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Screening Programs
Published in Ching-Yu Cheng, Tien Yin Wong, Ophthalmic Epidemiology, 2022
Jakob Grauslund, Malin Lundberg Rasmussen
The high number of diabetes-related examinations is often a barrier for effective diabetes care. In Denmark, systemic same-day-complication screening has recently been launched for patients with diabetes in order to integrate all diabetes examinations at the same day. This is a telemedicine-based screening program embracing DR screening. Patients attend a local hospital-based diabetes clinic. Micro- and macrovascular complications are evaluated, including fundus photography-based DR screening supported by OCT, when applicable. Retinal images are transferred electronically to a centralized grading center, from which DR grading is performed by certified ophthalmic experts within an hour. At the local hospital-based diabetes clinic, evaluation of DR is integrated with evaluation of nephropathy, neuropathy, blood pressure, and glycemic control, and based upon this, individualized plans for diabetes treatment are given by the attending diabetologist.
Vascular surgery
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
Specific treatment: arterial or mixed venous/arterial ulcers: see chronic lower limb ischaemia abovevenous ulcers: non-surgical management – rest and elevation of the leg, four layer compression bandaging only if ABPI >0.8surgical treatment – skin grafting and treatment of primary varicose veins may be beneficial.Diabetic ulcers: avoid mechanical stress to the limb. A multi-disciplinary approach with referral to a diabetologist, vascular surgeon, podiatrist, is essential.
Practice exam 3: Answers
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
Good glycaemic control before pregnancy.Diabetologist referral to review medication.Folic acid supplement.
Reconstruction of necrotizing soft tissue infection in the auricle and temporal region: a case report
Published in Case Reports in Plastic Surgery and Hand Surgery, 2023
Junpei Saito, Shoichi Ishikawa, Shigeru Ichioka
During the first hospital visit, skin and subcutaneous tissue necrosis and pus drainage were mainly observed on the posterior surface of the right auricle. The right auricle and the surrounding temporal area were erythematous and swollen (Figure 1). Vital signs were as follows: clear consciousness, heart rate of 118/min, blood pressure of 151/103 mmHg, a body temperature of 37.1 °C, and respiratory rate of 20/min. Blood tests showed leukocytes of 26,490/μl; CRP, 40.97 mg/dl; Hb, 14.7 g/dl; Na, 127 mEq/l; creatinine, 0.43 mg/dl; blood glucose, 475 mg/dl; HbA1c, 12.1%; high inflammatory response; and poor glucose control. The laboratory risk indicator for necrotizing fasciitis score was 9 points. The patient reported that she had no history of diabetes mellitus, but a slowly progressing insulin-dependent diabetes mellitus was diagnosed; during hospitalization, the diabetologist administered insulin to control her blood glucose level. Blood and pus cultures revealed methicillin-susceptible Streptococcus aureus. Antibiotic treatment was started with meropenem and daptomycin. Meropenem was administered for 6 days and daptomycin for 4 days. This regimen was subsequently de-escalated to cefazolin. Antibiotics were administered for 22 days, at which point acute signs of infection had subsided.
Diagnostic and prognostic value of the electrocardiogram in stable outpatients with type 2 diabetes
Published in Scandinavian Cardiovascular Journal, 2022
Mads C. T. Gregers, Morten Schou, Magnus T. Jensen, Jesper Jensen, Mark C. Petrie, Tina Vilsbøll, Jens Peter Goetze, Peter Rossing, Peter G. Jørgensen
Our data suggest that the ECG may be used routinely as a screening tool for HfrEF/ALVSD in patients with T2D in secondary care. HfrEF/ALVSD was a rare complication in this population. This high-lights a screening-based – i.e. ECG – rather than a diagnostic – i.e. referring to echocardiography – strategy to identify type 2 diabetes patients with HfrEF/ALVSD. Further, hazard ratios for the composite endpoint of HfpEF and HfmrEF was still significantly elevated why recognition of HF symptoms and/or abnormal ECG in a secondary diabetic clinic is important. Further collaboration between cardiologist and diabetologist is vital for these patients. However, if there is suspicion of HfpEF or HfmrEF, the patient should be referred for echocardiography – especially in patients with other prevailing risk markers.
Scientific independence and objectivity: many questions linger about treatment of type 2 diabetes, such as scientific study design, optimal glucose control and the safety of injecting exogenous insulin
Published in Postgraduate Medicine, 2020
The most commonly cited study in defense of the use of exogenous insulin in people with type 2 diabetes is the ORIGIN study [93]. Firstly, this study was never intended to investigate this question, and most worrying, although rarely reported, in ORIGIN – where the percentage of patients without a prior cardiovascular event at baseline was 41% – the primary endpoint was significantly increased in these patients by17% (HR = 1.17, 95%CI 1.00–1.37) in the insulin glargine arm (12.·7%) versus those treated with metformin plus SUs (11.0%) [94]. ORIGIN was a study in patients with dysglycemia with a median HbA1c of only 6.·4%. No experienced diabetologist would recommend insulin therapy for patients with this level of glucose control. Since the need for glucose lowering was minimal in these subjects, only a low dose of insulin was used in this study. Even so, severe hypoglycemia was markedly increased in the insulin glargine arm, but interestingly, mortality was also significantly higher in patients who experienced severe hypoglycemia in the control arm too (60% metformin, 47% SUs, 11% insulin). It seems very likely that the outcome of the ORIGIN study would have been very different if DPP-4 inhibitors or SGLT-2 inhibitors were used to lower glucose in the control arm, and not SUs.