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GEM - diabetes the basics part two - including ABC guidelines

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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

Guardian Drugs

  • 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?

Reference:

  1. Royal College of General Practitioners. Curriculum Statement 15.6 Metabolic Problems.

 


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