A population approach to Type 2 Diabetes

Question 1

There is higher prevalence in ethnic minority groups and poorer outcomes in d___ communities

Answer 1

deprived

Question 2

Type 2 diabetes treatmount account for just under 9% of the annual NHS budget which is around £__ a year

Answer 2

£8.8 billion

Question 3

_/10 cases of diabetes are preventable

Answer 3

9

Question 4

What is one of the biggest risk factors of type 2 diabetes?

Answer 4

Obesity

Question 5

The prevalence of severe o____ has increased since 1993 for both men and women

Answer 5

obesity

Question 6

Death rates for diabetes ______ considerably between 2001 and 2018

Answer 6

declined

Question 7

How can we reduce the impact of type 2 diabetes?

Answer 7

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

Question 8

Lifestyle and environmental factors increasing risk of diabetes

Answer 8

Sedentary job, calorie dense food, few fruit and vegetables, pulses and wholegrains

Question 9

Describe the 3 common factors promoting obesogenic environment

Answer 9

Physical environment - TV remote, lifts, car

Economic environment - cheap foods not fruit and veg, cheap TV watching

Sociocultural environment - family eating patterns, safety fears

Question 10

“The runaway weight gain train”

Answer 10

Obesogenic environment is a steep slope

Knowledge, prejudice, physiology are ineffective brakes

Accelerated by psychological factors (stigma, self-blame), low socioeconomic status

Question 11

Mechanisms that maintain overweight

Answer 11

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

Question 12

Known risk factors that may be recorded in a clinical record to identify who is at risk

Answer 12

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)

Question 13

Are screening tests the same or different for “pre-diabetes” and diabetes?

Answer 13

The same

Question 14

Currently available screening tests

Answer 14

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)

Question 15

Threshold for further testing: capillary or random test result is…

Answer 15

> 5.5 or 6 mmol/l

Question 16

What is the diagnostic range for IGT

Answer 16

7.8-11.0 mmol/l

Question 17

What is the diagnostic range for IFG?

Answer 17

6.1-6.9 mmol/l

Question 18

According to WHO criteria, what is the diagnostic threshold for diabetes?

Answer 18

FBG > or = 7.0 or 2 hr Gluc > or = 11.1 mmol/l

Question 19

Effective interventions to prevent diabetes include

Answer 19

1) sustained increase in physical activity

2) sustained change in diet

3) sustained weight loss

Question 20

NICE guidance is focussing on ethnic minority and socio-economically deprived communities at increased risk to find c______ appropriate interventions

Answer 20

culturally

Question 21

What are 3 ways to diagnose diabetes earlier

Answer 21

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

Question 22

Current practice when screening is undertakne

Answer 22

As part of CHD prevention (every 5 years from 40-74 years)

At review of hypertension management

Question 23

NICE guidance on preventing development of pre-diabetes

Answer 23

Focus on risk assessment followed by blood tests, cost-effective weight loss, diet and physical activity interventions

Question 24

How is NHS England investing in Type 2 Diabetes prevention?

Answer 24

“Healthier You: The NHS Diabetes Prevention Programme”
Lifestyle education
Weight loss support
Group physical exercise

Question 25

Supporting self-care for diabetes

Answer 25

Self monitoring (especially if on insulin)
Diet
Exercise
Drugs (support for taking medication)
Education
Peer support (Health Champions / Health Trainers)