A pre-specified secondary analysis of the DELIVER randomised controlled trial in 5788 people with heart failure with mildly reduced or preserved ejection fraction, with or without type 2 diabetes, explored the implications of early eGFR changes after initiation of dapagliflozin on later cardiovascular and renal risk. As expected, from baseline to 1 month, eGFR declines of >10% were more common in those actively treated with dapagliflozin than in those treated with placebo, occurring in 40% versus 25%. In placebo recipients, experiencing an initial eGFR reduction of >10% was associated with a higher risk of major adverse cardiovascular events. However, in those treated with dapagliflozin, although an initial eGFR reduction of >10% was common, this was not associated with adverse cardiovascular or renal outcomes compared to those treated with dapagliflozin who experienced smaller initial reductions in eGFR. The authors concluded that these findings reinforce the advice, based on earlier studies in those at high risk of cardiorenal disease, that SGLT2 inhibitors need not usually be discontinued or interrupted in response to an initial eGFR reduction. Other studies and editorials have concluded that routine monitoring of renal function is not required after initiating SGLT2 inhibitors unless volume depletion is considered a risk.

Pam Brown

GP in Swansea

Citation: Brown P (2023) Diabetes

Distilled: DELIVERing reassurance that early eGFR reductions with SGLT2 inhibitors should not prompt drug discontinuation. Diabetes & Primary Care 25: 205–7

Deborah Christie

Professor of Paediatric and Adolescent Psychology, University College London Hospitals and Dartford and Gravesham NHS Trusts

Citation: Christie D (2023) Q&A: Breaking the cycle – Empowering healthcare professionals to overcome stigma in diabetes care. Diabetes & Primary Care 25: 183–6 Q&A

Article disclosure: This article describes research commissioned by Abbott, and Professor Christie was paid a fee by Abbott to contribute to this article. The views expressed are those of the author and not necessarily those of Abbott. The article was commissioned by the Editorial Board as a topic of interest. The journal has received no funding, and all peer review and editorial decisions have been made independently and according to the journal’s usual procedures.

Citation: Christie D (2023) Q&A: Breaking the cycle – Empowering healthcare professionals to overcome stigma in diabetes care. Diabetes & Primary Care 25: 183–6

Background: Chronic wounds fail to progress through a normal sequence of repair. This study aimed to evaluate the chronic wound patient journey among healthcare professionals (HCPs) and patients in Indian settings.

Methods: A survey questionnaire was framed, including patient burden, initial diagnosis and treatment preference, referral pathway, challenges, and unmet needs of HCPs and patients.

Results: A total of 100 HCPs and 30 patients participated in the survey. The primary challenges faced by the patients include high treatment costs and accessibility to healthcare centres while HCPs reported high treatment cost and lack of awareness as challenges. Affordable treatment options and lack of awareness were cited as prime unmet needs by both HCPs and patients.

Conclusion: The use of adapted products and early initiation of treatment can aid in faster wound healing and can be cost-effective.

Authors:

Arun Bal, Sanjay Vaidya, Rajiv Parakh, Vivekanand, Pavan Belehalli, Madhu Periasamy, Jessy Thomas, Bharat Kotru, Beulah Priyadharshini D R, Venugopal K and Pratik Bhide

Arun Bal is Consultant Diabetic Foot Surgeon, S L Raheja Hospital, Mumbai, India;

Sanjay Vaidya is Consultant Plastic Surgeon, S L Raheja Hospital, Mumbai, India;

Rajiv Parakh is Consultant– Peripheral Vascular and Endovascular Surgery, Medanta Hospital, Gurugram, India;

Vivekanand is Consultant Vascular Surgeon, BMJ Hospital, Bangalore, India;

Pavan Belehalli is Orthopaedic Surgeon, KIER, Bangalore, India;

Madhu Periasamy is Consultant Plastic Surgeon, Ganga Hospital, Coimbatore, India;

Jessy Thomas is Surgeon – Podiatry, Hiranandani Hospital, Mumbai, India;

Bharat Kotru is Podiatrist and Wound Care Specialist, Max Hospital and Amandeep Hospital, Amritsar, India;

Beulah Priyadharshini D R is Medical Affairs Manager – India, Urgo Medical;

Venugopal K is Medical Affairs & Training Specialist – India, Urgo Medical;

Pratik Bhide is Managing Director, India, Urgo Medical

Providencia rettgeri is a Gram-negative bacillus that is most usually seen in urinary tract infections. Skin and soft tissue infections with P rettgeri are rare and there few case reports described in the literature. A 43-year old woman presented to the emergency department with a leg ulcer of 3 months duration. Microbiological results isolated P rettgeri and Pseudomonas aeruginosa. She underwent surgical debridement and split-thickness skin grafting alongside IV antibiotic therapy and dressing care, with complete resolution of the wound 3 months after admission. The differential diagnosis of leg ulcers is wide and must include infection and venous insufficiency. Although venous ulcers are common, typically they are not responsible for rapid evolving ulcers that destroy tissues below the muscular fascia. In this case report, the authors hypothesise that P rettgeri had a major role in the severity of the ulcer in an otherwise healthy woman. A greater understanding of how P rettgeri affects wound pathophysiology is needed in order to distinguish between colonisation versus infection and discriminate bacterial synergy, as well as having better treatment guidelines.

Authors:

Miguel Veríssimo, Diogo Guimarães, Diogo Casal, Sara Carvalho, Miguel Matias, Raquel Barbosa and Joaquim Bexiga

Miguel Veríssimo is Resident. Diogo Guimarães is Resident. Diogo Casal is Attending Physician. Sara Carvalho is Attending Physician. Miguel Matias is Resident. Raquel Barbosa is Resident. Joaquim Bexiga is Attending Physician. All at Plastic Surgery Department, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal.