Sofia Ness C. Bautista Guimalan, R.N.

BSN- 3 NF Journal Reading:

Mrs. Pamela February 10, 2011 (Thursday)

A practical guide to diagnosing type 2 diabetes Leigh O'Shea. Practice Nurse. Sutton: Jun 11, 2010. Vol. 39, Iss. 11; pg. 12, 6 pgs Diabetes is a common lifelong condition characterized by high blood glucose (blood sugar) levels. People with diabetes have problems converting food into energy, either because of a defect in insulin production by the pancreas, or because the cells in muscles, liver and fat do not use the insulin properly (known as insulin resistance), or both. Without insulin, the glucose remains in the blood and the body does not receive fuel for energy. It is not possible for the human body to function without insulin. A raised glucose, if left untreated, can cause the person to suffer with serious side-effects or even to lapse into a life threatening diabetic coma.1 Although diabetes cannot be cured, it can be treated successfully. Treatment aims to keep blood glucose levels as normal as possible and to control symptoms to prevent health problems developing later in life. PREVALENCE OF DIABETES Diabetes is the most common disease of metabolism, affecting 2.6 million people in the UK and it is thought that there are about half a million people with diabetes who are unaware that they have the condition.1 It is estimated that 15% of all adults and children diagnosed with diabetes have type 1 diabetes and 85% have type 2 diabetes. In the UK, it is estimated that 10% of adults diagnosed with diabetes have type 1 diabetes and 90% have type 2 diabetes.4 The Quality and Outcomes Framework (QOF)s provides information on the registrations for diabetes. In 2007-2008, the overall prevalence of diagnosed diabetes in Great Britain was found to be 3.9%. Not all diabetes is diagnosed - 15% of people with diabetes may be undiagnosed or not identified on a practice register.6 The prevalence of diabetes is higher in males (4.36%) than females (3.47%) and increases with age. RISK FACTORS FOR DIABETES Numerous global studies and the rising incidence of diabetes have shown that an individual's ethnicity can either increase or decrease their risk of developing diabetes.2 While in some cases this can be explained by access to healthcare and other socioeconomic factors, studies have proved that even with equal access prevalence of diabetes

differs between people of different ethnicity and those who are Black, Asian or from a minority ethnic group have an increased risk of developing type 2 diabetes from the age of 25 years. African-Caribbean or South Asian people who live in the UK are at least five times more likely to have diabetes than the white population. The condition is also becoming more common in children and young people of all ethnicities.1 In type 1 diabetes the signs and symptoms are usually very obvious, developing quickly, usually over a few weeks, and will require urgent referral to a specialist. In people with type 2 diabetes the signs and symptoms are less obvious or even non-existent. Older people may put the symptoms down to 'getting on a bit'. Investigations A diagnosis of diabetes should only be made on a laboratory result, and never using a meter in the GP surgery. One fasting blood sample is sufficient for diagnosis if the patient is symptomatic (polyuria, polydipsia and unexplained weight loss). Otherwise, two separate readings are needed to confirm the diagnosis. The diagnosis should not be based on samples taken in patients who are acutely unwell (eg suffering an infection) or those on corticosteroid therapy. A diagnosis of diabetes has important medical and legal implications for the patient. Therefore it should not be based solely on finding glycosuria, raised blood glucose (finger-prick sample) or elevated haemoglobin Alc (HbA!c) results. Patients diagnosed with impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) do not have diabetes, and must not be told that they do to avoid restrictions on their freedom. However they do have an increased risk of developing diabetes and should be targeted for intensive lifestyle advice and annual screening for the development of diabetes and cardiovascular risk factors. Oral glucose tolerance test If the diagnosis is still unclear from these tests (ie a fasting blood glucose of 6-7mmol/l), a glucose tolerance test should be done. The patient must fast overnight and a glucose drink is given containing a Standard amount of glucose (75g). Blood samples are taken before the drink is given and 2h later. A 2h blood glucose level above ll.lmmol/l is a diagnosis of diabetes; a level below 7.8mmol/l is normal; a level between these values (7.8-1 l.lmmol/1) suggests IGT (Table 2). A person with IGT should be advised to take similar steps to a person who has been diagnosed with diabetes, as follows: lose weight if their body mass index (BMI) is above 25kg/m^sup 2^ (Table 3) exercise more (Box 2) stop smoking

 routine lifestyle advice regarding alcohol, diet (Box 3), blood pressure, salt intake check fasting blood glucose annually for the development of diabetes. IGT is more than just a pre-diabetic state and people with this condition are at increased risk of developing some of the conditions associated with diabetes, such as heart disease including stroke and heart attacks. Pregnant women with IGT have an increased risk of miscarriage and stillbirth. The Case History (overleaf) presents the typical steps to diagnosis for a patient presenting with symptoms in the surgery. All nurses must be sure that, if they are making a diagnosis, they have the training and certification to support it.8 Diabetes UK1 is launching a GP Surgery Network designed for healthcare professionals in surgery settings (see Resources). It also provides medical information and patient materials to help in the diagnosis, treatment and self-management of people with diabetes. Additionally, there is a range of accredited courses available nationally at both degree and masters levels (see Resources).1 DIABETES RISK ASSESSMENT The NHS Health Check9 is a national initiative to systematically assess the health risks of people across England. It includes identification of individuals who are at a high risk of developing diabetes (Table 4). It is expected that this programme will identify some people with previously unidentified established disease and that they will then benefit from early diagnosis and treatment. There is no single way of identifying people who are at risk of developing diabetes or who have existing undiagnosed diabetes. However there are a number of ways of determining who is at high risk of developing this condition. In general practice national guidance10 suggests using increased BMI (adjusted for ethnicity) and raised blood pressure to identify those at high risk who should be given a blood glucose test. Source: O'Shea L. A practical guide to diagnosing type 2 diabetes. Practice Nurse 2010; : Jun 11, 2010. Vol. 39, Iss. 11; pgs. 12-18 Date retrieved: February 09, 2010 From:<http://proquest.umi.com/pqdweb? index=19&did=2071032351&SrchMode=1&sid=8&Fmt=3&VInst=PRO D&VType=PQD&RQT=309&VName=PQD&TS=1297269903&clientId =28403>