Clinical update

Type 2 diabetes Essential facts

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Type 2 diabetes is a lifelong condition that affects around three million people in the UK. It can lead to health complications such as heart disease, stroke, amputation and blindness. Care of people with diabetes takes up 10 per cent of the NHS budget.

Prevalence of prediabetes in England from 2003 to 2011 (June 2014) bmjopen.bmj.com/ content/4/6/e005002

What’s new

ALAMY

More than a third of adults in England are on the cusp of developing type 2 diabetes, according to an analysis of information from the Health Survey for England. The study published in the BMJ Open found that the proportion of people aged 16 or older with prediabetes soared from 11.6 per cent in 2003 to 35.3 per cent in 2013.

Signs/symptoms Prediabetes is defined in the study as blood glucose concentrations higher than normal, but lower than established thresholds for diabetes itself. The main symptoms are passing urine more often than usual (especially at night), increased thirst, extreme tiredness, unexplained weight loss, genital itching or regular episodes of thrush, slow healing of cuts and wounds, and blurred vision.

Causes/risk factors People are at greater risk of developing type 2 diabetes if they are over 40, have a close family member with the condition and are overweight – with a waist size above 80cm (31.5 inches) for women and 94cm (37 inches) for men. The risk of developing the condition is higher for people who are South Asian, Black African or African Caribbean. People from a South Asian background are at higher risk

Expert comment Keith Booles, lecturer at Staffordshire University and an RCN diabetes nursing forum member

NURSING STANDARD

NICE guidance on preventing type 2 diabetes – risk identification and interventions for high-risk individuals (July 2012) guidance.nice.org.uk/PH38

from the age of 25 and, for men, if they have a waist over 89cm (35 inches). People who have ever had high blood pressure, a heart attack or a stroke are at higher risk, as are those with severe mental illness for which they take medication. Women who have polycystic ovary syndrome and are overweight, and women who had gestational diabetes or gave to birth to a baby over 10lb, are also at higher risk.

How you can help your patient The National Institute for Health and Care Excellence (NICE) guidance says primary healthcare professionals should offer risk assessments to see if people are at high risk of type 2 diabetes, and carry out a blood test where necessary. You should explain to patients why, even though they feel healthy, they can still be at risk of developing type 2 diabetes. They also need to understand the implications of being at risk and how these can be avoided by making lifestyle changes.

‘Nurses in all settings need a greater understanding of type 2 diabetes, the risk factors and the best way for it to be managed. Nurses, especially those in primary care, need to give out healthy eating advice and information on the benefits of exercise. They need to support people to take responsibility for their own health and to live healthier lifestyles.

NICE guidance on the management of type 2 diabetes (May 2009) publications.nice.org.uk/ type-2-diabetes-cg87

Diabetes UK type 2 diabetes risk assessment tool riskscore.diabetes.org. uk/2013 Self-management skills for people with type 2 diabetes Hicks D (2010) Nursing Standard. rcnpublishing.com doi/abs/10.7748/ ns2010.10.25.6.48.c8039

‘When people are diagnosed, they need access to structured education on managing the condition so that it does not take over their lives. ‘Type 2 diabetes can be well managed, and complications can be avoided, if people know what to do. Unfortunately many patients are not offered this education.’ july 16 :: vol 28 no 46 :: 2014 19

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