Postprandial urinary C-peptide creatinine ratios before and during liraglutide treatment were weakly associated with the glycaemic response to treatment. Low pretreatment urinary C-peptide creatinine ratio may be more useful than higher values by predicting poorer glycaemic response.
Injectable glucagon-like peptide-1 receptor agonists (GLP1ras) have the distinct advantage of promoting weight loss as well as lowering glucose in type 2 diabetes. Treatment with a GLP-1ra is costly, thereby necessitating a restriction on widespread use, thus in the UK the National Institute for Health and Care Excellence (NICE) has published guidance on the use of these drugs.In the UK the Association of British Clinical Diabetologists (ABCD) conducted two nationwide audits on the use of exenatide twice daily and liraglutide once daily and noticed that deviations from NICE guidelines were common. Herein data have been used from both audits (following a combined total of 12,955 type 2 diabetes patients) to evaluate these treatment decisions, critically appraise the NICE guidelines and formulate recommendations for the use of GLP-1ras. Br J Diabetes Vasc Dis 2014;14:52-59
Necrobiosis lipoidica is an inflammatory disorder, associated with diabetes mellitus, for which the underlying pathological mechanism is unknown and for which there is no rational therapy. However, benefit has been reported from such different treatment regimens as drugs acting on the haemostatic mechanisms, corticosteroid therapy (topical, intralesional and systemic), enhancers of wound healing, surgery and immunomodulating therapies (including photochemotherapy). This is a review of these treatment options.
People with diabetes who administer a premixed insulin with a pen may require a largedose. Pens contain 150 or 300 units of insulin which is unlikely to be an exact multiple of the dose. Patients were asked what they did when the reservoir approached exhaustion. Twenty seven out of 110 patients were regularly giving two injections of insulin to avoid waste, although none had been instructed to do so. Seven other patients were taking action to avoid waste including five who were giving the wrong dose. The wastage of insulin is much less when using a 3 ml disposable pen than when using a 1.5 ml cartridge. If patients are instructed to use pens containing 300 units and advised to use the insulin left at the end of a pen for the smaller injection, the amount of insulin wasted is 3.6% compared with 13.6% wasted when using 1.5 ml cartridges. The total cost of insulin when using a dis‐posable pen is approximately one and a half times more than when using a cartridge, twice as much as when using a vial of the same human insulin, and two and half times more than when using pork insulin.
In a survey of 142 type 1 diabetic males, 40—59 years of age, 76 (54%) had erectile dysfunction (ED). Using a multi-variate analysis, the six most significant associations with ED were age (p = 0.009), duration of diabetes (p = 0.001), glycaemic control as assessed by HbA1c (p = 0.003), weight (p = 0.003), hypertension (p = 0.06) and microalbuminuria (p = 0.04). ED was associated with a higher cardiovascular risk score. In an assessment of categorical variables, retinopathy and laser therapy were also significant, reflecting the severity of underlying microangiopathy. It is concluded that despite advances in the management of micro- and macrovascular complications over the past 30 years, ED is still a common problem in diabetic males requiring careful assessment and appropriate treatment.
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