Practical Diabetes Care

✍ Scribed by David Levy

• Publisher: Wiley-Blackwell
• Year: 2018
• Tongue: English
• Leaves: 467
• Edition: 4
• Category: Library

✦ Table of Contents

fmatter
Untitled
©
Contents
Acknowledgments
Introduction
Clinical trials and organizations:abbreviations and acronyms
1 Classification, diagnosis and presentation, 1
Key points
A PRACTICAL CLASSIFICATION OF DIABETES
TYPE 1 DIABETES
Table 1.1 Phenotypic features of Type 1 diabetes.
Epidemiology; Type 1 diabetes in China
Further clinical pointers to Type 1 diabetes
AUTOIMMUNE ASSOCIATIONS OF TYPE 1 DIABETES
Box 1.1 Autoimmune conditions associated with Type 1 diabetes.
TYPE 2 DIABETES
Table 1.2 Diagnosing Type 2 diabetes in adults.
Latent autoimmune diabetes of adults (LADA): a valuable epidemiologicalconcept, but of limited value in immediate clinical decision‐making
Figure 1.1 Prevalence of Type 2 diabetes in the United Kingdom by ethnicity (age‐ and sex‐standardized).
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3 Infections and the diabetic foot, 49
4 Eyes and kidneys, 77
5 Neuropathy, musculoskeletal and skin, 115
6 Diabetes and the cardiovascular system, 141
7 Type 1 diabetes: glycaemic control, 171
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9 Type 2 diabetes: weight loss, exercise and other ‘lifestyle’
10 Type 2 diabetes: glycaemic control, 241
Key points
INTRODUCTION
THE PROGRESSIVE NATURE OF TYPE 2 DIABETES
Practice point:
GLYCAEMIC CONTROL AND COMPLICATIONS IN TYPE 2DIABETES
Microvascular complications
UKPDS
VADT, ACCORD, ADVANCE
Practice point
Macrovascular complications
VADT, ACCORD, ADVANCE
Multimodal intervention (Steno‐2)
Practice point
TARGETS FOR GLYCAEMIC CONTROL INTYPE 2 DIABETES
Box 10.1 UK (NICE) and USA (ADA) targets for glycaemic control.
SELF‐MONITORING OF BLOOD GLUCOSE INTYPE 2 DIABETES
PHARMACOLOGICAL MANAGEMENTOF HYPERGLYCAEMIA
Table 10.1 Drugs, patents and long‐term cardiovascular benefits.
INTENSIFICATION OF TREATMENT IN TYPE 2 DIABETES
GLYCAEMIC EFFICACY (MAGNITUDEOF ANTIHYPERGLYCAEMIC EFFECT) (TABLE 10.2)
Figure 10.2 Intensification of antihyperglycaemic treatment. Source: from NICE guidelineNG28, 2015.
Tableˇ10.2 Thumbnail characteristics ofdiabetes agents (adapted fromADA).
Durability of effect
METFORMIN
Glycaemic efficiency and durability
Practice point
Practice point
Effects on weight and risk of hypoglycaemia
Side effects
Practice point
Metformin and renal impairment
Table 10.3 Metformin dosing in CKD.
Practice point
Metformin in liver disease
Lactic acidosis
Contrast‐induced nephropathy and lactic acidosis
Vitamin B12 deficiency
AGENTS TO BE USED AFTER METFORMIN
SULFONYLUREAS AND PRANDIAL GLUCOSE REGULATORS(MEGLITINIDES)
Key practice points
Mechanism of action
Glycaemic efficiency and durability
Effects on weight and hypoglycaemia
Figure 10.4 Glycaemic control in the patients in the ADVANCE trial. Glycaemia is stablethroughout in all groups, with no evidence for glycaemic failure in those on gliclazide monotherapy.
Practice point
Practice point
Box 10.2 Clinical characteristics of patients developing severe sulfonylurea‐relatedhypoglycaemia.
Non‐glycaemic effects
Drug interactions
Meglitinides: repaglinide and nateglinide
DRUGS ACTING ON THE INCRETIN SYSTEM
DPP‐4 INHIBITORS (GLIPTINS)
Glycaemic efficiency and durability
Practice point
Table 10.4 Dosing of DPP‐4 inhibitors (gliptins) in renal impairment.
Effects on weight and risk of hypoglycaemia
Non‐glycaemic effects and adverse effects
GLP-1-RECEPTOR AGONISTS
Tableˇ10.5 GLP˙1˙receptor agonist drugs.
Glycaemic efficiency and durability
GLP‐1‐receptor agonists in long‐duration trials
Practice point
NICE Guidance (2010/2015–2016)
Continuous subcutaneous exenatide
Effects on weight and risk of hypoglycaemia
Hypoglycaemia
Practice point
Cardiovascular outcomes in long‐term studies of patients with establishedvascular disease
Practice point
Side effects
Table 10.6 Clinical characteristics of patients recruited into long‐term cardiovascular outcomestudies with GLP‐1‐receptor agonists liraglutide (LEADER), semaglutide (SUSTAIN‐6),and exenatide (ELIXA), and the SGLT2‐inhibitor empagliflozin (EMPA REG OUTCOME).
Pancreatic
SGLT2 INHIBITORS (‘FLOZINS’)
Key practice points
Glycaemic efficiency and durability
Table 10.7 SGLT2 inhibitor drugs.
Effects on weight and risk of hypoglycaemia
Non‐glycaemic effects
Practice point
Side effects
Genito‐urinary and bones
Practice point
Normoglycaemic diabetic ketoacidosis
Practice point
OTHER NON‐INSULIN AGENTS
Acarbose: α‐glucosidase inhibitors
Pramlintide and bromocriptine
Colesevelam
INSULIN TREATMENT
11 Hypertension, 315
12 Lipids, 359
13 Clinical aspects of the metabolic syndrome, 387
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index