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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Effective treatments for non-healing diabetic ulcers

Diabetic foot ulcer

Non-healing leg ulcers are a major burden for people with diabetes and for the health service.  This evidence review by the US Department of Veterans’ Affairs focuses on treatments approved by the US Food and Drug Administration but contains important findings that could be applicable in any setting. Clinical question The review addresses the following [read the full story…]

NHS Evidence Update on Diabetic Foot Problems

Foot examination

NHS Evidence is a service provided by NICE, the National Institute for Health and Clinical Excellence.  As part of this service, they publish regular updates of recent evidence that fits under the main sections of NICE guidance. In March, NHS Evidence produced an Evidence Update on Diabetic Foot Problems.  This is the first Evidence Update [read the full story…]

Intensive blood pressure control prevents strokes in diabetic patients with hypertension

Sphygmomanometer

What target, if any, should we aim for in treating hypertension in patients with type 2 diabetes? Clinical question: In type 2 diabetes with hypertension, is intensive treatment, compared with less intensive treatment, effective at reducing the risk of stroke, death or other cardiovascular events? Intensive treatment was defined as a target maximum of 130 [read the full story…]

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New guidelines for the management of diabetic retinopathy

Retinopathy

The Canadian Ophthalmological Society has published new guidance for the management of diabetic retinopathy. The guideline provides explicit account of the methods used to identify and evaluate the evidence and arrive at consensus.  Recommendations for clinical practice are set apart from the text that describes the evidence. The guideline covers: Definitions of disease Epidemiologyof diabetes [read the full story…]

Canadian guidelines for managing diabetic retinopathy

Retinopathy

The Canadian Journal of Opthalmology has recently published guidelines for managing diabetic retinopathy by the Canadian Ophthalmological Society. Coverage: Methodology Definitions Epidemiology Screening Telehealth and Teleophthalmology Risk Factors For And Prevention Of Progression Of Diabetic Retinopathy Treatment Modalities Pregnancy Neovascularization of The Iris Economic Considerations Support Appraisal hints: Does this guidance conform to AGREE principles? [read the full story…]

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Bevacizumab did not improve diabetic macular oedema at 12 weeks

Macular_oedema

We recently reported on new guidance from NICE about the treatment of diabetic macular oedema with ranibizumab.  Another systematic review recently looked at another injectable drug with a similar role: bevacizumab, or Avastin. Clinical question: In patients with diabetic macular oedema (DMO), does intravitral injection of bevacizumab (IVB) improve visual acuity? The review focused on [read the full story…]

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Increased risk of acute pancreatitis in people with diabetes

A pancreas

We already know that pancreatitis can lead to diabetes.  This systematic review of observational studies looked at whether people with diabetes can subsequently develop pancreatitis. Clinical question: In people with diabetes, what is the risk of developing acute pancreatitis? The reviewers were interested in studies that report new (incident) cases of pancreatitis rather than existing [read the full story…]

Ranibizumab may be cost-effective for diabetic macular oedema

Macular_oedema

Blindness is one of the most serious microvascular complications of diabetes.  The most common cause is diabetic macular oedema (DME).  Current treatment with lasers is often unsuccessful. The new injectable drug ranibizumab, which works by selectively inhibiting vascular enothelial growth factor A, has been seen in the RESTORE trial to improve visual acuity and quality [read the full story…]

Tight glycaemic control may prevent neuropathy in type 1 but not type 2

A foot with ants on it

There remains considerable uncertainty around the exact benefits and harms of tighter control of blood sugars.  This Cochrane systematic review looked at the evidence on neuropathy. Clinical question: In diabetes care, does tight glycaemic control prevent neuropathy? “Tight control” was defined as any intervention to enhance glucose control compared with standard care.  The review’s primary [read the full story…]