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.
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.
What are the practicalities of supporting people with diabetes who fast during Ramadan? Practice nurses can make a real difference by educating patients before Ramadan starts and advising them on what they need to consider before starting their fast. Patients need to be involved in the whole process so that they are well aware of the importance of managing their diabetes to ensure good control of their glucose levels throughout Ramadan. We review how to assess patients before Ramadan, what adjustments to make to medication and how to follow up.
Fasting during Ramadan means that you have longer gaps between meals than usual. Many people also eat more food in one meal – in particular, more carbohydrate-rich and fatty foods – during this time. If you have diabetes, this may mean that you have large swings in your blood sugar levels during Ramadan. During the day – when you are fasting – your blood sugar is likely to drop. This may make you feel weak, tired and dizzy. This is called hypoglycaemia (which means low sugar) – a period of hypoglycaemia is sometimes called a ‘hypo.’ People who are sick or whose health may be adversely affected by fasting – such as those with diabetes – do not have to fast during Ramadan. However, some people do decide to observe the fast. This leaflet gives you some tips on how to keep well.
One in 20 of the UK population—or 2.8 million people—have been diagnosed with type 2 diabetes, according to a recent report based on the Quality and Outcomes Framework (QOF) exception data. Most of these patients will have been identified in primary care, and GPs and practice nurses will be only too well aware of the burden of illness associated with the cardiovascular and microvascular complications of diabetes. The most effective means of reducing the risk of these microvascular complications is to ensure that each patient achieves and maintains their individualised glycaemic target. Recent guidance from the National Institute for Health and Clinical Excellence (NICE) provides recommendations on using liraglutide (Victoza), a new option for patients who do not achieve their target HbA1c using currently available therapies.
The most effective means of reducing the risk of complications associated with type 2 diabetes is to ensure that each patient achieves and maintains their individualised glycaemic target. New guidance from the National Institute for Health and Clinical Excellence (NICE) providesrecommendations on using liraglutide (Victoza), a new option for patients who do not achieve target HbA1c using currently available therapies.
The prevalence of many physical illnesses is increased in people with severe mental illness and accounts for around three quarters of all deaths; cardiovascular disease is the commonest cause of death. The level of screening for and management of diabetes and cardiovascular risk factors remains low but a straightforward yet systematic care pathway should go a long way towards reducing the health inequalities experienced by people with severe mental illness.
The sulphonylurea group of drugs and the biguanide drug metformin have both been available for use as glucose-lowering therapies for more than 50 years. There were, however, few other clinically relevant developments in this area of pharmacotherapy until about the year 2000. At that time a new class of glucose-lowering therapies, the thiazolidinediones pioglitazone and rosiglitazone, was launched. In 2007 two more new classes of therapy were launched, the dipeptidyl peptidase-4 (DPP-4) inhibitors and the glucagon-like peptide-1 (GLP-1) mimetics; both of these classes of agents work on the incretin pathway.A further new class of glucose-lowering agents, the sodium glucose co-transporter 2 (SGLT2) inhibitors, is likely to be launched in the next year or two. So much activity in glucose lowering pharmacotherapy in this past 12 years perhaps makes up for the previous 40 years of relative inactivity!In this article we discuss new glucose-lowering therapies and consider their place in diabetes management from the primary care perspective.
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.