Making Best Practice, Every Day Practice
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More than 4.9 million people in the UK have diagnosed diabetes and by 2030 Diabetes UK estimate there will be 5.5 million people with diabetes.
The care of patients with diabetes – particularly type 2 diabetes which counts for about 90% of patients seen in primary care – is a significant challenge.
Our resources focus on:
Detection of pre-diabetes conditions frequently associated with obesity and metabolic disorders
Early diagnosis of type 2 diabetes
Interventions to reduce the risks of cardiovascular and renal disease (the cardio-renal syndrome)
Glycaemic control with established therapies including metformin
The roles for newer agents including SGLT2 inhibitors and DDP-4 inhibitors
Importance of lipid (cholesterol) management and antihypertensive therapy
Additional contributions discuss:
The initiation and intensification of insulin in people with type 2 diabetes
Diagnosis and management of people with type 1 diabetes
Prevention of hypoglycaemia
Key issues in the management of older patients with diabetes involve both clinical skills and apatient-oriented approach. Ageing and co-morbidity may make management challenging, andclinicians need to be alert to factors such as impaired cognitive function, depression andincreased susceptibility to hypoglycaemia.
What is important when a nurse and patient are together in a consultation? Most of us have had consultations where the discussion did not appear to achieve anything, while, on other occasions, both parties seemed to be working well together. This article looks at how to share the process of planning treatment with a patient to improve health outcomes; it examines what concordance is, and how to achieve it, looking at how this might work out in practice.
Patients with type 2 diabetes and metabolic syndrome – management recommendations for reducing cardiovascular risk – Richard Hobbs, Eleanor McGregor, John Betteridge
Diabetes mellitus, in particular type 2 diabetes but also type 1 diabetes after the age of 40, confers substantial cardiovascular risk. In people with diabetes, at least in those who have had the disease for a few years, and no history of coronary heart disease, the risk of myocardial infarction is similar to that in non-diabetic patients with manifest cardiovascular disease. Intensive management of cardiovascular risk factors is, therefore, widely recommended for individuals with diabetes.
The recommendation by the National Institute for Health and Clinical Excellence (NICE)1 that men with type 2 diabetes should be assessed annually for erectile dysfunction (ED) may have far-reaching implications. Unfortunately, this is the only significant piece of NICE guidance not yet introduced into the GP Quality and Outcomes Framework (QOF) for 2010.1,2 Although NICE incorrectly classified ED as a neuropathic complication of type 2 diabetes (T2D) rather than a macrovascular, microvascular, endocrine and neuropathic process, the implication of the suggested full assessment of these men is important.
An understanding of evidence-based medicine and how to implement it in clinical practice is now crucial for all professionals involved in the delivery of healthcare. New evidence-based publications are constantly being developed to meet health professionals’ needs for clear, concise and up-to-date information.
In this issue we will review the United Kingdom Prospective Diabetes Study (UKPDS) 38 and the Collaborative Atorvastatin Diabetes Study (CARDS) using the ‘At-A-Glance’ format, as below:
A AcronymT Title and reference
A Aim and introduction
G GroupL Limb and endpointsA Absolute riskN Number needed to treat (NNT)C Clinical conclusionE Education for patient
In 2008, NICE published a comprehensive guideline on the management of type 2 diabetes which took a patient-centred approach to care and updated recommendations on the management of blood glucose, blood pressure, lipids, thrombosis, renal function and retinopathy. A number of new and emerging therapies for blood glucose management were not included at the time and the recent publication of NICE Clinical guideline 87 provides valuable recommendations on when and where these drugs should be used in the care pathway. They give more options for healthcare professionals and their patients with type 2 diabetes at a time of ongoing change in management of the condition.
People with type 2 diabetes are at an increased risk of cardiovascular disease (CVD), and management of diabetic dyslipidaemia is an essential part of diabetes management. The Joint British Societies’ 2 (JBS2) guidelines established the lipid targets of 4 mmol/L for total cholesterol and 2 mmol/L for LDL-cholesterol for people with type 2 diabetes and those with CVD. These lower targets for people with CVD were adopted by the NICE lipid modification guideline (CG67) in 2008, and the new NICE guideline for the management of type 2 diabetes continues this emphasis on lower lipid targets.
In May 2009, NICE published recommendations on the use of newer agents for the control of blood glucose in type 2 diabetes. This guideline provides a partial update for NICE Clinical Guideline 66 on the management of type 2 diabetes that was published last year. These newer agents include the dipeptidyl peptidase-4 (DPP-4) inhibitors, thiazolidinediones (TZDs), the glucagon-like peptide-1 (GLP-1) mimetic exenatide and the long-acting insulin analogues (insulin detemir and insulin glargine).
Several studies have suggested that postprandial rather than fasting hyperglycaemia may be a major determinant of cardiovascular risk. This article reviews the importance of postprandial hyperglycaemia and explores the benefits and risks of managing postprandial hyperglycaemia aggressively in order to prevent diabetes-related complications.
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