Diabetes Overview

Diabetes Overview Managing Diabetes in Primary Care

Diabetes Mellitus Diabetes mellitus is a condition in which there is a chronically raised blood glucose concentration It is caused by an absolute or relative lack of insulin i.e. insulin is not being produced from the pancreas or there is insufficient insulin or insulin action for the body’s needs James Street Family Practice, Louth GP Registrar Tutorial

Prevalence • 1.3 million in UK • 2.5% population diagnosed • “Missing Million”: • DUK reckon up to 2% more diabetics undiagnosed • Prevalence rises with age • 1 in 20 over 65 • 1 in 5 over 85 James Street Family Practice, Louth GP Registrar Tutorial

Sociology • European perspective • Britain among worst rates of Diabetic complications in Europe (renal failure, amputation, blindness) • Ethnicity • T2DM up to 6* more common in people of South Asian descent • T2DM up to 3* more common in people of African or Afro-Caribbean descent • Social Class • morbidity is up to 3.5* more in poorest than richest in our society James Street Family Practice, Louth GP Registrar Tutorial

Gender Variation • Prevalence higher in men than women • Risk of dying higher in women than men James Street Family Practice, Louth GP Registrar Tutorial

Definitions • World Health Organisation • Diabetes • fasting plasma glucose >7.0 • 2-h post-glucose load >11.1 • Impaired Glucose Tolerance • fasting <7.0 and • 2-h post-glucose load >7.8 • Impaired Fasting Glucose • fasting 6.1 – 7.0 James Street Family Practice, Louth GP Registrar Tutorial

Classification • Type 1 • insulin-dependent • Type 2 • non-insulin-dependent James Street Family Practice, Louth GP Registrar Tutorial

Type 1 Diabetes • Presents in childhood or early adult life • accounts for 15% cases in England • pancreatic ß–islet cells destroyed autoimmune James Street Family Practice, Louth GP Registrar Tutorial

Type 2 Diabetes • Often presents after age 40 • 85% of cases in England • insulin resistance • gradual onset • tiredness, frequent urination, increased thirst, weight loss • may be detected routinely • medical examination James Street Family Practice, Louth GP Registrar Tutorial

Complications • Microvascular • Cardiovascular • Other James Street Family Practice, Louth GP Registrar Tutorial

Microvascular • eye • retinopathy • maculopathy • nephropathy • neuropathy • feet/ulceration • postural hypotension • abnormal sweating • diarrhoea • erectile dysfunction James Street Family Practice, Louth GP Registrar Tutorial

Cardiovascular • CHD • angina • myocardial infarction • heart failure • Stroke/TIA • PVD • claudication • foot ulcers James Street Family Practice, Louth GP Registrar Tutorial

Other • cataract • infections • UTI • candidal • skin • soft tissue problems • frozen shoulder, trigger finger • skin problems • necrobiosis lipoidica diabeticorum • mental health problems James Street Family Practice, Louth GP Registrar Tutorial

Management Options • Diet • Oral Hypoglycaemics • Insulin • T1DM • T2DM James Street Family Practice, Louth GP Registrar Tutorial

Management of T1DM • Insulin • Pre-mixed “biphasic” • Basal Bolus • Insulin Pump James Street Family Practice, Louth GP Registrar Tutorial

Management of T2DM • Diet • low fat • high (complex) carbohydrate • Lifestyle modification • smoking cessation • reduce alcohol • reduce obesity • exercise James Street Family Practice, Louth GP Registrar Tutorial

Management of T2DM (2) • Glycaemic control • sulphonylureas • biguanides (metformin) • secretagogues (Repaglinide) • thiazolidinediones • Hypertension control • ACEI • Lipid control • statins James Street Family Practice, Louth GP Registrar Tutorial

Organised Diabetic Care • Practice Clinic • Nurse Specialist • GP Specialist • Call/Recall • Specialist Care • Liaison Nurse • Screening Services • Retinopathy • Podiatry James Street Family Practice, Louth GP Registrar Tutorial

Diabetes Overview