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Diabetes For PRIMIS Facilitators

Diabetes For PRIMIS Facilitators. Dr Dougal Darvill PRIMIS Clinical Advisor. Rule of 3s and Diabetes. About 3% of the population estimated to have diabetes, of these 1.3 have been diagnosed: 1/3 aware and good control 1/3 aware and poor control 1/3 unaware. What is Diabetes?.

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Diabetes For PRIMIS Facilitators

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  1. Diabetes For PRIMIS Facilitators Dr Dougal Darvill PRIMIS Clinical Advisor

  2. Rule of 3s and Diabetes • About 3% of the population estimated to have diabetes, of these 1.3 have been diagnosed: • 1/3 aware and good control • 1/3 aware and poor control • 1/3 unaware

  3. What is Diabetes?

  4. What is Diabetes? • Type I: sudden onset/younger people/B cells destroyed by body’s own immune system/15% diabetics/not preventable • Type II: gradual onset/older people /B cells unable to produce enough insulin for the body’s needs+resistance to insulin/85% diabetics/possible to delay onset ?prevent/overweight

  5. Diabetes classification • 1 Type I and Type II (C10E/C10F) • 2 Juvenile onset and Maturity onset (C1000/C1001) • 3 Insulin dependent and non-insulin dependent (C108/C109) • C2A. Insulin treated non-insulin dependent diabetes

  6. Diabetes NSF-Main Thrusts • 1 Improving the care for those already ‘in the system’ (detection and management of long term complications) • 2 Identifying those who do not know that they have diabetes • 3 Preventing Type II diabetes (reducing inequalities in risk of developing it) • 1/3 of Type II diabetics have a complication at diagnosis • www.doh.gov.uk/nsf/diabetes/

  7. Management of Diabetes • 1 Insulin • 2 Tablets • 3 Diet

  8. Complications of Diabetes • 1 Small blood vessels • 2 Large blood vessels • 3 Nerves • 1/3 of Type II diabetics have a complication at diagnosis

  9. Complications of Diabetes:small blood vessels • 1 Kidneys • 1/3 of Type II diabetics have a complication at diagnosis

  10. Complications of Diabetes:small blood vessels • 1 Kidneys • 2 Eyes • 1/3 of Type II diabetics have a complication at diagnosis

  11. Complications of Diabetes:large blood vessels • 1 Coronary artery disease • 2 Cerebrovascular disease • 3 Peripheral vascular disease • 1/3 of Type II diabetics have a complication at diagnosis

  12. Complications of Diabetes • 1 Small blood vessels • Kidneys, eyes • 2 Large blood vessels • 3 Nerves • 1/3 of Type II diabetics have a complication at diagnosis

  13. Screen if risk factors • 1 Overweight (BMI >25) • 2 First degree family history • 3 Asian/African origin • Test opportunistic (NSF) /?every 1-3 years (emerging evidence)

  14. Monitoring those at risk • 1 Gestational diabetics • 2 Impaired glucose tolerance or fasting glycaemia • 3 Polycystic ovaries (+obesity) Computers are a great potential help

  15. Actions to Prevent Diabetes • 1 Eat a balanced diet • 2 Lose weight • 3 Increase physical activity

  16. HbA1c High sugar Low sugar

  17. Primis Diabetes Queries • Disease registerNC and those at higher risk of diabetes • Long term control of blood sugarNC • Codes 42W%/44TB • Report style list of those without measurement in last year/ever • Blood pressure controlNC • 2469 systolic, 246A diastolic (NSF suggested codes) • Report style list poor control/no measurement

  18. Primis Diabetes Queries • Smoking historyNC/smoking cessation help in last yearNC • Cholesterol measurementNC/level (<5mmol/litre) NC • Report style list of those with no measurement • WeightNC/ obesity (report)/health education/on metformin • Report style list of those never having BMI calculated

  19. Primis Diabetes Queries:complications • Kidneys: Blood check in last yearNC (report on those without)/Urine check in last yearNC (report on those without) • Eyes: check in last yearNC (report on those without)/evidence of diabetic damage • Feet: check in last yearNC (report on those without)/evidence of diabetic damage

  20. Primis Diabetes QueriesNICE-Kidneys • High risk albuminuria (report style list) • Albumin/creatinine ratioNC (men and women separately) • ACE Inhibitors in high risk groupNC (report style list if not in last 6/12) • Blood Pressure control in high risk group (report style list if poor control) • Diabetic kidney disease register (report style list)

  21. Primis Diabetes Queries • Hypoglycaemic attacks/frequency in last year • Diabetic review in last year (report style list if without) • At risk populations-recording of ethnicity/FH of diabetes/BMI >30, Exercise assessment • List of those in highest risk groups (gestational/impaired glucose tolerance) not screened in past year (blood sugar)

  22. Primis Diabetes Queries • Place of care (hospital/shared/practice) • Type of care (insulin/tablets/diet) • Impotence (number) • Amputation (number) • Data Quality: Monitoring or related code but no diagnosis code

  23. Primis Diabetes Queries (NICE) • Framingham risk scores for under 75 years >15% report style list people needing statins/fibrates but not offered number with raised triglyceride level (>10) number on aspirin or declined, contraindicated • Number of Type II diabetics with Framingham risk score in past year

  24. End

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