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DIABETIC SCREENING PILOT PROJECT. HYPERTENSION >20% CVD. DM. CVD PVD. METABOLIC SYNDROME. IMPAIRED GTT. GLOS PCCAG SEPT 2007. Course Objectives. To report back to practices results of PCCAG pilot project To support practices in translating feedback into action.

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Presentation Transcript
slide1

DIABETIC SCREENING

PILOT PROJECT

HYPERTENSION

>20% CVD

DM

CVD PVD

METABOLIC SYNDROME

IMPAIRED GTT

GLOS PCCAG

SEPT 2007

slide2

Course Objectives

To report back to practices results of PCCAG pilot project

To support practices in translating feedback into action.

To provide opportunity to meet diabetic and weight management specialists.

slide3

WHO IS AT RISK OF DM?

oPatients withImpaired Fasting Glucose coded whose last fasting glucose was 6.1- 6.9 mmol/l (inc)

oPatients without Impaired Fasting Glucose coded whose last random glucose was >6.0 mmol/l

oWhite patients over 40 years (or black/Asians over 25 years) with 1st Degree F/H

oWhite patients over 40 years (or black/Asians over 25 years) with BMI >25

oPatients with CVD, or Hypertension

oWomen with Polycystic Ovary Syndrome (PCOS) who have a BMI >=30

oPeople with Severe Mental Health Problems (nGMS)

slide4

Why was the pilot group selected?

  • One practice from each locality was invited to participate after considering a combination of factors :
  • A DM prevalence on or below the county average (3.4%)
  • A high proportion of patients falling in the over 40 age group
  • No evidence of active screening i.e. little increase in DM incidence in the last four years
  • Keenness to identify asymptomatic people who have diabetes
  • Capacity to undertake the testing and support of high risk
  • patients

In addition, one practice with a proactive approach to screening was invited to participate as a control

slide5
What is the prevalence of Diabetes and Diabetic Risk Factors in the Group

The prevalence of Diabetes Mellitus varied from 1.8% to 6.2%

slide6

Low Prevalence

High Prevalence

slide7

? ACCURATE 25%

Many not recently measured

Probably not CKD

Low numbers

How much risk in this group?

why does the high prevalence practice have such numbers
Why does the high prevalence practice have such numbers.
  • Probably a combination of high Ethnicity within the practice (not coded) and a thorough diabetic screening program with results from large numbers of in-house GTTs.
what should you do
What should you do?

Use feedback proformer

slide10

1. How to identify patients who have Impaired Fasting Glucose who need follow-up

  • Use Indicator 1 and 2 if your practice codes patients with Impaired GT:
  • C11y3 Impaired fasting glycaemia
  • R10D0 [D]Impaired fasting glycaemia
  • C11y2 Impaired glucose tolerance
  • R102. [D]Impaired glucose tolerance test
  • R10E. [D]Impaired glucose tolerance
slide11

Indicator 1+2 Problems

  • Not many practices code for Impaired Glucose
  • How often to screen:
  • Every three years (Diabetes UK)?
  • Every 15 months with annual QOF or medication reviews?
  • Resources:
  • How to do all fasting bloods in the morning. Long waiting time for Secondary Care GTTs?
  • How to fund GTTs in Primary Care?
  • How often to do GTTs?
slide12

2. How to identify patients who have Impaired Fasting Glucose who need follow-up

Use Indicator 3 if your practice doesn’t code for impaired glucose results

slide13

WHO TO CONCENTRATE ON?

  • o Column AE – any glucose > = 7 is probably diabetic and needs a repeat level or a diagnosis
  • Column AE – any glucose which is 6.1 – 6.9 and needs a diagnosis of impaired fasting glucose as a problem title (for follow up) and consideration given to offering a GTT.
  • Column AB – any glucose greater 6.1 or above without a more recent fasting glucose needs to be checked to see if a repeat fasting level is required or a GTT.
slide14

Indicator 3 Problems

  • Prior to Spring 2007 laboratory coded all random and fasting codes as 44g
  • If we pulled off all patients with a glucose result at any point above 6 then this would have made the audit too large
  • Instead we only included patients who had had a glucose >7 mmol at some point. This means that some patients who have only ever had a fasting glucose or random between 6- 6.9 mmol could be missed.
slide15

WHAT TO DO WITH THOSE WITH IMPAIRED GLUCOSE?

HYPERTENSION

>20% CVD

DM

CVD PVD

METABOLIC SYNDROME

IMPAIRED GTT

Waist circumference!

slide16

WHAT TO DO WITH THOSE WITH IMPAIRED GLUCOSE?

HYPERTENSION

>20% CVD

DM

CVD PVD

METABOLIC SYNDROME

IMPAIRED GTT

RESOURCES PLEASE TO HELP WITH OBESITY

recommendations
RECOMMENDATIONS
  • Perform fasting glucose for all glucose testing where possible.
  • If a random glucose is performed then ensure patients with a result >=6.1 and patients with a previously raised glucose only have fasting glucose tests thereafter.
  • All fasting glucose =>6.1 – 6.9 to be coded as having impaired fasting glucose as an Active Problem.
  • Consider referring those patients with impaired fasting glucose with a high risk of developing diabetes for a GTT.
  • Following Glucose Tolerance Testing patients with an abnormal 120 min glucose to be coded as Impaired GTT.
  • Inform patients with Impaired Fasting Glucose or Impaired GTT and in addition assess for Metabolic Syndrome. Give health advice backed up with an appropriate leaflet.
  • Implement protocols for recording of accurate ethnicity, weight and 1st degree family history in the general population.