Textbook of Diabetes

Description

Front Matter Untitled Untitled Copyright Contents List of Contributors Preface to the Fifth Edition List of Abbreviations PART 1 Diabetes in its Historical and Social Context 1 The History of Diabetes Mellitus Key points Ancient times Table 1.1 Milestones in the clinical descriptions of diabetes and itscomplications. The 17th and 18th centuries 2 Classification and Diagnosis of Diabetes 3 Epidemiology of Type 1 Diabetes 4 Epidemiology of Type 2 Diabetes 5 The Global Burden of Diabetes PART 2 Normal Physiology 6 Islet Function and Insulin Secretion 7 Glucagon in Islet and Metabolic Regulation 8 Mechanism of Insulin Action 9 Control of Weight:HowDoWe Get Fat? PART 3 Pathogenesis of Diabetes 10 Autoimmune Type 1 Diabetes 11 Other Disorders with Type 1 Phenotype 12 Abnormalities of Insulin Secretion and β-Cell Defects in Type 2 Diabetes 13 Insulin Resistance in Type 2 Diabetes 14 Genetic Architecture of Type 2 Diabetes 15 Metabolic Disturbances in Diabetes 16 Obesity and Diabetes 17 The Microbiome and Diabetes PART 4 Other Types of Diabetes 18 Monogenic Causes of Diabetes 19 Drug-Induced Diabetes 20 Endocrine Disorders that Cause Diabetes 21 Pancreatic Diseases and Diabetes PART 5 Managing the Patient with Diabetes 22 Clinical Presentations of Diabetes 23 The Aims of Diabetes Care 24 Educating the Person with Diabetes 25 Lifestyle Issues: Diet 26 Lifestyle Issues: Exercise 27 Monitoring Diabetes 28 Drug Therapy: Special Considerations in Diabetes PART 6 Treatment of Diabetes 29 Insulin and Insulin Treatment Key points Life (and death) before insulin The discovery of insulin The first insulins Table 29.1 Insulin therapy milestones. Modifying the duration of action of insulinwithout altering its molecular structure Figure 29.3 Time action profiles of the different insulinformulations. Modifying the duration of insulin action throughaltering its molecular structure Different insulin concentrations Biosimilar insulins Reproducing physiological insulin delivery—thesize of the problem Oral, inhaled, intraperitoneal and intramuscularroutes of insulin administration Technique for subcutaneous injection of insulin Figure 29.6 Rotation of insulin injection sites. Complications of subcutaneous insulin therapy Insulin regimens Basal only regimen Combinations of prandial and basal insulins Selecting the most appropriate insulin regimen Type 1 diabetes Table 29.2 Out-patient/community pathway for people starting insulin for thefirst time. Type 2 diabetes Starting insulin for the first time Use of animal, human, and analog insulins Assessments of glycemic control Declaration of interest References 30 New Technologies for Glucose Monitoring and Insulin Administration 31 Oral Glucose-Lowering Agents 32 Non-Insulin Parenteral Therapies 33 How to Use Type 2 Diabetes Treatments in Clinical Practice: Combination Therapies Key points Introduction Pathophysiological rationale for usingmultiple therapies Figure 33.1 The multiple pathophysiological defectsthat lead to T2DM. The abnormalities described areexpressed variably in patients. Most individuals withT2DM have derangements in both insulin supply andinsulin action. More recently, abnormal incretin systemhas been described in addition to inadequate renalclearance of glucose. Many of these metabolic axes arein part driven by the brain but the link to diabetesremains unclear. Individual glucose-lowering drug classes Metformin Figure 33.2 General recommendations from the 2015 update to the ADA–EASDposition statement on management of hyperglycemia in T2DM [34]. Table 33.2 Available fixed-dose combinations of glucose-lowering agents ofdifferent classes. Thiazolidinediones Incretin-based therapy GLP-1 receptor agonists DPP-4 inhibitors SGLT-2 inhibitors Insulins 34 In-Hospital Treatment and Surgery in People with Diabetes Key points Introduction Known diabetes in hospital Undiagnosed diabetes and stress hyperglycemiain hospital Pathophysiology of hyperglycemiain acute illness Evidence of harm from in-hospitalhyperglycemia and effect of glucose lowering Glycemic targets for hospitalized inpatients The intensive care unit (ICU) General ward patients Surgical patients Current recommended standards of care forhospital inpatients with diabetes Diabetes self-management Patient satisfaction Box 34.1 Results from the UK National Diabetes InpatientAudit 2015. The role of the diabetes specialist team Staff education Figure 34.1 Prioritization of patients who shouldbe seen by the diabetes inpatient specialist team. Management of in-hospital hyperglycemia Medication to manage in-hospital hyperglycemia Self-management of diabetes in hospital Technology Subcutaneous and intravenous insulin protocols Indications for an intravenous insulin infusion Box 34.2 Indications for an intravenous insulin infusion(variable rate unless stated). Table 34.1 Insulin infusion table. Preparation and delivery of an intravenousinsulin infusion Transition from intravenous to subcutaneous insulin Table 34.2 Transition from intravenous to subcutaneous insulin. Box 34.3 Converting from intravenous to subcutaneous insulin. Avoiding and treating in-hospital hypoglycemia Frequency of hypoglycemia in hospitalized patients Causes of in-hospital hypoglycemia Table 34.3 Potential causes of in-hospital hypoglycemia. Morbidity and mortality associated within-hospital hypoglycemia Evidence for treatment options Management of in-hospital hypoglycemia Figure 34.2 Algorithm for the treatment of hypoglycemia in adults with diabetes in hospital. Hypoglycemia is defined as a blood glucose level of4.0 mmol/L (72 mg/dL) then a small carbohydrate snack should be givenfor symptom relief. ABC, airway, breathing, circulation; NBM, nil by mouth. Primary care Preoperative assessment Surgery in people with diabetes Primary care Table 34.4 Guidelines for perioperative adjustment of insulin. Preoperative assessment Hospital admission Table 34.5 Guidelines for perioperative adjustment of non-insulin medication. While in the operating theater and recovery Postoperative period Hospital discharge Emergency surgery Continuous subcutaneous insulin infusions(CSIIs; “pumps”) Glucocorticoid use Steroid therapy: impact on blood glucose Monitoring Medication options for people taking once-dailysteroid therapy Non-insulin therapies Insulin therapies Medication options for people taking multiple dailydoses of steroid Non-insulin therapies Insulin therapies Hospital discharge Steroid treatment in end-of-life care Foot care Conclusions References 35 Hypoglycemia in Diabetes 36 Acute Metabolic Complications of Diabetes: Diabetic Ketoacidosis and the Hyperosmolar Hyperglycemic State PART 7 Microvascular Complications in Diabetes 37 Pathogenesis of Microvascular Complications 38 Diabetic Retinopathy 39 Diabetic Nephropathy 40 Diabetic Peripheral and Autonomic Neuropathy PART 8 Macrovascular Complications in Diabetes 41 Pathogenesis of Macrovascular Complications in Diabetes 42 Cardiovascular Risk Factors: Hypertension 43 Diabetic Dyslipidemia and Risk of Cardiovascular Disease 44 Ischemic Heart Disease in Diabetes 45 Congestive Heart Failure 46 Cerebrovascular Disease 47 Peripheral Vascular Disease PART 9 Other Complications of Diabetes 48 Foot Problems in People with Diabetes 49 Sexual Function in Men and Women with Diabetes 50 Gastrointestinal Manifestations of Diabetes 51 Diabetes and Non-Alcoholic Fatty Liver Disease 52 The Skin in Diabetes 53 Bone and Rheumatic Disorders in Diabetes 54 Diabetes and Cancer: Evidence for Risk, Methodology and Implications 55 Diabetes and Infections PART 10 Psychosocial Aspects of Diabetes 56 Psychological Factors and Diabetes Mellitus 57 Psychiatric Disorders and Diabetes 58 Social Aspects of Diabetes PART 11 Diabetes in Special Groups 59 Diabetes in Childhood 60 Adolescence and Emerging Adulthood: Diabetes in Transition 61 Diabetes in Pregnancy 62 Diabetes in Old Age 63 Diabetes at the End of Life 64 The Role of the Multidisciplinary Team Across Primary and Secondary Care PART 12 Delivery and Organization of Diabetes Care 65 Models of Diabetes Care Across Different Resource Settings PART 13 Future Directions 66 Future Drug Treatments for Type 1 Diabetes 67 Future Drug Treatments for Type 2 Diabetes 68 Stem Cell Therapy in Diabetes 69 Islet Transplantation 70 Gene Therapy for Diabetes 71 Future Models of Diabetes Care Index