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New treatments for diabetes

Spring is in the air and specialist diabetes nurse Margaret Stubbs is urging nurses to help tackle the dual problem of obesity and diabetes

March and spring is on the way at long last, no excuse for our patients (and ourselves) not to get outside walking or taking part in other types of outdoor physical activity. This winter with all the rain we have had, has given many people the excuse not to take any exercise, let alone regular exercise. 

It is also that time when we have our practice manager (PM) or senior GP partners on our backs about QOF targets. I am personally very weary of the targets constantly hanging over us and pressurising us, seeking to distract us from our role of providing patient care. This year like the past two, I have repeatedly been challenging my PM to stop hassling us, to stop constantly phoning patients for a urine sample for albumin creatinine ratios and the like. Last year we were asked to phone patients about their depression status, we refused point blank, it is both inappropriate and also unethical.

This year my PM has been telling me to check whether patients are on maximum tolerated therapy for their diabetes, if they are, we can READ code them accordingly and gain ourselves some points somehow. There's always a new trick to try!

What drugs are you finding that you use more than others in lowering blood glucose? Have any of you tried the Gliflozin class with your diabetic patients? So far I have tried it with four patients and out of those, three have had very positive experiences, with almost zero side effects and after 3-4 months a loss of weight of several kgs at least, as well as a definite improvement in Hba1c. 

The three are all men, but the fourth - a lady with longstanding diabetes - developed a urinary tract infection after starting the drug and was reluctant to continue after that. I have a fifth patient considering it. These men were given the option of a GLP1 or the Gliflozin and opted for the Gliflozin, having been made aware of the potential side effects of both drugs, and the fact that the latter is a relatively new drug on the diabetes drug market.

Did you know that some new figures just released tell us that one in five cases of type 1 diabetes are being diagnosed in the over 40s? This means we must be aware of this when we have new diagnoses in our practice and not automatically assume that they will all have type 2. 

I have a gentleman in his early 50s, who was diagnosed with type 1 diabetes in June last year (2013). I was quite surprised by this when I first met him, although perhaps I shouldn't have been knowing that the Home Secretary Theresa May was only diagnosed just over a year ago and she was certainly over 40 at diagnosis. My older type 1 has found that stress causes his blood sugars to drop dramatically and so for a while he suffered frequent hypoglycaemic events because he did not realise what was triggering them. We now have a better understanding of this, and he knows to try and avoid potentially stressful situations.

I believe more of us working in the field of diabetes need to engage with the combination of diabetes and obesity. We cannot pretend that obesity is not an issue, but we do need to learn how to tackle this problem with our patients, and where we can, encourage or challenge our patients to recognise and start to deal with their weight problem before they are diagnosed with type 2 diabetes. 

Those already with diabetes, we must help to tackle their diet and lifestyle, in order to reduce their risks from diabetes and the linked coronary heart disease.