Authors' conclusions
Based on the studies included in this review, the overall therapeutic effect of skin grafts and tissue replacements used in conjunction with standard care shows an increase in the healing rate of foot ulcers and slightly fewer amputations in people with diabetes compared with standard care alone. However, the data available to us was insufficient for us to draw conclusions on the effectiveness of different types of skin grafts or tissue replacement therapies. In addition, evidence of long term effectiveness is lacking and cost-effectiveness is uncertain.
NHS England has published a non-mandatory diabetes transition service specification that sets out a best practice provision model for services for children and young people with diabetes.
Conclusions Low-density lipoprotein cholesterol may improve our understanding of fractures in diabetes patients, and it may be added to current fracture risk models in diabetes patients.
Conclusions NMA comparisons are useful in the absence of direct randomised controlled data. This NMA suggests that Gla-300 is also associated with a significantly lower risk of nocturnal hypoglycaemia compared with NPH and premixed insulin, with glycaemic control comparable to available basal insulin comparators.
NHS England has published a non-mandatory diabetes transition service specification that sets out a best practice provision model for services for children and young people with diabetes.
The document is intended to support commissioners in improving outcomes and has been developed to support improvements to existing children and young people’s and adult diabetes services to ensure that they take account of the needs of people up to the age of 25.
Based on NICE guidance and quality standards the potential indicators, now open for consultation, aim to improve healthcare by supporting both national frameworks and local quality improvement initiatives.
They are developed to be used by GP practices and CCGs for service development and improvement as well as for the Quality and Outcomes Framework (QOF) and the CCG Outcome Indicator Set (CCG OIS).
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.
Conclusions In people with diabetes, RAS blockers are not superior to other antihypertensive drug classes such as thiazides, calcium channel blockers, and β blockers at reducing the risk of hard cardiovascular and renal endpoints.
Patients with diabetes need better blood pressure control, not more debate about the relative merits of different drugs. To read the full article, log in using your NHS Athens
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Women who eat potatoes before pregnancy have an increased risk of developing gestational diabetes, new study results suggest. To read the full article, log in using your NHS Athens
To ascertain the extent of socioeconomic and health condition inequalities in people with diagnosed and undiagnosed diabetes and impaired glucose regulation (IGR) in random samples of the general population in England, as earlier diagnosis of diabetes and treatment of people with IGR can reduce adverse sequelae of diabetes. Various screening instruments were compared to identify IGR, in addition to undiagnosed diabetes. To read the full article, log in using your NHS Athens
Capillary blood glucose measurements are regularly used for nursing home residents with diabetes. The usefulness of these measurements relies on clear indications for use, correct measurement techniques, proper documentation and clinical use of the resulting blood glucose values. The use of a regular, invasive procedure may also entail additional challenges in a population of older, multimorbid patients who often suffer from cognitive impairment or dementia. The aim of this study was to explore the perspectives of physicians, registered nurses and auxiliary nurses on the use, usefulness and potential challenges of using capillary blood glucose measurements in nursing homes, and the procedures for doing so. Open Access Article
Commentary on:
Herrera KM, Rosenn BM, Foroutan J, et al. Randomized controlled trial of insulin detemir versus NPH for the treatment of pregnant women with diabetes. Am J Obstet Gynecol 2015;213:426.e1–7.
Context
Pregestational diabetes (pre-GDM) and gestational diabetes mellitus (GDM) affect as many as 1.3% and 9.2% of pregnancies, respectively.1 ,2 Hyperglycaemia during pregnancy has been associated with a two to three times increased risk of congenital defects and with the rate of macrosomia and stillbirth in the fetus and preeclampsia in the mother compared with pregnancies in a non-diabetic population.3 The risk of maternal and fetal complications is closely related to poor glycemic control, in particular postprandial hyperglycaemia.3 Current guidelines recommend intensification of glycemic control for at least 3 months before pregnancy in women with type 1 and type 2 diabetes.3 To achieve these goals, most patients are treated with multidose insulin injections with a combination of basal and prandial insulin. However, … To read the full article, log in using your NHS Athens
Importantly, the study doesn’t tell us if people’s sedentary behaviour led to them getting diabetes, or whether people became more sedentary after getting diabetes. However, it provides more evidence that spending a lot of time physically inactive is likely to be bad for our health.
There were fewer heart attacks and strokes when people with cardiovascular conditions, diabetes or kidney disease followed lower blood pressure targets than usually recommended. This came at the expense of only a small increase in rates of severe low blood pressure.