Khor Xiao Ying, Pappachan Joseph M, Jeeyavudeen Mohammad Sadiq
Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9UT, United Kingdom.
Faculty of Science, Manchester Metropolitan University, Manchester M15 6BH, United Kingdom.
World J Clin Cases. 2023 May 6;11(13):2890-2902. doi: 10.12998/wjcc.v11.i13.2890.
Diabetes care is often difficult without a proper collaboration between the patient and the care provider as the disease is mostly self-managed by patients through adjustments in their lifestyles, and medication doses to optimise glycaemic control. Most clinical guidelines on the management of diabetes mellitus (DM) provide only broad principles on diabetes care, and the blind follow-up of such principles without a proper review and consideration of patient characteristics often results in inadequate glycaemic control and diabetes complications consequently. Therefore, a proper understanding of the pathobiology, clinical situation, and comorbidities of the individual case is of paramount importance to tailoring the most appropriate management strategy in real-world diabetes care. With the aid of five unique cases of DM [(1) Medically managed type 2 diabetes mellitus (T2DM) with severe obesity; (2) Management of T2DM with unreliable glycated haemoglobin (HbA1c); (3) Obesity in a patient with type 1 diabetes mellitus (T1DM); and (4) Late diagnosis and subsequent management of monogenic diabetes and 5. Sudden worsening of well-controlled T2DM)] we elaborate on the importance of individualised diabetes care and the practicalities in these situations. The review also provides an evidence update on the management of different forms of DM to guide physicians in optimising the care of their patients in day-to-day clinical practice.
如果患者与医护人员之间没有适当的协作,糖尿病护理往往会很困难,因为这种疾病大多由患者通过调整生活方式和药物剂量来自我管理,以优化血糖控制。大多数糖尿病管理临床指南仅提供糖尿病护理的宽泛原则,盲目遵循这些原则而不适当审查和考虑患者特征,往往会导致血糖控制不佳,进而引发糖尿病并发症。因此,在现实世界的糖尿病护理中,正确了解个体病例的病理生物学、临床情况和合并症对于制定最合适的管理策略至关重要。借助五个独特的糖尿病病例((1) 药物治疗的重度肥胖2型糖尿病 (T2DM);(2) 糖化血红蛋白 (HbA1c) 不可靠的T2DM管理;(3) 1型糖尿病 (T1DM) 患者的肥胖症;(4) 单基因糖尿病的晚期诊断及后续管理;以及(5) 血糖控制良好的T2DM突然恶化),我们阐述了个体化糖尿病护理的重要性以及在这些情况下的实际操作。本综述还提供了不同类型糖尿病管理的证据更新,以指导医生在日常临床实践中优化对患者的护理。