David Morris

There is strong evidence that early-onset type 2 diabetes (commonly defined as that occurring in people under the age of 40 years) is a more aggressive condition than late-onset type 2 diabetes. The longer period of exposure to the risk factors of hyperglycaemia, hypertension and hyperlipidaemia and the more rapid progression of disease itself renders the individual more vulnerable to developing both microvascular and macrovascular complications at an earlier age. Early recognition and management of type 2 diabetes in younger people and public health messaging aimed at prevention of type 2 diabetes will be crucial to dealing with the problem. This article outlines the diagnosis, clinical implications and management of early-onset type 2 diabetes, with a particular focus on younger adults (rather than children and adolescents), in whom the condition is more common, and who are likely to be managed in primary care.

Citation: Morris D (2022) Early-onset type 2 diabetes: Clinical implications, diagnosis and management. Journal of Diabetes Nursing 26: [Early view publication]

Article points

Article points

1. The incidence of early-onset type 2 diabetes is increasing, with important individual health and socioeconomic consequences.

2. Individuals with early-onset type 2 diabetes experience more rapid progression of microvascular and cardiovascular complications than those with type 1 diabetes and those who develop type 2 diabetes in later years.

3. The presence of islet cell autoantibodies is predictive of future insulin requirement and the development of other autoimmune diseases.

4. If there is uncertainty about the type of diabetes in a child or young adult, it is safer to manage as type 1 diabetes and treat with insulin.

5. A holistic approach to earlyonset type 2 diabetes is essential. Socioeconomic status and psychological issues need to be taken into account.

Key words

- Children and young people - Early-onset type 2 diabetes

Author

David Morris, Specialist Doctor in Diabetes, Royal Shrewsbury Hospital; Clinical Undergraduate Tutor, Keele University; and retired GP

Andrew Hill

      Much evidence indicates that foot self-care behaviours, specifically, remain underutilised in the prevention of diabetic foot ulcers (DFUs). Adherence to care is a multidimensional phenomenon, determined by the interplay of several factors, including: social and economic, patient-related, health-system-related and conditionrelated factors. Of particular interest and relevance may be the role that depression plays in the context of foot self-care in diabetes, which is discussed in this article. Diabetes-associated depression is well established phenomenon and the prevalence of depression amongst people with diabetes is known to be in the range of 10%–15% — which is twice the rate of people without diabetes. Furthermore, the outcomes for diabetes and depression are worse when they appear together. The mechanisms of their co-existence are multiple and complex and likely involve sociological, psychological and physiological elements. Their co-existence also appears to heavily influence the likelihood of individuals to undertake self-care behaviour that may help to avert the worst of the diabetes-related complications, such as DFU and amputation

Citation: Hill A (2022) Depression — the ‘elephant in the room’ for the under-utilisation of foot self-care in diabetes. The Diabetic Foot Journal 25(4): 16–21

Key words

- Foot care practices - Patient and public involvement - Risk identification - Risk reduction

Article points

1. Adherence to foot selfcare behaviours is a multidimensional phenomenon, determined by the interplay of several factors, including: social and economic, patient related, health-system-related, and condition-related.

2. Depression is well known to co-exist in many people with diabetes — especially those who have suffered diabetesrelated complications, such a foot ulceration and amputation.

3. The co-existence of diabetes and depression appears to heavily influence the likelihood of individuals to undertake self-care behaviour that may help to avert the worst of the diabetes-related complications, such as DFU and amputation.

Authors

Andrew Hill is Senior Lecturer and Programme Lead, The SMAE Institute, Maidenhead, UK

Imogen Stamford

Research has shown that use of continuous glucose monitoring (CGM) is associated with improved time in range, improved HbA1c, and decreased risk of long-term complications secondary to type 1 diabetes. There are, however, several barriers that can lead to discontinuation of CGM, including pain, skin reactions, concerns around accuracy, sensor loss, interference with daily activity, and alarm fatigue. This review paper will outline the impact of decision fatigue and alarm fatigue in children and young people using CGM.

Citation: Stamford I (2022) CGM for children and young people with type 1 diabetes: NICE criteria and effects of decision fatigue and alarm fatigue. Diabetes Care for Children & Young People 12: [Early view publication]

Article points

1. While the advantages of continuous glucose monitoring (CGM) are well recognised, as practitioners it is important to be aware of the implications of CGM use.

2. People with diabetes can never have a day without checking and responding to ever-changing glucose levels, which puts them at an increased risk of developing decision fatigue.

3. It is important for practitioners to support patients in creating balance between setting alarm limits that are narrow enough to ensure patient safety, but not so narrow that alarms will be repeatedly triggered can lead to the risk of alarms being ignored.

Key words

- Alarm fatigue - Continuous glucose monitoring - Decision fatigue - Type 1 diabetes

Author

Imogen Stamford, Paediatric Diabetes Specialist Nurse, Oxford University Hospitals NHS Foundation Trust