Raindrops keep falling on my head’ might have been the theme tune for most of this summer. Hopefully, we might have a drier winter to make up for the downpours we have had over the last few months. But we hope this issue of BJPCN will provide a handy ‘umbrella’ to keep you dry under the storm clouds you might have to face in the day-to-day management of the wide range of patients with cardiovascular disease (CVD) and diabetes.
Herbal Medicines and the Clinical Management of Cardiovascular Disease and Diabetes
Many people use herbal medication of some sort, but several commonly used herbs have been shown to interact with prescribed medication. Studies show that many patients either do not realise that the herbs could interact (and anyway do not class the herbs as medicines) or do not want to tell their practitioner that they are using them. With many more nurse prescribers taking control of management of patients with longterm conditions such as diabetes and ischaemic heart disease, it is vital that we consider that the patient may be taking non-prescribed medication including herbs and supplements.
Lipid Modification in Primary Prevention – Treatment not Target
The NICE lipid modification guideline, published in May this year, covered both primary and secondary prevention of CVD. This article will look briefly at the principles of this guideline in relation to primary prevention and then go further to highlight the key issues regarding statin prescribing for people established to be at high cardiovascular risk.
Why do People with Diabetes Fall Off the Rails?
Why is it that some patients with diabetes are able to stick to the ‘straight and narrow’ while others fall off the rails? I decided to look at my client group to see if I could pick up on any particular issues that made people either forget that they have diabetes, or struggle to continue to control their blood glucose levels as they had previously been doing. This article reviews what I found and offers some suggestions on how to help patients get back in control.
Putting the NICE Guideline on Type 2 Diabetes into Practice
At last, the updated NICE (National Institute for Health and Clinical Excellence) guideline for the management of type 2 diabetes has been published. It includes an update on the management of blood glucose, blood pressure, lipids, renal function and retinopathy, but the key priorities for implementation are based on taking a patient-centred approach to care. In this article, we will focus on the important areas of patient education, dietary assessment, setting targets for HbA1c, self-monitoring and starting insulin therapy.
Making Sense of FINDRISC: the Finnish Diabetes Risk Score and How to Use it
In this article, we look at what FINDRISC is and how this tool can be used to effectively prevent and slow down the development of diabetes. We also discuss the correlation between blood glucose and cardiovascular risk before a diagnosis of diabetes has been made, and how to manage risk factors to significantly reduce morbidity and mortality.
Starting on a Gliptin – Sitagliptin or Vildagliptin
Heart Failure Specialist Nurses: Feeling the Impact
Heart Failure Specialist Nurses (HFSNs) now work in the community alongside their general practice colleagues. They can act as a valuable resource to support the primary care team in the management of heart failure patients. They carry out home visits and run community clinics to stabilise patients after discharge from hospital following an acute event. The aim is to educate patients and their family carers how to manage living with heart failure, up-titrate medications to optimal levels, stabilise the patient and then hand them back to the care of the primary care team, knowing that they will be referred back to the HFSN should their condition deteriorate. However, some complex patients with advanced heart failure (NYHA III or IV) and at high risk of re-hospitalisation are retained in the specialist nurse caseload.
Back to Basics: Making sense of peripheral arterial disease (PAD)
Making sense of type 1 diabetes in primary care
Primary care has traditionally managed people with type 2 diabetes, and people with type 1 diabetes have largely been the responsibility of secondary care. However, as blood glucose targets have become tighter and growing numbers of people with type 2 diabetes have started to require insulin, many in primary care have gradually taken on insulin management. As primary care professionals become more confident in the management of patients on insulin, many practices will be keen to take on the challenge of type 1 patients. This article looks at how type 1 differs from type 2 diabetes, which type 1 patients might be managed appropriately in primary care, and recaps on insulin regimens and dose adjustment.
Looking after women with diabetes during pregnancy
The care of pre-existing diabetes during pregnancy is complex and the remit of secondary care, but much can be done by primary care staff to ensure that pregnant women and their babies are safely on the right track by the time pregnancy is confirmed. In this article, we explore how to provide women with pre-existing diabetes with detailed and accurate preconceptual advice. Work needs to begin before contraception is discontinued to significantly reduce the risks for both mother and baby. In women with gestational diabetes, practice nurses can also be proactive postnatally, preventing progression to type 2 diabetes.
