Health Delivery


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

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.