Diabetes

2021 ◽  
pp. 837-980
Author(s):  
Gaya Thanabalasingham ◽  
Alistair Lumb ◽  
Helen Murphy ◽  
Peter Scanlon ◽  
Jodie Buckingham ◽  
...  
Keyword(s):  
Macrovascular Disease ◽  
Eye Disease ◽  
Hospital Inpatient ◽  
Comprehensive Overview ◽  
Recreational Drug Use ◽  
Diabetic Eye Disease ◽  
Inpatient Management ◽  
Sports And Exercise

This chapter provides a comprehensive overview of diabetes care and management. It starts with a classification and diagnosis of diabetes, followed by sections on expert management of both Type 1 and Type 2 diabetes. Living with diabetes is then explored, from sports and exercise, travel, alcohol and recreational drug use, and special considerations such as Ramadan. Hospital inpatient management and diabetes-related emergencies are covered in detail. Diabetes and pregnancy, and paediatric and transition diabetes both have sections explaining common and rare presentations. Finally there are sections on discrete diabetic conditions, such as diabetic eye disease, nephropathy and chronic kidney disease, neuropathy, the diabetic foot, and macrovascular disease.

scholarly journals Epidemiology of visual impairment, sight-threatening or treatment-requiring diabetic eye disease in children and young people in the UK: findings from DECS

2020 ◽  
pp. bjophthalmol-2020-315886
Author(s):  
Maria Carolina Ibanez-Bruron ◽  
Ameenat Lola Solebo ◽  
Phillippa Cumberland ◽  
Jugnoo S Rahi
Keyword(s):  
Young People ◽  
Self Management ◽  
Eye Disease ◽  
Visual Disability ◽  
Children And Young People ◽  
Eye Screening ◽  
Diabetic Eye Disease ◽  
The Uk ◽  
Prevention Of Diabetes

BackgroundWe investigated the incidence and causes of sight-threatening diabetes-related eye disease in children living with diabetes in the UK, to inform the national eye screening programme and enable monitoring of trends.MethodsWe undertook a prospective active national surveillance via the British Ophthalmic Surveillance Unit. Eligible cases were children aged 18 years or younger, with type 1 or 2 diabetes, newly diagnosed between January 2015 and February 2017 with sight-threatening diabetic eye disease.ResultsEight children were reported. The annual incidence of all sight-threatening diabetes-related eye disease requiring referral to an ophthalmologist among children living with diabetes (n=8) in the UK was 1.21 per 10 000 person-years (95% CI 0.52 to 2.39) and was largely attributable to cataract (n=5) 0.76 per 10 000 person-years (95% CI 0.25 to 1.77). The incidence of sight-threatening diabetic retinopathy (n=3) among those eligible for screening (12 to 18 year-olds living with diabetes) was 1.18 per 10 000 person-years (95% CI 0.24 to 3.46). No subjects eligible for certification as visually impaired or blind were reported.ConclusionsSecondary prevention of visual disability due to retinopathy is currently the sole purpose of national eye screening programmes globally. However, the rarity of treatment-requiring retinopathy in children/young people living with diabetes, alongside growing concerns about suboptimal screening uptake, merit new consideration of the utility of screening for primary prevention of diabetes-related morbidity by using the screening event and findings as a catalyst for better diabetes self-management.

scholarly journals Insulin therapy in the hospital setting: a time for a change?

2016 ◽  
Vol 10 (1) ◽  
pp. 23
Author(s):  
Ada Maffettone ◽  
Massimo Rinaldi ◽  
Luigi Ussano ◽  
Andrea Fontanella
Keyword(s):  
Hospital Setting ◽  
The Other ◽  
Hospital Inpatient ◽  
Insulin Administration ◽  
Diabetes Treatment ◽  
Successful Management ◽  
Pros And Cons ◽  
Insulin Pens

The number of people with diabetes mellitus worldwide is expected to be more than double from 171 million in 2000 to 366 million in 2030. Approximately 25% of all hospital inpatient days are affected by diabetes. In Italy there are more than 12,000 hospitalizations excesses for 100,000 people per year, with a huge economic impact. Ever since its discovery in the 1920s, insulin has been the milestone of type 1 diabetes treatment and its use is increasingly necessary for the successful management of type 2 diabetes. Often patients believe that injecting insulin can be painful, inconvenient and embarrassing; generally they are afraid of gaining weight and of hypoglycemia. On the other side, physician’s concerns regarding insulin administration include potential dosing errors and patient non-compliance. Ever since its discovery in the mid-1920s, insulin was administered subcutaneously using a vial and syringe. In 1985 the first pen device was launched. Currently disposable insulin pens are the most used and preferred by patients in the daily use, but are not routinely used for diabetic inpatients. In this paper we will focus on the pros and cons of insulin administration with pens in the hospital setting.

scholarly journals Waist-Height Ratio and the Risk of Severe Diabetic Eye Disease in Type 1 Diabetes: A 15-Year Cohort Study

2021 ◽  
Author(s):  
Erika B Parente ◽  
Valma Harjutsalo ◽  
Carol Forsblom ◽  
Per-Henrik Groop
Keyword(s):  
Type 1 Diabetes ◽  
Body Composition ◽  
Regression Analysis ◽  
Eye Disease ◽  
Composition Analysis ◽  
Height Ratio ◽  
Diabetic Eye Disease ◽  
Android Fat ◽  
Waist Height Ratio

Abstract Context Obesity prevalence has increased in type 1 diabetes (T1D). However, the relationship between body composition and severe diabetic eye disease (SDED) is unknown. Objective To investigate the associations between body composition and SDED in adults with T1D. Methods From 5401 adults with T1D in the Finnish Diabetic Nephropathy Study, we assessed 3468, and 437 underwent dual-energy X-ray absorptiometry for body composition analysis. The composite outcome was SDED, defined as proliferative retinopathy, laser treatment, antivascular endothelial growth factor treatment, diabetic maculopathy, vitreous hemorrhage, and vitrectomy. Logistic regression analysis evaluated the associations between body composition and SDED. Multivariable Cox regression analysis assessed the associations between the anthropometric measures and SDED. Subgroup analysis was performed by stages of albuminuria. The relevance ranking of each variable was based on the z statistic. Results During a median follow-up of 14.5 (interquartile range 7.8-17.5) years, 886 SDED events occurred. Visceral/android fat ratio was associated with SDED [odds ratio (OR) 1.40, z = 3.13], as well as the percentages of visceral (OR 1.80, z = 2.45) and android fat (OR 1.28, z = 2.08) but not the total body fat percentage. Waist-height ratio (WHtR) showed the strongest association with the SDED risk [hazard ratio (HR) = 1.28, z = 3.73], followed by the waist (HR 1.01, z = 3.03), body mass index (HR 1.03, z = 2.33), and waist-hip ratio (HR 1.15, z = 2.22). The results were similar in normo- and microalbuminuria but not significant in macroalbuminuria. A WHtR ≥ 0.5 increased the SDED risk by 28% at the normo- and microalbuminuria stages. Conclusions WHtR, a hallmark of central obesity, is associated with SDED in individuals with T1D.

PREVALENCE OF ADVANCED DIABETIC EYE DISEASE AND ITS ASSOCIATED RISK FACTORS IN TYPE 2 DIABETES MELLITUS

2021 ◽  
pp. 25-29
Author(s):  
Likathung Ngullie ◽  
Bratatee Roy ◽  
Sayantan Ghosh ◽  
Sneha Jain ◽  
Lakshmi Kanta Mondal
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Current Knowledge ◽  
Eye Disease ◽  
Care Centre ◽  
Eye Care ◽  
Diabetic Eye Disease

Purpose:To determine the prevalence of advanced diabetic eye disease (ADED ) in patients with type 2 diabetes mellitus (DM) attending a tertiary eye care centre in eastern India and the risk factors associated with the disease. Methods: All patients of type 2 DM attending at the out-patient-department of a tertiary eye care centre, with any stage of diabetic retinopathy (DR) were recruited for this study. Examination was carried out with the help of slit-lamp biomicroscope with +90D lens, direct and indirect ophthalmoscopy, Snellen's chart, refraction trial lens and B-scan Ultrasonography. Medical records were reviewed and data were extracted. Results: Out of 200 patients with DR, 22 patients presented with advanced diabetic eye disease (ADED). Thus, the prevalence of ADED in this study was 11%. Those with increased age of presentation, long duration of DM, deranged HbA1c and lipid prole are at signicantly higher risk of presenting with ADED. Conclusion: Prevalence of 11 % of ADED in patients with DM attending a tertiary eye care centre shows that this condition continues to be a major social problem despite current knowledge about advanced DR.

scholarly journals Management of diabetes complications in youth

2019 ◽  
Vol 10 ◽  
pp. 204201881986322 ◽  
Author(s):  
Lara E. Graves ◽  
Kim C. Donaghue
Keyword(s):  
Type 2 Diabetes ◽  
Type 1 Diabetes ◽  
Diabetes Complications ◽  
Microvascular Complications ◽  
Macrovascular Disease ◽  
Macrovascular Complications ◽  
Invasive Treatment ◽  
Positive Effects

Type 1 and type 2 diabetes are increasing in prevalence and diabetes complications are common. Diabetes complications are rarely studied in youth, despite the potential onset in childhood. Microvascular complications of diabetes include retinopathy, diabetic kidney disease or nephropathy, and neuropathy that may be somatic or autonomic. Macrovascular disease is the leading cause of death in patients with type 1 diabetes. Strict glycaemic control will reduce microvascular and macrovascular complications; however, they may still manifest in youth. This article discusses the diagnosis and treatment of complications that arise from type 1 and type 2 diabetes mellitus in youth. Screening for complications is paramount as early intervention improves outcome. Screening should commence from 11 years of age depending on the duration of type 1 diabetes or at diagnosis for patients with type 2 diabetes. Diabetic retinopathy may require invasive treatment such as laser therapy or intravitreal antivascular endothelial growth factor therapy to prevent future blindness. Hypertension and albuminuria may herald diabetic nephropathy and require management with angiotensin converting enzyme (ACE) inhibition. In addition to hypertension, dyslipidaemia must be treated to reduce macrovascular complications. Interventional trials aimed at examining the treatment of diabetes complications in youth are few. Statins, ACE inhibitors and metformin have been successfully trialled in adolescents with type 1 diabetes with positive effects on lipid profile, microalbuminuria and measures of vascular health. Although relatively rare, complications do occur in youth and further research into effective treatment for diabetes complications, particularly therapeutics in children in addition to prevention strategies is required.

Rates of Eye Care and Diabetic Eye Disease among Insured Patients with Newly Diagnosed Type 2 Diabetes

2020 ◽  
Author(s):  
William S. Gange ◽  
Benjamin Y. Xu ◽  
Khristina Lung ◽  
Brian C. Toy ◽  
Seth A. Seabury
Keyword(s):  
Type 2 Diabetes ◽  
Eye Disease ◽  
Newly Diagnosed ◽  
Eye Care ◽  
Diabetic Eye Disease ◽  
Insured Patients

scholarly journals Autoimmmune hepatitis

2021 ◽  
Author(s):  
Benedetta Terziroli Beretta-Piccoli ◽  
Giorgina Mieli-Vergani ◽  
Diego Vergani
Keyword(s):  
Mhc Class Ii ◽  
Late Onset ◽  
Immunosuppressive Treatment ◽  
Elevated Serum ◽  
Clinical Aspects ◽  
Comprehensive Overview ◽  
Insufficient Response ◽  
Circulating Autoantibodies

AbstractAutoimmune hepatitis (AIH) is a T-cell mediated, inflammatory liver disease affecting all ages and characterized by female preponderance, elevated serum transaminase and immunoglobulin G levels, positive circulating autoantibodies, and presence of interface hepatitis at liver histology. AIH type 1, affecting both adults and children, is defined by positive anti-nuclear and/or anti-smooth muscle antibodies, while type 2 AIH, affecting mostly children, is defined by positive anti-liver-kidney microsomal type 1 and/or anti-liver cytosol type 1 antibody. While the autoantigens of type 2 AIH are well defined, being the cytochrome P4502D6 (CYP2D6) and the formiminotransferase cyclodeaminase (FTCD), in type 1 AIH they remain to be identified. AIH-1 predisposition is conferred by possession of the MHC class II HLA DRB1*03 at all ages, while DRB1*04 predisposes to late onset disease; AIH-2 is associated with possession of DRB1*07 and DRB1*03. The majority of patients responds well to standard immunosuppressive treatment, based on steroid and azathioprine; second- and third-line drugs should be considered in case of intolerance or insufficient response. This review offers a comprehensive overview of pathophysiological and clinical aspects of AIH.

Issues Surrounding Tight Glycemic Control in People with Type 2 Diabetes Mellitus

1998 ◽  
Vol 32 (9) ◽  
pp. 896-905 ◽  
Author(s):  
Joli D Cerveny ◽  
Rachel D Leder ◽  
C Wayne Weart
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Macrovascular Disease ◽  
Tight Glycemic Control ◽  
Macrovascular Complications ◽  
Cooperative Study

OBJECTIVE: To review the prospective evidence surrounding the issue of tight glycemic control in people with type 2 diabetes mellitus and resultant long-term complications. DATA SOURCE: Conference proceedings and a MEDLINE search (1966–February 1998) identified pertinent English-language publications on type 2 diabetes in humans. Key search terms included insulin resistance, diabetes mellitus, non-insulin-dependent, macrovascular complications, microvascular complications, and intensive glycemic control. STUDY SELECTION: Selection of prospective epidemiologic and clinical studies were limited to those focusing on the management of type 2 diabetes. All articles with pertinent information relevant to the scope of this article were reviewed. DATA SYNTHESIS: The pathophysiology of type 1 and type 2 diabetes differ; however, both share chronic complications that significantly affect morbidity and mortality. People with type 1 diabetes have an absolute deficiency of insulin, whereas people with type 2 diabetes have varying degrees of insulin resistance and an inadequate compensatory insulin secretory response. The Diabetes Control and Complications Trial (DCCT) has clearly indicated that intense control of blood glucose in type 1 diabetes prevents and slows the progression of microvascular (i.e., retinopathy, nephropathy) and neuropathic complications. The Kumamoto study showed similar results in nonobese patients with type 2 diabetes. Intense insulin therapy in both populations has proven advantageous, thus supporting a common pathophysiologic process for the microvascular and neuropathic complications. Trends were seen toward fewer macrovascular (atherosclerotic disease) complications in the intensive insulin arm of the DCCT. Conversely, trends were seen toward an increase in macrovascular complications in the VA Cooperative study in people with type 2 diabetes using intensive insulin therapy. This may suggest a discordance in the pathophysiology of macrovascular disease between type 1 and type 2 diabetes. Additionally, it remains uncertain whether tight glycemic control prevents the onset or slows the progression of macrovascular disease. Two studies (the University Group Diabetes Program and the Veterans Affairs Cooperative Study on Glycemic Control and Complications in Type 2 Diabetes) to date have examined pharmacotherapy options for patients with type 2 diabetes and resultant macrovascular complications. It has yet to be determined whether any therapeutic intervention will decrease the morbidity and mortality of macrovascular disease in this population. CONCLUSIONS: In type 2 diabetes, limited prospective evidence does support tight glycemic control to help prevent or slow the progression of microvascular and neuropathic complications. It is uncertain whether tight glycemic control decreases macrovascular complications and which pharmacotherapeutic agent(s) is/are the best options. However, therapy that improves glucose control in combination with aggressive risk factor management should be initiated and enforced in patients with type 2 diabetes in an effort to reduce long-term complications.

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