Welcome to this issue of BJPCN. I find myself, rather like a modern-day Scrooge, worrying about how we will face the next financially challenging years in the NHS. The Government has recently announced a pay freeze for GPs, and Lawrence Buckman, chair of the BMA’s GP Committee, warns that this affects not just doctors but all of the members of the teams they work with. This will put pressure on primary care teams, which can spill into day-today interaction with each other and with patients. How can we ensure that the quality of patient care is maintained throughout these tough times?
Diagnosing diabetes: who to test and what test to use
Diabetes affects approximately 3-4% of the British population but is thought to be significantly under-diagnosed. How can we improve the number of patients who are diagnosed early and so improve their risk of long-term complications?
New role for HbA1c in diagnosing diabetes
Glycated haemoglobin – HbA1C, or A1C as it is now being called – should be used to diagnose diabetes, according to a recent recommendation from an international expert committee appointed by the American Diabetes Association, the International Diabetes Federation and the European Association for the Study of Diabetes. We explore the basis for this recommendation, and look at why HbA1C would provide a more accurate measure for diagnosing diabetes than glucose tests and what the change would mean in clinical practice.
Starting on a GLP-1 analogue: Byetta or Victoza
Back to Basics: Chronic kidney disease (CKD) algorithm
Putting the NHS health check programme into action: hearts, brains and kidneys
The prevention of cardiovascular disease (CVD) is being moved up a gear with the ambitious and wide-reaching NHS Health Check programme. The agenda for this programme has been clearly laid out for us in the Putting Prevention First best practice guidance that was published in April 2009. The “Cog Man” on the cover highlights the close links between the heart, brain, kidneys and diabetes, explaining the comprehensive nature of vascular risk assessment, and this image is going to be seen regularly on national leaflets and posters promoting the programme. This article provides a practical guideline for the primary care team on implementing the Health Check programme, setting out who we should be checking, what we should be checking and how we should act on what we find.
Back to Basics: Blood glucose-lowering therapy
New drugs and where they fit in the treatment algorithm
In May 2009, NICE published recommendations on the use of newer agents for the control of blood glucose in type 2 diabetes. This guideline provides a partial update for NICE Clinical Guideline 66 on the management of type 2 diabetes that was published last year. These newer agents include the dipeptidyl peptidase-4 (DPP-4) inhibitors, thiazolidinediones (TZDs), the glucagon-like peptide-1 (GLP-1) mimetic exenatide and the long-acting insulin analogues (insulin detemir and insulin glargine).
Chronic kidney disease: Helping practices to identify patients at risk and reduce progression
Chronic kidney disease (CKD) has moved rapidly up the healthcare agenda over the last few years. It has shifted from being considered as a rather nebulous condition of interest mainly to nephrologists to the front line of chronic disease detection and prevention in primary care as part of integrated management of vascular risk. In fact, […]
Helping patients with diabetes to win the battle to control their weight
Many people with type 2 diabetes are overweight or obese at diagnosis and continue to struggle to control their weight. This article looks at why people with diabetes find weight control more of a challenge than the rest of us and how practice nurses can help patients to remain positive, particularly when starting insulin to optimise blood glucose control.
What factors influence what we choose to eat and how can we improve choices?
Obesity is, quite literally, the big health problem of the 21st century, with rapidly increasing rates in both adults and children. In this article we explore why obesity is such a challenge and the role of primary healthcare professionals in addressing the problem. We try to unravel the wide range of factors that cause obesity before focusing on why people eat what they do and how we can help patients to review their eating habits, introduce changes to eat more healthily and then sustain those changes.
Swollen ankles: preventing, detecting and managing oedema
It is Friday afternoon and, checking your screen, you see your last free appointment has been given to a patient you have seen in the past for routine blood tests. This time when she enters the room you observe that her legs are covered with what looks like kitchen roll, and she is wearing supermarket carrier bags over her feet to protect her shoes. For many of us, this is a ‘heart sink’ patient – with heavy, wet and oedematous legs that are difficult to manage. To be able to manage this type of condition we first need to understand the possible causes of oedema, to identify patients who may be at risk for developing the problem, and to be aware when early intervention could be of benefit.
