Type 2 Diabetes

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.

Continuous glucose monitoring: friend or foe?

Glucose monitoring has revolutionised the management of diabetes by providing the means for patients to check their blood glucose level in real time. This review provides an update on continuous glucose monitoring, looks at the devices available and analyses what the strategy adds to diabetes management.

Back to Basics: Diagnosing diabetes

Diagnosing diabetes: who to test and what test to use

Diabetes affects approximately 3-4% of the British population but is thought to be significantly under-diagnosed. How can we improve the number of patients who are diagnosed early and so improve their risk of long-term complications?

New role for HbA1c in diagnosing diabetes

Glycated haemoglobin – HbA1C, or A1C as it is now being called – should be used to diagnose diabetes, according to a recent recommendation from an international expert committee appointed by the American Diabetes Association, the International Diabetes Federation and the European Association for the Study of Diabetes. We explore the basis for this recommendation, and look at why HbA1C would provide a more accurate measure for diagnosing diabetes than glucose tests and what the change would mean in clinical practice.

International expert committee recommends new role for HbA1C in diagnosing diabetes

Navigating the new NICE guideline on type 2 diabetes: Finding the best treatment pathway for each patient

The new NICE guideline enables us to individualise care bearing in mind the needs of the person in front of us. It is concerned with clinical efficacy, and – for once – the cost of care has not noticeably influenced its recommendations. In contrast, QOF does the exact opposite, demanding that we drive our patients’ HbA1c down to low […]

Helping patients with diabetes to win the battle to control their weight

Many people with type 2 diabetes are overweight or obese at diagnosis and continue to struggle to control their weight. This article looks at why people with diabetes find weight control more of a challenge than the rest of us and how practice nurses can help patients to remain positive, particularly when starting insulin to optimise blood glucose control.

Impaired Glucose Tolerance: What it is and How to Manage it

The new national strategy for vascular risk assessment, now being referred to as NHS Health Check, will include testing for diabetes and impaired glucose tolerance (IGT). This follows a major evaluation of the evidence showing that it is more cost-effective to screen individuals for IGT than screening for diabetes alone, but only as part of the broader vascular risk assessment. This article examines the concepts of IGT and impaired fasting glucose (IFG) and offers practical advice as to how these conditions can be managed in primary care.

Learning to live with insulin: helping patients to do well

Starting on insulin injections represents a major change for most people with diabetes. Many aspects of everyday life will need to be considered more carefully,which can be quite daunting.With adequate support and education from the practice nurse,patients can be encouraged to be proactive and positive towards this new stage in their lives. This article looks at people with type 2 diabetes or those with stable type 1 diabetes,who are likely to be managed in general practice.We discuss everyday concerns about using insulin,why people on insulin are prone to put on weight,how exercise affects blood glucose levels,how to manage illness in those with diabetes and how to adequately prepare for holidays.

Insulin in type 2 diabetes: getting the balancing act right

How much insulin does a patient with type 2 diabetes need for optimal glucose control? It can sometimes be a tricky balancing act to get the dose just right – too much increases the risk of hypoglycaemic episodes and too little risks poor glucose control and the associated long-term complications.In this article we review what the research and guidelines recommend in how to ensure each patient gets the best dose of insulin.

The year of care for diabetes: what can it achieve?

The Year of Care for diabetes project has its roots in the recent movement to put patient empowerment at the top of the health agenda.It reflects recent government publications,including Choosing Health: Making healthy choices easier and Our health, Our care, Our say. In this article we look at the development of the project, its aims and what it will mean in practice.

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