Detecting and managing type 2 diabetes in general practice – It’s About Time

The theme of this year’s National Diabetes Week is ‘It’s About Time’ and focuses on the urgent need for early diagnosis and management of type 2 diabetes.
 
Dr Gary Deed, GP and Chair of the RACGP’s Diabetes Specific Interests network, believes GPs have a crucial role to play in the context of the diabetes epidemic.
 
‘GPs are ideally placed to both proactively identify and manage people at risk of diabetes,’ he told newsGP.
 
‘The evidence shows that early detection and intervention of diabetes complications provides measurable improvement of patient outcomes.’
 
Once considered a ‘disease of affluence’, diabetes has now become a global health crisis and Australia is no exception. Around 1.7 million Australians have diabetes, including an estimated 500,000 Australians who remain undiagnosed. And that delayed diagnosis can have serious consequences, according to Chief Executive of Diabetes NSW and ACT, Sturt Eastwood. 
 
‘People can live with type 2 diabetes for up to seven years before being diagnosed, and in that time life-threatening health problems can develop,’ he said.
 
‘The earlier people are diagnosed, the earlier they can get the right treatment, which will reduce their risk of developing diabetes-related complications including limb amputation, blindness, kidney failure and heart disease.’
 
Resources such as the RACGP’s Guidelines for preventive activities in general practice can help GPs to identify groups at risk of the disease, including patients with obesity, hypertension and dyslipidaemia.
 
There are also more specific signs GPs can be alert to, as well.
 
‘GPs should familiarise themselves with the presentations of a symptomatic patient who needs diabetes diagnostic assessment – for example polyuria, polydipsia, poor wound healing or skin infections,’ Dr Deed said.
 
There are measures GPs can take in the case of patients without symptoms, as well.
 
‘Asymptomatic patients require higher levels of vigilance, but remembering to be proactive in raising awareness of the risks in high risk individuals and appropriately screen using tools such as AUSDRISK [Australian type 2 diabetes risk assessment tool] before further investigating them,’ Dr Deed said.
 
‘Remember also that Aboriginal and Torres Strait Islander people aged less than 18 years and people over the age of 40 need to be recalled for screening every three years, and anyone with a past impaired fasting glucose or elevated postprandial glucose needs annual recall for diabetes diagnostic re-evaluation.’ 
 
Tests for the detection and monitoring of diabetes involve regularly-occurring dates and deadlines, which can be hard for GPs to keep track of in the course of a busy day, but maintaining patient registers for automated practice systems can take care of this, ensuring that patients receive timely recalls for testing and metabolic monitoring.
 
‘HbA1c every three to six months, blood pressure and lipid checks, plus complication assessment as per the annual cycle of care – maintaining all of these require a proactive practice systems-based management approach,’ Dr Deed said.
 
Making sure all practice staff know how to maximise the use of automated practice systems also helps to ensure a coordinated, all-of-practice approach to diabetes care.
 
‘Train practice staff and nurses to ensure systems and recalls are able to identify patients at risk who may need to be screened or diagnosed,’ Dr Deed said.
 
Doing these things in general practice can help contribute to reducing the burden on the Australian health system and providing better outcomes for people with diabetes.
 
‘Early detection and early treatment is likely to provide lasting health benefits to people with type 2 diabetes, and could translate to savings of more than $700 million for the Australian health system each year,’ Diabetes Australia Chief Executive Greg Johnson said.

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