Re: Diabetes cases in UK reach all time high, charity warns
Dear Editor
The sheer numbers of patients with type 2 diabetes in the UK indicates that it should now be a part of general practice, and every doctor who is a General Practitioner and every physician must have adequate training and education about diabetes. The management of diabetes must not be restricted to endocrinologists and diabetes specialist nurses, if we want to see fewercomplications of diabetes.
Davidson's Principles and Practice of Medicine wrote, long back, that disease in 60% of patients with diabetes can be controlled with diet alone, and exercises. And this I have seen to be true in my practice. It further wrote that in the remaining 40% of patients most disease could be managed with metformin and sulphonylurea (gliclazide was favoured by BNF, due to its short half-life, and lesser propensity to cause hypoglycaemia).
Davidson's recommended that there should be 4 blood sugar tests per week as long as the diabetes is not under control, and once under control, at least monthly blood pressure and blood sugar checking should be continued for life.
On first diagnosis, secondary causes should be ruled out. At the first diagnosis itself, patients should be educated about the acute and chronic complications of diabetes, and also about the role of diet and physical activity. They should be guided how physical activity can be increased even without going to a gym, and a target of minimum 3 hours exercise in a week should be emphasized.
The six-monthly or annual reviews should be done for early detection of complications, like retinopathy (funduscopy), nephropathy (urine microalbumin), peripheral arterial disease (dorsalis pedis and anterior tibial pulses), coronary risk factors (lipid profile, Blood Pressure), neuropathy (neurological examination of lower limbs), etc.
One of the unrecognized complications of diabetes is falls and fracture of the neck of the femur. The peripheral neuropathy cause by diabetes reduces the position sense of the lower limbs, and this leads to positive Romberg's sign and falls. And one of the falls leads to fracture of the neck of the femur.
It would be a useful study to find out the incidence of fracture of the neck of the femur in the diabetic population vs that in the non-diabetic population.
Proactive preventive action can save several billion of pounds spent on complications of diabetes, and that money can be used formeasures which could increase the GDP of the country, which is the ultimate fulcrum on which everything else is supported.
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Re: Diabetes cases in UK reach all time high, charity warns
Dear Editor
The sheer numbers of patients with type 2 diabetes in the UK indicates that it should now be a part of general practice, and every doctor who is a General Practitioner and every physician must have adequate training and education about diabetes. The management of diabetes must not be restricted to endocrinologists and diabetes specialist nurses, if we want to see fewercomplications of diabetes.
Davidson's Principles and Practice of Medicine wrote, long back, that disease in 60% of patients with diabetes can be controlled with diet alone, and exercises. And this I have seen to be true in my practice. It further wrote that in the remaining 40% of patients most disease could be managed with metformin and sulphonylurea (gliclazide was favoured by BNF, due to its short half-life, and lesser propensity to cause hypoglycaemia).
Davidson's recommended that there should be 4 blood sugar tests per week as long as the diabetes is not under control, and once under control, at least monthly blood pressure and blood sugar checking should be continued for life.
On first diagnosis, secondary causes should be ruled out. At the first diagnosis itself, patients should be educated about the acute and chronic complications of diabetes, and also about the role of diet and physical activity. They should be guided how physical activity can be increased even without going to a gym, and a target of minimum 3 hours exercise in a week should be emphasized.
The six-monthly or annual reviews should be done for early detection of complications, like retinopathy (funduscopy), nephropathy (urine microalbumin), peripheral arterial disease (dorsalis pedis and anterior tibial pulses), coronary risk factors (lipid profile, Blood Pressure), neuropathy (neurological examination of lower limbs), etc.
One of the unrecognized complications of diabetes is falls and fracture of the neck of the femur. The peripheral neuropathy cause by diabetes reduces the position sense of the lower limbs, and this leads to positive Romberg's sign and falls. And one of the falls leads to fracture of the neck of the femur.
It would be a useful study to find out the incidence of fracture of the neck of the femur in the diabetic population vs that in the non-diabetic population.
Proactive preventive action can save several billion of pounds spent on complications of diabetes, and that money can be used formeasures which could increase the GDP of the country, which is the ultimate fulcrum on which everything else is supported.
Competing interests: No competing interests