Health Delivery


Prevention and diabetic kidney disease

Diabetic kidney disease (nephropathy) is a major cause of death in people with diabetes. It affects about one-third of people with the condition. Recent studies have demonstrated that the onset and course of diabetic nephropathy can be improved very significantly by several kinds of intervention. However, these interventions have their greatest impact if made before or very early in the course of the development

Management of early diabetic nephropathy

The number of people with diabetes is increasing worldwide mainly because of an increase in Type 2 diabetes. Diabetes is now the leading cause of end-stage renal disease (ESRD) in Western countries. Diabetic kidney disease (nephropathy) has been reported to occur in 25-40% of people with Type 1 or Type 2 diabetes. People with diabetes, especially those with kidney complications, also face an increased risk of death from cardiovascular disease (CVD).

Screening and diagnosis of diabetic nephropathy

Screening for diabetic kidney disease (nephropathy) or its earlier stage, microalbuminuria, is important. The person with diabetes and the carer both need to know with absolute certainty whether nephropathy is developing. They need to know because it is possible to prevent or at

Rapid Assessment Protocol for Insulin Access: overcoming barriers to care

Over 80 years after the discovery of insulin, access to it is still problematic for people in many parts of the developing world. In February 2001, at a meeting between the International Diabetes Federation (IDF) and the World Health Organization (WHO), a call was made for the establishment of a non-governmental organization to improve the sustainable, affordable and uninterrupted supply of quality insulin for people with Type 1 diabetes in areas of need.

Food power: a vegetarian approach to diabetes

Recent research has demonstrated the health benefits of diet and exercise for people with diabetes. The positive results offer an optimistic future to millions of people with the condition, and the many millions more who are at risk from diabetes around the world. We now know that therapeutic lifestyle interventions are highly effective in both preventing and managing the condition. In people with Type 2 diabetes, lifestyle changes can reduce and even eliminate the need for

Primary care in Tunisia: improving diabetes management

Tunisia, like most countries of the world, is experiencing an alarming rise in the number of people with diabetes: the prevalence of Type 2 diabetes in adults over 30 year of age rose from 4.2% in 1976 to 10% in 1995. In response, the Tunisian Ministry of Public Health have developed a National Programme of diabetes and high blood pressure (hypertension) management in primary care. Initially introduced in 1993, the Programme was then implemented throughout the country in 1998.

A guide to guide diabetes guideline development

Evidence-based guidelines have come of age in the last decade, with a number of countries producing one form of diabetes evidenced-based guideline or another. But this very concept has placed a barrier to guideline development in front of those with no expertise in the area, in contrast to the intuitively obvious consensus guidelines of old. As a result of demands from its members, the International Diabetes Federation (IDF) has sought to meet the need for guidance on guideline development. Philip Home discusses the new document which was made available at the recent IDF Congress in Paris.

Dentistry in diabetes diagnosis and management

Much attention is given to heart disease, nerve damage, kidney disease, and eye damage which can develop in people with diabetes. However, the mouth (oral) health complications associated with diabetes are often overlooked. In order to diagnose the potential presence of oral complications, it is very important for people with diabetes to have dental examinations at least every 6 months. In this article, Martin Gillis and Steven Saxon look at the oral health of people with diabetes with regard to the oral symptoms of undiagnosed diabetes, the oral health

Staged Diabetes Management: improving diabetes care worldwide

Diabetes and the disorders associated with diabetes currently affect one billion people world wide. Surprisingly, specialists care for less than 2% of people with diabetes and its related disorders. General practitioners constitute the principal care providers for almost all of these people. The majority of these health professionals serve in an environment with very limited resources. Nevertheless, within such health-care systems, these resources can be optimized, and evidence-based medicine can be practised. Roger S Mazze reports on the potential improvements to

Improved diabetes management in South Africa: the case for a capitation model

About 43 million people live in the Republic of South Africa. Approximately 80% of these receive government-sponsored medical care, and 20% receive medical care in the private sector – paid for either by themselves or by medical insurance schemes. The costs of diabetes management are considerable, both for the person with the condition and the health-care provider. These costs relate to the management of the condition and the treatment of short- and long-term diabetes