Abdullah Almaqhawi, A. Morrison, R. Berrington, M. Kong
Aim: Diabetic foot ulcers (DFUs) are linked to morbidity, decreased mobility, and feelings of isolation, powerlessness and sadness. The aim of our study was to explore the prevalence of anxiety and depression symptoms in adult patients with DFU.
{"title":"Anxiety and depression among patients attending a multidisciplinary foot clinic","authors":"Abdullah Almaqhawi, A. Morrison, R. Berrington, M. Kong","doi":"10.1002/pdi.2444","DOIUrl":"https://doi.org/10.1002/pdi.2444","url":null,"abstract":"Aim: Diabetic foot ulcers (DFUs) are linked to morbidity, decreased mobility, and feelings of isolation, powerlessness and sadness. The aim of our study was to explore the prevalence of anxiety and depression symptoms in adult patients with DFU.","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":"5 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89236253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
High cholesterol, in particular increased low-density lipoprotein (LDL), is a significant, modifiable risk factor in the development of cardiovascular disease (CVD). In people with diabetes, the risk of CVD is greatly increased and is the leading cause of morbidity and mortality. People with diabetes typically have a triad of elevated fasting and postprandial triglycerides, elevated LDL cholesterol and a relative reduction in high-density lipoprotein (HDL) cholesterol. While exercise, diet and tighter glycaemic control can contribute to improvements in the lipid profile, statins offer the biggest risk reduction with respect to CVD; every 1mmol/L reduction in LDL-C with statin therapy is associated with a 22% reduction in cardiovascular events.1 Statins may also have additional cardiovascular protective effects via their action on platelets, endothelium and atherosclerotic plaques. Statins therefore have an important role in the primary and secondary prevention of CVD. The pharmacology of atorvastatin is shown in Figure 1. HMG-CoA reductase catalyses the reduction of 3-hydroxy-3-methylglutaryl-coenzyme A to mevalonate, the rate limiting step of the hepatic pathway of cholesterol synthesis. Shorter-acting statins such as simvastatin should be taken at night as most cholesterol synthesis takes place when dietary intake is lowest. Atorvastatin has a longer half-life and can be taken at any time. Atorvastatin has oral bioavailability of 14% after first pass metabolism and is highly plasma protein bound. It is metabolised by the CYP450 system (CYP3A4) and eliminated in bile. CYP3A4 inhibitors such as clarithromycin, ciclosporin and ketoconazole can significantly increase plasma concentrations of atorvastatin and co-administration should be avoided or the dose of atorvastatin reduced. Atorvastatin has been studied in people with and without diabetes. It is well tolerated, efficacious and has minimal adverse events. A Cochrane review of 296 trials in 38,817 participants found that treatment with 10–80mg of atorvastatin was associated with a reduction in LDL-C of 37.1–51.7%.2 The Anglo-Scandinavian Cardiac Outcomes Trial – Lipid Lowering Arm (ASCOT-LLA) examined the effect on atorvastatin on the primary prevention of CVD. In all, 10,305 patients with hypertension and at least three cardiovascular risk factors were randomised to 10mg atorvastatin or placebo. The primary outcome was the combined endpoint of non-fatal myocardial infarction (MI) and fatal coronary heart disease (CHD). The trial was terminated early because of the reduction in coronary events and stroke. Treatment with atorvastatin was associated with a relative risk reduction in the primary endpoint of 36% compared with placebo (HR 0.64, 95% CI 0.5–0.83, p=000.5) and a 27% risk reduction in stroke (HR 0.73, 95% CI 0.56–00.96, p=0.0236).3 The efficacy of atorvastatin in the secondary prevention of CVD was demonstrated in the Treating to New Targets (TNT) trial. In this large-scale randomised t
相比之下，阿托伐他汀预防非胰岛素依赖型糖尿病冠心病终点研究(ASPEN)未能显示阿托伐他汀治疗2型糖尿病患者的主要终点(心血管死亡时间、非致死性心肌梗死、非致死性卒中、冠状动脉搭桥手术、心脏骤停和不稳定心绞痛住院)有任何影响，尽管ldl - c显著降低7可能是研究设计、方案改变、不同的终点和两组使用降脂治疗的问题影响了结果。ASCOT-LLA试验包括2532例2型糖尿病患者，随机接受10mg阿托伐他汀或安慰剂治疗。亚组分析未显示阿托伐他汀治疗的糖尿病患者致死性冠心病和非致死性心肌梗死的主要终点在统计学上有显著降低，这可能与检测显着差异的有限能力有关对该组的后续分析表明，阿托伐他汀显著降低了23%的所有心血管事件和手术的风险(HR 0.77, 95% CI 0.01-0.98, p=0.036)通过积极降低胆固醇水平预防卒中(SPARCL)研究调查了近期卒中或TIA但无冠心病患者使用80mg阿托伐他汀的情况。该试验对2型糖尿病患者进行亚组分析，发现主要心血管事件、冠状动脉事件和血运重建手术减少阿托伐他汀是一种有效和安全的治疗降脂治疗和预防心血管不良事件的患者有和没有糖尿病。目前的指南建议使用20mg或80mg阿托伐他汀分别用于心血管疾病的一级和二级预防。虽然新发糖尿病发病率的增加或血糖控制的恶化是一个重要的考虑因素，但对于有显著心血管风险的患者，不使用降脂治疗的风险可以说是更重要的。没有宣布任何利益冲突。
{"title":"Atorvastatin","authors":"Calum Richardson, Gerry McKay, Andrea Llano","doi":"10.1002/pdi.2450","DOIUrl":"https://doi.org/10.1002/pdi.2450","url":null,"abstract":"High cholesterol, in particular increased low-density lipoprotein (LDL), is a significant, modifiable risk factor in the development of cardiovascular disease (CVD). In people with diabetes, the risk of CVD is greatly increased and is the leading cause of morbidity and mortality. People with diabetes typically have a triad of elevated fasting and postprandial triglycerides, elevated LDL cholesterol and a relative reduction in high-density lipoprotein (HDL) cholesterol. While exercise, diet and tighter glycaemic control can contribute to improvements in the lipid profile, statins offer the biggest risk reduction with respect to CVD; every 1mmol/L reduction in LDL-C with statin therapy is associated with a 22% reduction in cardiovascular events.1 Statins may also have additional cardiovascular protective effects via their action on platelets, endothelium and atherosclerotic plaques. Statins therefore have an important role in the primary and secondary prevention of CVD. The pharmacology of atorvastatin is shown in Figure 1. HMG-CoA reductase catalyses the reduction of 3-hydroxy-3-methylglutaryl-coenzyme A to mevalonate, the rate limiting step of the hepatic pathway of cholesterol synthesis. Shorter-acting statins such as simvastatin should be taken at night as most cholesterol synthesis takes place when dietary intake is lowest. Atorvastatin has a longer half-life and can be taken at any time. Atorvastatin has oral bioavailability of 14% after first pass metabolism and is highly plasma protein bound. It is metabolised by the CYP450 system (CYP3A4) and eliminated in bile. CYP3A4 inhibitors such as clarithromycin, ciclosporin and ketoconazole can significantly increase plasma concentrations of atorvastatin and co-administration should be avoided or the dose of atorvastatin reduced. Atorvastatin has been studied in people with and without diabetes. It is well tolerated, efficacious and has minimal adverse events. A Cochrane review of 296 trials in 38,817 participants found that treatment with 10–80mg of atorvastatin was associated with a reduction in LDL-C of 37.1–51.7%.2 The Anglo-Scandinavian Cardiac Outcomes Trial – Lipid Lowering Arm (ASCOT-LLA) examined the effect on atorvastatin on the primary prevention of CVD. In all, 10,305 patients with hypertension and at least three cardiovascular risk factors were randomised to 10mg atorvastatin or placebo. The primary outcome was the combined endpoint of non-fatal myocardial infarction (MI) and fatal coronary heart disease (CHD). The trial was terminated early because of the reduction in coronary events and stroke. Treatment with atorvastatin was associated with a relative risk reduction in the primary endpoint of 36% compared with placebo (HR 0.64, 95% CI 0.5–0.83, p=000.5) and a 27% risk reduction in stroke (HR 0.73, 95% CI 0.56–00.96, p=0.0236).3 The efficacy of atorvastatin in the secondary prevention of CVD was demonstrated in the Treating to New Targets (TNT) trial. In this large-scale randomised t","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135288592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Findings from the latest National Diabetes Audit of the NHS Diabetes Prevention Programme (DPP) may point the way forward in reducing the incidence of type 2 diabetes.
{"title":"Latest audit shows the Diabetes Prevention Programme is pressing ahead in tackling non‐diabetic hyperglycaemia and type 2 risk","authors":"S. Chaplin","doi":"10.1002/pdi.2443","DOIUrl":"https://doi.org/10.1002/pdi.2443","url":null,"abstract":"Findings from the latest National Diabetes Audit of the NHS Diabetes Prevention Programme (DPP) may point the way forward in reducing the incidence of type 2 diabetes.","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":"88 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77249808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 59‐year‐old gentleman was admitted with diabetic ketoacidosis (DKA). His medication history included a sodium‐glucose co‐transporter 2 (SGLT2) inhibitor for the past six years. Relevant history includes undertaking a low‐carbohydrate diet for four months.
{"title":"Prolonged diabetic ketoacidosis due to SGLT2 inhibitor use and low‐carbohydrate diet","authors":"S. M. Mung, Ines Fonseca, S. Azmi, L. Balmuri","doi":"10.1002/pdi.2446","DOIUrl":"https://doi.org/10.1002/pdi.2446","url":null,"abstract":"A 59‐year‐old gentleman was admitted with diabetic ketoacidosis (DKA). His medication history included a sodium‐glucose co‐transporter 2 (SGLT2) inhibitor for the past six years. Relevant history includes undertaking a low‐carbohydrate diet for four months.","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":"2 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72513435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Diabetes: my life and nursing – from glass syringes to hybrid closed loops","authors":"J. Charlton","doi":"10.1002/pdi.2438","DOIUrl":"https://doi.org/10.1002/pdi.2438","url":null,"abstract":"","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":"245 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77240813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Zac-Varghese, S. Mathew, Daniel Go, P. Winocour
Sodium‐glucose cotransporter 2 inhibitors (SGLT2i) are increasingly initiated as treatment for type 2 diabetes due to favourable cardiorenal characteristics. However, studies have identified an increased risk of diabetic ketoacidosis (DKA).
{"title":"A case series of diabetic ketoacidosis associated with SGLT2 inhibitors","authors":"S. Zac-Varghese, S. Mathew, Daniel Go, P. Winocour","doi":"10.1002/pdi.2455","DOIUrl":"https://doi.org/10.1002/pdi.2455","url":null,"abstract":"Sodium‐glucose cotransporter 2 inhibitors (SGLT2i) are increasingly initiated as treatment for type 2 diabetes due to favourable cardiorenal characteristics. However, studies have identified an increased risk of diabetic ketoacidosis (DKA).","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":"1 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81325017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Insulin administration delegation in care homes and care settings","authors":"S. Cradock, L. Houghton, S. Gregory, Jane Rowney","doi":"10.1002/pdi.2439","DOIUrl":"https://doi.org/10.1002/pdi.2439","url":null,"abstract":"","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":"46 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87529752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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