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Diabetes Mellitus - A Brief Overview

Prevalence. 3% UK populationIncreases with Age to >10% in the over 65sAt least 2x more common amongst Asian, African and Afro-Caribbean people - up to 25% of Asians aged over 60. Incidence. Incidence of Type 2 diabetes is rising due toobesitylongevity. Terminology. Type 1 Type 2Impaired Glucos

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Diabetes Mellitus - A Brief Overview

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    1. Diabetes Mellitus - A Brief Overview Sara Ho 29/10/02

    2. Prevalence 3% UK population Increases with Age to >10% in the over 65s At least 2x more common amongst Asian, African and Afro-Caribbean people - up to 25% of Asians aged over 60

    3. Incidence Incidence of Type 2 diabetes is rising due to obesity longevity

    4. Terminology Type 1 Type 2 Impaired Glucose Tolerance (IGT) Impaired Fasting Glycaemia (IFG) Gestational Diabetes NB. Risk factors for cardiovascular disease (IGT) and/or future diabetes (IFG)

    5. Diagnosis With symptoms (polyuria, thirst..) a random venous plasma glucose ? 11.1 mmol/l a fasting venous plasma glucose ? 7.0 mmol/l 2 hour venous plasma glucose ? 11.1 mmol/l in an OGTT With no symptoms Dx must not be based on a single glucose determination. It requires a confirmatory venous plasma test on a subsequent day.

    6. Complications Retinopathy Nephropathy Neuropathy - peripheral - autonomic In addition, higher risk of cardiovascular disease

    7. Management Lifestyle advice “self-management” Optimal weight control/ diet Exercise (Smoking cessation) Cardiovascular risk modification BP > 140/80 should be treated Glycaemic control ? development and progression of microvascular complications

    8. Drugs used in Diabetes Insulins Suphonylureas Biguanides Thiazolidinediones – rosiglitazone Nateglinide, Repaglinide Acarbose Guar gum

    9. Routine Review Initial discussion General health and well- being Glycaemic control - self monitoring +/- symptoms Knowledge of diabetes and self-Mx skills Specific enquiry - smoking/ EtOH/ exercise For Annual Review, inc. Specific enquiry re. symptoms of diabetic complications - vision - chest pain/SOB - claudication - neuropathy

    10. Routine Review Examination Weight/ BMI Further clinical examination, as indicated ..Annual Review, also check BP Eye examination Foot examination

    11. Routine Review.. Investigation Urinanalysis HbA1c Further Ix, as indicated ..Annual Review, also check Serum creatinine Serum cholesterol (Fasting lipoprotein, if IHD)

    12. Routine Review Management Glycaemic control - diet/ Rx Cardiovascular risk factors +/- complications Individual targets and future Mx plans Next appointment ..Annual Review, also Specialist referrals Contraception/ Pre-conception Future reviews

    13. Targets/ Aims Implications Cost Audit

    14. Sources Recommendations for the Management of Diabetes in Primary Care, 2nd edition revised October 2000 - downloadable from Diabetes UK website DARTS UKPDS 35 Association of glycaemia with macro/ microvascular complications of Type 2 diabetes UKPDS 39 Efficacy of atenolol and captopril in reducing risk of macro/ microvasc complications of T2 diabetes UKPDS 63 Implementing intensive control of blood glucose conc and BP in T2 diabetes in England: cost analysis

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