Leflunomide
(Source: Practical Diabetes)
Source: Practical Diabetes - February 8, 2018 Category: Endocrinology Authors: Sean Murphy, Miles Fisher Tags: Drug notes Source Type: research

Diabetes Professional Care conference highlights
(Source: Practical Diabetes)
Source: Practical Diabetes - February 8, 2018 Category: Endocrinology Authors: Felix David Tags: Conference report Source Type: research

Management of atrial fibrillation in diabetes
Abstract Diabetes is an important risk factor for cardiovascular morbidity and mortality, and atrial fibrillation is linked to cardiovascular complications. The prevalence of both is increasing and they commonly co‐exist with a longer duration of diabetes and poorer control putting individuals at higher risk of atrial fibrillation. The complications of atrial fibrillation include heart failure and thromboembolism. There is an association between diabetes and atrial fibrillation and there are many theories as to the specific pathophysiology, including sharing similar precursors, but it is not clearly understood. What is u...
Source: Practical Diabetes - February 8, 2018 Category: Endocrinology Authors: Stephen Dobbin, Miles Fisher, Gerry McKay Tags: Review Source Type: research

Real ‐world evaluation of the DESMOND type 2 diabetes education and self‐management programme
Abstract Diabetes education and self‐management programmes are associated with improved biomedical, psychosocial and behavioural outcomes according to a number of randomised controlled trials (RCT) and systematic reviews. Observational studies are necessary to determine whether delivery of this education translates to improved outcomes in the real world. In 2008, the results of an RCT evaluating Diabetes Education and Self‐Management for Ongoing and Newly Diagnosed (DESMOND) in a multi‐ethnic population were published confirming the benefits of participating in this programme with sustained improvements at three year...
Source: Practical Diabetes - February 8, 2018 Category: Endocrinology Authors: Sudesna Chatterjee, Melanie J Davies, Bernie Stribling, Azhar Farooqi, Kamlesh Khunti Tags: Original article Source Type: research

Latest findings from the National Pregnancy in Diabetes audit report
(Source: Practical Diabetes)
Source: Practical Diabetes - February 8, 2018 Category: Endocrinology Authors: Steve Chaplin Tags: Short report Source Type: research

National audit shows diabetic foot care suffers from variation between services in ulcer outcomes
(Source: Practical Diabetes)
Source: Practical Diabetes - February 8, 2018 Category: Endocrinology Authors: Steve Chaplin Tags: Short report Source Type: research

Establishing the multidisciplinary Imperial Physical Activity and Diabetes clinic
Abstract Increasing numbers of people with diabetes are adopting exercise programmes. Fear of hypoglycaemia, and hypoglycaemia itself, are major issues for many people with diabetes undertaking physical activity. The risk of hypoglycaemia is exacerbated by endurance exercise. In addition, soft tissue injuries are more common in people with diabetes. We have established a multidisciplinary physical activity and diabetes clinic with the aim of empowering, educating and enabling people with diabetes to enjoy sport and exercise without fear of hypoglycaemia or frustration at glycaemic variability or soft tissue injuries. The m...
Source: Practical Diabetes - February 8, 2018 Category: Endocrinology Authors: Neil E Hill, Sian Rilstone, Carol Jairam, Stephen Chew, Dimitri Amiras, Nick S Oliver Tags: Care delivery Source Type: research

National standard setting and local developments in the care of type 2 diabetes
(Source: Practical Diabetes)
Source: Practical Diabetes - February 8, 2018 Category: Endocrinology Authors: Denis Pereira Gray, Kate Sidaway ‐Lee Tags: Leader Source Type: research

The spine in diabetes
(Source: Practical Diabetes)
Source: Practical Diabetes - January 1, 2018 Category: Endocrinology Authors: Rowan Hillson Tags: Leader Source Type: research

Evolocumab
(Source: Practical Diabetes)
Source: Practical Diabetes - December 5, 2017 Category: Endocrinology Authors: Louise McKenna, Gerry McKay, Miles Fisher Tags: Drug notes Source Type: research

Improving outcomes for pregnant women with diabetes
(Source: Practical Diabetes)
Source: Practical Diabetes - December 5, 2017 Category: Endocrinology Authors: Mark Greener Tags: Policy profile Source Type: research

Think pyomyositis!
We report the case of a 44‐year‐old male patient with a background of uncontrolled diabetes who presented with bilateral thigh pain and progressive leg weakness over three weeks. He had no other comorbidities and he denied any recent trauma or foreign travel. On examination he had multiple hard lumps in both thighs and blood results showed leucocytosis and raised inflammatory markers. Magnetic resonance imaging (MRI) showed multiple bilateral thigh abscesses. The diagnosis of pyomyositis was made and drains were inserted into the two largest abscesses. Simultaneously, he was started on antibiotics based on the drained ...
Source: Practical Diabetes - December 5, 2017 Category: Endocrinology Authors: Ann Nainan, Hind Shagali, Balasubramanian Srinivasan, Ammar Tarik Tags: Case report Source Type: research

An interesting unfolding of the diagnosis of hepatocyte nuclear factor ‐1 beta (HNF1β) monogenic diabetes
We present a case of RCAD syndrome with a previously unreported mutation. A 49‐year‐old man with diabetes mellitus was admitted with worsening chronic kidney disease requiring haemodialysis. He developed recurrent, unexplained hypoglycaemia despite discontinuing insulin, making the diagnosis of type 1 diabetes mellitus questionable. He had detectable serum C‐peptide (742 pmol/L), and anti‐GAD and anti‐pancreatic islet cell antibodies were negative. Abdominal imaging revealed renal cortical cysts and atrophic pancreas. A significant family history of diabetes mellitus with renal disease was also established which ...
Source: Practical Diabetes - December 5, 2017 Category: Endocrinology Authors: Pallavi Hegde, Annette Meldon, Lesley Lamen, Dushyant Sharma, Dhanya Kalathil Tags: Case report Source Type: research

Primary care diabetes prescribing volume and costs are on the increase
(Source: Practical Diabetes)
Source: Practical Diabetes - December 5, 2017 Category: Endocrinology Authors: Steve Chaplin Tags: Short report Source Type: research

Development of educational tools for doctors in training on inpatient diabetes management
Abstract The prevalence of diabetes among inpatients is increasing. The National Diabetes Inpatient Audit in 2015 showed that 17% of inpatients have diabetes of whom about 36% are on insulin therapy. The audit highlighted sub‐optimal care quality, with harm resulting from inpatient care across several areas of diabetes care. The National Diabetes Mortality and Morbidity project was set up to understand factors contributing to inpatient diabetes harm. The key recommendation arising from this project is mandatory education on inpatient diabetes for all staff. It is critical to take widespread action to improve training and...
Source: Practical Diabetes - December 5, 2017 Category: Endocrinology Authors: Sowmya Gururaj Setty, Heather Daly, Kath Higgins Tags: Original article Source Type: research

Evaluating insulin pump functionality during ionising radiation exposure
Abstract Concerns exist about the safety of ionising radiation on the components of insulin pumps and whether these will induce electronic failure or dysfunction. We therefore subjected six insulin pumps to two radiation exposure protocols; firstly in the cardiac catheterisation laboratory and subsequently computerised tomography scanning. The pumps were downloaded and functionality was monitored for four weeks after exposure. All pumps continued to work appropriately with no demonstrated loss of functionality, loss of bolus or basal delivery and no evidence of pump failure. Due to the nature of the method of this study we...
Source: Practical Diabetes - December 5, 2017 Category: Endocrinology Authors: Clare Alexandra Whicher, Malik Humayun, Emma Jenkins, Michael Brooks, Matthew Benbow, Chris Critoph, Helen Partridge Tags: Original article Source Type: research

Mobility with diabetes
(Source: Practical Diabetes)
Source: Practical Diabetes - December 5, 2017 Category: Endocrinology Authors: Rowan Hillson Tags: Leader Source Type: research

Inconclusive effects of once ‐weekly exenatide on cardiovascular outcomes in type 2 diabetes
(Source: Practical Diabetes)
Source: Practical Diabetes - November 1, 2017 Category: Endocrinology Authors: Chih Wong, Miles Fisher Tags: Leader Source Type: research

Sodium zirconium cyclosilicate
(Source: Practical Diabetes)
Source: Practical Diabetes - October 13, 2017 Category: Endocrinology Authors: Gregory Skoyles, Gerry McKay, Miles Fisher Tags: Drug notes Source Type: research

The latest National Diabetes Audit report sheds light on complications and mortality rates
(Source: Practical Diabetes)
Source: Practical Diabetes - October 13, 2017 Category: Endocrinology Authors: Steve Chaplin Tags: Short report Source Type: research

Type 1 diabetes and an insulin pump: an iterative review of qualitative literature
Abstract Psychosocial factors are becoming increasingly recognised as an important component in the holistic management of people living with diabetes. However, there is limited literature available that describes the psychosocial impact of insulin pump therapy on people living with type 1 diabetes mellitus. This paper systematically reviews recurrent themes within extant qualitative research and suggests avenues for future research. These themes explore the pump's impact on diabetes self‐management, altered self‐identity, perceptions by others and the emotional toll. The findings inform multidisciplinary health care p...
Source: Practical Diabetes - October 13, 2017 Category: Endocrinology Authors: Daniel N Grose, Casey L O'Brien, David J Castle Tags: Review Source Type: research

Exercise and type 1 diabetes: overcoming the barriers
(Source: Practical Diabetes)
Source: Practical Diabetes - October 13, 2017 Category: Endocrinology Authors: Mark Greener Tags: Policy profile Source Type: research

Diabetes distress and fear of hypoglycaemia: what are the psychological benefits of insulin pump therapy?
Abstract Living with type 1 diabetes imposes a considerable burden on the individual to continuously self‐manage their condition. As part of an ongoing audit, the psychological outcomes of insulin pump therapy were evaluated over a three‐year period. Adult patients completed self‐report questionnaires at initiation and after 12 months of pump therapy. Diabetes emotional distress was assessed using the Problem Areas in Diabetes Scale (PAID) and cognitive and behavioural aspects of fear of hypoglycaemia using the Hypoglycaemia Fear Survey (HFS‐W, HFS‐B). HbA1c and demographic data were obtained from the clinical re...
Source: Practical Diabetes - October 13, 2017 Category: Endocrinology Authors: Clare Shaban, Julia Knott, Emma Jenkins, Melanie Weiss, Jacqueline Ryder, Julie Charman, Helen Partridge Tags: Original article Source Type: research

Artificial neural networks in diabetes health care professional education: Effective Diabetes Education Now (EDEN)
(Source: Practical Diabetes)
Source: Practical Diabetes - October 13, 2017 Category: Endocrinology Authors: Petra Jones, Melanie Davies, Kamlesh Khunti, Sam Seidu, Sudesna Chatterjee Tags: New model in diabetes training Source Type: research

Lower limb oedema in diabetes
(Source: Practical Diabetes)
Source: Practical Diabetes - October 1, 2017 Category: Endocrinology Authors: Rowan Hillson Tags: Leader Source Type: research

Rituximab
(Source: Practical Diabetes)
Source: Practical Diabetes - September 11, 2017 Category: Endocrinology Authors: Claire Wood, Gerry McKay, Miles Fisher Tags: Drug notes Source Type: research

The impact of transition on NHS diabetes service delivery: key audit results spanning 2003 –2014
(Source: Practical Diabetes)
Source: Practical Diabetes - September 11, 2017 Category: Endocrinology Authors: Steve Chaplin Tags: Short report Source Type: research

Diabetes and mental health: often an ‘evidence‐free zone’
(Source: Practical Diabetes)
Source: Practical Diabetes - September 11, 2017 Category: Endocrinology Authors: Mark Greener Tags: Policy profile Source Type: research

Immune ‐mediated diabetes due to pembrolizumab
Abstract Melanoma is one of the most commonly occurring skin cancers in the UK. As recommended by NICE, there are a number of drugs available to treat melanoma and immunotherapeutic drugs are widely used to improve survival in metastatic melanoma. Monoclonal antibodies can cause immune‐related side effects, including diabetes. Pembrolizumab, an anti‐programmed cell death‐1 receptor monoclonal antibody (PD‐1 Ab), was given to a 63‐year‐old woman with metastatic melanoma. She developed osmotic symptoms with tiredness and confusion after pembrolizumab treatment cycles. She was diagnosed with diabetic ketoacidosis;...
Source: Practical Diabetes - September 11, 2017 Category: Endocrinology Authors: Pankaj Verlekar, Hermione Price Tags: Case report Source Type: research

Advance to Derby: it's not about the journey, it's about the destination
Abstract The 2017 Mary MacKinnon lecture described how we worked across organisational boundaries to improve diabetes care in Derby, putting the user at the centre of their care. These are principles that were important to Mary McKinnon. The Derby Model of integrated diabetes care resulted in improvements in all six domains of quality improvement, and saved £800 000 a year. Using preconception care and the PROCEED project as an example, the application of the Derby principles to a subspecialist area was considered. PROCEED also improved outcomes and saved £68 000 in its first year. Despite a challenging journey...
Source: Practical Diabetes - September 11, 2017 Category: Endocrinology Authors: Paru King Tags: State of the art lecture Source Type: research

Emerging technologies for diabetes
Abstract The lives of people with diabetes may be revolutionised by an explosion of new product developments and launches. These emerging technologies include new continuous blood glucose monitoring, innovative insulin delivery techniques and novel data and decision support mechanisms that could improve HbA1c levels. In addition, to potentially decreasing the time spent either in hypoglycaemia or hyperglycaemia, these new technologies also have the potential to improve a patient's quality of life as well as to reduce the burden of self‐management. Copyright © 2017 John Wiley & Sons. (Source: Practical Diabetes)
Source: Practical Diabetes - September 11, 2017 Category: Endocrinology Authors: Eleanor D Kennedy, Nick Oliver Tags: Review Source Type: research

Psychosocial outcomes in adults with type 1 diabetes following a novel ‘short course’ structured flexible MDI therapy self‐management programme
Abstract Our objectives were to evaluate the psychosocial impact of a novel education programme, comprising an abbreviated curriculum based on the ‘core elements’ of insulin self‐management education, with a view to identifying education options for those unable to attend a five‐day Dose Adjustment for Normal Eating (DAFNE) programme. The novel programme was developed by DAFNE course facilitators and trialled using participants naive to flexible multiple daily injection (MDI) education. Post‐course treatment satisfaction, wellbeing and diabetes distress were compared to baseline. Twenty‐one adults atten...
Source: Practical Diabetes - September 11, 2017 Category: Endocrinology Authors: Brigid A Knight, Ingrid J Hickman, Kristen Gibbons, Janet Taylor, Harold D McIntyre Tags: Original article Source Type: research

The CANVAS trial programme raises more questions than answers
(Source: Practical Diabetes)
Source: Practical Diabetes - September 11, 2017 Category: Endocrinology Authors: Miles Fisher Tags: Leader Source Type: research

Nails in diabetes
(Source: Practical Diabetes)
Source: Practical Diabetes - September 1, 2017 Category: Endocrinology Authors: Rowan Hillson Tags: Leader Source Type: research

Pancreatic autoantibodies: who to test and how to interpret the results
(Source: Practical Diabetes)
Source: Practical Diabetes - July 20, 2017 Category: Endocrinology Authors: Shivani Misra Tags: Test tips Source Type: research

Tests aiding diagnosis of monogenic diabetes
(Source: Practical Diabetes)
Source: Practical Diabetes - July 20, 2017 Category: Endocrinology Authors: Maggie Shepherd, Kevin Colclough, Tim J McDonald Tags: Test tips Source Type: research

Type 1 versus type 2 diabetes: is it time for a change?
(Source: Practical Diabetes)
Source: Practical Diabetes - July 20, 2017 Category: Endocrinology Authors: Patrick S Sharp Tags: Short report Source Type: research

Double diabetes: the cardiovascular implications of combining type 1 with type 2 diabetes
(Source: Practical Diabetes)
Source: Practical Diabetes - July 20, 2017 Category: Endocrinology Authors: Steve Cleland Tags: Short report Source Type: research

Diagnosing monogenic diabetes in clinical practice
(Source: Practical Diabetes)
Source: Practical Diabetes - July 20, 2017 Category: Endocrinology Authors: Katharine Owen Tags: Short report Source Type: research

Pancreatic exocrine dysfunction: common in type 3c diabetes, but don't forget types 1 and 2 diabetes mellitus
Abstract It is well understood that the pancreas has two distinct roles: the endocrine and exocrine functions, that are functionally and anatomically closely related. As specialists in diabetes care, we are adept at managing pancreatic endocrine failure and its associated complications. However, there is frequent overlap and many patients with diabetes also suffer from exocrine insufficiency. Here we outline the different causes of exocrine failure, and in particular that associated with type 1 and type 2 diabetes and how this differs from diabetes that is caused by pancreatic exocrine disease: type 3c diabetes. Copyright ...
Source: Practical Diabetes - July 20, 2017 Category: Endocrinology Authors: Katherine Alington, Michael H Cummings Tags: Review Source Type: research

Diagnosis and management of diabetes in older people
Abstract The incidence of diabetes has plateaued since 2004, although the prevalence continues to rise. The highest incidence is in people over the age of 70 years, most of whom have type 2 diabetes; a minority have type 1, which can present at any age. Type 1 diabetes may present more slowly in older people, a condition sometimes known as latent autoimmune diabetes in adults (LADA). Older people with diabetes have more than double the risk of cardiovascular disease compared to their non‐diabetic peers, and the risk of diabetes‐related major lower limb amputation is twice as high in those over 75 years compared with th...
Source: Practical Diabetes - July 20, 2017 Category: Endocrinology Authors: Anne Kilvert, Charles Fox Tags: Review Source Type: research

Severe insulin resistance: pathologies
Abstract In parallel with the increasing prevalence of obesity, rates of insulin resistance and its associated complications have increased; however, insulin resistance is not only a disease of the overweight and obese. Disorders of adipose tissue expandability and insulin receptor signalling cause syndromes of severe insulin resistance that may go unrecognised in clinical practice but whose metabolic complications are significant and often the initial presentation of the condition. This review will discuss the differing pathologies mediating insulin resistance that may be seen in clinical practice and will outline the phe...
Source: Practical Diabetes - July 20, 2017 Category: Endocrinology Authors: Audrey Melvin, Anna Stears Tags: Review Source Type: research

‘Type 3’ diabetes: a brain insulin‐resistant state linked to Alzheimer's disease
(Source: Practical Diabetes)
Source: Practical Diabetes - July 20, 2017 Category: Endocrinology Authors: Ken Shaw Tags: Leader Source Type: research

‘What sort of diabetes have I got?’ The importance of a label
(Source: Practical Diabetes)
Source: Practical Diabetes - July 1, 2017 Category: Endocrinology Authors: Clare Shaban Tags: Leader Source Type: research

Metformin in pregnancy
(Source: Practical Diabetes)
Source: Practical Diabetes - June 15, 2017 Category: Endocrinology Authors: Emily M Frier, Gerry McKay, David M Carty Tags: Drug notes Source Type: research

Whose diabetes is it anyway?
(Source: Practical Diabetes)
Source: Practical Diabetes - June 15, 2017 Category: Endocrinology Authors: Lindsay Oliver Tags: State of the art lecture Source Type: research

Effect of dehydration on blood tests
(Source: Practical Diabetes)
Source: Practical Diabetes - June 15, 2017 Category: Endocrinology Authors: Muhammad Masood Ashraf, Rustam Rea Tags: Test tips Source Type: research

Evaluation of the effect of GLP ‐1 agonists on quality of bowel preparation for colonoscopy in patients with diabetes
Abstract People with diabetes mellitus warrant a greater need for colonoscopy owing to the increased risk of colorectal cancer and autonomic neuropathy. Unfortunately, this population is reported to have a higher proportion of inadequate bowel preparation during colonoscopy, which translates into lower adenoma detection rates and repeat colonoscopies. Glucagon‐like peptide‐1 (GLP‐1) agonists commonly used in the management of diabetes are well known to cause delayed gastrointestinal (GI) transit times, yet it is unknown if they contribute to the higher frequency of inadequate bowel preparation in people with diabetes...
Source: Practical Diabetes - June 15, 2017 Category: Endocrinology Authors: Toishi Sharma, Nitin Das, Bahaaeldeen Ismail, Fernando Castro ‐Pavia, Jose Cabral, Carmen Villabona Tags: Original short report Source Type: research

Novel therapies in type 2 diabetes: insulin resistance
Abstract Insulin resistance plays an important role in the pathogenesis of type 2 diabetes and cardiovascular disease. Obesity is a major risk factor for the development of insulin resistance. Hence, treating obesity with lifestyle interventions is the cornerstone of managing insulin resistance. However, when lifestyle interventions fail to produce sustainable impact, then pharmacotherapy and/or bariatric surgery can produce significant improvements in weight, insulin resistance and glycaemic measures. Ectopic fat in the liver and muscle is one of the main mechanisms via which obesity impacts on insulin sensitivity. Hence,...
Source: Practical Diabetes - June 15, 2017 Category: Endocrinology Authors: Abd A Tahrani Tags: Review Source Type: research

Quality in Care Diabetes: more than an award
(Source: Practical Diabetes)
Source: Practical Diabetes - June 15, 2017 Category: Endocrinology Authors: Mark Greener Tags: Policy profile Source Type: research