Endodiabology October 2011 Issue 3

ENDODIABOLOGY
Endodiabology.blogspot.com

NORTHEAST
NEWSLETTER
FOR SPRs AND BOSSES TRAPPED
IN THE NORTHERN DEANERY

October 2011
Editors: Shaz Wahid (shahid.wahid@stft.nhs.uk) and
Petros Perros (petros.perros@ncl.ac.uk) and Arut Vijayaraman (riarut@aol.com )
Associate Editor: Srikanth Mada

StR PLACEMENTS (NTN year of training from 1st October 2010)
• Newcastle- Alison Heggie (2), Sudeep Manohar (5), Nimanthe De Alwis (3), Rohana Wright (3), Anjali SanthaKumar (3), Naveen Siddaramaiha (5), , Vacant, Vacant
• North Tyneside/Wansbeck- Asgar Madathil (4) from Jan 2012, Arif Ullah and Sajid Ethol Kalathil (3) job share with NGH community diabetes post
• South Tyneside- Catherine Napier (3)
• Gateshead- Kathryn Stewart (3)
• Sunderland- Sviatlana Zhyzhneuskaya (1), Shunmugam Nellaiappan (1) from Jan 2012
• North Tees/Hartlepool- Naveen Aggarwal (3), Atif Munir (4)
• Middlesbrough- Jacog Buckovan (2), Shunmugam Nellaiappan (1) till Jan 2012, Agnieska Sawiecicka (2), Stuart Little (3) from Jan 2012
• Bishop Auckland/Darlington/Durham- Humza Ali Khan (3)
• NGH- Arif Ullah/ Sajid Ethol Kalathil (3) job share
• Research with numbers (supervisor)- Stuart Little (3-Dr Shaw), Asgar Madathil (4-Dr Weaver), Sarah Steven (3-Prof Taylor), Anna Mitchell (1-Prof Pearce), Earn Gan (1-Prof Pearce)

MEETINGS / LECTURES / ANNOUNCEMENTS
• 11th October 2011 SfE Regional Clinical Cases Meeting. Venue TBC. Contact www.endocrinology.org/meetings/index
• 12th October 2011 Northern Endocrine & Diabetes Autumn CME, Durham. Contact Sarah Steven(sarah.steven@doctors.org.uk ) or Srikanth Mada (srikanth.mada@nhs.net )
• 7th – 9th November 2011 SfE Clinical Update 2011. Sheffield. Contact www.endocrinology.org/meetings
• 10th-12th November 2012 ABCD autumn meeting, London. Contact www.diabetologists.org.uk followed by SpRs meeting.
• 16th November 2011 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk .
• 23rd November 2011 Northern Endocrine Region Research and Audit Group meeting, Lumley Castle, Chester-le-street. Contact Shahid.wahid@stft.nhs.uk
• 24th-25th November 2011 Middlesbrough insulin pump course. Contact Nicky.Skippon@stees.nhs.uk
• 30th November 2011 RCP Updates in Medicine, Freeman Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk .
• 30th November-1st December 2012 60th British Thyroid Association Annual meeting, London, www.british-thyroid-association.org .
• 12th December 2011 SfE Clinical Cases. Exeter. Contact www.endocrinology.org/meetings
• 18th January 2012 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk .
• 24th January 2012 Northern Endocrine & Diabetes Winter CME, Freeman Hospital. Contact Sarah Steven(sarah.steven@doctors.org.uk ) or Srikanth Mada (srikanth.mada@nhs.net ) or Rohana Wright rohanawright@doctors.org.uk
• 29th February 2012 SfE Clinical Cases. London. Contact www.endocrinology.org/meetings
• 7th-9th March 2012 Diabetes UK APC. Glasgow. Contact www.diabetes.org.uk/conference
• 14th March 2012 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk .
• 19th-22nd March 2012 BES 2012. Harrogate. Contact www.endocrinology.org/meetings
• 18th April 2012 Acute Medicine Conference, Freeman Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk .
• 8th May 2012 Northern Endocrine & Diabetes Summer CME, Sunderland. Contact Sarah Steven(sarah.steven@doctors.org.uk ) or Srikanth Mada (srikanth.mada@nhs.net ) or Rohana Wright rohanawright@doctors.org.uk
• 16th May 2012 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk .
• 4th July 2012 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk .
• 19th September 2012 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk .
• 11th October 2012 Northern Endocrine & Diabetes Autumn CME, JCUH. Contact Sarah Steven(sarah.steven@doctors.org.uk ) or Srikanth Mada (srikanth.mada@nhs.net) or Rohana Wright rohanawright@doctors.org.uk
• 27th November 2012 RCP Updates in Medicine, Freeman Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk .
• 28th November 2012 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Sue Archibald 0191 223 1247 sue.archibald@nuth.nhs.uk .

TRAINING ISSUES
DIABETES & ENDOCRINOLOGY PIMD WEBSITE Our specialty website is available on http://mypimd.ncl.ac.uk/PIMDDev . Click onto the specialty training tab then follow to Diabetes & Endocrinology.
Registering with PMETB It is essential that all new StRs (even LATs) register with the PMETB through the Joint Royal Colleges of Physicians Training Board on www.jrcptb.org.uk. Not doing so means your training is not counted.
Portfolio Documentation It is a trainee’s responsibility to make sure their portfolio/log book is prospectively completed and the necessary signatures obtained. Any experience that is not signed off by your educational supervisor at the time cannot be counted towards training.
Documenting CCU and ITU experience It is essential that trainees document their CCU and ITU experience. This is best done by keeping a summary log of the cases seen on CCU and ITU and linking it with reflection or assessment. This should then be signed off by your Educational Supervisor to be of any use at the G(I)M PYAs.
MRCP Diabetes & Endocrinology This exam has to be completed and passed by all trainees appointed after August 2007 before their PYA. We recommend sitting it ASAP and well before your PYA.
The Kelly-Young MRCP Diabetes & Endocrinology Prize This prize is awarded annually at NERRAG to the youngest in terms of training year StR passing the MRCP Diabetes & endocrinology exam. Richard Quinton secures the funding of £800 and it is named after 2 distinguished former Endocrinologists in the region, Bill Kelly and Eric Young.
Critical incident/complaint If you are involved in a critical incident or if reporting an incident concerning training issues please inform your supervisor and the TPD. Ensure they are reflected upon in your portfolio
Portfolio Completion It is essential for trainees to engage with their portfolio on a regular basis and record learning. It is also essential to record the numbers of patients seen as news or reviews for clinics, on-call, ambulatory care. It is essential to record the number of specialty clinics undertaken. Undertaking this activity means that your Educational Supervisor should be able to engage with the portfolio so as to provide you that assessment for ARCP purposes. Please see Jacob’s article.
MERRIT The regional training for StRs is in place and has been delivered on 3 occasions. Contact Stuart and Srikanth for future dates. I really enjoyed preparing for and delivering the South Tyneside session. I was disappointed by the poor attendance given that I (Shaz) cancelled a clinic and then overbooked the preceding clinic by 100% to deliver the session. Hopefully attendance will improve.
Management Training A regional management programme is in place for StRs. Contact Nimantha De Alwis nimdeal@googlemail.com for more information.
Call For Mentors Please read the information in the letters section from Baldev Singh sent to the Editorial Team from Gillian Hawthorne.
Training Committee Chair- Nicky Leech nicola.leech@nuth.northy.nhs.uk; Regional Speciality Advisor- Shaz Wahid, shahid.wahid@sthct.nhs.uk; Programme Director- Arutchelvam Vijayaraman Vijayaraman.Arutchelvam@stees.nhs.uk; Consultant member- Richard Quinton, Richard.Quinton@nuth.nhs.uk; Consultant member-Jean MacLeod, Jean.Macleod@nth.nhs.uk; Consultant member-Dr Peter Carey; Consultant member-Simon Eaton, simon.eaton@northumbria-healthcare.nhs.uk; Consultant member-Salman Razvi salman.razvi@ghnt.nhs.uk ; Consultant member-Paul Peter paul.peter@cddah.nhs.uk ; SpR representative-Srikanth Mada srikanth.mada@nhs.net ; SpR representative-Stuart Little stuartlittle@doctors.org.uk

NEWS FROM THE NORTHEAST
• Congratulations to Arut on his formal appointment as TPD. Please read his article below.
• Congratulations to Sarah Stevens on her Research Fellowship award.
• Welcome to Gus Brookes, who has joined Jim Shaw as a research fellow from Bristol.
• Philip Home is retiring from his NHS post in Newcastle with effect from 31 December 2011. He continues in part time employment from Newcastle University thereafter. A personal thank you to him for his support over the years.
• Congratulations to Terry Aspray on his award of a grant from Arthritis Research UK to study the effects of vitamin D supplementation on bone health in men and women aged over 70: "Optimising Vitamin D Status in Older People: A Randomised Controlled Trial of Vitamin D Supplementation" Grant Code 19544 ; Lead Applicant Name Dr Terence Aspray; Total Amount Requested £ 660,398.
• Congratulations to Srikanth Mada on his appointment as Consultant Endocrinologist for County Durham & Darlington NHS FT.

LETTERS
10 top tips for the e-portfolio-Jacob Bukowczan
1.Don’t get hung up on where to put what.
2. Try and write in your natural style.
3. It’s all about quality not quantity.
4. Visit your e-portfolio regularly: making entries in a timely way and reviewing
the “whole picture” regularly.
5. Don’t put if off until tomorrow, there is never enough time to do it.
6. Review the range of your competencies on a regular basis.
7. Reflection is everything – do it at least once a month.
8. Use your on-calls wisely – ask consultant for an ACAT form after each post take ward round and keep record of all the patients you reviewed that day/night.
9. Use your library – scan and upload all your certificates, presentations, feedback forms early.
10. Link assessments/experiences to the curriculum as soon as possible.

The British Thyroid Association Meeting 30th November & 1st December 2011-Prof Simon Pearce
The BTA meeting in London includes a new half day SpR clinical teaching session on the Wednesday afternoon followed by the full-day clinical and scientific session the day after. Once again, we have a great programme of international speakers for both thyroid cancer and thyroid eye disease, as well as the usual suspects from Newcastle... Registration will be snip- most likely forty or 50 quid for SpRs: see the BTA website for a registration form shortly.
SpRs with interesting 'grey cases' in hyperthyroidism are welcome to submit a short synopsis to myself or Bijay Vaidya.

Call for Mentors: The National Diabetes Consultant Mentorship Programme (NDCMP)-Baldev Singh
May I update you regarding the NDCMP which is to run under the full regulation of the Association of British Clinical Dialectologists with Eli Lilly as the funding body?

Taking up a new consultant post in diabetes and endocrinology is both exciting and challenging. Acquiring experience, expertise and wisdom to develop in this role takes time and such development is not always best met by the standard processes of CME and CPD. Mentorship programmes are valued for their ability to offer independent, trusted and expert support, advice and guidance in relationship to professional development. Mentorship programmes already exist but they vary in their structure and quality, they are not always offered locally and there are none available that are specific to the speciality. Universally, senior SpRs express a high desire for effective Mentorship.

Arrangements are now formalised and the NDCMP will be fully established in early 2012. It will be well structured, well governed and sustained in to the long term. The programme will be systematically offered to all newly appointed consultants in Diabetes and Endocrinology. Mentees will be able to access ABCD accredited Mentors from within their own region and avail themselves of the benefits of a mentoring relationship lasting between 12 to 24 months.

Crucially to NDCMP will be our expert Mentors. They will be drawn from amongst established colleagues who have respect and reputation within the speciality. They will have:
• a minimum of 5 years service experience in substantive posts
• expertise in key other areas such as teaching and training, leadership and management, and service development and perhaps have undertaken extension roles such as (but not limited to) Clinical Director, College Tutor, Clinical Tutor, Undergraduate Lead, Specialist Training, Research, relevant District / Regional / National Committees.

Could those colleagues who feel they fit the bill and who are enthusiastic to be NDCMP Mentors please make themselves known to me (baldev.singh@nhs.net). A brief self nomination form will subsequently be dispatched. Please note that a Mentor group meeting is planned for the 18th (Friday late afternoon) and 19th of November 2011 at a central location (provisionally Coombe Abbey, Warwickshire, www.coombeabbey.com).

A message from our new TPD Arut
From October 1st, I will be taking over as the TPD, (I heard that this is the most desired and thankful job in the whole world, hence I applied!) I join you all in thanking Nicky Leech for managing the programme so well in the last few years. Despite all the challenges ahead, I am quite thrilled to take up this position and keen to work with everybody to uphold the high standards.
The main challenge is to continue to recruit high quality candidates into the specialty-training programme. Looking at the application ratios, our specialty is one of those with a lower ratio. Our region being for away from London does not help. However having highly reputed trainers and high standard research programmes available in the region, I expect will continue to make it attractive. We need to work further on popularising our specialty. I will be very grateful for your suggestions.
The other issue is, high number of outcome 2 in the ARCP, particularly in GIM. It is disheartening to note that some excellent trainees got this adverse outcome, simply because of issues with the e portfolio. This was distressing both for the trainers and the concerned trainees. We will work on continuously finding ways to engage with the e portfolio, by learning from each other’s good practice. I welcome trainees and trainers to share their practices. For example, our trainees at JCUH regularly bring cases for discussion and a NHS topic every fortnight to the educational supervisor and will do an assessment at the end. I noticed the trainees have done a large number of assessments by this way. We also encourage do get the SpR to lead the ward round frequently and do an ACAT at the end. Reviewing the validity of ALS is essential. I suggest that we have a target that no one fails in the forthcoming ARCP except for major training reasons.
We have the next round of interviews in October and we hope to recruit enough candidates, which will fill most gaps in the training programme. I thank all of you in advance for your help, support and guidance in the forthcoming years. Please keep in regular touch with your suggestions.
Regional Insulin Safety and Knowledge Programme-Jan Finn
This project is an initiative to review insulin safety and knowledge in the region. It is going to have a board which will meet 1-2hours bi-monthly (1st meeting 18th Oct 4-6pm venue tbc) so it would be beneficial for each service to have representation at this - someone who leads on diabetes/insulin safety.

There will also be 3 work streams
1/ Hospital insulin charts –An attempt to standardise common features on the hospital insulin charts across the region.
2/ National Insulin Passport-following NPSA guidance.
3/ Professional training - this work stream is going to develop a regional training programme for hospital based health care professionals. Ultimately it will work towards this training programme becoming a mandatory aspect of all health care workers training requirements.

Please send comments to jan.finn@nhs.net

RECENT PUBLICATIONS FROM THE NORTHEAST
1. Mellor A and Woods D. Serum Neutrophil Gelatinase Associated Lipocalin in Ballistic Injuries: A comparison between blast injuries and gunshot wounds. Journal of Critical Care, 2011.
2. Tornberg J, Sykiotis G, Keefe K, Plummer L, Hoang X, Hall JE, Quinton R, Seminara SB, Hughes VA, van Vliet G, van Uum S, Crowley WF, Jr., Habuchi H, Kimata K, Pitteloud N, Bülow H. 2011 Proceedings of the National Academy of Sciences of the United States of America. 108: 11524-11529.
3. Wahab F, Quinton R, Seminara SB. The kisspeptin signaling pathway and its role in human isolated GnRH deficiency. Molecular & Cellular Endocrinology. 2011; June 17 [epub ahead of print].
4. Chan YM, Broder-Fingert S, Paraschos S, Lapatto R, Au M, Hughes V, Bianco SD, Min L, Plummer L, Cerrato F, De Guillebon A, Wu IH, Wahab F, Dwyer A, Kirsch S, Quinton R, Cheetham T, Ozata M, Ten S, Chanoine JP, Pitteloud N, Crowley WF Jr, Martin KA, Schiffmann R, Van der Kamp HJ, Nader S, Hall JE, Kaiser UB, Seminara SB. GnRH-Deficient Phenotypes in Humans and Mice with Heterozygous Variants in KISS1/Kiss1. J Clin Endocrinol Metab. 2011 Aug 31. [Epub ahead of print].
5. A Munir, SL Toh, V Arutchelvam. Insulinoma in a patient with Type 2 Diabetes-Case report, published in Practical Diabetes , Volume 28 Issue 5 (June 2011).
6. Gan EH, Mitchell AL, Macarthur K, Pearce SH 2011 The role of a nonsynonymous CD226 (DNAX-accessory molecule-1) variant (Gly 307Ser) in isolated Addison's disease and autoimmune polyendocrinopathy type 2 pathogenesis. Clin Endocrinol (Oxf), 75(2):165-8.
7. Yarnall AJ, Hayes L, Hawthorne GC, Candlish CA, Aspray TJ. Diabetes in care homes: current care standards and residents' experience. Diabet Med. 2011 Jul 25. doi: 10.1111/j.1464-5491.2011.03393.x. [Epub ahead of print] 2.
8. Aspray TJ, Francis RM. Calcium and vitamin D supplementation and cardiovascular disease: quo vadis? Maturitas. 2011 Aug;69(4):285-6.
9. Sinclair AJ, Aspray TJ et al ; Task and Finish Group of Diabetes UK. Good clinical practice guidelines for care home residents with diabetes: an executive summary. Diabet Med. 2011 Jul;28(7):772-7. doi: 10.1111//.1464-5491.2011.03320.x.
10. Martin-Ruiz C, Jagger C, Kingston A, Collerton J, Catt M, Davies K, Dunn M, Hilkens C, Keavney B, Pearce SH, Elzen WP, Talbot D, Wiley L, Bond J, Mathers JC, Eccles MP, Robinson L, James O, Kirkwood TB, von Zglinicki T. Assessment of a large panel of candidate biomarkers of ageing in the Newcastle 85+ study. Mech Ageing Dev. 2011 Aug 16. [Epub ahead of print]
11. Vanderpump MP, Lazarus JH, Smyth PP, Laurberg P, Holder RL, Boelaert K, Franklyn JA; British Thyroid Association UK Iodine Survey Group (including Razvi S, Pearce SH). Iodine status of UK schoolgirls: a cross-sectional survey. Lancet. 2011 Jun 11;377(9782):2007-12.
12. Newby PR, Pickles OJ, Mazumdar S, Brand OJ, Carr-Smith JD, Pearce SH, Franklyn JA; Wellcome Trust Case-Control Consortium (WTCCC), Evans DM, Simmonds MJ, Gough SC. Follow-up of potential novel Graves' disease susceptibility loci, identified in the UK WTCCC genome-wide nonsynonymous SNP study. Eur J Hum Genet. 2010 Sep;18(9):1021-6.

RECENT PUBLICATIONS IN DIABETES & ENDOCRINOLOGY THAT HIT THE NEWS OR THAT MAY HAVE A SIGNIFICANT IMPACT ON MANAGEMENT

Management of hypertension: summary of NICE guidance. T Krause et al. BMJ 2011;343:d4891. An excellent summary of the guidelines with implications for our patients and services. Get ambulatory monitoring entrenched!
Investigating mixed hyperlipidaemia. A Viljoen and AS Wierzbicki. BMJ 2011;343:d5146. A useful clinical practice paper.
Electronic Health Records and Quality of Diabetes Care. RD Cebul et al. NEJM 2011;365:825-833. An excellent article that can be extrapolated to the UK and provides ammunition for those of us wishing to develop an interactice web-based system for both clinical interactions and register use.
Autoimmune encephalitis. SR Irani et al. BMJ 2011;342:d1918. An excellent editorial detailing 2 condition sthat we should be far more vigilant for than we are.
Multiple endocrine abnormalities. CMPG van Durne et al. Lancet 2011;378:540. An excellent case report of a rare cause for pituitary hypophisitis.
Weighing the benefits of high-dose Simvastatin against the risk of myopathy. A Egan & E Colman. NEJM 2011365:285-287. A perspective well worth a read and a reminder that we should no longer be going to Simvastatin 80mg.
Intensive glucose lowering treatment in type 2 diabetes. D Preiss & KK Ray. BMJ 2011;343:d4343. A thought provoking editorial and rather controversial?
Salt reduction lowers cardiovascular risk: meta-analysis of out come trials. FJ He & GA MacGregor. Lancet 2011;378:380-382. An excellent editorial reviewing the effectiveness of salt reduction. Make sure you have salt-reduction leaflets for your hypertensive patients in clinic.
Glycaemic control in type 1 diabetes during real time continuous glucose monitoring compared with self monitoring of blood glucose: meta-analysis of randomised controlled trial using individual patient data. JC Pickup et al. BMJ 2011;343:d3805. An excellent article that should change your practice if not already.
Diabetic ketoacidosis at the onset of type 1 diabetes. BMJ 2011;343:d3278. It is still common! The article acts a s a reminder and should provoke some thoughts on how you should reduce it in your locality.
Glucocorticoid-Induced Bone Disease. RS Weinstein. NEJM 2011;365:62-70. An excellent overview on clinical practice that is well worth a read.
The Lancet volume 378 2011 number 9786 9-15th July. This edition of the Lancet is essential reading. It includes 4 wonderful primary research papers on diet & Physical activity vs. usual care on diagnosis of Type 2 DM by Rob Andrews (some of you may remember Rob) and co, incidence of heart failure in type 1 DM by Lind et al, HbA1c use for pre-diabetes by Heianza et al and MRFIT on screen detected Type 2 DM by Griffin et al. The 4 accompanying Editorials add to the essential read.
National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. G Danaei et al. Lancet 2011;378:41-40. A mammoth and impressive study adding to the world perspective of diabetes.
Anti-CD3 antibodies for Type 1 diabetes: beyond expectations. JF Bach. Lancet 2011;378:459-460. See linked paper Lancet 2011;378:487-497.
Arresting type 1 diabetes after diagnosis: GAD is not enough. C Mathieu & P Gillard. Lancet 2011;378:291-292. see linked paper Lancet 2011;378:319-327.
New hope for immune intervention therapy in type 1 diabetes. BO Roep. Lancet 2011;378:376-378. See linked paper Lancet 2011;378:412-419.
The above 3 editorials with their linked primary research papers are a must read for an update on immunotherapy in type 1 diabetes.
Bardoxolone Methyl and Kidney Function in CKD with Type 2 Diabetes. PE Pergola et al. NEJM 2011;365:327-336. An antioxidant inflammation modulator useful in CKD. However a very mixed group of CKD patients.
Sharp: a stab in the right direction in chronic kidney disease. KK Stevens, AG Jardine. Lancet 2011;377:2153-2154. See linked paper Lancet 2011;377:2181-2192. An excellent editorial that critically reviews the linked paper and statin therapy in CKD.
Iodine status of UK schoolgirls: a cross-sectional survey. MP Vanderpump et al. Lancet 2011;377:2007-2012. An excellent study with a thought provoking conclusion. This should be a call to action.
Diagnosis, classification, and treatment of diabetes. A Farmer & R Fox. BMJ 2011;342:d3319. An excellent practical editorial.
Time trends in mortality in patients with type 1 diabetes: nationwide population based cohort study. V Harjutsalo et al. BMJ 2011;343:d5364. An interesting study demonstrating improving mortality in early onset type 1 diabetes but increasing mortality in type 1 late onset type 1 diabetes. Read on……………………………………………………………………………………….


NEXT NEWSLETTER Due out beginning of February 2012 so keep the gossip coming.

Endodiabology May 2011 Issue 2

ENDODIABOLOGY
Endodiabology.blogspot.com

NORTHEAST
NEWSLETTER
FOR SPRs AND BOSSES TRAPPED
IN THE NORTHERN DEANERY

June 2011
Editors: Shaz Wahid, Petros Perros and Arutchelvam Vijayaraman
Associate Editor: Srikanth Mada

StR PLACEMENTS (NTN year of training from 1st October 2010)
• Newcastle- Atif Munir (2), Sajid Ethol Kalathil (2), Catherine Napier (2), Naveen Aggarwal (2), Hamza Ali Khan (2), Agnieska Sawiecicka (1), Vacant
• North Tyneside/Wansbeck- Alison Heggie (1), Vacant
• South Tyneside- Nimanthe De Alwis (2)
• Gateshead- Kathryn Stewart (3)
• Sunderland- Jakob Buckovan (1), vacant
• North Tees/Hartlepool- Sudeep Manohar (4), vacant
• Middlesbrough- Arif Ullah (4), Naveen Siddaramaiha (4), Shunmugam Nellaiappan (1)
• Bishop Auckland/Darlington/Durham- Sathia Raghavan(1), Vacant
• NGH- Srikanth Mada(4),
• Research with numbers (supervisor)- Stuart Little (3-Dr Shaw), Asgar Madathil (4-Dr Weaver), Sarah Steven (3-Prof Taylor), Anna Mitchell (1-Prof Pearce), Earn Gan (1-Prof Pearce)
• Maternity Leave Rohana Wright (3), Anjali SanthaKumar (3)

MEETINGS / LECTURES / ANNOUNCEMENTS
• 4th-7th June 2011 ENDO 2011, Boston, USA. Contact endostaff@endo-societ.org or www.endo-society.org/scimeetings .
• 16th June 2011 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk
• 24th – 28th June 2011 American Diabetes Association 71st Annual Scientific Sessions, San Diego, USA. Contact meetings@diabetes.org .
• 13th July 2011 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk
• 12th - 16th September 2011 47th EASD annual meeting, Lisbon, Portugal. Contact www.easd.org
• 14th September 2011 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk
• 21st September 2011 DUK APC 2012 abstract deadline.
• 11th October 2011 SfE Regional Clinical Cases Meeting. Venue TBC. Contact www.endocrinology.org/meetings/index
• 12th October 2011 Northern Endocrine & Diabetes Autumn CME, Durham. Contact Sarah Steven(sarah.steven@doctors.org.uk ) or Srikanth Mada (srikanth.mada@nhs.net )
• 7th – 9th November 2011 SfE Clinical Update 2011. Venue TBC. Contact www.endocrinology.org/meetings/index
• 16th November 2011 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk
• 23rd November 2011 Northern Endocrine Region Research and Audit Group meeting, Lumley Castle, Chester-le-street. Contact Shahid.wahid@stft.nhs.uk
• 24th-25th November 2011 Middlesbrough insulin pump course. Contact Nicky.Skippon@stees.nhs.uk
• 30th November 2011 RCP Updates in Medicine, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk.

TRAINING ISSUES
STOP PRESS: NEW Assessment tools Please see www.jrcptb.org.uk; It is the trainee’s responsibility to make sure that the appropriate assessments are available in their portfolio for ARCP purposes. For 2011 there are 3 new work based assessment tools available: Patient Surveys, Audit Assessment and Teaching Observation. It is essential that you review the web site and make arrangements to utilize these new assessment tools as evidence for your ARCP.
DIABETES & ENDOCRINOLOGY PIMD WEBSITE Our specialty website is available on http://mypimd.ncl.ac.uk/PIMDDev . Click onto the specialty training tab then follow to Diabetes & Endocrinology.
Registering with PMETB It is essential that all new StRs (even LATs) register with the PMETB through the Joint Royal Colleges of Physicians Training Board on www.jrcptb.org.uk. Not doing so means your training is not counted.
Portfolio Documentation It is a trainee’s responsibility to make sure their portfolio/log book is prospectively completed and the necessary signatures obtained. Any experience that is not signed off by your educational supervisor at the time cannot be counted towards training.
Documenting CCU and ITU experience It is essential that trainees document their CCU and ITU experience. This is best done by keeping a summary log of the cases seen on CCU and ITU and linking it with reflection or assessment. This should then be signed off by your Educational Supervisor to be of any use at the G(I)M PYAs.
MRCP Diabetes & Endocrinology This exam has to be completed and passed by all trainees appointed after August 2007 before their PYA. We recommend sitting it ASAP and well before your PYA.
The Kelly-Young MRCP Diabetes & Endocrinology Prize This prize is awarded annually at NERRAG to the youngest in terms of training year StR passing the MRCP Diabetes & endocrinology exam. Richard Quinton secures the funding of £800 and it is named after 2 distinguished former Endocrinologists in the region, Bill Kelly and Eric Young.
Faculty training day The next Faculty training day is on 14th June 2011. It kicks off with the STC meeting followed by a trainers training session and the Trainers and Trainees meeting from 1530. For more details see the letters section.
GIM ARCPs This year’s GIM ARCP made for grim reading for our training programme. Out of the 12 trainees assessed 3 achieved an outcome 1 (satisfactory progression), 8 achieved an outcome 2 (targeted training needed with no additional time to CCT date) and 1 achieved an outcome 5 (further information required to make an award). The fall-out of this poor showing is multifactorial and something we will have to address. Before you blame the tensions between balancing GIM and specialty, the reasons relate a lot more to the fundamentals of educational supervision and trainee engagement. Further discussion will occur at the T&T meeting planned for 14th June 2011.
Critical incident/complaint If you are involved in a critical incident or if reporting an incident concerning training issues please inform your supervisor and the TPD. Ensure they are reflected upon in your portfolio
Educational Supervision With revalidation requiring evidence of effectiveness in all of our roles as a Consultant and with the School of Medicine publishing minimum standards for Educational Supervisors (see letters section), this critical role will come under the spotlight in the next 18-24 months. It is no longer acceptable to simply have been to the training courses and undertaken education supervision and other regional activity, such as ARCPs. The Consultant will have to show effectiveness in this role. The effectiveness of this role will be appraised at a Consultant’s appraisal (it should be any appraiser worth their salt!). To help a Consultant gather evidence of their effectiveness as an Educational Supervisor, at this year’s ARCPs the panel has made a note of good practice and areas to improve for each educational supervisor when reviewing their trainee’s e-portfolio using a structured feedback form developed by the School of Medicine. This feedback form will be returned to each educational supervisor for both GIM and DM&ENDO ARCPs so that they can reflect on their performance and develop an action plan for their appraisal to be part of their PDP. There will always need to be a carrot! It is common practice to ask trainees to vote with their feet when choosing a training unit. Following the GIM ARCPs, there has been a ground shift with the first factor to consider when allocating trainees post ARCP rapidly becoming the quality and effectiveness of the Educational Supervision that the training unit can deliver and has delivered.
Training Committee Chair- Nicky Leech nicola.leech@nuth.northy.nhs.uk; Regional Speciality Advisor- Shaz Wahid, shahid.wahid@sthct.nhs.uk; Programme Director- Arutchelvam Vijayaraman Vijayaraman.Arutchelvam@stees.nhs.uk; Consultant member (SAC rep)- Richard Quinton, Richard.Quinton@nuth.nhs.uk; Consultant member-Jean MacLeod, Jean.Macleod@nth.nhs.uk; Consultant member-Dr Peter Carey; Consultant member-Simon Eaton, simon.eaton@northumbria-healthcare.nhs.uk; SpR representative-Srikanth Mada srikanth.mada@nhs.net ; SpR representative-Stuart Little stuartlittle@doctors.org.uk

NEWS FROM THE NORTHEAST
• Congratulations to Mark Walker for being recently selected as an NIHR Senior Investigator, the first for our Region in Endocrinology and Metabolism.
• Some kind words for the region from Preethi Rao “I got the ‘Clinical endocrinology trust clinical practice award’ and ‘ highly commended oral presentation prize’ yesterday at the BES for the study I did with Salman at Gateshead. The title of the study is ‘Thyroid hormones in the euthyroid range predict subsequent body mass composition in women: The OPUS study’. I also got the opportunity to present our data at the young endocrinologist prize session. I am extremely thankful to the northern deanery and in particular to Salman for training me well to achieve these. I hence wanted to share this good news with you as I think the credit of these prizes definitely go to the northern deanery “.
• Congratulations to Sajid Kalathil and co-authors for their Best Poster award at the Pituitary Clinicopathological meeting in London in February 2011, the poster was on 'sellar Haemangiopericytoma'.

LETTERS
Faculty Development Day-Simon Pearce
I have arranged a further 'Training the Trainers' session on the subject of "Recognising and Responding to Underperforming trainees(including Action Planning)" to be delivered by Juliet Graves.

This session will be before the Trainers and Trainees meeting from 11.00 to 15.00 on June 14th, with the T&T meeting being from 15.30 to 18.00, both at the SHA Waterfront Building, Newburn.

Members of the STC will meet 09.30 to 10.45 at the same venue:

Northern Deanery
Waterfront 4
Newburn Riverside
Newcastle upon Tyne
NE15 8NY

Educational Supervisor, Clinical Supervisor and Clinical Trainer standards-Shaz Wahid
The Deanery School of Medicine have produced minimal standards for this varied group of trainers. The standards require that Trainers are selected for their roles, must understand what they are training in and must demonstrate ability as effective trainers. The School states that this is a developmental process and that not all specialties and sites will expect to be able to work to the highest standards immediately.

An Education Supervisor (ES) is defined as a trainer who is selected and appropriately trained to be responsible for the overall supervision and management of a specified trainee’s educational progress during a training placement or series of placements. The ES is responsible for the trainee’s educational agreement.

The Clinical Supervisor (CS) is defined as a trainer who is selected and appropriately trained to be responsible for overseeing a specified trainee’s clinical work and providing constructive feedback during a training placement. Some training schemes appoint an ES for each placement. The roles of clinical and educational supervisor may then be merged.

A Clinical Trainer (CTr) is defined as a trainer who undertakes targeted training in one specific curricular area. This might be, for example, a medic (or non-medic) teaching a medical trainee a specific craft skill.
Furthermore there is a defined group of School Officers, defined as some one holding a School position following formal advertisement and interview. These posts are all remunerated and, at present, consist of Head of School, School Leads for QM, DwDD and Faculty Development and all TPDs. Other STC roles are currently appointed/agreed within individual STC and are not a part of the formal School structure.

The following is suggested as a minimum standard for ESs for implementation across the school in 2010-2011. Previous attendance at a ‘Good practice in educational supervision’ course. Continuing CPD in education: a minimum requirement is an average of ½ day per annum on an educational activity related to the role of supervision with appropriate updates. These educational activities might be generic ones such as, for example, training in teaching, in mentoring, in feedback, in how to manage doctors in difficulty or might be specific to specialty practice such as how to teach craft skills. Suitable activities would include involvement in recruitment, attendance at STCs and ARCPs as long as these were interspersed with other activities of a more obviously educational value A range of courses offered by the Deanery is available at http://mypimd.ncl.ac.uk/training Equality and diversity training every 3 years. This can be provided by Trust or College. Anyone also involved in Recruitment and Selection must undertake training in this and a refresher course every three years. This is available via the Deanery. The ES must be familiar with the relevant eportfolio and maintain familiarity with the relevant curricula. The educational role must be included within the annual trust appraisal process and this documented using whatever format the particular trust wishes to follow.

The School of Medicine states that the time for determining standards for clinical supervisors is not yet arrived. Standards for clinical trainers are likely to arise from the specialty context in which such training is delivered. One of the Scholl of Medicine’s aspirational goals is that there should be a move to greater recognition of the importance of the role of CS and that such people should be encouraged to have training suitable to their role: Eportfolio training, work place based assessments training, training in effective feedback, in identifying DwDN and familiarity with the curricula.

The paper circulated by the School of Medicine discusses aspirational standards & goals such as formal mechanisms of trainer allocation, further definition of standards for a CS and CTr, more formal documentation of Educational roles at appraisal both at Trust and Regional level, the ability to deselect supervisors following appraisal.

The full paper will be circulated and discussed at the T&T meeting on 14th June 2011. My early verdict: a good pragmatic start with good intentions. Training should be seen as a mandatory professional role that needs to be done effectively. With the recent problems in recruitment a number of colleagues in my Trust will be moving towards converting their registrar posts to SAS posts. My comment “it would not be worth coming to work if I was not involved in training the young generation”. With undue bureaucracy in recent years when it comes to training our young generation there has been significant disillusionment amongst Consultants, further compounded by the clinical and performance measures that add to the “lot” of a Consultant. I am encouraged that early indications from this paper suggest that these standards will not be burdensome but add to routine appraisal and the working practice of a NHS Consultant. For those with more advanced roles in Education, they off course will quite rightly have more standards to achieve and require more formal appraisal of their role. There will always be those who will not engage in any way or form using the old adage “it is not in my job plan”! The way around that, well in our Trust with revalidation around the corner we will be moving to a mandatory e-portfolio for all Consultants in our Trust. We will make sure it is not over burdensome.

www.diabetesbible.com Mike Broad
I’ve been working with Dr Jeremy Turner, a consultant in diabetes and endocrinology at the Norfolk and Norwich Hospital, to develop an online guide to diabetes diagnosis and treatment.
The site is designed to help junior doctors to take full histories, and make very thorough assessments, as well as to unify and clarify patient pathways.
Diabetes Bible also includes management overviews on all common diabetes conditions, complications and emergencies. It includes links to latest guidelines (such as NICE and JBDS), and detailed investigation protocols as used by Norwich’s CIU. It’s a free to access site, and should be relevant for consultants, trainees, GPs and specialist nurses. The link to Diabetes Bible is available on the endodiabology website.
Existing links:
Norfolk Diabetes Prevention Study
http://www.norfolkdiabetespreventionstudy.nhs.uk/links
Hospital Dr
http://www.hospitaldr.co.uk/related-websites
Endobible
http://www.endobible.com/page.php?id=10
Young Diabetologists Forum
http://www.youngdiabetologists.org/index.php?option=com_wrapper&Itemid=143

RECENT PUBLICATIONS FROM THE NORTHEAST
1. M. Chetty; E. Sawyer; T. Dew; A. J. Chapman; J. Elson The use of novel biochemical markers in predicting spontaneously resolving 'pregnancies of unknown location' Human Reproduction 2011; doi: 10.1093/humrep/der064
2. A Munir, S Kalathil, S Nag. Pleural effusion caused by pioglitazone. Practical Diabetes International 2011 volume 28 No. 3.
3. Shaw N, Seminara SB, Welt CK, Au M, Plummer L, Hughes VA, Dwyer AA, Martin KA, Quinton R, Mericq V, Merino P, Crowley WF, Jr,, Pitteloud N, Hall JE. 2011 Expanding the phenotype and genotype of female GnRH deficiency. Journal of Clinical Endocrinology & Metabolism. 96: E566-576.
4. Mitchell AL, Dwyer AA, Pitteloud N, Quinton R. 2011 Genetic basis and variable phenotypic expression of Kallmann syndrome: towards a unifying theory. Trends in Endocrinology & Metabolism. Epub 19 April 2011
5. Woods D, Hooper T, Hodkinson P, Ball S, Wakeford R, Peaston B, Bairsto C, Green N, Mellor A. Effects of altitude exposure on brain natriuretic peptide in humans. Eur J Appl Physiol. 2011 Mar 11. [Epub ahead of print]

6. Woods D, Hooper T, Mellor A, Hodkinson P, Wakeford R, Peaston B, Ball S, Green N. Brain natriuretic peptide and acute hypobaric hypoxia in humans. J Physiol Sci. 2011 May;61(3):217-20. Epub 2011 Mar 24.

7. Shashithej K. Narayana, David R. Woods and Christopher J. Boos Management of amiodarone-related thyroid problems. Ther Adv Endocrinol Metab (2011) 0(0) 1_12 DOI: 10.1177/2042018811398516
8. Woods DR, Boos C, Roberts PR.. Cardiac arrhythmias at high altitude. J R Army Med Corps. 2011 Mar;157(1):59-62.
9. Hill NE, Stacey MJ, Woods DR. Energy at high altitude. J R Army Med Corps. 2011 Mar;157(1):43-8.
10. Woods DR, Stacey M, Hill N, de Alwis N. Endocrine aspects of high altitude acclimatization and acute mountain sickness. J R Army Med Corps. 2011 Mar;157(1):33-7.

RECENT PUBLICATIONS IN DIABETES & ENDOCRINOLOGY THAT HIT THE NEWS OR THAT MAY HAVE A SIGNIFICANT IMPACT ON MANAGEMENT
Vertebral Fractures. KE Ensrud & JT Schousboe. NEJM 2011;364:1634-1642. An excellent practical review article for this often encountered issue. Despite the effectiveness of calcitonin in acute vertebral fracture pain, cost prohibits its widespread use. Beside, I have seen pamidronate work!!.
Intensified glucose control in type 2 diabetes-whose agenda? JS Yudkin, B Richter, EAM Gale. Lancet 2011;377:1220-1221. A wonderful down to earth editorial. It certainly provoked controversy, but comes back to underlining the importance of individualised control for our patients. So the next time you get a letter from a GP asking you to get an 80 year old’s HbA1c of 69 mmol/mol (8.5% for those still not attuned!) to their QUoF target send them a copy of this editorial. I did last week!
Osteoporosis: now and the future. TD Rachner, S Khosla, LC Hofbauer. Lancet 2011;377:1276-1287. There is a lot happening in therapies for osteoporosis. This review article is well worth a read.
Myxoma, dyspnoea, tinnitus, scoliosis and alopecia. TK Rajab et al. Lancet 2011;377:1378. A wonderful case report. The next time you see alopecia think myxoma. Intrigued, read it…………………..
Vitamin D and prevention of cancer-Ready for Prime Time? JAE Manson et al. NEJM 2011;364:1385-1387. A very balanced article, well worth reading before we put Vitamin D in the water.
Ciliopathies. F Hildenbrandt et al. NEJM 2011;364:1533-1542. An excellent clinical science review paper. The link to us is the metabolic conditions associated with this syndrome. Well worth a read.
The challenge of managing coexistent diabetes and obesity. Clifford Bailey. BMJ 2011;342:913-918. A good review article with practical advice.
Pituitary apoplexy. BMJ 2011;342:668-669. An excellent editorial reviewing the SfE guidelines on the subject linked with an accompanying case report (BMJ 2011;342:d1221 doi:10.1136/bmj.d1221).
HbA1c: an old friend in new clothes. S Misra et al. Lancet 2011;377:1476-1477. A timely editorial, after which I have forgot about talking in %. Remember aim for an Hba1c of 48-58 mmol/mol!
Cardiovascular safety and diabetes drug development. DJ Drucker, AB Goldfine. Lancet 2011;377:977-979. The fall-out and debate continue……….
Rupture without warning. S Schimmack et al. Lancet 2011;377:966. Beware the ruptured thyroid cyst!
Deep Vein Thrombosis of the Upper Extremities. Nils Kucher. NEJM 2011;364:861-869. I know that this is Acute Medicine, but this review article is an essential read for all.
New Drugs for Hyponatraemia. A Amin and K Meeran. BMJ 2011;342:559-560. A very well balanced editorial worth a read.
Investigating hyponatraemia. A Wakil et al. BMJ 2011;342:594-596. Not bad. Personally what ever Peter Baylis and Steve Ball taught me in the late 90s has stayed with me thus far!
Hidden Harm. M Suzuki et al. Lancet 2011;377:874. Recently a lab manager advised me of the high number of timed overnight urines for normetadrenaline I am undertaking, specifically for EAU. I guess this case report was answer enough and it quickly winged its way over to him!
Glucagon-like peptide-1 analogues for type 2 diabetes. J Wilding and Kevin Hardy. BMJ 2011;342:433-435. A good update worth a read.
Islet transplantation in type 1 diabetes. H de Kort et al. BMJ 2011;342:426-432. An excellent update. Remember to look out for those patients with hypoglycaemic unawareness that may fit the criteria to refer to Jim Shaw.
Telehealthcare for long term conditions. S McLean et al. BMJ 2011;342:374-378. You IT geeks would love this paper. So did I!
Radioiodine therapy for hyperthyroidism. DS Ross. NEJM 2011;364:542-550. A good update well worth a read.
Gout. T Neogi. NEJM 2011;364:443-452. An excellent update.
Selenium and the course of mild Graves' orbitopathy. Marcocci C, Kahaly GJ et al. NEJM 2011;364:1920-1931. In this randomised, double-blind, placebo-controlled trial selenium (an antioxidant agent) or pentoxifylline (an antiinflammatory agent) were administered to 159 patients with mild Graves' orbitopathy. The patients were given selenium (100 μg twice daily), pentoxifylline (600 mg twice daily), or placebo (twice daily) orally for 6 months and were then followed for 6 months after treatment was withdrawn. Primary outcomes at 6 months were evaluated by means of an overall ophthalmic assessment, conducted by an ophthalmologist who was unaware of the treatment assignments, and a Graves' orbitopathy-specific quality-of-life questionnaire, completed by the patient. Secondary outcomes were evaluated with the use of a Clinical Activity Score and a diplopia score. At the 6-month evaluation, treatment with selenium, but not with pentoxifylline, was associated with an improved quality of life (P<0.001) and less eye involvement (P=0.01) and slowed the progression of Graves' orbitopathy (P=0.01), as compared with placebo. The Clinical Activity Score decreased in all groups, but the change was significantly greater in the selenium-treated patients. Exploratory evaluations at 12 months confirmed the results seen at 6 months. Two patients assigned to placebo and one assigned to pentoxifylline required immunosuppressive therapy for deterioration in their condition. No adverse events were evident with selenium, whereas pentoxifylline was associated with frequent gastrointestinal problems. In this study selenium administration significantly improved quality of life, reduced ocular involvement, and slowed progression of the disease in patients with mild Graves' orbitopathy suggesting a that oxygen free radicals do play a part in the pathophysiology behind Graves’ Orbitopathy.
Diabetes mellitus, fasting glucose, and risk of cause-specific death. Seshasai SR, Kaptoge S, et al. NEJM 2011;364:829-41. The authors calculated hazard ratios for cause-specific death, according to baseline diabetes status or fasting glucose level, from individual-participant data on 123,205 deaths among 820,900 people in 97 prospective studies. After adjustment for age, sex, smoking status, and body-mass index, hazard ratios among persons with diabetes as compared with persons without diabetes were as follows: 1.80 (95% confidence interval [CI], 1.71-1.90) for death from any cause, 1.25 (1.19-1.31) for death from cancer, 2.32 (95% 2.11 -2.56) for death from vascular causes, and 1.73 (1.62-1.85) for death from other causes. Diabetes (vs. no diabetes) was moderately associated with death from cancers of the liver, pancreas, ovary, colorectum, lung, bladder, and breast. Aside from cancer and vascular disease, diabetes (vs. no diabetes) was also associated with death from renal disease, liver disease, pneumonia and other infectious diseases, mental disorders, nonhepatic digestive diseases, external causes, intentional self-harm, nervous-system disorders, and chronic obstructive pulmonary disease. Hazard ratios were appreciably reduced after further adjustment for glycaemia measures, but not after adjustment for systolic blood pressure, lipid levels, inflammation or renal markers. Fasting glucose levels exceeding 5.6 mmol/L, but not levels 3.9 to 5.6 mmol/L, were associated with death. A 50-year-old with diabetes died, on average, 6 years earlier than a counterpart without diabetes, with about 40% of the difference in survival attributable to excess nonvascular deaths. This excellent paper demonstrates that in addition to vascular disease, diabetes is associated with substantial premature death from several cancers, infectious diseases, external causes, intentional self-harm, and degenerative disorders, independent of several major risk factors.
Insulin degludec, an ultra-long-acting basal insulin, once a day or three times a week versus insulin glargine once a day in patients with type 2 diabetes: a 16-week, randomised, open-label, phase 2 trial. Zinman B, Fulcher G, et al. Lancet. 2011;377:880-1. In this 16-week, randomised, open-label, parallel-group phase 2 trial, participants aged 18–75 years with type 2 diabetes and HbA1c of 7·0–11·0% were randomly allocated in a 1:1:1:1 ratio randomisation to receive insulin degludec either once a day or three times a week or insulin glargine once a day, all in combination with metformin. 62 participants were randomly allocated to receive insulin degludec three times a week (starting dose 20 U per injection [1 U=9 nmol]), 60 to receive insulin degludec once a day (starting dose 10 U [1 U=6 nmol]; group A), 61 to receive insulin degludec once a day (starting dose 10 U [1 U=9 nmol]; group B), and 62 to receive insulin glargine (starting dose 10 U [1 U=6 nmol]) once a day. At study end, mean HbA1c levels were much the same across treatment groups, at 7·3% (SD 1·1), 7·4% (1·0), 7·5% (1·1), and 7·2% (0·9), respectively. Estimated mean HbA1c treatment differences from insulin degludec by comparison with insulin glargine were 0·08% (95% CI –0·23 to 0·40) for the three dose per week schedule, 0·17% (–0·15 to 0·48) for group A, and 0·28% (–0·04 to 0·59) for group B. Few participants had hypoglycaemia and the number of adverse events was much the same across groups, with no apparent treatment-specific pattern. In this trial insulin degludec provides comparable glycaemic control to insulin glargine without additional adverse events and might reduce dosing frequency due to its ultra-long action profile. An interesting insulin to add to our therapies. It is worth checking out the 2 trials in the March Diabetes Care edition on insulin degludec as well.
Levothyroxine dose and risk of fractures in older adults: nested case-control study. Turner MR, Camacho X, et al. BMJ. 2011 Apr 28;342:d2238. In this nested case-control study adults aged 70 or more who were prescribed levothyroxine between 1 April 2002 and 31 March 2007 and followed for fractures until 31 March 2008 were studied. Cases were cohort members admitted to hospital for any fracture, matched with up to five controls from within the cohort who had not yet had a fracture. The primary outcome was fracture (wrist or forearm, shoulder or upper arm, thoracic spine, lumbar spine and pelvis, hip or femur, or lower leg or ankle) in relation to levothyroxine use (current, recent past, remote). Risk among current users was compared between those prescribed high, medium, and low cumulative levothyroxine doses in the year before fracture. Of 213 511 prevalent levothyroxine users identified, 22 236 (10.4%) experienced a fracture over a mean 3.8 years of follow-up, 18 108 (88%) of whom were women. Compared with remote levothyroxine use, current use was associated with a significantly higher risk of fracture (adjusted odds ratio 1.88, 95% confidence interval 1.71-2.05), despite adjustment for numerous risk factors. Among current users, high and medium cumulative doses (>0.093 mg/day and 0.044-0.093 mg/day) were associated with a significantly increased risk of fracture compared with low cumulative doses (<0.044 mg/day): 3.45 (3.27-3.65) and 2.62 (2.50-2.76), respectively. This study has shown that among adults aged 70 or more, current levothyroxine treatment was associated with a significantly increased risk of fracture, with a strong dose-response relation, hence outlining the importance to avoid overtreatment in this population.
Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): a randomised, placebo-controlled, phase 3 trial. Gadde KM, Allison DB, et al. In this 56-week phase 3 trial, the authors randomly assigned 2487 overweight or obese adults (aged 18-70 years), with a body-mass index of 27-45 kg/m2 and two or
more of hypertension, dyslipidaemia, diabetes or prediabetes, or abdominal obesity to placebo, once-daily phentermine 7·5 mg plus topiramate 46 mg, or once-daily phentermine 15·0 mg plus topiramate 92 mg in a 2:1:2 ratio Primary endpoints were the percentage change in bodyweight and the proportion of patients achieving at least 5% weight loss. Analysis was by intention to treat. At 56 weeks, change in bodyweight was -1·4 kg (least-squares mean -1·2%, 95% CI -1·8 to -0·7), -8·1kg (-7·8%, -8·5 to -7·1; p<0·0001), and -10·2 kg (-9·8%, -10·4 to -9·3; p<0·0001)in the patients assigned to placebo, phentermine 7·5 mg plus topiramate 46 mg, and phentermine 15·0 mg plus topiramate 92 mg, respectively. 204 (21%) patients achieved at least 5% weight loss with placebo, 303 (62%; odds ratio 6·3, 95% CI 4·9 to 8·0; p<0·0001) with phentermine 7·5 mg plus topiramate 46 mg, and 687 (70%; 9·0, 7·3 to 11·1; p<0·0001) with phentermine 15·0 mg plus topiramate 92 mg; for ≥10% weight loss, the corresponding numbers were 72 (7%), 182 (37%; 7·6, 5·6 to 10·2; p<0·0001), and 467 (48%; 11·7, 8·9 to 15·4; p<0·0001). The most common adverse events were dry mouth (24 [2%], 67 [13%], and 207 [21%] in the groups assigned to placebo, phentermine 7·5 mg plus topiramate 46 mg, and phentermine 15·0 mg plus topiramate 92 mg, respectively), paraesthesia (20 [2%], 68 [14%], and 204 [21%], respectively), constipation (59 [6%], 75 [15%], and 173 [17%], respectively), insomnia (47 [5%], 29 [6%], and 102 [10%], respectively), dizziness (31 [3%], 36 [7%], 99 [10%], respectively), and dysgeusia (11 [1%], 37 [7%], and 103 [10%], respectively). 38 (4%) patients assigned to placebo, 19 (4%) to phentermine 7·5 mg plus topiramate 46·0 mg, and 73 (7%) to phentermine 15·0 mg plus topiramate 92·0 mg had depression-related adverse events; and 28 (3%), 24 (5%), and 77 (8%), respectively, had anxiety-related adverse events. This trial suggests that the combination of phentermine and topiramate, with lifestyle interventions, might be a valuable treatment for obesity.

NEXT NEWSLETTER Due out beginning of October 2011 so keep the gossip coming.

Endodiabology February 2011 Issue 1

ENDODIABOLOGY
Endodiabology.blogspot.com

NORTHEAST
NEWSLETTER
FOR SPRs AND BOSSES TRAPPED
IN THE NORTHERN DEANERY

February 2011
Editors: Shaz Wahid (shahid.wahid@sthct.nhs.uk) and
Petros Perros (petros.perros@ncl.ac.uk) and Arut Vijayaraman (riarut@aol.com )
Associate Editor: Srikanth Mada

StR PLACEMENTS (NTN year of training from 1st October 2010)
• Newcastle- Atif Munir (2), Sajid Ethol Kalathil (2), Catherine Napier (2), Naveen Aggarwal (2), Hamza Ali Khan (2), Agnieska Sawiecicka (1), Vacant
• North Tyneside/Wansbeck- Alison Heggie (1), Vacant
• South Tyneside- Nimanthe De Alwis (2)
• Gateshead- Eeelin Lim (5)
• Sunderland- Jacog Buckovan (1), vacant
• North Tees/Hartlepool- Sudeep Manohar (4), vacant
• Middlesbrough- Arif Ullah (4), Naveen Siddaramaiha (4), Shunmugam Nelliyappan (1)
• Bishop Auckland/Darlington/Durham- Sathia Rajhavan(1), Vacant
• NGH- Srikanth Mada(4),
• Research with numbers (supervisor)- Stuart Little (3-Dr Shaw), Asgar Madathil (4-Dr Weaver), Sarah Steven (3-Prof Taylor), Anna Mitchell (1-Prof Pearce), Earn Gan (1-Prof Pearce),
• Maternity Leave Rohana Wright (3), Anjali SanthaKumar (3), Kathryn Stewart (3)

MEETINGS / LECTURES / ANNOUNCEMENTS
• 1st March 2011 SfE National Clinical Cases Meeting, Royal Society of Medicine, London. Contact conferences@endocrinology.org NOTE submissions deadline is 25th October 2010.
• 16th March 2011 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk
• 24th March 2011 Newcastle Magnetic Resonance Centre Symposium, Lindisfarne Room, 1st Floor, Kings Road Centre, NCLE. Contact beverly.hailstone@ncl.ac.uk We have both Hannele Yki-Jarvivnen and Michael Roden, two of the world’s most sought after speakers talking about the cutting edge of diabetes knowledge. There is no registration fee.
• 30th March – 1st April 2011 DUK Annual Professional Conference, London, ExCel ICC. Contact www.diabetes.org.uk NOTE abstract submission deadline 31st October 2010.
• 7th & 8th April 2011 Insulin Infusion Pump Course, JCUH, Middlesbrough. Contact nicky.skippon@stees.nhs.uk
• 11th-14th April 2011 SfE British Endocrine Societies annual conference, Birmingham ICC. Contact conferences@endocrinology.org NOTE abstract submissions deadline 15th November 2010.
• 13th April 2011 Northern Region Acute Medicine Study Day, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk
• 5th-6th May 2011 ABCD spring meeting, London. Contact www.diabetologists.org.uk
• 11th May 2011 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk
• 17th May 2011North East Obesity Forum, Obesity and Pregnancy, Stockton, Durham University, Queens Campus. Contact Louisa.ells@nepho.org.uk or Helen.moore@durham.ac.uk or Rachel.gallo@newcastle.ac.uk
• 18th May 2011 Northern Endocrine & Diabetes Summer CME, University Hospital of North Durham. Contact Sarah Steven sarah.steven@doctors.org.uk or Srikanth Mada srikanth.mada@nhs.net
• 4th-7th June 2011 ENDO 2011, Boston, USA. Contact endostaff@endo-societ.org or www.endo-society.org/scimeetings .
• 16th June 2011 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk
• 24th – 28th June 2011 American Diabetes Association 71st Annual Scientific Sessions, San Diego, USA. Contact meetings@diabetes.org .
• 13th July 2011 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk
• 12th - 16th September 2011 47th EASD annual meeting, Lisbon, Portugal. Contact www.easd.org
• 14th September 2011 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk
• 12th October 2011 Northern Endocrine & Diabetes Autumn CME, JCUH, Middlesbrough. Contact Sarah Steven(sarah.steven@doctors.org.uk ) or Srikanth Mada (srikanth.mada@nhs.net )
• 16th November 2011 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk
• 24th & 25th November 2011 Insulin Infusion Pump Course, JCUH, Middlesbrough. Contact nicky.skippon@stees.nhs.uk
• 30th November 2011 RCP Updates in Medicine, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk.

TRAINING ISSUES
STOP PRESS: NEW Assessment tools Please see www.jrcptb.org.uk; it is the trainee’s responsibility to make sure that the appropriate assessments are available in their portfolio for ARCP purposes. For 2011 there are 3 new work based assessment tools available: Patient Surveys, Audit Assessment and Teaching Observation. It is essential that you review the web site and make arrangements to utilize these new assessment tools as evidence for your ARCP.
DIABETES & ENDOCRINOLOGY PIMD WEBSITE Our specialty website is available on http://mypimd.ncl.ac.uk/PIMDDev . Click onto the specialty training tab then follow to Diabetes & Endocrinology.
Registering with PMETB It is essential that all new StRs (even LATs) register with the PMETB through the Joint Royal Colleges of Physicians Training Board on www.jrcptb.org.uk. Not doing so means your training is not counted.
Portfolio completion deadline is Friday May 13th 2011 therefore you must have worked with your supervisors well in advance of this (book time in their diary now!). This year an incomplete portfolio is likely to result in non-progression through training therefore please all do more than the minimum!
Portfolio Documentation It is a trainee’s responsibility to make sure their portfolio/log book is prospectively completed and the necessary signatures obtained. Any experience that is not signed off by your educational supervisor at the time cannot be counted towards training.
Documenting CCU and ITU experience It is essential that trainees document their CCU and ITU experience. This is best done by keeping a summary log of the cases seen on CCU and ITU and linking it with reflection or assessment. This should then be signed off by your Educational Supervisor to be of any use at the G(I)M PYAs.
MRCP Diabetes & Endocrinology This exam has to be completed and passed by all trainees appointed after August 2007 before their PYA. We recommend sitting it ASAP and well before your PYA.
The Kelly-Young MRCP Diabetes & Endocrinology Prize This prize is awarded annually at NERRAG to the youngest in terms of training year StR passing the MRCP Diabetes & endocrinology exam. Richard Quinton secures the funding of £800 and it is named after 2 distinguished former Endocrinologists in the region, Bill Kelly and Eric Young.
INFORMATION for QA Could each individual trainer send the following to Simon Pearce: educational qualifications, any training positions held and any educational courses attended.
MORE INFORMATION for QA Could each unit’s Training Lead please send to Simon Pearce a completed training unit information report and an updated SpR/StR job description.
Trainers & Trainees meeting The next T&T is on 14th June 2011. Details to be confirmed nearer the time, but please note in your diary.
ARCPs 2011 Mon 23rd, Tues 24th, Weds 25th May 2011. SpRs keep these dates free and volunteers for the panel please contact Nicky Leech. Minimal requirements will be: thorough portfolio documentation, 4 Case based Discussions, Reflective accounts, Personal library evidence of teaching attendance and reflection, 4 new Mini-CEXs since last ARCP, MSF from current unit with at least 12 returns and 3 consultants, Updated PDP This should be drawn up and discussed with your supervisor within 4 weeks of starting your new post and Supervisors sign off and report. PLEASE NOTE, add patient survey (use the RCP survey forms), audit assessment/reflection and teaching observation to the minimal requirements.
Critical incident/complaint If you are involved in a critical incident or if reporting an incident concerning training issues please inform your supervisor and the TPD. Ensure they are reflected upon in your portfolio
Medicine ARCP Will remain separate next year. Date 17th May 2011. Continue to add evidence to the curriculum and demonstrate progression. Keep detailed anonomised logs and link them. Make the portfolio easy to navigate. You will need a MSF, Patient survey, 6 ACATs, 6 CEX s, 4 CBDs, and be involved in a medical audit cycle.
Training Committee Chair- Simon Pearce, s.h.s.pearce@ncl.ac.uk; Regional Speciality Advisor- Shaz Wahid, shahid.wahid@sthct.nhs.uk; Programme Director- Nicky Leech nicola.leech@nuth.northy.nhs.uk; Consultant member (SAC rep)- Richard Quinton, Richard.Quinton@nuth.nhs.uk; Consultant member-Jean MacLeod, Jean.Macleod@nth.nhs.uk; Consultant member (TPD elect)-Arutchelvam Vijayaraman Vijayaraman.Arutchelvam@stees.nhs.uk ; Consultant member-Simon Eaton, simon.eaton@northumbria-healthcare.nhs.uk; SpR representative-Srikanth Mada srikanth.mada@nhs.net ; SpR representative-Stuart Little stuartlittle@doctors.org.uk

NEWS FROM THE NORTHEAST
• April 5th 2011- Professor James Fegan is the SFE visiting professor this year. He will be visiting Newcastle on this day. There will be a series of case presentations on that afternoon followed by his lecture at 17.00. Meeting will be held at Freeman Hospital Education centre. Clinical session will be followed by a Networking dinner. This will be an excellent opportunity for regional SpR’s to present cases and attend the networking meeting. For more details contact Steve.ball@nuth.nhs.uk, srikanth.mada@nhs.net
• Congratulations to Latika Sibal on her new Consultant appointment at Addenbrooke's Hospital.
• Welcome to Dr Shunmugam Nelliyappan as new StR in the region.
• Congratulations to Stuart Little as the new trainee rep on the STC.
• Congratulations to Arut on his nomination by the STC as our next TPD. His name will be forwarded to the Deanery. The aim will be for him to take over from Nicky in June 2011. Nicky will move into the Chair of the STC. We would like to thank Simon Pearce for his excellent work whilst the Chair of the STC.
• Philip Home has been invited by the ADA Programme Committee to talk in their annual meeting San Diego 2011 - this will be the fourth such invited lecture in 5 years. This time the topic is “Biosimilar insulins”.
• Congratulations to Terry Aspray on his recent appointment as Consultant in Metabolic Bone Disease at Freeman Hospital from 1st March 2011.
• It was an absolute pleasure to have Bill Kelly and Eric Young say a few words at NERRAG when presenting the prize named after their esteemed selves. Their words will live long in the memory.
• David Carr has now fully retired. ENDODIABOLOGY would like to wish him all the best and thank him for his contribution to the specialty in the region.
• Congratulations to Chandima Idampitya on her new Consultant appointment in Cumbria.
• Congratulations to Jola Weaver on being appointed a visiting Professor to King Abdulaziz University, Jeddah, SA.
• Congratulations to Roy Taylor on 5 yrs of the MRC, see meeting symposium details above, publication of a paper which was featured in the No. 1 spot on the cover of Dec Diabetes Care and shortly in the correspondence columns of DC and the award of a grant from the European Foundation for the Study of Diabetes. Evaluation of pancreas structure and function during return to normal glucose tolerance in type 2 diabetes. Euro 95,000.

LETTERS
Medical Leadership training on-line SHAZ WAHID
I personally am undertaking further management and leadership training using the Medical Leadership programme available on the e-learning for healthcare website www.e-lfh.org.uk . It is free! It is for all stages, whether you are experienced or a beginner. There are 6 folders: introductory modules, effective leadership, quality improvement, effective management in healthcare, ensuring effective health care, concluding modules. Each folder is further divided into modules to complete. I am partway through the introductory folder and can only highly recommend it to everyone. I would expect all StRs in Diabetes&Endo or Acute Medicine rotating to STNHSFT to undertake this programme as part of their management training under my supervision. This programme would highly complement the “7-habits of effectiveness” course that I encourage StRs under my supervision to attend at STNHSFT, again this is free other than the personal time you will have to give up over a weekend.
Book review-Textbook of Diabetes. 4th Edition, 2010. RI Holt, CS Cockram, A Flyvberg, BJ Goldstein. Wiley-Blackwell. SHAZ WAHID.
This was my staple reading when in SpR training. I invested in the new edition in November 2010 and I am not disappointed. The content is exceptional covering basic and clinical science with a focus on clinical application and healthcare delivery. There is both fun historical context and an international flavour to this new edition. Furthermore, the on-line access to the content and figures (for down load) adds value and prolongs the life of this edition. I have read about 1/3rd of the content (adolescent & transitional diabetes, monogenic diabetes, all the historical and social context section, diabetic nephropathy as examples) and have been impressed. I would highly recommend this new edition to both trainees and trainers.
My experience of on-line Recruitment & Selection training. SHAZ WAHID.
I was pleasantly surprised at how much I enjoyed the above training that is available on www.elearningworkpsychology.com/northern/ . It is mandatory for all interviewers and it will take no longer than 1-hour to complete. The FOCUS mnemonic sticks in the memory: Familiarise, Observe, Record, Classify, and Evaluate. Not only is useful for interviews but I would suggest when you next attend a service meeting or indeed any meeting! What I got most out of this training is the time I saved by not allocating a half day to the activity. If only Trust Mandatory training could be condensed into 1 hour………………………….

King’s Fund Diabetes Specialist Registrars Leadership Programme: May 09-13th 2011. Sponsored by the YDF- Srikanth Mada
I had the pleasure of attending the leadership course last year along with two other colleagues in the region. The course is held at Oxford and run by very experienced kings fund faculty over 5 days. A number of management issues such as Myers Briggs Personality indicator and preferred style of working, NHS finance (Macro financial flows & Micro budgeting), Belbin team roles, team working, and working across organization were covered in detail with practical workshops. Health policies and diabetes policies were dealt with Dr Sue Roberts. We had the opportunity to understand the principles of business case and developing new services, and a practical workshop to develop and present a new business case as a team.
Later half of the course concentrates on personality development, advanced communications skills, negotiating skills and presentation skills. Professional actor facilitated these sessions. Final day concentrates on preparing oneself for the consultant job, interview preparation and video recorded mock interview.
This is an excellent opportunity for every registrar to develop leadership skills mainly for those who are in their final 2 years. A Unique opportunity to meet colleagues from different regions which helps to establish networking. The course is free of cost including stay but one has to be a member of ABCD.

MERIT (Master class in Endocrinology and diabetes; Regional Interactive Teaching) Programme: Srikanth Mada, Stuart Little, Sarah Stevens.
The recent PMETB survey by the specialty trainees in this region identified areas of excellent training as well as areas where training opportunities could be improved.
As trainee representatives we invited constructive feedback from all trainees and subsequently a number of enthusiastic colleagues suggested ways of improving training opportunities. As a result of all the feedback obtained a pilot training programme (MERIT: Master class in Endocrinology and diabetes; Regional Interactive Teaching) has been drafted and was presented at the STC meeting in December. The revamped CME, which is mapped to cover all the aspects of curriculum has been a huge success and received a positive feedback. We do not want to replicate similar programme, instead we plan to give the responsibility of this programme to the trainees themselves i.e. a trainee led, consultant facilitated site specific teaching programme.
The location of the teaching will rotate between all training hospitals in the region and will take place in the first week of each month starting April 2011. It will be the responsibility of the resident trainee at each respective hospital to host the teaching and liaise with the consultant (host consultant) to agree the training programme for the afternoon. The session will consist of a trainee presentation (Hot topic/ topic over view etc) followed by a consultant facilitated master class/tutorial. Management topics can also be included within the programme.
It will be mandatory for every trainee to attend the sessions and if attendance is not possible it is each trainee’s responsibility to inform either of the trainee STC representatives (Srikanth or Stuart) so that it can be documented in the report to the STC panel. This will mean discussing with the consultants to make necessary arrangement so that clinical care is not impacted and consultants reducing the clinics on the day. Further information regarding the proposed programme will be circulated in due course.
The STC chair and the panel have agreed to implement the programme, the success of which will be reviewed at the next STC meeting.

GAINS (Grants for attending International & National symposium) Programme.
Srikanth Mada, Sarah Stevens, Stuart Little.
The SPARROWS programme has been an excellent and unique training opportunity for the year 3-5 SpR’s to attend the ADA followed by a presentation at the trainers and trainee meeting to share the experience and updates with rest of the colleagues. Unfortunately because of the financial constraints and ABPI rules of the funding bodies have withdrawn their support to the programme. We as the CME & STC committee are keen to keep this unique opportunity available as long as possible to all the registrars. The committee would be able to part fund two registrars to attend one diabetes and one endocrine symposium per year. A grant of £ 1000/ per SpR / year is available as a part of this programme. Application and the selection process remain same as before followed by a SpR presentation at the trainers and trainee meeting. Applications and further information to follow…
Are you proactive enough regarding your future?
An Honorary Research Assistant post at Newcastle University and Gateshead Trust will be advertised in the near future. Research area: vascular stem cells and endocrine disorders. The post will commence in August 2011 and is aimed to lead to MD/PhD (as a staff member of the Institute for Cellular Medicine reduced postgraduate degree fees will be payable). The first RA appointed to this post was Salman Razvi. He was then followed by Akheel Syed, Abdul Shakoor, Asgar Madathil, all as part of Out Of Programme Research (OOPR) scheme. For informal enquiries please contact Jola Weaver J.U.Weaver@ncl.ac.uk
My experience of the Specialty Examination MRCP Diabetes&Endo-Atif Munir
The SCE is now a compulsory component of assessment for CCT for all UK trainees in Diabetes & Endocrinology. Trainees who have gained the Certificate in Endocrinology and Diabetes and who are recommended for a CCT will be entitled to apply for the post nominal MRCP (UK) (Endocrinology and Diabetes).
The SCE in Endocrinology and Diabetes is delivered once a year & is a computer-based two-paper test with a total of 200 questions. Each paper contains 100 questions and lasts three hours. The papers are based on the MRCP (UK) ‘best of five’ multiple choice questions format & there is no negative marking. The exam fee has been increased from £800 to £825 for 2011. Candidates can attempt the Specialty Certificate Examination as many times as they wish, subject to continuing satisfaction of the eligibility criteria.
Although The Royal College guidance states that trainees should have at least attempted the examination once before their penultimate year assessment I would strongly encourage colleagues to take it when they feel confident. This would to quite an extent depend upon your clinical experience as this is purely a clinically oriented examination & most of the scenarios I thought were from everyday clinical practice. Hence clinical experience in my view would take preference over theoretical knowledge for this particular examination.
Royal college does not recommend any specific reading material however I can share my personal experience. Exam blueprint & sample questions can be downloaded from the MRCP website (www.mrcpuk.org/SiteCollectionDocuments/SCEEandDSampleQs.pdf) (www.mrcpuk.org/SiteCollectionDocuments/SCE_ED_blueprint.pdf). If you are pushed for time, which all of us are these days I would recommend going through Oxford Handbook of Diabetes & Endocrinology (Turner & Wass) which was perhaps my key to success. This is the most comprehensive tool to cover a wide range of high yield topics in a short span of time. WWW. Endotext.org would be my second resource for preparation. Going through up to date NICE guidance, in particular guidance related to management of diabetes during pregnancy is a must as there were quite a few questions directly based on current guidance. DVLA guidance regarding driving and Diabetes is worth a glance. Apart from NICE, publications for professionals by societies like ABCD, SFE, and BTA & DUK should be read to polish your preparation apart from keeping abreast of updates in core specialty topics. I would not recommend subscribing to online websites to access their questions banks as the exam is still in its early years and hence there is not a large pool of questions out there. I found such an endeavour a waste of time and money. There were a few pituitary MRI scans & retinal screening photographs hence familiarizing yourself with these can earn a few bonus points.
Last but not the least, I would strongly urge all appearing for the exam to try and take a few days off as study leave immediately before the examination day to revise and regroup your scattered thoughts.
I wish all my colleagues best of luck for their examination.


RECENT PUBLICATIONS FROM THE NORTHEAST
1. Rodondi N, den Elzen WP, Bauer DC, Cappola AR, Razvi S, Walsh JP, Asvold BO, Iervasi G, Imaizumi M, Collet TH, Bremner A, Maisonneuve P, Sgarbi JA, Khaw KT, Vanderpump MP, Newman AB, Cornuz J, Franklyn JA, Westendorp RG, Vittinghoff E, Gussekloo J; Thyroid Studies Collaboration. Subclinical hypothyroidism and the risk of coronary heart disease and mortality. JAMA. 2010 Sep 22;304(12):1365-74.
2. Simms RJ, Sayer JA, Quinton R, Walker M, Ellard S, Goodship TH. Monogenic diabetes, renal dysplasia and hypopituitarism: a patient with a HNF1A mutation. QJM. 2010 Nov 4. [Epub ahead of print].
3. Quinton R, Ball SG, Sayer J, Pearce SHS. Primary hyperparathyroidism: just how “primary” is it really? Therapeutic Advances in Endocrinology & Metabolism. 2010; 1: 191-196.
4. Here comes the sun, good news for bone health. Aspray TJ, Francis RM. Age Ageing. doi: 10.1093/ageing/afq164 Epub 2010 Dec 22.
5. Diabetes, falls and fractures. Mayne D, Stout NR, Aspray TJ. Age Ageing. 2010 Sep;39(5):522-5. Epub 2010 Jul 14.
6. Vitamin D and fractures: where are we now? Aspray TJ, Francis RM. Maturitas. 2010 Jul;66(3):221-2. Epub 2010 Apr 7.
7. Increased maternal homeostasis model assessment of insulin resistance (HOMA-IR) associated with older age at diagnosis of Type 1 diabetes in offspring. NJ leech, JO O Sullivan, P Avery, C Howey, K Burling, S Iyer, L Pascoe, M Walker and T Cheetham. Diabetic Medicine Dec 2010 Vol 27; 12 ; 1450.
8. Chen MJ, Jovanovic A, Taylor R. Utilizing the Second-Meal Effect in Type 2 Diabetes: Practical Use of a Soya-Yogurt Snack. Diabetes Care 33: 2552-4, 2010

RECENT PUBLICATIONS IN DIABETES & ENDOCRINOLOGY THAT HIT THE NEWS OR THAT MAY HAVE A SIGNIFICANT IMPACT ON MANAGEMENT
Bisphosphonates for Osteporoses. MJ Favus. NEJM 2010;363:20272035. A practical review article well worth a read for an update.
Safer administration of insulin: summary of a safety report from the National patient Safety Agency. TA Lamont et al. BMJ 2010;341:c5269. A useful summary of this essential reading report. Many of you have probably or are in the process of producing action plans for the recommendations.
Managing diabetic retinopathy. Z Okcrim, D Yorston. BMJ 2010;341:c5400. A useful read for an update. It is worth reading the individual seminal papers cited in this update.
Teriparatide for bone loss in the jaw. A Grey. NEJM 2010;363;2458-2459. An excellent editorial citing the evidence behind this therapy for osteonecrosis of the jaw. Well worth a read along with the linked letter.
Glycemic control in the ICU. BP Kavanagh, KC McCowen. NEJM 2010;363:2540-2546. An update that I do not entirely agree with. I believe the ADA guidance is spot on for this issue. Debate welcome………………………
Vitamin D Insufficiency. Clifford J Rosen. NEJM 2011;364:258-254. An excellent review and well worth a read.
Diagnosis and management of hereditary haemochromatosis. MA van Bokhoven et al. BMJ 2011;342:218-223. An excellent practical update that is essential reading for trainees and trainers.
Cholesterol efflux capacity, high-density lipoprotein function, and atherosclerosis. Khera AV, et al. NEJM 2011;364;127-135. The authors hypothesized that the capacity of HDL to accept cholesterol from macrophages would serve as a predictor of atherosclerotic burden. This is termed as cholesterol efflux capacity, and was measured in 203 healthy volunteers who underwent assessment of carotid artery intima-media thickness, 442 patients with angiographically confirmed coronary artery disease, and 351 patients without such angiographically confirmed disease by using a validated ex vivo system involving incubation of macrophages with apolipoprotein B-depleted serum from the study participants. The levels of HDL cholesterol and apolipoprotein A-I were significant determinants of cholesterol efflux capacity but accounted for less than 40% of the observed variation. An inverse relationship was noted between efflux capacity and carotid intima-media thickness both before and after adjustment for the HDL cholesterol level. Furthermore, efflux capacity was a strong inverse predictor of coronary disease status (adjusted odds ratio for coronary disease per 1-SD increase in efflux capacity, 0.70; 95% confidence interval [CI], 0.59 to 0.83, p<0.001). This relationship was attenuated, but remained significant, after additional adjustment for the HDL cholesterol level (OR 0.75[0.63-0.90], p=0.002) or apolipoprotein A-I level (OR 0.7[0.61-0.89], p=0.002). Additional studies showed enhanced efflux capacity in patients with the metabolic syndrome and low HDL cholesterol levels who were treated with pioglitazone, but not in patients with hypercholesterolemia who were treated with statins. The authors conclude that cholesterol efflux capacity from macrophages, a metric of HDL function, has a strong inverse association with both carotid intima-media thickness and the likelihood of angiographic coronary artery disease, independently of the HDL cholesterol level. It is well worth reading the accompanying editorial by Jay Heinecke that along with this article suggests that we will be in a better position to see whether raising HDL cholesterol with pharmacotherapy in individuals would be of any benefit utilising this method in the future or allow us to better target pharmacotherapy.
Selective vitamin D receptor activation with paricalcitol for reduction of albuminuria in patients with type 2 diabetes (VITAL study): a randomised controlled trial. de Zeeuw D. Lancet 2010;376:1543-51. In this placebo-controlled, double-blind trial, the investigators enrolled patients with type 2 diabetes and albuminuria who were receiving ACE inhibitors or angiotensin receptor blockers. Patients were assigned to receive 24 weeks’ treatment with placebo (n=88),1 μg/day paricalcitol (n=92), or 2 μg/day paricalcitol (n=92). The primary endpoint was the percentage change in geometric mean urinary albumin-to-creatinine ratio (UACR) from baseline to last measurement during treatment for the combined paricalcitol groups versus the placebo group. Change in UACR was: –3% (from 61 to 60 mg/mmol;95% CI –16 to 13) in the placebo group; –16% (from 62 to 51 mg/mmol; –24 to –9) in the combined paricalcitol groups, with a between-group difference versus placebo of –15% (95% CI –28 to 1; p=0.071); –14% (from 63 to 54 mg/mmol; –24 to –1) in the 1 μg paricalcitol group, with a between-group difference versus placebo of –11%(95% CI –27 to 8; p=0.23); and –20% (from 61 to 49 mg/mmol; –30 to –8) in the 2 μg paricalcitol group, with a between-group difference versus placebo of –18% (95% CI –32 to 0; p=0.053). Patients on 2 μg paricalcitol showed a nearly, sustained reduction in UACR, ranging from –18% to –28% (p=0.014 vs placebo). Incidence of hypercalcaemia, adverse events, and serious adverse events was similar between groups receiving paricalcitol versus placebo. This study suggests that the addition of 2 μg/day paricalcitol to RAAS inhibition safely lowers residual albuminuria in patients with diabetic nephropathy. I guess we should have vitamin D in the water supply! The accompanying editorial by Merlin Thomas and Mark Cooper is well worth a read to look into this novel therapy for diabetic nephropathy.


NEXT NEWSLETTER Due out beginning of June 2011 so keep the gossip coming.

Endodiabology October 2010

ENDODIABOLOGY
Endodiabology.blogspot.com

NORTHEAST
NEWSLETTER
FOR SPRs AND BOSSES TRAPPED
IN THE NORTHERN DEANERY

OCTOBER 2010
Senior Editors: Shaz Wahid, Petros Perros and Arutchelvam Vijayaraman
Associate Editor: Srikanth Mada

StR PLACEMENTS (NTN year of training from 1st October 2008)
• Newcastle- Atif Munir (2), Sajid Ethol Kalathil (2), Catherine Napier (2), Naveen Aggarwal (2), Hamza Ali Khan (2), Agnieska Sawiecicka (1), Vacant
• North Tyneside/Wansbeck- Alison Heggie (1), Vacant
• South Tyneside- Nimanthe De Alwis (2)
• Gateshead- Eeelin Lim (5)
• Sunderland- Jacog Buckovan (1), vacant
• North Tees/Hartlepool- Sudeep Manohar (4), vacant
• Middlesbrough- Arif Ullah (4)/Kathryn Stewart (3), Naveen Siddaramaiha (4), Vacant
• Bishop Auckland/Darlington/Durham- Sathia Rajhavan(1), Vacant
• NGH- Srikanth Mada(4),
• Research with numbers (supervisor)- Stuart Little (3-Dr Shaw), Asgar Madathil (4-Dr Weaver), Sarah Steven (3-Prof Taylor), Anna Mitchell (1-Prof Pearce), Earn Gan (1-Prof Pearce), Arif Ullah (4-Prof Bilous from 3/11)
• Maternity Leave Rohana Wright (3), Anjali SanthaKumar (3), Kathryn Stewart till 3/11 (3)

MEETINGS / LECTURES / ANNOUNCEMENTS
• 7 October 2010 British Thyroid Association annual meeting: Royal college of pathologists; London: Contact
• 15th-17th October 2010 Autumn Endocrine Retreat. Contact conferences@endocrinology.org
• 18 October 2010 National training scheme for the use of radioiodine in benign thyroid disease : Birmingham, UK ; Contact helen.flood@uhb.nhs.uk
• 21st October 2010 North East Obesity Forum, 4-6pm, Obesity & Ethnicity, Durham University. Contact Catherine Stone Catherine.Stone@aso.org.uk
• 26- 30 October 2010 : American Thyroid Association meeting : Palmsprings, USA : Website: www.thyroid.org
• 8th-10th November 2010 Society for Endocrinology Clinical Update, venue TBC. Contact www.endocrinology.org
• 9th November 2010 RCP Updates in Medicine, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk.
• 17th November 2010 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk.
• 18th-19th November 2010 ABCD autumn meeting, London. Contact www.diabetologists.org.uk followed by SpRs meeting 19th-21st November 2010.
• 24th November 2010 Northern Endocrine Region Research and Audit Group annual meeting, Lumley Castle, Durham 2pm-8pm. Contact shahid.wahid@sthct.nhs.uk
• 25th November 2010 Northern England Diabetes & Obesity Collaborative Research Meeting, The Marriot Hotel, Leeds 0900-1630. contact jane.mann@manchester.ac.uk
• 25th & 26th November 2010 Middlesbrough Insulin infusion Pump Course, James Cook University Hospital. Contact nicky.skippon@stees.nhs.uk
• 19th January 2011 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk.
• 26th January 2011 Northern Endocrine & Diabetes Winter CME, Freeman Hospital. Contact Sarah Steven or Srikanth Mada
• 1st March 2011 SfE National Clinical Cases Meeting, Royal Society of Medicine, London. Contact conferences@endocrinology.org NOTE submissions deadline is 25th October 2010.
• 16th March 2011 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk
• 30th March – 1st April 2011 DUK Annual Professional Conference, London, ExCel ICC. Contact www.diabetes.org.uk NOTE abstract submission deadline 31st October 2010.
• 11th-14th April 2011 SfE British Endocrine Societies annual conference, Birmingham ICC. Contact conferences@endocrinology.org NOTE abstract submissions deadline 15th November 2010.
• 13th April 2011 Northern Region Acute Medicine Study Day, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk
• 5th-6th May 2011 ABCD spring meeting, London. Contact www.diabetologists.org.uk
• 11th May 2011 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk
• 24th May 2011 Northern Endocrine & Diabetes Summer CME, JCUH, Middlesbrough. Contact Sarah Steven(sarah.steven@doctors.org.uk ) or Srikanth Mada (srikanth.mada@nhs.net )
• 4th-7th June 2011 ENDO 2011, Boston, USA. Contact endostaff@endo-societ.org or www.endo-society.org/scimeetings .
• 16th June 2011 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk
• 24th – 28th June 2011 American Diabetes Association 71st Annual Scientific Sessions, San Diego, USA. Contact meetings@diabetes.org .
• 13th July 2011 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk
• 14th September 2011 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk
• 12th October 2011 Northern Endocrine & Diabetes Autumn CME, Durham. Contact Sarah Steven(sarah.steven@doctors.org.uk ) or Srikanth Mada (srikanth.mada@nhs.net )
• 16th November 2011 ½ day SpR G(I)M teaching, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk
• 30th November 2011 RCP Updates in Medicine, Freeman Hospital. Contact Lorraine Waugh 0191 223 1247 Lorraine.waugh@tfh.nuth.northy.nhs.uk.

TRAINING ISSUES
DIABETES & ENDOCRINOLOGY PIMD WEBSITE Our specialty website is available on http://mypimd.ncl.ac.uk/PIMDDev . Click onto the specialty training tab then follow to Diabetes & Endocrinology. This site is essential reading, especially for ARCP preparation.
Registering with PMETB It is essential that all new SpRs/StRs (even LATs) register with the PMETB through the newly created Joint Royal Colleges of Physicians Training Board (formally the JCHMT) on www.jrcptb.org.uk. Not doing so means your training is not counted.
Log Book/Portfolio Documentation It is a trainee’s responsibility to make sure their portfolio/log book is prospectively completed and the necessary signatures obtained. Any experience that is not signed off by your educational supervisor at the time cannot be counted towards training. The e-portfolio for DM&ENDO is available now for StRs.
Assessment tools Please see www.jrcptb.org.uk; it is the trainee’s responsibility to give all the appropriate forms to their Educational or Clinical Supervisor. It is the trainee’s responsibility to make sure that the appropriate assessment summaries are available in their portfolio for ARCP purposes, e.g. MSF Summary Form.
Documenting CCU and ITU experience It is essential that trainees document their CCU and ITU experience. This is best done by keeping a summary log of the cases seen on CCU and ITU and linking it with reflection or assessment. This should then be signed off by your Educational Supervisor to be of any use at the Acute Medicine PYAs.
Audit Assessment tool This is now available in draft form on the JRCPTB website. Its use is highly recommended.
MRCP Diabetes & Endocrinology This exam has to be completed and passed by all trainees appointed after August 2007 before their PYA. We recommend sitting it ASAP and well before your PYA.
The Kelly-Young MRCP Diabetes & Endocrinology Prize This year sees the inaugural prize for SpRs passing the MRCP Diabetes & Endocrinology exam with the highest mark in the region. Richard Quinton secures the funding of £800 and it is named after 2 distinguished former Endocrinologists in the region, Bill Kelly and Eric Young. The prize will be presented at this year’s NERRAG meeting by both Bill and Eric to the 3 SpRs sharing the prize: Atif Munir, Nimanthe De Alwis and Sajid Ethol Kalathil.
INFORMATION for QA Could each individual trainer send the following to Simon Pearce: educational qualifications, any training positions held and any educational courses attended.
MORE INFORMATION for QA Could each unit’s Training Lead please send to Simon Pearce a completed training unit information report and an updated SpR/StR job description.
Trainers & Trainees meeting The next T&T is on 14th June 2011. Details to be confirmed nearer the time, but please note in your diary.
Another Trainee Rep on STC With Jeevan’s Consultant appointment a vacancy will exist from July 2010. Could interested SpRs please contact Nicky Leech.
TRAINERS EVENT 13th October 2010 This morning session is specifically for the faculty of trainers in Diabetes&Endocrinology in the Region. It promises to be an interesting morning with sessions on NHS Education England, Trainees in difficulty and on the job work based assessments.
ARCPs 2011 Mon 16th, Tues 17th, Weds 18th May 2011. SpRs keep these dates free and volunteers for the panel please contact Nicky Leech. Minimal requirements will be: thorough portfolio documentation, 4 Case based Discussions, Reflective accounts, Personal library evidence of teaching attendance and reflection, 4 new Mini-CEXs since last ARCP, MSF from current unit with at least 12 returns and 3 consultants, Updated PDP This should be drawn up and discussed with your supervisor within 4 weeks of starting your new post and Supervisors sign off and report.
NEDS CME Has undergone a revamp. See letter from Rohana Wright below.
Critical incident/complaint If you are involved in a critical incident or if reporting an incident concerning training issues please inform your supervisor and the TPD. Ensure they are reflected upon in your portfolio
Medicine ARCP Will remain separate next year. Date 19th May 2011. Continue to add evidence to the curriculum and demonstrate progression. Keep detailed anonomised logs and link them. Make the portfolio easy to navigate. You will need a MSF, Patient survey(if available), 6 ACATs, 6 CEX s, 4 CBDs, and be involved in a medical audit cycle.
Training Committee Chair- Simon Pearce, s.h.s.pearce@ncl.ac.uk; Regional Speciality Advisor- Shaz Wahid, shahid.wahid@sthct.nhs.uk; Programme Director- Nicky Leech nicola.leech@nuth.northy.nhs.uk; Consultant member (SAC rep)- Richard Quinton, Richard.Quinton@nuth.nhs.uk; Consultant member-Jean MacLeod, Jean.Macleod@nth.nhs.uk; Consultant member-Arutchelvam Vijayaraman Vijayaraman.Arutchelvam@stees.nhs.uk ; Consultant member-Simon Eaton, simon.eaton@northumbria-healthcare.nhs.uk; SpR representative-Srikkant Mada SpR representative

NEWS FROM THE NORTHEAST
• Congratulations to Shafie Kamruddin on his new appointments Consultant at Northallerton.
• Latika Sibal won the prize for best submitted oral presentation at the Heart UK meeting this summer. The work presented was part of the work in Newcastle for her PhD, awarded earlier this year. She continues in the locum consultant post at Addenbrooke's Hospital.
• Philip Home was invited by the American Diabetes Association to speak for the third time in four years at its Annual Congress in Orlando in June.
• Philip Home is now a member of the Steering Committee of the T-Emerge-8 CV outcomes study on taspoglutide, and the data safety boards of the Alecardio CV outcomes study on aleglitazar and the CANVAS study of canaglifloxicin, the latter for which he is Chair.
• For NICE Philip Home continues to chair the extended review of lapatinib, a novel breast cancer drug acting on the protein (tyrosine) kinase part of the growth factor receptor.
• Congratulations to Srikanth Made as a new Associate Editor for ENDODIABOLOGY.
• Congratulations to all 10 StRs in the region who sat the MRCP Endocrine exam and passed! 3 were 1st yr StRs. Well done to all.
• Sarah Steven and Srikanth Mada have joined Rohana Wright and Steve Ball on the NEDs CME committee.
• Srikanth Mada and Nimanthe De Alwis have taken over from Jeevan Mettayil in organising the SpR Management Forum.
• Srikanth Mada has joined the School of Medicine STC and Executive Committee as a trainee representative.
• Richard Quinton did an excellent job at the debate on testosterone in Type 2 Diabetes in the ABCD meeting. He was against the motion with Hugh Jones for the motion. Well done Richard.

LETTERS
The NEDS CME undergoes a revamp-Rohana Wright
This is just a reminder that the next CME day takes place on Tuesday 5th October at James Cook. This will follow the usual 9.30am-4.30pm structure as this date was booked prior to the decision to alter our format. And the dates for 2011 have now been confirmed:
Wednesday 26th January, Freeman Hospital; Tuesday 24th May, Durham; Wednesday 12th October, James Cook.

These days will all follow a new format, beginning at 1.30pm, finishing at 6.30pm, and will follow our curriculum based approach. There will also be non-clinical sessions incorporated into the programme. As you can see we are going to hold the May session in Durham, for a bit of a change of scenery, and we hope to use additional venues throughout the region in the coming years.

As I am now on maternity leave, any CME-related queries should be addressed to Sarah Steven (sarah.steven@doctors.org.uk ) or Srikanth Mada
(srikanth.mada@nhs.net ) who will be taking over my organisational duties while I am off.

DUK- Giggleswick Children’s summer camp-Srikanth Mada
I had a wonderful opportunity to volunteer as a clinical lead for DUK children’s summer camp held at Giggleswick school, north Yorkshire. It’s a week long camp consisting 60 children with type 1 diabetes between age groups 7 to 14 years. Each group consists of 10 children, one clinical lead, one dietician, two group leaders and a group supporter. Clinical leads take the handover of children from the parents and agree to achieve 3-4 objectives during their stay. The holiday is packed with high adrenaline activities such as caving, canoeing, kayaking, labyrinth, rock-climbing, high ropes, archery, abseiling,
and all day trip to Blackpool pleasure beech. Apart for all the fun it is an excellent opportunity to get a real time experience in understanding what it is living with diabetes and managing type 1 diabetes out side clinic setting. We get to teach them how to check BM’s, how to rotate sites, insulin titration, CHO counting and managing hypos. This camp gave me a real insight into living with diabetes, how disturbing and frightening a hypoglycaemic episode can be. An opportunity to understand managing diabetes in non clinic setting. One of the duty of group leads is to do midnight “hyporounds” as per rota to check kid’s at risk of nocturnal hypo following hectic day activity and manage them appropriate, which its self is a good learning experience. It is highly rewarding to see that kids injecting insulin on their own (who has never done before), successfully manage to rotate injection site, understand managing hypo and learn carbohydrate counting.
There were only 2 diabetologist’s (myself and the camp organiser) and rest 4 clinical lead slots were filled in by our specialist nurse colleagues- probably an opportunity that trainees need to grab in future. I strongly recommend all my colleagues SpR’s to consider attending one of these camps during their training, its great fun and excellent learning opportunity.

7-habits course at South Tyneside-Shaz Wahid.
New and old Consultants along with any StRs rotating to South Tyneside will be offered attendance at the in-house 7-habits course our Training & Development Dept. deliver 3 times a year. I am please to say Nimanthe has accepted the offer, just need to get Jon onto it before he retires! Here is the blurb:
“Stephen R. Covey is an internationally respected leadership authority. His book ‘The 7 Habits of Highly Effective People’ is an international best-seller and has been named as one of the 10 most influential management books ever. This flagship leadership programme has received very positive feedback from recent delegates and we would strongly encourage you to attend as part of your personal and professional development. The Signature Course has been modified to enable us to deliver this training in a 2-day workshop format – commencing at 8am and finishing around 5pm on both days. The venue for this event is to be confirmed but will be either Training & Development or the Ingham Wing Conference Room.

The aim of the workshop is to turn ineffectiveness into effectiveness with The 7 Habits which are briefly outlined below:
Habit 1: Be Proactive
Recognise how choices based on personal experience or beliefs can profoundly impact your effectiveness, both positively and negatively.
Habit 2: Begin with the End in Mind
Develop a clear definition of what is and is not important to you by creating your Personal Mission Statement.
Habit 3: Put First Things First
Increase the balance and fulfillment of your professional and personal life by investing a few minutes each day in the planning process.
Habit 4: Think Win-Win
Build a team that finds faster and better solutions through clear expectations, shared responsibilities, and an understanding of priorities.
Habit 5: Seek First to Understand Then to Be Understood
Develop the skills of effective communication that lead to greater influence and faster problem solving.
Habit 6: Synergize
Value and celebrate differences and understand how they contribute to more innovative and intelligent solutions.
Habit 7: Sharpen the Saw
Maintain and increase your newfound effectiveness by continually renewing yourself mentally and physically.”
Will be working on an 8th habit course soon!

RECENT PUBLICATIONS FROM THE NORTHEAST
1. Diabetes, falls and fractures. Mayne D, Stout NR, Aspray TJ. Age Ageing. 2010 Sep;39(5):522-5. Epub 2010 Jul 14.
2. Vitamin D and fractures: where are we now? Aspray TJ, Francis RM. Maturitas. 2010 Jul;66(3):221-2. Epub 2010 Apr 7.
3. Advani A, Johnson SJ, Nicol MR, Papacleovoulou G, Evans DB, Vaikkakara S, Mason JI, Quinton R. 2010 Adult-onset hypogonadotropic hypogonadism caused by aberrant expression of aromatase in an adrenocortical adenocarcinoma. Endocrine Journal. May 13. [Epub ahead of print].

4. Sykiotis GP, Plummer L, Hughes VA, Au M, Durrani S, Nayak-Young S, Quinton R, Hall JE, Gusella JF, Seminara SB, Crowley WF, jr, Pitteloud N. 2010 The oligogenic basis of idiopathic hypogonadotropic hypogonadism. Proceedings of the National Academy of Sciences of the United States of America. 107:15140-150144.

5. Gianetti E, Tusset C, Noel SD, Au MG, Dwyer AA, Hughes VA, Abreu AP, Carroll J, Trarbach E, Silveira LG, Costa EM, de Mendonça BB, de Castro M , Lofrano A, Hall JE, Bolu E, Özata M, Quinton R, Amory JK, Stewart SE, Arlt W, Cole TR, Crowley WF jr., Kaiser UB, Latronico AC, Seminara SB. 2010 TAC3/TACR3 mutations reveal preferential activation of gonadotropin-releasing hormone release by neurokinin B in neonatal life followed by reversal in adulthood. Journal of Clinical Endocrinology & Metabolism. 95: 2857-2867.

6. David Woods. Angiotensin-Converting Enzyme, Renin-Angiotenson System and Human Performance. Genetics and Sports. Medicine and Sport Science 2009, Vol 54, pp 72-87.

7. Boos CJ, Wheble GA, Campbell MJ, Tabner KC, Woods DR. Self-administration of exercise and dietary supplements in deployed British military personnel during Operation TELIC 13. J R Army Med Corps. 2010 Mar;156(1):32-6.

RECENT PUBLICATIONS IN DIABETES & ENDOCRINOLOGY THAT HIT THE NEWS OR THAT MAY HAVE A SIGNIFICANT IMPACT ON MANAGEMENT
Carcinoid Syndrome R Srirajaskanthan et al. BMJ 2010341:c3941. An excellent case reminding us how easy it can be to miss Carcinoid syndrome.
Opioid induced hypogonadism. RG Reddy et al. BMJ 2010;341:c4462. 2 case reports suggesting an association between opioids and hypogonadism. I certainly came across a case of this in a 23 yr-old woman when I was a SpR in PIU at the RVI (many moons ago!).
Primary ovarian insufficiency. M De Vos et al. Lancet 2010;376:911-921. An excellent review article well worth a read.
“Liberating the NHS”-another attempt to implement market forces in English health care. Nick Black. NEJM 2010;363:1103-1105. I have read plenty of articles on the white paper in the medical literature, but none as good as this. However, the best articles have been in the Health Service Journal that I read as part of my management role. I dare you to read it………………………………………………………….
Large prolactinoma. M Ahmed & O Al-Nozha. NEJM 2010;363:177. An excellent picture for teaching.
Management of people with diabetes wanting to fast during Ramadan. E Hui et al. BMJ 2010;340:c3053. A wonderful, practical review article that should be staple reading for trainees and an annual reminder for us senior folk.
Functional hypothalamic amenorrhoea. CM Gordon. NEJM 2010;363:365-371. A practical review article worth a read.
Diabetic Nephropathy. N Cheung et al. Lancet 2010;376:124-136. An excellent update well worth a read.
Calcium kidney stones. EM Worcester & FL Coe. NEJM 2010;363:954-963. Kidney stones are now on the new specialty curriculum, hence this article is very timely and good to boot!
Obesity therapy trials. 2 recent trilals detailing treatment with naltrexone&bupropion and Lorcaserin for weight management are worth a read with their accompanying editorials: FL Greenway et. Lancet 2010;376:595-605; SR Smith et al. NEJM 2010;363:245-256.
Lancet Diabetes Theme Issue. The 2010 volume 375 June 26-July2 edition of the Lancet is worth a read in its entirety. It includes new therapy options with dapaglifozin and a head to head comparison of glargine insulin and once-weekly exenatide.
Investigating secondary hyperhidrosis. AN Paisley & HM Buckler. BMJ 2010;341:c4475. An excellent article reviewing the steps in investigating this common referral to Endocrine clinic.
Effects of medical therapies on retinopathy progression in type 2 diabetes. The ACCORD study group. NEJM 2010;363:233-244. In the ACCORD randomised trial 10,251 participants with type 2 diabetes who were at high risk for cardiovascular disease to receive either intensive or standard treatment for glycaemia (target HbA1c , <6.0% or 7.0 to 7.9%, respectively) and also for dyslipidaemia (160 mg daily of fenofibrate plus simvastatin or placebo plus simvastatin) or for systolic BP control (target, <120 or <140 mm Hg) were enrolled. A subgroup of 2856 participants was evaluated for the effects of these interventions at 4 years on the progression of diabetic retinopathy by 3 or more steps on the Early Treatment Diabetic Retinopathy Study Severity Scale or the development of diabetic retinopathy necessitating laser photocoagulation or vitrectomy. At 4 years, the rates of progression of diabetic retinopathy were 7.3% with intensive glycaemia treatment, versus 10.4% with standard therapy (adjusted odds ratio, 0.67; [95% CI], 0.51-0.87; P=0.003); 6.5% with fenofibrate for intensive dyslipidaemia therapy, versus 10.2% with placebo (adjusted odds ratio, 0.60 [0.42-0.87]; P=0.006); and 10.4% with intensive blood-pressure therapy, versus 8.8% with standard therapy (adjusted odds ratio, 1.23[0.84-1.79]; P=0.29). The authors conclude that intensive glyacemic control and intensive combination treatment of dyslipidaemia, but not intensive blood-pressure control, reduced the rate of progression of diabetic retinopathy. An excellent trial that adds weight to fenofibrate use in diabetic retinopathy in addition to statin therapy. Nice to see glycaemic control does not get a knocking and still a little baffled with the BP effect, however UKPDS did last longer.
Identification of late-onset hypogonadism in middle-aged and elderly men. Wu FC et al. NEJM 2010;363:123-135. The authors surveyed a random population sample of 3369 men aged 40 to 79 years at eight European centres, using questionnaires. The collected data included the subjects' general, sexual, physical, and psychological health. Levels of total testosterone were measured in morning blood samples by mass spectrometry, and free testosterone levels were calculated with the use of Vermeulen's formula. Data were randomly split into separate training and validation sets for confirmatory analyses. In the training set, symptoms of poor morning erection, low sexual desire, and erectile dysfunction, inability to perform vigorous activity, depression, and fatigue were significantly related to the testosterone level. Increased probabilities of the three sexual symptoms and limited physical vigour were discernible with decreased testosterone levels (ranges, 8.0 to 13.0 nmol/l for total testosterone and 160 to 280 pmol/l for free testosterone). However, only the three sexual symptoms had a syndromic association with decreased testosterone levels. An inverse relationship between an increasing number of sexual symptoms and a decreasing testosterone level was observed. These relationships were independently confirmed in the validation set, in which the strengths of the association between symptoms and low testosterone levels determined the minimum criteria necessary to identify late-onset hypogonadism. This trial suggests that late-onset hypogonadism can be defined by the presence of at least three sexual symptoms associated with a total testosterone level of less than 11 nmol/l and a free testosterone level of less than 220 pmol/l.
Adverse events associated with testosterone administration. Basaria S and Coviello AD, et al. NEJM 2010;363:109-122. In this trial Community-dwelling men, 65 years or older, with limitations in mobility and a total serum testosterone level of 3.5 to 12.1 nmol/l or a free serum testosterone level < 173 pmol/l were randomly assigned to receive placebo gel or testosterone gel, to be applied daily for 6 months. The data and safety monitoring board recommended that the trial be discontinued early because there was a significantly higher rate of adverse cardiovascular events in the testosterone group than in the placebo group. A total of 209 men (mean age, 74 years) were enrolled at the time the trial was terminated. At baseline, there was a high prevalence of hypertension, diabetes, hyperlipidaemia, and obesity among the participants. During the course of the study, the testosterone group had higher rates of cardiac, respiratory, and dermatologic events than did the placebo group. A total of 23 subjects in the testosterone group, as compared with 5 in the placebo group, had cardiovascular-related adverse events. The relative risk of a cardiovascular-related adverse event remained constant throughout the 6-month treatment period. As compared with the placebo group, the testosterone group had significantly greater improvements in leg-press and chest-press strength and in stair climbing while carrying a load. In this population of older men with limitations in mobility and a high prevalence of chronic disease, the application of a testosterone gel was associated with an increased risk of cardiovascular adverse events. The small size of the trial and the unique population Limit extrapolation about the safety of testosterone therapy and certainly should not deter further trials. It is well worth reading the editorial by William Bremner (NEJM 2010;363:189-191) in relation to both of the above trials.
Effectiveness of sensor-augmented insulin-pump therapy in type 1 diabetes. Bergenstal RM, Tamborlane WV, et al. NEJM 2010;363:311-320. In this 1-year, multicentre, randomised, controlled trial, the efficacy of sensor-augmented pump therapy (pump therapy) with that of a regimen of multiple daily insulin injections (injection therapy) in 485 patients (329 adults and 156 children) with inadequately controlled type 1 diabetes was studied. Patients received recombinant insulin analogues and were supervised by expert clinical teams. At 1 year, the baseline mean HbA1c(8.3% in the two study groups) had decreased to 7.5% in the pump-therapy group compared with 8.1% in the injection-therapy group (P<0.001). The proportion of patients who reached an HbA1c <7% was greater in the pump-therapy group than in the injection-therapy group. The rate of severe hypoglycaemia in the pump-therapy group (13.31 cases per 100 person-years) did not differ significantly from that in the injection-therapy group (13.48 per 100 person-years, P=0.58). There was no significant weight gain in either group. This trial confirms the efficacy of the newer insulin pump technology in both adults and children with inadequately controlled type 1 diabetes.
Efficacy and safety of exenatide once weekly versus sitagliptin or pioglitazone as an adjunct to metformin for treatment of type 2 diabetes (DURATION-2): a randomised trial. Bergenstal RM, Wysham C et al. Lancet 2010;376:431-439. In this 26-week randomised, double-blind, double-dummy, superiority trial, patients with type 2 diabetes who had been treated with metformin, and at baseline had a mean HbA1c of 8.5%(SD 1.1), fasting plasma glucose of 9.1 mmol/L (2.6), and weight of 88.0 kg (20.1), were randomly assigned to receive: 2 mg injected exenatide once weekly plus oral placebo once daily (170-pts); 100 mg oral sitagliptin once daily plus injected placebo once weekly (172-pts); or 45 mg oral pioglitazone once daily plus injected placebo once weekly (172-pts). Primary endpoint was change in HbA1c between baseline and week 26. Analysis was by intention to treat, for all patients who received at least one dose of study drug. 491 patients received at least one dose of study drug and were included in the intention-to-treat analysis (160 on exenatide, 166 on sitagliptin, and 165 on pioglitazone). Treatment with exenatide reduced HbA1c(least square mean -1.5%, 95% CI -1.7 to -1.4) significantly more than did sitagliptin (-0.9%, -1.1 to -0.7) or pioglitazone (-1.2%, -1.4 to -1.0). Treatment differences were -0.6% (95% CI -0.9 to -0.4, p<0.0001) for exenatide versus sitagliptin, and -0.3% (-0.6 to -0.1, p=0.0165) for exenatide versus pioglitazone. Weight loss with exenatide (-2.3 kg, 95% CI-2.9 to -1.7) was significantly greater than with sitagliptin (difference -1.5 kg, 95% CI -2.4 to -0.7, p=0.0002) or pioglitazone (difference -5.1 kg, -5.9 to -4.3, p<0.0001). No episodes of major hypoglycaemia occurred. The most frequent adverse events with exenatide and sitagliptin were nausea (n=38, 24%, and n=16, 10%, respectively) and diarrhoea (n=29, 18%, and n=16, 10%, respectively); upper-respiratory-tract infection (n=17, 10%) and peripheral oedema (n=13, 8%) were the most frequent events with pioglitazone. This trial confirms what we could have all predicted, that exenatide once weekly is more effective with less weight gain when added in second line compared to sitagliptin and pioglitazone. Personally, therapies for Type 2 diabetes have promulgumated and individualizing treatment is the correct thing to do. However, the basic tenants of lifestyle advice, metformin therapy and structured education remain the bedrock of all therapies.


NEXT NEWSLETTER Due out beginning of February 2011 so keep the gossip coming.