Primary care has progressively embraced the management of diabetic patients over the past two decades. Almost all type 2 diabetes (T2D) and increasingly type 1 diabetes (T1D) are managed in primary care. This has in part been driven by obligations on GPs to produce registers and work towards clinical targets for this group of patients. The surveillance culture of primary care and its role in assessment of risk for cardiovascular morbidity and mortality has led to increasing numbers of diabetic patients being identified and therefore managed. It is estimated that there are over 2.6 million diabetics in the UK, and a further 500,000 who may be undiagnosed.
Diagnosis
T1D where there is an absolute lack of insulin and T2D where there is a relative deficiency may present with similar symptoms. Typically, these are polyuria, polydipsia and weight loss. However, onset in T1D is usually acute, with patients becoming seriously ill over a few days, whereas T2D may be almost silent allowing significant end organ damage by the time of presentation. Both conditions have a genetic component. In both conditions insulin resistance and obesity have a vital role in the development of the microvascular and macrovascular complications.
Management
Management involves identifying and assessing new patients followed by regular review of patients, patient education, and lifestyle and pharmacological interventions.
Screening for diabetes in practice is part systematic – newly registered patients have a urine test as part of a health screen (although this has a significant false negative), and the new NHS health check offers a check every 5 years (assessing blood sugar in those judged at risk). GPs have a low threshold of suspicion for testing for diabetes so patients with tiredness and opportunistic infections (boils, Candida) as well as more typical symptoms are likely to have opportunistic screening. Because diabetes is so common something like 1 in 10 such tests will be positive.
Regular review
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