As we start this New Year and try to make recompense for our excesses of the Christmas season, I’d like to get us all thinking. Recently in a newspaper article, there was reference made to the increasing number of healthcare professionals who are either overweight and obese and the suggestion was that they did not make appropriate role models when advising patients of the need to lose some weight.
What are your thoughts? Do we need to practise what we preach? Does our waistline or lack of it affect out patients’ motivation to live a healthier life? In the past, it has upset nurses to be told that they need to lose weight, by changing their diets and increasing their regular physical exercise. Many do not feel this is necessary in order to encourage healthy diets and lifestyles in their patients with diabetes.
On a different note, how well are we recognising the more unusual types of diabetes? Some time back I talked about a patient of mine who felt that she had a different type of diabetes to most; she told me that she had type 3 diabetes. Now, I later found out that it was more likely that she had either 'MODY' (maturity onset diabetes of the young) or 'LADA' (latent auto-immune diabetes of adulthood).
In the most recent edition of Diabetes and Primary Care, there is an extremely informative article explaining the differences in presentation of these more unusual types of Diabetes. Considering the LADA variety, I am tempted to think that I have probably got a few patients who fit this category, if they make up 12% of those initially diagnosed with type 2 diabetes.
If your surgery is anything like mine, these patients will also be incorrectly recorded as having type 2 diabetes, because we don’t appear to code LADA as such. It may be worth looking again at those patients who do not fit the typical picture of type 2 diabetes in your practice, and where there are those queries, testing for anti-pancreatic antibodies, particularly glutamic acid decarboxylase (GAD).
It is important that patients are recognised as having these particular variants so that they are given the most appropriate treatment. LADA patients may only be marginally overweight, and may not show any other signs of insulin resistance. These patients frequently progress to requiring insulin therapy within a few years of being diagnosed, and may also suffer from thyrotoxicosis or coeliac disease (other autoimmune diseases).
MODY is also misdiagnosed, and patients treated with Insulin, when often it is not required in these cases. There is a very useful website to help those of us less familiar with these types, it is: www.diabetesgenes.org.
Just a couple of brief thoughts; there is new form of insulin, Degludec, being launched and a new oral hypoglycaemic called Dapagliflozin; not only this, but it seems that NICE have altered their stance on treating diabetes macular oedema with Lucentis. This latter drug may be available following an agreement with Novartis (the manufacturer) for the drug to be available to NHS patients at a reduced cost.
There’s lots going on in the world of diabetes, so I’ll try and keep you updated, watch this space!