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Diabetes in GP

Diabetes in GP. Aims. The Aim of the session would be 'to feel more confident managing DM in GP' . Objectives. and the intended learning outcomes would be to manage a situation in 10 mins , what scenarios to be confident with, and when to refer...  . My experience. GP Partner 19 years

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Diabetes in GP

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  1. Diabetes in GP

  2. Aims • The Aim of the session would be 'to feel more confident managing DM in GP'

  3. Objectives • and the intended learning outcomes would be to manage a situation in 10 mins, what scenarios to be confident with, and when to refer... 

  4. My experience • GP Partner 19 years • “Supervised” in house Diabetic Clinic 19 years • Update Courses eg • Initiating Diabetes in GP • The Role of Byetta • Practical Skills eg How to perform Dopplers to measure ABPI • Case Discussions in House with Dr Jude

  5. Am I an expert ? • 2011-12 QOF Results • HBA < 7.5 63.6% 72.9% 72.7% • HBA < 8 75.9% 79.6% 82.6% • HBA < 9 85.1% 90% 90.8%

  6. Do we need to be experts in Diabetes ? • Or Chronic Diabetes Management

  7. The Role of the GP

  8. Diagnosis Patient A has had a Fasting Glucose of 7.2 and repeat levels 3 weeks later are 6.3 and HBA is 6.5% What is the diagnosis ? Why is it important ? Who would you screen ?

  9. The A-I of Diabetes • A is for HBA1c • Look at the trend and the medication • Metformin ? start sooner • Sulphonyluria • DPP-4 • Thiazolidinedione • Exenatide • Insulin • Acarbase

  10. B is for BP • What are the Targets? • Which Medication ?

  11. C is for Cholesterol • How do we decide who to treat ? • What Targets do we use ?

  12. MAYBE A LITTLE TOO MUCH “B” IN THE BLT?

  13. D is for Diet • When do we use the services of a Dietician ?

  14. E is for Eyes • What are the screening proceedures

  15. F is for Feet • What does QOF ask us to do ? • How to manage Autonomic Neuropathy ?

  16. G is for Genito-Urinary • Urine ACR • How do we manage a raised ACR ? • What else do we need to ask about ?

  17. H is for Height and Weight • Reminder for QOF ! • Targets? • What is the importance of Obesity ?

  18. I is for • ?????????????? • Influenza Vaccine

  19. Definition of Chronic Disease Management ?

  20. Definition of Chronic Disease Management ? • a system of coordinated healthcare interventions and communications for populations with long-term conditions in which patient self-care is significant.

  21. Models of Chronic Disease Management • What do we need to make it work ?

  22. The Wagner chronic care model. • Community resources and policies • Healthcare organisation : the structure, goals and values • Self-management support • Delivery system design: redesign • Decision support • Clinical information systems

  23. Take on more than your role and responsibility • “I’d just joined Gillette in the 90’s…………Voluntary participation in cross-functional teams is a great way to start. Not only does it put your learning curve on a steep incline, it also signals to the management that you’re the man to be considered when new or higher assignments open up in future. If you stay in your own little well, be prepared to be a frog that doesn’t get noticed till it croaks.”

  24. Patient B • Male 53yr Asian • Type 2 Since 2007 • HBA1c 2010- 8.9, 2011- 8.0, 2012 -7.4,May 2013 8.0 Gliclazide 40mg added, September HBA 7.5 • Rx Gliclazide 30mg MR, Gliclazide 40mg mane, Metformin 1g bd, Sitagliptin 100mg • BMI 2 0…….25……..30………35

  25. Communication of information • Can you see if you have any hypogonad male type 2 patients? We need a few for a study we are doing, as you know. I  will circulate this   to everyone at the practice to see if we can help.  I have a patient. Could you see him soon ? • Thanks. I can see him tomorrow if you can do the fax tonight. I will pick it up now and give him a call to attend in the morning. • Ok. Spoke to him.  I will see him at 9 am tomorrow.

  26. Task • Match A-I to the Wagner Chronic Care Model +/- Pointers when to Refer

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