A review of the published literature reveals 51 reported cases of temozolomide treatment for pituitary tumours, including 20 prolactinomas. Fifteen of the 20 prolactinomas showed a good response to temozolomide. Our analysis demonstrates a strong association between MGMT-negative staining and a good response to temozolomide (OR 9.35, P = 0.0030). Current clinical practice is to use temozolomide as a salvage therapy after all conventional modalities of treatment have failed. We suggest that, in selected cases, consideration should be given to using temozolomide earlier in the treatment algorithm.

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Diabetic neuropathy is a significant complication of chronic diabetes. We wished to discover whether we were successfully identifying patients who had developed neuropathic problems. Specifically, Diabetologists are traditionally poor at asking about erectile dysfunction (ED) and patients themselves are not always forthcoming as it an embarrassing medical problem. We targeted all patients attending diabetes review clinics over a 4-month period in two hospitals and asked them to complete an anonymous, self-reported questionnaire after their consultation with the diabetologist or diabetes specialist nurse. Whilst most aspects of diabetic neuropathy are routinely screened for in the diabetes clinic we found that the neuropathic symptoms of both ED and gastroparesis were not commonly enquired about, and that erectile failure was found to be more prevalent than previously. Diabetologists need to be more thorough in their assessment of diabetic neuropathy. This is especially of import with regards to ED because we often shy away from enquiring into such a personal area and male patients rarely highlight the issue due to embarrassment. Our post consultation questionnaire has now been modified to form a useful preconsultation neuropathy screening tool and this is undergoing validation.

On 23 March 2020 the United Kingdom went into lockdown to reduce transmission of COVID-19. In order to focus on acute care capacity and maintain social distancing, there was simultaneous widespread change in the depth and breadth of National Health Service (NHS) services and a reduction in preventative care for people with diabetes [1]. We are aware of numerous mainstream media reports of reductions in the numbers of people seeking care for non-COVID emergencies and a reported reduction in referrals for suspected malignancy.The incidence of diabetic foot ulcer in England has been estimated at between 2 and 6% [2,3], with considerable human and financial costs to the NHS of ~1% of its entire budget [3].Delays in access to specialist care appear to worsen ulcer severity and lead to an increase in amputation [4]. Prognosis for people with diabetes post major amputation is comparable with systemic malignancy [5].The Diabetes Care for You service provides consultant-led specialist multi-professional holistic out-of-hospital diabetes care for people within the area covered by the Brighton & Hove/High Weald Lewes and Havens clinical commissioning

This study posits that routine radiological reporting of thyroid incidentalomas, with further investigation when clinically appropriate, is warranted. The results suggest that lesion size and CT characteristics are not reliable criteria to triage patients for investigation/biopsy.

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Aims: The FreeStyle Libre (FSL) flash glucose monitoring device was made available on the UK National Health Services (NHS) drug tariff in 2017. This national audit aims to explore the UK real world experience of FSL and the impact on glycaemic control. Methods: Clinicians were invited to submit FSL user data to a secure web-based tool held within the NHS N3 network. Data were analysed from available initial submissions from the 60 out of 120 NHS hospital trusts registered for the audit. R3.5.0 was used for statistical analysis and T-test was used to compare the baseline and follow-up HbA1c. Within-person variations of HbA1c calculated adj-HbA1c-SD=SD/sq. Root [n/(n−1)]. Results: Data were available for 2,438 (2,348 people with type 1 diabetes) FSL users; age 34(IQR =19-51) years, 54% female, diabetes duration 14 (IQR=19-51) years, and BMI of 24(IQR=21-28) kg/m2 and participants had 10 (IQR=7-12) scans/day. The baseline HbA1c was 67.8(±17) (8.4%), and after a median follow-up of 6 months (n=625) HbA1c reduced to 61.8 (±14) (7.8%) mmol/l (P<0.0001)). HbA1c reduction was greater in those with initial HbA1c ≥69.4 (>8.5%) mmol/mol; HbA1c reduced from 85.8 mmol/mol (±15) (10%) to 73.1 mmol/mol (±15) (8.8%)). FSL use was also associated with reduced within-person HbA1c variability (5.37 pre-FSL vs. 3.15 post-FSL, P<0.0001). In the immediate 12 month period prior to FSL initiation, 5% patients reported a hospital admission related to hyperglycaemia/diabetic ketoacidosis. During the ongoing median follow-up of 6 months following FSL initiation this was 1%.​ Conclusions: These initial FSL audit data demonstrate significantly improved glycaemic control, reduction in HbA1c variability and less hyperglycaemia related hospital admissions in the first 6 months follow-up. Data collection is ongoing. Further analyses with longer follow-up may confirm these findings and inform future clinical practice and policy. Disclosure H. Deshmukh: None. E.G. Wilmot: Advisory Panel; Self; Dexcom, Inc. Research Support; Self; Diabetes UK. Speaker's Bureau; Self; Abbott, Eli Lilly and Company, Novo Nordisk Inc., Sanofi. D. Bishop: None. D.W. Lipscomb: Advisory Panel; Self; Sanofi. Speaker's Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Novo Nordisk A/S, Sanofi. Stock/Shareholder; Self; ABCAM, EKF Diagnostics, GlaxoSmithKline plc., Renalytix AI PLC. R. Banatwalla: None. R. Zaidi: None. Z.V. Smith: None. L. Overend: Other Relationship; Self; Lilly Diabetes, Novo Nordisk Inc. S. Kamaruddin: None. C.M. Hall: None. J. Macfadyen: None. A. Kilvert: Advisory Panel; Self; Sanofi. R.E. Ryder: Advisory Panel; Self; Novo Nordisk A/S. Speaker's Bureau; Self; Bioquest. C. Walton: Advisory Panel; Spouse/Partner; Celgene Corporation. Speaker's Bureau; Spouse/Partner; Leo Pharma, Novartis Pharmaceuticals Corporation. T. Sathyapalan: Speaker's Bureau; Self; Novo Nordisk Foundation. Other Relationship; Self; Bristol-Myers Squibb Company, Eli Lilly and Company, Sanofi-Aventis. Funding Association of British Clinical Diabetologists

The multidisciplinary team meeting has been successful, with perceived benefits for patients, improved imaging evaluation and efficiency of referral pathways, leading to more appropriate patient management.