Objective To investigate trends in incident and prevalent diagnoses of type 2 diabetes mellitus (T2DM) and its pharmacological treatment between 2000 and 2013.
Design Analysis of longitudinal electronic health records in The Health Improvement Network (THIN) primary care database.
Participants In total, we examined 8 838 031 individuals aged 0–99 years.
Outcome measures The incidence and prevalence of T2DM between 2000 and 2013, and the effect of age, sex and social deprivation on these measures were examined. Changes in prescribing patterns of antidiabetic therapy between 2000 and 2013 were also investigated.
Results Overall, 406 344 individuals had a diagnosis of T2DM, of which 203 639 were newly diagnosed between 2000 and 2013. The incidence of T2DM rose from 3.69 per 1000 person-years at risk (PYAR) (95% CI 3.58 to 3.81) in 2000 to 3.99 per 1000 PYAR (95% CI 3.90 to 4.08) in 2013 among men; and from 3.06 per 1000 PYAR (95% CI 2.95 to 3.17) to 3.73 per 1000 PYAR (95% CI 3.65 to 3.82) among women. Prevalence of T2DM more than doubled from 2.39% (95% CI 2.37 to 2.41) in 2000 to 5.32% (95% CI 5.30 to 5.34) in 2013. Being male, older, and from a more socially deprived area was strongly associated with having T2DM, (p<0.001). Prescribing changes over time reflected emerging clinical guidance and novel treatments. In 2013, metformin prescribing peaked at 83.6% (95% CI 83.4% to 83.8%), while sulfonylureas prescribing reached a low of 41.4% (95% CI 41.1% to 41.7%). Both remained, however, the most commonly used pharmacological treatments as first-line agents and add-on therapy. Thiazolidinediones and incretin based therapies (gliptins and GLP-1 analogues) were also prescribed as alternate add-on therapy options, however were rarely used for first-line treatment in T2DM.
Conclusions Prevalent cases of T2DM more than doubled between 2000 and 2013, while the number of incident cases increased more steadily. Changes in prescribing patterns observed may reflect the impact of national policies and prescribing guidelines on UK primary care.
Paediatric Care Online, hosted by the Royal College of Paediatrics and Child Health, may reduce child deaths by ensuring children receive the best possible treatment before they become too unwell, say child health experts.
Launching today (11 January), an online decision support tool, providing specialist diagnostic advice for paediatricians, GPs and nurses, along with other healthcare professionals, will ensure children get the right treatment at the earliest opportunity – preventing delays in care and potentially reducing avoidable child deaths.
Child health experts say that Paediatric Care Online (PCO UK), hosted by the Royal College of Paediatrics and Child Health (RCPCH) and developed by a partnership group, could contribute towards reducing the UK’s 2,000 avoidable deaths each year by ensuring that the right children get referred to hospitals and other specialist services, whilst others are seen in more appropriate settings.
Through the use of Key Practice Points – decision support tools that cover common signs and symptoms and critical care situations – PCO UK will also help healthcare professionals feel more secure about which patients can safely be managed at home.
George Freeman, Minister for Life Sciences, reflects on the latest developments to treat blindness and working towards a paperless NHS.
With the new year upon us, there are 2 upcoming anniversaries that are foremost in my mind. The first is the 5 year anniversary of the launch of the original Life Sciences Strategy in 2011, where we set out our goal to make the UK the world leader in this space. With more than £3.5 billion of investment and around 11,000 jobs created in the sector since the launch of the strategy, so much has been achieved in the past 5 years. But I believe there is so much more to do.
The second anniversary foremost in my mind is the countdown to the 70th anniversary of the founding of the NHS in 2018. A previous generation changed the world with the inspiring principle of healthcare for all free at the point of use. Almost 70 years on, I believe we have the chance to be as bold and innovative again, by embracing the new age of medical science and the transformative effect this can have for patients. That is what drives me as minister and why I believe 2016 will be a landmark year for our sector.
Achieving the vision set out in the Life Sciences Strategy means supporting the pioneers across our NHS, in medical research charities and within industry. That’s why it was a great privilege before Christmas to visit Moorfields Eye Hospital and John Radcliffe Hospital, celebrating innovations that are improving patient care.
Taking readings of brain activity before patients go for surgery could help doctors give a more accurate dose of anaesthetic, researchers suggest. At present, a patient’s body weight is the main factor in deciding the dose. But a University of Cambridge study indicated people with high levels of brain connectivity or “chatter” needed a larger dose to put them under.This could help doctors work out exactly the amount of anaesthetic a patient requires to become unconscious.
The study, published in PLOS Computational Biology, looked at how the brain’s electric signals changed in 20 healthy volunteers given a common anaesthetic called propofol. They were then asked to press different buttons when they heard different sounds. After reaching the maximum dose, some were still pressing buttons, while others were unconscious. The “chatter” or connectivity between areas of the brain was much more pronounced in those who were still conscious. And when the research team looked at brain activity when the participants were awake, using readings from an electroencephalogram (EEG), they found similar differences.
The Chief Medical Officer and some of the country’s most recognisable doctors have issued a video to raise awareness of antibiotic resistance. The video appeal is designed to raise awareness of the threat of antimicrobial resistance with parents and to offer advice on how everyone can play a part in tackling it.
Objective: To evaluate the prevalence and risk factors of dry eye disease (DED) in workers using visual display terminals (VDT).
Design: Systematic review and meta-analysis.
Data sources: We searched PubMed, Cochrane Library, Embase and Science Direct databases for studies reporting DED prevalence in VDT workers.
Results: 16 of the 9049 identified studies were included, with a total of 11 365 VDT workers. Despite a global DED prevalence of 49.5% (95% CI 47.5 to 50.6), ranging from 9.5% to 87.5%, important heterogeneity (I2=98.8%, p<0.0001) was observed. Variable diagnosis criteria used within studies were: questionnaires on symptoms, tear film anomalies and corneoconjunctival epithelial damage. Some studies combined criteria to define DED. Heterogeneous prevalence was associated with stratifications on symptoms (I2=98.7%, p<0.0001), tears (I2=98.5%, p<0.0001) and epithelial damage (I2=96.0%, p<0.0001). Stratification of studies with two criteria adjusted the prevalence to 54.0% (95% CI 52.1 to 55.9), whereas studies using three criteria resulted in a prevalence of 11.6% (95% CI 10.5 to 12.9). According to the literature, prevalence of DED was more frequent in females than in males and increased with age.
Conclusions: Owing to the disparity of the diagnosis criteria studied to define DED, the global prevalence of 49.5% lacked reliability because of the important heterogeneity. We highlight the necessity of implementing common DED diagnostic criteria to allow a more reliable estimation in order to develop the appropriate preventive occupational actions.
A community care project in London is helping to reduce pressures on A&E departments by treating patients at home. Via the Guardian Healthcare Network
A pioneering grassroots emergency service targeting frail older people who have fallen takes the hospital to the home in a money-saving solution that could help slash A&E admissions and offer a new model of community care.
The service, a joint project between the London Ambulance Service (LAS) and North East London NHS foundation trust (NELFT), goes out to nearly 30 people each week and keeps most of them – an average of 77% – out of emergency departments. And according to NELFT, in the 12 months following its launch in October 2014 the scheme saved the health service £188,000.
After starting as a pilot scheme, it is now an ongoing service funded by Barking and Dagenham, Havering and Redbridge clinical commissioning group which, like other commissioners, is under pressure to cut A&E admissions. The target was set at a 15% reduction by the coalition government.
The Cochrane Collaboration, known for their high-quality reviews and meta-analyses, recently published a systematic review of the efficacy of lithium as used to treat schizophrenia (Leucht et al, 2015). The aim was to assess whether lithium is an effective treatment for schizophrenia, whether used alone or in conjunction with antipsychotic medication.
Currently, there is no evidence that lithium is an effective treatment on its own for people with a schizophrenia diagnosis.
There is some evidence that combination treatment with lithium and antipsychotics is more effective than antipsychotics on their own, but this evidence comes from low quality studies prone to bias.
Lithium does not appear to have much to recommend it in the context of psychosis. Nonetheless, given the overall low quality of studies included, further research is necessary. The authors recommend larger, more well-conducted trials, focusing on patients without affective symptoms (e.g. depression) to establish whether lithium has an effect on the core symptoms (e.g. hallucinations & delusions). They also argue that a vital focus for future trials is schizoaffective disorder, for which lithium is frequently prescribed but without evidence for doing so.
There is a 99% probability of severe cold weather, icy conditions and heavy snow between 9.00 on Thursday 14 Jan and 12.00 on Tuesday 19 Jan in our region. This weather could increase the health risks to vulnerable patients and disrupt the delivery of services.
Public Health England have produced a Cold weather plan, which can help prevent the major avoidable effects on health during periods of cold weather in England.
It may be cold outside but NHS Choices has some helpful advice on how to keep warm and healthy over the winter.
Cold weather and our health
An animation showing what cold weather does to our health, what we can do to protect our friends and families from its effects and what we can do to help those who may feel the effects more than others.
This report contains a series of case studies that illustrate the positive work councils are undertaking with their local partners to support people living with autistic spectrum conditions (ASC) in their communities. The aim of the report is to ensure services and support are developed with people with autism, and not just delivered to them.