Patient Oriented Evidence that Matters
|Summary and Introduction|
|Diabetes Management and Glycaemic Control|
|Improving Cardiovascular Outcomes|
|Blood Glucose Self-Monitoring|
|Quick Reference Charts|
Full colour PDF of the Diabetes POEM.
- 90% of all people diagnosed with diabetes have type 2 diabetes. It is characterised by insulin resistance and/or insulin deficiency (Genuth et al, 2003).
- Behavioural modification (diet and physical activity) should always be promoted as first line therapy even where drug therapy is indicated.
- Pharmacologic management of glycaemic control can be achieved using oral hypoglycaemic agents or insulin. The emphasis on initial therapy for type 2 diabetes has been shifting from sulphonylureas to metformin.
- Most patients with type 2 diabetes will eventually fail to respond adequately to oral hypoglycaemic agents and will require insulin therapy.
- Individuals exhibiting symptoms of diabetes mellitus or reaching diagnostic thresholds for diabetes are at increased risk of death due to cardiovascular disease (Nesto, 2004). The metabolic syndrome is a cluster of fasting hyperglycaemia, abdominal adiposity, dyslipidaemia and hypertension. People with metabolic syndrome are at increased risk of cardiovascular disease and diabetes. Metabolic syndrome frequently coexists with diabetes.
- Atherogenesis is potentiated by the earliest stages of glucose intolerance. Patients with impaired glucose tolerance have up to twice the cardiovascular risk of those with normal glucose tolerance and therefore need aggressive risk management at the earliest opportunity.
- Along with glycaemic control, it is important to prevent cardiovascular disease through optimisation of risk factor modification. This includes aggressive treatment of hypertension, lipid lowering, smoking cessation and aspirin therapy.
- Current guidelines suggest a number of treatment targets including a target blood pressure goal <130/80 mmHg, an LDL cholesterol target <2.5mmol/L and an HbA1c target <7.0% (NZGG, 2003).
- Excessive self-monitoring of blood glucose appears to be occurring particularly in those with type 2 diabetes controlled on diet or oral medication. The frequency and pattern of monitoring depends on the clinical situation. It should not always be assumed to be beneficial.
Diabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycaemic control, be addressed.
The cornerstone of management of diabetes involves behavioural modification promoting healthy eating patterns and physical activity (refer to quick reference section, charts 7 & 8). Pharmacological therapy is much less effective if it is not combined with modification to diet and exercise. The diabetes POEMs focus on the drug treatment of adults with diabetes.
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