Monitoring blood glucose levels is a central part of managing diabetes effectively. Inadequate monitoring can put a patient at risk of both short- and long-term complications. Maintaining near normal blood glucose levels helps to prevent immediate problems such as hypoglycaemia and hyperglycaemia and longer-term microvascular complications, including retinopathy, renal disease and neuropathy. There are many different ways in which diabetes can be monitored; this article focuses on self blood glucose monitoring.
Self blood glucose monitoring
Maturity onset diabetes of the young (MODY)
MODY (maturity onset diabetes of the young) is a rare, genetic form of diabetes characterised by three main features: a young age of onset (<25yrs in at least one family member), non-insulin-dependent diabetes and autosomal dominant inheritance. MODY accounts for 1% of patients with diabetes in the UK – approximately 20,000 cases. It is often misdiagnosed, which can have major implications for patient management and investigating family members. In this article we review what causes MODY, how it is diagnosed and how to manage patients and their families.
How low can you go? Treating to new targets in cholesterol
Cardiovascular disease (CVD) remains the single biggest killer in the UK, accounting for 39% of deaths in the UK. It is important to remember CVD is not just a condition of old age, accounting for 36% of premature deaths among men and 27% among women. Several major clinical trials have shown that lowering cholesterol significantly reduces cardiovascular events and deaths. But how low should we go? The recent Treating to New Targets (TNT) trial suggested that it might be much lower than previously thought. Results showed that lowering LDL-cholesterol levels in patients with stable coronary heart disease (CHD) substantially below current targets achieved a significant further reduction in cardiovascular events.
Editorial
Welcome to this issue of the journal, with holidays a distant memory and the ‘back to work’ feeling which September brings. A little like January, September is a time of year associated with starting again, perhaps because we remember returning to school for the new academic year. BJPCN provides key information to help you negotiate your way successfully through the latest ‘timetable’ for general practice, ensuring that you are in the right place at the right time.
Calculating cardiovascular risk score
Happy holidays for people with heart disease or diabetes
Patients with chronic conditions such as heart disease or diabetes need to plan carefully before travelling long distances and taking holidays. Lifestyle changes can have an important impact on disease control, but a bit of thought and preparation beforehand should ensure that your patients’ holidays are both happy and healthy.
Hypertension: the big one for QOF points
In the third article in our series on the Quality and Outcomes Framework (QOF) we are reviewing how to score top marks for hypertension. This is probably the most difficult condition to treat to target but with careful attention to regular monitoring of patients with high blood pressure, treatment based on latest guidelines and careful recording of the outcomes of patient consultations, all practices should be able to gain points in this area.
Measuring waist circumference will help target diabetes prevention
Primary care nurses can target efforts to prevent type 2 diabetes by measuring patients’ waist circumference, according to a new definition of metabolic syndrome announced recently by the International Diabetes Federation. The definition focuses on excess abdominal fat – which results in people being ‘apple’ shaped – as a key contributor to the development of the dangerous mix of impaired glucose control, hypertension and hyperlipidaemia that sets people on the road to type 2 diabetes. Just looking at people’s body shape as they come into the surgery, measuring their waist size and taking steps to reduce it where indicated, can help in the ongoing fight against the disease.
24-hour ambulatory blood pressure monitoring
Ambulatory blood pressure monitoring (ABPM) is used widely in secondary care hypertension clinics, so what about its use in the primary care setting, where the majority of hypertension clinics take place? What are the potential benefits of ambulatory monitoring? Which patients should ABPM be used for? In this article we review the nuts and bolts of ABPM – when to use it, how to perform the test to obtain an accurate assessment of 24-hour BP and how to apply the results in clinical practice.
Unstable angina
Unstable angina describes a syndrome that is intermediate between stable angina and myocardial infarction: an accelerating or ‘crescendo’ pattern of chest pain that lasts longer than stable angina, occurs with less exertion or at rest, or is less responsive to medication. Unstable angina – like myocardial infarction – is an acute coronary syndrome (ACS), in contrast to stable angina, which is a chronic condition. It affects approximately six out of every 10,000 people. In this article, we review what causes unstable angina and how it should be diagnosed and treated.
One year on: boldly going where no primary care nurse has gone before
Welcome to the first year anniversary issue of the British Journal of Primary Care Nursing (BJPCN). It has been an eventful year for primary care nurses, with new challenges coming from all directions. In each issue of the journal we have tried to provide practical information and tools to help you find your way through the expanding universe of primary care in cardiovascular disease and diabetes – to boldly go where no primary care nurse has gone before!
How to score top marks for secondary prevention of coronary heart disease
In this second article in our series on the Quality and Outcome Framework (QOF), we will discuss how to maximise points in the secondary prevention of coronary heart disease (CHD) and heart failure. This will include lipid management and smoking cessation.