Diabetes

Practical Approach to Initiating SGLT2 Inhibitors in Type 2 Diabetes

Practical Approach to Initiating SGLT2 Inhibitors in Type 2 Diabetes

Sodium-glucose co-transporter 2 (SGLT2) inhibitors are an attractive novel therapeutic option for the treatment of type 2 diabetes. They block the reabsorption of filtered glucose in kidneys, mainly in proximal renal tubules, resulting in increased urinary glucose excretion and correction of the diabetesrelated hyperglycemia. Beyond improving glucose control, SGLT2 inhibitors offer potential benefits by reducing body weight and blood pressure. On the basis of the efficacy demonstrated in clinical trials, SGLT2 inhibitors are recommended as second- or third-line agents for the management of patients with type 2 diabetes.

Modern Medicine – June/July 2018

July 17, 2018 by Diabetes

Managing Lipid Abnormalities in Type 2 Diabetes

Managing Lipid Abnormalities in Type 2 Diabetes

Lipid abnormalities are present in over 60% of people with diabetes. The decision to initiate lipid lowering treatment should be based on absolute cardiovascular risk. Calculation of cardiovascular risk is appropriate in most people with diabetes. Statins are firstline therapy for prevention of cardiovascular disease in people with diabetes. Elevated triglyceride levels are common in people with diabetes and treatment may be beneficial in some patients.

Modern Medicine – May/June 2018

July 9, 2018 by Diabetes

Investigating New Diabetes in Young Adults

Investigating New Diabetes in Young Adults – MM1607

Distinguishing type 1 and type 2 diabetes in young adults is becoming difficult given the increase in obesity in this age group and deviation of cases from recognised phenotypes. Patients presenting with hyperglycaemia and ketosis should be diagnosed with type 1 diabetes and regarded as insulin deficient. Further management should be supervised by an endocrinologist. The presence of autoantibodies confirms the diagnosis of type 1 diabetes. The absence of autoantibodies does not exclude the diagnosis as up to 5% of patients with type 1 diabetes may be negative for autoantibodies. There is an increasing overlap between type 1 and type 2 diabetes despite their differing aetiologies.

Modern Medicine – July 2016

July 22, 2016 by Diabetes

Diabetes Management in Aged Care Facilities | Meeting the Challenges

Diabetes Management in Aged Care Facilities | Meeting the Challenges – MM1606

Diabetes is a common disease that GPs will encounter in patients in institutional care, particularly residential aged care facilities (RACFs). Elderly patients with diabetes benefit from a team approach to management.
The approach to diabetes management should be tailored to each individual patient. Institutions are not all the same: in-house staffing, supports and services vary and need to be well understood to manage chronic diseases effectively. In elderly people with a short life expectancy, excessively tight diabetes control is not recommended. De-prescribing can be difficult but should be considered for every older person with diabetes in institutional care.

Modern Medicine – June 2016

June 30, 2016 by Diabetes Geriantology Gerontology

Diabetes and Mental Illness Challenges and practical progress

Diabetes and Mental Illness Challenges and practical progress – MM1603

Severe mental illnesses are associated with premature death and accelerated
cardiometabolic disease. Diabetes contributes substantially to the health burden in severe mental illness, with glycaemic, lipid and hypertension control often below the targets accepted as standard of care. Treatment disparities and unmet health needs are common and contribute to poorer health outcomes.

Screening for diabetes with measurement of fasting glucose levels and/or
HbA1c should be undertaken every six months in people with severe mental
illness. If weight gain occurs in this group, lifestyle strategies to prevent diabetes should be undertaken, with support and follow up.

People with severe mental illness and diabetes should be considered as a
‘special needs’ group, requiring longer, more frequent appointments with regula follow up. Assumptions should not be made about a patient’s healthy behaviour literacy, access to healthy food and food preparation facilities and knowledge and skill sets necessary to prepare healthy meals. People with severe mental illness and diabetes may require supported training in these areas.

Modern Medicine – March 2016

March 18, 2016 by Diabetes Psychiatry

Grappling with Hypertriglyceridaemia Rosetta Stone or Pandora’s Box?

Grappling with Hypertriglyceridaemia Rosetta Stone or Pandora’s Box? – MM1506

Hypertriglyceridaemia is caused by interactions between many genetic and nongenetic factors and is a common risk factor for atherosclerotic cardiovascular disease (CVD). Treatment of hypertriglyceridaemia relies on correcting secondary factors and unhealthy lifestyle habits, particularly poor diet and lack of exercise. Pharmacotherapy is indicated for patients with established CVD and those at moderate-to-high risk of CVD.

Modern Medicine – June 2015

June 23, 2015 by Cardiology Diabetes Obesity

Management of Diabetes-Related Foot Ulcers: Optimising Outcomes

Management of Diabetes-Related Foot Ulcers: Optimising Outcomes – MM1505

Timely referral of patients to specialist multidisciplinary foot care services for intensive, comprehensive treatment of new onset foot ulcers is key to optimising outcomes. Continuity of care between the primary care setting and hospital services should be seamless to prevent unnecessary delays and to improve outcomes in affected patients.

Modern Medicine – May 2015

May 26, 2015 by Diabetes Woundcare

Diabetes as the Years Progress: How Does Management Differ?

Diabetes as the Years Progress: How Does Management Differ? – MM1502

It is important to recognise the various functional, medical and social issues that the elderly population with diabetes face and to use the expertise of multiple disciplines to deliver a safe and effective management plan, which needs to be as simple to follow as possible.

Modern Medicine – February 2015

February 24, 2015 by Diabetes Endocrinology Gerontology

Game Changers in Type 2 Diabetes: Adding Insulin to Hypoglycaemics

Game Changers in Type 2 Diabetes: Adding Insulin to Hypoglycaemics – MM1408

The first three medication steps in long-term glycaemic control for people with type 2 diabetes are relatively easy – the use of one, then two and then three hypoglycaemic agents – but doctors and patients are often reluctant to take the next step and may unnecessarily delay starting insulin therapy.

Modern Medicine – August 2014

August 20, 2014 by Diabetes Endocrinology
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