The Joint British Diabetes Societies guidelines for the management of diabetic ketoacidosis (these do not cover Hyperosmolar Hyperglycaemic Syndrome) are available in full at: This article summarizes the main changes from previous guidelines and discusses the rationale for the new recommendations. The key points are: Monitoring of the response to treatment (i) The method of choice for monitoring the response to treatment is bedside measurement of capillary blood ketones using a ketone meter.(ii) If blood ketone measurement is not available, venous pH and bicarbonate should be used in conjunction with bedside blood glucose monitoring to assess treatment response.(iii) Venous blood should be used rather than arterial (unless respiratory problems dictate otherwise) in blood gas analysers.(iv) Intermittent laboratory confirmation of pH, bicarbonate and electrolytes only.Insulin administration (i) Insulin should be infused intravenously at a weight-based fixed rate until the ketosis has resolved.(ii) When the blood glucose falls below 14 mmol ⁄ l, 10% glucose should be added to allow the fixed-rate insulin to be continued.(iii) If already taking, long-acting insulin analogues such as insulin glargine (Lantus Ò

These Joint British Diabetes Societies guidelines, commissioned by NHS Diabetes, for the perioperative management of the adult patient undergoing surgery are available in full in the Supporting Information. This document goes through the seven stages of the patient journey when having surgery. These are: primary care referral; surgical outpatients; preoperative assessment; hospital admission; surgery; post-operative care; discharge. Each stage is given its own considerations, outlining the roles and responsibilities of each group of healthcare professionals. The evidence base for the recommendations made at each stage, discussion of controversial areas and references are provided in the report. This document has two key recommendations. Firstly, that the management of the elective adult surgery patients should be with modification to their usual diabetes treatment if the fasting is minimized because the routine use of a variable rate intravenous insulin infusion is not recommended. Secondly, that poor preoperative glycaemic control leads to post-outcomes and thus, where appropriate, needs to be addressed prior to referral for surgery.Diabet. Med. 29, 420-433 (2012) Keywords diabetes, guidelines, perioperative management, surgery, variable rate intravenous insulin infusion Summary of key pointsOrganization and planning of care K1. Careful planning, taking into account the specific needs of the patient with diabetes, is required at all stages of the patient pathway from general practitioner referral to postoperative discharge.

The FreeStyle Libre (FSL) flash glucose-monitoring device was made available on the U.K. National Health Service (NHS) drug tariff in 2017. This study aims to explore the U.K. real-world experience of FSL and the impact on glycemic control, hypoglycemia, diabetes-related distress, and hospital admissions. RESEARCH DESIGN AND METHODS Clinicians from 102 NHS hospitals in the U.K. submitted FSL user data, collected during routine clinical care, to a secure web-based tool held within the NHS N3 network. The t and Mann-Whitney U tests were used to compare the baseline and follow-up HbA 1c and other baseline demographic characteristics. Linear regression analysis was used to identify predictors of change in HbA 1c following the use of FSL. Within-person variations of HbA 1c were calculated using adjusted SD for HbA 1c 5 SD/√(n/[n 2 1]). RESULTS Data were available for 10,370 FSL users (97% with type 1 diabetes), age 38.0 (618.8) years, 51% female, diabetes duration 16.0 (649.9) years, and BMI of 25.2 (616.5) kg/m 2 (mean [6SD]). FSL users demonstrated a 25.2 mmol/mol change in HbA 1c , reducing from 67.5 (620.9) mmol/mol (8.3%) at baseline to 62.3 (618.5) mmol/mol (7.8%) after 7.5 (interquartile range 3.4-7.8) months of follow-up (n 5 3,182) (P < 0.0001). HbA 1c reduction was greater in those with initial HbA 1c ‡69.5 mmol/mol (>8.5%), reducing from 85.5 (616.1) mmol/mol (10%) to 73.1 (615.8) mmol/mol (8.8%) (P < 0.0001). The baseline Gold score (score for hypoglycemic unawareness) was 2.7 (61.8) and reduced to 2.4 (61.7) (P < 0.0001) at follow-up. A total of 53% of those with a Gold score of ‡4 at baseline had a score <4 at follow-up. FSL use was also associated with a reduction in diabetes distress (P < 0.0001). FSL use was associated with a significant reduction in paramedic callouts and hospital admissions due to hypoglycemia and hyperglycemia/diabetic ketoacidosis. CONCLUSIONS We show that the use of FSL was associated with significantly improved glycemic control and hypoglycemia awareness and a reduction in hospital admissions.

The COVID‐19 pandemic has resulted in a rapid transfer of most diabetes care from face to face clinics to virtual consultations, and in general the response from people with diabetes and health professionals is positive. Advantages include saving time, travel and time off work. Disadvantages relate mainly to technological barriers but include increased difficulty in recognising and addressing emotional distress if non‐verbal clues are lost.People report that there is more focus on glucose levels and in this sense the consultations are more ‘efficient’. However, emotional issues may be more difficult to identify, particularly if the consultation is phone‐based. Diabetes distress and other diabetes‐related psychological issues are well recognised but people may be wary about discussing them remotely with a health care professional. To address this, the consultation should focus on the agenda of the person with diabetes, in particular life events or emotional difficulties that may be a barrier to good glucose control.Virtual consultations are certain to become a mainstay of future diabetes care but will not be suitable for everyone. First meetings should be face to face wherever possible to establish rapport; continuity of care is essential to maintain this. Access to technology, safeguarding issues and personal preference all influence suitability for virtual follow up. Training should be offered to diabetes professionals to help them get the most out of a virtual consultation. Copyright © 2020 John Wiley & Sons.

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