The latest review of diabetes foot care in England and Wales shows significant room for improvement. The National Diabetes Foot Care Audit (NDFA) 2014-2016 found that less than half of diabetes services in England and Wales have the recommended NICE care structures in place. In addition, 40% of ulcer episodes referred by a health professional only had an expert assessment after 2 or more weeks.
General practices are under increasing pressure to initiate insulin in type 2 diabetes, as it would be more efficient for the health service and more convenient for most patients. There are many different approaches to starting insulin, but it is essential for practice nurses to work closely with patients and progress slowly to ensure successful and safe outcomes.
We often take modern medicine for granted,but a review of the history of a disease and its treatment can help us put the whole thing in perspective.In this article,we trace the development of understanding about the nature and cause of diabetes and the use of insulin as a key treatment.
Type 2 diabetes and the metabolic syndrome (where a patient has a cluster of metabolic risk factors, including atherogenic dyslipidaemia, raised blood pressure and insulin resistance) are growing problems. Most researchers believe that the key is central obesity – fat stored in the abdomen around internal organs, which produces inflammatory mediators such as tumour necrosis factor (TNF). This leads to insulin resistance, when the normal amount of insulin secreted by the pancreas is no longer able to activate receptors on body cells, resulting in impaired glucose metabolism. However, this is an evolving science and the precise details are not yet fully understood. The insulin resistance/metabolic syndrome often leads to type 2 diabetes as the pancreas becomes less responsive, but this is not inevitable.
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.
The treatment approach to type 2 diabetes should begin with an assessment of cardiovascular disease (CVD) status, other comorbidities, and patient preferences, according to a draft of the upcoming 2018 joint consensus statement from the American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD). A preview of the draft document was presented in a symposium at the American Diabetes Association (ADA) 2018 Scientific Sessions.
The European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) have produced an updated consensus statement on how to manage hyperglycaemia in people with type 2 diabetes.
A new edition of the ‘End of Life Diabetes Care: Clinical Care Recommendations’ has been published recently. This is the third edition of the clinical recommendations commissioned by Diabetes UK that are designed to guide clinicians to delivering the best possible care for people with diabetes at the end of their life.