Here is a series of short videos recorded by Dr Ray O’Connor at the University of Limerick that cover aspects of management of type 2 diabetes (T2D).

This condition is managed differently in various jurisdictions with some health systems relying on secondary care and  others predominantly on primary care. There is also some debate as to whether T2D is a disease or a condition related to lifestyle. Nevertheless, it is an increasingly common problem with an increasing prevalence that requires an innovative approach to diagnosis and management.

We have edited these interviews into short clips of 1.30 to 6.00 minutes, ranging from a basic approach for students with no medical knowledge right through to the impact on the individual, what drug therapies should be used and how people manage the condition.

The focus of the videos is on the individual with the condition and each has a section on generalist management to show the community perspective.

1. What is diabetes? : the characterisation of the disease, how it has two main types T1D and T2D but can also be found during pregnancy (gestational diabetes) and after pancreatic damage
2. The Natural History of Diabetes Mellitus : T2D can be undiagnosed for a year or two because of the non-specific symptoms such as tiredness, lethargy and polyuria and thirst; the symptoms may be so subtle that people first present with complications of the nervous or cardiac system.
3. How common is the condition and how does it present? : The incidence, prevalence and symptoms of the condition and how early diagnosis relies on community services
4. How do people respond to the diagnosis?:
5. 
   Sometimes people suspect the diagnosis and explain that it may be due to a poor lifestyle and sometimes people are relieved by the diagnosis of diabetes because they were worried that it may be a more serious condition. They are usually aware of the condition and may have relatives with the condition.
6. Management of T2D? : Management of an individual with T2D is much more than simply blood sugar control. This section talks about diabetes review and biometric targets, complications, referral to secondary care, glycaemic, blood pressure and lipid control.To work with the individual to understand the causes and management of the different stages of the condition and how we should expect an early ‘honeymoon’ phase where they have no biochemical abnormality. The importance of lifestyle change and the programmes that help people with this (CODE or DESMOND) and how knowledge is key.

Please click the underlined words for more details on the CODE, DESMOND and DAFNE programmes

6. When should drug therapy be initiated?:
8. You first need to help the individual accept the diagnosis and signpost them to an information programme, to examine and assess whether there is associated co-morbidity or complications. It is important to help an understanding of how important lifestyle change is and how accepting of change is the patient. There is no point in prescribing drugs if the patient does not see the point of taking them so it is important to work with the individual. Assessment is multidisciplinary with involvement of dieticians for dietary advice and nurses to carry out a diabetes review and podiatrists to check for risk factors for foot ulcers and whether referral to secondary care is required.
9. Options to treat early diabetes:
10. Access to early care differs in different jurisdictions and so the secondary care American model results in earlier starting of drug therapy for some patients but in a strong primary care system, lifestyle changes can be encouraged first.
11. Why do some patients find it difficult to adhere to a treatment regime?:
12. 
    A discussion about the importance of understanding the attitudes and concerns of the individual

 

TO DO

 

Further learning:

Can I live with Diabetes: http://www.diabetes.ie

NICE 2014 Type 2 diabetes: The management of type 2 diabetes CG87:  https://www.nice.org.uk/guidance/cg87

ICGP A Practical Guide to Integrated Type 2 Diabetes Care Harkins V 2016