Foot ulceration in people with diabetes is an increasing problem which is costly to the NHS financially and to patients in terms of quality of life. Management is complex and involves a team approach to ensure the best results for patients.
Obesity is estimated to be responsible for more than 30,000 deaths each year, reducing lifespan by an average of nine years. The links between obesity, diabetes and cardiovascular disease are well documented, but overweight and obesity also causes 6% of cancers in the UK. These figures have resulted in warnings that obesity is the new smoking when it comes to risks to health and longevity. So the problem is clear. The challenge is to put into action what works.
Many newer drug classes are available to healthcare professionals for the management of type 2 diabetes. This month’s Back to Basics feature is a useful wallchart showing the targets for oral type 2 diabetes medications in the liver, gut, pancreas, kidney and muscle/adipose tissue.
This case study describes the diagnosis and management of 55-year old man with painful diabetic peripheral neuropathy. He is already receiving treatment for his diabetes but is experiencing burning pain in the soles of his feet, especially at night when lying in bed. He has paresthesia and numbness in toes and his sleep is interrupted because of his condition. He also presents with depression and has a number of diabetic complications and co-morbidities.
We all know that diabetes prevalence is increasing. It is estimated that by 2025, 5 million people will have Type 2 diabetes in the UK (Diabetes UK). That potentially means more pressure on an already creaking healthcare system and more people at risk of developing debilitating complications from their diabetes. It doesn’t have to be that way!
This case study presents an everyday clinical situation for you to review with guidance from an expert in the field.
The annual diabetic foot check plays a vital part in the support and education of people with diabetes. This can be performed easily and with minimal expense, but despite the NICE recommendation (NG19) that everyone with diabetes should have a foot check at least once a year, Diabetes UK reports that up to 400,000 people are not having this performed.
The time of year is one of a number of factors shown to affect HbA1c levels. This study investigated seasonal variations in HbA1c in a large population of people with diabetes in Scotland. These variations appear to have clinical significance in terms of making medication decisions and other aspects of clinical care.
Professor Mike Kirby highlights the key updates in the new NICE guidelines on the management of type 2 diabetes in adults and how these impact your practice. The updated guideline focuses on an individualised approach to patient care with recommendations on patient education, dietary advice, managing cardiovascular risk, managing blood glucose levels, and identifying and managing long-term complications.
Dr David Haslam, chair of the UK’s National Obesity Forum, provides a useful review of SGLT-2 inhibitors and their ability to lower glucose level, body weight and blood pressure in people with type 2 diabetes.
Volume 7, Supplement 2, Jul-Aug-Sep 2010