Janet Jarvis

How can structured self-management patient education improve outcomes in people with type 2 diabetes?

Type 2 diabetes (T2DM) is a long‐term chronic condition that is complex to manage, with the majority of management being done by the person with diabetes outside of the clinical setting. Because of its complexities, effective self‐management requires skills, confidence and the ability to make decisions and choices about treatments and lifestyle on a day‐to‐day basis. Equipping a person with these self‐management skills is in itself challenging and it is now widely accepted that structured education is an integral part of the management of T2DM. This paper explores whether structured self‐management education can improve outcomes in people with diabetes. The authors explore what self‐management education is, why it is needed and then go on to examine the recent evidence from clinical trials from 2006 onwards.

The potential impact of using glycated haemoglobin as the preferred diagnostic tool for detecting Type 2 diabetes mellitus

Diabet. Med. 27, 762–769 (2010)

Diabetes screening anxiety and beliefs

Aims  This study assesses the impact of screening for diabetes on anxiety levels in an ethnically mixed population in the UK, and explores whether beliefs about Type 2 diabetes account for these anxiety levels.

Insulin U-500 in severe insulin resistance in type 2 diabetes mellitus

Some patients with type 2 diabetes mellitus (T2DM) are profoundly insulin resistant and require large insulin doses to achieve optimal glycaemic control. However, large volumes of subcutaneous conventional U-100 insulin can cause discomfort at the injection site, resulting in poor concordance with insulin therapy. One therapeutic option is the use of U-500 insulin, thus reducing the insulin volume by 80%. This review will address the practical issues associated with the use of U-500, clinical efficacy and safety aspects of this concentrated insulin, which has an important role in a subgroup of patients with T2DM.

Screening for type 2 diabetes in a multiethnic setting using known risk factors to identify those at high risk: a cross-sectional study.

INTRODUCTION Screening enables the identification of type 2 diabetes mellitus (T2DM) during its asymptomatic stage and therefore allows early intervention which may lead to fewer complications and improve outcomes. A targeted screening program was carried out in a United Kingdom (UK) multiethnic population to identify those with abnormal glucose tolerance. METHODS A sample of individuals aged 25-75 years (40-75 white European) with at least one risk factor for T2DM were invited for screening from 17 Leicestershire (UK) general practices or through a health awareness campaign. All participants received a 75 g oral glucose tolerance test, cardiovascular risk assessment, detailed medical and family histories and anthropometric measurements. RESULTS In the 3,225 participants who were screened. 640 (20%) were found to have some form of abnormal glucose tolerance of whom 4% had T2DM, 3% impaired fasting glucose (IFG), 10% impaired glucose tolerance (IGT) and 3% both IFG and IGT. The odds of detecting IGT was approximately 60% greater (confounder-adjusted odds ratios [OR] 1.67 [1.22-2.29]) in the South Asian population. CONCLUSIONS Around one in five people who had targeted screening have IGT, IFG or T2DM, with a higher prevalence in those of South Asian origin. The prevalence of undetected T2DM is lower in South Asians compared to previously published studies and maybe due to increased awareness of this group being at high risk.

A randomized controlled trial examining combinations of repaglinide, metformin and NPH insulin.

Aims  To compare combination use of repaglinide, metformin and bedtime Neutral Protamine Hagedorn (NPH) insulin with conventional approaches of insulin initiation in patients with Type 2 diabetes (T2DM).

Adipocytokine Associations with Insulin Resistance in British South Asians

Aims. Adipocytokines are implicated in the pathogenesis of type 2 diabetes and may represent identifiable precursors of metabolic disease within high-risk groups. We investigated adiponectin, leptin, and TNF-α and assessed the contribution of these molecules to insulin resistance in south Asians. Hypothesis. South Asians have adverse adipocytokine profiles which associate with an HOMA-derived insulin resistance phenotype. Methods. We measured adipocytokine concentrations in south Asians with newly diagnosed impaired glucose tolerance or Type 2 Diabetes Mellitus in a case-control study. 158 (48.5% males) volunteers aged 25–75 years with risk factors for diabetes but no known vascular or metabolic disease provided serum samples for ELISA and bioplex assays. Results. Total adiponectin concentration progressively decreased across the glucose spectrum in both sexes. A reciprocal trend in leptin concentration was observed only in south Asian men. Adiponectin but not leptin independently associated with HOMA-derived insulin resistance after logistic multivariate regression. Conclusion. Diasporic south Asian populations have an adverse adipocytokine profile which deteriorates further with glucose dysregulation. Insulin resistance is inversely associated with adiponectin independent of BMI and waist circumference in south Asians, implying that adipocytokine interplay contributes to the pathogenesis of metabolic disease in this group.

Insulin glargine and its role in glycaemic management of Type 2 diabetes

Background: Insulin glargine (Lantus®) was the first recombinant-DNA long-acting insulin analogue to be licensed for use in the treatment of diabetes mellitus. Objective: This review considers the use of insulin glargine in the treatment of type 2 diabetes (T2DM). Methods: Medline, Cochrane and Embase databases were searched for relevant papers from the year 2000 onwards. Results/conclusion: Overall glargine provides at least equivalent glycaemic control and is associated with less hypoglycaemia, especially nocturnal hypoglycaemia owing to its 24 h peakless profile, which allows more aggressive titration to achieve glycaemic targets. Glargine has been shown to be safely initiated both individually and within a group setting and titration algorithms self-managed by patients are effective in achieving diabetes control. Despite these advantages, caution is needed as clinical guidelines do not advocate its use in all people with T2DM until clinical efficacy and cost effectiveness have been proved. However, insulin glargine is a welcome addition to the plethora of treatment options available for T2DM.

Development of a self‐management education module for those with type 2 diabetes on injectable therapies

The number of people using injectable therapies in the UK has dramatically increased over the last 20 years. People using insulin require intense support from health care professionals (HCPs). This paper describes a module which was developed for people with type 2 diabetes being treated with injectable therapies to empower them to effectively self‐manage their treatment. This was based on evidence from a previously published randomised controlled trial (the Microalbuminuria Education and Medication Optimisation [MEMO] study).