Type 2 Diabetes

HOT TOPIC | Commissioning in the new NHS: what are the implications for cardiovascular and diabetes services?

The new coalition government of the United Kingdom (UK) has announced plans to change the NHS radically in England. The Department of Health has published two important documents Equity and excellence: liberating the NHS and Liberating the NHS: commissioning for patients. The implications for primary and secondary care, and for local authorities, mental health services and community providers, will be enormous. The changes are taking place at a rapid pace and every manager and clinician in the NHS will need to keep abreast of developments as they will affect the way in which we all deliver services in the future.

Insulin in type 2 diabetes – a growing role for primary care

Today, many people with type 2 diabetes who need insulin have their insulin initiated in primary care. Here we discuss NICE recommendations for initiation and management of insulin, and the different types of insulin and delivery systems.

Keeping on track for good concordance with CVD and diabetes drugs

What is important when a nurse and patient are together in a consultation? Most of us have had consultations where the discussion did not appear to achieve anything, while, on other occasions, both parties seemed to be working well together. This article looks at how to share the process of planning treatment with a patient to improve health outcomes; it examines what concordance is, and how to achieve it, looking at how this might work out in practice.

Patients with type 2 diabetes and metabolic syndrome – management recommendations for reducing cardiovascular risk

Patients with type 2 diabetes and metabolic syndrome – management recommendations for reducing cardiovascular risk – Richard Hobbs, Eleanor McGregor, John Betteridge

Diabetes mellitus, in particular type 2 diabetes but also type 1 diabetes after the age of 40, confers substantial cardiovascular risk. In people with diabetes, at least in those who have had the disease for a few years, and no history of coronary heart disease, the risk of myocardial infarction is similar to that in non-diabetic patients with manifest cardiovascular disease. Intensive management of cardiovascular risk factors is, therefore, widely recommended for individuals with diabetes.

Testosterone and type 2 diabetes: the forgotten link

The recommendation by the National Institute for Health and Clinical Excellence (NICE)1 that men with type 2 diabetes should be assessed annually for erectile dysfunction (ED) may have far-reaching implications. Unfortunately, this is the only significant piece of NICE guidance not yet introduced into the GP Quality and Outcomes Framework (QOF) for 2010.1,2 Although NICE incorrectly classified ED as a neuropathic complication of type 2 diabetes (T2D) rather than a macrovascular, microvascular, endocrine and neuropathic process, the implication of the suggested full assessment of these men is important.

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

Achieving effective lipid management in diabetes

People with type 2 diabetes are at an increased risk of cardiovascular disease (CVD), and management of diabetic dyslipidaemia is an essential part of diabetes management. The Joint British Societies’ 2 (JBS2) guidelines established the lipid targets of 4 mmol/L for total cholesterol and 2 mmol/L for LDL-cholesterol for people with type 2 diabetes and those with CVD. These lower targets for people with CVD were adopted by the NICE lipid modification guideline (CG67) in 2008, and the new NICE guideline for the management of type 2 diabetes continues this emphasis on lower lipid targets.

New guideline provides a breath of fresh air that helps to individualise diabetes care

Type 2 diabetes patient with muscle aches on statin therapy

Type 2 diabetes patient without CVD, not achieving lipid targets

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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