Practical Implementation Tips: Type 2 Diabetes (T2Dm).
922 WordsApr 3, 20174 Pages
Practical Implementation Tips: Type 2 Diabetes (T2DM)
1. Identify those at high risk of T2DM on your practice register
The State of the nation 2016 (England): time to take control of diabetes1 report from Diabetes UK warns us that 5 million people in England are at high risk of developing T2DM. We have high quality evidence from several international diabetes prevention studies2 that early lifestyle intervention can reduce both long-term progression to T2DM, and long-term incidence of cardiovascular & all-cause mortality. Based on this evidence, the NHS Diabetes Prevention Programme3 was launched during 2016 to provide individualised lifestyle support for those at high risk of T2DM.
NICE Public Health Guidance 38 “Prevention of T2DM…show more content…
If repeat test is also >48mmol/mol, then a diagnosis of T2DM can be established o If HbA1c 42-47mmol/mol this suggests high risk of diabetes; follow flowchart above o If HbA1c 30kg/m2
• Previous macrosomic baby weighing >4.5kg
• A family history of diabetes (1st degree relative with diabetes)
• A minority ethnic background with a high prevalence of diabetes (e.g. South or East Asian, Middle Eastern, Afro-Caribbean, Hispanic)
• Previous GDM
• 2+ glycosuria on antenatal screening (or 1+ on two or more occasions during pregnancy)
NICE NG3 Diabetes in Pregnancy11 recommend we diagnose GDM as follows:
• A FBG ≥5.6mmol/l or a 2-hour blood glucose post 75g oral glucose tolerance test ≥7.8mmol/l
• As you can see, these thresholds are much lower than we would use to diagnose T2DM in the non-pregnant individual; we need to ensure that we do not miss this significant diagnosis
GDM greatly increases the risk of future T2DM12, however, many women with GDM are unfortunately lost to follow-up after pregnancy, often understandably due to busy family lives13.
NICE NG3 Diabetes in Pregnancy11 recommend we follow-up those with GDM as follows:
• Offer lifestyle advice and check a FBG at 6-13 weeks after birth in those women with GDM. Do not routinely offer an oral glucose tolerance test o Pragmatically, this could comprise part of the routine 6-week post-partum check
• If the FBG is ≥7mmol/l, a diagnosis of T2DM can be