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Diabetes care has undergone a rapid change in delivery since the first lockdown from COVID-19 in March 2020. As such, services have had to reshape and transform into virtual diabetes reviews. Vulnerable communities with high diabetes incidence or risk have experienced health disparities, not least because of COVID-19, but also as a result of slower medication reviews and escalation of diabetes prescribing as required. This article critically examines the presenting inequalities in diabetes care provision in the UK. In particular focusing on the experience of minority ethnic populations, who experience inequality and health disparities, especially related to prescribing of newer medications in type 2 diabetes. Evidence from studies and reports underpins the debates presented about reconsidering diabetes care delivery and in particular listening to and working with local practices and their communities to disseminate health messages and provide person-centred educational opportunities. [ABSTRACT FROM AUTHOR]

Anne Phillips explores the ways in which diabetes consultations can be maximised to deliver the best effects for people living with diabetes and health professionals involved in their care Changes to diabetes care due to the COVID-19 pandemic have caused extra pressures for both people living with diabetes and the health professionals involved in their care. Virtual and remote consulting has caused many health professionals to experience stress and usual face-to-face conversations with people living with diabetes have changed in context, frequency and delivery. The nuances of non-verbal communication can be lost in virtual consultations, so it is vitally important that health professionals are aware of this and consider how to deliver consultation conversations to the best effect. It is imperative that every contact counts and every virtual and face-to-face consultation has meaning for the person living with diabetes to maximise the benefit for the individual and their circumstances. [ABSTRACT FROM AUTHOR]

The NHS Long Term Plan, launched in January 2019, outlined several targets and schemes to improve patient care. However, practice nurses need to be aware of what these changes might mean for their practice, particularly in diabetes care This is an exciting time of transformation and engagement in diabetes care for general practice. The King's Fund (2018) reported 'a shared responsibility for health' which echoes this vision for transformation in terms of diabetes care and supporting more avenues to enable people to gain the skills and knowledge to live well with their condition. Furthermore, the new NHS Long Term Plan (NHS, 2019) announced several initiatives for people living with diabetes, which are detailed in this article. [ABSTRACT FROM AUTHOR]

Smoking is the biggest avoidable cause of death, disability, and social inequality in health in the UK. Smokers are at increased risk of developing type 2 diabetes, and the risk reduces when people stop smoking. In those with diabetes, smoking increases the risk of experiencing complications. Macrovascular complications, such as stroke and cardiovascular disease, are also more common in people who smoke. Smoking can also inhibit wound healing, affect tissue health and accelerate the occurrence of microvascular complications. Practice nurses have a duty to inform patients of these increased risks and have an opportunity to reduce harm by encouraging smoking cessation, whether by traditional stop smoking methods or e-cigarettes. [ABSTRACT FROM AUTHOR]

Background: UK cardiac rehabilitation has reached for the first time 50% uptake in 2016; however, this still leaves 50% of the eligible group not starting cardiac rehabilitation. The characteristics of patients missing cardiac rehabilitation are relatively unknown with some studies in America suggesting that patients with diabetes have a reduced likelihood of joining cardiac rehabilitation. Methods: This study used routinely collected data from the National Audit of Cardiac Rehabilitation to investigate proportional differences in patients with cardiovascular disease with, and without, diabetes taking up the offer of cardiac rehabilitation. Results: The proportion of patients with diabetes entering cardiac rehabilitation dropped by between 7% and 15% depending on the age group (<40 years, 7% reduction; 61–80 years, 15%). The study’s results showed that in all demographic and diagnostic groups, the proportion of patients with diabetes was significantly less than that of the eligible group (p < 0.001). There was no difference in the proportion of loss, from eligible to starting cardiac rehabilitation, between males and females, which was 13% for both groups. Conclusion: This study confirms, in a new UK population with over 121,002 eligible patients, that there is a statistically significant drop in patients with diabetes taking up cardiac rehabilitation. This study is unique in looking at all four key diagnosis and treatment groups and comparing them to those taking up cardiac rehabilitation. To achieve the target of 65% uptake set by NHS England, improvements in identifying and targeting complex patients, such as those with diabetes, need to be adopted. [ABSTRACT FROM AUTHOR]

The authors of this article outline and illustrate a case of an unusual foot complication in a patient with type 2 diabetes and sarcoidosis, who went on to develop a large plantar foot verruca and nodular prurigo after getting accidently burned. Here they describe the patient's dramatic wound healing journey in words and pictures. [ABSTRACT FROM AUTHOR]

It is important for people with diabetes who plan to travel to receive appropriate advice to make the trip as safe as possible. The information the person with diabetes receives should be individualised and tailored to their particular needs. It is critical for the the individual to achieve good blood glucose control before travelling to avoid the risk of complications while abroad, and they should also receive the country-speciic travel advice for vaccinations that other travellers would receive. Diabetes does not prevent travel, but requires careful planning by both the health professional and the traveller . [ABSTRACT FROM AUTHOR]

Type 2 diabetes is increasing in prevalence at a worrying rate and has been exacerbated by the worldwide obesity epidemic. The number of people in the UK diagnosed with type 2 diabetes has soared by 60% in the past 10 years. Type 2 diabetes is a very serious condition, with significant associated risks, and is the leading cause of avoidable macro- and microvascular complications. Health professionals have a key role in enabling and optimising person-centred approaches, educating and augmenting the essential skills every person, whatever his or her individual circumstances, requires for the successful self-management of this lifelong condition. This article reviews approaches to care for the management of hyperglycaemia in type 2 diabetes, which includes optimising person-centred targets, promoting individualised care, minimising the risk of complications and promoting education from diagnosis onwards. [ABSTRACT FROM AUTHOR]

The following literature review will focus on sexual dysfunction in women living with diabetes, drawing on international studies in this specialist field. The key aim of this paper is generate a greater understanding and recognition of the issues facing these women and to determine a more proactive approach to identification, consultation and potential treatment options. The main findings highlight the unique role practitioners have with women with diabetes and how to facilitate partnership working. Nurses have the most frequent contact with people living with diabetes in any healthcare system. Nurses' knowledge about sexuality in relation to diabetes should improve patient education, recognition and could signal undiagnosed or increased risk of sexual dysfunction to enable treatment so care can be optimised accordingly (Sivrikaya et al„ 2014). [ABSTRACT FROM AUTHOR]

The article investigates the occurrence of diabetes in adult populations over the age of 18 and the opportunities to promote primary prevention facilitated by practice nursing. Topics discussed include the projected worldwide effect of Type 2 diabetes on 592 million people by 2030, and findings of a study which associates diabetes to high rates of cardiovascular disease (CVD) deaths. It cites that increased physical activity in diabetes patients lowers risk for CVD development.

As the incidence of diabetes in the UK is increasing, it is important that healthcare professionals are confident in carrying out diabetes care in their clinical area. The care of people with diabetes admitted to hospital can be sub-optimal owing to the limitations of current protocols. In this article, the authors discuss the results of a pilot audit questionnaire testing staff knowledge concerning the use of variable rate intravenous insulin infusions within a critical care environment. [ABSTRACT FROM AUTHOR]

The authors examine the literature to determine the effects of hyperglycaemia and hypoglycaemia within the critical care setting. They review the original evidence for the use of intensive glucose monitoring in critical and intensive care and critically discuss new evidence that the strict parameters are causing increased incidence of hypoglycaemic events. The commencement and duration of intensive glucose management as well as protocols to minimise glycaemic variability in critically ill individuals are also explored. [ABSTRACT FROM AUTHOR]

The article offers information on the occurrence of dementia in older people suffering from diabetes. It is mentioned that dementia is characterized by memory loss, impairment of thinking and reasoning and changes in mood and personality. Also, the patients with diabetes mellitus often develop dementia because of poor blood supply to brain that causes cerebrovascular diseases. The author mentions that practice nurses play an important role in the diagnosis and treatment of dementia. INSET: CASE STUDY 1.

The article focuses on the skin-related issues that can be associated to a person with diabetes. It states that people with diabetes have the tendency to present several skin complications including diabetic dermopathy, digital sclerosis, and eruptive xanthomatosis. It discusses various bacterial and fungal infections that could affect the skin of diabetic people such as folliculitis, mucormycosis, and candida paronychia. It also presents a case study of a 23-year-old woman with type 1 diabetes. INSET: CASE STUDY I.

The article discusses the important factors to consider in treating older patients with diabetes. It investigates the ethical considerations for health professionals in decision making with older people. Also, it mentions on the role of practice nurses in providing individualized diabetes care for them. It notes on the risk of diabetes as well as its vascular, neurological, and psychological complications for older people which includes dementia, hypertension, and physical disabilities. INSETS: CASE STUDY I;CASE STUDY 2;Key Points.

The article discusses the role of practice nurses in helping women with diabetes to manage their sexual dysfunction problems. It examines the issues on female sexual dysfunction relative to the consideration given by practice nurses for the sexual wellbeing of a patient. It states that practice nurses could have a discussion with patients on their sexual wellbeing wherein they must recognize the patient's cultural sensitivities when talking about sexual health and treatment for the dysfunction. INSET: Case Study 1.

It is well documented that there is a high prevalence of psychological ill-health in people with chronic conditions, and screening people annually for depression has become a facet of the Quality and Outcomes Framework (QOF) (NHS Employers, 2010). Many groups of people with long term conditions can be at increased risk of depression, although the evidence is strongest for people with diabetes and chronic heart disease (Cohen, 2006). This article explores the interactions between physical and psychological factors and how practitioners can more adequately identify both depression and psychological distress in people with chronic illnesses. [ABSTRACT FROM AUTHOR]

The article discusses the role of nurses in working with people who experience psychological challenges in managing their diabetes. A case study involving a 66 year old man with type 2 diabetes who visits his practice nurse for monitoring and diabetes-related education is presented. Assessment of psychological and psychosocial adjustment to diabetes is discussed.

This article explores the high risk of diabetes and cardiovascular diseases in adults over 18 years of age and recognises, through the literature, the potential role for nurses in engagement with diabetes prevention strategies in their everyday practice. It considers the latest international projections for diabetes, a critical review of evidence of how diabetes can be prevented and how effective methods of detection of pre-diabetes can be employed with every clinical encounter with adults who perhaps previously were not considered to be ‘at risk’ of developing type 2 diabetes. Effective consultation approaches to raise diabetes awareness within populations and to enable tailored approaches to public health lifestyle advice are explored, to encourage each practitioner to ‘think diabetes’ in every clinical encounter. [ABSTRACT FROM AUTHOR]