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Grampian, United Kingdom

Muller K.,Grampian Diabetes Research Unit | Ghouri N.,University of Glasgow | Walker L.,Grampian Diabetes Research Unit | Philip S.,Grampian Diabetes Research Unit
British Journal of Diabetes and Vascular Disease | Year: 2011

AimsDiabetes inpatient specialist teams (DISTs) support other departments to care for people with diabetes. The aim of this study was to evaluate the role of our adult DIST to ascertain the types of patients referred, reasons for referrals and the frequency of referrals.MethodsUsing prospectively collected data on our adult DIST activity (patients > 14 yrs), we retrospectively analysed all referrals over a 48-month period (October 2004-October 2008). We also performed a more focused study over a two-month period obtaining more detailed information on DIST-patient interaction.ResultsOver the 48 months of the study, more referrals were from medical (1879, 66%) than from surgical specialties (641, 23%). Most medical referrals were from the acute medical admissions unit (411, 14.4%); the most common referral being hyperglycaemia (339, 15%). Inpatient review was the most frequent task undertaken (76% of DIST-patient interactions), which included optimisation of medication and re-review, and 15% of reviews occurred at weekends. Following an education strategy for nursing staff, referrals for hypoglycaemia decreased (27.4% in 2005, 14.7% in 2008, p=0.04 for trend).ConclusionA DIST makes important contributions to diabetes care in all major hospital departments. Evaluating referral patterns can help identify educational needs. © SAGE Publications 2011. Source


Scotland G.,University of Aberdeen | McKeigue P.,University of Edinburgh | Philip S.,Grampian Diabetes Research Unit | Leese G.P.,LMC Diabetes & Endocrinology | And 4 more authors.
Diabetic Medicine | Year: 2016

Aims: To assess the cost-effectiveness of adopting risk-stratified approaches to extended screening intervals in the national diabetic retinopathy screening programme in Scotland. Methods: A continuous-time hidden Markov model was fitted to national longitudinal screening data to derive transition probabilities between observed non-referable and referable retinopathy states. These were incorporated in a decision model simulating progression, costs and visual acuity outcomes for a synthetic cohort with a covariate distribution matching that of the Scottish diabetic screening population. The cost-effectiveness of adopting extended (2–year) screening for groups with no observed retinopathy was then assessed over a 30–year time horizon. Results: Individuals with a current grade of no retinopathy on two consecutive screening episodes face the lowest risk of progressing to referable disease. For the cohort as a whole, the incremental cost per quality-adjusted life year gained for annual vs. biennial screening ranged from approximately £74 000 (for those with no retinopathy and a prior observed grade of mild or observable background retinopathy) to approximately £232 000 per quality-adjusted life year gained (for those with no retinopathy on two consecutive screening episodes). The corresponding incremental cost-effectiveness ratios in the subgroup with Type 1 diabetes were substantially lower; approximately £22 000 to £85 000 per quality-adjusted life year gained, respectively. Conclusions: Biennial screening for individuals with diabetes who have no retinopathy is likely to deliver significant savings for a very small increase in the risk of adverse visual acuity and quality of life outcomes. There is greater uncertainty regarding the long-term cost-effectiveness of adopting biennial screening in younger people with Type 1 diabetes. © 2016 Diabetes UK Source


Looker H.C.,University of Dundee | Nyangoma S.O.,University of Dundee | Cromie D.T.,NHS Lanarkshire | Olson J.A.,NHS Grampian | And 12 more authors.
British Journal of Ophthalmology | Year: 2014

Aims: Diabetic retinopathy screening aims to detect people at risk of visual loss due to proliferative diabetic retinopathy, but also refers cases of suspected macular oedema (maculopathy). At the introduction of screening, ophthalmology was concerned that referral rates would be unmanageable. We report yield of referable disease by referral reason for the first 5 years of the programme. Methods: We extracted screening results from a nationwide clinical diabetes database to calculate annual referral rates to ophthalmic clinics. We used logistic regression to examine associations between clinical measures and referable disease. Results: 182 397 people underwent ≥1successful retinal screening between 2006 and 2010. The yield of referable eye disease was highest in the first 2 years of screening (7.0% and 6.0%) before stabilising at ∼4.3%. The majority of referrals are due to maculopathy with 73% of referrals in 2010 based on a finding of maculopathy. Conclusions: The commonest cause for referral is for suspected macular oedema (maculopathy). Referral rates for retinopathy have stabilised, as predicted, at relatively low rates. However, ophthalmology workload continues to rise as new treatment options (ie, monthly intraocular injections) have unexpectedly increased the impact on ophthalmology. A review of the screening referral path for maculopathy may be timely. Source


Looker H.C.,University of Dundee | Nyangoma S.O.,University of Dundee | Cromie D.,NHS Lanarkshire | Olson J.A.,Royal Infirmary | And 11 more authors.
Diabetologia | Year: 2012

Aims/hypothesis: The aim of this study was to examine the prevalence of and risk factors for diabetic retinopathy in people with newly diagnosed type 2 diabetes mellitus, using Scottish national data. Methods: We identified individuals diagnosed with type 2 diabetes mellitus in Scotland between January 2005 and May 2008 using data from the national diabetes database. We calculated the prevalence of retinopathy and ORs for risk factors associated with retinopathy at first screening. Results: Of the 51,526 people with newly diagnosed type 2 diabetes mellitus identified, 91.4% had been screened by 31 December 2010. The median time to first screening was 315 days (interquartile range [IQR] 111-607 days), but by 2008 the median was 83 days (IQR 51-135 days). The prevalence at first screening of any retinopathy was 19.3%, and for referable retinopathy it was 1.9%. For individuals screened after a year the prevalence of any retinopathy was 20.5% and referable retinopathy was 2.3%. Any retinopathy at screening was associated with male sex (OR 1.19, 95% CI 1.14, 1.25), HbA1c (OR 1.07, 95% CI 1.06, 1.08 per 1% [11 mmol/mol] increase), systolic BP (OR 1.06, 95% CI 1.05, 1.08 per 10 mmHg increase), time to screening (OR for screening >1 year post diagnosis = 1.12, 95% CI 1.07, 1.17) and obesity (OR 0.87, 95% CI 0.82, 0.93) in multivariate analysis. Conclusions/interpretation: The prevalence of retinopathy at first screening is lower than in previous UK studies, consistent with earlier diagnosis of diabetes. Most newly diagnosed type 2 diabetic patients in Scotland are screened within an acceptable interval and the prevalence of referable disease is low, even in those with delayed screening. © 2012 The Author(s). Source


Livingstone S.J.,University of Dundee | Levin D.,University of Dundee | Looker H.C.,University of Dundee | Lindsay R.S.,University of Glasgow | And 14 more authors.
JAMA - Journal of the American Medical Association | Year: 2015

Importance: Type 1 diabetes has historically been associated with a significant reduction in life expectancy. Major advances in treatment of type 1 diabetes have occurred in the past 3 decades. Contemporary estimates of the effect of type 1 diabetes on life expectancy are needed. Objective: To examine current life expectancy in people with and without type 1 diabetes in Scotland. We also examined whether any loss of life expectancy in patients with type 1 diabetes is confined to those who develop kidney disease. Design, Setting, and Participants: Prospective cohort of all individuals alive in Scotland with type 1 diabetes who were aged 20 years or older from 2008 through 2010 and were in a nationwide register (n=24 691 contributing 67 712 person-years and 1043 deaths). Main Outcomes and Measures: Differences in life expectancy between those with and those without type 1 diabetes and the percentage of the difference due to various causes.Results: Life expectancy at an attained age of 20 years was an additional 46.2 years among men with type 1 diabetes and 57.3 years among men without it, an estimated loss in life expectancy with diabetes of 11.1 years (95%CI, 10.1-12.1). Life expectancy from age 20 years was an additional 48.1 years among women with type 1 diabetes and 61.0 years among women without it, an estimated loss with diabetes of 12.9 years (95%CI, 11.7-14.1). Even among those with type 1 diabetes with an estimated glomerular filtration rate of 90 mL/min/1.73m2 or higher, life expectancy was reduced (49.0 years in men, 53.1 years in women) giving an estimated loss from age 20 years of 8.3 years (95%CI, 6.5-10.1) for men and 7.9 years (95%CI, 5.5-10.3) for women. Overall, the largest percentage of the estimated loss in life expectancy was related to ischemic heart disease (36%in men, 31% in women) but death from diabetic coma or ketoacidosis was associated with the largest percentage of the estimated loss occurring before age 50 years (29.4%in men, 21.7%in women).Conclusions and Relevance: Estimated life expectancy for patients with type 1 diabetes in Scotland based on data from 2008 through 2010 indicated an estimated loss of life expectancy at age 20 years of approximately 11 years for men and 13 years for women compared with the general population without type 1 diabetes. © 2015 American Medical Association. All rights reserved. Source

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