GEM - diabetes the basics part two - including ABC guidelines

In the first diabetes module the focus was glycaemic control. This module will cover other aspects of diabetes care (again with particular reference to type II diabetes).

A method for describing management problems in diabetes is to use the ABC guidelines format (see notes for details). This allows the care of a diabetic patient to be considered in terms of predefined categories:

• A - advice
• B - blood pressure
• C - cholesterol
• D - diabetic control
• E - eyes
• F - feet
• G - guardian drugs

In this module the B, C and G will be formally covered. A link to a pdf of a complete version of the ABC guidelines developed by Coventry PCT is included at the end of this GEM.

Blood pressure in type II diabetics:

• according to NICE, does the presence of microalbuminuria influence management of hypertension and if so, how?
  • GPN reference
• ACE inhibitors are a first-line treatment in patients in hypertensive caucasian patients younger than 55 years according to NICE guidance for treatment of adults with hypertension. What is the significance of trials such as:
  • HOPE study
    • GPN reference
  • ALLHAT
    • GPN reference
  • ASCOT
    • GPN reference
• NICE guidance - renal disease in type II diabetics
  • at what level of eGFR should a patient be referred for specialist opinion?
  • what influence does renal disease have on prescribing metformin?
    • GPN reference
  • if macroalbuminuria is present then what is this predictive of
    • GPN reference

Cholesterol in type II diabetes:

• Two important trials in this area are the Heart Protection Study (HPS) and the Collaborative Atorvastatin
  • which statins was used in the HPS study and at what dose
    • GPN reference
  • when considering the data from CARDS, be aware of the recruitment criteria for the trial and how this would have affected the CVD risk of patients within the trial
    • GPN reference
  • this GPN page summarise the evidence relating to cholesterol and diabetes
    • GPN reference
• What about combination therapy.
  • Is there compelling evidence for the use of combination of fibrate and statin in diabetic patients with a combined hyperlipidaemia? Evidence relating to this is available from the FIELD trial. Examine the results of the trial and consider the significance of the endpoints of the trial
    • GPN reference for FIELD trial
    • what is the difference between a primary and secondary endpoint
      • GPN reference
    • who should initiate combination therapy with a statin and fibrate, if indicated?
      • GPN reference

Guardian Drugs

• The two "guardian drugs" are ACE inhibitors (or ARBs) and ACE inhibitors
  • what is the significance relating to use of ACE inhibitors and deterioration in renal function
    • GPN reference
• with respect to aspirin
  • when should aspirin be used in patients with diabetes?
    • GPN reference

Reference:

1. Royal College of General Practitioners. Curriculum Statement 15.6 Metabolic Problems.