Researchers say circulating mononuclear cells (the largest type of white blood cell) and lymphocytes, exist in a proinflammatory state in obese persons known to be at increased risk of developing heart disease, diabetes, or both.
Accumulating evidence supports the hypothesis that chronic low-grade inflammation and activation of the innate immune system are closely involved in the pathogenesis of the type 2 diabetes.
Our search found agents that might improve symptoms of neuropathy (eg, evening primrose oil, alpha-lipoic acid, capsaicin) without affecting glucose control. Evening primrose oil, alpha-lipoic acid, and capsaicin have received the greatest attention for t
Benefits of integrating high-throughput microarray studies, together with protein–protein interaction networks, in elucidating the underlying biological processes associated with a complex disorder.
Ex: Managing the Metric vs Managing the Patient: The Physician’s View of Pay for Performance, Inpatient Management Guidelines for People with Diabetes, Reducing Health Care Costs for Plan Members with Congestive Heart Failure...
Chronic inflammation is also involved in diseases as diverse as atherosclerosis, cancer, heart valve dysfunction, obesity, diabetes, congestive heart failure, digestive system diseases, and Alzheimer's disease...The New England Journal of Medicine publish
Diabetes Study Partially Halted After Deaths * Sign In to E-Mail or Save This * Print * Reprints * Share o Del.icio.us o Digg o Facebook o Newsvine o Permalink By GINA KOLATA Published: F
enkungen angeordnet hatte.
"Die Produkte, die vom Markt genommen werden, sind die jüngste Generation von Insulin-Produkten mit Pen-System", sagte Novo-Nordisks-Sprecher Mike Rulis in Kopenhagen. Rulis erklärte, die Firma werde die Produkte zwar weiter zum alten Preis anbieten, doch da die Regierung eine Preissenkung um 25 Prozent angeordnet hat, würden die Großhändler nur noch mit Verlust verkaufen können.
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This study explored the annual occurrence/incidence of bacterial infections, and their association with chronic hyperglycemia and diabetic nephropathy, in patients with type 1 diabetes. Open Access Article
The UK National Institute for Health and Care Excellence (NICE) guideline on diabetes recommends at least annual monitoring of patients with type 2 diabetes mellitus (T2DM) for proteinuria. To date, little has been published on the frequency of proteinuria monitoring in T2DM, and its association with risk factors for renal complications. We aimed to describe proteinuria monitoring in patients with T2DM. Open Access Article
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'What this study adds A substantial positive association was seen between use of warfarin with glipizide/glimepiride and hospital admission/emergency department visits for hypoglycemia and related diagnoses, particularly in patients starting warfarin. The findings suggest the possibility of a significant drug interaction between these medications.'
Objective Type I and II diabetes are associated with a greater relative risk of cardiovascular diseases (CVD) in women than in men. Sex differences in adiposity storage may explain these findings. Open Access Article
Our aim was to assess the impact of an educational initiative for non-specialist, healthcare professionals in the community on the process and quality measures of diabetes care delivered, and changes in their learning experiences and clinical management behaviour in the short and long term. Open Access Article
Musculoskeletal symptoms limit adherence to exercise interventions for individuals with type 2 diabetes. People with diabetes may be susceptible to tendinopathy due to chronically elevated blood glucose levels. Therefore, we aimed to investigate this potential association by systematically reviewing and meta-analysing case–control, cross-sectional, and studies that considered both of these conditions. To read the full article, log in using your NHS Athens
Evidence shows the longer between appointments the higher the chance of a young person developing psychosocial issues such as anxiety and depression and increased HbA1c. Diabetes is also linked to higher rates of eating disorders.
The Diabetes Transition Service Specification is designed to inform commissioners’ development of a clear specification based on local context.
Commentary on:
Malanda UL, Bot SD, Kostense PJ, et al. Effects of self-monitoring of glucose on distress and self-efficacy in people with non-insulin-treated type 2 diabetes: a randomized controlled trial. Diabet Med 2015. Published Online First.
Context
While it is generally accepted that blood glucose monitoring is an important component of treatment in the management of insulin-treated diabetes (both type 1 and type 2 diabetes), the role of blood glucose monitoring in those with type 2 diabetes treated by oral agents remains uncertain. Systematic reviews of randomised controlled trials have persistently failed to find benefits on blood glucose control or hypoglycaemia in people with type 1 diabetes.1 ,2 This emphasises the methodological challenges of establishing the value of self-monitoring of blood glucose in individuals with type 2 diabetes on oral agents, who are at … To read the full article, log in using your NHS Athens
Commentary on:
Balk EM, Earley A, Raman G, et al. Combined diet and physical activity promotion programs to prevent type 2 diabetes among persons at increased risk: a systematic review for the community preventive services task force. Ann Intern Med 2015;163:437–51.
Context
Type 2 diabetes mellitus (T2DM) is a significant and growing medical problem affecting close to 400 million people worldwide1 and almost 10% of the US population2 while imposing a major financial burden on society.3 Furthermore, an estimated 37% of the US adult population is at risk of T2DM, making primary prevention of T2DM a critical public health objective. Large clinical trials have shown that combined diet and physical activity promotion programmes … To read the full article, log in using your NHS Athens
The UK National Screening Committee (UK NSC) has published a number of recommendations today (15 January 2015) following its meeting on 19 November 2015.
The independent expert committee made 11 recommendations in total, which included improvements to existing screening programmes for Down’s syndrome and other related conditions, cervical cancer, bowel cancer and eye screening for people with diabetes.
NICE – the National Institute for Health and Care Excellence – is consulting on potential new indicators for the NICE indicator menu. Indicators encourage health professionals to assess patients on a range of key health issues where diagnosis and treatment is supported by evidence-based guidelines. The aim is to tackle widespread public health challenges one patient at a time. Areas where indicators are being suggested include diabetes and stroke.
A parliamentary report identifies weaknesses in the current national approach to diabetes prevention, resulting in the continued increase in the cost of diabetes to the NHS.
Difficulty in sleeping is associated with an increased risk of developing type 2 diabetes, a study published in Diabetologia has found. To read the full article, log in using your NHS Athens
Conclusions The relative effect of DPP-4 inhibitors on the risk of heart failure in patients with type 2 diabetes is uncertain, given the relatively short follow-up and low quality of evidence. Both randomised controlled trials and observational studies, however, suggest that these drugs may increase the risk of hospital admission for heart failure in those patients with existing cardiovascular diseases or multiple risk factors for vascular diseases, compared with no use.
Pioglitazone was incorrectly described as a PPAR-gamma inhibitor in this News story (BMJ 2016;352:i1029, doi:10.1136/bmj.i1029) when it is an agonist. To read the full article, log in using your NHS Athens
To assess the effect of metformin versus placebo both in combination with insulin analogue treatment on changes in carotid intima-media thickness (IMT) in patients with type 2 diabetes. Open Access Article
The objective of this project was to summarise the evidence on the clinical effectiveness and cost-effectiveness of the MiniMed® Paradigm™ Veo system (Medtronic Inc., Northridge, CA, USA) and the Vibe™ (Animas® Corporation, West Chester, PA, USA) and G4® PLATINUM CGM (continuous glucose monitoring) system (Dexcom Inc., San Diego, CA, USA) in comparison with multiple daily insulin injections (MDIs) or continuous subcutaneous insulin infusion (CSII), both with either self-monitoring of blood glucose (SMBG) or CGM, for the management of T1DM in adults and children.
Group clinics for people with diabetes were effective in improving blood sugar levels, blood pressure and diabetes-related quality of life. There was no evidence of group clinics being better than individual appointments for other diabetes outcomes or in other health conditions. This systematic review examined group clinics, rather than individual appointments for the care of people with chronic conditions. Most of the evidence identified was about clinics set up for people with diabetes and came from the US.
Up to 100,000 people in England will be offered places on the world’s first nationwide programme to stop them developing Type 2 diabetes.
Healthier You: the NHS Diabetes Prevention Programme will start this year with a first wave of 27 areas covering 26 million people, half of the population, and making up to 20,000 places available. This will rollout to the whole country by 2020 with an expected 100,000 referrals available each year after.
A letter in a leading journal has sparked controversy by claiming that Indian alternative medicines for diabetes are “maximum hype, minimum science.” To read the full article, log in using your NHS OpenAthens details
Future Hospital Programme case study comes from King’s College Hospital NHS Foundation Trust. It explores the need to integrate both psychological and social interventions into diabetes care for patients with complex psychological needs.
Can diabetes care be improved by choosing carefully which patients need to be seen by specialists and delegating the rest to community based services with enhanced skills? The results are in for the Super Six scheme in Portsmouth, which was designed to do just this, and they are very encouraging, says Partha Kar, consultant at Portsmouth Hospital NHS Trust. To read the full article, log in using your NHS OpenAthens details
Skin grafts and tissue replacement products can help heal diabetic foot ulcers in some cases, and may also slightly reduce the numbers of future amputations. Foot ulcers are common and can be hard to treat, but failure to heal them carries high risk for amputation and mortality
According to charity Diabetes UK, more than four million people are living with diabetes in the UK. Nine out of ten of those have type 2 diabetes, with 200,000 new diagnoses every year. Around £10 billion is spent every year on diabetes care – roughly 10% of total NHS spending. To read the full article, log in using your NHS OpenAthens details
Two primary things should be existed in recipes for diabetes is the low sugar and saturated fats. Changing over most loved recipes into diabetic ones is not only forgetting the sugars use, but also presenting unsaturated fats as well as less refined substances in the menu. You need to know how to convert the ordinary recipes to be recipes for diabetes. Hence, you still can eat a certain menu you love with less scarification.
Millom locals have come together to launch a brand new type two diabetes support group called ‘2s R Us’, with one lady travelling from as far as Barrow to attend.
Community member Karen Jackson-Smith organised the type two diabetes support group following her own diagnosis in August.
Karen became motivated to set up the group after finding out that the nearest support groups were in Lancaster, Preston and Penrith.
She said: “I was really pleased with the turnout at the first group, lots of health concerns were shared which can be addressed at future meetings. It was clear that people are keen to get their diabetes under control and this community-led group will help us to support each other in doing this.”
Type 2 diabetes is increasing in prevalence at a worrying rate and has been exacerbated by the worldwide obesity epidemic. The number of people in the UK diagnosed with type 2 diabetes has soared by 60% in the past 10 years. Type 2 diabetes is a very serious condition, with significant associated risks, and is the leading cause of avoidable macro- and microvascular complications. Health professionals have a key role in enabling and optimising person-centred approaches, educating and augmenting the essential skills every person, whatever his or her individual circumstances, requires for the successful self-management of this lifelong condition. This article reviews approaches to care for the management of hyperglycaemia in type 2 diabetes, which includes optimising person-centred targets, promoting individualised care, minimising the risk of complications and promoting education from diagnosis onwards. To read the full article, log in using your NHS OpenAthens details
The purpose of this small evaluation on five patients presenting to community podiatry services in Birmingham with foot ulceration was to explore common problems associated with diabetes and other high-risk conditions and illustrate the clinical effectiveness and experience of using a chitosan absorbent gelling fibre dressing. To read the full article, log in using your NHS OpenAthens details
In July 2016, recommendation 1.15.1 has been reworded to clarify the role of GPs in referring people for eye screening and also to add information on when this should happen.
The award winning DESMOND is now firmly established as the structured education course of choice for people with Type 2 diabetes and is now being delivered in Europe, Australia and piloted in Qatar. Over 6000 in Cumbria people with Type 2 Diabetes have attended the nationally recognised DESMOND structured education programme since it was launched in the county in 2009. Another 4000 people who were identified at risk of developing Type 2 Diabetes have also attended the DESMOND Walking Away programme. DESMOND is a fundamental element in the treatment pathway of Type 2 Diabetes, providing a high value intervention to support people to take control and self-manage.
The USA and England have joined forces on two films for healthcare professionals to show how they are reducing the combined 90million people living in their countries collectively who are on-track to develop Type 2 diabetes.
Top experts from both sides of the Atlantic shared tactics to reduce the 86 million Americans and 5million people in England at increased risk of developing the disease which can cause blindness and amputation.
Introduction Type 1 diabetes (T1D) is characterised by autoimmune destruction of pancreatic β cells leading to insulin deficiency. Prompt referral to a specialist paediatric diabetes team (PDT) for insulin initiation and further management is important to prevent diabetic ketoacidosis (DKA), which remains the most common cause of death in this condition. To read the full article, log in using your NHS OpenAthens details
In 2007-2010, Sheffield’s diabetes footcare profile showed that their amputation rates were much higher than the England average.
The Sheffield Trust diabetes team identified problems and delays in the patients’ footcare journey by using simple, proven service improvement techniques such as root cause analysis and process mapping.
The consultant diabetologists then led a service redesign, working with members of the footcare team to streamline the referral process.
There were a number of interventions, including the development of a simple inpatient foot screening tool and improving footcare-related patient education.
The team transformed local footcare, reducing amputation rates by 45% over three years.
Alginate dressings are used in current clinical practice to manage exudating wounds that require high moisture absorption, such as burns and pressure ulcers. A Cochrane systematic review performed an extensive systematic search to identify randomized controlled trials assessing alginate compared with alternative wound dressings in people with diabetic foot ulcers but found that the evidence was low quality and too sparse on which to base conclusions on their benefits and harms.
Commentary on:
Libman IM, Miller KM, DiMeglio LA, et al., T1D Exchange Clinic Network Metformin RCT Study Group. Effect of metformin added to insulin on glycemic control among overweight/obese adolescents with type 1 diabetes: a randomized clinical trial. JAMA 2015;314:2241–50.
Context
Weight gain in individuals with type 1 diabetes (T1D) is associated with an increase in other cardiovascular risk factors (eg, hypertension, dyslipidaemia) and increasing insulin resistance, often requiring higher doses of insulin to maintain adequate glycaemic control. The goal of the current study was to explore the use of metformin to improve glycaemic control in overweight and obese adolescents with T1D. To read the full article, log in using your NHS OpenAthens details
To explore the effectiveness of two types of health education on improving knowledge concerning diabetes and insulin injection, insulin injection skills and self-efficacy, satisfaction with health education and glycated hemoglobin (HbA1c) and creatinine levels among patients with type 2 diabetes who began insulin therapy using a pen injector. Login using your SSSFT NHS OpenAthens for full text. SSOTP - You can request a copy of this article by replying to this email. Please ensure you are clear which article you are requesting.
Background In our recently published study, including walnuts in the diets of adults with prediabetes led to overall improvement in diet quality. This report adds to those study findings by examining the food groups displaced during walnut inclusion in the diets of those adults with prediabetes.
Conclusions Our data suggest that walnut inclusion in the diets of adults at risk for diabetes led to an increase in intake of other healthful foods. Open Access Article
The story is based on a study which aimed to see whether taking a 10-minute walk after a main meal resulted in lower blood glucose levels than a single 30-minute walk each day for people with type 2 diabetes.
The study, which involved 41 adults, found that taking shorter, more frequent walks immediately after meals reduced blood glucose by around 12% compared with a single 30-minute walk.
Remission of pre-diabetes to normal is an important health concern which has had little success in the past. This study objective was to determine the effect on remission of pre-diabetes with a high protein (HP) versus high carbohydrate (HC) diet and effects on metabolic parameters, lean and fat body mass in prediabetic, obese subjects after 6 months of dietary intervention. Open Access Article
Objective: This study examined the effect of personalized text messages on physical activity, as measured by a pedometer, and clinical outcomes in a diverse population of patients with T2DM
Reducing carbohydrate, regardless of high or low GI, decreased GA and fructosamine. This suggests that reducing carbohydrate content, rather than GI, is a better strategy for lowering glycemia in adults at risk for diabetes. Open Access Article
Background: Diabetes in pregnancy is a global problem. Technological innovations present exciting opportunities for novel approaches to improve clinical care delivery for gestational and other forms of diabetes in pregnancy.
The award is in recognition of the team’s efforts in perfecting an innovative Hypoglycaemia simulation training programme. The programme forms part of their work at the Royal Cornwall Hospital and could prove to be a lifesaver.
Implications for practice and research
Large-scale acceptance of telemonitoring of patient self-administered tests (eg, glucose, blood pressure) will require attention to how additional workload will be integrated into the workflow of the clinic.
Additional research is required to fine tune telemonitoring interventions, including content, intervention dose, intervention length and appropriate targeting to subpopulations with chronic illness. To read the full article, log in using your NHS OpenAthens details
Microvascular complications (retinopathy, nephropathy, and neuropathy) affect hundreds of millions of patients with type 2 diabetes. They usually affect people with longstanding or uncontrolled disease, but they can also be present at diagnosis or in those yet to have a diagnosis made. The presentation and progression of these complications can lead to loss of visual, renal, and neurologic functions, impaired mobility and cognition, poor quality of life, limitations for employment and productivity, and increased costs for the patient and society. If left uncontrolled or untreated, they lead to irreversible damage and even death. This review focuses on the primary and secondary prevention of diabetic microvascular complications in patients with type 2 diabetes, beyond glycemic control. To read the full article, log in using your NHS OpenAthens details
Continuous glucose monitoring can improve glycaemic control in patients with type 1 diabetes who use insulin injections, two studies published in JAMA have found.12
This consists of a sensor under the skin with a transmitter attached that reports glucose levels continuously to the patient on a handheld monitor. Most patients whose continuous glucose monitoring has been compared with self monitored blood glucose have used insulin pumps, whereas the two new studies were carried out in patients with type 1 diabetes who injected insulin. To read the full article, log in using your NHS OpenAthens details
However, it's important to put these findings in context. Diabetes has previously been linked with pancreatic cancer, though it is unclear why. It could be that diabetes increases the risk of pancreatic cancer. What is probably more likely is that rapid onset or progression of diabetes could be a symptom of the cancer itself.
Diabetes is fairly common in the UK, with around 4 million cases, while pancreatic cancer remains very rare. Just because you have diabetes does not mean you will go on to get pancreatic cancer.
Objective We aimed to describe patterns of weight change in insulin-naive patients with type 2 diabetes mellitus (T2DM) starting basal insulin (BI) treatment.
Conclusions Though BI therapy leads to modest weight gain over the subsequent year, this may be limited by BI initiation at an early stage of the disease. As such, delaying the start of insulin therapy based on fears of weight gain appears counter-productive, and should be reconsidered. Open Access Article
Policies to ‘screen and treat’ people to prevent type 2 diabetes are unlikely to have a substantial effect on the growing diabetes epidemic, say researchers from the University of Oxford. To read the full article, log in using your NHS OpenAthens details
This document summarises the evidence-base on type 2 diabetes mellitus: medicines optimisation priorities. It is a key therapeutic topic which has been identified to support medicines optimisation. It is not formal NICE guidance.
Public health strategies aiming to prevent adult weight gain in the whole population could be twice as effective in reducing the incidence of type 2 diabetes as weight loss strategies targeting only obese people, analysis of a large population based follow-up study has found. To read the full article, log in using your NHS OpenAthens details
This document summarises the evidence-base on safer insulin prescribing. It is a key therapeutic topic which has been identified to support medicines optimisation. It is not formal NICE guidance.
Increasing levels of physical activity decreases the risk of premature mortality associated with chronic diseases e.g., coronary heart disease, type 2 diabetes, stroke. Despite this, most adults in England do not meet physical activity guidelines. Physical activity advice and signposting offered to at-risk patients by primary care providers is recommended. However, exercise medicine education is sparse, leading to poor practitioner knowledge of the risk reduction evidence and strategies to implement effective patient behaviour change. The ‘Generation Games’ intervention seeks physical activity increase in the 50+ population of Oxfordshire. It offers a Health Professional Education Programme (HPEP) providing exercise medicine education, and promotion of Generation Games to which health professionals can signpost patients. There is a poor evidence base concerning how such education translates into patient exercise behaviour change.
Conclusions: Individuals with type 2 diabetes improved their glycemic control and lost more weight after being randomized to a very low-carbohydrate ketogenic diet and lifestyle online program rather than a conventional, low-fat diabetes diet online program. Thus, the online delivery of these very low-carbohydrate ketogenic diet and lifestyle recommendations may allow them to have a wider reach in the successful self-management of type 2 diabetes.
Open access. To describe how diabetes nurses in primary care experience the process of learning to practise the person-centred counselling approach Guided Self-Determination among adults with type 2 diabetes.
Globally, diabetes is increasing with concerns about the impact on outcomes, including premature death and the costs associated with managing the condition. Research indicates that adults with intellectual disabilities (ID) are two to three times more likely to develop diabetes; however, there has been limited focus on diabetes service utilisation in this population. The aim of this study is to explore the perceptions and experiences of diabetes and ID practitioners. Login using your SSSFT NHS OpenAthens for full text. SSOTP - You can request a copy of this article by replying to this email. Please ensure you are clear which article you are requesting.
It has been the generally held viewpoint of clinicians, as well as the recommended positioning of consensus guideline groups (e.g., American Diabetic Association), that diabetes education is an essential component of any comprehensive plan to manage diabetes, predicated on the belief that educational investment results in improved control of diabetes and better outcomes.
Based on 4 studies in 632 participants, individual patient education did not improve glycemic control over a 12 to 18 month period compared with usual care (mean difference −0.08%, 95% CI −0.25% to 0.08%).
Objective To compare the effectiveness of a novel model of care (“Stepping Up”) with usual primary care in normalising insulin initiation for type 2 diabetes, leading to improved glycated haemoglobin (HbA1c) levels. To read the full article, log in using your NHS OpenAthens details
The promotion of a healthy diet, physical activity and measurement of blood glucose levels are essential components in the care for women with gestational diabetes mellitus (GDM). Smartphones offer a new way to promote health behaviour. The main aim is to investigate if the use of the Pregnant+ app, in addition to standard care, results in better blood glucose levels compared with current standard care only, for women with GDM. Open Access Article
The study reported in this article aimed to analyse factors associated with the risk of ulceration in the feet of patients with diabetes using a conceptual hierarchic model. It was a cross-sectional study carried out with 1515 people with diabetes mellitus aged 40 years and older. To read the full article, log in using your NHS OpenAthens details
To validate the European Health Literacy Survey Questionnaire (HLS-EU-Q47) in people with type 2 diabetes mellitus. Login using your SSSFT NHS OpenAthens for full text. SSOTP - You can request a copy of this article by replying to this email. Please ensure you are clear which article you are requesting.
As part of World Diabetes Day which takes place on November 14, the area’s Clinical Commissioning Groups (CCGs) for Staffordshire have announced there will be a number of education sessions available in the New Year for newly diagnosed or existing patients who have type 2 diabetes.
Long-term regular physical activity training was found to be helpful in improving glycemic control, body composition and cardiovascular fitness among patients with T2DM.
Open Access Article
Humans are not mice, and these early findings can't be applied to us. And as metformin is only licensed as a diabetes treatment, we don't know whether it would be safe or appropriate to use it for nicotine withdrawal symptoms.
Also, this study provided no evidence that metformin would be any better than the many well-established treatments to help people quit smoking, such as nicotine replacement therapy.
Objectives To assess the long-term cost-effectiveness of insulin pumps and Dose Adjustment for Normal Eating (pumps+DAFNE) compared with multiple daily insulin injections and DAFNE (MDI+DAFNE) for adults with type 1 diabetes mellitus (T1DM) in the UK. Open Access Article