1. Primary Care Diabetes
Dr Bruce Davies
02/01/2019

2. Introduction - Diabetes
2% of UK population.
66% have been diagnosed.
Each GP will find 2-3 new cases per year.
20-30 cases per GP on their lists.
5-10% of NHS budget.
Childhood DM doubling every 10 years.
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3. Topics of Discussion Detection Education & counselling
Components of continuing care
Aims
Management
Who to refer
CDM and future NSF
Audit
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4. Detection – How / When Symptoms New patient checks 75+ checks Medicals
Systematic
Opportunistically
ANC
Other risk factors
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5. Diagnostic Criteria Random glucose > 11mmol
Fasting glucose > 7mmol
2 hours after 75g glucose orally > 11mmol
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6. Education Lifelong disease Knowledge is power
3 times more likely to die prematurely
Reactions vary to what is really bad news
Lifestyle changes are needed
Specialist health education material
Specialist educators
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7. Education BDA A on going process Not one off
Need more information as and when they can use it
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8. Education Partnership with health professionals –
Full multidisciplinary teams
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9. At Diagnosis Full examination Explanations
See a dietician +/- follow-up
See a chiropodist +/- follow-up
Monitoring education
Implications for driving, insurance, DVLA, script charges etc
BDA
Education about lifestyle
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10. Once Reasonably Controlled
At least annual review
Eye surveillance
Education when necessary
Formal medical review
Weight
Urine
Bloods (HbA1, cholesterol)
Review of control
Blood pressure
Legs and feet
Discuss any problems
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11. Time and Resources Annual check takes about 30 minutes
Most practices use a practice nurse
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12. Aims Patient takes pragmatic responsibility for own health
Minimise symptoms
Glycaemic control
Weight
Blood pressure
Cholesterol
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13. Who to Refer? Acutely unwell at diagnosis Insulin treatment required
Child
Pregnant or pre-conceptual
Complications
Patient request
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14. Real Life
Mrs A is a 68 year old widow who attends often because of her angina and COPD. She is getting more tired and feels it is due to old age.
Must be the angina or breathing getting worse ?
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15. Maybe Not!
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16. Mea Culpa
I’ve forgotten to test these peoples urine on more than one occaision
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17. Questions No evidence that self blood monitoring does any good
Some evidence of harm!
Control of BP in diabetics may be better for long term outcome than blood sugar!
How can compliance be improved?
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18. Questions
Many type 2 diabetics would be better off not knowing their diagnosis?
The government should have better diet and exercise policies?
Hospital care is better than practice care?
Primary care is better?
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19. Homework What drugs when? Treatment of cholesterol? Treatment of BP
Treatment of complications
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20. CDM and Future NSF
Small annual fee per GP for “systematic care” + Audit
NSF next year will make it better defined and ? Bigger fee
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21. Audit Heaps of possibilities. Diagnosis. Follow-up. Monitoring.
How well controlled.
Etc.Etc.
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22. References
Gallichan M. Self-monitoring by people with diabetes: evidence based practice. BMJ 1997;314:964-7
UKPDS 33. Lancet 1998;352:837-53
Diagnosis and classification. Diabetes care 1997;20:
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