Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
P134
Vitamin B12 is lower in metformin treated
patients but haemoglobin is unaffected
RP Narayanan1, SG Anderson2, E Onyekwelu3 and AH Heald1,3
1
1780 years). The study involved 7,456 men and 5,297 women.
Comparison between groups used t tests.
Results: Vitamin B12 levels when checked were significantly lower in
metformin treated patients (2,767 subjects, mean 355.1 ng/l, 95 per
cent CI 347.1363.1 ng/l) than non-metformin treated patients (1,567
subjects, mean 419.1 ng/l, 95 per cent CI 407.8430.3 ng/l), P < 0.001.
There was no difference in folate levels (P = 0.17). Interestingly MCV
was lower in metformin vs. non-metformin treated patients (90.1fL vs.
91.3fL) as was MCH (90.7pg vs. 90.3pg), P < 0.001. There was no
difference in Hb (136.1 vs. 135.6 g/l). Mean HbA1c was 7.47 per cent
(58 mmol/mol) and 6.88 per cent (52 mmol/mol) in the metformin and
non-metformin groups respectively (P < 0.001).
Conclusion: While vitamin B12 levels were lower in metformin
treated patients, there was no difference in circulating Hb. This has
implications for long-term monitoring requirements in metformin
treated patients.
72
P136
National Diabetes Audit (NDA): comparison
between all-cause mortality in people with
diabetes and the general population in
England; more than 20,000 excess deaths in
people with diabetes and higher risks in
Type 1 diabetes
D Eayres1, J Barrett2, C Buttery2, J Henderson2 and B Young3
1
Public Health Information, NHS Information Centre, Leeds, UK, 2Clinical
Audit Support Unit, NHS Information Centre, Leeds, UK, 3Department of
Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK
P137
National Diabetes Audit (NDA):
investigation by age and sex of excess
deaths in people with diabetes in England;
greater effects in the young and in Type 1
females
DIABETICMedicine
P138
Audit of a diabetic renal clinic: an appraisal
of the AABC treatment paradigm
K Al-Hourani1, T Mehrali2, A Murtaza2 and P De2
1
Merton College, University of Oxford, Oxford, UK, 2Diabetes and Endocrine
Unit, City Hospital, Birmingham, UK
Aim: To audit the outcome of our diabetic renal clinic using AABC
(HbA1c and aspirin, blood pressure, cholesterol/lipids) strategy.
Methods: Baseline data T0 in 2009 were compared with final data T1
end 2010 from clinic letters and electronic data of 186 patients
attending this clinic between 2009 and 2010.
Results: In all, 173/186 (93 per cent) had Type 2 diabetes (male 118);
53 per cent of patients were South Asian, 23 per cent Caucasian, 23 per
cent Afro-Caribbean. Mean HbA1c was T0 7.96 per cent vs. T1 8.23
per cent, P = 0.3. Significant improvements in blood pressure control
(mean SBP T0 141.5 vs. T1 136.8, P = 0.04; mean DBP T0 74.3 vs. T1
68.3, P = 0.0002) and triglycerides (mean TG T0 2.33 vs. T1 1.7,
P139
Audit of the continuous subcutaneous
insulin infusion multidisciplinary service at
the University Hospitals Bristol NHS
Foundation Trust (UHB)
A Thomson-Moore, E Jones and N Thorogood
Diabetes and Endocrinology, University Hospitals Bristol NHS Foundation
Trust, Bristol, UK
73
DIABETICMedicine
P140
Safer administration of insulin: using an
audit to get the basics right and reduce risks
of patient harm
AC Reid, A Barridge, S Burmiston, C Hamilton and M Knapper
Department of Diabetes and Endocrinology, Guys and St Thomas NHS
Foundation Trust, London, UK
P141
National Diabetes Audit (NDA): routine care
is less effective and outcomes are poorer in
younger people compared with older
people who have diabetes in England
B Young1, A Uddin2, J Barrett2 and J Henderson2
< 25 year, <15 per cent, age > 55 year, > 30 per cent; Type 2 diabetes, age
< 55 year, <50 per cent, age > 70 year, >70 per cent). The <55 year age
group accounts for 91 per cent of all age diabetic ketoacidosis; 62 per
cent of end stage kidney disease (ESKD) in Type 1 and 15 per cent of
ESKD in Type 2 diabetes; 15 per cent of all major amputations; and 12
per cent of all myocardial infarctions.
Conclusions: Measures of care quality in younger people with both
Type 1 and Type 2 diabetes are poorer than in older people. Perhaps
systems of care for younger people should be specifically targeted for
improvement.
P142
Improvements to diabetes services as a
result of participating in the NHS Diabetes
National Diabetes Inpatient Audit
LJ Richards, G Eyres, L Allan, G Johnson and G Sweeney
NHS Diabetes, Newcastle-Upon-Tyne, UK
1
Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK, 2Clinical
Audit Support Unit, NHS Information Centre, Leeds, UK
74
P143
An audit on referral for oral glucose
tolerance tests
M Sadeghi1, C Rai1, A Taylor2 and M Banerjee1,3
1
P144
Audit of inpatient management of diabetes
in the elderly
A Mackett and KS Myint
Diabetes and Endocrinology, Norfolk and Norwich University Hospitals NHS
Foundation Trust, Norwich, UK
DIABETICMedicine
P145
What proportion of patients fail NICE
criteria for continuing GLP-1 treatment
beyond 6 months and why
L Wessels, S Keigan, SV OBrien and KJ Hardy
Diabetes Centre, St Helens Hospital, St Helens, UK
P146
The impact of the diabetes outreach team
on long-term glycaemic control
H Siddique1, AA Tahrani2, W Leong2, K Crowley1, G Wheatley1
and C Holmes1
1
Diabetes, Dudley Group of Hospital NHS Trust, Dudley, UK, 2Diabetes,
University Hospital of Birmingham, Birmingham, UK
Aim: The aim of this audit was to assess the effectiveness of service
provided by the dedicated Diabetes Outreach Team at Russells Hall
Hospital, Dudley, UK.
Methods: We performed a retrospective audit of all inpatients who
were seen by our Diabetes Outreach Team between June 2007 and
December 2010. Blood samples including HbA1c at the initial visit and
subsequent follow-up (at our Diabetes Clinic) at 3 to 6 months were
collected.
Results: Over 3.5 years, baseline data were available for 2,490
patients, and 1,224 patients had follow-up data. Of these, 199 had
Type 1 diabetes and 990 Type 2 (16.7 vs. 83.3 per cent); 35 patients had
unspecified type. Thirty-two patients were referred for new onset Type
1 diabetes, 91 for Type 2 (2.6 vs. 7.4 per cent); 235 (19.2 per cent) were
referred because of hypoglycaemia. Mean age was 65.2 (+19.03) years.
Of the total sample, after excluding hypoglycaemia related admissions,
using paired t test the baseline HbA1c was 9.27 ( 2.57) and follow-up
HbA1c 8.32 ( 2.03) (P < 0.001). Patients with new onset Type 1
diabetes dropped their HbA1c from 12.55 per cent to 7.43 per cent and
new onset Type 2 from 10.7 per cent to 7.29 per cent, while patients
known to have diabetes also dropped their HbA1c from 8.99 per cent to
75
DIABETICMedicine
8.46 per cent (P < 0.001 for all comparisons). When the samples were
analysed based on their age (<50, 5074, >75), once again there was a
statistically significant drop in HbA1c.
Conclusion: By providing a comprehensive care, structured education
and appropriate intervention though our Diabetes Outreach Team, we
have shown a significant reduction in objective markers of long-term
glycaemic control for recently hospitalised patients.
P147
A clinical audit of the insulin pump service
in Lanarkshire
A White, H Innes, P Reid, K Gallagher, L Wilson, L Doran,
E McIntyre and T Sandeep
Department of Diabetes, Monklands Hospital, Airdrie, UK
76
Clinical care and other categories posters: beta cells, islets and stem cells
DIABETICMedicine
P151
Socioeconomic status and cardiovascular
mortality in people with Type 2 diabetes in
Scotland
C Jackson1, J Walker2, C Fischbacher3 and S Wild2
1
Scottish Collaboration for Public Health Research and Policy, Medical
Research Council, Edinburgh, UK, 2Public Health Sciences, University of
Edinburgh, Edinburgh, UK, 3Information Services Division, NHS National
Services Scotland, Edinburgh, UK
P152
Effect of exenatide on cardiovascular
parameters: evidence from a small cohort
study
I Ramracheya
Centre for Diabetes and Endocrinology, Royal Berkshire NHS Foundation
Trust, Reading, UK
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DIABETICMedicine
cent (P < 0.05) at 3 and 6 months and 10 per cent (P < 0.05) at
12 months. There was a small reduction in total cholesterol levels at
3 months. At 6 months and 12 months total cholesterol fell
significantly (P < 0.05) by 5 per cent (3.9 0.1 vs. 3.7 0.1) and 8
per cent (3.9 0.1 vs. 3.6 0.1) respectively. LDL levels were
unaffected in this cohort.
Conclusions: Exenatide treatment can significantly and timedependently improve cardiovascular risk factors. Further studies are
needed to assess the long-term cardiovascular benefits of exenetide.
P153
Frequency and characteristics of carotid
artery plaque in older people with Type 2
diabetes: the Edinburgh Type 2 Diabetes
Study
CM Robertson1, MWJ Strachan2, L Nee3, J Morling1, S Masle1
and JF Price1
1
Centre for Population Health Sciences, University of Edinburgh, Edinburgh,
UK, 2Metabolic Unit, Western General Hospital, Edinburgh, UK, 3Department
of Radiology, Western General Hospital, Edinburgh, UK
P154
Sex differences in cardiovascular disease
risk factor profiles in those with Type 1
diabetes in Scotland
HM Colhoun
Population Health Sciences (PHS), University of Dundee, Dundee, UK
78
P155
New onset hyperglycaemia in a multi-ethnic
cohort presenting with acute coronary
syndrome
A Mathew and P De
Diabetes and Endocrine Unit, City Hospital, Birmingham, UK
P156
Relieving the stress: the effect of primary
percutaneous coronary intervention on
blood glucose levels in ST elevation
myocardial infarction
1
DIABETICMedicine
P157
Estimating absolute cardiovascular risk
reduction in young South Asians with newly
diagnosed glucose disorders
DR Webb1, LJ Gray2, K Khunti2, A Farooqi2 and MJ Davies1
1
Cardiovascular Sciences, University of Leicester, Leicester, UK, 2Health
Sciences, University of Leicester, Leicester, UK
P159
Important lessons from a rare case of
Charcot osteoarthropathy of the wrist in
diabetes
ME Edmonds1, V Kavarthapu2, J Compson2, G Vivian3, D Elias4
and NL Petrova1
1
79
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P160
Improved metabolic response to exercise on
sulfonylurea drugs compared with insulin in
HNF1A-MODY
AN Lumb1, G Thanabalasingham2,3, IW Gallen1 and
KR Owen2,3
1
P161
6q24 transient neonatal diabetes, due to
hypomethylation of the maternal TND locus,
is characterised by impaired insulin
sensitivity and secretion
YS Cheah1,2, T Evans3, L Docherty4, DJG Mackay4, IK Temple4
and SA Amiel1,2
1
Diabetes Research Group, Kings College London, London, UK, 2Department
of Diabetes, Kings College Hospital NHS Foundation Trust, London, UK,
3
Paxton Green Group Practice, Lambeth Primary Care Trust, London, UK,
4
Faculty of Medicine, University of Southampton, Southampton, UK
P162
Hypoglycaemia documented with
continuous glucose sensing in a case of
dead in bed
N Waheed, MI Butt, E Jones, A Newton, S Wong and C Dayan
P163
Managing insulin and carbohydrate
requirements for an athlete with Type 1
diabetes: cycling from John OGroats to
Lands End
R Ritchie1, J Hadley2, S Woodman1 and R Holt3
1
Nutrition and Dietetics, University Hospital Southampton NHS Foundation
Trust, Southampton, UK, 2Community Diabetes Service Solent NHS Trust,
Solent, Southampton, UK, 3Institute of Developmental Sciences, University of
Southampton, Southampton, UK
We report a 41-year-old man who was found dead in his bed with a
continuous glucose monitoring device in situ. He had Type 1 diabetes
diagnosed at age 14 years. He had poor glycaemic control during his
teenage years and suffered from severe hypoglycaemic episodes and
reduced hypoglycaemic awareness resulting in three road traffic
accidents. His diabetes was complicated by retinopathy, nephropathy
and neuropathy. He began continuous subcutaneous insulin pump
therapy in 2005 and linked continuous real-time glucose monitoring in
June 2009. He lived alone and was last seen alive and well by his
family 7 days prior to being found dead in bed with no signs of any
violent injury. The post-mortem download of his glucose monitoring
device and insulin pump showed frequent hypoglycaemic episodes
over the preceding few days. On the last day of pump and sensor
interaction, he was noted to be hypoglycaemic around 16:00 h and he
temporarily stopped and then restarted his pump. Despite the evidence
of alarms from the continuous glucose monitor, he remained
persistently hypoglycaemic. At 17:00 h, he administered 10 units of
insulin bolus on two occasions while still hypoglycaemic. This was the
last recorded interaction between the patient and the pump/sensor
system. He was found dead in bed 7 days later. Post-mortem
examination was consistent with death several days before and
showed no specific cause of death. Hypoglycaemia is known to
precipitate sudden cardiac arrhythmias which in our patient may have
been the cause of death.
80
P164
Use of insulin pump therapy in patients with
cystic fibrosis related diabetes: a case series
S Gupta and R Canavan
Endocrinology and Diabetes Centre, St Vincents University Hospital, Dublin,
Ireland
P165
MODY: its not always what it says on the
tin
JT Cameron1, M Shepherd2, S Ellard2 and E Pearson1
DIABETICMedicine
P166
Insulin-type cutaneous amyloid from insulin
injections
IW Seetho1, A Coup2 and SA Olczak3
1
Department of Diabetes and Endocrinology, Derby Hospitals NHS
Foundation Trust, Royal Derby Hospital, Derby, UK, 2Department of Cellular
Pathology, Pilgrim Hospital, Boston, UK, 3Department of Diabetes and
Endocrinology, Pilgrim Hospital, Boston, UK
P167
GLIS3 mutations: a rare cause of neonatal
diabetes
O Ajala1, J Jones2, S Ellard3, C Shaw-Smith3 and BA Millward1
1
Diabetes Clinical Research Centre, Peninsula College of Medicine and
Dentistry, Plymouth, UK, , 2Primary Care Trust, Cornwall and Isles of Scilly,
UK, 3Peninsula College of Medicine and Dentistry, University of Exeter, Exeter,
UK
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P168
Ketoacidosis is not always due to diabetes
O Ajala and DE Flanagan
Department of Diabetes and Endocrinology, Plymouth Hospitals NHS Trust,
Plymouth, UK
P169
Glycogenic hepatopathy: a rare and
potentially reversible complication of
poorly controlled diabetes
B Paranandi1, J Hannah2, S Ashton-Cleary2, R Rea2 and
A Austin1
P170
Autoimmune pancreatitis and diabetes
N Kaimal, A Kyriacou, C Babbs, S Taggart and B Young
Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK
1
Hepatology, Royal Derby Hospital, Derby, UK, 2Diabetes and Endocrinology,
Royal Derby Hospital, Derby, UK
82
P171
Acromegaly: a rare but important cause of
insulin resistance in Type 1 diabetes
J Prague1, MSB Huda2, A McGregor1 and D Hopkins2
1
2
P172
Boerhaaves syndrome and diabetes
S Zhyzhneuskaya, R Sinha, J Chapman and R Nayar
Diabetes and Endocrinology, City Hospitals Sunderland NHS Foundation
Trust, Sunderland, UK
DIABETICMedicine
P173
Person with Type 1 diabetes and
hypoglycaemia unawareness who regained
hypoglycaemia awareness and improved
glycaemic control post DAFNE course: a case
report
KE Jones, S Fleming and J Morgan
Diabetes Resource Centre, Northumbria Healthcare NHS Foundation Trust,
North Tyneside, UK
P174
Ketoacidosis in non-diabetic pregnancy
F Le Neveu1, B Hywel2 and J Harvey1
1
Department of Endocrinology and Diabetes, Wrexham Maelor Hospital, Betsi
Cadwaladr University Health Board, Wrexham, UK, 2Department of Medicine,
Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board,
Wrexham, UK
83
DIABETICMedicine
P176
Previously unrecognised HNF1B in a
diabetes clinic: the value of systematic
testing in patients with young-onset
diabetes
S Tiley1,2, M Shepherd1,2, UNITED Research Team1,2,
TM McDonald3, S Ellard4 and AT Hattersley1,2
P175
Eruptive xanthoma preceding acute
presentation of severe
hypertriglyceridaemia with new onset
diabetes complicated by pancreatitis: a case
report
R Ahluwalia1 and L Overend2
1
Diabetes and Endocrinology, Royal Liverpool and Broadgreen University
Hospital, Liverpool, UK, 2Diabetes and Endocrinology, St Helens and
Knowsley Teaching Hospitals NHS Trust, Prescot, UK
1
Peninsula National Institute for Health Research (NIHR) Clinical Research
Facility, Peninsula College of Medicine and Dentistry, University of Exeter,
Exeter, UK, 2Research and Development, Royal Devon and Exeter Foundation
Trust, Exeter, UK, 3Department of Clinical Chemistry, Royal Devon and Exeter
Foundation Trust, Exeter, UK, 4Molecular Genetics, Royal Devon and Exeter
Foundation Trust, Exeter, UK
P177
Dual onset of autoimmune hepatitis and
diabetes in an 18 year old patient
M Reddy, C Feeney and D Gable
Department of Diabetes, Endocrinology and Metabolic Medicine, St Marys
Hospital, Imperial College Healthcare NHS Trust, London, UK
84
P178
Does exercise preserve the honeymoon
period in Type 1 diabetes? A presentation of
three clinical cases
A Kennedy and P Narendran
School of Clinical and Experimental Medicine, University of Birmingham,
Birmingham, UK
DIABETICMedicine
P179
Recurrent spontaneous nocturnal
hypoglycaemia during enteral feeding
in cystic fibrosis related diabetes
K-L Bluett1, G Noble-Bell2, C Elston3, P Choudhary2 and
D Hopkins2
1
Nutrition and Dietetics, Kings College Hospital NHS Foundation Trust,
London, UK, 2Diabetic Medicine, Kings College Hospital NHS Foundation
Trust, London, UK, 3Respiratory Medicine, Kings College Hospital NHS
Foundation Trust, London, UK
P180
Furosemide as a treatment of diabetic
macular oedema in pregnancy
MH Charlton and PM Dodson
Department of Diabetes, Heart of England Foundation Trust, Birmingham, UK
85
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Clinical care and other categories posters: children, adolescents and young adults
P181
An insulin gene mutation presenting as
maturity-onset diabetes of the young
SA Mughal1,2, A Webster3, S Ellard4 and KR Owen1,2
1
Oxford Centre for Diabetes Endocrinology and Metabolism, University of
Oxford, Oxford, UK, , 2Oxford National Institute for Health Research (NIHR)
Biomedical Centre, Churchill Hospital, Oxford, UK, 3Oxford Radcliffe Hospitals
(NHS Trust), Oxford, UK, 4Institute of Biomedical and Clinical Science,
Peninsula Medical School, Exeter, UK
Most patients with insulin gene (INS) mutations have neonatal diabetes.
However, a few patients present with clinical characteristics similar to
maturity-onset diabetes of the young (MODY). We present a family
clinically diagnosed as MODY who on further investigation were found
to have a novel INS mutation. A 20-year-old lean woman was referred
to our monogenic diabetes clinic with symptoms of postprandial
reactive hypoglycaemia. She was concerned because her father and
sister had similar symptoms before developing diabetes. Her sister was
diagnosed with non-insulin requiring diabetes at age 15. Their father
was diagnosed with Type 2 diabetes at 35 years and was wellcontrolled on metformin. MODY was suspected, but mutations in
common MODY genes were not found. Further genetic investigation
revealed that both her sister and father had the H29Q INS mutation.
Our patient underwent an extended oral glucose tolerance test. Fasting
glucose was 5.5 mmol/l, 17 mmol/l at 2 h and 6.6 mmol/l at 4 h.
Insulin and C-peptide levels were 20pmol/l and 0.29nmol/l fasting
rising to a maximum of 206pmol/l and 1.74nmol/l respectively at 2 h.
HbA1c was 6.3 per cent. No symptoms or biochemical confirmation of
hypoglycaemia was made. Diagnostic genetic testing confirmed the
same INS mutation in our patient. INS mutations account for G1 per
cent of MODY and are treated with insulin sensitisers or exogenous
insulin. Unlike HNF1A/4A-MODY, sulfonylureas are contraindicated
as they are thought to increase beta cell decline. This family illustrates
the importance of establishing the exact genetic aetiology in patients
presenting with a MODY-like phenotype to ensure appropriate
treatment.
P183
How many paediatric patients are making
endogenous insulin?
S Hamersley1,2, M Shepherd1,2, REJ Besser1,2, The United
Research Team1,2, TJ McDonald3 and AT Hattersley1,2
1
Peninsula National Institute for Health Research (NIHR) Clinical Research
Facility, PCMD University of Exeter, Exeter, UK, 2Research and Development,
Royal Devon and Exeter NHS Foundation Trust, Exeter, UK, 3Department of
Clinical Chemistry, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
86
Clinical care and other categories posters: children, adolescents and young adults
P184
Diabetes Patient Experience Project with
Children, Young People and Parents:
developing a standard toolkit to guide
regional paediatric diabetes networks in the
ongoing collection of quantitative and
qualitative patient experience feedback
from children and young people as well as
parental opinion
P Hindmarsh1,3 and A Wright2,3
1
Developmental Endocrinology Research Unit, University College London,
London, UK, 2Social Research, Ci Research Ltd, Wilmslow, UK, 3Diabetes
Information, NHS Diabetes, Newcastle-Upon-Tyne, UK
P185
Standards for inpatient care for children
and young people with diabetes: are they
being achieved?
JA Edge1, F Ackland2, S Payne3, A McAuley3, C Burren4,
E Hind5, J Burditt2 and D Sims6
1
DIABETICMedicine
P187
Guidelines for the management of diabetic
ketoacidosis in adults and children
administer significant differences in fluid
volumes: does this place young adults at
risk of cerebral oedema?
KJ Cox2, SA Greene1 and V Alexander1
1
87
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Clinical care and other categories posters: children, adolescents and young adults
P188
Preserved endogenous insulin secretion as
measured by urinary C-peptide creatinine
ratio is associated with improved HbA1c and
less glycaemic variability in paediatric Type
1 diabetes
REJ Besser1, P Choudhary2, BM Shields1, TJ McDonald1,3,
AG Jones1, BA Knight1 and AT Hattersley1
1
Peninsula National Institute for Health Research (NIHR) Clinical Research
Facility, Peninsula College of Medicine and Dentistry, University of Exeter,
Exeter,UK, 2Diabetes Research Group, Weston Education Centre, Kings
College London, London, UK, 3Department of Clinical Biochemistry, Royal
Devon and Exeter NHS Foundation Trust, Exeter, UK
88
P189
Audit of care of young adults with Type 1
diabetes in Tayside
CY Allan1, A Bell2, R McCalpine3, S Ogston2, D Voigt4 and
ADR Mackie4
1
Undergraduate Medicine, Dundee University, Dundee, UK, 2Health
Informatics Centre, NHS Tayside, Dundee, UK, 3Clinical Technology Centre,
NHS Tayside, Dundee, UK, 4Diabetes, NHS Tayside, Dundee, UK
DIABETICMedicine
P192
Lead Diabetes Midwives Network: a
valuable network?
1
Diabetes, James Cook University Hospital, South Tees NHS Trust,
Middlesbrough, UK, 2Institute of Cell Science, Newcastle University,
Newcastle-Upon-Tyne, UK
P191
Evaluation of consultant nurse led
intermediate diabetes care services in
England
J James1, D Hicks2, J Hill3 and G Vanterpool4
1
Aim: NHS reforms demand that resources used are clinically and cost
effective. Specialist nurse led intermediate care costs are half those of
hospital care. Lack of evidence in intermediate care effectiveness led to a
TREND-UK audit of existing services. The aim was to assess clinical
effectiveness and patient satisfaction in consultant nurse and diabetes
specialist nurse led intermediate care clinics.
Method: Retrospective randomised data collected from 52 case
notes (two from each letter of the alphabet) in nine English centres
included HbA1c, total cholesterol and blood pressure (BP) at referral
and 6 months. Statistical significance was calculated using Students
paired t test. A Diabetes UK one-page questionnaire was sent to
participants and assessed number of consultations, input, patient
participation and changes in practice post-intervention. Individuals
self-rated their ability to manage pre- and post-intervention using a
Likert scale.
Results: The cohort was 424 subjects, mean age 59, 52 per cent men
(n = 219). The average number of appointments was 3.8, median 3.
HbA1c reduced by a mean of 1.14 per cent (9.53 vs. 8.39, P < 0.0001;
n = 381). Total cholesterol reduced by a mean of 6.84 per cent (4.53 vs.
4.22 mmol/l, P < 0.0001; n = 269); systolic BP, mean 136.63 vs.
135.49mm Hg, P = 0.3547; diastolic BP, mean 78.71 vs. 78.27mm Hg,
P = 0.5773 (n = 269). Patient satisfaction questionnaires returned
(n = 123, 29 per cent) showed that 88 per cent were very satisfied that
concerns were met, 97 per cent (n = 115) felt included in consultations,
and 80 per cent made positive changes. A three-point rise was seen in the
Likert scale and average self-rating doubled in patients perceived ability
to self-manage post-intervention.
Conclusion: Patients achieved significant positive clinical outcomes in
Hba1c and cholesterol reduction in the direction of NICE targets.
Feedback showed high patient satisfaction and increased confidence in
ability self-manage.
P193
Quality improvement from a nurse led
intermediate care diabetes service in a
multi-ethnic population: implementation
and evaluation one year on
J James, J Fairfield, J Spiers, J Ferns, O Sudar, M Trown,
M Roshan, S Jackson and R Gregory
Department of Diabetes and Endocrinology, University Hospitals of Leicester,
NHS Trust Leicester, UK
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Clinical care and other categories posters: diet, lifestyle, obesity and inflammation
P194
Diabetes specialist nurse calling: an audit of
diabetes specialist nurse workload
generated by patient phone contacts
K Leong1, P Joseph1, I Fenna1 and KS Leong1,2
1
Diabetes Department, Clatterbridge Hospital, Wirral, UK, 2Diabetes
Department, Arrowe Park Hospital, Wirral, UK
P196
Effect of Mediterranean diet on fasting
glucose compared with other dietary
interventions: a network meta-analysis
1
Magnetic Resonance Centre, Newcastle University, Newcastle-Upon-Tyne,
UK, 2Metabolic Medicine Unit, Sunderland Royal Hospital, Sunderland, UK,
3
Department of Surgery, Sunderland Royal Hospital, Sunderland, UK
90
Clinical care and other categories posters: diet, lifestyle, obesity and inflammation
Results: Ten studies met the inclusion criteria, nine examined fasting
glucose levels (n = 1399), seven fasting insulin levels (n = 1362) and
four HbA1c levels (n = 516). Length of follow-up had no significant
effect on relative effectiveness of interventions. None of the
interventions were significantly better than the others in lowering
fasting glucose, fasting insulin or HbA1c. Compared to a healthy diet
with advice, a Palaeolithic diet with advice reduced fasting blood
glucose (FBG) by about 0.73 mmol/l (95%CI: )1.572 to 0.07), yet low
fat diet with advice increased FBG by 0.43 mmol l (95%CI: )0.21 to
1.10), MD with advice by 0.05 mmol l (95%CI: )0.35 to 0.46) and
MD only by 0.10 mmol l (95%CI: )0.39 to 0.59). Similar trends were
obtained for fasting insulin and HbA1c levels. Results for HbA1c levels
were largely imprecise because fewer studies reported on this outcome.
Overall, a Palaeolithic diet with Advice had an 96% probability of
being the best intervention for improving fasting blood glucose levels.
P197
The incidence of undiagnosed prediabetes
in the population requesting bariatric
surgery
LL Chuah, S Jackson and C Le Roux
Imperial Weight Centre, Imperial College Healthcare NHS Trust, London, UK
Aim: In some areas of the UK, funding for bariatric surgery is restricted
to morbidly obese patients with comorbidities such as diabetes. We
aimed to test for the presence of undiagnosed diabetes or prediabetes in
patients referred for bariatric surgery with no known diabetes, who
would otherwise be denied bariatric surgery.
Methods: Twenty-eight patients who were not known to have
diabetes had an HbA1c and oral glucose tolerance test (OGTT).
ADA criteria for diagnosis of diabetes [HbA1c 6.5 per cent, fasting
blood glucose (FBG) 7 mmol/l, 2 h OGTT 11.1 mmol/l] and
prediabetes (HbA1c 5.76.4 per cent, FBG 5.66.9 mmol/l, 2 h OGTT
7.811.0 mmol/l) were used.
Results: The group of 28 patients (10 male) were 44.5 2.3 years old
with a mean body mass index of 44.5 1.4 kg/m2. Of these, 18
patients (64 per cent) had prediabetes and four patients (14 per cent)
had diabetes. In the prediabetes cohort, six patients were diagnosed on
one positive parameter, nine patients were diagnosed on two
parameters being positive, and three patients had all parameters
positive (FBG, 2 h OGTT and HbA1c). In the diabetes cohort, three
patients were diagnosed on one positive parameter whereas one was
diagnosed on two parameters (FBG +HbA1c).
Conclusion: A total of 78 per cent of our morbidly obese population
has undiagnosed prediabetes and diabetes. The number needed to treat
to prevent diabetes after bariatric surgery is two. Given the preventative
benefit of bariatric surgery, we would suggest that all patients referred
for bariatric surgery should be screened for prediabetes. More studies
are required to convince commissioners of the beneficial effect of
bariatric surgery for patients with prediabetes.
DIABETICMedicine
P198
Results of bariatric surgery and
conservative management in all subjects
referred to South Devon Healthcare obesity
service, 2006 to 2011
K Williams1, E Potter1, F Robertson2, R Dyer3 and RB Paisey3
1
Nutrition and Dietetics, South Devon Healthcare, Torquay, UK, 2Year 13,
Ivybridge College, Ivybridge, UK, 3Diabetes and Endocrinology, South Devon
Healthcare, Torquay, UK
P199
The effect of weight change on glycated
albumin concentrations following bariatric
surgery in obese Type 2 diabetes patients
MM Aye1, JM Ng1, N Lewis2, J Varghese3, H Kahal1, J Konya1,
SL Atkin1 and ES Kilpatrick2
1
Department of Diabetes, Endocrinology and Metabolism, University of Hull,
Kingston-upon-Hull, UK, 2Department of Biochemistry and Blood Sciences,
Hull and East Yorkshire Hospital NHS Trust, Kingston-upon-Hull, UK,
3
Department of Diabetes, Endocrinology and Metabolism, Hull and East
Yorkshire Hospital NHS Trust, Kingston-upon-Hull, UK
91
DIABETICMedicine
Clinical care and other categories posters: early detection and prevention
P200
Diabetes as a screening tool in referral for
bariatric surgery?
C Prener, LL Chuah and C Le Roux
Imperial Weight Centre, Imperial College Healthcare NHS Trust, London, UK
Study has suggested that bariatric surgery has the highest mortality
benefit in patients with raised fasting insulin levels. We therefore aimed
to assess (1) any positive association between BMI > 50 kg/m2 and
comorbidities; (2) the impact on other comorbidities if diabetes is used
as the only referral criterion.
Methods: Seventy-eight patients were scored using the modified
Kings Obesity Staging Criteria, which assessed airways, BMI,
cardiovascular, diabetes, gonadal, health status and body image.
Each domain was classified as 0 (normal health), 1 (at risk), 2
(established disease) or 3 (advanced disease).
Results: Of 78 patients, 54 had BMI > 50 kg/m2 (mean BMI
56.0 0.9) and 24 had BMI 50 kg/m2 (mean BMI 46.0 0.9).
No significant differences were found between these two groups in
airways (1.5 0.1 vs. 1.3 0.1), cardiovascular (1.1 0.1 vs.
1.3 0.2), diabetes (1.3 0.1 vs. 1.3 0.1) or gonadal (0.8 0.1
vs. 0.8 0.3). The only significant difference was in body image, with
BMI 50 kg/m2 having a higher score (2.0 0.2 vs. 1.6 0.1,
P = 0.04). There were 38 (48.7 per cent) patients with diabetes (mean
BMI = 53.9 1.2) compared with 40 without (mean BMI =
54.4 1.4). The diabetes cohort had more comorbidities with regard
to airways (1.6 0.1 vs. 1.3 0.1, P = 0.02) and gonadal (1.1 0.2
vs. 0.5 0.1, P = 0.007).
Conclusion: Diabetes rather than BMI would be a better prioritising
criterion for bariatric surgery, because its predictive value for other
comorbidities sensitive to weight loss is higher and the potential
mortality benefit is more pronounced.
P202
Racial disparities in risk of diabetes and
cardiovascular risk in a Southeast Asian
population: initial results of the Eastern
Community Health Outreach (ECHO)
programme
RS Shekhawat1, SK Sonu1, F Kwong Ming2, J Khoo1 and B Ng1
1
2
92
DIABETICMedicine
P204
A pilot study examining group and 1:1
education for obesity in the primary and
secondary care settings
E Jones1, F Palmer2, K John1, J Nedin1, R Tristham3 and
JW Stephens2,4
1
Department of Dietetics, Morriston Hospital, ABM University Health Board,
Swansea, UK, 2Diabetes Research Group, College of Medicine, Swansea
University, Swansea, UK, 3Clydach Primary Care Centre, ABM University
Health Board, Swansea, UK, 4Department of Diabetes and Endocrinology,
Morriston Hospital, ABM University Health Board, Swansea, UK
P205
Impact of community pharmacy diabetes
monitoring and education programme on
diabetes management: a randomised
controlled study
M Ali1, F Schifano1, P Robinson2, G Phillips3, A Sinclair4 and
S Dhillon1
1
School of Pharmacy, University of Hertfordshire, Hatfield, UK, 2Research,
Merck Sharp and Dohme Ltd, Hoddesdon, UK, 3Manor Pharmacy Group, St
Albans, UK, 4Bedfordshire and Hertfordshire Postgraduate Medical School,
University of Bedfordshire, UK
93
DIABETICMedicine
P206
Successful patient education following the
withdrawal of Mixtard 30 in southern
Derbyshire
J Simpson, L Langeland, J Ortega, W White and R Rea
Diabetes and Endocrinology, Royal Derby Hospital, Derby, UK
P207
First diabetes: a successful integrated
healthcare partnership for diabetes patients
in Derby
R Rea1,2, J Lindsay2,3, S Gregory2,3, D Prescott2,4, T Gray2,
A Warren2,3, J Hannah1,2, L Langeland1,2, P Dhindsa1,2 and
G Tan1,2
1
Department of Diabetes and Endocrinology, Royal Derby Hopsital, Derby,
UK, 2First Diabetes, Derby, UK, 3Overdale Medical Practice, Derby, UK,
4
Department of Engagement and Strategy, Royal Derby Hospital, Derby, UK
94
P208
Supporting a new culture of innovative
collaboration for diabetes services redesign
through a bespoke professional education
programme for primary care practitioners
PW Holdich1, M Freeman2, W Gillibrand1, V Newton1 and
J Oldroyd2
1
2
P209
Implementing ThinkGlucose in practice:
evaluation of ward based diabetes
education for nurses
LC Kelly
Department of Diabetes, Hinchingbrooke Hospital NHS Trust, Huntingdon,
UK
Aim: The staff survey aimed to identify gaps in knowledge and areas
for training, to provide appropriate, streamlined education and to
reduce potential harm, while improving the patient experience.
Method: The diabetes ward was selected to pilot a pre-ThinkGlucose
survey and trial an education package. A questionnaire consisting of 12
questions was developed in relation to diabetes treatment and
management. Some questions were open in order not to lead the
responses. Responses were assessed against strict criteria for consistent
interpretation. Responders were anonymous. Education sessions were
delivered on the ward for up to 15 min, four times a week for 3 months.
Aide memoires were used to embed teaching.
Results: Findings demonstrated no significant increase in knowledge.
Unqualified staff demonstrated a better understanding of
hypoglycaemia. Open questions suggested that symptoms of blood
glucose imbalance were known but there was confusion concerning
hypoglycaemia and hyperglycaemia. Treatment answers mostly related
to moderate and severe hypoglycaemia rather than mild
hypoglycaemia. Less willingness to complete the post-questionnaire
than the pre-questionnaire was apparent.
Conclusion: It was disappointing that the ThinkGlucose survey did
not confirm that there had been an increase in knowledge. Alternative
strategies for teaching methods, times and venues need to be considered
for delivering and embedding education to comply with the NHS
Diabetes recommendation that staff are appropriately trained to
deliver safe care to people with diabetes. The value of a pilot exercise
was demonstrated.
P210
Ward based, small group teaching on
management of diabetes to new junior
doctors
NMW De Alwis, R Wright, J Wier, K Dukhan and S Wahid
South Tyneside District Hospital, Harton Lane, South Shields, UK
DIABETICMedicine
P211
The NHS Diabetes safe use of insulin
e-learning course: is it making a difference
for healthcare professionals in the UK?
G Eyres1, LJ Richards1, A Morton1, H Wilkinson1, J James2 and
G Sweeney1
1
95
DIABETICMedicine
P212
Inpatient diabetes: a novel APPortunity
M Patel1 and S Gupta2
1
Diabetes, Southampton General Hospital, Southampton, UK, 2General
Intensive Care, Southampton General Hospital, Southampton, UK
P213
The Ipswich Touch Test and Foot of the Bed
form identify inpatients at risk of hospital
acquired foot ulceration
C Kerry, PRJ Vas, AC Scott, N Baker, D Fowler and G Rayman
Ipswich Diabetes and Endocrinology Centre, Ipswich Hospital NHS Trust,
Ipswich, UK
96
P214
See one, do one, teach one: perhaps not
when it comes to diabetes care
PL Wong1, J Murray2, A Jones2 and R Nayar1
1
Department of Diabetes and Endocrinology, City Hospitals Sunderland NHS
Foundation Trust, Sunderland, UK, 2Department of Medicine, University of
Newcastle, Newcastle-Upon-Tyne, UK
P215
Insulin safety programme at the Royal
Surrey County Hospital
C Pengilley, H Hopkins, B Tuthill, V Watts and D Russell-Jones
Cedar Centre, Royal Surrey County Hospital, Guildford, UK
P216
Self-assessed confidence in qualified wardbased nurses managing diabetes care
within the hospital environment: audit
results before and after attendance at a
formal education programme
DIABETICMedicine
P217
Understanding and knowledge towards
current UK driving advice in patients with
diabetes treated with insulin
DS Bohania1, A Mulla1 and J Shakher2
1
P218
Diabetes self-management strategies after
DAFNE structured education
P Mansell1, L Grant2, D Cooke2, R Rea3, C Taylor4, J Speight5
and S Heller6
1
Department of Diabetes and Endocrinology, Nottingham University Hospitals
NHS Trust, Nottingham, UK, 2Department of Epidemiology and Public Health,
University College, London, UK, 3Department of Diabetes and Endocrinology,
Derby Hospitals NHSFT, Derby, UK, 4Department of Diabetes and
Endocrinology, Sheffield Teaching Hospitals NHSFT, Sheffield, UK, 5School of
Psychology, Deakin University, Melbourne, Australia, 6School of Medicine and
Biomedical Sciences, University of Sheffield, Sheffield, UK
P219
Effectiveness of lifestyle education for
reducing diabetes and cardiovascular risk in
people with metabolic syndrome
AJ Dunkley1, MJ Davies2, MA Stone1, NA Taub1, J Troughton3,
T Yates2 and K Khunti1
1
P220
Alcohol and diabetes: what is the patients
perspective?
G Morrison1, T Coleman2, CL Morrison3, TS Purewal1 and
PJ Weston1
1
Diabetes Centre, Royal Liverpool University Hospital, Liverpool, UK, 2School
of Medicine, University of Liverpool, Liverpool, UK, 3Pendyffryn Medical
Group, Prestatyn, UK
97
DIABETICMedicine
P225
P221
X-PERT Diabetes structured education
improves health and cuts costs
TA Deakin, CA Finch and SR Seed
Structured Education, X-PERT Health, Hebden Bridge, UK
P222
Improving the outcomes of pump therapy
E Jenkins, J Knott, J Ryder, M Weiss, C Shaban, J Charman,
D Kerr and D Cavan
Bournemouth Diabetes and Endocrine Centre (BDEC), Royal Bournemouth
Hospital, Bournemouth, UK
P223
Does duration of Type 1 diabetes affect the
outcomes of structured education?
1
1
Academic Unit of Diabetes, Endocrinology and Metabolism, University of
Sheffield, Sheffield, UK, 2Department of Diabetes and Endocrinology, Victoria
Infirmary, Glasgow, UK, 3Department of Diabetes and Endocrinology,
Nottingham University Hospitals, Nottingham, UK
P224
Can online structured education for people
with Type 1 diabetes improve glycaemic
control and quality of life?
SL Fearnley1,2, M Joyce2, C Jairam2, N Oliver2 and A Dornhorst2
1
Department of Nutrition and Dietetics, Imperial College Healthcare NHS
Trust, London, UK, 2Department of Diabetes, Imperial College Healthcare
NHS Trust, London, UK
P226
The Ipswich Touch Test (IpTT): screening for
diabetic neuropathy at home
S Sharma, C Kerry, J Rosier, H Atkins and G Rayman
Diabetes Research Unit, Ipswich Hospital NHS Trust, Ipswich, UK
P227
My diabetes My Way: empowering people
with diabetes through electronic record
access
SG Cunningham1, M Brillante2, RR McAlpine1, D Wake3,
A Waller4, J Walker5, A Emslie-Smith6 and A Morris3
1
Clinical Technology Centre, University of Dundee, Dundee, UK, 2Health
Informatics Centre, University of Dundee, Dundee, UK, 3Clinical Research
Centre, University of Dundee, Dundee, UK, 4School of Computing, University
of Dundee, Dundee, UK, 5St Johns Hospital, Livingston, UK, 6Tayside
Diabetes Managed Clinical Network, Dundee, UK
P228
A 12-year audit of BERTIE: successful
outcomes for at least 5 years
J Knott, J Ryder, E Jenkins, J Charman, C Shaban, C Cross,
M Weiss and D Cavan
Bournemouth Diabetes and Endocrine Centre (BDEC), Royal Bournemouth
Hospital, Bournemouth, UK
98
P229
Developing a computer-based selfmanagement programme for people with
Type 2 diabetes: user perspectives
E Gubert, K Pal, C Dack and E Murray
Department of Primary Care and Population Health, University College
London, London, UK
P230
Who still follows DAFNE and can baseline
characteristics help us to understand the
extent to which people continue to follow
DAFNE principles?
D Cooke2, C McWhinnie1 and L Kamps1
1
Department of Diabetes and Endocrinology, University College London
Hospitals, London, UK, 2Department of Epidemiology and Public Health,
University College London, London, UK
DIABETICMedicine
respondents were still dose adjusting. About 31 per cent no longer kept a
DAFNE diary mainly due to lack of time. Those with longer diabetes
duration were more likely to fill in their DAFNE diary (t = 2.1, df = 67,
P = 0.04). Those with higher baseline HbA1c values were less likely to
report adjusting long-acting insulin (t = 2.0, df = 68, P = 0.05).
Women were significantly more likely to still use a DAFNE diary
(chi-squared 5.2, P = 0.023).
Conclusions: Whilst this is only a small-scale survey, it suggests that
dose adjustment, recording and responding to blood glucose are the
behaviours for which people need help and support in incorporating
into their day-to-day diabetes management.
P231
A diet of 140 characters: the role of Twitter
networks in the diabetes information
horizon
EM Cerri, AR Fisher and S Taheri
Collaborations for Leadership in Applied Health Research and Care (CLAHRC),
University of Birmingham, Birmingham, UK
P232
Transforming our insulin pump service
S Kay, C Soar and RCL Page
Diabetes Unit City Campus, Nottingham University Hospitals NHS Trust,
Nottingham, UK
Aim: Frustrated by the traditional clinic setting for pump patients and
finding they had similar concerns and problems, we reorganised the
service.
Method: Our new look service offers each patient an annual one to
one appointment to discuss their aspirations for the following year using
the Year of Care model. In addition 90 min monthly group clinics were
99
DIABETICMedicine
P233
Why should people with Type 1 diabetes
miss out? Establishing Year of Care in the
hospital setting
RCL Page, A Archer and S Kay
Diabetes Unit City Campus, Nottingham University Hospitals NHS Trust,
Nottingham, UK
100
P234
Needle use and disposal in patients with
diabetes
NMW De Alwis, D Basham, A Stewart, J Wier, B Marron and
K Dukhan
Department of Diabetes and Endocrinology, South Tyneside District Hospital,
Harton Lane, South Shields, UK
P235
Development of a behavioural intervention
targeting free-living physical activity in
adults with Type 2 diabetes in primary care:
Movement as Medicine
L Avery1, L Taylor2, M Lievesley2, K Mosely3,6, J Speight3,4,
FF Sniehotta5 and MI Trenell1,7,8
1
Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne,
UK, 2Centre for Design Research, Northumbria University, Newcastle-UponTyne, UK, 3Applied Health Psychology Research, Uxbridge, UK, 4Australian
Centre for Behavioural Research in Diabetes, Deakin University, Melbourne,
Australia, 5Institute of Health and Society, Newcastle University, NewcastleUpon-Tyne, UK, 6Faculty of Arts & Sciences, Australian Catholic University,
Sydney, Australia, 7National Institute for Health Research (NIHR) Biomedical
Research Centre for Ageing, Age-related Disease, Newcastle University,
Newcastle-Upon-Tyne, UK, 8MRC Centre for Brain Ageing, Vitality, Newcastle
University, Newcastle-Upon-Tyne, UK
P236
A systematic review of behaviour change
interventions targeting physical activity,
exercise and HbA1c in adults with Type 2
diabetes
L Avery1,2, D Flynn2,3, A van Wersch4, FF Sniehotta2,3 and
MI Trenell1,5,6
1
Institute of Cellular Medicine, Newcastle University, Newcastle-Upon Tyne,
UK, 2Newcastle Health Psychology Group, Newcastle University, NewcastleUpon Tyne, UK, 3Institute of Health and Society, Newcastle University,
Newcastle-Upon Tyne, UK, 4School of Social Sciences and Law, Teesside
University, Middlesbrough, UK, 5National Institute for Health Research (NIHR)
Biomedical Research Centre for Brain Ageing and Age-related Disease,
Newcastle University, Newcastle-Upon Tyne, UK, 6Medical Research Council
Centre for Brain Ageing and Vitality, Newcastle University, Newcastle-Upon
Tyne, UK
DIABETICMedicine
P237
How to reduce the risk of failing to reach
recruitment targets: lessons learnt from a
pump pilot trial
KD Barnard1, MJ Campbell2, C Emery3, AJ Young1 and
S Heller4
1
Faculty of Medicine, University of Southampton, Southampton, UK, 2School
of Health and Related Research (SCHARR), University of Sheffield, Sheffield,
UK, 3DAFNE National Institute for Health Research (NIHR) Project Office, Royal
Hallamshire Hospital, Sheffield, UK, 4Academic Unit of Diabetes,
Endocrinology and Metabolism, University of Sheffield, Sheffield, UK
P238
Acceptability of lifestyle education for
people with metabolic syndrome: a
qualitative evaluation
AJ Dunkley1, MA Stone1, H Fisher1, MJ Davies2 and K Khunti1
1
101
DIABETICMedicine
P239
Structured education: increasing referrals
and maximising attendance at the X-PERT
programme for people with Type 2 diabetes
S Lucas, CA Winter, N Collett, A Goodchild and J Grummit
Bexley Community Diabetes Team, Bexley Care Trust NHS SE London,
Bexleyheath, UK
102
P240
Cardiovascular risk related to gestational
diabetes and polycystic ovary syndrome:
are women aware?
J Wylie1, J Tomlinson2, J Pinkney2, G Letherby3 and
E Stenhouse4
1
Peninsula Local Diabetes Research Network, Peninsula College of Medicine
and Dentistry, Plymouth, UK, 2University Medicine, Derriford Hospital,
Peninsula College of Medicine and Dentistry, Plymouth, UK, 3School of Social
Science and Social Work, Faculty of Health, Education and Society, Plymouth
University, Plymouth, UK, 4School of Nursing and Midwifery, Faculty of
Health, Education and Society, Plymouth University, Plymouth, UK
P241
Auditing structured education in a national
Type 1 diabetes programme: does it make a
difference?
G Thompson1 and CD Taylor2
1
National DAFNE Programme, Northumbria Healthcare Foundation NHS
Trust, North Shields, UK, 2Diabetes Service, Sheffield Teaching Hospitals NHS
Foundation Trust, Sheffield, UK
Results: Ten centres were audited in both 2007 and 2010, enabling
comparison of results. Due to database redevelopment, three criteria
covering data collection could not be scored in 2010; therefore only 19
items were compared. Mean (SD) scores were green 2007, 8.6 (1.8);
2010, 12.9 (3.1); amber 2007, 6.0 (2.6); 2010, 4.8 (2.1); red 2007, 4.4
(3.1); 2010, 1.3 (1.3). Criteria most commonly scored red in 2007
related to ongoing educator QA: core skills forms (six centres); session
learning outcomes forms (five); development objectives (five); plan for
QA (seven). In 2010 these red scores reduced to core skills (three
centres); learning outcomes (zero); development objectives (three); QA
plan (three).
Conclusions: DAFNE centres that have undergone consecutive audits
demonstrated improvement in meeting structured education standards
recommended by NICE. Fully achieving all standards is a challenge for
busy clinicians and requires local planning and leadership as well as
centralised organisation and administration.
P242
Eat study: exploring the patient experience
of changes in appetite and diet with incretin
analogue therapy in Type 2 diabetes
RM Paisey1, G Letherby2, M Smith2, S Estcort3 and
E Stenhouse2
1
Diabetes Research Department, Torbay Hospital South Devon Healthcare
NHS Foundation Trust, Torquay, UK, 2Faculty of Health, Education and
Society, Plymouth University, Plymouth, UK, 3Diabetes Research Network
Clinical Trials, Royal Devon and Exeter NHS Foundation Trust Hospital,
Exeter, UK
DIABETICMedicine
P243
Resilience and its association with
personality, self-efficacy, self-care,
everyday worries and low moods in Type 2
diabetes patients and a community sample
M Grivnova1 and JW Huber2
1
Life Sciences, Roehampton University, London, UK, 2Centre for Health &
Wellbeing Research, The University of Northampton, Northampton, UK
P244
A rough guide of how youre doing: young
peoples understanding of clinical markers
in Type 1 diabetes
B Johnson1,2, S Brierley1,2, V Young1,2, C Eiser1,2, S Heller1,3,
Diabetes Theme Research Group and CLAHRC South Yorks1
1
Diabetes Theme, National Institute for Health Research (NIHR) CLAHRC for
South Yorkshire, Sheffield, UK, 2Child and Family Research Group,
Department of Psychology, University of Sheffield, Sheffield, UK, 3Academic
Unit of Diabetes, Endocrinology and Metabolism, School of Medicine,
University of Sheffield, Sheffield, UK
103
DIABETICMedicine
P245
Development of the Adolescent Diabetes
Needs Assessment Tool (ADNAT)
H Cooper1, J Spencer1, G Lancaster2, M Johnson3, R Lwin4,
A Titman2, S Wheeler1 and M Didi5
1
104
P246
Development and piloting of a structured
education curriculum for insulin pump
therapy prior to the REPOSE (Relative
Effectiveness of Pumps over MDI with
Structured Education) trial
CD Taylor1, H Rogers2, C Ward3, J Carling4, D Kitchener5 and
L Oliver6
1
Department of Diabetes, Sheffield Teaching Hospitals NHS Foundation Trust,
Sheffield, UK, 2Department of Diabetes, Kings College Hospital NHS
Foundation Trust, London, UK, 3Department of Diabetes, Cambridge
University Hospitals NHS Trust, Cambridge, UK, 4Department of Diabetes,
Harrogate NHS Foundation Trust, Harrogate, UK, 5Department of Diabetes,
University Hospitals of Leicester NHS Trust, Leicester, UK, 6Department of
Diabetes, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
P247
The role of social networks in the South
Asian population with diabetes: an
exploratory study
NR Patel, AP Kennedy, CA Chew-Graham, D Reeves and
C Blickem
Health Sciences and Primary Care Research Group, Greater Manchester
CLAHRC, University of Manchester, Manchester, UK
P248
Evaluation of the NewDEAL education
programme for Type 1 diabetes using
patient stories
K Fraser1, E Sharp2, H Millar1, A Bramley1, AJ Mackenzie1 and
CJ Kelly1
1
DIABETICMedicine
P249
Glycaemic control and weight seven years
after DAFNE structured education in Type 1
diabetes
P Mansell1 and D Gunn2
1
Diabetes and Endocrinology, Nottingham University Hospitals, Nottingham,
UK, 2Medical School, University of Nottingham, Nottingham, UK
P250
A qualitative study to explore how women
with Type 1 diabetes manage their diabetes
during the menopausal transition
L Mackay1, L Kilbride2 and D Horsburgh2
1
Metabolic Unit, Western General Hospital, Edinburgh, UK, 2Faculty of
Health, Life and Social Sciences, Edinburgh Napier University, Edinburgh, UK
105
DIABETICMedicine
P251
Barriers associated with uptake of diabetes
multidisciplinary group education: a survey
of patients view in a PCT in southeast
England
MO Lawal
Faculty of Health, University of West London, London, UK
P252
Successful weight reducers in the
workplace: experiences of men and women
who participated in the Prosiect Sir Gar
lifestyle intervention programme
EM Di Battista1,3, M Williams2, S Rice2, JW Stephens3,
RM Bracken3 and SD Mellalieu3
1
Nutrition and Dietetics Department, Hywel Dda Health Board, Llanelli, UK,
Diabetes Centre, Hywel Dda Health Board, Llanelli, UK, 3College of
Engineering, Swansea University, Swansea, UK
2
106
P253
Do we care about the road safety of people
living with diabetes?
RA Dixon, A Lloyd and M Saeed
Department of Diabetes, University Hospitals Birmingham NHS Foundation
Trust, Birmingham, UK
Aim: Currently there are 2.8 million people in the UK living with
diabetes. Several studies have demonstrated a link between
hypoglycaemia and driving mishaps. The aim of the study was to
assess patient awareness of recently imposed changes to driving
regulations relevant to diabetes.
Methods: A 37-point anonymous structured questionnaire was
distributed amongst 47 registered drivers attending a secondary care
diabetes clinic in Birmingham. Information concerning diabetes
treatment and knowledge of Driver and Vehicle Licensing Agency
(DVLA) regulations, including recognition of hypoglycaemic episodes,
in addition to general precautions regarding hypoglycaemia, was
sought.
Results: Despite finding that 72.3 per cent of participants had received
information concerning DVLA regulations and advised precautions,
the present study showed a surprising lack of awareness of details
important for safe driving. Amongst those surveyed, only 73.3 per cent
were always aware of when they were becoming hypoglycaemic, an
absolute licence stipulation according to DVLA regulations. With
regard to advised precautions, 29.8 per cent of patients were unable to
identify a capillary blood glucose level of 5 mmol/l or greater as a safe
level for driving. Interestingly, only 14.9 per cent of patients understood
the recommendation of a 45min wait after achieving this recommended
safe capillary blood glucose level.
Conclusions: Whilst the majority of people living with diabetes have
received information concerning the driving regulations, there is a
worrying lack of understanding of safe driving practices, indicating that
P254
An exploration of the perceptions and
requirements of using email communication
for people with diabetes and on insulin
therapy requiring specialist nurse care
DIABETICMedicine
P255
The educational value of childrens support
holidays organised by Diabetes UK
MD Sinczak1 and MA Saeed2
1
P256
The educational value of childrens support
holidays organised by Diabetes UK:
volunteers perspective
MD Sinczak1 and MA Saeed2
1
P257
The relationship between diabetes self-care,
psychological adjustment, social support
and glycaemic control in the Lebanese
population with Type 2 diabetes
O Sukkarieh-Haraty1, E Howard2, R Nemr3 and M Nasrallah4
1
107
DIABETICMedicine
P258
Diabetes awareness among patients with
diabetes at West Middlesex University
Hospital NHS Trust
A Falinska, C Lim, P Rihal, C Gunpot, K Ahmed and R Kaushal
Diabetes, West Middlesex University Hospital, London, UK
108
P259
Implementation of a Type 2 diabetes
prevention pathway within routine primary
care
T Yates1, S Rogers2, B Stribling3, S Hyatt4, M Davies4 and
MJ Davies4
1
Cardiovascular Sciences, University of Leicester, Leicester, UK, 2Consultant in
Public Health, NHS Northamptonshire, Northampton, UK, 3DESMOND
National Office, University Hospitals of Leicester NHS Trust, Leicester, UK,
4
Nene Commissioning, Northampton, UK
P260
Proactive education of inpatients with
diabetes and healthcare professionals
works
AP Brooks, J Chong, K Haynes, S Nero and A Norris
Specialist Diabetes Care Inpatient Team, Royal Hampshire County Hospital,
Winchester, UK
P261
Hypoglycaemia and driving: assessing the
knowledge of our patients with Type 1 and
insulin treated Type 2 diabetes
MJ Boyd1, D Holton1 and AW Patrick1,2
1
2
DIABETICMedicine
P262
Integrating SweetText, a mobile phone
behavioural support programme for young
people with Type 1 diabetes, into clinical
service in Kuwait and Scotland
A Greene1, A Shaltout2, V Alexander1, M Brillante3,
SG Cunningham4, E Fairley2, N Halawa2, D AlHuwail2,
D Wake5, RR McAlpine4 and SA Greene1
1
Child Health, University of Dundee, Dundee, UK, 2KSeHIN, Dasman Diabetes
Institute, Kuwait, 3Health Informatics Centre, University of Dundee, Dundee,
UK, 4Clinical Technology Centre, University of Dundee, Dundee, UK, 5Clinical
Research Centre, University of Dundee, Dundee, UK
P263
Involving end-users in the development of a
pre-consultation information booklet for
people with Type 2 diabetes attending an
outpatient review appointment: a
qualitative study
M ODonnell1, B McGuire2 and SF Dinneen1,3
1
Department of Medicine, National University of Ireland Galway, Galway,
Ireland, 2School of Psychology, National University of Ireland Galway, Galway,
Ireland, 3Diabetes Day Centre, University Hospitals Galway, Galway, Ireland
109
DIABETICMedicine
P264
Patients practice and knowledge of
diabetic foot care in a regional care setting
PS Yap1, N Barclay2, K Spence2 and WA Watson1,2
1
Division of Medical and Dental Education, University of Aberdeen,
Aberdeen, UK, 2Diabetes Centre, NHS Grampian, Aberdeen, UK
110
P265
Accuracy of nutritional scales used for
carbohydrate counting and insulin dose
adjusting
NR McConnell
Nutrition and Dietetic Department, Bradford Teaching Hospitals NHS
Foundation Trust, Bradford, UK
P266
Having a visual reference, Carbs and Cals,
makes insulin pump users carbohydrate
estimates more accurate
NR McConnell
Dietetic Department, Bradford Teaching Hospitals NHS Foundation Trust,
Bradford, UK
P267
Carbohydrate counting and insulin
adjustment group sessions for patients with
Type 2 diabetes on a multiple insulin
injection regime
E Adams and S Hood
Diabetes Centre, Dorset County Hospital, Dorchester, UK
P268
The cost-effectiveness of providing DAFNE
to subgroups of predicted responders
J Kruger1, A Brennan1, P Thokala1 and S Heller2
1
2
DIABETICMedicine
P269
Evaluating the effectiveness of two
diabetes education programmes (DESMOND
vs. Conversation Map) for newly diagnosed
Type 2 diabetes patients at NHS Bromley
S Emmambux1 and JW Huber2
1
Life Sciences, Roehampton University, London, UK, 2Centre for Health &
Wellbeing Research, The University of Northampton, Northampton, UK
P270
The cost-effectiveness of providing a DAFNE
follow-up intervention to predicted nonresponders
J Kruger1, A Brennan1, P Thokala1 and S Heller2
1
2
111
DIABETICMedicine
P271
A single session of structured education for
newly diagnosed individuals with Type 2
diabetes enhances confidence in engaging
group education and ability to self-manage
G Nasteva1, E Jennings2, P Greene2, J Harvey3 and D Mellor1
1
Clinical Sciences, University of Chester, Chester, UK, 2Nutrition and Dietetics,
Betsi Cadwaladr University Health Board, Wrexham, UK, 3Diabetes and
Endocrinology, Betsi Cadwaladr University Health Board, Wrexham, UK
112
P272
Prevention in practice: diabetes
N Kanumilli and N Milne
General Practice, Northenden Group Practice, Manchester, UK
P273
Providing patients access to their online
electronic patient records: an evaluation of
usage and usefulness
F Mukoro, G Sweeney and B Mathews
Research and Evaluation, NHS Kidney Care, London, UK
P274
Evaluation of initial structured group
education in newly diagnosed Type 2
diabetes
E Jennings1, P Greene1, G Nasteva2, D Mellor2, P Cowley1 and J
Harvey3
1
Nutrition and Dietetic Department, Betsi Cadwaladr University Health Board,
Wrexham, UK, 2Department of Clinical Sciences, University of Chester,
Chester, UK, 3Diabetes, Endocrinology and Metabolism, Cardiff University,
Cardiff, UK
P275
Delivery of the Berger Accu Chek education
programme for patients with Type 1
diabetes: time well spent? A clinical audit
F Hegarty, A Griffin and A Gavaghan
Diabetes Team, Letterkenny General Hospital, Letterkenny, Ireland
DIABETICMedicine
P276
An interpretative phenomenological
analysis of womens experience of living
with diabetes
JR Smith
Health and Social Care, Open University, Milton Keynes, UK
P277
Applying a cognitive behavioural model to a
diabetes self-management education
programme
Y Doherty1, H Daly1, L Martin Stacey1, C Taylor1, J Troughton1
and S Cradock2
1
Diabetes Research Group, University Hospitals of Leicester NHS Trust,
Leicester, UK, 2Department of Health Sciences, University of Leicester,
Leicester, UK
113
DIABETICMedicine
P278
Early changes in glycated haemoglobin
(HbA1c) can be used to predict glycaemic
outcomes at 1 year following the Dose
Adjustment for Normal Eating (DAFNE)
course
C Cheyette and A Beckwith
Diabetes, Kings College Hospital, London, UK
114
P279
Diabetes Improvement through Mentoring
and Peer-led Education (DIMPLE)
C Mead1, P Gilbert2, S Husbands3, J OBrien5, R Matthews4 and
DIMPLE Project Group6
1
Public Health, NHS Hammersmith and Fulham, London, UK, 2Hammersmith
and Fulham Diabetes User Group, London, UK, 3Public Health, NHS Harrow,
London, UK, 4Patient and Public Involvement, National Institute for Health
Research (NIHR) CLAHRC for Northwest London, London, UK, 5Equality and
Diversity Team, Diabetes UK, London, UK, 6NHS North West London, London,
UK
P280
Primary to secondary school transition for
children living with Type 1 diabetes
ME Wasserfall1, B Widmer2, P Jackson3, J Cropper4 and C
Harbutt5
1
Nutrition and Dietetics, Evelina Childrens Hospital, Kings College NHS
Foundation Trust, London, UK, 2General Paediatrics, Evelina Childrens
Hospital, Kings College NHS Foundation Trust, London, UK, 3Nutrition and
Dietetics, Guys and St Thomas NHS Foundation Trust, London, UK,
4
Childrens Psychological Medicine, Evelina Childrens Hospital, Kings College
NHS Foundation Trust, London, UK, 5General Paediatrics, Kings College NHS
Foundation Trust, London, UK
P281
The impact and outputs from the Year of
Care programme
SH Roberts1,2, S Dilks3, S Eaton1, I Hodkinson4, G Johnson5, N
Lewis-Barned1, L Oliver1, B Turner2 and A Worthington4
1
Diabetes Resource Centre, Northumbria Healthcare NHS Foundation Trust,
North Shields, UK, 2Diabetes UK, London, UK, 3NHS Kirklees and Calderdale,
Huddersfield, UK, 4NHS Tower Hamlets, London, UK, 5NHS Diabetes,
Newcastle-upon-Tyne, UK
DIABETICMedicine
P282
Short-term evaluation of care planning
implementation in primary care
W Malik1, P Hill2 and M Ince3
1
Community Specialist Diabetes Team, Birmingham Community Healthcare
Trust, Birmingham, UK, 2Clinical Health Psychology, Birmingham Community
Healthcare Trust, Birmingham, UK, 3The Hawthorns, GP Surgery, Redhill, UK
115
DIABETICMedicine
P284
A systematic review of cultural barriers
impeding ethnic minority groups from
accessing effective diabetes care services
P Zeh1,2, HK Sandhu1, AM Cannaby2 and JA Sturt1,2
1
Warwick Medical School, University of Warwick, Coventry, UK, 2Research
and Development, University Hospitals Coventry and Warwickshire NHS Trust,
Coventry, UK
116
P285
The provision of culturally competent
diversity interventions to ethnic minority
groups with diabetes: a systematic review
P Zeh1,2, HK Sandhu1, AM Cannaby2 and JA Sturt1,2
1
Warwick Medical School, University of Warwick, Coventry, UK, 2Research
and Development, University Hospitals Coventry and Warwickshire NHS Trust,
Coventry, UK
DIABETICMedicine
P290
Trends in the incidence of lower extremity
amputations in individuals with and
without diabetes over a five year period in
the Republic of Ireland
C Buckley1,2, A OFarrell3, R Cavanagh4, AD Lynch1, D De la
Harpe3, H Johnson3, IJ Perry2, C Bradley1 and M Horgan1
1
P287
Hospital admissions for diabetic foot
disease
P Follett1, R Young2 and N Holman1
1
Diabetes Health Intelligence, Yorkshire and Humber Public Health
Observatory, York, UK, 2Diabetes and Endocrinology, Salford Royal NHS
Foundation Trust, Salford, UK
P288
NICE feet shame about the sores: an audit
of foot inspection of inpatients suffering
with diabetes
R Thomas
Podiatry Department, Morriston Hospital, Swansea, UK
P289
A population-based study of the
relationship between neuropathic pain
severity and important patient-related
health outcomes in diabetic neuropathy:
time to revaluate current clinical practice?
117
DIABETICMedicine
P291
The West of Ireland diabetes foot study:
prevalence of risk factors for diabetic foot
ulceration in Irish general practice
L Kelly1, L Hurley1, AP Garrow2, LG Glynn3, C McIntosh4, P
Gillespie5 and SF Dinneen1,6
1
Diabetes Centre, Galway University Hospitals, Health Service Executive (HSE)
West, Galway, Ireland, 2School of Health Sciences, University of Salford,
Salford, UK, 3Department of General Practice, National University of Ireland
Galway, Galway, Ireland, 4Discipline of Podiatry, School of Health Sciences,
National University of Ireland Galway, Galway, Ireland, 5Irish Centre for Social
Gerontology, School of Business and Economics, National University of
Ireland Galway, Galway, Ireland, 6Department of Medicine, National
University of Ireland Galway, Galway, Ireland
P292
Vascular intervention in diabetic foot ulcer
patients promotes healing and prevents
amputation only when performed early
after presentation of ulcer
R Gornall1, R MacCarthy2, J Isaacs3, S Cliff4, I Dimitropoulos5
and RB Paisey5
1
Podiatry, Torbay Care Trust, Torquay, UK, 2Vascular Surgery, South Devon
Healthcare NHS Foundation Trust, Torquay, UK, 3Radiology, South Devon
Healthcare NHS Foundation Trust, Torquay, UK, 4Nuffield Studentship, South
Devon Healthcare NHS Foundation Trust, Torquay, UK, 5Medicine, South
Devon Healthcare NHS Foundation Trust, Torquay, UK
118
critical. Our aim was to audit the effectiveness of lower limb angioplasty
and bypass grafting in ulcer healing and prevention of amputation and
death in diabetic subjects with foot ulceration.
Methods: In total 250 foot ulcers in persons with diabetes were
treated in South Devon Healthcare Trust clinics between August 2009
and July 2011 and their details, interventions and outcomes were
recorded prospectively on a database.
Results: Sixty-three were clinically diagnosed with significant
ischaemia and underwent duplex scanning. Thirty-seven proceeded to
angioplasty and eight to femoral-popliteal bypass grafting. Intervention
within 20 days of ulcer presentation resulted in healing in all 16 cases,
whilst delay beyond this time in 29 subjects was associated with healing
in eight, minor amputation in 11, major amputation in five and death in
five. Fishers exact test showed significant difference in outcome
according to the timing of intervention not explained by differences in
age, gender or renal function. This is in the context of 20 minor
amputations, nine major amputations and 20 deaths in the 187 subjects
without critical lower limb vascular disease.
Conclusions: Foot ulcers complicated by ischaemia in those with
diabetes should be revascularised early to improve outcome.
P293
An analysis of PressureStat measurements
collected during the West of Ireland
Diabetes Foot Study
S Cormican1, L Kelly2, L Hurley2, AP Garrow3, LG Glynn4,
C McIntosh5 and SF Dinneen1,2
1
Department of Medicine, National University of Ireland Galway, Galway,
Ireland, 2Diabetes Centre, Galway University Hospitals, HSE West, Galway,
Ireland, 3School of Health Sciences, University of Salford, Salford, UK,
4
Department of General Practice, National University of Ireland Galway,
Galway, Ireland, 5Discipline of Podiatry,School of Health Sciences, National
University of Ireland Galway, Galway, Ireland
Aim: Elevated plantar pressure (EPP) is a risk factor for diabetic foot
ulceration but is difficult to measure and define clinically. We aimed to
determine the usefulness of PressureStat measurements in diabetic foot
assessments.
Methods: The PressureStat device enables quantification of EPP by
creating a carbon footprint. A total of 530 pairs of PressureStat
measurements were collected during the West of Ireland Diabetes Foot
Study. These inprints were analysed and described according to
presence or absence, site and area of EPP, and foot arch type. Chisquared tests were used to determine correlations between these data
and other risk factors.
Results: Based on the definition used (> 6.5kPa of plantar pressure) 76
per cent of individuals had one or more areas of EPP. The mean number
of EPP sites was three on the right foot and four on the left. In all, 8 per
cent had EPP based on a definition of > 10 sites with pressure > 6.5kPa.
The commonest EPP sites were the first and fifth metatarsal heads (50
per cent and 28 per cent respectively) and the hallux (44 per cent). Pes
cavus, pes planus and neutral feet were present in 6 per cent, 9 per cent
and 80 per cent respectively. Insensitivity to the 10 g monofilament, an
indicator of sensory dysfunction, was commoner among individuals
with vs. without EPP (25 per cent vs. 15 per cent for > 6.5kPa,
p = 0.043; and 48 per cent vs. 21 per cent for EPP at > 10 sites;
p < 0.001). EPP was not associated with abnormal vibration perception
threshold or neuropathy disability score. EPP defined as > 10 sites was
associated with future risk of ulceration (odds ratio 10.4; 95 per cent CI
2.740.6).
Conclusion: We conclude that measurement of EPP adds value to
diabetic foot assessment in a research setting.
P294
The West of Ireland Diabetes Foot Study: the
incremental costs of diabetic foot ulceration
in Ireland
P Gillespie1, L Kelly2, L Hurley2, AP Garrow3, LG Glynn4,
SF Dinneen1,5 and C McIntosh6
1
Irish Centre for Social Gerontology, School of Business and Economics,
National University of Ireland Galway, Galway, Ireland, 2Diabetes Centre,
Galway University Hospitals, Health Service Executive (HSE) West, Galway,
Ireland, 3The School of Health Sciences, University of Salford, Salford, UK,
4
Department of General Practice, National University of Ireland Galway,
Galway, Ireland, 5Department of Medicine, National University of Ireland
Galway, Galway, Ireland, 6Discipline of Podiatry, School of Health Sciences,
National University of Ireland Galway, Galway, Ireland
P295
Do we care about our patients with diabetes
feet? Diabetic foot examination at the
front-door
SN Iqbal1, Z Majid1, A Tiwari2, I Wilson3 and MA Saeed4
1
College of Medical and Dental Sciences, University of Birmingham,
Birmingham, UK, 2Department of Vascular Surgery, University Hospitals
Birmingham NHS Foundation Trust, Birmingham, UK, 3Department of
Podiatry, University Hospitals Birmingham NHS Foundation Trust,
Birmingham, UK, 4Department of Diabetes, University Hospitals Birmingham
NHS Foundation Trust, Birmingham, UK
DIABETICMedicine
P296
The cost of foot care for people with
diabetes in England and the potential for
quality improvement and savings: an
economic analysis
M Kerr1,2
1
2
119
DIABETICMedicine
P297
Improvement in foot examination and
documentation in inpatients with diabetes
following introduction of a foot stamp
A Norris, JSW Li Von Chong, AP Brooks, S Nero, K Haines,
K Lambert, G Mlawa, E Tang, R Goodwin, S Kirby and S Zarif
Diabetes Team, Winchester and Eastleigh Healthcare NHS Trust, Winchester,
UK
P298
Establishing a multidisciplinary diabetes
foot clinic does not ensure attendance nor
reduce amputation rates
JM Mongan1, TO Olateju1, S Tuck2 and D Meeking1
1
Diabetes Centre, Queen Alexandra Hospital, Portsmouth Hospital NHS Trust,
Portsmouth, UK, 2Podiatry, Solent Healthcare, Portsmouth, UK
120
P299
Development of a podiatry led community
foot screening service in North Wales
CL Morrison1, G Morrison2 and S Harmes3
1
Pendyffryn Medical Group, Prestatyn, UK, 2Diabetes Centre, Royal Liverpool
University Hospital, Liverpool, UK, 3Betsi Cadwaladr University Health Board,
Royal Alexandra Hospital, Rhyl, UK
P300
A three year audit from 2007 to 2010 of
community podiatry follow-up of patients
discharged from secondary care
P Solanki1 and KS Leong2
1
Podiatry, Wirral University Teaching Hospital, Wirral, UK, 2Endocrinology,
Wirral University Teaching Hospital, Wirral, UK
Aim: Patients discharged from hospital podiatry clinics are at high risk
of re-ulceration and need regular follow-up by community podiatry. In
P301
A pilot podiatric audit of people with
diabetes receiving haemodialysis
P Solanki1, KS Leong2 and A Crowe3
1
Podiatry, Wirral University Teaching Hospital, Wirral, UK, 2Endocrine, Wirral
University Teaching Hospital, Wirral, UK, 3Nephrology, Wirral University
Teaching Hospital, Wirral, UK
DIABETICMedicine
P302
Impact of a multidisciplinary foot ward
round on inpatients with active foot disease
V Chikthimmah1, R Pickin2, R Cooke3, P Lal3 and S Benbow1
1
Aims: Putting Feet First and NICE guidance highlight the importance
of appropriate inpatient management of the diabetic foot. Therefore we
have determined the impact of an innovative multidisciplinary foot
team (MDFT) ward round set up to provide specialised input to
inpatients with active foot disease and we review adherence to the local
hospital antibiotic policy.
Methods: The MDFT (diabetologist, podiatrist, microbiologist,
pharmacist) initiated a pilot weekly ward round, initially across
medical wards, providing expert opinion on active foot disease
management. Data collected prospectively over 7 months (January
July 2011) were analysed.
Results: Fifty-seven patients (mean age 66.9, range 3291 years; male
to female ratio 37 to 20; Type 1 to Type 2 diabetes 8 to 47; two no
diabetes) were seen on 216 occasions in total. Only 36.8 per cent (21/
57) were on a diabetes ward. Twenty-seven (47.3 per cent) were
primary foot admissions. Fifteen had neuropathic, 21 neuroischaemic
and three ischaemic ulcers (18 miscellaneous foot conditions including
pre-ulcerative lesions). On initial review inappropriate antibiotic
prescriptions were altered/stopped in 30 per cent (10/33) and initiated
in 12 per cent (7/57), and on subsequent reviews dosages were altered/
antibiotics were changed in 31 per cent (12/38). Pressure relief was
organised in 21 per cent (12/57). The MDFT coordinated care with
vascular surgeons, diabetes specialist nurses and radiologists and
advised on appropriate investigations. Two patients died of causes
related to primary foot condition (five other deaths), 9 per cent (5/57)
underwent minor amputations, and for 16 per cent (9/57) the foot
lesions healed by discharge. Forty-two of 44 (95 per cent) had
appropriate follow-up arranged and 10 per cent (6/57) were discharged
to community care. The MDFT contributed significantly to 68 per cent
of patients (39/57).
Conclusion: An MDFT ward round can increase awareness, help
integrate and coordinate care and improve management of foot related
issues. Timely and appropriate provision of antibiotics, off-loading and
effective wound management can contribute to improved outcomes
and also improve patient safety.
P303
Discontinuation of treatment in patients
with painful diabetic peripheral neuropathy
BHT Miller, A Aparnareddy, M Soliman and SM Rajbhandari
Department of Diabetes, Lancashire Teaching Hospitals Trust, Chorley, UK
121
DIABETICMedicine
Results: Mean HbA1c was 8.7 ( 2.5) per cent and the median
follow-up was of 26 weeks duration. Of these, 15 subjects did not need
any treatment apart from reassurance; 40 (31.3 per cent) patients had a
good response and 41 (32.0 per cent) had tolerable pain with treatment;
13 (10.2 per cent) did not respond to treatment. There was no difference
in the response to treatment between males and females (P = NS) or
those above and below 60 years of age (P = NS). Amitriptiline was
prescribed in 71 cases and was continued on 49.3 per cent of these cases.
Pregabalin was prescribed in 61 cases with 37.7 per cent continuing it
and duloxetin was prescribed in 33 cases with 51.5 per cent continuing
it.
Conclusions: Our study shows that two-thirds of patients with PDPN
have satisfactory response to treatment; however, there is a need to try
various medications until a favourable outcome is achieved. The
withdrawal rate of various treatments may be more than 50 per cent
when treating patients with PDPN in real life.
P305
Chronic kidney disease and diabetes:
visiting the NICE guidelines
J Jack, S Williams, A Velusamy, A Crown, A Smith and N
Vaughan
Diabetes and Endocrinology, Brighton and Sussex University Hospitals,
Brighton, UK
P304
Treatment choices for managing
hyperglycaemia in patients with diabetes
and a moderate to severe renal disease
F Palmer1, SL Prior1, DA Jones1, DE Price2 and JW Stephens1,2
1
Diabetes Research Group, Institute of Life Science, Swansea University,
Swansea, UK, 2Department of Diabetes and Endocrinology, Morriston
Hospital, Abertawe Bro Morgannwg (ABM) University Health, Swansea, UK
122
DIABETICMedicine
P307
Management of diabetic ketoacidosis
improves with implementation of care
pathway
RM Manikandan, J Abel, R Verdaguer, R Rajendran and
MG Masding
Department of Diabetes and Endocrinology, Poole Hospital NHS Foundation
Trust, Poole, UK
between January and July 2009 (n = 28) prior to the introduction of the
CP.
Results: In both years, the majority of admissions were through the
emergency department 20/28 in 2009 and 20/26 in 201011. After
implementing the CP, hospital stay was reduced from a median of
4.0 days (range 247) to 2.9 days (range 188; P = 0.05). The duration
of intravenous insulin fell from a median of 26 h (range 876 h) to
17.5 h (range 442 h; P < 0.04). The numbers of patients reviewed by
the diabetes team increased from 18/28 seen in 2009 to 22/26 in 2010.
Continuation of long-acting insulin analogues went up from 13/20 to
13/17. However, 7/26 patients developed hypoglycaemia on the CP
fixed insulin infusion regime.
Conclusions: The implementation of a CP for DKA management,
with introduction of bedside capillary ketones measurement and fixed
rate insulin infusion, was associated with a reduction in length of stay
and less time on intravenous insulin. We believe that DKA management
has markedly improved in our Trust with these changes.
P308
Engaging in a new culture of innovative
collaboration for diabetes services redesign
MS Freeman1, W Gillibrand2, V Newton2, PW Holdich2 and
J Oldroyd1
1
Long Term Conditions, NHS Kirklees, Huddersfield, UK, 2Division of Podiatry &
Clinical Sciences, School of Human & Health Sciences, University of
Huddersfield, Huddersfield, UK
123
DIABETICMedicine
P309
Annual audits and a diabetes practice
development team: improving diabetes care
and outcomes for patients in general
practice
A Goodchild, K Ellard, S Berg and H Brenchely-King
Community Diabetes Team, Bexley Care Trust, Bexleyheath, UK
Aim: According to Healthcare for London [1] most essential care and
some enhanced services should take place in GP practices. Our aim was
to determine if annual performance monitoring and assessment would
raise the standard of diabetes care in GP practices and establish their
training needs.
Method: The Diabetes Practice Development Team (DPDT),
established in 2009, comprises a GP with special interest, diabetes
specialist nurse and patient representative. Their role was to visit all 28
practices following the DPDT designed annual diabetes audit. They
then supported practices to develop diabetes service management plans
depending on audit results, training needs, quality of registers and
patient survey results and to agree their tier status according to
Healthcare for London.
Results: All practices were audited and 97 per cent were visited
annually. Twenty-seven practices now have accurate diabetes,
prediabetes and gestation registers. Twenty-five teams are trained to
deliver a care planning approach (Year of Care); 356 healthcare
professionals attended training courses; referral to X-PERT structured
education increased from 80 to 742 to 1,659 each year. 91 per cent of
patients were happy with the diabetes care received at their practice.
Bexley has achieved the highest DM23 QOF outcome in London at 61
per cent (HbA1c less than 7 per cent). Eighty insulin starts have been
achieved in Tier 2 practices. A phone survey of practice teams found the
DPDT helped focus attention and improve competence and confidence
in diabetes management.
Conclusion: Ongoing assessment and review by a dedicated team
(including patients) is improving general practice standards and has
enabled an understanding of practices needs.
Reference:
[1] Healthcare for London: Diabetes Guide for London. (Dr Steve
Thomas led the working group, 2008).
P310
Evaluation of a community-based diabetic
retinopathy screening initiative
J Alade1, S McHugh1, C Buckley1,2,3, K Murphy3, S Doherty3,
G OKeeffe3, E Keane3, M James3, C Coughlan3, J Traynor3,
IJ Perry1, D Quinlan2,3 and M Horgan2
1
Department of Epidemiology and Public Health, University College Cork,
Cork, Ireland, 2Diabetes in General Practice (DiGP) Ltd, University College
Cork, Cork, Ireland, 3Retinopathy Subgroup, Diabetes Services
Implementation Group (DSIG), Health Service Executive (HSE) South, Ireland
124
P311
Cost-effective analysis of U-500 compared
with U-100 insulin among obese patients
with Type 2 diabetes with suboptimal
glucose control: retrospective observational
study of routine clinical care
R Jacob1, P Thomson2, K Ward2, E Higgins2 and I Idris2,3
1
Trent Research Design Services for East Midlands, University of Nottingham,
Nottingham, UK, 2Diabetes and Endocrinology, Sherwood Forest Hospitals
Foundation Trust, Nottinghamshire, UK, 3School of Graduate Entry Medicine,
University of Nottingham, Nottingham, UK
P312
Patient and staff experiences of the East
Cambs and Fenland diabetes integrated care
initiative: a qualitative longitudinal study
E Harwood1, S Cohn2 and D Simmons1
1
Institute of Metabolic Science, Cambridge University Hospitals NHS
Foundation Trust, Cambridge, UK, 2General Practice and Primary Care
Research Unit, Institute of Public Health, Cambridge University, Cambridge,
UK
P313
Optimal interval and cost-effectiveness of
coeliac disease screening for patients with
Type 1 diabetes
WS Wong, C Goddard, H Gillett, J Walker and K Adamson
Diabetes Department, St Johns Hospital, Livingston, UK
Aim: This study aims to find out the optimal screening interval for
coeliac disease (CD) among patients with Type 1 diabetes and to
examine the cost-effectiveness of such screening programme.
Methods: CD screening was initially carried out at the Royal
Infirmary of Edinburgh (RIE) and St Johns Hospital (SJH) in 1996
and 2005 respectively. A total of 218 RIE patients were screened again
in 2005 while 867 SJH patients were screened in 2010. Antitransglutaminase antibodies (anti-TTG) level was measured in all
patients and patients with raised anti-TTG were referred to
gastroenterology for diagnostic intestinal biopsy.
DIABETICMedicine
P314
A review of emergency calls to NHS
ambulance services in England from people
with diabetes suffering a hypoglycaemic
event
M Bailey1, S Mortley1 and AR Scott2
1
Clinical Audit and Research Department, East of England Ambulance Service
NHS Trust, Norwich, UK, 2Diabetes, Sheffield Teaching Hospitals, Sheffield,
UK
NICE Quality Standard 13 for adults with diabetes states that: People
with diabetes who have experienced hypoglycaemia requiring medical
attention should be referred to a specialist diabetes team. Previous
studies of ambulance call-outs to people with hypoglycaemia have been
generally confined to single localities or regions. All NHS ambulance
services in England participate in the benchmarking of a set of national
clinical performance indicators (NCPIs), one topic of which is
hypoglycaemia. The NCPI requires detailed information on all cases
occurring during the sample month OR a maximum of 300 cases.
Where this maximum is exceeded the Trusts are asked to indicate the
total number reported. All 12 ambulance authorities submitted data
collected during February 2010 (cycle 4) and August 2010 (cycle 5).
Detailed information was supplied on 2904 call-outs for
hypoglycaemia, with an additional 925 calls noted during that
period. In August 2010 the reported number was 2828.
Extrapolating these figures for a year gives 45,948 cases of
hypoglycaemia using the 999 system. Only 35.4 per cent (range 26.5
57.9 per cent) of patients were transported to hospital. Direct referral
was made to an appropriate health professional in 068.2 per cent of
999 calls for hypoglycaemia. It is not known how many ambulance
authorities have referral pathways to specialist diabetes services but
these data suggest that these are not widespread and that the burden of
hypoglycaemia is considerable. Discussions are under way at a national
level to ensure that the appropriate pathways of care exist between
ambulance services and specialist diabetes services to ensure better care
for people with diabetes.
125
DIABETICMedicine
P315
Birth to designation: a safe
multidisciplinary bariatric service
G Jackson-Koku1, T OConnor1, L Halder1, J Abraham1,
N Reddy1,2, T Barber1,2, I Fraser1, V Menon1, MK Piya1,2 and
S Kumar1,2
1
2
P316
Use of analogue insulin in patients with
Type 2 diabetes: an unnecessary expense for
the NHS
M Shepherd1,2, BM Shields1, B Knight1,2, TJ McDonald1,3 and
AT Hattersley1,2
1
Peninsula National Institute for Health Research (NIHR) Clinical Research
Facility, Peninsula College of Medicine and Dentistry, University of Exeter,
Exeter, UK, 2Research and Development, Royal Devon and Exeter NHS
Foundation Trust, Exeter, UK, 3Clinical Chemistry, Royal Devon and Exeter
NHS Foundation Trust, Exeter, UK
126
P317
Prevalence and management of diabetes in
people with learning disabilities
LG Taggart
School of Nursing, University of Ulster, Coleraine, UK
P318
Impact of the 2010 Diabetic Ketoacidosis
(DKA) Guidelines (based on the 2010 Joint
British Diabetes Societies Inpatient Care
Group Standards of Care) and IV Insulin and
Fluid Prescription Chart on DKA
management at University Hospitals Bristol
NHS Foundation Trust
A Thomson-Moore, A Low, J Williams, K Bradley and
N Thorogood
Diabetes and Endocrinology, University Hospitals Bristol NHS Foundation
Trust, Bristol, UK
P319
Transcribing errors in insulin prescriptions:
are our patients in safe hands?
HJ Roderick1 and MA Saeed2
1
School of Medical and Dental Sciences, University of Birmingham,
Birmingham, UK, 2Department of Diabetes, University Hospitals Birmingham
NHS Foundation Trust, Birmingham, UK
DIABETICMedicine
P320
Introduction of a hyperglycaemia
management pathway safely reduces
hospital admissions
R Herring, C Pengilley, H Hopkins, B Tuthill and S Davidson
Centre for Endocrinology, Diabetes and Research, Royal Surrey County
Hospital, Guildford, UK
127
DIABETICMedicine
P324
Factitious hypoglycaemia: diagnostic
pitfalls
S Kalathil1, C Napier1, S Pattman2, K Abouglila3 and RA James4
1
P323
Hypoglycaemia and accident risk in people
with Type 2 diabetes treated with
antidiabetes drugs without insulin
J Signorovitch1, D Macaulay2, M Diener2, EQ Wu1,
JB Gruenberger3 and BM Frier4
1
Health Care Practice, Analysis Group Inc., Boston, MA, USA, 2Health Care
Practice, Analysis Group Inc., New York, NY, USA, 3HE&OR Global CVM,
Novartis Pharmaceuticals Corporation, Basel, Switzerland, 4Department of
Diabetes, Royal Infirmary, Edinburgh, UK
P325
Increasing hospital attendances with
hypoglycaemia (from 2006 to 2011)
N Rashid1, E Baker1, E Denver2 and M Barnard1
1
Diabetes and Endocrinology, Whittington Hospital, London, UK, 2Centre for
Clinical Science and Technology, Whittington Hospital, London, UK
P326
Severe hypoglycaemia in the community:
development of a network-wide pathway
JE Rooney and S Benbow
North Mersey Diabetes Network, c/o NHS Knowsley, Huyton, Liverpool, UK
128
P327
Incidence and management of inpatient
hypoglycaemic episodes
ZJ Cousland, N Phelan, N Patel, A Ososanya, K DuckworthBrown, S Dissanayake and E Jude
Department of Diabetes and General Medicine, Tameside General Hospital,
Ashton-Under-Lyne, UK
P328
Incidence of hypoglycaemia in the acute
medical admission unit
HK Tan and DE Flanagan
Diabetes and Endocrinology, Plymouth Hospital NHS Trust, Plymouth, UK
P329
An evaluation of the effectiveness of hypo
boxes on the management of adult
inpatient hypoglycaemia at Cardiff
University Hospital Wales (UHW)
AS Howe and C Dustan
Diabetes and Endocrinology, University Hospital Wales, Cardiff, UK
DIABETICMedicine
P330
A review of hypoglycaemia in Bedford
Hospital inpatients
L Faghahati, L Cowley and A Melvin
Diabetes Centre, Bedford Hospital NHS Trust, Bedford, UK
129
DIABETICMedicine
P331
Innovative hypoglycaemia care pathway for
admission avoidance; a partnership
approach with a local ambulance trust
S Jackson, J James, J Fairfield, J Spiers, M Roshan, J Ferns,
O Sudar and R Gregory
Department of Metabolic Medicine, University Hospitals of Leicester NHS
Trust, Leicester, UK
P332
Impaired hypoglycaemia awareness in Type
1 diabetes in an outpatient setting
HK Tan and DE Flanagan
Diabetes and Endocrinology, Plymouth Hospital NHS Trust, Plymouth, UK
130
IHA had longer mean duration diabetes, 30.1 15.1 years vs.
15.2 14.7 years for patients without IHA (p = 0.021). Seven
patients had at least one episode of severe hypoglycaemia within
12 months, of whom two have a Gold Score of 3 or below. All with IHA
were using basal bolus analogue insulin regimens. Three were
considering pump therapy. Seven patients (87.5 per cent) with IHA
discussed hypoglycaemia during their consultation with a specialist
compared with 14 patients (63.6 per cent) without IHA.
Conclusion: The prevalence of IHA was higher in this study than in
previous work suggesting that the problem may still be underestimated.
It was appropriately recognised, and treatment strategies documented
for the majority, on attendance at specialist clinics.
P333
The value of electronic recording of blood
glucose in the surveillance for inpatient
hypoglycaemia
K Nirantharakumar1,2, A Kennedy2,3, T Marshall1,
P Narendran2,3 and JJ Coleman2,3
1
Department of Public Health, Epidemiology and Biostatistics, University of
Birmingham, UK, 2Queen Elizabeth Hospital, Edgbaston, Birmingham, UK,
3
School of Clinical and Experimental Medicine, University of Birmingham, UK
P334
Tight glycaemic control and hypoglycaemia
in elderly patients admitted to hospital: are
these patients overtreated?
KA Jackson and M Teh
Department of Diabetes and Endocrinology, Good Hope Hospital, Sutton
Coldfield, UK
P335
An analysis of all cases of severe
hypoglycaemia presenting to a major
teaching hospital over one year
VJ Parfitt and R Bhake
Department of Diabetes and Endocrinology, North Bristol NHS Trust, Bristol,
UK
DIABETICMedicine
a paramedic, 31; the emergency department, seven. Outcomes: twentyfive patients were admitted; the rest were discharged after initial
treatment (two against medical advice). None died. Management
followed local guidelines in 38 cases. All frail elderly/slow to recover
patients (17) were admitted, but only 8/10 of those with sulfonylurea
related hypos. Only 17 patients were given advice for preventing future
hypos, only two advice regarding driving and in only six was evidence of
hypoglycaemia unawareness sought.
Conclusions: Patients on animal insulins were overrepresented,
suggesting an increased risk. Principal management deficiencies were
in plans and advice to patients to prevent future hypos, detection of
hypoglycaemia unawareness and communication with usual
caregivers.
P336
Drivers of recurrent severe hypoglycaemia
and implications for its prevention: a
qualitative study of adults with Type 1
diabetes
SM Barendse1, H Singh2, S Little3, M Rutter4,5, JAM Shaw3,
J Speight1,6,7 and S Heller8
1
131
DIABETICMedicine
P337
Does having a hypoglycaemia treatment
algorithm and a hypo box improve
knowledge regarding awareness about the
appropriate management of hypoglycaemia
amongst nursing staff?
D Beeharry1, I Lamen1, T Reid2, R Burnham2, D Sharma1 and
A Meldon1
1
Diabetes and Endocrinology, Royal Liverpool University Hospital, Liverpool,
UK, 2Medical School, Liverpool University, Liverpool, UK
P340
Mortality among inpatients with diabetes
N Holman
Diabetes Health Intelligence, Yorkshire and Humber Public Health
Observatory, York, UK
132
DIABETICMedicine
P341
Assessment of glucose homeostasis in
coronary care in Birmingham
P342
Demonstration of improvement in
management in diabetic ketoacidosis with
yearly audits
N Tufton, WH Cheung, R Freudenthal and M Rossi
Diabetes and Endocrine, Whittington Hospital NHS Trust, London, UK
P343
Which came first? Myocardial infarction or
diabetic ketoacidosis
D Beeharry, R Shankland and D Sharma
Diabetes Department, Royal Liverpool University Hospital, Liverpool, UK
P344
Introduction of an insulin prescribing chart
is associated with a reduction in insulin
prescribing errors
NE Hawkins, J Abel and MG Masding
Diabetes and Endocrinology, Poole Hospital NHS Foundation Trust, Poole, UK
P345
Does the introduction of diabetes inpatient
specialist nurses have an effect on the
average length of stay for adult inpatients
with diabetes? An interrupted time series
analysis
SA Jones
Diabetes Health Intelligence, Yorkshire and Humber Public Health
Observatory, York, UK
133
DIABETICMedicine
P346
Perioperative management of patients with
diabetes: a review of current clinical
practice
L McLaren1, A McIntosh2 and A Kernohan1
P347
Variation in inpatient activity
P Follett1, R Young2 and N Holman1
1
Diabetes Health Intelligence, Yorkshire and Humber Public Health
Observatory, York, UK, 2Diabetes and Endocrinology, Salford Royal NHS
Foundation Trust, Salford, UK
1
Department of Diabetes and Endocrinology, Southern General Hospital,
Glasgow, UK, 2Medical School, University of Glasgow, Glasgow, UK
134
P348
Hyperglycaemia and screening for diabetes
in the acute medical admissions unit
MPM Graham-Brown, B Champaneri, H Taki and S Ghosh
Department of Diabetes and Endocrinology, University Hospital Birmingham,
Birmingham, UK
Background: Our initial audit in 2008 showed that only 66 per cent
of acute medical patients had any form of blood (capillary or venous)
glucose measurements on admission. We then produced a guideline on
blood glucose measurement and diabetes screening. Blood glucose
measurement on admission and adherence to guidelines was audited on
two consecutive years.
Methods: This was a retrospective audit of glucose measurement on
admission to the medical assessment unit. Information gathered
included age, presenting complaint, previous diagnosis of diabetes,
glucose measurement on admission and follow-up of abnormal results.
Results: Data were collected on 180 patients in 2009 and 100 patients
in 2010. A diagnosis of diabetes prior to admission was seen in 14 per
cent (2009) and 28 per cent (2010). Of those patients without a
diagnosis of diabetes on admission, 65 per cent (2009) and 96 per cent
(2010) had glucose measured on admission. Hyperglycaemia in not
known diabetics, as defined by an admission blood glucose of 7 mmol/l
or more, was present in 42 per cent (2009) and 33 per cent (2010).
Hyperglycaemia in patients without known diabetes was not followed
up according to the guidelines.
Conclusions: Our serial audits show that although blood glucose
measurements are increasingly being done in acute medical patients,
P349
Inpatient diabetes in the Black and Minority
Ethnic (BME) diabetes population
S Ghosh1, K Kimani2, R Potluri3, A Natalwala4, R Heun5 and
P Narendran6
1
Diabetes, University Hospital Birmingham NHS Trust, Selly Oak Hospital,
Birmingham, UK, 2University of Nairobi, Nairobi, Kenya, 3Cardiovascular
Medicine, University of Manchester, Manchester, UK, 4Neurosurgery, Royal
Hallamshire Hospital, Sheffield, UK, 5Psychiatry, Royal Derby Hospital, Derby,
UK, 6Clinical and Experimental Medicine, University of Birmingham,
Birmingham, UK
P350
Inpatient costs for people with diabetes in
England and the potential for quality
improvement and savings: an economic
analysis
M Kerr1,2
1
2
DIABETICMedicine
P351
Outcome data after implementing
ThinkGlucose in a district general hospital:
the Dudley experience
H Siddique, A Stroyde, K Crowley, C Holmes, J Dale and
K Gorton
Diabetes and Endocrinology, Dudley Group of Hospitals NHS Trust, Dudley,
UK
135
DIABETICMedicine
P352
Evaluation of an inpatient diabetes care
model that improves patient safety
D Selvarajah, C Nelson, C Stocks, C Nisbett, K Hudson and
FM Creagh
Diabetes Centre, Sheffield Teaching Hospitals NHS Foundation Trust,
Sheffield, UK
P353
Hyperglycaemia in acute coronary
syndromes: management within the Mersey
and North West deaneries
AB Reid and S Osula
Cardiology, Warrington Hospital, Warrington, UK
136
P354
Inpatient management of hyperglycaemia
following glucocorticoid therapy
JW Limbrick1, FEA Hartley1, A Barridge2, D Kariyawasam2 and
S Thomas2
1
Kings College London, University of London, London, UK, 2Diabetes and
Endocrine Department, Guys and St Thomas NHS Foundation Trust, London,
UK
P355
No excess mortality from hypoglycaemia or
hypokalaemia during use of a standardised
variable rate intravenous insulin infusion in
the management of hyperglycaemia in
acute coronary syndrome: experience of the
Trial of Intravenous Insulin to Achieve
Normoglyacemia in Acute Coronary
Syndrome (TITAN-ACS)
MS Hammersley1 and JS Birkhead2
1
P356
Achieving and maintaining
normoglycaemia using a standardised
variable rate intravenous insulin infusion in
the management of hyperglycaemia in
acute coronary syndrome: experience of the
Trial of Intravenous Insulin to Achieve
Normoglycaemia in Acute Coronary
Syndrome (TITAN-ACS)
MS Hammersley1 and JS Birkhead2
1
DIABETICMedicine
P357
Applying basic principles in diabetes care:
case series of inpatient hypoglycaemia
J Jones1, B Mumford1, H Husband2, R Griffiths2, H Lawless2
and N Agarwal1
1
Diabetes Centre, Cwm Taf Health Board, Merthyr Tydfil, UK, 2Diabetes
Centre, Cwm Taf Health Board, Llantrisant, UK
137
DIABETICMedicine
Clinical care and other categories posters: insulin: actions, metabolism and therapy
P359
Insulin requirements and the metabolic
syndrome in patients with Type 1 diabetes
of extreme (> 50 years) duration
S Bujawansa1, C Daousi1, SC Bain2, AH Barnett3 and GV Gill1
1
Department of Diabetes and Endocrinology, Aintree University Hospitals
NHS Foundation Trust, Liverpool, UK, 2Department of Medicine, University of
Wales, Swansea, UK, 3Department of Diabetes, Birmingham Heartlands
Hospital, Birmingham, UK
138
P360
Associations between estimated glucose
disposal rate and chronic diabetes-related
complications in the Golden Years Cohort
(Type 1 diabetes > 50 years duration)
S Bujawansa1, GV Gill1, SC Bain2, AH Barnett
and C Daousi1
Clinical care and other categories posters: insulin: actions, metabolism and therapy
P361
Audit of a district general hospitals practice
compared with NICE guidance TA151:
continuous subcutaneous insulin infusion
for the treatment of diabetes
DS Hughes, R Mahto, E Dilley, M Summers, T Gibbs and
P Horrocks
Diabetes Department, Warwick Hospital, Warwick, UK
Aims: To determine how our current practice differs from the national
standard NICE TA151 Diabetes: Insulin Pump Therapy published in
July 2008.
Method: Patients receiving insulin pump therapy (CSII) were
identified and available case notes were reviewed (audit period
FebruaryApril 2011). Data were collected regarding diabetes type,
indication for CSII therapy, date CSII therapy commenced, HbA1c,
indication for continuing CSII therapy and number of clinics attended.
Results: The number of patients identified as potentially using CSII
therapy was 74. The number of complete patient records available
which were reviewed was 39 (53 per cent). Median age of CSII therapy
users was 46 years (2581), with the median date that CSII therapy
commenced February 2006 (February 2002 to August 2010). The mean
number of new patients commencing CSII therapy each year was five.
The primary indication for starting CSII therapy was disabling
hypoglycaemia whilst trying to achieve HbA1c < 7.5 per cent. The
percentage of patients fulfilling NICE TA151 criteria for commencing
CSII therapy was 85 per cent, and the percentage of patients fulfilling
NICE TA151 criteria to continue CSII therapy after 1 year was 74 per
cent. The median number of clinics attended in the year before starting
CSII therapy was four, and the median number of clinics attended in the
year after commencing CSII therapy was three.
Conclusion: The audit has highlighted that the majority of our
patients started on CSII therapy fulfil the NICE TA151 criteria.
However, the department is doing less well when it comes to
withdrawing CSII therapy after 1 year for those patients who do not
continue to fulfil the NICE TA151 criteria.
P362
Improvement and maintenance of HbA1c
following continuous subcutaneous insulin
infusion therapy: a Welsh perspective
V Lewis-Jenkins, G Tagoury, J Beaverstock, A Bray and P Evans
Diabetes Centre, Cwm Taf LHB, Cwm Taf LHB, Wales
DIABETICMedicine
Results: The average HbA1c of the cohort was 8 per cent prior to CSII
initiation followed by 7.6 per cent, 7.6 per cent and 7.7 per cent in years
1, 2 and 3. Of the cohort, 35 patients who started CSII therapy with an
HbA1c of greater than 8 per cent showed an improvement of 1.4 per
cent, 1.4 per cent and 1.2 per cent in years 1, 2 and 3 respectively.
The remaining 37 patients commencing with an HbA1c of less than
8 per cent remained stable from initiation to the end of year 3 (average
7.3 per cent pre CSII therapy followed by 7.3 per cent, 7.5 per cent
and 7.4 per cent).
Conclusions: The average HbA1c of all patients who commenced
CSII therapy improved over years 1 and 2; a slight deterioration was
observed in year 3, although this was not significant. As expected,
patients who started with an HbA1c above 8 per cent benefited from the
greatest reduction. The main concern in patients with an HbA1c less
than 8 per cent was severe hypoglycaemia and hypo unawareness, and
whilst these patients maintained rather than improved their HbA1c,
severe hypoglycaemic episodes were halved and hypo awareness
improved.
P363
Impact of the discontinuation of Mixtard 30
on people with diabetes
M Greig, Y Mohamed Elhassan, L Hunt, C Nisbet, H Stead,
S Hudson and R Gandhi
Department of Diabetes, Sheffield Teaching Hospitals NHS Foundation Trust,
Sheffield, UK
139
DIABETICMedicine
Clinical care and other categories posters: insulin: actions, metabolism and therapy
P364
Metformin therapy reduces the
development of insulin resistance (HOMAIR)
in streptozotocin induced Type 1 diabetes
Wistar rats
JS Effendi and Z Haque
Biochemistry Department, Dow University of Health Sciences, Karachi,
Pakistan
P365
Humulin R (U-500) two years on: audit
results of patients with Type 2 diabetes
managed on Humulin R (U-500) insulin for
two years
P366
Development of a chemiluminescent assay
for measurement of insulin glargine
GJ Dunseath1, S Woodhead2, A Woodhead2 and S Luzio1
1
Diabetes Research Group, Swansea University, Swansea, Wales, 2Invitron
Ltd, Monmouth, Wales
140
P367
Optimising insulin therapy in patients with
Type 2 diabetes
M Ahmad, AY Laleye and A Ahmad
Diabetes and Endocrinology, Royal Liverpool University Hospital, Liverpool,
UK
Clinical care and other categories posters: insulin: actions, metabolism and therapy
P368
Study of Once-daily LeVemir (SOLVE): UK
results from a 24-week international
observational study
K Khunti1 and J Vora2
1
DIABETICMedicine
P369
Metabolic response to insulin initiation in
patients with Type 2 diabetes in a clinical
setting
RW Jones1,2, AE Denver1,2 and M Barnard1
1
Diabetes, Whittington Health NHS, London, UK, 2Research Department of
Clinical Physiology, University College London, London, UK
141
DIABETICMedicine
Clinical care and other categories posters: insulinotropic agents and enteroinsular hormones
P372
Projected cost-effectiveness of exenatide
once weekly versus exenatide twice daily for
the treatment of Type 2 diabetes in the UK
P371
Projected long-term clinical and economic
outcomes of exenatide once weekly versus
sitagliptin for the treatment of Type 2
diabetes in the UK
BP Wilson1, A Beaudet2, J Caputo3 and L Timlin1
1
Eli Lilly and Company Ltd, Windlesham, UK, 2IMS Consulting Group, Basel,
Switzerland, 3IMS Consulting Group, London, UK
142
Eli Lilly and Company Ltd, Windlesham, UK, 2IMS Consulting Group, Basel,
Switzerland, 3IMS Consulting Group, London, UK
P373
Adding exenatide to insulin in Type 2
diabetes: benefits to glycated haemoglobin
and body mass index in clinical practice
RM Manikandan, P Miles and MG Masding
Department of Diabetes and Endocrinology, Poole Hospital NHS Foundation
Trust, Poole, UK
Clinical care and other categories posters: insulinotropic agents and enteroinsular hormones
daily dose was 118.6 units (SD 67.6); it dropped by 17.6 units (14.8 per
cent fall) at 3 months (P = 0.004), stayed at a similar level at 6 months
and rose to 106.8 units (SD 65.2; P = NS) at 912 months. BMI fell
from baseline [mean (SD) 41.8 kg/m2 (6.3); 912 months 39.6 kg/m2
(6.0); P < 0.05]. At baseline, average HbA1c was 81.9 mmol/mol (SD
14.3), dropped to 68.6 mmol/mol (SD 15.4) at 3 months (P < 0.0001)
and continued to be lower than baseline at 6 months [71.3 mmol/mol
(SD 19.1); P = 0.027] and 912 months [70.6 mmol/mol (SD 19.5);
P = 0.007]. Exenatide treatment was stopped in nine patients (three due
to intolerance; six did not achieve targets)
Conclusion: Adding exenatide in patients with Type 2 diabetes
already on insulin therapy resulted in a reduced HbA1c and BMI, which
was maintained at 12 months. However, whilst daily insulin dose
initially fell, the amount of insulin used returned to baseline to maintain
these benefits.
P374
An observational analysis of the combined
use of insulin and incretin therapies in Type
2 diabetes
CJ Smith1, SE Sneddon2, N Roe2 and RS Drummond1
1
Glasgow Royal Infirmary, Diabetes and Endocrinology, NHS Greater Glasgow
and Clyde, Glasgow, UK, 2University of Glasgow Medical School, Glasgow,
UK
DIABETICMedicine
P375
Is the effect of exenatide on diabetes
control sustained in patients not on insulin
therapy?
I Ramracheya
Royal Berkshire NHS Foundation Trust, Reading, UK
P375A
Clinical effectiveness of concomitant
therapy with exenatide twice daily and
basal insulin in patients with Type 2
diabetes: a real-world analysis
M Pawaskar1, Q Li2, LJ Lee1, M Reynolds2 and BJ Hoogwerf1
1
Eli Lilly & Company and Lilly USA LLC, Indianapolis, USA, 2United BioSource
Corporation, Lexington, MA, USA
143
DIABETICMedicine
144
P377
Hospital-wide diabetic nephropathy
monitoring: an IT-facilitated
multidisciplinary team based approach
SR Page1, L Evans2, A Archer1, CE Bebb2, M Hall2, V Oguntolu1
and C Byrne2
1
Diabetes, Nottingham University Hospitals, Nottingham, UK, 2Nephrology,
Nottingham University Hospitals, Nottingham, UK
DIABETICMedicine
P379
Redesigning an intensive insulin service for
patients with Type 1 diabetes: a patient
engagement exercise
1
DENOVaRS, Kings College London, London, UK, 2Diabetes Centre, Kings
College Hospital NHS Foundation Trust, London, UK
145
DIABETICMedicine
Results: Three RCTs of fair quality with 386 participants showed that
weight reduction programmes were associated with a decrease in AHI
(11.46 /hr [95 per cent confidence interval 1.69 to 21.23] compared
with controls. Seven uncontrolled before-and-after studies with 172
participants also showed significant decrease in AHI [5.17/h (95 per
cent confidence interval 2.05, 8.28)] post intervention. In addition,
uncontrolled before-and-after studies with 86 participants showed a
significant decrease in ODI4 [19.16/h (95 per cent confidence interval
14.23 to 24.09)].
Conclusions: Although studies are limited, lifestyle interventions
have been shown to produce clinically relevant improvements in OSA.
These results need confirmation in patients with diabetes, but suggest
that lifestyle change should remain a cornerstone of diabetes care.
Clinical care and other categories posters: lipids and fatty liver
fibrosis were less consistent with only one study showing a significant
reduction. The majority of studies also reported improvements in
glucose control/insulin sensitivity following intervention. However,
study design, definition of disease, assessment methods and
interventions varied considerably across studies.
Conclusion: Lifestyle modifications leading to weight reduction and/
or increased physical activity consistently reduced liver fat and
improved glucose control/insulin sensitivity.
P382
Systematic literature review on weight
training and glycaemia
J Chisholm1, L Kilbride1 and J McKnight2
P381
A systematic review of lifestyle
modification in adults with non-alcoholic
fatty liver disease
C Thoma1, CP Day2 and MI Trenell1
1
Physical Activity and Exercise Research Group, Newcastle University,
Newcastle-Upon-Tyne, UK, 2Medical School, Newcastle University,
Newcastle-Upon-Tyne, UK
1
School of Nursing, Midwifery and Social Care, Edinburgh Napier University,
Edinburgh, UK, 2Metabolic Unit, Western General Hospital, Edinburgh, UK
146
Clinical care and other categories posters: lipids and fatty liver
DIABETICMedicine
P385
A new national clinical service for patients
with severe insulin resistance or
lipodystrophy
AJ Stears1,2, J Harris1,2, C Hames2, C Jenkins Liu2, D Dunger3,
D Savage1,2, R Semple1,2 and S ORahilly1,2
1
P384
Aminotransferases indicate changes in
hepatosteatosis in people with Type 2
diabetes: the Edinburgh Type 2 Diabetes
Study.
J Morling1, MWJ Strachan2, RM Williamson2, L Nee3,
CM Robertson1, S Glancy3, R Reynolds4 and JF Price1
1
Centre for Population Health Sciences, University of Edinburgh, Edinburgh,
UK, 2Metabolic Unit, Western General Hospital, Edinburgh, UK, 3Radiology
Department, Western General Hospital, Edinburgh, UK, 4Queens Medical
Research Institute, University of Edinburgh, Edinburgh, UK
147
DIABETICMedicine
P387
Stopping insulin following genetic testing:
the importance of making the correct
diagnosis
M Shepherd1,2, UNITED research team1,2, S Ellard3 and
AT Hattersley1,2
1
Peninsula National Institute for Health Research (NIHR) Clinical Research
Facility, Peninsula College of Medicine and Dentistry, University of Exeter,
Exeter, UK, 2Research and Development, Royal Devon and Exeter NHS
Foundation Trust, Exeter, UK, 3Department of Molecular Genetics, Royal
Devon and Exeter NHS Foundation Trust, Exeter, UK
148
Results: In our hospital (450 beds) 144,774 CBG tests were carried
out over 1 year: 29,611 control samples and 115,161 patient samples.
The number of tests per day ranged from 191 to 395 (mean 315). The
patient tests were attributed to departments in the following
frequencies: elderly care (17,966), medicine (38,721), surgery
(28,543) and other (29,931). The glucose distribution for all patient
tests was [centile (glucose in mmol/l)] 2.5 (3.2), 25 (5.7), 50 (7.6), 75
(10.7), 97.5 (20.6). There was no significant departmental effect on the
distribution. For hypoglycaemic (< mmol/l) values (5.6 per cent of
patient tests), 50 per cent were 3.3 mmol/l, with 6 per cent < 2 mmol/
l. For glucose values 11 mmol/l (22.4 per cent of patient tests), 50 per
cent were < 14.2 mmol/l, with 20 per cent 18 mmol/l.
Conclusions: Very large numbers of CBGs are carried out annually.
28 per cent of unselected patient tests fall outside the desirable range.
The database contains patients without diabetes, implying that the
percentage of undesirable test results in patients with diabetes is even
higher. This information supplements the NDIA snapshot and supports
increased specialty input into inpatient diabetes.
DIABETICMedicine
P390
Intensive diabetic nephropathy
management is associated with sustained
clinical improvements and favourable
outcomes over 10 years
SV OBrien, S Nair and KJ Hardy
Diabetes Centre, St Helens Hospital, St Helens, UK
P391
Impaired but improving outcomes for those
with diabetes related foot ulceration and
renal failure
RB Paisey1, M Waterson2, J Davis3, J Zeng4, A Rys1 and
R Gornall5
1
Department of Diabetes, Torbay Hospital, Torbay, UK, 2Department of
Biochemistry, Torbay Hospital, Torbay, UK, 3Department of Orthopaedics,
Torbay Hospital, Torbay, UK, 4Nuffield Bursary, Torbay Hospital, Torbay, UK,
5
Department of Podiatry, Torbay Care Trust, Torbay, UK
P392
Combined diabetesrenal clinic: an
evaluation of management indicators
E Knight, VN Cherukuri, L Varadhan, GI Varughese and
AB Walker
Diabetes and Endocrinology, University Hospitals North Staffordshire NHS,
Stoke-on-Trent, UK
P393
Secondary hyperparathyroidism and
vitamin D deficiency are common in people
with Type 2 diabetes and modest renal
impairment
I Tullo1, S Winship1, M Bilous1, J Ellis1, R Mukhtar1, A Phillips1,
V Arutchelvam1, S Nag1, S Jones1 and RW Bilous1,2
1
Diabetes Department, James Cook University Hospital, South Tees NHS
Trust, Middlesbrough, UK, 2Institute of Cell Science, Newcastle University,
Newcastle-Upon-Tyne, UK
149
DIABETICMedicine
P394
An audit of the multidisciplinary diabetic
follow-up of patients with end-stage
diabetic nephropathy attending the dialysis
centre at Ealing Hospital in West London
P Behary1, FWD Tai1, O Najam1, A Saso2 and K Baynes1
1
2
150
P395
Use of the direct renin inhibitor aliskiren in
a mixed ethnic clinical practice: an
observational audit
E Mozdiak and P De
Diabetes and Endocrine Unit, City Hospital, Birmingham, UK
Clinical care and other categories posters: new technologies, therapies and treatment
DIABETICMedicine
P397
Basalbolus therapy with insulin degludec
improves long-term glycaemic control with
less nocturnal hypoglycaemia compared
with insulin glargine in Type 1 diabetes:
results of a one year trial
S Heller1, AMO Francisco2, H Pei3 and D Russell-Jones4
1
P398
Sitagliptin in the real world
MD Feher1,2,3, N Munro1,2,3, K Jeyaraman1, H Nizar1, Z
Mickute1 and K Watters1,2,3
1
Beta Cell Diabetes Centre, Chelsea and Westminster Hospital, London, UK,
Clinical Sciences Research Institute (CSRI), Warwick Medical School,
Warwick, UK, 3Diabetes Therapies Evaluation Network, London, UK
2
P400
Diabetes in pregnancy: mode of delivery
and pregnancy outcome: Diabetes in
Pregnancy Mother and Baby 3
O Ajala1, E Stenhouse2, I Montague3 and BA Millward1
1
Diabetes Clinical Research Centre, Peninsula College of Medicine and
Dentistry, Plymouth, UK, 2School of Nursing and Midwifery Faculty of Health,
Education and Society, Plymouth University, Plymouth, UK, 3Department of
Maternal and Child Health, Plymouth Hospitals NHS Trust, Plymouth, UK
151
DIABETICMedicine
P401
Benefit of metformin in reducing weight
gain and insulin requirement in pregnancies
complicated by gestational diabetes
RA Iftakhar1, K Cheer1, S Wylie2, SJ Howell1 and K Kaushal1
1
Diabetes and Endocrinology, Lancashire Teaching Hospitals NHS Foundation
Trust, Preston, UK, 2Obstetrics and Gynaecology, Lancashire Teaching
Hospitals NHS Foundation Trust, Preston, UK
P402
Maternal efficacy and safety outcomes, and
perinatal outcomes, in a randomised trial
comparing insulin detemir with neutral
protamine Hagedorn insulin in 310 pregnant
women with Type 1 diabetes
D McCance1, M Hod2, M Ivanisevic3, S Duran-Garcia4,
L Jovanovic5, ER Mathiesen6 and P Damm7
1
Metabolic Unit, Royal Victoria Hospital, Belfast, UK, 2Obstetrics and
Gynecology, Rabin Medical Center, Petah Tiqva, Israel, 3Department of
Obstetrics and Gynecology, University Hospital of Zagreb, Zagreb, Croatia,
4
Hospital Universitario De Valme, Sevilla, Spain, 5Sansum Diabetes Research
Institute, Santa Barbara, USA, 6Endocrine Department, Copenhagen
University Hospital, Copenhagen, Denmark, 7Center for Pregnant Women
with Diabetes, Department of Obstetrics, Rigshospitalet, Copenhagen,
Denmark
P403
Incidence of gestational diabetes in an
obese population using the International
Association of Diabetes and Pregnancy
Study Groups (IADPSG) criteria in the UK
Pregnancies Better Eating and Activity Trial
(UPBEAT) pilot study
RA Maitland1, S Barr1, A Briley2, P Seed1 and L Poston1
1
Womens Health Academic Centre KHP, Kings College London, London,
UK, 2Guys and St Thomas NHS Foundation Trust, London, UK
152
P404
PROCEED (Preconception Care for Diabetes
in Derby): a teams without walls approach
P King1,3, C Westcott1, S Ruston2, K Gale1,3, S Ashton-Cleary1,3
and G Tan3
1
Diabetes and Endocrinology, Derby Hospitals NHS Foundation Trust, Derby,
UK, 2Derbyshire County PCT, Derby, UK, 3Intercare Health, Derby, UK
P405
Effect of ethnicity on conversion to
impaired glucose regulation and/or Type 2
diabetes following gestational diabetes
KJ Ly1, D Todd2, S Nolan3, SA Mostafa4, MJ Davies4 and
IG Lawrence5
1
Department of Diabetes and Endocrinology, University Hospitals of Leicester
NHS Trust, Leicester, UK, 2Department of Womens and Childrens Services,
University Hospitals of Leicester NHS Trust, Leicester, UK, 3Department of
Health Sciences, University of Leicester, Leicester, UK, 4Department of
Cardiovascular Sciences, University of Leicester, Leicester, UK, 5Department
of Diabetes and Endocrinology, University Hospitals of Leicester NHS Trust,
Leicester, UK
P406
Diabetes antenatal care at a large district
general hospital: an audit from 1997 to 2010
FK Kavvoura1, D Graham2, R Crowley2, H Simpson1, P Street2
and M Elsheikh1
1
Centre for Diabetes and Endocrinology, Royal Berkshire Hospital, Reading,
UK, 2Department of Obstetrics, Royal Berkshire Hospital, Reading, UK
DIABETICMedicine
P407
The National Diabetes in Pregnancy Audit:
lessons from a prospective proof of concept
pilot in England
N Lewis-Barned1, R Bell2, N Holman3, H Murphy4,
HJ Stephens5, R Young6 and L Allen7
1
Diabetes and Endocrinology Service, Northumbria Healthcare NHS
Foundation Trust, Northumbria, UK, 2Institute for Health and Society,
Newcastle University, Newcastle-Upon-Tyne, UK, 3Diabetes Health
Intelligence, Yorkshire and Humber Public Health Observatory, York, UK,
4
Metabolic Research Laboratories and National Institute for Health Research
(NIHR) Biomedical Research Centre, Cambridge University, Cambridge, UK,
5
Diabetes Information, NHS Diabetes, Manchester, UK, 6National Diabetes
Information Service, NHS Diabetes, Salford, UK, 7Diabetes Information, NHS
Diabetes, Newcastle-Upon-Tyne, UK
153
DIABETICMedicine
P408
An audit on gestational diabetes reflecting
on the changes in NICE guidance (2008)
DJ Martin1, EP Birdsall1, S Murray1, JM Roland2, and S Oyibo2
1
Aims: The aim of this audit was to identify how many women with a
raised glucose tolerance test would require medication, metformin,
gliblenclamide or insulin, during their pregnancy. NICE (2008) suggest
that 1020 per cent of women will need oral hypoglycaemia agents or
insulin if diet and exercise are not effective in controlling diabetes.
Methods: Data were collected from 230 pregnant women who were
referred to the community diabetes team between January 2010 and
December 2010. They were divided into three groups: diet controlled
gestational diabetes post glucose tolerance test (GTT) of between
7.8 mmol and 8.9 mmol; gestational diabetes had a GTT of over
9 mmol; women with previous gestational diabetes. At the initial
consultation all women received dietary and lifestyle advice and there
was weekly telephone contact. Data were collected on weeks of
gestation when medication was started and the age of the woman.
Results: In total there were 125 women with diet controlled
gestational diabetes with a GTT between 7.8 mmol and 8.9 mmol of
whom 84 required medication, 79 women with gestational diabetes
with a GTT over 9 mmol of whom 60 required medication, and 33
previous gestational diabetes pregnancies of whom 23 required
medication. They commenced diabetes medication as follows: under
10 weeks, two; 1019 weeks, 33; 2029 weeks, 113; 3034 weeks,
six; 35 weeks, 15. A hundred and thirty women were over 30 years of
age.
Conclusion: The audit found the number of women requiring
medication was significantly more than NICE suggested in 2008. This
has had an impact on the workload of the community diabetes team and
the hospital antenatal clinics.
P409
Abstract withdrawn.
P410
How do professionals decide whether to
introduce medication in gestational
diabetes?
MH Charlton
Department of Diabetes, Heart of England Foundation Trust, Birmingham, UK
154
P411
The effect of body mass index on pregnancy
outcomes in gestational diabetes
AW Tang1, S Ballal1, N Goenka2, D MCaulay2, J Davies1 and
F Joseph2
1
Women and Childrens Division, Countess of Chester NHS Foundation Trust,
Chester, UK, 2Department of Diabetes and Endocrinology, Countess of
Chester NHS Foundation Trust, Chester, UK
P412
Metformin in gestational diabetes: a
retrospective analysis of its introduction
into an insulin-based protocol of care
C Cheyette, V Deprez and S Ramasamy
DIABETICMedicine
P413
Annual screening for Type 2 diabetes in
women with a history of gestational
diabetes: an opportunity for prevention and
early diagnosis
A Schlesinger and JM Bissell
Mid Yorks NHS Trust Diabetes Centre, Pontefract, UK
P414
Identifying women with persistent
abnormal glucose metabolism following
gestational diabetes: what was NICE once
may not be NICE anymore
V Photiou1, A Verma2, D MCaulay1, N Goenka1, DL Ewins1,
J Davies3, M Clement-Jones4, IF Casson5 and F Joseph1
1
Department of Diabetes and Endocrinology, Countess of Chester NHS
Foundation Trust, Chester, UK, 2Manchester Urban Collaboration of Health,
School of Translational Medicine, Manchester Academic Health Sciences
Centre, Manchester, UK, 3Department of Obstetrics and Gynaecology,
Countess of Chester NHS Foundation Trust, Chester, UK, 4Department of
Obstetrics and Gynaecology, Liverpool Womens Hospital, Liverpool, UK,
5
Department of Diabetes and Endocrinology, Aintree University Hospitals
NHS Foundation Trust, Liverpool, UK
P415
Comparison of pregnancy outcomes of first
and second pregnancies in women with
Type 1 diabetes
J Berry, D Rajasingham and A Brackenridge
Diabetes and Endocrine, Guys and St Thomas NHS Foundation Trust,
London, UK
155
DIABETICMedicine
P418
Design and development of
mydiabetesliving.com: data and designs
from phases 1 and 2 of the Psychological
Online Support for Diabetes study
CS McKenzie1, A Montgomery1, K Bennert1, D Kessler1 and
P Gregor2
1
2
P417
The effect of GLP-1 agonist therapy on
hospital anxiety and depression score,
compared with insulin treatment
L Kockum, K Adamson, J Walker and A Dover
Department of Diabetes, St Johns Hospital, Livingston, UK
P419
The sensitivity and specificity of the PHQ-9
as a screening tool for depression in
individuals with newly diagnosed Type 2
diabetes
K Twist1, D Stahl2, SA Amiel1, K Winkley3 and K Ismail3
1
Diabetes and Nutritional Science Division, Kings College London, London,
UK, 2Department of Biostatistics, Institute of Psychiatry, London, UK,
3
Academic Department of Psychological Medicine, Institute of Psychiatry,
London, UK
156
P420
Association between N-terminal pro B-type
natriuretic peptide (NT-proBNP) and
depressive symptoms in elderly patients
with Type 2 diabetes: the Edinburgh Type 2
Diabetes Study
I Feinkohl1, N Sattar2, P Welsh2, R Reynolds6, IJ Deary3,4,
MWJ Strachan5 and JF Price1
1
Centre for Population Health Sciences, University of Edinburgh, Edinburgh,
UK, 2Institute of Cardiovascular and Medical Sciences, University of Glasgow,
Glasgow, UK, 3Psychology in the School of Philosophy, Psychology and
Language Sciences, University of Edinburgh, Edinburgh, UK, 4Centre for
Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh,
Edinburgh, UK, 5Metabolic Unit, Western General Hospital, Edinburgh, UK,
6
Centre for Cardiovascular Sciences, Queens Medical Research Institute,
University of Edinburgh, Edinburgh, UK
P421
Alcohol associated risks for young adults
with Type 1 diabetes: a narrative review
KD Barnard1, R Holt1, AJ Young1, J Lawton2 and JMA Sinclair3
1
Faculty of Medicine, University of Southampton, Southampton, UK, 2Social
Sciences, University of Edinburgh, Edinburgh, UK, 3Wessex Alcohol Research
Collaborative, University of Southampton, Southampton, UK
DIABETICMedicine
P422
Fear of hypoglycaemia: is there an
association with glycaemic control,
hypoglycaemic symptoms and diabetes
emotional distress in people with Type 1
diabetes?
E Sheils, J Knott, D Cavan and C Shaban
Bournemouth Diabetes and Endocrine Centre, Royal Bournemouth Hospital,
Bournemouth, UK
157
DIABETICMedicine
P423
Predictors of fear of hypoglycaemia in UK
children and adolescents with Type 1
diabetes and their families
P Tah1, CE Lloyd2, L Gonder-Frederick3, K Vajda3 and
KA Matyka1
1
Division of Metabolic and Vascular Health, Warwick Medical School,
Coventry, UK, 2Faculty of Health and Social Care, Open University, Milton
Keynes, UK, 3Behavioral Medicine Center, University of Virginia Health
System, Virginia, USA
P424
Reflection: a benchmark for future audits of
counselling services for people with
diabetes
A Archer1, T Cooper1, S Marks2, K Ackroyd2, M Wan2,
B Bullock2, H Begg2, C Jones2, M Hall2, S Winterburn2,
E Jackson2, J Forrest2, J Stone2, K Hubbard2 and J Newstead2
1
Diabetes and Endocrinology, Nottingham University Hospitals, Nottingham,
UK, 2Department of Diabetes City Hospital Campus, Nottingham University
Hospitals, Nottingham, UK
158
P425
The influence of genetic explanations of
Type 2 diabetes on patients attitudes to the
efficacy of preventative behaviours and
treatment and personal responsibility for
the condition
LE Davies and K Thirlaway
Applied Psychology, University of Wales Institute Cardiff, Cardiff, UK
P426
Recognition of being overweight and obese
in young adults
E Stenhouse1, T Lander2, R OSullivan2, M Moore2 and G Rees3
1
School of Nursing and Midwifery, Faculty of Health, Education and Society,
Plymouth University, Plymouth, UK, 2School of Health Professions, Faculty of
Health, Education and Society, Plymouth University, Plymouth, UK, 3School of
Biomedical and Biological Sciences, Faculty of Science and Technology,
Plymouth University, Plymouth, UK
P427
Investigating the relationship between
positive affect and health outcomes in
people living with diabetes
MR Patel, M Harrison, A Jackson and S Williams
School of Pharmacy and Biomolecular Sciences, University of Brighton,
Brighton, UK
DIABETICMedicine
1.063.00) after controlling for exercise, avoiding high fat foods and
engaging in active coping strategies. This was not independent of
NA (P = 0.089). Individuals who followed a healthy diet (U = 625;
z = 2.69; P < 0.01; r = 0.29) or avoided high fat foods (U = 617.5;
z = 2.77; P < 0.01; r = 0.30) had lower HbA1c levels. No direct link
was found between PA and HbA1c; however, following a healthy diet
acted as a moderator in this relationship [F(1,82) = 0.4.65; P < 0.05].
PA predicted DQOL satisfaction after controlling for age, body mass
index, NA, marital status, engaging in instrumental coping strategies
and DQOL impact [R2 change 0.02; change in F(1,113) = 5.10;
P < 0.05].
Conclusion: Diabetes self-care has been shown to improve glucose
control and consequently reduce the onset of complications. This study
suggests that individuals high in PA are more likely to follow such selfcare activities and have better DQOL. Further studies are needed to
elucidate the directional nature of this relationship.
P428
The importance of measuring diabetes
distress in young people with Type 1
diabetes
S Brierley1,2, B Johnson1,2, V Young1,2, C Eiser1,2, S Heller1,3,
Diabetes Theme Research Group and CLAHRC South Yorks1
1
National Institute for Health Research (NIHR) CLAHRC for South Yorkshire,
Sheffield, UK, 2Child and Family Research Group, Department of Psychology,
University of Sheffield, Sheffield, UK, 3Academic Unit of Diabetes,
Endocrinology and Metabolism, School of Medicine and Biomedical Sciences,
University of Sheffield, Sheffield, UK
159
DIABETICMedicine
P429
Quality and Outcomes Framework (QOF)
screening questions for depression in
patients with diabetes: effective but
non-efficient
SR Abu-Roomi1, S Javed2, SC Bain3, DE Price1 and
JW Stephens1,3
1
Department of Diabetes and Endocrinology, Morriston Hospital, Swansea,
UK, 2General Practice, The Robert Street Practice, Pembrokeshire, UK,
3
Diabetes Research Group, Institute of Life Science, Swansea University,
Swansea, UK
P430
Emotional wellbeing and diabetes control
prior to hospital admission for diabetic
ketoacidosis in Type 1 diabetes: a service
evaluation
KY Matheson1,2, AJA Keen1 and AE Gold1
1
160
P431
Predictors of quality of life gains among
people with Type 1 diabetes participating in
the Irish Dose Adjustment for Normal Eating
(DAFNE) study
MC OHara1, M Byrne2, J Newell3,4, N Coffey4, D OShea5,6,
D Smith7, C McGurk8, CH Courtney9, S Heller10, SF Dinneen1,11
1
Diabetes and Endocrinology Centre, University Hospital Galway, Galway,
Ireland, 2School of Psychology, National University of Ireland (NUI), Galway,
Ireland, 3HRB Clinical Research Facility, National University of Ireland (NUI),
Galway, Ireland, 4School of Mathematics, Statistics and Applied Mathematics,
National University of Ireland (NUI), Galway, Ireland, 5Diabetes and
Endocrinology, St Vincents University Hospital, Dublin, Ireland, 6Diabetes and
Endocrinology, St Columcilles Hospital, Dublin, Ireland, 7Diabetes, Beaumont
Hospital, Dublin, Ireland, 8Diabetes, St Lukes General Hospital, Kilkenny,
Ireland, 9Regional Endocrinology and Diabetes Centre, Royal Victoria
Hospital, Belfast, UK, 10Academic Unit of Diabetes, Endocrinology and
Metabolism, School of Medicine and Biomedical Sciences, University of
Sheffield, Sheffield, UK, 11School of Medicine, National University of Ireland
(NUI), Galway, Ireland
P432
The My Hypo Compass psycho-educational
intervention: design of a novel curriculum
to aid the prevention of severe
hypoglycaemia
S Little1, SM Barendse2, D Kyne3, J Speight2, RM Thomas1,
ML Evans4 and JAM Shaw1
1
Institute of Cellular Medicine, Newcastle University, Newcastle-Upon-Tyne,
UK, 2AHP Research, Hornchurch, UK, 3Newcastle Diabetes Centre,
Newcastle-Upon-Tyne Hospitals NHS Foundation Trust, Newcastle-UponTyne, UK, 4Institute of Metabolic Science, University of Cambridge, UK
DIABETICMedicine
P434
Implementation and review of a preconsultation checklist within a young
persons diabetes service
C Darbyshire, D Pearson, E Stewart, S Copland, A Mayo and
SC McGeoch
Diabetes Service, NHS Grampian, Aberdeen, UK
161
P433
The effectiveness of a mindfulness-based
cognitive therapy intervention specifically
designed for adults with diabetes
experiencing significant levels of anxiety
and/or depression: a pilot clinical service
AJA Keen1, E Duncan2 and AE Gold1
1
DIABETICMedicine
P436
Abstract withdrawn.
P435
Evaluating the effectiveness of a rapid
response psychotherapy initiative in the
young persons diabetes clinic
S Singham
Diabetes and Endocrine Centre, Guys and St Thomas NHS Foundation Trust,
London, UK
162
P437
Disordered eating in young adults with Type
1 diabetes: predictors of disordered eating
behaviour
V Young1,2, C Eiser1,2, B Johnson1,2, S Brierly1,2 and S Heller2,3
1
Psychology, University of Sheffield, Sheffield, UK, 2National Institute for
Health Research (NIHR) CLAHRC for South Yorkshire, Sheffield, UK, 3School
of Medicine and Biosciences, University of Sheffield, Sheffield, UK
DIABETICMedicine
P439
Relationship between retinopathy grade
from digital retinal screening, age and
visual acuity: when does retinopathy impact
on the vision of the patient with diabetes?
IM Stratton1, SJ Aldington1, M Histed2, S Chave3 and PH
Scanlon3
1
English National Screening Programme for Diabetic Retinopathy,
Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT), Gloucester, UK,
2
Gloucestershire Diabetic Eye Screening Service, Gloucestershire Hospitals
NHS Foundation Trust (GHNHSFT), Gloucester, UK, 3Department of
Ophthalmology, GHNHSFT, Gloucester, UK
P440
Obstructive sleep apnoea (OSA) is
associated with the development and
progression of diabetic retinopathy,
independent of conventional risk factors
and novel biomarkers for diabetic
retinopathy
S Rudrappa1, G Warren2 and I Idris1,3
1
Diabetes and Endocrinology, Sherwood Forest Hospitals Foundation Trust,
Nottinghamshire, UK, 2Trent Research Design Services for East Midlands,
University of Nottingham, Nottingham, UK, 3School of Graduate Entry
Medicine, University of Nottingham, Nottingham, UK
Aim: The aim of this study was to investigate the relationship between
OSA, the apnoeahypopnoea index (AHI) and diabetic retinopathy
(DR) independent of clinical parameters and serum biomarkers
implicated in the development and progression of DR.
Methods: Thirty-one patients underwent a standard in-hospital sleep
study. Details of their diabetes, clinical parameters, retinopathy grading
and HbA1c levels were recorded. Assessment of serum biomarkers
included levels of vascular endothelial growth factor, interleukin-6,
tumour necrosis factor a, hsCRP, monocyte chemoattractant protein 1
and matrix metalloproteinases levels.
Results: Seventeen patients were identified to have OSA; mean age
54.9 11.3 years, body mass index 35.3 4.8 kg/m2, HbA1c
9.2 2.4 and diabetes duration 11.0 8.3 years. All clinical and
biochemical parameters were equally matched between OSA and nonOSA patients, except for the Epworth score (11.0 vs. 6.8, P = 0.008)
and the AHI score (23.4 17.1 vs. 3.1 1.0, P < 0.0001), which by
definition were increased in patients with OSA. Retinopathy score
(P = 0.04) but not maculopathy score (P = 0.15) were significantly
worse in the OSA group. The proportion of patients with proliferative
DR (R3) was significantly higher in the OSA group (chi-squared 4.8;
163
DIABETICMedicine
P441
Progression of diabetic retinopathy to
referable or sight threatening retinopathy?
Does it matter whether there is background
retinopathy in either or both eyes?
SJ Aldington1, PH Scanlon2, M Histed3, S Chave2 and IM Stratton2
1
English National Screening Programme for Diabetic Retinopathy, Gloucester
Hospitals NHS FT, UK, 2Ophthalmology, Gloucester Hospitals NHS FT, UK,
3
Gloucestershire Diabetic Eye Screening Service, Gloucester, UK
P442
High prevalence of diabetic retinopathy at
first eye screening due to delayed inclusion
into the diabetic retinopathy register
L Sellahewa1, C Simpson2, J Duffy2, P Maharajan2 and I Idris1,3
1
Diabetes and Endocrinology, Sherwood Forest Hospitals Foundation Trust,
Nottingham, UK, 2North Notts Diabetic Retinopathy Screening Programme,
Sherwood Forest Hospitals Foundation Trust, Nottingham, UK, 3School of
Graduate Entry Medicine, University of Nottingham, Nottingham, UK
164
eyes once patients are diagnosed with Type 2 diabetes. These screening
programmes rely on GP practices to inform the screening offices of such
patients. We have recently identified a cohort of patients whose
inclusion into the retinopathy screening register was delayed by more
than 1 month. We report the prevalence of retinopathy and their ocular
outcomes following their first screening within an optometry based
screening programme.
Methods: Data were obtained and audited from the diabetic
retinopathy screening database and hospital based clinical
information record.
Results: A total of 36 patients were identified, mean age
62.2 17.1 years, of whom 19 were female. Mean delay of their
first retinopathy screening from diagnosis of diabetes was
12.9 25.8 months. Prevalence for any retinopathy at presentation
was 44.4 per cent (n = 16) and for any maculopathy was 8.3 per cent
(n = 3). Two patients required urgent referrals to the hospital
ophthalmology service for suspected proliferative retinopathy (R3)
although both gradings were downgraded following slit-lamp and
fluorescein angiogram assessments. Two patients had sight threatening
maculopathy (M1) requiring ophthalmology referral. Neither the
duration of delay from diagnosis to first retinopathy screening nor age
of patients influenced the development of sight threatening disease.
Conclusion: The observed prevalence of retinopathy at presentation
appears to be slightly higher than that observed from the UKPDS.
Delayed referral to the screening programme may contribute to the high
prevalence of any retinopathy at first presentation to the screening
programme.
P443
Evaluating digital diabetic retinopathy
screening in people aged 90 years and over
AS Tye1, HM Wharton1, JM Gibson1,2, M Clarke1, A Wright1
and PM Dodson1,2
1
DIABETICMedicine
P444
An audit of current screening practice for
diabetic retinopathy in Type 1 and Type 2
diabetes patients
P445
Diabetic retinopathy screening: is there a
link between number of images graded and
grading accuracy?
165
DIABETICMedicine
per cent, 0.8 per cent, 2.3 per cent, 5.9 per cent and 10.4 per cent. The
cumulative continuous observation period was 16,687 person-years in
which 99 people developed diabetes (80 Type 2 diabetes, 13 GDM).
The cumulative incidence of Type 2 diabetes was 4.8/1,000 personyears. Using Cox regression analysis, age and body mass index (BMI)
were significant predictors of incident diabetes (P < 0.01);
hyperandrogenism reduced the risk of diabetes (P < 0.01).
Conclusions: Women with PCOS have a higher prevalence/incidence
of Type 2 diabetes which increases with age and BMI. Screening for
diabetes and early lifestyle intervention should be considered at a
younger age.
P447
Understanding of the risks of Type 2
diabetes by women with polycystic ovary
syndrome
J Tomlinson1, G Letherby2, J Pinkney1 and E Stenhouse2
1
University Medicine, Peninsula College of Medicine and Dentistry, Plymouth,
UK, 2Faculty of Health Education and Society, Plymouth University, Plymouth, UK
P448
Screening for diabetes in acute medical
admissions in Ireland using guidelines from
the American Diabetes Association (ADA),
the US Department of Veterans Affairs/
Department of Defense (VA/DoD) 2010 and
WHO 2006
KT OBrien1, FM Ali1, DB Moore1, IM Stratton2, SE Manley3
and GA Roberts1
1
Endocrinology and Diabetes Research Group, Waterford Institute of
Technology, Waterford, Ireland, 2English National Diabetic Retinopathy
Screening Programme, Gloucestershire Hospitals NHS Foundation Trust,
Cheltenham, UK, 3Clinical Biochemistry, University Hospitals Birmingham NHS
Foundation Trust, Birmingham, UK
166
P450
Diabetes care provision in UK general
practices: patients and healthcare
professionals perspectives
G Hawthorne1, MP Eccles2, E Stamp2, S Hrisos2, N Steen2,
M Elovainio3, JJ Francis4, JM Grimshaw5, M Hunter2,
M Johnston6 and J Presseau2
1
Newcastle Diabetes Centre, Newcastle-Upon-Tyne Hospitals NHS
Foundation Trust, Newcastle-Upon-Tyne, UK, 2Institute of Health and Society,
Newcastle University, Newcastle-Upon-Tyne, UK, 3National Institute for
Health and Welfare, Health Services Research Unit, Helsinki, Finland, 4Health
Services Research Unit, University of Aberdeen, UK, 5Clinical Epidemiology
Program, Ottawa, Canada, 6College of Life Sciences and Medicine, University
of Aberdeen, Aberdeen, UK
DIABETICMedicine
P451
Testing multiple theories of behaviour
across multiple health professional
behaviours in primary care: an investigation
of diabetes care provision in the UK
J Presseau1, M Johnston2, JJ Francis3, S Hrisos1, E Stamp1,
IN Steen1, G Hawthorne4, JM Grimshaw5, M Elovainio6,
M Hunter1 and MP Eccles1
1
Institute of Health and Society, Newcastle University, Newcastle-Upon-Tyne,
UK, 2College of Life Sciences and Medicine, University of Aberdeen,
Aberdeen, UK, 3Health Services Research Unit, University of Aberdeen,
Aberdeen, UK, 4Diabetes Centre, Newcastle-Upon-Tyne Hospitals NHS
Foundation Trust, Newcastle-Upon-Tyne, UK, 5Clinical Epidemiology, Ottawa
Hospital Research Institute, Ottawa, Canada, 6Health Services Research Unit,
National Institute for Health and Welfare, Helsinki, Finland
Aims: The aim of this prospective predictive study was to inform the
design of interventions to improve quality of diabetes care by identifying
theory-based predictors of six professional behaviours related to Type 2
diabetes management in primary care. The objective was to test
constructs from social cognitive theory, learning theory, the theory of
planned behaviour, and action and coping planning separately as
predictors of prescribing (to reduce blood pressure and for glycaemic
control), advising (about weight, self-management and general
education) and examining feet.
Methods: GPs and practice nurses (n = 427) from 99 UK primary
care practices completed postal questionnaires at baseline (including
measures of theoretical constructs and scenario-based simulations) for
each behaviour, and then self-reported their behaviour 12 months later.
The main predicted outcomes were intention strength, direct estimation
of intention, simulated behaviour and self-reported behaviour.
Results: For all behaviours, mean scores on all theoretical constructs
exceeded the midpoint on measurement scales. Self-efficacy and coping
planning mean scores were lower than for other constructs. Intention/
proximal goals, self-efficacy and habit predicted all six behaviours.
Over all behaviours, each theory accounted for significant variance in
self-reported behaviour (median R2 = 0.15), behaviour simulation
(median R2 = 0.05), intention strength (median R2 = 0.66) and direct
estimation of intention (median R2 = 0.34).
Conclusions: Theories that include constructs which consistently
predict intention and behaviour for all six clinical behaviours (ie social
cognitive theory, learning theory, planning) and with lower mean scores
and higher variability (ie self-efficacy, habit, coping plans) should
inform interventions to change clinical behaviours to enhance quality of
diabetes care.
P452
Introducing a new style of patient
consultation within the diabetes clinic in
North Cumbria
K Vithian1, A Routledge1, N Higgins1, J Redgate1, E Simpson1
and C Hay2
1
167
DIABETICMedicine
P453
The GAPPTM (Global Attitudes of Patients
and Physicians in Insulin Therapy) study:
identifying risk factors associated with
injection omission/non-adherence in insulin
treated patients with Type 1 and Type 2
diabetes
AH Barnett1, LF Meneghini2, P-M Schumm-Draeger3 and
M Peyrot4
1
Diabetes Centre, Heart of England NHS Foundation Trust and University of
Birmingham, Birmingham, UK, 2Miller School of Medicine, University of
Miami, Miami, USA, 3Clinic for Endocrinology, Diabetology and Angiology,
Academic Teaching Hospital Munich Bogenhausen, Munich, Germany,
4
Sociology and Medicine, Loyola University of Maryland and Johns Hopkins
University, Baltimore, USA
168
P454
Enhancing DiabetesE to help general
practices implement the NICE quality
standard for diabetes (adults)
K Moore, B Wright and H Seymour
DiabetesE, Innove, Manchester, UK
P455
Diabetes redesign in Her Majestys Prison
Wakefield: tackling the challenges
R Jenkins1, T Kadis1, J Wilson2, T Celliers3 and D Nagi1
1
Edna Coates Diabetes Centre, Pinderfields Hospital, Mid Yorks Health Trust,
Wakefield, UK, 2Long Term Conditions Team Public Health, NHS Wakefield
District, Wakefield, UK, 3MY Therapies, Mid Yorks Health Trust, Wakefield,
UK
Aims: There is evidence to support that diabetes care for the prison
population remains suboptimal. An innovative service redesign to
support primary care and reduce inequalities by delivering high quality
diabetes care was implemented in the Wakefield District. This model
was then replicated in HMP Wakefield (high security) with the aim of
improving clinical outcomes for prisoners.
Methods: The intervention included one session per month by a
diabetologist and diabetes specialist nurse to initially undertake
individual case note reviews (CNRs) and organise specialist clinics with
diabetes dietitian input. However, after the initial CNR it became clear
that more specialist sessions were needed to ensure a thorough initial
review of all patients. The model also includes inpatient ward rounds in
the hospital wing, together with education of appropriate staff.
Results: The prevalence of diabetes is currently 8.8 per cent (66/745) of
prisoners(10percent Type 1,90percent Type 2).Since2010, 90 percent
ofthepatientshavebeenreviewedandappropriatemanagementinitiated
including annual reviews. There has been a significant increase in the
uptake of retinal screening, HbA1c recording and foot examination.
Sincethisnewinitiativetodelivercareclosertohome,therehavebeenno
prisonerswhohaveneededtobeseeninthehospitalbaseddiabetesclinics
and a dramatic reduction in hospital attendances for hypoglycaemia and
diabetes related admissions with significant associated cost savings.
Conclusion: This innovative approach addresses the quality
improvement, productivity and prevention agenda and brings benefits
to the prisoners and healthcare staff.
P456
Pursuing perfection in the diabetes review
clinic
PS Grant1 and DW Lipscomb2
1
2
P457
Survey of diabetes care in university
healthcare centres in the UK
KS Myint1, P Coathup2, C Jensen1 and MJ Sampson1
1
Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS
Foundation Trust, Norwich, UK, 2University of East Anglia Health Care Centre,
Norwich, UK
DIABETICMedicine
P458
Patients views on nurse:patient diabetes
consultations in a community care setting
R Priharjo1, A McVicar2 and J Smith3
1
169
DIABETICMedicine
P460
Are we missing an opportunity in the
diabetic retinopathy clinic?
PS George1,2, G Leese1 and J Ellis2
1
2
P461
Management of diabetes in the Queen
Elizabeth Central Hospital, Blantyre,
Malawi: a comparison with the UK
A Hide
Medical Education, University of Liverpool, Liverpool, UK
covering 9,800 people with a prevalence of diabetes of 4.3 per cent; and
(2) QECH in Blantyre, the sole teaching hospital in the country
providing care to six million people in South Malawi. Management of
diabetes within the UK was taken from national and local guidelines.
Management of diabetes at QECH was observed during attendance at
diabetes clinics.
Results: The prevalence of diabetes in Malawi is currently estimated
at 5.6 per cent. Medication is expensive and stocks often run out.
Prescribing may depend on where the patient lives and how far they
are able to travel for medication rather than nationally agreed
prescribing guidelines. Investigations taken for granted in the UK, such
as HbA1c, cholesterol and lipid profiles, are not available. Patients felt
that their diabetes had a bigger impact on their lives than patients in
the UK and they had fewer opportunities for education about their
disease.
Conclusions: Management of diabetes in Malawi is affected by the
low income resource setting. Limited availability of investigations and
medications taken for granted in the UK mean that clinicians have extra
considerations when deciding on appropriate management. Patient
education and understanding about diabetes was a large factor in
suboptimal blood glucose control.
P462
Doseresponse relationship between HbA1c
and inpatient cost in Cambridgeshire:
preliminary results
D Yu1, A Aggarwal2 and D Simmons1
1
Institute of Metabolic Science, Cambridge University Hospitals NHS
Foundation Trust, Cambridge, UK, 2Rainbow Surgery, Ramsey, Huntingdon,
Cambridge, UK
170
P463
Diabetes local enhanced service in
Birmingham East and North Primary Care
Trust
SM Choudhury1, S Hussain1, GL Yao1, J Hill2, W Malik2 and
S Taheri1,3
1
College of Medical and Dental Sciences, University of Birmingham,
Birmingham, UK, 2Community Diabetes Team, Birmingham Community
Healthcare NHS Trust, Birmingham, UK, 3Heartlands Biomedical Research
Centre (HBMRC), Heart of England Foundation Trust, Birmingham, UK
P464
Use of diabetes care pathways and
ThinkGlucose toolkit in adult inpatients
ZJ Cousland, N Phelan, N Patel, A Ososanya, K DuckworthBrown, S Dissanayake and E Jude
Department of Diabetes and General Medicine, Tameside General Hospital,
Ashton-Under-Lyne, UK
DIABETICMedicine
P465
An evaluation of Diabetes Virtual Clinic
(DVC): a collaborative and integrated
service to improve diabetes care in Lambeth
RR Atkinson1,3, M Chamley1, D Karuyawasam2 and A Forbes3
1
171
DIABETICMedicine
P467
Factors which might influence the success of
GLP-1 agonist therapy in Type 2 diabetes
L Kockum, SA Ritchie, J Walker and K Adamson
Department of Diabetes, St Johns Hospital, Livingston, UK
P468
Exenatide treatment with insulin has less
improvement in glycaemic control than
without insulin but the same reduction in
weight
A Bowes, V Field, J Haviland and D Kerr
Bournemouth Diabetes and Endocrine Centre (BDEC), Royal Bournemouth
and Christchurch Hospitals NHS Trust, Bournemouth, UK
172
P469
Resource use in patients with Type 2
diabetes who initiated exenatide twice
daily or insulin therapy: six month data
from CHOICE
B Guerci1, H Sapin2, C-G Ostenson3, T Krarup4,
M Theodorakis5, M Reaney6, J Kiljanski7, C Salaun2,
S Matthaei8 and C Mathieu9
1
Diabetology, Nutrition, Metabolic Disorders, Brabois Hospital and Center of
Clinical Investigation, Yandoeuvre-Les-Nancy, France, 2Eli Lilly GmbH, Paris,
France, 3Department of Molecular Medicine and Surgery, Karolinska
Institutet, Stockholm, Sweden, 4Department of Endocrinology, Bispebjerg
Hospital, Copenhagen, Denmark, 5Department of Clinical Therapeutics,
University of Athens School of Medicine, Athens, Greece, 6Eli Lilly and
Company Ltd, Windlesham, UK, 7Eli Lilly, Warsaw, Poland, 8Diabetes-Centre
Quakenbruck, Quakenbruck, Germany, 9Department of Endocrinology, UZ
Gasthuisberg, Leuven, Belgium
(0.77), respectively. 93.8 per cent patients had at least one contact with
an HCP in 6 months pre-insulin initiation [mean (SD) 8.45 (9.19)
visits]; 93.2 per cent post-initiation [11.11 (16.75)]. Mean doses of both
treatments increased during the first 6 months post-initiation.
Conclusions: Mean resource utilisation increased following initiation
of injectable therapy. Increases in mean test strip use per week (+ 32 per
cent) and mean contacts with HCPs (+ 31 per cent) were observed in the
insulin cohort. Respective observations for the ExBID cohort were
12.7 per cent and 2.7 per cent.
P470
Exenatide therapy: proven to be effective in
weight reduction and improving glycaemic
control in people with Type 2 diabetes on
insulin
H Rachabattula1, R Mukhtar2 and T Robinson3
1
P471
Replacing insulin with exenatide in a South
Asian population group with Type 2
diabetes
R Agha-Jaffar and KA Steer
Diabetes and Endocrinology, Northwick Park Hospital, Northwest London
Hospitals NHS Trust, London, UK
DIABETICMedicine
P472
High prevalence of vitamin B12 deficiency in
patients on metformin based treatment:
data from the Teesside Anaemia in Diabetes
Study
S Nag, M Bilous, S Winship, R Bilous and S Jones
Diabetes and Endocrinology, James Cook University Hospital, Middlesbrough,
UK
173
DIABETICMedicine
P474
Characteristics of patients surviving
50 years or more with diabetes
S Mehmet and S Ibrahim
Diabetes Centre, Queen Marys Hospital, South London Healthcare NHS
Trust, London, UK
P475
Responders to insulin therapy at 18 months
among adults with newly diagnosed Type 1
diabetes: which insulin regimen should we
start?
H Tate1, A Pillai1, G Thomson1,2, DJ Fernando1,2 and I Idris1,3
1
Diabetes and Endocrinology, Sherwood Forest Hospitals Foundation Trust,
UK, 2Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield,
UK, 3School of Graduate Entry Medicine, University of Nottingham,
Nottingham, UK
174
P476
Audit on the acute management of diabetic
ketoacidosis in adults at Scunthorpe
General Hospital
V Singh, A Modi, P Dromgoole, M Malik and A Elmalti
Department of Diabetes and Endocrinology, Scunthorpe General Hospital,
Scunthorpe, UK
P477
The impact of continuous subcutaneous
insulin infusion in patients with Type 1
diabetes
M Shanmugasundaram1, MA Karamat1, J Hand2, A Field2,
MH Charlton2 and P Dyer2
1
Medical School, University of Birmingham, Birmingham, UK, 2Diabetes
Centre, Heart of England NHS Foundation Trust, Birmingham, UK
DIABETICMedicine
before and after initiation of CSII therapy, from hospital records and
Clarks questionnaires respectively.
Results: Mean age of the patients was 41.7 12.6 years, duration of
diabetes was 23.2 11.6 years, and 36 per cent of the patients were
male. Thirty-one (43 per cent) patients were initiated on CSII due to
hypoglycaemia, 32 (44.5 per cent) for poor glycaemic control and nine
(12.5 per cent) for both. The average number of years on CSII was
3.4 2.6. There was significant improvement in glycaemic control
before and after CSII therapy initiation (8.7 1.74 per cent vs.
8.1 1.4 per cent respectively, P = 0.02). Sub-analysis showed
patients with worse glycaemic control (HbA1c 8.5 per cent) did
best, with a mean HbA1c of 10.4 1.38 per cent before and
9.3 1.43 per cent after CSII therapy initiation (P = 0.02). Clark
questionnaires were available for 30 patients before and 53 after CSII
therapy. We found a trend towards improvement in hypoglycaemia
awareness (9 per cent vs. 17 per cent), and a reduction in the rate of
moderate hypoglycaemia (40 per cent vs. 24.5 per cent) before and after
CSII initiation respectively. These did not reach significance.
Conclusion: This audit found a significant improvement in glycaemic
control with use of CSII therapy. Initiation of CSII also led to reduced
rates of moderate hypoglycaemia and improved hypoglycaemia
awareness. We would like to improve our services further and reaudit after a year.
P480
Complication status of patients with a new
diagnosis of Type 2 diabetes in South
London, UK
K Winkley1, S Sivaprasad2, D Stahl3, S Thomas4, K Ismail1 and
SA Amiel5
1
Psychological Medicine, Kings College London and Institute of Psychiatry,
London, UK, 2Opthalmology, Kings College Hospital NHS Foundation Trust,
London, UK, 3Biostatistics, Kings College London and Institute of Psychiatry,
London, UK, 4Diabetes, Guys and St Thomas NHS Foundation Trust,
London, UK, 5Diabetes and Nutritional Sciences, Kings College London,
London, UK
P479
Changes in early drug treatment for Type 2
diabetes in Scotland
HC Looker
Population Health Sciences, University of Dundee, Dundee, UK
P481
Clinical inertia in people with Type 2
diabetes before insulin initiation in routine
clinical practice in the UK versus a global
cohort: baseline data from the SOLVETM
study
J Vora1, K Khunti2, J-F Yale3 and LF Meneghini4
1
Department of Diabetes and Endocrinology, Royal Liverpool University
Hospitals NHS Trust, Liverpool, UK, 2Department of Health Sciences,
University of Leicester, Leicester, UK, 3McGill Nutrition and Food Science
Centre, Royal Victoria Hospital, Montreal, Canada, 4Diabetes Research
Institute, University of Miami Miller School of Medicine, Miami, USA
175
DIABETICMedicine
P482
Investigation of the effects of bariatric
surgery on the microvascular complications
of Type 2 diabetes
LL Chuah, A Mohite, S Faruq, P Shah, A Miras and C Le Roux
Imperial Weight Centre, Imperial College Healthcare NHS Trust, London, UK
P483
A cross-sectional audit into insulin
prescription and concordance with National
Institute of Health and Clinical Excellence
(NICE) guidance for Type 2 diabetics on longacting analogue insulin
TJ Fox and DE Flanagan
Diabetes and Endocrinology, Plymouth Hospital NHS Trust, Plymouth, UK
Aims: NICE guidance from 2009 (Clinical Guidance 87) specifies that
patients with Type 2 diabetes should be treated with natural protamine
Hagedon (NPH) insulin initially. Long-acting insulin analogues
(detemir and glargine) should be used second-line in specific
circumstances only. We undertook a cross-sectional audit of 100
patients to establish the degree to which we are adhering to the NICE
guidelines for Type 2 diabetes with regard to analogue insulin
prescribing. In those cases in which an analogue insulin was
prescribed we aimed to establish if there was a justifiable reason
documented for non-concordance.
Methods: Clinic correspondence for the last 100 patients was
examined and patients with Type 2 diabetes on long-acting insulin
were identified. Patients on pre-mixed insulin were excluded following
the discontinuation of Mixtard since the publication of the guidance.
Data on age, gender, body mass index (BMI), duration of diabetes and
treatment were recorded.
Results: A hundred patients (43 female, 57 male) with a mean age of
59.2 years, mean BMI of 33.7 kg/m2 and mean duration of diabetes
13 years were studied. 17 per cent were treated with NPH insulin in
176
line with NICE guidance. 37 per cent were treated with insulin
glargine and 46 per cent with detemir. Of those treated with analogue
insulin 16/73 (19 per cent) had no documented reason for nonconcordance.
Conclusion: Although our use of analogue insulin was high the
majority of patients had a recognised indication for this such as frequent
hypoglycaemia or need for once-daily insulin or a basalbolus regimen.
This may reflect the complex nature of the patients managed in
secondary care.
P484
Conversion time to insulin in patients with
Type 2 diabetes
M Ahmad, M Jabeen and A Ahmad
Diabetes and Endocrinology, Royal Liverpool University Hospital, Liverpool,
UK
Aim: The average time taken to convert Type 2 diabetes patients with
HbA1c 7 per cent from oral hypoglycaemic agents (OHGAs) to
insulin therapy was reported to be 9.6 years, increasing risk of
complications. Our aim was to investigate and improve the time
taken to initiate insulin and improve HbA1c.
Method: In 2007 (JanuaryMarch), we selected 100 consecutive
Type 2 diabetes patients on insulin referred to the Royal Liverpool
University Hospital diabetes clinic within the last 10 years. The data
collected were the times taken to initiate insulin from the date of
referral. Recommendations were then put in place in 2007 to reduce
the time to initiate insulin. In 2011 (JanuaryMarch) another sample
of 100 patients on one OHGA referred to the clinic after 2007 was
reviewed.
Results: The time taken to initiate insulin in patients reviewed in 2007
was 7.6 1.1 (mean SEM) years. The recommendation made was
to add and maximise OHGAs every 4 months if HbA1c remained 7
per cent aiming to initiate insulin within 1824 months. From 2007 to
2011, 70 per cent were initiated on insulin within 2 years with 60 per
cent of these showing a mean HbA1c reduction of 1.3 per cent over
2 years. 10 per cent had optimal glycaemic control on two or more
OHGAs while the remaining 20 per cent had HbA1c 7 per cent
awaiting insulin start.
Conclusion: Although the time to convert patients to insulin therapy
before the recommendations were put in place was better than previous
reports, it was not optimal. After the recommendations were
implemented patients were converted to insulin three times faster
with the majority showing improvement in HbA1c over a shorter
period.
P485
Barriers to insulin therapy in people with
Type 2 diabetes: a qualitative exploration of
attitudes in a multi-ethnic population
N Patel1, MA Stone1, H Eborall1, C McDonough1, MJ Davies2
and K Khunti1
1
DIABETICMedicine
177