Aspirin use prevented serious vascular events in persons who had diabetes and no evident cardiovascular disease at trial entry, but it also caused major bleeding events. The absolute benefits were largely counterbalanced by the bleeding hazard. (Funded by the British Heart Foundation and others; ASCEND Current Controlled Trials number, ISRCTN60635500 ; ClinicalTrials.gov number, NCT00135226 .).

Among patients with diabetes without evidence of cardiovascular disease, there was no significant difference in the risk of serious vascular events between those who were assigned to receive n-3 fatty acid supplementation and those who were assigned to receive placebo. (Funded by the British Heart Foundation and others; Current Controlled Trials number, ISRCTN60635500 ; ClinicalTrials.gov number, NCT00135226 .).

This exploratory randomised controlled trial examined the effectiveness of a novel short messaging service intervention underpinned by the theory of planned behaviour (TPB) in improving insulin administration in young adults with type 1 diabetes and the role of moderating variables. Those in the intervention condition (N = 8) received one daily text message underpinned by TPB constructs: Attitudes, subjective norms, perceived behavioural control and intention. Those in the control condition (N = 10) received weekly general health messages. Self-reported insulin administration was the main outcome measure; conscientiousness and consideration of future consequences (CFC) were measured as potential moderators. Analyses of covariance revealed no main effects of condition for morning and afternoon injections but a marginally significant effect for evening injections (p = .08). This main effect was qualified by significant interactions of condition with conscientiousness (p = .001), CFC (p = .007) and a three-way interaction among condition, conscientiousness and CFC (p = .009). Exploration of the interactions indicated the intervention significantly improved evening injection rates only in the low conscientiousness and low CFC groups. This effect was particularly strong among those low in both conscientiousness and CFC. Further investigation is warranted, using more objective measures of insulin adherence in a larger sample.

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Exercise through swimming is beneficial for patients with diabetes; however, swimming pool environments are known to favour infection. There is at present no available literature on outcomes of swimming pool associated diabetic foot infections and we describe a novel case series of patients who presented with foot infections after using a swimming pool.Individuals attending our Diabetes Limb Salvage Clinic with foot ulcers/infections who had an injury or infection after exposure to a swimming pool environment were identified. We noted ulcer characteristics, pathogens, length of hospital stay and clinical outcomes.Seven individuals (six male, one female, aged 36–68 years) were exposed to a swimming pool environment while on holiday, and within 48 hours had a new ulcer or worsening of their pre‐existing ulcers. Five had new ulcers (two injured their feet on the swimming pool floor, three developed blisters after swimming); two had worsening of their pre‐existing foot ulcers. All patients required hospitalisation (5–20 days) at presentation with severe foot infection. Microbiology showed six patients had mixed flora isolated from their ulcers: Staphylococcus aureus (three), Corynebacterium (two), enteric flora (two), Pseudomonas (one), Streptococcus group C‐G (one) and Bacteroides (one). In terms of outcomes: one patient had a below knee amputation; two required minor amputations.People with diabetes who sustain a foot injury in a swimming pool environment may develop complex infections with waterborne organisms that can be difficult to eradicate, resulting in considerable morbidity including amputation. These risks need to be highlighted and individuals with diabetes advised to protect their feet in water. Copyright © 2021 John Wiley & Sons.

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