diabetes for primis facilitators
DESCRIPTION
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?. - PowerPoint PPT PresentationTRANSCRIPT
PRIMIS Third National Conference Tuesday 1 April 2003
Birmingham
Diabetes For PRIMIS Facilitators
Dr Dougal DarvillPRIMIS Clinical Advisor
PRIMIS Third National Conference Tuesday 1 April 2003
Birmingham
PRIMIS Third National Conference Tuesday 1 April 2003
Birmingham
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
PRIMIS Third National Conference Tuesday 1 April 2003
Birmingham
What is Diabetes?
PRIMIS Third National Conference Tuesday 1 April 2003
Birmingham
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
PRIMIS Third National Conference Tuesday 1 April 2003
Birmingham
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
PRIMIS Third National Conference Tuesday 1 April 2003
Birmingham
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/
PRIMIS Third National Conference Tuesday 1 April 2003
Birmingham
Management of Diabetes
• 1 Insulin
• 2 Tablets
• 3 Diet
PRIMIS Third National Conference Tuesday 1 April 2003
Birmingham
Complications of Diabetes
• 1 Small blood vessels
• 2 Large blood vessels
• 3 Nerves
• 1/3 of Type II diabetics have a complication at diagnosis
PRIMIS Third National Conference Tuesday 1 April 2003
Birmingham
Complications of Diabetes:small blood vessels
• 1 Kidneys
• 1/3 of Type II diabetics have a complication at diagnosis
PRIMIS Third National Conference Tuesday 1 April 2003
Birmingham
Complications of Diabetes:small blood vessels
• 1 Kidneys
• 2 Eyes
• 1/3 of Type II diabetics have a complication at diagnosis
PRIMIS Third National Conference Tuesday 1 April 2003
Birmingham
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
PRIMIS Third National Conference Tuesday 1 April 2003
Birmingham
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
PRIMIS Third National Conference Tuesday 1 April 2003
Birmingham
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)
PRIMIS Third National Conference Tuesday 1 April 2003
Birmingham
Monitoring those at risk
• 1 Gestational diabetics
• 2 Impaired glucose tolerance or fasting glycaemia
• 3 Polycystic ovaries (+obesity)
Computers are a great potential help
PRIMIS Third National Conference Tuesday 1 April 2003
Birmingham
Actions to Prevent Diabetes
• 1 Eat a balanced diet
• 2 Lose weight
• 3 Increase physical activity
PRIMIS Third National Conference Tuesday 1 April 2003
Birmingham
High sugarLow sugar
HbA1c
PRIMIS Third National Conference Tuesday 1 April 2003
Birmingham
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
PRIMIS Third National Conference Tuesday 1 April 2003
Birmingham
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
PRIMIS Third National Conference Tuesday 1 April 2003
Birmingham
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
PRIMIS Third National Conference Tuesday 1 April 2003
Birmingham
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)
PRIMIS Third National Conference Tuesday 1 April 2003
Birmingham
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)
PRIMIS Third National Conference Tuesday 1 April 2003
Birmingham
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
PRIMIS Third National Conference Tuesday 1 April 2003
Birmingham
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
PRIMIS Third National Conference Tuesday 1 April 2003
Birmingham
• End