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)
The penis as a barometer of cardiovascular risk
The arteries that supply the penis are very small and may be more prone to atherosclerosis than larger vessels. This means that the penis may be the first area in a man’s body to suffer from a reduction in blood flow and so signal cardiovascular disease.
Evidence in Practice
There are just not enough hours in the day to read all the research journals, even if you wanted to. This section of BJPCN – Evidence in Practice – will keep you on top of relevant research without having to spend hours in the library. Each review gives you a bite-size summary of new research, pulling out key points for primary care and recommending the action that you might consider taking.
Editorial
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.
Warfarin for atrial fibrillation: ‘faff’ or lifesaver?
Improving the management and prevention of stroke is a priority for the NHS. Atrial fibrillation (AF) is widely recognised to be a major cause of stroke. Moreover, it is a preventable cause in that the increased risk of stroke associated with AF can be markedly reduced by anticoagulation with warfarin. Yet a substantial number of cases of AF remain undetected and untreated. Of more concern, even after identification of AF, many individuals at high risk of stroke do not receive warfarin. This article reviews the evidence on the importance of AF as a cause of stroke and assesses the benefits of anticoagulation and our reluctance to anticoagulate. Finally, it explores ways of improving on current practice, to increase the proportion of patients with AF receiving anticoagulants.
Editorial
Happy 60th birthday to the NHS! The service has transformed the health of people in this country over its 60 years, and a significant part of this has been in cardiovascular disease and diabetes, the focus of BJPCN. We hope this issue will provide a ‘party bag’ of useful goodies that you can dip into to help in your everyday practice over the next sixty years!
Familial hypercholesterolaemia: caring for the one in 500 patients affected
Familial hypercholesterolaemia (FH) is the commonest genetic disorder in people of European and Japanese descent, affecting about 1 in 500 people. It is characterised by high levels of total and LDL cholesterol and is the most important clinical syndrome leading to premature coronary heart disease (CHD). Despite huge advances in unravelling its complex pathophysiology and the effectiveness of modern treatments, awareness of the syndrome and its consequences remains low and affected individuals are still overlooked and denied the potential benefits of treatment.
