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Diabet. Med. 29, 662-669 (2012) Abstract Aims To assess the numeracy and literacy skills of individuals with Type 1 diabetes and determine if there is a relationship with achieved glycaemic control independent of their duration of diabetes, diabetes education, demographic and socio-economic factors. Methods One hundred and twelve patients completed the study (mean current age 43.8 ± 12.5 years, 47% male, mean duration of diabetes 22.0 ± 13.2 years) out of 650 randomly selected patients from the Bournemouth Diabetes and Endocrine Centre's diabetes register. The Skills for Life Initial Assessments were used to measure numeracy and literacy. These indicate skills levels up to level 2, equivalent to the national General Certificate of Secondary Education grades A*-C. HbA1c was also measured. Pearson's correlation was used to measure the correlation of numeracy and literacy scores with HbA1c. To compare mean HbA1c between those with or without level 2 skills, t-tests were used, and multiple linear regression was used to investigate whether any differences were independent of duration of diabetes, diabetes education, demographic and socio-economic factors. Results Literacy was not associated with achieved HbA1c. In contrast, participants with numeracy skills at level 2 or above achieved an HbA1c lower than those with numeracy skills below level 2 ( P = 0.027). Although higher socio-economic status was associated with lower mean HbA1c, the relationship between numeracy and HbA1c appeared to be independent of socio-economic factors. Conclusions Low numeracy skills were adversely associated with diabetes control. Assessment of numeracy skills may be relevant to the structure of diabetes education programmes. [ABSTRACT FROM AUTHOR]

Background: In 1999, 270,000 cases of cancer were registered in the United Kingdom, placing a large burden on the NHS. Cancer outcome data in 1999 suggested that UK survival rates were poorer than most other European countries. In the same year, a Department of Health review noted that clinical trials accrual was poor (<3.5% of incident cases) and hypothesised that increasing research activity might improve outcomes and reduce the variability of outcomes across England. Thus, the National Cancer Research Network (NCRN) was established to increase participation in cancer clinical research.Methods: The NCRN was established in 2001 to provide a robust infrastructure for cancer clinical research and improvements in patient care. Remit of NCRN is to coordinate, support and deliver cancer clinical research through the provision of research support staff across England. The NCRN works closely with similar networks in Scotland, Wales and the Northern Ireland. A key aim of NCRN is to improve the speed of research and this was also assessed by comparing the speed of study delivery of a subset of cancer studies opening before and after NCRN was established.Results: Patient recruitment increased through NCRN, with almost 32,000 (12% of annual incident cases) cancer patients being recruited each year. Study delivery has improved, with more studies meeting the recruitment target - 74% compared with 39% before NCRN was established.Conclusion: The coordinated approach to cancer clinical research has demonstrated increased accrual, wide participation and successful trial delivery, which should lead to improved outcomes and care. [ABSTRACT FROM AUTHOR]

Aim The aim of the present study was to determine the prevalence of anxiety and depression in a large UK group of people with Type 1 diabetes. Methods Patients aged 16–60 years were invited to complete self-report questionnaires when they attended outpatient clinic appointments. HbA1c was recorded from the clinic database. Results Analysis was based on 273 complete questionnaires. The mean scores for both anxiety (mean 6.4,sd 4.5) and depression (mean 3.4,sd 3.5) were consistent with normative data. Females reported significantly higher mean anxiety than males, although neither reached the criterion for ‘caseness’. Significant differences to the norm were observed for the percentages reporting moderate to severe levels of depression in males (χ2 = 6.44; d.f. = 2; P = 0.04) and moderate to severe levels of anxiety in females (χ2 = 7.47; d.f. = 2; P = 0.02). HbA1c was positively correlated with HADS scores (anxiety r = 0.2, P = 0.001, depression r = 0.14, P = 0.02). Conclusions While there is no significant difference in the mean anxiety or depression in this cohort compared with those reported for a non-diabetic, healthy population, the results suggest that there is an increased prevalence of clinically relevant anxiety in females and of depression in males with Type 1 diabetes when compared with the normative data. [ABSTRACT FROM AUTHOR]

Alcohol and hypoglycaemia independently affect cognitive function. This may be relevant for insulin-treated diabetic patients who drive motor vehicles. The aim of this study was to examine the effect of mild hypoglycaemia (2.8 mmol/l) with modest alcohol intoxication (levels below UK driving limits) on intellectual performance in patients with Type 1 diabetes. A hyperinsulinaemic glucose clamp (60 mU/m2) was used to study 17 subjects [age 35 ± 8 years, HbA1c 8.1 ± 1.4% (mean ±  sd)] on four occasions: (A) euglycaemia (4.5 mmol/l) with placebo, (B) euglycaemia with alcohol, (C) hypoglycaemia (2.8 mmol/l) with placebo, and (D) hypoglycaemia with alcohol. Cognitive performance was assessed using four-choice reaction time (4CRT, primary outcome), measurements of general intellectual skills [trail making B (TMB) and digit symbol substitution (DSST)], and visual information processing [visual change detection (VCD)]. A test related to driving performance (hazard perception) was also used. In experiments B and D the average blood alcohol level was 43 mg/dl. This was associated with deterioration in 4CRT {+ 35 ms [95% confidence interval (CI) 20, 50]} and TMB, whereas hypoglycaemia without alcohol increased 4CRT only [+ 39 ms (95% CI 5, 73)]. However, when alcohol was combined with hypoglycaemia, there was marked deterioration in all the cognitive function tests [4CRT 74 ms (95% CI 35, 113), TMB, DSST and VCD]. Hazard perception was not affected. The effect of alcohol was no different in euglycaemia than in hypoglycaemia, i.e. there was no interaction. Whereas hypoglycaemia did not reduce the likelihood that the subjects would drive, alcohol did. The cumulative effect of alcohol and hypoglycaemia on cognitive function together has implications for driving in patients with Type 1 diabetes. Both independently impair cognitive function and together the effects are additive. Patients with Type 1 diabetes should be educated about hypoglycaemia and driving and should avoid alcohol completely if planning to drive. Diabet. Med. 21, 230–237 (2004) [ABSTRACT FROM AUTHOR]

Objective: To compare two regimens of intra-arterial chemotherapy for the treatment of hepatic metastases from colorectal cancer. Design: Open study. Setting: Teaching hospital, UK Subjects: 57 patients with unresectable metastases confined to the liver, and an indwelling catheter in the hepatic artery. Interventions: The first 33 patients had a 24-hour intra-arterial infusion of 5-fluorouracil (5-FU) 1500 mg/m[sup 2], together with folinic acid 200 mg/m[sup 2] intravenously for the first and last two hours of the 5-FU infusion. This was repeated at weekly intervals for six weeks followed by a two-week gap before the next cycle. The remaining 24 patients had a two-weekly regimen in which folinic acid 200 mg/m[sup 2] was infused intravenously over 2 hours followed by an intra-arterial loading dose of 5-FU 400 mg/m[sup 2] over 15 minutes; 5-FU 1600 mg/m[sup 2] was then given by intra-arterial infusion over 22 hours. This was repeated on day 2 and then at two-weekly intervals. Main outcome measures: Response rate and toxicity. Results: Median follow-up was 21 months, and estimated median survival 19 months. 29 patients (51%) have responded, 5 completely. There are no significant differences between the groups. Sites of progression were liver alone 26 (53%), lung alone 9 (18%), liver and lung 3 (6%), and the remainder in local or regional nodes (n = 7) or bone (n = 4). Six patients experienced WHO grade 3 or 4 toxicity. Conclusion: The two regimens have high response rates and cause little systemic toxicity. Intra-arterial chemotherapy for hepatic metastases from colorectal cancer is currently being compared with conventional systemic chemotherapy in a randomised controlled trial. [ABSTRACT FROM AUTHOR]

The article examines the importance of numeracy in people performing insulin pump therapy in Great Britain. It notes that the training for insulin pump therapy involves skills with handling numbers. It mentions however that Great Britain has high numbers of adults with low levels of numeracy compared with other countries. It explores examples from workbooks which assess the numeracy of patients starting insulin pump therapy.

The article focuses on the meta-analysis of studies that compare continuous subcutaneous insulin infusion (CSII) with multiple daily injections of insulin (MDI) in Type 1 diabetes in Great Britain. The use of CSII as an option for patients with Type 1 diabetes was recommended by the National Institute of Health and Clinical Excellence (NICE). It is noted that the result of the students support the observations from clinical trials and the recommendations from NICE.

Argues against the claim that mortality associated with diabetes is typical in Great Britain. Age group that suffer from diabetes-related accidents; Steps that should be taken to arrest diabetes in the country.

Objectives: To evaluate whether the additional information provided by minimally invasive glucose monitors results in improved glycaemic control in people with poorly controlled insulin-requiring diabetes, and to assess the acceptability and health economic impact of the devices., Design: A four-arm randomised controlled trial was undertaken., Setting: Participants were recruited from secondary care diabetes clinics in four hospitals in England., Participants: 404 people aged over 18 years with insulin-treated diabetes mellitus (types 1 or 2) for at least 6 months who were receiving two or more injections of insulin daily were eligible. Participants had to have had two glycosylated haemoglobin (HbA1c) values > or = 7.5% in the last 15 months., Interventions: Participants were randomised to one of four groups. Two groups received minimally invasive glucose monitoring devices [GlucoWatch Biographer or MiniMed Continuous Glucose Monitoring System (CGMS)]. These groups were compared with an attention control group (standard treatment with nurse feedback sessions at the same frequency as those in the device groups) and a standard control group (reflecting common practice in the clinical management of diabetes in the UK)., Main Outcome Measures: Change in HbA1c from baseline to 3, 6, 12 and 18 months was the primary indicator of short- to long-term efficacy in this study. Perceived acceptability of the devices was assessed by use and a self-report questionnaire. A health economic analysis was also performed., Results: At 18 months all groups demonstrated a decline in HbA1c levels from baseline. Mean percentage changes in HbA1c were -1.4 for the GlucoWatch group, -4.2 for the CGMS group, -5.1 for the attention control group and -4.9 for the standard care control group. At 18 months the relative percentage reduction in HbA1c in each of the intervention arms was less than that in the standard care control group. In the intention to treat analysis no significant differences were found between any of the groups at any of the assessment times. There was no evidence that the additional information provided by the devices resulted in any change in the number or nature of treatment recommendations offered by the nurses. The health economics analysis indicated no advantage in the groups who received the devices; a lower cost and higher benefit were found for the attention control arm. Assessment of device use and acceptability indicated a decline in use of both devices, which was most marked in the GlucoWatch group by 18 months (20% still using GlucoWatch versus 57% still using the CGMS). The GlucoWatch group reported more side effects, greater interference with daily activities and more difficulty in using the device than the CGMS group., Conclusions: Continuous glucose monitors do not lead to improved clinical outcomes and are not cost-effective for improving HbA1c in unselected individuals with poorly controlled insulin-requiring diabetes. On acceptability grounds the data suggest that the GlucoWatch will not be frequently used by individuals with diabetes because of the large number of side effects.

The incidence of cancer and related mortality was studied in 1651 patients from six dialysis centres in England over 10 years. The only type of cancer for which there was a significant excess was non-Hodgkin's lymphoma (four cases observed against an expected incidence of 0.15 (p < 0.001); three deaths against an expected 0.1 (p < 0.001)). This excess could not be attributed to either subsequent transplantation or treatment with immunosuppressive drugs. Since immunodepression is a feature of chronic renal failure, these observations together with those on patints treated with immunosuppressive drugs suggest that immunosuppression favours the development of non-Hodgkin's lymphoma. Studies in which it is concluded that patients receiving dialysis show an excess of other types of cancer have certain shortcomings; the unusual opportunities for detecting cancer in such patients may account for some of the reported excess.