Association of British Clinical Diabetologists, Diabetes Technology Network UK and Association of Children's Diabetes Clinicians Survey of UK Healthcare Professional Attitudes Towards Open-Source Automated Insulin Delivery Systems

INTRODUCTION

Automated insulin delivery (AID) systems can enable improved glycaemic outcomes with reduced mental burden. Open-source AID (OS-AID) systems overcome some of the developmental and access barriers enabling a wider use of these systems. Limited data are available on healthcare professional (HCP) opinions and current practice regarding these systems. The aim of this survey was to gain insight into HCP perceptions and practices around OS-AID.

METHODS

This survey was developed collaboratively with OS-AID users and distributed to adult and children's teams, using an online survey tool. Results were received between February and April 2019. Responses were assessed using simple descriptive statistics with analyses stratified by respondent characteristics.

RESULTS

317 responses were obtained from a range of HCPs in both adult and paediatric services. Key results include: HCP perception of OS-AID as "risky in the wrong hands" (43%); 91% felt uncomfortable initiating discussions around OS-AID because of lack of regulation (67%) and/or their own lack of knowledge (63%). Half of HCPs (47%) reported that they would choose OS-AID if they themselves had type 1 diabetes.

CONCLUSIONS

HCPs are generally supportive of OS-AID users but many feel uncomfortable with the technicalities of the systems given the lack of approval. Knowledge around the use of these systems was limited. Re-assessment of HCP perceptions should be performed in the future given the evolving landscape of diabetes technology, recent consensus statements and emerging ethical and legal perspectives.

Size-dependent growth of individual Atlantic salmon Salmo salar alevins from hatch to first feeding

Variation in egg size, hatch timing and size at hatch, and their influence on individual growth rates of Atlantic salmon Salmo salar alevins up to first feeding were examined in pure strain and hybrid crosses of fish from Scotland and Canada. At the intra-female, intra-cross type and inter-cross type levels, specific growth rates prior to first feed were strongly size dependent, with smaller and later hatching alevins growing significantly faster. The magnitude of this size-dependent growth was greatest in the hybrid crosses. This resulted in a 40% reduction in the coefficient of variation (c.v.) in alevin size from post-hatch to first feeding at the intra-female level, and a reduction of both intra- and inter-cross differences in alevin sizes in the same period.

A microsatellite linkage map for Atlantic salmon (Salmo salar)

A linkage map of the Atlantic salmon is described here consisting of 15 linkage groups containing 50 microsatellite loci with a 14 additional unlinked markers (including three allozymes). The map shows the largest sex-specific recombination rate differences so far found in any vertebrate species (3.92:1 female:male). Homologies with previous linkage mapping studies of Atlantic salmon and rainbow trout are described. An in silico search of the Genbank database carried out using the microsatellites used in the mapping process identified significant matches between the flanking regions of the microsatellite SS11 and the calcium-binding mitochondrial carrier protein, 'Aralar1'.

Polyarteritis presenting with thrombocytosis and central retinal vein thrombosis

We report a case of polyarteritis in a 54 year old woman who presented with marked thrombocytosis and acute blindness in one eye secondary to central retinal vein thrombosis. She also developed bilateral pulmonary infiltrates and renal failure. The diagnosis was confirmed by histological changes in the renal biopsy. Treatment with immunosuppressives, plasma exchange and antiplatelet drugs led to rapid clinical improvement and recovery of renal function and prevented further thromboembolic episodes. Plasma exchange and antiplatelet drugs should be considered in polyarteritis group of systemic vasculitis especially in the presence of thromboembolic complications or thrombocytosis.

The natural history of membranous nephropathy in the West of Scotland

Membranous nephropathy was diagnosed in 54 patients between January 1975 and June 1983 in the Royal Infirmary, Glasgow. It was the commonest cause of the nephrotic syndrome and, with IgA nephropathy, the commonest primary glomerular disease. A cause was found in 10 patients. The last seven patients diagnosed were enrolled in the MRC trial. The natural history of the remaining 37 patients with idiopathic membranous nephropathy was studied. After an average observation period of 64 months, 50 per cent had stable renal function with or without proteinuria and 50 per cent had progressive renal failure or had died of other causes (five patients). Of the factors examined only heavy proteinuria and hypertension were significantly more common in patients who developed progressive renal failure. No patient who entered remission relapsed. Vascular complications were an important cause of morbidity and mortality. Incidence of events of arterial occlusion was significantly higher in these patients compared with patients with IgA nephropathy. Treatment of patients with membranous nephropathy should, therefore, be judged not only by its efficacy in preventing progressive renal failure, but also by its effect on vascular disease and by its toxicity.

Polyarteritis nodosa and monocytic leukaemia

A 67 year old man presented with a polyarteritis nodosa-like syndrome with renal, pulmonary joint and neurological involvement during the 'preleukaemic' stage of monocytic leukaemia. The association between these two conditions is discussed.

Clostridium difficile-associated colitis in uremic patients

Five uremic patients managed in a renal unit developed Clostridium difficile-associated colitis. Four cases occurred in a cluster at about the same time. All patients had previously received or were on antibiotic therapy at the onset of diarrhea and one patient was also on oral steroid therapy. Cefotaxime, a third generation cephalosporin was involved in all five cases. All patients had severe diseases with explosive diarrhea and systemic toxicity. The diagnosis was confirmed in all cases by culture of C. difficile and demonstration of high titers of C. difficile cytotoxin in the stool. Histology from rectal biopsy in one patient showed classical pseudomembranous colitis. Response to treatment with vancomycin was generally good though one patient had two relapses. Uremic patients have impaired immune response and intestinal motility and are predisposed to C. difficile infection. Cross-infection can occur and the isolation of affected patients seems prudent.

Polyarteritis group of systemic vasculitis--new diagnostic criteria

We have used new diagnostic criteria to define patients with the polyarteritis nodosa (PAN) group of vasculitis. These were the combination of a necrotising glomerulitis without diffuse deposits of immunoglobulins or complement components in a patient presenting with systemic disease and multi-organ involvement. Twenty-two patients who fulfilled these criteria presented to our unit between 1975 and 1982. The diagnosis of PAN was confirmed by traditional histological criteria in eight. We anticipate that the use of these criteria will lead to earlier diagnosis and thereby improve the management of this potentially lethal disorder.

Phenylbutazone-induced systemic vasculitis with crescentic glomerulonephritis

Two patients had phenylbutazone-induced systemic vasculitis syndrome. Both presented with acute oliguric renal failure, and renal biopsies showed severe crescentic glomerulonephritis with marked interstitial inflammatory cell infiltration. Withdrawal of phenylbutazone and treatment with immunosuppressives and plasma exchange led to recovery of renal function in one case.

Collagenous colitis: possible response to sulfasalazine and local steroid therapy

A patient with rheumatoid arthritis and collagenous colitis apparently responding to sulfasalazine and prednisolone enemas is reported. It is suggested that this form of therapy should be considered in patients with this rare disorder not only as a short-term measure but also, in the case of sulfasalazine, as long-term treatment in patients with chronic symptoms.

Plasma exchange in the treatment of mesangiocapillary glomerulonephritis

9 patients with primary glomerulopathies and slowly progressive renal failure were treated by regular plasma exchanges without immunosuppressive drug therapy. All 3 patients with the subendothelial type of mesangiocapillary glomerulonephritis (MCGN-I) had no progression of their renal failure while undergoing plasma exchanges. The creatinine rose when treatment was stopped and fell again in 2 patients who restarted plasma exchange. 2 patients with hypocomplementaemia and dense deposit disease (MCGN-II) and all 3 patients with idiopathic membranous nephropathy (IMN) did not benefit. 1 patient with normo-complementaemic MCGN-II had some improvement in renal function which lasted 18 months. Proteinuria fell or was unchanged during the 1st month of plasma exchange in the 4 who improved and increased in the 5 who did not. The response to plasma exchanges could not be attributed to removal of circulatory complexes or changes in reticulo-endothelial function. Regular 2.8-litre plasma exchanges using 4.3% immunoalbumin proved to be safe for periods up to 44 months. Regular plasma exchange appears to prevent progression to renal failure in patients with MCGN-I.

Post-irradiation sarcoma of the lower lip

This report records the occurrence of an irradiation induced fibrosarcoma of the lower lip which appears to be the first case documented in this site. The problems associated with the histopathological diagnosis of such lesions are discussed and the value of electronmicroscopical examination of spindle cell sarcomas stressed.

Changes in the glomerular capillary wall induced by lymphocyte products and serum of nephrotic patients

This study demonstrated that a soluble factor derived from patients with nephrotic syndrome caused changes consistent with the development of proteinuria when infused into the renal artery of a rat. The supernatants of cultures of stimulated lymphocytes of patients with the nephrotic syndrome containing autologous sera were infused into the renal arteries of rats and caused patchy spreading of the foot processes of epithelial cells and reduction of charge of the glomerular basement membrane of rat kidneys. The equivalent supernatants from normal subjects did not produce these changes.

An improved method of reporting on laryngectomy specimens

A new simple method is described for the macroscopic examination of total laryngectomy specimens. The technique facilitates assessment of the spread of laryngeal carcinoma without the need of serial sections.