Looking back over the past five years since I started writing these blogs, I have written on a wide variety of topics related to diabetes, and hope that what I have talked about has been relevant to those of you working in diabetes care within general practice.
For you, I wonder what is the most challenging part of your work with those who have diabetes whether it is type 1 or type 2. Diabetes is such a wide-ranging condition, touching people in so many different ways, and the way it is now managed has changed dramatically in the past 15 years or so.
15 years ago, there were ‘One Stop Shop’ clinics held in general practice, and the practice nurse was very much a part of a team, which included a podiatrist and dietician, whom the patient saw regularly. With the huge growth in the incidence of diabetes, we do not have such resources today, and the practice nurse now provides the bulk of the contact time in general practice.
Back then the medications used to manage diabetes were few, and consisted of Metformin and Sulphonylureas, as well as Acarbose occasionally. Insulin was available, but not in the vast array we have now. Now we have DPP4 inhibitors or Gliptins, GLP1 RAs (non-insulin injectable therapies) and SGLT2 inhibitors. Insulins range from the very flat and long-acting (analogues) in double or triple concentration to the ultra-rapid doses that are given before meals, and methods of administration include insulin pump technology.
We have so many blood glucose meters now, it can be hard to choose what is most cost effective for our patients to use, and we can now test blood ketones, progress for those with type 1. What about continuous blood glucose monitoring or ‘flash blood glucose monitoring’? I’m thinking here of the Freestyle Libre monitoring device. What a difference these can make to helping people to engage with their diabetes and see more clearly where they may need to make any changes to their management.
Life with diabetes is changing all the time, there are apps to help count calories; there are blood glucose meters that talk to smartphones. How long will it be, until all that is required is a smartphone with the appropriate blood glucose technology? I can imagine a smartphone app that would swipe a sensor worn on the body and measure the blood glucose and advise on appropriate insulin dosing.
All of this, of course, is to assist current diabetes patients in managing their condition every day – but what is being done in the way of prevention? How is the Diabetes Prevention Programme faring? Not enough opportunities are being provided to educate the wider population about how they can avoid developing diabetes, eat more healthily, take more physical activity, and generally live a much healthier life. It does not seem to be as high on our priorities as it should be. How are we going to stem the tide of diabetes, particularly type 2, with the current obesity epidemic?
I don’t have the answers, although I wish I did, and am sure many of you may have felt this.
For sure we are going to need to change our models of working, so that we can reach more people more efficiently, without requiring additional resources. We cannot see every person face-to-face for all the support they may require, but we do have email, and mobile phones to text or call with. There will be new technology available in the near future and we must get to grips with it, so that our patients have all the resources they need to manage their diabetes to the highest level and enjoy the best quality of life possible.
Don’t let lack of resources stand in your way, seize the opportunities for more effective management now.