Providing Diabetes Care in General Practice: A Practical Guide to Integrated Care

Contents......Page 6
About the author......Page 8
Foreword......Page 10
Acknowledgements......Page 11
Introduction......Page 14
Part I Diabetes: an overview......Page 16
Prevalence and incidence......Page 18
The consequences of diabetes: microvascular complications......Page 21
The consequences of diabetes: macrovascular complications......Page 24
Life expectancy and mortality rates......Page 25
Impact of diabetes on the individual......Page 26
The aims of diabetes care......Page 28
How is diabetes care organised in the UK?......Page 29
The role of the specialist team......Page 30
Diabetes UK......Page 37
SUMMARY......Page 39
References......Page 40
Further reading......Page 42
The general practitioner......Page 43
The practice nurse and community (district) nurse......Page 45
The team approach to integrated diabetes care......Page 49
New ways of working in primary care diabetes......Page 50
SUMMARY......Page 53
References......Page 54
Further reading......Page 55
3 The General Medical Services contract and practice-based commissioning......Page 56
How to gain points and improve diabetes care......Page 58
QOF points explained......Page 61
Nurses in the GMS contract......Page 65
References......Page 66
Further reading......Page 67
4 The educational needs of the team......Page 68
Diabetes education for the primary care team – what is available?......Page 70
Diabetes education for the primary healthcare team – what is needed?......Page 74
Further reading......Page 75
Part II Providing diabetes care......Page 76
How to set up a system of care......Page 78
The General Medical Services contract......Page 80
Planning the service......Page 81
Organisation of the service......Page 83
Who might be offered the practice diabetes service?......Page 84
Who will be involved in the provision of the practice diabetes service?......Page 85
Ideal facilities for the diabetes service......Page 87
Essential equipment: screening and monitoring......Page 89
Resources for diabetes education......Page 91
Materials for organising and recording information......Page 92
Further reading......Page 93
Advertising the practice diabetes service......Page 94
Diabetes registers......Page 95
Links with specialist services......Page 98
7 The diagnosis and symptoms of diabetes mellitus......Page 101
Public awareness of diabetes......Page 104
Who should we screen?......Page 105
Diagnosis of diabetes mellitus......Page 107
References......Page 111
8 Providing the service......Page 112
Initial explanation of diabetes and provision of psychological support......Page 113
Initial treatment and care......Page 114
Example of criteria for specialist referral......Page 120
Sample protocol for performing a routine review......Page 121
Sample protocol for performing an annual review......Page 122
Recall and follow-up......Page 123
References......Page 127
The background......Page 128
Types of nurse prescriber......Page 130
Supplementary prescribing......Page 131
Patient group directions......Page 135
Websites......Page 136
Aims of treatment......Page 137
Starting treatment (type 2 diabetes)......Page 139
Dietary recommendations for people with diabetes......Page 144
Activity for health......Page 151
Glycaemic index......Page 152
Further reading......Page 155
Oral medication......Page 156
Insulin therapy......Page 168
References......Page 188
Further reading......Page 189
The benefits of monitoring......Page 190
Blood glucose control......Page 192
High blood glucose levels (hyperglycaemia)......Page 193
Low blood glucose levels (hypoglycaemia, ‘hypo’)......Page 198
Self-monitoring of blood glucose......Page 200
References......Page 207
Further reading......Page 208
13 Eye care and screening......Page 209
Features of an acceptable national programme: an integrated pattern of care......Page 211
The role of the primary care team......Page 212
Visual acuity......Page 214
Opticians/optometrists......Page 216
Cataracts......Page 217
Laser treatment/therapy......Page 218
Further reading......Page 220
14 Foot care and surveillance......Page 221
What foot care should be provided by the primary care team?......Page 227
The diabetic foot......Page 228
Examination of the feet......Page 231
Identification of people at risk of diabetic foot problems......Page 235
Treatment......Page 236
Further reading......Page 240
15 Aspects of culture relating to diabetes care......Page 241
Diabetes prevalence and complications......Page 242
The effect of diabetes in ethnic communities......Page 243
Barriers to effective communication......Page 244
Religions......Page 249
African/Caribbean populations......Page 256
Providing diabetes care......Page 257
Further resources......Page 259
Further reading......Page 260
16 Structured patient education......Page 261
Key criteria......Page 262
Living with diabetes......Page 267
Further reading......Page 278
17 Personal diabetes records and care plans......Page 279
What is a care plan?......Page 280
References......Page 282
After confirmation of diagnosis......Page 294
Further reading......Page 307
19 Auditing care......Page 308
DiabetesE......Page 311
The National Diabetes Audit......Page 312
Further reading......Page 315
Part III About diabetes......Page 316
Classification and types......Page 318
History......Page 319
Further reading......Page 321
21 Type 1 diabetes mellitus......Page 322
The causes of type 1 diabetes......Page 323
Further reading......Page 324
22 Type 2 diabetes mellitus......Page 325
Diagnosis......Page 327
References......Page 328
Further reading......Page 329
Impaired glucose tolerance (Unwin et al, 2002)......Page 330
Gestational diabetes mellitus......Page 331
Further reading......Page 334
24 Complications of diabetes......Page 335
Macrovascular complications......Page 337
Microvascular complications......Page 342
Chronic kidney disease......Page 347
Association with other conditions......Page 351
References......Page 356
Further reading......Page 357
Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance......Page 359
UK Prospective Diabetes Study......Page 360
Primary Care Diabetes – a National Survey......Page 364
The Hypertension Optimal Treatment study......Page 365
The DECODE Study Group......Page 366
Anglo-Scandinavian Cardiac Outcomes Trial......Page 368
Heart Protection Study......Page 369
Appendices......Page 372
What care you should expect from your diabetes care team......Page 374
Annual review checklist......Page 378
Primary Care Diabetes Society (www.pcdsociety.org)......Page 381
Diabetes Research and Wellness Foundation (www.drwf.org.uk)......Page 382
Patient UK (www.patient.co.uk)......Page 383
Insulin Dependent Diabetes Trust (www.iddtinternational.org)......Page 384
Aims of diabetes care......Page 385
Provision of diabetes care......Page 387
Skills required to provide care for people with diabetes in primary care......Page 389
Planning mechanisms across the nations......Page 391
Diabetes UK......Page 393
Education......Page 395
Useful books for the primary care team......Page 398
Useful reports/papers......Page 399
Useful websites......Page 402
Diabetes UK publications......Page 403
Journals......Page 405
Companies......Page 407
Diabetes-focused organisations for professionals......Page 410
Patient support organisations......Page 412
Hypoglycaemia......Page 416
Diabetic ketoacidosis......Page 419
Hyperglycaemic hyperosmolar non-ketotic coma......Page 420
General advice (‘sick day rules’)......Page 421
Glossary......Page 423
Index......Page 428