There is good evidence that tight glycaemic control significantly improves outcomes in patients with type 2 diabetes. All practice nurses will be looking to achieve the new General Medical Services contract (GMS2) targets for HbA1c reduction in diabetes (see box). Practices will be developing prescribing strategies to achieve this reduction, in accordance with good clinical practice. Metformin offers an important first-line therapy for type 2 diabetes. The introduction of a new, sustained-release formulation – Glucophage SR – should improve patient compliance with metformin and so improve glycaemic control.
There is no doubt about it, achieving and maintaining weight loss long term is a great challenge. Primary care nurses have a significant role in motivating patients to adopt a healthy lifestyle and to persevere with weight management programmes. In the last issue of BJPCN we looked at how to raise the tricky subject of obesity with patients. This time, we continue the issue by exploring how practice nurses ensure a positive working relationship with their patients with weight problems and encourage them as they tackle the long-term issue of obesity.
Renal disease is common and is increasing in prevalence as the main risk factor for impaired kidney function – diabetes – affects more people. Approximately 30% of patients with type 2 diabetes develop some degree of nephropathy, with some ethnic groups at even higher risk. Diabetes is now the largest single cause of end-stage renal disease in the UK, accounting for 30–40% of all cases. The very early stages are asymptomatic and the disease process develops slowly over 15–20 years, so early screening and prevention strategies are paramount in reducing the burden of renal failure. Primary care nurses are well placed to play a pivotal role in this process.
More and more is being expected of practices in improving the management of diabetes – with initiatives such as the National Service Framework (NSF) for Diabetes and NICE guidance setting increasingly ambitious targets. The National Diabetes Support Team (NDST) has been set up to help support local services throughout the NHS and in meeting these challenges. In this issue, they share latest advice for practices and patients on disposing of used syringes and other sharps.
Fasting during Ramadan – lasting from 15th October to 12th November this year – is one of the five pillars of Islam. The experience of fasting is intended to teach Muslims self-discipline and self-restraint, and to help them understand a little of the plight of the less privileged. But what are the implications of fasting for patients with type 2 diabetes?
It's something that we do so often, but are we always doing it the best way? Check out how to measure blood pressure (BP) correctly, with latest advice from the National Institute for Clinical Excellence and the British Hypertension Society.
This article considers a possible scenario in primary care in which a patient presents with chest pain. Test yourself to see what you would do. Then check this against our recommendations, reflecting on your current procedures and policies within your practice.
Sleep apnoea is far more than just snoring associated with brief periods of suspended breathing while asleep. It is an important risk factor for cardiovascular disease and diabetes, so it is well worth asking patients whether they suffer breathing problems during the night and then following up those who do. More than one-third of people with sleep apnoea have hypertension, so measuring blood pressure is important in assessing risk factors and then establishing appropriate preventive treatment.