Identification and management of patients at risk of T2DM

1. Identify risk using validated computer based risk assignment tools using practice data, or a validated self-assessment questionnaire (can be online)
   1. Individuals 40+, except pregnant women
   2. Individuals aged 25-39 of South Asian, Chinese, African Caribbean Black African and other high risk black and minority ethnic groups
   3. Individuals with conditions that increase the risk of T2DM
2. Individuals with high risk scores should be offered a blood glucose test to determine the risk of progression to T2DM or identify possible T2DM
3. Risk management: all individuals should be offered guidance on how to prevent or delay the onset of the condition, including discussion of the risks and:
   1. If low risk: brief advice on the benefits of healthy lifestyle and modifying risk factors
   2. If moderate risk: brief intervention on the benefits of healthy lifestyle and modifying risk factors
   3. If high risk: intensive intervention to increase physical activity, achieve and maintain weight loss, increase dietary fibre intake, reduce fat and saturated fat intake
   4. If T2DM: enter diabetes management pathway

Nutritional management of diabetes

Aims of management of diabetes

• Relieve acute symptoms
• Avoid extremes of hypo and ketoacidosis
• Reduce risk of micro and macrovascular complications
  • Maintain near-normal control of blood glucose levels
  • BP control
  • Weight loss if overweight/obese, weight management
• Maintain quality of life

Components of diabetes management

• Type 1 (10% of adults) - diet and insulin
• Type 2 (90% of adults), gestational (5% of pregnant women) - lifestyle alone, lifestyle and medication (strong association with obesity)

Dietary recommendations common to all types of diabetes

• Individuals with diabetes should be encouraged to follow general healthy eating principles (Eatwell guide)
  • Reduces the risk of weight gain and obesity
  • Reduces the risk of other chronic diseases
  • Maintain dental health
  • Maintain general health and wellbeing

Role of diet and lifestyle in the management of type 2 diabetes

• Majority (80-90%) of T2DM patients are overweight
• Reducing adiposity improves insulin sensitivity and β-cell function
• To improve glycaemic control and risk of CVD, prioritise sustained weight loss of ≳5% in overweight people by reducing calorie intake and increasing energy expenditure
• Low carbohydrate diet - effective in short term, no significant differences at 12 months compared with higher carbohydrate diet