Clinical Care

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The metabolic syndrome: genetics, lifestyle and ethnicity

Over a few million years, human genes gradually evolved, enabling us to survive frequent periods of famine. Our genes are still essentially the same; but we are currently exposed to lifestyles for which we are not programmed. We were

Continuous glucose monitoring: overcoming the obstacles

Systems that allow people with diabetes to continuously monitor glucose changes over a period of several days are now available and new models with advanced features will soon follow. These systems require the insertion of a needle or a catheter into the fatty tissue under a person’s skin. But people with diabetes look forward to the introduction of a non-invasive system – one which does not penetrate their skin.

Pulmonary insulin: current status

Attempts to develop the lungs as a route for the delivery of insulin began as early as the 1920s. But inhalers that could deliver insulin via the lungs in a clinically viable manner were not developed until the 1990s. The lungs offer a large surface area of 100 m² to 140 m² (roughly the size of a tennis court) for the absorption of inhaled insulin. Moreover, the very thin alveolar-capillary barrier on the surface of the lungs allows for rapid uptake of insulin into the blood, similar to that seen with the rapid-acting insulin analogues – or even faster. Jay Skyler brings us up to date

'Double diabetes' in young people and how to treat it

In most countries around the world, there has been an increase in the number of children and young people with diabetes. While in general it is relatively easy to distinguish whether a child or teenager has type 1 diabetes or type 2 diabetes, in some cases, young people have elements of both kinds of the condition. This new phenomenon has been labelled ‘double diabetes’ or ‘hybrid diabetes’. Francine Kaufman reports on the existence of double diabetes and the implications of this condition for the initial categorization and treatment of young people who are diagnosed with diabetes.

Focus on the front line: the role of pharmacists in diabetes care

The effective delivery of health care requires a partnership between people and their health-care providers. Because of the multidisciplinary nature of diabetes care, this team-based approach is appropriate. Indeed, a multidisciplinary team approach involving people with diabetes and health-care providers, such as nurses, dietitians, pharmacists, and physicians, has been proven to result in lower average levels of blood glucose, a reduction in diabetes complications, and improved quality of life.

A global guideline for type 2 diabetes: using a new 'levels of care' approach

The International Diabetes Federation (IDF) is not in the business of delivering clinical care to people with diabetes; but it is committed to the view that everyone with diabetes should benefit from the best possible care that could be available to them. One foundation of such care is to ensure that it is based on the best possible scientific knowledge. Here we describe the approach behind the recently published IDF Global guideline for Type 2 diabetes, an evidence-based guideline designed to assist care at different levels of resources.

Screening for the diabetic foot: how and why

Given the dimensions of the current global diabetes pandemic, the number of people who are at risk of developing a diabetes-related foot complication is enormous – and growing. Everybody with the condition is at risk, irrespective of the type or severity of their diabetes. The aim of screening is to identify the people who are at greatest risk in order to allocate to them limited medical resources. Several simple screening techniques exist that can help to distribute therapeutic and preventive foot care to those in greatest need. Edgar Peters reports.

Cause for concern: the pathology of the non-ulcerative foot

Those people with diabetes who are aware of the threat that is posed by diabetes foot complications are right to be terrified by the worst-case scenario: the loss by amputation of one of their feet or legs. People with diabetes are at risk of developing a series of common conditions that can represent a conduit for infection to their vulnerable feet. Andrew Clarke describes the apparently minor conditions that in fact require adequate attention or need to be prevented before chronic ulcers develop and the consequences become tragic.

Understanding the development of diabetic foot complications

Foot complications are the leading cause of hospitalization in people with diabetes. Losing a limb is one of the most dreaded complications of the condition – with reason: compared to those without the condition, people with diabetes have a 15-fold increased risk of suffering an amputation. In this article, Vilma Urbancic-Rovan describes the pathophysiology of diabetes foot damage and argues that the amputation rate could be significantly reduced with improved care and education for people with the condition.

A new IDF worldwide definition of the metabolic syndrome: the rationale and the results

The metabolic syndrome is one of the major public health issues of our time. The International Diabetes Federation (IDF) believes that this cluster of factors is driving the twin global epidemics of type 2 diabetes and cardiovascular disease. If current trends continue, the premature deaths and disabilities resulting from these conditions will cripple the health budgets of many nations – both developed and

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