Clinical Gems

Rudy Bilous, MD, FRCP Richard Donnelly, MD, PHD, FRCP, FRACP Pregestational diabetes is the most common medical problem that complicates pregnancy, affecting 1 in 264 births (0.38%) in the UK in 2002–3, with over 25% occurring in women with type 2 diabetes. The Kaiser Permanente database recorded an average rate of 1.3% …

Rudy Bilous, MD, FRCP Richard Donnelly, MD, PHD, FRCP, FRACP Exercise Regular physical exercise is an important component of the management and prevention of type 2 diabetes (Figure 26.1). Aerobic exercise, in particular, and resistance exercise improve insulin sensitivity and glycemic control. Blood glucose and lipid profiles improve, as well as insulin …

Rudy Bilous, MD, FRCP Richard Donnelly, MD, PHD, FRCP, FRACP Particular groups of patients with diabetes are at risk of different psychological problems (Table 25.1). Many chil­dren show remarkable resilience to the diagnosis of diabetes, but about one-third have some temporary psychological distress, mostly ‘adjustment disorders’ such as difficulty in sleeping, depression, …

Rudy Bilous, MD, FRCP Richard Donnelly, MD, PHD, FRCP, FRACP Diabetes affects the cellular biochemistry of skin and connective tissues, in particular collagen synthesis and struc­ture, as well as cutaneous microvascular blood flow. Several non-infective skin conditions are associated with type 1 and/ or type 2 diabetes (Box 24.1). Diabetic dermopathy (‘shin …

Rudy Bilous, MD, FRCP Richard Donnelly, MD, PHD, FRCP, FRACP Disordered gastrointestinal motor function occurs in both type 1 and type 2 diabetes and can result in symptoms of nausea, vomiting, diarrhea or constipation, malnutrition, poor glycemic control and delayed absorption of orally administered drugs (Figure 23.1). Gustatory sweating, typically affecting the …

Rudy Bilous, MD, FRCP Richard Donnelly, MD, PHD, FRCP, FRACP Symptoms of sexual dysfunction affect both men and women with diabetes. The most common problem among men is erectile dysfunction (ED), which is defined as ‘the inability to achieve or maintain an erection sufficient for sexual intercourse’. ED occurs 10–15 years earlier …

Rudy Bilous, MD, FRCP Richard Donnelly, MD, PHD, FRCP, FRACP The high-risk diabetic foot The lifetime risk of a person with diabetes developing foot ulceration is around 25%. Recent studies suggest that the population-based incidence of diabetic foot ulcers is 1-4% with a prevalence of 4-10%. The risk of amputation is 10–30-fold …

Rudy Bilous, MD, FRCP Richard Donnelly, MD, PHD, FRCP, FRACP Atherosclerosis For any given age, level of cholesterol or BP, the risk of atherosclerotic cardiovascular disease (CVD) is 3 to 5-fold higher among patients with diabetes compared with subjects without diabetes. Macrovascular complications include fatal and non-fatal coronary heart disease (CHD) events, …

Rudy Bilous, MD, FRCP Richard Donnelly, MD, PHD, FRCP, FRACP Diabetes and hypertension have been termed the ‘bad companions’ for cardiovascular disease risk. Diabetes alone increases this risk 2 – 4-fold; in the presence of hypertension, the risk for coronary heart disease is further trebled and for stroke, doubled. There is also …

Rudy Bilous, MD, FRCP Richard Donnelly, MD, PHD, FRCP, FRACP Dyslipidemia in type 2 diabetes Abnormalities of blood lipids are common in patients with type 2 diabetes, even when there is reasonable glycemic control. The characteristic dyslipidemia of type 2 diabetes consists of elevated very low-density lipoprotein (VLDL) triglyceride (TG) levels, reduced …