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‘What sort of diabetes have I got?’ The importance of a label
When an individual receives a diagnosis this precipitates a range of responses which are influenced by the meaning of the diagnosis, or label, to that person and those around them.In this article, Clare Shaban informs health professionals how the impact of these factors can be mitigated by supportive listening, accurate information and emotional support.
‘Type 3’ diabetes: a brain insulin-resistant state linked to Alzheimer’s disease
(click here for the full web article)
Identifying novel sub-type variants of diabetes has always provided a measure of academic interest as well as an engaging area for debate and discussion. Having established the relatively clear-cut classification of type 1 and type 2 diabetes, it was perhaps inevitable that a further category of type 3 diabetes would emerge. In this article, Ken Shaw discusses the intriguing proposal that the term type 3 diabetes could be appropriately applied to an association between a state of brain insulin resistance and dementia.
Severe insulin resistance: pathologies
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In parallel with the increasing prevalence of obesity, rates of insulin resistance and its associated complications have increased; however, insulin resistance is not only a disease of the overweight and obese. This review discusses the differing pathologies mediating insulin resistance that may be seen in clinical practice, and outlines the phenotypic characteristics that may allow their differentiation.
Audrey Melvin, Anna Stears
Diagnosis and management of diabetes in older people
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Older people with diabetes have more than double the risk of cardiovascular disease compared to their non-diabetic peers, and the risk of diabetes-related major lower limb amputation is twice as high in those over 75 years compared with the 40–64 age group. In this article, Anne Kilvert and Charles Fox discuss the ways in which treatment targets for glycaemic control, blood pressure and cholesterol should be individualised in the care of older people.
Anne Kilvert, Charles Fox
Pancreatic exocrine dysfunction: common in type 3c diabetes, but don’t forget types 1 and 2 diabetes mellitus
As specialists in diabetes care, we must be adept at managing pancreatic endocrine failure and its associated complications. However, there is frequent overlap and many patients with diabetes also suffer from exocrine insufficiency. Here Katherine Alington and Michael Cummings outline the different causes of exocrine failure and how this differs from diabetes that is caused by pancreatic exocrine disease: type 3c diabetes.
Katherine Alington, Michael Cummings
Diagnosing monogenic diabetes in clinical practice
Does your patient have monogenic diabetes or some other form of diabetes? In clinical practice, this may not be immediately apparent – and some cases can present a diagnostic dilemma for the diabetes multidisciplinary team. Here, using case examples, Professor Katharine Owen explores the best ways in which to approach such dilemmas and gives practical advice in relation to diagnostic parameters.
Double diabetes: the cardiovascular implications of combining type 1 with type 2 diabetes
The current prevalence of double diabetes is 25%, but this is projected to rise over the next few years. As Dr Steve Cleland here describes, we may need to widen our horizons and learn to spot patients with double diabetes in order to address cardiovascular risk at an earlier stage, and be prepared to use concurrent therapeutic strategies normally reserved for patients with type 2 diabetes.
Type 1 versus type 2 diabetes: is it time for a change?
Is there a case for redefining our classification of diabetes to inform clinical practice for the benefit of patients? Dr Patrick Sharp here explores this key question, and provides practical advice – at the same time evaluating salient parameters which feed into the debate.
Tests aiding diagnosis of monogenic diabetes
Here, Professor Maggie Shepherd, Kevin Colclough and Dr Tim McDonald provide some background on islet autoantibody, C-peptide and genetic tests for use in individuals with diabetes, incorporating what samples are required, practical points to consider and where to find additional information.
Maggie Shepherd, Kevin Colclough, Tim McDonald
Pancreatic autoantibodies: who to test and how to interpret the results
Access to pancreatic autoantibody requests is increasing; however, deciding whom to test and how to interpret results remain unclear. In this article, Dr Shivani Misra explores the evidence base and controversies around pancreatic autoantibody testing, and discusses some recommendations about how to use the test in a clinically meaningful way.