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.
Information on withdrawal of four insulins by Lilly
Protecting renal function in people with diabetes
Flora Fit Street
Welcome to another unique service helping your practice achieve QOF targets
Therapies for diabetes
New European diabetes nursing journal
BHF gets kids to get fit
Salt – facts for a healthy heart
Making full use of BJPCN online
Resources for smoking cessation
Aventis insulin withdrawals
What patients think about long-term anticoagulant therapy
Effective long-term anticoagulation requires a good working partnership between patients and the healthcare team. A key part of this is that patients understand how their treatment works, why it has been given and how to take it correctly. AntiCoagulation Europe, a patient organisation for people on anticoagulants, recently carried out a survey of 711 patients with atrial fibrillation (AF) from seven European countries (France, Germany, Italy, Norway, Spain, Sweden and the UK) being treated with a vitamin K antagonist (VKA) such as warfarin. The it’s about time survey was designed to explore patients’ insights into their treatment. The results show that many patients have gaps in their understanding about anticoagulation therapy and emphasise the need for ongoing patient education and the development of more patient-friendly anticoagulants to improve outcomes and quality of life.
Back to Basics: A BJPCN Guide – How lipid-modifying drugs work
Optimising lipid levels: looking beyond LDL-cholesterol
Treatment with statins is undoubtedly making a major contribution to reducing high-risk patients’ chance of a heart attack or another coronary event. However, their risk remains high, since over half of patients included in statin clinical trials suffered a further coronary event within five years. There is growing evidence that we need to move beyond simply lowering low-density lipoprotein cholesterol (LDL-C) and optimise the whole lipid profile.
Non-statin strategies for modifying lipids
Raised cholesterol is the commonest risk factor for CHD. Reducing cholesterol can be an effective way to help lower a patient’s risk of heart disease, particularly when cholesterol levels are already high. Dr Rubin Minhas looks at how to help patients to lower their cholesterol levels without drug treatment. He will discuss other lipid modifying drugs in future issues.
Ezetimibe: a new type of lipid-lowering therapy
Only half of patients being treated for elevated cholesterol levels are currently reaching targets, according to recent research. So what can we do to improve things? One option is to add a new type of lipid-lowering drug – ezetimibe – to a statin. This article reviews how ezetimibe works and its place in primary care management of raised lipids.
Optimising treatment of type 2 diabetes with metformin
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.
Optimising the treatment of type 2 diabetes with newer insulins
Primary care nurses play a central role in the management of type 2 diabetes in the community. This includes helping patients to use their drug treatment correctly. Although many patients with type 2 diabetes initially respond well to weight loss and exercise, most require oral hypoglycaemics and half of all patients eventually require insulin to control their glucose levels in order to prevent the devastating long-term complications of inadequately controlled diabetes. Linda Goldie gives an up-to-date review of the newer insulins – including the insulin analogues, insulin lispro, insulin aspart and insulin glargine – that have been introduced.
Disposing of used syringes and other sharp clinical waste
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.
