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Colin Dayan

and Gareth Williams



Diagnosis—use of HbA1c for screening and diagnosis. Estimation of urinary C-peptide: creatinine ratio to distinguish MODY from type 1 diabetes.

Types of diabetes—description of ‘ketone-prone’ diabetes

Management—comment on withdrawal of some thiazolidinediones (troglitazone, rosiglitazone) for safety reasons. Discussion of use of saxagliptin in patients with severe chronic renal failure. Increased emphasis on intensive dietary support in type 2 diabetes and updated discussion of approach to medication.

Monitoring—discussion of change from reporting HbA1c as a percentage to in mmol HbA1c per mol of haemoglobin (mmol/mol).

Surgery in patients with diabetes—recommendations amended in line with new UK guidelines.

Diabetic ketoacidosis—emphasis on value of bedside finger-prick testing for blood ketones in diagnosis and management; modified treatment algorithm to advise fixed rate insulin infusion with addition of 10% dextrose infusion when blood glucose falls to less than 14 mmol/litre.

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date: 21 October 2021

Diabetes mellitus can be defined as a state of chronic hyperglycaemia sufficient to cause long-term damage to specific tissues, notably the retina, kidney, nerves, and arteries. It is due to inadequate production of insulin and/or ‘resistance’ to the glucose-lowering and other actions of insulin, and is a significant and growing threat to global health, affecting more than 250 million people worldwide....

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