pre diabetes

7/13/2019 Pre Diabetes

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Produced by The Alfred Workforce Development Team

on behalf of DHS Public Health -

Diabetes Prevention and Management InitiativeJune 2005

Diabetes Prevention and

Early Detection

Best Practice Guidelines

An overview

Module 3.1


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DPMI Workforce Development

The Alfred Workforce Development Team June 2005

Presentation purpose

Target audience

Health professionals and project workers on DPMI projects

Aim

To aid in planning of stages 2 and 3 of DPMI projects

Objectives

Provide an overview of the prevention of diabetes

Discuss type 2 diabetes risk factors and screening Discuss prediabetes and implications in practice and for the

projects

Discuss IGT/IFG diagnosis, communicating risk to consumers andbest practice care projects.


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Prevention of diabetes

Recommendations to reduce risk of type 2 diabetes

Regular physical activity

Interventions to reduce obesity

Waist circumference, body weight and body mass index (BMI)identify individuals who should seek and be offered weight

management program

Individuals at risk should have dietary intake

assessed and receive individualised dietary advice

and continued dietetic support

Evidence Based Guideline for the Prevention of Type 2 Diabetes. Australian Government

NHMRC www.diabetesaustralia.com.au/education_info/nebg.html


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Prevention of diabetes

Recommendations to reduce risk of type 2 diabetes

Identification of women with GDM would allow:

Postnatal clinical interventions in those with diabetes

Option to use preventive methods to reduce the risk of

Type 2 diabetes

Diet and exercise education in children should include:

Parental involvement

Behavioural techniques

Evidence Based Guidelines for the Prevention of Type 2 Diabetes. Australian Government

NHMRC www.diabetesaustralia.com.au/education_info/nebg.html


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Screening for diabetes and risk factors

Active case detection and diagnosis of Type 2 diabetes should beconsidered for the following reasons:

Type 2 diabetes is serious and costly

Natural history includes asymptomatic phase which is not benign andduring which it can be diagnosed

Early treatment reduces morbidity from long term complications Case detection and diagnosis has a favourable risk:benefit ratio

NBOverall prevalence does not justify universal testing of theentire Australian adult population but rather opportunistic case

detection.Evidence Based Guideline for the case Detection and Diagnosis of Type 2 Diabetes.

Australian Government NHMRC www.diabetesaustralia.com.au/education_info/nebg.html


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Opportunistic case detection

Test high risk individuals People with IGT or IFG

Aboriginal and Torres Strait Islanders aged 35 years and over

Certain high risk non-English speaking background groups aged 35years and over (specifically Pacific Islander people, people from the Indian subcontinent

or of Chinese origin); People aged 45 years and over who have either or both of the

following risk factors: Obesity (BMI = 30 )

Hypertension;

All people with clinical cardiovascular disease (myocardial infarction,angina or stroke

Women with polycystic ovary syndrome who are obese.

Evidence Based Guideline for the case Detection and Diagnosis of Type 2 Diabetes.

Australian Government NHMRC www.diabetesaustralia.com.au/education_info/nebg.html


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The Alfred Workforce Development Team June 2005Evidence Based Guideline for the case Detection and Diagnosis of Type 2 Diabetes.Australian Government NHMRC www.diabetesaustralia.com.au/education_info/nebg.html


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Definition

Pre diabetes includes both

Impaired Glucose Tolerance

Impaired Fasting Glucose


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Pre diabetes

16% of population have pre diabetes

AusDiab Study (Dunstan et al, 2002)

Pre diabetes associated with

Increased risk of microvascular complications

Increase risk of microalbuminuria and neuropathy

(lower prevalence than diabetes but higher than general

population)

Increase risk of cancer breast, colon, liver and pancreas.

Increased risk of developing diabetes

Need to consider age: how relevant is IGT or IFG in a

person 75 years old?


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Does pre diabetes predict

diabetes?

Impaired Fasting Glucose

11 year follow up

IGT

17%

IFG

7%

Normal

38%Diabetes

Impaired glucose Tolerance

11 year follow up

IGT

30%

Normal

24%

Diabetes

46%

Progression of IGT/IFG to diabetes in 11 year follow upPresentation Stephen Twigg. Pre diabetes SymposiumADS & ADEA Annual Scientific Meeting Sydney 2004


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Interventions

Increased physical activity and weight

loss can reduce risk of type 2 diabetes

?Reduce cardiovascular risk

Need to focus on follow up and review

given high risk of developing diabetes

Need to encourage ongoing review and

management of CVD risk factors


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Communicating risk to consumers

Is it a condition vs risk factor?

What is the name of the condition? Will thename influence how seriously consumers view it

i.e. pre diabetes vs impaired glucose tolerance. No label may mean not taken seriously

No label may mean no intervention. No followup

Implications for individuals if labelled with acondition where approx 1/3 will revert back tonormal.


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How is pre diabetes managed in

general practice?

Mapping exercise (Div of GP Perth)

GP audit. Nearly 1/3 of patient with prediabetes had not

had a blood glucose test in the past 12 months

Waist circumference was only recorded for 10%patients

50% had their weight recorded

Lipids and BP were recorded in almost all patients

( not sure how often)Presentation by A Derbyshire. ADS & ADEA Annual Scientific Meeting Sydney 2004


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DPMI Workforce Development The Alfred Workforce Development Team June 2005

Primary care management of Type 2

diabetes

GP Focus Groups GPs reluctant to pursue aggressive case finding

GPs dont involve other HPs in management of prediabetes

Most follow up is oppurtunistic No recall systems

Patient characteristics such as motivation, lack ofunderstanding were seen as the greatest barriers

to managing pre diabetes in GP practice

Presentation by Kaye NeylonADS & ADEA Annual Scientific Meeting Sydney 2004


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DPMI Workforce Development The Alfred Workforce Development Team June 2005

Group education for Impaired Glucose

Tolerance - does it work?

ACT Diabetes Service

Referred clients (n=34) with IGT/IFG attended 2 group ed sessions(1 hr nutrition/ 1 hr information) asked to identify possiblelifestyle modifications.

Responses

- 79% exercise - 59% weight loss,- 5% smoking cessation - 5% stress reduction.

6 month telephone follow up (78% response) reported lifestylechanges implemented and maintained

- 68% exercise - 56 % dietary changes

- 50% weight loss - 5% stress reduction- 0% smoking cessation.

- Presentation by W.R MossmanADS & ADEA Annual Scientific Meeting Sydney 2004

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