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Contents lists available at ScienceDirect
Primary Care Diabetes journal homepage: http://www.elsevier.com/locate/pcd
How do you keep up-to-date?
We have all seen estimations of the numbers of original papers and reviews that are published each day, month or year and we know that new medical journals are coming into existence pretty well daily. Is there any chance of anyone reading them all? No chance at all. Is there any chance of anyone reading even those articles that are relevant to their everyday practice? Very little, if you also need to work, sleep and eat. If I am asked the question “How do I keep up to date”, I have to say “I don’t”. I try but it is a rather haphazard process. Being someone who likes to hold a paper journal rather than peering at a screen, I am disadvantaged and besides, I want to enjoy keeping up to date rather than it becoming a chore. My usual regime is to devote Sunday morning to reading my accumulated journals for that week. The BMJ serves to keep me up to date with the gossip, some topical science and the occasional new ﬁnding to keep one step ahead of my students. Diabetic Medicine is a must and so are Diabetes Care and Diabetologia. Then, on the more general side, Clinical Medicine, the journal of the RCP London. These together with Balance, Diabetes Update and, of course Primary Care Diabetes (of more, later), take me comfortably up to, and sometimes beyond, Sunday lunch time. Last Sunday’s browsing revealed a few gems. Mindful of the St Vincent Declaration anniversary this year, I was pleased to see a report from colleagues in Dundee (Schoﬁeld et al. ) suggesting a signiﬁcant reduction in lower limb major amputations in the Tayside population over the 7 years from 2000. The numbers each year being quite small (20–30 or so in men and 10–12 in women), the rates ﬂuctuate considerably. Nevertheless an encouraging result made the more credible by robust local information. Another article in the same issue of the journal (Thomas et al. ) set out some alarming ﬁgures relating to a phenomenon that is evident to anyone on the diabetes scene—the increase of type 2 diabetes in men. They described an increase, in terms of crude (unadjusted) prevalence from 1.2% in 1978–1980 to 12.1% in 2005. The rate of increase accelerates over time and is particularly striking in Scottish towns. Men do not consult their GPs as often as they should. Much of this pathology, even the diagnosis of diabetes itself, is likely, therefore, to be hidden from view in places that have not been studied as intensively
as was done by the authors of that article. Standard works on diabetes written in the 1980s described signiﬁcantly higher prevalences in women than in men (particularly multiparous women), a phenomenon that has been effectively reversed. The decline of physical activity at work in most occupations favoured by men has led to a marked change in the distribution of overweight and obesity and, as a consequence, an explosion of type 2 diabetes in them. More general reading included the summary, in the BMJ of 22 August, of the meta-analysis of neuraminidase inhibitors in the treatment of inﬂuenza in children, a publication which hit the swine ‘ﬂu headlines, even though it was nothing at all to do with swine ‘ﬂu. Also, the elegant rebuttal, by Des Spence, in the same BMJ of the lies, half truths and exaggerations about our NHS which are ﬂying about the USA at the moment—NICE panels being described as “death panels”, for example. We may not agree with everything NICE says but, with true British understatement, describing them as “death panels” is taking things “just a bit too far”. We also may have our reservations about the NHS at the moment and about its future but, to paraphrase what was once said about democracy, the NHS may be a bad system of health care but many of the others are so much worse. What of “on-line” means of keeping up-to-date? I am a novice here, I have to admit. However, I am becoming addicted to Professor Sir Muir Gray’s latest brain-child—“Behind the Headlines” (http://www.nhs.uk/news/Pages/NewsIndex. aspx). This website undertakes to provide “an unbiased and evidence-based analysis of health stories that make the news”. The main target audience for the site is GPs, providing rapid analysis, by experts, that can inform them about stories that hit the press and which can (as did the cancer and the pill scare story and many others in the past) prompt questions from the worried well in the morning surgery. These past embarrassments have been made worse by the press getting hold of the story before the relevant journal has hit GPs’ desks. There are 49 “stories” about diabetes on the site as I write this. For example—“Eye drops heal glaucoma” (Daily Telegraph, 10th August) or “A common anti-diabetes drug [metformin] may boost the potency of vaccines against cancer” (BBC News, last May). The site makes it clear that the ﬁrst of these
1751-9918/$ – see front matter © 2009 Published by Elsevier Ltd on behalf of Primary Care Diabetes Europe. doi:10.1016/j.pcd.2009.09.001
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was a study in rats, the second in mice. The rosiglitazone story (“Diabetes drug ‘increases risk of heart attack”’) that made the Times in December 2007 was, of course, analysed in full on the site at the time. I have never known any of my GP colleagues comment upon this site nor even reveal that they know of its existence. I would be interested in your comments. My favourite web-based update on diabetes at the moment is: [email protected]
Unfortunately, the person who runs this site, Jim Young – a former member of the University staff here in Swansea – has had to reduce the frequency of its updates from daily to weekly. This is because of current lack of sponsorship for the site. We are all doing our best to help him. If you want to subscribe, contact him at [email protected]
Another source of regular updates that seems to be relevant and sound is Diabetes & Endocrinology MedscapeCME Pulse (MedscapeCME [email protected]
). In this issue of the journal, amongst other topics, we have some realistic observations (from Jordan and Greece) of the challenges of achieving good glucaemic control and reduc-
ing other risk factors; an evaluation of the effect of practice nurse involvement in care (Netherlands); some observations on complementary and alternative medicine use in children with diabetes (USA) and a conﬁrmation that, yes, blood pressure readings can be higher when measured in hospital clinics than in primary care. We may also have the ﬁrst observation (from Thailand) that mortality from inﬂuenza A H1N1 may be commoner in people with diabetes than those without. Read on and continue to update yourselves!
 C.J. Schoﬁeld, et al., Diabetic Medicine 26 (2009) 773–777.  M.C. Thomas, et al., Diabetic Medicine 26 (2009) 766–772.
Rhys Williams Swansea University, United Kingdom E-mail address: [email protected]
31 August 2009