Understanding this chronic disease can reduce its impact.

Diabetes is a chronic disease affecting almost one million Australians over the  age of 25, with the potential for significant morbidity and mortality. In Australia, diabetes is the leading cause of blindness over the age of 60, the second leading cause of end-stage renal failure, and contributes to more than 60% of deaths related to cardiovascular disease and stroke.

The incidence and prevalence of diabetes is steadily rising, both nationally and internationally, and it is projected that, by 2010, 1.23 million Australians will be affected by the disease.

The Federal Government has listed diabetes as one of the five diseases targeted in the National Chronic Disease Strategy (NCDS). The NCDS focuses on four action areas:

1. Prevention across the continuum
2. Early detection and treatment
3. Integration and continuity of prevention and care 
4. Self-management.

 Prevention across the Continuum

Type 2 diabetes mellitus (T2DM) comprises 90% of those with diabetes. The aetiology of T2DM is multifactorial, with genetic and ethnic components. Aboriginal and Torres Strait Islanders, South-East Asians and Indians are among the populations at highest risk. A family history of T2DM increases risk by about 50 per cent. In addition to genetic factors, environmental determinants are highly associated with T2DM, including obesity and sedentary lifestyle. Improving lifestyle reduces the risk of developing T2DM by up to 60%, even in high-risk groups.

Prediabetes

Prediabetes includes the terms impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) and are early abnormalities in glucose tolerance (see Table 1). The risk of T2DM is increased 10- to 20-fold with a history of prediabetes.

When both tests are performed, iFG or iGT should be diagnosed only if diabetes is not diagnosed by the other test. *A diagnosis of diabetes needs to be confirmed with a repeat test

Gestational Diabetes

Gestational diabetes mellitus (GDM) is associated with an increased risk of T2DM. Within 10 years of GDM, approximately 50% of women will develop T2DM. Studies have shown that modifications in diet, exercise and weight can prevent the progression in high-risk populations. The Finnish Diabetes Prevention Study took high-risk patients and randomised them to intensive intervention or control. The intensive intervention group received frequent consultations with a nutritionist and access to a supervised circuit exercise program. The intervention group lost more weight and reduced onset of T2DM by 58 per cent.

 Early Detection and Treatment

Reducing the macro- and microvascular complications of diabetes is critical. Early detection and treatment is essential. For patients who have risks factors, diligent screening for onset of prediabetes or T2DM is important. Once diagnosed, it is important these individuals are educated and motivated. Community health programs are available for newly diagnosed patients and are usually group based. They are often run in modules, which the patient attends usually on a weekly basis, and some centres run culturally specific programs.

Integration and Continuity of Prevention and Care

Continued education and updating is important. As diabetes is a chronic disease there will be periods of time where patients will lose motivation, and hit complications and setbacks. Diabetes is not a static disease, and there may be a need for targeted management of complications. Individual counselling and treatment with a multidisciplinary team is often required. Depression is commonly associated with diabetes, and psychological support may be needed.

Self-Management

The management of a chronic disease (CDM) is focused on reducing progression and complications and maximising the wellbeing of individuals with the chronic disease and their families. CDM is multidisciplinary. The Wagner model for CDM aims to have an informed, activated patient and a prepared, proactive team. Self-management underpins the activated motivated patient. Diabetes is an ideal chronic disease for self-management, as treatment centres on self-monitoring, dietary modifications, physical activity and medication administration. All of these skills require motivation, awareness and behaviour change. Self-management support can take the form of education, motivational counselling and psychology. Other self-management interventions that can be provided by a community health centre for patients with diabetes include stress management sessions, walking groups, strength training and gentle exercise groups.

Key points

• Diabetes is a lifelong chronic disease that requires ongoing management to maximise health, wellbeing and reduce complications.
• Community health services both in the private and public sector can provide services for the continuum of disease, from prevention to development of complications.
• Prevention programs can be accessed for high-risk patients in the community.
• Community health centres provide a number of services for chronic disease management, individual counselling with different allied health providers, case management for complex medical issues, and group education.
• Community health services can significantly contribute to the proactive prepared chronic disease team.

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References

See Medical Observer http://www.medicalobserver.com.au/

Content Updated August 10, 2009