2.  The Aim of the session would be 'to feel more confident managing DM in GP'

4.  and the intended learning outcomes would be to manage a situation in 10 mins, what scenarios to be confident with, and when to refer...

5.  GP Partner 19 years  “Supervised” in house Diabetic Clinic 19 years  Update Courses eg ◦ Initiating Diabetes in GP ◦ The Role of Byetta ◦ Practical Skills eg How to perform Dopplers to measure ABPI ◦ Case Discussions in House with Dr Jude

6.  2011-12 QOF Results  HBA < 7.5 63.6%72.9%72.7%  HBA < 875.9%79.6%82.6%  HBA < 985.1%90%90.8%

7.  Or Chronic Diabetes Management

9. Patient A has had a Fasting Glucose of 7.2 and repeat levels 3 weeks later are 6.3 and HBA is 6.5% What is the diagnosis ? Why is it important ? Who would you screen ?

10.  A is for HBA1c  Look at the trend and the medication  Metformin ? start sooner  Sulphonyluria  DPP-4  Thiazolidinedione  Exenatide  Insulin  Acarbase

11.  What are the Targets?  Which Medication ?

13.  How do we decide who to treat ?  What Targets do we use ?

15.  When do we use the services of a Dietician ?

16.  What are the screening proceedures

17.  What does QOF ask us to do ?  How to manage Autonomic Neuropathy ?

18.  Urine ACR  How do we manage a raised ACR ?  What else do we need to ask about ?

20.  Reminder for QOF !  Targets?  What is the importance of Obesity ?

21.  ??????????????  Influenza Vaccine

23.  a system of coordinated healthcare interventions and communications for populations with long-term conditions in which patient self-care is significant.

24.  What do we need to make it work ?

25.  Community resources and policies  Healthcare organisation : the structure, goals and values  Self-management support  Delivery system design: redesign  Decision support  Clinical information systems

26.  “I’d just joined Gillette in the 90’s…………Voluntary participation in cross- functional teams is a great way to start. Not only does it put your learning curve on a steep incline, it also signals to the management that you’re the man to be considered when new or higher assignments open up in future. If you stay in your own little well, be prepared to be a frog that doesn’t get noticed till it croaks.”

27.  Male 53yr Asian  Type 2 Since 2007  HBA1c 2010- 8.9, 2011- 8.0, 2012 -7.4, May 2013 8.0 Gliclazide 40mg added, September HBA 7.5  Rx Gliclazide 30mg MR, Gliclazide 40mg mane, Metformin 1g bd, Sitagliptin 100mg  BMI 2 0…….25……..30………35

28.  Can you see if you have any hypogonad male type 2 patients? We need a few for a study we are doing, as you know. I will circulate this to everyone at the practice to see if we can help. I have a patient. Could you see him soon ?  Thanks. I can see him tomorrow if you can do the fax tonight. I will pick it up now and give him a call to attend in the morning.  Ok. Spoke to him. I will see him at 9 am tomorrow.

29.  Match A-I to the Wagner Chronic Care Model +/- Pointers when to Refer