Clinical Care

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Making progress with immune therapies for type 1 diabetes

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.


All that glitters is not gold- why we need better trials and reporting

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

Back to the future: investigating new treatments for type 1 diabetes using old inexpensive drugs

"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,

From victim to protector – what the brain does with hypoglycaemia

The human brain depends on glucose to fuel all its functions. Although the brain can use other metabolic substrates, and babies’ brains do, glucose is its  normal energy source. As the brain stores very little glucose, its proper function depends on a reliable supply from its circulation. If blood glucose concentrations fall too low, then brain malfunction results. But what is the plasma glucose concentration that is ‘too low’? Stephaine Amiel looks into this surprisingly controversial topic.


Biosimilar insulins

Insulin is a complex protein, manufactured to a high standard, and requiring special expertise. As modern insulins come offpatent, many companies are expected to try to enter the market with copies of current branded insulins, termed 'biosimilar insulins'. Philip Home discusses the issues in development and production of such biosimilars, and the regulatory hurdles and likely consequences for the insulin market.



Diabetes in prison: double the sentence or an opportunity for treatment?

Among the prison population, psychological disorders and infectious diseases, such as hepatitis and HIV/AIDS, are the most widely recognized medical conditions. According to the authors of this report from France, diabetes is one of the ‘forgotten diseases’ in the penal system. Although in wider society diabetes is recognized as a chronic public health issue, there are very few data on people with diabetes in prison.

A multi-partner approach to developing excellence in diabetes management training in four African countries

Human resources for healthcare in West Africa are among the world’s most limited, severely restricting the capacity of countries in the region to provide effective, equitable public health services to their people. Indeed, the lack of health professionals throughout sub-Saharan Africa has become a significant barrier to achieving the UN’s millennium development goals.

Diabetes education for people with type 2 – a European perspective

Therapeutic diabetes education is a prerequisite for the effective management of type 2 diabetes. Yet in several European countries, diabetes education remains insufficiently implemented. While effective educational programmes have been developed and evaluated in a number of countries, funding for implementation is still inadequate. Although improvements have been made in recent decades, there is still a long way to go to meet the Europe-wide need for diabetes education. Monika Grüsser reports on some developments to date.

Diabetes, diabetes treatment and cancer risk

To say that the diabetes world has been rocked by recent revelations about cancer might be too strong a term; but it certainly has been shaken. A growing bank of data over the last few years has put cancer very much 'on the radar’ of diabetes clinicians and researchers alike. Andrew Renehan tells the stories behind the headlines.

Diabetic foot care and prevention in Senegal: adding an extra dimension to the Step-by-Step model

Every 30 seconds, a lower limb is amputated as a result of diabetes; of all the amputations in the world, about 70% are suffered by people with diabetes – foot ulceration being a key factor in developing regions. Yet these amputations can be prevented. As well as medical factors, numerous social and socio-environmental issues affect the development of diabetic foot problems. This report focuses on Africa-specific factors. Although in Africa neuropathy is a major contributing factor, it is not the only one: even a simple injury that becomes infected can be a precursor to amputation.

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