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The last decade has seen significant advances in the management of type 1 diabetes. The usual management of type 1 diabetes involves ‘physiological’ basal bolus regimens with multiple daily insulin injections, but use of insulin pumps (continuous subcutaneous insulin infusion) is growing. Structured education programmes are of great importance in realizing the potential of the flexible insulin regimens...
The prevalence of diabetes mellitus in the inpatient population is three times greater than in the general population. A significant proportion of inpatient expenditure in the UK is spent on the care of patients with diabetes. Despite this, patients with diabetes stay longer in hospital than patients without diabetes and have increased mortality and morbidity. The emerging evidence is in favour of...
Type 2 diabetes mellitus (T2DM) is a common metabolic disorder characterized by chronic hyperglycemia. It is associated with reduced life expectancy owing to a greater risk of heart disease, stroke, peripheral neuropathy, renal disease, blindness and amputation. The best known predictors of increased diabetes risk are elevated fasting plasma glucose, abnormal glucose tolerance test, obesity and evidence...
Diabetes mellitus represents a set of autoimmune, metabolic and genetic disorders that share one major characteristic, hyperglycaemia. The recommended way of measuring plasma glucose and the threshold used to define what is normal or abnormal have gone through several iterations over the past two decades. These recommendations, and the current definitions of diabetes and intermediate states of hyperglycaemia,...
Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS) remain two of the most commonly encountered metabolic emergencies. They are both potentially life threatening when not managed correctly. DKA occurs most frequently (but not exclusively) in people with type 1 diabetes who are absolutely insulin deficient. HHS (formerly known as HONK – hyperosmolar non-ketotic state) occurs most...
Self-monitoring of blood glucose (SMBG) is an integral part of diabetes care, allowing patients to identify patterns, calculate doses and identify hypoglycaemic or hyperglycaemic excursions. Structured education on interpretation of the results and algorithms to calculate insulin doses, structured and automated approaches to pattern recognition, and automation of data collection through these devices...
The disease burden related to diabetes is high and rising in every country, fuelled by the global rise in the prevalence of obesity and unhealthy lifestyles. The latest estimates show a global prevalence of 382 million people with diabetes in 2013, expected to rise to 592 million by 2035. The aetiological classification of diabetes has now been widely accepted. Type 1 and type 2 diabetes are the two...
Hypoglycaemia is a feared and common unwanted effect of diabetes treated with insulin or sulfonylureas, and is the main reason why insulin-treated individuals often fail to achieve the levels of glycaemic control necessary to prevent diabetic complications. Normal brain function depends upon a continuous supply of glucose. If blood glucose falls below normal, interruption of this supply leads to cerebral...
Type 2 diabetes mellitus (T2DM) is a chronic multifactorial disorder associated with hyperglycaemia and long-term end-organ damage. This end-organ damage is due to hyperglycaemia and the accompanying risk factors such as hypertension, dyslipidaemia and obesity, leading to increased risk of cardiovascular disease and mortality. It is essential to adopt effective multifactorial risk reduction strategies...
Type 1 diabetes mellitus (T1DM) is a chronic disease characterized by hyperglycaemia secondary to inadequate production of insulin by the pancreas. This is the result of T cell-mediated autoimmune destruction of the insulin-producing β cells in the islets of Langerhans, and is associated with circulating autoantibodies to β-cell antigens. The classic clinical presentation of T1DM is an acute onset...
Whereas most people with diabetes mellitus have type 1 (T1DM) or type 2 diabetes (T2DM), there are other inherited forms of diabetes and insulin resistance syndromes, which represent about 2–5% of all cases of diabetes. Monogenic forms of pancreatic β-cell dysfunction include maturity-onset diabetes of the young (MODY) and neonatal diabetes (NDM), with MODY being the most common form of inherited...
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