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Introduction: Increasing numbers of people admitted to hospital have diabetes and need specialist support. To date, there is no mechanism which can help teams estimate the number of health care professionals they need to provide optimal care for people with diabetes in hospitals. Methods: The Joint British Diabetes Societies (JBDS) for Inpatient Care Group organised a survey of specialist inpatient diabetes teams in the UK for current staffing and the perception of optimal staffing using mailing lists available through their representative organisations. The results were verified and confirmed by one‐to‐one conversations with individual respondents and discussed in multiple expert‐group meetings to agree on the results. Results: Responses were received from 17 Trusts covering 30 hospital sites. Current diabetes specialist staffing level per 100 people with diabetes in hospital (Median, IQR) for consultants was 0.24 (0.22–0.37), diabetes inpatient specialist nurses was 1.94 (1.22–2.6), dieticians was 0.00 (0.00–0.00), podiatrists was 0.19 (0.00–0.62), pharmacists was 0.00 (0.00–0.37), psychologists was 0.00 (0.00–0.00). The teams also reported that for optimal care the total staff needed for each group (Median, IQR) was much higher; consultants 0.65 (0.50–0.88), specialist nurses 3.38 (2.78–4.59), dieticians 0.48 (0.33–0.72), podiatrists, 0.93 (0.65–1.24), pharmacists, 0.65 (0.40–0.79) and psychologists 0.33 (0.27–0.58). Based on the results of the survey, the JBDS expert group produced an Excel calculator to estimate staffing needs of any hospital site in question just by populating a few of the cells. Conclusion: Current inpatient diabetes staffing is much lower than needed in most Trusts who responded to the survey. The JBDS calculator can provide an estimate of the staffing needs of any hospital. [ABSTRACT FROM AUTHOR]

Summary The aim of our study was to clarify the association between glycated haemoglobin (HbA1c) and postoperative outcomes in people without an existing diagnosis of diabetes. Half a million adults were recruited into the UK Biobank prospective cohort study between March 2006 and October 2010. We divided participants into three groups: no diagnosis of diabetes and HbA1c < 42 mmol.mol−1; no diagnosis of diabetes and elevated HbA1c (≥ 42 mmol.mol−1 with no upper limit); and prevalent diabetes (regardless of HbA1c concentration) at recruitment. We followed up participants by linkage with routinely collected hospital data to determine any surgical procedures undertaken after recruitment and the associated postoperative outcomes. Our main outcome measure was a composite primary outcome of 30‐day major postoperative complications and 90‐day all‐cause mortality. We used logistic regression to estimate the odds of the primary outcome by group. We limited analyses to those who underwent surgery within one year of recruitment (n = 26,653). In a combined effects logistic regression model, participants not known to have diabetes with HbA1c ≥ 42 mmol.mol−1 had increased odds of the primary outcome (OR [95% CI] 1.43 [1.02–2.02]; p = 0.04), when compared with those without diabetes and HbA1c < 42 mmol.mol−1. This effect was attenuated and no longer statistically significant in a direct effects model with adjustment for hyperglycaemia‐related comorbidity (OR [95% CI] 1.37 [0.97–1.93]; p = 0.07). Elevated pre‐operative HbA1c in people without diabetes may be associated with an increased risk of complications, but the association is likely confounded by end‐organ comorbidity. In contrast to previous evidence, our findings suggest that to prevent adverse postoperative outcomes, optimisation of pre‐existing morbidity should take precedence over reducing HbA1c in people without diabetes. [ABSTRACT FROM AUTHOR]

The article discusses that high doses of glucocorticoids exacerbate hyperglycaemia in people with diabetes. It mentions that glucocorticoids are the commonest cause of people with diabetes developing potentially life-threating hyperglycaemic hyperosmolar state (HHS) in hospital. It also mentions that COVID-19 infection is associated with significant insulin resistance.

We present an Executive Summary of a guideline produced by a Joint British Diabetes Societies for Inpatient Care Writing Group for managing frail older inpatients with diabetes. This represents a multidisciplinary stakeholder consensus document providing more than 100 recommendations in eight areas: functional assessment and detection of frailty; preventative care: assessing risk factors and avoiding hospital admissions; general inpatient management principles; managing therapy choices for the frail older inpatient with diabetes; managing associated comorbidities and concerns; pre‐operative assessment and care; discharge planning and principles of follow‐up; and end of life care. The document is intended to guide effective clinical decision‐making in an inpatient setting and is supported by four appendices: Appendix 1, STOPPFRAIL criteria; Appendix 2, Acute care toolkit 3—Royal College of Physicians; Appendix 3, a description of physical performance and frailty measures for routine NHS application; and Appendix 4, Inpatient Frailty Care Pathway—template. This document is expected to enhance clinical outcomes and overall health status for this vulnerable inpatient population of older people with diabetes. The full version of the guideline, including the appendices, can be found at https://abcd.care/sites/abcd.care/files/resources/Inpatient_Care_of_the_Frail_Older_Adult.pdf [ABSTRACT FROM AUTHOR]

People with diabetes account for nearly one‐fifth of all inpatients in English and Welsh hospitals; of these, up to 90% are admitted as an emergency. Most are admitted for a reason other than diabetes with only 8% requiring admission for a diabetes‐specific cause. Healthcare professionals working in emergency departments experience numerous clinical challenges, notwithstanding the need to know whether each individual with diabetes requires urgent admission. This document has been developed and written by experts in the field, and reviewed by the parent organizations of the Joint British Diabetes Societies for Inpatient Care—Diabetes UK, the Diabetes Inpatient Specialist Nurse Group and the Association of British Clinical Diabetologists. The document aims to support staff working in emergency departments and elsewhere by offering practical advice and tools for effective, appropriate and safe triage. Each section relates to the commonest diabetic specific emergencies and algorithms can be printed off to enable ease of access and use. What's new?: About one in six acute hospital beds in the UK is occupied by someone with diabetes, over 80% of whom are admitted as an emergency not related to their diabetes.This guideline is aimed at teams working in areas where acute admissions occur to help them appropriately manage glucose‐related emergencies.It looks at the acute management of those known to have diabetes and those at risk of developing dysglycaemia.Areas covered are hypoglycaemia, hyperglycaemia, diabetic ketoacidosis, hyperosmolar hyperglycaemic state, the diabetic foot, end of life care and how to deal with an unknown insulin regimen in an acutely unwell individual. [ABSTRACT FROM AUTHOR]

The National Diabetes Stakeholders Covid‐19 Response Group was formed in early April 2020 as a rapid action by the Joint British Diabetes Societies for Inpatient Care, Diabetes UK, the Association of British Clinical Diabetologists, and Diabetes Frail to address and support the special needs of residents with diabetes in UK care homes during Covid‐19. It was obvious that the care home sector was becoming a second wave of Covid‐19 infection and that those with diabetes residing in care homes were at increased risk not only of susceptibility to infection but also to poorer outcomes. Its key purposes included minimising the morbidity and mortality associated with Covid‐19 and assisting care staff to identify those residents with diabetes at highest risk of Covid‐19 infection. The guidance was particularly created for care home managers, other care home staff, and specialist and non‐specialist community nursing teams. The guidance covers the management of hyperglycaemia by discussion of various clinical scenarios that could arise, the management of hypoglycaemia, foot care and end of life care. In addition, it outlines the conditions where hospital admission is required. The guidance should be regarded as interim and will be updated as further medical and scientific evidence becomes available. Novelty statement: This rapid response guidance represents the first national stakeholder action to address the special needs and vulnerabilities of care home residents with diabetes during Covid‐19This guidance is designed to support clinical decision‐making in care homes and takes into account the availability of skilled personnel and level of care present, and the inevitable limitations on diabetes monitoringA set of different clinical scenarios are given covering the various likely situations care staff will face with residents with diabetes who develop Covid‐19 and what are the key actions to take to improve outcomesThe guidance provides an optimal level of diabetes care approach during the exceptional circumstances of this pandemic but the Response Group recognises that care home settings may not be able to fully meet this unprecedented challenge [ABSTRACT FROM AUTHOR]

The article discusses the guidance on the management of inpatient hyperglycaemia in the midst of the coronavirus disease 2019 (COVID-19) pandemic, published by the British National Diabetes Inpatient COVID-19 Response Group. Topics explored include the impact of the pandemic on the delivery of acute inpatient care to individuals with diabetes, the recommendations on the adjustment of long-acting insulin dosages, and brief details about the updates to the existing clinical guidance.

We present a summary of a guideline produced by an international group of experts for managing type 1 diabetes in adults with an emphasis on the special needs of older people with this condition. The rationale for delivering high‐quality diabetes care for adults with type 1 diabetes, why it is important to include older people in our considerations, and the key underpinning principles of the guideline are included. The structure of the recommendations given is described and consists of 'general' recommendations followed by 'specific' recommendations according to three categories depending on the characteristics of adults addressed, such as functional level or self‐management ability. Recommendations are provided in the areas of: clinical diagnosis, establishing management plans and glucose regulation, diabetes self‐management education, nutritional therapy, physical activity, exercise and lifestyle modification, insulin treatments and regimens, use of technology in diabetes management, hypoglycaemia, managing cardiovascular risk, management of microvascular risk, and inpatient management of type 1 diabetes and ketoacidosis. What's new?: This work represents the first diabetes guideline that makes both general and specific recommendations based on descriptive and functional characteristics of adults with type 1 diabetes.This is the first type 1 diabetes guideline that considers the needs of older adults with this condition.Recommendations are designed to provide a guide to allowing comprehensive assessment model and risk stratification approaches (including functional assessment) to be central features of management.The recommendations provide an individualized multidimensional integrated approach to the comprehensive management of type 1 diabetes in adults. [ABSTRACT FROM AUTHOR]

Aim: To investigate factors influencing diagnostic discordance for non‐diabetic hyperglycaemia and Type 2 diabetes. Methods: Some 10 000 adults at increased risk of diabetes were screened with HbA1c and fasting plasma glucose (FPG). The 2208 participants with initial HbA1c ≥ 42 mmol/mol (≥ 6.0%) or FPG ≥ 6.1 mmol/l were retested after a median 40 days. We compared the first and second HbA1c results, and consequent diagnoses of non‐diabetic hyperglycaemia and Type 2 diabetes, and investigated predictors of discordant diagnoses. Results: Of 1463 participants with non‐diabetic hyperglycaemia and 394 with Type 2 diabetes on first testing, 28.4% and 21.1% respectively had discordant diagnoses on repeated testing. Initial diagnosis of non‐diabetic hyperglycaemia and/or impaired fasting glucose according to both HbA1c and FPG criteria, or to FPG only, made reclassification as Type 2 diabetes more likely than initial classification according to HbA1c alone. Initial diagnosis of Type 2 diabetes according to both HbA1c and FPG criteria made reclassification much less likely than initial classification according to HbA1c alone. Age, and anthropometric and biological measurements independently but inconsistently predicted discordant diagnoses and changes in HbA1c. Conclusions: Diagnosis of non‐diabetic hyperglycaemia or Type 2 diabetes with a single measurement of HbA1c in a screening programme for entry to diabetes prevention trials is unreliable. Diagnosis of non‐diabetic hyperglycaemia and Type 2 diabetes should be confirmed by repeat testing. FPG results could help prioritise retesting. These findings do not apply to people classified as normal on a single test, who were not retested. What's new?: Diagnosis of non‐diabetic hyperglycaemia is a key component of diabetes prevention programmes and clinical practice. Non‐diabetic hyperglycaemia diagnosis with a single test often changes to normality when re‐tested.Classification based on both HbA1c and fasting plasma glucose independently predicted discordant diagnosis of non‐diabetic hyperglycaemia and Type 2 diabetes.Diagnosis of non‐diabetic hyperglycaemia and Type 2 diabetes should be based on two HbA1c measurements. [ABSTRACT FROM AUTHOR]

Aims: Adolescents with Type 1 diabetes commonly experience episodes of ketoacidosis. In 2014, we conducted a nationwide survey on the management of diabetic ketoacidosis in young people. The survey reported how individual adolescents with diabetes were managed. However, the costs of treating diabetic ketoacidosis were not reported. Methods: Using this mixed population sample of adolescents, we took a 'bottom‐up' approach to cost analysis aiming to determine the total expense associated with treating diabetic ketoacidosis. The data were derived using the information from the national UK survey of 71 individuals, collected via questionnaires sent to specialist paediatric diabetes services in England and Wales. Results: Several assumptions had to be made when analysing the data because the initial survey collection tool was not designed with a health economic model in mind. The mean time to resolution of diabetic ketoacidosis was 15.0 h [95% confidence interval (CI) 13.2, 16.8] and the mean total length of stay was 2.4 days (95% CI 1.9, 3.0). Based on data for individuals and using the British Society of Paediatric Endocrinology and Diabetes (BSPED) guidelines, the cost analysis shows that for this cohort, the average cost for an episode of diabetic ketoacidosis was £1387 (95% CI 1120, 1653). Regression analysis showed a significant cost saving of £762 (95% CI 140, 1574; P = 0.04) among those treated using BSPED guidelines. Conclusion: We have used a bottom‐up approach to calculate the costs of an episode of diabetic ketoacidosis in adolescents. These data suggest that following treatment guidelines can significantly lower the costs for managing episodes of diabetic ketoacidosis. What's new?: Adolescents with Type 1 diabetes frequently experience diabetic ketoacidosis. However, how much treating this condition costs in this age group remains unknown in the UK.We used the 2014 national survey data set to conduct a novel, 'bottom‐up' approach to cost analysis.Our data suggest that the average cost of an episode of diabetic ketoacidosis in an adolescent in the UK in 2014 was £1387.Use of the British Society of Paediatric Endocrinology and Diabetes guidelines was associated with a significant £762 reduction in costs. [ABSTRACT FROM AUTHOR]

The article discusses the guidance on the management of diabetic ketoacidosis (DKA) in the midst of the coronavirus disease 2019 (COVID-19) pandemic, published by the British National Diabetes Inpatient COVID-19 Response Group. Topics explored include the subcutaneous insulin regimen that clinicians need to ensure availability in case of DKA, the required monitoring of oxygen saturations and fluid balance in concerned patients, and the recommended use of rapid acting insulin analogues.

The UK National Diabetes Inpatient COVID Response Group was formed at the end of March 2020 to support the provision of diabetes inpatient care during the COVID pandemic. It was formed in response to two emerging needs. First to ensure that basic diabetes services are secured and maintained at a time when there was a call for re‐deployment to support the need for general medical expertise across secondary care services. The second was to provide simple safe diabetes guidelines for use by specialists and non‐specialists treating inpatients with or suspected of COVID‐19 infection. To date the group, comprising UK‐based specialists in diabetes, pharmacy and psychology, have produced two sets of guidelines which will be continually revised as new evidence emerges. It is supported by Diabetes UK, the Association of British Clinical Diabetologists and NHS England. What's new?: Diabetes specialist services help avoid unnecessary admission and readmission of people with diabetes to secondary care facilities and inpatient teams facilitate their care whilst admitted.Clinicians and trainees without diabetes expertise are providing diabetes care during the COVID‐19 pandemic.This Position Statement outlines the need to maintain key elements of specialist diabetes services with a focus on delivering safe inpatient diabetes care.The Position Statement also outlines simple pathways for the management of inpatients with diabetes by admitting teams in secondary care.This Position Statement will be useful to trusts/health boards in redesigning clinical services during the COVID‐19 pandemic and helping ensure that the safe care of people with diabetes. [ABSTRACT FROM AUTHOR]

Peri-operative hyperglycaemia, whether the cause is known diabetes, undiagnosed diabetes or stress hyperglycaemia, is a risk factor for harm, increased length of stay and death. There is increasing evidence that peri-operative hyperglycaemia is a modifiable risk factor, and many of the interventions required to improve the outcome of surgery must be instituted before the actual surgical admission. These interventions depend on communication and collaboration within the multidisciplinary team along each stage of the patient journey to ensure that integration of care occurs across the whole of the patient-centred care pathway. [ABSTRACT FROM AUTHOR]

The aims of these guidelines are to improve the inpatient experience and safety for people with diabetes through effective self-management. The guidelines are aimed primarily at healthcare professionals working in hospitals, although some aspects are relevant to staff involved in pre-admission preparation. The guidelines suggest an approach to providing patient information, the circumstances in which self-management is appropriate, the development of care plans and the elements needed for effective self-management. This document is an abridged and modified version of 'Self-management of diabetes in hospital' adapted specifically for Diabetic Medicine. The full version can be found online at: www.diabetes. org.uk/joint-british-diabetes-society or https://abcd.care/joint-british-diabetes-societies-jbds-inpatient-care-group. [ABSTRACT FROM AUTHOR]

Glucocorticoids (steroids) are widely used across many medical specialities for their anti-inflammatory and immunosuppressive properties. However, one of their major side effects is the development of hyperglycaemia. It is well recognized that high glucose levels in people with diabetes in hospital are associated with harm and increased lengths of hospital stay. The use of glucocorticoid (steroid) treatment in people with pre-existing diabetes will undoubtedly result in worsening glucose control, and this may be termed 'steroid-induced hyperglycaemia', and will warrant temporary additional, and more active, glycaemic management. A rise in glucose may occur in people without a known diagnosis of diabetes, and this may be termed 'steroid-induced diabetes'. There is a lack of evidence to guide how people with hyperglycaemia should be managed, and much of the guidance given here is a consensus based on best practice collated from around the United Kingdom. Where evidence is available, this is referenced. These guidelines on the management of people with diabetes treated with steroids has been adapted specifically for Diabetic Medicine. The full version of the guidelines can be found on line at: www.diabetes.org.uk/joint-british-diabetes-society or https:// abcd.care/joint-british-diabetes-societies-jbds-inpatient-care-group. [ABSTRACT FROM AUTHOR]

Optimal glycaemic control before and during pregnancy improves both maternal and fetal outcomes. This article summarizes the recently published guidelines on the management of glycaemic control in pregnant women with diabetes on obstetric wards and delivery units produced by the Joint British Diabetes Societies for Inpatient Care and available in full at www.diabetes.org.uk/joint-british-diabetes-society and https://abcd.care/joint-british-diabetes-societies-jbds-inpa tient-care-group. Hyperglycaemia following steroid administration can be managed by variable rate intravenous insulin infusion (VRIII) or continuous subcutaneous insulin infusion (CSII) in women who are willing and able to safely selfmanage insulin dose adjustment. All women with diabetes should have capillary blood glucose (CBG) measured hourly once they are in established labour. Those who are found to be higher than 7 mmol/l on two consecutive occasions should be started on VRIII. If general anaesthesia is used, CBG should be monitored every 30 min in the theatre. Both the VRIII and CSII rate should be reduced by at least 50% once the placenta is delivered. The insulin dose needed after delivery in insulin-treated Type 2 and Type 1 diabetes is usually 25% less than the doses needed at the end of first trimester. Additional snacks may be needed after delivery especially if breastfeeding. Stop all anti-diabetes medications after delivery in gestational diabetes. Continue to monitor CBG before and 1 h after meals for up to 24 h after delivery to pick up any pre-existing diabetes or new-onset diabetes in pregnancy. Women with Type 2 diabetes on oral treatment can continue to take metformin after birth. [ABSTRACT FROM AUTHOR]

Objective: To look at haematological and biochemical variables as predictors of outcomes in people admitted to hospital with a diabetic foot ulcer (DFU) without the use of technology or devices. In particular, to see if there was a relationship between admission blood cell and protein levels, and the likelihood of angioplasty, amputation, and death at one year after admission. Method: A five-year retrospective analysis of patients admitted to a tertiary multidisciplinary specialist diabetic foot clinic looking at admission C-reactive protein (CRP), white cell count (WCC), neutrophil count and HbA1c and their relationship to likelihood of angioplasty, minor or major amputation, and death at one year after admission. Results: We identified 206 patients, in whom there was 1 year mortality rate of 6.3%. Raised WCC and CRP levels were significantly associated with major amputation (p=0.0035 and p<0.01, respectively). Raised WCC and neutrophil levels and were significantly associated with mortality (p=0.01 and p=0.002, respectively). The need for angioplasty was associated with raised CRP (p<0.05) but not with WCC or neutrophil count. There was no association of risk of minor amputations with admission HbA1c, CRP, WCC and neutrophils. Mean length of hospital stay was 17.5 (standard deviation ±14.0) days. Conclusion: Commonly measured haematological and biochemical markers were useful predictors of outcomes for patients admitted to hospital for acute foot wounds. In addition, we found a much lower 1 year mortality and shorter length of hospital stay than previously recorded, possibly due to the introduction of a multidisciplinary weekly ward round. [ABSTRACT FROM AUTHOR]

Aims To assess the management of diabetic ketoacidosis in young people, which differs in the UK between paediatric and adult services, and to evaluate outcomes and extent to which national guidelines are used. Methods A standardized questionnaire was sent to all paediatric and adult diabetes services in England, requesting details of all diabetic ketoacidosis admissions in young people aged > 14 years in paediatric services ('paediatric' patients), and in young adults up to the age of 22 years in adult services ('adult' patients). Results A total of 64 adult patients aged ≤ 22 years (mean age 19.2 years) were reported, of whom seven were aged between 10 and 16 years. A total of 71 paediatric patients were reported [mean (range) age 14.9 (11-18) years]. We found that 85% of paediatric and 69% of adult patients were treated according to national guidelines, 99% of paediatric and 89% of adult patients were treated with 0.9% saline and fixed-rate insulin infusions and 16% of adult patients received an insulin bolus. Insulin treatment was initiated later in paediatric patients than in adult patients (100 vs 39 min; P < 0.001). In 23% of adult patients and 8.8% of paediatric patients, potassium levels were < 3.5 mmol/l ( P < 0.005). The lowest mean potassium levels were 3.8 mmol/l in paediatric and 3.5 mmol/l in adult patients ( P < 0.005). Hypoglycaemia occurred in 42.3% of paediatric and 36% of adult patients. Time to resolution was similar in paediatric and adult patients (16.0 vs 18.2 h), as was duration of hospital stay (2.35 vs 2.53 days). Conclusions Young people were treated according to national guidelines, but the quality of monitoring was variable in both paediatric and adult settings. The incidence of hypoglycaemia and hypokalaemia was unacceptably high. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the performance and safety of MepilexTransfer Ag (MTAg) in the treatment of infected diabetic foot ulcers (DFU). Method: Patients with locally infected DFU were treated with the test dressing for up to 4 weeks, with a further 12 weeks of follow-up in a non-comparative study. Changes to wound infection and wound size as well as the condition of the peri-wound skin from baseline were assessed.Wound pain during dressing change was measured using a visual analogue scale (VAS). The investigators and patients documented their opinions on their overall experience of the test dressing and on key performance parameters. Results: Following treatment with the test dressing, the signs and symptoms of local wound infection present in the target DFU were substantially reduced compared with baseline. Following the post-treatment evaluation, the majority of the DFU exhibited no signs of infection, and mean wound size was reduced by 50%.Wound size also continued to steadily decrease during follow-up. At the end of treatment five DFUs were completely healed and a further six healed by the end of the follow-up period. Concomitantly, over the course of the study, wound exudate levels were reduced and there was a significant improvement in the condition of the peri-wound area. Wound pain at dressing change was low throughout; generally patients felt no anxiety during the dressing change procedure. The patients considered it a comfortable dressing that remained in place and allowed ease of movement during wear. The investigating clinicians were highly satisfied with the overall performance, especially with respect to its ease of application and removal, conformability and flexibility. Conclusion: This study has demonstrated the potential of the dressing to provide topical antimicrobial activity directly to an infected DFU, suggesting prompt treatment of an infected DFU with this topical antimicrobial could aid wound complications. [ABSTRACT FROM AUTHOR]

Diabet. Med. 29, 420-433 (2012) Abstract These Joint British Diabetes Societies guidelines, commissioned by NHS Diabetes, for the perioperative management of the adult patient undergoing surgery are available in full in the Supporting Information. This document goes through the seven stages of the patient journey when having surgery. These are: primary care referral; surgical outpatients; preoperative assessment; hospital admission; surgery; post-operative care; discharge. Each stage is given its own considerations, outlining the roles and responsibilities of each group of healthcare professionals. The evidence base for the recommendations made at each stage, discussion of controversial areas and references are provided in the report. This document has two key recommendations. Firstly, that the management of the elective adult surgery patients should be with modification to their usual diabetes treatment if the fasting is minimized because the routine use of a variable rate intravenous insulin infusion is not recommended. Secondly, that poor preoperative glycaemic control leads to post-outcomes and thus, where appropriate, needs to be addressed prior to referral for surgery. [ABSTRACT FROM AUTHOR]

Diabet. Med. 29, 420-433 (2012) Abstract These Joint British Diabetes Societies guidelines, commissioned by NHS Diabetes, for the perioperative management of the adult patient undergoing surgery are available in full in the Supporting Information. This document goes through the seven stages of the patient journey when having surgery. These are: primary care referral; surgical outpatients; preoperative assessment; hospital admission; surgery; post-operative care; discharge. Each stage is given its own considerations, outlining the roles and responsibilities of each group of healthcare professionals. The evidence base for the recommendations made at each stage, discussion of controversial areas and references are provided in the report. This document has two key recommendations. Firstly, that the management of the elective adult surgery patients should be with modification to their usual diabetes treatment if the fasting is minimized because the routine use of a variable rate intravenous insulin infusion is not recommended. Secondly, that poor preoperative glycaemic control leads to post-outcomes and thus, where appropriate, needs to be addressed prior to referral for surgery. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect of dietary flavonoids on cardiovascular disease (CVD) risk in postmenopausal women with type 2 diabetes on established statin and hypoglycemic therapy.Research Design and Methods: Despite being medicated, patients with type 2 diabetes have elevated CVD risk, particularly postmenopausal women. Although dietary flavonoids have been shown to reduce CVD risk factors in healthy participants, no long-term trials have examined the additional benefits of flavonoids to CVD risk in medicated postmenopausal women with type 2 diabetes. We conducted a parallel-design, placebo-controlled trial with type 2 diabetic patients randomized to consume 27 g/day (split dose) flavonoid-enriched chocolate (containing 850 mg flavan-3-ols [90 mg epicatechin] and 100 mg isoflavones [aglycone equivalents)]/day) or matched placebo for 1 year.Results: Ninety-three patients completed the trial, and adherence was high (flavonoid 91.3%; placebo 91.6%). Compared with the placebo group, the combined flavonoid intervention resulted in a significant reduction in estimated peripheral insulin resistance (homeostasis model assessment of insulin resistance [HOMA-IR] -0.3 ± 0.2; P = 0.004) and improvement in insulin sensitivity (quantitative insulin sensitivity index [QUICKI] 0.003 ± 0.00; P = 0.04) as a result of a significant decrease in insulin levels (-0.8 ± 0.5 mU/L; P = 0.02). Significant reductions in total cholesterol:HDL-cholesterol (HDL-C) ratio (-0.2 ± 0.1; P = 0.01) and LDL-cholesterol (LDL-C) (-0.1 ± 0.1 mmol/L; P = 0.04) were also observed. Estimated 10-year total coronary heart disease risk (derived from UK Prospective Diabetes Study algorithm) was attenuated after flavonoid intervention (flavonoid +0.1 ± 0.3 vs. placebo 1.1 ± 0.3; P = 0.02). No effect on blood pressure, HbA(1c), or glucose was observed.Conclusions: One-year intervention with flavan-3-ols and isoflavones improved biomarkers of CVD risk, highlighting the additional benefit of flavonoids to standard drug therapy in managing CVD risk in postmenopausal type 2 diabetic patients. [ABSTRACT FROM AUTHOR]

Objective: The primary aim of this pilot observational study was to assess the reduction in wound depth and area achieved with a new negative pressure wound therapy (NPWT) system in diabetic patients with foot ulcers and post-amputation wounds. Secondary aims were to assess pain levels, extent of exudate removal, and ease of use of the system for both the patient and care giver. l Method: Patients in both acute and home care settings were enrolled into this 4-week study. Dressings were changed three times per week. Wound area and depth, exudate removal and pain severity were evaluated at each dressing change. At the final visit, the investigators and patients were surveyed with respect to equipment and dressings used in the study.. l Results: Sixteen patients were enrolled into the study. Data relating to 14 patients with a variety of post-amputation wounds were included in the intention-to-treat (ITT) analysis. The post-amputation wounds showed a general trend for a reduction in the median wound surface area between baseline (22.9cm2; range 0.5–55) and the final visit (15.3cm2; range 2.4–63.5). This equates to a median change (calculated from the percentage change in wound area for each patient individually) of -41% (range -82% to +15%). There was also a general trend in reduction in the median depth between baseline (17mm; range 0–35) to final visit (5mm; range 0–35). One patient presented with a foot ulcer that demonstrated a 50% reduction in depth from baseline to the final assessment. The device effectively managed wound exudate and most patients reported low pain levels during therapy. Ease of use of the system was rated very highly by investigators and patients. l Conclusion: This pilot study indicates that the use of the new NPWT system can be expected to have a positive effect on the healing of post-amputation wounds and foot ulcers in patients with diabetes. The findings demonstrate that the system is easy to use, effectively controls exudate and minimises pain and inconvenience for patients being treated with NPWT. l Declaration of interest: This study was sponsored by Molnlycke Heath Care (Gothenburg, Sweden) and Medela AG (Baar, Switzerland). The authors have no other conflicts of interest that are directly relevant to the content of this manuscript. [ABSTRACT FROM AUTHOR]

The article presents a case study related to 52-year-old man was seen with a 3-week history of hyperglycaemic symptoms. Topics include the insulin has required to stimulate the synthesis of lipoprotein lipase inside adipocytes, the retinal images of the man's right eye at presentation show lipaemia retinalis, and the lipaemia retinalis being a rare ocular manifestation of hypertriglyceridaemia.