Clinical Care

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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.

After a pregnancy with diabetes - a window of opportunity

The period after a woman gives birth provides a window of opportunity to impact on her short- and long-term future health. The end of a pregnancy heralds a transition both physically and mentally, and in terms of self-care. After delivery, most of the hormones that make a woman with gestational diabetes insensitive to the action of insulin are no longer present. In women with pre-existing diabetes, insulin needs drop dramatically; some women requiring insulin therapy to live may not need insulin for up to 72 hours.

Obesity stigma - causes, effects and some practical solutions

Obesity has become a pandemic, affecting adults and children around the world.  Considerable medical, scientific and lifestyle-related knowledge and resources are being channelled into the identification of strategies to combat this major public health problem. Despite these multidisciplinary efforts, however, little attention has been paid to the damaging social and psychological consequences of obesity.

The results and implications of the ACCORD and ADVANCE trials

Recently, two clinical trials addressed the role of tight blood glucose control on cardiovascular risk in people with type 2 diabetes: the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study and the Action in Diabetes and Vascular Disease (ADVANCE) trial. The ACCORD study included 10,251 people with type 2 diabetes and was designed to determine whether intensive blood glucose control (HbA1c below 6%) as compared to a conventional approach (HbA1c between 7% and 7.9%) would result in favourable cardiovascular outcomes in people with type 2 diabetes at high vascular risk.

HbA1c results in relation to familiar every-day measurements - the near future

Haemoglobin A1c (HbA1c) is widely used to determine levels of long-term blood glucose, judge the adequacy of diabetes management, and adjust therapies. HbA1c results are expressed as the percentage of haemoglobin that is exposed to glucose (glycated). People’s day-to-day diabetes management is guided by self-monitoring of  capillary glucose concentrations, which are measured  in mmol/l or mg/dl.

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