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