Vytorin

By Z. Moff. University of New Orleans.

The most commonly observed all-cause adverse events across the trials were headache buy genuine vytorin online, flushing purchase discount vytorin on-line, and dyspepsia discount vytorin 20 mg online. Overall purchase vytorin on line amex, these events were less frequent for participants taking placebo compared with those taking sildenafil. These effects were usually of a mild to moderate or transient nature not requiring discontinuation of the therapy. These events were numerically more frequent in participants treated with sildenafil, ranging from 94 97 101 97 3 percent to 29 percent, compared with the range of 0 percent to 12 percent for placebo- treated participants. In the majority of these trials, the rate for withdrawals due to adverse events in placebo-treated participants ranged between 2 and 8. These events were reported for participants treated with sildenafil, 89 with the exception of one case of myocardial infarction and one case of urinary tract 166 infection in placebo-treated participants. In general, the quality of reporting 82, serious adverse events was poor, and some studies did not provide a full description of events. For the 95,96 remaining 27 participants in two trials, the treatment group designation was not reported. Severe angina 33 87 pectoris occurred in a participant taking 100 mg sildenafil and in another patient taking 84 placebo. Heart failure, atrial fibrillation, and arrhythmia occurred in two participants taking 143 143,160 sildenafil. Cerebrovascular events occurred in two participants taking sildenafil, one of 160 which was taking 100 mg of sildenafil. Respiratory events included pneumococcal pneumonia 143 143 in one participant on placebo and pulmonary edema in another participant on sildenafil. Accidental injuries were reported in two participants, one severe vertebral fracture in a 83 87 participant taking sildenafil, and the other a hand injury in a participant taking placebo. Four of the eight deaths occurred in placebo groups, one resulting from 126 123,171 myocardial infarction. Two 123 deaths occurred in participants treated with sildenafil; one of these resulted from an accident, 88 and the other from cardiac arrest. For more details on serious adverse events in each trial, please refer to Table 10. Similarly, two other trials showed that participants treaded with sildenafil compared with those on placebo, experienced a significantly greater mean number of erections (grade 34) per month. Five trials indicated a statistically significant longer mean duration of erections (60 percent rigidity) for participants treated with sildenafil compared with those who received placebo. The results of analyses provided for these trials did not reveal any treatment effect modification by the above-mentioned factors. Additionally, two other trials examined and compared two different dosage regimens of sildenafil (i. Both trials indicated a numerically increasing trend in the incidence of any 96 adverse events observed with the higher dose of sildenafil. None of these three trials reported any 35 85,93 statistical test results for the observed between-treatment differences. These trials compared 93 96 25 mg to 50 mg, and 10 mg to 25 mg and 50 mg of sildenafil. There were three other instances of serious adverse events (myocardial infarction, renal cell carcinoma, and epileptic crisis) in one 96 trial. The group designation of the participants experiencing these events were not reported. The rate of 85 96 discontinuation ranged from 0 percent to 3 percent for the 10 mg dose of sildenafil, from 0 137 93,96 85 96 percent to 4. Safety data was not reported for the trial that compared different timing of sildenafil (100 161 157 mg) administration in relation to food and sexual activity. In the trial comparing nightly (50 mg) and as needed (50 mg to 100 mg) sildenafil dosing regimens, the proportion of withdrawals due to adverse events was similar across the two groups (approximately 7 percent). Reportedly, none of the participants in this trial 157 developed a serious adverse event. Although none of these trials provided a formal statistical test for the observed between-arm (sildenafil versus placebo) differences, the degree of improvement tended to increase numerically with a higher dose of sildenafil. In two trials, the corresponding proportion of participants who received 100 mg sildenafil ranged from 84 to 88 78,86 percent. In two other trials the participants mean duration of penile rigidity (>80 percent and >60 percent, respectively) in minutes at the base and the tip of the penis was shown to increase numerically with higher doses of sildenafil (10 mg versus 25 mg versus 100 85 mg). In one trial, the mean duration of penile rigidity at the base of the penis for participants receiving 10 mg sildenafil was 3. The ranges for the mean 85,93 duration of penile rigidity (>60 percent or >80 percent) in two trials, were 5. The mean 36 number of erections per week (grades 34) was also shown to be numerically greater in two 93,96 trials. For example, the mean number of erections per week in one trial among participants 96 who received 10 mg, 25 mg, and 50 mg sildenafil was 2. In one trial, participants received either a fixed dose (50 mg every night) or a 161 flexible dose (50 or 100 mg, as needed) of sildenafil for 12 months; in the other trial participants were randomly assigned to receive 100 mg/d of sildenafil either 1 hour before/during 157 a meal or 3060 minutes before sexual activity. In the first trial, the effect of a fixed dose of sildenafil given every night was maintained to a greater extent compared with that achieved with a flexible dosage of sildenafil. In the other trial, the time between sildenafil administration and intercourse attempt (00. This study reported a higher proportion of participants with one or more adverse events in the combination arm (cabergoline and sildenafil) compared with the sildenafil monotherapy arm (12. Among these five trials, the incidence of any adverse event was reported in only one, in which more participants were found to have experienced one or more adverse event in the 40 mg phentolamine treatment group as compared with the flexible-dose (25 124 mg to 100 mg) sildenafil treatment group (41. More patients in the phentolamine group than in the sildenafil group experienced respiratory (17. The most frequent adverse events that 124 occurred during the trial were headache and rhinitis. These events were flushing, chest pain, shortness of breath with tachycardia in one participant, and cerebrovascular event and worsening of existing pterygium in the other two participants. One participant in the sildenafil treatment 124 group experienced a rupture of the Achilles tendon. The rates of withdrawals due to adverse events in participants treated 124 173 with sildenafil in two trials were <1. The corresponding rates for 124 173 participants treated with phentolamine and alfuzosin were 3. Quantitative Synthesis - Meta-analysis of Trials Monotherapy (any dose: 10, 25, 50, 100 mg) versus placebo. Sensitivity analysis was performed with respect to the duration of sildenafil treatment. The meta-analysis restricted to trials with 12-week treatment did not 2 appreciably affect the magnitude of the effect estimate and the degree of I test for heterogeneity, which decreased from 51. No meta-analysis for adverse events could be performed, due to a lack of 91 sufficient detail for the adverse events definitions provided in the trials. Note that one trial included younger patients (mean: 45, range 1855 years) compared with the other trial (mean: 115 53, range 2475 years). One of the trials used a crossover design; it reported pre- crossover results graphically, without presenting numeric measures of the variability. In the same trial, no participant had any adverse events; therefore, no meta-analysis for adverse events was performed. There were two trials that looked at patients with chronic renal failure on peritoneal dialysis. A meta-analysis for adverse events was also not feasible, since in one 108 of the trials only one event was observed. Meta-analysis was possible for sildenafil versus placebo trials involving hypertensive 143,147 patients using multiple antihypertensive drugs (i. Note that the respective rates in the sildenafil arms were quite similar (73 percent versus 71 percent). The two trials employed similar dosing regimens (from 50 mg to 25 mg or 100 mg) and duration of sildenafil treatment (68 143,147 weeks). Meta-analysis of trials comparing different doses of sildenafil (dose-response effect). Of these, two trials were conducted in 78 93 clinically distinct groups of participants (those with spina bifida and diabetes ) and therefore were not included in the meta-analysis. Therefore, the meta-analysis exploring the dose-response 86,96,137 effect of sildenafil was based on three trials.

Communication is the key: ask questions of all of your health care providers discount vytorin online amex, and make sure they are all talking to each other about your treatment as well purchase vytorin on line amex. If you have had diabetes for some time buy vytorin 30 mg free shipping, you may also have complications from your diabetes order 30 mg vytorin with visa. These additional health problems can make it more diffcult to manage your diabetes and overall health. You may be under the care of several different health care providers, and you may take multiple medications, making it challenging to fnd a balance. For example, a medicine may be useful in treating one health problem, but it might make another issue worse. Here are some tips if you have multiple health conditions and several health care providers caring for you: have regular medical check ups make sure members of your health team are talking to one another about your care. You will need to decide when to get some extra help in the home, when to move into an aged care facility, when to stop driving, and how you would like to be cared for towards the end of your life. These things are not always easy to consider or talk about, but starting the conversation about how you want to live in later life is a positive thing to do. Some people feel worried about the idea of an assessment, but it is just a way of working out how much help you need and what type of care or services you are eligible for. The planning process involves thinking about your values and beliefs and your wishes about what medical care you would like to have if you are not able to make your own decisions. An important part of the planning process is to discuss your wishes with your family and other people who are close to you, as well as talking to your medical team. You may also choose to write down your wishes in an Advance Care Directive, sometimes called a living will. We have summarised these tips in a checklist (below) that will help you manage diabetes as you age. Have your blood glucose targets regularly reviewed by your doctor Develop or review your hypoglycaemia (hypo) plan with your heath care team (if you inject insulin or take certain medications for your diabetes) Develop or review your hyperglycaemia (hyper) plan with your heath care team Develop or review your sick day plan with your heath care team Have the following things reviewed regularly by your health care team: medicines memory falls risk food choices physical activity emotional wellbeing Make sure members of your health team are talking to one another about your health management Consider getting a personal medical alarm Talk to your family and doctor about an Advance Care Directive, sometimes called a living will. What are the differences in the outcome in both countries after the treatment of diabetes (type 2) using drug and diet therapy? The chosen mate- rials were read through several times carefully, findings were gathered and classified to identify results. The results also show the general guidelines necessary for nurses, patient and their caregiver (e. This thesis focuses on the use of diet and drug therapy as a treatment of diabetes type 2. It will give an overview of how nurses, parents, caregivers and as well as0 patients contribute in the treatment of diabetes. The main topic of this thesis is to compare the diet and drug therapy in the treat- ment of diabetes (type2) in Finland and the United States. Since diabetes, espe- cially type 1, is showing more cases every day, authors will briefly mention few things people can do in order to prevent diabetes. Though type2 diabetes is characterized by multiple metabolic abnor- malities, Insulin resistance is the most common feature with patients. Hypergly- caemia which is also connected to type 2 diabetes, develops only when there is an accompanying defect in insulin secretion in relation to the degree of insulin re- sistance. As the duration of type 2 diabetes lengthens, there is a functional defect in the pancreatic beta-cell resulting from a decrease in beta cell mass. The pan- creatic beta cell function defects include decreased production of endogenous in- sulin, reduced unresponsiveness to glucose and worsening hyperglycaemia. Type 2 diabetes comprises 90% of people with diabetes around the world and ap- pears largely as a result of excess body weight and physical inactivity. The com- mon symptoms include excessive excretion of urine (polyuria), thirst (polydipsia) and excess body weight. As a result, the disease may be diagnosed several years after onset, once complications have already arisen. However, for people with other medical complication such as kidney damage or cerebrovascular damage, the target is <130/80mmHg. Patients can also be taught how to measure their own blood pressure and the measures to take when the result is below or above normal. Most of the patients do want to and are able to monitor their own glu- cose level. The reason for the self-blood glucose monitoring must be authorized and patient must be educated on how to interpret the result and the action that needs to be carried out whether the blood sugar has raised more or its getting bet- ter. Health provider must make sure that patient doing the self-blood glucose monitoring are reviewed on impact regularly. Individual should take three regular meals and ensure different ranges; snacks may be needed between meals and before bed where medication/insulin controls diabetes. Drink about 8 glasses a day especially water, patient must not add sugar or sweeteners to drinks and choose sugar-free drinks. This situation leads to hyper- glycaemia, which is an increase in blood glucose concentrations. The major con- sequences diabetes has on the body are severe damage to the kidneys, heart (e. Statistics show that it is the major cause of blindness, amputation and kidney failure. Furthermore, about 347 million people in the world have diabetes and in 2012, diabetes was the major cause of 1. Diabetes Type 1 is not preventable with current knowledge and was previously referred to as insulin dependent, juvenile or childhood- onset diabetes. However, the risk for developing type 1 dia- betes has been linked to exposure to some viral infections or environmental fac- tors. Diabetes type 1 is identified by the lack of insulin production by the pancreas and requires daily administration of insulin. The common causes of diabetes type 2 are unhealthy diet, lack of physical activity and obesity (over weight). Its symptoms are similar to that of diabetes type 1, except that they are 13(55) less obvious, which makes it mostly difficult to be diagnosed in the early stages, hence complications would have already risen. It is indicated by hyper- glycemia with above normal blood glucose levels but below the diagnostic of dia- betes. When this happens, the risk of complications during pregnancy and at de- livery is increased. Gestational diabetes is determined through prenatal screening, instead of reported symptoms. The authors wanted to discuss the causes, symptoms, diagnostic criteria as well as diet and treatment of type 2 diabetes. It is not always, but usually it is associated with obese or overweight people with a sedentary life style. Other risk factors that could lead to the development of diabe- tes type 2 include: family history and history of gestational diabetes. During the early stages, diabetes type 2 can be managed through healthy diet and regular physical activity but as it progresses, there will be a need for oral drug or insulin. This helps care givers and the patient to access and follow the efficiency of their glycemic control plan. Every three months, examinations of blood pressure, eyes as well as skin and bones on feet and legs are done in order to prevent diabetes related complications. It allows patient to determine if they have reached the glycemic target by evaluating their response to therapy. The outcome may be useful in the prevention of hypoglycemia and ad- justing medications (especially dosage of prandial insulin). It helps to achieve gly- caemic goals for clients, using irregular insulin injections, medical nutritional thera- py and non-insulin therapy. It should be done periodically for patient that are not achieving glycemic goals or changed therapy. The point-of-care testing in A1C grants proper decision when needed on therapy changes. Healthy meal means eating food from all the food groups, low calories and taking the same amount of carbohydrate at each meal (Medlineplus 2015a.

Half of the countries in this survey reported prevalence rates between 10 and 20% best buy vytorin. Another interesting point is the absence of gradient between Western and Eastern societies order vytorin line. Discussion Aim of this project was to collect epidemiological data worldwide with the contribution of the National Societies Members of The World Gastroenterology Organization purchase 20mg vytorin free shipping, and to review the literature in order to provide new awareness of the prevalence of digestive disorders and diseases discount vytorin 20 mg line. For this purpose, a total of 142 National Societies were contacted and literature searches with appropriate key terms were conducted using the main scientific and medical databases. Herein, this report gives the definition and prevalence of the most frequent functional disorders and diseases of the gastrointestinal system. Obtained data from a considerable number of countries are presented in the tables. Infection by Helicobacter pylori is the most prevalent digestive disease in the adult population, with median prevalence around 50% of the World population. As pointed out by previous surveys, differences between countries appear to be associated with socio-economic development. A highly interesting observation of our survey is the reduced prevalence found in children and young adults due to a reduced infection rate in the last decades, thanks to improved hygienic and environemental conditions. Among the gastrointestinal diseases of highest severity, colorectal cancer remains the most frequent disease, and it is still associated with high mortality. Age-standardized data demonstrates that incidence of colorectal cancer is 10 to 20 times higher in countries in the top quartile (Western Europe and North America) as compared to those in the lowest quartile (Africa, India). Median prevalence rates for these conditions are around 15% of the population with quartiles ranging from 8% up to 30% in different countries. It is important to remark that functional constipation is highly prevalent among children of the industrialized societies with prevalence rates ranging from 20 to 34%. Finally, dyspepsia is a functional disorder that requires further epidemiological investigation. Prevalence rates seem to be around 10 to 20% of the population, but data are scarce and widely dispersed because of the wide diversity of the definitions used in epidemiological studies. To summarize, this report provides for the first time a valuable tool to assess the prevalence of some of the main gastrointestinal disorders and diseases worldwide. Many of current data point out consistenly to high prevalence of functional digestive disorders and diseases on the world population. A major limitation is the limited availability of data from African and some Asian countries. Further surveys coordinated by the National Societies, including prospective studies, will provide further insights into this interesting topic. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Recent developments in the pathophysiology and therapy of gastroesophageal reflux disease and nonerosive reflux disease. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. The effects of dietary fat and calorie density on esophageal acid exposure and reflux symptoms. Association of body mass index with heartburn, regurgitation and esophagitis: results of the Progression of Gastroesophageal Reflux Disease study. Fruit and vegetable intake and prevalence of colorectal adenoma in a cancer screening trial. Viruses are Kam L Hon1 responsible for approximately 70% of episodes of acute gastroenteritis in children and rotavirus 1 is one of the best studied of these viruses. Oral rehydration therapy is as effective as intravenous Department of Paediatrics, The Chinese University of therapy in treating mild to moderate dehydration in acute gastroenteritis and is strongly Hong Kong, Hong Kong Special recommended as the frst line therapy. Vomiting is one of the main reasons to explain the underuse of oral Department of Pediatrics, The University of Calgary, Calgary, rehydration therapy. Antiemetics are not routinely recommended in treating acute gastroenteritis, Alberta, Canada though they are still commonly prescribed. Ondansetron is one of the best studied antiemetics and its role in enhancing the compliance of oral rehydration therapy and decreasing the rate of hospitalization has been proved recently. The guidelines regarding the recommendation on antiemetics have been changed according to the evidence of these recent studies. Children in developing countries are particular at risk of both morbidity and mortality. Worldwide, gastroenteritis affects 3 to 5 billion children each year, and accounts for 1. In the United States, the admission rate is 9 per 1000, per annum, for children younger than 5 years old. The difference can also be Tel +852 26322861 explained by the fact that, the incidence of acute gastroenteritis is signifcantly higher Fax +852 26360020 Email ccm250@ha. This is an Open Access article 6554 which permits unrestricted noncommercial use, provided the original work is properly cited. Chow et al Dovepress is a developed city, and yet the admission rate is even higher the cause of 205,000 to 272,000 emergency department than many of the developing countries. By the age of 5 years, the cumulative risk is 1 in 24, a fgure Etiology that is 3 times higher than the that of the United States. The peak age for had diarrhea and vomiting, 7% had diarrhea and fever, 4% infection ranges from 6 months to 2 years. Other common had vomiting and fever, 3% had fever alone, 2% had vomiting viruses causing gastroenteritis include calicivirus, adenovirus alone and 0. Vomiting is one of the diarrhea episodes in hospitalized children, with detection most important symptoms for considering failure of oral rates varying from 3. However, less developed therapy in treating acute gastroenteritis, with mild to countries have a higher rate of parasites and Escherichia moderated dehydration, has been demonstrated by many coli infection which are both relatively uncommon in the randomized controlled trials. The data showed that there were no important clinical Rotavirus as a prototypic differences between oral hydration therapy and intravenous virus for gastroenteritis therapy for rehydration secondary to acute gastroenteritis Rotavirus is a prototypical virus because it is the most common in children; and that children treated with oral rehydration virus that causes acute gastroenteritis in children which therapy spent less time in hospitals. Moreover, patients results in hospitalization and treatment with intravenous fuid. Importantly, this 410,000 physician visits are due to the rotavirus infection, result is unlikely to change with further trials because there 98 submit your manuscript| www. In 1970s the diarrheal illness related deaths use oral rehydration therapy in scenarios of mild dehydration were 4. A crowded or emer- The oral rehydration solution is regarded as one of gency department with long waiting times would cause 22% the most important medical advances of the 20th century. Regarding Although there is much evidence to support the usage of the severity of dehydration, 49. In terms of symptoms, only 8% of the emer- oral rehydration solution is still described as an underused gency department physicians would consider intravenous simple therapy. Data from Europe, hand, patients refusing to drink was the most likely reason Australia and Canada show that 80% to 94% of hospitalized for choosing intravenous therapy (up to 96%). Vomiting children do not have any signs of dehydration and yet they was the second most important reason given for intravenous still receive intravenous therapy. Up to 82% of rotavirus infected children therapy, any treatments in acute gastroenteritis should presented with vomiting, a fgure that was very similar to improve the success or compliance of oral rehydration the study by Staat and colleagues in 2002. Safety and cost are also important episodes and duration of vomiting in gastroenteritis patients, issues. Successful oral rehydration therapy always means the mean number of vomiting episodes was 4. In summary this may partly more pleasant for the children and more comfortable for the explain why the oral rehydration solution is an underused caregivers. The pathophysiology of vomiting Reasons of underused oral and the mechanisms of antiemetic rehydration therapy medications The reasons for the underuse of oral rehydration therapy are Vomiting is usually defned as a violent expulsion of the not fully understood. In 2002 Ozuah and colleagues published stomach contents through the mouth and being a very a national random survey of emergency physicians selected unpleasant symptom. The mechanism of vomiting has been A total of 176 physicians responded (73% response rate). Emetic stimuli can be transmitted directly to ing are rich in serotoninergic, dopaminergic, histaminic, and the vomiting center or through the chemoreceptor trigger muscarinic receptors. The chemoreceptor trigger zone, located in the area emetic stimuli by blocking D2 receptors in the chemoreceptor postrema of the fourth ventricle and outside the blood-brain trigger zone. On the other hand, the vomiting center does ment or prevention of vomiting due to causes other than not only receive information from the chemoreceptor trigger motion sickness. However, the exact mechanism of vomiting in Physicians who feel that antiemetic therapy is indicated in a gastroenteritis is not known; although it is thought to be due given situation should be aware of potential adverse effects.

People with diabetes (or parents/guardians) should: try to speak to their general practitioner or diabetes team if they feel they (or their children) have significant psychosocial issues such as those detailed in this section cheap 20mg vytorin visa. The remainder of the section includes updated material which is relevant to the management of children purchase generic vytorin line, adolescents and adults with type 1 diabetes purchase vytorin with american express. In 2009 the Scottish Diabetes Survey indicated there were 27 order vytorin 20mg otc,363 patients with type 1 diabetes in Scotland. Non-type 1 diabetes is being recognised with increasing frequency, particularly emerging molecular forms of diabetes, diabetes secondary to pancreatic disease and a rise in type 2 diabetes and other insulin-resistance syndromes in the young. While there are known antibody markers of prediction in high risk subjects, there is no evidence for effective methods of prevention of type 1 diabetes. The evidence on the role of the intensification of therapy in the attempt to achieve as rapid as possible normoglycaemia is inconsistent. In particular, there is no evidence of a sustained effect of any specific insulin therapy on glycaemic control during the first few months after diagnosis. Therefore, no recommendation can be given for the most appropriate insulin therapy at diagnosis. Thus, there is no agreed single target for 1+ glycaemic control in these patients. The guideline development group concluded that identifying a single target for all people with type 1 diabetes was not appropriate, but that patients should discuss this with their healthcare professionals, in the knowledge that the overall aim is to achieve the lowest HbA1c as possible, which does not interfere with the patients quality of life. B Intensive insulin therapy should be delivered as part of a comprehensive support package. While there is no evidence on the most effective form of support package, in general this refers to increased contact between patients and their families with a local multidisciplinary team of health professionals delivering specific healthcare strategies. Both basal (eg, glargine and detemir) and rapid-acting (eg, lispro, aspart and glulisine) insulin analogues are prescribed widely in the management of type 1 diabetes. Rapid-acting insulin analogues in adults In comparison with regular human insulin and as part of a basal bolus regimen, short-acting insulin analogues have a small but statistically significant effect on HbA1c in people with type 1 diabetes, with a reduction of approximately 0. Some studies have reported a reduction in hypoglycaemia in association with their use, however there is considerable heterogeneity between these studies, making it difficult to draw firm conclusions. The use of insulin analogues has been associated with an improvement in treatment satisfaction scores in several, though not all, studies which used a validated assessment tool. B An intensified treatment regimen for adults with type 1 diabetes should include either regular human or rapid-acting insulin analogues. The first meta-analysis, undertaken by the Canadian Agency for Drugs and Technologies in Health, concluded that use of glargine was associated with a reduction in HbA1c of 0. Comparison of insulin detemir and insulin glargine In a 52 week study comparing insulin detemir and insulin glargine as the basal component of a basal bolus regimen in 443 patients with type 1 diabetes, there was no difference or change + 1 in HbA1c or rates of hypoglycaemia between the groups. According to the study protocol, two thirds of the detemir group completed the study on twice daily detemir. Even these few are of relatively short duration, and most involve small numbers of subjects. One systematic review identified four studies in pre-pubertal children and one study involving adolescents which showed no difference in glycaemic control (as measured by HbA1c) between 1++ the use of rapid-acting insulin analogues and regular human insulin. One study showed reduction in rates of both overall and nocturnal hypoglycaemia when using rapid-acting insulin analogues. In developed countries its usage is increasing in patients with type 1 diabetes, who are expert at carbohydrate counting or have undertaken an appropriate structured education course. Concern has been raised over the lack of independently funded studies to allow objective comparison of results. Such studies should not restrict entry on the basis of hypoglycaemia and should use a validated QoL assessment. Progress against targets should be monitored and, if appropriate, alternative treatment strategies should be offered. B Dietary advice as part of a comprehensive management plan is recommended to improve glycaemic control. No studies were identified looking at the impact of self or carer care compared to routine care on length of stay or patient satisfaction. There are several different methods of providing advice and support to those diagnosed with type 1 diabetes in Scotland. Transition models have evolved according to local circumstances and beliefs 4 and their complexity makes comparison very difficult. There is little evidence available on the different adolescent transition models and their benefits and there is no evidence to recommend a particular transition model. Some common themes appear in the literature: Patients and their families favour a structured transition from paediatric to adult services together with adequate information along the way. Those adults responsible for them during school hours may not be experienced 3 in the care of children with diabetes. Complications such as hypoglycaemia and poor glycaemic control may occur during these times. The first study involved school-based consultations from the diabetes nurse, but was described as a pilot study, with no control group 2- and a self-selected intervention group. The intervention consisted of increased visits during 1- school hours to discuss diabetes and advice on dose adjustments. Intensification of diabetes management requires increased monitoring and insulin use and, as this significantly improves glycaemic control, should be available to all children while at school. Children at school should be supported with all necessary aspects of diabetes care, such as glucose monitoring, insulin injection and treatment of hypoglycaemia. Improvements in blood glucose control are associated with + 229,230 1 improvements in quality of life, providing there is no increase in hypoglycaemic symptoms. For clarity and simplicity the guideline development group suggests 12 years of age in both boys and girls. Recommendations for screening patients with type 1 diabetes for retinopathy, nephropathy and hypertension are included in sections 10. There is no evidence that routine screening for autonomic neuropathy or hyperlipidaemia are of benefit in children and adolescents with type 1 diabetes. C Patients with cystic fibrosis should be screened annually for diabetes from 10 years of age. C Young people with diabetes should be screened for thyroid and coeliac disease at onset of diabetes and at intervals throughout their lives. Standard blood tests exist to screen for thyroid and coeliac disease but there are limited data to support the specific frequency of screening. People with type 1 diabetes: should have the right to choose not just the insulin regimen, but whether to use an analogue (designer insulin), human or animal insulin. People with diabetes must appreciate the time action profiles of their type of insulin, have knowledge of injection sites and absorption rates of insulin. Ideally all of the above should form part of an education programme provided locally by the Diabetes Team, with the aim to empower patients to make the choice that is right for them. This will often involve the local Diabetes Team in office hours, but outwith these times arrangements vary across Scotland. Hospital admission- If you have concerns about your diabetes management as an inpatient ask the local ward staff to have the Diabetes Team review your progress. Healthcare professionals should: develop a local transition process that facilitates a seamless move to an adult service, which encourages regular attendance of teenagers. However, type 1 and 2 diabetes are high risk states for both the woman and her fetus. There are increased complications of diabetes, severe hypoglycaemia, and progression of microvascular complications. Rates of fetal and neonatal loss and major congenital malformation are increased by at least two to threefold. The prevalence of type 2 diabetes is increasing in women of reproductive age and outcomes may be equivalent or worse than in those with type 1 diabetes. Management prior to and during pregnancy should follow the same intensive programme of metabolic, obstetric and neonatal supervision. National audits on management of diabetes in pregnancy indicate that adverse pregnancy outcomes remain higher in women with diabetes than in the non-diabetic population.