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Journal Cover Diabetic Medicine
  [SJR: 1.654]   [H-I: 116]   [130 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  [1579 journals]
  • Insulin secretory defect in familial partial lipodystrophy type 2 and
           successful long-term treatment with a glucagon-like peptide 1 receptor
    • Authors: F. Banning; M. Rottenkolber, I. Freibothe, J. Seissler, A. Lechner
      Abstract: BackgroundFamilial partial lipodystrophies are rare monogenic disorders that are often associated with diabetes. In such cases, it can be difficult to achieve glycaemic control.Case reportWe report a 34-year old woman with familial partial lipodystrophy type 2 (Dunnigan) and diabetes; her hyperglycaemia persisted despite metformin treatment. A combined intravenous glucose tolerance–euglycaemic clamp test showed severe insulin resistance, as expected, but also showed strongly diminished first-phase insulin secretion. After the latter finding, we added the glucagon-like peptide-1 receptor agonist liraglutide to the patient's treatment regimen, which rapidly normalized plasma glucose levels. HbA1c values
      PubDate: 2017-10-17T04:36:44.29428-05:0
      DOI: 10.1111/dme.13527
  • Incident ischaemic stroke and Type 2 diabetes: trends in incidence and
           case fatality in Scotland 2004–2013
    • Authors: S. H. Read; D. A. McAllister, H. M. Colhoun, B. Farran, C. Fischbacher, J. J. Kerssens, G. P. Leese, R. S. Lindsay, R. J. McCrimmon, S. McGurnaghan, S. Philip, N. Sattar, S. H. Wild,
      Abstract: AimTo describe trends in first ischaemic stroke incidence and case fatality in adults with and without a diagnosis of Type 2 diabetes prior to their ischaemic stroke event in Scotland between 2004 and 2013.MethodsUsing population-wide hospital admission, death and diabetes datasets, we conducted a retrospective cohort study. Negative binomial and logistic regression models were used to calculate year-specific incidence and case-fatality rates for people with Type 2 diabetes and for people without diabetes.ResultsDuring 41.0 million person-years of follow-up there were 69 757 ischaemic stroke events. Type 2 diabetes prevalence among patients who experienced ischaemic stroke increased from 13.5% to 20.3% between 2004 and 2013. Stroke incidence rates declined by 2.7% (95% CI 2.4, 3.0) annually for people with and without diabetes [diabetes/year interaction: rate ratio 0.99 (95% CI 0.98, 1.01)]. Type 2 diabetes was associated with an increased risk of ischaemic stroke in men [rate ratio 1.23 (95% CI 1.17, 1.30)] and women [rate ratio 1.41 (95% CI 1.35, 1.48)]. Case-fatality rates were 14.2% and 12.7% in people with Type 2 diabetes and without diabetes, respectively. Case fatality declined by 3.5% (95% CI 2.7, 4.5) annually [diabetes/year interaction: odds ratio 1.01 (95% CI 0.98, 1.02)].ConclusionsIschaemic stroke incidence declined no faster in people with a diagnosis of Type 2 diabetes than in people without diabetes. Increasing prevalence of Type 2 diabetes among stroke patients may mean that declines in case fatality over time will be less marked in the future.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-17T04:36:35.233289-05:
      DOI: 10.1111/dme.13528
  • Diabetic striatopathy manifesting as severe consciousness disturbance with
           no involuntary movements
    • Authors: Hiroki Sato; Makoto Hamano, Etsuko Fushimi, Toshiaki Takahashi, Yohei Horikawa, Satoru Horiguchi
      Abstract: BackgroundDiabetic striatopathy, one of the complications of diabetes mellitus, is characterized by involuntary movements, including hemichorea and hemiballismus, and the presence of hyperintense lesions on T1-weighted magnetic resonance imaging of the striatum.Case reportWe present a case of diabetic striatopathy manifesting as severe consciousness disturbance without chorea or ballismus. A 58-year-old man was admitted to our hospital in a state of unconsciousness. He was diagnosed with diabetic striatopathy as a result of extremely elevated blood glucose levels and typical magnetic resonance imaging findings in the left striatum, although involuntary movements were absent. He was treated with insulin, and his glucose levels were well maintained. His neuropsychiatric symptoms recovered, rather slowly but completely, after ~20 days.ConclusionThis case indicates the diversity of striatal dysfunction induced by hyperglycaemia. For good prognosis of diabetic striatopathy, prompt diagnosis and appropriate treatments are important. Physicians should be aware that this disease can cause various neurological and psychiatric symptoms other than chorea or ballismus.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-17T04:31:16.8678-05:00
      DOI: 10.1111/dme.13526
  • 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
  • Rituximab for the treatment of type B insulin resistance syndrome: a case
           report and review of the literature
    • Authors: Ken Iseri; Masayuki Iyoda, Yasuto Shikida, Takako Inokuchi, Tomoki Morikawa, Noriko Hara, Tsutomu Hirano, Takanori Shibata
      Abstract: BackgroundType B insulin resistance syndrome is a rare disease characterized by refractory transient hyperglycaemia and severe insulin resistance associated with circulating anti-insulin receptor antibodies. A standardized treatment regimen for type B insulin resistance syndrome has yet to be established.Case reportWe report the case of a 64-year-old man undergoing haemodialysis for antineutrophil cytoplasmic antibody-associated vasculitis and diabetic nephropathy, who developed rapid onset of hyperglycaemia (glycated albumin 52.1%). Type B insulin resistance syndrome was diagnosed, on the basis of positivity for anti-insulin receptor antibodies and the man's autoimmune history of antineutrophil cytoplasmic antibody-associated vasculitis and idiopathic thrombocytopenic purpura. Although severe hyperglycaemia persisted in spite of corticosteroids and high-dose insulin therapy, rituximab treatment resulted in remarkable improvement of the man's severe insulin resistance and disappearance of anti-insulin receptor antibodies without any adverse effects.ConclusionsAccording to a literature review of 11 cases in addition to the present case, rituximab appears to be a safe and effective strategy for the treatment of corticosteroid-resistant type B insulin resistance syndrome.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-16T09:50:25.813655-05:
      DOI: 10.1111/dme.13524
  • RD Lawrence Lecture 2017 Incretins: the intelligent hormones in diabetes
    • Authors: V. A. Gault
      Abstract: The incretin hormones glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) have attracted considerable scientific and clinical interest due largely to their insulin-releasing and glucose-lowering properties. Indeed, GLP-1-based therapies are now key treatment options for many people with diabetes worldwide. In contrast, GIP-based agents have yet to reach the clinic based primarily on the impaired insulinotropic action of GIP observed in people with diabetes. Nevertheless, GIP is a key physiological regulator of insulin secretion and stable forms of GIP show much promise in rodent models to alleviate diabetes–obesity. Recent studies suggest that GIP may have an important role to play in a combination therapeutic approach or bioengineered with other gut peptides. Moreover, recent experimental studies indicate that incretins also exert pleiotropic effects in regions of the brain associated with learning and memory, thereby supporting preclinical data demonstrating that incretin-based drugs improve cognitive function. This review article, based on the RD Lawrence Lecture presented at Diabetes UK Annual Professional Conference (2017), provides a brief overview of incretins with a major focus on GIP, the development of designer GIP analogues, and how these molecules can improve cognition. Thus, incretins can be considered as ‘the intelligent hormones’ and may hold the key to successfully treating the alarming rise in neurodegenerative disorders.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-16T09:46:38.420374-05:
      DOI: 10.1111/dme.13522
  • Risk of pre-eclampsia in women taking metformin: a systematic review and
    • Authors: A. Alqudah; M. C. McKinley, R. McNally, U. Graham, C. J. Watson, T. J. Lyons, L. McClements
      Abstract: AimsTo perform meta-analyses of studies evaluating the risk of pre-eclampsia in high-risk insulin-resistant women taking metformin prior to, or during, pregnancy.MethodsA search was conducted of the Medline, EMBASE, Web of Science and Scopus databases. Both randomized controlled trials and prospective observational cohort studies of metformin treatment vs placebo/control or insulin either prior to or during pregnancy were selected. The main outcome measure was the incidence of pre-eclampsia in each treatment group.ResultsOverall, in five randomized controlled trials comparing metformin treatment (n=611) with placebo/control (n=609), no difference in the risk of pre-eclampsia was found (combined/pooled risk ratio 0.86, 95% CI 0.33–2.26; P=0.76; I2=66%). Meta-analysis of four cohort studies again showed no significant effect (risk ratio 1.21, 95% CI 0.56–2.61; P=0.62; I2=30%). A meta-analysis of eight randomized controlled trials comparing metformin (n=838) with insulin (n=836), however, showed a reduced risk of pre-eclampsia with metformin (risk ratio 0.68, 95% CI 0.48–0.95; P = 0.02; I2=0%). No heterogeneity was present in the metformin vs insulin analysis of randomized controlled trials, whereas high levels of heterogeneity were present in studies comparing metformin with placebo/control. Pre-eclampsia was a secondary outcome in most of the studies. The mean weight gain from time of enrolment to delivery was lower in the metformin group (P=0.05, metformin vs placebo; P=0.004, metformin vs insulin).ConclusionsIn studies randomizing pregnant women to glucose-lowering therapy, metformin was associated with lower gestational weight gain and a lower risk of pre-eclampsia compared with insulin.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-16T09:46:00.065075-05:
      DOI: 10.1111/dme.13523
  • Diabetes-related major lower limb amputation incidence is strongly related
           to diabetic foot service provision and improves with enhancement of
           services: peer review of the South-West of England
    • Authors: R. B. Paisey; A. Abbott, R. Levenson, A. Harrington, D. Browne, J. Moore, M. Bamford, M. Roe,
      Abstract: AimsTo investigate the relationship between high diabetes-related lower limb amputation incidence and foot care services in the South-West region of England.MethodsThe introduction of 10 key elements of foot care service provision in one area of the South-West resulted in stabilization of foot ulcer incidence and sustained reduction in amputation incidence from 2007. Services introduced included administrative support, standardized general practice foot screening, improved community podiatry staffing, hospital multidisciplinary foot clinics, effective care pathways, availability of an orthotist and audit. Peer reviews of the region's diabetes foot care services were undertaken to assess delivery of these service provisions and compare this with major amputation incidence in other regions with data provided by Yorkshire and Humber Public Health Observatory Hospital Episode Statistics. Recommendations were made to improve service provision. In 2015 changes in service provision and amputation incidence were reviewed.ResultsInitial reviews in 2013 showed that the 3-year diabetes-related major amputation incidence correlated inversely with adequate delivery of diabetes foot care services (P=0.0024, adjusted R2 =0.51). Repeat reviews in 2015 found that two or more foot care service improvements were reported by six diabetes foot care providers, with improvement in outcomes. The negative relationship between major amputation incidence and service provision remained strong both in the period 2012–2015 and in the year 2015 only (P ≤0.0012, adjusted R2 =0.56, and P= 0.0005, R2=0.62, respectively).ConclusionsMajor diabetes-related lower limb amputation incidence is significantly inversely correlated with foot care services provision. Introduction of more effective service provision resulted in significant reductions in major amputation incidence within 2 years. Failure to improve unsatisfactory service provision resulted in continued high amputation incidence.
      PubDate: 2017-10-11T04:45:28.054208-05:
      DOI: 10.1111/dme.13512
  • Attenuated heart rate recovery predicts risk of incident diabetes:
           insights from a meta-analysis
    • Authors: S. H. Qiu; C. Xue, Z. L. Sun, J. M. Steinacker, M. Zügel, U. Schumann
      Abstract: AimsTo assess the association between attenuated heart rate recovery, a non-invasive measure of autonomic dysfunction, and risk of diabetes in the general population.MethodsDatabases were searched for cohort studies up to May 2017 that reported the association of heart rate recovery with the risk of diabetes. The overall hazard ratios for slowest vs fastest heart rate recovery (the referent) and for every 10-beats-per-min decrement in heart rate recovery were calculated using a random effects meta-analysis model.ResultsFour cohort studies with 430 incident cases of diabetes among a total of 9113 participants during a mean follow-up period of 8.1 years were included. Results showed that the slowest heart rate recovery was associated with a higher risk of diabetes (hazard ratio 1.66, 95% CI 1.16 to 2.38) vs the fastest heart rate recovery, and the hazard ratio of risk of diabetes for every 10-beats-per-min decrement in heart rate recovery was 1.29 (95% CI 1.13 to 1.48). No significant interaction effect was observed regarding the efficacy of 1-min and 2-min heart rate recovery in predicting risk of diabetes (both Pfor interaction>0.60); however, a linear dose–response relationship existed for overall studies and for studies using 1-min heart rate recovery as the exposure (both P>0.60 for non-linearity).ConclusionsAttenuated heart rate recovery is associated with an increased risk of diabetes in a dose-dependent manner, and measurement of heart rate recovery is worth recommending as part of diabetes risk assessment in clinical routines.This article is protected by copyright. All rights reserved.
      PubDate: 2017-09-25T11:29:00.335584-05:
      DOI: 10.1111/dme.13517
  • 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
  • Premixed vs basal-bolus insulin regimen in Type 2 diabetes: comparison of
           clinical outcomes from randomized controlled trials and real-world data
    • Authors: U. Anyanwagu; J. Mamza, J. Gordon, R. Donnelly, I. Idris
      Abstract: AimTo evaluate the concordance between data derived from randomized controlled trial (RCT) and real-world estimates of HbA1c and weight change after 24 weeks of initiation of a basal-bolus compared with a premixed insulin regimen in people with Type 2 diabetes.MethodsData eight RCTs were pooled after a systematic review of studies examining basal-bolus (n = 1893) or premixed (n = 1517) regimens. Real-world data were extracted from the UK primary care dataset for people on basal-bolus (n = 7483) or premixed insulin regimens (n=10 744). The mean differences between HbA1c and weight from baseline were calculated using t-tests, while analysis of variance was used to compare the two populations. Linear regression analyses were used to determine the predictors of this change.ResultsBoth insulin regimens were associated with HbA1c reductions (real-world data –0.28%; RCT data, –1.4%) and weight gain (real-world data, +0.27 kg; RCT data, +2.96 kg) but there were no significant differences between basal-bolus and premixed insulin. Discordances in the pattern of treatment response were observed, however, between real-world and RCT data for both insulin regimens. For any given baseline HbA1c concentration, the change in HbA1c in the RCTs was greater than in real-world conditions and for those with baseline weight above ~60 kg, RCT data showed overall weight gain in contrast to slight weight loss in the real-world population. Lastly, for both randomized controlled trial and real-world populations, while greater baseline weight was associated with reduced response to treatment, the association was much steeper in the RCT than in the real-world population. In addition, greater baseline weight was associated with greater weight reductions after both premixed insulin and basal-bolus insulin regimens, although to a lesser extent with the latter.ConclusionThese results highlight discrepancies between real-world outcomes and RCT results with respect to starting basal-bolus insulin therapy (which is lower in real-world) or premixed insulin regimens in people with Type 2 diabetes.This article is protected by copyright. All rights reserved.
      PubDate: 2017-09-25T11:02:09.849904-05:
      DOI: 10.1111/dme.13518
  • Inequalities in glycaemic control, hypoglycaemia and diabetic ketoacidosis
           according to socio-economic status and area-level deprivation in Type 1
           diabetes mellitus: a systematic review
    • Authors: L. M. E. Lindner; W. Rathmann, J. Rosenbauer
      Abstract: AimThe aim of this systematic review was to examine the associations of individual-level as well as area-level socio-economic status and area-level deprivation with glycaemic control, hypoglycaemia and diabetic ketoacidosis in people with Type 1 diabetes mellitus.MethodsOvid MEDLINE was searched to identify relevant cohort, case–control or cross-sectional studies published between January 2000 and June 2015. Search results were screened by title, abstract and keywords to identify eligible publications. Decisions on inclusion or exclusion of full texts were made independently by two reviewers. The Newcastle–Ottawa Scale was used to estimate the methodological quality of included studies. Quality assessment and extracted data of included studies were synthesized narratively and reported according to the PRISMA statement.ResultsLiterature search in Ovid MEDLINE identified 1345 eligible studies. Twenty studies matched our inclusion and exclusion criteria. Two articles were additionally identified through hand search. According to the Newcastle-Ottawa Scale, most of the studies were of average quality. Results on associations of socio-economic status and area-level deprivation with glycaemic control and hypoglycaemia were contradictory between studies. By contrast, lower socio-economic status and higher area-level deprivation were associated with a higher risk for diabetic ketoacidosis in all except one study.ConclusionsLower socio-economic status and higher area-level deprivation are associated with a higher risk of experiencing diabetic ketoacidosis in people with Type 1 diabetes mellitus. Access to care for socially deprived people needs to be expanded to overcome impairing effects on the course of the condition and to reduce healthcare disparities.This article is protected by copyright. All rights reserved.
      PubDate: 2017-09-25T11:01:46.858637-05:
      DOI: 10.1111/dme.13519
  • High risk of conversion to diabetes in first-degree relatives of
           individuals with young-onset type 2 diabetes: a 12-year follow-up analysis
    • Authors: Y. Zhang; A. O. Y. Luk, E. Chow, G. T. C. Ko, M. H. M. Chan, M. Ng, A. P. S. Kong, R. C. W. Ma, R. Ozaki, W. Y. So, C. C. Chow, J. C. N. Chan
      Abstract: AimFamily history of diabetes is an established risk factor for Type 2 diabetes, but the impact of a family history of young-onset diabetes (onset
      PubDate: 2017-09-25T10:55:20.284858-05:
      DOI: 10.1111/dme.13516
  • Association between HbA1c and peripheral neuropathy in a 10-year follow-up
           study of people with normal glucose tolerance, impaired glucose tolerance
           and Type 2 diabetes
    • Authors: M. Peterson; R. Pingel, N. Lagali, L. B. Dahlin, O. Rolandsson
      Abstract: AimsTo explore the association between HbA1c and sural nerve function in a group of people with normal glucose tolerance, impaired glucose tolerance or Type 2 diabetes.MethodsWe conducted a 10-year follow-up study in 87 out of an original 119 participants. At study commencement (2004), 64 men and 55 women (mean age 61.1 years) with normal glucose tolerance (n=39), impaired glucose tolerance (n=29), or Type 2 diabetes (n=51) were enrolled. At the 2014 follow-up (men, n=46, women, n=41; mean age 71.1 years), 36, nine and 42 participants in the normal glucose tolerance, impaired glucose tolerance and Type 2 diabetes categories, respectively, were re-tested. Biometric data and blood samples were collected, with an electrophysiological examination performed on both occasions.ResultsAt follow-up, we measured the amplitude of the sural nerve in 74 of the 87 participants. The mean amplitude had decreased from 10.9 μV (2004) to 7.0 μV (2014; P
      PubDate: 2017-09-20T03:50:30.529224-05:
      DOI: 10.1111/dme.13514
  • Perioperative passport: empowering people with diabetes along their
           surgical journey
    • Authors: E. Page; F. Akiboye, S. Jackson, C. Kerry, R. Round, G. Rayman,
      Abstract: AimTo determine whether a handheld ‘perioperative passport’ could improve the experience of perioperative care for people with diabetes and overcome some of the communication issues commonly identified in inpatient extracts.MethodsIndividuals with diabetes undergoing elective surgery requiring at least an overnight stay were identified via a customized information technology system. Those allocated to the passport group were given the perioperative passport before their hospital admission. A 26-item questionnaire was completed after surgery by 50 participants in the passport group (mean age 69 years) and by 35 participants with diabetes who followed the usual surgical pathway (mean age 70 years). In addition, the former group had a structured interview about their experience of the passport.ResultsThe prevalence of those who reported having received prior information about their expected diabetes care was 35% in the control group vs 92% in the passport group (P
      PubDate: 2017-09-18T03:15:42.785789-05:
      DOI: 10.1111/dme.13513
  • Decline of insulin therapy and delays in insulin initiation in people with
           uncontrolled diabetes mellitus
    • Authors: N. Hosomura; S. Malmasi, D. Timerman, V.J. Lei, H. Zhang, L. Chang, A. Turchin
      Abstract: AimsTo design and validate a natural language processing algorithm to identify insulin therapy decline from the text of physician notes, and to determine the prevalence of insulin therapy decline and its impact on insulin initiation.MethodsWe designed the algorithm using the publicly available natural language processing platform Canary. We evaluated the accuracy of the algorithm on 1501 randomly selected primary care physicians’ notes from the electronic medical record system of a large academic medical centre. Using the validated language model, we then studied the prevalence of insulin therapy decline between 2000 and 2014.ResultsThe algorithm identified documentation of insulin therapy decline with a sensitivity of 100% (95% CI 82.4–100), a positive predictive value of 95% (95% CI 74.4–99.9), and a specificity of 99.9% (95% CI 99.6–100.0). We identified 3295 insulin-naïve adults with Type 2 diabetes who were recommended insulin therapy; 984 of them (29.9%) initially declined insulin. People with HbA1c ≥ 75 mmol/mol (9.0%) were more likely [766/2239 (34.2%)] to have declined insulin than people with HbA1c 53–63 mmol/mol (7.0–7.9%) and 64–74 mmol/mol (8.0–8.9%; P < 0.0001). Among the people who initially declined but ultimately started insulin [374/984 (38.0%)], mean time to insulin initiation was 790 days.ConclusionsInsulin therapy decline is common, potentially leading to progression of hyperglycaemia and a delay in achievement of glycaemic control. Further investigation is needed to determine the reasons, risk factors and long-term outcomes of this important clinical phenomenon.
      PubDate: 2017-09-14T04:00:25.804114-05:
      DOI: 10.1111/dme.13454
  • Exercise to preserve β-cell function in recent-onset Type 1 diabetes
           mellitus (EXTOD) – a randomized controlled pilot trial
    • Authors: P. Narendran; N. Jackson, A. Daley, D. Thompson, K. Stokes, S. Greenfield, M. Charlton, M. Curran, T. P. J. Solomon, A. Nouwen, S. I. Lee, A. R. Cooper, M. Mostazir, R. S. Taylor, A. Kennedy, R. C. Andrews
      Abstract: AimResidual β-cell function is present at the time of diagnosis with Type 1 diabetes. Preserving this β-cell function reduces complications. We hypothesized that exercise preserves β-cell function in Type 1 diabetes and undertook a pilot trial to address the key uncertainties in designing a definitive trial to test this hypothesis.MethodsA randomized controlled pilot trial in adults aged 16–60 years diagnosed with Type 1 diabetes within the previous 3 months was undertaken. Participants were assigned to control (usual care) or intervention (exercise consultation every month), in a 1 : 1 ratio for 12 months. The primary outcomes were recruitment rate, drop out, exercise adherence [weeks with ≥ 150 min of self-reported moderate to vigorous physical activity (MVPA)], and exercise uptake in the control group. The secondary outcomes were differences in insulin sensitivity and rate of loss of β-cell function between intervention and control at 6 and 12 months.ResultsOf 507 individuals who were approached, 58 (28 control, 30 intervention) entered the study and 41 completed it. Participants were largely white European males, BMI 24.8 ± 3.8 kg/m2, HbA1c 75 ± 25 mmol/mol (9 ± 2%). Mean level of objectively measured MVPA increased in the intervention group (mean 243 to 273 min/week) and 61% of intervention participants reached the target of ≥ 150 min/week of self-reported MVPA on at least 42 weeks of the year. Physical activity levels fell slightly in the control group (mean 277 to 235 min of MVPA/week). There was exploratory evidence that intervention group became more insulin sensitive and required less insulin. However, the rate of loss of β-cell function appeared similar between the groups, although the change in insulin sensitivity may have affected this.ConclusionWe show that it is possible to recruit and randomize people with newly diagnosed Type 1 diabetes to a trial of an exercise intervention, and increase and maintain their exercise levels for 12 months. Future trials need to incorporate measures of greater adherence to exercise training targets, and include more appropriate measures of β-cell function. (Clinical Trials Registry No; ISRCTN91388505)
      PubDate: 2017-09-14T02:50:13.801475-05:
      DOI: 10.1111/dme.13439
  • 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
  • Measuring Type 1 diabetes stigma: development and validation of the Type 1
           Diabetes Stigma Assessment Scale (DSAS-1)
    • Authors: J. L. Browne; A. D. Ventura, K. Mosely, J Speight
      Abstract: AimsTo develop and validate a self-report measure designed to assess perceived and experienced stigma for adults with Type 1 diabetes: the Type 1 Diabetes Stigma Assessment Scale.MethodsA large item-pool (64 items) was drafted based on qualitative data from interviews with 27 adults with Type 1 diabetes. Eleven adults with Type 1 diabetes completed the draft questionnaire (responding to items using a five-point Likert scale), and participated in cognitive debriefing interviews. Based on their feedback, the item-pool was reduced and refined. Adults with Type 1 diabetes (N=898) completed an online survey including the draft stigma questionnaire (41 items) and other validated measures. Psychometric validation included principal components analysis and confirmatory factor analysis (split samples), internal consistency reliability assessment and Spearman's rho correlations.ResultsScale reduction techniques resulted in 19 items (α=0.93). An unforced three-factor solution suggested three subscales: Treated Differently (six items, α=0.89); Blame and Judgement (six items, α=0.88); and Identity Concerns (seven items, α=0.89). This was corroborated with a confirmatory factor analysis, which demonstrated reasonable model fit with the three factors; less so for a single-factor model. Satisfactory concurrent, convergent and discriminant validity were demonstrated.ConclusionsThe 19-item Type 1 Diabetes Stigma Assessment Scale is a valid and reliable measure of the perceptions and experiences of Type 1 diabetes stigma. This novel, relatively brief measure has satisfactory psychometric properties. The Type 1 Diabetes Stigma Assessment Scale is now available for investigations into the nature and magnitude of the relationships between diabetes stigma and diabetes self-care behaviours and outcomes.This article is protected by copyright. All rights reserved.
      PubDate: 2017-09-11T02:16:29.237135-05:
      DOI: 10.1111/dme.13507
  • Fournier's gangrene in a man on empagliflozin for treatment of Type 2
    • Authors: S. Kumar; A. J. Costello, P. G. Colman
      Abstract: Use of sodium glucose co-transporter 2 (SLGT2) inhibitors has been associated with an increased risk of genital infections secondary to increased glycosuria [1]. Our report highlights a case of Fournier's gangrene, the most severe and potentially fatal type of genital infection, which was preceded by multiple episodes of thrush in a man treated with empagliflozin for Type 2 diabetes.This article is protected by copyright. All rights reserved.
      PubDate: 2017-09-08T22:55:29.919508-05:
      DOI: 10.1111/dme.13508
  • Systematic review and meta-analysis of the efficacy of interventions for
           people with Type 1 diabetes mellitus and disordered eating
    • Authors: P. Clery; D. Stahl, K. Ismail, J. Treasure, C Kan
      Abstract: AimTo examine the types of interventions currently available for people with Type 1 diabetes mellitus and their effectiveness.BackgroundThe prevalence of disordered eating in people with Type 1 diabetes mellitus is twice that in their counterparts without diabetes, and is associated with worse biomedical outcomes and greater mortality.MethodsMedline, Embase, PsycINFO, the Cochrane Library, PubMed and OpenGrey databases were searched up to August 2016 to identify studies on interventions in people with Type 1 diabetes-associated disordered eating. For the systematic review, intervention components were identified and their effectiveness was examined. For the meta-analysis, the pooled effect sizes of glycaemic control (HbA1c) between pre- and post-treatment in treatment and comparison groups were calculated using a random effects model.ResultsOf 91 abstracts reviewed, six studies met the inclusion criteria, of which three had appropriate data for the meta-analysis (n = 118). The pooled effect size was –0.21 95% CI (–0.58 to 0.16; where negative values represent an improvement in HbA1c levels), indicating no statistically significant improvement in the treatment group compared with comparison group. Inpatient therapy appeared to be the most effective treatment, and this had multiple components including cognitive behavioural therapy, psychoeducation and family therapy.ConclusionLimited or no improvement in glycaemic control and disordered eating symptoms was observed in people with Type 1 diabetes-associated disordered eating who were receiving currently available interventions. The present review suggests that developing an intensive intervention with a joint focus on both disordered eating and diabetes management is needed for this complex patient group.This article is protected by copyright. All rights reserved.
      PubDate: 2017-09-08T22:55:28.585585-05:
      DOI: 10.1111/dme.13509
  • Focus group study to identify the central facets of fear of hypoglycaemia
           in people with Type 2 diabetes mellitus
    • Authors: J. Grammes; W. Stock, C. G. Mann, E. M. Flynn, T. Kubiak
      Abstract: AimsTo determine key worries about hypoglycaemia among insulin-using adults with Type 2 diabetes using a focus group approach.MethodsThirteen focus groups were conducted in three diabetes outpatient care units and one peer support group was set up, in Germany. A total of 64 insulin-dependent adults with Type 2 diabetes (36.5% women, mean age 65.2 ± 11.0 years) discussed their worries about hypoglycaemia. The qualitative results were assigned into thematic categories using a bottom-up coding procedure. Participants completed the Hypoglycaemia Fear Survey and demographic measures were recorded. The results of the Hypoglycaemia Fear Survey were contrasted with the focus group findings to evaluate how accurately the Hypoglycaemia Fear Survey comprehensively captures features of fear of hypoglycaemia in Type 2 diabetes.ResultsEight themes were identified: ‘unconsciousness/death’; ‘aloneness/ helplessness’, ‘fear of hurting somebody’; ‘shame’; ‘loss of physical control’; ‘long-term complications’; ‘diabetes self-management issues’; and ‘impaired awareness’. A total of 30 participants (46.9 %) scored ≥3 on at least one item of the Hypoglycaemia Fear Survey worry subscale, indicating elevated worries. The Hypoglycaemia Fear Survey comprehensively captured all identified themes. Self-efficacy with regard to diabetes self-management seemed to play an important role in fear of hypoglycaemia in Type 2 diabetes.ConclusionsGiven that even subclinical worries can have negative effects on quality of life and diabetes self-management, emphasis should be placed on diabetes education; in particular, to help patients to develop self-efficacy concerning diabetes self-management. The Hypoglycaemia Fear Survey comprehensively captures hypoglycaemia worries in Type 2 diabetes. Additional assessment of self-efficacy might be beneficial to identify people at risk of developing hypoglycaemia worries.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-30T02:50:29.022589-05:
      DOI: 10.1111/dme.13506
  • HbA1c variability is associated with increased mortality and earlier
           hospital admission in people with Type 1 diabetes
    • Authors: G. S. Walker; S. G. Cunningham, C. A. R. Sainsbury, G. C. Jones
      Abstract: AimDespite evidence of morbidity, no evidence exists on the relationship between HbA1c variability and mortality in Type 1 diabetes. We performed an observational study to investigate whether the association between HbA1c 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.MethodsPeople 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 HbA1c 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.ResultsSome 6048 individuals with Type 1 diabetes were included in the analysis. Median HbA1c CV was 7.9. The hazard ratio (HR) for mortality for those with an HbA1c CV above the median value is 1.5 over 47 months of follow-up (P 
      PubDate: 2017-08-19T05:30:19.875009-05:
      DOI: 10.1111/dme.13455
  • Exploring residual risk for diabetes and microvascular disease in the
           Diabetes Prevention Program Outcomes Study (DPPOS)
    • Authors: L. Perreault; Q. Pan, V. R. Aroda, E. Barrett-Connor, D. Dabelea, S. Dagogo-Jack, R. F. Hamman, S. E. Kahn, K. J. Mather, W. C. Knowler, The Diabetes Prevention Program Research Group
      Abstract: AimApproximately half of the participants in the Diabetes Prevention Outcomes Study (DPPOS) had diabetes after 15 years of follow-up, whereas nearly all the others remained with pre-diabetes. We examined whether formerly unexplored factors in the DPPOS coexisted with known risk factors that posed additional risk for, or protection from, diabetes as well as microvascular disease.MethodsCox proportional hazard models were used to examine predictors of diabetes. Sequential modelling procedures considered known and formerly unexplored factors. We also constructed models to determine whether the same unexplored factors that associated with progression to diabetes also predicted the prevalence of microvascular disease. Hazard ratios (HR) are per standard deviation change in the variable.ResultsIn models adjusted for demographics and known diabetes risk factors, two formerly unknown factors were associated with risk for both diabetes and microvascular disease: number of medications taken (HR = 1.07, 95% confidence intervals (95% CI) 1.03 to 1.12 for diabetes; odds ratio (OR) = 1.10, 95% CI 1.04 to 1.16 for microvascular disease) and variability in HbA1c (HR = 1.02, 95% CI 1.01 to 1.03 for diabetes; OR = 1.06, 95% CI 1.04 to 1.09 for microvascular disease per sd). Total comorbidities increased risk for diabetes (HR = 1.10, 95% CI 1.04 to 1.16), whereas higher systolic (OR = 1.22, 95% CI 1.13 to 1.31) and diastolic (OR = 1.14, 95% CI 1.05 to 1.22) blood pressure, as well as the use of anti-hypertensives (OR = 1.41, 95% CI 1.23 to 1.62), increased risk of microvascular disease.ConclusionsSeveral formerly unexplored factors in the DPPOS predicted additional risk for diabetes and/or microvascular disease – particularly hypertension and the use of anti-hypertensive medications – helping to explain some of the residual disease risk in participants of the DPPOS. (Clinical Trial Registry Nos: DPP NCT00004992 and DPPOS NCT00038727)This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-19T05:15:20.444062-05:
      DOI: 10.1111/dme.13453
  • Efficacy and safety of alirocumab in people with prediabetes vs those with
           normoglycaemia at baseline: a pooled analysis of 10 phase III ODYSSEY
           clinical trials
    • Authors: L.A. Leiter; D. Müller-Wieland, M.T. Baccara-Dinet, A. Letierce, R. Samuel, B. Cariou
      Abstract: AimTo assess the lipid-lowering efficacy and safety of alirocumab, a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor, in people with hypercholesterolaemia and prediabetes at baseline vs people with normoglycaemia at baseline in a pooled analysis of 10 ODYSSEY phase III trials.MethodsPeople classified as having prediabetes had baseline HbA1c ≥39 mmol/mol (5.7%) and
      PubDate: 2017-08-11T01:51:15.268545-05:
      DOI: 10.1111/dme.13450
  • Self-compassion is associated with optimum self-care behaviour, medical
           outcomes and psychological well-being in a cross-sectional sample of
           adults with diabetes
    • Authors: M. Ferrari; M. Dal Cin, M. Steele
      Abstract: AimTo investigate the role of self-compassion in diabetes outcomes, a construct which may be relevant to chronic conditions, given its focus on compassion toward oneself, especially in times of difficulty.MethodsIn this cross-sectional study we collected data online from 310 adults diagnosed with diabetes. The questionnaire measured three primary outcomes: self-management behaviours; HbA1c levels and psychological well-being. Potential predictors were also assessed, including self-compassion, locus of control, social support and demographics.ResultsMultiple regression analyses showed that self-compassion had the most consistent association with better outcomes, including all forms of self-management behaviour, HbA1c levels and psychological well-being. Self-compassion was independently associated with 55.1% of the variance in well-being. Internal locus of control was also significantly associated with better well-being and HbA1c outcomes. Chance and external locus of control and social support were generally associated with poorer outcomes.ConclusionsHigher levels of self-compassion are typically associated with improved self-management behaviour, medical outcomes and psychological well-being in adults with diabetes mellitus. The present findings suggest that self-compassion may be a parsimonious and suitable intervention target. Future interventions and consultations with medical professionals may benefit from fostering self-compassion in adults with diabetes mellitus.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-11T01:51:04.106204-05:
      DOI: 10.1111/dme.13451
  • Excess psychosocial burden in women with diabetes and premature acute
           coronary syndrome
    • Authors: T. M. Peters; R. Pelletier, H. Behlouli, A. M. Rossi, L. Pilote
      Abstract: AimDiabetes is a stronger risk factor for acute coronary syndrome for women than men. We investigate whether behavioural and psychosocial factors contribute to the disparity in acute coronary syndrome risk and outcomes among women with diabetes relative to women without diabetes and men.MethodsAmong 939 participants in the GENESIS-PRAXY cohort study of premature acute coronary syndrome (age ≤ 55 years), we compared the prevalence of traditional and non-traditional factors by sex and Type 2 diabetes status. In a case-only analysis, we used generalized logit models to investigate the influence of traditional and non-traditional factors on the interaction of sex and diabetes.ResultsIn 287 women (14.3% with diabetes) and 652 men (10.4% with diabetes), women and men with diabetes showed a heavier burden of traditional cardiac risk factors compared with individuals without diabetes. Women with diabetes were more likely to be the primary earner and have more anxiety relative to women without diabetes, and reported worse perceived health compared with women without diabetes and men with diabetes. The interaction term for sex and diabetes (odds ratio (OR) 1.40, 95% confidence intervals (95% CI) 0.83–2.36) was diminished after additional adjustment for non-traditional factors (OR 1.12, 95% CI 0.54–2.32), but not traditional factors alone (OR 1.41, 95% CI 0.84–2.36).ConclusionsWe observed trends toward a more adverse psychosocial profile among women with diabetes and incident acute coronary syndrome compared with women without diabetes and men with diabetes, which may explain the increased risk of acute coronary syndrome in women with diabetes and may also contribute to worse outcomes.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-11T01:50:18.164387-05:
      DOI: 10.1111/dme.13452
  • The prevalence of diabetes-specific emotional distress in people with Type
           2 diabetes: a systematic review and meta-analysis
    • Authors: N. E. Perrin; M. J. Davies, N. Robertson, F. J. Snoek, K. Khunti
      Abstract: AimsPsychological comorbidity, such as depression and/or diabetes-specific emotional distress (diabetes distress), is widespread in people with Type 2 diabetes and is associated with poorer treatment outcomes. Although extensive research into the prevalence of depression has been conducted, the same attention has not been given to diabetes distress. The aim of this systematic review was to determine the overall prevalence of diabetes distress in people with Type 2 diabetes.MethodsSeven databases were searched to identify potentially relevant studies; eligible studies (adult population aged > 18 years with Type 2 diabetes and an outcome measure of diabetes distress) were selected and appraised independently by two reviewers. Multiple fixed- and random-effects meta-analyses were performed to synthesize the data; with primary analyses to determine the overall prevalence of diabetes distress in people with Type 2 diabetes, and secondary meta-analyses and meta-regression to explore the prevalence across different variables.ResultsFifty-five studies (n = 36 998) were included in the meta-analysis and demonstrated an overall prevalence of 36% for diabetes distress in people with Type 2 diabetes. Prevalence of diabetes distress was significantly higher in samples with a higher prevalence of comorbid depressive symptoms and a female sample majority.ConclusionsDiabetes distress is a prominent issue in people with Type 2 diabetes that is associated with female gender and comorbid depressive symptoms. It is important to consider the relationship between diabetes distress and depression, and the significant overlap between conditions. Further work is needed to explore psychological comorbidity in Type 2 diabetes to better understand how best to identify and appropriately treat individuals.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-11T01:45:41.8694-05:00
      DOI: 10.1111/dme.13448
  • REPOSE: repositioning insulin pump therapy in Type 1 diabetes
    • Authors: N. S. Oliver
      Abstract: In 2008, the National Institute for Health and Care Excellence (NICE) technology appraisal of continuous subcutaneous insulin infusion (CSII, insulin pump therapy) for people with Type 1 diabetes was published [1]. Implementation of this enables children under the age of 12 years to access CSII, and consideration of CSII for adults and children over 12 years with challenging hypo- or hyperglycaemia. In Scotland, the Scottish Intercollegiate Guidelines Network (SIGN) guidance for management of diabetes states that CSII therapy should be considered for people unable to achieve their glycaemic targets, for those who experience recurring episodes of severe hypoglycaemia, and in infants and very young children with very low basal insulin requirements, for whom even small doses of basal insulin analogue may result in hypoglycaemia [2]. In both documents, CSII should be provided in a specialist centre and is an adjunct to structured education. Since these guidelines were implemented insulin pump uptake in England has increased with 11.7% of people with Type 1 diabetes attending participating specialist services treated with an insulin pump in 2015 [3] and this number expected to rise over time.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-11T01:45:28.427701-05:
      DOI: 10.1111/dme.13449
  • Meeting American Diabetes Association diabetes management targets: trends
           in Mauritius
    • Authors: M. Tabesh; J. E. Shaw, P. Z. Zimmet, S. Soderberg, S. Kowlessur, M. Timol, N. Joonas, G. M. M. Alberti, J. Tuomilehto, B. J. Shaw, D. J. Magliano
      Abstract: AimsTo examine the proportion of people with diabetes in the multi-ethnic country of Mauritius meeting American Diabetes Association targets in 2009 and 2015.MethodsData from independent population-based samples of 858 and 656 adults with diagnosed diabetes in 2009 and 2015, respectively, were analysed with regard to recommended American Diabetes Association targets for HbA1c, blood pressure and LDL cholesterol.ResultsIn 2015 compared with 2009, the proportion of people achieving American Diabetes Association targets for glycaemic control in Mauritius was higher in women (P≤0.01) and in those with only a primary education level (P=0.07), but not in men or people with a higher level of education. Achievement of blood pressure
      PubDate: 2017-08-09T10:45:19.232471-05:
      DOI: 10.1111/dme.13447
  • Transmission of Type 2 diabetes to sons and daughters: the D.E.S.I.R.
    • Authors: B. Balkau; R. Roussel, S. Wagner, J. Tichet, P. Froguel, G. Fagherazzi, F. Bonnet,
      Abstract: AimsTo document the family transmission of Type 2 diabetes to men and women.MethodThe French D.E.S.I.R. cohort followed men and women over 9 years, with 3-yearly testing for incident Type 2 diabetes. First- and/or second-degree family histories of diabetes were available for 2187 men and 2282 women. Age-adjusted hazard ratios were estimated for various family members and groupings of family members, as well as for a genetic diabetes risk score, based on 65 diabetes-associated loci.ResultsOver 9 years, 136 men and 63 women had incident Type 2 diabetes. The hazard ratios for diabetes associated with having a first-degree family member with diabetes (parents, siblings, children) differed between men [1.21 (95% CI 0.80, 1.85)] and women [3.02 (95% CI 1.83, 4.99); Pinteraction=0.006]. The genetic risk score was predictive of diabetes in both men and women, with similar hazard ratios 1.10 (95% CI 1.06, 1.15) and 1.08 (95% CI 1.02, 1.14) respectively, for each additional at-risk allele. In women, the risk associated with having a family member with diabetes persisted after adjusting for the genetic score.ConclusionWomen with a family history of diabetes (paternal or maternal) were at risk of developing Type 2 diabetes and this risk was independent of genetic score; in contrast, for men, there was no association. Diabetes screening and prevention may need to more specifically target women with diabetes in their family, but further studies are required as the number of people with diabetes in this study was small.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-09T10:40:27.467138-05:
      DOI: 10.1111/dme.13446
  • Physical activity and Type 1 diabetes: an underused therapy
    • Authors: T. Yates; M. J. Davies
      Abstract: Aerobic exercise training has consistently been shown to be an effective therapy in the management of Type 2 diabetes, resulting in reductions in HbA1c of ~8 mmol/mol (0.7%) [1]. Moreover, physical activity and cardiorespiratory fitness have been strongly associated with a decreased risk of morbidity and mortality in those with Type 2 diabetes. Despite a wealth of evidence for Type 2 diabetes, less is understood about the therapeutic potential of physical activity in Type 1 diabetes.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-09T08:55:22.932461-05:
      DOI: 10.1111/dme.13445
  • Nutrient re-routing and altered gut-islet cell crosstalk may explain early
           relief of severe postprandial hypoglycaemia after reversal of Roux-en-Y
           gastric bypass
    • Authors: M. S. Svane; M. B. Toft-Nielsen, V. B. Kristiansen, B. Hartmann, J. J. Holst, S. Madsbad, K. N. Bojsen-Møller
      Abstract: BackgroundRoux-en-Y gastric bypass is associated with an increased risk of postprandial hyperinsulinaemic hypoglycaemia, but the underlying pathophysiology remains poorly understood. We therefore examined the effect of re-routing of nutrient delivery on gut-islet cell crosstalk in a person with severe postprandial hypoglycaemia after Roux-en-Y gastric bypass.Case reportA person with severe postprandial hypoglycaemia, who underwent surgical reversal of Roux-en-Y gastric bypass, was studied before reversal and at 2 weeks and 3 months after reversal surgery using liquid mixed meal tests and hyperinsulinaemic-euglycaemic clamps. The nadir of postprandial plasma glucose rose from 2.8 mmol/l to 4.1 mmol/l at 2 weeks and to 4.4 mmol/l at 3 months after reversal. Concomitant insulin- and glucagon-like peptide-1 secretion (peak concentrations and area under the curve) clearly decreased after reversal, while concentrations of glucose-dependent insulinotropic polypeptide and ghrelin increased. Insulin clearance declined after reversal, whereas clamp-estimated peripheral insulin sensitivity was unchanged. The person remained without symptoms of hypoglycaemia, but had experienced significant weight gain at 15- month follow-up.DiscussionAccelerated nutrient absorption may be a driving force behind postprandial hyperinsulinaemic hypoglycaemia after Roux-en-Y gastric bypass. Re-routing of nutrients by reversal of the Roux-en-Y gastric bypass diminished postprandial plasma glucose excursions, alleviated postprandial insulin and glucagon-like peptide-1 hypersecretion and eliminated postprandial hypoglycaemia, which emphasizes the importance of altered gut-islet cell crosstalk for glucose metabolism after Roux-en-Y gastric bypass.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-07T07:12:17.314256-05:
      DOI: 10.1111/dme.13443
  • Diabetes risk in women with gestational diabetes mellitus and a history of
           polycystic ovary syndrome: a retrospective cohort study
    • Authors: R. Bond; R. Pace, E. Rahme, K. Dasgupta
      Abstract: AimsTo investigate whether polycystic ovary syndrome further increases postpartum diabetes risk in women with gestational diabetes mellitus and to explore relationships between polycystic ovary syndrome and incident diabetes in women who do not develop gestational diabetes.MethodsThis retrospective cohort study (Quebec Physician Services Claims; Hospitalization Discharge Databases; Birth and Death registries) included 34 686 women with gestational diabetes during pregnancy (live birth), matched 1:1 to women without gestational diabetes by age group, year of delivery and health region. Diagnostic codes were used to define polycystic ovary syndrome and incident diabetes. Cox regression models were used to examine associations between polycystic ovary syndrome and incident diabetes.ResultsPolycystic ovary syndrome was present in 1.5% of women with gestational diabetes and 1.2% of women without gestational diabetes. There were more younger mothers and mothers who were not of white European ancestry among those with polycystic ovary syndrome. Those with polycystic ovary syndrome more often had comorbidity and a lower proportion had a previous pregnancy. Polycystic ovary syndrome was associated with incident diabetes (hazard ratio 1.52; 95% CI 1.27, 1.82) among women with gestational diabetes. No conclusive associations between polycystic ovary syndrome and diabetes were identified (hazard ratio 0.94; 95% CI 0.39, 2.27) in women without gestational diabetes.ConclusionIn women with gestational diabetes, polycystic ovary syndrome confers additional risk for incident diabetes postpartum. In women without gestational diabetes, an association between PCOS and incident diabetes was not observed. Given the already elevated risk of diabetes in women with a history of gestational diabetes, a history of both polycystic ovary syndrome and gestational diabetes signal a critical need for diabetes surveillance and prevention.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-07T07:11:16.420593-05:
      DOI: 10.1111/dme.13444
  • Clinic variation in glycaemic control for children with Type 1 diabetes in
           England and Wales: a population-based, multilevel analysis
    • Authors: D. Charalampopoulos; R. Amin, J. T. Warner, G. Muniz-Terrera, V. Mazarello Paes, R. M. Viner, T. Stephenson
      Abstract: AimTo understand the scope for improving children's glycaemic outcomes by reducing variation between clinics and examine the role of insulin regimen and clinic characteristics.MethodsCross-sectional analysis of 2012–2013 National Paediatric Diabetes Audit data from 21 773 children aged
      PubDate: 2017-08-05T03:20:22.129619-05:
      DOI: 10.1111/dme.13442
  • Gestational diabetes care and outcomes for refugee women: a
           population-based cohort study
    • Authors: S. Khan; Z. Yao, B. R. Shah
      Abstract: AimTo determine the prevalence of adverse clinical outcomes, the rates of healthcare utilization, and the incidence of post-partum Type 2 diabetes in refugees with gestational diabetes (GDM), compared with other immigrants and non-immigrants.MethodsA population-based cohort study was conducted using healthcare databases in Ontario, Canada. Over 40 000 women with GDM having singleton live births between 2002 and 2014 were identified. We identified GDM adverse outcomes such as macrosomia, pre-eclampsia and respiratory distress syndrome. Antenatal and newborn healthcare utilization were ascertained. Women were then followed for diagnosis of diabetes post-partum.ResultsBoth refugees and other immigrants had a lower rate than non-immigrants of many adverse GDM outcomes, including pre-eclampsia [(RR) 0.65, 95% confidence interval (95% CI) 0.44–0.95 and 0.61, 95% CI 0.52–0.72, respectively], preterm birth (RR 0.87, 95% CI 0.75–0.995 and 0.85, 95% CI 0.80–0.91, respectively), and respiratory distress syndrome (RR 0.83, 95% CI 0.70–0.97 and 0.78, 95% CI 0.72–0.84, respectively). However, refugees were less likely to attend well-baby care in time for the first routine vaccination (RR 0.92, 95% CI 0.88–0.95). Incidence of post-partum diabetes was high in all groups, but refugee women were at increased risk (hazard ratio 1.23, 95% CI 1.11–1.37).ConclusionsDespite different circumstances leading to migration, refugees have a similar ‘healthy immigrant effect’ to other immigrants, with respect to adverse GDM outcomes. However, newborns of refugees were less likely to have well-baby care, and refugee women were also at especially high risk of developing diabetes post-partum. These are both important public health issues.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-05T03:15:33.833518-05:
      DOI: 10.1111/dme.13440
  • Effect of multiparity and ethnicity on the risk of development of
           diabetes: a large population-based cohort study
    • Authors: B. Almahmeed; B. R. Shah, G. Mukerji, V. Ling, G. L. Booth, D. S. Feig
      Abstract: AimsTo investigate the relationship between increasing parity and diabetes in a large, population-based cohort, and to examine if this relationship is different among high-risk ethnic groups.MethodsA population-based, retrospective cohort study was performed in 738 440 women aged 18–50 years, who delivered babies in Ontario between 1 April 2002 and 31 March 2011. Diabetes incidence postpartum was calculated for each parity and ethnic group. A multivariable analysis of the effect of parity and ethnicity on the incidence of diabetes was performed using a Cox proportional hazards model, adjusting for confounders.ResultsThe diabetes incidence rate per 1000 person-years was 3.69 in women with 1 delivery, 4.12 in women with 3 deliveries and 7.62 in women with ≥5 deliveries. Women with ≥3 deliveries had a higher risk of developing diabetes compared with women with 1 delivery [adjusted hazard ratios 1.06 (95% CI 1.01–1.11) for 3 deliveries, 1.33 (95% CI 1.25–1.43) for 4 deliveries and 1.53 (95% CI 1.41–1.66) for ≥5 deliveries). A similar rise in risk could be seen in Chinese and South-Asian women, with the most influence in Chinese women [hazard ratio 4.59 (95% CI 2.36–8.92) for ≥5 deliveries].ConclusionsThere was a positive and graded relationship between increasing parity and risk of development of diabetes. The influence of parity was seen in all ethnicities. This association may be partly related to increasing weight gain and retention with increasing parity, or deterioration in β-cell function. This merits further exploration.This article is protected by copyright. All rights reserved.
      PubDate: 2017-08-05T03:15:32.590392-05:
      DOI: 10.1111/dme.13441
  • Characteristics of people with high visit-to-visit glycaemic variability
           in Type 2 diabetes
    • Authors: J. D. Noyes; E. Soto-Pedre, L. A. Donnelly, E. R. Pearson
      Abstract: AimIncreased visit-to-visit glycaemic variability is independently associated with adverse outcomes in Type 2 diabetes. Our aim was to identify the patient characteristics associated with raised visit-to-visit glycaemic variability in people with Type 2 diabetes.MethodsA case–control study was conducted to establish associations between HbA1c variability and clinical covariates in 10 130 people with Type 2 diabetes. Variability was calculated by two metrics [sd and coefficient of variation (CV)] from a minimum of four HbA1c readings obtained over a 4-year period. High and low variability groups were defined as the top and bottom tertile of the sd or CV, and used in logistic regression analyses including a number of clinical and biochemical covariates. The analyses were stratified into low mean (
      PubDate: 2017-07-29T04:05:21.079153-05:
      DOI: 10.1111/dme.13435
  • 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
  • External national validation of the Leicester Self-Assessment score for
           Type 2 diabetes using data from the English Longitudinal Study of Ageing
    • Authors: S. R. Barber; N. N. Dhalwani, M. J. Davies, K. Khunti, L. J. Gray
      Abstract: AimsTo validate the Leicester Self-Assessment score using a representative English dataset for detecting prevalent non-diabetic hyperglycaemia or undiagnosed Type 2 diabetes (defined as HbA1c ≥6.0%) and for identifying those who may go on to develop Type 2 diabetes within 10 years.MethodsData were taken from the English Longitudinal Study of Ageing, a nationally representative dataset of people aged ≥50 years. The area under the receiver–operator curve and performance metrics for the score at the recommended score threshold (≥16), were calculated for the outcomes of HbA1c ≥42 mmol/mol (6.0%) at baseline and self-reported Type 2 diabetes within 10 years in those aged 50–75 years at baseline.ResultsA total of 3203 individuals had a baseline HbA1c measurement, of whom 247 (7.7%) had an HbA1c concentration ≥ 42 mmol/mol (6.0%). The area under the receiver–operator curve was 69.4% (95% CI 66.0–72.9) for baseline HbA1c ≥42 mmol/mol. A total of 3550 individuals had diabetes status recorded at 10 years, of whom 324 (9.1%) were diagnosed with Type 2 diabetes within this time; the area under the receiver–operator curve for this outcome was 74.9% (95% CI 72.4–77.5). The score threshold of ≥16 had a sensitivity of 89.2% (95% CI 85.3–92.4) and a specificity of 42.3% (95% CI 40.5–44.0) for Type 2 diabetes within 10 years.ConclusionsThe Leicester Self-Assessment score is validated for use across England to identify people with non-diabetic hyperglycaemia or undiagnosed Type 2 diabetes. Those with a high score are at high risk of developing diabetes in the future.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-26T02:56:12.812257-05:
      DOI: 10.1111/dme.13433
  • Predictors of early renal function decline in adults with Type 1
           diabetes: the Coronary Artery Calcification in Type 1 Diabetes and the
           Pittsburgh Epidemiology of Diabetes Complications studies
    • Authors: P. Bjornstad; T. Costacou, R. G. Miller, D. M. Maahs, M. J. Rewers, T. J. Orchard, J. K. Snell-Bergeon
      Abstract: AimDiabetic kidney disease is one of the leading complications of Type 1 diabetes, but its prediction remains a challenge. We examined predictors of rapid decline in estimated GFR (eGFR) in two Type 1 diabetes cohorts: the Coronary Artery Calcification in Type 1 Diabetes (CACTI) and the Pittsburgh Epidemiology of Diabetes Complications (EDC).MethodsA select subset of participants (CACTI: n = 210 and EDC: n = 98) diagnosed before 17 years of age with Type 1 diabetes duration ≥ 7 years, and follow-up data on eGFR by CKD-EPI creatinine for up to 8 years were included in the analyses. Early renal function decline was defined as annual decline in eGFR ≥ 3 ml/min/1.73 m2, and normal age-related decline as eGFR ≤ 1 ml/min/1.73 m2. Parallel logistic regression models were constructed in the two cohorts.ResultsEarly renal function decline incidence was 36% in CACTI and 41% in EDC. In both cohorts, greater baseline eGFR (CACTI: OR 3.12, 95% CI 1.97–5.05; EDC: OR 1.92, 95% CI 1.17–3.15 per 10 ml/min/1.73 m2) and log albumin-to-creatinine (ACR) (CACTI: OR 3.24, 95% CI 1.80–5.83; EDC: OR 1.87, 95% CI 1.18–2.96 per 1 unit) predicted greater odds of early renal function decline in fully adjusted models. Conversely, ACE inhibition predicted lower odds of early renal function decline in women in CACTI, but similar relationships were not observed in women in EDC.ConclusionsA substantial proportion of people with Type 1 diabetes in the EDC and CACTI cohorts experienced early renal function decline over time. ACE inhibition appeared to be protective only in women in CACTI where the prevalence of its use was twofold higher compared with the EDC.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-22T09:40:27.567323-05:
      DOI: 10.1111/dme.13430
  • Sleep duration and progression to diabetes in people with prediabetes
           defined by HbA1c concentration
    • Authors: Chan-Won Kim; Yoosoo Chang, Eunju Sung, Seungho Ryu
      Abstract: AimsTo evaluate the association between sleep duration and the risk of progression to diabetes among people with prediabetes, defined by HbA1c values.MethodsWe conducted a cohort study in 17 983 adults who underwent health check-up examinations, including assessments of sleep duration and quality. Diabetes was defined as either HbA1c ≥48 mmol/mol (6.5%), or the use of antidiabetic medication. Time-dependent proportional hazards models were used to evaluate the association between sleep duration and the risk of progression to diabetes.ResultsDuring 31,582 person-years of follow-up, 664 incident cases of diabetes were identified; the incidence rate was 21.0 per 1000 person-years. The multivariate adjusted hazard ratios for progression to diabetes in people with sleep durations of ≤5, 6 and ≥8 h compared with 7 h were 1.68 (95% CI 1.30–2.16), 1.44 (95% CI 1.17–1.76) and 1.23 (95% CI 0.85–1.78), respectively (P for quadratic trend
      PubDate: 2017-07-22T09:40:25.217064-05:
      DOI: 10.1111/dme.13432
  • Levels of wound calprotectin and other inflammatory biomarkers aid in
           deciding which patients with a diabetic foot ulcer need antibiotic therapy
           (INDUCE study)
    • Authors: J. R. Ingram; S. Cawley, E. Coulman, C. Gregory, E. Thomas-Jones, T. Pickles, R. Cannings-John, N. A. Francis, K. Harding, K. Hood, V. Piguet
      Abstract: AimsDeciding if a diabetic foot ulcer is infected in a community setting is challenging without validated point-of-care tests. Four inflammatory biomarkers were investigated to develop a composite algorithm for mildly infected diabetic foot ulcers: venous white cell count, C-reactive protein (CRP) and procalcitonin, and a novel wound exudate calprotectin assay. Calprotectin is a marker of neutrophilic inflammation.MethodsIn a prospective study, people with uninfected or mildly infected diabetic foot ulcers who had not received oral antibiotics in the preceding 2 weeks were recruited from community podiatry clinics for measurement of inflammatory biomarkers. Antibiotic prescribing decisions were based on clinicians’ baseline assessments and participants were reviewed 1 week later; ulcer infection was defined by clinicians’ overall impression from their two assessments.ResultsSome 363 potential participants were screened, of whom 67 were recruited, 29 with mildly infected diabetic foot ulcers and 38 with no infection. One participant withdrew early in each group. Ulcer area was 1.32 cm2 [interquartile range (IQR) 0.32–3.61 cm2] in infected ulcers and 0.22 cm2 (IQR 0.09–1.46 cm2) in uninfected ulcers. Baseline CRP for mild infection was 9.00 mg/ml and 6.00 mg/ml for uninfected ulcers; most procalcitonin levels were undetectable. Median calprotectin level in infected diabetic foot ulcers was 1437 ng/ml and 879 ng/ml in uninfected diabetic foot ulcers. Area under the receiver operating characteristic curve for a composite algorithm incorporating calprotectin, CRP, white cell count and ulcer area was 0.68 (95% confidence intervals 0.52–0.82), sensitivity 0.64, specificity 0.81.ConclusionsA composite algorithm including CRP, calprotectin, white cell count and ulcer area may help to distinguish uninfected from mildly infected diabetic foot ulcers. Venous procalcitonin is unhelpful for mild diabetic foot ulcer infection.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-22T09:40:19.749786-05:
      DOI: 10.1111/dme.13431
  • Acceptability of a very-low-energy diet in Type 2 diabetes: patient
           experiences and behaviour regulation
    • Authors: L. Rehackova; V. Araújo-Soares, A. J. Adamson, S. Steven, R. Taylor, F. F. Sniehotta
      Abstract: AimsTo evaluate the acceptability of an 8-week very-low-energy diet for remission of Type 2 diabetes, and to identify the barriers and facilitators of adherence and the behavioural strategies used by participants of the Counterbalance study.MethodsEighteen of the 30 participants in the Counterbalance study (ISRCTN88634530) took part in semi-structured interviews. Of these, 15 participants were interviewed before and after the 8-week very-low-energy diet intervention. Thematic analysis was used to analyse the narratives.ResultsThe prospect of diabetes remission, considerable weight loss and long-term health improvement provided participants with substantial initial motivation. This motivation was sustained through the experience of rapid weight loss, improvements in blood glucose levels, social support and increased physical and psychological well-being. Overall, adherence to the very-low-energy diet for 8 weeks was perceived as much easier than anticipated, but required personal effort. Participants addressed challenges by removing food from the environment, planning, avoidance of tempting situations or places, and self-distraction. Weight loss and improvements in blood glucose levels lead to a sense of achievement and improvements in physical and psychological wellbeing.ConclusionsDietary treatment for reversal of Type 2 diabetes is acceptable and feasible in motivated participants, and the process is perceived as highly gratifying. Research outside of controlled trial settings is needed to gauge the generalizability of these findings.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-20T09:00:23.934138-05:
      DOI: 10.1111/dme.13426
  • Association between thyroid dysfunction and dysglycaemia: a prospective
           cohort study
    • Authors: C.-H. Chang; Y.-C. Yeh, S.-R. Shih, J.-W. Lin, L.-M. Chuang, J. L. Caffrey, Y.-K. Tu
      Abstract: AimsTo compare the incidence of hyperglycaemia among participants with low, elevated and normal serum thyroid-stimulating hormone concentration, as well as the incidence of abnormal thyroid function test results among participants with normal blood glucose and those with hyperglycaemia.MethodsIn a prospective study, a cohort of 72 003 participants with normal, low and elevated serum thyroid-stimulating hormone concentration were followed from the study beginning to the first report of diabetes and prediabetes. A proportional hazards regression model was used to calculate the hazard ratios and 95% CIs for each outcome, adjusting for age, sex, education level, smoking, alcohol consumption and obesity. Analyses for the association between dysglycaemia and incident abnormal thyroid function test were also conducted.ResultsDuring a median 2.6 year follow-up, the incident rates for dysglycaemia, particularly prediabetes, were substantially higher in participants with elevated thyroid-stimulating hormone concentrations at baseline, while the rates for participants with normal and low thyroid-stimulating hormone were similar. After controlling for risk factors, participants with elevated thyroid-stimulating hormone retained a 15% increase in risk of prediabetes (adjusted hazard ratio 1.16, 95% CI 1.05–1.28), but were not at greater risk of diabetes (adjusted hazard ratio 1.04, 95% CI 0.68–1.52). By contrast, participants with normal and low thyroid-stimulating hormone concentrations had similar dysglycaemia risks. Participants with diabetes and prediabetes were not at greater risks of developing abnormal thyroid function test results when compared with participants with euglycaemia.ConclusionsPeople with elevated serum thyroid-stimulating hormone concentration are at greater risk of developing prediabetes. Whether this includes a greater risk of developing frank diabetes may require an extended period of follow-up to clarify.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-14T20:50:37.610483-05:
      DOI: 10.1111/dme.13420
  • Diabetes and risk of occupational injury: a cohort study
    • Authors: A. Kouvonen; M. Kivimäki, J. Pentti, V. Aalto, T. Oksanen, M. Virtanen, J. Vahtera
      Abstract: AimsTo investigate if diabetes is associated with a higher risk of occupational (workplace or commuting) injury.MethodsMedication data from the Finnish Prescription Register were used to identify diabetes cases in 2004 in a large employee cohort (the Finnish Public Sector study). These data were linked to injury records obtained from the Federation of Accident Insurance Institutions. A total of 1020 diabetes cases (median age 52 years, range 20 to 65 years; 66% women) and their 5234 age- and sex-matched controls were followed up until 2011. Sex-stratified Cox proportional hazards models, adjusting for age, occupational status, obesity and health behaviours, were applied. Because of the small number of men in the cohort, injury types and locations were only examined among women.ResultsDuring the median follow-up of 6.7 years, 25% of the participants with diabetes (n=252) and 20% of those without (n=1051) experienced an occupational injury. The association between diabetes and injury was stronger in women than men (P=0.048). Diabetes was associated with a higher risk of workplace (hazard ratio 1.37, 95% CI 1.11 to 1.69) and commuting (hazard ratio 1.36, 95% CI 1.03 to 1.79) injury in women. With regard to different injury types and locations, diabetes was associated with bone fractures, dislocations, sprains and strains, and injuries to upper and lower extremities. In men, there was an association between insulin-treated diabetes and commuting injury (hazard ratio 3.14, 95% CI 1.52 to 6.49).ConclusionsDiabetes was associated with workplace and commuting injuries in women. Men with insulin-treated diabetes had a higher risk of commuting injuries.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-13T10:05:19.272321-05:
      DOI: 10.1111/dme.13423
  • Individual and partner's level of occupation and the association with
           HbA1c levels in people with Type 2 diabetes mellitus: the Dutch Diabetes
           Pearl cohort
    • Authors: A. Rutte; S. P. Rauh, M. T. Schram, G. Nijpels, J. H. DeVries, F. Holleman, H. Pijl, O. M. Dekkers, B. Özcan, E. J. G. Sijbrands, C. J. Tack, E. J. Abbink, H.W. de Valk, B. Silvius, B. H. R. Wolffenbuttel, C. D. A. Stehouwer, N. C. Schaper, J. M. Dekker, J. W. Beulens, P. J. M. Elders, F. Rutters,
      Abstract: AimsTo examine the cross-sectional association between individual/partner's level of occupation with HbA1c levels in people with Type 2 diabetes in the Netherlands.MethodsWe included people with Type 2 diabetes with a partner who were treated in primary, secondary and tertiary care in the Diabetes Pearl cohort. Occupational level was classified according to International Standard Classification of Occupations (ISCO)-08 skill levels. Linear regression analyses were performed stratified for sex, and corrected for age, recruitment centre and diabetes medication.ResultsIn total, 3257 participants (59.8% men, mean 62.2±9.4 years) were included. For men, having a partner with an intermediate level of occupation was associated with lower HbA1c levels [e.g. ISCO level 3: –2 mmol/mol (95% CI –4;–1) or -0.2% (95% CI –0.4;–0.1)], compared with having a partner of the highest occupational level (ISCO level 4). In women, having an unemployed partner was associated with higher HbA1c levels [14 mmol/mol (95% CI 6; 22) or 1.3% (95% CI 0.6; 2.0)], compared with having a partner of the highest occupational level.ConclusionsPartner's occupational status provided additional information on the association between socio-economic status and HbA1c levels in people with Type 2 diabetes. Women seemed to benefit from a partner with a higher occupational status, while men seemed to benefit from a partner with a lower status. Because of the cross-sectional nature of the present study, more research is necessary to explore this association.This article is protected by copyright. All rights reserved.
      PubDate: 2017-07-13T09:50:22.356035-05:
      DOI: 10.1111/dme.13422
  • Prevalence and characteristics of paediatric Type 2 diabetes in the
           Republic of Ireland
    • Authors: M. I. O'Dea; S. M. O'Connell, M. J. O'Grady
      Abstract: ObjectiveTo establish the prevalence of paediatric Type 2 diabetes in the Republic of Ireland and describe patient demographics, initial presentation, management, outcomes, comorbidities and complications.MethodsUsing a standardized proforma we conducted a cross-sectional survey of children and adolescents aged < 16 years with a diagnosis of Type 2 diabetes between October and December 2015 in each of the 19 centres in the Republic of Ireland responsible for the care of children with diabetes.ResultsTwelve cases of Type 2 diabetes were identified, giving a prevalence in children aged
      PubDate: 2017-07-13T09:45:21.633142-05:
      DOI: 10.1111/dme.13425
  • A practical framework for encouraging and supporting positive behaviour
           change in diabetes
    • Authors: L. Fisher; W. H. Polonsky, D. Hessler, M. B. Potter
      Abstract: A wide range of diabetes-directed interventions – including novel medications, devices and comprehensive education programmes – have been shown to be effective in clinical trials. But in the real world of diabetes care their efficacy is often dependent upon on how well a clinician is able to support personal engagement and motivation of the person with diabetes to use these new tools and knowledge consistently, and as directed . Although many person-centred motivational and behavioural strategies have been developed, for example, action planning, motivational interviewing and empowerment-based communication, the sheer number and apparent lack of clear differences among them have led to considerable confusion. The primary goal of this review, therefore, is to provide a practical framework that organizes and structures these programmes to enhance their more systematic use in clinical care. Its purpose is to enhance clinician efforts to respectfully encourage and support engagement and motivation for behaviour change in people with diabetes. The three-step framework for organizing and describing the specific clinical processes involved is based on self-determination theory and includes: clinician preparation for a different type of clinical encounter, clinician/person with diabetes relationship building, and clinician utilization of specific behavioural tools. We conclude with practical considerations for application of this framework to the real world of clinical care.This article is protected by copyright. All rights reserved.
      PubDate: 2017-06-21T11:50:24.359829-05:
      DOI: 10.1111/dme.13414
  • Behavioural implications of traditional treatment and closed-loop
           automated insulin delivery systems in Type 1 diabetes: applying a
           cognitive restraint theory framework
    • Authors: A. R. Kahkoska; E. J. Mayer-Davis, K. K. Hood, D. M. Maahs, K. S. Burger
      Abstract: As the prevalence of obesity in Type 1 diabetes rises, the effects of emerging therapy options should be considered in the context of both weight and glycaemic control outcomes. Artificial pancreas device systems will ‘close the loop’ between blood glucose monitoring and automated insulin delivery and may transform day-to-day dietary management for people with Type 1 diabetes in multiple ways. In the present review, we draw directly from cognitive restraint theory to consider unintended impacts that closed-loop systems may have on ingestive behaviour and food intake. We provide a brief overview of dietary restraint theory and its relation to weight status in the general population, discuss the role of restraint in traditional Type 1 diabetes treatment, and lastly, use this restraint framework to discuss the possible behavioural implications and opportunities of closed-loop systems in the treatment of Type 1 diabetes. We hypothesize that adopting closed-loop systems will lift the diligence and restriction that characterizes Type 1 diabetes today, thus requiring a transition from a restrained eating behaviour to a non-restrained eating behaviour. Furthermore, we suggest this transition be leveraged as an opportunity to teach people lifelong eating behaviour to promote healthy weight status by incorporating education and cognitive reappraisal. Our aim was to use a transdisciplinary approach to highlight critical aspects of the emerging closed-loop technologies relating to eating behaviour and weight effects and to promote discussion of strategies to optimize long-term health in Type 1 diabetes via two key outcomes: glycaemic control and weight management.This article is protected by copyright. All rights reserved.
      PubDate: 2017-06-19T02:36:41.095239-05:
      DOI: 10.1111/dme.13407
  • Table of Contents 1
    • Pages: 1489 - 1489
      PubDate: 2017-10-17T06:42:11.504393-05:
      DOI: 10.1111/dme.13246
  • Table of Contents 2
    • Pages: 1491 - 1491
      PubDate: 2017-10-17T06:42:07.778527-05:
      DOI: 10.1111/dme.13247
  • Aims and Scope
    • Pages: 1492 - 1492
      PubDate: 2017-10-17T06:42:08.478637-05:
      DOI: 10.1111/dme.13248
  • The language of diabetes: the good, the bad and the ugly
    • Authors: R. I. G. Holt; J. Speight
      Pages: 1495 - 1497
      PubDate: 2017-10-17T06:42:08.5523-05:00
      DOI: 10.1111/dme.13520
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