Pyomyositis is a rare and serious acute purulent bacterial infection of the skeletal muscle. Diabetes is the most important predisposing factor and, if left untreated, the infection has significant complications. We report the case of an adult male who presented acutely with a history of abdominal pain, nausea and vomiting and bilateral thigh pain. His abdominal examination was unremarkable, but a fluctuant swelling was identified in both thighs. Biochemical investigations revealed raised inflammatory markers and diagnostic chemistry of diabetic ketoacidosis. Pyomyositis was treated with intravenous antibiotics and surgical abscess drainage. MRI is the definitive investigation of choice to diagnose pyomyositis. Differential diagnoses include cellulitis, septic arthritis and deep vein thrombosis.
{"title":"Bilateral extensive leg pyomyositis presenting with diabetic ketoacidosis","authors":"J. Shah, K. Seejore, M. Mansfield","doi":"10.15277/bjd.2021.322","DOIUrl":"https://doi.org/10.15277/bjd.2021.322","url":null,"abstract":"Pyomyositis is a rare and serious acute purulent bacterial infection of the skeletal muscle. Diabetes is the most important predisposing factor and, if left untreated, the infection has significant complications. We report the case of an adult male who presented acutely with a history of abdominal pain, nausea and vomiting and bilateral thigh pain. His abdominal examination was unremarkable, but a fluctuant swelling was identified in both thighs. Biochemical investigations revealed raised inflammatory markers and diagnostic chemistry of diabetic ketoacidosis. Pyomyositis was treated with intravenous antibiotics and surgical abscess drainage. MRI is the definitive investigation of choice to diagnose pyomyositis. Differential diagnoses include cellulitis, septic arthritis and deep vein thrombosis.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2021-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48211636","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}
D. Nagi, S. Rowles, Andrew Macklin, U. Dashora, Heather D Oliver, D. Patel
Executive Summary A national survey on integrated diabetes services was carried out by the Association of British Clinical Diabetologists (ABCD) during the COVID-19 pandemic and has provided some very useful insights into the current state of integration to deliver a joined-up diabetes service in the UK. This survey was carried out during the second half of 2020 and explored three main areas: (1) current state of clinical integration between primary and secondary (specialist) diabetes services; (2) the state of IT integration among the diabetes IT systems and hospital-based electronic patient records (EPR) and between hospital and primary care; (3) to ascertain the membership of their views on a ‘one-stop service’ for collecting annual review data for diabetes and the potential barriers to achieve this. The results presented are a summary of the survey, while the full unedited survey report, especially on the qualitative aspects, is available to ABCD members. The survey was mailed to 518 individuals, of which 431 (83.2%) were consultants and 53 (10.2%) were specialist registrars. Of the 83 replies received, 98% were from consultants and the responses represented a total of 73 hospital diabetes services. The findings of this survey revealed that full integration of clinical services among primary care and specialist diabetes teams is uncommon, although there are good examples of clinical integration in different formats. In a number of areas, primary care and specialist diabetes services continue to work in silos despite a universal recognition that integrated services are desirable and are likely to improve quality of care. Clinical leadership, resources and buy-in from those who commission services were deemed important factors to help improve the development of integrated care systems. In hospitals with dedicated diabetes IT systems the information flow from these diabetes systems to the EPR was not universal, raising concerns that vital information about an individual’s diabetes may not be available to other hospital clinical specialities at the time of delivery of care, posing a significant clinical risk. IT integration among primary and specialist diabetes teams in England was only available in certain areas and was mostly based around the use of SystmOne. The survey also identified a diversity of opinions regarding the current arrangements of the Quality Outcome Framework (QOF), where GPs are incentivised to collect data for annual review of routine diabetes care. Many were of the opinion that annual review processes should be performed by clinical teams who are tasked to deliver diabetes care to the individual, while others felt that the status quo should continue with primary care GPs being responsible. A one-stop service for eye screening for diabetes and other annual measurements nearer to people’s homes was identified as an improvement, but several logistic barriers were identified. We recognise the limitations of any survey which expr
{"title":"Integrated diabetes care: The Association of British Clinical Diabetologists (ABCD) national survey report","authors":"D. Nagi, S. Rowles, Andrew Macklin, U. Dashora, Heather D Oliver, D. Patel","doi":"10.15277/bjd.2021.325","DOIUrl":"https://doi.org/10.15277/bjd.2021.325","url":null,"abstract":"Executive Summary\u0000A national survey on integrated diabetes services was carried out by the Association of British Clinical Diabetologists (ABCD) during the COVID-19 pandemic and has provided some very useful insights into the current state of integration to deliver a joined-up diabetes service in the UK.\u0000This survey was carried out during the second half of 2020 and explored three main areas: (1) current state of clinical integration between primary and secondary (specialist) diabetes services; (2) the state of IT integration among the diabetes IT systems and hospital-based electronic patient records (EPR) and between hospital and primary care; (3) to ascertain the membership of their views on a ‘one-stop service’ for collecting annual review data for diabetes and the potential barriers to achieve this. The results presented are a summary of the survey, while the full unedited survey report, especially on the qualitative aspects, is available to ABCD members.\u0000The survey was mailed to 518 individuals, of which 431 (83.2%) were consultants and 53 (10.2%) were specialist registrars. Of the 83 replies received, 98% were from consultants and the responses represented a total of 73 hospital diabetes services.\u0000The findings of this survey revealed that full integration of clinical services among primary care and specialist diabetes teams is uncommon, although there are good examples of clinical integration in different formats. In a number of areas, primary care and specialist diabetes services continue to work in silos despite a universal recognition that integrated services are desirable and are likely to improve quality of care. Clinical leadership, resources and buy-in from those who commission services were deemed important factors to help improve the development of integrated care systems.\u0000In hospitals with dedicated diabetes IT systems the information flow from these diabetes systems to the EPR was not universal, raising concerns that vital information about an individual’s diabetes may not be available to other hospital clinical specialities at the time of delivery of care, posing a significant clinical risk. IT integration among primary and specialist diabetes teams in England was only available in certain areas and was mostly based around the use of SystmOne.\u0000The survey also identified a diversity of opinions regarding the current arrangements of the Quality Outcome Framework (QOF), where GPs are incentivised to collect data for annual review of routine diabetes care. Many were of the opinion that annual review processes should be performed by clinical teams who are tasked to deliver diabetes care to the individual, while others felt that the status quo should continue with primary care GPs being responsible. A one-stop service for eye screening for diabetes and other annual measurements nearer to people’s homes was identified as an improvement, but several logistic barriers were identified.\u0000We recognise the limitations of any survey which expr","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2021-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44433365","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}
Nadia Chaudhury, Alexandros-Leonidas D Liarakos, K. Gopalakrishnan, W. Ayub, N. Murthy, R. Rao
Introduction Liraglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, is a recognised treatment for type 2 diabetes mellitus (T2DM). It mimics human GLP-1 and works by augmenting insulin secretion, inhibiting glucagon secretion and inhibiting gastric acid secretion.1 It has been shown to not only improve glycaemic control in people with diabetes, but also result in weight loss, reduced hypoglycaemic episodes, reduced albuminuria, reduced progression to macroalbuminuria and reduced incidence of myocardial infarction and stroke events.2–5 Gastrointestinal upset is the commonest reported side effect, which occurs in up to 56% of patients in clinical trials. Furthermore, BNF recommends avoiding liraglutide treatment in end-stage renal disease/estimated glomerular filtration rate (eGFR) <15 mL/min/1.73 m2 (depending on brand), due to the increased risk of adverse events. We present a rare case of a female with chronic kidney disease (CKD), whose treatment with liraglutide was associated with rapid deterioration of renal function and tubulointerstitial nephritis. Our literature search highlighted one previous case, thus we would like to raise awareness of this potential rare side effect of liraglutide treatment.6 We have further conducted a literature search of all case reports noting associations of glucose-lowering therapies with acute interstitial nephritis to raise awareness of this potential complication.
{"title":"Antidiabetic Medication-Induced Acute Interstitial Nephritis: Case Report and Literature Search","authors":"Nadia Chaudhury, Alexandros-Leonidas D Liarakos, K. Gopalakrishnan, W. Ayub, N. Murthy, R. Rao","doi":"10.15277/bjd.2021.321","DOIUrl":"https://doi.org/10.15277/bjd.2021.321","url":null,"abstract":"Introduction Liraglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, is a recognised treatment for type 2 diabetes mellitus (T2DM). It mimics human GLP-1 and works by augmenting insulin secretion, inhibiting glucagon secretion and inhibiting gastric acid secretion.1 It has been shown to not only improve glycaemic control in people with diabetes, but also result in weight loss, reduced hypoglycaemic episodes, reduced albuminuria, reduced progression to macroalbuminuria and reduced incidence of myocardial infarction and stroke events.2–5 Gastrointestinal upset is the commonest reported side effect, which occurs in up to 56% of patients in clinical trials. Furthermore, BNF recommends avoiding liraglutide treatment in end-stage renal disease/estimated glomerular filtration rate (eGFR) <15 mL/min/1.73 m2 (depending on brand), due to the increased risk of adverse events. We present a rare case of a female with chronic kidney disease (CKD), whose treatment with liraglutide was associated with rapid deterioration of renal function and tubulointerstitial nephritis. Our literature search highlighted one previous case, thus we would like to raise awareness of this potential rare side effect of liraglutide treatment.6 We have further conducted a literature search of all case reports noting associations of glucose-lowering therapies with acute interstitial nephritis to raise awareness of this potential complication.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2021-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48107919","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}
EMPA-REG OUTCOME was a landmark trial with the sodium-glucose co-transporter-2 (SGLT2) inhibitor empagliflozin, which demonstrated significant reductions in major adverse cardiovascular events (MACE, a composite of cardiovascular death, non-fatal myocardial infarction and non-fatal stroke) driven by reductions in cardiovascular deaths and accompanied by an early reduction in hospitalisation for heart failure. This was followed by cardiovascular outcome trials with canagliflozin, dapagliflozin and ertugliflozin. The CANVAS Program was an integrated analysis of the CANVAS and CANVAS-R trials with canagliflozin. It demonstrated a significant reduction in MACE, but not in any of the components, and there was an unexpected increase in amputations and fractures with canagliflozin. The DECLARE-TIMI 58 trial with dapagliflozin had two co-primary endpoints. A composite endpoint of cardiovascular death or hospitalisation for heart failure was significantly reduced, but there was no significant difference in MACE comparing dapagliflozin with placebo. Analysis of patients with a prior myocardial infarction, however, demonstrated significant reductions in MACE. The VERTIS CV trial with ertugliflozin was disappointing as there was no difference in MACE comparing ertugliflozin and placebo. In all four trials a reduction in hospitalisation for heart failure was observed in patients with type 2 diabetes, regardless of whether they had existing atherosclerotic cardiovascular disease or increased cardiovascular risk. Pre-specified renal outcomes were reduced with empagliflozin, canagliflozin and dapagliflozin, and these drugs are now commonly used in the management of people with type 2 diabetes. It is hard to envisage an ongoing role for ertugliflozin in routine clinical management as the evidence for its cardiovascular benefit is not convincing.
{"title":"Series: Cardiovascular outcome trials for diabetes drugs Canagliflozin and the CANVAS Program, dapagliflozin and DECLARE-TIMI 58, ertugliflozin and VERTIS CV","authors":"M. Fisher","doi":"10.15277/bjd.2021.320","DOIUrl":"https://doi.org/10.15277/bjd.2021.320","url":null,"abstract":"EMPA-REG OUTCOME was a landmark trial with the sodium-glucose co-transporter-2 (SGLT2) inhibitor empagliflozin, which demonstrated significant reductions in major adverse cardiovascular events (MACE, a composite of cardiovascular death, non-fatal myocardial infarction and non-fatal stroke) driven by reductions in cardiovascular deaths and accompanied by an early reduction in hospitalisation for heart failure. This was followed by cardiovascular outcome trials with canagliflozin, dapagliflozin and ertugliflozin. The CANVAS Program was an integrated analysis of the CANVAS and CANVAS-R trials with canagliflozin. It demonstrated a significant reduction in MACE, but not in any of the components, and there was an unexpected increase in amputations and fractures with canagliflozin. The DECLARE-TIMI 58 trial with dapagliflozin had two co-primary endpoints. A composite endpoint of cardiovascular death or hospitalisation for heart failure was significantly reduced, but there was no significant difference in MACE comparing dapagliflozin with placebo. Analysis of patients with a prior myocardial infarction, however, demonstrated significant reductions in MACE. The VERTIS CV trial with ertugliflozin was disappointing as there was no difference in MACE comparing ertugliflozin and placebo. In all four trials a reduction in hospitalisation for heart failure was observed in patients with type 2 diabetes, regardless of whether they had existing atherosclerotic cardiovascular disease or increased cardiovascular risk. Pre-specified renal outcomes were reduced with empagliflozin, canagliflozin and dapagliflozin, and these drugs are now commonly used in the management of people with type 2 diabetes. It is hard to envisage an ongoing role for ertugliflozin in routine clinical management as the evidence for its cardiovascular benefit is not convincing.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2021-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43951732","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}
David M. Williams, J. Davies, Benjamin Field, R. Gandhi, Sophie Harris, K. Khunti, D. Nagi, P. Narendran, R. Rea, Y. Ruan, R. Ryder, K. Várnai, S. Wild, E. Wilmot, T. Min, J. Platts, R. Chudleigh, J. Stephens, S. Rice
Background: People with diabetes and coronavirus disease 2019 (COVID-19) have a significantly greater risk of death and/or intensive care unit (ICU) admission. The Association of British Clinical Diabetologists (ABCD) recently audited outcomes for people hospitalised in the UK with diabetes and COVID-19. Methods: The ABCD COVID-19 and diabetes audit was a retrospective audit of patients admitted to UK hospitals with diabetes and COVID-19 between March and December 2020. Data related to patients admitted in Wales were compared with patients admitted in England and Scotland. Results: In Wales, 40/82 (48.7%) patients with diabetes had COVID-19-related mortality compared with 1,149/2,916 (39.1%) in the UK group (p=0.08). The Welsh cohort were more likely to be Caucasian, have a higher body mass index and HbA1c, be diagnosed with diabetic retinopathy and prescribed a sodium-glucose co-transporter 2 inhibitor or insulin than those in England and Scotland. Patients admitted to the ICU in Wales were more likely to be male and have type 2 diabetes. Conclusions: Patients admitted to hospital with diabetes and COVID-19 in Wales had a poorer outcome compared with England and Scotland. This disparity may reflect social inequality, differences in cardiovascular risk factors and/or differences in diabetes medications between hospitalised patients in Wales and the UK.
{"title":"COVID-19 outcomes in people with diabetes in Wales: a secondary analysis of the ABCD audit","authors":"David M. Williams, J. Davies, Benjamin Field, R. Gandhi, Sophie Harris, K. Khunti, D. Nagi, P. Narendran, R. Rea, Y. Ruan, R. Ryder, K. Várnai, S. Wild, E. Wilmot, T. Min, J. Platts, R. Chudleigh, J. Stephens, S. Rice","doi":"10.15277/bjd.2021.319","DOIUrl":"https://doi.org/10.15277/bjd.2021.319","url":null,"abstract":"Background: People with diabetes and coronavirus disease 2019 (COVID-19) have a significantly greater risk of death and/or intensive care unit (ICU) admission. The Association of British Clinical Diabetologists (ABCD) recently audited outcomes for people hospitalised in the UK with diabetes and COVID-19.\u0000Methods: The ABCD COVID-19 and diabetes audit was a retrospective audit of patients admitted to UK hospitals with diabetes and COVID-19 between March and December 2020. Data related to patients admitted in Wales were compared with patients admitted in England and Scotland.\u0000Results: In Wales, 40/82 (48.7%) patients with diabetes had COVID-19-related mortality compared with 1,149/2,916 (39.1%) in the UK group (p=0.08). The Welsh cohort were more likely to be Caucasian, have a higher body mass index and HbA1c, be diagnosed with diabetic retinopathy and prescribed a sodium-glucose co-transporter 2 inhibitor or insulin than those in England and Scotland. Patients admitted to the ICU in Wales were more likely to be male and have type 2 diabetes.\u0000Conclusions: Patients admitted to hospital with diabetes and COVID-19 in Wales had a poorer outcome compared with England and Scotland. This disparity may reflect social inequality, differences in cardiovascular risk factors and/or differences in diabetes medications between hospitalised patients in Wales and the UK.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2021-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44642680","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. Nana, S. Moore, Riyanath Loganathan, Victoria Williams, Mohammad Sohel Rahman, E. Jennings, A. Dixon, L. Bondugulapati
Introduction: There is a paucity of evidence regarding the efficacy of a very low-calorie diet (VLCD) in the real-world setting. We evaluated outcomes in patients with type 2 diabetes mellitus (T2DM) who underwent VLCD. Methods: This retrospective observational study included all patients who had undergone VLCD from 2014 to 2017 (n=61). The VLCD consisted of an eight-week 800 kcal/day dietary restriction. Metabolic parameters and medications were recorded at baseline, immediately post-VLCD and at 6 and 12 months. Results: There was a significant reduction in weight of 9.96 kg (p<0.001) immediately post-VLCD, with net weight loss sustained to 12 months (p<0.05). There was a significant reduction in body mass index (BMI) sustained to 12 months (p<0.05). Paired HbA1c data were available for 38 patients. There was a significant reduction in HbA1c of 13.29 mmol/mol immediately post-VLCD (p<0.001), however no significant reduction was observed at 12 months (p>0.05). 78.7% patients had a reduction in T2DM medication burden post-VLCD, sustained in 44.3% of patients at 12 months. Analysis of patients with T2DM diagnosis duration >6 years demonstrated statistically significant weight loss sustained to 12 months (p<0.001). Conclusion: Our results demonstrate sustained reduction in BMI and weight, reduction in medication burden and temporary reduction in HbA1c in patients with T2DM undertaking a VLCD in the real-world setting
{"title":"Very low-calorie diet in patients with longstanding type 2 diabetes mellitus: a study of real-world outcomes","authors":"M. Nana, S. Moore, Riyanath Loganathan, Victoria Williams, Mohammad Sohel Rahman, E. Jennings, A. Dixon, L. Bondugulapati","doi":"10.15277/bjd.2021.316","DOIUrl":"https://doi.org/10.15277/bjd.2021.316","url":null,"abstract":"Introduction: There is a paucity of evidence regarding the efficacy of a very low-calorie diet (VLCD) in the real-world setting. We evaluated outcomes in patients with type 2 diabetes mellitus (T2DM) who underwent VLCD.\u0000Methods: This retrospective observational study included all patients who had undergone VLCD from 2014 to 2017 (n=61). The VLCD consisted of an eight-week 800 kcal/day dietary restriction. Metabolic parameters and medications were recorded at baseline, immediately post-VLCD and at 6 and 12 months.\u0000Results: There was a significant reduction in weight of 9.96 kg (p<0.001) immediately post-VLCD, with net weight loss sustained to 12 months (p<0.05). There was a significant reduction in body mass index (BMI) sustained to 12 months (p<0.05). Paired HbA1c data were available for 38 patients. There was a significant reduction in HbA1c of 13.29 mmol/mol immediately post-VLCD (p<0.001), however no significant reduction was observed at 12 months (p>0.05). 78.7% patients had a reduction in T2DM medication burden post-VLCD, sustained in 44.3% of patients at 12 months. Analysis of patients with T2DM diagnosis duration >6 years demonstrated statistically significant weight loss sustained to 12 months (p<0.001).\u0000Conclusion: Our results demonstrate sustained reduction in BMI and weight, reduction in medication burden and temporary reduction in HbA1c in patients with T2DM undertaking a VLCD in the real-world setting","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2021-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45214506","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}
So-called 'real-world' studies seem increasingly popular in diabetes care, as are the economic evaluations in secondary literature based upon them. The term is usually used for pharmacoepidemiological uncontrolled observational studies of different designs. Interpretation of the study findings is, however, badly undermined by the very reasons that the randomised controlled blinded study was invented – namely, non-medication study effects and biases in investigator selection and behaviour. In diabetes studies, glucose control seems particularly susceptible to such effects, perhaps through changes in patient motivation and education. Further, insulin studies are heavily influenced by baseline factors such as the site of starting insulin, the health circumstances of the patient at the time and the clinician involved. It is rare to see these issues adequately addressed or attempts made to understand their influence. In this article an attempt is made to discuss some of the issues further.
{"title":"'Real-world' clinical trials in diabetes care: meaningful or meaningless?","authors":"P. Home","doi":"10.15277/bjd.2021.317","DOIUrl":"https://doi.org/10.15277/bjd.2021.317","url":null,"abstract":"So-called 'real-world' studies seem increasingly popular in diabetes care, as are the economic evaluations in secondary literature based upon them. The term is usually used for pharmacoepidemiological uncontrolled observational studies of different designs. Interpretation of the study findings is, however, badly undermined by the very reasons that the randomised controlled blinded study was invented – namely, non-medication study effects and biases in investigator selection and behaviour. In diabetes studies, glucose control seems particularly susceptible to such effects, perhaps through changes in patient motivation and education. Further, insulin studies are heavily influenced by baseline factors such as the site of starting insulin, the health circumstances of the patient at the time and the clinician involved. It is rare to see these issues adequately addressed or attempts made to understand their influence. In this article an attempt is made to discuss some of the issues further.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2021-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41818008","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}
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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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}
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