Clinical medicine (London, England)
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Diabetes is the most common cause of end-stage kidney disease. Randomised controlled trials have shown a significant benefit of sodium-glucose transporter-2 inhibitors in patients with diabetic kidney disease (DKD), and guidelines now suggest these drugs should be considered in all patients with DKD irrespective of glucose control. ⋯ Management of diabetes in patients on renal replacement therapy (dialysis or transplantation) is uniquely challenging. This article outlines guidance on management of glucose in these vulnerable groups of patients.
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Inpatient hyperglycaemia is associated with poor patient outcomes. The majority of inpatients with diabetes are admitted with non-diabetes-related conditions and are primarily cared for by a clinician who does not specialise in diabetes. We describe common inpatient hyperglycaemia scenarios and outline strategic management approaches for the general physician, enabling better frontline care for people with diabetes.
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To review advance care planning (ACP) practice during the COVID-19 pandemic, evaluating the number of plans created, patient participation, cardiopulmonary resuscitation recommendations and variation between different population groups. ⋯ Increased ACP during a crisis can be achieved alongside increased patient participation in decision making. A tool such as ReSPECT that supports recommendations for, as well as limitations on, treatment may have enabled the expansion of ACP observed.
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A 54-year-old woman presented to the emergency department with fluctuating consciousness without localising signs and non-specific neurology. Urgent computed tomography (CT) was unremarkable and differentials of opioid overdose or post-ictal state were considered. Magnetic resonance imaging of the brain demonstrated an artery of Percheron (AOP) infarct; resulting from occlusion of an uncommon anatomical variant in the thalamic and midbrain circulation. This should be considered in patients presenting with fluctuating consciousness and normal CT.