Research and studies

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Outpatient and inpatient diabetes care delivery

Diabetes care is inherently complex – hence the need for 19 chapters of evidence review and recommendations in the Global Guideline. Pulling all the recommendations together to ensure the implementation of effective delivery of care therefore needs some organization of its own, as is discussed in this article. A special situation is that of people with diabetes in hospital, who are often subject to disruption of lifestyle due to illness, procedures, or surgery, with knock-on effects on their diabetes management.

Pregnancy

Diabetes increases the risks in pregnancy for both the mother and her infant. However, pre-pregnancy advice where possible, detection of undiagnosed or new (gestational) diabetes in pregnancy, and careful management of diabetes throughout pregnancy, with close liaison between healthcare professionals involved in diabetes, obstetric and neonatal care, can all help to achieve the desired outcome of a healthy mother and baby. The Global Guideline only addresses areas of pregnancy care that are commonly affected by the

Protecting eyesight, feet, and the nervous system

Classically, diabetes complications are thought of as damaging the heart and blood vessels, eyes, kidneys and nervous system. Blood vessel damage, together with nerve damage, leads to foot problems. Protection of the heart, blood vessels and kidneys is dealt with in an earlier article, as is protection of all of these by control of blood glucose levels. Here we describe how disabling problems which are developing in the eyes, feet, and nervous system despite those measures can be managed optimally.

Cardiovascular risk, blood pressure, and kidney damage

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.

Use of oral glucose-lowering drugs and insulin

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.

Glucose control: measures, levels and monitoring

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 IDF 'Global Guideline for Type 2 Diabetes': background and methods

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.

From research to policy: the development of a national diabetes programme in Cameroon

Ten years ago, without evidence to suggest otherwise, diabetes was not considered a public priority in Cameroon; the emphasis of Government health policy was on tackling the HIV/AIDS epidemic and attempting to eradicate communicable diseases. Efforts had been made to set up centres specializing in diabetes and hypertension, but without the backing of a national diabetes programme, most of these closed within a few years. The lack of data on non-communicable diseases constituted a major roadblock to the development of any such programme.

Treating the syndrome today and in the future

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

The metabolic syndrome: genetics, lifestyle and ethnicity

Over a few million years, human genes gradually evolved, enabling us to survive frequent periods of famine. Our genes are still essentially the same; but we are currently exposed to lifestyles for which we are not programmed. We were

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