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Lifestyle Counselling 1 

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 Scenarios

Lifestyle Counselling 1 
By Jitesh Arora   .   January 18, 2024 .   Last reviewed:   24/09/24 .    




Summary

In this scenario, the student is tasked with counselling a patient who has been diagnosed with pre-diabetes. The focus is on providing detailed information about pre-diabetes and type 2 diabetes, the importance of lifestyle changes in reversing pre-diabetes and preventing diabetes, and potential complications of diabetes. 

 

Please ensure that this scenario and mark scheme align with the most up-to-date UK NICE guidelines and the BNF when using it for your OSCE assessment. 

 

You will need a student pharmacist and an actor for this OSCE station. 

Revision Topics
Be aware, this may reveal any answers!

Pre-diabetes  

Student Instructions

You are a pharmacist. You have been asked to counsel a middle-aged woman who is now pre-diabetic. Please provide detailed information on pre-diabetes and type 2 diabetes, the significance of lifestyle changes, and potential complications. You are expected to answer any questions and address the patient’s concerns. 

 

To do: 

  1. Obtain a concise medical history from the patient and address any questions or concerns they may have.Provide lifestyle advice to the patient if necessary.  

 


You have 8 minutes.
You have access to the BNF. 

Actor AI 🤖 (Beta)
Actor Instructions

You are Sarah Wilson (Sair-uh, Will-sun). 

 

Opening Statement: “I was told I have pre-diabetes, and I am worried about what it means. Can you explain what pre-diabetes is and what I can do about it?” 

 

Patient Information: 
Provide this information when prompted.

  • Name: Sarah Wilson 

  • Age: 40 

  • Medical History:  

    • “I am pre-diabetic; I also have osteoarthritis in my left knee.” 

  • Medication History:  

    • “Paracetamol to manage my pain when needed.” 

  • Allergies:  

    • “Penicillin which causes a rash.” 

  • Symptoms:  

    • “None now. I feel fine.” 

  • Social History:  

    • “I don’t drink alcohol.” 

    • “I smoke 1 pack per day.” 

 

  • If the pharmacist asks: 

    • “I have a stressful job as a teacher.” 

    • “I have a bad habit of eating sugary foods - sweets, chocolates, cake, throughout the day when I get stressed.” 

    • “I don’t exercise at all.” 

    • “My BMI is in the normal range. I am not overweight.” 

    • “I don’t know any of my test results, this is just what the doctor told me.”  

 

If the pharmacist provides suitable lifestyle advice or small changes:

"I am happy to try that."

Questions (use to prompt the student if they miss these areas): 

  1. “What is pre-diabetes, and how is it different from type 2 diabetes?” 

  1. “What lifestyle changes can I make to reverse pre-diabetes and prevent type 2 diabetes?” 

  1. “What are the potential complications of type 2 diabetes if it develops?” 

  1. “If I start checking my blood sugars at home, what level do I need to be aiming for?” 

Mark Scheme

Introduction 
0 / 2
Introduce yourself and greet the patient professionally.
+1
Confirm the patient's name and age.
+1
Medical History 
0 / 3
Acknowledge the patient's pre-diabetes diagnosis.
+1
Confirms allergies.
+1
Confirms medication history including dose, frequency, indication, including any over-the-counter products and herbal remedies 
+1
Management and Advice 
0 / 15
Provide a detailed explanation of pre-diabetes and how it differs from type 2 diabetes, including:
Defining pre-diabetes as having an HbA1c level between 42 and 47 mmol/mol, where normal is below 42 mmol/mol, and diabetes is above 48 mmol/mol
+1
Explaining HbA1c in patient-friendly terms as a measure of average blood sugar over the past two to three months, with pre-diabetes indicating a higher risk of developing diabetes 
+1
Explain the importance of lifestyle changes in managing pre-diabetes, including:
Dietary modifications, such as reducing sugar and refined carbohydrates, increasing fibre intake, and adhering to a balanced diet 
+1
As the patient discusses eating a lot of foods when stressed, an excellent student might as more about this and refer the patient to the GP to rule out an eating disorder if suitable.
Recommending regular physical activity, such as at least 150 minutes of moderate-intensity exercise per week e.g., brisk walking Providing specific exercises and timings, such as brisk walking for 30 minutes most days, and strength training at least twice a week 
+1
Addressing smoking cessation, explaining the risks of smoking in the context of diabetes, emphasising the importance of quitting, and offering specific strategies to quit, such as using nicotine replacement therapy or accessing NHS smoking cessation services 
+1
Providing strategies for stress management, such as mindfulness, meditation, or counselling, and emphasising the impact of stress on blood glucose levels 
+1
Address the potential complications of type 2 diabetes if pre-diabetes progresses, including (Maximum 4 marks awarded):
Prone to infections, which can be more frequent and severe
Diabetic retinopathy can lead to sudden vision changes, floaters, or flashes of light
Peripheral neuropathy, with symptoms like numbness, tingling, and pain in the extremities
Autonomic neuropathy may cause symptoms such as digestive issues, urinary problems, or blood pressure fluctuations
Chronic kidney disease, with symptoms like fluid retention, shortness of breath, and elevated blood pressure
Diabetic foot, including signs like ulcers, skin colour changes, or a loss of sensation in the feet
Hyperosmolar hyperglycaemic state, with symptoms like extreme thirst, dry skin, and confusion
Accept any suitable alternatives
Explain that managing pre-diabetes through lifestyle changes significantly reduces the risk of these complications and can reverse the pre-diabetic stage.
Explain that blood glucose level targets for pre-diabetes are typically:
Fasting blood sugar: 5.6 to 6.9 mmol/L.
+1
2 hours after meals: Below 7.8 mmol/L.
+1
Emphasise that achieving and maintaining these targets is essential.
+1
Signposts to suitable resource during consultation such as NHS, diabetes UK or education programmes
+1
Collaborates with patient to agree on an achievable goal and setting up a following up appointment
+1
Communication 
0 / 5
Use appropriate language for the person and situation.
+1
Use clear and understandable language.
+1
Ensure the patient understands the importance of lifestyle changes, potential complications, the role of regular monitoring, and blood glucose level targets.
+1
Conclude the conversation professionally, reassuring the patient and offering to assist with any further questions or concerns.
+1
The student did not say anything that could harm the patient  
+1
This includes but is not limited to, providing incorrect information or medication, misdiagnosing conditions, neglecting to inquire about allergies, making incorrect referrals, or failing to act on red-flag symptoms.
Time Management
0 / 1
Completed the scenario in time and achieved 70% of marks
+1

Any criteria marked in red must be met to pass this station.   




red flag Red Flags missed: 0

Total Score
0/
Skills
professionalism 0/3
communication 0/11
information gathering 0/4
patient safety 0/3
patient education 0/20
knowledge 0/16
problem solving 0/4
diagnostic reasoning 0/3
patient-centred care 0/3
Time Management 0/1


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Referral Criteria

Referral Criteria for Diabetes / Pre-Diabetes 

 
Refer to A&E if: 

  • Severe hyperglycaemia or hypoglycaemia:Very high or low blood sugar levels not improving with initial treatment. 

  • Diabetic ketoacidosis (DKA) or Hyperosmolar Hyperglycaemic State (HHS):Symptoms like rapid breathing, confusion, abdominal pain, vomiting, or fruity-smelling breath. 

  • Severe infection or foot ulcers:Signs of infection around a wound or ulcer, particularly in the foot. 

 

Refer for an urgent GP appointment if: 

  • Newly diagnosed diabetes with high blood sugar:Patients with a new diabetes diagnosis and high blood sugar may suggest diabetes is not controlled currently. 

  • Persistent symptoms suggesting diabetes:Ongoing symptoms such as excessive thirst, frequent urination, or unexplained weight loss. 

  • Signs of complications:Vision changes, numbness, or persistent infections indicating potential diabetic complications. 

 
Refer for a routine GP appointment if: 

  • Review diabetes or pre-diabetes management:Stable diabetes and pre-diabetes require a check-up to adjust management and monitor for complications. This would include lifestyle modification advice not working despite community intervention.  

References

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