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Diabetes: Management and Pharmacotherapy01:15

Diabetes: Management and Pharmacotherapy

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The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
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Diabetes Mellitus: Type 2 and Gestational01:22

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Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...
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Diabetes Mellitus: Overview and Type I Subtype01:22

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Diabetes mellitus is a chronic metabolic disorder characterized by high blood glucose levels due to inadequate insulin production, insulin resistance, or both. The condition affects millions worldwide and can significantly impact their health and quality of life.
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Dipeptidyl peptidase 4 (DPP-4) is a serine protease widely distributed in the body. It's involved in the inactivation of GLP-1 and GIP hormones, which are crucial for insulin regulation. DPP-4 inhibitors, such as sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin (Nesina), and vildagliptin (Galvus), help increase the proportion of active GLP-1, enhancing insulin secretion. These inhibitors work by competitively binding to DPP-4. This binding causes a...
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Peripheral Artery Disease III: Interprofessional Care01:27

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Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
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Diabetes: Symptoms, Diagnosis, and Complications01:15

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For most patients, experiencing several weeks of polyuria, polydipsia, fatigue, and significant weight loss may indicate the presence of diabetes. Furthermore, adults displaying the phenotypic appearance of type 2 diabetes (particularly those who are obese and not initially insulin-requiring), may have islet cell autoantibodies, suggesting autoimmune-mediated β cell destruction and a diagnosis of latent autoimmune diabetes of adults (LADA). The categorization of glucose homeostasis is...
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Can We Reduce Diabetes-Related Lower Limb Amputations?

Sarah Johnson-Lynn1,2, Mohamed Abdelrahman1, Mona Abouzaid1

  • 1The William Kelly Diabetes Centre, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK.

British Journal of Hospital Medicine (London, England : 2005)
|November 24, 2025
PubMed
Summary

Preventing lower extremity amputations in diabetes is crucial due to high costs and patient burden. Multidisciplinary care and novel interventions show promise in limb preservation, though rates are stagnating or increasing in some regions.

Keywords:
diabetic feetfoot ulcerperipheral vascular diseasesurgical amputation

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Area of Science:

  • Diabetology
  • Vascular Surgery
  • Podiatry

Background:

  • Diabetes-related lower extremity amputations pose significant physical, psychosocial, and economic burdens.
  • The annual cost in England is substantial, impacting the National Health Service budget.
  • While major amputation rates decreased globally with multidisciplinary teams, recent trends show stagnation in the UK and increases in the USA, particularly in younger and socially deprived populations.

Purpose of the Study:

  • To review interventions proven to reduce lower limb amputations in patients with diabetes.
  • To highlight novel clinical, surgical, and dressing interventions for limb preservation.
  • To discuss strategies for improving diabetic foot care across the patient journey.

Main Methods:

  • Review of existing literature and clinical practices.
  • Analysis of trends in amputation rates.
  • Discussion of multidisciplinary team services, root cause analysis, and prompt expert referral.
  • Exploration of novel plastic and vascular surgery techniques and advanced wound care.

Main Results:

  • Multidisciplinary diabetes foot services have historically reduced amputation rates.
  • Recent increases in amputation rates are linked to younger patients and social deprivation.
  • Whole systems approaches and prompt expert assessment are key to improving outcomes.
  • Novel surgical and dressing interventions show potential for enhanced limb salvage.

Conclusions:

  • Effective diabetic foot care requires integrated, multidisciplinary approaches.
  • Addressing socioeconomic factors and ensuring timely expert intervention are critical.
  • Emerging surgical and wound care technologies offer new hope for limb preservation in complex cases.