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Episode 11

Management of type 2 diabetes

Show notes

Welcome to Generally Speaking, the conversation for all GPs.

Join GPs Dr Gill Singleton and Dr Billy Stoupas as they discuss some of the most pressing topics and issues surrounding the operations of a GP.

This episode, Dr Singleton and Dr Stoupas chat to Dr Gary Deed, Chair of the RACGP Specific Interests Diabetes network and clinical editor of the RACGP and Diabetes Australia’s 2020 edition of the Diabetes Handbook. He’ll share his insights and GP’s perspective on how to navigate the complexities of diagnosis, treatment, and even more importantly, how we can work on prevention of this chronic condition.

29 July 2020 - 01:41 PM | 24 min 33 sec

(00:23) Recorded during National Diabetes Week, Dr Singleton and Dr Stoupas get straight into it, given type 2 diabetes is a topic with many intricacies.

The doctors discuss some of the stats of the condition in Australia and how it has been described as ‘the epidemic of the 21st century’, with one person every five minutes diagnosed in Australia. Of the estimated 1.7 million Australians with diabetes, 500,000 don’t even know they have it.

Dr Stoupas and Dr Singleton move on to the interconnected nature of this condition with other diseases and the domino effect of diabetes against a landscape of chronic conditions in the country. It’s then time to talk to the authority, Dr Gary Deed.

Introduction of Dr Gary Deed

(03:59) Dr Deed explains his interest in the disease.

As a person with diabetes, he relays the tricky nature of being both patient and doctor with this affliction. And as a result, how he found his way into advocacy and then furthered the cause by helping some of his colleagues to better understand the condition and the evidence. Ultimately, that’s how he aligned with the RACGP in education and advocacy on the condition.

(05:12) Dr Deed talks through the importance of early diagnosis and the complex matrix of the strict criteria that provide a framework for that diagnosis.

While it begins as a sea of numbers, he breaks down the markers that help a GP formulate the optimum way to manage their patients who show early signs of the condition.

(09:06) Dr Deed responds to Dr Singleton’s question regarding high-risk individuals, like those with polycystic ovarian syndrome, fatty liver, hepatic steatosis or polycystic ovarian syndrome.

He acknowledges those high-risk conditions and continues that even women with gestational diabetes carry an ongoing risk even after the pregnancy is finished.

Many of those at higher risk have what is called normalising of the glucose. Some people who are overweight who don’t have any of these conditioners can be at risk as well, and Dr Deed highlights the importance of GPs to help positively encourage their patients to modify aspects of their lifestyle that are in the realm of their influence, such as getting a bit more physically active and quitting smoking.

(10:41) Dr Deed responds to Dr Singleton’s question about the recently released Diabetes Handbook.

He applauds the team effort, including supportive staff from the RACGP and a group of about 90 GPs who are on the coalface of treatment in their clinics. The authoring team endeavoured to not make it too academic and to incorporate information that can actually be implemented – hence why it is called a handbook. It pertains to high-level evidence and recommendations, but also outlines tools to help utilise those recommendations. He encourages GPs to use the handbook in their practice and share it with other primary care givers in their clinics.

(13:00) Dr Deed follows on from Dr Stoupas’ two-pronged question about insulin.

First, the trepidation that some patients might feel in having their treatment progress to it being prescribed. And then on to the issue of products like Ryzodeg. He acknowledges that the use of insulin in a patient’s treatment could be overwhelming if the topic isn’t brought into the treatment conversation early enough. Communication, education and support around the patient from both peers and professionals can help to ease the anxiety that may occur. And there are of course, mental health issues around the disease to take into consideration. On the subject of Ryzodeg, Dr Deed explains that we are talking about a commercial name for a combination of two sorts of insulin. Insulin degludec, a long-acting compound, and insulin aspart, a rapid-acting insulin. Both of these function as blood-glucose lowering agents, but can be administered once a day for ease of treatment while still dealing with after-meal spikes in glucose.

(18:04) Dr Deed comments on Dr Singleton’s observations around the inequity around chronic disease in general, but in particular when it comes to diabetes.
If you live in a remote area, your access to healthcare and the outcomes of your healthcare tend to align with the lower levels, while those who live in more metropolitan areas might be classified as a higher socioeconomic sort of grouping. And it’s even worse if you are an Aboriginal and/or Torres Strait Islander person. It is an important issue for Dr Deed, but one he acknowledges can’t be properly dealt with in this podcast. He suggests that if you’re working with people who are from these particular groups, who show disadvantage in diabetes, seek help from the RACGP, the Diabetes Handbook, or other agencies like Diabetes Australia.
 
(20:45) Dr Deed is asked to look to the future and he suggests that a lot of it is already here in terms of monitoring and treatment.

For instance, he has an app on his phone that allows him to check his glucose levels at any time and even without a skin prick. While there is a huge amount of investment in research taking place, he is concerned about the prevalence of the disease in the future, with one in four predicted to have the condition in the next 25 years.

(22:33) Dr Singleton thanks Dr Deed for his participation and insights, and confesses that she too has diabetes (type 1) and is grateful for the advances in science treatment and technology which help her manage the condition.

(23:45) Dr Singleton and Dr Stoupas reflect on the veritable encyclopaedia that is Dr Gary Deed and point to the reference materials.

‘What we’re seeing is an epidemic, of course I mean, we’re all going to get more and more patients and then isn’t it predicted that one quarter of us may suffer from diabetes in the next 25 years if we’re over the age of 25? It’s effectively a call to action.’

‘National Diabetes Week [2020 was] about mental health. We really spent a lot of time outlining tools that you can use to identify different types of mental health conditions that are particular to diabetes. One which is called diabetes distress. This isn’t depression, it isn’t anxiety. It’s an overwhelming affliction of people who are overwhelmed with the chronic disease of diabetes. And it really affects things like quality of life and adherence and persistence with medication.’

– Dr Gary Deed
 

  • If you would like to learn more about Dr Gary Deed’s experience and insights, or are just wanting to connect, visit his LinkedIn here
  • If you would like to learn more about Dr Gill Singleton’s achievements and insights, or would like to connect, please visit here.
  • If you would like to learn more about Dr Billy Stoupas’ achievements and insights, or would like to connect, please visit here.

Resources referred to in the Generally Speaking podcast and on the website are views of the hosts and not necessarily endorsed by RACGP.

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