The onset of diabetes foot complications signals a new stage of diabetes progression. Amputation may be the result of such difficulties and can impact upon all aspects of a person's life such as mobility, independence, relationships, and possible loss of earning potential, all likely triggers of distress.
{"title":"The importance of asking about wellbeing in a diabetes foot clinic","authors":"C. Bewsey","doi":"10.1002/pdi.2465","DOIUrl":"https://doi.org/10.1002/pdi.2465","url":null,"abstract":"The onset of diabetes foot complications signals a new stage of diabetes progression. Amputation may be the result of such difficulties and can impact upon all aspects of a person's life such as mobility, independence, relationships, and possible loss of earning potential, all likely triggers of distress.","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74727899","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}
This paper aims to describe experiences and challenges when managing diabetes along with dementia from the perspectives of those living with these conditions, their informal carers and health care professionals.
{"title":"Managing diabetes and dementia, a challenging duo: a scoping review","authors":"Florence Sharkey, V. Coates","doi":"10.1002/pdi.2469","DOIUrl":"https://doi.org/10.1002/pdi.2469","url":null,"abstract":"This paper aims to describe experiences and challenges when managing diabetes along with dementia from the perspectives of those living with these conditions, their informal carers and health care professionals.","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78017791","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}
The Diabetes UK Professional Conference 2023 saw health care professionals from around the world arrive in Liverpool for the three‐day event. The programme saw experts in all aspects of diabetes sharing their skills and knowledge, allowing attendees to develop their own practice, as well as providing tantalising insights into the future of diabetes care. Dr Katherine Bishop reports on some of the highlights from the conference.
{"title":"Highlights from the Diabetes UK Professional Conference 2023","authors":"K. Bishop","doi":"10.1002/pdi.2470","DOIUrl":"https://doi.org/10.1002/pdi.2470","url":null,"abstract":"The Diabetes UK Professional Conference 2023 saw health care professionals from around the world arrive in Liverpool for the three‐day event. The programme saw experts in all aspects of diabetes sharing their skills and knowledge, allowing attendees to develop their own practice, as well as providing tantalising insights into the future of diabetes care. Dr Katherine Bishop reports on some of the highlights from the conference.","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91397019","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}
T woman touched the snake’s flickering tongue. She was fascinated, and completely unafraid. Indeed, she kept asking to touch the poisonous snakes too, and they had to stop her picking up the tarantula. She found the haunted house funny and scared one of the ‘monsters’ by poking it in the head. The fearless subject of these unusual experiments is SM who has Urbach-Wiethe disease. This condition includes bilateral destruction of the amygdala. ‘SM provides a rare glimpse into the adverse consequences of living life without the amygdala. For SM, the consequences have been severe. Her behavior, time and time again, leads her back to the very situations she should be avoiding, highlighting the indispensable role that the amygdala plays in promoting survival by compelling the organism away from danger. Indeed, it appears that without the amygdala, the evolutionary value of fear is lost.’1
{"title":"Fear in diabetes","authors":"R. Hillson","doi":"10.1002/pdi.2462","DOIUrl":"https://doi.org/10.1002/pdi.2462","url":null,"abstract":"T woman touched the snake’s flickering tongue. She was fascinated, and completely unafraid. Indeed, she kept asking to touch the poisonous snakes too, and they had to stop her picking up the tarantula. She found the haunted house funny and scared one of the ‘monsters’ by poking it in the head. The fearless subject of these unusual experiments is SM who has Urbach-Wiethe disease. This condition includes bilateral destruction of the amygdala. ‘SM provides a rare glimpse into the adverse consequences of living life without the amygdala. For SM, the consequences have been severe. Her behavior, time and time again, leads her back to the very situations she should be avoiding, highlighting the indispensable role that the amygdala plays in promoting survival by compelling the organism away from danger. Indeed, it appears that without the amygdala, the evolutionary value of fear is lost.’1","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89340754","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}
Katherine E Wakelin, Rebecca K Read, N. O'Donnell, Marisa Baker, R. Satherley, Rose Stewart, Christina J Jones
A higher proportion of children and young people (CYP) with type 1 diabetes (T1D) present with disordered eating compared to CYP without T1D. Due to the complexities of T1D management in addition to eating disorder treatment, it is essential to discuss T1D and Disordered Eating (T1DE) with families to screen early and frequently. This enables those most vulnerable to be identified and treated early.
{"title":"Integrating conversations about disordered eating in children and young people into routine type 1 diabetes care: a practical guide","authors":"Katherine E Wakelin, Rebecca K Read, N. O'Donnell, Marisa Baker, R. Satherley, Rose Stewart, Christina J Jones","doi":"10.1002/pdi.2464","DOIUrl":"https://doi.org/10.1002/pdi.2464","url":null,"abstract":"A higher proportion of children and young people (CYP) with type 1 diabetes (T1D) present with disordered eating compared to CYP without T1D. Due to the complexities of T1D management in addition to eating disorder treatment, it is essential to discuss T1D and Disordered Eating (T1DE) with families to screen early and frequently. This enables those most vulnerable to be identified and treated early.","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88582021","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}
In developed countries, diabetes mellitus (DM) is one of the main causes of end stage renal disease (ESRD). In addition, the development of chronic kidney disease (CKD) further increases the already significantly increased cardiovascular (CV) risk in patients with diabetes. Both albuminuria and impaired renal function predict CV disease-related morbidity. The multifactorial pathogenesis of DM-related CKD involves structural, physiological, hemodynamic, and inflammatory processes. Instead of a so-called glucocentric approach, current evidence suggests that a multimodal, interdisciplinary treatment approach is needed to also prevent further progression of CKD and reduce the risk of cardiovascular events. Combined antihypertensive, antihyperglycemic and hypolipidemic therapy is the basis of a comprehensive approach to prevent the progression of diabetic kidney disease. According to recent evidence, adjunctive therapy with the non-steroidal mineralocorticoid receptor antagonist (MRA) finerenone - in addition to the use of an ACE (angiotensin converting enzyme) or AT1 (angiotensin II receptor subtype 1) blocker and an SGLT2 (sodium-glucose cotransporter-2) inhibitor - represents an effective therapeutic tool to improve nephroprotection in CKD. The aim of this review is to provide brief information on this promising pharmacotherapeutic approach to the treatment of diabetic kidney disease.
{"title":"Finerenone","authors":"Rachel Mauchlen, G. McKay","doi":"10.1002/pdi.2471","DOIUrl":"https://doi.org/10.1002/pdi.2471","url":null,"abstract":"In developed countries, diabetes mellitus (DM) is one of the main causes of end stage renal disease (ESRD). In addition, the development of chronic kidney disease (CKD) further increases the already significantly increased cardiovascular (CV) risk in patients with diabetes. Both albuminuria and impaired renal function predict CV disease-related morbidity. The multifactorial pathogenesis of DM-related CKD involves structural, physiological, hemodynamic, and inflammatory processes. Instead of a so-called glucocentric approach, current evidence suggests that a multimodal, interdisciplinary treatment approach is needed to also prevent further progression of CKD and reduce the risk of cardiovascular events. Combined antihypertensive, antihyperglycemic and hypolipidemic therapy is the basis of a comprehensive approach to prevent the progression of diabetic kidney disease. According to recent evidence, adjunctive therapy with the non-steroidal mineralocorticoid receptor antagonist (MRA) finerenone - in addition to the use of an ACE (angiotensin converting enzyme) or AT1 (angiotensin II receptor subtype 1) blocker and an SGLT2 (sodium-glucose cotransporter-2) inhibitor - represents an effective therapeutic tool to improve nephroprotection in CKD. The aim of this review is to provide brief information on this promising pharmacotherapeutic approach to the treatment of diabetic kidney disease.","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81717241","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}
Allopurinol is licensed in the United Kingdom for the prophylaxis of gout as well as uric acid and calcium oxalate renal stones. It can also be prescribed for the prophylaxis of hyperuricaemia associated with cancer chemotherapy. Allopurinol effectively lowers serum uric acid levels and reduces the risk of recurrent gout symptoms. It is commenced after an acute attack has fully subsided to avoid precipitating a flare in symptoms. The recommended starting dose is 100mg to reduce the risk of adverse reactions and the dose is subsequently increased if the serum urate lowering response is unsatisfactory.1 The drug is well tolerated although skin reactions, which may occur at any time during treatment, are the most common adverse effects. Fortunately, hypersensitivity reactions such as Stevens-Johnson syndrome are rarely seen in clinical practice. Allopurinol is a structural analogue of the naturally-occurring purine base hypoxanthine. It is a competitive inhibitor of xanthine oxidase, the enzyme responsible for the conversion of hypoxanthine to xanthine and of xanthine to uric acid, the end product of purine metabolism. (See Figure 1.) Xanthine oxidase is an enzyme that generates reactive oxygen species, promoting oxidative stress which inactivates the anti-atherosclerotic substance nitric oxide. Allopurinol is about 90% absorbed from the gastrointestinal tract with peak plasma levels 1.5 hours post dose. There is negligible protein binding and the plasma half life is 1–-2 hours due to its rapid renal clearance with a lower dose used in the presence of renal impairment. After the ingestion of allopurinol the plasma level of uric acid is reduced. Hypoxanthine, xanthine and uric acid are excreted in the urine but because of their levels of solubility there is a decreased risk of crystalluria. With the use of allopurinol the plasma concentration of uric acid is reduced below its level of solubility, encouraging the dissolution of gouty tophi. Hyperuricaemia and gout are closely associated with insulin resistance syndrome and frequently coexist with metabolic syndrome and type 2 diabetes. Observational and animal studies have identified hyperuricaema as an independent risk factor for insulin resistance and prediabetes. Observational studies have indicated that raised urate levels are an independent predictor of albuminuria and early decline in renal function in those with either type 1 or type 2 diabetes. In animal studies, allopurinol has been shown to improve insulin resistance. The drug has also been shown to improve endothelial function in those with type 2 diabetes and associated mild hypertension in addition to those with heart failure, and in smokers. It also causes regression of left ventricular hypertrophy in those with type 2 diabetes. Lowering of urate levels with allopurinol has overall not shown an improvement in diabetic kidney disease outcomes. Allopurinol reduces oxidative stress by reducing superoxide anions and other free radicals which
89 - 1.21, p = 0.65)。任何原因死亡的HR为1.02 (95% CI 0.87-1.20, p=0.77)。从次要时间到事件结果的结果同样显示心血管相关住院的全范围无差异。两组之间严重不良反应无差异，试验中平均尿酸水平在正常范围内。在试验中，两组患者中有21.7%患有糖尿病，治疗组中有0.8%患有1型糖尿病，20.8%患有2型糖尿病。同样，糖尿病患者的结果也没有差异。科学证据表明，别嘌呤醇在高氧化应激时期预防缺血性心脏病方面可能有益。基于ALL-HEART研究，别嘌呤醇不能被推荐用于缺血性心脏病(包括糖尿病)患者心血管事件的二级预防。痛风和主要心血管疾病患者的CARES研究显示，与别嘌呤醇相比，服用非布司他(一种新型黄嘌呤氧化酶抑制剂)的患者心血管相关死亡和全因死亡率风险更高。在这项试验的基础上，国家卫生和保健卓越研究所(NICE)国家临床指南NG219建议痛风和主要心血管疾病患者避免使用非布司他，选择别嘌呤醇作为药物。别嘌呤醇是一种自1966年开始使用的药物，是一种经过试验和测试的有效的降尿酸药物，用于预防慢性痛风。它仍然是我们长期治疗这种疾病的一线药物，NICE推荐一种治疗到目标的策略。没有证据表明它能改善有或没有糖尿病的心血管结局或减缓糖尿病肾病的进展。
{"title":"Allopurinol","authors":"Alan Begg","doi":"10.1002/pdi.2460","DOIUrl":"https://doi.org/10.1002/pdi.2460","url":null,"abstract":"Allopurinol is licensed in the United Kingdom for the prophylaxis of gout as well as uric acid and calcium oxalate renal stones. It can also be prescribed for the prophylaxis of hyperuricaemia associated with cancer chemotherapy. Allopurinol effectively lowers serum uric acid levels and reduces the risk of recurrent gout symptoms. It is commenced after an acute attack has fully subsided to avoid precipitating a flare in symptoms. The recommended starting dose is 100mg to reduce the risk of adverse reactions and the dose is subsequently increased if the serum urate lowering response is unsatisfactory.1 The drug is well tolerated although skin reactions, which may occur at any time during treatment, are the most common adverse effects. Fortunately, hypersensitivity reactions such as Stevens-Johnson syndrome are rarely seen in clinical practice. Allopurinol is a structural analogue of the naturally-occurring purine base hypoxanthine. It is a competitive inhibitor of xanthine oxidase, the enzyme responsible for the conversion of hypoxanthine to xanthine and of xanthine to uric acid, the end product of purine metabolism. (See Figure 1.) Xanthine oxidase is an enzyme that generates reactive oxygen species, promoting oxidative stress which inactivates the anti-atherosclerotic substance nitric oxide. Allopurinol is about 90% absorbed from the gastrointestinal tract with peak plasma levels 1.5 hours post dose. There is negligible protein binding and the plasma half life is 1–-2 hours due to its rapid renal clearance with a lower dose used in the presence of renal impairment. After the ingestion of allopurinol the plasma level of uric acid is reduced. Hypoxanthine, xanthine and uric acid are excreted in the urine but because of their levels of solubility there is a decreased risk of crystalluria. With the use of allopurinol the plasma concentration of uric acid is reduced below its level of solubility, encouraging the dissolution of gouty tophi. Hyperuricaemia and gout are closely associated with insulin resistance syndrome and frequently coexist with metabolic syndrome and type 2 diabetes. Observational and animal studies have identified hyperuricaema as an independent risk factor for insulin resistance and prediabetes. Observational studies have indicated that raised urate levels are an independent predictor of albuminuria and early decline in renal function in those with either type 1 or type 2 diabetes. In animal studies, allopurinol has been shown to improve insulin resistance. The drug has also been shown to improve endothelial function in those with type 2 diabetes and associated mild hypertension in addition to those with heart failure, and in smokers. It also causes regression of left ventricular hypertrophy in those with type 2 diabetes. Lowering of urate levels with allopurinol has overall not shown an improvement in diabetic kidney disease outcomes. Allopurinol reduces oxidative stress by reducing superoxide anions and other free radicals which","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134992408","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}
Here, Mark Greener discusses the work of key diabetes stakeholders in reducing the environmental footprint left by plastics used in diabetes care, innovations in diabetes device sustainability, and the collaborative approach that is emerging across the pharmaceutical industry for the good of the planet.
{"title":"The greening of diabetes","authors":"M. Greener","doi":"10.1002/pdi.2442","DOIUrl":"https://doi.org/10.1002/pdi.2442","url":null,"abstract":"Here, Mark Greener discusses the work of key diabetes stakeholders in reducing the environmental footprint left by plastics used in diabetes care, innovations in diabetes device sustainability, and the collaborative approach that is emerging across the pharmaceutical industry for the good of the planet.","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75034950","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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