The role of primary health care in primary and secondary prevention of diabetes

Abstract

In Australia, diabetes represents a major burden in both human and financial terms, drawing heavily on limited health care resources including trained staff and carers. In contrast to many other health conditions, evidence suggests that many aspects of the burden imposed by diabetes could be avoided through preventive measures. Type 1 diabetes mellitus (T1DM) is a genetically linked autoimmune disease and there is currently no known prevention. However, the risk for complications associated with T1DM can be reduced by optimal management of blood glucose levels. Type 2 diabetes mellitus (T2DM) accounts for over 85 per cent of all diabetes in Australia. Obesity is a major contributor to the development of T2DM and weight loss has been shown to reduce the incidence of T2DM in people with impaired glucose tolerance (IGT). Therefore, primary prevention of T2DM has generally focused on weight loss and lifestyle interventions, while secondary prevention to reduce the risk of diabetes-related complications centres on use of pharmacotherapy in addition to diet and lifestyle interventions to manage surrogate markers of complication risk (e.g. blood glucose levels, blood pressure, and lipid levels). The aim of this research is to examine diabetes programmes reporting outcome data and used in general practice settings to identify and proactively manage individuals at high risk for developing diabetes; or where diabetes is diagnosed, at risk for development of, or deterioration in, diabetes-related complications. Comparison of programme structure with published evidence is used together with outcome data to assess programmes.