Hypogonadism in males

Today's session covered hypogonadism in males with highlights including:

• Kallman's syndrome
• Testosterone replacement and its controversies
• Erectile dysfunction in diabetes

Hypogonadism and testosterone replacement from PeninsulaEndocrine

Hypogonadism and testosterone replacement part 2 from PeninsulaEndocrine

Erectile dysfunction in diabetes from PeninsulaEndocrine

The Diabetic Foot

The diabetic foot from PeninsulaEndocrine

The role of the podiatrist from PeninsulaEndocrine

Important trials in Type 1 and Type 2 diabetes

Careers Fair 2013 - Diabetes and Endocrinology

For those of you who missed the regional Careers Fair, here's why we should encourage trainees to pursue a career in Diabetes and Endocrinology... with a little help from 007 and friends!

Macrovascular Disease in Diabetes

Macrovascular disease in diabetes from PeninsulaEndocrine

Identifying and Managing Hyperglycaemia in Acute Coronary Syndromes

Identifying and Managing Hyperglycaemia in Acute Coronary Syndromes from PeninsulaEndocrine

Pancreatic transplantataion

Panc presentation biochem dept feb2010

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Altrom's Syndrome

Alström syndrome

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... and these are Torbay's Pregnancy in Diabetes Guidelines

Torbay antenatal clinic guidelines

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Diabetes and Pregnancy

A good, Torbay session on diabetes and pregnancy. Reinforcing the complications, uncertainties and management options for managing diabetes in pregnancy.

For me, it highlighted the differences in practice across the region - as well as how we are all taking slightly different approaches to the advice given by NICE.

Gestational diabetes

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Obesity - a growing problem!

This was a really interesting session, leading to healthy debate on the solution to the obesity crisis. As ever, debate led to polarised views about the role of the endocrinologist, the role of government, the role of society and the role of surgery in the management of obesity.

Here is Tom's balanced look at things:

Obesity

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Torbay Mid-Foot Amputation Audit

The Torbay Foot team, have audited their mid-foot amputations in the two years to 2007. These are their results.

Mid Foot Amputations Torbay 2009

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Estimated Average Glucose - eAG

It has been deemed by the powers that be that estimated average glucose isn't going to be used in the UK, yet.

However, in mainland europe and in the States - they are going for it and for every HbA1c request, you get back three numbers: a percent, a mmol/mol value and an estimated average glucose.

This American presentation explains what it is and why it might be useful. I wouldn't be surprised if we start using it here.

eAG - Estimated Average Glucose

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Insulins And Insulin Delivery

We had a really good session this Friday. This is a case based presentation highlighting how different insulin regimes may be useful in different people. It also highlights the results of the 4T study in initiating insulin for patients with T2DM.

Insulins And Insulin Delivery

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The Dreaded New HbA1c

This is an adapted presentation from one of lab equipment manufacturers and the only one that I've come across that gives sensible reasons for switching to the new HbA1c range.

It sets out the changes, the reasons behind those changes and has a conversion chart.

All someone needs to do is write a short programme that will convert one figure into another....

... on the horizon, which might change this is the idea of estimated average glucose (eAG) analogous to eGFR to be reported alongside the new HbA1c. Watch this space.

New Hb A1c Numbers Presentation

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Diabetic nephropathy

Angus' comprehensive look at the pathology, risk factors and treatable variables for diabetic nephropathy.

Diabetic Nephropathy

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Exeter Guidelines for Management of Painful Diabetic Peripheral Neuropathy

This flow-chart is that used at the RD&E for the management of painful diabetic peripheral neuropathy

Management of Painful diabetic neuropathy - Exeter guidelines

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Management of Painful Diabetic Neuropathy

Angus' presentation, which talks about all neuropathy associated with Diabetes Mellitus with a focus on the treatment options available for painful diabetic neuropathy.

Diabetic Neuropathy

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RD&E Exenatide Audit.

Pam Bowman, the academic F2 has audited the initial use of exenatide at the RD&E.

Exenatide, the first commercially available GLP-1 analogue, has been mentioned in the latest NICE guidelines for those with a BMI >35, an HbA1c >7.5%, on maximum oral metformin and sulphonylurea, who would otherwise be starting a high-cost medication.

NICE also mention criteria for success: a weight loss >5% at one year and improvement in HbA1c >1%

The audit is limited in scope as not many patients have been on the medication 6 months, let alone one year.

The interesting issues are that we are using it off-licence (i.e in those already on insulin) and that doesn't seem to influence outcome.

Here is the audit. Other peoples thoughts, experiences and comments would be useful... just use the comments link at the bottom of this post.

Exenatide Presentation

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Aspirin for Primary Prevention of Cardiovascular Events in Diabetes: Still an Open Question

This JAMA editorial highlights the uncertainty in the use of aspirin in primary prevention for people with diabetes.

Hopefully the Ascend Trial will help to answer this question.

Below, the Exeter Drugs update (Co-authored by KMM) expands on this issue taking a look at the recently published evidence in the POPADAD and JPAD trials:

Exeter Drugs Update

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