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Is Diabetes really that complicated?

Is Diabetes really that complicated?. Dr Jon Tuppen GPSI Diabetes. Consider this case. ♂ DOB 14.5.57 14 May 2007 15:28 Smoker (137R.) "6-7 a day“

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Is Diabetes really that complicated?

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  1. Is Diabetes really that complicated? Dr Jon Tuppen GPSI Diabetes

  2. Consider this case ♂ DOB 14.5.57 14 May 2007 15:28 Smoker (137R.) "6-7 a day“ had a routine taxi driver medical examination - letter from Dr. Coull, had high B.P readings - 175/120, and 2+ of sugar in urine, no symptoms, not on any medication @ present, going through very stressful period . o/e - B.P - 175/112, H.R - regular, Chest - HS - normal, no murmur advice to get bloods done including fasting glucose, Hba1c, repeat B.P readings on 2 different occasions with nurse 1 wk apart, ECG , start on lisinopril tablets 5mg & r/w in 3-4 wks time. Smoking cessation advice (Ua1Nz) • what would you have done from here? • What is the diagnosis?

  3. Bloods • Serum glucose level (44f..): 6.60 mmol/L • Serum creatinine level : 120.00 umol/L • Serum cholesterol level : 6.00 mmol/L • Serum sodium level : 139.00 mmol/L • Serum albumin level (XE2eA): 46.00 g/L • Serum globulin level (XE2eB): 25.00 g/L • ALT/SGPT serum level (44G3.): 88.00 iu/L

  4. Would you like anything else? Is this any use?? HbA1c level (DCCT aligned) (XaERp): 6.1 % Is this any use?? CVD risk assessment done (10yr value) (Y04e8): 32.43 %

  5. So what happened??

  6. Next contact was…….. “thinks is diabetic. Polyuria and polydypsia for 6/52 with assoc wt loss, feeling tired. FHx of DM -father, grandparents. d/w pt significance and pts understanding. Keen for testing. Sent for fasting bloods U&E, LFT, Chol, Glu, TFT, FBC. r/v with results”.

  7. Risk ? What risk?

  8. Is it important what style we use to deal with patients?

  9. Engaged empowered patient Organised proactive system = Better outcomes Partnership We know what works…..The evidence base for all long term conditions In England : The Diabetes NSF Internationally: The Chronic Care Model - Wagner

  10. discussed ideas about the best way to manage their diabetes agreed a plan to manage their condition over the next 12 months discussed their goals in caring for their diabetes And in diabetes…The % of adults who report they…… had at least one check up in the last 12 months and From ‘Managing Diabetes’ Healthcare Commission: 2007

  11. Personalised Care Planning and the Patients’ Prospectus • NHS Next Stage Review “High Quality Care For All” commitments: • By 2010 all 15.4 million people with a long term condition will be offered a personalised care plan. • A new Patients’ Prospectus will provide people with long-term conditions information about the choices that should be available locally to enable them to self care in partnership with the health and social care professionals

  12. ...the individual, their needs and choices at the centre of the process. Goal setting to support people to achieve outcomes such as walking unaided or return to work …includes support for self care. The Patients’ Prospectus will drivedemand for self care services such as access to peer support networks, generic or disease specific courses, tools and devices and healthy living advice.Promotes choice. …includes helpful and relevant information, through an Information Prescription, for example about conditions, treatments, care services, benefits, and support groups. …coordinated services for those that need it, contingency planning. Action planning and review. Results in a single overarching care plan Care Planning – the National Messages …… A process of discussion, negotiation and shared decision making that takes place between the person and their professional who have an equal partnership Personalised Care Planning Individualised services, meeting holistic needs. Wider choice supports commissioning decisions

  13. Consider things like Admin Who does what When will be it be held Where will be it be held Audit Who else do you need to involve? Education of workforce Who has main responsibility? etc Consider from the patients side What will you want ? What information do you need? What will you main concerns be? Time commitment on diabetes care Impact on work/ family / insurance etc Task: Design from scratch a diabetic system for your practice and consider how it integrates with other parts of local diabetes care

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