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Leading the way in patient care......
 

Ash Surgery

Chilton Place
Ash
Canterbury
Kent
CT3 2HD
Telephone: 01304 812227
Fax: 01304 813788

The Importance Prevention of Type 2 Diabetes

Identifying and Treating Risk Factors Early.

For many people who develop Type 2 diabetes (T2DM), the onset is gradual and many will have (unconsciously) been living with the condition for some time before a formal diagnosis is made.

This is why many people with T2DM will have large and small vessel disease by the time their condition is diagnosed.

Some people will not be diagnosed with frank diabetes, but may be found to be “Pre Diabetic”.  In this group, and in those who are at high risk of diabetes/ pre diabetes but whose blood tests are still within normal, life style modifications can significantly reduce the risk of developing frank T2DM.

Who should consider having a risk assessment for T2DM

  • All UK adults except pregnant women
  • All those aged 25-39 for South Asian, Chinese, African Caribbean, black African and other high risk ethnic groups (Except during pregnancy)
  • All adults with conditions known to increase the risk of T2DM
  • Cardiovascular disease, Stroke, Hypertension
  • Polycystic Ovaries, History if Gestational Diabetes
  • Mental Health Problems
  • Obesity.

Risk Assessment

Use of a validated risk assessment tool

  • The Diabetes UK Risk Score Assessment Tool

This is available on line to individuals and calculates risk based on the following information

Sex/ Age/ ethnic background/ family history/ waist measurement/ ht, wt, BMI/ past blood pressure issues

Results are quoted as Low/ Increased/ Moderate or High.

The tool explains the result and highlights areas where one might actively be able to reduce risk.

  • In the GP Surgery.

Computer Software in the Surgery uses a similar tool, the QDiabetes Risk which achieves similar result.

HbA1C Blood Test for Diabetes/ Pre-Diabetes

All those with elevated risk score for T2DM should have a blood test to

  • Identify those with, as yet, ?undiagnosed T2DM (HbA1c >48)
  • If they have no symptoms of T2DM, then a redo test should be booked to confirm
  • If confirmed- Start active management (Referral for advice on Lifestyle Changes/ Medication if needed
  • Identify those at higher risk (those already in Pre Diabetic Blood test range) (HbA1c 42-48)
  • Start preventative measures (Referral to National Diabetes Prevention Programme) for Lifestyle measures, diet, exercise, some may be adviced medication.

 

  • Identify those with normal results, and consider their need for prevention strategies (lifestyle changes/ weight loss/ exercise) and also their need for ongoing monitoring.

Medications that can be considered for Prevention of T2DM

For the prevention of development of Pre-Diabetes to Diabetes, the strongest evidence lies with Lifestyle changes- Diet and Exercise.

So referral to the National Diabetes Prevention Programme, or commitment to a self-styled programme is of the utmost importance.

Failing that, clinicians can consider the use of 2 medicines

Metformin. (use of which, to prevent T2DM is off licence, so needs discussion with clinician)

Orlistat.  (for those with BMI >28 and as part of an overall strategy for weight loss)

                If weight loss of >=5%  has not occurred after 3 months, then orlistat should be stopped.

 

Reassessment of Risk

Low Risk Group- Reassessment with validated risk tool every 5 years.

Moderate Risk- A high score, but normal bloods. Reassess every 3 years.

High Risk- (Pre diabetic Blood results). Reassess YEARLY with check on BMI and Lifestyle issues.

 

 
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