Real life issues & answers: The diabetic patient

Jane Diggle, Church View Health Centre, South Wales
Amy Rylance, Diabetes UK

 

What are the clinical issues?

  • Type 2 diabetes increases the risk of cardiovascular events – 25% of people in the UK who experience stroke, myocardial infarction and heart failure have type 2 diabetes.
  • Poor glycaemic control has devastating consequences and we can do more to achieve better outcomes.
  • Non-adherence to medication is a major cause of poor glycaemic control. If you can achieve better adherence, you can reduce the rate of hospitalisation and lower all-cause mortality.
  • Patients’ recall of information given during consultation is very low (14%).

 

What are the implications and answers?

  • Pictograms (simple diagrams/illustrations combined with key figures/words) integrated into the patient care system provide individual data and improve the retention of relevant written information (to 80%).
  • These pictograms provide a personal care planner allowing the setting of personal goals. This greatly improves non-adherence and improves HbA1c control. This is being used throughout the UK as part of a self-care challenge to the type 2 diabetes patient.
  • A serious event, such as an MI, in a non-adherent patient, creates the opportunity to re-evaluate and support the patient better.

Key take-home messages

  1. People with type 2 diabetes require holistic care to achieve optimum outcomes.
  2. Regardless of age, an ACE-inhibitor is first choice for lowering blood pressure.
  3. Aim for a 40% reduction from baseline in non-HDL cholesterol as this is better than a ‘fire and forget’ approach.
  4. Be careful with targets in the elderly.
  5. In the presence of cardiovascular disease, use agents such as the SGLT-2 inhibitors or GLP-1 agents with proven cardiovascular benefits.
  6. Provide patient with tools to self-manage their disease.