Clinical Care

Issues relating to people with diabetes injecting themselves with insulin quite rightly are an important focus of diabetes care. Concerns include avoiding the complications of inaccurate dosing, and ensuring the proper care of injection sites and correct use of blood glucose selfmonitoring. The current implementation of the 2010 EU Directive on sharps injury prevention, places the spotlight of attention on the safety and protection of healthcare professionals when they are administering treatment to people with diabetes. Questions arise over the risks to the diabetes specialist.

China is experiencing an increase in the number of people with type 1 diabetes. New cases as well as improved life expectancy among people with established diabetes are behind the rising prevalence. The incidence of type 1 diabetes among children has been put at 0.59 per 100,000 people per year. Although this is farlower than in some other regions, such as northern Europe, our numbers are huge because China has such a large population – in excess of 1.3 billion.

Successful implementation of structured education programmes that teach people with type 1 diabetes to use insulin flexibly around normal

Two English diabetologists were among an international audience while Michael Berger told it to throw away the diet from the therapeutic approach

Australian diabetes healthcare professionals in Melbourne learned about the DAFNE programme for people with type 1 diabetes in 2004, during a visit to the International Diabetes Institute there by Stephanie Amiel. Rather like the UK teams a few years earlier, a teamof nine health professionals from four Australian centres undertook DAFNE training in the UK that year. Prior to this, there were no evidence-based group programmes providing structured education for people with type 1 in Australia.

There is overwhelming evidence that improving HbA1c reduces the risk of longterm complications and improves quality of life. In Kuwait, however, few people with diabetes reach their target levels and, as a consequence, remain at risk of diabetes complications. Healthcare professionals ask the people in their care to test their blood glucose three or four times a day. Yet in many regions, very few people with diabetes have received education on how to adjust their insulin according to their blood glucose results.

In November 2010, a pioneering team comprising a nurse educator, a dietitian and an endocrinologist from Singapore General Hospital completed a
DAFNE course and postcourse educator training in Australia, at the OzDAFNE centre, Diabetes Australia-Victoria. This was the first step in a process that successfully took the DAFNE model Singapore. The Clinical Leads for the Singapore initiative describe the experience so far and look to the future and continental development of their growing programme.

Thirty-five years on from the demonstration that type 1 diabetes has an autoimmune basis, we have learned an enormous amount about the disease. We know its genetic basis (immune genes), its pathological basis (immune cells) and we would expect to be converting this insight into therapeutic advances (immunebased). Certainly, the field of immunotherapy for type 1 diabetesis very active. Here, Mark Peakman reviews the progress being made and scans the horizon for the mostlikely future breakthroughs.

In an age of increasing global information overload, it is becoming progressively more difficult to discern real health and safety signals, or potentially beneficial possibilities, from background noise. The explosion in exploratory analyses of emerging large-scale medical record databases and registries

"Great disappointments in medicine frequently give rise to great innovation – so the saying goes – but who expected a 20-year detour?" Denise Faustman and her team were disappointed by their findings from human islet cell transplantation trials and felt compelled to return to the bench for 20 years to understand why the trials had been less successful than had been hoped. They first turned to an animal model of type 1 diabetes, which,