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Diabetes service development

Update on Diabetes Services 41 st Annual General Practitioner Study Day 28 th January 2012 Dr. Eoin O’Sullivan Consultant Endocrinologist Bon Secours Cork. Diabetes service development. What’s done (or almost done!) Laboratory developments Type 1 diabetes Pre-diabetes policy Podiatry

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Diabetes service development

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  1. Update on Diabetes Services41stAnnual General Practitioner Study Day28thJanuary 2012Dr. Eoin O’SullivanConsultant EndocrinologistBon Secours Cork

  2. Diabetes service development • What’s done (or almost done!) • Laboratory developments • Type 1 diabetes • Pre-diabetes policy • Podiatry • Exercise classes for type 2 diabetes • Nurse-led diabetes clinics • What’s next • Insulin pump clinic restructuring • More work on in-patient hyperglycaemia

  3. Laboratory developments • HbA1c • Same day turnover in new in-house assay • Better decision making on in-patients with diabetes/hyperglycaemia • Clearer advice on discharge for patients and GPs • Blood ketone testing • Vital for assessment of hyperglycaemic ketosis • Being incorporated into new “Sick day rules” patient information leaflet

  4. Type 1 Diabetes • Continuous glucose monitor sensors (CGMS) • To assist in maximising glycaemic control including avoidance of hypoglycaemia • Restructuring of insulin pump clinics • Unified approach between diabetes nurse specialist, dietician and clinician • Blood ketone monitoring • Home care as well as during admissions

  5. Pre-diabetes • “Impaired Glucose Regulation” (IGR) or “Non-Diabetic Hyperglycaemia” (NDH) • Risk factors similar to T2DM • 1 in 7 adults, with annual progression to diabetes of 5-12% • Approx 50% will develop T2DM in 5 years • IGT especially is associated with increased cardiovascular risk • Management • Diet and exercise (±Metformin) • Cardiovascular risk factor reduction

  6. Diagnostic criteria for diabetes *Single abnormal value sufficient if hyperglycaemic symptoms; otherwise repeat the same test on subsequent day unless have 2 different but concordant tests

  7. Pre-diabetes patient information leaflet • What is pre-diabetes? • What is the significance of pre-diabetes? • How do Imanage my pre-diabetes • Dietary and exercise advice • How should my pre-diabetes be followed up? • Useful contact information

  8. How should my pre-diabetes be followed up? Your GP will need to follow up your blood sugar levels (as well as your blood pressure and cholesterol). This can be done in a number of ways e.g. a fasting blood test, a non-fasting blood test, and/or an oral glucose tolerance test. This involves a fasting blood test, followed by a prescribed sugary drink and another blood test 2 hours later.

  9. Podiatry • Foot ulcers in diabetes are a significant cost of care • Podiatry access will be provided for patients with diabetes who are found to have foot ulcers

  10. Exercise classes for type 2 diabetes • Minimum of 6-8 patients with diabetes/pre-diabetes • Pre assessment/ screening • 8 exercise classes once a week (1 hour) • Exclusion criteria include insulin use/high risk of hypoglycaemia, poorly controlled diabetes, unstable cardiovascular disease

  11. Nurse-led diabetes clinics • Restructuring of types of clinics offered to maximise patient needs • Increasing communication between diabetes nurse clinic and review in Cork Clinic • More referrals from Rooms to nurse-led clinic to try to maximise home control and where possible avoid admission

  12. Diabetes clinics

  13. What next?

  14. Inzucchi SE et al. NEJM 2006

  15. In-patient hyperglycaemia (10-25%) • Increased in-hospital mortality • Increased risk of infection • Increased length of stay

  16. In-patient hyperglycaemia • New ward-based insulin prescription chart • Structured approach to in-patient hyperglycaemia • Protocols for management of hyperglycaemia

  17. Endocrine developments • Synacthen tests in OPD • Thyroid nodule MDT

  18. Thank you Dr Eoin O’Sullivan Suite 6, Cork Clinic, Western Road Tel: 021-4341955 Fax: 021-4346148 E-mail: ccendocrinology@gmail.com

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