Clinical Care

English

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.

Lifestyle and nutritional management

It is often stated that dietary management is a cornerstone of diabetes care. More recently, physical activity has also been recognized as a useful fundamental intervention. When it is realized that both of these can affect a variety of the problems that bedevil people with diabetes – including excess body weight, high blood glucose levels, high blood fat levels, and high blood pressure – it is not difficult to see why these issues might be regarded as fundamental.

Patient education and psychological care

People with diabetes deliver most of their own care. This reflects the observation that diabetes and its associated features touch on most aspects of daily living, and aspects as fundamental as eating and physical activity. To deliver such care requires knowledge, but even with knowledge it may not be easy to adjust to optimal self-care. This makes patient education a complex therapeutic issue.

Outpatient and inpatient diabetes care delivery

Diabetes care is inherently complex – hence the need for 19 chapters of evidence review and recommendations in the Global Guideline. Pulling all the recommendations together to ensure the implementation of effective delivery of care therefore needs some organization of its own, as is discussed in this article. A special situation is that of people with diabetes in hospital, who are often subject to disruption of lifestyle due to illness, procedures, or surgery, with knock-on effects on their diabetes management.

High costs, low awareness and a lack of care - the diabetic foot in Nigeria

Nigeria, with a population of about 128 million people, is Africa’s most populous country. Life expectancy at birth is 47 years; about 60% of the population live below the poverty line. While healthcare structures and institutions are inadequate, and there is a chronic lack of skilled healthcare personnel, diabetes is on the increase. Uncontrolled urbanization is the driving force behind rising obesity levels and a subsequent boom in levels of type 2 diabetes.

Children

The relatively recent emergence in children of type 2 diabetes, a condition once considered ‘late-onset’, has been viewed with consternation around the world. Guidelines directed at healthcare professionals dealing with children have generally focused on type 1 diabetes; it is only now becoming apparent that type 2 diabetes in children is a serious condition and that it is at least as demanding to manage. The chapter on children in the Global Guideline seeks to raise awareness of these problems, which are faced by increasing numbers of families.

Pregnancy

Diabetes increases the risks in pregnancy for both the mother and her infant. However, pre-pregnancy advice where possible, detection of undiagnosed or new (gestational) diabetes in pregnancy, and careful management of diabetes throughout pregnancy, with close liaison between healthcare professionals involved in diabetes, obstetric and neonatal care, can all help to achieve the desired outcome of a healthy mother and baby. The Global Guideline only addresses areas of pregnancy care that are commonly affected by the

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