GEP Medicine in Society Handbook 2019/20

 Introduction - Diabetes Mellitus is a common chronic condition which can be divided into Type 1 and Type 2. Type 1 is principally a disease of younger adults and children and is due to the total failure of insulin production in the pancreas. Type 2 diabetes usually affects people over age 40 but is increasingly being seen in younger age groups.

The diagnosis of diabetes mellitus has major implications for both patients and the healthcare community alike. According to the National Service Framework (NSF) for Diabetes (published 2001), patients with diabetes have:

• a life expectancy which is reduced, on average, by more than 20 years in people with Type 1 diabetes and by up to 10 years in people with Type 2 diabetes
• a significantly raised morbidity and mortality from coronary heart disease, stroke, renal failure, peripheral vascular disease and eye disease
• additional risks in pregnancy: women with diabetes have an increased chance of losing the baby during pregnancy or at birth, of the baby having a congenital malformation, or of the baby dying in infancy

The impact on healthcare resources is also significant. The NSF states that:-

• around 5% of total NHS resources and up to 10% of hospital in-patient resources are used for the care of people with diabetes
• people with diabetes are twice as likely to be admitted to hospital as the general population and, once admitted, are likely to have a length of stay that is up to twice the average
• the presence of diabetic complications increases NHS costs more than five-fold, and increases by five the chance of a person needing hospital admission
• one in 20 people with diabetes incurs social services costs and, for these people, the average annual costs were £2,450 (1999). More than three-quarters of these costs were associated with residential and nursing care, while home help services accounted for a further one-fifth. The presence of complications increased social services costs four-fold.

As with all chronic conditions, expert multidisciplinary care is essential and must form an important bridge between primary and secondary care. Diabetes Mellitus has a very high prevalence in the East End of London. As a result of the NSF, we have seen increasing amount of resources directed towards the excellent multidisciplinary teams here in Newham.

 Learning Issues

• What is the WHO definition of diabetes mellitus?
• What theories of pathogenesis are given for Type 1 and Type 2 diabetes?
• What is Impaired Glucose Tolerance (IGT) and what prognostic significance does it have?
• What common complications arise in diabetes mellitus? How are they classified or subdivided?
• What is the value of an annual diabetic review? Who should be involved in this review?
• Why is the incidence of Diabetes mellitus increasing in the UK? Why is the incidence of Type 2 diabetes increasing in the under 40s?
• How would you educate a patient with newly diagnosed diabetes? What topics would you cover?
• What are the DVLA regulations for a person with diabetes?

  Suggested Learning Tasks

• Interview and record your conversation with a person with diabetes. List the diabetic complications they have and their views on their diabetes.
• List the medications of one of the patients you interview today.
• Ask the DSN what education she provides to someone newly diagnosed with diabetes

 Reference

DVLA Guide to Medical Standards of Fitness to Drive

www.dft.gov.uk/dvla/medical/~/media/pdf/medical/at_a_glance.ashx