ALBUMIN:CREATININE ASSESSMENT IN CHRONIC KIDNEY DISEASE AND DIABETES
There are now four agents in the new class of glucose-lowering agents called dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) available in the UK. They are, in order of launch in the UK, sitagliptin, vildagliptin, saxagliptin and linagliptin. Several others are in the pipeline and are likely to be launched before long. This article will discuss their place in treating diabetes and the differences between them.
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.
As obesity rates continue to soar in women of reproductive age, gestational diabetes mellitus (GDM) is an increasingly important and prevalent problem. Appropriate recognition and careful management of GDM are essential. This will not only improve the outcomes of pregnancy, but may also have a beneficial effect on a woman’s lifelong risk of developing type 2 diabetes.
Glycaemic index (GI) is a hot topic, often misunderstood by healthcare professionals and patients. This article fills the gaps by explaining the low-GI diet in detail, describing the benefits and barriers to using GI in practice, the benefits in patients with diabetes and the controversy that surrounds it. The aim is to help primary care professionals to make informed decisions on when and how to use GI in helping patients with diabetes to plan their diet.
As the use of insulin therapy becomes more common in the ever-growing population of people with diabetes, practice nurses need to be aware of the range of insulins now available and how they work as they take on more responsibility for the management of these patients. In this article, we look at the production and role of insulin in the body and how type 1 and type 2 diabetes affects this. Moving on to newer insulins, we review how longer-acting insulins are used to mimic the characteristics of natural background insulin, the role of shorteracting insulins available for mealtime bolus doses, and the use of insulin mixtures in practice.
There is a Danish proverb that states ‘Better to ask twice than lose your way once’. Unfortunately however, in my opinion, people living with diabetes – especially those with type 2 diabetes – do not question their healthcare professionals enough about what they can expect from living with the condition. This is especially true in the area of hypoglycaemia – or low blood sugar.1 We often attribute diabetes with high blood sugar, but many people don’t appreciate the potential dangers of letting their blood sugar get too low.
Effective management of type 2 diabetes requires tight control of blood glucose levels to prevent long-term complications. Recently a number of new oral therapies have become available to help patients achieve this goal. This article provides information on how each agent works, how these different agents may be used, and the side-effects to look out for.
The National Institute for Health and Clinical Excellence (NICE) recommends that all people with diabetes should receive nine key tests at their annual diabetes review. These important markers ensure diabetes is well controlled and are designed to prevent longterm complications. The nine key tests are: weight, blood pressure, smoking status, HbA1c, urinary albumin, serum creatinine, cholesterol, eye examinations and foot examinations. This review discusses the importance of each marker of improved long-term care of patients.