British Journal of

Healthcare Assistants

The HCAs Role in Diabetes The HCAs Role in Diabetes Management in Primary CareManagement in Primary Care

Linda GoldieClinical Director

Primary Care Training Centre

What is diabetes?What is diabetes?

A condition where the amount of glucose in the body is too high because the body is

unable to deal with it.

www.diabetes.org.uk

It’s a big problem!It’s a big problem!

2 million people in the UK have diabetes and the numbers are growing!

70,000 more diagnosed this year

750,000 unaware they have it!

Complications linked to diabetesComplications linked to diabetes

Heart DiseaseStroke Kidney FailureBlindnessNerve damagePeripheral Vascular Disease

What can the HCA do?What can the HCA do?

Diabetes care involves the multidisciplinary care team.

Lets look at a patient!

What information and care does What information and care does Jim need?Jim need?

Who will do it?Who will do it?

What is diabetes?What is diabetes?

Verbal and written information on what diabetes is

What type of diabetes do you What type of diabetes do you suspect Jim has?suspect Jim has?

Type 1 ?

OR

Type 2 ?

Type 1 DiabetesType 1 Diabetes

No insulin productionYoungSudden onset – illSlim?Insulin needed for survival

Type 2 DiabetesType 2 Diabetes

Not enough insulin produced or the body is resistant to the insulin produced Older Family History Race Overweight/obese Increased waist circumference

Waist circumferenceWaist circumference

6.910.6

17.714.7

26.230.4

50.945.8

62.7 62.2

0

10

20

30

40

50

60

70

Men Women

Rem

ain

ing

Lif

etim

e R

isk

(%)

Underweight

Normal

Overweight

Obese

Very Obese

Narayan et al. Diabetes Care 2007;30:1562-1566Ref

Obesity Increases Lifetime Diabetes RiskObesity Increases Lifetime Diabetes RiskObesity Increases Lifetime Diabetes RiskObesity Increases Lifetime Diabetes Risk

Lifetime Risk at Age 45 (Total Population)

7.612.2

19.8 17.1

29.735.4

57 54.6

70.374.4

0

10

20

30

40

50

60

70

80

Men Women

Rem

ain

ing

Lif

etim

e R

isk

(%)

Underweight

Normal

Overweight

Obese

Very Obese

Narayan et al. Diabetes Care 2007;30:1562-1566Ref

Obesity Increases Lifetime Diabetes RiskObesity Increases Lifetime Diabetes RiskObesity Increases Lifetime Diabetes RiskObesity Increases Lifetime Diabetes Risk

Lifetime Risk at Age 18 (Total Population)

1. Warram JH et al. Ann Intern Med 1990; 113: 909–915.2. Haffner SM et al. Diabetes Care 1999; 22: 562–568.

> 90% of Type 2

diabetes patients

are insulin resistant2

Insulin resistance

precedes Type 2 diabetes by

up to 20 years1

Healthy LifestyleHealthy Lifestyle

DietAlcoholPhysical ActivitySmoking

Key PointsKey Points

BOGH picture

Weight reductionWeight reduction

Increase fruit and vegReduce fats and sugarsCareful with alcohol!

EAT LESS!

Pharmacological interventions

Is this the role of a HCA?Is this the role of a HCA?

Almost certainly yes!Everyone working in primary care should

be giving health promotion messagesBUT

be aware of your limitations

ExerciseExercise

Physical ActivityPhysical Activity

Jim doesn’t need to put on lycra and aim to be like these guys!

Just be more active!

Stop Smoking!Stop Smoking!

Smoking cessation advice

What would Jim say if told to eat What would Jim say if told to eat this with this warning?this with this warning?

“My A*******se!!”

So why do this?So why do this?

Smoking cessationSmoking cessation

Support and encouragement essential!

If you are trained to give this advice then do it!

At Clinic - At Clinic -

Height and Weight = BMI

Waist circumference– Women 80 cms– Asian Men 90 cms– White/Black 94 cms

Measuring waist circumferenceMeasuring waist circumference

Avoiding complicationsAvoiding complications

Blood pressureBlood tests

– HbA1c to assess diabetes control– Cholesterol and Lipids– Renal function

Urine test– protein

The HCA can play a valuable role doing these “tasks” within the diabetes clinic

Medication adviceMedication advice

Tablets to reduce blood glucose level

Tablets (statins) to reduce cholesterol

Tablets (aspirin) to reduce clotting

Tablets (ace inhibitors) to protect the kidneys

Tablets to reduce blood pressure

Medication adviceMedication advice

Normally left to the doctors and nurses

Further checksFurther checks

FEET

EYES

HBGM Results

PodiatryPodiatry

General condition Basic advice

Pulses Sensation

EYESEYES

Visual Acquity

Retinal photography

Home Blood Glucose MonitoringHome Blood Glucose Monitoring

How to test

When to test

What to do with the results

Further informationFurther information

Employment

Driving

Insurance

Travel

EmploymentEmployment

Will Jim be able to continue to work or continue to seek employment with diabetes?

Some jobs may be affected for example HGV drivers

PSV drivers

DrivingDriving

Driving InformationDriving Information

No problems generally

If insulin treated in the future safety issues need to be addressed related to blood glucose testing

InsuranceInsurance

Need to inform relevant companies– Car– Travel– Life on new policies otherwise no disclosure

needed

Travel adviceTravel advice

General healthcare advice– Travel vacs– Insurance– Sexual health Diabetes related advice

Medication/storageFlying/time zonesFoot care

HCA as part of the multi-HCA as part of the multi-disciplinary diabetes teamdisciplinary diabetes team

Patient Doctor Nurse DSN Dietitian Podiatrist Optometrist Pharmacist

THE HEALTH CARE

ASSISTANT!

British Journal of

Healthcare Assistants

Thank you for listening and Thank you for listening and participatingparticipating

Linda Goldielgoldie@primarycaretraining.co.uk

www.primarycaretraining.co.uk