Copyright © 2013 John Wiley & Sons. Practical Diabetes 2013; 30(4): 151–153 “
“The incidence of major amputation in diabetes varies up to 10-fold between primary care trusts (PCTs) in England. Historically, there have
been concerns about the reliability of databases which are used to obtain such figures, but the available evidence suggests that the documented variation is likely to be real. While a high prevalence of ethnic minorities may contribute to the low incidence observed in some PCTs, it is also thought the variation may relate largely to the structure of available specialist services. This paper reviews the factors which need to be considered in exploring possible explanations for the variation which has been observed. Copyright © 2012 John Wiley & Sons. “
“The electronic age is bringing advances in the treatment of diabetes, and this is important because the
complications of diabetes remain Buparlisib concentration Enzalutamide price despite the availability of effective therapeutic tools such as insulin. These developments focus on the need to deliver accurately timed and sized doses for predicted blood glucose levels. In this review, blood monitoring methods are discussed since, although the chemistry remains based on the enzymic oxidation of glucose, the display, storage and manipulation of data have transformed recently to engage with smartphone users. Continuous glucose monitoring sensing (CGMS) types are described along with an appreciation of the shortcomings of sensor technology. The discussion includes responses to other barriers to CGMS use for reducing the HbA1c value safely so that hypoglycaemia can be avoided. The newer pumps and the emergence of the minimalised patch pumps and patch pens are described. This includes the moves to attract more type 2 users to pump use, addresses the perceived obtrusiveness noted by younger users, and reviews the obstacles to rolling out pump use more widely in the UK. Penultimately, after reference to
islet implants, the combination of the continuous sensing and conventional pump strategies to form a closed Org 27569 loop system is described, including a summary of the electronic algorithms and the clinical performance of systems in research settings. The review closes with an explanation of how other closed loop systems have been developed including the peritoneal Medtronic and the DiaPort and a smart gel, non-electronic design. Copyright © 2013 John Wiley & Sons. “
“Type 2 diabetes is common and is associated with progressive beta cell loss, insulin deficiency, organ damage and effects on mental health and wellbeing. The current management focus is on stringent blood glucose control (HbA1c <7% [53mmol/mol]) and early insulin initiation. Insulin is a high-risk medicine and is associated with a high rate of errors, adverse events and admissions to hospital.