as the greatest barriers to managing pre diabetes in GP practice Presentation by Kaye Neylon ADS & ADEA Annual Scientific Meeting Sydney 2004

DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Group education for Impaired Glucose Tolerance - does it work? ACT Diabetes Service Referred clients (n=34) with IGT/IFG attended 2 group ed sessions (1 hr nutrition/ 1 hr information) asked to identify possible lifestyle modifications. Responses - 79% exercise- 59% weight loss, - 5% smoking cessation - 5% stress reduction. 6 month telephone follow up (78% response) reported lifestyle changes implemented and maintained - 68% exercise- 56 % dietary changes - 50% weight loss- 5% stress reduction - 0% smoking cessation. - Presentation by W.R Mossman ADS & ADEA Annual Scientific Meeting Sydney 2004