By Rowan Hillson
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Additional resources for Practical diabetes care
Effect of intensive diabetes management on macrovascular events and risk factors in the Diabetes Control and Complications Trial. Am J Cardiol, 75, 894–903. DCCT Research Group (1996). Lifetime benefits and costs of intensive therapy as practiced in the Diabetes Control and Complications Trial. JAMA, 276, 1409–15. , et al. (1999). Periodic health examination, 1999 update: 1. Detection, prevention and treatment of obesity. Canadian Task Force on Preventive Health Care. CMAJ, 160, 513–25. , et al.
But it may be better to find out what the patient wants to know first. ‘No question is ever stupid if it has to be a question’ (Thomas, personal communication). Many people do not know how their body works. Breathing, circulation, digestion are all mysterious. Patients may have startling misconceptions, for example that babies emerge through the umbilicus, or that the gall-bladder drains bile into the blood (this one has been around for hundreds of years). The basic knowledge required to understand about diabetes is rarely complete.
Primary care staff are often thought to be better at this than those in secondary care. They usually know the patient and their circumstances better. They often know relatives who may have a considerable bearing on the patient’s behaviour. g. dementia, metabolic disarray), movement and mobility (arthritis, stroke, amputation), sensation (neuropathy), balance (stroke, postural hypotension), concentration (malaise from persistent hyperglycaemia, pain), vision (cataract, retinopathy), and hearing (diabetic deafness) can all impede care.
Practical diabetes care by Rowan Hillson