Clinical Care

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Improving accuracy, ensuring consistency – the future for reporting HbA1c

Globally, where the test is available, the measurement of haemoglobin A1c (HbA1c) has become central to the management of diabetes. By giving an objective assessment of glucose control over the preceding 2 to 3 months, it can guide treatment decisions in a way that single blood glucose measurements cannot. The authors describe efforts to standardize and improve the way HbA1c is reported, and explain the practical implications of the recent changes in the way the test is measured.

Offloading the diabetic foot in the developing world

Diabetic foot complications are the most common cause of hospital admissions among people with diabetes. Worldwide, more than 1 million amputations are performed each year as a consequence of diabetes, which means that a lower limb is lost to diabetes somewhere in the world every 30 seconds. If a person with diabetes has a lesion on the sole of a foot, offloading bodyweight is of vital importance; all therapeutic efforts are bound to fail if he or she continues to walk on an ulcer.


Diabetes and eye disease: what people with diabetes and healthcare professionals need to know

The good news is that most cases of severe vision loss due to diabetes are preventable; the bad news is that tens of thousands of people lose vision to diabetes each year despite all we know about prevention and treatment. Indeed, diabetes is a leading cause of vision loss around the world. Compared with the general population, people with diabetes have a 25-fold increased risk of blindness.


Low testosterone in men with type 2 diabetes - a growing public health concern

Testosterone is the principal sex hormone in men. It is important not only for normal sexual function but also for maintaining bone and muscle strength, mental and physical energy, and overall well-being. Low testosterone is associated with diminished libido, erectile dysfunction, increased fat mass, decreased muscle, bone mass and energy, depression, and anaemia. Type 2 diabetes may be one of the commonest causes of  hypogonadism – a lack of function in the testes, which adversely affects testosterone production.

Asthma, obesity and type 2 diabetes - mechanisms, management and prevention

Obesity, currently a worldwide epidemic, is associated with a number of conditions, including coronary artery disease, lipid abnormalities, gallstones, cancer and type 2  diabetes, obstructive sleep apnoea, and obesity hypoventilation. Recently, studies have shown that asthma may also be associated with, and perhaps worsened by, obesity. Ongoing research suggests that type 2 diabetes and asthma may be linked to obesity through chronic systemic inflammation.

Diabetes and the promise of a preventive and therapeutic role for vitamin D

Vitamin D is naturally present in a few foods and produced in the body when ultraviolet rays from sunlight come into contact with the skin. This fat-soluble vitamin is also available as a dietary supplement. The principal biological function of vitamin D is to maintain levels of calcium and phosphorus in the blood, aiding the absorption of calcium, and helping to form and maintain strong bones. Recent research findings have suggested that vitamin D also may provide protection from osteoporosis, high blood pressure, some cancers, and several autoimmune diseases, including diabetes.

A gender perspective of diabetes and cardiovascular disease - the need for deeper understanding

Rates of diabetes continue to increase rapidly around the world. The current prevalence of about 5.1% is set to rise to 6.3% by 2025 – 333 million people with the condition. Further huge numbers of people are unaware that they have undiscovered diabetes and pre-diabetes conditions. The number of people with impaired glucose tolerance will increase from 314 million to 472 million over the next 15 years or so. These people are at dangerously high risk both for future diabetes complications and early death through cardiovascular disease.

Reproductive health in women with diabetes - the need for pre-conception care and education

Diabetes provokes a range of reproductive and sexual health problems: menstrual changes, fertility disorders, urinary and vaginal infections, urinary incontinence and sexual dysfunction. Early diagnosis and treatment of these problems, with well-planned pre-conception care, can protect maternal and infant health. In this report, Seyda Ozcan and Nevin Sahin call for reproductive and sexual healthcare to be included in women’s diabetes management plan.

New findings in gestational diabetes - the HAPO Study

The diagnosis of gestational diabetes has for decades been based either on criteria that predict a mother’s risk for developing type 2 diabetes in the future, or those used for non-pregnant women. But gestational diabetes also carries a risk for the baby. Moreover, the level at which maternal blood glucose provokes risk for the foetus remains unclear.


Managing diabetes and preventing complications during pregnancy and delivery

The risk to a woman of having diabetes during her reproductive years varies worldwide and compares with the regional risks for the condition in general – on average between 5% and 8%. In all pregnant women, the risk for gestational diabetes should be assessed and screened early if a number of risk factors are present. Indeed, any form of diabetes during gestation, whether it develops during pregnancy or is present before conception, requires excellent multi-facetted management before and during pregnancy, and around the time of delivery.

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