Improving outcomes for older people with diabetes (2021)

Type of publication:
Journal article

Author(s):
*Morris, David

Citation:
Practice Nursing; Jul 2021; vol. 32 (no. 7); p. 270-276

Abstract:
Older people with diabetes have unique challenges. David Morris discusses the importance of individualising care for this group of people An individualised approach aiming to maximise safety, preserve autonomy and improve quality of life is needed when helping an older person to manage their diabetes. It is important to interpret the older person’s diabetes in the context of their overall health concerns, including reference to co-morbidities, cognitive function, lifestyle, social setting, and life expectancy, and practice nurses are well placed to work in partnership with people with diabetes to achieve this. Pharmacological treatment goals must be realistic, acknowledging the metabolic consequences of old age, the risks of hypoglycaemia and the dangers of
polypharmacy.

Evidence-based use of newer agents in type 2 diabetes (2021)

Type of publication:
Journal article

Author(s):
*Morris, D.

Citation:
Journal of Prescribing Practice; Jun 2021; vol. 3 (no. 6); p. 224-234

Abstract:
The DPP-4 inhibitors, GLP-1 receptor agonists and SGLT-2 inhibitors are newer agents for glycaemic control in type 2 diabetes that can offer additional health benefits. All three treatments carry a low risk of hypoglycaemia. GLP-1 RAs and SGLT-2 inhibitors are associated with weight loss and DPP-4 inhibitors are weight neutral. The GLP-1 RAs and SGLT-2 inhibitors offer protection against cardiovascular events. SGLT-2 inhibitors are the agents of choice to add on to metformin for glycaemic control in chronic kidney disease and heart failure, with GLP-1 RAs an alternative to be considered if SGLT-2 inhibitors are poorly tolerated or contraindicated. DPP-4 inhibitors are very well tolerated. Gastrointestinal side-effects can be problematic with GLP-1 RAs though frequently these settle with time. Genital thrush is a common side-effect with SGLT-2 inhibitors and diabetic ketoacidosis is a rare but serious side-effect. It is important that healthcare professionals with responsibility in diabetes familiarise themselves with these treatments in order to know when and how to safely and effectively deploy them. The selection of newer agents should be based on careful assessment of individual circumstances. Overall, the standpoint has shifted from a largely glucocentric approach to one considering the impact of treatments on weight, risk of hypoglycaemia, and co-morbidities (notably atherosclerotic cardiovascular disease, heart failure and chronic kidney disease). Case histories are used in the article to illustrate the pragmatic use of these agents.

GLP-1 receptor agonists in type 2 diabetes: An underused asset? Updated January 2021 (2021)

Type of publication:
Journal article

Author(s):
*Morris, David

Citation:
Journal of Diabetes Nursing; Jan 2021; vol. 25 (no. 1); p. 1-13

Abstract:
As our understanding of the incretin hormones has increased, a number of drugs targeting this system have been developed. The realisation of this potential has developed rapidly, and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are now a standard feature in management guidelines for type 2 diabetes. This article reviews the operation of the incretin system and the mechanism by which GLP-1 RAs act to provide benefit in type 2 diabetes. The availability and indications for use of the GLP-1 RAs, and their clinical benefits and disadvantages, are summarised. The position of GLP-1 RAs in the management of type 2 diabetes is discussed pragmatically, with reference to various key guidelines. This article has been updated in January 2021 to incorporate recent guideline changes and the launch in the UK of an oral formulation of semaglutide.

GLP-1 receptor agonists in type 2 diabetes: An underused asset? (2020)

Type of publication:
Journal article

Author(s):
*Morris, David

Citation:
Journal of Diabetes Nursing; Aug 2020; vol. 24 (no. 5); p. 1-11

Abstract:
As our understanding of the incretin hormone system has increased, a number of drugs targeting this system have been developed. The realisation of this potential has developed rapidly, and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are now a standard feature in management guidelines for type 2 diabetes. This article reviews the operation of the incretin system and the mechanism by which GLP-1 RAs act to provide benefit in type 2 diabetes. The availability and indications for use of the GLP-1 RAs, and their clinical benefits and disadvantages, are summarised. The position of GLP-1 RAs in the management of type 2 diabetes is discussed pragmatically, with reference to various key guidelines.