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Koombana diabetes education
 

Koombana diabetes education

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An overview of diabetes education in a general practice setting.

An overview of diabetes education in a general practice setting.

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  • 486 sessions were provided in the last calender year(increase of 73%) to 233 patients ( increase of 36%).
  • These recommended targets come from ADS. Note the patient factors impacting on recommended targets. Long term advantages of intensifying HbA1c% - microvascular benefits (1% reduction in HbA1c% there is a 37% microvascular lowering). - macrovascular – legacy effect Any diabetes-related complication or diabetes-related death by 21% and all cause mortality or myocardial infarction by 14%. Helen fits into short duration, no clinical cardiovascular disease and requires glucose lowering therapy - <6.5% Notice the reporting of HbA1c units. Units have changed to be reported in SI units which is mmol/mol dual reporting will occur until July 2013. SI units reference method is more specific for HbA1c and is more analytically robust (less possible error). The SI method is more specific for HbA1c and does not measure several other haemoglobin sugar complexes so the results are 10-40% lower than those from National glycohaemoglobin standardisation program (NGSP). Also removes confusion between HbA1c % and actual blood glucose values in mmol/L. What are the long term advantages of maintaining Helen’s glycaemic control at target levels? (next slide)
  • Given the importance of BP and lipid management to reduce CVD, National Vascular Disease Prevention Alliance guidelines suggest treating all patients with diabetes according to CV risk. Looking at Helen’s management now, how would you assess her CV risk to best direct treatment? Mention Australian CV risk chart – no need to measure Helen because she is at high risk (over 60 with diabetes). Do you ever use the risk calculator as an education tool? These NVDPA guidelines came out mid 2012. They are a conglomerate of Diabetes Australia, Kidney Health Australia, Stroke Foundation and National Heart Foundation. Some of the targets have changed and these are reflected in the table on the slide. (BP, cholesterol) Are you aware of the changes? And how does/would this impact on your practice? How could you assist Helen in increasing her adherence to her antihypertensive and cholesterol medicines? Other than for BP management, why is ramipril an appropriate antihypertensive for Helen? Would you increase the dose? Would you suggest Helen be commenced on aspirin? So, now we have managed her CV risk, What are your thoughts on tightening Helen’s glycaemic control remembering she has a current HbA1c of 8.1% ?

Koombana diabetes education Koombana diabetes education Presentation Transcript

  • The Journey to Diabetes Education Nicole Frayne BPharm, MPS, AACPA, CDE
  • Why Diabetes?
  • The epidemic continues to grow
  • Diabetes Clinics -KHN Funded under Australian Governments Rural Health Primary Services Program. Provides one to one educational sessions in Gp practices and at KHN.
  • Diabetes Referrals
  • Medication Use in Type 2
  • Outcomes HbA1c% improvements : 20% receiving multiple sessions, 15% had marked improvements in HbA1c% Overcomes barriers of EPC referrals One to one education sessions. Multidisciplinary relationships established.
  • Journey to Credentialling Postgraduate certificate in diabetes education. 1800 hours of clinical practice in the area of diabetes. Application to ADEA submitting evidence.
  • 2013 to 2014 Extension of services Evaluation of services (formal)
  • What is new?
  • HbA1c Reporting
  • Recommended HbA1c targets Clinical Situation HbA1c target mmol/mol (%) General target ≤ 53 (7.0) Specific clinical situations Diabetes of short duration & no clinical cardiovascular disease Requiring lifestyle modification ± metformin ≤ 42 (6.0) Requiring any anti-diabetic agents other than metformin or insulin ≤ 48 (6.5) Requiring insulin ≤ 53 (7.0) Pregnancy or planning pregnancy ≤ 42 (6.0) Diabetes of longer durationor clinical cardiovascular disease ≤ 53 (7.0) Recurrent severe hypoglycaemia or hypoglycaemia unawareness ≤ 64 (8.0) Patients with major co-morbiditieslikely to limit life expectancy Symptomatic Aust. diabetes society position statement: individualization of HbA1c targets for adults with diabetes mellitus. Sydney: Australian Diabetes Society, 2009
  • Address blood pressure & lipids as a priority Modified from National Vascular disease Prevention Alliance Guidelines for the management of absolute cardiovascular risk, 2012 (see NPS leaflet)
  • Questions?