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Worsening the blow: the effects of smoking on diabetes complications

Cigarette smoking is a serious hazard to health. Yet, although as a group people with diabetes are at increased risk of developing cardiovascular disease, this does not appear to influence smoking habits among them. Tobacco use among people with diabetes is strongly associated with a further increase in the risk of developing cardiovascular complications. Furthermore, research has indicated that smoking has negative effects on the metabolism of glucose and lipids (fat), leading

The diabetic foot: epidemiology, risk factors and the status of care

The development of foot problems is not an inevitable consequence of having diabetes. Indeed, most foot lesions are preventable. However, recent statistics are somewhat depressing: approximately a quarter of all people with diabetes worldwide at some point during their lifetime will develop sores or breaks (ulcers) in the skin of their feet. Moreover, as the number of people with diabetes rises worldwide, there can be little doubt that the burden of diabetes-related foot

Providing care for all people with diabetes in the Netherlands

The health system in the Netherlands is set for an overhaul. In January 2006, new health legislation, which includes important reforms in the provision of diabetes care, comes into effect. Having played an important advisory role in the design of this new legislation, the Dutch Diabetes Association (DVN) predicts signifi cant improvements in diabetes care as a result of the reforms. However, not all the stakeholders in diabetes care are happy with the changes, which were the central issue in several national and regional strikes by primary care doctors. As a

The Mediterranean diet and the prevention of diabetes

In the 1950s, the relationship between dietary habits and cardiovascular disease was explored for the first time in an epidemiological study: the Seven Countries Study, which is considered a milestone of research in cardiology and nutrition. It was found that cardiovascular disease was 50% less common in the populations living in the Mediterranean area than in those living in northern Europe or the USA. The marked difference in the diets of the respective populations largely accounted for this disparity in rates of cardiovascular disease. In this article, Gabriele Riccardi

Therapeutic diabetes education: the Cuban experience

Cuba is a small island country in the Caribbean with 11 million inhabitants. As in other countries, diabetes is a major challenge to health in Cuba. In order to reduce the health and economic impact of diabetes and improve the quality of life of people with the condition, a country-wide diabetes education programme began development over 30 years ago, linking and promoting optimum care and education. Rosario García and Rolando Suárez report on the achievements of the programme and highlight the central role of diabetes education over three decades of care initiatives in Cuba.

Diabetes education in Africa: what we need to know

Education is the cornerstone of diabetes care and management. Yet while many health-care professionals subscribe to this idea, it is not applied universally. In developing countries in particular, much work remains to be done in order to improve the content, structure and provision of diabetes education. Margueritte de Clerck looks at education needs in Africa and makes some recommendations on the role and responsibilities of fellow health-care professionals, particularly those who work in low-income countries.

Childhood obesity and type 2 diabetes: a growing public health challenge in UAE

In the oil-exporting Arab countries – Saudi Arabia, Kuwait and the United Arab Emirates (UAE) – the economic growth and development of the past three decades have been dramatic. This socio-economic progress has brought benefits to many people in the region, such as improved access to health care, education, and safe drinking water. However, economic development has set the scene for the

The Signal System: an empowering tool for healthy food choices

If the growing burden of obesity-driven type 2 diabetes is to be stabilized or reduced, the general public must receive adequate information about healthy eating. However, non-compliance with nutrition advice continues to hamper diabetes care. When it is available, this advice is traditionally given in standardized 24-hour menus as a list of ‘don’ts’. People are asked to keep a running count of the carbohydrates or calories they consume throughout the day. It is therefore not surprising that nutrition advice is perceived by many as being difficult to follow;

Achieving excellence in diabetes foot care: one step at a time

By the time you finish reading this paragraph, it is likely that at least one person has lost part of a foot or leg through diabetic foot disease. This happens every 30 seconds. An amputation is often preceded by an ulcer; 15% of people with diabetes are affected by a foot ulcer at some time in their life. With the global diabetes population set to rise to 333 million by 2025, there is an urgent need for a co-ordinated preventive clinical response to reduce the impact of the diabetic foot.

Diabetes in people with HIV

It is estimated that over 39 million people worldwide are infected with the human immunodeficiency virus (HIV). The introduction of protease inhibitors as part of the anti-HIV therapy has contributed to a huge reduction in the number of people who die from the acquired immunodeficiency syndrome (AIDS). However, the use of these drugs has been associated with new-onset diabetes; recent studies have

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