Monday, September 28, 2015

Endodiabology February 2015


ENDODIABOLOGY
Endodiabology.blogspot.com 

NORTHEAST
 NEWSLETTER
FOR SPECIALTY TRAINEES AND BOSSES TRAPPED 
IN THE NORTHERN DEANERY

February 2015                                    
 Editors: 

Shaz Wahid 
Petros Perros , Arutchelvam Vijayaraman  


StR PLACEMENTS
RVI
Sarah Steven
Naveen Aggarwal
Earn Hui Gan (Academic Clinical Lectureship)
Taimur Gulfam
Murali Ganguri
Ali Alidibiat
David Bishop
James Cook University Hospital
Yasir Mamooji
Satish Artham
Vikram Lal
North Allerton/ JCUH
Vacant
Northumbria(Wansbeck/North Tyneside)
Rohana Wright-LTFT
Jakub Buckowczan
Mavin Macauley
Queen Elizabeth Hospital
Sviatlana V Zhyzhneuskaya
South Tyneside Hospital
Suhel Ashraff
Durham
Kathryn Stewart-LTFT
Darlington 
Hamza Ali Khan till CCT
Sue Tee From 2.2.15
North Tees Hospital
Jehangir Abbas
Muhammed Asam
Sunderland
Stuart Little
Anna Mitchell (Academic Clinical Lectureship)
Research with numbers
Naveen Siddaramaiah (Prof Rudy Bilous)
Alison Heggie (Prof Mark Walker)
Catherine Napier (Prof Simon Pearce)

MEETINGS / LECTURES / ANNOUNCEMENTS  

TRAINING ISSUES
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 £400 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.
Management Training A regional management programme is in place for StRs. Contact Alison Heggie alison_heggie@hotmail.com for more information.
From the TPD I am pleased to inform you that 2 of our trainees have secured highly competitive academic clinical lecturer posts. Congratulations Anna Mitchell and Earn Gan.
Another ARCP is fast approaching. The GIM ARCP is on 12.5.15 which will be performed by the panel in the trainees’ absence. The speciality ARCP is on 19-21.5.15. As usual we will have large panels. We wish to continue our practice with the ARCP to be trainee focussed and to be used as an opportunity for the trainees to get feedback from the panel and get future training and career guidance. This is not an examination and there will not be surprises for you. Arrange for the appointment with your educational supervisors by late March/ Early April and go through the ARCP decision aids with your educational supervisors in detail. Get the appropriate competencies signed off. If there are any problems, please inform the TPD well in advance. We will do everything in my control to help you achieve excellence in your training.
ARCP decision aid: August 2014: Diabetes, Endocrinology
ARCP decision aid: November 2014: GIM
There is an additional requirement by our school of Medicine, which does not appear in our decision aid: you are expected to do have your prescribing practice assessed in a work place based assessment (a CbD, Mini CEX or ACAT). The school has mandated this be undertaken by all trainees in their 1st year of training and in their final year f training. Hence I request all the trainees to include ‘prescription practice’ in one of your assessments.
As a training programme, we are not content with producing just good trainees, but strive to achieve excellence. Hence we will explore ways to continuously improve.
We have just secured the diabetes fellowship for another 2 years to provide excellent opportunity for 1 trainee each year. More details will be sent soon.
There will be an opportunity for a trainee to join the STC as a trainee representative soon. Details will follow soon.
We all are working together very well in developing our programme to be excellent. However, I will strongly encourage trainees, if they have any problems, to bring to the notice of your Educational supervisors and the TPD immediately. We have a strong culture of listening and constructively reacting to resolve all issues. Hence, I will continuously ask for trainees’ support in running the programme to the highest standards to be the best in the country.

Training Committee Programme Director- Arutchelvam Vijayaraman Vijayaraman.Arutchelvam@stees.nhs.uk; Education CME Lead- Steve Ball s.g.ball@ncl.ac.uk ; Quality Management lead-Dr Peter Carey Peter.Carey2@chs.northy.nhs.uk; Consultant member-Shaz Wahid Shahid.wahid@stft.nhs.uk ; Consultant member- Richard Quinton, Richard.Quinton@nuth.nhs.uk; Consultant member-Jean MacLeod, Jean.Macleod@nth.nhs.uk; 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 ;Consultant member-Jeevan Mettayil jeevan.mettayil@stft.nhs.uk ; Consultant Member-Sath Nag sath.nag@stees.nhs.uk ; Consultant member-Nicky Leech nicola.leech@nuth.northy.nhs.uk; StR representative- Jahangir Abbas jehangir11@yahoo.com ; StR representative-Vacant

NEWS FROM THE NORTHEAST
  • Congratulations to Dr Stuart Little on his appointment has consultant in Diabetes in Newcastle upon Tyne, he is in post already. 
  • Congratulations to Dr Ahmed Abou Saleh on his appointment as Consultant in Diabetes in Newcastle . He will move from his current post as clinical teaching fellow to the consultant post at the end of March. 
  • Thank you and farewell to Atif Munir who has been working as locum Diabetologist in Newcastle for more than a year. We wish him well on his future plans in Pakistan
  • Aaron Liew, currently a post-CST research fellow with Jim Shaw, has been awarded a (3-month , 15,000 Euro) European Endocrine Exchange (3E) fellowship by UEMS (Union European de Medecins Specialists), under the joint supervision of Jim Shaw, Richard Quinton and Graham Roberts (Waterford).  He’ll be working in Newcastle on cardiovascular aspects of Turner syndrome.
  • Congratulations to David Bishop for winning the 2014 Kelly-Young MRCP Diabetes & Endocrinology Prize that he received at NERRAG last year.
  • Please note NERRAG has moved to 30th September 2015 this year.
  • Congratulations to an old friend Woodsy. His full title: Lt Colonel David R Woods. Consultant Advisor (Army) Medicine. Senior Lecturer Military Medicine. Visiting Professor Carnegie Research Institute, Leeds Beckett University


LETTERS
News from Prof Taylor
An EASD Workshop on NAFLD will be held in Newcastle on Mon 12 and Tues 13th May. Anyone wishing to present a paper or attend should contact Sandra (Sandra Blackwood sandra.blackwood@newcastle.ac.uk). European leaders in this interface field of hepatology and diabetes will come together to assess research progress and determine future directions. 
Paper – Rury Holman and I have collaborated to use UKPDS data to demonstrate why people of “normal” weight can develop type 2 diabetes. Read all about the Personal Fat Hypothesis: Normal weight individuals who develop Type 2 diabetes: the personal fat threshold. Roy Taylor and Rury R. Holman. Clinical Science (2015) 128, 405–410 doi: 10.1042/CS20140553

RECENT PUBLICATIONS FROM THE NORTHEAST
  1. Balasubramanian R, Choi J-H, Francescatto L, Willer JR, Horton ER, Asimacopoulos EP, Stankovic KM, Plummer L, Buck CL, Quinton R, Nebesio TD, Mericq V, Merino PM, Meyer BF, Monies D, Gusella JF, Al Tassan N, Katsanis N, Crowley WF,Jr. 2014 Functionally compromised CHD7 alleles in patients with Isolated GnRH Deficiency. Proceedings of the National Academy of Sciences of the United States of America. 111: 17953-17958.
  2. Mitchell AL, Napier C, Asam M, Siddaramaiah N, Heed A, Morris M, Miller M, Perros P, James RA, Ball SG, Pearce SH, Quinton R. 2014 Saving lives of in-patients with adrenal insufficiency: implementation of an alert scheme within the Newcastle-upon-Tyne Hospitals e-Prescribing platform. Clinical Endocrinology. 81: 937-938.
  3. Diurnal variation in skeletal muscle and liver glycogen in humans with normal health and type 2 diabetes. Macauley M, Smith FE, Thelwall PE, Hollingsworth KG, Taylor R. Clin Sci (Lond). 2015 Jan 13. [Epub ahead of print]
  4. Copeptin and arginine vasopressin at high altitude: relationship to plasma osmolality and perceived exertion. Mellor AJ, Boos CJ, Ball S, Burnett A, Pattman S, Redpath M, Woods DR. Eur J Appl Physiol. 2014 Sep 12. [Epub ahead of print]
  5. Rating of Perceived Exertion and Acute Mountain Sickness during a High Altitude Trek. Adrian J Mellor, David R Woods, John O’Hara, Mark Howley, James Watchorn, Christopher Boos.  Aviation, Space and Environmental Medicine, in press 2014.
  6. Cardiac biomarkers at high altitude. Mellor A, Boos C, Holdsworth D, Begley J, Hall D, Lumley A, Burnett A, Hawkins A, O’Hara J, Ball S, Woods DR.   High Alt Med Biol, in press 2014.
  7. Physiology studies at high altitude; why and how. Mellor A, Woods D. J R Army Med Corps. 2014 Jun;160(2):131-4.
  8. The gonadotrophic response of Royal Marines during an operational deployment in Afghanistan. Hill NE, Woods DR, Delves SK, Murphy KG, Davison AS, Brett SJ, Quinton R, Turner S, Stacey M, Allsopp AJ, Fallowfield JL. Andrology 2015, in press.
  9. Nutritional Status and The Gonadotrophic Response to a Polar Expedition. David R. Woods, Simon K. Delves, Sophie E. Britland, Anneliese Shaw, Piete E. Brown, Conor Bentley, Simon Hornby, Anne Burnett, Sue A. Lanham-New, Jo L. Fallowfield. Applied Physiology, Nutrition and Metabolism, in press 2015.
  10. Stacey M, Brett S, Woods D, Jackson S, Ross D. Case ascertainment of heat illness in the British Army: evidence of under-reporting from analysis of Medical and Command notifications, 2009-13. Journal of the Royal army Medical Corps, in press 2015.
  11. Jabbar A, Razvi S. Thyroid disease and vascular risk. Clin Med. 2014 Dec;14 Suppl 6:s29-32.
  12. Madathil A, Hollingsworth KG, Blamire AM, Razvi S, Newton JL, Taylor R, Weaver JU. Levothyroxine improves abnormal cardiac bio-energetics in subclinical hypothyroidism - a cardiac magnetic resonance spectroscopic study. J Clin Endocrinol Metab. 2014 Dec 26:jc20142942.
  13. Reference Genes for Expression Studies in Hypoxia and Hyperglycemia Models in Human Umbilical Vein Endothelial Cells. S Bakhashab, S Lary,F Ahmed,H-J Schulten, A Bashir,FW Ahmed, AL Al-Malki, HS Jamal, MA Gari, and Jolanta U. Weaver. Genes, Genomes, Genetics (G3) (Bethesda). Nov 2014; 4(11): 2159–2165. Published online Sep 5, 2014.  doi:  10.1534/g3.114.013102
  14. Levothyroxine improves abnormal cardiac bio-energetics in subclinical hypothyroidism - a cardiac magnetic resonance spectroscopic study. Madathil A, Hollingsworth KG, Blamire AM, Razvi S, Newton JL, Taylor R, Weaver JU. J Clin Endocrinol Metab. 2014 Dec 26:jc20142942. [Epub ahead of print]

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

Safety, effectiveness, and cost effectiveness of long acting versus intermediate acting insulin for patients with type 1 diabetes: systematic review and network meta-analysis. AC Tricco et al. BMJ 2014;349:g5459. Long acting analogues are more superior than intermediate acting insulin, but with a small HbA1c difference. I often get quizzed about this for South Tyneside as we are very high users of analogue insulin. I point to the best HbA1c in the country and give that unspoken answer in my head “what would you rather have if given a choice as a patient”.
Insulin pump treatment compared with multiple daily injections for treatment of type 2 diabetes (OpT2mise): a randomised open-label controlled trial. Y Reznik et al. Lancet 2014;384:1265-72. Given the proven effectiveness in this trial, eventually this option will have to be considered for my patients with type 2 diabetes on MDI who have been through our group education (carb counting) course who have not achieved the control they wish for. The trick will be convincing the commissioners. The accompanying editorial (P Choudhary Lancet 2014;384:1240-41 is a good read.
Physiological approach to assessment of acid-base disturbances. K Berend et al. NEJM 2014;371:1434-45. An excellent read adding the theory behind the practicality of this often “auto-pilot” area when on-call.
Once-weekly dulaglutide versus once-daily liraglutide in metformin-treated patients with type 2 diabetes (AWARD-6): a randomised, open-label, phase 3, non-inferiority trial. KM Dungan et al. Lancet 2014;384:1349-1357. The same old issue of anther “me too” therapy. You will be surprised to learn that I have not tried any of the once-weekly GLP-1 agonists in my patients (probably reflects the fact that I mainly see patients with type 1 diabetes, renal disease and labile control in my 2 clinics a week). They do provide anther option. The accompanying editorial by Andre Scheen (Lancet 2014;384:1325-1327) is very balanced.
The target of metformin in type 2 diabetes. E Ferrannini. NEJM  2014;371:1547-1548. At last I can give a more specific answer to patients and junior Drs-read the article and find out!
Type B insulin-resistance syndrome: a cause of reversible autoimmune hypoglycaemia. O Bourron et al. Lancet 2014;384:1548-49. A wonderful case report.
Glycaemic control and excess mortality in type 1 diabetes. M Lind et al. NEJM 2014;371:1972-82. Even if achieving tight control of an HbA1c < 53 mmol/mol there is still a two-fold risk of cardiovascular death. It is one of the reasons we go through cardiovascular risk factor control in detail during the transition period.
Identification, assessment, and management of overweight and obesity: summary of updated NICE guidance. BMJ 2014;349:g6608. A good summary of the NICE guidance.
Effects of intensive glycaemic control on ischaemic heart disease: analysis of data from the randomised, controlled ACCORD trial. HC Gerstein et al. Lancet 2014;384:1936-1941. If you have not read them or assimilated their messages you really need to. I am talking about ACCORD, VADT, ADVANCE, UKPDS. The accompanying editorial (JL Chiasson and JL Lorier Lancet 2014;384:1906-1907) is well worth a read. My aim remains an HbA1c < 58 mmol/mol in the majority of my patients.
Gigantism and Acromegaly due to Xq26 microduplications and GPR101 mutation. G Trivellin et al. NEJM 2014;371:2363-74. A good read.
Lactic acidosis.  JA Kraut and NE Nicolas. NEJM 2014;371:2309-19. An excellent review article.
Glucagon-like peptide-1 receptor agonist and basal insulin combination treatment for the management of type 2 diabetes: a systematic review and meta-analysis. C Eng et al. Lancet 2014;384:2228-34. As summarised by the accompanying editorial (LA Young and JB Buse Lancet 2014;384:2180-2181) “the combination of GLP-1 agonist and basal insulin has finally arrived as a more powerful and safer alternative to insulin in the management of type 2 diabetes”. In your clinical practice you need to decide which GLP 1 agonist and basal insulin you prefer.
Blood glucose concentration and risk of pancreatic cancer: systematic review and dose-response meta-analysis. W-C Liao et al. BMJ 2015;350:g7371. Interesting finding that the risk begins in pre-diabetes.
Type 2 diabetes and cancer: umbrella review of meta-analyses of observational studies. KK Tsilidis et al. BMJ 2015;350:g7607. Type 2 diabetes and risk of cancer. A Satija et al. BMJ 2015;350:g7707. Both worth a read mainly to look at how methodology can give 2 different answers.
Patiromer in patients with kidney disease and hyperkalaemia receiving RAAS inhibitors. MR Weir et al. NEJM 2015;372:211-21. Sodium Zirconium Cyclosilicate in hyperkalaemia. DK Packham et al. NEJM 2015;372:222-31. A new era for the treatment of hyperkalaemia? JR Ingelfinger. NEJM 2015;372:275-277. New tricks for a common issue. SZC is the more promising one.
PCSK9 inhibition with evolocumab (AMG 145) in heterozygous familial hypercholesterolaemia (RUTHERFRD-2): a randomised, double-blind, placebo-controlled trial. FJ Raal et al. Lancet 2015;385:331-40. Inhibitin f PCSK9 with evolocumab in homozygous familial hypercholesterolaemia (TESLA Part B): a randomised, double-blind, placebo-controlled trial. FJ Raal et al. Lancet 2015;385:341-50. Well worth  a read along with the accompanying editorial by Raul Santos & Gerald Watts (Lancet 2015;385:307-9) to get a grip with this expanding therapeutic field.
HMG-coenzyme A reductase inhibition, type 2 diabetes, and body weight: evidence from genetic analysis and randomised trials. DI Swerdlow et al. Lancet 2015;385:351-61. Well worth a read. The accompanying editorial by Timothy Frayling (Lancet 2015;385:310-12) goes through the background with clarity and gives an excellent summary answer.
What is the best glomerular filtration marker to identify people with chronic kidney disease most likely to have poor outcomes? EJ lamb et al. BMJ 2015;350:g7667. An excellent article. Basically I shall continue to use our labs eGFR alone, but for people with an eGFR 45-59 and no albuminuria I shall check cystatin C once. If high risk identified I shall keep them under my follow-up. Will now check with the labs about measuring cystatin C!
Acid-base problems in diabetic ketacidosis. KS Kamel & ML Halperin. NEJM 2015;372:546-54. A wonderful review article exploring 3 common issues.




NEXT NEWSLETTER Due out beginning of June 2015 so keep the gossip coming.





posted by Arutchelvam at 9:42 PM