Health Delivery

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The English National Service Framework: a primary care perspective

Martin Kent is a general practitioner with a special interest in the management and care of people with diabetes, and a clinical advisor in diabetes to the local Primary Care Trust (PCT). Matt Rangué is the Associate Director of Nursing & Clinical Governance to the Trust, with responsibility for workforce development, training and quality in the delivery of the new UK Diabetes National Service Framework (NSF). Martin and Matt see the UK Diabetes NSF as a valuable tool around which to plan and deliver services to people with diabetes.

Identifying the risk factors: diabetes in Asian Indians

As prevalence of diabetes increases globally, developing countries such as India face the massive burden of a diabetes epidemic in the urban population. Migrant Asians from the Indian subcontinent are known to have a higher prevalence of Type 2 diabetes than the host populations and other migrant ethnic groups. Studies conducted in several Asian countries in the last decade highlighted a rising prevalence of Type 2 diabetes in the urban population. The prevalence of impaired glucose tolerance (IGT) is also on the rise, indicating a possible further increase in diabetes in the future.

Diabetes in Pakistan

Pakistan is a South-Asian country with a population of approximately 150 million. Diabetes prevalence in Pakistan is high: 12% of people above 25 years of age suffer from the condition and 10% have impaired glucose tolerance (IGT). When one considers the associated risk factors present in Pakistani society, the large number of people with diabetes is no surprise. Obesity tops the list.

Diabetic hand infections in the tropics

Diabetes-related foot infections are a scourge all over the world. People suffer such infections when the skin of the foot breaks down secondary to peripheral nerve damage – one of the complications of diabetes. High blood sugar (hyperglycaemia) impairs a person's defences to infection. In poorly controlled diabetes in particular, infection can occur abruptly and spread rapidly. It is not so well-known that similar infections can occur in the hand. Globally, this is much less common than foot infection. However, it is a significant problem, particularly in the tropics.

Awareness and education in Egypt: the DELTA project

Egypt and some of the Gulf countries have among the highest prevalence rates of diabetes in the world, notably Type 2 diabetes. Changes in socio-economic patterns, relatively rapid urbanization, and a 'fast-food culture' are taking their toll. In Egypt and the Gulf region, cardiovascular disease (CVD) is now a major health problem, and high blood cholesterol levels and hypertension are recognized as 'silent killers'. However, there is relatively little awareness of the serious threat to health presented by diabetes, or its role in causing CVD.

Pregnancy and diabetic nephropathy

Twenty years ago, medical opinion was against women with diabetic kidney disease (nephropathy) proceeding with pregnancy. With new technology and increasing experience, the outcome for these women and their children has improved substantially. Over the last decade, there has been a substantial decline in the number of women with diabetic nephropathy who die during pregnancy, childbirth and early maternity. Successful pregnancies with fetal survival rates of up to 95% are now achievable in women with diabetes who suffer kidney damage.

Anaemia: a silent complication of diabetes

Tiredness and lethargy are associated with diabetes, but are usually due to uncontrolled blood glucose (sugar) levels. However there may be other causes of tiredness as in the rest of the population, and these include anaemia. Awareness of anaemia in diabetes is low, both among patients and health-care professionals. Yet if anaemia is diagnosed and corrected, the result can be a major change in quality of life. One cause of anaemia in people with diabetes is kidney disease.

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

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