My last blog was more than a little controversial, firstly in talking about carbohydrate intake in the role of managing type 1 or type 2 diabetes, and secondly, the suggestion that we should use duidelines as just that, but at the same time be able to use our clinical judgement to guide us.
It is now over a year since the Diabetes UK 15 healthcare essentials checklist was launched. If you can cast your mind back that far, you may remember that one of the aims of this checklist was to empower those who have diabetes to monitor the care they receive and ask for more from their healthcare providers in whatever areas which are lacking. How are we faring as we look at the list of aspects of care we should be providing? If I’m honest, I know the ones I am more likely to overlook are:
1. The referral of those newly diagnosed, to education courses to help them understand and also manage their diabetes.
2. Ensuring my diabetes patients receive appropriate emotional and psychological support.
Two topics I’d like to mention are the Hba1c and also the possible prevention of type 2 diabetes. Over the past two years there has been this change in the way we record Hba1c in mmol/mol in the UK as opposed to a percentage, in order to promote consistency worldwide.
How easy do you find it to use the mmol/mol method? Also, what do we understand by this particular measurement? A survey carried out by the Young Diabetologists Forum found that approximately 20% of their study group (mixture of patients and healthcare professional) were still unaware of the switch to mmol/mol. Many of us are still using conversion charts, so that we can understand the results correctly and also be able to explain the results to our patients. This survey also asked respondents to explain what they understood by the term Hba1c, and they received a wide variety of answers. Diabetes UK gives this definition on their website (www.diabetes.org.uk):
“The most common test is the Hba1c test, which indicates your blood glucose levels for the previous 2-3 months. The Hba1c measures the amount of glucose that is being carried by the red blood cells in the body”
This is a simple and clear way of describing what the Hba1c is, so that any of us - whether we are healthcare professionals or patients - can understand what we are talking about. The authors of the survey mentioned earlier concluded that we over-rely on this test and that it may be the time to re-evaluate the place of the Hba1c in diabetes management.
Due to the dramatic increase in type 2 diabetes in line with the obesity epidemic, there are lots of recommendations being made regarding the need to try and prevent type 2 diabetes. Not only that, but there is also the need to find those who are most at risk of going on to possibly develop type 2 diabetes and educate and monitor them in order to try and prevent them from developing type 2 diabetes. One of the biggest areas of concern is in the adolescent population, who if they go on to develop type 2 diabetes will almost certainly go on to suffer from multiple complications of the condition.
We urgently need to change our lifestyles, increase the amount of physical exercise we do regularly, eat more fruit and vegetables and reduce portion sizes of our food generally. We are surely sitting on the proverbial time bomb; the question is how can we stop it happening?
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