Australian Family Physician June 2006 - Diabetes
Vol 35, (6) 373 - 462
The theme for the June issue of AFP is diabetes.
This month's articles include impaired glycaemic function, the
management of type 2 diabetes, gestational diabetes, nephropathy,
diabetes monitoring, high protein diets and diabetes and complementary
medicine in the management of diabetes.
Australia’s impaired glycaemic function
Jenni Parsons
Glynnis, aged 59 years, is a new patient to my practice. She was diagnosed with diabetes 15 years ago but the messages of lifestyle modification appear to have completely passed her by. She has come to see me to get me to 'fix up her diabetes' because, after noting deteriorating vision, she has had to have laser treatment to her eyes.
Letters to the Editor
The opinions expressed by correspondents in this column are in no way endorsed by either the Editors or The Royal Australian College of General Practitioners.
Management of type 2 diabetes in Australian general practice
Janice Charles, Anthea Ng, Graeme Miller
The BEACH program, a continuous national study of general practice activity in Australia, gives us an overview of type 2 diabetes management in Australian general practice. Terms used by the general practitioner participants included in this analysis were: type 2 diabetes, noninsulin dependent diabetes, diabetes mellitus, adult onset diabetes, and insulin treated type 2 diabetes. This provides a backdrop against which the articles in this issue of Australian Family Physician can be further considered.
Type 2 diabetes - The pharmacotherapy of glycaemic control and risk factor modification.
Jonathan Cohen, Peter Colman
Patients with diabetes have a high cardiovascular risk. In addition to achieving good glycaemic control, cardiovascular risk reduction is a vital component of management.
Teenagers with diabetes - management challenges
Fergus Cameron
During adolescence major hormonal, neuro-maturational, emotional and psychosocial changes occur within a relatively
short time interval. The additional burden of living with a chronic disease such as type 1 diabetes can further add to the potential for instability.
Gestational diabetes
Glynis Ross
Gestational diabetes (GD) affects 5-10% of pregnant women in Australia. Long term follow up studies show that most women with GD will progress to type 2 diabetes. The Australian Carbohydrate Intolerance in Pregnant Women study (ACHOIS) has addressed the issue of whether identifying and treating GD reduces perinatal morbidity in offspring.
Neglected nephropathy
Tuck Y Yong, Patrick J Phillips, P Toby H Coates
Diabetic nephropathy is a significant contributor to the morbidity, mortality and health care cost among patients with diabetes. With increasing understanding of this problem, the natural progression of diabetic nephropathy can potentially be changed.
Sick day management for patients with diabetes
Lesley V Campbell, Jan Alford
In this article we consider some of the central issues in dealing with patients with diabetes when they get sick. In approaching the problem, we have also attempted to highlight the difference in managing type 1 and type 2 diabetes.
Diabetes monitoring - frequently asked questions
Patrick J Phillips, George Phillipov
Which blood glucose values are important - before or after meals? All blood glucose values over 24 hours contribute to overall glycaemic control and to the potential risk of microvascular complications. However, if the blood glucose before a meal is high, the blood glucose afterward will invariably be higher.
High protein diets and diabetes
Melissa Carapetis, Patrick J Phillips
Higher protein diets are currently 'hot'. The CSIRO total wellbeing diet book has been on the bestseller list in Australia and internationally. Various other high protein diets have also had, or are getting, media attention. However, high protein diets, particularly for people with diabetes, are controversial. There are questions about effectiveness and safety, especially in the long term. As a general practitioner people will look to you for advice about what to eat. This article summarises the pros and cons of two of the popular higher protein diets - the Atkins diet and the CSIRO total wellbeing.
Complementary medicine in the managent of diabetes
Craig Hassed
This is the fourth of a series of articles looking at the available evidence for complementary medicine relating to the theme topic in Australian Family Physician.
Foot assessment in patients with diabetes
Rajna Ogrin, Alison Sands
Diabetes has long been associated with increased risk of foot ulceration and lower extremity amputation.
Cosmetic and reconstructive breast surgery
Thomas Lam, Meagan Brennan, James French
This fifteenth and final article in our series on breast disease provides general practitioners with information that will allow them to give their patients a balanced view about issues related to cosmetic breast surgery. As well as breast augmentation and breast reduction surgery, the latest on the breast implant 'silicone controversy' and other procedures such as breast reconstruction following mastectomy are discussed.
Brain teaser: Mask of depression
Jerzy K Pawlak
Case history: A woman, 55 years of age, was showing symptoms of depression and anxiety (depressed mood, insomnia, feeling anxious, decreased recent memory). The patient was started on sertraline 50 mg once per day.
Clinical challenge
Jenni Parsons
Questions for this month's clinical challenge are based on articles in this issue. The style and scope of questions is in keeping with the MCQ of the College Fellowship exam. The quiz is endorsed by the RACGP Quality Assurance and Continuing Professional Development Program and has been allocated 4 CPD points per issue. Answers to this clinical challenge will be published next month, and are available immediately following successful completion online at: www.racgp.org.au/clinicalchallenge.
Failure to diagnose: gestational diabetes
Sara Bird
Case histories are based on actual medical negligence claims, however certain facts have been omitted or changed by the author to ensure the anonymity of the parties involved. Medical negligence claims involving an allegation of 'failure to diagnose' account for up to 50% of claims against general practitioners. This article examines a case in which there was a failure to diagnose and appropriately manage gestational diabetes.
Computers can’t listen - algorithmic logic meets patient centredness
Christopher Pearce, Steve Trumble
The doctor-patient relationship is crucial to the practice of medicine and yet the rise of science in the 19th and 20th centuries shifted doctors' focus away from the patient toward another entity: the disease. Slowly, the medical profession is rediscovering the importance of the doctor-patient relationship. General practice has contributed significantly by developing the patient centred clinical method, and further models have been introduced that take into account both the doctor's and the patient's perspectives. More recent changes in medicine - particularly computerisation and the introduction of evidence based medicine - may once again threaten this emphasis on patient centredness.
Cancer trends in Queensland - incidence and mortality from 1982-2001 in light of cancer prevention strategies
Kam Cheong Wong
The impact of cancer is multifaceted, ie. it worsens the quality of life of sufferers and increases the burden to caregivers, families, the community, and the government. The objective of this article is to provide some descriptive analyses of cancer trends in Queensland and discuss these in the light of cancer prevention policies and strategies in Australia.
Book reviews
Ron McCoy, Vicki Kotsirilos
Reviewed this month are To Travel Hopefully - An Autobiography by Charles Bridges-Webb and the IMgateway electronic medical database.
Are there health benefits from improving basic nutrition in a remote Aboriginal community?
Raymond Jones, Fiona Smith
Otitis media, chronic suppurative otitis media, and skin infections are common in many Aboriginal communities.
Management of primary superficial basal cell carcinoma
Beverly Raasch, Torres Woolley
Superficial basal cell carcinoma (SBCC) is a skin cancer commonly treated by general practitioners. Little is known about how GPs choose from the available treatment options.
Qualities of a good training practice - perceptions of advanced general practice resistrars
Robert Moorhead
General practice registrars report satisfaction with their placements in Australian training practices. However, more needs to be known about which criteria comprise this global satisfaction.
A qualitative study of GPs’ views on modern genetics
Laurence Bathurst, Qi Rong Huang
With rapid advances in genetics and increased public awareness of genetic testing for many hereditary diseases, the demand for genetic services may increase. We wondered how developments in genetics have impacted on general practice and the position general practitioners have taken in practising the new genetics.