The FAS is part of the WICKED project (Wolverhampton Interface Care, Knowledge Empowered Diabetes), and consists of three key care processes in diabetes: namely HbA1c, urinary albumin:creatinine GDC-0068 cell line ratio and retinal screening. A retrospective case control study in a single GP practice was undertaken on all the patients (n=478) failing two or more parameters over 15 months. They were compared to those with no access failure matched for age, gender, ethnicity and type of diabetes. Among the 51 cases with a FAS ≥2, two or three process measures were absent in 84% and 16% respectively.

Excluding service failure, this was due to non-attendance in 35% but otherwise associated with other clinical constraints in 41% (mental health, house bound, palliative care, multi-morbidity) and their deprivation index was significantly higher (p<0.01). Extrapolating to the whole health economy (n=16 644), 2362 (14%) would have a FAS of ≥2 of whom 968 (6%) would have failed access in association with these constraints. In conclusion, it is possible to identify people who are failing access to structured diabetes care using readily available

data calculated as the FAS score. Failed access is not usually due to patient default or disengagement but rather, in almost 65%, either due to significant clinical disadvantage or pure failure of service.

Copyright © 2014 John Wiley & Sons. “
“Since the introduction of insulin analogues, there have been several published case reports SCH727965 datasheet of overdoses with this medication. Refractory hypoglycaemia with potentially serious neurological sequelae, including death, can occur in severe insulin overdoses. Around 30 years ago, long before insulin analogues were available, several authors reported that the excision of the soft tissue at the injection site lowered plasma insulin concentrations in overdoses with conventional short-acting and depot insulin. In a suicide attempt, an 18-year-old man had injected himself with a large amount of insulin analogues into the abdominal wall; check 50 minutes after the overdose he became hypoglycaemic. He was commenced on an intravenous infusion of glucose and the injection site was surgically excised. Serial serum insulin concentrations were measured. After the excision of the insulin injection site, serum insulin concentrations fell from 4220 to 88pmol/L within 2.5 hours. Those results were only available after several weeks. As a precaution at the time, the glucose infusion had been continued for 67 hours. We observed the last hypoglycaemic event in our patient a few minutes after the surgical intervention. The patient suffered no complications and was discharged following a psychiatric assessment.