A Practical Guide to Integrated Care for Type 2 Diabetes

A new guide for GPs and Hospital Clinicians on the management and identification of Type 2 Diabetes was launched today by the Minister for Health and Children, Ms Mary Harney, TD. The guide is a the result of a new collaboration between the Health Service Executive, the Department of Health and Children, the Irish College of General Practitioners (ICGP) and the Irish Endocrine Society.

The guidelines outline the concept of Integrated Care for Type 2 Diabetes, which involves all primary, secondary and specialist health services working together to achieve the best outcomes for people with diabetes mellitus – and in practical terms means that both GPs and Hospital clinicians assume joint responsibility for the patient’s care.

Type 2 diabetes accounts for over 85 to 90 % of all cases of diabetes in European countries, and in Ireland at the moment, nearly one person in every twenty has Type 2 Diabetes. With our ageing population and the worrying rise in obesity and overweight in our society, we are seeing dramatic annual increases in numbers of people developing this chronic disease.

Welcoming the guidelines, Minister Harney said,’ this publication recognises that to provide the optimum care for people with Type 2 Diabetes, we must closely align the services provided in the community or primary care sector together with our hospital diabetes units and diabetes centres.’

Written by Dr. Velma Harkins (Irish College of General Practitioners), with support from Dr. Richard Firth of the Irish Endocrine Society and Dr. John Devlin of the Department of Health and Children, this practical guide outlines the fundamentals for diagnosis of type 2 diabetes, the targets for clinical care and the interventions that are appropriate at each stage of the disease.

Speaking at the launch, Dr. Harkins said ‘These guidelines are unique, in that they outline a model of care which can be adapted to the Irish system and also recognise the changing dynamic in Irish healthcare. They are the first guidelines for chronic disease management which have been agreed across primary, secondary and tertiary care. They emphasise that patients with type 2 diabetes often have complex needs and need careful management and structured care to improve their quality of life and outcomes.’

The onset of Type 2 diabetes is subtle, and the true prevalence of Type 2 is underestimated. Many cases are undiagnosed because blood sugar rising above normal levels develops gradually and is often not severe enough for the patient to notice any of the classic symptoms of diabetes – fatigue, excessive thirst, increased appetite. Also, there is now substantial evidence that Type 2 diabetes can be prevented or delayed and people at high risk of developing diabetes can be identified easily.

For most people diagnosed with Type 2 diabetes their condition is life-long and while new types of medication and medical devices are constantly being produced, the basic foundation for good diabetes care still focuses on healthy eating and physical activity, monitoring blood glucose levels and taking medication.

Dr. Richard Firth (Consultant Endocrinologist at the Mater Hospital), said at the launch that, ‘the management of Type 2 diabetes involves behavioural change best achieved through the type of integrated care and education outlined in these guidelines. Routine integrated care involves the patient, GP, practice nurse, diabetologist, clinical nurse specialist in diabetes, dietician, ophthalmologist and podiatrist – and best practice means this team of professionals collaborating closely to care for their patients’.

Describing the launch of these guidelines as a major step forward for patients and service providers, James Conway (HSE Diabetes Expert Advisory Group) added that

‘the HSE is currently rolling out a network of Primary Care Teams, who will play a key role in the prevention and management of chronic disease. These guidelines will be an important support to professionals delivering services to people with Type 2 Diabetes, but will also act as a map and a model for Primary Care Teams in supporting all types of Chronic Disease in the community"

Thank you to the work of the Diabetes Interest Group of the INDI for their contribution to this document.

See attached pdf document