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Diabetes in the young: a ticking time bomb?

Well, I'm here again with another selection of key topics in the diabetes world. My name is Margaret and I work as a Practice Nurse and Clinical Lead for a Walk In Centre and GP surgery in Portsmouth.

How many of you have teenagers in your practice who are being diagnosed with type 2 diabetes? If this trend continues and increases, in line with the current obesity epidemic, we are going to have our work cut out to help these youngsters get their head round their diagnosis and learn to manage their diabetes.

In the USA it is estimated that around 20% under the age of 20 years old have been diagnosed with either type 1 or type 2 diabetes. Metformin is an ideal drug to use in treating youngsters with type 2 diabetes, as it is also useful in helping to reduce body mass, and as these youngsters will probably also be obese this is a definite asset.

If, however, these are picked up earlier as impaired glucose tolerant, the drug of choice in delaying progression to full-blown type 2 diabetes by 7-10 years, appears to be the thiazoldindione group of drugs.

How would you approach the management of this group of patients? How would you try to engage with them? Do you have any tips to share with the rest of us? Are we going to see an increased morbidity due to type 2 diabetes and its complications? Is bariatric surgery the best way to tackle this in such young people? How are we going to meet this challenge? Will we be adequately prepared for the task that lies ahead?

On a different tack, how are we all coping with the use of mmol/mol as our units for Hba1c? Will it confuse our patients to know this? What about the proposal to use Hba1c as a diagnostic screening tool for diabetes, with a value of lees than and equal to 6.5 % or more correctly now 48mmol/mol? In the UK it seems this has not yet been confirmed, as there are some recent studies that suggest that Hba1c is a less sensitive and less specific test.

All the time there are new drug therapies emerging to help manage type 2 diabetes. How can we be sure they are effective in the long term? Can we believe all that the pharmaceutical companies tell us in their bid to persuade us to buy and use their products? There is now a once weekly version of Exenatide available called Bydureon; do any of you have patients who are prescribed this yet? What about Insulin Degludec, which has a very long acting profile, and which research suggests can be taken one to three times a week and achieve a comparable glycaemic control to Insulin Glargine?

We need to work hard in order to keep abreast of the continual changes in the treatment and management of diabetes.

We are going to have to work hard to keep up to date with all the developments in the world of diabetes. If you are aware of some new development which you think should be included in this blog, please contact me. One thing is for sure - diabetes is not going away.

To read Margaret's first diabetes blog, Hot topics in diabetes care, click here