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Major articles on diabetes

Frailty predicts adverse outcomes in older people with diabetes

23 Jan 2017Registered users

In older people living with diabetes, geriatric syndromes, which indicate frailty, are emerging as a third category of complications in addition to the traditional microvascular and macrovascular sequelae. Frailty is defined by the presence of three or more phenotypes (weight loss, weakness, decreased physical activity, exhaustion and slow gait speed). Patients may progress from a non-frail to pre-frail or frail state. With timely intervention, there is a greater chance for an individual to recover from pre-frail to non-frail than to deteriorate into frailty.

Set individualised targets for patients with type 2 diabetes

23 Sep 2016

In type 2 diabetes regular physical activity totalling 30 minutes most days of the week improves muscle insulin sensitivity, lipid profile and blood pressure although a total of 60-75 minutes a day is required for weight reduction and better metabolic profiles. NICE guidelines acknowledge the need for individualised treatment targets. Lowering HbA1c is beneficial in reducing microvascular complications and may have macrovascular benefits in the long term. However, intensive glycaemic control in the elderly with more advanced disease may not have similar benefits and poses a risk due to hypoglycaemia.

Improving the detection and management of type 1 diabetes

25 Jan 2016Registered users

Type 1 diabetes affects around 370,000 adults in the UK, about 10% of all those diagnosed with diabetes. In type 1 diabetes there is a lack of beta cell insulin secretion as a result of autoimmune destruction of the beta cells. However, patients are not affected by insulin resistance, and so do not routinely experience the features of metabolic syndrome that occur in type 2 diabetes. It is therefore important to classify the type of diabetes correctly and to recognise that type 1 diabetes is a condition with its own management requirements. Structured education is the cornerstone of care providing tools to allow effective self-management.

Improving outcomes in diabetes in pregnancy

21 May 2015Paid-up subscribers

One in 250 pregnancies in the UK involves diabetes. The majority of cases (87.5%) are gestational diabetes, 7.5% are type 1 and 5% are type 2 diabetes. Diabetes in pregnancy is associated with a five fold increase in risk of stillbirth and a two-fold increased risk of congenital defects compared with the general maternity population. Women with gestational diabetes have a significant lifetime risk of developing type 2 diabetes, hence diabetes screening must be undertaken on an annual basis in primary care.

Managing patients with type 2 diabetes and obesity

22 Jan 2015Paid-up subscribers

Diabetes risk increases exponentially with increasing BMI particularly if fat accumulates centrally and/or in the skeletal muscle, liver and other organs such as the pancreas. Those with diabetes and co-existing obesity, particularly if it is severe, are also at risk of other obesity-related conditions, such as cardiovascular disease, obstructive sleep apnoea, joint pain, many cancers and depression. Supporting patients to lose weight should be considered a key goal of diabetes care for all overweight and obese patients with type 2 diabetes.

Risk factor control is key in diabetic nephropathy

24 Feb 2014Paid-up subscribers

Prolonged duration of diabetes, poor glycaemic control and hypertension are major risk factors for both diabetic nephropathy and cardiovascular disease. Optimising blood sugar control together with excellent control of blood pressure can reduce the risk of developing diabetic nephropathy. Diabetic nephropathy should be considered in any patient with diabetes when persistent albuminuria develops.

Tailor treatment in the older patient with type 2 diabetes

24 Jan 2013Paid-up subscribers

In older people, diabetes is a disabling disease due to the associated vascular complications, multiple comorbidities and the increased prevalence of geriatric syndromes. Because of the complexity of diabetes in old age a comprehensive assessment is important at initial diagnosis, with the aim of preventing loss of autonomy and preserving independence. Cognitive and physical dysfunction are common in older people with diabetes which may affect health outcomes and quality of life. Individual therapeutic targets should take into consideration functional status, life expectancy and patient preferences.

Identifying patients at risk of type 2 diabetes

21 Aug 2012Paid-up subscribers

In July 2012, NICE published guidance on the identification and management of type 2 diabetes in adults who are at high risk. This new NICE guidance dovetails with the NHS Health Check programme. The guidance advises using a validated risk assessment tool to identify patients at risk of diabetes. NICE recommends that high-risk patients should be offered a programme encouraging them to undertake a minimum of 150 minutes of moderate intensity physical activity a week, gradually lose weight to reach and maintain a BMI within the healthy range, increase consumption of whole grains, vegetables, and other foods that are high in dietary fibre, reduce the total amount of fat in their diet and eat less saturated fat.

Identifying patients with the metabolic syndrome

27 Aug 2009Paid-up subscribers

The age-adjusted prevalence of metabolic syndrome was approximately 25% of the US adult population in a national survey published in 2002. In a community-based  study in the US, the relative risk of developing diabetes over 11 years among obese patients was increased 10-fold in those with the syndrome, and the risk of developing CVD was increased 2-fold. The prevalence of the syndrome in adults in the UK is of the order of 15-20%.

 

Clinical reviews of research - by GPwSI diabetes

Insulin pumps vs multiple injections in adults with type 1 diabetes

23 May 2017Registered users

A randomised controlled trial comparing insulin pump use with multiple daily injections suggests that when patients are engaged with intensive self-management, insulin pump therapy may not add significant extra benefits in adults.

How accurate are screening tests for pre-diabetes?

22 Feb 2017Paid-up subscribers

A recent meta-analysis has confirmed that interventions in patients with pre-diabetes reduce the rate of progression to overt diabetes, but found that the screening tests used to identify pre-diabetes are inaccurate. The study was commissioned by policy makers in a London borough who wanted to identify an effective screen and treat policy in an area of high diabetes prevalence. The UK investigators trawled through Medline, PreMedline and Embase for eligible papers evaluating the accuracy of tests for pre-diabetes, and controlled studies of interventions (lifestyle changes or metformin) in pre-diabetes patients identified by screening. A total of 2,874 titles were scanned and 148 eligible papers reviewed. The final analysis included 49 studies of screening tests and 50 intervention trials.

Blood pressure and risk of cardiovascular events in type 2 diabetes

23 Jan 2017Registered users

A large cohort study has found that lower systolic blood pressure (BP) is associated with reduced cardiovascular risk in type 2 diabetes patients with no previous cardiovascular disease (CVD). However, there was evidence of a J-shaped relationship between systolic BP and heart failure, and also all cause mortality.

Is frequent self-monitoring and on-line reporting of blood glucose worthwhile?

23 Jan 2017Registered users

Frequent self-monitoring of blood glucose had a significant effect on HbA1c only when combined with frequent on-line reporting, in a study from Canada.

Diabetes therapy and bladder cancer risk

24 Oct 2016Registered users

A UK population-based cohort study concludes that pioglitazone is associated with an increased risk of bladder cancer in patients with type 2 diabetes.

Diabetes therapy and cardiovascular outcomes

23 Sep 2016Registered users

A large UK study  has shown clinically important differences in the risk of heart failure, cardiovascular disease (CVD), and all cause mortality in patients on different drugs, alone and in combination, for type 2 diabetes. Overall, use of gliptins or glitazones was associated with reduced risks of all three outcomes compared with non-use of these drugs.

Gastric bypass induces remission in type 2 diabetes patients with mild-moderate obesity

01 Aug 2016Paid-up subscribers

The CROSSROADS randomised controlled trial of Roux-en-Y gastric bypass (RYGB) versus intensive lifestyle and medical intervention has demonstrated better rates of type 2 diabetes remission in patients with mild-moderate obesity treated with bariatric surgery in this US study. This study used a well informed population-based sample, and included patients with a BMI < 35 kg/m2. The 60% figure for diabetes remission is in line with findings from a UK national registry of more than 3,000 diabetes patients who were operated on between 2011 and 2013, which showed 65% remission of diabetes.

Hypoglycaemia risk with combination therapy in type 2 diabetes

23 Jun 2016Registered users

A meta-analysis has suggested that the addition of a DPP-4 inhibitor to existing sulphonylurea (SU) therapy is associated with a 50% increased risk of hypoglycaemia in type 2 diabetes patients and one excess case for every 17 patients treated in the first six months. These findings emphasise the importance of following the recommendation to reduce SU dose when commencing a DPP-4 inhibitor.

 

Pre-set searches in diabetes