Health Delivery


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

Staged Diabetes Management in Mexico: optimizing care with limited resources

In 1997, diabetes became the third leading cause of death in Mexico. This is a national phenomenon. Regardless of geography or the rural or urban nature of their populations, deaths due to diabetes have increased in 28 of the 32 states in Mexico. Conservative estimates place the current rate of diabetes prevalence at 7.4% among people aged 20-79 years. Estimates from other sources are even higher. Clearly diabetes has become one of the principle public health problems in the country.

Growth hormone: a potential treatment option in diabetes?

Despite major fluctuations in supply and demand, sophisticated mechanisms in the body maintain levels of blood sugar (glucose) within narrow limits. Although under normal conditions, insulin is the major regulator of blood glucose levels, growth hormone (GH) and insulin-like growth factor-1 (IGF-1) play an important contributory role. Both of these hormones have potent effects on glucose metabolism which may be utilized in diabetes management. Richard Holt explains the growing interest in exploiting the effects of GH and IGF-1 for people with diabetes.

End-stage kidney disease: option and problems

While fewer people with Type 1 diabetes are developing end-stage kidney disease (end-stage diabetic nephropathy, ESDN), the number of people with Type 2 diabetes reaching ESDN is growing rapidly. In this article, Eberhard Ritz answers some key questions about the issues around care for people with diabetes who suffer ESDN.

Improving diabetes therapy: improving satisfaction

Research advances in diabetes have led to increased therapeutic options for people with the condition. This has led to increasing levels of satisfaction among the consumers of these treatment options – people with diabetes. One aspect of satisfaction deals specifically with the person's evaluation of medical treatments. Treatment satisfaction

Sisters Together: move more, eat better, prevent diabetes

Populations around the world are getting fatter. People of all ages are showing signs of diabetes and other conditions which are associated with being fat. It has been found that people of African, Asian and Hispanic origins are at particularly increased risk from obesity and obesity-related conditions such as diabetes. Due to a variety of cultural and socio-economic factors, women from these populations seem to be at especially high risk from the dangers of overweight.

Diabetes education: training trainers in the Caribbean

The people of the Caribbean region are facing a serious threat to health which will potentially overwhelm healthcare systems in the small and relatively poor countries of the region. It is estimated that by the year 2010, the number of people with diabetes in the Caribbean will reach 20 million. Diabetes prevalence in the area is projected to increase to approximately 25% of the adult population.