Practical diabetes care

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	Contents
	Acknowledgments
	Introduction
	Clinical trials and organizations:abbreviations and acronyms
1 Classification, diagnosis and presentation, 1
	Key points
	A PRACTICAL CLASSIFICATION OF DIABETES
		TYPE 1 DIABETES
			Table 1.1 Phenotypic features of Type 1 diabetes.
			Epidemiology; Type 1 diabetes in China
			Further clinical pointers to Type 1 diabetes
		AUTOIMMUNE ASSOCIATIONS OF TYPE 1 DIABETES
		Box 1.1 Autoimmune conditions associated with Type 1 diabetes.
		TYPE 2 DIABETES
		Table 1.2 Diagnosing Type 2 diabetes in adults.
		Latent autoimmune diabetes of adults (LADA): a valuable epidemiologicalconcept, but of limited value in immediate clinical decision‐making
		Figure 1.1 Prevalence of Type 2 diabetes in the United Kingdom by ethnicity (age‐ and sex‐standardized).
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3 Infections and the diabetic foot, 49
4 Eyes and kidneys, 77
5 Neuropathy, musculoskeletal and skin, 115
6 Diabetes and the cardiovascular system, 141
7 Type 1 diabetes: glycaemic control, 171
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9 Type 2 diabetes: weight loss, exercise and other ‘lifestyle’
10 Type 2 diabetes: glycaemic control, 241
	Key points
	INTRODUCTION
	THE PROGRESSIVE NATURE OF TYPE 2 DIABETES
	Practice point:
	GLYCAEMIC CONTROL AND COMPLICATIONS IN TYPE 2DIABETES
		Microvascular complications
			UKPDS
			VADT, ACCORD, ADVANCE
			Practice point
		Macrovascular complications
			VADT, ACCORD, ADVANCE
			Multimodal intervention (Steno‐2)
			Practice point
	TARGETS FOR GLYCAEMIC CONTROL INTYPE 2 DIABETES
	Box 10.1 UK (NICE) and USA (ADA) targets for glycaemic control.
	SELF‐MONITORING OF BLOOD GLUCOSE INTYPE 2 DIABETES
	PHARMACOLOGICAL MANAGEMENTOF HYPERGLYCAEMIA
	Table 10.1 Drugs, patents and long‐term cardiovascular benefits.
	INTENSIFICATION OF TREATMENT IN TYPE 2 DIABETES
	GLYCAEMIC EFFICACY (MAGNITUDEOF ANTIHYPERGLYCAEMIC EFFECT) (TABLE 10.2)
		Figure 10.2 Intensification of antihyperglycaemic treatment. Source: from NICE guidelineNG28, 2015.
		Tableˇ10.2 Thumbnail characteristics ofdiabetes agents (adapted fromADA).
		Durability of effect
		METFORMIN
			Glycaemic efficiency and durability
			Practice point
			Practice point
			Effects on weight and risk of hypoglycaemia
			Side effects
			Practice point
			Metformin and renal impairment
			Table 10.3 Metformin dosing in CKD.
			Practice point
			Metformin in liver disease
			Lactic acidosis
			Contrast‐induced nephropathy and lactic acidosis
			Vitamin B12 deficiency
		AGENTS TO BE USED AFTER METFORMIN
		SULFONYLUREAS AND PRANDIAL GLUCOSE REGULATORS(MEGLITINIDES)
			Key practice points
			Mechanism of action
			Glycaemic efficiency and durability
			Effects on weight and hypoglycaemia
			Figure 10.4 Glycaemic control in the patients in the ADVANCE trial. Glycaemia is stablethroughout in all groups, with no evidence for glycaemic failure in those on gliclazide monotherapy.
			Practice point
			Practice point
			Box 10.2 Clinical characteristics of patients developing severe sulfonylurea‐relatedhypoglycaemia.
			Non‐glycaemic effects
			Drug interactions
			Meglitinides: repaglinide and nateglinide
		DRUGS ACTING ON THE INCRETIN SYSTEM
		DPP‐4 INHIBITORS (GLIPTINS)
			Glycaemic efficiency and durability
			Practice point
			Table 10.4 Dosing of DPP‐4 inhibitors (gliptins) in renal impairment.
			Effects on weight and risk of hypoglycaemia
			Non‐glycaemic effects and adverse effects
		GLP-1-RECEPTOR AGONISTS
			Tableˇ10.5 GLP˙1˙receptor agonist drugs.
			Glycaemic efficiency and durability
			GLP‐1‐receptor agonists in long‐duration trials
			Practice point
			NICE Guidance (2010/2015–2016)
			Continuous subcutaneous exenatide
			Effects on weight and risk of hypoglycaemia
			Hypoglycaemia
			Practice point
			Cardiovascular outcomes in long‐term studies of patients with establishedvascular disease
			Practice point
			Side effects
			Table 10.6 Clinical characteristics of patients recruited into long‐term cardiovascular outcomestudies with GLP‐1‐receptor agonists liraglutide (LEADER), semaglutide (SUSTAIN‐6),and exenatide (ELIXA), and the SGLT2‐inhibitor empagliflozin (EMPA REG OUTCOME).
			Pancreatic
		SGLT2 INHIBITORS (‘FLOZINS’)
			Key practice points
			Glycaemic efficiency and durability
			Table 10.7 SGLT2 inhibitor drugs.
			Effects on weight and risk of hypoglycaemia
			Non‐glycaemic effects
			Practice point
			Side effects
			Genito‐urinary and bones
			Practice point
			Normoglycaemic diabetic ketoacidosis
			Practice point
		OTHER NON‐INSULIN AGENTS
			Acarbose: α‐glucosidase inhibitors
			Pramlintide and bromocriptine
			Colesevelam
		INSULIN TREATMENT
11 Hypertension, 315
12 Lipids, 359
13 Clinical aspects of the metabolic syndrome, 387
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index