Clinical Care

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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.

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.

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