1 Measuring and Improving the Quality of Diabetes care in General Practice Dr M Grixti. Dr C Scalpello, Dr C Mercieca, Dr P Mangion, Dr T O Sullivan
2 Outline of presentation Statistics Diabetes care,as the model for chronic diseases management Shared care project Clinical Audit report Summary Conclusions Recommendations
3 International Diabetes Federation Europe General Assembly Together We Are Stronger St Julian's, Malta 9- September 8 Diabetes currently affects approximately 8.6% of the adult population of the European Union -around million people across the current 7 EU Member States. Individual country prevalence rates range from 4% in the United Kingdom to.8% in Germany. The IDF Diabetes Atlas 6 estimates that the diabetes prevalence rate in Malta is 9.7% of the adult population, representing 8,6 people. The Atlas forecasts a rise in prevalence to.6% by 5. Data from IDF and FEND Audit Report 6
4 International Diabetes Federation Europe General Assembly Together We Are Stronger St Julian's, Malta 9- September 8 MALTA - Key Statistics IDF Atlas IDF Atlas 6 Estimated National diabetes prevalence (% of total population aged -79) Estimated number of people with diabetes 9.% 5,8 9.7% 8,6 Estimated cost of diabetes National Plan Not Available No Data from IDF and FEND Audit Report 6
5 International Diabetes Federation Europe General Assembly Together We Are Stronger St Julian's, Malta 9- September 8 The National Diabetes Association (Ghaqda Maltija Kontra id-dijabete) states that there are over, diagnosed persons with diabetes in Malta. They expect this number to double by. Furthermore, 84% of people with diabetes in Malta are either overweight or obese. Deaths from DM : 9.% of deaths from all causes in Malta are attributable to DM. Diabetes atlas 4 th Ed 9 National Diabetes Association, http;//www.dibetesmalta.org/profile.php WHO, World Health Statistics 7, Diabetes in Malta: Current findings and future trends, Malta Medical Journal, Vol. 7: (March 5), 4.pdf
6 International Diabetes Federation Europe General Assembly Together We Are Stronger St Julian's, Malta 9- September 8 "DIABETES The Policy Puzzle: Is Europe Making Progress?" The 8 report provides the latest evidence of the spiraling diabetes epidemic in Europe Diabetes prevalence rates in Europe continue to rise and are predicted to reach an average of.% of the EU population by 5 a burden which national healthcare systems will find hard to bear. The international Diabetes Federation European Region ( IDF Europe) and the Federation of European Nurses in Diabetes ( FEND) announce the publication of the second edition of their pan European diabetes policy audit.
7 The burning questions Why involve general practice & primary care? Does general practice need to adapt to provide effective diabetes care? Can primary care perform? Does shared care add value? Can we influence psycho-social well-being?
8 Why involve general practice and primary care? Diabetes is a complex multisystem metabolic disorder characterized by raised blood glucose levels associated with inadequate insulin production or inefficient insulin utilisation. Diabetes is usually a lifelong condition from the time of diagnosis. People with type diabetes have an increased risk of depression, which is consistent with the association between increased frequency of depression among people with other chronic diseases. People with diabetes therefore need long-term care that is consistent, offers continuity and holistic support, is accessible and is delivered in context with their changing life styles and with other medical conditions, preferably in a convenient local setting. Hence it is an ideal condition for general practitioner based care.
9 Organization of Diabetes care Type diabetes is gradually progressive, requiring frequent reassessment and modification of treatment Diabetes treatment is lifelong, but its organization should be tailored to the individual in terms of age, education, support and experience of the condition Patient education and involvement to motivate significant lifestyle change are as important as clinical examination and prescribing. Diabetes competes with other priorities, and patient motivation will fluctuate As a basic standard of care, people with diabetes should have regular access to a doctor, nurse and dietician. The objectives of care include controlling the symptoms of diabetes, prolonging life and preventing the long-term complications of the condition, while preserving quality of life.
10 Diabetes care models Structured care organised, planned care characterised by registration, recall & regular review Shared care planned care jointly delivered by teams in primary and secondary care with enhanced communication
11 Anatomy of shared care ( ECAD) Community-based nurse & dietician Liaison group Agreed targets Protocols eg insulin Training Regular reports Type patients GP visits Annual review in hosp Complication screening Audit
12 Is shared Care the answer to the problem of diabetes? Pilot project of shared care involving primary care team at Gzira Health Centre and Specialists at Mater Dei Hospital Dr Mario Grixti PHC/MCFD
13 Diabetes Shared Care Program for the Maltese Islands This shared care model shows the feasibility of collating audit data and the potential of this approach for describing patterns of care and highlighting general and local deficiencies. Information about levels of performance in large numbers of patients can be used to set standards or norms against which individual practitioners can compare their own activity. Comparison of the health needs of local populations with national data could be used to inform commissioning services. However, audits should employ uniform evidence-based criteria so as to facilitate collation and allow comparison.
14 Audit approach (4) docs patients items Structure Process first Outcomes Intermediate End-point Docs compared with: Each other Gold standard Irish colleagues What explains differences? Organisation Attention Rigour Access
15 Patient No Eyes screened (=yes, =no) Record complications (=yes, =no) No. Reviews attended (number) No. HbAIc records (number) No. BP records (number) No. Weight records (number) No. BMI records (number) No. Foot exams (number) Smoking status (=yes, =no) No. Dietician reviews (number) Most recent HbAc record (%) Most recent Systolic BP (mmhg) Most recent Total Chol. (mmol/l) Most recent BMI (kg/m²) No. BP Medications (number) Aspirin use (=yes, =no) No. OHA's (number) Insulin added/increased (=yes, =no) CVD events 8 (number) New Foot Ulcers 8 (=yes, =no) Death 8 (=yes, =no)
16 Summary of data Total patients 67 had eyes screened (68%) 56 had a record of complications (5%) 898 had smoking status recorded (9%) 89 reviews attended (mean.9 visits per patient) 96 HbAc records Mean HbAc 6.8, Max.8 Mean Systolic BP 6 Mean total cholesterol 5.5, range.-9.5 Mean BMI 8.9, Range patients (4%) were on aspirin 4 (.6%) had insulin added or altered during the year 84 BP records 887 weight records 54 BMI records 67 foot exams 6 dietician visits 9 CVD events (.9%) 6 foot ulcers deaths
17 Eyes Screened Count of GP No Eyes screened GP No Record of complications Count of GP No 5 5 Record of complications GP No It is a concern that between ¼ and ½ of patients do not have a record of retinopathy screening, and most do not have the presence or otherwise of complications recorded
18 Number of reviews attended Count of GP No 5 5 No of reviews attended GP No No of HbAc results Count of GP No 5 5 No of HbAcrecords GP No All patients attended for diabetes reviews, which is encouraging, and most are having HbAc tests at least once a year. Ideally this should rise to -4 times depending on treatment changes during the year
19 No of BP readings Count of GP No 5 5 No of BP records GP No No of weight records Unsurprisingly, most patients have several BP readings, but it is gratifying that most also have more than weight record.
20 No of BMI records No of foot examinations Transferring weight to BMI involves height recording, and undertaking the calculation although GP software systems sometimes do this automatically. The lack of a record of foot examination in / of the group is a concern, reflecting time constraints and patient and provider reluctance.
21 Smoking status recorded? Number of dietician reviews Smoking status is very well-recorded, while access to dietetic care is clearly inadequate.
22 Mean HbAc (%) Total Mean Systolic BP Total Glucose and BP control is very adequate in this sample, with room for improvement in one group.
23 Mean Total Cholesterol Total... 4 Mean BMI Total Similarly, lipid and weight control is consistent between groups and generally across international norms
24 Mean number of BP medications (an indicator of intensive treatment) Total Number on Aspirin Total Compared with other studies, numbers receiving aspirin is low (perhaps under current evidence we shouldn t do anything about that) and BP prescribing is also low (indicating less intensive BP reduction or a population with less tendency to metabolic syndrome and high BP)
25 Mean number of oral hypoglycaemics Total No of patients with Insulin added or adjusted Total In contrast, glycaemic treatment is quite intensive, particularly with regard to insulin initiation. Insulin Initiation is a common barrier in general practice.
26 Summary data for entire group Total patients 67 had eyes screened (68%) 56 had a record of complications (5%) 898 had smoking status recorded (9%) 89 reviews attended (mean.9 visits per patient) 96 HbAc records 84 BP records 887 weight records 54 BMI records 67 foot exams 6 dietician visits Mean HbAc 6.8, Max.8 Mean Systolic BP 6 Mean total cholesterol 5.5, range.-9.5 Mean BMI 8.9, Range patients (4%) were on aspirin 4 (.6%) had insulin added or altered during the year 9 CVD events (.9%) 6 foot ulcers deaths The summary data confirms the generally good control, while some areas of process will be improved with investment of simple resources into community-based diabetes care.
27 Comparison with Ireland( ECAD) Measure % having HbAc Mean HbAc result % having a chol Mean tot chol % seeing a dietician % taking aspirin % having CVD events % having foot ulcers Proportion dying Ireland 9 % % 4.47 mmol/l % 7 % 8.6 %.4 %.4 % Malta 79 % % 5.5 mmol/l 6 % 4 % 9. % 4.4 %. %
28 Conclusions Diabetes is a major threat to health Investment in more effective care Numbers overwhelm system Primary care offers an immediate solution GP participation is cost effective Shared, not shifted care Resource all sectors adequately Needs of patients st priority Support integration Collect comparable data Use EU experiences
29 Recommendations Joint treatment of patients between the family physician and the diabetes specialist, may be a proposed model to improve diabetes control. This model of treatment should be checked in a prospective study. Good care of the diabetic patient reduces the incidence of long-term complications. Treatment should be interdisciplinary; in the last decade a debate has raged over how to optimize treatment and how to use the various services efficiently. We are recommending a shared care program with the secondary care specialists and we have produced an audit which shows that shared care is possible and that quality of care delivered to diabetic patients by General Practitioners with a special clinical interest in diabetes does work and could be the way forward in this country for other chronic disease management.
30 Thank You World Diabetes day 4 th November 9 Diabetes education and prevention Acknowledgement Dr D Vella Baldacchino Prof S Fava Dr T O Sullivan Mrs M Dimech Director Primary Care Director Dept of Diabetes and endocrinology at MDH Director East Coast Area Diabetes shared care program Nurse i/c of Diabetes Clinic at GHC
Diabetes Introduction The attached paper is adapted from the initial background paper on Diabetes presented to the Capital and Coast District Health Board Community and Public Health Advisory Committee
G:\ CDM\BHCIG Diabetes Pathway FINAL September 05.doc 1 BHCiG: TYPE 2 DIABETES MANAGEMENT PATHWAY MODEL INTRODUCTION What is the aim of the model? To improve the capacity of primary care health practitioners
Managing diabetes in the post-guideline world Dr Helen Snell Nurse Practitioner PhD, FCNA(NZ) Overview Pathogenesis of T2DM Aims of treatment The place of glycaemic control Strategies to improve glycaemic
Personalized Therapy Algorithms for Type 2 Diabetes: A Phenotypization-based Approach Riccardo Candido on behalf of the Personalized Therapy AMD Study Group Diabetes Canter A.S.S. 1 Triestina, Italy BACKGROUND
Submission by the Irish Pharmacy Union to the Department of Health on the Scope for Private Health Insurance to incorporate Additional Primary Care Services January 2015 1 IPU Submission to the Department
DIABETES A chronic, debilitating and often deadly disease Diabetes is a chronic condition that arises when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin
Statistics of Type 2 Diabetes Of the 17 million Americans with diabetes, 90 percent to 95 percent have type 2 diabetes. Of these, half are unaware they have the disease. People with type 2 diabetes often
National Diabetes Audit 2013-2014 and 2014-2015 Report 1: Care Processes and Treatment Targets Version 1.0 Published: 28 January 2016 Introduction The National Diabetes Audit (NDA) continues to provide
Breaking Down the Barriers - Masterclass training package and modules Assessment of a patient with urgent mental health needs in an emergency department Module 1 Module 2 Mental health awareness training
Therapeutic Inertia Dr Samuel Seidu. Declaration of interests Sam Seidu has acted as advisory board member and/or speaker for Novartis, Janssen, Novo Nordisk, Lilly, Boehringer Ingelheim, MSD, Amgen, Astra
Int J Endocrinol Metab 2009;2: 51-55 The Effect of the Change in the Definition of Type 2 Diabetes on Patient Demographics ORIGINAL ARTICLE Tildesley HD a,b, Wise JS b, Mazanderani AB a, Aydin CA b, Fraser
Scottish Diabetes Survey 2011 Scottish Diabetes Survey Monitoring Group Foreword The Scottish Diabetes Survey 2011 data reflects many aspects of the quality of diabetes care across the whole of Scotland.
Type 1 Diabetes W ( Juvenile Diabetes) hat is Type 1 Diabetes? Type 1 diabetes, also known as juvenile-onset diabetes, is one of the three main forms of diabetes affecting millions of people worldwide.
Primary/secondary care interface Nurse-led management of newly diagnosed type 2 diabetes Joan Everett and David Kerr Article points 1The diagnosis of diabetes can have a profound psychological impact upon
Preventive Health Unit Cardiovascular disease risk in Queensland 2011 12: blood pressure, cholesterol, obesity and diabetes About this report This report is designed for a technical audience, and assumes
1 Nutrition Type 2 Diabetes: A Growing Challenge in the Healthcare Setting NAME OF STUDENT 2 Type 2 Diabetes: A Growing Challenge in the Healthcare Setting Introduction and background of type 2 diabetes:
KEY FACTS Diabetes is on the rise, and is among the top 10 causes of death in Singapore. Indians are most likely to have diabetes, followed by the Malays and Chinese. The risk of diabetes can be reduced
International Diabetes Federation (IDF) North America and Caribbean (NAC) Regional Workshop Supporting the Implementation of the United Nations (UN) Resolution on Diabetes (61/225) in the North America
Population Health Management Program Program (formerly Disease Management) is dedicated to improving our members health and quality of life. Our Population Health Management Programs aim to improve care
TYPE 2 DIABETES MELLITUS: NEW HOPE FOR PREVENTION Robert Dobbins, M.D. Ph.D. Learning Objectives Recognize current trends in the prevalence of type 2 diabetes. Learn differences between type 1 and type
Key Priority Areas Key Priority Area 1: Improving access and reducing inequity Key Direction for Change Primary health care is delivered through an integrated service system which provides more uniform
PCT Prescribing Report Drugs used in Type 2 Diabetes Discussion Points 1. Does your PCT have a strategy for prevention of type 2 diabetes? Does your PCT provide the sort of intensive multifactorial lifestyle
Virtual Diabetes Centre Chronic Disease Management 2013 1 Type 2 Diabetes An exploding clinical problem Diabetes, as with other chronic diseases: A complex illness that requires: a comprehensive approach
PERSONNEL SPECIFICATION Title Diabetes Nurse Band 6 Department Primary and Community Care Location Community Diabetes Nursing Team Southern Sector Date May 2015 Factors Essential Criteria Desirable Criteria
Chapter 7: Strengthen the Role & Impact of Ill Health Prevention Diabetes Lead author: Dr Sapna Chauhan Introduction Diabetes is a major public health issue. There are currently around 3.8 million people
Diabetes Coaching: A nurse-led approach for better selfmanagement of patients with diabetes in Primary Care Submission for the 2014 Canterbury DHB Quality Improvement and Innovation Awards Te Rawhiti Family
Type 2 Diabetes: When to Initiate And Intensify Insulin Therapy Julie Bate on behalf of: Dr John Wilson Endocrinologist Capital and Coast DHB Declarations I have received travel funding and speaker fees
What is DIABETES? By: Gwen Hall Diabetes Specialist Nurse, Community Diabetes Services Portsmouth, Primary Care Team. WHAT IS DIABETES? What is diabetes? In simple terms diabetes prevents your body converting
STATE OF THE NATION Challenges for 2015 and beyond England The state of the nation: diabetes in 2014 4 Care for children and young people 28 The challenges for 2015 and beyond: what needs to happen over
Clinical Practice Guidelines for Diabetes Management Diabetes is a disease in which blood glucose levels are above normal. Over the years, high blood glucose damages nerves and blood vessels, which can
Understanding diabetes Do the recent trials help? Dr Geoffrey Robb Consultant Physician and Diabetologist CMO RGA UK Services and Partnership Assurance AMUS 25 th March 2010 The security of experience.
Evaluation of Fife- DICE: Type 2 diabetes insulin conversion Article points 1. Fife-DICE is an insulin conversion group education programme. 2. People with greater than 7.5% on maximum oral therapy are
Kansas Behavioral Health Risk Bulletin Kansas Department of Health and Environment November 7, 1995 Bureau of Chronic Disease and Health Promotion Vol. 1 No. 12 Diabetes Mellitus in Kansas Diabetes mellitus
TYPE 2 DIABETES IN THE CHILD AND ADOLESCENT DR. Trinh Thi Kim Hue CONTENTS Definition Diagnosis Treatment Comorbidities and Complications Comorbidities and Complications Screening for T2D References DEFINITION
Effect of Liraglutide on Body Weight in Non-diabetic Obese Subjects or Overweight Subjects With Co-morbidities: SCALE - Obesity and Prediabetes This trial is conducted in Africa, Asia, Europe, Oceania,
YOUR GUIDE TO DIABETES b What is diabetes? b Type 2 diabetes prevention b Prevention checklist b Living with diabetes b Complications b Terms to know b Resources To promote and protect the health of Canadians
Type 2 Diabetes Type 2 diabetes is the most common form of diabetes, accounting for 90 95% of cases. 1 Charts 1 and 2 reflect the effect of increasing prevalence on prescribing and costs of products used
What is an oral glucose tolerance test? The oral glucose tolerance test (also known as a GTT or ogtt) is used to investigate if you have diabetes by assessing how your body responds to a dose of glucose
Diabetes and Life Insurance A Special Report by LifeInsure.co.uk Introduction Securing life insurance as a diabetic can be a difficult and costly process. Many insurers will refuse cover, or will set very
UNIVERSITY OF MEDICINE AND PHARMACY CRAIOVA DOCTORAL SCHOOL DOCTORATE THESIS - Summary CHRONIC COMPLICATIONS IN PATIENTS WITH TYPE 1 DIABETES MELLITUS - Epidemiological study - PhD Manager: Professor PhD.
Diabetes: The Numbers Changing the Way Diabetes is Treated. What is Diabetes? Diabetes is a group of diseases characterized by high levels of blood glucose (blood sugar) Diabetes can lead to serious health
Diabetes mellitus care in Malta The role of the family doctor Jean K Soler Diabetes mellitus care in Malta The role of the family doctor Aims and objectives of care Aims of diabetes care Avoiding complications
Managing Diabetes: It s s Not Easy But It s s Worth It Presenter Disclosures W. Lee Ball, Jr., OD, FAAO (1) The following personal financial relationships with commercial interests relevant to this presentation
Nutrition Therapy in Diabetes Mellitus. Dorothy Debrah Diabetes Specialist Dietitian University Hospital, Llandough. Wales, UK February 2012 University Hospital Llandough DIABETES MELLITUS. Definition:
An integrated IT approach to Chronic Disease Management Presented by: Steve Courtney Chief Executive Officer Health Information Systems (UK) Ltd March 2011 Who are Health Information Systems (UK) Ltd Company
MEDICATION THERAPY ADHERENCE CLINIC : DIABETES PHARMACEUTICAL SERVICES DIVISION MINISTRY OF HEALTH MALAYSIA First Edition, 2010 Pharmaceutical Services Division Ministry of Health, Malaysia ALL RIGHT RESERVED
White Paper Catalysts driving successful decisions in life sciences. Diabetes Trends in the U.S.: Results from the National Health and Wellness Survey by Kathy Annunziata and Nikoletta Sternbach January
The Danish Healthcare System and the Danish Registers Jens Søndergaard, MD, PhD Professor, family physician, clinical pharmacologist Research Unit for General Practice, Institute of Public Health, University
DIABETES WEIGHT ENDOBARRIER THERAPY The first endoscopically-delivered device therapy for obese patients with type 2 diabetes Restore the metabolic health of your patients with EndoBarrier Therapy. Dual
Title: Identifier: Replaces: Policy For The Adjustment Of Insulin Doses By Paediatric Diabetes Specialist Nurses Working With Children Within NHS Grampian N/A Across NHS Boards Organisation Wide Directorate
Insulin Pump Therapy for Type 1 Diabetes Aim(s) and objective(s) This guideline has been developed to describe which patients with Type 1 Diabetes should be referred for assessment for insulin pump therapy
Effect of liraglutide on body weight in overweight or obese subjects with type 2 diabetes: SCALE - Diabetes This trial is conducted in Africa, Asia, Europe and the United States of America (USA). The aim
KIH Cardiac Rehabilitation Program For any further information Contact: +92-51-2870361-3, 2271154 Feedback@kih.com.pk What is Cardiac Rehabilitation Cardiac rehabilitation describes all measures used to
7 th DIETS/EFAD Conference Type 2 Diabetes: the pandemic waiting to happen Cathy Breen EFAD ESDN Diabetes Lead/Irish Nutrition and Dietetic Institute/ Endocrine Unit, St Columcille s Hospital, Loughlinstown,
MEETING YOUR GOALS An Overview and Guide to Healthy Living with Type 2 Diabetes MEETING YOUR GOALS This brochure was designed to help you understand the health goals to live a healthy lifestyle with type
NHS Dorset Clinical Commissioning Group Access Criteria for Tier 3 Weight Management Programme Supporting people in Dorset to lead healthier lives POLICY TRAIL AND VERSION CONTROL SHEET: Policy Reference:
TYPE 2 DIABETES IN CHILDREN DIAGNOSIS AND THERAPY Ines Guttmann- Bauman MD Clinical Associate Professor, Division of Pediatric Endocrinology, OHSU Objectives: 1. To discuss epidemiology and presentation
Effectiveness of an iphone application on Diabetes Self-Management Ms Morwenna Kirwan, Dr. Corneel Vandelanotte, Dr. Mitch Duncan, Dr Andrew Fenning, Prof. Kerry Mummery Institute for Health and Social
Self Care in New Zealand A roadmap toward greater personal responsibility in managing health Prepared by the New Zealand Self Medication Industry Association. July 2009 What is Self Care? Self Care describes
Workshop A Tara Kadis Considerations/barriers in decision making about insulin verses GLP-1 use in people with type 2 diabetes Which Insulin regimes should we consider? Diabetes is a progressive multi-system
Group 1 notes Abi / Nicole Type 2 Diabetes workshop notes 4.1 Population The group discussed the following sub groups that may need addressing: Men-as they tend to die earlier compared with women, their
CLINICAL AUDIT TOOL: Type 2 Diabetes and Glycaemic Control Introduction This clinical audit tool addresses glycaemic control for people with type 2 diabetes. It draws on best practice guidance reproduced
Baskets of Care Diabetes Subcommittee Disclaimer: This background information is not intended to be a comprehensive scientific discussion of the topic, but rather an attempt to provide a baseline level
Challenges in Glycemic Control in Adult and Geriatric Patients Denyse Gallagher, APRN-BC, CDE Endocrinology Nurse Practitioner Provide an overview of diabetes prevalence; discuss challenges and barriers
HLTEN611B Apply principles of diabetic nursing care Release: 1 HLTEN611B Apply principles of diabetic nursing care Modification History Not Applicable Unit Descriptor Descriptor This competency unit describes
Improving cardiometabolic health in Major Mental Illness Dr. Adrian Heald Consultant in Endocrinology and Diabetes Leighton Hospital, Crewe and Macclesfield Research Fellow, Manchester University Metabolic
NPDA National Paediatric Diabetes Audit National Paediatric Diabetes Audit Report 2013-14 Part 1: Care Processes and Outcomes National Paediatric Diabetes Audit 2013-14 Report 1: Care Processes and Outcomes
in the Netherlands Care-standards Structure of Workshop Short introduction: in the Netherlands 10min Discussion of 4 questions 60min How can self management be a part of diabetes disease management? How
Burns & McDonnell On-Site Clinic A Prescription for Financial and Productivity Success Fall 2013 Lockton Companies C OMPAN Y P R OFI L E Engineering, architecture, construction, environmental and consulting
LC Paper No. CB(2)626/12-13(04) For discussion on 18 February 2013 Legislative Council Panel on Health Services Elderly Health Assessment Pilot Programme PURPOSE This paper briefs Members on the Elderly
2 Ashtree Court, Woodsy Close Cardiff Gate Business Park Cardiff CF23 8RW Tel: 029 2073 0310 firstname.lastname@example.org www.rpharms.com 18 th October 2011 Submission to: Call for Evidence: Response from: National
The London Assembly s Health and Environment Committee intends to review diabetes care in London. Aim of review The purpose of this review is for the Committee to understand the extent of diabetes prevalence
Inova Health System Using the Concept of Being Safe as a Positive Motivator In Diabetes Education Ann Carnes MN RN CDE Sally Guise RD CDE AADE Annual Meeting August 6, 2009 Why Safety? 67% of Americans
Page 1 of 5 Type 2 Diabetes Type 2 diabetes occurs mainly in people aged over 40. The 'first-line' treatment is diet, weight control and physical activity. If the blood glucose level remains high despite
Prediabetes: A Woman s Perspective AMERICAN COLLEGE OF ENDOCRINOLOGY CONSENSUS STATEMENT ON THE DIAGNOSIS AND MANAGEMENT OF PRE-DIABETES IN THE CONTINUUM OF HYPERGLYCEMIA Joanne Kaiser-Smith, D.O., FACOI,
OBESITY: An underestimated threat Public perceptions of obesity in Europe COUNTRY SUMMARY GERMANY Conducted by independent strategic insight agency Opinium, in collaboration with the European Association
Diabetes Definition Diabetes is a chronic (lifelong) disease marked by high levels of sugar in the blood. Causes Insulin is a hormone produced by the pancreas to control blood sugar. Diabetes can be caused