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Diabetes and endocrinology

Ep 45 – Detecting and managing non-alcoholic fatty liver disease in type 2 diabetes

In this episode, which has been recorded for Chronic Conditions Month 2022, Dr Steve Holmes (GP, Shepton Mallet and Clinical Respiratory Lead, NHS England South West and NHS Somerset) and Dr Sarah Davies (GPwSI in Diabetes, Cardiff) discuss non-alcoholic fatty liver disease (NAFLD) in the context of diabetes. How is NAFLD best detected, diagnosed and managed in high-risk populations? How can primary care professionals identify those who are at risk of fibrosis?

Ep 44 – Latest thinking and evidence on chronic kidney disease

In this episode, which has been recorded for Chronic Conditions Month 2022, Dr Yassir Javaid (Cardiovascular and Diabetes Lead, Northamptonshire CCG) and Dr Patrick Holmes (GP, Darlington) examine the latest developments in renal medicine, with a focus on assessing and managing chronic kidney disease (CKD). What role do sodium–glucose cotransporter 2 inhibitors have in the management of the condition, both in people with diabetes and those without diabetes?

Ep 41 – Emotional wellbeing and long-term conditions

In this episode, which has been recorded for Chronic Conditions Month 2022, Dr Sarah Davies (GPwSI in Diabetes, Cardiff) and Dr Peter Bagshaw (Clinical Lead in Dementia and Mental Health, South Gloucestershire CCG) discuss the interplay between mental health and conditions such as diabetes, dementia and heart disease. What role do lifestyle factors such as diet and physical activity have in modulating such relationships? Most importantly, what can we do to help patients who may be stuck in a vicious cycle whereby physical ailments adversely impact mental health, which can, in turn, make positive lifestyle changes more difficult to achieve.

Ep 35 – Subclinical hyperthyroidism in primary care

In this episode, Dr Kevin Fernando discusses diagnostic and management tips – as well as pitfalls to avoid – related to subclinical hyperthyroidism. Fatima is a 71-year-old woman who presents in primary care with non-specific malaise and a past medical history of atrial fibrillation, ischaemic heart disease and osteoporosis. On examination, there is no evidence of thyroid swelling. Her blood tests reveal a suppressed thyroid-stimulating hormone (TSH), but normal free thyroxine (FT4) and free triiodothyronine (FT3). Given Fatima's comorbidities, what should we do next?

Ep 32 – Gynaecomastia: investigation and management in primary care

In this episode, Kate discusses gynaecomastia and its investigation and management in primary care. She talks us through an infographic produced by The Association of Breast Surgery called Guidance on Gynaecomastia and considers the following important questions: “who do I need to be worried about?”, “what investigations should I consider?” and “when should I make a referral?”.

Ep 31 – Diagnosing and managing Addison’s disease in primary care

In this episode, Kevin discusses the case of Louise, a 19-year-old who has been living with type 1 diabetes for the last 12 years and hypothyroidism for the last 8 years. She presents to us in primary care with a history of recurring unexplained hypoglycaemic episodes despite proactive adjustments to her insulin regimen. In addition to her insulin, she is taking levothyroxine 150 μg/day. She has not recently made significant changes to her diet or daily physical activity. Louise has also been experiencing light-headedness when rising from a sitting position. She has a BMI of 19 kg/m2, and a recent HbA1c value was 63 mmol/mol (7.9%). You record her sitting blood pressure as 119/67 mmHg and her standing value as 99/72 mmHg. You notice some patches of vitiligo on her face. What should we do next?

Ep 29 – Investigations for chronic kidney disease in primary care

In this episode, which has been recorded for Chronic Conditions Month 2021, Dr Yassir Javaid (Cardiovascular and Diabetes Clinical Lead, Nene CCG) and Dr Kevin Fernando (GP Partner at North Berwick Health Centre and Education Director for GPnotebook Education) discuss the detection of chronic kidney disease in primary care. What do the different tests tell us? What are the most up-to-date guidelines on investigations for CKD, and what do they recommend we do? How often should we be conducting tests for renal function and albuminuria?

Ep 26 – Severe mental illness and diabetes

In this episode, which has been recorded for Chronic Conditions Month 2021, Dr Peter Bagshaw (Clinical Lead in Dementia and Mental Health, South Gloucestershire CCG) and Dr Kevin Fernando (GP Partner at North Berwick Health Centre and Education Director for GPnotebook Education) discuss the interplay between diabetes and severe mental illness (SMI). What exactly is meant by SMI? How prevalent is mental illness in people with diabetes? What is the role of the gut–brain axis? What signs should clinicians be looking out for in spotting depression?
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