Practical Diabetes最新文献

{"title":"Highlights from the Diabetes UK Professional Conference 2023","authors":"K. Bishop","doi":"10.1002/pdi.2470","DOIUrl":"https://doi.org/10.1002/pdi.2470","url":null,"abstract":"The Diabetes UK Professional Conference 2023 saw health care professionals from around the world arrive in Liverpool for the three‐day event. The programme saw experts in all aspects of diabetes sharing their skills and knowledge, allowing attendees to develop their own practice, as well as providing tantalising insights into the future of diabetes care. Dr Katherine Bishop reports on some of the highlights from the conference.","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":"1 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91397019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fear in diabetes","authors":"R. Hillson","doi":"10.1002/pdi.2462","DOIUrl":"https://doi.org/10.1002/pdi.2462","url":null,"abstract":"T woman touched the snake’s flickering tongue. She was fascinated, and completely unafraid. Indeed, she kept asking to touch the poisonous snakes too, and they had to stop her picking up the tarantula. She found the haunted house funny and scared one of the ‘monsters’ by poking it in the head. The fearless subject of these unusual experiments is SM who has Urbach-Wiethe disease. This condition includes bilateral destruction of the amygdala. ‘SM provides a rare glimpse into the adverse consequences of living life without the amygdala. For SM, the consequences have been severe. Her behavior, time and time again, leads her back to the very situations she should be avoiding, highlighting the indispensable role that the amygdala plays in promoting survival by compelling the organism away from danger. Indeed, it appears that without the amygdala, the evolutionary value of fear is lost.’1","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":"5 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89340754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating conversations about disordered eating in children and young people into routine type 1 diabetes care: a practical guide","authors":"Katherine E Wakelin, Rebecca K Read, N. O'Donnell, Marisa Baker, R. Satherley, Rose Stewart, Christina J Jones","doi":"10.1002/pdi.2464","DOIUrl":"https://doi.org/10.1002/pdi.2464","url":null,"abstract":"A higher proportion of children and young people (CYP) with type 1 diabetes (T1D) present with disordered eating compared to CYP without T1D. Due to the complexities of T1D management in addition to eating disorder treatment, it is essential to discuss T1D and Disordered Eating (T1DE) with families to screen early and frequently. This enables those most vulnerable to be identified and treated early.","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":"79 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88582021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of menstrual hormonal fluctuations on the glycaemic control in women with type 1 diabetes mellitus","authors":"C. Milionis, I. Ilias, E. Venaki, E. Koukkou","doi":"10.1002/pdi.2468","DOIUrl":"https://doi.org/10.1002/pdi.2468","url":null,"abstract":"Information on physiological processes that affect insulin action and glycaemia is of paramount importance in the treatment of type 1 diabetes mellitus because optimal blood glucose control can prevent or decelerate microvascular complications. In insulin‐deficient premenopausal women, sensitivity to exogenous insulin seems to be lower during ovulation and in the luteal phase compared to the follicular phase. This difference directly affects glucose management. The risk for hyperglycaemia is oftentimes higher in the second half of the catamenial cycle, while hypoglycaemic events may occur more often in the follicular phase. Ovarian steroids (oestradiol and progesterone) are probable modulating factors in insulin action. Rising oestradiol during midcycle and high progesterone in the secretory phase of the menstrual cycle may contribute to insulin resistance. The underlying physiological mechanisms are largely unknown. It is possible that progesterone enhances gluconeogenesis in the liver and oestradiol binds to insulin and its receptor, thereby increasing resistance to insulin. These actions remain to be clarified. Additional factors related to the catamenial cycle may also facilitate variability in insulin sensitivity. The presence of glycaemic changes during the menstrual cycle is not consistent among premenopausal women with type 1 diabetes. The variability of blood glucose throughout the menstrual cycle should be considered when adjusting insulin dosage in susceptible subjects. Copyright © 2023 John Wiley & Sons.","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":"44 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74839202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Finerenone","authors":"Rachel Mauchlen, G. McKay","doi":"10.1002/pdi.2471","DOIUrl":"https://doi.org/10.1002/pdi.2471","url":null,"abstract":"In developed countries, diabetes mellitus (DM) is one of the main causes of end stage renal disease (ESRD). In addition, the development of chronic kidney disease (CKD) further increases the already significantly increased cardiovascular (CV) risk in patients with diabetes. Both albuminuria and impaired renal function predict CV disease-related morbidity. The multifactorial pathogenesis of DM-related CKD involves structural, physiological, hemodynamic, and inflammatory processes. Instead of a so-called glucocentric approach, current evidence suggests that a multimodal, interdisciplinary treatment approach is needed to also prevent further progression of CKD and reduce the risk of cardiovascular events. Combined antihypertensive, antihyperglycemic and hypolipidemic therapy is the basis of a comprehensive approach to prevent the progression of diabetic kidney disease. According to recent evidence, adjunctive therapy with the non-steroidal mineralocorticoid receptor antagonist (MRA) finerenone - in addition to the use of an ACE (angiotensin converting enzyme) or AT1 (angiotensin II receptor subtype 1) blocker and an SGLT2 (sodium-glucose cotransporter-2) inhibitor - represents an effective therapeutic tool to improve nephroprotection in CKD. The aim of this review is to provide brief information on this promising pharmacotherapeutic approach to the treatment of diabetic kidney disease.","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":"22 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81717241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Allopurinol","authors":"Alan Begg","doi":"10.1002/pdi.2460","DOIUrl":"https://doi.org/10.1002/pdi.2460","url":null,"abstract":"Allopurinol is licensed in the United Kingdom for the prophylaxis of gout as well as uric acid and calcium oxalate renal stones. It can also be prescribed for the prophylaxis of hyperuricaemia associated with cancer chemotherapy. Allopurinol effectively lowers serum uric acid levels and reduces the risk of recurrent gout symptoms. It is commenced after an acute attack has fully subsided to avoid precipitating a flare in symptoms. The recommended starting dose is 100mg to reduce the risk of adverse reactions and the dose is subsequently increased if the serum urate lowering response is unsatisfactory.1 The drug is well tolerated although skin reactions, which may occur at any time during treatment, are the most common adverse effects. Fortunately, hypersensitivity reactions such as Stevens-Johnson syndrome are rarely seen in clinical practice. Allopurinol is a structural analogue of the naturally-occurring purine base hypoxanthine. It is a competitive inhibitor of xanthine oxidase, the enzyme responsible for the conversion of hypoxanthine to xanthine and of xanthine to uric acid, the end product of purine metabolism. (See Figure 1.) Xanthine oxidase is an enzyme that generates reactive oxygen species, promoting oxidative stress which inactivates the anti-atherosclerotic substance nitric oxide. Allopurinol is about 90% absorbed from the gastrointestinal tract with peak plasma levels 1.5 hours post dose. There is negligible protein binding and the plasma half life is 1–-2 hours due to its rapid renal clearance with a lower dose used in the presence of renal impairment. After the ingestion of allopurinol the plasma level of uric acid is reduced. Hypoxanthine, xanthine and uric acid are excreted in the urine but because of their levels of solubility there is a decreased risk of crystalluria. With the use of allopurinol the plasma concentration of uric acid is reduced below its level of solubility, encouraging the dissolution of gouty tophi. Hyperuricaemia and gout are closely associated with insulin resistance syndrome and frequently coexist with metabolic syndrome and type 2 diabetes. Observational and animal studies have identified hyperuricaema as an independent risk factor for insulin resistance and prediabetes. Observational studies have indicated that raised urate levels are an independent predictor of albuminuria and early decline in renal function in those with either type 1 or type 2 diabetes. In animal studies, allopurinol has been shown to improve insulin resistance. The drug has also been shown to improve endothelial function in those with type 2 diabetes and associated mild hypertension in addition to those with heart failure, and in smokers. It also causes regression of left ventricular hypertrophy in those with type 2 diabetes. Lowering of urate levels with allopurinol has overall not shown an improvement in diabetic kidney disease outcomes. Allopurinol reduces oxidative stress by reducing superoxide anions and other free radicals which","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134992408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of integrated diabetes and mental health care for type 1 diabetes and disordered eating (T1DE): the ComPASSION service","authors":"Daisy Wild, M. Kerr, Carla Figueiredo, H. Partridge","doi":"10.1002/pdi.2445","DOIUrl":"https://doi.org/10.1002/pdi.2445","url":null,"abstract":"Type 1 diabetes and disordered eating (T1DE) is often poorly understood and treatment is inadequate in many cases, with little or no co‐ordination between physical and mental health teams. In 2019, NHS England launched two pilot programmes to increase understanding of T1DE, and to trial an integrated diabetes and mental health pathway for assessment, referral and treatment. This paper sets out key findings from the independent evaluation of one of these pilots, the ComPASSION service in Wessex, including baseline patient characteristics, clinical outcomes, and patient and staff experience. Among 11 patients with at least 12 months follow‐up, the median change in HbA1c was a reduction of 31mmol/mol. Copyright © 2023 John Wiley & Sons.","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":"55 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82293123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetes Professional Care conference 2022: key updates","authors":"J. Ogden","doi":"10.1002/pdi.2449","DOIUrl":"https://doi.org/10.1002/pdi.2449","url":null,"abstract":"Health care professionals working in diabetes flocked to the Diabetes Professional Care conference, held over two days in London's Olympia venue, in November 2022.","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":"33 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82929223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The greening of diabetes","authors":"M. Greener","doi":"10.1002/pdi.2442","DOIUrl":"https://doi.org/10.1002/pdi.2442","url":null,"abstract":"Here, Mark Greener discusses the work of key diabetes stakeholders in reducing the environmental footprint left by plastics used in diabetes care, innovations in diabetes device sustainability, and the collaborative approach that is emerging across the pharmaceutical industry for the good of the planet.","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":"33 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75034950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Embedding guidelines into clinical practice","authors":"Judy Winter","doi":"10.1002/pdi.2447","DOIUrl":"https://doi.org/10.1002/pdi.2447","url":null,"abstract":"Type 2 diabetes is a complex, chronic illness requiring continuous medical care with multifactorial risk‐reduction strategies beyond glycaemic control. Cardiovascular and metabolic derangements individually and interdependently lead to a substantial increase in cardiovascular disease morbidity and mortality. Chronic kidney disease is also associated with increased risks of cardiovascular morbidity, premature mortality and decreased quality of life. Established and evolving treatment strategies including moderate physical activity, weight reduction, rigorous blood pressure control, correction of dyslipidaemia, and glycaemic control have proven beneficial in reversing these abnormal responses and decreasing the cardiovascular risk. Most patients with type 2 diabetes are treated by their primary health care team who need guidance in choosing the best treatment regimens for their patients since the number of glucose‐lowering agents is rapidly increasing, as is the amount of clinical data regarding these drugs. Early intervention models of care improve glycaemic, cardiovascular and patient outcomes. Copyright © 2023 John Wiley & Sons.","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":"88 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79387228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}