Vital diabetes : your essential reference for diabetes management in primary care

Introduction 3 1 The impact of living with type 2 diabetes 8 2 Insights into type 2 diabetes 11 United Kingdom Prospective Diabetes Study (UKPDS) 11 Prevalence and Incidence of Type 2 Diabetes in the UK 12 Primary Care Diabetes – A National Survey 13 The Heart Protection Study 14 3 National Service Frameworks and NICE 16 Standards 16 Implementation of the NSF 18 The National Institute for Clinical Excellence 19 4 Screening and identification 22 Prevalence and screening 22 Identification 23 Where and how people present in primary care 25 Diagnostic criteria 26 Impaired fasting glucose and impaired glucose tolerance 27 Criteria for referral 28 Breaking the news 29 Patient and carer information: what is diabetes? 30 5 Early management of type 2 diabetes 32 The metabolic syndrome 32 Hypertension 33 Assessing and examining the newly diagnosed patient 35 Patient and carer information: first steps 38 What to do next: ongoing management plan 39 Patient and carer information: ongoing management 42 Contents 5 Contents 6 Educating patients about managing type 2 diabetes 43 Myths and misconceptions 43 Encouraging self-management 43 Education checklist: the primary care team 44 Cultural issues 45 Patient and carer information: lifestyle issues 46 7 Longer term management of type 2 diabetes 51 Targets for good blood glucose control 51 Treatment plan for type 2 diabetes 52 Treatment with tablets 53 8 How to control blood glucose levels 59 Understanding hyperglycaemia 59 Patient and carer information: monitoring your diabetes 61 Understanding hypoglycaemia 63 Patient and carer information: hypoglycaemia 63 9 How to reduce long-term complications of diabetes 65 Heart and major vessel disease 65 Patient and carer information: looking after your heart 66 Feet 67 Patient and carer information: looking after your feet 70 Diabetic retinopathy 71 Patient and carer information: looking after your eyes 72 Diabetic nephropathy 74 Autonomic neuropathy and sexual dysfunction 75 Patient and carer information: sexual issues 76 Impact of the menopause: recommendations 76 10 How to manage type 1 diabetes 77 Presentation and diagnosis 77 Dose Adjustment for Normal Eating (DAFNE) 78 Children and young people: main issues 78 11 How to manage pregnancy and gestational diabetes 80 Pregnant women with diabetes 80 Gestational diabetes mellitus (GDM) 81 6 Vital Diabetes 12 Living with diabetes 82 Patient and carer information:immunisation 82 Patient and carer information: dental care 82 Family planning advice (for women) 83 Patient and carer information: driving 83 Patient and carer information: occupational licences 84 Patient and carer information: travelling abroad 84 Patient and carer information: life insurance 85 13 Emergencies and illness 86 Emergencies 86 Patient and carer information: what to do when you’re ill 88 Important Rules 88 14 Diabetes care and general practice 89 Practice and shared protocols 89 Audit and quality control monitoring 89 The primary health care team 91 Appendix 1: Blood glucose self-monitoring 93 Appendix 2: Specimen agreed protocols with secondary care 96 Appendix 3: The GP Contract: Clinical Quality indicators for diabetes 100 Glossary of terms 102 Resources 105 Self help for the primary care team 105 Useful reports/key references 106 Useful publications 106 Companies and organisations 109 Insurances, finance and pensions 110 Feedback Form 111 Priority Order Form 112