Alcohol forms part of the diet for over 90% of adults in the UK and is unusual in being both a nutrient and a drug. For many of us, alcohol is a safe and pleasurable part of the diet. However, there is growing concern that many people who see themselves as social drinkers are consuming levels that may cause harm. Understanding how to assess safe levels of alcohol consumption and identify strategies for cutting down can help us to advise our patients how to moderate their intake.
Alcohol-related harm is a major public health concern, and since April 2013 questions to identify problem drinkers have been included in the NHS Health Check for people aged 40-74 years. But young people are also a key at-risk group for hazardous consumption, and the physical harms of alcohol may be compounded by risks to their sexual health.
It has become increasingly clear that many people in this country are putting themselves at risk because they are continuing to drink above their recommended weekly units. Most of these people are not drunk drivers in police cells or antisocial drinkers arriving at A&E departments on Saturday night. They are people who come to see us at our chronic disease clinics or for treatment for an acute illness. The inclusion of questions about alcohol in NHS Health Checks is the ideal opportunity to discuss the potential risks of excessive drinking, and this special issue explains how we can help patients to choose a healthier approach to alcohol.
We are a nation with an alcohol-induced dichotomy: we have a love affair with alcohol but are increasingly aware of its dangers. The pub has been a cornerstone of our society, providing a source of relationships and artistic imagination. However, our nation's favourite drug is also responsible for as many life-years lost as tobacco, but with additional psychological and socio-economic costs.
NHS Health Checks now include AUDIT-C, a brief screening tool designed to help identify people who may be problem drinkers. Taking the test can be a sobering experience for patients, but now is the time to get a grip on our national relationship with alcohol.
Unplanned pregnancy with poor glycaemic control at conception is associated with major maternal and perinatal complications. However, contraception is used haphazardly by women with diabetes and is often not discussed by diabetes professionals. Practice nurses need to be able to give appropriate advice about contraception to the increasing numbers of women of childbearing age who have type 1 or type 2 diabetes.
NICE recommends that all patients with diabetes should be offered a structured educational programme at diagnosis, together with regular reviews and updates. Several programmes are available that meet NICE criteria, and there is evidence that they can help to improve patients' quality of life, well-being and diabetic control.