Diabetes

A practical evidence-based approach to management of type 2 diabetes in children and young people (CYP): UK consensus (2024)

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Type of publication:
Journal article

Author(s):
White, Billy; Ng, S M; Agwu, J C; Barrett, T G; Birchmore, N; Kershaw, M; Drew, J; Kavvoura, F; Law, J; Moudiotis, C; Procter, E; Paul, P; Regan, F; Reilly, P; Sachdev, P; *Sakremath, R; Semple, C; Sharples, K; Skae, M; Timmis, A; Williams, E; Wright, N; Soni, A.

Citation:
BMC Medicine. 22(1):144, 2024 Apr 02.

Abstract:
BACKGROUND: Type 2 diabetes in young people is an aggressive disease with a greater risk of complications leading to increased morbidity and mortality during the most productive years of life. Prevalence in the UK and globally is rising yet experience in managing this condition is limited. There are no consensus guidelines in the UK for the assessment and management of paediatric type 2 diabetes. METHODS: Multidisciplinary professionals from The Association of Children's Diabetes Clinicians (ACDC) and the National Type 2 Diabetes Working Group reviewed the evidence base and made recommendations using the Grading Of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. RESULTS AND DISCUSSION: Young people with type 2 diabetes should be managed within a paediatric diabetes team with close working with adult diabetes specialists, primary care and other paediatric specialties. Diagnosis of diabetes type can be challenging with many overlapping features. Diabetes antibodies may be needed to aid diagnosis. Co-morbidities and complications are frequently present at diagnosis and should be managed holistically. Lifestyle change and metformin are the mainstay of early treatment, with some needing additional basal insulin. GLP1 agonists should be used as second-line agents once early ketosis and symptoms are controlled. Glycaemic control improves microvascular but not cardiovascular risk. Reduction in excess adiposity, smoking prevention, increased physical activity and reduction of hypertension and dyslipidaemia are essential to reduce major adverse cardiovascular events. CONCLUSIONS: This evidence-based guideline aims to provide a practical approach in managing this condition in the UK.

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Improving outcomes for older people with diabetes (2021)

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Type of publication:
Journal article

Author(s):
*Morris, David

Citation:
Practice Nursing; Jul 2021; vol. 32 (no. 7); p. 270-276

Abstract:
Older people with diabetes have unique challenges. David Morris discusses the importance of individualising care for this group of people An individualised approach aiming to maximise safety, preserve autonomy and improve quality of life is needed when helping an older person to manage their diabetes. It is important to interpret the older person's diabetes in the context of their overall health concerns, including reference to co-morbidities, cognitive function, lifestyle, social setting, and life expectancy, and practice nurses are well placed to work in partnership with people with diabetes to achieve this. Pharmacological treatment goals must be realistic, acknowledging the metabolic consequences of old age, the risks of hypoglycaemia and the dangers of
polypharmacy.

GLP-1 receptor agonists in type 2 diabetes: An underused asset? (2020)

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Type of publication:
Journal article

Author(s):
*Morris, David

Citation:
Journal of Diabetes Nursing; Aug 2020; vol. 24 (no. 5); p. 1-11

Abstract:
As our understanding of the incretin hormone system has increased, a number of drugs targeting this system have been developed. The realisation of this potential has developed rapidly, and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are now a standard feature in management guidelines for type 2 diabetes. This article reviews the operation of the incretin system and the mechanism by which GLP-1 RAs act to provide benefit in type 2 diabetes. The availability and indications for use of the GLP-1 RAs, and their clinical benefits and disadvantages, are summarised. The position of GLP-1 RAs in the management of type 2 diabetes is discussed pragmatically, with reference to various key guidelines.

Managing diabetes during the COVID-19 pandemic (2020)

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Type of publication:
Journal article

Author(s):
*Morris, David

Citation:
Practice Nursing; Nov 2020; vol. 31 (no. 11); p. 450-455

Abstract:
People with diabetes are known to be more severely affected by COVID-19 than the general population. David
Morris provides an overview of how to manage the illness in this group The outbreak of a new viral infection in
Wuhan, a city in Habei Province, China, became evident in December 2019. For most individuals who contract
COVID-19 the disease is mild to moderate. Older people are disproportionately affected with serious disease,
while children appear less likely to experience serious illness. A number of conditions are linked to increased
severity of disease and poorer outcomes including both type 1 and type 2 diabetes. This article looks at why
those with diabetes are at higher risk, and how to manage diabetes during the pandemic.

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