Type 1 Diabetes

Nine processes of care for diabetes

The National Institute for Health and Clinical Excellence (NICE) recommends that all people with diabetes should receive nine key tests at their annual diabetes review. These important markers ensure diabetes is well controlled and are designed to prevent longterm complications. The nine key tests are: weight, blood pressure, smoking status, HbA1c, urinary albumin, serum creatinine, cholesterol, eye examinations and foot examinations. This review discusses the importance of each marker of improved long-term care of patients.

Back to Basics: Diagnosis of CKD with and without diabetes

Preventing delayed diagnosis of type 1 diabetes: time to act

Ensuring an early diagnosis of type 1 diabetes to prevent ketoacidosis

The onset of type 1 diabetes is usually rapid, taking patients and their relatives and friends, and even healthcare professionals by surprise. Diagnosis can involve some degree of diabetic ketoacidosis (commonly referred to as DKA). It is estimated that approximately 30% of newly diagnosed children seen by a healthcare professional have problems related to their diabetes before diagnosis, which suggests that practitioners are missing opportunities to diagnose type 1 diabetes at an earlier stage and possibly avoiding DKA. In this article, we explore how primary care staff can achieve earlier diagnosis of type 1 diabetes.

Maintaining tight glucose control during Ramadan

What are the practicalities of supporting people with diabetes who fast during Ramadan? Practice nurses can make a real difference by educating patients before Ramadan starts and advising them on what they need to consider before starting their fast. Patients need to be involved in the whole process so that they are well aware of the importance of managing their diabetes to ensure good control of their glucose levels throughout Ramadan. We review how to assess patients before Ramadan, what adjustments to make to medication and how to follow up.

Caring for your diabetes during Ramadan

Fasting during Ramadan means that you have longer gaps between meals than usual. Many people also eat more food in one meal – in particular, more carbohydrate-rich and fatty foods – during this time. If you have diabetes, this may mean that you have large swings in your blood sugar levels during Ramadan. During the day – when you are fasting – your blood sugar is likely to drop. This may make you feel weak, tired and dizzy. This is called hypoglycaemia (which means low sugar) – a period of hypoglycaemia is sometimes called a ‘hypo.’ People who are sick or whose health may be adversely affected by fasting – such as those with diabetes – do not have to fast during Ramadan. However, some people do decide to observe the fast. This leaflet gives you some tips on how to keep well.

Cardiovascular disease and diabetes in people with severe mental illness: causes, consequences and pragmatic management

The prevalence of many physical illnesses is increased in people with severe mental illness and accounts for around three quarters of all deaths; cardiovascular disease is the commonest cause of death. The level of screening for and management of diabetes and cardiovascular risk factors remains low but a straightforward yet systematic care pathway should go a long way towards reducing the health inequalities experienced by people with severe mental illness.

New glucose-lowering therapies for diabetes: a review

The sulphonylurea group of drugs and the biguanide drug metformin have both been available for use as glucose-lowering therapies for more than 50 years. There were, however, few other clinically relevant developments in this area of pharmacotherapy until about the year 2000. At that time a new class of glucose-lowering therapies, the thiazolidinediones pioglitazone and rosiglitazone, was launched. In 2007 two more new classes of therapy were launched, the dipeptidyl peptidase-4 (DPP-4) inhibitors and the glucagon-like peptide-1 (GLP-1) mimetics; both of these classes of agents work on the incretin pathway.A further new class of glucose-lowering agents, the sodium glucose co-transporter 2 (SGLT2) inhibitors, is likely to be launched in the next year or two. So much activity in glucose lowering pharmacotherapy in this past 12 years perhaps makes up for the previous 40 years of relative inactivity!In this article we discuss new glucose-lowering therapies and consider their place in diabetes management from the primary care perspective.

Multifactorial intervention in diabetes care: ‘At-A-Glance’ analysis of evidence

An understanding of evidence-based medicine and how to implement it in clinical practice is now crucial for all professionals involved in the delivery of healthcare. New evidence-based publications are constantly being developed to meet health professionals’ needs for clear, concise and up-to-date information.

In this issue we will review the United Kingdom Prospective Diabetes Study (UKPDS) 38 and the Collaborative Atorvastatin Diabetes Study (CARDS) using the ‘At-A-Glance’ format, as below:

A AcronymT Title and reference

A Aim and introduction

G GroupL Limb and endpointsA Absolute riskN Number needed to treat (NNT)C Clinical conclusionE Education for patient

Omega-3 fatty acids: optimising their use in cardiovascular disease and diabetes

*The British Journal of Primary Care Nursing approached Abbott Healthcare Products Limited to fund the production of this supplement. The company was not involved in its development, although it was asked to review it for technical accuracy just prior to printing. Editorial control has remained with the British Journal of Primary Care Nursing at all times.

How to provide excellent care for patients with diabetes

How can primary healthcare professionals take diabetes care beyond the General Medical Services (GMS) contract towards creating a primary care centre of excellence, while earning maximum QOF points in the process? Many patients are currently not achieving good glycaemic control despite incentives to encourage healthcare practitioners to help their diabetes patients reach HbA1c targets. Several new policies and schemes have recently been implemented to provide incentives for reaching treatment goals, and this article discusses how these can be beneficial to both general practices and diabetes patients.

Caring for patients with diabetes who have intercurrent illness

Modern treatments available to people with diabetes enable the 1.3 million living with the condition in England alone to minimise and control its impact on their daily lives like never before. But what happens when a person with diabetes develops intercurrent illness, such as a cold or flu? We review the steps to take to ensure that these patients maintain good glycaemic control throughout the ups and downs of other health challenges.

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