Module 3.

Diabetes Prevention and

Early Detection
Best Practice Guidelines
An overview

Produced by The Alfred Workforce Development Team

on behalf of DHS Public Health Diabetes Prevention and Management Initiative
June 2005

Presentation purpose
Target audience
Health professionals and project workers on DPMI projects
Aim

To aid in planning of stages 2 and 3 of DPMI projects

Objectives

Provide an overview of the prevention of diabetes

Discuss type 2 diabetes risk factors and screening
Discuss prediabetes and implications in practice and for the projects
Discuss IGT/IFG diagnosis, communicating risk to consumers and
best practice care projects.
DPMI Workforce Development The Alfred Workforce Development Team June 2005

Prevention of diabetes

Recommendations to reduce risk of type 2 diabetes

Regular physical activity

Interventions to reduce obesity

Waist circumference, body weight and body mass index (BMI)

identify individuals who should seek and be offered weight
management program

Individuals at risk should have dietary intake

assessed and receive individualised dietary advice
and continued dietetic support
Evidence Based Guideline for the Prevention of Type 2 Diabetes. Australian Government
NHMRC www.diabetesaustralia.com.au/education_info/nebg.html
DPMI Workforce Development The Alfred Workforce Development Team June 2005

Prevention of diabetes

Recommendations to reduce risk of type 2 diabetes

Identification

of women with GDM would allow:

Postnatal clinical interventions in those with diabetes

Option to use preventive methods to reduce the risk of

Type 2 diabetes
Diet and exercise education in children should include:
Parental involvement
Behavioural techniques

Evidence Based Guidelines for the Prevention of Type 2 Diabetes. Australian Government
NHMRC www.diabetesaustralia.com.au/education_info/nebg.html

DPMI Workforce Development The Alfred Workforce Development Team June 2005

Screening for diabetes and risk factors

Active case detection and diagnosis of Type 2 diabetes should be

considered for the following reasons:

Type 2 diabetes is serious and costly

Natural history includes asymptomatic phase which is not benign and
during which it can be diagnosed
Early treatment reduces morbidity from long term complications
Case detection and diagnosis has a favourable risk:benefit ratio

NB Overall prevalence does not justify universal testing of the

entire Australian adult population but rather opportunistic case
detection.

Evidence Based Guideline for the case Detection and Diagnosis of Type 2 Diabetes.
Australian Government NHMRC www.diabetesaustralia.com.au/education_info/nebg.html

DPMI Workforce Development The Alfred Workforce Development Team June 2005

Opportunistic case detection

Test high risk individuals

People with IGT or IFG

Aboriginal and Torres Strait Islanders aged 35 years and over
Certain high risk non-English speaking background groups aged 35
years and over

(specifically Pacific Islander people, people from the Indian subcontinent

or of Chinese origin);

People aged 45 years and over who have either or both of the
following risk factors:

Obesity (BMI = 30 )
Hypertension;
All people with clinical cardiovascular disease (myocardial infarction,
angina or stroke
Women with polycystic ovary syndrome who are obese.

Evidence Based Guideline for the case Detection and Diagnosis of Type 2 Diabetes.
Australian Government NHMRC www.diabetesaustralia.com.au/education_info/nebg.html
DPMI Workforce Development The Alfred Workforce Development Team June 2005

DPMI Workforce Development The Alfred Workforce Development Team June 2005

Evidence Based Guideline for the case Detection and Diagnosis of Type 2 Diabetes.
Australian Government NHMRC www.diabetesaustralia.com.au/education_info/nebg.html

Definition
Pre

diabetes includes both

Impaired Glucose Tolerance

Impaired Fasting Glucose

DPMI Workforce Development The Alfred Workforce Development Team June 2005

Pre diabetes

16% of population have pre diabetes

AusDiab Study (Dunstan et al, 2002)

Pre diabetes associated with

Increased risk of microvascular complications

Increase risk of microalbuminuria and neuropathy
(lower prevalence than diabetes but higher than general
population)
Increase risk of cancer breast, colon, liver and pancreas.
Increased risk of developing diabetes

Need to consider age: how relevant is IGT or IFG in a

person 75 years old?
DPMI Workforce Development The Alfred Workforce Development Team June 2005

Does pre diabetes predict

diabetes?
Progression of IGT/IFG to diabetes in 11 year follow up
Presentation Stephen Twigg. Pre diabetes Symposium ADS & ADEA Annual Scientific Meeting Sydney 2004

DPMI Workforce Development The Alfred Workforce Development Team June 2005

Interventions
Increased

physical activity and weight

loss can reduce risk of type 2 diabetes
?Reduce cardiovascular risk
Need to focus on follow up and review
given high risk of developing diabetes
Need to encourage ongoing review and
management of CVD risk factors

DPMI Workforce Development The Alfred Workforce Development Team June 2005

Communicating risk to consumers

Is

it a condition vs risk factor?

What is the name of the condition? Will the
name influence how seriously consumers view it
i.e. pre diabetes vs impaired glucose tolerance.
No label may mean not taken seriously
No label may mean no intervention. No follow
up
Implications for individuals if labelled with a
condition where approx 1/3 will revert back to
normal.
DPMI Workforce Development The Alfred Workforce Development Team June 2005

How is pre diabetes managed in general

practice?
Mapping

exercise (Div of GP Perth)

GP audit.
Nearly

1/3 of patient with prediabetes had not

had a blood glucose test in the past 12 months
Waist circumference was only recorded for 10%
patients
50% had their weight recorded
Lipids and BP were recorded in almost all patients
( not sure how often)
Presentation by A Derbyshire. ADS & ADEA Annual Scientific Meeting Sydney 2004

DPMI Workforce Development The Alfred Workforce Development Team June 2005

Primary care management of Type 2

diabetes
GP Focus Groups
GPs reluctant to pursue aggressive case finding
GPs dont involve other HPs in management of pre
diabetes
Most follow up is oppurtunistic
No recall systems
Patient characteristics such as motivation, lack of
understanding were seen as the greatest barriers
to managing pre diabetes in GP practice
Presentation by Kaye Neylon ADS & ADEA Annual Scientific Meeting Sydney 2004

DPMI Workforce Development The Alfred Workforce Development Team June 2005

Group education for Impaired Glucose

Tolerance - does it work?
ACT Diabetes Service
Referred clients (n=34) with IGT/IFG attended 2 group ed sessions
(1 hr nutrition/ 1 hr information) asked to identify possible
lifestyle modifications.
Responses
- 79% exercise
- 59% weight loss,
- 5% smoking cessation
- 5% stress reduction.

6 month telephone follow up (78% response) reported lifestyle

changes implemented and maintained
- 68% exercise
- 56 % dietary changes
- 50% weight loss
- 5% stress reduction
- 0% smoking cessation.
-

Presentation by W.R Mossman ADS & ADEA Annual Scientific Meeting Sydney 2004
DPMI Workforce Development The Alfred Workforce Development Team June 2005