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The majority of patients with type 2 diabetes are obese and/or have an increased proportion of visceral fat, factors which in themselves are associated with insulin resistance. Other risk factors include increasing age and sedentary lifestyle. There is also a strong genetic predisposition to type 2 diabetes².

Chronic hyperglycaemia of diabetes is associated with long-term damage, dysfunction and failure of various organ systems. Early diagnosis, adequate treatment to control hyperglycaemia, and management of associated risk factors and complications therefore are all essential to reduce the burden of diabetes. Effective screening strategies are therefore of particular importance in reducing this burden. Discover the diagnostic tests necessary to diagnose type 2 diabetes mellitus and intermediate hyperglycaemia or pre-diabetes.

The early and aggressive treatment and management of diabetes mellitus is important for a successful long term outcome in patients with diabetes mellitus. The use of oral agents and lifestyle changes are the generally accepted early treatments followed later by insulin therapy. Current treatment algorithms and IDF guidelines should be used to find the appropriate treatment regime for individual patients.

As with many diseases, our knowledge of diabetes mellitus is increasing through research. Recent developments include the use of new treatments and guidelines in clinical practice. There has been an update to the IDF guidelines concerning GLP-1 agonists. DPP-4 inhibitors are now used in the treatment of diabetes, and SGLT-2 inhibitors are being investigated for this use.

References

1. Unwin, N. et al. The IDF Diabetes Atlas: Providing Evidence, Raising Awareness and Promoting Action. Diabetes Res Clin Pract 87, 2-3 (2010).

2. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 33 Suppl 1, S62-9 (2010).

In early dementia the symptoms of Alzheimer’s disease include memory loss, disorientation and confusion. These symptoms are caused by the loss of neurons and worsen with continuous neurodegeneration. The pathology of dementia is not solely the result of a cholinergic deficit. It is known that, chronically and pathologically elevated glutamate concentrations play an important role.

In general two main groups of dementia can be distinguished, requiring different types of treatment:

• Cerebro-organic (primary) forms of dementia
• Non-cerebro-organic (secondary) forms of dementia

Depending on the stage of the disease, clinical symptoms of varying intensity dominate. With the progression of AD, treatment is aimed particularly at improving and stabilizing personal everyday functions, so as to keep patients independent for as long as possible. 

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The management of systemic fungal infections is also a major challenge for healthcare professionals. Due to the invasive nature of fungal infections, many treatments are pre-emptive and are therefore initiated without identifying the specific fungus involved. Targeted approaches will become a more viable option as the speed and delivery of diagnostic methods improve.

The Anti-infectives Knowledge Centre aims to provide you with the most recent information in the areas of both CDI and systemic fungal infections with regularly updated content to help assist in the fight against these diseases.

The Knowledge Centre currently provides information on CDI, including:

• Prevalence – the incidence of CDI and the factors that have been attributed to the rise in these infections
• Symptoms – the symptoms of CDI, including how pseudomembranous colitis manifests
• Recurrence – the impact of recurring infection on patient outcomes
• Diagnosis – the importance of early diagnosis and the diagnostic tests available
• Treatment – treatment options recommended by the current ESCMID guidelines

Additional information on systemic fungal infections will be added soon.

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References
1. Crobach MJ, et al. Clin Microbiol Infect 2009; 15: 1053‐1066
2. Bauer MP, et al. Clin Microbiol Infect 2009; 15: 1067‐1079

Date of preparation November 2012 AI/12/0038/EUc

The evidence available that supports disease modification in atopic dermatitis has been well documented; however currently there is no clear definition of disease modification in atopic dermatitis.

Clinical management of atopic dermatitis is dependent on the severity of patient’s symptoms, however all patients should receive help and advice to aid in lifestyle changes that will decrease the risk of a disease flare. In addition to this, treatment with non-pharmaceutical products such as emollients and pharmaceutical agents such as topical corticosteroids is standard practice.

The Atopic Dermatitis Knowledge Centre is developed in collaboration with Astellas Pharma Europe Ltd.

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August 2012 DERM/12/0009/EUd

Diagnosis of COPD can be made using a combination of different methods; patient history, physical examination, airflow measurements, chest X-ray, and electrocardiogram.²

This progressive disease has no cure; however treatments for COPD are widely used to reduce the symptoms. Treatment guidelines outline the available treatments for specific stages of COPD.²

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References:
1. WHO The global burden of disease: 2004 update. Part 2 – Causes of death. Available at: http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_part2.pdf (Accessed 11 November 2011).
2. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (updated 2010). Available at: http://www.goldcopd.com/ - (accessed 11 November 2011).
3. Rennard S, Decramer M, Caverley PMA et al. Impact of COPD in North America and Europe in 2000: subjects' perspective of Confronting COPD International Survey. Eur Respir J 2002; 20: 799-805.
4. Kumar P and Clark M (Eds.) Chapter 13 – Cardiovascular disease. In: Clinical Medicine 6th ed. Philadelphia, PA: Elsevier Saunders, 2005.
5. Agustí A. Systemic effects of chronic obstructive pulmonary disease – what we know and what we don't know (but should). Proc Am Thorac Soc 2007; 4: 522-525.

The prevalence of post-myocardial infarction heart failure is less well known as it is difficult to distinguish between pre-existing and incident heart failure. However current estimates suggest that approximately 1 in 5 patients hospitalised with an acute coronary syndrome either present with heart failure or develop heart failure during their hospital stay.⁵

Many of the signs and symptoms of heart failure are non-specific and vary in severity depending on the disease class. The most common of these are breathlessness, fatigue, exercise intolerance, and fluid retention as evidenced by ankle swelling, peripheral oedema, and an elevated jugular venous pressure.⁶

Due to the non-specific nature of symptoms, the diagnosis of heart failure can be difficult. Tests can include echocardiogram, ECG, chest X-ray, laboratory tests. Following a positive diagnosis heart failure is classified into functional classes that relate to disease severity.

Management of heart failure involves lifestyle modifications, pharmacological treatment and occasionally surgery. In patients with chronic heart failure, optimal therapy involves treatment with diuretics, ACE inhibitors, certain β-blockers and a mineralocorticoid receptor antagonist.

The Heart Failure Knowledge Centre brings together current information related to chronic heart failure and post-myocardial infarction, including:

• Epidemiology
• Symptoms and Diagnosis
• Classification
• Treatment Options

References