Vital Diabetes

Charles Fox is a Consultant with Special Interest in Diabetes at Northampton General Hospital Trust, with over 30 years of experience. He is co-author of Diabetes - the 'at your fingertips' guide, the classic patient reference book which is about to be split into two editions, the first concentrating on type 1 diabetes, the other focusing on type 2. He also wrote Diabetes in the Real World (winner of the Richard Asher Award from the British Medical Association), on how to manage diabetes in general practice. Mary MacKinnon MMed Sci, RGN has nearly 30 years experience of diabetes care in primary and specialist health care settings. She co-ordinated diabetes services in Sheffield for 10 years and set up diabetes education for nurses at the University of Sheffield. She was a co-founder and Director of Education of Warwick Diabetes Care, the University of Warwick and has contributed to diabetes development nationally and internationally. Mary was the author of the first four editions of Providing Diabetes Care in General Practice and has been a pioneer in facilitating the extended role of nurses in diabetes care.

Introduction 7 Acknowledgements 8 1 The impact of living with diabetes 9 2 Insights into type 2 diabetes 12 United Kingdom Prospective Diabetes Study (UKPDS) 12 Prevalence and incidence of type 2 diabetes in the UK 13 Primary care diabetes - a national survey 14 The Heart Protection Study 15 Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) 17 3 National Service Frameworks and NICE 19 Standards 19 Implementation of the NSF 21 The National Institute for Health and Clinical Excellence 22 4 Screening and identification 25 Prevalence and screening 25 Identification 26 Where and how people present in primary care 27 Diagnostic criteria 28 Impaired fasting glucose and impaired glucose tolerance 29 Criteria for referral 31 Breaking the news 32 Patient and carer information: what is diabetes? 34 5 Early management of type 2 diabetes 36 The metabolic syndrome 36 Hypertension 37 Assessing and examining the newly diagnosed patient 39 Patient and carer information: first steps 42 What to do next: ongoing management plan 43 Patient and carer information: ongoing management 46 6 Educating patients about managing type 2 diabetes 47 Myths and misconceptions 47 Encouraging self-management 47 Education checklist: the primary care team 48 Cultural issues 49 Patient and carer information: lifestyle issues 51 7 Longer term management of type 2 diabetes 55 Targets for good blood glucose control 55 Treatment plan for type 2 diabetes 57 Treatment with tablets 57 Insulin in type 2 diabetes 62 8 How to control blood glucose levels 63 Understanding hyperglycaemia 63 Patient and carer information: monitoring your diabetes 65 Understanding hypoglycaemia 66 Patient and carer information: hypoglycaemia prevention 67 Patient and carer information: hypoglycaemia management 68 9 How to reduce long-term complications of diabetes 69 Heart and major vessel disease 69 Patient and carer information: looking after your heart 70 Feet 71 Patient and carer information: looking after your feet 74 Diabetic retinopathy 75 Patient and carer information: looking after your eyes 76 Diabetic nephropathy 78 Autonomic neuropathy and sexual dysfunction 79 Patient and carer information: sexual issues 80 Impact of the menopause: recommendations 80 10 How to manage type 1 diabetes 81 Presentation and diagnosis 81 Dose Adjustment for Normal Eating (DAFNE) 82 Children and young people: main issues 82 11 How to manage pregnancy and gestational diabetes 84 Pregnant women with diabetes 84 Pre-pregnancy and family planning advice 85 Gestational diabetes mellitus (GDM) 86 12 Living with diabetes 87 Patient and carer information: immunisation 87 Patient and carer information: dental care 88 Patient and carer information: life insurance 88 Patient and carer information: driving 89 Patient and carer information: occupational licences 90 Patient and carer information: travelling abroad 91 13 Emergencies and illness 92 Emergencies 92 Patient and carer information: what to do when you're ill 94 14 Diabetes care and general practice 95 Practice and shared protocols 95 Audit and quality control monitoring 95 The primary health care team 97 Appendix 1: Blood glucose self-monitoring 99 Appendix 2: Specimen agreed protocols with secondary care 102 Appendix 3:The GP Contract: Clinical Quality indicators for diabetes 106 Glossary of terms 108 Resources 111 Self help for the primary care team 111 Useful reports/key references 112 Useful publications 113 Key websites 114 Companies and organisations 115 Insurances, finance and pensions 116 Feedback Form 117 Other titles 118 Priority Order Form 120 Vital Diabetes 4ed Final 20/11/06 12:53 Page 5