Joint British Diabetes Societies for Inpatient Care (JBDS-IP) Clinical Guideline Inpatient care of the frail older adult with diabetes: an Executive Summary

We present an Executive Summary of a guideline produced by a Joint British Diabetes Societies for Inpatient Care Writing Group for managing frail older inpatients with diabetes. This represents a multidisciplinary stakeholder consensus document providing more than 100 recommendations in eight areas: functional assessment and detection of frailty; preventative care: assessing risk factors and avoiding hospital admissions; general inpatient management principles; managing therapy choices for the frail older inpatient with diabetes; managing associated comorbidities and concerns; pre-operative assessment and care; discharge planning and principles of follow-up; and end of life care. The document is intended to guide effective clinical decision-making in an inpatient setting and is supported by four appendices: Appendix 1, STOPPFRAIL criteria; Appendix 2, Acute care toolkit 3-Royal College of Physicians; Appendix 3, a description of physical performance and frailty measures for routine NHS application; and Appendix 4, Inpatient Frailty Care Pathway-template. This document is expected to enhance clinical outcomes and overall health status for this vulnerable inpatient population of older people with diabetes. The full version of the guideline, including the appendices, can be found at https://abcd.care/sites/abcd.care/files/resources/Inpatient_Care_of_the_Frail_Older_Adult.pdf

Managing hyperglycaemia during antenatal steroid administration, labour and birth in pregnant women with diabetes

Optimal glycaemic control before and during pregnancy improves both maternal and fetal outcomes. This article summarizes the recently published guidelines on the management of glycaemic control in pregnant women with diabetes on obstetric wards and delivery units produced by the Joint British Diabetes Societies for Inpatient Care and available in full at www.diabetes.org.uk/joint-british-diabetes-society and https://abcd.care/joint-british-diabetes-societies-jbds-inpatient-care-group. Hyperglycaemia following steroid administration can be managed by variable rate intravenous insulin infusion (VRIII) or continuous subcutaneous insulin infusion (CSII) in women who are willing and able to safely self‐manage insulin dose adjustment. All women with diabetes should have capillary blood glucose (CBG) measured hourly once they are in established labour. Those who are found to be higher than 7 mmol/l on two consecutive occasions should be started on VRIII. If general anaesthesia is used, CBG should be monitored every 30 min in the theatre. Both the VRIII and CSII rate should be reduced by at least 50% once the placenta is delivered. The insulin dose needed after delivery in insulin‐treated Type 2 and Type 1 diabetes is usually 25% less than the doses needed at the end of first trimester. Additional snacks may be needed after delivery especially if breastfeeding. Stop all anti‐diabetes medications after delivery in gestational diabetes. Continue to monitor CBG before and 1 h after meals for up to 24 h after delivery to pick up any pre‐existing diabetes or new‐onset diabetes in pregnancy. Women with Type 2 diabetes on oral treatment can continue to take metformin after birth

A guideline for the outpatient management of glycaemic control in people with cancer

Individuals with cancer are at increased risk of developing new onset diabetes mellitus and hyperglycaemia, and an estimated 20% of people with cancer already have an underlying diagnosis of diabetes mellitus. People with both cancer and diabetes may have an increased risk of toxicities, hospital admissions and morbidity, with hyperglycaemia potentially attenuating the efficacy of chemotherapy often secondary to dose reductions and early cessation. Numerous studies have demonstrated that hyperglycaemia is prognostic of worse overall survival and risk of cancer recurrence. These guidelines aim to provide the oncology/haemato-oncology and diabetes multidisciplinary teams with the tools to manage people with diabetes commencing anti-cancer/ glucocorticoid therapy, as well as identifying individuals without a known diagnosis of diabetes who are at risk of developing hyperglycaemia and new onset diabetes

Enhancing diabetes care for the most vulnerable in the 21st century::Interim findings of the National Advisory Panel on Care Home Diabetes (NAPCHD)

Older adults with diabetes may carry a substantial health burden in Western ageing societies, occupy more than one in four beds in care homes, and are a highly vulnerable group who often require complex nursing and medical care. The global pandemic (COVID-19) had its epicentre in care homes and revealed many shortfalls in diabetes care resulting in hospital admissions and considerable mortality and comorbid illness. The purpose of this work was to develop a national Strategic Document of Diabetes Care for Care Homes which would bring about worthwhile, sustainable and effective quality diabetes care improvements, and address the shortfalls in care provided. A large diverse and multidisciplinary group of stakeholders (NAPCHD) defined 11 areas of interest where recommendations were needed and using a subgroup allocation approach were set tasks to produce a set of primary recommendations. Each subgroup was given 5 starter questions to begin their work and a format to provide responses. During the initial phase, 16 key findings were identified. Overall, after a period of 18 months, 49 primary recommendations were made, and 7 major conclusions were drawn from these. A model of community and integrated diabetes care for care home residents with diabetes was proposed, and a series of 5 ‘quick-wins’ were created to begin implementation of some of the recommendations that would not require significant funding. The work of the NAPCHD is ongoing but we hope that this current resource will help leaders to make these required changes happen

Endocrinologic, neurologic, and visual morbidity after treatment for craniopharyngioma

Craniopharyngiomas are locally aggressive tumors which typically are focused in the sellar and suprasellar region near a number of critical neural and vascular structures mediating endocrinologic, behavioral, and visual functions. The present study aims to summarize and compare the published literature regarding morbidity resulting from treatment of craniopharyngioma. We performed a comprehensive search of the published English language literature to identify studies publishing outcome data of patients undergoing surgery for craniopharyngioma. Comparisons of the rates of endocrine, vascular, neurological, and visual complications were performed using Pearson’s chi-squared test, and covariates of interest were fitted into a multivariate logistic regression model. In our data set, 540 patients underwent surgical resection of their tumor. 138 patients received biopsy alone followed by some form of radiotherapy. Mean overall follow-up for all patients in these studies was 54 ± 1.8 months. The overall rate of new endocrinopathy for all patients undergoing surgical resection of their mass was 37% (95% CI = 33–41). Patients receiving GTR had over 2.5 times the rate of developing at least one endocrinopathy compared to patients receiving STR alone or STR + XRT (52 vs. 19 vs. 20%, χ2P < 0.00001). On multivariate analysis, GTR conferred a significant increase in the risk of endocrinopathy compared to STR + XRT (OR = 3.45, 95% CI = 2.05–5.81, P < 0.00001), after controlling for study size and the presence of significant hypothalamic involvement. There was a statistical trend towards worse visual outcomes in patients receiving XRT after STR compared to GTR or STR alone (GTR = 3.5% vs. STR 2.1% vs. STR + XRT 6.4%, P = 0.11). Given the difficulty in obtaining class 1 data regarding the treatment of this tumor, this study can serve as an estimate of expected outcomes for these patients, and guide decision making until these data are available

A theoretical study of self-diffusion, viscosity and Schmidt number of inert liquids and their temperature dependence

15-21<span style="font-size:16.0pt;mso-bidi-font-size: 11.0pt;line-height:115%;font-family:" times="" new="" roman";mso-fareast-font-family:="" "times="" roman";color:black;mso-ansi-language:en-in;mso-fareast-language:="" en-us;mso-bidi-language:hi"="" lang="EN-IN">A statistical theory for transport or mass and momentum through atomic liquids is presented. Both the characteristic features of liquid phase viz. the strong correlations among the atoms over smaller distances and high temporal disorder have been incorporated in the development of theory. Relations been developed for the coefficient of self diffusion D and coefficient of viscosity <span style="font-size:16.0pt; mso-bidi-font-size:11.0pt;line-height:115%;font-family:" times="" new="" roman";="" mso-fareast-font-family:"times="" roman";mso-ansi-language:en-in;mso-fareast-language:="" en-us;mso-bidi-language:hi"="" lang="EN-IN">η. An explicit expression for Schmidt number Sc = symbol has also been derived. For the first time, the temperature dependence or Schmidt number in the liquid phase has been studied. Calculated value or D. η and Sc or neon. argon. Krypton and xenon over a wide range of temperature (Tm to 0.9 Tc are in good agreement with the reported experimental data. In fact Sc is a  true index of strength of atomic correlations, hence its temperature dependence reflects the gradual loss or order with the rise in temperature in liquid phase. It is found that for inert liquids the three quantities studied in the present work correspond very closely if values or properties at the melting  and melting temperatures are used as reducing parameters.</span

Theoretical study of transport of heat through amorphous helical polymers

29-33A study of transport of heat through non-conducting amorphous helical polymers is presented. Predominant phonon scattering processes have been identified on the basis of general structural features and the effect of temperature on these. Accordingly, relations have been deduced for the dependence of the thermal conductivity λ on temperature T. It is shown that the glass transition temperature Tg of polymers can also be predicted through the conductivity trends, estimated values of <i style="mso-bidi-font-style: normal">Tg of PMMA, PIB and PTFE are quite close to the reported ones. Present study reveals that the helical polymers fall in 'group A' of the classification of linear polymers proposed recently by the authors (Polymer 37, (1996), 231). Calculated values of λ, of five different isotropic polymers viz. PIB, PTFE, PCTFE, PET and PMMA, over a wide range of temperature (90- 370 K), are in excellent agreement with the available experimental data (maximum deviation is 4%). Proposed theory also explains the effect of extrusion on the thermal conductivity. Theoretically computed values of thermal conductivities of extruded PMMA in the <span style="font-size:11.0pt;line-height:115%;font-family:Calibri;mso-fareast-font-family: Calibri;mso-bidi-font-family:" times="" new="" roman";color:black;mso-ansi-language:="" en-us;mso-fareast-language:en-us;mso-bidi-language:ar-sa"="">draw direction All and in the perpendicular to the draw direction λ<span style="font-size:11.0pt;line-height:115%;font-family:Arial;mso-fareast-font-family: Calibri;color:black;mso-ansi-language:EN-US;mso-fareast-language:EN-US; mso-bidi-language:AR-SA">┴<span style="font-size:11.0pt; line-height:115%;font-family:Calibri;mso-fareast-font-family:Calibri; mso-bidi-font-family:" times="" new="" roman";color:black;mso-ansi-language:en-us;="" mso-fareast-language:en-us;mso-bidi-language:ar-sa"=""> agree well with the reported experimental values. Maximum deviation being 2%.</span

A theoretical study of heat capacity of inert liquids

438-442<span style="font-size: 15.0pt;mso-bidi-font-size:8.0pt;font-family:" times="" new="" roman","serif""="">A statistical theory for heat capacity of atomic liquids is presented in this paper. Both the characteristic features of the liquid phase viz. the short -range spatial order and significant temporal disorder have been incorporated in the development of the theory. A relation has been deduced for specific heat at constant volume Cv in terms of topological-short-range-order parameter, x. Calculated values of Cv for neon, argon, krypton and xenon over temperature region Tm - 0.9 Tc are in good agreement with the experimental values. The maximum deviation is less than 5 %. Interestingly, it is found that for these inert liquids, some of the equilibrium and transport properties, viz. average coordination number, surface tension, self-diffusion, viscosity and thermal conductivity, studied by the authors earlier, trends of Cvr = Cv/ <span style="font-size:15.0pt;mso-bidi-font-size:8.0pt;font-family: " times="" new="" roman","serif""="">CVm versus Tr <span style="font-size:19.5pt;mso-bidi-font-size:12.5pt;font-family: " times="" new="" roman","serif""="">= <span style="font-size:15.5pt; mso-bidi-font-size:8.5pt;font-family:" times="" new="" roman","serif""="">T/ Tm <span style="font-size:15.0pt;mso-bidi-font-size:8.0pt;font-family: " times="" new="" roman","serif""="">also correspond quite closely. </span

Theoretical study of self-diffusion of liquid alkali elements

479-483<span style="font-size: 15.0pt;mso-bidi-font-size:8.0pt;font-family:" times="" new="" roman","serif""="">A new approach to study the variation of the self-diffusion coefficient through the temperature dependence of the topological-short- <span style="font-size: 15.0pt;mso-bidi-font-size:8.0pt;font-family:" times="" new="" roman","serif""="">range-order (TSRO) existing in the liquid phase has been presented. A relation has been obtained for the temperature dependence or the coefficient of self-diffusion (D). <span style="font-size:15.0pt;mso-bidi-font-size:8.0pt;font-family: " times="" new="" roman","serif""="">Present study indicates that, both the decrease in TSRO as well as the increase in themal energy govern the trend of self-diffusion coefficient with temperature. Calculated values of the self-diffusion coefficient for alkali elements (Li , Na, K, Rb) are in good agreement with the available experimental data, over a wide range of temperatures <span style="font-size:15.5pt;mso-bidi-font-size:8.5pt; font-family:" arial","sans-serif""="">(Tm- Tb) i.e. from melting to normal boiling temperature, the maximum deviation is 6.9%. It is found that, the trends of reduced self-diffusion coefficient Dr=D/Dm <span style="font-size:15.0pt;mso-bidi-font-size:8.0pt;font-family: " times="" new="" roman","serif""="">versus reduced temperature Tr=T/Tm <span style="font-size:15.0pt;mso-bidi-font-size:8.0pt;font-family: " times="" new="" roman","serif""="">correspond quite closely, for all alkali elements except lithium, the maximum deviation from common trend being ~6%. </span