Shaifali Kulkarni, P. Welsh, Myzoon Ali, J. Petrie
Background: The long-term burden of self-management in type 2 diabetes can impact quality of life. Aims: To examine associations between demographic and clinical factors, anxiety/depression and perception of health in people with type 2 diabetes. Methods: Retrospective analyses of anonymised data from completed clinical trials provided by the diabetes subsection of Virtual International Cardiovascular and Cognitive Trials Archive (VICCTA). Data on demographics, polypharmacy, HbA1c, anxiety/depression (EQ-5D-3L) and perception of health (EQ-5D-3L VAS) were extracted. Regression analyses explored associations amongst polypharmacy, HbA1c and quality of life (anxiety/depression and health perception) at baseline. Results: In 2783 participants with type 2 diabetes (median age 66 years (IQR 61–70), n=1,595 (57%) male), female sex and Caucasian/European ethnicity were each associated with increased anxiety/depression and lower EQ-5D-3L VAS scores. Following adjustment for covariates, each additional prescribed medication was associated with increased anxiety/depression: OR 1.09 (95% CI 1.04 to 1.14; p<0.001) and lower VAS scores: B= −1.06 (95% CI −1.37 to −0.75, p<0.001)). Conclusion: Demographic factors and polypharmacy are associated with anxiety/depression and lower health perception.
{"title":"Quality of life in people with Type 2 diabetes; a study in a multi-ethnic clinical trial population","authors":"Shaifali Kulkarni, P. Welsh, Myzoon Ali, J. Petrie","doi":"10.15277/bjd.2021.315","DOIUrl":"https://doi.org/10.15277/bjd.2021.315","url":null,"abstract":"Background: The long-term burden of self-management in type 2 diabetes can impact quality of life. Aims: To examine associations between demographic and clinical factors, anxiety/depression and perception of health in people with type 2 diabetes. Methods: Retrospective analyses of anonymised data from completed clinical trials provided by the diabetes subsection of Virtual International Cardiovascular and Cognitive Trials Archive (VICCTA). Data on demographics, polypharmacy, HbA1c, anxiety/depression (EQ-5D-3L) and perception of health (EQ-5D-3L VAS) were extracted. Regression analyses explored associations amongst polypharmacy, HbA1c and quality of life (anxiety/depression and health perception) at baseline. Results: In 2783 participants with type 2 diabetes (median age 66 years (IQR 61–70), n=1,595 (57%) male), female sex and Caucasian/European ethnicity were each associated with increased anxiety/depression and lower EQ-5D-3L VAS scores. Following adjustment for covariates, each additional prescribed medication was associated with increased anxiety/depression: OR 1.09 (95% CI 1.04 to 1.14; p<0.001) and lower VAS scores: B= −1.06 (95% CI −1.37 to −0.75, p<0.001)). Conclusion: Demographic factors and polypharmacy are associated with anxiety/depression and lower health perception.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2021-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42630079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The argument against everyone with hyperosmolar hyperglycaemic syndrome being given prophylactic treatment dose anticoagulation","authors":"K. Dhatariya, Philip Weston","doi":"10.15277/bjd.2021.314","DOIUrl":"https://doi.org/10.15277/bjd.2021.314","url":null,"abstract":"","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2021-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46215586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction Hyperosmolar hyperglycaemic state (HHS) is one of two serious metabolic derangements that occur in people with diabetes mellitus. The first cases of HHS were described by von Frerichs and Dreschfeld in the 1880s with an ‘unusual diabetic coma’. It is a serious, life-threatening, but fortunately rare emergency that, although less common than its counterpart, diabetic ketoacidosis (DKA), has around a 10 times higher mortality rate, up to 15–20%.1 HHS accounts for around 1% of hospital admissions in people with diabetes, typically in the elderly. Increasing prevalence of obesity has additionally increased the incidence of HHS in the paediatric population. Prognosis is worse when associated with increasing comorbidities, age and significant electrolyte abnormalities.2 It is well known that diabetes can affect the clotting pathway, resulting in endothelial dysfunction, eventually enhancing the activation of procoagulant factors, predisposing towards thrombosis. This process is further amplified in both hyperosmolarity and DKA.3 Several case reports highlight the significant mortality and morbidity that can be associated with venous thromboembolism (VTE) and its complications in people with hyperosmolarity including fatality from massive pulmonary embolism.1 Patients having major orthopaedic surgery tend to receive extended VTE prophylaxis and demonstrate significant reduction in VTE with this therapy. Given the paucity of evidence for prophylactic versus therapeutic anticoagulation in HHS, we looked at the evidence surrounding orthopaedic surgery where there has been considerable research. Direct oral anticoagulants are now being used for VTE prophylaxis in orthopaedic patients and may have a role in acutely unwell medical patients with a low risk of bleeding.4 The evidence regarding the potential benefit of prolonged anticoagulation in HHS remains unclear.5 We performed a literature review to look at the evidence.
{"title":"Anticoagulation in hyperosmolar hyperglycaemic state: a case report and review of the literature","authors":"S. Sim, A. Morrison, R. Gregory, M. Kong","doi":"10.15277/bjd.2021.313","DOIUrl":"https://doi.org/10.15277/bjd.2021.313","url":null,"abstract":"Introduction Hyperosmolar hyperglycaemic state (HHS) is one of two serious metabolic derangements that occur in people with diabetes mellitus. The first cases of HHS were described by von Frerichs and Dreschfeld in the 1880s with an ‘unusual diabetic coma’. It is a serious, life-threatening, but fortunately rare emergency that, although less common than its counterpart, diabetic ketoacidosis (DKA), has around a 10 times higher mortality rate, up to 15–20%.1 HHS accounts for around 1% of hospital admissions in people with diabetes, typically in the elderly. Increasing prevalence of obesity has additionally increased the incidence of HHS in the paediatric population. Prognosis is worse when associated with increasing comorbidities, age and significant electrolyte abnormalities.2 It is well known that diabetes can affect the clotting pathway, resulting in endothelial dysfunction, eventually enhancing the activation of procoagulant factors, predisposing towards thrombosis. This process is further amplified in both hyperosmolarity and DKA.3 Several case reports highlight the significant mortality and morbidity that can be associated with venous thromboembolism (VTE) and its complications in people with hyperosmolarity including fatality from massive pulmonary embolism.1 Patients having major orthopaedic surgery tend to receive extended VTE prophylaxis and demonstrate significant reduction in VTE with this therapy. Given the paucity of evidence for prophylactic versus therapeutic anticoagulation in HHS, we looked at the evidence surrounding orthopaedic surgery where there has been considerable research. Direct oral anticoagulants are now being used for VTE prophylaxis in orthopaedic patients and may have a role in acutely unwell medical patients with a low risk of bleeding.4 The evidence regarding the potential benefit of prolonged anticoagulation in HHS remains unclear.5 We performed a literature review to look at the evidence.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2021-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45118460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Hadjiconstantinou, H. Eborall, J. Troughton, N. Robertson, K. Khunti, M. Davies
Background: Many feel that their new identity as ‘someone living with diabetes’ does not fit with their biography. Some individuals may be able to re-assess life goals, adapt their identity and adjust to living with type 2 diabetes mellitus (T2DM). For others, the biographical disruption experienced with their condition may negatively affect their emotional well-being and identity. Aim: To conceptualise and explore the emotional challenges experienced living with T2DM, using biographical disruption as analytical references. Design and setting: Secondary qualitative analysis of data collected from 31 semi-structured interviews. Method: Semi-structured interviews were conducted with people with T2DM in England. Data analysis was informed by constant comparative techniques. Results: People with T2DM undergo a cognitive process when their biography suddenly becomes interrupted. Suboptimal T2DM can bring a feeling of loss of control over one’s future, and loss of independence. What used to be perceived as ‘normal’ is now perceived as something that requires regular management, negatively impacting their daily routine and ability to carry out activities that once used to be effortless. Conclusions: Living with T2DM that is socially stigmatised can lead to poor well-being and may disturb one’s life biography. Strategies must take place to bring awareness to healthcare professionals of the impact and disruption that T2DM can have on an individual’s biography, identity and diabetes management.
{"title":"A secondary qualitative analysis exploring the emotional and physical challenges of living with type 2 diabetes","authors":"M. Hadjiconstantinou, H. Eborall, J. Troughton, N. Robertson, K. Khunti, M. Davies","doi":"10.15277/bjd.2021.309","DOIUrl":"https://doi.org/10.15277/bjd.2021.309","url":null,"abstract":"Background: Many feel that their new identity as ‘someone living with diabetes’ does not fit with their biography. Some individuals may be able to re-assess life goals, adapt their identity and adjust to living with type 2 diabetes mellitus (T2DM). For others, the biographical disruption experienced with their condition may negatively affect their emotional well-being and identity.\u0000Aim: To conceptualise and explore the emotional challenges experienced living with T2DM, using biographical disruption as analytical references.\u0000Design and setting: Secondary qualitative analysis of data collected from 31 semi-structured interviews.\u0000Method: Semi-structured interviews were conducted with people with T2DM in England. Data analysis was informed by constant comparative techniques.\u0000Results: People with T2DM undergo a cognitive process when their biography suddenly becomes interrupted. Suboptimal T2DM can bring a feeling of loss of control over one’s future, and loss of independence. What used to be perceived as ‘normal’ is now perceived as something that requires regular management, negatively impacting their daily routine and ability to carry out activities that once used to be effortless.\u0000Conclusions: Living with T2DM that is socially stigmatised can lead to poor well-being and may disturb one’s life biography. Strategies must take place to bring awareness to healthcare professionals of the impact and disruption that T2DM can have on an individual’s biography, identity and diabetes management.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2021-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46037311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Case presentation A 29-year-old female presented with acute onset right thigh pain and swelling 24 hours after peritoneal dialysis catheter insertion. She had a background of type 1 diabetes mellitus diagnosed over 20 years prior to presentation. Her glycaemic control had been suboptimal, with multiple episodes of diabetic ketoacidosis and complications including diabetic retinopathy, gastroparesis, autonomic neuropathy and end stage renal disease secondary to diabetic nephropathy, requiring peritoneal dialysis. She was discharged after completing a course of intravenous antibiotics for presumed infection but re-presented one week later to her renal team with worsening right thigh pain and swelling. There was no history of trauma or symptoms to suggest an infective aetiology. On examination she was in severe pain. She was tachycardic with a pulse rate of 110 bpm, blood pressure was elevated at 158/90 mmHg, she was afebrile and had normal oxygen saturation levels. The peritoneal catheter site appeared clean and her abdomen was soft with no ascites. The right thigh was markedly enlarged, circumference 45 cm compared with 25 cm on the left (Figure 1), very tender and warm to touch and movement limited due to pain. There was no erythema or inguinal lymphadenopathy and peripheral pulses were easily palpable.
{"title":"Diabetic myonecrosis: challenges in diagnosis and management","authors":"Kanyada Koysombat, Sarra Elmustafa, Hardi Madani, Felicity Kaplan","doi":"10.15277/bjd.2021.311","DOIUrl":"https://doi.org/10.15277/bjd.2021.311","url":null,"abstract":"Case presentation A 29-year-old female presented with acute onset right thigh pain and swelling 24 hours after peritoneal dialysis catheter insertion. She had a background of type 1 diabetes mellitus diagnosed over 20 years prior to presentation. Her glycaemic control had been suboptimal, with multiple episodes of diabetic ketoacidosis and complications including diabetic retinopathy, gastroparesis, autonomic neuropathy and end stage renal disease secondary to diabetic nephropathy, requiring peritoneal dialysis. She was discharged after completing a course of intravenous antibiotics for presumed infection but re-presented one week later to her renal team with worsening right thigh pain and swelling. There was no history of trauma or symptoms to suggest an infective aetiology. On examination she was in severe pain. She was tachycardic with a pulse rate of 110 bpm, blood pressure was elevated at 158/90 mmHg, she was afebrile and had normal oxygen saturation levels. The peritoneal catheter site appeared clean and her abdomen was soft with no ascites. The right thigh was markedly enlarged, circumference 45 cm compared with 25 cm on the left (Figure 1), very tender and warm to touch and movement limited due to pain. There was no erythema or inguinal lymphadenopathy and peripheral pulses were easily palpable.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2021-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47477122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: We systematically reviewed all relevant literature on diabetic kidney disease (DKD) and pregnancy published in the last 20 years to provide accurate and up-to-date information to inform family planning and maternal care. Methods: A systematic review was completed in PubMed and Embase. Papers reporting maternal, fetal or renal outcomes of pregnant women with DKD published between 2001 and 2020 were included. Results: 799 potentially relevant articles were identified, 731 of which were excluded on abstract alone. 68 full-text articles were reviewed and 15 papers were included as they met the selection criteria but were heterogeneous for size, study setting and years studied. The definition of DKD varied between papers and changed over time. 843 women with 873 pregnancies were included. There were high rates of pre-eclampsia and caesarean section, up to 64% and 100% respectively. Prematurity and neonatal intensive care admission were common, reported in up to 100% and 75%, respectively. Maternal and fetal complications were more common with more severe proteinuria and renal impairment. Pregnancy did not hasten progression of DKD. Discussion: Adverse pregnancy outcomes are frequently encountered and correlate with degree of proteinuria and renal impairment. This information enables individualised risk stratification when a woman is considering pregnancy.
{"title":"Diabetic kidney disease and pregnancy outcomes: a systematic review","authors":"S. Gleeson, S. Svetitsky, C. Frise","doi":"10.15277/bjd.2021.306","DOIUrl":"https://doi.org/10.15277/bjd.2021.306","url":null,"abstract":"Introduction: We systematically reviewed all relevant literature on diabetic kidney disease (DKD) and pregnancy published in the last 20 years to provide accurate and up-to-date information to inform family planning and maternal care.\u0000Methods: A systematic review was completed in PubMed and Embase. Papers reporting maternal, fetal or renal outcomes of pregnant women with DKD published between 2001 and 2020 were included.\u0000Results: 799 potentially relevant articles were identified, 731 of which were excluded on abstract alone. 68 full-text articles were reviewed and 15 papers were included as they met the selection criteria but were heterogeneous for size, study setting and years studied. The definition of DKD varied between papers and changed over time. 843 women with 873 pregnancies were included. There were high rates of pre-eclampsia and caesarean section, up to 64% and 100% respectively. Prematurity and neonatal intensive care admission were common, reported in up to 100% and 75%, respectively. Maternal and fetal complications were more common with more severe proteinuria and renal impairment. Pregnancy did not hasten progression of DKD.\u0000Discussion: Adverse pregnancy outcomes are frequently encountered and correlate with degree of proteinuria and renal impairment. This information enables individualised risk stratification when a woman is considering pregnancy.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2021-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44322829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Travers, J. Dawson, A. Muthusami, Michael L. Wall
Introduction: Diabetes mellitus is a significant cause of morbidity and mortality. Foot-related complications affect 2–2.5% of people with diabetes. There is significant variation in outcomes for patients with diabetic foot disease within the UK. The multidisciplinary approach to diabetic foot disease is well publicised and protocols, guidance and consensus approaches exist for most components of the management of diabetic foot disease. Antimicrobial therapy to treat diabetic foot infections based on microbiological sampling and culture is well documented, but no consensus exists on how these samples should be obtained, processed and reported. Methods: A literature review was undertaken to establish the reporting of techniques used in obtaining and processing microbiological samples in diabetic foot disease to establish if consensus exists in the methodologies used with a view to develop best practice guidelines. Results: Six out of 102 papers reported all processes in obtaining and processing microbiological samples. Conclusion: No gold standard consensus exists for microbiological sampling of diabetic foot infections, preventing optimisation of this aspect of management of diabetic foot disease and ultimately potentially adversely affecting the outcomes of this growing patient cohort.
{"title":"Review of microbiological sampling in diabetic foot disease","authors":"H. Travers, J. Dawson, A. Muthusami, Michael L. Wall","doi":"10.15277/bjd.2021.310","DOIUrl":"https://doi.org/10.15277/bjd.2021.310","url":null,"abstract":"Introduction: Diabetes mellitus is a significant cause of morbidity and mortality. Foot-related complications affect 2–2.5% of people with diabetes. There is significant variation in outcomes for patients with diabetic foot disease within the UK. The multidisciplinary approach to diabetic foot disease is well publicised and protocols, guidance and consensus approaches exist for most components of the management of diabetic foot disease. Antimicrobial therapy to treat diabetic foot infections based on microbiological sampling and culture is well documented, but no consensus exists on how these samples should be obtained, processed and reported.\u0000Methods: A literature review was undertaken to establish the reporting of techniques used in obtaining and processing microbiological samples in diabetic foot disease to establish if consensus exists in the methodologies used with a view to develop best practice guidelines.\u0000Results: Six out of 102 papers reported all processes in obtaining and processing microbiological samples.\u0000Conclusion: No gold standard consensus exists for microbiological sampling of diabetic foot infections, preventing optimisation of this aspect of management of diabetic foot disease and ultimately potentially adversely affecting the outcomes of this growing patient cohort.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2021-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47063548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Shah, Harshal Deshmukh, E. Wilmot, J. Patmore, P. Choudhary, Peter Christian, R. Herring, N. Furlong, S. Saunders, P. Narendran, D. Barnes, C. Walton, R. Ryder, T. Sathyapalan
Background: Dose Adjustment For Normal Eating (DAFNE) is the gold standard National Institute for Health and Care Excellence (NICE) recommended structured education programme that promotes self-management in people living with type 1 diabetes (T1D). We have recently shown that FreeStyle Libre (FSL) is associated with improved haemoglobin A1c (HbA1c) and hypoglycaemia awareness. Aims: To explore the effect of structured education including DAFNE on HbA1c and GOLD score when combined with FSL use. Methods: The ABCD national audit data on FSL users were used to conduct this prospective longitudinal study. The Stu- dent’s t test was used to compare the baseline and follow-up HbA1c and a change in the GOLD score for hypoglycaemia awareness. The baseline demographic and clinical characteristics of the study population were compared using ANOVA. Linear regression analysis identified predictors of change in HbA1c with FSL use. Results: The study consisted of 14,880 people living with insulin-dependent diabetes mellitus (IDDM), 97% of whom had T1D, of which 50% were female, with a mean±SD base- line HbA1c of 70±18 mmol/mol and baseline body mass index (BMI) of 25.3±6.2 kg/m2. Follow-up data for HbA1c were avail- able for 6,446 participants while data for GOLD score were available for 5,057 participants. The study population was divided into three groups: 6,701 people with no prior structured education (Group 1), 3,964 with other structured education (Group 2), and 4,215 had previously attended DAFNE structured education (Group 3). Groups 2 and 3 who had previously attended structured education had a lower initial HbA1c than those in Group 1 (p<0.0001). However, there was a significant but similar magnitude of the fall in HbA1c across all groups (−8.10 mmol/mol vs −6.61 mmol/mol vs −6.22 mmol/mol in Groups 1, 2 and 3, respectively), with p (ANOVA)=0.83. Similarly, the decline in GOLD score was comparable in Groups 1, 2 and 3 (−0.33 vs −0.30 vs −0.34, respectively), with p (ANOVA)=0.43. Linear regression analysis identified higher baseline HbA1c (β=0.585, p<0.0001), number of FSL scans over 14 days (β=−0.026, p=0.00135) and other structured education (β=−1.207, p=0.02483) as predictors of HbA1c reduction. Prior DAFNE training was not associated with improved HbA1c reduction in the linear regression model. Conclusions: FSL use was associated with improvements in HbA1c and GOLD score. Although DAFNE is an evidence- based intervention to improve outcomes in those with T1D, DAFNE attendance prior to commencing FSL did not influence HbA1c or GOLD score outcomes when compared with FSL use alone. Other structured education was identified as a predictor of HbA1c reduction when combined with FSL use.
背景:正常饮食剂量调整(DAFNE)是国家健康与护理卓越研究所(NICE)推荐的结构化教育计划的金标准，旨在促进1型糖尿病患者(T1D)的自我管理。我们最近发现FreeStyle Libre (FSL)与改善血红蛋白A1c (HbA1c)和低血糖意识相关。目的:探讨包括DAFNE在内的结构化教育与FSL联合使用对HbA1c和GOLD评分的影响。方法:采用ABCD国家审计数据对FSL使用者进行前瞻性纵向研究。Stu- dent’s t检验用于比较基线和随访HbA1c以及低血糖认知的GOLD评分的变化。使用方差分析比较研究人群的基线人口学和临床特征。线性回归分析确定了使用FSL后HbA1c变化的预测因子。结果:该研究纳入了14880例胰岛素依赖型糖尿病(IDDM)患者，其中97%为T1D，其中50%为女性，平均±SD基线HbA1c为70±18 mmol/mol，基线体重指数(BMI)为25.3±6.2 kg/m2。随访的HbA1c数据为6,446名参与者，GOLD评分数据为5,057名参与者。研究人群分为三组:6,701人没有先前的结构化教育(第一组)，3,964人接受过其他结构化教育(第二组)，4,215人以前参加过DAFNE结构化教育(第三组)。先前参加过结构化教育的第2组和第3组的初始HbA1c低于第一组(p<0.0001)。然而，在所有组中，HbA1c的下降幅度显著但相似(1、2和3组分别为- 8.10 mmol/mol vs - 6.61 mmol/mol vs - 6.22 mmol/mol)， p(方差分析)=0.83。同样，1、2和3组的GOLD评分下降具有可比性(分别为- 0.33 vs - 0.30 vs - 0.34)， p(方差分析)=0.43。线性回归分析发现，较高的基线HbA1c (β=0.585, p<0.0001)、14天内FSL扫描次数(β= - 0.026, p=0.00135)和其他结构化教育(β= - 1.207, p=0.02483)是HbA1c降低的预测因子。在线性回归模型中，先前的DAFNE训练与改善的HbA1c降低无关。结论:FSL使用与HbA1c和GOLD评分的改善相关。虽然DAFNE是一种基于证据的干预措施，可以改善T1D患者的预后，但与单独使用FSL相比，在开始FSL之前参加DAFNE并不影响HbA1c或GOLD评分结果。当与FSL联合使用时，其他结构化教育被确定为HbA1c降低的预测因子。
{"title":"Previous structured education attendance and the relationship with HbA1c and hypoglycaemia awareness in people living with type 1 diabetes mellitus using FreeStyle Libre: insights from the Association of British Clinical Diabetologists (ABCD) Nationwide Audit","authors":"N. Shah, Harshal Deshmukh, E. Wilmot, J. Patmore, P. Choudhary, Peter Christian, R. Herring, N. Furlong, S. Saunders, P. Narendran, D. Barnes, C. Walton, R. Ryder, T. Sathyapalan","doi":"10.15277/bjd.2021.308","DOIUrl":"https://doi.org/10.15277/bjd.2021.308","url":null,"abstract":"Background: Dose Adjustment For Normal Eating (DAFNE) is the gold standard National Institute for Health and Care Excellence (NICE) recommended structured education programme that promotes self-management in people living with type 1 diabetes (T1D). We have recently shown that FreeStyle Libre (FSL) is associated with improved haemoglobin A1c (HbA1c) and hypoglycaemia awareness.\u0000Aims: To explore the effect of structured education including DAFNE on HbA1c and GOLD score when combined with FSL use.\u0000Methods: The ABCD national audit data on FSL users were used to conduct this prospective longitudinal study. The Stu- dent’s t test was used to compare the baseline and follow-up HbA1c and a change in the GOLD score for hypoglycaemia awareness. The baseline demographic and clinical characteristics of the study population were compared using ANOVA. Linear regression analysis identified predictors of change in HbA1c with FSL use.\u0000Results: The study consisted of 14,880 people living with insulin-dependent diabetes mellitus (IDDM), 97% of whom had T1D, of which 50% were female, with a mean±SD base- line HbA1c of 70±18 mmol/mol and baseline body mass index (BMI) of 25.3±6.2 kg/m2. Follow-up data for HbA1c were avail- able for 6,446 participants while data for GOLD score were available for 5,057 participants. The study population was divided into three groups: 6,701 people with no prior structured education (Group 1), 3,964 with other structured education (Group 2), and 4,215 had previously attended DAFNE structured education (Group 3). Groups 2 and 3 who had previously attended structured education had a lower initial HbA1c than those in Group 1 (p<0.0001). However, there was a significant but similar magnitude of the fall in HbA1c across all groups (−8.10 mmol/mol vs −6.61 mmol/mol vs −6.22 mmol/mol in Groups 1, 2 and 3, respectively), with p (ANOVA)=0.83. Similarly, the decline in GOLD score was comparable in Groups 1, 2 and 3 (−0.33 vs −0.30 vs −0.34, respectively), with p (ANOVA)=0.43. Linear regression analysis identified higher baseline HbA1c (β=0.585, p<0.0001), number of FSL scans over 14 days (β=−0.026, p=0.00135) and other structured education (β=−1.207, p=0.02483) as predictors of HbA1c reduction. Prior DAFNE training was not associated with improved HbA1c reduction in the linear regression model.\u0000Conclusions: FSL use was associated with improvements in HbA1c and GOLD score. Although DAFNE is an evidence- based intervention to improve outcomes in those with T1D, DAFNE attendance prior to commencing FSL did not influence HbA1c or GOLD score outcomes when compared with FSL use alone. Other structured education was identified as a predictor of HbA1c reduction when combined with FSL use.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2021-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44489565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sodium-glucose linked transporter 2 inhibitors (SGLT2i) have been demonstrated to improve cardiovascular outcomes. In particular, SGLT2i appear to be beneficial in improving heart failure outcomes in people with and without diabetes. The aim of this review was to synthesis current evidence from randomised controlled trials (RCTs) comparing SGLT2i to placebo in adults with type 2 diabetes mellitus. The outcomes of interest were rate hospitalisation due to heart failure (primary), death due to heart failure (secondary) and incidence rates of heart failure (secondary).Methods: Searches were performed using recognised terms in MedLine, EMBASE, Pubmed and CINAHL. Studies were included if they compared an SGLT2i to inhibitor in an RCT and contained data for an outcome of interest. Studies were reviewed for inclusion by two people (TSJC and REJR) and data extraction and bias assessment were performed using a modified Cochrane’s data extraction tool and bias assessment tool. Meta-analysis of hazard ratios was performed in RevMan 5.4 using generic inverse variance and a fixed effects model where possible.Results: 2,850 records were identified of which 11 were eventually included, covering 9 clinical studies. Eight of these were suitable for meta-analysis for the outcome of hospitalisation due to heart failure – the pooled hazard ratio was found to be 0.69 (95% CI 0.63, 0.75). Interstudy heterogeneity was minimal (I2 0%) Only one study contained outcomes for death specifically due to heart failure, but its results were not significant. No current studies report incidence rates of new heart failure diagnosis.Conclusion: SGLT2is reduce the rates of hospitalisation due to heart failure in people with type 2 diabetes. This may help mediate the improvements seen in all cardiovascular outcomes, especially when assessed as a composite. More evidence is needed to support their use in reduce mortality due to heart failure and incidence rates of new heart failure in this high-risk cohort.
{"title":"The effect of sodium-glucose link transporter 2 inhibitors on heart failure end points in people with type 2 diabetes mellitus: a systematic review and meta-analysis","authors":"T. Crabtree, R. Ryder","doi":"10.15277/bjd.2021.307","DOIUrl":"https://doi.org/10.15277/bjd.2021.307","url":null,"abstract":"Sodium-glucose linked transporter 2 inhibitors (SGLT2i) have been demonstrated to improve cardiovascular outcomes. In particular, SGLT2i appear to be beneficial in improving heart failure outcomes in people with and without diabetes. The aim of this review was to synthesis current evidence from randomised controlled trials (RCTs) comparing SGLT2i to placebo in adults with type 2 diabetes mellitus. The outcomes of interest were rate hospitalisation due to heart failure (primary), death due to heart failure (secondary) and incidence rates of heart failure (secondary).Methods: Searches were performed using recognised terms in MedLine, EMBASE, Pubmed and CINAHL. Studies were included if they compared an SGLT2i to inhibitor in an RCT and contained data for an outcome of interest. Studies were reviewed for inclusion by two people (TSJC and REJR) and data extraction and bias assessment were performed using a modified Cochrane’s data extraction tool and bias assessment tool. Meta-analysis of hazard ratios was performed in RevMan 5.4 using generic inverse variance and a fixed effects model where possible.Results: 2,850 records were identified of which 11 were eventually included, covering 9 clinical studies. Eight of these were suitable for meta-analysis for the outcome of hospitalisation due to heart failure – the pooled hazard ratio was found to be 0.69 (95% CI 0.63, 0.75). Interstudy heterogeneity was minimal (I2 0%) Only one study contained outcomes for death specifically due to heart failure, but its results were not significant. No current studies report incidence rates of new heart failure diagnosis.Conclusion: SGLT2is reduce the rates of hospitalisation due to heart failure in people with type 2 diabetes. This may help mediate the improvements seen in all cardiovascular outcomes, especially when assessed as a composite. More evidence is needed to support their use in reduce mortality due to heart failure and incidence rates of new heart failure in this high-risk cohort.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2021-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46059955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
DEVOTE (Trial Comparing Cardiovascular Safety of Insulin Degludec versus Insulin Glargine in Patients with Type 2 Diabetes at High Risk of Cardio-vascular Events) was an FDA-mandated cardiovascular outcome trial and was the first – and at present the only – completed trial comparing two insulins. DEVOTE compared insulin degludec and insulin glargine (U100) in 7,637 people with type 2 diabetes with established cardiovascular disease, chronic kidney disease, or both, and older diabetic patients with increased cardiovascular risk. DEVOTE demonstrated non-inferiority for major cardiovascular events (MACE), a composite of death from cardiovascular causes, non-fatal myocardial infarction and non-fatal stroke, with a pre-specified non-inferiority margin of 1.3. At 24 months the mean HbA1c was similar in the two groups. Mean fasting plasma glucose was significantly lower in the degludec group than in the glargine group, and pre-specified severe hypoglycaemia was also significantly lower in the degludec group. DEVOTE satisfied the FDA cardiovascular safety requirements for new antidiabetic therapies.
{"title":"Series: Cardiovascular outcome trials for diabetes drugs Degludec and DEVOTE","authors":"M. Fisher","doi":"10.15277/BJD.2021.302","DOIUrl":"https://doi.org/10.15277/BJD.2021.302","url":null,"abstract":"DEVOTE (Trial Comparing Cardiovascular Safety of Insulin Degludec versus Insulin Glargine in Patients with Type 2 Diabetes at High Risk of Cardio-vascular Events) was an FDA-mandated cardiovascular outcome trial and was the first – and at present the only – completed trial comparing two insulins. DEVOTE compared insulin degludec and insulin glargine (U100) in 7,637 people with type 2 diabetes with established cardiovascular disease, chronic kidney disease, or both, and older diabetic patients with increased cardiovascular risk. DEVOTE demonstrated non-inferiority for major cardiovascular events (MACE), a composite of death from cardiovascular causes, non-fatal myocardial infarction and non-fatal stroke, with a pre-specified non-inferiority margin of 1.3. At 24 months the mean HbA1c was similar in the two groups. Mean fasting plasma glucose was significantly lower in the degludec group than in the glargine group, and pre-specified severe hypoglycaemia was also significantly lower in the degludec group. DEVOTE satisfied the FDA cardiovascular safety requirements for new antidiabetic therapies.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2021-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45904295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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