Primary Care DM management

Question 1

core clinical problems

Answer 1

obesity 
thirst
weight loss
tiredness
unhealthy lifestyles 
abnormal blood results 
collapse 
abdominal pain

Question 2

who should be screened in primary care for T2DM?

Answer 2

high risk groups should be screened once a year for a fasting venous (plasma) glucose measurement

• impaired glucose tolerance
• impaired fasting glycaemia
• past history of gestational diabetes

high risk groups who should be screened opportunistically

• non-caucasian
• family history of T2DM
• obese (esp. central adiposity)
• women with PCOS

Question 3

what presentation should diabetes diagnosis be considered for?

Answer 3

thirst and polyuria
unexplained weight loss or tiredness
pruritus vulvae, balanitis or recurrent UTIs
recurrent infections
blurring of vision (usually an osmotic and not permanent)
discoloured or ulcerated feet
acutely unwell - vomiting/ abdominal pain (children)

Question 4

diagnose diabetes if?

Answer 4

classical symptoms + either random (>/= 11.1 mmol/L) or fasting glucose (>/=7.0 mmol/L) venous plasma conc. 
no symptoms (incidental finding), do additional testing (don't just diagnose based on one measurement 
if ketouria present with severe symptoms (vomiting and dehydration - urgent hospital admission needed) or mild symptoms and weight loss (insulin therapy?)

Question 5

what cases should be referred to secondary care?

Answer 5

T1DM (urgent) 
patients with low/normal BMI 
children 
pregnant/planning a pregnancy 
pre-existing chronic renal impairment 
consider referral if patient is under 40 and diagnosed with T2DM (esp. if strong family history of diabetes)
specific clinical concern

Question 6

what is the mental health aspect of diabetes?

Answer 6

depression is more common in people with diabetes than the general population (remission of depression is often associated with better glycaemic control)