Diabetes updateDiabetes update

Gillian Clarke Gillian Clarke

Diabetes Lead/Advanced Diabetes Lead/Advanced DietitianDietitian

DiabesityDiabesity

• 21.7% of the 21.7% of the patients referred to patients referred to the service have the service have diabetes.diabetes.

• Diet and lifestyle is Diet and lifestyle is the cornerstone of the cornerstone of good diabetes good diabetes managementmanagement

SIGN 116 Grade A recommendation:SIGN 116 Grade A recommendation:

• Obese adults with Type 2 diabetes Obese adults with Type 2 diabetes should be offered individualised should be offered individualised interventions to encourage weight interventions to encourage weight loss (loss (including lifestyle, including lifestyle, pharmacological or surgical pharmacological or surgical interventions) interventions) in order to improve in order to improve metabolic control. metabolic control.

Encouraging patients to take

control

Becoming aware of the changes in

blood and physical changes due to

weight loss.

Recognising links between eating, weight and glucose

control.

Recognising the need for

medication

‘Activity increase’ helps

with glucose control.

Interacting with our team more intensively for

up to 18 months.

Interacting with others in

the same situation.

What are we doing to support What are we doing to support patients with diabetes?patients with diabetes?

• Patients asked to report their most Patients asked to report their most recent results/medication to group recent results/medication to group leader. Encouraging self-efficacy of leader. Encouraging self-efficacy of their diabetes care.their diabetes care.

• Conversation Map education sessions Conversation Map education sessions run by specialist dietitians. Well run by specialist dietitians. Well evaluated.evaluated.

• Linking more closely with acute and Linking more closely with acute and community diabetes services:community diabetes services:

- liaising with GP’s over diabetes medications - liaising with GP’s over diabetes medications that may be affecting weight loss progress.that may be affecting weight loss progress.

- Consultant Diabetologists consulted prior to - Consultant Diabetologists consulted prior to patients on insulin commencing the patients on insulin commencing the programme.programme.

- liaising with diabetes teams when patients - liaising with diabetes teams when patients are being considered for bariatric surgery.are being considered for bariatric surgery.

CONVERSATION MAPSCONVERSATION MAPS

78% found Conversation Map session 78% found Conversation Map session extremely useful. 22% found it very extremely useful. 22% found it very

useful.useful.

• ““Very informative and educational.”Very informative and educational.”• ““This has helped me to understand more This has helped me to understand more

about Diabetes – I am not so worried about about Diabetes – I am not so worried about it now.”it now.”

• ““I liked the style of the group, as very I liked the style of the group, as very encouraging for myself and others.”encouraging for myself and others.”

• ““Dietitians were very knowledgeable and Dietitians were very knowledgeable and motivating.”motivating.”

• ““The map was informative and relevant as The map was informative and relevant as well as colorful and interesting.”well as colorful and interesting.”

Pilot outcomes from GCWMS Pilot outcomes from GCWMS Diabetes patientsDiabetes patients

• Patients with type 2 diabetes on insulin (who are Patients with type 2 diabetes on insulin (who are less amenable to weight management less amenable to weight management interventions than those not on insulin)interventions than those not on insulin)

• Completed at least Phase 1 of the GCWMS Completed at least Phase 1 of the GCWMS programmeprogramme

• Showed a mean weight loss of Showed a mean weight loss of 6.03%6.03%

• Showed a mean reduction in HbA1c of Showed a mean reduction in HbA1c of 0.56%0.56% (SD (SD ++ 1.57) over a mean of 11 months 1.57) over a mean of 11 months

• UKPDS study has shown that a 1% reduction in UKPDS study has shown that a 1% reduction in HbA1c is associated with a decreased risk in HbA1c is associated with a decreased risk in diabetes complications.diabetes complications.

Case Study – Mr F (55yrs Case Study – Mr F (55yrs old)old)

• Attended ax with T2DM, hypertension.Attended ax with T2DM, hypertension.Wt=107.1kg, ht=1.67m, Wt=107.1kg, ht=1.67m,

BMI=39.4kg/mBMI=39.4kg/m22

• Inactive sedentary job as driving Inactive sedentary job as driving instructor. Irregular meal pattern, instructor. Irregular meal pattern, frequent takeaways, large portion frequent takeaways, large portion sizes at meals.sizes at meals.

• Dm medication – Insulin – 60u with Dm medication – Insulin – 60u with meals, 100u evening and Metformin.meals, 100u evening and Metformin.

Weight loss over the course of Weight loss over the course of the programme.the programme.

Phase 1 Phase 1 Phase 2 Phase 2 Phase 3Phase 3

Weight Weight loss (kg)loss (kg)

12.912.9 99 9.59.5

CumulativCumulative weight e weight loss (kg)loss (kg)

12.912.9 24.924.9 35.235.2

HbA1c levelsHbA1c levels

March 2012 (started March 2012 (started phase 1 of phase 1 of programme)programme)

62 mmol/mol (7.8%)62 mmol/mol (7.8%)

November 2012 November 2012 ((insulin insulin discontinueddiscontinued, only , only on Metformin)on Metformin)

46 mmol/mol (6.4%)46 mmol/mol (6.4%)

April 2013 April 2013 (discharged from DM (discharged from DM clinic at Stobhill, for clinic at Stobhill, for annual r/v at GP)annual r/v at GP)

40 mmol/mol (5.8%)40 mmol/mol (5.8%)