NHS England: Action for Diabetes

Stethoscope on a keyboard

NHS England has announced a new strategy document for diabetes care, called Action for Diabetes.  The document is for Clinical Commissioning Groups (CCGs), to serve as a reference on the work that is going on across NHS England. It will also be of interest to the wider community interested in diabetes care to see what [read the full story…]

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Collaborative Care improves outcomes for people with diabetes and depression

Unhappy woman

Today, our cousin the Mental Elf has posted an important blog about the management of people with diabetes and depression. Around 20% of patients with diabetes meet diagnostic criteria for depression.  NICE guidelines state that Collaborative Care (CC) should form part of a well-developed stepped-care programme for people with moderate to severe depression and a [read the full story…]

National Diabetes Audit highlights the need to focus on prevention and treatment of heart failure

Missing the target

In answering the question “Are we ‘doing things right’ in Diabetes care?”, a good place to start is to look at all the data we have about patients in the NHS.    The National Diabetes Audit does just that for NHS services in England and Wales. Over two million people have diabetes in England and [read the full story…]

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Intensive glycaemic control does not reduce mortality in type 2 diabetes

Lots of different pills

More isn’t necessarily better.  This seems true in respect of glycaemic control in type 2 diabetes. More intensive control risks additional hypoglycaemia, where less intensive control risks long term complications. An updated Cochrane systematic review looked at the impact of tighter or intensive glycaemic control on overall mortality. Methods The reviewers searched bibliographic databases, the [read the full story…]

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Evidence of improved cardiovascular risk for people with diabetes in England between 1994 and 2009

Vitruvian data man

This study evaluated trends in cardiovascular risk factors among people with diabetes. Data obtained as part of the Health Survey for England (HSE) between 1994 and 2009 were examined with particular focus on the differences between men and women and between social classes. It was important to investigate possible trends so that the impact of [read the full story…]

The Finnish Diabetes Risk Score did not perform well as a screening tool for type 2 diabetes

A pen ticking off a checklist

A recent UK Health Technology Assessment pointed out the problems with screening for type 2 diabetes.  However, research continues into the performance of tools to detect type 2.  On the basis of this paper, we won’t be changing that advice any time soon. Methods This community screening study was undertaken in urban settings in the [read the full story…]

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Review finds no evidence for topiramate in treating neuropathic pain

Unhappy woman

Diabetic neuropathy is a common complication of diabetes.  This condition is very painful and substantially compromises quality of life.  Its progressive nature places a further burden on patients and their carers. Current guidance recommends a range of possible drug treatments, including the antidepressant drugs amitriptyline or duloxetine and the anti-convulsant pregabalin.  A recent Cochrane review [read the full story…]

HTA recommends against screening for type 2 diabetes in the UK

Asian man

Following on from our report of the ADDITION trial last week, we can add that the UK Health Technology Assessment programme has updated its recommendation against screening for type 2 diabetes. Their recommendation to the National Screening Committee contains an analysis of new evidence published between 2009 and January 2012. Elves everywhere – coniferous, deciduous [read the full story…]

From our Dental Elf: evidence of improved metabolic control in type 2 diabetes after treating periodontal disease

Dental examination

Clinical question: In type 2 diabetes, does non-surgical treatment of periodontal disease lead to improved glycaemic control? Methods: An updated systematic review of randomised trials. Results: The review concluded there was evidence of a small reduction in HbA1c after treatment for gum disease.  However, the studies were of poor quality with some evidence of publication [read the full story…]

RCT finds that screening for type 2 diabetes in primary care did not improve clinical outcomes

singled out

If we pick up a disease early, we can treat it early.  So screening tests must be a good thing, right? Not necessarily. Testing is only beneficial if it enables us to provide better care.  There are many examples from clinical practice that demonstrate how earlier is not necessarily better.  Sometimes “lead-time bias” can mislead [read the full story…]

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