A population approach to Type 2 Diabetes Flashcards
There is higher prevalence in ethnic minority groups and poorer outcomes in d___ communities
deprived
Type 2 diabetes treatmount account for just under 9% of the annual NHS budget which is around £__ a year
£8.8 billion
_/10 cases of diabetes are preventable
9
What is one of the biggest risk factors of type 2 diabetes?
Obesity
The prevalence of severe o____ has increased since 1993 for both men and women
obesity
Death rates for diabetes ______ considerably between 2001 and 2018
declined
How can we reduce the impact of type 2 diabetes?
Identify people at risk of diabetes
Prevent diabetes via primary prevention
Diagnose sooner via secondary prevention
Effective management and supporting self-management via tertiary prevention
Lifestyle and environmental factors increasing risk of diabetes
Sedentary job, calorie dense food, few fruit and vegetables, pulses and wholegrains
Describe the 3 common factors promoting obesogenic environment
Physical environment - TV remote, lifts, car
Economic environment - cheap foods not fruit and veg, cheap TV watching
Sociocultural environment - family eating patterns, safety fears
“The runaway weight gain train”
Obesogenic environment is a steep slope
Knowledge, prejudice, physiology are ineffective brakes
Accelerated by psychological factors (stigma, self-blame), low socioeconomic status
Mechanisms that maintain overweight
Physical: more weight = more difficult to exercise. Dieting leads to metabolic response
Psychological: low self-esteem and guilt, comfort eating
Socioeconomic - reduced opportunities, employment, relationships, social mobility
Known risk factors that may be recorded in a clinical record to identify who is at risk
Age, sex, ethnicity, family history
Weight, BMI, waist circumference
History of gestational diabetes
Hypertension or vascular disease
Impaired Glucose Tolerance (IGT) or Impaired Fasting Glucose (IGF)
Are screening tests the same or different for “pre-diabetes” and diabetes?
The same
Currently available screening tests
HbA1c
Random capillary blood glucose
Random venous blood glucose
Fasting venous blood glucose
Oral glucose tolerance test (venous blood glucose 2 hours after oral glucose load)
Threshold for further testing: capillary or random test result is…
> 5.5 or 6 mmol/l
What is the diagnostic range for IGT
7.8-11.0 mmol/l
What is the diagnostic range for IFG?
6.1-6.9 mmol/l
According to WHO criteria, what is the diagnostic threshold for diabetes?
FBG > or = 7.0 or 2 hr Gluc > or = 11.1 mmol/l
Effective interventions to prevent diabetes include
1) sustained increase in physical activity
2) sustained change in diet
3) sustained weight loss
NICE guidance is focussing on ethnic minority and socio-economically deprived communities at increased risk to find c______ appropriate interventions
culturally
What are 3 ways to diagnose diabetes earlier
1) raise awareness and possible symptoms in community
2) raise awareness and symptoms in health professionals
3) use clinical records to identify those at risk and use blood tests to screen before symptoms develop
Current practice when screening is undertakne
As part of CHD prevention (every 5 years from 40-74 years)
At review of hypertension management
NICE guidance on preventing development of pre-diabetes
Focus on risk assessment followed by blood tests, cost-effective weight loss, diet and physical activity interventions
How is NHS England investing in Type 2 Diabetes prevention?
“Healthier You: The NHS Diabetes Prevention Programme”
Lifestyle education
Weight loss support
Group physical exercise
Supporting self-care for diabetes
Self monitoring (especially if on insulin)
Diet
Exercise
Drugs (support for taking medication)
Education
Peer support (Health Champions / Health Trainers)
