Grampian guidelines 2009Grampian MCN meeting
27th May 2009
Donald PearsonConsultant Diabetologist NHS Grampian
Lead Clinician for Diabetes in Scotland
Improving the lives of people with Improving the lives of people with diabetes in Grampiandiabetes in Grampian
ResearchResearch
Evidence Evidence
GuidelinesGuidelines
ImplementationImplementation
EvidenceEvidence
GuidelinesGuidelines
ImplementationImplementation
Better Outcomes Better Outcomes
Improving the lives of people with Improving the lives of people with Diabetes in GrampianDiabetes in Grampian
ResearchResearch EvidenceEvidence
Improving the lives of people with Improving the lives of people with Diabetes in GrampianDiabetes in Grampian
ResearchResearch
EvidenceEvidence
SIGNSIGN
EvidenceEvidence
SIGNSIGN
Local GuidelinesLocal Guidelines
Electronic Guideline Electronic Guideline Four main sectionsFour main sections
Electronic Guideline Electronic Guideline Four main sectionsFour main sections
A: A: CLASSIFICATION, DIAGNOSIS, INITIAL CLASSIFICATION, DIAGNOSIS, INITIAL MANAGEMENT, PREVENTION AND MANAGEMENT, PREVENTION AND SCREENINGSCREENING
B: B: SUPPORTING SELF-MANAGEMENTSUPPORTING SELF-MANAGEMENT
C: C: GLYCAEMIC CONTROLGLYCAEMIC CONTROL
D: D: COMPLICATIONSCOMPLICATIONS
Scottish Diabetes Survey 2007Scottish Diabetes Survey 2007
Prevalence ofPrevalence of Diabetes in ScotlandDiabetes in Scotland
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
3.5%
4.0%
4.5%
5.0%
2001 2002 2003 2004 2005 2006 2007 A&A Bo D&G Fi FV Gr GG Hi Lan Lo Ork Sh Tay WI
NHS Boards 2006
Prevention of Type 2 Diabetes MellitusPrevention of Type 2 Diabetes Mellitus
In AdultsSet realistic goals – don’t worry if the odd day is missed but try to make sure physical activity is part of everyday life
Encourage the person to select activities that they enjoy – such as walking, cycling, swimming, aerobics and gardening
Minimise sedentary activities, such as sitting for long periods watching television, at a computer or playing video games.
Build activity into the day – for example, get off the bus a stop earlier and walk, take the stairs instead of the lift, take a walk at lunchtime.
Electronic Guideline Electronic Guideline Four main sectionsFour main sections
A: A: CLASSIFICATION, DIAGNOSIS, INITIAL CLASSIFICATION, DIAGNOSIS, INITIAL MANAGEMENT, PREVENTION AND MANAGEMENT, PREVENTION AND SCREENINGSCREENING
B: B: SUPPORTING SELF-MANAGEMENTSUPPORTING SELF-MANAGEMENT
C: C: GLYCAEMIC CONTROLGLYCAEMIC CONTROL
D: D: COMPLICATIONSCOMPLICATIONS
“ The average person with diabetes will spend 3 hours with a Healthcare Professional and will take care of themselves for the remaining 8757 hours in a year”
0.034%
Electronic Guideline Electronic Guideline Four main sectionsFour main sections
A: A: CLASSIFICATION, DIAGNOSIS, INITIAL CLASSIFICATION, DIAGNOSIS, INITIAL MANAGEMENT, PREVENTION AND MANAGEMENT, PREVENTION AND SCREENINGSCREENING
B: B: SUPPORTING SELF-MANAGEMENTSUPPORTING SELF-MANAGEMENT
C: C: GLYCAEMIC CONTROLGLYCAEMIC CONTROL
D: D: COMPLICATIONSCOMPLICATIONS
0%
10%
20%
30%
40%
50%
60%
70%
80%
2004 2005 2006 2007 2004 2005 2006 2007 2004 2005 2006 2007
≤ 7.5 %
≤ 140 mmHG≤ 5 mmol/l
HbA1c Systolic BP Cholesterol
Patients reaching targets for HbA1c,Patients reaching targets for HbA1c,Blood Pressure and Cholesterol in 2004-2007Blood Pressure and Cholesterol in 2004-2007
Electronic Guideline Electronic Guideline Four main sectionsFour main sections
A: A: CLASSIFICATION, DIAGNOSIS, INITIAL CLASSIFICATION, DIAGNOSIS, INITIAL MANAGEMENT, PREVENTION AND MANAGEMENT, PREVENTION AND SCREENINGSCREENING
B: B: SUPPORTING SELF-MANAGEMENTSUPPORTING SELF-MANAGEMENT
C: C: GLYCAEMIC CONTROLGLYCAEMIC CONTROL
D: D: COMPLICATIONSCOMPLICATIONS
Scottish Diabetes Survey 2007Scottish Diabetes Survey 2007
Diabetic retinopathy screeningDiabetic retinopathy screening
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2007 A&A Bo D&G Fi FV Gr GG Hi Lan Lo Ork Sh Tay WI
Screened <15 months Screened >15 months Not known
Improving the lives of people with Improving the lives of people with Diabetes in GrampianDiabetes in Grampian
ImplementationImplementationDiabetes Action Plan 2006Diabetes Action Plan 2006Better Diabetes Care : Consultation Document 2009Better Diabetes Care : Consultation Document 2009
OutcomesOutcomesQuality Improvement Scotland 2004, 2007Quality Improvement Scotland 2004, 2007Scottish Diabetes Survey 2001-9Scottish Diabetes Survey 2001-9
Working in partnership with patients to Working in partnership with patients to deliver patient centred caredeliver patient centred care
Listen to patients and Listen to patients and respond to their concerns respond to their concerns and preferencesand preferences
Give patients the Give patients the information they want or information they want or need in a way they can need in a way they can understandunderstand
Respect patients’ right to Respect patients’ right to reach decisions with you reach decisions with you about their treatment and about their treatment and carecare
Support patients in caring Support patients in caring for themselves to improve for themselves to improve and maintain their healthand maintain their health
GMC Good Medical Practice GMC Good Medical Practice 20062006