Diabetes Overview

Managing Diabetes in Primary Care

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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

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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

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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

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Gender Variation

Prevalence higher in men than women

Risk of dying higher in women than men

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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

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Classification

Type 1 insulin-dependent

Type 2 non-insulin-dependent

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Type 1 Diabetes

Presents in childhood or early adult life accounts for 15% cases in England pancreatic ß–islet cells destroyed autoimmune

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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

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Complications

Microvascular Cardiovascular Other

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Microvascular

eye retinopathy maculopathy

nephropathy neuropathy

feet/ulceration postural hypotension abnormal sweating diarrhoea erectile dysfunction

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Cardiovascular

CHD angina myocardial infarction heart failure

Stroke/TIA PVD

claudication foot ulcers

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Other

cataract infections

UTI candidal skin

soft tissue problems frozen shoulder, trigger finger

skin problems necrobiosis lipoidica diabeticorum

mental health problems

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Management Options

Diet Oral Hypoglycaemics Insulin

T1DM T2DM

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Management of T1DM

Insulin Pre-mixed “biphasic” Basal Bolus Insulin Pump

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Management of T2DM

Diet low fat high (complex) carbohydrate

Lifestyle modification smoking cessation reduce alcohol reduce obesity exercise

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Management of T2DM (2)

Glycaemic control sulphonylureas biguanides (metformin) secretagogues (Repaglinide) thiazolidinediones

Hypertension control ACEI

Lipid control statins

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Organised Diabetic Care

Practice Clinic Nurse Specialist GP Specialist Call/Recall

Specialist Care Liaison Nurse

Screening Services Retinopathy Podiatry