An overview of diabetes and its complications

Diabetes mellitus is a metabolic disorder in which the body’s capacity to utilise glucose, fat and protein is disturbed due to impairment in insulin secretion and/or insulin resistance leading to chronic hyperglycaemia. Therefore, having an understanding of the underlying pathophysiology and the acute and/or long-term complications of diabetes will enable the development of strategies for ameliorating the condition. Individuals may be classified as having pre-diabetes or diabetes based on their fasting blood glucose and/or postprandial blood glucose. In this regard, individuals with impaired fasting glycaemia (IFG) have fasting plasma glucose >6.1 mmol/L to 7.8 mmol/L to <11.1 mmol/L following a 2 hour oral glucose tolerance test and both IFG and IGT define the extent of glucose dysregulation between the range of normoglycaemia and type 2 diabetes. The diagnostic criteria for patients with diabetes are fasting plasma glucose ≥7.0 mmol/L and oral glucose tolerance Test (OGTT) ≥11.1 mmols/L.1 While normal fasting glucose depends on the ability to sustain the production of basal insulin and promotion of insulin sensitivity at the level of the liver, IFG results from abnormalities of these metabolic functions and are often characterised by raised hepatic glucose output and defect in early insulin secretion.2 However, during OGTT, the normal body’s response is usually in the form of increased insulin secretion, decreased hepatic glucose production and enhanced glucose uptake in the liver and the muscle. Therefore, IGT is often associated with peripheral insulin resistance, mostly in the skeletal muscle. In addition to IFG and IGT, other risk factors for type 2 diabetes include genetics/family history, environmental factors such as type of diet and physical activity, obesity, age and body fat distribution

Diabetic retinopathy screening: A systematic review on patients’ non-attendance

Diabetic Retinopathy is a microvascular complication of diabetes, that can go undetected and unnoticed until irreversible damage and even blindness has occurred. Effective screening for diabetic retinopathy has been proven to reduce the risk of sight loss. The National Health Service (NHS) which provides healthcare for all UK citizens, implemented systematic retinal screening for diabetic retinopathy in England in 2003, with the aim of identifying and treating all patients with sight threatening retinopathy. Crucial to this is patients partaking in the programme. Therefore, increasing screening uptake has been a major focus of the programme. This review explores the views of people living with diabetes who do not attend retinal screening, their characteristics, concerns, experiences of retinal screening and their understanding of the risks of diabetic retinopathy. All studies that satisfied the study inclusion criteria on ‘patients’ non-attendance at retinal screening’, between 2003 to 2017 were included after extensive database search. A total of 16 studies were included in the review. Findings showed that socio-economic deprivation was a major risk factor for non-attendance, about 11.5–13.4% of the screened population had sight threatening retinopathy (STDR), repeated nonattendance was linked to sight threatening diabetic retinopathy, and that certain factors, could be barriers or incentives for screening uptake. Some of those factors are modifiable whilst others are not

The impact of changes in health and social care on enteral feeding in the community

This paper examines the impact of the changes to health and social care on enteral feeding in the community, outlines implications for practice and offers recommendations to ameliorate the challenges. It is now clear that there have been significant changes especially in the last 10 years in health and social care provisions in the UK with an overarching effect on enteral nutrition in the community. Advances in technology, increasing demand and treatment costs, the need for improvement in quality, economic challenges, market forces, political influences and more choices for patients are some of the factors driving the change. Government’s vision of a modern system of health and social care is based on initiatives such as clinically led commissioning, establishment of Monitor, shifting care from acute hospitals to community settings, integrating health and social care provisions, Quality, Innovation, Productivity and Prevention (QIPP) program and the concept of “Big Society”. These strategies which are encapsulated in various guidelines, policies and legislation, including the health and social care Act, 2012 are clarified. The future challenges and opportunities brought on by these changes for healthcare professionals and patients who access enteral nutrition in the community are discussed and recommendations to improve practice are outlined

Recent advances in enteral nutrition

There have been significant advances in the provision of enteral nutrition support in the acute and community healthcare settings. Enteral nutrition is beneficial to individuals who have functional guts but may not be able to meet their nutritional requirements via a normal diet. Most of these people have neurological conditions such as stroke, multiple sclerosis and dementia which could impact on swallowing reflexes, leading to dysphagia [1]. Others may have cancer, intellectual disability or conditions such as HIV and failure to thrive

Implementing early supported discharge in patients with acute exacerbation of chronic obstructive pulmonary disease.

Aim: The purpose of this paper is to present the development and implementation of Early Supported Discharge (ESD) for those patients admitted to hospital with an acute exacerbation of chronic obstructive pulmonary disease (COPD). It also outlines the collaboration between secondary and primary care using Kotters 8-step change model. Background: Acute exacerbation of chronic obstructive pulmonary disease (COPD) accounts for 1:20 emergency admissions daily, 500 of which are admitted spending an average of 6.5 days in hospital. Alternatives to managing exacerbation of COPD in a hospital setting were first suggested by the Royal College of Physicians in 1981. Emergency admissions for COPD place a significant burden on the resources of the NHS. Methods: Kotters 8-step model of change was used in this study. All adult patients (55 years or older) admitted to the Acute Medical ward with an exacerbation of COPD were assessed for their suitability for ESD. The period of the study was from February to June 2011. The service was operational from Monday to Thursday, and between the hours of 09.00 and 12 midday. Patients admitted with the diagnosis of COPD were identified by; • Accessing admissions information via a hospital information system • Referral from nurse in charge of admissions ward • Referral from Doctors. Results: The approach adopting a change model has resulted in a period of six months 27 patients being discharged under the ESD scheme. Only one patient was readmitted within 30 days. Conclusion: Approaching the change in smaller steps encourages reflection and development of leadership skills, and analysing the small steps allowed the development of a clear strategy which moved ESD forward. This service development has been a very positive experience, in the main due to the collaboration between the Respiratory Nurses and COPD Team

The role of Exenatide in managing cardiovascular risks and complications in patients with type 2 diabetes

The aim of this systmatic review is to examine the role of exenatide BID in managing cardiovascular risks and complications in patients with type 2 diabetes.rnMethod: This involved a literature search including a general scoping of the data bases which found previous reviews relevant to the population and intervention of interest, but these were either more than 4 years old, were narrative reviews or included liraglutide and studies which were not randomised. The current systematic review is based only on randomised controlled studies. rnrnThe literature search strategy for the review relied on previously published guidelines for reviews and was based on the Population (P), the Interventions (I), Comparative interventions (C) and Outcomes (O) (PICO) framework. A number of databases including EBSCO host, encompassing Academic search premier, Medline, Psychology and Behavioural sciences collection, PSYCINFO, SPORTDISCUSS and Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus were accessed.rnIn addition, ‘Boolean’ search strategy allowing the combination of search terms such as ‘Exenatide’ AND ‘Diabetes’ AND ‘cardiovascular diseases’; ‘Exenatide’ AND ‘Diabetes’ AND ‘glycaemic control’; ‘GLP–1’ AND ‘Diabetes’; ‘GLP–1’ AND ‘Diabetes’ AND ‘cardiovascular diseases’; ‘GLP–1’ AND ‘Diabetes’ AND ‘macrovascular diseases’; ‘Exenatide’ AND ‘Cardiovascular risks’; ‘Exenatide’ AND ‘Cardiovascular complications’; Exenatide’ AND ‘ glycaemic control’ was used.rnThe quality of the studies selected were evaluated using the checklists for quantitative studies.rnTen (10) randomised controlled studies which met the inclusion criteria were selected for the current review. rnThe outcome measures included in the search were; Cardiovascular risks, Cardiovascular complications, glycaemic control.rnAll the studies reviewed except 1 showed that the use of exenatide BID as a monotherapy or in combination with other medications was associated with reduction in most cardiovascular risks and complications such as weight, blood pressure, glycated haemoglobin which are associated with type 2 diabetes compared with control.rnr

The challenges of home enteral tube feeding: A global perspective

The aim of this review is to provide a global perspective of Home Enteral Tube Feeding (HETF) and to outline some of the challenges of home enteral nutrition (HEN) provisions. It is well established that the number of patients on HETF is on the increase worldwide due to advances in technology, development of percutaneous endoscopic gastrostomy techniques, and the shift in care provisions from acute to community settings. While the significance of home enteral nutrition in meeting the nutritional requirements of patients with poor swallowing reflexes and those with poor nutritional status is not in doubt, differences exist in terms of funding, standards, management approaches and the level of infrastructural development across the world. Strategies for alleviating some of the challenges militating against the effective delivery of HETF including the development of national and international standards, guidelines and policies for HETF, increased awareness and funding by government at all levels were discussed. Others, including development of HEN services, which should create the enabling environment for multidisciplinary team work, clinical audit and research, recruitment and retention of specialist staff, and improvement in patient outcomes have been outlined. However, more research is required to fully establish the cost effectiveness of the HEN service especially in developing countries and to compare the organization of HEN service between developing and developed countries

Nutrition and Chronic Conditions

The effects of nutrition in chronic conditions, such as diabetes, cardiovascular disease, dementia, stroke, and inflammatory bowel disease continue to generate interest among researchers. This stems from the fact that diet is a modifiable risk factor for these diseases, which manifest either as single entities or in co-morbid states in individuals and populations around the world. In particular, the prevalence of diabetes and cardiovascular disease is on the rise, especially in developed countries, but also in developing economies, partly due to lifestyle changes, including diet. For example, ischaemic heart disease is the leading cause of death globally. When combined with stroke, these conditions accounted for 15 million deaths in 2015 and are the world’s greatest killers (WHO, 2017). Furthermore, WHO (2016), reported that there were an estimated 422 million adults who were living with diabetes in 2014. This is significantly higher than the 108 million in 1980, representing a rise in worldwide diabetes prevalence from 4.7% in 1980 to 8.5% in 2014 among the adult population. These chronic conditions and their associated complications have significant implications for morbidity and mortality, and incur huge costs to the health services around the world. The composition of the diet, the proportion and types of macronutrients and micronutrients present in the diet are major contributors to these diseases. In addition, the beneficial effects of nutritional interventions have been well documented although differences remain among researchers with respect to their overall impact. The evaluation of the role of nutrition in chronic conditions draws on its effect on body weight and body composition, glycaemic and insulin excursions, vascular remodeling, and gastro-intestinal dysfunction. Therefore, this Special Issue on “Nutrition and Chronic Conditions” aims to evaluate the effect of nutrition in the development, care, and management of chronic conditions. The primary conditions of interest are diabetes, cardiovascular disease, dementia, stroke, and inflammatory bowel disease

Dietary Intake and Type 2 Diabetes

This book examines the risk factors associated with type 2 diabetes and discusses the evidence relating to dietary strategies for managing people with this condition. It is clear from the evidence presented that a range of dietary interventions can provide useful approaches for managing people with type 2 diabetes, including the regulation of blood glucose and lipid parameters, and for reducing the risks of acute and chronic diabetic complications