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Aims/hypothesisThe aim of this work was to describe the clinical characteristics of adults with type 1 diabetes admitted to hospital and the risk factors associated with severe coronavirus disease-2019 (COVID-19) in the UK.MethodsA retrospective cohort study was performed using data collected through a nationwide audit of people admitted to hospital with diabetes and COVID-19, conducted by the Association of British Clinical Diabetologists from March to October 2020. Prespecified demographic, clinical, medication and laboratory data were collected from the electronic and paper medical record systems of the participating hospitals by local clinicians. The primary outcome of the study, severe COVID-19, was defined as death in hospital and/or admission to the adult intensive care unit (AICU). Logistic regression models were used to generate age-adjusted ORs.ResultsForty UK centres submitted data. The final dataset included 196 adults who were admitted to hospital and had both type 1 diabetes and COVID-19 on admission (male sex 55%, white 70%, with mean [SD] age 62 [19] years, BMI 28.3 [7.3] kg/m2 and last recorded HbA1c 76 [31] mmol/mol [9.1 (5.0)%]). The prevalence of pre-existing microvascular disease and macrovascular disease was 56% and 39%, respectively. The prevalence of diabetic ketoacidosis on admission was 29%. A total of 68 patients (35%) died or were admitted to AICU. The proportions of people that died were 7%, 38% and 38% of those aged <55, 55–74 and ≥75 years, respectively. BMI, serum creatinine levels and having one or more microvascular complications were positively associated with the primary outcome after adjusting for age.Conclusions/interpretationIn people with type 1 diabetes and COVID-19 who were admitted to hospital in the UK, higher BMI, poorer renal function and presence of microvascular complications were associated with greater risk of death and/or admission to AICU. Risk of severe COVID-19 is reassuringly very low in people with type 1 diabetes who are under 55 years of age without microvascular or macrovascular disease.In people with Type 1 diabetes and COVID-19 admitted to hospital in the UK, BMI and one or more microvascular complications had a positive association and low serum creatine levels had a negative association with death/admission to intensive care unit after adjusting for age.

This study aims to estimate the budget impact of increased uptake of the FreeStyle Libre Flash Glucose Monitoring system in people with type 1 diabetes mellitus (T1DM) in the UK. A budget impact model was developed, applying real-world data collected in the Association of British Clinical Diabetologists (ABCD) FreeStyle Libre Nationwide Audit. Costs of diabetes glucose monitoring in a T1DM population (n=1790) using self-monitoring of blood glucose (SMBG) or the FreeStyle Libre system were compared with a scenario with increased use of the FreeStyle Libre system. The ABCD audit demonstrates FreeStyle Libre system use reduces diabetes-related resource utilization. The cost analysis found that higher acquisition costs are offset by healthcare costs avoided (difference £168 per patient per year (PPPY)). Total costs were £1116 PPPY with FreeStyle Libre system compared with £948 PPPY with SMBG. In an average-sized UK local health economy, increasing FreeStyle Libre system uptake from 30% to 50% increased costs by 3.4% (£1 787 345-£1 847 618) and when increased to 70% increased by a further 3.3%. Increased uptake of the FreeStyle Libre system in the T1DM population marginally increases the cost to UK health economies and offers many system benefits.

Introduction The syndrome of inappropriate antidiuresis (SIAD) is the commonest cause of euvolaemic hyponatraemia in patients admitted to hospital. The mortality after discharge from hospital has not been previously studied in patients with SIAD. Aims To compare mortality in patients with SIAD and those with kidney injury (KI). To identify underlying diagnoses associated with deaths due to SIAD. Methods Single-centre retrospective cohort analyses of 804 patients with severe hyponatraemia over a 3-year period. Five-year survival data in patients with SIAD and those with KI were compared. The underlying diagnoses that contributed to SIAD in this cohort were analysed using ICD-10 codes. Results 202 patients had SIAD using biochemical cut-off parameters; 248 patients had KI. Patient with KI had a statistically significant (log-rank p<0.0001) shorter median survival time (2.24 months (95% CI 1.3 to 4.3)) compared with those with SIAD (31.0 months (95% CI 21.6 to 54.8)). 53.8% (n=78) of patients with hyponatraemia due to SIAD died within the first year after admission; the corresponding figure for those presenting with KI was 74.1% (n=166). Five years after admission, 80.8% (n=117) of those with SIAD had died; the corresponding figure for those with KI was 88.4% (n=200). In those patients with SIAD that died within the first year, malignancy appeared to be the most common cause (25.4%) followed by infection (23.8%). Conclusions Severe hyponatraemia in SIAD carries a high mortality after discharge, and although this seems often to be attributable to the underlying cause, the extent to which treatment with V2-recptor antagonists may help to correct the hyponatraemia associated with SIAD and influence the medium-to-long-term outcome in such patients is worthy of further study.

An Aid to the MRCP PACES Volume 3: Station 5 is a brand new, fully updated edition of the best-selling PACES revision guide to address the newest Station, covering Integrated Clinical Assessment, with content guided by the experiences of PACES candidates. The cases and scenarios have been written in accordance with the latest examining and marking schemes used for the exam providing an invaluable training and revision aid for all MRCP PACES candidates. In order to fully support candidates taking the exam, this trilogy of best-selling revision aids is now presented as: An Aid to the MRCP PACES Volume 1: Stations 1 and 3, Fourth Edition 9780470655092 An Aid to the MRCP PACES Volume 2: Stations 2 and 4, Fourth Edition 9780470655184 An Aid to the MRCP PACES Volume 3: Station 5, Fourth Edition 9781118348055.

Objective To understand the ethnic differences in coronary heart disease risk among inpatients with diabetes following acute coronary syndrome. Design Single-centre retrospective cohort-analysis of patients with type II diabetes over a six-year period receiving standard care. Setting Birmingham, UK. Participants One thousand and one hundred and five patients with type II diabetes from a multi-ethnic background. Main outcome measures Odds ratios of coronary heart disease events among three ethnic groups. Results The prevalence of coronary heart disease events was 20.7% in Asian, 13.2% in Caucasian and 7.7% in Afro-Caribbean patients. Asian patients were younger at diagnosis of diabetes (−5.1 years p < 0.001 versus Afro-Caribbeans and −7.1 years p < 0.001 versus Caucasians). The mean number of events was highest amongst Asian (1.2) compared to Caucasian (1.1) and Afro-Caribbean (1.0) patients (p = 0.04). The mean age at first event was 61.3 years for Asians, 62.5 years and 65.8 for Afro-Caribbeans and Caucasians, respectively (analysis of variance F[2,131] = 2.36 p = 0.09). Un-adjusted odds ratios for at least one coronary heart disease event were highest among Asian men (OR 5.04; 95% CI 2.31–11.01; p < 0.0001) with Afro-Caribbean women as baseline (OR 1.0). The odds ratios remain largely unchanged (1.0 Afro-Caribbeans [baseline], 1.27 [p = 0.56] Caucasians and 3.2 [p = 0.001] for Asians) when corrected for age, gender, duration of diabetes, insulin dependency, mean low-density lipoprotein-cholesterol, triglycerides and high-density lipoprotein-cholesterol, mean glycated haemoglobin, mean systolic and diastolic blood pressure (logistic regression; ROC: 79% AUC). Afro-Caribbean patients had the highest mean high-density lipoprotein-cholesterol (1.6 mmol/L) and the lowest risk for coronary heart disease events. Conclusions Asian patients were younger at their first event and diagnosed earlier with diabetes. Asian men had the highest risk of coronary heart disease event which correlated with the lowest levels of high-density lipoprotein-cholesterol.

Abstract Disclosure: H. Deshmukh: HD has received travel award from Abbott to present at various meetings. E. Wilmot: E.G.W. has received personal fees from Abbott, AstraZeneca, Dexcom, Eli Lilly, Embecta, Insulet, Medtronic, Novo Nordisk, Roche, Sanofi, Sinocare, and Ypsomed and research support from Abbott, Embecta. C. Walton: C.W. has a spouse/partner serving on the advisory panel for Celgene and on the speakers bureaus for LEO Pharma and Novartis. R. Ryder: R.E.J.R. serves on the advisory panel for Novo Nordisk and on the speakers bureau for BioQues. T. Sathyapalan: . T.S. serves on the speakers bureau for Novo Nordisk Foundation. Background: The objective of this study was to study the association between coefficient of variation (CV), a measure of glycemic variability, with diabetes-related distress and hypoglycaemia awareness in people living with type 1 diabetes Methods: We used data from the Association of British Clinical Diabetologist FreeStyle Libre audit. Regression models were performed to explore associations between CV, diabetes-related distress, hypoglycaemia awareness (Gold Score), adjusting for clinical characteristics such as age, gender, BMI, and diabetes duration. Results: The study consisted of 162 participants with a mean age 48.3 (17.9) years and a mean duration of diabetes 17.5(13.6) years. The mean CV was 34.4(8.9)% with 55.2% of participants demonstrating a CV below 36%. The CV was significantly correlated with Gold score (r2 = 0.239, p = 0.003) but not with diabetes related distress (P=0.5). Regression analysis showed that higher CV was associated with higher Gold score (β = 0.031, p = 0.017). For diabetes-related distress, CV demonstrated a borderline association (β = 0.019, p = 0.060). Conclusions: These real-world data show that CV is associated with hypoglycaemia awareness. These findings underscore the importance of glycaemic variability in optimizing diabetes in clinical practice. Presentation: Monday, July 14, 2025

This new edition of An Aid to the MRCP Paces Volume 2: Stations 2 and 4 has been fully revised and updated, and reflects feedback from PACES candidates as to which cases frequently appear in each station. The cases and scenarios have been written in accordance with the latest examining and marking schemes used for the exam providing an invaluable training and revision aid for all MRCP PACES candidates.

An Aid to the MRCP PACES Volume 3: Station 5 is a brand new, fully updated edition of the best-selling PACES revision guide to address the newest Station, covering Integrated Clinical Assessment, with content guided by the experiences of PACES candidates.The cases and scenarios have been written in accordance with the latest examining and marking schemes used for the exam providing an invaluable training and revision aid for all MRCP PACES candidates.In order to fully support candidates taking the exam, this trilogy of best-selling revision aids is now presented as:An Aid to the MRCP PACES Volume 1: Stations 1 and 3, Fourth Edition9780470655092An Aid to the MRCP PACES Volume 2: Stations 2 and 4, Fourth Edition9780470655184An Aid to the MRCP PACES Volume 3: Station 5, Fourth Edition9781118348055

An Aid to the MRCP PACES Volume 3: Station 5 is a brand new, fully updated edition of the best-selling PACES revision guide to address the newest Station, covering Integrated Clinical Assessment, with content guided by the experiences of PACES candidates. The cases and scenarios have been written in accordance with the latest examining and marking schemes used for the exam providing an invaluable training and revision aid for all MRCP PACES candidates. In order to fully support candidates taking the exam, this trilogy of best-selling revision aids is now presented as: An Aid to the MRCP PACES Volume 1: Stations 1 and 3, Fourth Edition 9780470655092 An Aid to the MRCP PACES Volume 2: Stations 2 and 4, Fourth Edition 9780470655184 An Aid to the MRCP PACES Volume 3: Station 5, Fourth Edition 9781118348055