Clinical Care

English

Diabetes and HIV/AIDS in sub-Saharan Africa: the need for sustainable healthcare systems

Chronic diseases, such as heart disease, stroke, cancer, chronic respiratory diseases and diabetes, are by far the leading cause of mortality worldwide, representing 60% of all deaths. Contrary to common perception, 80% of chronic disease deaths occur in low- and middle-income countries. This invisible epidemic is an underestimated cause of poverty and hinders the economic development of many countries. Sub-Saharan Africa carries the highest burden of disease in the world, the bulk of which still consists of the communicable diseases HIV/AIDS, tuberculosis and malaria.

Insulin pump therapy in children and adolescents: risks and benefits

During the last decade, insulin pump therapy has gained widespread acceptance in the treatment of children and adolescents with type 1 diabetes. In some of the European and North American paediatric diabetes centres, more than half of the young people with diabetes try to simulate a normal pattern of insulin secretion by means of an insulin pump (continuous subcutaneous insulin infusion).

The changing face of coeliac disease: links with other autoimmune disorders

The onset of coeliac disease, together with type 1 diabetes, influences glycaemic control, and more precisely the development of hypoglycaemia. These conditions share a similar genotype. The main problem of coeliac disease is intolerance to gliadin, a gluten protein found in cereals such as wheat, rye and barley; the only treatment is a gluten-free diet. Spomenka Ljubic and Zeljko Metelko report on the growing body of evidence linking coeliac disease and other autoimmune disorders, including type 1 diabetes, and describe recommended procedures for its diagnosis and treatment.

Breastfeeding and diabetes - benefits and special needs

Breastfeeding has numerous advantages for mothers with diabetes and their babies. Nursing mothers have lower insulin requirements and better control of their blood glucose; breastfed babies may have a lower risk of developing diabetes themselves. Alison Stuebe describes these potential benefits and highlights the special needs of breastfeeding mothers with diabetes.

The IDF consensus on the prevention of type 2 diabetes

Early intervention to prevent or delay type 2 diabetes benefits people who are at high risk of developing the condition in terms of increased life expectancy and quality of life. It also benefits societies and healthcare systems in economic terms. In order to address the growing impact of type 2 diabetes, the International Diabetes Federation (IDF) Task Force on Prevention and Epidemiology convened a consensus workshop in 2006. Its primary goal was the prevention of type 2 diabetes in developed and developing countries.

Managing diabetes during Ramadan

Fasting during Ramadan, one of the five pillars of Islam, is an obligatory duty for all healthy adult Muslims. Ramadan, a lunar month, can last for 29 or 30 days, and its timing changes with respect to seasons. Depending on the geographical location

The challenge of adolescence: hormonal changes and sensitivity to insulin

Puberty is a period of rapid and radical physical, psychological and social change during which a child, in physiological terms, becomes an adult capable of reproduction. Adolescence refers as much to the psychosocial characteristics of development during puberty as to the physical changes. Adolescents with diabetes, who need to adhere to a complex medical regimen based around self-care throughout this period of development, face a series of particular and considerable challenges.

No more nightmares: treatments to prevent nocturnal hypoglycaemia in children

For many young people and their parents, nocturnal hypoglycaemia is perhaps the most feared short-term complication of diabetes. Intensive diabetes control is beneficial for all people with the condition – maintaining good blood glucose control overnight is critical in reducing the body’s exposure to high glucose levels. But it increases the risk of a dangerous drop in blood glucose levels while people are asleep. David Dunger and Roman Hovorka describe the problem of nocturnal hypoglycaemia and look forward to future developments that might reduce and eventually eradicate the risks.

An overview of non-medical prescribing: past, present and future

The move towards non-medical prescribing is a process that has evolved over the past 20 years. But some diabetes healthcare professionals continue to question its benefits. In this article, June James looks at the challenges surrounding non-medical prescribing and describes the training required for effective prescribing. The author focuses mainly on work undertaken in the UK but also explores non-medical prescribing in other countries, and the potential impact this might have on diabetes care worldwide.

Polycystic ovary syndrome and women with diabetes

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder to affect women of reproductive age. Although it was first described almost 70 years ago, there has been no universal agreement about its definition. Eleni Kousta and Stephen Franks describe the prevalence, symptoms, and cause of PCOS, and look at long-term health implications and the available and possible future treatments for women with the syndrome.

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