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Hot topics in diabetes care

Welcome to the first expert blog in diabetes. I'd like to use this as an opportunity to highlight current hot topics in the world of diabetes and also try to challenge your thinking on these.

I hope you will feel able to respond to what I write and make me aware of topics you'd like to see included in this blog. As you're probably aware there's a lot happening currently in the management of diabetes (both type 1 and type 2), and I'll talk about those shortly.

Earlier this week, a young woman came into my room and said that she had type 3 diabetes. Now, I hear you say, "But there's no such thing is there?" Well, she went on to tell me that this could be a genetic type. Before I dismissed her suggestion out of hand, I asked her to have a complete set of fasting bloods, including an Hba1c and to bring in all the documentation concerning this seemingly unbelievable diagnosis.

My colleague and I were rather amused by this suggestion, after the consultation; however in the meantime, I have looked into this so-called 'type 3' diabetes. I have trawled the internet and found some information that would suggest there is possibly another such diabetes category. This week she returned with documentation in hand and it transpires she has in fact got MODY (which for the uninitiated is maturity onset diabetes of youth).

A team from the USA have found that this possible type 3 affects brain insulin levels, and appears to be linked with Alzheimer's disease. If you know more on this subject I'd really like to hear from you.

Anyway, what about these hot topics? I read in one of my nursing journals that NICE have decided not to recommend the drug Lucentis (ranibizumab) for use in patients with diabetic macular oedema. This is the first licensed treatment of its kind and is, of course, expensive; but how does it compare to the cost of providing treatment and long-term care for those who go blind from this condition and then either cannot work or possibly care for themselves?

What about the proposed changes to prescribing we are being encouraged to make; instead of prescribing analogue insulins we're being asked to consider a return to human insulins? I've heard some experts say this is a cost-saving exercise and may well cause more hypoglycaemic attacks for patients.

Others state that evidence shows that this is not the case, and the human insulins work equally well at lower cost. We should also remember that human insulins are recognised as masking the early warning signs of hypoglycaemic attacks. What do you think about these proposed changes? Do you have an opinion and is it evidence based? How do you think patients cope with having to change their drugs like this; there was a similar sequence of events with the use of statins.

There are other topics which I could include, but I've run out of space, so will bring you more topics on the subject of diabetes in a month. In the meantime, please do send me your comments in the box below.