GP & Diabetes Centre


Outpatient clinics take place in Suite 21,  Blackrock Clinic every Tuesday and Friday morning from 9am – 1pm.

You can arrange a referral by letter or by filling out the referral form that can be downloaded from this link: Referral Form

Patients should have the following tests done 2 weeks before their visit:

Blood

HbA1c, FBC, U&E, LFTs, calcium, fasting lipid profile, Vit B12, TSH

If they have a new diagnosis of Type 2 diabetes they should also have an Iron profile

Urinalysis

Albumin creatnine ratio

A telephone/email service is provided by Tara, Diabetes Nurse Specialist, for support and advice to patients and health professionals. This is available from 8am to 4.30pm, Monday to Friday.

For any diabetes-related queries you can contact Tara at 087 908 2374 or diabetes@blackrock-clinic.com

Diagnostic criteria for diabetes

Type 2 Diabetes

Glucose units in mmol/L

SYMPTOMATIC

(eg. polyuria, polydipsia, unexplained weight loss)

 

ASYMPTOMATIC

A single fasting plasma glucose ≥ 7

OR

A single random plasma glucose ≥ 11.1

A fasting plasma glucose ≥ 7 on

two separate occasions

OR

A random plasma glucose ≥ 11.1 on two separate occasions

OR

An * HbA1c ≥ 6.5% (48mmol/mol) on two separate occasions

OR

An * HbA1c ≥ 6.5% AND a single elevated plasma glucose

(fasting ≥ 7 or random ≥ 11.1)

 

 

Impaired Fasting Glucose

(IFG)

Pre-Diabetes

Impaired Glucose Tolerance

(IGT)

Fasting plasma glucose

6.1 – 6.9 mmol/L

 

HbA1c 5.7 – 6.4%

(39 – 47 mmol/mol)

2 hour plasma glucose

 7.8 – 11.0 mmol/L

(after 75g oral

glucose load)

 

The clinical management of IFG, pre-diabetes and IGT is similar, ie. education on lifestyle changes to increase physical activity, eat a healthier diet and lose weight.

* Caution with use of HbA1c for diagnosis of diabetes:

An HbA1c of < 6.5% (48mmol/mol) does not exclude diabetes.

HbA1c cannot be used in cases of increased red cell turnover (pregnancy, anaemia, haemoglobinopathies) or rapid rise in sugar levels (type 1 diabetes, acute illness, steroids).

Criteria for testing for type 2 diabetes in asymptomatic adults

Consider in all adults who are overweight (BMI ≥ 25kg/m2) and have additional risk factors:

  • Physical inactivity
  • First degree relative with diabetes
  • High-risk ethnicity (eg African, Latino, Asian)
  • Women who delivered a baby weighing > 9lb (4kg) or who were diagnosed with gestational diabetes
  • Hypertension (≥ 140/90mmHg or on antihypertensive therapy)
  • HDL cholesterol < 0.9mmol/L and/or triglyceride > 2.8mmol/L
  • Women with PCOS
  • Severe obesity
  • History of cardiovascular disease

In the absence of the above criteria, testing should begin age 45 yrs

If the results are normal, repeat testing at 3-year intervals, with consideration of more frequent testing depending on initial results and risk status eg those with pre-diabetes should be tested yearly.

Adapted from ADA Standards of Medical Care in Diabetes 2013 available at

http://care.diabetesjournals.org/content/36/Supplement_1/S11.full.pdf

Useful links for management of diabetes and obesity 

Screening for microvascular complications –

Retinopathy

http://www.diabeticretinascreen.ie/health-professionals.24.html

Neuropathy

HSE Model of Care for the Diabetic Foot

http://www.hse.ie/eng/about/Who/clinical/natclinprog/diabetesprogramme/modelofcarediabetes.pdf

Nephropathy

Micro-albuminuria screening should be conducted annually.

Send first void urine in the absence of urinary tract infection for Albumin Creatinine Ratio (ACR).

An abnormal result of >2.5mg/mmol is an indication to repeat the test twice within the following 4 months.

  • If both results are normal repeat annually
  • If two of the three tests are abnormal micro-albuminuria is confirmed

The following can affect the reliability of the test:

  • Exercise within previous 24 hours
  • Infection
  • Congestive Heart Failure
  • Marked hyperglycaemia
  • UTI
  • Haematuria
  • Pregnancy

X-PERT free community structured diabetes education programme

Link to the X-Pert document 

Programme for Healthy Eating and Weight Management (PHEW)

Link to the PHEW document

Diabetes Ireland

http://www.diabetes.ie/downloads/

Published reports and patient information materials 

Diabetes UK

http://www.diabetes.org.uk/Professionals/

UK GP update on diabetes management

http://www.gp-update.co.uk/files/docs/GP_Update-Spring_2013_diabetes.pdf

American Association of Clinical Endocrinologists Diabetes Management Algorithm 2013

https://www.aace.com/files/aace_algorithm.pdf 

National Obesity Forum Care Pathway and Toolkit

www.nationalobesityforum.org.uk

Algorithms, guidelines and advice on weight management issues in adults

and children, for health care professionals and the general public

Department of Health/NHS Obesity Care Pathway

www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4134408

Pathways for weight management in adults and children, including detailed

advice about raising the issue of weight and downloadable leaflets for patients.

Canadian Obesity Network – 5As of obesity management

http://www.obesitynetwork.ca/5As

Ask permission, assess risk, advise on risks and treatment options, agree on realistic weight loss expectations and a SMART plan, assist in addressing drivers and barriers and offering education and resources.

Exercise is medicine

www.exerciseismedicine.org

An initiative focused on encouraging primary care physicians to include exercise in treatment plans for patients. Includes exercise prescription and programme information.

National Heart Lung and Blood Institute (NHLBI). Identification, Evaluation and Treatment of Overweight and Obesity in Adults

www.nhlbi.nih.gov/guidelines/obesity/practgde.htm

Extremely comprehensive booklet from the NHLBI (order printed copies or download free) – patient information includes sample food and exercise diaries, weight and goal records, walking programmes, advice on overcoming obstacles to change, how to make healthy choices when shopping, cooking or choosing from restaurant menus.

The National Weight Control Registry (NWCR)

http://www.nwcr.ws

The largest prospective investigation of long-term successful weight loss maintenance, the NWCR was developed to identify and investigate the characteristics of individuals who have succeeded at long-term weight loss. The NWCR is tracking over 10,000 individuals who have lost significant amounts of weight and kept it off for long periods of time. Research findings report how they achieved and maintained this weight loss. Some key messages include:

  • 78% eat breakfast every day.
  • 75% weigh themselves at least once a week.
  • 62% watch less than 10 hours of TV per week.
  • 90% exercise, on average, about 1 hour per day