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Muscles in diabetes
Muscle problems are more common among people with diabetes than we realise. Patients may not mention them. Causes are likely to be multiple. It can be difficult to distinguish the contributions made by problems within the muscles (for example, abnormal metabolism, cells, or electrical activity), and external issues, such as circulation and innervation.
Rowan Hillson 

Webcam consultations for diabetes: findings from four years of experience in Newham
(click here for full web article)
Newham diabetes service supports an ethnically diverse population in a deprived urban area and exemplifies challenges faced throughout the NHS with rising demand, high outpatient ‘did not attend’ rates and poor health outcomes. With funding from the Health Foundation, we aimed to provide more accessible and cost-effective care by replacing selected follow-up outpatient appointments with webcam consultations.
Joanne Morris, Desiree Campbell-Richards, Joseph Wherton, Rita Sudra, Shanti Vijayaraghavan, Trisha Greenhalgh, Anna Collard, Emma Byrne and Teresa O’Shea

Biosimilar insulin: the current landscape
(click here for full web article) 
Since insulin was isolated in 1922, its production has continued to evolve, more recently with the ‘incremental innovation’ of insulin analogues with improved pharmacodynamic and pharmacokinetic profiles. The approval of Abasaglar, biosimilar glargine insulin, marks the latest development in insulin therapy. The present article reviews the current biosimilar landscape including manufacture, regulation, safety and prescribing issues.
Andrea Llano, Miles Fisher and Gerry McKay

Let’s Prevent Diabetes: from idea to implementation
(click here for full web article)
The prevention of type 2 diabetes mellitus is a global health care priority. We describe a programme of work, which developed a method for identifying those with non-diabetic hyperglycaemia in primary care and developed and tested a prevention programme suitable for delivery within the NHS. The subsequent implementation of this programme as part of the NHS Diabetes Prevention Programme is then described.
Laura J Gray, Jacqui Troughton, Kamlesh Khunti and Melanie J Davies

National Diabetes Audit 2015–2016 shows variations in care processes and targets
The ‘V’ word is again prominent in the latest report on care processes and treatment targets from the National Diabetes Audit. As Steve Chaplin here reports, variation, unexplained by case mix, means that people in some parts of the country are being let down by their NHS.
Steve Chaplin

A case of hemichorea-hemiballism presenting in association with diabetic ketoacidosis
The management and diagnosis of metabolic causes of movement disorders are often delayed as other more common diagnoses are pursued. This often leads to clinical deterioration in symptoms, such as the development of DKA in this case. In this case study, we explore the relationship between diabetes and hemichorea-hemiballism.
Hibba Kurdi, Dana Ershaid and Peter Evans

Challenges in identifying and managing cerebral oedema at first presentation of type 1 diabetes
Cerebral oedema is an uncommon but potentially devastating consequence of DKA. In the UK, the overall incidence of CE is reported as 6.8 per 1000 episodes of DKA. This article investigates the case of an 11-year-old girl with known asthma presented to the emergency department with a 24-hour history of dyspnoea and chest pain. 
Suma Uday and Ruth Krone

Microalbuminuria screening in diabetes
In this second article in the ‘Test tips’ series, Dr Iona Galloway and Professor Gerry McKay outline what microalbuminuria is, why we should screen those with diabetes for it, which test to perform, who should be screened, how to interpret the results, and practical points to consider.
Iona Galloway and Gerry McKay

Omarigliptin is one example of a long-acting DPP-4 inhibitor which is administered once weekly as either monotherapy or as add-on therapy for optimisation of glycaemic control. It has been licensed for use in Japan since 2015 but its phase III development programme in Europe and the United States has been halted for undisclosed commercial reasons. No other information regarding this decision has been made public.
Iona Galloway, Gerry McKay and Miles Fisher

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