In this article, we examine the evidence for areas of consensus as well as ongoing uncertainty or controversy about dietary guidelines for type 2 diabetes. What is the best dietary approach? Is it possible to achieve remission of type 2 diabetes with lifestyle behaviour changes or is it inevitably a condition causing progressive health decline? (BMJ)
Diabetes News
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Dulaglutide versus insulin glargine in patients with type 2 diabetes and moderate-to-severe chronic kidney disease (AWARD-7)
In patients with type 2 diabetes and moderate-to-severe chronic kidney disease, once-weekly dulaglutide produced glycaemic control similar to that achieved with insulin glargine, with reduced decline in eGFR. Dulaglutide seems to be safe to use to achieve glycaemic control in patients with moderate-to-severe chronic kidney disease (The Lancet Diabetes & Endocrinology)
National Diabetes Audit – Insulin Pump Report 2016-17
Report for people with Type 1 diabetes on an insulin pump at National, LHB, and Hospital/Trust level for the Audit period 2016-17 (NHS Digital)
Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis
Neither the rate of administration nor the sodium chloride content of intravenous fluids significantly influenced neurologic outcomes in children with diabetic ketoacidosis (NEJM)
A Randomized Controlled Trial Comparing Efficacy and Safety of Insulin Glargine 300 Units/mL Versus 100 Units/mL in Older People With Type 2 Diabetes: Results From the SENIOR Study
Efficacy and safety of Gla-300 was demonstrated in older people (≥65 years of age) with type 2 diabetes, with comparable reductions in HbA1c and similarly low or lower risk of documented symptomatic hypoglycemia versus Gla-100. A significant benefit in hypoglycemia reduction was seen in participants aged ≥75 years (Diabetes Care)
Therapeutic luminal coating of the intestine
Oral administration of this gut-coating formulation modulated the nutrient contact with bowel mucosa, which lowered the glucose responses in rodent models indicating a potential therapeutic utility in diabetes (Nature Materials)
Skin hydration of the heel with fissure in patients with diabetes: a cross-sectional observational study
To prevent heel fissures, moisturizing care should aim at achieving skin hydration of 20%. If skin hydration is <20%, prevention of fissures may warrant not only specialized moisturizing care but also consideration of treatment for tinea pedis (Chronic Wound Care Management and Research)
Topical Epidermal Growth Factor Spray for the Treatment of Chronic Diabetic Foot Ulcers
This study confirms that application of spray-applied rhEGF in DFU patients results in faster healing velocity and higher complete healing rate regardless of HbA1c levels (Diabetes Research and Clinical Practice)
Association of Metformin Use With Risk of Lactic Acidosis Across the Range of Kidney Function
In 2 real-world clinical settings, metformin use was associated with acidosis only at eGFR less than 30 mL/min/1.73 m2. Our results support cautious use of metformin in patients with type 2 diabetes and eGFR of at least 30 mL/min/1.73 m2 (JAMA)
A retrospective observational study of people with Type 1 diabetes with self‐reported severe hypoglycaemia reveals high level of ambulance attendance but low levels of therapy change and specialist intervention
We observed a high level of ambulance service intervention but surprisingly low levels of hypoglycaemia follow‐up, therapy change and specialist intervention in people self‐reporting severe hypoglycaemia. These results suggest there may be important gaps in care pathways for people with Type 1 diabetes self‐reporting severe hypoglycaemia (Diabetic Medicine)
HbA1c response after insulin initiation in patients with type 2 diabetes mellitus in real life practice: Identifying distinct subgroups
Most patients showed a stable HbA1c response, but one out of six patients showed either a poor response, or a rapid initial response only after insulin initiation. Response patterns were associated with age, diabetes duration and risk‐factor controls at the time of insulin initiation (Diabetes, Obesity and Metabolism)
Time trends and geographical variation in prescribing of drugs for diabetes in England from 1998 to 2017
In England there is extensive geographical variation in the prescribing of diabetes drugs after metformin, and increasing use of higher‐cost DPP‐4 inhibitors and SGLT‐2 inhibitors compared with low‐cost sulphonylureas. Our findings strongly support the case for comparative effectiveness trials of current diabetes drugs (Diabetes, Obesity and Metabolism)
Mechanisms of metformin action: In and out of the gut
Recent evidence suggests that metformin exerts glucose‐lowering effects via its action in the gut. The accumulation in the colon of 18F‐labeled fluorodeoxyglucose (FDG), a nonmetabolizable derivative of glucose, is markedly augmented after metformin administration, indicating that metformin affects the handling of glucose in colon whereas the underlying mechanism and the significance to glucose metabolism of the finding remain to be determined (Journal of Diabetes Investigation)
Hyperkalaemia in people with diabetes: occurrence, risk factors and outcomes in a Danish population‐based cohort study
One in six newly diagnosed people with diabetes experienced a hyperkalaemic event, which was associated with severe clinical outcomes and death (Diabetic Medicine)
Prevalence of active Charcot disease in the East Midlands of England
Non‐specialist professionals should have greater awareness of the existence of this uncommon complication of diabetes in the hope that earlier diagnosis will lead to lesser degrees of deformity (Diabetic Medicine)
The relationship between intensification of blood glucose-lowering therapies, health status and quality of life in type 2 diabetes: The Fremantle Diabetes Study Phase II
These real-life data show that treatment intensification, including insulin initiation, does not impact adversely on patient well-being in community-based type 2 diabetes (Diabetes Research and Clinical Practice)
Effectiveness and safety of long-term treatment with sulfonylureas in patients with neonatal diabetes due to KCNJ11 mutations: an international cohort study
High-dose sulfonylurea therapy is an appropriate treatment for patients with KCNJ11 permanent neonatal diabetes from diagnosis. This therapy is safe and highly effective, maintaining excellent glycaemic control for at least 10 years (The Lancet Diabetes & Endocrinology)
Diabetes, driving and fasting during Ramadan: the interplay between secular and religious law
Ultimately further research on glycemic control and management when fasting and driving, as well as a formal legal guidance on this topic, is required to safeguard healthcare professionals and the public from the potential dangers of driving with diabetes and fasting (BMJ)
Diabetes Fatigue Syndrome
The authors share clinical pearls which can help the diabetes healthcare provider diagnose DFS, identify its etiologic factors and manage the syndrome (Diabetes Therapy)
Predictors of changing insulin dose requirements and glycaemic control in children, adolescents and young adults with Type 1 diabetes
This longitudinal assessment identifies clinically meaningful modifiable (e.g. insulin regimen) and non‐modifiable (e.g. sex) factors predictive of insulin requirements and HbA1c levels in young people with Type 1 diabetes; anticipatory insulin adjustments may improve glycaemic control (Diabetic Medicine)
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