Half of the adolescents reported body and weight concerns, less than 1 in 10 reported DEBs. Screening for yellow flags for DEBs as a part of clinical routine using a stepwise approach and early assistance is recommended to prevent onset or deterioration of DEBs (Pediatric Diabetes)
Archives for June 2016
DKA patients with type 2 diabetes required management with a modified treatment protocol to resolve their profound hyperglycemia and dehydration compared with those with type 1 diabetes (Journal of Diabetes and Its Complications)
The Edinburgh Hypoglycemia symptom delta scores during clamp were attenuated from 10.7 (6.4) before to 5.2 (4.9) after surgery. There were also marked post-surgery reductions in glucagon, cortisol, catecholamine and sympathetic nerve responses to hypoglycemia (Diabetes)
Double diabetes [type 1 diabetes and features of metabolic syndrome] seems to be an independent and important risk factor for persons with type 1 diabetes in developing macrovascular and microvascular comorbidities (Diabetes Research and Clinical Practice)
Diabetic children have thicker corneas, lower ECD, an increased polymegathism, and a decreased pleomorphism. The duration of diabetes is the factor that affects all of these changes (Journal of Diabetes Research)
The report presents the 2015 results and analyses the changes in activity and outcomes over the last four contributory years (2010 to 2013)
These data suggest that aspects of emotional regulation and emotional intelligence play a role in glycemic control in adult patients with T2 diabetes and do so even in the context of several variables relevant to diabetes (Primary Care Diabetes)
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Given the epidemiology of diabetes, it is understandable that there is a shift in routine management from secondary to primary care. Whether there is enough support for primary care is debatable but usually there is enough guidance to manage non insulin treated patients – and even those on non complex insulin regimes. So far so good! However, there is a risk that patients with T1DM may get caught up in the rush to transfer care out of hospital. In fact, this week’s episode of Pulse describes a commissioning intention of a CCG to actively promote it.
However, it is often not understood that T1 and T2 diabetes behave like two separate conditions when it comes to glucose lowering. Furthermore, there is a major difference in the education that these patients require, specifically the intricacies of carbohydrate counting, correction doses and the detailed awareness of the profiles of a variety of rapid and longer acting insulin, not to mention pump therapy. Type 1 patients often possess. There is also the higher risk of hypoglycaemia including unawareness with all the associated issues including the impact on driving.
Whilst it is possible that practices have the skills to manage T1 patients, it is unlikely that this can be done without significant support from specialist care. This can come in a variety of ways including education sessions, virtual or e-consultation to name a couple. It is unclear from the proposals as to how this will be done. Furthermore, there is no acknowledgement that T1 patients are often highly motivated and educated about their condition, commonly having more knowledge about ‘their’ diabetes than the health care professional treating them. Significant input would be necessary to convince these patients that the transfer of care does not come at the expense of clinical care.
Overall, the location of care is not important, ensuring that the right patient is seen by the right clinician is vital to ensure that this group of patients are not disadvantaged.
Dr. Mark Freeman
The combined effects of ARBs on ESRD and CVD and mortality in patients with diabetic nephropathy varies considerably between patients. A substantial proportion of patients remain at high risk for both outcomes despite ARB treatment (Diabetes, Obesity and Metabolism)
Reflections From a Diabetes Care Editors’ Expert Forum
Edited by Jeffrey Callen, Joseph Jorizzo and others
Published by Elsevier (May 2016)
This excellent book will naturally appeal to two distinct schools of physicians, namely dermatologists and general physicians (are there any left?) who want to brush up on their dermatological skills which have a bearing on general diseases. There is a fascinating connection between skin conditions and internal disorders and this book is an excellent connection between the two specialties. This book is a relatively slim volume of 460 pages but it packs a lot of information and knowledge within its covers.
At index acute myocardial infarction, diabetes was common and associated with significant long-term excess mortality, over and above the effects of comorbidities, risk factors and cardiovascular treatments (Journal of Epidemiology & Community Health)
A modern, updated approach to glycaemic control in people with diabetes, in fact, must focus not only on reaching and maintaining optimal HbA1c levels as soon as possible, but to obtain this result by reducing postprandial hyperglycaemia and glycaemic variability, while avoiding hypoglycaemia (Diabetes Research and Clinical Practice)
This study demonstrates some increased clinical signs of ocular surface disease but not an increase in subjective symptoms of dry eyes, with increasing severity of DPN (British Journal of Ophthalmology)
Our study suggests that plant-based diets, especially when rich in high-quality plant foods, are associated with substantially lower risk of developing T2D. This supports current recommendations to shift to diets rich in healthy plant foods, with lower intake of less healthy plant and animal foods (PLoS Medicine)
Long-term pioglitazone treatment is safe and effective in patients with prediabetes or T2DM and NASH (Annals of Internal Medicine)
This issue of Diabetes Care presents today’s AP state of the art, including reports on multinational home-use AP trials, studies in young children, the use of multihormonal approaches to mitigate meal-related hyperglycemia, and discussions of AP study designs and outcome measure (Diabetes Care)
Diabetes remission up to 3 years after RYGBP and LAGB was proportionally higher with increasing postsurgical weight loss. However, the nearly twofold greater weight loss–adjusted likelihood of diabetes remission in subjects undergoing RYGBP than LAGB suggests unique mechanisms contributing to improved glucose metabolism beyond weight loss after RYGBP (Diabetes Care)
Edited by: Alison Smith, Maria Kisiel, and Mark Radford
Published by Oxford University Press
This sturdy 766-page handbook fills the niche between diminutive pocket books and elaborate text books. It would be at home in the nurses’ room of any surgical ward, clinic, operating theatre, or ancillary department. Suitable for students and qualified nurses it can also be used at the bedside as a clinical or teaching aid.