Produced by The Alfred Workforce Development Team
on behalf of DHS Public Health -
Diabetes Prevention and Management Initiative
June 2005
Diabetes Prevention and
Early Detection
Best Practice Guidelines
An overview
Module 3.1
DPMI Workforce Development The Alfred Workforce Development Team June 2005
Presentation purpose
Target audience
Health professionals and project workers on DPMI projects
Aim
To aid in planning of stages 2 and 3 of DPMI projects
Objectives
Provide an overview of the prevention of diabetes
Discuss type 2 diabetes risk factors and screening
Discuss prediabetes and implications in practice and for the
projects
Discuss IGT/IFG diagnosis, communicating risk to consumers and
best practice care projects.
DPMI Workforce Development The Alfred Workforce Development Team June 2005
Prevention of diabetes
Recommendations to reduce risk of type 2 diabetes
Regular physical activity
Interventions to reduce obesity
Waist circumference, body weight and body mass index (BMI)
identify individuals who should seek and be offered weight
management program
Individuals at risk should have dietary intake
assessed and receive individualised dietary advice
and continued dietetic support
Evidence Based Guideline for the Prevention of Type 2 Diabetes. Australian Government
NHMRC www.diabetesaustralia.com.au/education_info/nebg.html
DPMI Workforce Development The Alfred Workforce Development Team June 2005
Prevention of diabetes
Recommendations to reduce risk of type 2 diabetes
Identification of women with GDM would allow:
Postnatal clinical interventions in those with diabetes
Option to use preventive methods to reduce the risk of
Type 2 diabetes
Diet and exercise education in children should include:
Parental involvement
Behavioural techniques
Evidence Based Guidelines for the Prevention of Type 2 Diabetes. Australian Government
NHMRC www.diabetesaustralia.com.au/education_info/nebg.html
DPMI Workforce Development The Alfred Workforce Development Team June 2005
Screening for diabetes and risk factors
Active case detection and diagnosis of Type 2 diabetes should be
considered for the following reasons:
Type 2 diabetes is serious and costly
Natural history includes asymptomatic phase which is not benign and
during which it can be diagnosed
Early treatment reduces morbidity from long term complications
Case detection and diagnosis has a favourable risk:benefit ratio
NB Overall prevalence does not justify universal testing of the
entire Australian adult population but rather opportunistic case
detection.
Evidence Based Guideline for the case Detection and Diagnosis of Type 2 Diabetes.
Australian Government NHMRC www.diabetesaustralia.com.au/education_info/nebg.html
DPMI Workforce Development The Alfred Workforce Development Team June 2005
Opportunistic case detection
Test high risk individuals
People with IGT or IFG
Aboriginal and Torres Strait Islanders aged 35 years and over
Certain high risk non-English speaking background groups aged 35
years and over
(specifically Pacific Islander people, people from the Indian subcontinent
or of Chinese origin);
People aged 45 years and over who have either or both of the
following risk factors:
Obesity (BMI = 30 )
Hypertension;
All people with clinical cardiovascular disease (myocardial infarction,
angina or stroke
Women with polycystic ovary syndrome who are obese.
Evidence Based Guideline for the case Detection and Diagnosis of Type 2 Diabetes.
Australian Government NHMRC www.diabetesaustralia.com.au/education_info/nebg.html
DPMI Workforce Development The Alfred Workforce Development Team June 2005
Evidence Based Guideline for the case Detection and Diagnosis of Type 2 Diabetes.
Australian Government NHMRC www.diabetesaustralia.com.au/education_info/nebg.html
DPMI Workforce Development The Alfred Workforce Development Team June 2005
Definition
Pre diabetes includes both
Impaired Glucose Tolerance
Impaired Fasting Glucose
DPMI Workforce Development The Alfred Workforce Development Team June 2005
Pre diabetes
16% of population have pre diabetes
AusDiab Study (Dunstan et al, 2002)
Pre diabetes associated with
Increased risk of microvascular complications
Increase risk of microalbuminuria and neuropathy
(lower prevalence than diabetes but higher than general
population)
Increase risk of cancer breast, colon, liver and pancreas.
Increased risk of developing diabetes
Need to consider age: how relevant is IGT or IFG in a
person 75 years old?
DPMI Workforce Development The Alfred Workforce Development Team June 2005
Does pre diabetes predict
diabetes?
Impaired Fasting Glucose
11 year follow up
IGT
17%
IFG
7%
Normal
38%
Diabetes
Impaired glucose Tolerance
11 year follow up
IGT
30%
Normal
24%
Diabetes
46%
Progression of IGT/IFG to diabetes in 11 year follow up
Presentation Stephen Twigg. Pre diabetes Symposium ADS & ADEA Annual Scientific Meeting Sydney 2004
DPMI Workforce Development The Alfred Workforce Development Team June 2005
Interventions
Increased physical activity and weight
loss can reduce risk of type 2 diabetes
?Reduce cardiovascular risk
Need to focus on follow up and review
given high risk of developing diabetes
Need to encourage ongoing review and
management of CVD risk factors
DPMI Workforce Development The Alfred Workforce Development Team June 2005
Communicating risk to consumers
Is it a condition vs risk factor?
What is the name of the condition? Will the
name influence how seriously consumers view it
i.e. pre diabetes vs impaired glucose tolerance.
No label may mean not taken seriously
No label may mean no intervention. No follow
up
Implications for individuals if labelled with a
condition where approx 1/3 will revert back to
normal.
DPMI Workforce Development The Alfred Workforce Development Team June 2005
How is pre diabetes managed in
general practice?
Mapping exercise (Div of GP Perth)
GP audit.
Nearly 1/3 of patient with prediabetes had not
had a blood glucose test in the past 12 months
Waist circumference was only recorded for 10%
patients
50% had their weight recorded
Lipids and BP were recorded in almost all patients
( not sure how often)
Presentation by A Derbyshire. ADS & ADEA Annual Scientific Meeting Sydney 2004
DPMI Workforce Development The Alfred Workforce Development Team June 2005
Primary care management of Type 2
diabetes
GP Focus Groups
GPs reluctant to pursue aggressive case finding
GPs dont involve other HPs in management of pre
diabetes
Most follow up is oppurtunistic
No recall systems
Patient characteristics such as motivation, lack of
understanding were seen as the greatest barriers
to managing pre diabetes in GP practice
Presentation by Kaye Neylon ADS & ADEA Annual Scientific Meeting Sydney 2004
DPMI Workforce Development The Alfred Workforce Development Team June 2005
Group education for Impaired Glucose
Tolerance - does it work?
ACT Diabetes Service
Referred clients (n=34) with IGT/IFG attended 2 group ed sessions
(1 hr nutrition/ 1 hr information) asked to identify possible
lifestyle modifications.
Responses
- 79% exercise - 59% weight loss,
- 5% smoking cessation - 5% stress reduction.
6 month telephone follow up (78% response) reported lifestyle
changes implemented and maintained
- 68% exercise - 56 % dietary changes
- 50% weight loss - 5% stress reduction
- 0% smoking cessation.
- Presentation by W.R Mossman ADS & ADEA Annual Scientific Meeting Sydney 2004
