Diabetes care journal editorial board members,diabetic drugs for type 2 60v,glyburide for the treatment of gestational diabetes mellitus - Plans On 2016


Each year, the American Diabetes Association reviews and updates the Standards of Medical Care in Diabetes. The Association states that people with insulin-dependent diabetes who successfully use insulin pumps and continuous glucose monitors (CGMs) should have continued access at age 65 and beyond. Reflecting new evidence on cardiovascular disease risk among women, the age at which to consider daily aspirin therapy dropped from 60 and older to 50 and older. The age at which the Association recommends all adults have a baseline test for type 2 diabetes and future diabetes risk.
For women of childbearing age with diabetes, the guidelines highlight the importance of discussing with a health care provider options for family planning and effective contraception. Soon after diagnosis of type 1 diabetes, kids in this age range should have a fasting lipid profile (cholesterol test). For the treatment of diabetic macular edema that affects central vision, intravitreal anti-VEGF injections work better than laser therapy to slow vision loss and improve vision. Food insecurity, intellectual problems, mental illness, and HIV: The guidelines include tailored treatment suggestions for people with diabetes who also live with these challenges. Register for free recipes, news you can use, and simple health tips – delivered right to your inbox. While she’s still spinning music, DJ Spinderella (aka Deidra Roper) is no longer spinning her wheels when it comes to getting the right information to help her family members who have diabetes.
See why DAA members are excited and proud to work together on behalf of people with diabetes and prediabetes. Our mission is to unite and align key diabetes stakeholders and the larger diabetes community around key diabetes-related policy and legislative efforts in order to elevate diabetes on the national agenda.
The Academy of Nutrition and Dietetics (AND), formerly the American Dietetic Association, is the world's largest organization of food and nutrition professionals. The Diabetes Advocacy Alliance™ is working to increase awareness of, and action on, the diabetes epidemic among legislators and policymakers. The national kidney foundation, inc., a major voluntary health organization, seeks to prevent kidney and urinary tract diseases, improving the health and well being. The national institute diabetes digestive kidney diseases (niddk) supports wide range medical research grants universities . Autosomal dominant polycystic kidney disease (adpkd) common monogenic kidney disease fourth leading -stage kidney disease adults. Dedicated awareness, prevention treatment kidney disease, nkf helps care , suffer , risk kidney disease..
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As a pharmacist working for an international charity, Owen Wood shares his knowledge ofA mass vaccination and medicines procurement.
Diabetes campaign poster Running a successful public health campaign requires a number of key components, including adequate planning, creative campaign materials and the involvement of all pharmacy staff.
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Hypoglycemia undoubtedly is the major obstacle to glycemic control in type 1, insulinopenic spectrum of type 2 and some other forms of diabetes, the a€?brittle diabetesa€? in particular. Hypoglycemia is a fact of life for many patients living with type 1 diabetes and it has been seen that on an average, they suffer from two episodes of symptomatic hypoglycemia per week and one episode of severe hypoglycemia per year.
Hypoglycemia in diabetes is typically the outcome of relative or absolute iatrogenic hyperinsulinemia and compromised physiologic and behavioral defenses against declining plasma glucose concentrations.
Hypoglycemia is frightening and inconvenient to patients and the fear of hypoglycemia prevents them from achieving optimal control. There are evidences to show that a history of severe hypoglycemia in the elderly is associated with a greater risk of dementia. Prolonged and profound hypoglycemia can cause irreversible neurological damage as depicted in one of the accompanying case reports, and an estimated 2a€“4A % of people with type 1 diabetes die from hypoglycemia [4]. Minimizing the risk of hypoglycemia requires acknowledging the problem, reevaluating the glycemic goal, applying the appropriate principles of aggressive glycemic therapy including SMBG, considering the risk factors for HAAF and patient education. For any community that rely on the mass media to tell them what matters most, any issue that is not in the news probably does not exist. Ahead of the World Hepatitis Day scheduled( July 28), The Society for Gastroenterology and Hepatology in Nigeria (SOGHIN) in collaboration with Health Communication and Development Initiative (HCDI) and the World Hepatitis Alliance held a skills-building session and round table in Lagos for journalists on the disease. With the theme Telling the Hepatitis Story: One Test, One Shot, One Hope ,the skills building session had two main objectives one of which is to enhance the capacity of journalists in Nigeria to contribute towards effective Hepatitis response through accurate, sustained and broad-based reporting of Hepatitis disease. Obom-Egbulem, who is also Managing Editor, Nigerian Health Journal said the skills building session is also aimed at examining the role media advocacy could play in improving access to testing, treatment and vaccination as well as reducing Hepatitis related mortality.
Obom-Egbulem said the choice of title for the roundtable was informed by an understanding that there is an effective way to make an issue known and that way is to tell it as a story. Explaining how important the role of the media is in raising the level awareness about Hepatitis, Obom-Egbulem said that, news is not what happened or what people say it is. He added that Hepatitis B is caused by infection with Hepatitis B Virus (HBV) in childhood which the body fails to clear and this result in chronic illness that lasts more than six months and in some cases for life.


Lesi added that there testing early for Hepatitis B and getting vaccinated remains a better way to responds to the epidemic and these are priorities that government must promote. Continuing, Obom-Egbulem said that someone must take responsibility for opening up the space for Nigerians to talk about Hepatitis B and avoid complications such as liver cancer and liver cirrhosis.
The publication is the go-to source for health care providers who serve patients with diabetes. You and your health care provider can seek a balance between the general guidelines and tailored therapy that fits your situation and needs.
Currently, Medicare requires insulin secretion testing to authorize insulin pumps and does not cover CGMs. People under age 50 with multiple cardiovascular disease risk factors, such as obesity and high blood pressure, may also benefit from aspirin therapy. An individual woman’s target may be less than 6 percent, if she can safely achieve it without significant hypoglycemia. We'll check in with you twice each month to share timely tips and friendly health reminders. AND is committed to improving the nation's health and advancing the profession of dietetics through research, education, and advocacy. A summary of DAA advocacy priorities is presented in this document: Advocacy Priorities in 2016.
Strict glycemic control reduces the vascular complications of diabetes which comes at the cost of increased risk of hypoglycemia. The well-known risk factors of hypoglycemia are wrong type or excessive or ill-timed dosing of insulin or insulin secretagogue, reduced insulin clearance (in renal failure), increased insulin sensitivity (low counter-regulatory hormones, following weight loss or exercise), decreased endogenous glucose production (liver failure), decreased exogenous glucose delivery (missed meal or fasting) and increased glucose utilization (during and shortly after exercise). On the other hand, cognitive impairment is significantly associated with subsequent episodes of severe hypoglycemia in these patients. Though similar data are not available for patients with type 2 diabetes, severe hypoglycemia was associated with mortality in the ADVANCE and the ACCORD trial.
While the driver and licensing agency (DVLA) of the UK does not allow driving in individuals with more than one episode of severe hypoglycemia in the preceding 12A months, the awareness related to diabetes, therapy, self monitoring of blood glucose (SMBG), and related issues among drivers is poor in the eastern world as put forward by a small study from the United Arab Emirates in this issue of the journal. At present, we have a wide range of antidiabetic medications in our therapeutic armamentarium in both oral and injectable forms which are anti-hyperglycemic rather than hypoglycemic and these agents can help many patients reach and maintain their target safely without causing hypoglycemia. On 30 October 2014, Earl Howe, Parliamentary Under Secretary of State at the Department of Health, said in parliament that the NHS is on track to fulfil this ambition, delivered through the QIPP (quality, innovation, productivity and prevention) challenge.
It comes from a November 2010 report from the then University of London School of Pharmacy and the York Health Economics Consortium, a consulting and research organisation.
Although the savings can be a convincing economic argument for operating a CIVAS, the safety benefits conferred through the specific skills founded in the pharmacy aseptic suite and the better labelling of reconsituted product is the main driver. And if that issue happens to be Hepatitis B-a highly infectious viral disease that affects about 350million people globally and 19million Nigerians, then there’s a huge problem.
But it is hardly ever in the news not withstanding that one out of every eighth person in the region is a carrier of the Hepatitis B virus which can lead to liver cancer and other forms of liver damage if not detected early and treated.
Olufunmilayo Lesi, Consultant physician and Gastroenterologist at the Lagos University Teaching Hospital (LUTH) also provided vital information about the disease which she says has been relegated on the priority list of public health concerns.
Why are we still having cases of liver cancer and liver cirrhosis due to chronic Hepatitis B in the midst of available and effective treatment and vaccination?”,she wondered.
Lesi’s puzzle begins with putting Hepatitis B in the news and keeping it there; it is more than an issue for Word Hepatitis Day coverage alone”, argued Obom-Egbulem.
Evidence-based medicine was in its infancy—most treatment was based on professional opinion rather than research. Read on for a few highlights and significant changes you’ll find in the 2016 guidelines. Some women may need a more relaxed target range of less than 7 percent to minimize the risk of hypoglycemia. Degree and duration of I?-cell secretory defect, a history of severe hypoglycemia or hypoglycemia unawareness, recent antecedent hypoglycemia, prior exercise or sleep, and aggressive therapy are the indicators of compromised defenses against hypoglycemia. Defective glucose counter-regulation, left-ward shift of the glycemic thresholds for sympathoadrenal outflow, and altered symptomatic and behavioral responses by recent antecedent hypoglycemia and the resultant hypoglycemia unawareness lead to a vicious cycle of recurrent hypoglycemia. Contrary to previous belief, there is no association between frequency of severe hypoglycemia and cognitive decline in adolescents and younger adults with type 1 diabetes.
The death rate in the ADVANCE in people with severe hypoglycemia was 19.5A %, in those without it was 9A %.
While targeting and maintenance of satisfactory glycemic control that can be achieved safely in a particular patient is of utmost importance, undue concerns about hypoglycemia should not be an excuse for poor glycemic control. According to QIPP, it seems quite obvious to say, efficiencies can be made by focusing on boosting the quality of care rather than just cutting costs.Yet a recent report from the Academy of Medical Royal Colleges claims around a fifth of mainstream clinical practice brings no benefit to patients and that wasted prescribed medicines cost the NHS in England around A?300m a year. Regularly quoted, the sum includes unused prescription medicines retained in patientsa€™ homes, returned to community pharmacies and binned in nursing homes. Enhanced stability (and therefore expiry) often results from the assured aseptic preparation too.One thing is for sure - we don't do nearly enough to support adherence.
Ros Band, health development manager at Health First, a specialist NHS health promotion service for Lambeth, Southwark and Lewisham, has been working with the PCTs to develop the campaigns, evaluate learning to date and create a strategy for the next programme. This value approximates the lower limit of plasma glucose concentration in the normal post-absorptive state.
However, as the patients approach towards the insulin-deficient end of the spectrum of the disease, the incidence progressively increases. Other potential risk factors are some of the long-term complications of diabetes like gastroparesis, poor vision, and manual dexterity and macroalbuminuria (even in absence of significantly decreased renal function). The easy wins will be in high cost therapies like Oral Oncology and HIV antiviral treatment.


In healthy individuals, this particular level of plasma glucose is the threshold for activation of counter-regulatory mechanisms, and it is also low enough to potentially reduce the physiological defenses against subsequent hypoglycemia. For example, in the UK Hypoglycemia Study, the incidence of severe hypoglycemia in insulin treated type 2 diabetics was 10 and 70 episodes per 100 patient-years if the treatment duration was less than 2A years or more than 5A years, respectively.
Though patients with diabetes and hypertension have a higher risk of micro and macro vascular complications and mortality relative to diabetes without hypertension, the effect of hypertension on the incidence of hypoglycemia is largely unknown. Though distinct from classic diabetic autonomic neuropathy, the key feature of HAAF, an attenuated sympathoadrenal response to a given level of hypoglycemia, is more prominent in patients with diabetic autonomic neuropathy.
However, the relationships between hypoglycemia, achieved glycemia, treatment intensity, and death were not straightforward in the ACCORD trial.
Secondary care and pharmacy homecare are working together on such initiatives.However, pennies make pounds, and although the NHS Advanced Services have an important part to play in improving everyday adherence, more and improved services will be crucial as we go into the future.
In a cross-sectional study involving more than 55,000 patients with type 2 diabetes, Tran et al. The mechanism of the attenuated sympathoadrenal response is yet to be crystallized, and a number of hypotheses have been put forward like the cerebral-network hypothesis, the brain fuel-transport hypothesis, the brain-metabolism hypothesis, and the systemic-mediator hypothesis. Hypoglycemia causes abnormal cardiac repolarization as evidenced by prolonged corrected QT interval and increased QT dispersion and a resultant fatal arrhythmia is perhaps the underlying cause of an unexpected death during the night, the so-called a€?dead in bed syndromea€? described by Tattersall and Gill years ago. The leftover medicines they have at home may not be retrievable and cannot be reused in any case a€” or wasted. Particularly for the hard to reach patients like the housebound that we never see and have very limited opportunity to engage with. The ADA workgroup has classified hypoglycemia in persons with diabetes in the following five types: severe, documented symptomatic, asymptomatic, probable symptomatic, and relative.
In patients with one or more episodes of severe hypoglycemia, this functional disorder is usually reversible after a short-term (2a€“3A weeks) relaxation of glycemic targets.
Interestingly, the relationship between severe hypoglycemia and adverse events in ADVANCE revealed that people who had severe hypoglycemia were found to have higher mortality even up to 48A months after the event. Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration. In some cases the ongoing saving from the medicines stopped may exceed the waste remaining at home.Within hospitals, the waste from parenteral medicines (infusions stopped or vials partly used, for example) can rarely be mitigatedPills left behind after patients fail to finish the course of, say, an antibiotic might be considered wasteful, too. Though the study has not looked into the class of anti-hypertensive medications, which are known to increase insulin sensitivity (ACE inhibitors, angiotensin receptor blockers) or hypoglycemia unawareness (I?-blockers) and the underlying pathogenetic basis of such association, it calls for further research to confirm this particular association and identify the mechanisms involved. Majority of deaths in both ADVANCE and ACCORD occurred after a variable period from the hypoglycemic episodes, which raises the possibility of other underlying mechanisms in addition to acute arrhythmia. Co-prescription of many medications like ACE inhibitors, I?-blockers, salicylates, and different antibiotics (fluoroquinolones, cotrimoxazole) have also been shown to increase the frequency of hypoglycemia. Acute hypoglycemia activates pro-inflammatory cytokines, increases platelet activation, decreases systemic fibrinolysis, promotes endothelial dysfunction, accelerates atherosclerosis, and may ultimately result in cardiovascular death. Of greater concern would be the potential for antimicrobial resistance or ongoing costs of care if the infection is not treated effectively.Within hospitals, the waste from parenteral medicines (infusions stopped or vials partly used, for example) can rarely be mitigated. Fluoroquinolones, one of the commonly prescribed antibiotics worldwide, are known to cause hyperinsulinemic hypoglycemia by blocking ATP-sensitive potassium channels in the pancreatic I? cells.
The British Diabetic Association Cohort Study, II: cause-specific mortality in patients with insulin-treated diabetes mellitus. Some hospitals, often paediatric centres, have developed so-called centralised intravenous additive services a€”A where a single vial of a high-cost drug is split into several bags or syringes in an aseptic unit a€” but there are labour, consumables and administrative costs involved in making such savings.Poor adherence to prescribed medicines is another known source of waste. Although incidences of hypoglycemia induced by fluoroquinolones (Gatifloxacin, Levofloxacin) have mostly been reported in adults with diabetes concomitantly taking insulin or insulin secretagogues, the adverse effect has also been reported in normoglycemic older individuals with renal impairment. In this issue, an interesting case of Lomefloxacin-induced hyperinsulinemic hypoglycemia has been reported in an 88-year-old male with prediabetes and stage 3 chronic kidney disease. It might be associated with no waste, and may inadvertently lead to savings if patients pick up their prescriptions less frequently, although these patients may be putting their health at risk depending on the condition. For pharmacists, these sessions follow the regular community pharmacy forum and include tips on how to run a successful campaign.
Pharmacists will be well aware that some patients continue to pick up their prescriptions and have them dispensed without any intention of taking the drugs a€” maybe because they do not want to disappoint the doctor.Invest to saveCommunity pharmacy interventions like medicines use reviews in England, discharge medicines reviews in Wales and the chronic medication service in Scotland provide opportunities to spot poor adherence and have frank conversations with patients about their beliefs and intentions around medicines use.
But consider, instead, the blood pressure drug enalapril, with an annual cost of around A?15 a€” a meagre saving if you identify a patient who is refusing to take it. Nonetheless, in both cases, the patient will be at risk of cardiovascular events with associated hospital admissions and after-care.The focus must be on quality and outcomes, on ensuring each patient is engaged with their treatment a€”A this might mean additional adherence support, choosing a more acceptable but pricier treatment or stopping the drugs altogether.
Using words like a€?wastefula€? to describe the NHS may prompt the usual headlines, but does not reflect the complexity of the matter, nor is it helpful. They tested the diabetes campaign material on a user group identified through Diabetes UK, he says. The questionnaire was designed in association with the PCT public health director and medical director, and associated diabetologists, so as to avoid inappropriate referrals. Campaign material was sent to community pharmacies two weeks before the campaign was due to start. Frances Wellburn, community pharmacy contracts and development manager at Lambeth PCT, says that next year the PCT hopes to incorporate screening into both the diabetes and hypertension campaigns.
The staff need to know that, embrace it and be proactive.a€? Having a dedicated area within the pharmacy where health promotion material can be displayed has helped to attract people into the pharmacy, he adds. For each campaign, he records how many leaflets are issued, what advice is given in response to a question, what advice is offered without a question, and how many customers are referred to another person or organisation.



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