1. Diabetes Aspects of the Local Enhanced Service Dr Mark Barrett Dr Jeremy Sandford Dr Aythen Elkindi

2. Search on patients with raised glucose and Hba1c and code appropriately Run Q diabetes Increase Prevalence and Improve Outcomes

3. Talk about family history, even our cat has Diabetes.

4. 42yr old Bangladeshi patient Non smoker, no record FH, BMI 25 QD score=11% Add correct FH and correct BMI of 30.5 QD score increases to 59% Q diabetes example

5. Hba1c Diabetes Hba1c ≥ 48 mmol/mol (6.5%) Pre-diabetes 42-47 mmol/mol (6-6.4%) Code for type 1 or type 2 diabetes Code for pre-diabetes (C115Y) Hba1c on patients with Q diabetes ≥ 10 Diagnosis

6. Prevalence of diabetes October 2013 7,800 June 2014 8,104 Total of 482 new diagnoses These figures don’t add up. Likely patients moving or deaths. Some numbers (Pan Camden)

7. Eligible for Q diabetes risk 154,000 99,000 have had Q diabetes risk performed So still work to do More numbers

8. 243 patients Hba1c > 48 & not coded as diabetes 1901 patients Hba1c 42-47 & not coded as Pre-Diabetes Easy wins How can we improve diabetes prevalence?

9. Audit patients Hba1c > 75 mmol/mol Include worst 20% of diabetes register Reasons for poor control Submit by the end of June Initial themes from audits submitted so far ……… Audit of patients with poor Control

10. Diabetes Audit Initial Findings

11. 3 practices- 154 patients HbA1c Context Mean = 86.9 Median = 82.8 Mode = 76

12. Type of diabetes Audit PopulationWhole Practice Diabetic Population 19% of patients reviewed in the audit were diagnosed with Type 1 Diabetes, this compares with 9% of the total practices’ diabetic population. There is variation between practices.

13. Time since diagnosis 57% of patients within the audit were diagnosed earlier than 2007. Only 4% within the audit were diagnosed post 2011. All patients over the age of 65 were diagnosed in 2009 or earlier.

14. Proportions with complications Not all patients within the audit had complications recorded. The complication most commonly recorded was retinopathy, where 43% patients (excluding nulls) within the audit had this recorded. Green; % with complications

15. DNA 17% of patients within the audit had DNA’s recorded. 50% were on insulin 81% were Type 2 8% were on maximum oral therapy They were across all age groups

16. Invite patients for review. Offer care planning Develop care plan Use Templates Promote 9 care processes from diabetes UK Monitor progress Review of patients with poor control

17. Blood glucose Blood pressure Cholesterol level Retinal Screening Foot and leg check Kidney function (urine) Kidney function (blood) Weight Smoking 9 care processes

18. Room for improvement 885 patients with Hba1c > 75 Only 175 patients reviewed so far See patients/use templates! How are we doing?

19. GP lead and Consultant Identify areas to discuss Review of data (scorecards, medicines management and referral data) Case discussion and complex patients Discussion of local services and pathways and the new diabetes website Action plan with agreed timelines Suggestions welcome Practice Visits

21. Questions and answers

22. Thank you