CHRONIC COMPLICATIONS OF DIABETES

SHE Level 5
SCQF Credit Points 15.00
ECTS Credit Points 7.50
Module Code MMC125884
Module Leader Catherine Wright
School School of Health and Life Sciences
Subject Biological and Biomedical Sciences
Trimester
  • B (January start)

Pre-Requisite Knowledge

Standard programme entry requirements

Summary of Content

This module will generate an in-depth knowledge and understanding of microvascular complications not covered in "Pathophysiology and Therapeutics of Diabetes"; in particular eye disease. Treatment and support for these complications will be discussed. The module will also critically evaluate problems relevant to Type 1 and Type 2 associated mental health issues, concordance, gastrointestinal tract complications, chronic skin wounds and infection.

Syllabus

Skin and wound healing in the diabetic patient: Causes and complications of wound healing failure in people with diabetes. Traditional wound management (dressings) and novel experimental methods of improving wound healing. Patient support. Emerging and novel therapies for diabetes: Introduction to current replacement therapies for B-cell function and the potential of stem cell technologies and personalised medicine as future benefits for diabetic patients Gastrointestinal complications Gastrointestinal complications of diabetes include gastro-oesophageal reflux disease, gastroparesis, intestinal enteropathy (which can cause diarrhoea, constipation & faecal incontinence) and non-alcoholic fatty liver disease. Diagnosis and medication. Controlling blood glucose levels is important for managing most gastrointestinal conditions. Eye diseases associated with diabetes: Retinopathy, cataract, anterior segment of the eye. Risk factors, symptoms, clinical signs, surgical and non-surgical treatment modalities. Retinal screening in Scotland. Mental health issues: Depression and anxiety; clinical diagnosis, diabetes-specific problems, patient management (lifestyle factors) and therapies available. Symptoms and consequences of depression for the diabetic patient. Neurobiology of depression; reason for increased incidence with diabetes and how these co-morbidities are best managed. An understanding of the mechanisms of action and side-effects of anti-depressant drugs. Infection and the diabetic patient: Bacterial pathogens typically associated with infections of the diabetic patient. Immunocompromised status of the patient related to the condition. Local and systemic infection prevention measures, diagnosis, and treatment strategies. Wound management and patient support.

Learning Outcomes

On successful completion of this module the student should be able to:1. Critically analyse and discuss the pathologic mechanisms and therapeutic support for gastrointestinal tract complications.2. Demonstrate an advanced understanding of the clinical signs, pathology, surgical and non-surgical treatment of eye disease associated with diabetes as well as the support of the blind/partially blind patient and an awareness of retinal screening programmes.3. Understand the psychological basis underpinning management of issues of self esteem and concordance in diabetic patient groups.4. Have knowledge of the clinical diagnosis, management and therapies associated with depression and other mental health problems related to diabetes. 5. Have in-depth knowledge of specific infections associated with this patient group and the principles and practices and wound management.

Teaching / Learning Strategy

Methods used will include lectures, student centred learning, tutorials, critical appraisal of the literature and data analysis exercises

Indicative Reading

This module will utilise mainly recent review articles from specialist journals such as Annual Reviews, Blood, British Journal of Haematology, Clinical Biochemistry, Clinical Microbiology Reviews, Endocrinology, Infection and Immunity, Journal of Bacteriology, Journal of Clinical Microbiology, Journal of Histochemistry and Cytochemistry, Journal of Pathology, Journal of Virology, Lancet, Lancet Infectious Diseases, Trends in Pharmacological Sciences, Trends in Microbiology International Wound Journal, Journal of Wound Care. Recommended Reading: Mental Health Issues Indicative reading from the empirical literature will be provided throughout the lectures Healy, D. Psychiatric Drugs (2016). 6th edition, Churchill-Livingstone. James K. Rustad, Dominique L. Musselman, Charles B. Nemeroff. Psychoneuroendocrinology, Volume 36, Issue 9, October 2011, Pages 1276-1286. Leonard E. Egede, Charles Ellis Diabetes and depression: Global perspectives Diabetes Research and Clinical Practice, Volume 87, Issue 3, March 2010, Pages 302-312. Richard C. Shelton, Andrew H. Miller Eating ourselves to death (and despair): The contribution of adiposity and inflammation to depression . Progress in Neurobiology, Volume 91, Issue 4, August 2010, Pages 275-299. Andrea A. Riley, Mindy L. McEntee, Linda Gerson, Cheryl R. Dennison Depression as a Comorbidity to Diabetes: Implications for Management The Journal for Nurse Practitioners, Volume 5, Issue 7, July-August 2009, Pages 523-535. Michael J. Stuart, Bernhard T. Baune Depression and type 2 diabetes: Inflammatory mechanisms of a psychoneuroendocrine co-morbidity Neuroscience & Biobehavioral Reviews, Volume 36, Issue 1, January 2012, Pages 658-676. Infection Carroll KC and Butel J (2015). Jawetz, Melnick & Adelberg's Medical Microbiology (27 th edition). McGraw Hill. Greenwood D et al., (2012). Medical Microbiology; a guide to microbial infections: pathogenesis, immunity, laboratory diagnosis and control (18 th edition). Churchill Livingstone. Mandell GL et al ., (2014). Principles and Practice of Infectious Disease - 2 volumes (8 th Edition). Churchill Livingstone. Murray PR and Rosenthal KS (2015). Medical Microbiology (8 th edition). Elsevier Mosby. ( Good text book - chapters arranged by organism ). Torok E and Moran E (2016) (2 nd edition). Oxford Handbook of Infectious Diseases and Microbiology (Oxford Medical Handbooks). OUP Oxford. Kasper DL and Fauci AS (2017). Harrison's Infectious Diseases (3rd edition). McGraw-Hill Medical. Gastrointestinal Tract Shakil, A., Church, A.J., Rao, S.S. (2008) Gastrointestinal complications of diabetes. American Family Physician, 77, 1697-1702. Skin and wound healing in the diabetic patient Shaw TJ, and Martin P (2009) Wound repair at a glance. Journal of Cell Science 122, 3209-3213 Falanga V (2005) Wound healing and its impairment in the diabetic foot. Lancet 2005; 366: 1736-43 Becker DL et al (2012) Connexins in wound healing: perspectives in diabetic patients Biochim Biophys Acta vol 1818, 2068-2075 -720 Emerging and Novel therapies for diabetes http://www.biochemistry.org/384/384/index.html Sordi V, Pellegrini S, Krampera M, Marchetti P, Pessina A, Ciardelli G, Fadini G, Pintus C, Pante G, Piemonti L (2017) Stem cells to restore insulin production and cure diabetes. Nutrition, metabolism, and cardiovascular diseases : NMCD 27 (7):583-600. doi:10.1016/j.numecd.2017.02.004 Tabatabaei Qomi R, Sheykhhasan M (2017) Adipose-derived stromal cell in regenerative medicine: A review. World journal of stem cells 9 (8):107-117. doi:10.4252/wjsc.v9.i8.107 Eye Diseases associated with diabetes Kanski, J.J. (2011) Clinical Ophthalmology (7th edition). Butterworth-Heinemann. Efron, N. The Glenn A. Fry Award Lecture 2010: Ophthalmic Markers of Diabetic Neuropathy. Optom Vis Sci 2011; 88:661-683. Cheung, N. Mitchel, P., Wong, T. Diabetic Retinopathy. Lancet 2010; 376:124-36. Bruce, A.S., and Loughnan, M.S. (2012) Anterior eye disease and therapeutics A-Z - (2nd edition). Elsevier. Optometry today shared care services: DIABETES: Continuing Professional Development (1997) AOP & City University. Individual lecturers may give further essential reading. E-sources http://www.ewma.org/ http://www.tvs.org.uk/ http://www.woundbedpreparation.com http://www.woundcaresociety.org http://www.woundsuk.com

Transferrable Skills

The student's personal transferable skills will be extended in the following areas: - Critical thinking and problem solving - Communication (oral and written) - Information retrieval from library and electronic sources - Review and critical analysis of published data - Use of computers for word processing, reviewing current literature and information gathering, use of drawing packages - Independent study skills

Module Structure

Activity Total Hours
Tutorials (FT) 12.00
Lectures (FT) 22.00
Directed Learning 12.00
Independent Learning (FT) 86.00
Assessment (FT) 18.00

Assessment Methods

Component Duration Weighting Threshold Description
Exam (Exams Office) 3.00 50.00 45% Written exam
Coursework 1 1.00 50.00 45% Essay