PowerPoint Presentation

Diabetes Aspects of the Local Enhanced ServiceDr Mark BarrettDr Jeremy SandfordDr Aythen ElkindiSearch on patients with raised glucose and Hba1c and code appropriately

Run Q diabetes

Increase Prevalence and Improve Outcomes

Talk about family history, even our cat has Diabetes.42yr old Bangladeshi patient

Non smoker, no record FH, BMI 25QD score=11%

Add correct FH and correct BMI of 30.5QD score increases to 59%

Q diabetes example

Hba1c

Diabetes Hba1c 48 mmol/mol (6.5%)

Pre-diabetes 42-47 mmol/mol (6-6.4%)

Code for type 1 or type 2 diabetes

Code for pre-diabetes (C115Y)

Hba1c on patients with Q diabetes 10

Diagnosis

Prevalence of diabetes

October 2013 7,800 June 2014 8,104

Total of 482 new diagnoses

These figures dont add up. Likely patients moving or deaths.Some numbers (Pan Camden)

Eligible for Q diabetes risk 154,00099,000 have had Q diabetes risk performed

So still work to doMore numbers

243 patients Hba1c > 48 & not coded as diabetes

1901 patients Hba1c 42-47 & not coded as Pre-Diabetes

Easy winsHow can we improve diabetes prevalence?

Audit patients Hba1c > 75 mmol/mol

Include worst 20% of diabetes register

Reasons for poor control

Submit by the end of June

Initial themes from audits submitted so far Audit of patients with poor Control

Diabetes AuditInitial Findings 3 practices- 154 patients

HbA1cContext

Mean = 86.9Median = 82.8Mode = 76Type of diabetes

Audit PopulationWhole Practice Diabetic Population19% of patients reviewed in the audit were diagnosed with Type 1 Diabetes, this compares with 9% of the total practices diabetic population.

There is variation between practices.Time since diagnosis

57% of patients within the audit were diagnosed earlier than 2007.

Only 4% within the audit were diagnosed post 2011.

All patients over the age of 65 were diagnosed in 2009 or earlier.

Proportions with complications

Not all patients within the audit had complications recorded.

The complication most commonly recorded was retinopathy, where 43% patients (excluding nulls) within the audit had this recorded.

Green; % with complications

DNA

17% of patients within the audit had DNAs recorded.

50% were on insulin81% were Type 28% were on maximum oral therapyThey were across all age groups

Invite patients for review.

Offer care planning

Develop care plan

Use Templates

Promote 9 care processes from diabetes UK

Monitor progressReview of patients with poor control

Blood glucose

Blood pressure

Cholesterol level

Retinal Screening

Foot and leg check

Kidney function (urine)

Kidney function (blood)

Weight

Smoking 9 care processes

Room for improvement

885 patients with Hba1c > 75

Only 175 patients reviewed so far

See patients/use templates!How are we doing?

GP lead and Consultant

Identify areas to discuss

Review of data (scorecards, medicines management and referral data)

Case discussion and complex patients

Discussion of local services and pathways and the new diabetes website

Action plan with agreed timelines

Suggestions welcomePractice Visits

Questions and answers

Thank you