Clinical Gems

Rudy Bilous, MD, FRCP Richard Donnelly, MD, PHD, FRCP, FRACP   Modern management of type 1 diabetes comprises a package of measures including multiple daily injections for a more physiological insulin replacement; assessment of glycaemic control using blood glucose self-monitoring as well as clinic tests such as glycated haemoglobin (HbA1c); insulin dosage …

Rudy Bilous, MD, FRCP Richard Donnelly, MD, PHD, FRCP, FRACP   Diabetic control ‘defines the extent to which the metabolism in the person with diabetes differs from that in the person without diabetes. Measurement usually focuses on blood glucose: ‘good ‘ control implies maintenance of near-normal blood glucose concentrations throughout the day. …

Rudy Bilous, MD, FRCP Richard Donnelly, MD, PHD, FRCP, FRACP   Maturity-onset diabetes of the young Maturity-onset diabetes of the young (MODY) owes its name to a time when diabetes was defined by age of onset. The nomenclature has stuck, however, and MODY defines usually non-insulin dependent diabetes occurring before the age …

Rudy Bilous, MD, FRCP Richard Donnelly, MD, PHD, FRCP, FRACP   Epidemiological studies of diabetes prevalence are often based upon age and self-reported diagnosis. Consequently differentiating type 1 and type 2 patients in population studies is difficult. The most recent authoritative review of global prevalence published by the International Diabetes Federation (IDF) …

  Rudy Bilous MD, FRCP Richard Donnelly MD, PHD, FRCP, FRACP   The most common cause of type 1 diabetes (over 90% of cases) is T cell-mediated autoimmune destruction of the islet beta cells leading to a failure of insulin production. The exact aetiology is complex and still imperfectly understood. However, it …

Rudy Bilous MD, FRCP Richard Donnelly MD, PHD, FRCP, FRACP   Islet structure and function Insulin is synthesized in and secreted from the β-cells within the islets of Langerhans in the pancreas. The normal pancreas has about 1 million islets, which constitute about 2-3% of the gland’s mass. All of the islet …

  Rudy Bilous MD, FRCP Richard Donnelly MD, PHD, FRCP, FRACP   Impact on healthcare expenditure Diabetes is an expensive disease. About 75% of the direct costs are absorbed by the long-term complications, rather than the management of diabetes itself. In the USA in 2002, the annual economic burden of diabetes was …

Rudy Bilous MD, FRCP Richard Donnelly MD, PHD, FRCP, FRACP   Diabetes mellitus is diagnosed by identifying chronic hyperglycemia. The World Health Organization (WHO) and the American Diabetes Association (ADA) have used a fasting plasma glucose (FPG) of 126mg/dL.(7 mmol/L) or higher to define diabetes (Table 3.1 ). This originated from epidemiological …

Rudy Bilous MD, FRCP Richard Donnelly MD, PHD, FRCP, FRACP   Diseases with the clinical features of diabetes have been recognised since antiquity. The Ebers papyrus, dating from 1550 BC, describes a polyuric state that resem­bles diabetes. The word ‘diabetes’ was first used by Aretaeus of Cappadocia in the second century AD. …

Richard S. Beaser, MD This week’s excerpt covers the following topics: What drugs restore incretin function How to titrate GLP-1 agonists Learn the contraindications and precautions for the DPP-IV inhibitors The typical doses for the different DPP-IV’s….