much of what we do in our profession has been determined by evidence from large, long-term intervention trials. These provide a strong evidence base for recommending person specific targets for HbA1c, blood pressure and lipids. However, as diabetes specialists we also have an important role in ensuring that the condition is well managed during hospital admission and in this area there is very limited evidence on which to base recommendations. The incidence of diabetes is rising exponentially and as a consequence the number of inpatients with diabetes is also rising. Attention is therefore focusing on inpatient care, with recognition that this is frequently suboptimal. The 2010 National Inpatient Audit reports a mean diabetes prevalence of 15% (range 6.6–24.3%) among inpatients in acute hospitals.1 The audit shows that patients with diabetes experience high levels of medication and management errors and increased length of stay.1,2 Guidelines for the management of inpatients with diabetes are needed to standardise and improve care across the UK. Surgery in people with diabetes is a neglected area, with surgeons and anaesthetists often happy with the idea of ‘permissive hyperglycaemia’, assuming that short (or even long) term hyperglycaemia is less likely to do the patient harm than a hypoglycaemic episode while under anaesthetic. However, recent data from the US have demonstrated that people with diabetes undergoing surgery have an almost 50% greater chance of postoperative mortality than those with normal glucose tolerance and have adverse consequences in all measures of postoperative morbidity.3 Furthermore, people with preoperative hyperglycaemia, who were not previously known to have diabetes, had a risk of perioperative death up to 12 times that of people without diabetes, rising to 40 times if the hyperglycaemia persisted postoperatively.3 These are powerful data and if you could tell your surgical colleagues that you could reduce their perioperative mortality by 12-fold without them even putting knife to skin, you would probably get their attention fairly swiftly.
{"title":"The new NHS Diabetes guidelines on the perioperative management of people with diabetes","authors":"K. Dhatariya, A. Kilvert","doi":"10.1002/PDI.1591","DOIUrl":"https://doi.org/10.1002/PDI.1591","url":null,"abstract":"much of what we do in our profession has been determined by evidence from large, long-term intervention trials. These provide a strong evidence base for recommending person specific targets for HbA1c, blood pressure and lipids. However, as diabetes specialists we also have an important role in ensuring that the condition is well managed during hospital admission and in this area there is very limited evidence on which to base recommendations. The incidence of diabetes is rising exponentially and as a consequence the number of inpatients with diabetes is also rising. Attention is therefore focusing on inpatient care, with recognition that this is frequently suboptimal. The 2010 National Inpatient Audit reports a mean diabetes prevalence of 15% (range 6.6–24.3%) among inpatients in acute hospitals.1 The audit shows that patients with diabetes experience high levels of medication and management errors and increased length of stay.1,2 Guidelines for the management of inpatients with diabetes are needed to standardise and improve care across the UK. Surgery in people with diabetes is a neglected area, with surgeons and anaesthetists often happy with the idea of ‘permissive hyperglycaemia’, assuming that short (or even long) term hyperglycaemia is less likely to do the patient harm than a hypoglycaemic episode while under anaesthetic. However, recent data from the US have demonstrated that people with diabetes undergoing surgery have an almost 50% greater chance of postoperative mortality than those with normal glucose tolerance and have adverse consequences in all measures of postoperative morbidity.3 Furthermore, people with preoperative hyperglycaemia, who were not previously known to have diabetes, had a risk of perioperative death up to 12 times that of people without diabetes, rising to 40 times if the hyperglycaemia persisted postoperatively.3 These are powerful data and if you could tell your surgical colleagues that you could reduce their perioperative mortality by 12-fold without them even putting knife to skin, you would probably get their attention fairly swiftly.","PeriodicalId":92116,"journal":{"name":"Practical diabetes international : the journal for diabetes care teams worldwide","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/PDI.1591","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51025183","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 pioneering study of OSA, reportedthat OSA affected 2–4% of the general population in 1993. Morerecent reports, taking into accountthe increased prevalence of obesity,estimate that up to 17% of adultshave OSA. Importantly, OSA is com-mon in patients with type 2 diabetesmellitus (T2DM). This prevalencevaries depending on the populationand setting of the study but rangesfrom 20% to as much as 80%. While obesity is an importantcontributor to OSA, less than 50% ofOSA is attributable to obesity. Otherfactors which are also important inOSA include age (older individuals),gender (men greater than women),ethnicity (African Americans andHispanics), and craniofacial abnor-malities. OSA has been associatedwith polycystic ovarian syndrome,hypothyroidism, and less commonendocrine conditions such asacromegaly. Smoking and alcoholconsumption can exacerbate OSA.Several gene polymorphisms havebeen associated with OSA in linewith a complex genetic condition.Obesity is a common risk factor forboth diabetes and OSA. However,emerging evidence suggests a rela-tionship between OSA and diabetesindependent of obesity.OSA belongs to a spectrum ofbreathing disorders during sleep(sleep-disordered breathing) thatrange from simple snoring to com-plete cessation of breathing. OSA ischaracterised by frequent abnormalpauses in breathing during sleep.These pauses are obstructive innature and occur despite respiratoryeffort by the patient. OSA is associ-ated with repetitive blood oxygendesaturation because of lack of air-flow into the lungs. Obstructiveevents during sleep are associatedwith arousals that are often unno-ticed by the patient. These arousalsresult in fragmented sleep thatcauses excessive daytime sleepiness(EDS). This increases the risk ofroad and workplace accidents. Thesymptoms of OSA include snoring,witnessed breath-holds, gasping andchoking, fatigue, reduced alertness,nocturia, morning headaches, refluxoesophagitis, poor memory, lowmood and genderual dysfunction.Some of these symptoms are alsoseen in poorly controlled diabetes,resulting in the possibility of OSAbeing forgotten in patients with dia-betes. Severe OSA can be potentiallylife threatening if left untreated,resulting in heart failure and arryth-mias. There is increasing evidencelinking OSA to vascular, metabolic,haematological and genetic markersassociated with increased risk for cardiovascular disease. Identifying patients with OSA inthe diabetes clinic tends not to occurbecause of lack of awareness of therelationship between the two condi-tions. OSA questionnaires are notvery useful either, because they havenot been designed for the diabetespopulation. Also, diabetes patientsmay not specifically report sleepi-ness. Potential indicators of OSA indiabetes patients include frequentheadaches, acid reflux disease,impotence, poor glycaemic control,and uncontrolled hypertension.
{"title":"Obstructive sleep apnoea and type 2 diabetes: Whose disease is it anyway?","authors":"S. Choudhury, S. Taheri","doi":"10.1002/PDI.1589","DOIUrl":"https://doi.org/10.1002/PDI.1589","url":null,"abstract":"a pioneering study of OSA, reportedthat OSA affected 2–4% of the general population in 1993. Morerecent reports, taking into accountthe increased prevalence of obesity,estimate that up to 17% of adultshave OSA. Importantly, OSA is com-mon in patients with type 2 diabetesmellitus (T2DM). This prevalencevaries depending on the populationand setting of the study but rangesfrom 20% to as much as 80%. While obesity is an importantcontributor to OSA, less than 50% ofOSA is attributable to obesity. Otherfactors which are also important inOSA include age (older individuals),gender (men greater than women),ethnicity (African Americans andHispanics), and craniofacial abnor-malities. OSA has been associatedwith polycystic ovarian syndrome,hypothyroidism, and less commonendocrine conditions such asacromegaly. Smoking and alcoholconsumption can exacerbate OSA.Several gene polymorphisms havebeen associated with OSA in linewith a complex genetic condition.Obesity is a common risk factor forboth diabetes and OSA. However,emerging evidence suggests a rela-tionship between OSA and diabetesindependent of obesity.OSA belongs to a spectrum ofbreathing disorders during sleep(sleep-disordered breathing) thatrange from simple snoring to com-plete cessation of breathing. OSA ischaracterised by frequent abnormalpauses in breathing during sleep.These pauses are obstructive innature and occur despite respiratoryeffort by the patient. OSA is associ-ated with repetitive blood oxygendesaturation because of lack of air-flow into the lungs. Obstructiveevents during sleep are associatedwith arousals that are often unno-ticed by the patient. These arousalsresult in fragmented sleep thatcauses excessive daytime sleepiness(EDS). This increases the risk ofroad and workplace accidents. Thesymptoms of OSA include snoring,witnessed breath-holds, gasping andchoking, fatigue, reduced alertness,nocturia, morning headaches, refluxoesophagitis, poor memory, lowmood and genderual dysfunction.Some of these symptoms are alsoseen in poorly controlled diabetes,resulting in the possibility of OSAbeing forgotten in patients with dia-betes. Severe OSA can be potentiallylife threatening if left untreated,resulting in heart failure and arryth-mias. There is increasing evidencelinking OSA to vascular, metabolic,haematological and genetic markersassociated with increased risk for cardiovascular disease. Identifying patients with OSA inthe diabetes clinic tends not to occurbecause of lack of awareness of therelationship between the two condi-tions. OSA questionnaires are notvery useful either, because they havenot been designed for the diabetespopulation. Also, diabetes patientsmay not specifically report sleepi-ness. Potential indicators of OSA indiabetes patients include frequentheadaches, acid reflux disease,impotence, poor glycaemic control,and uncontrolled hypertension.","PeriodicalId":92116,"journal":{"name":"Practical diabetes international : the journal for diabetes care teams worldwide","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/PDI.1589","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51025107","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}
An Australian National Consensus Position on Outcomes and Indicators for Diabetes Education identified knowledge and understanding as the outcomes most directly affected by diabetes education. A subsequent literature review failed to identify a validated, suitable questionnaire for measuring knowledge. Consequently, we aimed to develop a minimum diabetes knowledge questionnaire (DKQ) suitable for people with both type 1 and type 2 diabetes. Content validity was established through literature review, Delphi survey of 52 opinion leaders and a workshop of Australian Diabetes Educators (n ≥300). The resulting instrument was tested for internal consistency on 129 and for reliability on 57 people with type 1 and type 2 diabetes, respectively. The final questionnaire contains: 12 multiple choice questions common to type 1 and type 2 diabetes, e.g. normal blood glucose levels, complications, diet, exercise, selfmonitoring of blood glucose, annual check-ups, support services, and sick-days; two questions for people on oral medication/insulin only; and one question (sick-days) for people with type 1 diabetes only. For the first 12 questions, the internal consistency was good (Cronbach’s α=0.73); with the additional item for type 1 diabetes, the internal consistency was slightly better (α=0.79) as it was with the additional items for people on medication/insulin (α=0.76). No particular item seemed to adversely affect the overall consistency of the questionnaire. Comparing test-retest pilots, total scores showed good reliability with no evidence of change over time (t=1.73; df=56; p The DKQ is now ready to use for evaluating knowledge outcomes of diabetes education.
{"title":"Development and validation of a diabetes knowledge questionnaire","authors":"C. Eigenmann, T. Skinner, R. Colagiuri","doi":"10.1002/PDI.1586","DOIUrl":"https://doi.org/10.1002/PDI.1586","url":null,"abstract":"An Australian National Consensus Position on Outcomes and Indicators for Diabetes \u0000Education identified knowledge and understanding as the outcomes most directly \u0000affected by diabetes education. A subsequent literature review failed to identify a \u0000validated, suitable questionnaire for measuring knowledge. Consequently, we aimed to \u0000develop a minimum diabetes knowledge questionnaire (DKQ) suitable for people with \u0000both type 1 and type 2 diabetes. Content validity was established through literature review, Delphi survey of 52 \u0000opinion leaders and a workshop of Australian Diabetes Educators (n ≥300). The resulting \u0000instrument was tested for internal consistency on 129 and for reliability on 57 people with \u0000type 1 and type 2 diabetes, respectively. The final questionnaire contains: 12 multiple choice questions common to type 1 and \u0000type 2 diabetes, e.g. normal blood glucose levels, complications, diet, exercise, selfmonitoring \u0000of blood glucose, annual check-ups, support services, and sick-days; two \u0000questions for people on oral medication/insulin only; and one question (sick-days) for \u0000people with type 1 diabetes only. For the first 12 questions, the internal consistency was good (Cronbach’s α=0.73); \u0000with the additional item for type 1 diabetes, the internal consistency was slightly better \u0000(α=0.79) as it was with the additional items for people on medication/insulin (α=0.76). No \u0000particular item seemed to adversely affect the overall consistency of the questionnaire. Comparing test-retest pilots, total scores showed good reliability with no evidence of \u0000change over time (t=1.73; df=56; p \u0000 \u0000The DKQ is now ready to use for evaluating knowledge outcomes of diabetes \u0000education.","PeriodicalId":92116,"journal":{"name":"Practical diabetes international : the journal for diabetes care teams worldwide","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/PDI.1586","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51025041","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":"Pleural effusion caused by pioglitazone: case report","authors":"A. Munir, S. Kalathil, S. Nag","doi":"10.1002/PDI.1583","DOIUrl":"https://doi.org/10.1002/PDI.1583","url":null,"abstract":"","PeriodicalId":92116,"journal":{"name":"Practical diabetes international : the journal for diabetes care teams worldwide","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/PDI.1583","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51025462","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":"An unusual cause for deterioration of glycaemia in diabetes","authors":"A. Nayak, V. Baskar","doi":"10.1002/PDI.1584","DOIUrl":"https://doi.org/10.1002/PDI.1584","url":null,"abstract":"","PeriodicalId":92116,"journal":{"name":"Practical diabetes international : the journal for diabetes care teams worldwide","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/PDI.1584","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51025477","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}
C. Mclachlan, R. Beach, Richard Laing, G. Frazer, H. Lunt, T. Cawood
{"title":"Could glucose self‐monitoring become the preferred tool for screening and monitoring glucose control in cystic fibrosis?","authors":"C. Mclachlan, R. Beach, Richard Laing, G. Frazer, H. Lunt, T. Cawood","doi":"10.1002/PDI.1587","DOIUrl":"https://doi.org/10.1002/PDI.1587","url":null,"abstract":"","PeriodicalId":92116,"journal":{"name":"Practical diabetes international : the journal for diabetes care teams worldwide","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/PDI.1587","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51025054","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":"The enigma of diagnosing and managing diabetic peripheral neuropathic pain in everyday practice: time to QOF up?","authors":"S. Davies, D. Coppini","doi":"10.1002/PDI.1580","DOIUrl":"https://doi.org/10.1002/PDI.1580","url":null,"abstract":"","PeriodicalId":92116,"journal":{"name":"Practical diabetes international : the journal for diabetes care teams worldwide","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2011-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/PDI.1580","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51025401","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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