Diabetes

The SGLT2 inhibitors - where are we now? (2017)

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Type of publication:
Journal article

Author(s):
*Morris, David

Citation:
Journal of Diabetes Nursing; Jun 2017; vol. 21 (no. 5); p. 162-167

Abstract:
Sodium–glucose cotransporter 2 (SGLT2) inhibitors are once-daily oral agents effective in treating hyperglycaemia in people with type 2 diabetes, with additional benefits including weight loss and a low risk of hypoglycaemia. This review provides a basic guide to the SGLT2 inhibitors licensed in the UK, including their mechanism of action, benefits, adverse effects and limitations, and place in treatment. Advice on avoiding the rare but serious adverse effect of diabetic ketoacidosis is also provided.

Link to full-text: http://www.thejournalofdiabetesnursing.co.uk/media/content/_master/4984/files/pdf/jdn_21-5_162-7.pdf

Managing problems with medications for type 2 diabetes (2017)

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Type of publication:
Journal article

Author(s):
*Morris, David

Citation:
Practice Nursing; Apr 2017; vol. 28 (no. 4); p. 148-152

Abstract:
The most recent National Institue for Health and Care Excellence (NICE) and European Association for the Study of Diabetes guidelines on management of type 2 diabetes (NICE, 2015; Inzucchi et al, 2015) emphasise the need to individualise glycemic targets and treatments, and highlight that working in partnership with the person concerned should be central to decision making. In addition to assessing the likely efficacy of a treatment, consideration should be given to tolerability and safety. The possibility of medication problems and side- effects needs to be anticipated and if a medication is chosen then a means for identifying and dealing with these should be considered in advance. Most adverse drug reactions are predictable and dose- dependent, the exception being allergic reactions. This article will consider problems arising with medications used for type 2 diabetes, excluding insulin.

Overview of diabetes... This reflective account is based on NS852 Mayo P (2016) An overview of diabetes (2017)

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Type of publication:
Journal article

Author(s):
*Ponomarenko-Jones, Rosalind

Citation:
Nursing Standard; May 2017; vol. 31 (no. 36); p. 64-65

Abstract:
The article presents a reflective account of how a continuing professional development (CPD) article improved Rosalind Ponomarenko-Jones's knowledge of the pathophysiology, symptoms and diagnosis of diabetes. Topics discussed include the nature of the CPD activity, lesson learned from the CPD activity and how she changed or improved her practice.

Best practice in management of type 2 diabetes (2016)

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Type of publication:
Journal article

Author(s):
*Morris, David Stuart

Citation:
Nurse Prescribing, 2016, vol./is. 14/Sup10(0-5)

Abstract:
This article will highlight best practice in managing type 2 diabetes in adults. HbA1c is the preferred diagnostic test for type 2 diabetes, the threshold for diagnosis being 48 mmol/ mol. Structured education is the cornerstone of management of type 2 diabetes with a focus on diet, exercise and weight loss. Multiple risk factors for complications need to be addressed including hypertension, dyslipidaemia and smoking (the most important factors in targeting macrovascular disease) and hyperglycaemia (more important in targeting microvascular disease). It is important to recognise that HbA1c targets need to be individualised. Metformin remains the first-line drug for hyperglycaemia in type 2 diabetes. Sulphonylureas, pioglitazone, DPP-4 inhibitors and SGLT-2 inhibitors are all recommended as possible add-on therapies to metformin, the choice again depending on individual circumstances. GLP-1 agonists and insulin can be considered in more intractable cases of hyperglycaemia.

New-onset diabetes after renal transplant (NODAT) presenting as diabetic ketoacidosis (DKA) in a patient with sickle cell disease (2015)

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Type of publication:
Conference abstract

Author(s):
*Kaldindi S.R., *Moulik P., *Macleod A.

Citation:
Diabetic Medicine, March 2015, vol./is. 32/(117-118)

Abstract:
A 42-year-old Afro-Caribbean female presented with 1 week history of polyuria, polydypsia and vomiting. She had a background of transfusion associated iron overload and renal failure secondary to sickle cell disease. She underwent a live donor renal transplant 8 months prior to admission. Immunosuppressive therapy included tacrolimus, mycophenolate, prednisolone 5mg once a day. There was no family history of diabetes. She had a normal body mass index. Results revealed a pH of 7.08, bicarbonate of 6.6mmol/l, capillary blood glucose tests recorded as greater than 28.7mmol/l, ketones 7.0mmol/l, Hb 84 g/l. Her creatinine was 101mumol/l (baseline 90), eGFR 52 and tacrolimus levels were within therapeutic range. No obvious precipitant for diabetic ketoacidosis (DKA) was found. She responded well to intravenous fluids and insulin. Her glutamic acid decarboxylase (GAD) and islet antigen 2 (IA2) antibodies were negative. Possible causes for her diabetes include iron overload, steroid therapy, tacrolimus. In her case, she presented with a short timeline of symptoms along with severe DKA. This is typical of Type 1 diabetes, even though her antibodies were negative. NODAT usually behaves like Type 2 diabetes but, rarely, such patients can also present with an insulin deficient state similar to Type 1 diabetes. The Renal Association suggests lower levels of tacrolimus to decrease NODAT risk and screening for diabetes post-transplant. A steroid sparing immunosuppressive regimen may help in reducing the incidence of NODAT.

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