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…. People with diabetes can’t lead Should you normal lives be having that cake? People with diabetes will Type 1 eventually is worse go blind than Eating sugar type 2 gives you diabetes People with diabetes I have mild need to eat diabetes diabetic foods

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 taken up into cells to be Insulin burnt as fuel released Glucose level goes up ( carbohydrate /liver) Glucose Brain level falls needs Glucagon Insulin fuel / release adrenalin stopped 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 Eye Disease Stroke Kidney - leaking Erectile dysfunction protein Diabetic Peripheral Nerve Arterial Damage Disease - 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 HbA1c – measure of diabetes control 1. Urine ACR 2. Cholesterol 3. Kidney function 4. Feet – pulses, sensation 5. Blood Pressure 6. Retinal Screening 7. Weight 8. Smoking 9.

Blood Retinal Pressure Screening Cholesterol Smoking HBA1 Creatinine (blood test) c Urine ACR Foot exam Foot exam - Sensation - pulses

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 1990s onwards.. GLUCOSE SENSOR INSULIN PUMP

Insulin pump therapy  Delivers insulin continuously  Adjust rate that insulin is delivered  Flexibility

Closed loop / artificial pancreas

Transplants  Whole pancreas  Islet cells

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?

Diabetes Practice Education nurse for annual Podiatrist review Hunter St Hospital podiatry Community diabetes Sees GP specialist nurses for insulin Stays in hospital clinic DSN thinks BOB victoza would be 52 yrs better Worried about Sends back weight to GP Referred to dietitian Retinal screen at local Drummond Street walk-in GP refers centre to hospital DSN Annual Seen in hospital review hospital

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?