Clinical Care

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Never say never – implementing DAFNE in Kuwait

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.

Great results for DAFNE Singapore – next stop, South-East Asia

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.


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.

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