Abstract There is a complex bidirectional relationship between diabetes and mental illness, where diabetes is associated with an increased prevalence of a range of mental disorders and several mental illnesses increase the risk of diabetes. The reasons why people with mental illness are at higher risk of diabetes and vice versa are multifactorial. When diabetes and mental illness occur together, the outcomes for both conditions are worsened, and the co‐morbidity places a higher burden on the individual living with the conditions.Severe mental illness is associated with a twofold increased risk of diabetes, and the onset of diabetes is approximately 10 years earlier in people with mental illness than in the general population. Health behaviour interventions to reduce the incidence of diabetes may be less effective than previously thought. However, trials on obesity drugs, particularly glucagon‐like peptide‐1 receptor agonists, are showing promise. Diabetes care for people with severe mental illness seems to have improved in the past decade. Interventions have been developed to address the unique challenges of living with severe mental illness and diabetes.Depression is twice as common in people with diabetes. Depression increases the risk of diabetes and vice versa. Although general population risk factors for depression apply to people with diabetes, diabetes‐specific risk factors include the development of complications and insulin use in people with type 2 diabetes. Managing depression includes efforts to prevent depression, timely diagnosis and treatment with psychological or pharmacological treatments.Health care professionals have a responsibility to ensure that people with mental illness and diabetes are not disadvantaged.

Abstract Background: Diabetes distress is the term used to describe the diabetes‐specific emotional distress resulting from the challenges of managing this demanding chronic condition.Aims: This study aimed to determine the prevalence of diabetes distress and its subtypes in adults with type 2 diabetes who attended our community‐based clinics and to investigate the relationship between diabetes distress scores and demographic factors and diabetes variables (HbA1c and treatment regimen).Methods: Patients were referred to our specialist diabetes team by primary care teams. Clinical details, including current treatment regimen and recent HbA1c result, were recorded. Patients then completed the Diabetes Distress Scale (DDS) 17 questionnaire. Data from all 82 patients who attended our clinic from May 2022 to November 2022 were analysed.Results: A high level of diabetes distress (mean score of ≥3) was found in 17 patients (20.7%), and a moderate level of diabetes distress was found in 22 patients (26.8%). Patients with an HbA1c of >90mmol/mol had significantly higher mean regimen‐related distress than those with an HbA1c of <60mmol/mol (2.58±1.18 vs 1.86±0.8, respectively; p=0.03). In addition, patients with higher HbA1c had higher diabetes‐related emotional distress than those with lower HbA1c. However, this result did not demonstrate statistical significance. Conversely, patients with optimal HbA1c levels had significantly lower mean interpersonal distress scores than the rest of the cohort (1.13±0.99 vs 1.80±0.99, respectively; p=0.01).Conclusions: Diabetes distress is common among patients attending community‐based diabetes services. Further research is needed to determine the most effective strategies for reducing diabetes distress and improving clinical outcomes.

Abstract Background and aims: Treatment‐induced neuropathy of diabetes is an acute small‐fibre neuropathy associated with rapid glycaemia improvement.Methods: This study is a narrative review carried out based on a bibliographic review, using articles indexed in PubMed/Medline and Scielo.Results: This entity is more frequent in adult patients with poor previous glycaemic control. Its precise pathophysiology is unknown, but it is likely related to unrestored microcirculation changes that occurred during the hyperglycaemic period. It presents with intense, sudden neuropathic pain and autonomic dysfunction after a rapid glycaemic correction and a poorer analgesic response than in diabetic neuropathy.Conclusions: Since rapid glycaemia correction is the cause of this problem, clinical practice guidelines that can help physicians to prevent, diagnose and manage this entity should be developed. Copyright © 2023 John Wiley & Sons.

Abstract This study aimed to investigate the utility of first trimester HbA1c in predicting gestational diabetes mellitus (GDM) in obese women with Grade II–III obesity. HbA1c was measured during the first trimester in 160 obese women. A 75g oral glucose tolerance test (OGTT) was performed between 24–28 weeks gestation and GDM diagnosed by WHO criteria.The prevalence of GDM was 24%. An HbA1c of ≤28mmol/mol had 100% negative predictive value for GDM. An HbA1c of ≥33mmol/mol had a 69.2% sensitivity and 63.6% specificity for GDM. At higher HbA1c cut‐offs, the odds ratio (OR) for developing GDM increased; at a threshold of ≥39mmol/mol, the OR for GDM was 10.1 (95% CI 2.5–40.5).Women with a first trimester HbA1c of ≤28mmol/mol are at very low risk of developing GDM and may not require an OGTT at 28 weeks, while those with HbA1c ≥39mmol/mol may benefit from early glucose monitoring in pregnancy. Copyright © 2023 John Wiley & Sons.

The legacy of Dr Arnold Bloom is recorded on the Diabetes UK Roll of Honour which aims to acknowledge people who have played an exceptional role in the history of diabetes. It is an incredible honour and a privilege to be awarded the 2023 Diabetes UK Arnold Bloom Award and for the opportunity to deliver this lecture.

Abstract The prevalence of chronic kidney disease (CKD) is rising worldwide and is a major contributor to morbidity and mortality. It is estimated to affect over 800 million people globally.CKD and its complications carry a substantial financial burden to the NHS in both primary and secondary care. The lack of public awareness of CKD and its complications leads to a reduction in planned follow‐up attendance; clinician awareness of the biomarkers of CKD and progression is still lacking. Measures to improve awareness are needed.Diabetes mellitus remains the single most common cause of progressive renal impairment and over 40% of patients with diabetes will develop diabetic kidney disease in their lifetime. A multidisciplinary approach to management and early intervention are therefore key to halt the progress of diabetic kidney disease. The National Institute for Health and Care Excellence has set clear guidelines for the management of diabetic kidney disease, highlighting newer therapeutic agents like SGLT2 inhibitors. New guidelines are also in place for referral to secondary care involving the Kidney Failure Risk Equation, as it identifies patients at increased risk of progressing to end stage kidney disease.Without robust measures for early detection and management of CKD, progression to kidney failure may occur, exacerbating the increase in cardiovascular disease, premature deaths and poor quality of life. This article is a call to action for the optimal and timely management of CKD. Copyright © 2023 John Wiley & Sons.

Abstract Type 2 diabetes is a complex, chronic illness requiring continuous medical care with multifactorial risk‐reduction strategies beyond glycaemic control. Cardiovascular and metabolic derangements individually and interdependently lead to a substantial increase in cardiovascular disease morbidity and mortality. Chronic kidney disease is also associated with increased risks of cardiovascular morbidity, premature mortality and decreased quality of life. Established and evolving treatment strategies including moderate physical activity, weight reduction, rigorous blood pressure control, correction of dyslipidaemia, and glycaemic control have proven beneficial in reversing these abnormal responses and decreasing the cardiovascular risk. Most patients with type 2 diabetes are treated by their primary health care team who need guidance in choosing the best treatment regimens for their patients since the number of glucose‐lowering agents is rapidly increasing, as is the amount of clinical data regarding these drugs. Early intervention models of care improve glycaemic, cardiovascular and patient outcomes. Copyright © 2023 John Wiley & Sons.

Abstract Aims: To audit eye screening attendance rates in children pre and post implementation of a screening service offered on the same day as their diabetes clinic appointment and to identify characteristics of non‐attenders.Methods: Data were extracted from the diabetic eye screening software ‘OptoMize’ between 1 April 2018 and 31 March 2019 (pre intervention) and between 1 April 2019 and 31 March 2020 (post intervention). Attendance rates of 72 eligible participants were gained and their diabetes characteristics (age, duration of diabetes and HbA1c) were examined pre and post intervention with application of the Mood's median test in order to determine statistical significance.Results: Same day screening with routine diabetes appointments improved the eye screening attendance rate by 22%. Those with a higher HbA1c were significantly less likely to attend (p<0.05) pre intervention, while post intervention, the median HbA1c of those who did not attend was lower than those who did. There was no significant difference between the age of participants for those who attended and those who did not pre and post intervention (p=0.705/0.235). Those who did not attend despite the intervention had a longer duration of diabetes than those who did, yet significance was not gained.Conclusion: This study has addressed a gap within existing knowledge and provided quantitative analysis within the field of paediatric diabetic eye screening. Findings have identified the positive impact of a ‘same day screening service’ integrated with routine diabetes care on attendance, and have also identified a clear improvement in attendance rates of those with the higher risk factors of developing sight‐threatening retinopathy. Copyright © 2023 John Wiley & Sons.