British Journal of Healthcare Assistants The HCAs Role in Diabetes Management in Primary Care Linda Goldie Clinical Director Primary Care Training Centre

What is diabetes? A condition where the amount of glucose in the body is too high because the body is unable to deal with it.

It ’ s a big problem! 2 million people in the UK have diabetes and the numbers are growing! 70,000 more diagnosed this year 750,000 unaware they have it!

Complications linked to diabetes Heart Disease Stroke Kidney Failure Blindness Nerve damage Peripheral Vascular Disease

What can the HCA do? Diabetes care involves the multidisciplinary care team. Lets look at a patient!

What information and care does Jim need? Who will do it?

What is diabetes? Verbal and written information on what diabetes is

What type of diabetes do you suspect Jim has? Type 1 ? OR Type 2 ?

Type 1 Diabetes No insulin production Young Sudden onset – ill Slim? Insulin needed for survival

Type 2 Diabetes Not enough insulin produced or the body is resistant to the insulin produced Older Family History Race Overweight/obese Increased waist circumference

Waist circumference

Narayan et al. Diabetes Care 2007;30: Obesity Increases Lifetime Diabetes Risk Lifetime Risk at Age 45 (Total Population)

Narayan et al. Diabetes Care 2007;30: Obesity Increases Lifetime Diabetes Risk Lifetime Risk at Age 18 (Total Population)

1. Warram JH et al. Ann Intern Med 1990; 113: 909– Haffner SM et al. Diabetes Care 1999; 22: 562–568. > 90% of Type 2 diabetes patients are insulin resistant 2 Insulin resistance precedes Type 2 diabetes by up to 20 years 1

Healthy Lifestyle Diet Alcohol Physical Activity Smoking

Key Points BOGH picture

Weight reduction Increase fruit and veg Reduce fats and sugars Careful with alcohol! EAT LESS! Pharmacological interventions

Is this the role of a HCA? Almost certainly yes! Everyone working in primary care should be giving health promotion messages BUT be aware of your limitations

Exercise

Physical Activity Jim doesn’t need to put on lycra and aim to be like these guys! Just be more active!

Stop Smoking! Smoking cessation advice

What would Jim say if told to eat this with this warning?

“My A*******se!!”

So why do this?

Smoking cessation Support and encouragement essential! If you are trained to give this advice then do it!

At Clinic - Height and Weight = BMI Waist circumference – Women 80 cms – Asian Men 90 cms – White/Black 94 cms

Measuring waist circumference

Avoiding complications Blood pressure Blood tests – HbA1c to assess diabetes control – Cholesterol and Lipids – Renal function Urine test – protein

The HCA can play a valuable role doing these “tasks” within the diabetes clinic

Medication advice Tablets to reduce blood glucose level Tablets (statins) to reduce cholesterol Tablets (aspirin) to reduce clotting Tablets (ace inhibitors) to protect the kidneys Tablets to reduce blood pressure

Medication advice Normally left to the doctors and nurses

Further checks FEET EYES HBGM Results

Podiatry General condition Basic advice Pulses Sensation

EYES Visual Acquity Retinal photography

Home Blood Glucose Monitoring How to test When to test What to do with the results

Further information Employment Driving Insurance Travel

Employment Will Jim be able to continue to work or continue to seek employment with diabetes? Some jobs may be affected for example HGV drivers PSV drivers

Driving

Driving Information No problems generally If insulin treated in the future safety issues need to be addressed related to blood glucose testing

Insurance Need to inform relevant companies – Car – Travel – Life on new policies otherwise no disclosure needed

Travel advice General healthcare advice – Travel vacs – Insurance – Sexual health Diabetes related advice Medication/storage Flying/time zones Foot care

HCA as part of the multi- disciplinary diabetes team Patient Doctor Nurse DSN Dietitian Podiatrist Optometrist Pharmacist THE HEALTH CARE ASSISTANT!

British Journal of Healthcare Assistants Thank you for listening and participating Linda Goldie