GLP-1 receptor agonists and their role in managing type 2 diabetes.

Until recently the focus in diabetes care was on managing blood glucose - a glucocentric view. This is changing to a more holistic model aimed at prevention, treatment and management through lifestyle interventions as well as medication. An estimated 5 million people in the UK are living with diabetes, most have type 2 diabetes which is associated with obesity. Type 2 diabetes can be prevented, treated with diet and weight loss, or managed with medication. The number of people with diabetes has reached epidemic proportions. To manage diabetes well and reduce complications of poorly managed diabetes, management of the condition can no longer be restricted to endocrinologists and diabetes specialist nurses. This article provides guidance on how glucagon-like peptide-1 receptor agonists can be used in the management of type 2 diabetes.

Diabetic bladder dysfunction.

More than 4.3 million people in the UK have been diagnosed with diabetes and there are thought to be a further 850 000 people living with diabetes who have not yet been diagnosed (Diabetes UK, 2024). Around half of all adults who have diabetes experience bladder dysfunction. It is one of the most common complications of diabetes, yet there is little in the medical literature and it is often unrecognised and poorly treated (Wittig et al, 2019). This article uses a case history approach to examine how diabetes can affect the bladder.

Intermittent catheterisation.

When an individual has voiding difficulties, the person may require a urinary catheter. Enabling the person to choose an appropriate method of catheterisation and supporting them can have an enormous impact on the individual's health and wellbeing. Indwelling urethral catheters are suitable for some people but for others they can affect a person's lifestyle and lead to depression. Intermittent catheterisation can work well for some people. Intermittent self-catheterisation has been used to manage urinary retention for over 3500 years. It remains the 'gold standard' in terms of bladder drainage, but it is under-used and indwelling catheters remain more common. This article examines the history of intermittent catheterisation, indications for self-catheterisation and how to support people to use self-catheterisation.

Stoma care: an update.

Each year an estimated 13 500 stoma surgeries are carried out in the UK (Kettle, 2019). Stoma surgery may involve the formation of a colostomy or an ileostomy. The person with a stoma may require help and support from the community nurse. This article aims to update readers on the indications for colostomy and ileostomy surgery and to enable them to support ostomates to reduce the risks of complications.

Type 2 diabetes post pandemic: enabling your patients to regain control.

There are now an estimated five million people living with diabetes in the UK, most have type 2 diabetes. The COVID-19 pandemic affected access to care, led to delays in diagnoses of diabetes and many people with diabetes experienced a deterioration in their diabetes control. This article provides guidance on how nurses can work with people at risk of diabetes to prevent diabetes, to induce remission and how to use medication to treat diabetes.

Can medication increase the risk of falls? The importance of medication review.

Falls are the second leading cause of unintentional injury deaths worldwide and are a major health issue for older people. One of the factors that can increase the risk of falls is medication. This article examines how medication can affect fall risk and how medication review can reduce the risk of falls.

A guide to diagnosing and treating benign prostatic hypertrophy.

Benign prostatic hypertrophy (BPH) is a condition where the prostate becomes enlarged. It affects all men and is part of the ageing process. Globally, the incidence rates of BPH have risen by 70% between 2000-2019. When left untreated, it can lead to acute urinary retention, impaired bladder emptying, urinary tract infections, bladder stones, kidney failure or gross haematuria. In this article, Linda Nazarko describes the causes and consequences of BPH along with treatment options that are available for it.

Bowel care at end of life.

Most people, given a choice prefer to die at home. As death approaches the dying person may say "please let me die at home, in my own bed". Many relatives promise their loved ones that they can remain at home until the end. One issue that can cause great distress and at times lead to unnecessary hospital admission is poorly managed bowel care. This article will examine how ageing, illness and medication can affect bowel function and quality of life.

Scabies: an update for community nurses.

Community nurses may encounter scabies in homeless people, those living in prisons, people living at home or in people living in care homes. Scabies is more prevalent in older adults and there is evidence that this infection is becoming more prevalent and difficult to treat. The community nurse can help reduce such risks. This article aims to enable the community nurse to be aware of the clinical features of scabies and how it is treated.

Treating head lice: a case study.

People who are homeless are greater risk of infections than the general public because they are often in poor health and have difficulty maintaining hygiene. This article discusses the treatment of head lice and uses a case history to outline specific issues that may arise in a person who is homeless and how these can be managed.

Red legs: how to differentiate between cellulitis, venous eczema and lipodermatosclerosis.

Community nurses often encounter people with red legs. There are a number of reasons why an individual may develop red legs. The most common causes of red legs are cellulitis, venous eczema and lipodermatosclerosis. All have different causes and require different treatments. This article aims to enable readers to differentiate between these conditions which can appear similar, and to offer effective evidence-based care.

Type 2 diabetes: an update for community nurses.

There are now over four million people living with diabetes in the UK, the majority having type 2 diabetes. The prevalence of type 2 diabetes is rising in line with growing obesity levels. This article will explore prevalence of type 2 diabetes, its prevention and treatment. It also provides guidance on how nurses can work with people at risk of diabetes, to prevent it, induce remission and create awareness of medications used to treat it.

Acute urinary retention: patient investigations and treatments.

Acute urinary retention (AUR) is the sudden inability to pass urine. AUR is more common in men and older men are at highest risk. The most common causes are obstructive in nature-prostatic hyperplasia is responsible for more than half the cases of AUR in men. AUR can also be caused by infection, inflammation, and by iatrogenic and neurological problems. This article outlines how AUR is diagnosed and treated.

Eczema and the older person.

Age-related changes lead to an increase in skin problems, and around 70% of older people have a treatable skin condition. However, ageing and poor physical health can make it difficult for older people to care for their skin. Eczema, a chronic inflammatory skin condition, where the skin becomes red, inflamed, itchy and scaly, can develop easily in older adults. This can, in turn, become infected and cause discomfort and health problems. This article explains how ageing affects the skin, how eczema can develop and how it can be treated, also touching upon the different types of eczema. It aims to equip community nurses with knowledge about this common condition and how to recognise and manage it.

Providing dignified continence care to older people at end of life.

The prevalence of urinary incontinence increases as a person ages, as age-related changes make it more difficult to maintain continence. Long-term conditions and treatments prescribed to treat conditions, such as heart failure, can lead to an urgency to void the bladder. Frailty can make it difficult for an older person to respond this need. At end of life, mobility is often compromised and people can experience extreme fatigue. Caregivers can obtain support to manage an individual's incontinence during the day but often struggle alone at night. Caregivers can become exhausted and a situation can reach breaking point. Working with the older person and caregivers to determine the goals of care and how to meet them can make a huge difference. It can take the pressure off the entire family, meet a person's needs and enable the person to stay at home. This article aims to enable nurses to understand the problems older people may experience and how to work with the older person and caregivers to develop solutions that maintain dignity and enhance quality of life.

A good idea badly implemented? Revised National Early Warning Score 2 in community settings.

The revised National Early Warning Score (NEWS2), a tool used to measure acute deterioration in hospital, has been introduced in acute NHS hospitals and ambulance services. Community nurses report that when they call 999 requesting an ambulance to take a person to hospital, they are asked to provide a NEWS score. They report that when the NEWS score is high, ambulance staff prioritise the call. The NEWS score is being introduced in the community by default. This article will outline how the NEWS score is calculated, its uses and limitations and asks if the NEWS score accurately measures acute deterioration in people living in the community and predicts the need for referral to accident and emergency services.

Faecal incontinence: investigation, treatment and management.

Faecal incontinence (FI) is a hidden problem that is under-diagnosed, under-investigated and under treated. Up to 10% of adults can experience an episode of FI. The prevalence of FI in the adult population has been estimated at 0.8-6.2%. Recent North American research indicates a prevalence of 8.3% in adults living in the community. This article explores the reasons why adults can develop FI, the importance of assessment, what treatments are available and how intractable FI can best be managed.

Male urinary incontinence management: penile sheaths.

Urinary incontinence is a hidden problem that affects 14 million adults in the UK. It affects around 30% of men aged 65 and over and can have a huge effect on quality of life. Often this distressing symptom can be treated effectively. It is important to manage incontinence while the man is undergoing investigations and treatment or when treatment is not possible. This article examines the role of urinary sheaths in the management of incontinence and provides links to further information.