Type 2 diabetes (T2DM) is a growing health issue globally, which, until recently, was considered to be both chronic and progressive. Although having lifestyle and dietary changes as core components, treatments have focused on optimising glycaemic control using pharmaceutical agents. With data from bariatric surgery and, more recently, total diet replacement (TDR) studies that have set out to achieve remission, remission of T2DM has emerged as a treatment goal. A group of specialist dietitians and medical practitioners was convened, supported by the British Dietetic Association and Diabetes UK, to discuss dietary approaches to T2DM and consequently undertook a review of the available clinical trial and practice audit data regarding dietary approaches to remission of T2DM. Current available evidence suggests that a range of dietary approaches, including low energy diets (mostly using TDR) and low carbohydrate diets, can be used to support the achievement of euglycaemia and potentially remission. The most significant predictor of remission is weight loss and, although euglycaemia may occur on a low carbohydrate diet without weight loss, which does not meet some definitions of remission, it may rather constitute a ‘state of mitigation’ of T2DM. This technical point may not be considered as important for people living with T2DM, aside from that it may only last as long as the carbohydrate restriction is maintained. The possibility of actively treating T2DM along with the possibility of achieving remission should be discussed by healthcare professionals with people living with T2DM, along with a range of different dietary approaches that can help to achieve this.

Although carbohydrate restriction is not a new approach for the management of Type 2 diabetes, interest in its safety and efficacy has increased significantly in recent years. The purpose of the current narrative review is to summarise the key relevant research and practical considerations in this area, as well as to explore some of the common concerns expressed in relation to the use of such approaches. There is a strong physiological rationale supporting the role of carbohydrate restriction for the management of Type 2 diabetes, and available evidence suggests that low carbohydrate dietary approaches (LCDs) are as effective as, or superior to, other dietary approaches for its management. Importantly, LCDs appear to be more effective than other dietary approaches for facilitating a reduction in the requirement for certain medications, which leads to their effects on other health markers being underestimated. LCDs have also been demonstrated to be an effective method for achieving remission of Type 2 diabetes for some people. The available evidence does not support concerns that LCDs increase the risk of cardiovascular disease, that such approaches increase the risk of nutrient deficiencies, or that they are more difficult to adhere to than other dietary approaches. A growing number of organisations support the use of LCDs as a suitable choice for individuals with Type 2 diabetes.

C (2018) Efficacy of anthropometric measures for identifying cardiovascular disease risk in adolescents: review and meta-analysis. Minerva Pediatrica, 70 (4). pp. 371-382.

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Background. Since 2007 Durham and Cleveland Firearms Police have trained a small number of firearms police officers to an enhanced level of first aid qualification. This article reviews the history of this programme, the patient report forms submitted during the period 2013-2016 and analyses the types of incidents attended. Methods: 66 PRFS were interrogated and analysed from a four-year period between Jan 2013 and Dec 2016. There was a marked increase in PRFs submitted during that time. Over half the casualties were male, resulting from assault (15) 21%), road traffic collisions (14)19%) and deliberate self-harm (14)19%). The most frequent medical interventions were wound dressing and direct pressure, airway manoeuvres and Oxygen therapy. On-scene times with patients prior to handover to NHS staff ranged from 0->60 mins. 0-20 minutes (22), 20-40 minutes (15), 40-60 minutes (10) and >60 minutes (1). Discussion: This data shows that the TTMs provide a useful medical response often arriving before other medical provision is on scene. Despite the primary role being to respond to firearms trauma, officers have dealt with a range of medical scenarios and provided a range of interventions.