Journal Cover Diabetic Medicine
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   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  [1589 journals]
  • 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
  • Predictors of early renal function decline in Type 1 diabetes: retinopathy
    • Authors: M. Monlun; L. Blanco, L. Alexandre, K. Mohammedi, V. Rigalleau
      Abstract: We were interested to read the recent article in Diabetic Medicine by Bjornstad et al. [1], who found that high estimated GFR (eGFR) and albumin excretion rates predicted early renal function decline in 91/308 people with Type 1 diabetes mellitus. Early renal function decline is defined as a three- to fivefold increase in annual eGFR loss compared with the normal physiology of aging (~1 ml/min/1.73m2/year).This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-28T08:45:32.379075-05:
      DOI: 10.1111/dme.13558
  • Research: Educational and Psychological Aspects Eating disorders in people
           with Type 1 diabetes: experiential perspectives of both clients and
           healthcare professionals
    • Authors: P. Macdonald; C. Kan, M Stadler, G. L. De Bernier, A. Hadjimichalis, A-S. Le Coguic, J. Allan, K. Ismail, J. Treasure
      Abstract: AimsTo explore the experiential perspective of people with Type 1 diabetes mellitus and eating disorders and that of the healthcare professionals treating them, and to understand the experience of both sides to inform future development of healthcare services.MethodsParticipants were recruited from Diabetics with Eating Disorders (a national UK charity), and through professional networks. Nine partially/fully recovered individuals with Type 1 diabetes and eating disorders and eight healthcare professionals participated in semi-structured interviews carried out by medically trained researchers. Data were transcribed and coded using a six-stage framework of thematic analysis.ResultsFour superordinate themes and several subordinate themes emerged from the Type 1 diabetes and eating disorders dataset: (1) perceptions surrounding service provision; (2) reflections on the recovery process; (3) the experiential perspective of living with Type 1 diabetes and an eating disorder; and (4) support mechanisms. Healthcare professional data elicited three superordinate themes and several subordinate themes: (1) service provision; (2) personal insight and reflection of professional role; and (3) challenges of working with dual diagnoses.ConclusionPeople with Type 1 diabetes and eating disorders and their healthcare professionals provided insight into healthcare services from the patient and care delivery perspectives. There was general agreement from both groups that a multidisciplinary, collaborative (family inclusive), clinical approach to treatment is important, as well as adequate training opportunities for service providers. These findings may help to inform development strategies for multidisciplinary care approaches to Type 1 diabetes complicated by eating disorders.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-27T11:02:21.875287-05:
      DOI: 10.1111/dme.13555
  • Insulin degludec overdose may lead to long-lasting hypoglycaemia through
           its markedly prolonged half-life
    • Authors: J. Uchida; Y. Oikawa, T. Katsuki, H. Takeda, A. Shimada, T. Kawai
      Abstract: BackgroundOverdose of insulin often causes long-lasting severe hypoglycaemia. Insulin degludec has the longest duration of action among the available insulin products; thus, an overdose of insulin degludec can lead to long-lasting hypoglycaemia. In the present paper, we report the case of a woman with long-lasting hypoglycaemia attributable to insulin degludec overdose and markedly prolonged insulin degludec half-life.Case reportA 64-year-old woman with Type 2 diabetes receiving insulin therapy was taken to an emergency department because of disturbed consciousness 21 h after self-injection of 300 units of insulin degludec (4.34 units/kg). Her plasma glucose level was 2.3 mmol/l. She received repeated intravenous boluses of dextrose for 43 h with continuous intravenous dextrose infusion, but no improvement in long-lasting hypoglycaemia or consciousness was observed. Considering the possibility of adrenal insufficiency, intravenous dexamethasone was administered, and her plasma glucose levels subsequently remained above 5.5 mmol/l without intravenous dextrose boluses. She gradually regained consciousness. A total of 34 h after the overdose, her plasma immunoreactive insulin levels were markedly increased and then gradually declined over ~400 h. The insulin degludec half-life was 40.76 h.ConclusionAlthough the reported half-life of insulin degludec in the body is ~25 h when administered in standard doses (0.4–0.8 units/kg), no study has investigated its half-life after overdose. In the present case, the half-life of insulin degludec was ~1.6 times longer than that observed with standard doses, probably leading to long-lasting hypoglycaemia. Physicians should be aware of the possibility of unexpected long-lasting severe hypoglycaemia resulting from insulin degludec overdose.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-27T09:56:11.813757-05:
      DOI: 10.1111/dme.13557
  • Low annual frequency of HbA1c testing in people with Type 2 diabetes in
           primary care practices in Germany
    • Authors: K. Kostev; L. Jacob, W. Rathmann
      Abstract: AimsTo analyse the annual frequency of HbA1c testing, as well as the factors associated with higher or lower testing frequency, in people with Type 2 diabetes mellitus in general practices and specialist diabetes practices in Germany.MethodsA total of 43 509 people diagnosed with Type 2 diabetes between January 2016 and December 2016 in 557 medical practices (51% of all practices) were included in this study. The primary outcome was the annual recorded frequency of HbA1c testing in 2016. Multivariable logistic regression analyses were performed to identify variables associated with the odds of HbA1c concentration being tested at least twice in 2016, using predefined demographic and clinical variables.ResultsThe mean (sd) number of reported HbA1c tests was 2.7 (1.6) in 2016. Overall, 74% of individuals had at least two annual HbA1c measurements. The likelihood of receiving ≥2 HbA1c tests was inversely associated with stroke (odds ratio 0.81, 95% CI 0.74–0.89), shorter diabetes duration (≤1 year: odds ratio 0.77, 95% CI 0.70–0.84) and higher mean HbA1c concentration (≥8.5%: odds ratio 0.85, 95% CI 0.76–0.94) and was positively associated with specialist diabetes care (odds ratio 1.24, 95% CI 1.14–1.36), hypertension (odds ratio 1.10, 95% CI 1.04–1.17), hyperlipidaemia (odds ratio 1.48, 95% CI 1.41 to 1.55), renal complications (odds ratio 1.41, 95% CI 1.32 to 1.50), neuropathy (odds ratio 1.27, CI 1.20 to 1.35) and retinopathy (odds ratio 1.38, 95% CI 1.25 to 1.52).ConclusionsOnly three out of four individuals with Type 2 diabetes underwent at least two HbA1c tests in Germany in 2016, which means that 25% of individuals underwent fewer tests than required by German guidelinesThis article is protected by copyright. All rights reserved.
      PubDate: 2017-11-25T10:45:27.986075-05:
      DOI: 10.1111/dme.13556
  • Emerging adulthood and Type 1 diabetes: insights from the DAWN2 Study
    • Authors: M. Vallis; I. Willaing, R. I. G. Holt
      Abstract: AimsTo compare clinical, psychological, education and social variables in emerging adults (aged 18–30 years) with Type 1 diabetes with their adult counterparts aged>30 years.MethodsA single assessment multinational sample was surveyed as part of the larger second Diabetes Attitudes, Wishes and Needs (DAWN2) study. Participants completed a series of surveys incorporating demographic as well as clinical questions (comorbidities, hypoglycaemia) and validated self-report scales concerning psychosocial (health impact, quality of life, beliefs and attitudes, self-management behaviours, healthcare experience and family support) and diabetes education factors.ResultsEmerging adults differed from adults aged>30 years with regard to a number of psychosocial variables. Emerging adults reported better overall quality of life, social support and support from their healthcare team compared with adults aged>30 years of age; however, emerging adults experienced greater diabetes-specific distress and were less engaged in self-management. Diabetes education was related to a number of indicators, while experience of discrimination was harmful, but these impacts did not differ between emerging adults and adults aged>30 years. An analysis of geographical regions suggested that emerging adults in North America and Europe had better well-being than older adults, while the opposite was observed in Asia.ConclusionsEmerging adults, particularly those in the later phase (ages 25–30 years) are especially at risk in terms of diabetes-specific distress. There is a need for novel interventions to meet the needs of these vulnerable emerging adults more effectively.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-24T04:02:24.033461-05:
      DOI: 10.1111/dme.13554
  • A survey of staffing levels in paediatric diabetes services throughout the
    • Authors: D. Charalampopoulos; R. Amin, J. T. Warner, R. M. Viner, F. Campbell, J. A. Edge, T. Stephenson, ,
      Abstract: AimsTo assess staffing levels of healthcare professionals involved in the care of children and young people with diabetes in the UK.MethodsA web-based questionnaire was distributed to lead consultant paediatricians from all paediatric diabetes services in the UK between October and December 2014. Data on staffing levels and other aspects of diabetes services were collected and differences between the four nations of the UK and across the 10 English diabetes networks were explored.ResultsSome 175 services (93%) caring for 29 711 children and young people aged ≤ 24 years with diabetes participated in the survey. Northern Ireland and Wales had the lowest ratio of total staff to patient population. Nursing caseloads per one whole-time equivalent (WTE) nurse ranged from 71 patients in England to 110 patients in Northern Ireland with only 52% of the UK services meeting the Royal College of Nursing recommended nurse-to-patient ratio of
      PubDate: 2017-11-24T03:50:25.06411-05:0
      DOI: 10.1111/dme.13550
  • Men across a range of ethnicities have a higher prevalence of diabetes:
           findings from a cross-sectional study of 500000 UK Biobank participants
    • Authors: L. D. Ferguson; U. E. Ntuk, C. Celis-Morales, D. F. Mackay, J. P. Pell, J. M. R. Gill, N. Sattar
      Abstract: AimsStudies show that white men have a higher prevalence of Type 2 diabetes mellitus than women at a given age and BMI, but equivalent standardized data for other ethnic groups in the UK are sparse.MethodsThis cross-sectional study analysed UK Biobank data from 489 079 participants to compare the prevalence of diabetes mellitus across four major ethnic groups including: 471 700 (96.4%) white, 7871 (1.6%) South Asian, 7974 (1.6%) black and 1534 (0.3%) Chinese participants, before and after standardizing for age, socio-economic status (SES), BMI and lifestyle factors including physical activity, TV viewing, fruit and vegetable intake, processed meat, red meat, oily fish, alcohol intake and smoking. A subgroup analysis of South Asians was also undertaken.ResultsCrude diabetes prevalence was higher in men across all four ethnicities. After standardizing for age, SES, BMI and lifestyle factors, a significant sex difference in diabetes prevalence persisted in white (men 6.0% vs. women 3.6%), South Asian (21.0% vs. 13.8%) and black individuals (13.3% vs. 9.7%) (P 
      PubDate: 2017-11-24T03:50:20.645958-05:
      DOI: 10.1111/dme.13551
  • Testosterone therapy for sexual dysfunction in men with Type 2 diabetes: a
           systematic review and meta-analysis of randomized controlled trials
    • Authors: M. Algeffari; C. N. Jayasena, P. MacKeith, A. Thapar, W. S. Dhillo, N. Oliver
      Abstract: AimTo evaluate the effectiveness of testosterone therapy on a range of sexual function domains in men with Type 2 diabetes.MethodElectronic databases were searched for studies investigating the effect of testosterone therapy on sexual function in men with Type 2 diabetes. All randomized controlled trials were considered for inclusion if they compared the efficacy of testosterone therapy with that of placebo and reported sexual function outcomes. Statistical analysis was performed using a random-effects model, and heterogeneity was expressed using the I2 statistic.ResultsA total of 611 articles were screened. Six randomized control trials, in a total of 587 men with Type 2 diabetes, were eligible for inclusion. The pooled data suggested that testosterone therapy improves sexual desire (random-effects pooled effect size 0.314; 95% CI 0.082–0.546) and erectile function (random-effects pooled effect size 0.203; 95% CI 0.007–0.399) when compared with control groups. Testosterone therapy had no significant effect on constitutional symptoms or other sexual domains compared with control groups. No studies have investigated the incidence of prostate cancer, fertility and cardiovascular disease after testosterone therapy in men with Type 2 diabetes.ConclusionTestosterone therapy may moderately improve sexual desire and erectile function in men with Type 2 diabetes; however, available data are limited, and the long-term risks of testosterone therapy are not known in this specific patient group. We conclude that testosterone therapy is a potential treatment for men with Type 2 diabetes non-responsive to phosphodiesterase-5 inhibitors. Testosterone therapy could be considered for men with Type 2 diabetes when potential risks and benefits of therapy are carefully considered and other therapeutic options are unsuitable.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-24T02:55:41.931679-05:
      DOI: 10.1111/dme.13553
  • Person-centred, web-based support in pregnancy and early motherhood for
           women with Type 1 diabetes mellitus: a randomized controlled trial
    • Authors: K. Linden; M. Berg, A. Adolfsson, C. Sparud-Lundin
      Abstract: AimsTo report results from and explore use of a multicentre, parallel-group, unblinded, randomized controlled trial testing the effectiveness in terms of well-being and diabetes management of a person-centred, web-based support programme for women with Type 1 diabetes, in pregnancy and postpartum.MethodsBetween 2011 and 2014, 174 pregnant women with Type 1 diabetes were randomly allocated (1:1) to web-based support and standard care (intervention group, n=83), or standard care (control group, n=91). The web-based support consisted of evidence-based information; a self-care diary for monitoring of daily activities; and peer support in a discussion forum. The primary outcomes (mean difference, measured at 6 months after childbirth) were well-being and diabetes management.ResultsNo differences were found with regard to the primary outcome measure scores for general well-being [1.04 (95% CI –1.28 to 3.37); P= 0.68] and self-efficacy of diabetes management [0.076 (95% CI –0.123 to 0.275); P= 0.75], after adjustment for baseline differences in the insulin administration method, nor with regard to the secondary outcome measures.ConclusionsAt 6 months after childbirth, the web-based support plus standard care was not superior to standard care in terms of general well-being or self-efficacy of diabetes management. This might be explained by the low number of participants who had a high activity level. Few simultaneously active participants in the web-based programme and stressors in motherhood and diabetes postpartum were the main barriers to its use. Further intervention studies that offer web-based support are needed, with lessons learned from the present study.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-24T02:50:22.862504-05:
      DOI: 10.1111/dme.13552
  • Reducing amputation in diabetes: work from the West Country provides both
           evidence and a tool-kit
    • Authors: W. Jeffcoate; B. Young
      PubDate: 2017-11-22T01:55:26.264313-05:
      DOI: 10.1111/dme.13538
  • Cost-effectiveness of the psycho-educational blended (group and online)
           intervention HypoAware compared with usual care for people with Type 1 and
           insulin-treated Type 2 diabetes with problematic hypoglycaemia: analyses
           of a cluster-randomized controlled trial
    • Authors: M. de Wit; S. M. P. A. Rondags, M. W. van Tulder, F. J. Snoek, J. E. Bosmans
      Abstract: AimsTo evaluate the cost-effectiveness of HypoAware, a blended (group and online) psycho-educational intervention based on the evidence-based Blood Glucose Awareness Training, in comparison with usual care in people with Type 1 and Type 2 diabetes with a high risk of severe hypoglycaemia.MethodsWe performed an economic evaluation, from a societal and healthcare perspective, that used data from a 6-month, multicentre, cluster-randomized controlled trial (n=137).ResultsThe proportion of people with at least one severe hypoglycaemic event per 6 months was 0.22 lower (95% CI –0.39 to –0.06) and the proportion of people with impaired hypoglycaemia awareness was 0.16 lower (95% CI –0.34 to 0.02) in the HypoAware group. There was no difference in quality-adjusted life-years (–0.0; 95% CI –0.05 to 0.05). The mean total societal costs in the HypoAware group were EUR708 higher than in the usual care group (95% CI –951 to 2298). The mean incremental cost per severe hypoglycaemic event prevented was EUR2,233. At a willingness-to-pay threshold of EUR20,000 per event prevented, the probability that HypoAware was cost-effective in comparison with usual care was 54% from a societal perspective and 55% from a healthcare perspective. For quality-adjusted life-years the incremental cost-effectiveness ratio was EUR119,360/quality-adjusted life-year gained and the probability of cost-effectiveness was low at all ceiling ratios.ConclusionsBased on the present study, we conclude that HypoAware is not cost-effective compared to usual care. Further research in less well-resourced settings and more severely affected patients is warranted.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-18T02:20:32.795452-05:
      DOI: 10.1111/dme.13548
  • Family behaviours that have an impact on the self-management activities of
           adults living with Type 2 diabetes: a systematic review and meta-synthesis
    • Authors: J. Vongmany; T. Luckett, L. Lam, J. L. Phillips
      Abstract: AimsTo identify family behaviours that adults with Type 2 diabetes’ perceive as having an impact on their diabetes self-management.BackgroundResearch suggests that adults with Type 2 diabetes perceive that family members have an important impact on their self-management; however, it is unclear which family behaviours are perceived to influence self-management practices.MethodsThis meta-synthesis identified and synthesized qualitative studies from the databases EMBASE, Medline and CINAHL published between the year 2000 and October 2016. Studies were eligible if they provided direct quotations from adults with Type 2 diabetes, describing the influence of families on their self-management. This meta-synthesis adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement.ResultsOf the 2606 studies screened, 40 were included. This meta-synthesis identified that adults with Type 2 diabetes perceive family behaviours to be either: 1) facilitators of diabetes self-management; 2) barriers to diabetes self-management; or 3) equivocal behaviours with the potential to both support and/or impede diabetes self-management. Seven sub-themes were identified within these themes, including: four facilitator sub-themes (‘positive care partnerships’; ‘family watchfulness’; ‘families as extrinsic motivator’ and ‘independence from family’); two barrier sub-themes (‘obstructive behaviours’ and ‘limited capacity for family support’); and one equivocal behaviours subtheme (‘regular reminders and/or nagging’).ConclusionWhile most family behaviours are unambiguously perceived by adults with Type 2 diabetes to act as facilitators of or barriers to self-management, some behaviours were perceived as being neither clear facilitators nor barriers; these were termed ‘equivocal behaviours’. If the concept of ‘equivocal behaviours’ is confirmed, it may be possible to encourage the adult living with Type 2 diabetes to reframe these behaviours so that they are perceived as enabling their diabetes self-management.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-18T02:10:27.644848-05:
      DOI: 10.1111/dme.13547
  • Route to improving Type 1 diabetes mellitus glycaemic outcomes: real-world
           evidence taken from the National Diabetes Audit
    • Authors: A. H. Heald; M. Livingston, A. Fryer, G. Y. C. Moreno, N. Malipatil, R. Gadsby, W. Ollier, M. Lunt, M. Stedman, R. J. Young
      Abstract: AimTo use general practice-level data for England, available through the National Diabetes Audit, and primary care prescribing data to identify prescription treatment factors associated with variations in achieved glucose control (HbA1c).MethodsGeneral practice-level National Diabetes Audit data on Type 1 diabetes, including details of population characteristics, services, proportion of people achieving target glycaemic control [HbA1c ≤58 mmol/mol (7.5%)] and proportion of people at high glycaemic risk [HbA1c>86 mmol/ml (10%)], were linked to 2013–2016 primary care diabetes prescribing data on insulin types and blood glucose monitoring for all people with diabetes.ResultsA wide variation was found between the 10th percentile and the 90th percentile of general practices in both target glycaemic control (15.6% to 44.8%, respectively) and high glycaemic risk (4.8% to 28.6%, respectively). Our analysis suggests that, given the extrapolated total of 280 000 people with Type 1 diabetes in the UK, there may be the potential to increase the number of those within target glycaemic control from 80 000 to 101 000; 53% of this increase (11 000 people) would result from service improvements and 47% (10 000 people) from medication and technology changes. The same improvements would also provide the opportunity to reduce the number of people at high glycaemic risk from 42 000 to 26 500. A key factor associated with practice-level target HbA1c achievement was greater use of insulin pumps for up to an additional 56 000 people.ConclusionIf the HbA1c achievement rates in service provision, medication and use of technology currently seen in practices in the 90th percentile were to be matched with regard to HbA1c achievement rates in all general practices, glycaemic control might be improved for 36 500 people, with all the attendant health benefits.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-09T10:50:22.045241-05:
      DOI: 10.1111/dme.13541
  • Intrapartum glycaemic control and neonatal hypoglycaemia in pregnancies
           complicated by diabetes mellitus: a systematic review
    • Authors: J. M. Yamamoto; J. Benham, K. Mohammad, L. E. Donovan, S. Wood
      Abstract: AimsTo examine whether, in neonates of mothers with Type 1, Type 2 and gestational diabetes mellitus, in-target intrapartum glycaemic control was associated with a lower risk of neonatal hypoglycaemia compared with out-of-target glycaemic control.MethodsWe searched PubMed and EMBASE for all available publications, regardless of year, based on a published protocol (PROSPERO CRD42016052439). Studies were excluded if they did not report original data or were animal studies. Data were extracted from published reports in duplicate using a prespecified data extraction form. The main outcome of interest was the association between in-target intrapartum glycaemic control and neonatal hypoglycaemiaResultsWe screened 2846 records for potential study inclusion; 23 studies, including approximately 2835 women with diabetes, were included in the systematic review. Only two of those studies specifically examined in-target vs out-of-target intrapartum glycaemic control. Of the studies included, six showed a relationship between intrapartum glucose and neonatal hypoglycaemia, five others showed a relationship in at least one of the analyses performed and 12 did not find a significant relationship. Only one study was identified as having a low risk of bias.ConclusionsThere is a paucity of high-quality data supporting the association of glucose during labour and delivery with neonatal hypoglycaemia in pregnancies complicated by diabetes. Further studies are required to examine the impact of tight glycaemic targets in labourThis article is protected by copyright. All rights reserved.
      PubDate: 2017-11-08T12:05:29.572817-05:
      DOI: 10.1111/dme.13546
  • Route to improving Type 1 diabetes mellitus glycaemic outcomes: real-world
           evidence taken from the National Diabetes Audit
    • Authors: P. J. Hammond
      Abstract: The National Diabetes Audit (NDA) has helped to highlight the disparity in glycaemic outcomes between those with Type 1 and those with Type 2 diabetes. Whilst ~70% of those with Type 2 diabetes achieve an HbA1c concentration
      PubDate: 2017-11-08T12:05:21.608162-05:
      DOI: 10.1111/dme.13545
  • Mortality and acute complications in children and young adults diagnosed
           with Type 1 diabetes in Yorkshire, UK: a cohort study
    • Authors: T. C. Evans-Cheung; H. J. Bodansky, R. C. Parslow, R. G. Feltbower
      Abstract: AimsTo examine all-cause and cause-specific mortality in a population-based cohort of people with early and late onset of Type 1 diabetes.MethodsThe Yorkshire Register of Diabetes in Children and Young People includes individuals with early (0–14 years) and late (1529 years) Type 1 diabetes onset, diagnosed between 1978 and 2013. This register was linked to death certification data from the Office for National Statistics to calculate standardized mortality ratios, cumulative mortality curves using Kaplan–Meier survival estimates, and Cox regression modelling. Ethnicity was derived using Onomap. Deprivation status was classified using the Townsend index. The underlying cause of death in each case was clinically verified.ResultsThere were 229 deaths in 5498 individuals with 100 959 person-years of follow-up. The overall standardized mortality ratio was 4.3 (95% CI 3.8 to 4.9). There were no significant differences in standardized mortality ratios according to age of onset, sex or deprivation status. The standardized mortality ratios were significantly higher for people of white ethnic origin [8.1 (95% CI 6.9 to 9.4)] than for those of South-Asian ethnic origin [3.4 (95% CI 1.7 to 6.4)]. The mortality risk was lower in those diagnosed in later years (2002 to 2013 for the early-onset and 2006 to 2013 for the late-onset group) compared with earlier years (1991 to 1997 for the early-onset and 1991 to 1997 for the late-onset group) for both onset groups [hazard ratio 0.13 (95% CI 0.05 to 0.33) vs 0.24 (95% CI 0.07 to 0.81)]. Mortality risk improved over time for chronic complications in the early-onset group only, but there was no improvement in either onset group with regard to acute complications.ConclusionsAn excess of deaths in the population with Type 1 diabetes remains. Although the all-cause mortality risk has fallen over time, no improvement has been found in the mortality risk associated with acute complications.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-07T08:20:40.231324-05:
      DOI: 10.1111/dme.13544
  • Association between diabetes mellitus and olfactory dysfunction: current
           perspectives and future directions
    • Authors: H. Zaghloul; M. Pallayova, O. Al-Nuaimi, K. R. Hovis, S. Taheri
      Abstract: The increasing global prevalence of diabetes mellitus presents a significant challenge to healthcare systems today. Although diabetic retinopathy, nephropathy and neuropathy are well-established complications of diabetes, there is a paucity of research examining the impact of dysglycaemia on the olfactory system. Olfaction is an important sense, playing a role in the safety, nutrition and quality of life of an individual, but its importance is often overlooked when compared with the other senses. As a result, olfactory dysfunction is often underdiagnosed. The present review article aims to present and discuss the available evidence on the relationship between diabetes and olfaction. It also explores the associations between olfactory dysfunction and diabetes complications that could explain the underlying pathogenesis. Finally, it summarizes the putative pathological mechanisms underlying olfactory dysfunction in diabetes that require further investigation.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-06T15:05:21.605903-05:
      DOI: 10.1111/dme.13542
  • Prevalence and severity of non-alcoholic fatty liver disease are
           underestimated in clinical practice: impact of a dedicated screening
           approach at a large university teaching hospital
    • Authors: T. Marjot; E. Sbardella, A. Moolla, J. Hazlehurst, G. D. Tan, M. Ainsworth, J. F. L. Cobbold, J.W. Tomlinson
      Abstract: AimsTo define the attitudes and current clinical practice of diabetes specialists with regard to non-alcoholic fatty liver disease and, based on the results, implement an evidenced-based pathway for non-alcoholic fatty liver disease assessment.MethodsAn online survey was disseminated to diabetes specialists. Based on findings from this survey, we sought a local solution by launching an awareness campaign and implementing a screening algorithm across all diabetes clinics at a secondary/tertiary referral centre.ResultsA total of 133 diabetes specialists responded to the survey. Fewer than 5% of responders correctly assessed the prevalence and severity of advanced fibrotic non-alcoholic fatty liver disease in people with diabetes as 50–75%. Whilst most clinicians performed liver function tests, only 5.7% responded stating that they would use, or had used, a non-invasive algorithm to stage the severity of non-alcoholic fatty liver disease. Implementing a local non-alcoholic fatty liver disease awareness campaign and screening strategy using pre-printed blood request forms, we ensured that 100% (n=395) of all people with Type 1 and Type 2 diabetes mellitus attending secondary/tertiary care diabetes clinics over a 6-month period were appropriately screened for advanced fibrotic non-alcoholic fatty liver disease using the Fib-4 index; 17.9% required further investigation or assessment.ConclusionsThe prevalence and severity of non-alcoholic fatty liver disease are underestimated among diabetes specialists. The Fib-4 index can easily be incorporated into clinical practice in secondary/tertiary care to identify those individuals at risk of advanced fibrosis who require further assessment and who may benefit from a dedicated multidisciplinary approach to their management.This article is protected by copyright. All rights reserved.
      PubDate: 2017-11-02T02:45:30.324534-05:
      DOI: 10.1111/dme.13540
  • Research: Complications Prognosis of the infected diabetic foot ulcer: a
           12-month prospective observational study
    • Authors: Mwidimi Ndosi; Alexandra Wright-Hughes, Sarah Brown, Michael Backhouse, Benjamin A. Lipsky, Moninder Bhogal, Catherine Reynolds, Peter Vowden, Edward Jude, Jane Nixon, E. Andrea Nelson
      Abstract: AimsTo determine clinical outcomes and explore prognostic factors related to ulcer healing in people with a clinically infected diabetic foot ulcer.MethodsThis multicentre, prospective, observational study reviewed participants’ data at 12 months after culture of a diabetic foot ulcer requiring antibiotic therapy. From participants’ notes, we obtained information on the incidence of wound healing, ulcer recurrence, lower extremity amputation, lower extremity revascularization and death. We estimated the cumulative incidence of healing at 6 and 12 months, adjusted for lower extremity amputation and death using a competing risk analysis, and explored the relationship between baseline factors and healing incidence.ResultsIn the first year after culture of the index ulcer, 45/299 participants (15.1%) had died. The ulcer had healed in 136 participants (45.5%), but recurred in 13 (9.6%). An ipsilateral lower extremity amputation was recorded in 52 (17.4%) and revascularization surgery in 18 participants (6.0%). Participants with an ulcer present for ~2 months or more had a lower incidence of healing (hazard ratio 0.55, 95% CI 0.39 to 0.77), as did those with a PEDIS (perfusion, extent, depth, infection, sensation) perfusion grade of ≥2 (hazard ratio 0.37, 95% CI 0.25 to 0.55). Participants with a single ulcer on their index foot had a higher incidence of healing than those with multiple ulcers (hazard ratio 1.90, 95% CI 1.18 to 3.06).ConclusionsClinical outcomes at 12 months for people with an infected diabetic foot ulcer are generally poor. Our data confirm the adverse prognostic effect of limb ischaemia, longer ulcer duration and the presence of multiple ulcers.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-30T10:05:34.154211-05:
      DOI: 10.1111/dme.13537
  • Research: Educational and psychological aspects Pilot feasibility study
           examining a structured self-management diabetes education programme,
           DESMOND-ID, targeting HbA1c in adults with intellectual disabilities
    • Authors: L. Taggart; M. Truesdale, M. E. Carey, L. Martin-Stacey, J. Scott, B. Bunting, V. Coates, M. Brown, T. Karatzias, R. Northway, J. M. Clarke
      Abstract: AimTo report on the outcomes of a pilot feasibility study of a structured self-management diabetes education programme targeting HbA1c.MethodsWe conducted a two-arm, individually randomized, pilot superiority trial for adults with intellectual disability and Type 2 diabetes mellitus. A total of 66 adults with disabilities across the UK met the eligibility criteria. Of these, 39 agreed to participate and were randomly assigned to either the DESMOND-ID programme (n=19) or a control group (n= 20). The programme consisted of seven weekly educational sessions. The primary outcome was HbA1c level, and secondary outcomes included BMI, diabetes illness perceptions, severity of diabetes, quality of life, and attendance rates.ResultsThis study found that the DESMOND-ID programme was feasible to deliver. With reasonable adjustments, the participants could be recruited successfully, and could provide consent, complete the outcome measures, be randomized to the groups and attend most of the sessions, with minimal loss to follow-up. The fixed-effects model, the interaction between occasion (time) and condition, showed statistically significant results (0.05 level) for HbA1c; however, the CI was large.ConclusionThis is the first published study to adapt and pilot a national structured self-management diabetes education programme for adults with intellectual disability. This study shows it is possible to identify, recruit, consent and randomize adults with intellectual disabilities to an intervention or control group. Internationally, the results of this pilot are promising, demonstrating that a multi-session education programme is acceptable and feasible to deliver. Its effectiveness should be further tested in an adequately powered trial.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-30T10:05:31.740118-05:
      DOI: 10.1111/dme.13539
  • Risk of prostate cancer across different racial/ethnic groups in men with
           diabetes: a retrospective cohort study
    • Authors: C. B. Chen; D. T. Eurich, S. R. Majumdar, J. A. Johnson
      Abstract: AimTo examine the associations between prostate cancer, diabetes and race/ethnicity.MethodsUsing administrative data from British Columbia, Canada for the period 1994 to 2012, we identified men aged ≥50 years with and without diabetes. Validated surname algorithms identified men as Chinese, Indian or of other race/ethnicity. Multivariable Cox regression was used to estimate adjusted risks of prostate cancer according to diabetes status and race/ethnicity.ResultsOur cohort of 160 566 men had a mean (sd) age of 64.7 (9.4) years and a median of 9 years’ follow-up. The incidence rates of prostate cancer among those with and without diabetes were 177.4 (171.7–183.4) and 216.0 (209.7–222.5) per 1000 person-years, respectively. The incidence among Chinese men was 120.9 (109.2–133.1), among Indian men it was 144.1 (122.8-169.0) and in men of other ethnicity it was 204.8 (200.2–209.5). Diabetes was independently associated with a lower risk of prostate cancer (adjusted hazard ratio 0.82, 95% CI 0.78–0.86), as was Chinese (adjusted hazard ratio 0.54, 95% CI 0.46,0.63) and Indian (adjusted hazard ratio 0.66, 95% CI 0.49,0.89) race/ethnicity; however, there was no statistically significant interaction between diabetes status and race/ethnicity (all P>0.1).ConclusionDiabetes and Chinese and Indian race/ethnicity were each independently associated with a lower risk of prostate cancer.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-27T11:45:50.156323-05:
      DOI: 10.1111/dme.13536
  • Modelling incremental benefits on complications rates when targeting lower
           HbA1c levels in people with Type 2 diabetes and cardiovascular disease
    • Authors: S. A. Mostafa; R. L. Coleman, O. F. Agbaje, A. M. Gray, R. R. Holman, M. A. Bethel
      Abstract: AimGlucose-lowering interventions in Type 2 diabetes mellitus have demonstrated reductions in microvascular complications and modest reductions in macrovascular complications. However, the degree to which targeting different HbA1c reductions might reduce risk is unclear.MethodsParticipant-level data for Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS) participants with established cardiovascular disease were used in a Type 2 diabetes-specific simulation model to quantify the likely impact of different HbA1c decrements on complication rates. Ten-year micro- and macrovascular rates were estimated with HbA1c levels fixed at 86, 75, 64, 53 and 42 mmol/mol (10%, 9%, 8%, 7% and 6%) while holding other risk factors constant at their baseline levels. Cumulative relative risk reductions for each outcome were derived for each HbA1c decrement.ResultsOf 5717 participants studied, 72.0% were men and 74.2% White European, with a mean (sd) age of 66.2 (7.9) years, systolic blood pressure 134 (16.9) mmHg, LDL-cholesterol 2.3 (0.9) mmol/l, HDL-cholesterol 1.13 (0.3) mmol/l and median Type 2 diabetes duration 9.6 (5.1–15.6) years. Ten-year cumulative relative risk reductions for modelled HbA1c values of 75, 64, 53 and 42 mmol/mol, relative to 86 mmol/mol, were 4.6%, 9.3%, 15.1% and 20.2% for myocardial infarction; 6.0%, 12.8%, 19.6% and 25.8% for stroke; 14.4%, 26.6%, 37.1% and 46.4% for diabetes-related ulcer; 21.5%, 39.0%, 52.3% and 63.1% for amputation; and 13.6%, 25.4%, 36.0% and 44.7 for single-eye blindness.ConclusionsThese simulated complication rates might help inform the degree to which complications might be reduced by targeting particular HbA1c reductions in Type 2 diabetes.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-23T02:40:24.772195-05:
      DOI: 10.1111/dme.13533
  • A decrease in serum 1,5-anhydroglucitol levels is associated with the
           presence of a first-degree family history of diabetes in a Chinese
           population with normal glucose tolerance
    • Authors: X. Hu; X. He, X. Ma, H. Su, L. Ying, J. Peng, Y. Wang, Y. Bao, J. Zhou, W. Jia
      Abstract: AimThis study aimed to investigate alterations in HbA1c, glycated albumin (GA) and 1,5-anhydroglucitol (1,5-AG) in Chinese first-degree relatives of individuals with diabetes (FDR) in pursuit of an index for early screening of glucose metabolism disturbance.MethodsA total of 467 participants (age range: 20–78 years) with normal weight and normal glucose tolerance, as determined by a 75-g oral glucose tolerance test, were enrolled. HbA1c was measured using high-pressure liquid chromatography. Serum GA and 1,5-AG levels were determined by enzymatic methods. Serum insulin levels were measured using an electrochemiluminescence immunoassay.ResultsThe study population included 208 FDR and 259 non-FDR. Serum 1,5-AG levels were lower in FDR than that in non-FDR (20.4 ± 7.5 vs 23.8 ± 8.3 μg/ml, P < 0.001), but HbA1c and GA levels did not differ between them (P = 0.835 and 0.469, respectively). Logistic regression analysis revealed an independent relationship between a first-degree family history of diabetes and reduced serum 1,5-AG levels (odds ratio = 0.944, P < 0.001). Multiple regression analysis showed that a first-degree family history of diabetes (β = –3.041, P < 0.001) and insulinogenic index (β = 0.081, P = 0.001) were independently associated with serum 1,5-AG levels.ConclusionIn a Chinese population with normal glucose tolerance, serum 1,5-AG levels were lower among FDR, and serum 1,5-AG levels were independently associated with FDR status. For FDR, serum 1,5-AG levels were more sensitive than HbA1c or GA levels to early-phase abnormality in glucose metabolism.This article is protected by copyright. All rights reserved.
      PubDate: 2017-10-23T02:35:23.866056-05:
      DOI: 10.1111/dme.13534
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • Table of Contents 1
    • Pages: 1 - 1
      PubDate: 2017-12-10T22:07:08.772463-05:
      DOI: 10.1111/dme.13458
  • Table of Contents 2
    • Pages: 3 - 3
      PubDate: 2017-12-10T22:07:11.493014-05:
      DOI: 10.1111/dme.13459
  • Aims and Scope
    • Pages: 4 - 4
      PubDate: 2017-12-10T22:07:10.769534-05:
      DOI: 10.1111/dme.13460
  • Reducing the burden of diabetes complications
    • Authors: R. I. G. Holt
      Pages: 7 - 7
      PubDate: 2017-12-10T22:07:09.518255-05:
      DOI: 10.1111/dme.13549
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