In the first diabetes module the focus was glycaemic control. This module will cover other aspects of diabetes care (again with particular reference to type II diabetes).
A method for describing management problems in diabetes is to use the ABC guidelines format (see notes for details). This allows the care of a diabetic patient to be considered in terms of predefined categories:
- A - advice
- B - blood pressure
- C - cholesterol
- D - diabetic control
- E - eyes
- F - feet
- G - guardian drugs
In this module the B, C and G will be formally covered. A link to a pdf of a complete version of the ABC guidelines developed by Coventry PCT is included at the end of this GEM.
Blood pressure in type II diabetics:
- according to NICE, does the presence of microalbuminuria influence management of hypertension and if so, how?
- ACE inhibitors are a first-line treatment in patients in hypertensive caucasian patients younger than 55 years according to NICE guidance for treatment of adults with hypertension. What is the significance of trials such as:
- NICE guidance - renal disease in type II diabetics
- at what level of eGFR should a patient be referred for specialist opinion?
- what influence does renal disease have on prescribing metformin?
- if macroalbuminuria is present then what is this predictive of
Cholesterol in type II diabetes:
- Two important trials in this area are the Heart Protection Study (HPS) and the Collaborative Atorvastatin
- which statins was used in the HPS study and at what dose
- when considering the data from CARDS, be aware of the recruitment criteria for the trial and how this would have affected the CVD risk of patients within the trial
- this GPN page summarise the evidence relating to cholesterol and diabetes
- What about combination therapy.
- Is there compelling evidence for the use of combination of fibrate and statin in diabetic patients with a combined hyperlipidaemia? Evidence relating to this is available from the FIELD trial. Examine the results of the trial and consider the significance of the endpoints of the trial
- GPN reference for FIELD trial
- what is the difference between a primary and secondary endpoint
- who should initiate combination therapy with a statin and fibrate, if indicated?
- The two "guardian drugs" are ACE inhibitors (or ARBs) and ACE inhibitors
- what is the significance relating to use of ACE inhibitors and deterioration in renal function
- with respect to aspirin
- when should aspirin be used in patients with diabetes?
- Royal College of General Practitioners. Curriculum Statement 15.6 Metabolic Problems.