Diabetes Update 6 May 2014 Sarita Naik Consultant in Diabetes and - - PowerPoint PPT Presentation

Members ‘Sweet Meet’ Diabetes Update

6 May 2014

Sarita Naik Consultant in Diabetes and Endocrinology

Some of the myths….

Should you be having that cake?

Type 1 is worse than type 2

Eating sugar gives you diabetes

People with diabetes will eventually go blind I have mild diabetes People with diabetes need to eat diabetic foods

People with diabetes can’t lead normal lives

How many people have diabetes?

• Globally
• 366 million (double over next 20 years)
• UK
• 4.45%
• 2.9 million people
• 850, 000 undiagnosed
• 10% type 1
• 90% type 2

What does the pancreas do?

• Insulin
• Glucagon
• Digestives

enzymes

How is glucose regulated in the body?

Glucose level goes up ( carbohydrate /liver) Insulin released Glucose taken up into cells to be burnt as fuel Glucose level falls Brain needs fuel Insulin release stopped

Glucagon / adrenalin e stimulate s glucose release

• But…
• Weight gain
• Genetics
• Environmental triggers
• Pancreatic damage/surgery
• Pancreas affected

What is type 1 diabetes?

• Autoimmune – antibodies destroy the pancreatic cells

producing insulin/glucagon

• Dependent on insulin treatment to control blood glucose

levels

• Younger age

What is type 2 diabetes?

• Insulin resistance
• Associated with weight gain
• Fat cells release chemicals that increase

insulin resistance

• Pancreas compensates and releases more

insulin to control blood glucose

What are the risks for type 2 diabetes?

• Over age 40 (25 South Asian)
• Close family member with diabetes
• Overweight with a large waist size (over 31.5 inches for

women/37 inches for men)

• Medication – steroids, antipsychotics
• Pre-diabetes

What are the complications of diabetes?

Heart Disease Stroke Peripheral Arterial Disease

Kidney

• leaking

protein Eye Disease

Erectile dysfunction Diabetic Nerve Damage

• Pain
• numbnes

s

But the good news is..

• Complications progress slowly
• Screen – identify early
• Improving glucose control – delay or prevent

progression

• NINE CARE PROCESSES

Nine care processes

1.

HbA1c – measure of diabetes control

2.

Urine ACR

3.

Cholesterol

4.

Kidney function

5.

Feet – pulses, sensation

6.

Blood Pressure

7.

Retinal Screening

8.

Weight

9.

Smoking

Blood Pressure Cholesterol Smoking Foot exam

• pulses

Creatinine (blood test) Urine ACR Retinal Screening

Foot exam

• Sensation

HBA1 c

Diabetes control

• HbA1c – measure of glucose levels over 2-3months
• Type 2
• Oral medications
• Injectable treatment
• Insulin
• Type 1
• insulin

Discovery of Insulin – Banting and Best (and Marjorie)

Leonard Thompson – first patient to receive insulin treatment (1920s)

1960s

1980s

Mid 1980s

What are the barriers to good diabetes control?

Barrier 1: Hypoglycaemia Blood glucose level < 3.5

Hypoglycaemia

• Frightening, loss of control
• Recurrent hypos
• Body adjusts
• Blunted hormone response
• Lose awareness of hypos
• Severe hypos – conscious levels impaired, needing assistance, fits

What is the second barrier?

Elliot P Joslin

Self-management

• Joslin considered to be father of ‘self-management’
• Informed, good diabetes education
• Be able to make choices about medication
• Plan your care in collaboration

DAFNE

• Education programme (type

1 diabetes)

• Carbohydrate counting

(matching insulin dose to carbohydrate)

• Peer support

Psychological Support

But can newer treatments help with hypoglycaemia and self-management?

CONTINUOUS GLUCOSE SENSOR

INSULIN PUMP

1990s onwards..

Insulin pump therapy

• Delivers insulin continuously
• Adjust rate that insulin is delivered
• Flexibility

Closed loop / artificial pancreas

Transplants

• Islet

cells

• Whole pancreas

Islet cell transplants

Islet cell transplants

• Seven centres in the UK
• Insulin independence rate of 25% at 5 years
• Reduction in severe hypoglycaemia
• Anti-rejection medication
• Excess risk of cancer
• infection

But what about type 2 diabetes?

Sees GP DSN thinks victoza would be better Community diabetes specialist nurses for insulin Stays in hospital clinic Hospital podiatry Podiatrist Hunter St Sends back to GP GP refers to hospital

BOB 52 yrs

Retinal screen Drummond Street Referred to dietitian at local walk-in centre Worried about weight Seen in hospital Practice nurse for annual review Annual review DSN hospital Diabetes Education

What are the current problems?

• Missing out on nine care processes
• Duplication
• System difficult to navigate
• Multiple visits to different healthcare professionals
• Mixed messages

Integrated system

• Patient centred
• No duplication
• All patients receiving 9 care processes
• Appropriate healthcare professional at the right time

• Camden
• Camden CCG
• Camden Community Diabetes
• Royal Free
• Islington
• Islington CCG
• Islington Community Diabetes

Nurses

• Whittington
• Value based commissioning
• Commission services
• Best outcomes for patients
• efficient

What does that mean for staff?

• GPs and practice nurses
• Receive better education
• Practice visits from diabetes consultants
• Same message
• Multi-disciplinary team meetings
• Include social, mental health support
• Better communication between all HCP
• Closer working with community diabetes team

What does that mean for you?

• Flexible education programmes
• Good diabetes care from your GP/community nurses
• Quick access to hospital services if you need them

• Better diabetes control
• Better self-management skills
• Less complications
• Better quality of life

To summarise:

• Diabetes is increasing
• Diabetes
• Type 1 and type 2
• Associated with significant complications
• Complications of treatment eg hypoglycaemia
• Integrated care is the best care

Thank you for listening. Any questions?