Type 2 Diabetes

Preventing the Progression of Pre-Diabetes

Making the Most of Insulins in Primary Care

Insulin therapy has, historically, been initiated and managed by specialist services in secondary care. However, the recent shift in focus from secondary to primary care services, together with the fact that insulin therapy in type 2 diabetes is becoming more common, means that many GPs and practice nurses are becoming increasingly involved in insulin management. This article reviews the different types of insulin now available and how to use them, with the aim of unravelling some of the mysteries surrounding insulin management.

Finger Pricking Good: Optimising Self-Testing of Blood Glucose in Diabetes

Finger pricking or self-monitoring of blood glucose (SMBG) – which patients with diabetes can regularly use to check their own blood sugar levels – is not cheap. Most practices spend 40% more on blood testing strips than on oral hypoglycaemic drugs. Dr Karet carefully reviews the evidence for which patients we should be advising to selfmonitor, how often they should test their blood glucose and – most importantly – how they should act on the results.

What’s on the Menu? Eating Out with Diabetes and Heart Disease

Learning to accept and live with a chronic condition such as diabetes or coronary heart disease (CHD) is as crucial a part of treatment as medications. As eating outside the home is increasingly a feature of today’s society, it is important that patients with diabetes or CHD feel able to enjoy meals out without any feelings of guilt. In this article, we suggest practical tips for helping patients with diabetes and heart disease to eat out healthily.

Organising Care For The Person Newly Diagnosed With Diabetes

The focus of diabetes care is well established in general practice, with practice nurses taking on much of the responsibility for diabetes management. The white paper Our Health, Our Care, Our Say talks about high quality care being delivered to patients close to where they live. So, in the future, general practice can expect to take on more responsibility for conditions such as diabetes. This article discusses the priorities for the newly diagnosed patient, and the importance of sound advice and guidance in the early stages.

Keep taking the tablets: achieving adherence in type 2 diabetes

Most patients with type 2 diabetes require many tablets to control their diabetes and prevent cardiovascular complications. Patients are often prescribed two or three antidiabetic agents, two or three antihypertensives, one or more lipid-lowering tablets and low-dose aspirin. Research has warned that fewer than 50% of patients take their prescribed diabetes medication adequately. The consequence of this poor adherence is increased risk of cardiovascular complications. How do we help patients to take their tablets and so improve their health and long-term outcomes?

Type 2 diabetes in south Asian communities in the UK

People from ethnic minorities may not get the diabetes care they need because of issues associated with language, literacy and culture, warned a recent Audit Commission report on diabetes – Testing Times. This article explores these issues and gives some insight into the challenges of looking after South Asians – Bangladeshis, Pakistanis, Indians and Sri Lankans – with diabetes, as well as offering some pointers to improve their care and treatment.

Diabetes in Pregnancy: Future CVD Patients in Waiting?

Gestational diabetes – glucose intolerance occurring during pregnancy – is relatively common, affecting around four in every hundred pregnancies. A lot of research has linked low birth weight in babies born to mothers with diabetes to increased risk of vascular disease in later adult life. But much less attention has been focused on the mother’s subsequent health risks after having gestational diabetes. In this article, we review the increased risk of diabetes and vascular disease in later life in women suffering gestational diabetes and how to improve follow-up and prevention.

Scoring QOF points for diabetes

IIn this, the fifth article in our series on the Quality and Outcomes Framework (QOF), we review how to score top points for diabetes. This is an area that has been managed almost wholly in Primary Care for many years. Virtually all practices now have a diabetes clinic, which generally has extensive nurse involvement – with many being nurse-led. Practices are doing extremely well in this area and many are achieving a very high percentage of points. Figures for practices in England showed that on average they scored 93.2% of the QOF points for diabetes. This article offers some pointers on how to keep up the good work.

Maturity onset diabetes of the young (MODY)

MODY (maturity onset diabetes of the young) is a rare, genetic form of diabetes characterised by three main features: a young age of onset (<25yrs in at least one family member), non-insulin-dependent diabetes and autosomal dominant inheritance. MODY accounts for 1% of patients with diabetes in the UK – approximately 20,000 cases. It is often misdiagnosed, which can have major implications for patient management and investigating family members. In this article we review what causes MODY, how it is diagnosed and how to manage patients and their families.

Self blood glucose monitoring

Monitoring blood glucose levels is a central part of managing diabetes effectively. Inadequate monitoring can put a patient at risk of both short- and long-term complications. Maintaining near normal blood glucose levels helps to prevent immediate problems such as hypoglycaemia and hyperglycaemia and longer-term microvascular complications, including retinopathy, renal disease and neuropathy. There are many different ways in which diabetes can be monitored; this article focuses on self blood glucose monitoring.

Measuring waist circumference will help target diabetes prevention

Primary care nurses can target efforts to prevent type 2 diabetes by measuring patients’ waist circumference, according to a new definition of metabolic syndrome announced recently by the International Diabetes Federation. The definition focuses on excess abdominal fat – which results in people being ‘apple’ shaped – as a key contributor to the development of the dangerous mix of impaired glucose control, hypertension and hyperlipidaemia that sets people on the road to type 2 diabetes. Just looking at people’s body shape as they come into the surgery, measuring their waist size and taking steps to reduce it where indicated, can help in the ongoing fight against the disease.

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