Patient-centred care

In the three years since its inception and after two initial rounds of funding, the International Diabetes Federation’s BRIDGES programme has become one of the principal funding initiatives in diabetes worldwide. With the recent announcement of its third round of funding, BRIDGES has consolidated its position in the fast-developing and innovative sector of translational research.

People with diabetes occupy a significant proportion of hospital beds – about 10% in the UK, although this may be an underestimate. While diabetes specialists are often based in a hospital, the majority of people with diabetes who are admitted to hospital – at a time when their diabetes might be difficult to control – do not actually meet the diabetes team.

Chronic conditions are increasing. The number of people affected by chronic non-communicable conditions, including diabetes and heart disease, is growing worldwide. Collectively, chronic conditions were responsible for 35 million – a full 60% – of all deaths in 2005. This is twice the number of deaths due to infectious diseases, poor maternal health and malnutrition combined. In addition to causing high death rates, chronic conditions account for almost half of the world’s disability.

Diabetes can have both a daily and long-term impact on people with the condition – both physically and in terms of its psychosocial effects. It is now known that people with diabetes are at a substantially increased risk of experiencing mental distress, particularly depression. Furthermore, a growing bank of evidence points to a two-way relationship between the conditions. Yet depression is often under-diagnosed in people with diabetes.

As the world’s population ages, the impact of chronic diseases will drive health systems around the world in two ways – adding significantly to the cost, and imposing considerable constraints on the already strained healthcare workforce. It is estimated that the health budgets of most developed nations will consume 20% of their gross domestic product by the 2020s. The most recent World Health Organization Health Workforce Report suggests shortfalls of some 4.3 million healthcare workers over the next decade – including nurses, doctors and health administrators.

Since early case reports in the 1980’s, there has been considerable interest in examining the connection between type 1 diabetes and eating disorders. Some researchers argue that the attention to food portions (especially carbohydrates), blood glucose, body weight, and exercise that are characteristic of standard medical treatment for type 1 diabetes resembles the rigid thinking about food and body image that is characteristic of people with eating disorders without diabetes.

The development of leaders in healthcare is recognized as being integral to improving the quality of care. However, where most leadership development focuses on an individual, a recent intervention in the UK operated on the theory that improvements are more likely to last if all team members are involved in developing leadership skills and understanding. In this article, Jan Walmsley and Andy Brown report on ‘Shared Leadership for Change’, which aimed to improve team effectiveness in six diabetes clinical networks.

The onset of coeliac disease, together with type 1 diabetes, influences glycaemic control, and more precisely the development of hypoglycaemia. These conditions share a similar genotype. The main problem of coeliac disease is intolerance to gliadin, a gluten protein found in cereals such as wheat, rye and barley; the only treatment is a gluten-free diet. Spomenka Ljubic and Zeljko Metelko report on the growing body of evidence linking coeliac disease and other autoimmune disorders, including type 1 diabetes, and describe recommended procedures for its diagnosis and treatment.

Breastfeeding has numerous advantages for mothers with diabetes and their babies. Nursing mothers have lower insulin requirements and better control of their blood glucose; breastfed babies may have a lower risk of developing diabetes themselves. Alison Stuebe describes these potential benefits and highlights the special needs of breastfeeding mothers with diabetes.