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Preconceptions in diabetes

Two of my patients with diabetes told me a few weeks ago that the Daily Express had published an article that said meat can be a causative factor for the development of type 2 diabetes. How any of your patients come in and asked you about this?

There always seems to be articles in newspapers making such claims, suggesting cures for diabetes, radical diets that will rid us of diabetes, wonder drugs that will make us lose weight. There is no shortage of these type of claims. The thing is how seriously do we need to take them? I was quite reassured by the comment Diabetes UK gave on this, because they said that a lot more research is needed before we can be “confident there really is a link”.

It is hard enough encouraging our patients to eat more moderate quantities of food and take more physical exercise. A reduction in portion sizes is so often what is required, and an awareness of what foods will really cause them to put on weight or raise their blood sugars excessively. Many still try to persuade me that they eat little more than a few lettuce leaves, and don't understand why they can't lose weight.

That is probably why so many are quite excited to try the Glucagon-like peptide-1(GLP-1) analogues, because of the prospect of being able to lose some weight. Thankfully the bad press that they encountered recently has proved unfounded; we know that there is a risk of pancreatitis with both these and the DPP4 inhibitor group of drugs. Therefore patients who have had such problems in the past would not be prescribed these. I have certainly been relieved to read the reassuring reports that have emerged, as these drugs do offer useful alternatives to those who cannot tolerate metformin and for whom weight gain is enough of a problem anyway without starting on a sulphonylurea.

Earlier this year we witnessed the emergence of a completely new class of drug in the diabetes world. This drug works by causing the body to excrete excess glucose in the urine, by its impact on one of the kidney's tubules, producing some weight loss. It is now approximately six months since dapagliflozin was licensed by the National Institute for Health and Care Excellence (NICE); how many of us have started prescribing this drug? I have one patient taking it, he is due to attend for review any time now, as it is three months since he started taking the drug; what am I going to find?

A challenge that is becoming more common is that of preparing women of childbearing age with diabetes for pregnancy. While at the Primary Care Diabetes Society conference, I heard a little about what should be done in this area, and then locally at diabetes network meeting, the diabetes midwives spoke of the need for pre-conceptual care. They explained the risks to both mother and child of not having blood sugars well controlled prior to conception.

Whether it is type 1 or type 2 diabetes, the risks are significant, and with more younger women developing type 2 diabetes we need to be aware of the risks and where to refer such patients for the right support and management. In my locality pre-conceptual clinics are run, and during pregnancy there are multi-disciplinary clinics for those with diabetes, in order to try and ensure the best possible outcomes. I currently have two young female patients with type 2 diabetes attending this pre-conceptual clinic. It is important that we know what is available for our patients in this type of situation.