QJM : monthly journal of the Association of Physicians
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Diabetic ketoacidosis (DKA) is still a major contributor to morbidity and mortality in diabetes. The triad of hyperglycaemia, ketosis and acidosis can be diagnosed within a few minutes of the patient presenting, by measuring blood glucose and ketones using a meter, and venous blood pH on a blood gas analyser. Quantifying ketosis allows accurate distinction between simple hyperglycaemia and metabolic decompensation. We review the management of DKA, and the emerging role of near-patient testing in diagnosing ketosis and monitoring its resolution.
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Some 20-25% of UK adults are obese according to the WHO criterion (BMI >/=30 kg/m(2)). Type 2 diabetes, increasingly recognized as a major complication of overweight and obesity, is beginning to appear in UK adolescents, following the trends in the US. Epidemiological data indicate that the prevalence of overweight and obesity has doubled or tripled in the past few decades in the US, in Europe, and even in many developing countries. ⋯ Initiatives have been introduced by the government to increase the physical education syllabus in school to a minimum of 2 h/week, and the promotion of fruit and vegetables. Further research is required on the physiological and psychological causes of overweight and obesity in children and adults, and randomized, controlled, school and community-based trials are required to pilot preventative initiatives. Monitoring of the progress in prevention at both organizational and outcome level is required, and also of adverse outcomes such as a rise in the prevalence of eating disorders.