Clinical Care

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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.

Erectile dysfunction in men with diabetes - an early warning for heart disease

The burden of erectile dysfunction has not been well documented across age and ethnicity. A number of studies have reported a prevalence of around 35% in middle-aged men, rising to over 75% in elderly men. Some ethnic groups appear to be at increased risk. Much higher rates have been reported in men with diabetes – up to 90%. In this article, Ronald Ma and Peter Tong describe the mechanisms linking erectile dysfunction and diabetes, its association with atherosclerosis, and look at the cardiovascular implications for men with diabetes and erectile dysfunction.

Obstructive sleep apnoea and type 2 diabetes - the IDF consensus

Recent years have seen an expansion in the number of conditions that are recognized as having a link with diabetes. In people with sleep apnoea breathing stops briefly but repeatedly during sleep. It is commonly associated with obesity, and therefore frequently occurs in people with type 2 diabetes. However, recent research demonstrates the likelihood of a relationship between obstructive sleep apnoea and diabetes that is independent of obesity. The links between the conditions are particularly important as both increase the risk of cardiovascular disease.

The key to preventing burnout: understanding the burden of diabetes treatment

Type 2 diabetes significantly increases a person’s risk of developing multiple health complications, but the risk of these complications can be significantly reduced with modern, comprehensive diabetes care. This care is inherently complex because of its use of multiple medications in conjunction with lifestyle changes in diet, exercise, and blood glucose self-monitoring.

Managing sick days in people with diabetes

When people become unwell with a minor illness like influenza, a urinary tract infection or gastric upset, they are likely to lose their appetite, and low energy levels are common. Most people just want to stay in bed, take the relevant medication, sleep, and hope the discomfort recedes – which it normally does.

Do stem cells hold the key to a future cure for diabetes?

The high expectations that stem cells will cure diabetes have been met with a considerable degree of scepticism, particularly from people who have been hearing for decades that a cure is ‘just around the corner’. The conclusion of this article is that stem cell biology is promising and might deliver the advances the diabetes community has been waiting for. But no one knows how long this will take; no timetables for expected success will be presented – which might be a disappointment to some.

Oral health in people with diabetes: why should we care?

Diabetes can lead to important changes in the mouth. Oral infections in turn may adversely affect metabolic control and impact on the quality of life of people with diabetes. Over the years, however, caring for the mouth has been overlooked by physicians who have been focusing on other diabetes complications. Of particular concern to dentists and dental hygienists is the impact of diabetes on diseases affecting gum tissues and teeth – the most common cause of tooth loss in people with diabetes.

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