Individualized Diabetes Management: A Guide for Primary Care

Description:

In the past few decades a revolution in our approach to treating type 2 diabetes has occurred following the recognition that the condition is caused by multiple defects. A range of new treatments are now available, with many more forthcoming, utilising differing mechanisms of action that allow targeted and more effective therapy of this multifactorial disease than ever before. The increasing requirement in the UK to move much of diabetes practice into the community requires much more detailed knowledge of the condition by GPs and practice nurses. In this bespoke book, the authors aim to show how new mechanisms of glucose control and advances in treatments arising from this can tailor treatment to the individual in primary care. This book incorporates the recently published ADA/EASD guidelines and the 2015 update from the National Institute for Health and Clinical Excellence (NICE). Essential reading for the multi-professional diabetes care team, this book should also be of interest to hospital specialists in training.

Table of Contents:

1 Type 2 diabetes: epidemiology, complications and costs

Epidemiology

Diabetes complications

Costs

References

2 Challenges to glycaemic control

Type 2 diabetes is a progressive disease

Adherence to management plans

Clinical inertia

Provider barriers

Patient barriers

System barriers

Overcoming clinical inertia

References

3 Barriers to adherence and their solutions

Which patients are most at risk of non-adherence?

Age-related morbidities

Lifestyle challenges

Change in situation

Loss or lack of motivation

Depression

Ethnicity

Poor perception and knowledge of disease

Problems with therapy

Complexity of dosing regimen

Fear of injections

Safety and tolerability

Lack of knowledge

How to question patients about non-adherence

Tailor adherence solution to non-adherence problem

Conclusions

References

4 Advantages and disadvantages of new therapies

Older therapies

Metformin

Modified-release metformin

Sulphonylureas

Meglitinides

Thiazolidinediones (glitazones)

Alpha-glucosidase inhibitors

Newer therapies

Incretin-based therapies

DPP-4 inhibitors

GLP-1 receptor agonists

SGLT-2 inhibitors

Combination therapy with newer agents

References

5 New insulin developments

Basal insulins

Biosimilar insulins

Insulin degludec

Glargine U300

Rapid-acting insulin analogues

Ultra-rapid-acting insulin analogues

Inhaled insulin

Conclusions

References

6 Personalised management

Factors to consider in personalised diabetes management

Lifestyle management

Pre-diabetes

Diagnosed type 2 diabetes

Pharmacotherapy

Early and intensive treatment with initial combination therapy

Advantages of a personalised approach

References

7 Organisation of diabetes care

Role of the primary care team in multi-professional care

Aims of integrated care

Personalised care planning

Preparing for a care planning discussion

References

Index