COVID-19 and peripheral arterial complications in people with diabetes and hypertension: A systematic review #Covid19RftLks

Rastogi, A., Dogra, H. & Jude, E.B | 2021| COVID-19 and peripheral arterial complications in people with diabetes and hypertension: A systematic review| Diabetes Metab Syndr| | 15 | 5 | 102204. doi: 10.1016/j.dsx.2021.102204. Epub ahead of print. PMID: 34303918; PMCID: PMC8266514.

COVID-19 is a unique thrombo-inflammatory condition and patients with background diabetes or hypertension are more susceptible for lower limb complications due to peripheral arterial disease presenting as gangrene. The authors conducted a systematic review of the reported cases of peripheral gangrene in COVID-19 patients, co-existing comorbidities, specific treatment given, and outcomes of limb amputations or death.

COVID-19 and peripheral arterial complications in people with diabetes and hypertension: A systematic review [primary paper]

University of Leeds: Research suggests drugs could reverse diabetes damage

University of Leeds | June 2020 | Research suggests drugs could reverse diabetes damage

Drugs developed to treat Alzheimer’s Disease could be repurposed to prevent – or even reverse – damage done to the blood vessels of people who are obese or have type 2 diabetes, according to research.

People suffering from a range of conditions called metabolic syndrome – which includes type 2 diabetes, high blood pressure, high cholesterol and obesity – have a stiffening of their blood vessels and that puts them at increased risk of a heart attack or stroke.

In a breakthrough, scientists at the University of Leeds and University of Dundee have discovered a key mechanism that triggers changes in the blood vessels, which can eventually lead to cardiovascular disease.

It starts when people begin to overproduce an enzyme called BACE1 which in turn creates a protein called beta amyloid.

Raised levels of beta amyloid are associated with damage to the surface lining of blood vessels, the endothelium. This disrupts the normal functioning of the blood vessels leading to high blood pressure and atherosclerosis, the build-up of plaque along the walls of the blood vessels (Source: University of Leeds).

Full press release from the University of Leeds

Elevated circulating amyloid concentrations in obesity and diabetes promote vascular dysfunction

National Diabetes Audit – Report 2: Complications and Mortality

This report from the National Audit of Diabetes covers complications arising from diabetes. Most cardiovascular and diabetes specific complications are covered.

Part a is divided into three main sections: cardiovascular complications, diabetes specific complications and mortality. Each section aims to address overall rates, time trends, geographical variation and hospital utilisation.

Part b investigates associations between patient characteristics and adverse outcomes. The impact of changes to lifestyle and treatment have been estimated for both the person with diabetes and diabetes services for the first time.

The reports can be downloaded here:

Preventing amputations major concern as diabetes numbers rise

Public Health England | April 2019 |Preventing amputations major concern as diabetes numbers rise

Public Health England’s (PHE)  analysis of new data from the Diabetes Foot Care Profiles, published by PHE’s National Cardiovascular Intelligence Network, shows that the number of major lower limb amputations (above the ankle) continues to rise – with 7,545 major amputations over the past 3 years between 2015 to 2018, compared with 6,957 between 2012 to 2015.

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The overall number of major amputations is increasing, as the number of people with diabetes rises, but the rate among people with diabetes is not significantly increasing.

Key findings from this data show that during the 3-year period of 2015 to 2016 up to 2017 to 2018:

  • patients from England had 147,067 hospital stays for diabetic foot disease
  • the average length of stay in hospital was 8 days and the total number of days spent in hospital for diabetic foot disease was 1,826,734
  • 85,837 individual patients were admitted for foot disease and 33% of these had more than one stay over the 3 years
  • the rate of major amputations was greatest among men (male rate 10.5/10,000 population-years compared with females 4.9; and the white population rate of 9.6/10,000 and non-white 2.6)

Full details are at PHE 

#TalkAboutComplications

Scibilia, R. & Aldred, C. | 2019|#TalkAboutComplications| BMJ|364 |k5258

In the latest edition of the  BMJ, Renza Scibilia and Chris Aldred write about how to take the blame out of complications for patients and their determination to reframe the way complications are discussed by changing the language used in these conversations.  They write about their #TalkAboutComplications hashtag on Twitter and how people with diabetes and chronic conditions engaged with and responded to it. 

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“Often the focus and language around complications are on prevention rather than on risk reduction. The understanding is that no matter how well a condition is managed, there is always some risk that a complication could develop. Even if the self management of diabetes is not ideal, there is no value in apportioning blame.” (Renza Scibilia and Chris Aldred)

Read the full piece in the BMJ 

Assessing and managing the acute complications of diabetes mellitus

Palk, L.E. |2018| Assessing and managing the acute complications of diabetes mellitus. |Nursing Standard| doi: 10.7748/ns.2018.e11250

Nurses commonly encounter patients with type 1 or type 2 diabetes mellitus in their practice. Management of these conditions requires an in-depth knowledge of blood glucose monitoring. It is essential that nurses are aware of normal blood glucose levels, so that they can respond to complications caused by elevated and reduced blood glucose levels. This article aims to enhance nurses’ knowledge of the acute metabolic complications of diabetes, such as diabetic ketoacidosis and hyperosmolar hyperglycaemic state, to assist in their recognition and management in clinical practice. It discusses the causes, pathophysiology and treatment of these complications, which are regarded as potentially life-threatening medical emergencies (Source: Nursing Standard).

Rotherham NHS staff may request the article from the Library 

26,378 diabetes-related lower limb amputations in the last three years

Diabetes UK | December 2018 | 26,378 diabetes-related lower limb amputations in the last three years

New analysis from Diabetes UK  shows there were 26,378 lower limb amputations related to diabetes in England from 2014 to 2017, an increase of almost one- fifth  (19.4%) from 2010-2013.

The analysis reveals that here has been a significant rise in minor lower limb amputations (26.5%), defined as below the ankle, and a more gradual increase in the number of major lower limb amputations (4.1%), defined as below the knee.

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Head of Care at Diabetes UK, Dan Howarth said:

“The shocking number of lower limb amputations related to diabetes grows year on year. An amputation, regardless of whether it’s defined as minor or major, is devastating and life-changing. A minor amputation can still involve losing a whole foot.

“To reduce the number of amputations related to diabetes, we are calling on NHS England to maintain the Diabetes Transformation Fund beyond 2019. Many diabetes amputations are avoidable, but the quality of footcare for people living with diabetes varies significantly across England. Transformation funding since 2017 is working and will help to reduce these variations, but much work still needs to be done.” (Source: Diabetes UK)

Read the full release from Diabetes UK

In the news:

Guardian Record 169 UK patients a week get diabetes-related amputations