Presentation is loading. Please wait.

Presentation is loading. Please wait.

Pathways – Dr Duncan Fowler Ipswich Hospital Diabetes Centre will have a more active role in supporting primary care pathways, through education, its advice.

Similar presentations


Presentation on theme: "Pathways – Dr Duncan Fowler Ipswich Hospital Diabetes Centre will have a more active role in supporting primary care pathways, through education, its advice."— Presentation transcript:

1 Pathways – Dr Duncan Fowler Ipswich Hospital Diabetes Centre will have a more active role in supporting primary care pathways, through education, its advice line and , outreach and face-to-face contact where appropriate Pathways are usually out of date and can’t cover all eventualities Care should be individualised and the integrated service will provide ongoing advice based on up to date data and medications Having said that: pathways still have a role

2 Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) Diabetes Care 2012;35:1364–1379 Diabetologia 2012;55:1577–1596

3 Fig. 2. T2DM Antihyperglycemic Therapy: General Recommendations

4

5

6

7 Fig. 3. Sequential Insulin Strategies in T2DM Diabetes Care 2012;35:1364–1379 Diabetologia 2012;55:1577–1596

8 Indications and therapeutic options for dual therapy in patients with Type 2 diabetes

9 Commonly occurring situations Intermittent illnesses: Stop metformin Rehydrate with non-sugary drinks Hypercholesterolaemia: Atorvastatin – escalate up to 80mg, then refer for consideration of ezetimib Erectile dysfunction: Diabetes is a risk factor for erectile dysfunction but assessment and management of patients is similar Medical, psychiatric, surgical, relationship, sexual and drug history Clinical examination, including genital examination, blood pressure, heart rate and waist circumference Serum lipids, fasting plasma glucose, recent HbA1 c, morning testosterone and SHBG Consider digital rectal examination and PSA Combined oral contraceptive: Diabetes poses no additional independent risk factor to venous thromboembolism to the established risk factors

10 Other Pathways Renal Impairment Hypoglycaemia Anti-platelet therapy – noting that NICE Clinical Guidelines have been superceded by some more recent evidence GLP-1 agonists SGLT2 inhibitors Foot protection Autonomic neuropathy, explosive nocturnal diarrhoea and neuropathic pain


Download ppt "Pathways – Dr Duncan Fowler Ipswich Hospital Diabetes Centre will have a more active role in supporting primary care pathways, through education, its advice."

Similar presentations


Ads by Google