Recent items - The British Journal of Diabetes & Vascular Disease
Role of maternal vitamin B12 on the metabolic health of the offspring: a contributor to the diabetes epidemic?
06/08/2010 01:51
There is increasing evidence, in humans and other mammals, that periconceptional nutritional status influences health in adulthood. This is called ‘foetal programming’ and is likely to be mediated through DNA methylation. Micronutrients, especially B vitamins such as folic acid and vitamin B12 play crucial roles in providing methyl groups for such reactions. This is called epigenetic regulation and may provide some clues to the epidemic of type 2 diabetes and cardiova [...]
06/08/2010 01:51
There is increasing evidence, in humans and other mammals, that periconceptional nutritional status influences health in adulthood. This is called ‘foetal programming’ and is likely to be mediated through DNA methylation. Micronutrients, especially B vitamins such as folic acid and vitamin B12 play crucial roles in providing methyl groups for such reactions. This is called epigenetic regulation and may provide some clues to the epidemic of type 2 diabetes and cardiova [...]
Cognitive decline: the relevance of diabetes, hyperlipidaemia and hypertension
06/08/2010 01:51
Cognitive decline including mild cognitive impairment describes a heterogeneous condition with cognitive changes between normal ageing and dementia. Cognitive impairment can be promoted or caused by treatable somatic factors. In this review, three important cardiovascular risk factors, diabetes mellitus, hypercholesterolaemia and hypertension, and their association with cognitive decline, are assessed. Though there are many hints of a causal association between diabetes mellitus [...]
06/08/2010 01:51
Cognitive decline including mild cognitive impairment describes a heterogeneous condition with cognitive changes between normal ageing and dementia. Cognitive impairment can be promoted or caused by treatable somatic factors. In this review, three important cardiovascular risk factors, diabetes mellitus, hypercholesterolaemia and hypertension, and their association with cognitive decline, are assessed. Though there are many hints of a causal association between diabetes mellitus [...]
Cascade screening for familial hypercholesterolaemia in Scotland
06/08/2010 01:51
The publication of the UK National Institute for Health and Clinical Excellence familial hypercholesterolaemia guideline led to a combined meeting of lipidologists and geneticists in Scotland. It was agreed to implement a system of cascade screening for familial heterozygous hypercholesterolaemia based on genetic testing to identify family members of known cases who have not previously been diagnosed and treated. The cascade screening system for familial heterozygous hypercholest [...]
06/08/2010 01:51
The publication of the UK National Institute for Health and Clinical Excellence familial hypercholesterolaemia guideline led to a combined meeting of lipidologists and geneticists in Scotland. It was agreed to implement a system of cascade screening for familial heterozygous hypercholesterolaemia based on genetic testing to identify family members of known cases who have not previously been diagnosed and treated. The cascade screening system for familial heterozygous hypercholest [...]
A retrospective review of the management of asymptomatic retinal emboli identified during diabetic retinopathy screening: a case of inappropriate referral?
06/08/2010 01:51
Background Diabetic retinopathy screening generates many referrals of diabetic patients to ophthalmic clinics for incidental non-retinopathy pathology such as asymptomatic retinal emboli. Evidence exists that these patients have a 10 fold increased relative risk of stroke. With this in mind we evaluated our current management for this group. Methods A retrospective review was conducted for patients referred by the screening programme to the Eye Clinic, [...]
06/08/2010 01:51
Background Diabetic retinopathy screening generates many referrals of diabetic patients to ophthalmic clinics for incidental non-retinopathy pathology such as asymptomatic retinal emboli. Evidence exists that these patients have a 10 fold increased relative risk of stroke. With this in mind we evaluated our current management for this group. Methods A retrospective review was conducted for patients referred by the screening programme to the Eye Clinic, [...]
Patient preferences for diabetes care
06/08/2010 01:51
Patient choice or preference has been promoted as an essential element of a patient-centred health service. In response to a questionnaire, accessed via a specialist hospital diabetes clinic where the majority of patients had longstanding insulin treated diabetes, over 90% of patients expressed a preference for consultation with a specialist doctor and 70% preferred a specialist nurse to be involved in their ongoing care in the specialist diabetes centre setting.
06/08/2010 01:51
Patient choice or preference has been promoted as an essential element of a patient-centred health service. In response to a questionnaire, accessed via a specialist hospital diabetes clinic where the majority of patients had longstanding insulin treated diabetes, over 90% of patients expressed a preference for consultation with a specialist doctor and 70% preferred a specialist nurse to be involved in their ongoing care in the specialist diabetes centre setting.
Association between circulating endothelial progenitor cells and hs-CRP in patients with diabetes
06/08/2010 01:51
Aim Endothelial progenitor cells (EPCs) play a critical role in maintaining endothelial function and might affect the progression of vascular disease. This study investigated the relationship between circulating EPCs and high-sensitivity C-reactive protein (hs-CRP) in patients with diabetes. Methods Our study population comprised 190 consecutive patients, with and without diabetes. To obtain EPC numbers, CD34+ and CD133+ cells in peripheral blood were c [...]
06/08/2010 01:51
Aim Endothelial progenitor cells (EPCs) play a critical role in maintaining endothelial function and might affect the progression of vascular disease. This study investigated the relationship between circulating EPCs and high-sensitivity C-reactive protein (hs-CRP) in patients with diabetes. Methods Our study population comprised 190 consecutive patients, with and without diabetes. To obtain EPC numbers, CD34+ and CD133+ cells in peripheral blood were c [...]
Bariatric surgery for diabetes: gastric banding is simple and safe
06/08/2010 01:51
Bariatric surgery (BS) is an important treatment option for selected patients with obesity and type 2 diabetes, and laparoscopic adjustable gastric banding (LAGB) is an effective procedure for many of these patients. This treatment has become preferred in many centres because it is the simplest current option and therefore has substantially better short- and long-term safety profiles than the alternative and more invasive surgical procedures that are advocated by some. The select [...]
06/08/2010 01:51
Bariatric surgery (BS) is an important treatment option for selected patients with obesity and type 2 diabetes, and laparoscopic adjustable gastric banding (LAGB) is an effective procedure for many of these patients. This treatment has become preferred in many centres because it is the simplest current option and therefore has substantially better short- and long-term safety profiles than the alternative and more invasive surgical procedures that are advocated by some. The select [...]
Surgical interventions to correct metabolic disorders
06/08/2010 01:51
Obesity and related metabolic disorders are increasing especially in developing countries. It is widely accepted that in extremely obese patients bariatric surgery reduces body weight and improves type 2 diabetes and the metabolic syndrome. Weight loss partially explains this effect as do weight loss-independent mechanisms linked to gut hormones, peptide YY, ghrelin, glucagon-like peptide-1, and glucose-dependent insulinotropic peptide/gastric inhibitory polypeptide. Several grou [...]
06/08/2010 01:51
Obesity and related metabolic disorders are increasing especially in developing countries. It is widely accepted that in extremely obese patients bariatric surgery reduces body weight and improves type 2 diabetes and the metabolic syndrome. Weight loss partially explains this effect as do weight loss-independent mechanisms linked to gut hormones, peptide YY, ghrelin, glucagon-like peptide-1, and glucose-dependent insulinotropic peptide/gastric inhibitory polypeptide. Several grou [...]
Intentional and unintentional non-adherence in community dwelling people with type 2 diabetes: the effect of varying numbers of medicines
06/08/2010 01:51
People with type 2 diabetes are often prescribed multi-medicines which can be difficult to manage. Non-adherence to medicines can be intentional (e.g. active decision) or unintentional (e.g. forgetting). The objective of this study was to measure intentional and unintentional non-adherence to differing numbers of medicines prescribed in type 2 diabetes. A cross-sectional survey using the Morisky medication adherence scale (with intentional and unintentional non-adherence subscale [...]
06/08/2010 01:51
People with type 2 diabetes are often prescribed multi-medicines which can be difficult to manage. Non-adherence to medicines can be intentional (e.g. active decision) or unintentional (e.g. forgetting). The objective of this study was to measure intentional and unintentional non-adherence to differing numbers of medicines prescribed in type 2 diabetes. A cross-sectional survey using the Morisky medication adherence scale (with intentional and unintentional non-adherence subscale [...]
Familial dysbetalipoproteinaemia, chronic inflammatory arthropathy and diabetes mellitus causing premature peripheral vascular atherosclerosis
06/08/2010 01:51
06/08/2010 01:51
The new world of biosimilars: what diabetologists need to know about biosimilar insulins
05/08/2010 18:31
Biosimilar pharmaceuticals are emerging as patent protection on the original biopharmaceutical products expires. However, biopharmaceuticals are particularly complex molecules, and biosimilar insulins present special challenges. In part this reflects their structure and chemical modification after synthesis to attain a biologically active form. Their therapeutic window is narrow and the accuracy of their dosing is highly dependent on the formulation and quality of the administrat [...]
05/08/2010 18:31
Biosimilar pharmaceuticals are emerging as patent protection on the original biopharmaceutical products expires. However, biopharmaceuticals are particularly complex molecules, and biosimilar insulins present special challenges. In part this reflects their structure and chemical modification after synthesis to attain a biologically active form. Their therapeutic window is narrow and the accuracy of their dosing is highly dependent on the formulation and quality of the administrat [...]
Diabetes and thyroid disorders
05/08/2010 18:31
It has long been recognised that thyroid hormones have marked effects on glucose homeostasis. Glucose intolerance is associated with hyperthyroidism and most recently it was shown that hypothyroidism is characterised by insulin resistance. Although autoimmune thyroid disease is more prevalent in type 1 diabetes as a result of their common origin, in patients with type 2 diabetes the prevalence of hypothyroidism and hyperthyroidism is similar to that of the general population. How [...]
05/08/2010 18:31
It has long been recognised that thyroid hormones have marked effects on glucose homeostasis. Glucose intolerance is associated with hyperthyroidism and most recently it was shown that hypothyroidism is characterised by insulin resistance. Although autoimmune thyroid disease is more prevalent in type 1 diabetes as a result of their common origin, in patients with type 2 diabetes the prevalence of hypothyroidism and hyperthyroidism is similar to that of the general population. How [...]
Insulin usage in type 2 diabetes mellitus patients in UK clinical practice: a retrospective cohort-based analysis using the THIN database
05/08/2010 18:31
This retrospective cohort-based study assessed the change in glycated haemoglobin A1C (HbA 1C) in patients with type 2 diabetes, with existing prescriptions for oral antidiabetic drugs (OADs), prescribed insulin versus those prescribed subsequent OADs. A cohort of patient records drawn from the The Health Improvement Network (THIN) database was stratified by maximum concurrent number of OADs. Of 128,568 unique patient records identified, 67.7% (n=87,057) had received at least one [...]
05/08/2010 18:31
This retrospective cohort-based study assessed the change in glycated haemoglobin A1C (HbA 1C) in patients with type 2 diabetes, with existing prescriptions for oral antidiabetic drugs (OADs), prescribed insulin versus those prescribed subsequent OADs. A cohort of patient records drawn from the The Health Improvement Network (THIN) database was stratified by maximum concurrent number of OADs. Of 128,568 unique patient records identified, 67.7% (n=87,057) had received at least one [...]
Resistant hypertension as a pointer to unsuspected Cushing's syndrome in patients with diabetes: three case reports
05/08/2010 18:31
Secondary causes of diabetes are uncommon but early recognition is important so that patients receive appropriate diagnosis and treatment. Cushing’s syndrome is a rare disorder which is associated with weight gain, diabetes and hypertension. Since obesity is common in type 2 diabetes, a diagnosis of Cushing’s syndrome may be easily overlooked. Herein we describe resistant/refractory hypertension as a clinical clue to suspect Cushing’s syndrome in patients with d [...]
05/08/2010 18:31
Secondary causes of diabetes are uncommon but early recognition is important so that patients receive appropriate diagnosis and treatment. Cushing’s syndrome is a rare disorder which is associated with weight gain, diabetes and hypertension. Since obesity is common in type 2 diabetes, a diagnosis of Cushing’s syndrome may be easily overlooked. Herein we describe resistant/refractory hypertension as a clinical clue to suspect Cushing’s syndrome in patients with d [...]
TRAQ-D (Trinidad Risk Assessment Questionnaire for Type 2 Diabetes Mellitus): a cheap, reliable, non-invasive screening tool for diabetes
05/08/2010 18:31
The objective of this study was to design a reliable, valid and culturally appropriate risk questionnaire and determine its effectiveness as a tool for the early detection of type 2 diabetes mellitus in Trinidad. Initially, a questionnaire with 21 close-ended questions on known risk factors for diabetes was administered to 456 patients, and a series of logistic regressions extracted the most significant factors (p<0.05). These factors were scored using their odds ratio and a t [...]
05/08/2010 18:31
The objective of this study was to design a reliable, valid and culturally appropriate risk questionnaire and determine its effectiveness as a tool for the early detection of type 2 diabetes mellitus in Trinidad. Initially, a questionnaire with 21 close-ended questions on known risk factors for diabetes was administered to 456 patients, and a series of logistic regressions extracted the most significant factors (p<0.05). These factors were scored using their odds ratio and a t [...]
SGLT2 inhibitors: glucuretic treatment for type 2 diabetes
05/08/2010 18:31
Sodium glucose co-transporter-2 (SGLT2) inhibitors offer a novel approach to treat diabetes by reducing hyperglycaemia via increased glucosuria. This approach reduces renal glucose reabsorption in the proximal renal tubules providing an insulin-independent mechanism to lower blood glucose. The glucuretics are advanced in clinical development and dapagliflozin has received most extensive study. Once daily dapaglifolozin as monotherapy or as add-on to metformin for 12—24 week [...]
05/08/2010 18:31
Sodium glucose co-transporter-2 (SGLT2) inhibitors offer a novel approach to treat diabetes by reducing hyperglycaemia via increased glucosuria. This approach reduces renal glucose reabsorption in the proximal renal tubules providing an insulin-independent mechanism to lower blood glucose. The glucuretics are advanced in clinical development and dapagliflozin has received most extensive study. Once daily dapaglifolozin as monotherapy or as add-on to metformin for 12—24 week [...]
DIAMAP: an innovative blueprint for the future of diabetes research in Europe
05/08/2010 18:31
The challenge of rising mortality and morbidity from diabetes and its complications will only be met through greater investment in research. European expertise is well placed to play a leading role in this effort particularly if integrated, coordinated and supported by adequate funding and more rational use of these funds. A Road Map for Diabetes Research in Europe (DIAMAP) has charted a route for diabetes research in Europe encompassing molecules to clinical sciences. This revie [...]
05/08/2010 18:31
The challenge of rising mortality and morbidity from diabetes and its complications will only be met through greater investment in research. European expertise is well placed to play a leading role in this effort particularly if integrated, coordinated and supported by adequate funding and more rational use of these funds. A Road Map for Diabetes Research in Europe (DIAMAP) has charted a route for diabetes research in Europe encompassing molecules to clinical sciences. This revie [...]
Use of U-500 insulin in continuous subcutaneous insulin infusion in a patient with severe insulin resistance
05/08/2010 18:31
U-500 insulin (Humulin R; Eli Lilly, Indianapolis, Indiana, USA) is five times as concentrated as conventional U-100 insulins. We report the case of a woman with marked insulin resistance in whom the use of U-500 insulin in continuous subcutaneous insulin infusion (CSII) resulted in a marked improvement. Benefits included improved glycated haemoglobin A1C, decreased volume of insulin required, fewer reservoir changes, greater patient satisfaction and cost savings. We discuss the [...]
05/08/2010 18:31
U-500 insulin (Humulin R; Eli Lilly, Indianapolis, Indiana, USA) is five times as concentrated as conventional U-100 insulins. We report the case of a woman with marked insulin resistance in whom the use of U-500 insulin in continuous subcutaneous insulin infusion (CSII) resulted in a marked improvement. Benefits included improved glycated haemoglobin A1C, decreased volume of insulin required, fewer reservoir changes, greater patient satisfaction and cost savings. We discuss the [...]
Thoughts on paediatric diabetes care in the UK
05/08/2010 13:39
Paediatric diabetes ranks among the most common chronic diseases in childhood and affects 23,000 children under 17 years in the UK with an increase at a rate of about 3% a year. Acute medical management at manifestation is well established and successfully conducted in the vast majority of cases. The chronic long-term treatment is challenging and involves self-managed, regular subcutaneous insulin administration for life, together with diet, exercise and lifestyle support to avoid short and long [...]
05/08/2010 13:39
Paediatric diabetes ranks among the most common chronic diseases in childhood and affects 23,000 children under 17 years in the UK with an increase at a rate of about 3% a year. Acute medical management at manifestation is well established and successfully conducted in the vast majority of cases. The chronic long-term treatment is challenging and involves self-managed, regular subcutaneous insulin administration for life, together with diet, exercise and lifestyle support to avoid short and long [...]
Structured education in type 1 diabetes
05/08/2010 13:39
The UK has been slow to promote effective intensive insulin therapy among those with type 1 diabetes. Although many adults use multiple injections, few self-manage their diabetes effectively and maintain tight glucose targets. However, in recent years reports from other countries that high-quality skills training in self- management can improve glycaemic control while lowering rates of hypoglycaemia have changed attitudes. The DAFNE (Dose Adjustment for Normal Eating) trial, which promotes a fle [...]
05/08/2010 13:39
The UK has been slow to promote effective intensive insulin therapy among those with type 1 diabetes. Although many adults use multiple injections, few self-manage their diabetes effectively and maintain tight glucose targets. However, in recent years reports from other countries that high-quality skills training in self- management can improve glycaemic control while lowering rates of hypoglycaemia have changed attitudes. The DAFNE (Dose Adjustment for Normal Eating) trial, which promotes a fle [...]
Insulin dose adjustment and exercise in type 1 diabetes: what do we tell the patient?
05/08/2010 13:39
Many people with type 1 diabetes are keen to exercise and play sport. Different types of exercise cause different problems with glycaemic control and require different management strategies. Physiological problems and possible management solutions in type 1 diabetes are considered for three types of exercise using case scenarios. Moderate intensity exercise is linked with hypoglycaemia and so insulin dose reductions and carbohydrate supplementation are discussed. Similar strategies for dealing w [...]
05/08/2010 13:39
Many people with type 1 diabetes are keen to exercise and play sport. Different types of exercise cause different problems with glycaemic control and require different management strategies. Physiological problems and possible management solutions in type 1 diabetes are considered for three types of exercise using case scenarios. Moderate intensity exercise is linked with hypoglycaemia and so insulin dose reductions and carbohydrate supplementation are discussed. Similar strategies for dealing w [...]
Diabetic ketoacidosis (DKA) in Birmingham, UK, 2000--2009: an evaluation of risk factors for recurrence and mortality
05/08/2010 13:39
Diabetic ketoacidosis (DKA) is an acute metabolic complication of type 1 diabetes mellitus. This study aimed to define the DKA mortality rate in a Birmingham population and to identify risk factors for mortality and repeat admissions. An evaluation of 137 patients’ notes retrieved from five hospitals in and around Birmingham, UK, identified 278 admissions over a 9-year period (2000—2009). The International Classification of Disease 10 coding system for DKA, E101, was employed to ide [...]
05/08/2010 13:39
Diabetic ketoacidosis (DKA) is an acute metabolic complication of type 1 diabetes mellitus. This study aimed to define the DKA mortality rate in a Birmingham population and to identify risk factors for mortality and repeat admissions. An evaluation of 137 patients’ notes retrieved from five hospitals in and around Birmingham, UK, identified 278 admissions over a 9-year period (2000—2009). The International Classification of Disease 10 coding system for DKA, E101, was employed to ide [...]
Recent advances in the pharmacological management of painful diabetic neuropathy
05/08/2010 13:39
Painful diabetic peripheral neuropathy (DPN) affects 10—26% of all diabetic patients and continues to pose significant clinical/treatment challenges. Pharmacological treatment of painful DPN includes tricyclic antidepressants (TCAs), selective serotonin noradrenaline reuptake inhibitors (SNRIs), selective serotonin reuptake inhibitors, anticonvulsants, opiates, the antioxidant alpha lipoic acid, membrane stabilisers, topical capsaicin etc. Over the past five years many compounds have under [...]
05/08/2010 13:39
Painful diabetic peripheral neuropathy (DPN) affects 10—26% of all diabetic patients and continues to pose significant clinical/treatment challenges. Pharmacological treatment of painful DPN includes tricyclic antidepressants (TCAs), selective serotonin noradrenaline reuptake inhibitors (SNRIs), selective serotonin reuptake inhibitors, anticonvulsants, opiates, the antioxidant alpha lipoic acid, membrane stabilisers, topical capsaicin etc. Over the past five years many compounds have under [...]
Screening for coeliac disease in an adult cohort of patients with type 1 diabetes
05/08/2010 13:39
Patients with type 1 diabetes have an increased prevalence of coeliac disease as compared with the general population due to common genotypes. Recent evidence has suggested that deregulation of gastrointestinal mucosal immunity may be essential to the development of both diseases. Currently, strong evidence supports the serological screening of paediatric patients with type 1 diabetes for coeliac disease. A key clinical question in the management of type 1 diabetes is whether adult patients shou [...]
05/08/2010 13:39
Patients with type 1 diabetes have an increased prevalence of coeliac disease as compared with the general population due to common genotypes. Recent evidence has suggested that deregulation of gastrointestinal mucosal immunity may be essential to the development of both diseases. Currently, strong evidence supports the serological screening of paediatric patients with type 1 diabetes for coeliac disease. A key clinical question in the management of type 1 diabetes is whether adult patients shou [...]
Solving the mystery: the 'renal cysts and diabetes syndrome'
05/08/2010 13:39
Diabetologists and non-specialist physicians have traditionally focused on treatment rather than diagnosis in the management of diabetes. The diagnosis of type 1 or type 2 diabetes in a busy admissions unit or a diabetes clinic is usually based on biochemical diagnostic criteria, age at onset, body mass index and the presence or absence of ketoacidosis. More challenging for the clinician is to utilise clinical skills and knowledge to detect monogenic diabetes, which has important consequences in [...]
05/08/2010 13:39
Diabetologists and non-specialist physicians have traditionally focused on treatment rather than diagnosis in the management of diabetes. The diagnosis of type 1 or type 2 diabetes in a busy admissions unit or a diabetes clinic is usually based on biochemical diagnostic criteria, age at onset, body mass index and the presence or absence of ketoacidosis. More challenging for the clinician is to utilise clinical skills and knowledge to detect monogenic diabetes, which has important consequences in [...]
Review: Does hypoglycaemia cause cardiovascular events?
05/08/2010 13:39
Strict glycaemic control is strongly advocated in people with type 2 diabetes to prevent vascular disease. However, the outcomes of two large clinical trials have indicated the potential dangers of pursuing this policy in those at high risk of cardiovascular disease, with an excess of fatal vascular events being associated with a higher frequency of severe hypoglycaemia. Hypoglycaemia secondary to insulin and sulphonylurea therapy is often associated with serious morbidity; anecdotal evidence ha [...]
05/08/2010 13:39
Strict glycaemic control is strongly advocated in people with type 2 diabetes to prevent vascular disease. However, the outcomes of two large clinical trials have indicated the potential dangers of pursuing this policy in those at high risk of cardiovascular disease, with an excess of fatal vascular events being associated with a higher frequency of severe hypoglycaemia. Hypoglycaemia secondary to insulin and sulphonylurea therapy is often associated with serious morbidity; anecdotal evidence ha [...]
Review: Saxagliptin: a review
05/08/2010 13:39
Modulation of the effects of incretin hormones provides a novel mechanism of action for some of the newer therapies for patients with type 2 diabetes. The selective, reversible dipeptidyl peptidase-4 inhibitor saxagliptin has demonstrated robust improvements in glycaemic control, as monotherapy or as add-on therapy to metformin, sulphonylureas and thiazolidinediones, without significant change in body weight and while exhibiting a low risk of hypoglycaemia.
05/08/2010 13:39
Modulation of the effects of incretin hormones provides a novel mechanism of action for some of the newer therapies for patients with type 2 diabetes. The selective, reversible dipeptidyl peptidase-4 inhibitor saxagliptin has demonstrated robust improvements in glycaemic control, as monotherapy or as add-on therapy to metformin, sulphonylureas and thiazolidinediones, without significant change in body weight and while exhibiting a low risk of hypoglycaemia.
Current developments in the treatment of diabetes: the incretin therapies
05/08/2010 13:39
The prevalence of type 2 diabetes in the UK has increased enormously over recent years and is closely associated with obesity and other risk factors for cardiovascular disease. The incretin system, which contributes significantly to the insulin response in healthy individuals, but is impaired in individuals with diabetes, offers a target for the development of agents that address many aspects of diabetes. These agents are broadly split into two categories — the glucagon-like polypeptide-1 [...]
05/08/2010 13:39
The prevalence of type 2 diabetes in the UK has increased enormously over recent years and is closely associated with obesity and other risk factors for cardiovascular disease. The incretin system, which contributes significantly to the insulin response in healthy individuals, but is impaired in individuals with diabetes, offers a target for the development of agents that address many aspects of diabetes. These agents are broadly split into two categories — the glucagon-like polypeptide-1 [...]
Insulin-treated diabetes and driving: what is the patient's knowledge of current regulations?
05/08/2010 13:39
Our survey aimed to determine whether educational deficits exist regarding patients’ knowledge of current driving regulations. We surveyed 100 insulin-treated diabetes patients using questionnaires in October 2008. Fifty-eight were male and 42 female. Mean age was 52.9 years, mean duration of diabetes 15.1 years and mean glycated haemoglobin A1C 7.5%. Eighty-nine patients (89%) had notified the UK Driver and Vehicle Licensing Agency and 79 (79%) their insurance company of insulin treatment [...]
05/08/2010 13:39
Our survey aimed to determine whether educational deficits exist regarding patients’ knowledge of current driving regulations. We surveyed 100 insulin-treated diabetes patients using questionnaires in October 2008. Fifty-eight were male and 42 female. Mean age was 52.9 years, mean duration of diabetes 15.1 years and mean glycated haemoglobin A1C 7.5%. Eighty-nine patients (89%) had notified the UK Driver and Vehicle Licensing Agency and 79 (79%) their insurance company of insulin treatment [...]
Hypoglycaemia in patients with type 2 diabetes: minimising the risk
05/08/2010 13:39
Achieving optimal glycaemic control is a priority for the management of diabetes and among patients with type 2 diabetes, it is increasingly becoming apparent that hypoglycaemia is a barrier to this. Hypoglycaemia can be associated with acute and long-term morbidity and is potentially fatal. Strategies to minimise the risk of hypoglycaemia in patients with type 2 diabetes are outlined here, including the need for patient education and optimisation of current treatments.
05/08/2010 13:39
Achieving optimal glycaemic control is a priority for the management of diabetes and among patients with type 2 diabetes, it is increasingly becoming apparent that hypoglycaemia is a barrier to this. Hypoglycaemia can be associated with acute and long-term morbidity and is potentially fatal. Strategies to minimise the risk of hypoglycaemia in patients with type 2 diabetes are outlined here, including the need for patient education and optimisation of current treatments.
Determining the risk of hypoglycaemia in people with type 2 diabetes: an approach for clinical practice
05/08/2010 13:39
Hypoglycaemia and its consequences are a significant risk for many people who have type 2 diabetes, yet it is often under-recognised, and may be avoidable. Severe hypoglycaemic events have an impact on mortality, morbidity and quality of life of many people with type 2 diabetes. With current clinical guidelines recommending strict glycaemic control, it is likely that the clinical risk of hypoglycaemia will increase, such that better recognition of the symptoms of hypoglycaemia is increasingly im [...]
05/08/2010 13:39
Hypoglycaemia and its consequences are a significant risk for many people who have type 2 diabetes, yet it is often under-recognised, and may be avoidable. Severe hypoglycaemic events have an impact on mortality, morbidity and quality of life of many people with type 2 diabetes. With current clinical guidelines recommending strict glycaemic control, it is likely that the clinical risk of hypoglycaemia will increase, such that better recognition of the symptoms of hypoglycaemia is increasingly im [...]
Facial and finger erysipelas: an unusual complication of home blood glucose monitoring
05/08/2010 13:39
05/08/2010 13:39
Review: The importance of residual endogenous beta-cell preservation in type 1 diabetes
05/08/2010 13:39
Achieving tight glycaemic control in type 1 diabetes remains very challenging for patients. However, some individuals retain a degree of endogenous beta-cell function for 5 or more years after diagnosis, and prospective studies confirm that this is associated not only with lower glycated haemoglobin A1c levels, and less hypoglycaemia, but also a reduced incidence of long-term complications. An independent effect of insulin C-peptide may contribute to this beneficial effect. Retention of even sma [...]
05/08/2010 13:39
Achieving tight glycaemic control in type 1 diabetes remains very challenging for patients. However, some individuals retain a degree of endogenous beta-cell function for 5 or more years after diagnosis, and prospective studies confirm that this is associated not only with lower glycated haemoglobin A1c levels, and less hypoglycaemia, but also a reduced incidence of long-term complications. An independent effect of insulin C-peptide may contribute to this beneficial effect. Retention of even sma [...]
Review: Metabolic memory in type 1 diabetes
05/08/2010 13:39
Metabolic memory and its possible mechanisms are reviewed. In clinical practice in type 1 diabetes the concept of metabolic memory has developed largely from the observations of the Epidemiology of Diabetes Interventions and Complications (EDIC) study, which followed the Diabetes Control and Complications Trial (DCCT). In the former intensive treatment group, after 10 years follow-up, when glycated haemoglobin levels had converged completely, there was less progression of retinopathy and lower r [...]
05/08/2010 13:39
Metabolic memory and its possible mechanisms are reviewed. In clinical practice in type 1 diabetes the concept of metabolic memory has developed largely from the observations of the Epidemiology of Diabetes Interventions and Complications (EDIC) study, which followed the Diabetes Control and Complications Trial (DCCT). In the former intensive treatment group, after 10 years follow-up, when glycated haemoglobin levels had converged completely, there was less progression of retinopathy and lower r [...]
Influences of diabetes on the development and progression of cardiovascular disease
05/08/2010 13:39
05/08/2010 13:39
Review: Management of hyperglycaemia in acute coronary syndrome
05/08/2010 13:39
To review the management of blood glucose in acute coronary syndrome (ACS) a literature search was undertaken using Medline and Embase databases (January 1950—July 2008), bibliographies of retrieved articles, review articles and Department of Health reports. Trials were eligible for inclusion in the review if they (i) included patients with ACS and hyperglycaemia with or without diabetes or compared insulin infusion or glucose-potassium-insulin infusion with active controls, (ii) were rand [...]
05/08/2010 13:39
To review the management of blood glucose in acute coronary syndrome (ACS) a literature search was undertaken using Medline and Embase databases (January 1950—July 2008), bibliographies of retrieved articles, review articles and Department of Health reports. Trials were eligible for inclusion in the review if they (i) included patients with ACS and hyperglycaemia with or without diabetes or compared insulin infusion or glucose-potassium-insulin infusion with active controls, (ii) were rand [...]
Review: Hyperglycaemia and the vascular glycocalyx: the key to microalbuminuria and cardiovascular disease in diabetes mellitus?
05/08/2010 13:39
The vascular glycocalyx is a gel layer between endothelium and the blood, 0.5 µm thick. Evidence is presented from published studies to indicate that hyperglycaemia causes damage to the vascular glycocalyx. This damage results in microalbuminuria, excess fluid transfer to the interstitium, reduction in nitric oxide (NO) production by arterial endothelium, and leukocyte and platelet adhesion to endothelium leading to atherothrombosis. The lack of NO production proceeds from the fact that gl [...]
05/08/2010 13:39
The vascular glycocalyx is a gel layer between endothelium and the blood, 0.5 µm thick. Evidence is presented from published studies to indicate that hyperglycaemia causes damage to the vascular glycocalyx. This damage results in microalbuminuria, excess fluid transfer to the interstitium, reduction in nitric oxide (NO) production by arterial endothelium, and leukocyte and platelet adhesion to endothelium leading to atherothrombosis. The lack of NO production proceeds from the fact that gl [...]
Review: Endothelial cell dysfunction, medial arterial calcification and osteoprotegerin in diabetes
05/08/2010 13:39
Macrovascular complications such as cardiovascular disease and peripheral vascular disease are the leading cause of increased mortality and morbidity, respectively, in patients with diabetes mellitus. The aetiopathogenesis of macrovasculopathy in diabetes is multifactorial and differs in types 1 and 2 diabetes. Endothelial cell dysfunction is an early feature of diabetic vasculopathy and is associated with poor glycaemic control. Chronic hyperglycaemia may promote an adverse vascular milieu lead [...]
05/08/2010 13:39
Macrovascular complications such as cardiovascular disease and peripheral vascular disease are the leading cause of increased mortality and morbidity, respectively, in patients with diabetes mellitus. The aetiopathogenesis of macrovasculopathy in diabetes is multifactorial and differs in types 1 and 2 diabetes. Endothelial cell dysfunction is an early feature of diabetic vasculopathy and is associated with poor glycaemic control. Chronic hyperglycaemia may promote an adverse vascular milieu lead [...]
A new use for B-type natriuretic peptide: to detect myocardial ischaemia in non-heart failure patients
05/08/2010 13:39
B-type natriuretic peptide (BNP) is a natriuretic peptide released primarily by ventricular myocytes in response to various physiological and pathological stimuli. In addition to its established diagnostic role in patients with heart failure, a growing body of evidence suggests that raised levels of BNP in the absence of heart failure can indicate myocardial ischaemia. This appears to be the case in patients with symptomatic, and even asymptomatic coronary artery disease (CAD). In this review, w [...]
05/08/2010 13:39
B-type natriuretic peptide (BNP) is a natriuretic peptide released primarily by ventricular myocytes in response to various physiological and pathological stimuli. In addition to its established diagnostic role in patients with heart failure, a growing body of evidence suggests that raised levels of BNP in the absence of heart failure can indicate myocardial ischaemia. This appears to be the case in patients with symptomatic, and even asymptomatic coronary artery disease (CAD). In this review, w [...]
Diabetes mellitus and travel-related illnesses
05/08/2010 13:39
International travel, including patients travelling with diabetes mellitus, is predicted to increase in the coming decades. These patients will require pre-travel education regarding adjusting insulin and oral antidiabetic agents during their journey especially if they fall ill. The spectrum of travel-related illnesses includes food and waterborne diseases, airborne and vector-borne diseases, zoonoses, sexually transmitted and blood-borne diseases, and diseases transmitted by soil. This article [...]
05/08/2010 13:39
International travel, including patients travelling with diabetes mellitus, is predicted to increase in the coming decades. These patients will require pre-travel education regarding adjusting insulin and oral antidiabetic agents during their journey especially if they fall ill. The spectrum of travel-related illnesses includes food and waterborne diseases, airborne and vector-borne diseases, zoonoses, sexually transmitted and blood-borne diseases, and diseases transmitted by soil. This article [...]
Lessons learned from biosimilar epoetins and insulins
05/08/2010 13:39
Patients with diabetes and renal failure may already be receiving biosimilar epoetin and may receive biosimilar insulin in the near future. Because these biosimilar pharmaceuticals (or follow-on biologics) are complex protein molecules manufactured in lengthy and inherently variable processes involving living organisms, they have the potential to induce an immunogenic, rather than a therapeutic, response. This response is dependent as much on the method of manufacture and formulation, as on the [...]
05/08/2010 13:39
Patients with diabetes and renal failure may already be receiving biosimilar epoetin and may receive biosimilar insulin in the near future. Because these biosimilar pharmaceuticals (or follow-on biologics) are complex protein molecules manufactured in lengthy and inherently variable processes involving living organisms, they have the potential to induce an immunogenic, rather than a therapeutic, response. This response is dependent as much on the method of manufacture and formulation, as on the [...]
Quality and safety in NHS Scotland
05/08/2010 13:39
If the 1990s was the decade of evidence-based medicine the following decade has seen a gradual move towards evidence-based care delivery. The translation of discovery research into actual improvements in care is a challenging transition. Quality improvement techniques developed in industry are an attempt to bridge this gap. Unprecedented improvements in the safety of air travel, oil exploration and nuclear power have occurred because of cultural change after major disasters. In contrast healthca [...]
05/08/2010 13:39
If the 1990s was the decade of evidence-based medicine the following decade has seen a gradual move towards evidence-based care delivery. The translation of discovery research into actual improvements in care is a challenging transition. Quality improvement techniques developed in industry are an attempt to bridge this gap. Unprecedented improvements in the safety of air travel, oil exploration and nuclear power have occurred because of cultural change after major disasters. In contrast healthca [...]