Making Best Practice, Every Day Practice
Lipohypertrophy is surprisingly common in people using insulin to control their diabetes. As more and more people with diabetes are managed in primary care, practice nurses take on a greater role in the management and education of these patients. This article considers what lipohypertrophy is, how it can be prevented and how it should be managed once it has been identified.
Aliskiren (Rasilez) is the first in a new class of medicines – the direct renin inhibitors – to treat high blood pressure to become available in more than a decade. In this article we review how aliskiren works, what makes it different from other drugs acting on the reninangiotensin system (RAS), its efficacy and tolerability and its likely place in the management of hypertension.
Exenatide (Byetta) is the first glucagon-like peptide-1 analogue (GLP-1 analogue) to be approved for the treatment of type 2 diabetes. It is a twice-daily injection, currently prescribable only by consultants, given before breakfast and before the evening meal. The early signs are that this new and different medicine has the potential to be very exciting for both patients and healthcare professionals. Studies show a reduction in HbA1c as well as steady weight loss – every diabetic’s dream! In this article, we look at how exenatide works, where it fits into current practice and the pros and cons of this new preparation.
Sitagliptin (trade name Januvia) is the first in a new class of drugs for diabetes – the dipeptidyl peptidase-4 (DPP-4) inhibitors. This new, oral hypoglycaemic agent has recently been approved for the treatment of type 2 diabetes. It is available on prescription and can be prescribed in primary care. Principal advantages include lack of weight gain and hypoglycaemia, which should make sitagliptin very popular with patients. This article looks at what a DPP-4 inhibitor is and how it works to lower blood glucose, as well as where this class of drug fits into current practice.
Glitazones were rapidly incorporated into the management of patients with type 2 diabetes after their introduction. How do they work and when should we consider using them? And what should we make of recent discussions about the possibility of an increased risk of myocardial infarction with rosiglitazone?
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