The authors believe that a comprehensive risk management under a multiagency/multidisciplinary framework should be undertaken for all adults with ID and epilepsy in day-to-day clinical practice to reduce mortality in people with ID.

The data confirm that DAFNE participation improves glycaemic control in Type 1 diabetes with benefits being sustained for 5 years. This study is the first to demonstrate reduced HbA variability after completion of structured education. This is new evidence of the beneficial impact of DAFNE on glycaemic profile.

Aim Despite evidence of morbidity, no evidence exists on the relationship between HbA 1c variability and mortality in Type 1 diabetes. We performed an observational study to investigate whether the association between HbA 1c variability and mortality exists in a population of people with Type 1 diabetes. As a secondary outcome, we compared onset of first hospital admission between groups.Methods People with Type 1 diabetes were identified for inclusion from the Scottish Care Information -Diabetes data set. This database includes data of all people known to have diabetes who live within Scotland. A survival analysis was carried out over a 47-month period comparing two groups; group 1 with a HbA 1c coefficient of variation (CV) above the median CV value, and group 2 with a CV below the median value. Time to death or first admission was also analysed. A Cox proportional hazard model was used to compare time to death, adjusting for appropriate covariables.Results Some 6048 individuals with Type 1 diabetes were included in the analysis. Median HbA 1c CV was 7.9. The hazard ratio (HR) for mortality for those with an HbA 1c CV above the median value is 1.5 over 47 months of follow-up (P < 0.001). HR for survival to either the first admission to hospital or death for those with an HbA 1c CV above the median value was 1.35 (95% confidence interval 1.25-1.45) over 730 days of follow-up (P < 0.001).Conclusion Our results show that people with greater HbA 1c variability have a higher rate of mortality and earlier hospital admission in Type 1 diabetes. Diabet. Med. 34, 1541-1545(2017

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all are based at Leicestershire Partnership NHS Trust, Leicester, UK. AbstractPurpose -The purpose of this paper is to identify psychotropic medication being prescribed for people with intellectual disability "as and when required" (PRN); the indications, frequency of use, rate of poly-pharmacy and contribution of PRN medication towards this. The paper also aimed to identify individual and environmental factors associated with PRN medication prescribing. Design/methodology/approach -Data were collected from nursing and medical records for the 119 service users in the acute assessment and treatment unit and NHS residential care settings managed by specialist intellectual disability services covering Leicester, Leicestershire and Rutland over a month period. Data were analysed using descriptive statistics and logistic regression to calculate adjusted odds ratios for predictor variables. Findings -In total, 72 per cent of the service users were prescribed and 25 per cent were administered PRN medication over the study period. The most common indications for PRN prescribing were aggression and agitation. Lorazepam and chlorpromazine were the most frequently prescribed PRN medications. The rate of poly-pharmacy was 41 and 38 per cent of this was attributable to PRN medication. Male gender and history of challenging behaviour were found to be significant factors associated with PRN medication prescribing. Originality/value -PRN medications are commonly prescribed in people with intellectual disabilities and contribute to poly-pharmacy. Whilst PRN medication continues to remain an effective therapeutic option in situations where environmental and behavioural approaches are proving insufficient, their use should always be in conjunction with effective review mechanisms.