Diabetes treatment

People with type 2 diabetes suffer badly from heart disease, strokes, and damage to the blood supply to their feet. Indeed, these cardiovascular conditions are the major causes of ill-health and death in people with the condition. A significant proportion of that ill-health is preventable, including by attention to the levels of fats and sugar in the blood, the clotting tendency of the blood, and blood pressure. Raised blood pressure is also responsible for worsening of eye damage and kidney damage in people with type 2 diabetes, and is therefore particularly well worth treating.

It is important not to think of diabetes as being ‘treated’. And it is important not to think of diabetes management as being about lowering blood glucose levels alone. Other aspects of management are important enough to require separate chapters, both in the Global Guideline and in this Supplement. Nevertheless, the control of blood glucose is central to the management of type 2 diabetes, and nearly all people with the condition will need oral glucose-lowering drugs or insulin to help optimize this important cardiovascular risk factor.

Blood glucose control is central to the very nature of diabetes, and the late complications which can develop. Unfortunately, it cannot be sensed by the person with diabetes unless levels are very high or very low. Accordingly, blood glucose control has to be measured reliably, and this needs to be done in the clinic and in normal life. Evidently, the results have then to be related to the risks of developing complications – hence targets and intervention levels.

The International Diabetes Federation (IDF) is not in the business of delivering clinical care to people with diabetes; but it is committed to the view that everyone with diabetes should benefit from the best possible care that could be available to them. One foundation of such care is to ensure that it is based on the best possible scientific knowledge. In this Supplement to Diabetes Voice we summarize in non-technical language the evidence base and recommendations of the IDF Global Guideline.

As patients, many of us assume that we are receiving the best possible treatment for any medical condition we may have – people with diabetes are no exception. However, with an increasing emphasis on empowerment and choice, many of us are no longer prepared to simply assume that the treatment we are offered is the best available. For others, doubts arise when a treatment seems ineffective or there are adverse effects. Is the prescribed treatment the most suitable? Are there alternative treatments that might be more successful? Both patients and physicians

Diabetes is associated with numerous long-term complications. Many of these, like kidney failure and ischaemic heart disease, are life threatening. Others, such as eye damage and nerve damage, impact heavily on quality of life. But sexual difficulties, which affect both women and men with diabetes, often receive less attention than they deserve, despite the high levels of distress they generate. Mac Robertson looks at the risks for sexual dysfunction in men and women with diabetes and describes the current management options.

Nobody can single-handedly manage the many and diverse aspects of diabetes. To be effective, diabetes care requires the coordinated input of people with diabetes and a range of healthcare providers, including a diabetes nurse, dietician, psychologist, pharmacist, physiotherapist or podiatrist, among others. Close

We can take advantage of the metabolic syndrome: it can be used as a simple and effective tool to assess health risks in people with type 2 diabetes and those without the condition. We can benefit from the universal availability of the tools needed to make a diagnosis – at no further cost. Given the excessive levels of death and disability suffered by people with type 2 diabetes and its associated conditions, it is of the utmost importance that early and appropriate steps are taken once a diagnosis of the metabolic syndrome is made. Fortunately, there

In most countries around the world, there has been an increase in the number of children and young people with diabetes. While in general it is relatively easy to distinguish whether a child or teenager has type 1 diabetes or type 2 diabetes, in some cases, young people have elements of both kinds of the condition. This new phenomenon has been labelled ‘double diabetes’ or ‘hybrid diabetes’. Francine Kaufman reports on the existence of double diabetes and the implications of this condition for the initial categorization and treatment of young people who are diagnosed with diabetes.

Foot ulcers are caused by an imbalance between excessive pressure on the sole of the foot and repetitive stress from walking. It does not take much pressure to provoke an ulcer, so the skin has a built-in protection system. Normally, harmful pressure or motion against the skin will set off a protective pain alarm. Unfortunately, in people with diabetes nerve damage (neuropathy), this pressure goes undetected and can cause serious injury. Having lost the ‘gift of pain’, people with diabetes neuropathy often do not notice the problem until an ulcer has formed.