Pam Brown
GP in Swansea
Citation: Brown P (2024) Diabetes Distilled: Diabetes remission in the real world. Diabetes & Primary Care 26: 145–7
Diabetes remission is achievable at scale in the real world, according to early results from the NHS Type 2 Diabetes Path to Remission programme published in Lancet Diabetes & Endocrinology. Of 7540 people referred to the programme between September 2020 and December 2022, a total of 1740 started the total diet replacement section of the programme before January 2022, and 960 (55%) completed the programme. Mean weight loss for the 1710 who started the programme and had follow-up data available was 9.4 kg (8.3%), with a mean weight loss of 10.3 kg (9.3%) among the 945 who completed the programme. Amongst the 945 who completed the programme and had two HbA1c measurements, 32% achieved remission, with mean weight loss of 15.9 kg (14.4%), while overall 27% of those who started the programme achieved remission regardless of whether they completed. Remission rates are lower than in trials such as DiRECT and DIADEM-I, despite similar levels of weight loss. The authors highlight that an additional 17% of participants met the HbA1c targets for remission but continued on metformin and may otherwise have achieved remission. These early results confirm that type 2 diabetes remission is indeed possible at scale in the real world, outside of clinical trials.
Pam Brown GP in Swansea
Citation: Brown P (2024) Diabetes Distilled: Impact of metformin timing on glucose and GLP-1 response. Diabetes & Primary Care 26: 143–4
Glucose-lowering effects in response to normal-release metformin are greater when the drug is given 30 or 60 minutes before, rather than with, food, according to this small study in people with well-controlled type 2 diabetes published in Diabetologia. Endogenous GLP-1 secretion increased when metformin 1000 mg was given 30 or 60 minutes prior to a glucose infusion, whereas there was no increase when the metformin was administered at the same time as the glucose. The results suggest that, if tolerated, administering standard release metformin before meals may lead to improved postprandial glycaemic control.
刘晗 负压引流与创面修复
是不是 瘘了？
原创： 十六点五 中山二院糖尿病足中心
男性，24岁，3年前外院诊断“下丘脑生殖细胞瘤”，进行γ刀治疗后，长期应用“氢化可的松”早晚各2片维持，半年前不慎损伤左小腿下部外侧皮肤，之后长期不愈合，收入院。
含银的敷料是目前治疗糖尿病足的主流敷料，有各种剂型，包括泡沫状、胶冻态、液态、粉末态、膏态等等，生产的厂家的非常多，其中的质量良莠不齐，很难鉴别。
进一步的清创就到了骨骼，对于骨髓炎最彻底的治疗方法就是去除被细菌侵袭的骨，正常的骨骼一般是浅黄色，如果发白或者变黑，往往就提示这段骨头可能活性比较差，另外，还有一种是面积比较大的骨暴露，一般的肉芽组织很难爬上去，因此，对于坏死的骨头及较大面积的骨暴露，一般需要清除。
皮下组织中的脂肪组织在足部分布广泛，而皮下脂肪中血管分布非常少，在相对或绝对缺血的糖尿病足中，脂肪组织边缘的是否出血不是其是否存活的可靠指标。
这是一个我们在《糖尿病足切开设计（1）》中提到过，这次从不同角度谈谈足趾的保全。
伤口世界平台生态圈，以“关爱人间所有伤口患者”为愿景，连接、整合和拓展线上和线下的管理慢性伤口的资源，倡导远程、就近和居家管理慢性伤口，解决伤口专家的碎片化时间的价值创造、诊疗经验的裂变复制、和患者的就近、居家和低成本管理慢性伤口的问题。
2019广东省医疗行业协会伤口管理分会年会
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