Consensus meeting on reporting glycated haemoglobin (HbA1c) and estimated average glucose (eAG) in the UK: report to the National Director for Diabetes, Department of Health

2008 ◽  
Vol 25 (4) ◽  
pp. 381-382 ◽  
Author(s):  
J. H. Barth ◽  
S. M. Marshall ◽  
I. D. Watson
2022 ◽  
Vol 8 ◽  
pp. 205520762110593
Author(s):  
Tim Robbins ◽  
Adam Hopper ◽  
Jack Brophy ◽  
Elle Pearson ◽  
Risheka Suthantirakumar ◽  
...  

Background COVID-19 placed significant challenges on healthcare systems. People with diabetes are at high risk of severe COVID-19 with poor outcomes. We describe the first reported use of inpatient digital flash glucose monitoring devices in a UK NHS hospital to support management of people with diabetes hospitalized for COVID-19. Methods Inpatients at University Hospitals Coventry & Warwickshire (UHCW) NHS Trust with COVID-19 and diabetes were considered for digitally enabled flash glucose monitoring during their hospitalization. Glucose monitoring data were analysed, and potential associations were explored between relevant parameters, including time in hypoglycaemia, hyperglycaemia, and in range, glycated haemoglobin (HbA1c), average glucose, body mass index (BMI), and length of stay. Results During this pilot, digital flash glucose monitoring devices were offered to 25 inpatients, of whom 20 (type 2/type 1: 19/1; mean age: 70.6 years; mean HbA1c: 68.2 mmol/mol; mean BMI: 28.2 kg/m2) accepted and used these (80% uptake). In total, over 2788 h of flash glucose monitoring were recorded for these inpatients with COVID-19 and diabetes. Length of stay was not associated with any of the studied variables (all p-values >0.05). Percentage of time in hyperglycaemia exhibited significant associations with both percentage of time in hypoglycaemia and percentage of time in range, as well as with HbA1c (all p-values <0.05). The average glucose was significantly associated with percentage of time in hypoglycaemia, percentage of time in range, and HbA1c (all p-values <0.05). Discussion We report the first pilot inpatient use of digital flash glucose monitors in an NHS hospital to support care of inpatients with diabetes and COVID-19. Overall, there are strong arguments for the inpatient use of these devices in the COVID-19 setting, and the findings of this pilot demonstrate feasibility of this digitally enabled approach and support wider use for inpatients with diabetes and COVID-19.


Genes ◽  
2021 ◽  
Vol 12 (7) ◽  
pp. 991
Author(s):  
Erik Widen ◽  
Timothy G. Raben ◽  
Louis Lello ◽  
Stephen D. H. Hsu

We use UK Biobank data to train predictors for 65 blood and urine markers such as HDL, LDL, lipoprotein A, glycated haemoglobin, etc. from SNP genotype. For example, our Polygenic Score (PGS) predictor correlates ∼0.76 with lipoprotein A level, which is highly heritable and an independent risk factor for heart disease. This may be the most accurate genomic prediction of a quantitative trait that has yet been produced (specifically, for European ancestry groups). We also train predictors of common disease risk using blood and urine biomarkers alone (no DNA information); we call these predictors biomarker risk scores, BMRS. Individuals who are at high risk (e.g., odds ratio of >5× population average) can be identified for conditions such as coronary artery disease (AUC∼0.75), diabetes (AUC∼0.95), hypertension, liver and kidney problems, and cancer using biomarkers alone. Our atherosclerotic cardiovascular disease (ASCVD) predictor uses ∼10 biomarkers and performs in UKB evaluation as well as or better than the American College of Cardiology ASCVD Risk Estimator, which uses quite different inputs (age, diagnostic history, BMI, smoking status, statin usage, etc.). We compare polygenic risk scores (risk conditional on genotype: PRS) for common diseases to the risk predictors which result from the concatenation of learned functions BMRS and PGS, i.e., applying the BMRS predictors to the PGS output.


2020 ◽  
Vol 9 (2) ◽  
pp. e000756
Author(s):  
Yu Zhen Lau ◽  
Kate Widdows ◽  
Stephen A Roberts ◽  
Sheher Khizar ◽  
Gillian L Stephen ◽  
...  

IntroductionThe UK Department of Health have targeted a reduction in stillbirth by 50% by 2025; to achieve this, the first version of the Saving Babies’ Lives Care Bundle (SBLCB) was developed by NHS England in 2016 to improve four key areas of antenatal and intrapartum care. Clinical practice guidelines are a key means by which quality improvement initiatives are disseminated to front-line staff.MethodsSeventy-five clinical practice guidelines covering the four areas of antenatal and intrapartum care in the first version of SBLCB were obtained from 19 maternity providers. The content and quality of guidelines were evaluated using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Maternity health professionals in participating organisations were invited to participate in an anonymous survey to determine perceptions toward and experiences of the use of clinical practice guidelines using a series of Likert scales.ResultsUnit guidelines showed considerable variation in quality with median scores of 50%–58%. Only 4 (5.6%) guidelines were recommended for use in clinical practice without modifications, 54 (75.0%) were recommended for use subject to modifications and 12 (16.7%) were not recommended for use. The lowest scoring domains were ‘rigour of development’, ‘stakeholder involvement’ and ‘applicability’. A significant minority of unit guidelines omitted recommendations from national guidelines. The majority of staff believed that clinical practice guidelines standardised and improved the quality of care but over 30% had insufficient time to use them and 24% stated they were unable to implement recommendations.ConclusionTo successfully implement initiatives such as the SBLCB change is needed to local clinical practice guidelines to reduce variation in quality and to ensure they are consistent with national recommendations . In addition, to improve clinical practice, adequate time and resources need to be in place to deliver and evaluate care recommended in the SBLCB.


2009 ◽  
Vol 91 (8) ◽  
pp. 283-283 ◽  
Author(s):  
Margaret Wilson

The National Advice Centre for Postgraduate Dental Education (NACPDE) was founded in 1978 and is based in the Faculty of Dental Surgery of The Royal College of Surgeons of England and funded by the Department of Health. The UK has traditionally played an important part in providing clinical training and postgraduate education for dentists from all parts of the world. But it is equally important to recognise the contribution oversea-strained dentists have made to the NHS.


2009 ◽  
Vol 91 (8) ◽  
pp. 641-644 ◽  
Author(s):  
TD Reid ◽  
LJ Finney ◽  
AR Hedges

INTRODUCTION Timing of intervention in symptomatic carotid disease is critical. The UK Department of Health's National Stroke Strategy published in December 2007 recommends urgent carotid intervention within 48 h, in appropriate patients, who have suffered a transient ischaemic attack (TIA), amaurosis fugax or minor stroke. Despite the running of a rapid-access clinic for patients with symptoms of TIA, the time from symptom to surgery is rarely less than 2 weeks. To date, there has been little published research on the UK public response to the symptoms of TIA, and no study at all of the response of primary care to such patients. The aim of this study was to ascertain both these responses to see whether a 48-h target is achievable. PATIENTS AND METHODS A total of 402 men attending our aortic aneurysm screening sessions were asked to complete a questionnaire requesting their most likely response to an episode of amaurosis fugax or TIA. All 45 GP practices in the hospital catchment area were asked how they would respond to patients requesting to be seen with the symptoms used in the questionnaire. RESULTS Nearly one in six patients would ignore the symptom unless it recurred, approximately half would request a GP appointment and a third would see an optician if they had amaurosis fugax. The mean waiting time to see a GP was 2 days for a routine appointment and within 24 h for an emergency appointment. CONCLUSIONS It is clear that a significant number of people would ignore the first symptom of carotid ischaemia; for those with amaurosis fugax, nearly a third would initially seek help from their optician. Those given a routine GP appointment would have to wait a minimum of 2 days. If the Department of Health is serious about reducing the incidence of stroke and introducing a target of 48 h from symptom to treatment, then there needs to be a wide-spread public and healthcare education programme, in particular alerting opticians and GP receptionists that these symptoms constitute a medical emergency.


2006 ◽  
Vol 30 (6) ◽  
pp. 229-231 ◽  
Author(s):  
Sanju George ◽  
Bill Calthorpe ◽  
Sudhir Khandelwal

The NHS International Fellowship Scheme for consultants offers overseas consultants, in specialties including psychiatry, an opportunity to work in the UK (Goldberg, 2003). This was launched by the Department of Health in 2002 and so far over 100 consultant psychiatrists have been recruited. However, there are several aspects of the project that are unclear. How long will this recruitment continue? Are there any arrangements in place to encourage overseas consultants to return to their home country at the end of their fellowship? Are they eligible to train senior house officers (SHOs) and specialist registrars (SpRs)? Will the recruitment under the scheme have an impact on job opportunities for SpRs currently training in the UK? Why is membership of the Royal College of Psychiatrists being granted to the newly recruited consultants without an examination? These and many more concerns have arisen in the wake of this scheme. In this article, we evaluate the scheme, discuss its implications and suggest possible ways forward.


Legal Studies ◽  
2007 ◽  
Vol 27 (3) ◽  
pp. 511-535 ◽  
Author(s):  
Ryan Morgan

Much of the legal attention surrounding human embryonic stem (ES) cell research within the UK has, to date, focused on cloning techniques. Whilst this is both understandable and appropriate given litigation on this topic, there has been less focus on other areas. This paper identifies and analyses areas of incoherence and deficiency within the regulatory architecture governing human ES cell derivation and research within the UK. This is not merely a theoretical exercise, as there are indications that many of the policy objectives currently being pursued in this area have, at best, a shaky jurisdictional basis. It is all too easy to recall that lobby groups have challenged the Human Fertilisation and Embryology Act 1990, the legislative foundation for embryo research and most infertility treatment, on the basis of jurisdictional uncertainty and statutory interpretation. Whilst many pro-life campaigners are opposed to ES cell research on ethical grounds, the arguments utilised thus far in relation to litigation have been entirely legal, involving issues of statutory interpretation and whether the regulator, the Human Fertilisation and Embryology Authority (HFEA), or the Department of Health have acted ultra vires the 1990 Act. This paper will reveal that there are a number of further areas which might be open to attack on this basis.


2020 ◽  
Author(s):  
Marit de Jong ◽  
Mark Woodward ◽  
Sanne A.E Peters

<b>Objective:</b> Diabetes has shown to be a stronger risk factor for myocardial infarction (MI) in women than men. Whether sex differences exist across the glycaemic spectrum is unknown. We investigated sex differences in the associations of diabetes status and glycated haemoglobin (HbA1c) with the risk of MI. <br> <b>Research Design and Methods:</b> Data were used from 471,399 (56% women) individuals without cardiovascular disease (CVD) included in the UK Biobank. Sex-specific incidence rates were calculated by diabetes status and across levels of HbA1c, using Poisson regression. Cox proportional hazards analyses estimated sex-specific hazard ratios (HR) and women-to-men ratios by diabetes status and HbA1c for MI during a mean follow-up of 9 years. <br> <b>Results:</b> Women had lower incidence rates of MI than men, regardless of diabetes status or HbA1c level. Compared with individuals without diabetes, prediabetes, undiagnosed diabetes, and previously diagnosed diabetes were associated with increased risk of MI in both sexes. Previously diagnosed diabetes was more strongly associated with MI in women (HR 2∙33 [95%CI 1∙96;2∙78]) than men (1∙81 [1∙63;2∙02]), with a women-to-men ratio of HRs of 1∙29 (1∙05;1∙58). Each 1% higher HbA1c, independent of diabetes status, was associated with an 18% greater risk of MI in both women and men.<br> <b>Conclusions:</b> Although the incidence of MI was higher in men than women, the presence of diabetes is associated with a greater excess relative risk of MI in women. However, each 1% higher HbA1c was associated with an 18% greater risk of MI in both women and men.<br> <br>


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