Diabetes Prevention in General Practice

1. Diabetes Prevention in General Practice

2. Diabetes Prevention • Diabetes is a serious problem…. • Diabetes is Australia’s fastest growing chronic disease. Currently, almost one in four Australian adults have diabetes or are at risk of developing diabetes. • In Victoria, we are currently seeing over 70 new cases of diabetes diagnosed every day and the incidence is increasing across all ages. • Over 700,000 Victorians are estimated to be at high risk of developing type 2 diabetes. • It is estimated that 90% of the type 2 diabetes epidemic is driven by weight gain, largely resulting from unhealthy diet and inadequate physical activity.

3. Map showing how many people have diabetes across Victoria in 2001 <2% people with diabetes 2-4% people with diabetes >4% people with diabetes Map showing how many people have diabetesacross Victoria in 2008

4. Local Government area data For Diabetes incidence data in local government areas 2001-2008 please click here and scroll to the relevant local area

5. What is the best intervention for prevention? Both lifestyle andpharmacological interventions reduce the rate of type 2 diabetes progressing in people with impaired glucose tolerance. Lifestyle interventions have been demonstrated to be as equally effective as medication to delay onset, with fewer and less serious side effects. Should a lifelong course of medication treat what is fundamentally a lifestyle issue? CL Gillies, KR Abrams, PC Lambert, NJ Cooper, AJ Sutton, RT Hsu, K Khunti. Pharmacological and lifestyle interventions to prevent or delay type 2 diabetes in people with impaired glucose tolerance: systematic review and meta analysis. BMJ 2007,

6. Diabetes Prevention General practice is a key player in diabetes prevention. They have the ability to identify and refer people who are at high risk of developing type 2 diabetes to a Lifestyle Modification Program.

7. Lifestyle Interventions on the Prevention of Type 2 Diabetes Clinical trials have consistently demonstrated that lifestyle changes, including reducing weight and increasing physical activity, are effective in reducing the risk of developing type 2 diabetes and the impact lasts for years (Absetz et al., 2007; Laatikainen et al., 2007).

8. Diabetes Prevention In Victoria there are two main Lifestyle Modification Programs (LMPs) • Life! Taking Action on Diabetes • Reset Your Life

9. Who is eligible for a Life! course? There is funding for the following to participate in a Life! course: • A person who is 40-49, does not have diabetes but is at high risk of developing type 2 diabetes • A person 50+, does not have diabetes but is at high risk of developing type 2 diabetes • An aboriginal or Torres Strait Islander adult, does not have diabetes but is at high risk of developing type 2 diabetes • An adult (18+) who has a self reported history of Ischemic Heart Disease or Gestational Diabetes Please discuss eligibility criteria with your local division of general practice

10. Who is eligible for a Reset Your Life course? There is funding for the following people to participate in Reset Your Life • People between the ages of 40-49, who do not have diabetes but are at high risk of developing type 2 diabetes • Aboriginal and Torres Strait Islander people between the ages of 15-54 who do not have diabetes but are at high risk of developing type 2 diabetes Please speak to your local division for eligibility criteria

11. Health Assessment items • The MBS Health Assessment items should be used to refer people between the ages of 40-49 & Aboriginal or Torres Strait Islanders aged between 15-54. • The timed health assessments (701, 703, 705, 707) that can be used include: A health assessment for people aged 45-49 years who are at risk of developing a chronic disease A type 2 diabetes risk evaluation for people aged 40-49 years with a high risk of developing type 2 diabetes as determined by the AUSDRISK tool A Health assessment for Aboriginal and Torres Strait Islander people (separate item # 715)

12. How do you refer? • <Division to insert local referral pathway>

13. Who are your local LMP facilitators • <Division to insert list here>

14. Who do you send referrals to? • Division to insert local referral process

15. What is your local division of general practice doing in Diabetes Prevention • <Division to insert information here>

16. How can the clinic benefit from referring to a LMP? • Claiming MBS Health assessments • Life! case Finding Funding initiative • Life! First Visit Initiative Please speak to you <division to insert project officer name> for more information on these

17. Case study: Annual Health screens Clinic A has a very proactive GP in chronic disease prevention, she has set up a system of annual health checks. The health checks include venepucture health screen blood tests (a fasting glucose, cholesterol, ESR, FBE, U&E’s and if indicated a PSA). Also included in the annual health screen is a pulmonary function test, ECG and patients are encouraged to utilise the bowel cancer screening test that are available. This health check is conducted by the practice nurse who has 30 minutes to complete it. During this time she starts a conversation with the patient on Lifestyle factors, lifestyle behaviours and completes the AUSDRISK test. If eligible for a LMP and 40-49 year old, the nurse encourages patient to come back for a Health Assessment and referral. If the patient is eligible and 50 or over, the nurse completes a First Visit with the patient and refers them to the local LMP.

18. For more information please speak to <insert name of local division> about eligibility criteria and referral pathways.