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Journal Cover Diabetic Medicine
  [SJR: 1.654]   [H-I: 116]   [140 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0742-3071 - ISSN (Online) 1464-5491
   Published by John Wiley and Sons Homepage  [1592 journals]
  • Predictive performance of a genetic risk score using 11 susceptibility
           alleles for the incidence of Type 2 diabetes in a general Japanese
           population: a nested case–control study
    • Authors: A. Goto; M. Noda, M. Goto, K. Yasuda, T. Mizoue, T. Yamaji, N. Sawada, M. Iwasaki, M. Inoue, S. Tsugane,
      Abstract: AimsTo assess the predictive ability of a genetic risk score for the incidence of Type 2 diabetes in a general Japanese population.MethodsThis prospective case–control study, nested within a Japan Public Health Centre-based prospective study, included 466 participants with incident Type 2 diabetes over a 5-year period (cases) and 1361 control participants, as well as 1463 participants with existing diabetes and 1463 control participants. Eleven susceptibility single nucleotide polymorphisms, identified through genome-wide association studies and replicated in Japanese populations, were analysed.ResultsMost single nucleotide polymorphism loci showed directionally consistent associations with diabetes. From the combined samples, one single nucleotide polymorphism (rs2206734 at CDKAL1) reached a genome-wide significance level (odds ratio 1.28, 95% CI 1.18–1.40; P = 1.8 × 10–8). Three single nucleotide polymorphisms (rs2206734 in CDKAL1, rs2383208 in CDKN2A/B, and rs2237892 in KCNQ1) were nominally associated with incident diabetes. Compared with the lowest quintile of the total number of risk alleles, the highest quintile had a higher odds of incident diabetes (odds ratio 2.34, 95% CI 1.59–3.46) after adjusting for conventional risk factors such as age, sex and BMI. The addition to the conventional risk factor-based model of a genetic risk score using the 11 single nucleotide polymorphisms significantly improved predictive performance; the c-statistic increased by 0.021, net reclassification improved by 6.2%, and integrated discrimination improved by 0.003.ConclusionsOur prospective findings suggest that the addition of a genetic risk score may provide modest but significant incremental predictive performance beyond that of the conventional risk factor-based model without biochemical markers.This article is protected by copyright. All rights reserved.
      PubDate: 2018-02-14T14:25:24.23168-05:0
      DOI: 10.1111/dme.13602
  • Diabetes UK evidence-based nutrition guidelines for the prevention and
           management of diabetes
    • Authors: P. A. Dyson; D. Twenefour, C. Breen, A. Duncan, E. Elvin, L. Goff, A. Hill, P. Kalsi, N. Marsland, P. McCardle, D. Mellor, L. Oliver, K. Watson
      Abstract: A summary of the latest evidence-based nutrition guidelines for the prevention and management of diabetes is presented. These guidelines are based on existing recommendations last published in 2011, and were formulated by an expert panel of specialist dietitians after a literature review of recent evidence. Recommendations have been made in terms of foods rather than nutrients wherever possible. Guidelines for education and care delivery, prevention of Type 2 diabetes, glycaemic control for Type 1 and Type 2 diabetes, cardiovascular disease risk management, management of diabetes-related complications, other considerations including comorbidities, nutrition support, pregnancy and lactation, eating disorders, micronutrients, food supplements, functional foods, commercial diabetic foods and nutritive and non-nutritive sweeteners are included. The sections on pregnancy and prevention of Type 2 diabetes have been enlarged and the weight management section modified to include considerations of remission of Type 2 diabetes. A section evaluating detailed considerations in ethnic minorities has been included as a new topic. The guidelines were graded using adapted ‘GRADE’ methodology and, where strong evidence was lacking, grading was not allocated. These 2018 guidelines emphasize a flexible, individualized approach to diabetes management and weight loss and highlight the emerging evidence for remission of Type 2 diabetes. The full guideline document is available at:This article is protected by copyright. All rights reserved.
      PubDate: 2018-02-14T09:25:50.518471-05:
      DOI: 10.1111/dme.13603
  • Hypertriglyceridaemic–waist phenotype and risk of diabetes in people
           with impaired fasting glucose in primary care: a cohort study
    • Authors: V. Y-W. Guo; E. Y-T. Yu, C. K-H. Wong, R. W-S. Sit, J. H-L. Wang, C. L-K. Lam
      Abstract: AimWe aimed to determine the prospective association between baseline triglyceridaemic–waist phenotypes and diabetic mellitus incidence in individuals with impaired fasting glucose seen in primary care.MethodsA cohort of 1101 participants (84.4% of the recruited individuals) with impaired fasting glucose were recruited from three primary care clinics during regular follow-ups to monitor their chronic conditions. Baseline triglyceridaemic–waist phenotypes were divided into four groups: (1) normal waistline and triglyceride level (n = 252); (2) isolated central obesity (n = 518); (3) isolated high triglyceride level (n = 80); and (4) central obesity with high triglyceride level (i.e. hypertriglyceridaemic–waist phenotype) (n = 251). The presence of diabetes at follow-up was determined by fasting plasma glucose (≥ 7.0 mmol/l) and/or 2-h 75-g oral glucose tolerance test (≥ 11.1 mmol/l) and/or HbA1c (47.5 mmol/mol; ≥ 6.5%) according to American Diabetes Association diagnostic criteria. Multivariable Cox proportional hazards regressions were established to assess the impact of different triglyceridaemic–waist phenotypes on time to diabetes onset.ResultsAfter a mean follow-up period of 6.5 months (sd 4.7 months), the number of diabetes cases was significantly higher in the group with hypertriglyceridaemic–waist phenotype (52.2%) compared with the other three phenotype groups (group 1: 28.2%; group 2: 34.6%; group 3: 30.0%). Only the hypertriglyceridaemic–waist phenotype showed an increased risk of developing diabetes (hazard ratio 1.581, 95% CI 1.172–2.134; P = 0.003) compared with the group with normal waistline and triglyceride level after controlling for confounders.ConclusionThe combination of central obesity and hypertriglyceridaemia is associated with> 50% risk of progression to diabetes within 6 months among individuals with impaired fasting glucose seen in primary care.This article is protected by copyright. All rights reserved.
      PubDate: 2018-02-13T14:15:22.326216-05:
      DOI: 10.1111/dme.13601
  • Use of non-vitamin K oral anticoagulants in people with atrial
           fibrillation and diabetes mellitus
    • Authors: O. Itzhaki; B. Zadok, A. Eisen
      Abstract: AimsTo examine the efficacy and safety of non-vitamin K oral anticoagulants in people with both atrial fibrillation and diabetes mellitus.MethodsWe reviewed efficacy and safety data from the warfarin-controlled phase III non-vitamin K oral anticoagulants trials (ARISTOTLE, RE-LY, ROCKET-AF, ENGAGE and AF-TIMI 48) and their post hoc analyses with regard to diabetes status. We also reviewed the updated literature regarding this population.ResultsAt baseline 20–40% of the participants in the phase III non-vitamin K oral anticoagulants trials had diabetes mellitus at baseline. This population, in comparison with those without diabetes, was more likely to have other comorbidities, such as hypertension and coronary artery disease; thus, their cardiovascular risk was higher. Participants with diabetes had higher rates of stroke and systemic embolism than participants without diabetes. This risk was decreased using non-vitamin K oral anticoagulants, with no significant interaction by diabetic status or the specific drug used. Overall, compared with warfarin, non-vitamin K oral anticoagulants were safe and reduced the incidence of major bleeding in people with atrial fibrillation and diabetes, although the results varied with the different non-vitamin K oral anticoagulants.ConclusionsThe efficacy and safety of non-vitamin K oral anticoagulants compared with warfarin generally extend to participants with diabetes mellitus, although dedicated randomized trials or real-world data are lacking.This article is protected by copyright. All rights reserved.
      PubDate: 2018-02-13T14:10:23.743976-05:
      DOI: 10.1111/dme.13600
  • Diabetes stigma is associated with negative treatment appraisals among
           adults with insulin-treated Type 2 diabetes: results from the second
           Diabetes MILES – Australia (MILES-2) survey
    • Authors: E. Holmes-Truscott; J. L. Browne, A. D. Ventura, F. Pouwer, J. Speight
      Abstract: AimTo explore factors associated with negative insulin appraisals among adults with Type 2 diabetes mellitus, including perceived and experienced diabetes stigma.MethodsThe second Diabetes MILES – Australia study (MILES-2) is a national survey of adults with diabetes, focused on behavioural and psychosocial issues. Subgroup analyses were conducted on the responses of 456 adults with insulin-treated Type 2 diabetes (38% women; mean ± sd age: 61.2 ± 8.8 years; diabetes duration: 14.5 ± 7.5 years; years using insulin: 6.4 ± 5.5). Participants completed validated measures of perceived and experienced diabetes stigma (Type 2 Diabetes Stigma Assessment Scale), insulin appraisals [Insulin Treatment Appraisal Scale (ITAS)] and known correlates of insulin appraisals: diabetes-specific distress (Problem Areas In Diabetes scale) and diabetes-specific self-efficacy (Confidence in Diabetes Self-care scale). A multiple linear regression was conducted (N = 279) to determine the contribution of those variables found to be associated with ITAS Negative scores.ResultsUnivariable analyses revealed negative insulin appraisals were associated with demographic and self-care characteristics (age, employment status, BMI, years using insulin, injections per day), self-efficacy, diabetes-specific distress and diabetes stigma (all P 
      PubDate: 2018-02-08T00:25:46.978751-05:
      DOI: 10.1111/dme.13598
  • The relationship between socio-economic status and diagnosed Type 2
           diabetes is changing with economic growth in Nanjing, China
    • Authors: F. Xu; J. He, Z. Wang, R. S. Ware
      Abstract: AimIn developed countries, the relationship between socio-economic status (SES) and Type 2 diabetes was positive several decades ago but is now negative. However, in developing societies such as China the relationship remains positive. It is likely that at some stage of economic development the SES–Type 2 diabetes association will become negative in developing communities. This study aimed to examine whether this inflexion is approaching in China.MethodsTwo cross-sectional surveys were undertaken in Nanjing, China, in 2000 and 2011. The same sampling approach was used to randomly select participants. Diagnosed Type 2 diabetes was the outcome variable. SES was measured using monthly family average income and divided into thirds. Mixed-effects models were used to calculate the association between SES and Type 2 diabetes.ResultsThere were 19 861 (response rate, 90.1%) and 7824 (response rate, 82.8%) participants in 2000 and 2011, respectively. A 2.6-fold increase in Type 2 diabetes prevalence was observed from 3.0% (95% confidence interval 2.8%, 3.3%) in 2000 to 8.2% (7.7%, 8.8%) in 2011 (P 
      PubDate: 2018-02-08T00:20:23.760858-05:
      DOI: 10.1111/dme.13597
  • Intermittent fasting in Type 2 diabetes mellitus and the risk of
           hypoglycaemia: a randomized controlled trial
    • Authors: B. T. Corley; R. W. Carroll, R. M. Hall, M. Weatherall, A. Parry-Strong, J. D. Krebs
      Abstract: AimsTo establish whether the risk of hypoglycaemia is greater with 2 consecutive days of very-low-calorie diet compared with 2 non-consecutive days of very-low-calorie diet in people with Type 2 diabetes.MethodsThis was a non-blinded randomized parallel group interventional trial of intermittent fasting in adults. The participants had a BMI of 30–45 kg/m2, Type 2 diabetes treated with metformin and/or hypoglycaemic medications and an HbA1c concentration of 50–86 mmol/mol (6.7–10%). The participants followed a 2092–2510-kJ diet on 2 days per week for 12 weeks. A total of 41 participants were randomized 1:1 to consecutive (n=19) or non-consecutive (n=22) day fasts, of whom 37 (n=18 and n=19, respectively) were included in the final analysis. The primary outcome was difference in the rate of hypoglycaemia between the two study arms. Secondary outcomes included change in diet, quality of life, weight, lipid, glucose and HbA1c levels, and liver function.ResultsThe mean hypoglycaemia rate was 1.4 events over 12 weeks. Fasting increased the rate of hypoglycaemia despite medication reduction (relative rate 2.05, 95% CI 1.17 to 3.52). There was no difference between fasting on consecutive days and fasting on non-consecutive days (relative rate 1.54, 95% CI 0.35 to 6.11). Improvements in weight, HbA1c, fasting glucose and quality of life were experienced by participants in both arms.ConclusionsIn individuals with Type 2 diabetes on hypoglycaemic medications, fasting of any type increased the rate of hypoglycaemia. With education and medication reduction, fewer than expected hypoglycaemic events occurred. Although it was not possible to determine whether fasting on consecutive days increased the risk of hypoglycaemia, an acceptable rate was observed in both arms.This article is protected by copyright. All rights reserved.
      PubDate: 2018-02-06T07:45:32.514857-05:
      DOI: 10.1111/dme.13595
  • Diabetic retinopathy in a remote Indigenous primary healthcare population:
           a Central Australian diabetic retinopathy screening study in the
           Telehealth Eye and Associated Medical Services Network project
    • Authors: L. Brazionis; A. Jenkins, A. Keech, C. Ryan, A. Brown, J. Boffa, S. Bursell,
      Abstract: AimTo determine diabetic retinopathy prevalence and severity among remote Indigenous Australians.MethodsA cross-sectional diabetic retinopathy screening study of Indigenous adults with Type 2 diabetes was conducted by locally trained non-ophthalmic retinal imagers in a remote Aboriginal community-controlled primary healthcare clinic in Central Australia and certified non-ophthalmic graders in a retinal grading centre in Melbourne, Australia. The main outcome measure was prevalence of any diabetic retinopathy and sight-threatening diabetic retinopathy.ResultsAmong 301 participants (33% male), gradable image rates were 78.7% (n =237) for diabetic retinopathy and 83.1% (n =250) for diabetic macular oedema, and 77.7% (n =234) were gradable for both diabetic retinopathy and diabetic macular oedema. For the gradable subset, the median (range) age was 48 (19–86) years and known diabetes duration 9.0 (0–24) years. The prevalence of diabetic retinopathy was 47% (n =110) and for diabetic macular oedema it was 14.4% (n =36). In the fully gradable imaging studies, sight-threatening diabetic retinopathy prevalence was 16.2% (n =38): 14.1% (n =33) for clinically significant macular oedema, 1.3% (n =3) for proliferative diabetic retinopathy and 0.9% (n =2) for both. Sight-threatening diabetic retinopathy had been treated in 78% of detected cases.ConclusionsA novel telemedicine diabetic retinopathy screening service detected a higher prevalence of ‘any’ diabetic retinopathy and sight-threatening diabetic retinopathy in a remote primary care setting than reported in earlier surveys among Indigenous and non-Indigenous populations. Whether the observed high prevalence of diabetic retinopathy was attributable to greater detection, increasing diabetic retinopathy prevalence, local factors, or a combination of these requires further investigation and, potentially, specific primary care guidelines for diabetic retinopathy management in remote Australia.This article is protected by copyright. All rights reserved.
      PubDate: 2018-02-06T02:00:35.296586-05:
      DOI: 10.1111/dme.13596
  • Mindfulness and fear of hypoglycaemia in parents of children with Type 1
           diabetes: results from the Diabetes MILES Youth – The Netherlands
    • Authors: J. Aalders; E. Hartman, G. Nefs, A. Nieuwesteeg, C. Hendrieckx, H.-J. Aanstoot, P. Winterdijk, E. van Mil, J. Speight, F. Pouwer
      Abstract: AimsTo identify the sociodemographic and clinical correlates of fear of hypoglycaemia among parents of children (aged 4–18 years) with Type 1 diabetes and to examine the relationships between parental fear of hypoglycaemia, mindfulness and mindful parenting.MethodsSociodemographic, self-reported clinical and psychological data were extracted from the cross-sectional Diabetes MILES Youth – The Netherlands dataset. Questionnaires included the Hypoglycaemia Fear Survey – Parent Worry (parental fear of hypoglycaemia), the Freiburg Mindfulness Inventory – Short version (mindfulness) and the Interpersonal Mindfulness in Parenting Scale (mindful parenting).ResultsA total of 421 parents (359 mothers) participated. Hierarchical linear regression analyses showed that greater parental fear of hypoglycaemia was related to younger parental age, low educational level, non-Dutch nationality, more frequent blood glucose monitoring, and less general mindfulness. Adding mindful parenting to the model negated the previous contribution of general mindfulness. In this model, lower mindful parenting was related to greater parental fear of hypoglycaemia. In particular, parents with an increased ability to be less judgemental of themselves as parents and less reactive to emotions within parenting interactions reported less fear of hypoglycaemia. In total, 21% of the variance in parental fear of hypoglycaemia was explained.ConclusionParental fear of hypoglycaemia was associated largely with parental characteristics, including non-modifiable sociodemographics (i.e. age, education, nationality) and modifiable psychological factors (i.e. mindful parenting). These findings suggest that it is important to further explore mindfulness-based interventions for parents to reduce fear of hypoglycaemia next to interventions to reduce hypoglycaemia.This article is protected by copyright. All rights reserved.
      PubDate: 2018-01-31T12:02:48.819583-05:
      DOI: 10.1111/dme.13594
  • Prevalence and correlates of depressive symptoms in older adults across
           the glycaemic spectrum: the Atherosclerosis Risk in Communities (ARIC)
    • Authors: A. M. Rawlings; A. R. Sharrett, S. H. Golden, B. G. Windham, E. Selvin
      Abstract: AimsTo document the prevalence of current depressive symptoms and history of depression across the glycaemic spectrum in older adults, and examine if measures of health status and healthcare satisfaction, access and utilization explain differences in the prevalence of current depressive symptoms by diabetes status.MethodsWe conducted a cross-sectional study of 6226 participants aged 67–90 years who attended the 2011–2013 visit of the Atherosclerosis Risk in Communities (ARIC) study. Diabetes was based on self-report, medication use and HbA1c. Current depressive symptoms were defined using the Center for Epidemiologic Studies Depression 11-item questionnaire, and history of depression was assessed via self-report. We examined obesity, history of cardiovascular disease, hypertension, kidney disease, cognitive function, and self-reported health compared with others. Prevalence and prevalence ratios were estimated using age-, race-, and sex-adjusted Poisson regression.ResultsThe prevalence of current depressive symptoms was 5.4% in people without diabetes and 11.0% in people with diabetes (prevalence ratio 2.04, 95% CI 1.60, 2.48); the prevalence of history of depression was 11% in people without diabetes and 17.7% in people with diabetes (prevalence ratio 1.61, 95% CI 1.28,1.95). Strong correlates of current depressive symptoms were history of depression (prevalence ratio 3.86, 95% CI 3.05, 4.90) and reporting poor health compared with others (prevalence ratio 3.88, 95% CI 2.93, 5.15). No variables had significantly different associations with depressive symptoms across glycaemic categories (P for interaction>0.10).ConclusionsIn older adults, current depressive symptoms were twice as prevalent in people with diabetes compared with those without. Measures of health status and healthcare did not explain differences in depressive symptoms between people with and without diabetes.This article is protected by copyright. All rights reserved.
      PubDate: 2018-01-31T11:57:37.470468-05:
      DOI: 10.1111/dme.13593
  • Preferences for treatment among adolescents with Type 1 diabetes: a
           national study using a discrete choice experiment model
    • Authors: G. Forsander; S. Stallknecht, U. Samuelsson, C. Marcus, M. Bøgelund
      Abstract: AimTo test the possibility of using a discrete choice experiment model, on a national level in adolescents with Type 1 diabetes, in order to obtain a better understanding of drivers of and barriers to diabetes self-care.MethodsA survey instrument was constructed and tested on a small group of the target population: adolescents aged 15 to
      PubDate: 2018-01-30T12:40:31.586919-05:
      DOI: 10.1111/dme.13592
  • Role of omalizumab in insulin hypersensitivity: a case report and review
           of the literature
    • Authors: S. Mishra; L. Connors, B. Tugwell
      Abstract: BackgroundInsulin allergy is a rare yet severe side effect of exogenous insulin use. Management typically involves use of alternative antihyperglycaemic agents, symptom control with antihistamines, use of different insulin formulations, and induction of tolerance with incremental doses of insulin. This treatment regimen is not always successful, and the use of omalizumab, an anti-IgE monoclonal antibody, has been used to induce tolerance to insulin.Case reportG.M. is a 62-year-old man with Type 2 diabetes mellitus. His condition was not optimized on oral agents, and insulin therapy was required. G.M. had anaphylaxis to insulin NPH, and subsequent skin-prick testing was positive to insulin aspart, insulin NPH, insulin glulisine, insulin detemir, regular insulin, insulin glargine 100 units/ml and insulin glargine 300 units/ml. He received incremental doses of several insulin formulations; however, he experienced diffuse urticaria preventing optimal glycaemic control. Three successful cases have been described in the literature of omalizumab inducing tolerance to exogenous insulin; therefore, G.M. was started on omalizumab. He subsequently tolerated treatment doses of insulin glulisine and insulin detemir with no allergic reactions and with improvement in glycaemic control.ConclusionTo our knowledge, this is the first described case of allergy to insulin glargine 300 units/ml and reiterates the potential use of omalizumab in insulin allergy. Further research is warranted to determine if omalizumab should be considered standard of care in difficult-to-treat insulin hypersensitivity.This article is protected by copyright. All rights reserved.
      PubDate: 2018-01-30T12:40:25.928771-05:
      DOI: 10.1111/dme.13591
  • Assessing the economic value of maintained improvements in Type 1 diabetes
           management, in terms of HbA1c, weight and hypoglycaemic event incidence
    • Authors: P. McEwan; H. Bennett, K. Bolin, M. Evans, K. Bergenheim
      Abstract: AimsInsulin therapy is indicated for people with Type 1 diabetes mellitus; however, treatment-related weight gain and hypoglycaemia represent barriers to optimal glycaemic management. This study assessed the health economic value of maintained reductions in HbA1c, BMI and hypoglycaemia incidence among the UK Type 1 diabetes mellitus population.MethodsThe Cardiff Type 1 Diabetes Model was used to estimate lifetime costs, life-years and quality-adjusted life-years (QALYs) for individuals with Type 1 diabetes mellitus at different baseline HbA1c, BMI and hypoglycaemic event rates. Results were discounted at 3.5%, and the net monetary benefit associated with improving Type 1 diabetes mellitus management was derived at £20 000/QALY gained. Per-person outputs were inflated to national levels using UK Type 1 diabetes mellitus prevalence estimates.ResultModelled subjects with an HbA1c of 86 mmol/mol (10.0%) were associated with discounted lifetime per-person costs of £23 795; of which £12 649 may be avoided by maintaining an HbA1c of 42 mmol/mol (6.0%). Combined with estimated QALY gains of 2.80, an HbA1c of 42 mmol/mol (6.0%) vs. 86 mmol/mol (10.0%) was associated with an £68 621 per-person net monetary benefit. Over 1 year, unit reductions in BMI produced £120 per-person net monetary benefit, and the avoidance of one non-severe hypoglyceamic event up to £197.ConclusionsMaintained reductions in HbA1c significantly alleviate the burden associated with Type 1 diabetes mellitus in the UK. Given the influence of weight and hypoglycaemia on health economic outcomes, they must also be key considerations when assessing the value of Type 1 diabetes mellitus technologies in clinical practice.This article is protected by copyright. All rights reserved.
      PubDate: 2018-01-27T12:10:23.202963-05:
      DOI: 10.1111/dme.13590
  • Transfer from paediatric to adult care for young adults with Type 2
           diabetes: the SEARCH for Diabetes in Youth Study
    • Authors: S. Agarwal; J. K. Raymond, S. Isom, J. M. Lawrence, G. Klingensmith, C. Pihoker, S. Corathers, S. Saydah, R. B. D'Agostino, D. Dabelea
      Abstract: AimTo describe factors associated with transfer from paediatric to adult care and poor glycaemic control among young adults with Type 2 diabetes, using the SEARCH for Diabetes in Youth study.MethodsYoung adults with Type 2 diabetes were included if they had a baseline SEARCH visit while in paediatric care at
      PubDate: 2018-01-27T07:50:19.808246-05:
      DOI: 10.1111/dme.13589
  • Artificial intelligence in diabetes care
    • Authors: V. Buch; G. Varughese, M. Maruthappu
      Abstract: Medical artificial intelligence (AI) is moving forward at considerable pace. Promising research ideas are surfacing in clinical waters; AI is automating the national 111 triage service [1] and has exhibited dermatologist-level performance at identifying suspicious skin lesions, a task where experts frequently disagree [2]. The present article explores how machine learning, a prominent branch of AI, may be set to transform diabetes care.This article is protected by copyright. All rights reserved.
      PubDate: 2018-01-24T23:00:30.733416-05:
      DOI: 10.1111/dme.13587
  • Diabetes technology: improving care, improving patient-reported outcomes
           and preventing complications in young people with Type 1 diabetes
    • Authors: P. Prahalad; M. Tanenbaum, K. Hood, D. M Maahs
      Abstract: With the evolution of diabetes technology, those living with Type 1 diabetes are given a wider arsenal of tools with which to achieve glycaemic control and improve patient-reported outcomes. Furthermore, the use of these technologies may help reduce the risk of acute complications, such as severe hypoglycaemia and diabetic ketoacidosis, as well as long-term macro- and microvascular complications. In addition, diabetes technology can have a beneficial impact on psychosocial health by reducing the burden of diabetes. Unfortunately, diabetes goals are often unmet and people with Type 1 diabetes too frequently experience acute and long-term complications of this condition, in addition to often having less than ideal psychosocial outcomes. Increasing realization of the importance of patient-reported outcomes is leading to diabetes care delivery becoming more patient-centred. Diabetes technology in the form of medical devices, digital health and big data analytics have the potential to improve clinical care and psychosocial support, resulting in lower rates of acute and chronic complications, decreased burden of diabetes care, and improved quality of life.This article is protected by copyright. All rights reserved.
      PubDate: 2018-01-22T02:58:46.78652-05:0
      DOI: 10.1111/dme.13588
  • Diabetes and technology in 2030: a utopian or dystopian future'
    • Authors: D. Kerr; C. Axelrod, C. Hoppe, D. C. Klonoff
      Abstract: The ability of an individual living with diabetes to have human-to-human contact with their healthcare provider is not keeping pace with the number of people developing diabetes. From a futurist perspective, however, this dichotomy of diabetes care represents an opportunity for digital healthcare. The focus of technological innovation is unlikely to be the replacement of the multidisciplinary diabetes team but rather the provision of meaningful individual and family support between clinic visits and, on a larger scale, the facilitation of population health management for diabetes. We can also expect to see new therapies, including implantable drug delivery systems, automated closed-loop systems and miniaturized non-invasive glucose monitoring systems. New digital health technologies will create a ‘digital diabetes ecosystem’ to enhance rather than devolve care from humans. Concerns related to data privacy and ownership will inevitably rise, thus a future for diabetes care relying heavily on technology is not inevitably utopian. Nevertheless, revolutions in the development of novel sensors, accumulation of ‘big data’, and use of artificial intelligence will provide exciting opportunities for preventing, monitoring and treating diabetes in the near future.This article is protected by copyright. All rights reserved.
      PubDate: 2018-01-22T02:40:58.597407-05:
      DOI: 10.1111/dme.13586
  • Flash forward: a review of flash glucose monitoring
    • Authors: L. Leelarathna; G. Wilmot
      Abstract: The FreeStyle Libre flash glucose monitor became available on prescription (subject to local health authority approval) in all four nations of the UK from November 2017, a watershed moment in the history of diabetes care. Calibration free, the FreeStyle Libre is a disc worn on the arm for 14 days which is designed largely to replace the recommended 4–10 painful finger-stick blood glucose tests required each day for the self-management of diabetes. This review discusses clinical data from randomized and observational studies, considers device accuracy metrics and deliberates its popularity and the potential challenges that this new device brings to diabetes care in the UK. In randomized trials, FreeStyle Libre use is associated with a reduction in hypoglycaemia and, in observational studies, improvements in HbA1c levels. User satisfaction is high and adverse events are low. Accuracy of the FreeStyle Libre is comparable to currently available real-time continuous glucose monitors in adults, children and during pregnancy; the cost of the FreeStyle Libre is lower. Glucose data can be visualized in multiple devices and platforms, and summarized in an ambulatory glucose profile to aid pattern recognition and insulin dose adjustment. There is a need for appropriate education, of both users and healthcare professionals, to harness the full benefits. Further randomized studies to assess the long-term impact on HbA1c, particularly in those with high baseline HbA1c and in specific age groups, such as adolescents and young adults, are warranted. The potential impact on complications, is yet to be realized.This article is protected by copyright. All rights reserved.
      PubDate: 2018-01-22T02:31:08.053252-05:
      DOI: 10.1111/dme.13584
  • Continuous glucose monitoring in pregnant women with Type 1 diabetes:
           benefits for mothers, using pumps or pens, and their babies
    • Authors: Denice S. Feig; Helen R. Murphy
      Abstract: AimsTo review the current literature on the use of continuous glucose monitoring during pregnancy in women with Type 1 diabetes.MethodsWe searched the literature for randomized controlled trials using continuous glucose monitoring during pregnancy in women with Type 1 diabetes.ResultsThree randomized trials were found and discussed in this review. One UK study found a reduction in large-for-gestational-age infants; however, only masked continuous glucose monitoring was used in that study. A Danish study used intermittent real-time continuous glucose monitoring and found no differences. The present authors conducted the CONCEPTT trial, in which pregnant women and women planning pregnancy were randomized to receive continuous glucose monitoring or standard care. We found a greater drop in HbA1c, more time spent in the target range, and a reduction in some adverse neonatal outcomes in women using continuous glucose monitoring. Numbers-needed-to-treat to prevent a large-for-gestational-age infant, a neonatal intensive care unit admission for>24 h, and a neonatal hypoglycaemia event were low. These findings were seen in both injection and pump users and across all countries. Possible reasons for differences in study findings are discussed. In addition, several issues need further study. Glycaemic variability and differences in dietary intake may also have played a role. Despite excellent glycaemic control, babies continue to be large. More research is needed to understand the role of glucose targets and the dynamic placental processes involved in fetal growth.ConclusionsThe use of continuous glucose monitoring in women with Type 1 diabetes in pregnancy is associated with improved glycaemic control and neonatal outcomes. Further research examining the glycaemic and non-glycaemic variables involved in fetal growth and the cost–benefit of using continuous glucose monitoring in pregnancy is warranted.This article is protected by copyright. All rights reserved.
      PubDate: 2018-01-20T01:55:24.0063-05:00
      DOI: 10.1111/dme.13585
  • Postnatal experiences, knowledge and perceptions of women with gestational
    • Authors: C E Eades; E F France, J M M Evans
      Abstract: AimWomen with gestational diabetes mellitus (GDM) are at increased risk of Type 2 diabetes. This study aimed to explore experiences, knowledge and perceptions of women with GDM to inform the design of interventions to prevent or delay Type 2 diabetes.MethodsSemi-structured interviews were carried out with 16 women with GDM who were recruited from a clinic in one Scottish health board. A framework approach was used to manage and analyse data according to themes informed by psychological theory (self-regulation model and theory of planned behaviour).ResultsGDM is not seen as an important, or even real diagnosis among some women, and this perception may result from the perceived minimal impact of GDM on their lives. Some women did experience a bigger emotional and practical impact. Knowledge and understanding of Type 2 diabetes was poor in general and many women were unconcerned about their future risk. Lower concern appeared to be linked to a lower perceived impact of GDM. Lifestyle changes discussed by women mostly related to diet and were motivated primarily by concern for their baby's health. Many women did not maintain these changes postnatally, reporting significant barriers.ConclusionsThis study has suggested potential avenues to be explored in terms of content, timing and potential recipients of interventions. Educational interventions postnatally could address illness perceptions in women with GDM and redress the situation where lack of aftercare downplays its seriousness. For lifestyle interventions, the child's health could be used as a motivator within the context of later joint or family intervention.This article is protected by copyright. All rights reserved.
      PubDate: 2018-01-16T12:00:21.269204-05:
      DOI: 10.1111/dme.13580
  • Dual-hormone artificial pancreas: benefits and limitations compared with
           single-hormone systems
    • Authors: Tricia M. Peters; Ahmad Haidar
      Abstract: Technological advances have made the artificial pancreas a reality. This has the potential to improve the lives of individuals with Type 1 diabetes by reducing the risk of hypoglycaemia, achieving better overall glucose control, and enhancing quality of life. Both single-hormone (insulin-only) and dual-hormone (insulin and glucagon) systems have been developed; however, a focused review of the relative benefits of each artificial pancreas system is needed. We reviewed studies that directly compared single- and dual-hormone systems to evaluate the efficacy of each system for preventing hypoglycaemia and maintaining glycaemic control, as well as their utility in specific situations including during exercise, overnight and during the prandial period. We observed additional benefits with the dual-hormone artificial pancreas for reducing the risk of hypoglycaemic events overall and during exercise over the study duration. The single-hormone artificial pancreas was sufficient for maintenance of euglycaemia in the overnight period and for preventing late-onset post-exercise hypoglycaemia. Future comparative studies of longer duration are required to determine whether one system is superior for improving mean glucose control, eliminating severe hypoglycaemia, or improving quality of life.This article is protected by copyright. All rights reserved.
      PubDate: 2018-01-16T08:50:28.391761-05:
      DOI: 10.1111/dme.13581
  • The National Pregnancy in Diabetes (NPID) audit: challenges and
           opportunities for improving pregnancy outcomes
    • Authors: H. R. Murphy; R. Bell, A. Dornhorst, R. Forde, N. Lewis-Barned
      Abstract: Our aim was to review the data from the National Pregnancy in Diabetes (NPID) audit, and to identify the challenges and opportunities for improving pregnancy outcomes in women with diabetes. We reviewed three years of NPID data and relevant diabetes and obstetric literature, and found that there has been little change in pregnancy preparation or outcomes over the past 3 years, with substantial clinic-to clinic variations in care. Women with Type 2 diabetes remain less likely to take 5 mg preconception folic acid (22.8% vs. 41.8%; P 
      PubDate: 2018-01-16T08:45:19.750686-05:
      DOI: 10.1111/dme.13579
  • The effect of uric acid lowering treatment on albuminuria and renal
           function in Type 1 diabetes: a randomized clinical trial
    • Authors: S. Pilemann-Lyberg; F. Persson, J. Frystyk, P. Rossing
      Abstract: Significant improvements have been made in the management of Type 1 diabetes over the last three decades [1]. We wanted to examine if uric acid lowering with allopurinol changes the urinary albumin excretion rate (UAER) or 51Cr EDTA GFR in people with Type 1 diabetes and diabetic nephropathy.This article is protected by copyright. All rights reserved.
      PubDate: 2018-01-07T22:35:36.827892-05:
      DOI: 10.1111/dme.13577
  • The association of self-reported diabetes with impaired social functioning
           in low-, middle- and high-income countries: findings from the World Health
    • Authors: A. Loerbroks; R. M. Herr, A. Icks, J. A. Bosch
      Abstract: AimEpidemiological studies from high-income countries show that diabetes is associated with impaired social functioning. As healthcare systems in middle- and low-income countries offer fewer resources to curtail the potential social impact of diabetes, we performed a comparative study on the diabetes–social impairment link in low-, middle- and high-income countries.MethodsWe use data from the cross-sectional World Health Survey (n = 235 428 from 10 low-income, 29 middle-income and 9 high-income countries). Diabetes was defined by self-reports of a diagnosis. Impaired social functioning was considered present if participants reported severe or extreme difficulties with personal relationships or participation in the community. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) in the overall sample and by income regions. ORs were corrected for demographics and health-related lifestyles, and then additionally adjusted for impairments that may explain any observed association (i.e. impaired vision, mood, cognition and mobility).ResultsIn the overall sample, we confirmed an association between self-reported diabetes and impaired social functioning (OR = 1.47, 95% CI = 1.18–1.83). The strength of that relationship increased with decreasing country income (e.g. OR in low-income countries = 2.23, 95% CI = 1.14–4.37). Associations were substantially attenuated by further correction for impairments, in particular mood problems, in the overall sample (OR = 0.92, 95% CI = 0.72–1.16) and all income regions.ConclusionsSelf-reported diabetes is associated with impaired social functioning in high- and middle-income countries, and this relationship is even stronger in low-income countries. Associations are largely explained by physical and mental impairments, which may be due to diabetes.This article is protected by copyright. All rights reserved.
      PubDate: 2018-01-07T22:35:33.370617-05:
      DOI: 10.1111/dme.13578
  • Table of Contents 1
    • Pages: 285 - 285
      PubDate: 2018-02-13T09:01:38.724004-05:
      DOI: 10.1111/dme.13466
  • Table of Contents 2
    • Pages: 287 - 287
      PubDate: 2018-02-13T09:01:40.741959-05:
      DOI: 10.1111/dme.13467
  • Aims and Scope
    • Pages: 288 - 288
      PubDate: 2018-02-13T09:01:40.65616-05:0
      DOI: 10.1111/dme.13468
  • Diabetic Medicine and Diabetes UK
    • Authors: R. I. G. Holt
      Pages: 291 - 291
      PubDate: 2018-02-13T09:01:41.489243-05:
      DOI: 10.1111/dme.13583
  • Corrigendum
    • Pages: 394 - 394
      PubDate: 2018-02-13T09:01:38.686731-05:
      DOI: 10.1111/dme.13573
  • List of reviewers 2017
    • Pages: 395 - 398
      PubDate: 2018-02-13T09:01:42.287627-05:
      DOI: 10.1111/dme.13582
  • Weight-based carbohydrate treatment of hypoglycaemia in people with Type 1
           diabetes using insulin pump therapy: a randomized crossover clinical trial
    • Authors: L. McTavish; B. Corley, M. Weatherall, E. Wiltshire, J. D. Krebs
      Abstract: AimTo test whether weight-based treatment is more effective than usual care in people with Type 1 diabetes receiving continuous subcutaneous insulin infusion therapy with regard to both hypoglycaemia and avoiding excessive rebound hyperglycaemia.MethodsChildren and adults on continuous subcutaneous insulin infusion were enrolled into a study with a crossover design. Each episode of hypoglycaemia (defined as capillary glucose
      PubDate: 2017-12-28T20:20:29.379854-05:
      DOI: 10.1111/dme.13576
  • Life satisfaction is a protective factor against the onset of Type 2
           diabetes in men but not in women: findings from the MONICA/KORA cohort
    • Authors: A. M. Piciu; H. Johar, K. Lukaschek, B. Thorand, K. H. Ladwig
      Abstract: AimsTo investigate the association of high life satisfaction with incident Type 2 diabetes separately in men and women.MethodsA longitudinal analysis was conducted among the 7107 participants (3664 men, 51.5%; 3443 women, 48.5%) aged 25–74 years (mean ± sd age 47.8 ±13.7 years) of two population-based MONICA/KORA surveys conducted in 1989–1995 and followed up until 2009. Life satisfaction was assessed using a one-item instrument with a six-order response level, which was dichotomized into high vs medium or low. Sex-specific hazard ratios were estimated using Cox proportional hazards models.ResultsCrude incidence rates for Type 2 diabetes per 10 000 person-years were lower in participants with high than in those with medium or low life satisfaction (men: 57 vs 73; women: 37 vs 48). In men with high life satisfaction, there was a 27% risk reduction in incident Type 2 diabetes (hazard ratio 0.73, 95% CI 0.56–0.94; P=0.02) in a model adjusted for sociodemographic, behavioural and clinical risk factors. The association lost statistical significance after further adjusting for depressed mood (hazard ratio 0.79, 95% CI 0.61–1.03). Life satisfaction was not significantly associated with incident Type 2 diabetes in women.ConclusionLife satisfaction may be a valuable asset in assessing risk of Type 2 diabetes, especially in men, and in the development of more effective prevention strategies to deter onset of diabetes. More research is needed to investigate the underlying potential causal pathways that may link life satisfaction to the development of Type 2 diabetes.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-26T08:55:30.279848-05:
      DOI: 10.1111/dme.13574
  • Sulfonylurea vs insulin therapy in individuals with sulfonylurea-sensitive
           permanent neonatal diabetes mellitus, attributable to a KCNJ11 mutation,
           and poor glycaemic control
    • Authors: J. Stanik; A. Dankovcikova, L. Barak, M. Skopkova, M. Palko, J. Divinec, I. Klimes, D. Gasperikova
      Abstract: BackgroundTherapy with sulfonylurea is preferable to insulin in the majority of individuals with KCNJ11 mutations, but not all of these people achieve target levels of HbA1c in long-term follow-up. We aimed to compare sulfonylurea therapy with insulin treatment in two sulfonylurea-sensitive individuals with a KCNJ11 mutation who had poorly controlled permanent neonatal diabetes mellitus.Case reportWe report on two individuals with a KCNJ11 mutation (p.R201H) who are currently aged 35 (SVK1) and 21 years (SVK2). These individuals were switched from insulin to sulfonylurea in 2005. Data from the first 4 (SVK2) and 8 years (SVK1) of the follow-up showed improved diabetes control and increased quality of life for both individuals. During the following years, however, both individuals failed to retain good diabetes control (HbA1c ≤ 53 mmol/mol; 7.0%). We therefore changed the therapy to a combination of insulin and sulfonylurea in both individuals, or to insulin monotherapy in SVK1, and compared the effects on HbA1c with those of sulfonylurea monotherapy. HbA1c levels in both individuals worsened after adding insulin to sulfonylurea [67 mmol/mol (8.3%) vs 77 mmol/mol (9.2%) in SVK1 and 106 mmol/mol (11.8%) vs 110±19 mmol/mol (12.2±1.7%) in SVK2], and after switching to only insulin therapy in SVK1 [57 mmol/mol (7.4%) vs 62 mmol/mol (7.8%)] when compared with sulfonylurea monotherapy.DiscussionOur data show that sulfonylurea monotherapy might be preferable to insulin in people with permanent neonatal diabetes mellitus sensitive to sulfonylurea even when HbA1c is above target.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-26T08:55:28.803819-05:
      DOI: 10.1111/dme.13575
  • Bridging technology and clinical practice: innovating inpatient
           hyperglycaemia management in non-critical care settings
    • Authors: Hood Thabit; Roman Hovorka
      Abstract: Emerging evidence shows that suboptimal glycaemic control is associated with increased morbidity and length of stay in hospital. Various guidelines for safe and effective inpatient glycaemic control in the non-critical care setting have been published. In spite of this, implementation in practice remains limited because of the increasing number of people with diabetes admitted to hospital and staff work burden. The use of technology in the outpatient setting has led to improved glycaemic outcomes and quality of life for people with diabetes. There remains an unmet need for technology utilisation in inpatient hyperglycaemia management in the non-critical care setting. Novel technologies have the potential to provide benefits in diabetes care in hospital by improving efficacy, safety and efficiency. Rapid analysis of glucose measurements by point-of-care devices help facilitate clinical decision-making and therapy adjustment in the hospital setting. Glucose treatment data integration with computerized glucose management systems underpins the effective use of decision support systems and may streamline clinical staff workflow. Continuous glucose monitoring and automation of insulin delivery through closed-loop systems may provide a safe and efficacious tool for hospital staff to manage inpatient hyperglycaemia whilst reducing staff workload. This review summarizes the evidence with regard to technological methods to manage inpatient glycaemic control, their limitations and the future outlook, as well as potential strategies by healthcare organizations such as the National Health Service to mediate the adoption, procurement and use of diabetes technologies in the hospital setting.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-21T03:06:06.576924-05:
      DOI: 10.1111/dme.13563
  • Progress of the Healthier You: NHS Diabetes Prevention Programme:
           referrals, uptake and participant characteristics
    • Authors: E. Barron; R. Clark, R. Hewings, J. Smith, J. Valabhji
      Abstract: AimsTo describe early progress of the Healthier You: NHS Diabetes Prevention Programme, a behavioural intervention designed to prevent or delay onset of Type 2 diabetes in people in England already identified to be at high risk, to assess numbers of referrals received by Programme providers and the proportion that attended the initial assessment, and to identify the factors associated with attendance rates.MethodsThese analyses examine the data for referrals received between June 2016 and March 2017.ResultsThere were 43 603 referrals received, 16% higher than expected. Of those referred, 49% attended the initial assessment, higher than the 40% modelled uptake. Of those referred, there was no significant difference in uptake by sex (P=0.106); however, attendance per 100 000 population varied significantly by sex, age group, ethnicity and deprivation; it was significantly lower for men (P
      PubDate: 2017-12-20T05:25:19.814869-05:
      DOI: 10.1111/dme.13562
  • Protein-altering variants of PTPN2 in childhood-onset Type 1A diabetes
    • Authors: M. Okuno; T. Ayabe, I. Yokota, I. Musha, K. Shiga, T. Kikuchi, N. Kikuchi, A. Ohtake, A. Nakamura, K. Nakabayashi, K. Okamura, Y. Momozawa, M. Kubo, J. Suzuki, T. Urakami, T. Kawamura, S. Amemiya, T. Ogata, S. Sugihara, M. Fukami,
      Abstract: AimTo conduct PTPN2 mutation analysis in Japanese people with childhood-onset Type 1A diabetes in order to examine whether PTPN2 variants contribute to the risk of this condition.MethodsPTPN2 mutation analysis was carried out for 169 unrelated Japanese people with childhood-onset Type 1A diabetes. We searched for coding variants that were absent or extremely rare in the general population and were scored as damaging by multiple in silico programs. We performed mRNA analysis and three-dimensional structural prediction of the detected variants, when possible. We also examined possible physical links between these variants and previously reported risk SNPs as well as clinical information from variant-positive children.ResultsOne frameshift variant (p.Q286Yfs*24) and two probably damaging missense substitutions (p.C232W and p.R350Q) were identified in one child each. Of these, p.Q286Yfs*24 and p.C232W were hitherto unreported, while p.R350Q accounted for 2/121,122 alleles of the exome datasets. The p.Q286Yfs*24 variant did not encode stable mRNA, and p.C232W appeared to affect the structure of the tyrosine-protein phosphatase domain. The three variants were physically unrelated to known risk SNPs. The variant-positive children manifested Type 1A diabetes without additional clinical features and invariably carried risk human leukocyte antigen alleles.ConclusionsThe results provide the first indication that PTPN2 variants contribute to the risk of Type 1A diabetes, independently of known risk SNPs. PTPN2 coding variants possibly induce non-specific Type 1A diabetes phenotypes in individuals with human leukocyte antigen-mediated disease susceptibility. Our findings warrant further validation.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-16T16:55:27.092452-05:
      DOI: 10.1111/dme.13566
  • Best friend or spy: a qualitative meta-synthesis on the impact of
           continuous glucose monitoring on life with Type 1 diabetes
    • Authors: L. H. Messer; R. Johnson, K. A. Driscoll, J. Jones
      Abstract: AimsThis is a meta-synthesis of extant qualitative literature related to impact of continuous glucose monitoring (CGM). CGM has been available for a decade for the management of Type 1 diabetes and is the lynchpin of future artificial pancreas technologies. Clinical uptake of CGM is an important area of inquiry. The purpose of this meta-synthesis is to understand the impact of CGM on individuals with Type 1 diabetes and others (parents, significant others, providers) in order to design appropriate clinical interventions for adherence.MethodsStudies published in English between 2007 and 2017 were included, reflecting commercial CGM availability. PubMed, PsychINFO, CINALH, Web of Science and EMBASE databases were queried using search terms related to CGM, qualitative, experience and Type 1 diabetes. Included articles contained original qualitative or mixed-method research on CGM, sensor-augmented pump or closed-loop therapies. Articles underwent quality appraisal and thematic interpretive integration by a multidisciplinary team.ResultsNine articles (343 participants) met the inclusion criteria and were included in the synthesis. Six novel themes emerged: interacting with CGM, burden of living with CGM, feeling different from others, feeling empowered, interacting with glucose information and impact on relationships.ConclusionCGM affects physical, emotional and relational aspects of life. Clinicians can help minimize the burden of CGM with carefully delivered education and expectation-setting with individuals. Empowerment and relational partnerships in diabetes care can be explored to maximize satisfaction with CGM. Systematic interpretive synthesis of qualitative studies provides a comprehensive, contextual understanding of the impact of CGM on daily life and relationships.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-16T16:55:25.431-05:00
      DOI: 10.1111/dme.13568
  • Diabetes and chronic kidney disease: an increasingly common multi-morbid
           disease in need of a paradigm shift in care
    • Authors: P. H. Winocour
      Abstract: Diabetes is considered the commonest cause of end-stage renal disease. The increasing incidence of obesity and an ageing population, together, will lead to a greater number of people with diabetes associated with chronic kidney disease that could either be secondary to diabetic nephropathy or of different aetiology. Ageing and obesity influence approaches to the management of diabetes and accurate assessment of kidney disease. People with diabetes and chronic kidney disease consume a disproportionate component of expenditure on medical care. Guidelines on managing diabetes and kidney disease do not recognize the complex multi-morbid nature of the process. In addition to managing glycaemia and monitoring renal function, the assessment and management of cardiovascular disease risk factors and cardiovascular disease itself need to be factored into care. People with diabetes and diabetic nephropathy are more vulnerable to retinopathy and foot complications requiring coordinated care. People with diabetes and chronic kidney disease are more prone to anaemia and metabolic bone disease than those without diabetes at similar stages of chronic kidney disease, further increasing their vulnerability to acute complications from cardiovascular disease, foot emergencies and fractures. People with diabetes and chronic kidney disease are also more prone to hospitalization with infections and acute kidney injury. Given the 30–40% prevalence of kidney disease amongst people with diabetes, potentially>2% of the adult population would fit into this category, making it vital that new surveillance models of supported care are provided for those living with diabetes and kidney disease and for primary care teams who manage the vast majority of such people.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-16T16:51:53.239185-05:
      DOI: 10.1111/dme.13564
  • European Association for the Study of the Liver (EASL), European
           Association for the Study of Diabetes (EASD) and European Association for
           the Study of Obesity (EASO) clinical practice recommendations for the
           management of non-alcoholic fatty liver disease: evaluation of their
           application in people with Type 2 diabetes
    • Authors: A. L. Sberna; B. Bouillet, A. Rouland, M. C. Brindisi, A. Nguyen, T. Mouillot, L. Duvillard, D. Denimal, R. Loffroy, B. Vergès, P. Hillon, J. M. Petit
      Abstract: AimsTo evaluate the application of the recently proposed recommendations by the European Association for the Study of the Liver, European Association for the Study of Diabetes and European Association for the Study of Obesity for the diagnosis, treatment and follow-up of non-alcoholic fatty liver disease in people with Type 2 diabetes.MethodsA total of 179 people with Type 2 diabetes were included in this study. Liver fat content (assessed using proton magnetic resonance spectroscopy), fatty liver index score, non-alcoholic fatty liver disease fibrosis score, and SteatoTest and FibroTest scores were determined.ResultsAccording to proton magnetic resonance spectroscopy, 68.7% of participants had steatosis (liver fat content>5.5%). The application of the guidelines using several combinations (fatty liver index + non-alcoholic fatty liver disease fibrosis scores, Steatotest + FibroTest scores, proton magnetic resonance spectroscopy + non-alcoholic fatty liver disease fibrosis score, proton magnetic resonance spectroscopy + FibroTest) resulted in a referral to a liver clinic for 33.5–84.9% people with Type 2 diabetes.ConclusionsThe application of these new algorithms for the diagnosis, and follow-up of non-alcoholic fatty liver disease would lead to an excessive number of people with Type 2 diabetes being referred to a liver clinic. We suggest that new clinical and/or biological biomarkers of steatosis and fibrosis be specifically validated in people with Type 2 diabetes.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-16T16:51:51.889138-05:
      DOI: 10.1111/dme.13565
  • Psychosocial impacts of hybrid closed-loop systems in the management of
           diabetes: a review
    • Authors: C. Farrington
      Abstract: There is a pressing need for new treatment regimens that enable improved glycaemic control and reduced diabetes self-management burdens. Closed-loop, or artificial pancreas, systems represent one of the most promising avenues in this regard. Closed-loop systems connect wearable continuous glucose monitor (CGM) sensors to smartphone- or tablet-mounted algorithms that process and model CGM data to deliver precise and frequently updated doses of fast-acting insulin (and glucagon in dual-hormone systems) to users via wearable pumps. Recent studies have demonstrated that closed-loop systems offer significant benefit in terms of improved glycaemic control. However, less attention has been paid to the psychosocial impact on users of closed-loop systems. This article reviews recent research on psychosocial aspects of closed-loop usage in light of preceding research on user experience of currently available technologies such as insulin pumps and CGM sensors. The small, but growing body of research in this field reports generally positive user experience and a number of experienced benefits including: reassurance and reduced anxiety, improved sleep and confidence, and ‘time off’ from diabetes demands. However, these benefits are counterbalanced by important challenges, ranging from variable levels of trust to concerns about physical bulk, technical glitches and difficulties incorporating closed-loop systems into everyday life. Future research should explore psychosocial aspects of closed-loop usage in more diverse groups and with regard to clinicians, as well as users, to ensure that the clinical benefits of closed-loop systems are realized at scale in routine medical care.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-16T16:51:50.373772-05:
      DOI: 10.1111/dme.13567
  • A randomized controlled pilot study of continuous glucose monitoring and
           flash glucose monitoring in people with Type 1 diabetes and impaired
           awareness of hypoglycaemia
    • Authors: M. Reddy; N. Jugnee, A. El Laboudi, E. Spanudakis, S. Anantharaja, N. Oliver
      Abstract: AimHypoglycaemia in Type 1 diabetes is associated with mortality and morbidity, especially where awareness of hypoglycaemia is impaired. Clinical pathways for access to continuous glucose monitoring (CGM) and flash glucose monitoring technologies are unclear. We assessed the impact of CGM and flash glucose monitoring in a high-risk group of people with Type 1 diabetes.MethodsA randomized, non-masked parallel group study was undertaken. Adults with Type 1 diabetes using a multiple-dose insulin-injection regimen with a Gold score of ≥ 4 or recent severe hypoglycaemia were recruited. Following 2 weeks of blinded CGM, they were randomly assigned to CGM (Dexcom G5) or flash glucose monitoring (Abbott Freestyle Libre) for 8 weeks. The primary outcome was the difference in time spent in hypoglycaemia (below 3.3 mmol/l) from baseline to endpoint with CGM versus flash glucose monitoring.ResultsSome 40 participants were randomized to CGM (n = 20) or flash glucose monitoring (n = 20). The participants (24 men, 16 women) had a median (IQR) age of 49.6 (37.5–63.5) years, duration of diabetes of 30.0 (21.0–36.5) years and HbA1c of 56 (48–63) mmol/mol [7.3 (6.5–7.8)%]. The baseline median percentage time
      PubDate: 2017-12-12T03:17:29.739785-05:
      DOI: 10.1111/dme.13561
  • Utility of HbA1c and fasting plasma glucose for screening of Type 2
           diabetes: a meta-analysis of full ROC curves
    • Authors: A. Hoyer; W. Rathmann, O. Kuss
      Abstract: AimsThere is still debate on the optimal threshold for population-based screening of diabetes (diagnosed by the oral glucose tolerance test) using tests like HbA1c or fasting plasma glucose. Meta-analyses provide meaningful input in such situations. The aim of this article is to perform a meta-analysis that includes the complete information reported in the individual studies of two existing systematic reviews.MethodsWe screened the individual studies from two systematic reviews and reconstructed the full four-fold tables for every reported threshold. Using a recently proposed meta-analysis model for the comparison of two diagnostic tests, we compared HbA1c with fasting plasma glucose, and estimated meta-analytic receiver operating characteristic (ROC) curves for both tests using the 11.1 mmol/l threshold of the 2-h post-challenge glucose level (2 h-PG) as the standard.ResultsWe included nine studies from two existing systematic reviews in our analysis.Based on our data set, the optimal threshold lies between 42 and 44 mmol/mol (6.0–6.2%) for HbA1c, and 6.2–6.4 mmol/l for fasting plasma glucose choosing the Youden index as the technical criterion. In addition, we found that there is no relevant difference in the performance of HbA1c and fasting plasma glucose .ConclusionsIn our meta-analysis, we found that the optimal threshold with reference to the 2 h-PG should be chosen between 42 and 44 mmol/mol (6.0–6.2%) for HbA1c, and 6.2–6.4 mmol/l for fasting plasma glucose on the basis of maximal sensitivity and specificity.This article is protected by copyright. All rights reserved.
      PubDate: 2017-12-12T03:16:43.345545-05:
      DOI: 10.1111/dme.13560
  • Type 2 diabetes remission 2 years post Roux-en-Y gastric bypass and sleeve
           gastrectomy: the role of the weight loss and comparison of DiaRem and
           DiaBetter scores
    • Authors: A. Pucci; U. Tymoszuk, W. H. Cheung, J. M. Makaronidis, S. Scholes, G. Tharakan, M. Elkalaawy, M. Guimaraes, M. Nora, M. Hashemi, A. Jenkinson, M. Adamo, M. Monteiro, N. Finer, R. L. Batterham
      Abstract: AimsThe comparative efficacy of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy on Type 2 diabetes remission and the role of weight loss are unclear. The DiaRem Type 2 diabetes remission prediction score uses HbA1c, age and Type 2 diabetes medications but not Type 2 diabetes duration. The aim of this study was to compare the predictive value of the DiaRem score with the DiaBetter score that includes Type 2 diabetes duration, upon combined (complete plus partial) 2-year post-surgery Type 2 diabetes remission in people following RYGB and sleeve gastrectomy, and to investigate the relationship between weight loss and Type 2 diabetes remission.MethodsA retrospective single-centre cohort study of obese people with Type 2 diabetes who underwent RYGB (107) or sleeve gastrectomy (103) and a separate validation cohort study (173) were undertaken. Type 2 diabetes remission, per cent weight loss, DiaRem, DiaBetter scores and areas under receiving operator characteristic (ROC) curves were calculated. The relationship between per cent weight loss and Type 2 diabetes remission was investigated using logistic regression with multivariate adjustments.ResultsThe proportion of people achieving Type 2 diabetes remission was highest for those with the lowest DiaBetter and DiaRem scores, and lowest in those with the highest scores. Areas under the ROC curves were comparable [DiaBetter: 0.867 (95% CI: 0.817–0.916); DiaRem: 0.865 (95% CI: 0.814–0.915), P = 0.856]. Two-year per cent weight loss was higher post RYGB [26.6 (95% CI: 24.8–28.4)] vs post-sleeve gastrectomy [20.6 (95% CI: 18.3–22.8), P < 0.001]. RYGB had 151% higher odds of Type 2 diabetes CR compared with sleeve gastrectomy [OR 2.51 (95% CI: 1.12–5.60), P = 0.025]. This association became non-significant when adjusted for per cent weight loss.ConclusionDiaBetter and DiaRem scores predict Type 2 diabetes remission following RYGB and sleeve gastrectomy. Two-year per cent weight loss plays a key role in determining Type 2 diabetes remission.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-21T10:35:19.894303-05:
      DOI: 10.1111/dme.13532
  • Optimal prandial timing of bolus insulin in diabetes management: a review
    • Authors: D. Slattery; S. A. Amiel, P. Choudhary
      Abstract: The inability to achieve optimal diabetes glucose control in people with diabetes is multifactorial, but one contributor may be inadequate control of postprandial glucose. In patients treated with multiple daily injections of insulin, both the dose and timing of meal-related rapid-acting insulin are key factors in this. There are conflicting opinions and evidence on the optimal time to administer mealtime insulin. We performed a comprehensive literature search to review the published data, focusing on the use of rapid-acting insulin analogues in patients with Type 1 diabetes. Pharmacokinetic and pharmacodynamic studies of rapid-acting insulin analogues, together with postprandial glucose excursion data, suggest that administering these 15–20 min before food would provide optimal postprandial glucose control. Data from clinical studies involving people with Type 1 diabetes receiving structured meals and rapid-acting insulin analogues support this, showing a reduction in post-meal glucose levels of ~30% and less hypoglycaemia when meal insulin was taken 15–20 min before a meal compared with immediately before the meal. Importantly, there was also a greater risk of postprandial hypoglycaemia when patients took rapid-acting analogues after eating compared with before eating.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-17T04:26:51.81542-05:0
      DOI: 10.1111/dme.13525
  • Could FreeStyle Libre™ sensor glucose data support decisions for
           safe driving'
    • Authors: G. Rayman; J. Kroeger, J. Bolinder
      Abstract: AimMany countries require individuals with diabetes to adhere to standards regarding blood glucose testing in order to be granted or retain a driving licence. Currently, interstitial glucose results may not be used. The aim of this study was to determine whether interstitial glucose measurements using flash glucose-sensing technology can provide additional information to augment safe driving.MethodsSensor data from two European studies (NCT02232698 and NCT02082184) on use of the FreeStyle Libre Glucose Monitoring System™ in insulin-treated Type 1 and Type 2 diabetes, 241 and 224 participants respectively, were used to determine the frequency of a low interstitial sensor glucose result (
      PubDate: 2017-09-25T11:26:59.648387-05:
      DOI: 10.1111/dme.13515
  • Characterizing adults with Type 2 diabetes mellitus and intellectual
           disability: outcomes of a case-finding study
    • Authors: L. D. Bryant; A. M. Russell, R. E. A. Walwyn, A. J. Farrin, A. Wright-Hughes, E. H. Graham, D. Nagi, A. Stansfield, J. Birtwistle, S. Meer, R. A. Ajjan, A. O. House
      Abstract: AimsTo report the results of a case-finding study conducted during a feasibility trial of a supported self-management intervention for adults with mild to moderate intellectual disability and Type 2 diabetes mellitus, and to characterize the study sample in terms of diabetes control, health, and access to diabetes management services and support.MethodsWe conducted a cross-sectional case-finding study in the UK (March 2013 to June 2015), which recruited participants mainly through primary care settings. Data were obtained from medical records and during home visits.ResultsOf the 325 referrals, 147 eligible individuals participated. The participants’ mean (sd) HbA1c concentration was 55 (15) mmol/mol [7.1 (1.4)%] and the mean (sd) BMI was 32.9 (7.9) kg/m2, with 20% of participants having a BMI>40 kg/m2. Self-reported frequency of physical activity was low and 79% of participants reported comorbidity, for example, cardiovascular disease, in addition to Type 2 diabetes. The majority of participants (88%) had a formal or informal supporter involved in their diabetes care, but level and consistency of support varied greatly. Post hoc exploratory analyses showed a significant association between BMI and self-reported mood, satisfaction with diet and weight.ConclusionsWe found high obesity and low physical activity levels in people with intellectual disability and Type 2 diabetes. Glycaemic control was no worse than in the general Type 2 diabetes population. Increased risk of morbidity in this population is less likely to be attributable to poor glycaemic control and is probably related, at least in part, to greater prevalence of obesity and inactivity. More research, focused on weight management and increasing activity in this population, is warranted.This article is protected by copyright. All rights reserved.
      PubDate: 2017-09-12T07:30:18.99532-05:0
      DOI: 10.1111/dme.13510
  • No calcitonin change in a person taking dulaglutide diagnosed with
           pre-existing medullary thyroid cancer
    • Authors: S. I. Sherman; R. T. Kloos, R. M. Tuttle, A. Pontecorvi, H. Völzke, K. Harper, C. Vance, J. T. Alston, A. L. Usborne, K.W. Sloop, M. Lakshmanan
      Abstract: BackgroundGlucagon-like peptide-1 receptor agonists, such as dulaglutide, exenatide and liraglutide, are approved to treat Type 2 diabetes mellitus. Although these drugs provide substantial glycaemic control, studies in rodents have prompted concerns about the development of medullary thyroid carcinoma. These data are reflected in the US package insert, with boxed warnings and product labelling noting the occurrence of these tumours after clinically relevant exposures in rodents, and contraindicating glucagon-like peptide-1 receptor agonist use in people with a personal or family history of medullary thyroid carcinoma or in people with multiple endocrine neoplasia type 2. However, there are substantial differences between rodent and human responses to glucagon-like peptide-1 receptor agonists. This report presents the case of a woman with pre-existing medullary thyroid carcinoma who exhibited no significant changes in serum calcitonin levels despite treatment with dulaglutide 2.0 mg for 6 months in the Assessment of Weekly Administration of LY2189265 [dulaglutide] in Diabetes-5 clinical study (NCT00734474).Case reportElevated serum calcitonin was noted in a 56-year-old woman with Type 2 diabetes mellitus at the 6-month discontinuation visit in a study of long-term dulaglutide therapy. Retroactive assessment of serum collected before study treatment yielded an elevated calcitonin level. At 3 months post-study, calcitonin level remained elevated; ultrasonography revealed multiple bilateral thyroid nodules. Eventually, medullary thyroid carcinoma was diagnosed; the woman was heterozygous positive for a germline RET proto-oncogene mutation.ConclusionThe tumour was not considered stimulated by dulaglutide therapy because calcitonin remained stable throughout.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-29T04:00:27.12975-05:0
      DOI: 10.1111/dme.13437
  • Bolusing frequency and amount impacts glucose control during hybrid
    • Authors: L. Bally; H. Thabit, Y. Ruan, J. K. Mader, H. Kojzar, S. Dellweg, C. Benesch, S. Hartnell, L. Leelarathna, M. E. Willinska, M. L. Evans, S. Arnolds, T. R. Pieber, R. Hovorka
      Abstract: AimTo compare bolus insulin delivery patterns during closed-loop home studies in adults with suboptimally [HbA1c 58–86 mmol/mol (7.5%–10%)] and well-controlled [58 mmol/mol (
      PubDate: 2017-07-29T04:00:24.83529-05:0
      DOI: 10.1111/dme.13436
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