| CODE | MED5201 | |||||||||
| TITLE | Diabetes Complications: Prevention, Screening and Management 2 | |||||||||
| UM LEVEL | 05 - Postgraduate Modular Diploma or Degree Course | |||||||||
| MQF LEVEL | 7 | |||||||||
| ECTS CREDITS | 10 | |||||||||
| DEPARTMENT | Medicine | |||||||||
| DESCRIPTION | This study-unit is the second one to deal with diabetes-related complications. It provides an overview of the pathological processes underpinning the development of microvascular complications of diabetes and related co-morbidities. A multidisciplinary faculty will provide students with a detailed review of the importance of screening, investigating and managing the microvascular complications and the evidence base for risk factor control and how micro and macrovascular complications differ in this respect. Peripheral vascular disease alone and in combination with peripheral neuropathy contribute to the significant morbidity and mortality which significantly burden patients, relatives and healthcare providers as do nephropathy, retinopathy and a host of other health problems ranging from dermatological problems to reproductive problems which will be tackled. Students will analyse the tools that can be employed to screen and diagnose these various comorbitidies, and the healthcare burden of these will be highlighted. Through placements with various practitioners in the different fields they will develop the skills and competances to identify and manage such complications as part of a multidisciplinary team. Study-unit Aims: The aim of this study-unit is to enable students to evaluate and reflect on the pathogenesis of diabetic neuropathy (peripheral and autonomic), peripheral vascular disease and the diabetic foot, retinopathy, nephropathy and reproductive dysfunction. Students should gain an in-depth understanding of prevention, diagnosis and management of diabetes related complications , appreciate the psychological impact and the impact on quality of life of diabetic complications, as well as evaluate the economic costs and the social impact of diabetes on the individual, the family unit, and healthservice provision. Learning Outcomes: 1. Knowledge & Understanding: By the end of the study-unit the student will be able to: a. Describe the pathophysiology of the microvascular complications (retinoapthy, nephropathy and neuropathy) of diabetes; b. Plan screening and investigation algorithms for the timely detection of complications; c. Discuss glycaemic and risk factor management as cornerstones in both the prevention and management of various complications; d. Describe the various tests to detect and quantify the extent of autonomic neuropathy and the impact on the gastrointestinal and genitourinary systems; e. Describe the various forms of neuropathy - acute senory, chronic sensorimotor, distal symmetric polyneuropathy, focal and autonomic neuropathy; f. Classify the various stages of nephropathy, quantitation of proteinuria and renal impairment, the limitations of estimated glomerular filtration rate and the impact on urine output with disease progression; g. Describe the indications for dialysis, the advantages and disadvantages of peritoneal vs haemodialysis and identification of subjects who could benefit from possible renal transplantation; h. Classify the various stages of diabetic retinopathy and appreciate the utility of panretinal photocoagulation; i. Describe the dermatological and musculoskeletal problems including osteoporosis that subjects with diabetes can develop; j. Understand the spectrum of sexual and reproductive dysfunction that can affect both genders in the course of their disease; k. Describe methods to identify eating disorders, anxiety and depression in a timely fashion and apply knowledge to developing treatment strategies. 2. Skills: By the end of the study-unit the student will be able to: a. Utilise best available evidence to develop prevention strategies in relation to th emicrovascular complications of diabetes; b. Implement screening strategies in the community, primary and secondary care; c. Manage risk factors in order to prevent the onset and slow the rate of progression of complications of diabetes in concordance with international guidelines and practice recommendations; d. Review, propose and implement different management strategies for the effective prevention and management of the various complications and co-morbidities; e. Screen, identify and manage such problems through application of the clinical skills necessary, selection and interpretation of different investigative modalities - laboratory based and imaging as well as bedside investigation such as the use of Doppler to quantify the extent of the problem and plan the relevant pathway for the patient; f. Support patients with significant morbidity to facilitate their rehabilitation into society and work; g. Appraise the needs of patients with significant mobility problems secondary to diabetic neuropathy and peripheral vascular disease, Charcot's arthropathy, visual impairment; h. Facilitate access to dialysis in end stage renal disease and monitor patients on dialysis for secondary complications; i. Assess the psychological impact of different diabetes-related complications and provide the necessary support as well as empowering patients to take control of their diabetes and diabetes related problems; j. Identify eating disorders, anxiety and depression and contribute to a multidisciplinary framework to support and treat these patients; k. Evaluate patients for possible sexual dysfunction and disorders of growth, development and reproduction, as well as osteoporosis in the different types of diabetes. Main Text/s and any supplementary readings: Main texts - Griffin JE and Ojeda SR (2012) Textbook of Endocrine Physiology (6th Edition) Oxford. Oxford University Press. - Tobias ES, Connor M, Ferguson -Smith Malcolm 2011 Essential Medical Genetics 6th Editon. Wiley -Blackwell. - Holt RLG & Hanley NA 2012 Essential Endocrinology and Diabetes 6th Edition Wiley-Blackwell. - Kasper D L, Fauci AS, Hauser SL Harrisons Principles of Internal Medicine 19th Edition. McGraw Hill. - Melmed S, Polonsky KS, Reed Larsen P Krnenberg HM, Williams Textbook of Endocrinology 13th Edition Elsevier. Supplementary texts - International Diabetes Federation (2015) IDF Diabetes Atlas 7th ed. Available online at: https://www.idf.org/e-library/epidemiology-research/diabetes-atlas.html - International Diabetes Federation (2015) IDF Diabetes Atlas 7th ed. interactive map Available online at:http://www.diabetesatlas.org/across-the-globe.html - NICE guideline on Diabetes Foot Problems (NG19 from 2015) - NICE (2016) Diabetes in Adults Available online at: https://www.nice.org.uk/guidance/qs6/resources/diabetes-in-adults-pdf-58299425989 - World Health Organisation (2016) Global Report on Diabetes World Health Organisation Press Geneva Available online at: http://apps.who.int/iris/bitstream/10665/204871/1/9789241565257_eng.pdf - American Diabetes Association (2017) Standards of Medical Care in Diabetes - 2017, Diabetes Care, 40(Suppl. 1) pp. S11鈥揝24, DOI: 10.2337/dc17-S005. - Gallman, E.C., Conner, R.S. & Johnson, E. 2017, "Improving the Detection of Foot Abnormalities in Patients With Diabetes", Clinical Diabetes, vol. 35, no. 1, pp. 55-59. - NICE, 2016, 鈥淒iabetic foot problems: prevention and management鈥�, available at https://www.nice.org.uk/Guidance/NG19 , Accessed the 25/07/2017. - Schaper, N.C., Van Netten, J.J., Apelqvist, J., Lipsky, B.A. & Bakker, K. 2017, 鈥淧revention and management of foot problems in diabetes: A Summary Guidance for Daily Practice 2015, based on the IWGDF guidance documents鈥�, Diabetes Research and Clinical Practice, vol. 124, pp. 84-92. - Calleja N., Azzopardi Muscat N., Reiff S., Fava S., Vassallo J., Torpiano J., Grixti M., Caruana M., Theuma R., Grixti M., Camilleri P., Zammit McKeon A. (2015) Diabetes: A National Public Health Priority; A National Strategy for Diabetes. Ministry of Health, Malta. Available online at: https://deputyprimeminister.gov.mt/en/Documents/National-Health-Strategies/NDS-EN.pdf |
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| STUDY-UNIT TYPE | Blended Learning | |||||||||
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| LECTURER/S | Michael Boffa Mario J. Cachia Kevin Cassar David V Coppini Cynthia Formosa Melissa Marie Formosa Ruth Galea Jan Janula Elizabeth Martinelli Stephen Mizzi Ventura Stephanie Savona Charles Savona Ventura Diana Marie Vassallo Josanne Vassallo |
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The University makes every effort to ensure that the published Courses Plans, Programmes of Study and Study-Unit information are complete and up-to-date at the time of publication. The University reserves the right to make changes in case errors are detected after publication.
The availability of optional units may be subject to timetabling constraints. Units not attracting a sufficient number of registrations may be withdrawn without notice. It should be noted that all the information in the description above applies to study-units available during the academic year 2025/6. It may be subject to change in subsequent years. |
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