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VOLUME 10 NUMBER 1 • MARCH 2013
REVIEW
SA JOURNAL OF DIABETES & VASCULAR DISEASE
9.
Sandhu S, Al-Sarraf A, Taraboanta C
et al
. Incidence of pancreatitis, secondary
causes, and treatment of patients referred to a specialty lipid clinic with
severe hypertriglyceridemia: a retrospective cohort study.
Lipids Health Disease
2011;
10
:157
10. Sarwar N, Danesh J, Eriksdottir G
et al
. Triglycerides and the risk of coronary
heath disease: 10,158 incident cases among 262,525 participants in 29 western
prospective studies.
Circulation
2007;
115
:450-8.
11. Skrapari I, Perrea D, Ioannidis I
et al
. Glibenclamide improves postprandial
hypertriglyceridaemia in Type 2 diabetic patients by reducing chylomicrons but not
the very low-density lipoprotein subfraction levels.
Diabet Med
2001;
18
:781-5.
12. Yuan G, Al-Shali KZ, Hegele RA. Hypertriglyceridemia: its etiology, effects and
treatment.
CMAJ
2007;
176
:1113-20.
13. Tentolouris NA, Stylianou E, Lourida D
et al.
High postprandial triglyceridemia in
patients with type 2 diabetes and microalbuminuria.
J Lipid Res
2007;
48
:218-25.
14. Angiolillo DJ, Roffi M, Fernandez-Ortiz A. Tackling the thrombotic burden
in patients with acute coronary syndrome and diabetes mellitus.
Expert Rev
Cardiovasc Ther
2011;
9
:697-710.
15. Choudhuri G, Lakshmi CP, Goel A. Pancreatic diabetes.
Trop Gastroenterol
2009;
30
:71-5.
16. Ewald N, Hardt PD, Kloer HU. Severe hypertriglyceridemia and pancreatitis:
presentation and management.
Curr Opin Lipidol
2009;
20
:497-504.
17. Tonsi AF, Bacchion M, Crippa S
et al
. Acute pancreatitis at the beginning of the
21st century: The state of the art.
World J Gastroenterol
2009;
15
:2945-59.
18. Nair D, Merriman H, Morrell J
et al
. Consensus guideline on reducing cardiovascular
events and pancreatitis through the effective management of triglycerides. In:
Foord-Kelcey G (ed.). Guidelines: summarising clinical guidelines for primary care.
42nd ed. Berkhamsted: MGP Ltd, 2010;91-95.
19. Jialal I, Amess W and Kaur M. Management of hypertriglyceridaemia in the
diabetic patient.
Curr Diab Rep
2010;
10
:316-20.
20. Kolovou GD, Mikhailidis DP, Kovar J
et al
. Assessment and clinical relevance of
non-fasting and postprandial triglycerides: an expert panel statement.
Current
Vascular Pharmacology
2011;
9
:258-70.
21. British Cardiac Society; British Hypertension Society; Diabetes UK; HEART UK;
Primary Care Cardiovascular Society; Stroke Association. JBS 2: Joint British
Societies’ guidelines on prevention of cardiovascular disease in clinical practice.
Heart
2005;
91
(suppl 5):v1-52.
22. The National Collaborating Centre for Chronic Conditions (NCCCC). Type 2
diabetes. National clinical guidance for management in primary and secondary
care (update). London: Royal College of Physicians, 2008.
.
uk/nicemedia/live/11983/40803/40803.pdf (Accessed 8 March 2012)
23. Solano MP, Goldberg RB. Lipid management in type 2 diabetes.
Clin Diab
2006;
24
;27-32.
24. Oh R, Lanier J. Management of hypertriglyceridemia.
Am Fam Physician
2007;
75
:1365-71.
25. The FIELD study investigators. Effects of long-term fenofibrate therapy on
cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD
study): randomised controlled trial.
Lancet
2005;
366
:1849-61.
26. Goldfine AB, Kaul S, Hiatt WR. Fibrates in the treatment of dyslipidemias – time
for a reassessment.
N Engl J Med
2011;
365
:481-4.
27. Sacks FM, Carey VJ, Fruchart JC. Combination lipid therapy in type 2 diabetes. N
Engl J Med
2010;
363
:692-3.
28. Yokoyama M, Origasa H, Matsuzaki M
et al
. Effects of eicosapentaenoic acid on
major coronary events in hypercholesterolaemic patients (JELIS): a randomised
open label, blinded endpoint analysis.
Lancet
2007;
369
:1090-8.
29. Omacor Summary of Product Characteristics.
/
medicine/10312 (Accessed 11 October 2011)
30. National Institute for Health and Clinical Excellence. NICE clinical guideline 48.
Secondary prevention in primary and secondary care for patients following a
myocardial infarction. London: NICE, 2007.
/
live/11008/30493/30493.pdf (Accessed 8 March 2012)
Correct words and language assist weight-loss consultations
SAJDVD recommeded action
Primary care professionals have an important role to play
in motivating patients in weight loss. They need to use an
individualised approach in discussing weight with their
patients and to motivate weight loss.
References
1.
Gray C, Hunt K, Lorimer K,
et al
. Words matter: a qualitative investigation
of which weight status terms are acceptable and motivate weight loss
when used by health professionals.
BMC Public Health
2011;
11
: 513.
2.
NICE obesity guideline.
3.
SIGN obesity guideline.
G
eneral practitioners’ choice of words may have a direct
impact on patients’ weight loss, according to a recent UK
qualitative study.
1
The study used 34 semi-structured face-to-face
and telephone interviews to explore the acceptability of various
weight-status terms and their effectiveness in motivating lifestyle
changes. Interview transcripts were analysed using the systematic
framework approach.
Although some men and younger people seem to appreciate
a direct approach from healthcare professionals, others needed
to be treated more sensitively. Many people favoured the term
‘overweight’ to describe their weight status although there
were doubts about its effectiveness to motivate weight loss.
The response to the term ‘obese’ was largely negative although
responders recognised that it could be appropriate in a health
consultation. The use of the word ‘fat’ was viewed by most
interviewees, particularly women, as being too personal or
judgemental.
However, other terms that were considered acceptable by
clinicians included ‘high BMI’, ‘unhealthy BMI’ and ‘unhealthily
high body weight’. These three terms were also considered
professional and useful to motivate weight loss. Use of the terms
‘fat’ and ‘large’ were not generally considered motivational when
used by a health professional and the word ‘obese’ should be used
carefully by healthcare professionals with clear explanation of
what this actually means to the individual. A popular suggestion
was to related weight status to health to motivate weight loss,
and a number of responders felt it important to allow time for
full discussion of the problem, including health implications and
possible solutions.
NICE
2
and SIGN
3
have recently published comprehensive
clinical guidelines for the assessment, treatment and support
of patients who are overweight and obese. Current evidence
suggests that the cost of excess weight and obesity to society
is £15.8 billion per year and is forecast to rise to £49.9 billion
by 2050.
EVIDENCE IN PRACTICE
