Diabetes

Print

Click on heading to read full article

  Diabetes management during Ramadan
During Ramadan many of our Muslim patients will want to fast. How best can we support them in this?
  Lipids, aspirin, cardiovascular risk and diabetes
We all know that people who have had an MI are at increased risk of further coronary events. But did you know that people with diabetes who have not had an MI, are at the same risk of having a coronary event as non-diabetics who have had an MI? (NEJM 2010;362:1628).
  Managing diabetic foot complications
  Self-monitoring in type 2 diabetes
Lately there has been a real shift away from self-monitoring.
  Insulin in type 2 diabetics
NICE place insulin at step 4. But if we are to use insulin, which regimen should we use? This DTB article very helpfully looks at the evidence and makes some simple recommendations.
  The new diabetes drugs

Before we start, we should remind ourselves of what the Drugs and Therapeutics Bulletin had to say about the newer drugs for diabetes:

HbA1c improvements from the newer drugs are 'little better than can be achieved with other oral hypoglycaemic drugs…and (have an) unknown effect on diabetic complications and mortality or how safe they are in the long term' (DTB 2008;46:7).

 
  Early care in diabetes
Can early intervention with intensive lifestyle change affect outcomes in newly diagnosed diabetes?
  NICE on drugs to control blood sugar
This section includes the updated NICE guidance on the use of hypoglycaemic agents. The next section looks at the new drugs – evidence for use, costs, harms.
  Blood sugar targets
Ever since UKPDS was published a decade or so ago, we have been driven towards tighter and tighter targets for blood sugar control, because of the evidence showing that this reduces cardiovascular endpoints. Now NICE have set a target HbA1c of 6.5%/48mmol/mol. However, other research (discussed overleaf) suggests this may be too low and suggests there may be harms from tight control.
  NICE and SIGN guidelines for type 2 diabetes

NICE guidelines are summarised in 5 sections in this book:

Overview of management 
Blood sugar targets 
NICE on hypoglycaemics 
The new diabetes drugs 
Lipids in diabetes.
  Impaired glucose tolerance


WHO diagnostic criteria for impaired fasting glucose is:

  • Fasting plasma glucose level of 6.1–6.9mmol/l

American Diabetes Association cut off for 'pre-diabetes':

  • HbA1c of 5.7–6.4% (39–47mmol/mol)
  New units for glycaemic control
Why? Internationally standards are changing so that a standard reference method will be used by all laboratories across the globe. Since June 2011 HbA1c results have been reported in mmol/mol rather than percentages (some labs will continue to report both).
  Diagnostic criteria for type 2 diabetes

Can HbA1c be used for diagnosing diabetes?

 

Yes and no! WHO now allow the use of HbA1c in the diagnosis of diabetes (see criteria below).