S. Manley, Samiul Mostafa, Jonathan Webber, Kavitha D Ganapathy, Roy Taylor, Randie R Little, Rajeev P Raghavan, Craig Webster, Alison Barratt, R. Round, Irene Stratton, Andreas Karwath, John A. Williams, Georgios V. Gkoutos, G. Roberts, Sandip Ghosh
Background: Glycated haemoglobin (HbA1c) measurement is used for diagnosis, management and remission of type 2 diabetes (T2DM), with measurements comparable worldwide and the World Health Organization listing medical conditions that affect its accuracy. Admission glucose is in the ‘diabetes’ range in 5% of emergency hospital admissions without prior diagnosis, with literature searches indicating inconsistent practice on using HbA1c to confirm diagnosis. As oral glucose tolerance tests (OGTT) were not possible during the COVID-19 pandemic, guidance was issued by the Royal College of Obstetrics and Gynaecology on using HbA1c for gestational diabetes mellitus. Aims: This study explores use of HbA1c at Queen Elizabeth Hospital Birmingham, a large university hospital serving a multi- ethnic adult population. Methods: Information is presented on comparability, clinical audits, research studies and current practice, and is illustrated by case reports. Results: Data from the National Glycohemoglobin Standardization Program show comparability of laboratoryHbA1c and point-of-care testing methods from 1993 to 2023. Although HbA1c was used to diagnose gestational diabetes during the COVID-19 pandemic, hospitals have reverted to OGTT post pandemic. In contrast, HbA1c is now being used to assess T2DM remission. Case reports illustrate these scenarios and highlight the complexity of decision-making when the accuracy of the HbA1c reading is affected by multiple co- morbidities. Conclusions: This wider use of HbA1c includes remission of T2DM but the diagnosis of gestational diabetes has reverted to OGTT post pandemic. A pictorial representation of HbA1c range is presented to aid understanding of this test. It is suitable for diagnosis of diabetes in most people except those with some variant haemoglobins or abnormal red blood cell turnover.
{"title":"When is HbA1c useful and what do the numbers mean – do they help or hinder?","authors":"S. Manley, Samiul Mostafa, Jonathan Webber, Kavitha D Ganapathy, Roy Taylor, Randie R Little, Rajeev P Raghavan, Craig Webster, Alison Barratt, R. Round, Irene Stratton, Andreas Karwath, John A. Williams, Georgios V. Gkoutos, G. Roberts, Sandip Ghosh","doi":"10.15277/bjd.2023.417","DOIUrl":"https://doi.org/10.15277/bjd.2023.417","url":null,"abstract":"Background: Glycated haemoglobin (HbA1c) measurement is used for diagnosis, management and remission of type 2 diabetes (T2DM), with measurements comparable worldwide and the World Health Organization listing medical conditions that affect its accuracy. Admission glucose is in the ‘diabetes’ range in 5% of emergency hospital admissions without prior diagnosis, with literature searches indicating inconsistent practice on using HbA1c to confirm diagnosis. As oral glucose tolerance tests (OGTT) were not possible during the COVID-19 pandemic, guidance was issued by the Royal College of Obstetrics and Gynaecology on using HbA1c for gestational diabetes mellitus. Aims: This study explores use of HbA1c at Queen Elizabeth Hospital Birmingham, a large university hospital serving a multi- ethnic adult population. Methods: Information is presented on comparability, clinical audits, research studies and current practice, and is illustrated by case reports. Results: Data from the National Glycohemoglobin Standardization Program show comparability of laboratoryHbA1c and point-of-care testing methods from 1993 to 2023. Although HbA1c was used to diagnose gestational diabetes during the COVID-19 pandemic, hospitals have reverted to OGTT post pandemic. In contrast, HbA1c is now being used to assess T2DM remission. Case reports illustrate these scenarios and highlight the complexity of decision-making when the accuracy of the HbA1c reading is affected by multiple co- morbidities. Conclusions: This wider use of HbA1c includes remission of T2DM but the diagnosis of gestational diabetes has reverted to OGTT post pandemic. A pictorial representation of HbA1c range is presented to aid understanding of this test. It is suitable for diagnosis of diabetes in most people except those with some variant haemoglobins or abnormal red blood cell turnover.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139175439","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":"Snippets from EASD 2023","authors":"Caroline Day","doi":"10.15277/bjd.2023.427","DOIUrl":"https://doi.org/10.15277/bjd.2023.427","url":null,"abstract":"","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139175856","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}
A. Mirzababaei, Sanaz Mehranfar, Farideh Shiraseb, Faezeh Abaj, Sara Hajishizari, Cain C.T. Clark, K. Mirzaei
Background: Epidemiological studies have reported that dietary acid load is associated with psychological disorders through different pathways. We aimed to examine the association of dietary acid-base load with psychological disorders, sleep and circadian rhythm. Methods: This study was performed on 404 female subjects aged 18 years and above. We evaluated potential renal acid load (PRAL) and net endogenous acid production (NEAP) score by a validated food frequency questionnaire (FFQ) for Iran which contained 147 items. To assess psychological disorders, an Iranian validated version of the depression, anxiety and stress scale (DASS-21) was used. The Pittsburgh Sleep Quality Index (PSQI) and morning-evening questionnaire (MEQ) were applied to evaluate sleep quality and circadian rhythm status, respectively. Results: After adjustment for a wide range of confounding variables, a significant positive association was observed between dietary acid-base load and severe depression (ORPRAL=1.10, 95% CI=1.01-1.19, p=0.02 and ORNEAP=2.46, 95% CI=1.41-14.61, p=0.02). Women in the high dietary acid base load category had higher anxiety (ORPRAL=1.12, 95% CI=1.02-1.23, p=0.01 and ORNEAP=1.80,95% CI=1.12-10.72, p=0.01). There was a strong positive relationship between dietary acid-base load and sleep disturbance (p<0.05). Additionally, circadian rhythm assessment showed that those with greater commitment to PRAL had 23% higher risk of being completely evening type, while the odds of being completely morning type were decreased by 15% and 12% across higher adherence to PRAL and NEAP. Conclusion: Women with higher dietary acid-base load score had greater odds for depression, anxiety, psychological distress, sleep disturbance and evening-type circadian rhythm compared to lower ones.
{"title":"association of dietary acid-base load with psychological disorders, sleep and circadian rhythm among obese and overweight women: a cross-sectional study","authors":"A. Mirzababaei, Sanaz Mehranfar, Farideh Shiraseb, Faezeh Abaj, Sara Hajishizari, Cain C.T. Clark, K. Mirzaei","doi":"10.15277/bjd.2023.425","DOIUrl":"https://doi.org/10.15277/bjd.2023.425","url":null,"abstract":"Background: Epidemiological studies have reported that dietary acid load is associated with psychological disorders through different pathways. We aimed to examine the association of dietary acid-base load with psychological disorders, sleep and circadian rhythm. Methods: This study was performed on 404 female subjects aged 18 years and above. We evaluated potential renal acid load (PRAL) and net endogenous acid production (NEAP) score by a validated food frequency questionnaire (FFQ) for Iran which contained 147 items. To assess psychological disorders, an Iranian validated version of the depression, anxiety and stress scale (DASS-21) was used. The Pittsburgh Sleep Quality Index (PSQI) and morning-evening questionnaire (MEQ) were applied to evaluate sleep quality and circadian rhythm status, respectively. Results: After adjustment for a wide range of confounding variables, a significant positive association was observed between dietary acid-base load and severe depression (ORPRAL=1.10, 95% CI=1.01-1.19, p=0.02 and ORNEAP=2.46, 95% CI=1.41-14.61, p=0.02). Women in the high dietary acid base load category had higher anxiety (ORPRAL=1.12, 95% CI=1.02-1.23, p=0.01 and ORNEAP=1.80,95% CI=1.12-10.72, p=0.01). There was a strong positive relationship between dietary acid-base load and sleep disturbance (p<0.05). Additionally, circadian rhythm assessment showed that those with greater commitment to PRAL had 23% higher risk of being completely evening type, while the odds of being completely morning type were decreased by 15% and 12% across higher adherence to PRAL and NEAP. Conclusion: Women with higher dietary acid-base load score had greater odds for depression, anxiety, psychological distress, sleep disturbance and evening-type circadian rhythm compared to lower ones.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139173134","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}
E. Wilmot, S. Wild, Y. Ruan, S. Hadjadj, M. Wargny, Myia S. Williams, P. Saulnier, Xu Zhu, R. Ryder, R. Pekmezaris, M. Marre, Ben Field, P. Narendran, Sophie Harris, J. Gautier, D. Patel, K. Várnai, J. Davies, R. Roussel, R. Rea, P. Gourdy, B. Cariou, Alyson K. Myers, K. Khunti
Aims: To describe the relationship between race/ethnicity and adverse outcomes related to coronavirus disease 2019 (COVID-19) in adults with T2DM admitted to hospital in the UK, France and USA. Methods: Study data from the UK ABCD nationwide COVID- 19 audit, the French CORONADO nationwide initiative and the USA AMERICADO multi-centre study were analysed to assess the association between race/ethnicity and severe COVID-19. Severe COVID-19 was defined as death in hospital and/or admission to the intensive care unit (ICU). Logistic regression models were used to generate age-adjusted odds ratios. Results: Data from 3,471 patients in the ABCD audit, from 2,451 CORONADO patients and from 9,321 AMERICADO patients admitted with COVID-19 and T2DM were analysed. Race/ethnicity data were available for 3,410 (98%), 2,173 (89%) and 8,893 (95%) patients, respectively. In the UK ABCD audit cohort, Asian and Black race/ethnicity were associated with an increased risk of death/ICU admission compared to White when adjusted for age and sex (OR 2.14; 1.38-3.29 and OR 2.09; 1.17-3.74, respectively). When adjusted for additional confounders the association was stronger (Asian OR 2.88; 1.72-4.82 and Black OR 2.20; 1.12-4.30). In the CORONADO cohort Middle Eastern/North African race/ethnicity was protective against death/ICU admission (OR 0.57; 0.36-0.91). There was no association between ethnicity and death alone in the AMERICADO dataset. Conclusion: In those with T2DM admitted to hospital with COVID-19, a non-White race/ethnicity was associated with higher risk of death/ICU admission in the UK ABCD data but not in French CORONADO or USA AMERICADO datasets. Further research is required to improve our understanding of the observed discrepancies in outcomes.
{"title":"The impact of race/ethnicity on the clinical outcomes of people with type 2 diabetes admitted to hospital with COVID-19: an observational multi-national analysis","authors":"E. Wilmot, S. Wild, Y. Ruan, S. Hadjadj, M. Wargny, Myia S. Williams, P. Saulnier, Xu Zhu, R. Ryder, R. Pekmezaris, M. Marre, Ben Field, P. Narendran, Sophie Harris, J. Gautier, D. Patel, K. Várnai, J. Davies, R. Roussel, R. Rea, P. Gourdy, B. Cariou, Alyson K. Myers, K. Khunti","doi":"10.15277/bjd.2023.411","DOIUrl":"https://doi.org/10.15277/bjd.2023.411","url":null,"abstract":"Aims: To describe the relationship between race/ethnicity and adverse outcomes related to coronavirus disease 2019 (COVID-19) in adults with T2DM admitted to hospital in the UK, France and USA.\u0000Methods: Study data from the UK ABCD nationwide COVID- 19 audit, the French CORONADO nationwide initiative and the USA AMERICADO multi-centre study were analysed to assess the association between race/ethnicity and severe COVID-19. Severe COVID-19 was defined as death in hospital and/or admission to the intensive care unit (ICU). Logistic regression models were used to generate age-adjusted odds ratios.\u0000Results: Data from 3,471 patients in the ABCD audit, from 2,451 CORONADO patients and from 9,321 AMERICADO patients admitted with COVID-19 and T2DM were analysed. Race/ethnicity data were available for 3,410 (98%), 2,173 (89%) and 8,893 (95%) patients, respectively. In the UK ABCD audit cohort, Asian and Black race/ethnicity were associated with an increased risk of death/ICU admission compared to White when adjusted for age and sex (OR 2.14; 1.38-3.29 and OR 2.09; 1.17-3.74, respectively). When adjusted for additional confounders the association was stronger (Asian OR 2.88; 1.72-4.82 and Black OR 2.20; 1.12-4.30). In the CORONADO cohort Middle Eastern/North African race/ethnicity was protective against death/ICU admission (OR 0.57; 0.36-0.91).\u0000There was no association between ethnicity and death alone in the AMERICADO dataset.\u0000Conclusion: In those with T2DM admitted to hospital with COVID-19, a non-White race/ethnicity was associated with higher risk of death/ICU admission in the UK ABCD data but not in French CORONADO or USA AMERICADO datasets. Further research is required to improve our understanding of the observed discrepancies in outcomes.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46018399","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}
This paper reviews data regarding the role of vitamin D in the genesis of type 1 diabetes (T1DM) and considers the hypothesis that vitamin D deficiency increases the incidence rate of T1DM. Vitamin D has actions on immune cells that would suppress autoimmunity with preservation of anti- infective actions. Geographical latitude and both season of diagnosis and of birth affect case numbers, most likely via the effect of UVB sunlight on vitamin D synthesis. Other factors, such as seasonal viral infections, may be important. Serum concentrations of 25(OH) vitamin D have mostly been found to be lower with diagnosis of T1DM. Vitamin D deficiency is common, particularly in the UK. From data on vitamin D concentrations in non-diabetic controls in mostly southerly nations this review estimates the population mean serum 25(OH)D concentration associated with low T1DM incidence to be >80 nmol/l. Achieving this in Britain would require supplementing current intake with 1500-2000 IU vitamin D daily. Increased food fortification would be the most effective method. An estimate based on the limited data available suggests this might generate a 25-30% reduction in the incidence of T1DM.
{"title":"Vitamin D in the prevention of type 1 diabetes: would increasing food fortification reduce the incidence?","authors":"J. Harvey","doi":"10.15277/bjd.2023.405","DOIUrl":"https://doi.org/10.15277/bjd.2023.405","url":null,"abstract":"This paper reviews data regarding the role of vitamin D in the genesis of type 1 diabetes (T1DM) and considers the hypothesis that vitamin D deficiency increases the incidence rate of T1DM. Vitamin D has actions on immune cells that would suppress autoimmunity with preservation of anti- infective actions. Geographical latitude and both season of diagnosis and of birth affect case numbers, most likely via the effect of UVB sunlight on vitamin D synthesis. Other factors, such as seasonal viral infections, may be important. Serum concentrations of 25(OH) vitamin D have mostly been found to be lower with diagnosis of T1DM.\u0000Vitamin D deficiency is common, particularly in the UK. From data on vitamin D concentrations in non-diabetic controls in mostly southerly nations this review estimates the population mean serum 25(OH)D concentration associated with low T1DM incidence to be >80 nmol/l. Achieving this in Britain would require supplementing current intake with 1500-2000 IU vitamin D daily. Increased food fortification would be the most effective method. An estimate based on the limited data available suggests this might generate a 25-30% reduction in the incidence of T1DM.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43653106","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}
Vitamin D is a hormone synthesised in the skin from 7-dehydrocholesterol following ultraviolet B (UVB) radiation exposure from sunlight. Limited dietary sources of vitamin D make it difficult for certain groups to maintain optimum serum 25hydroxyvitamin D (25OHD) levels. These high-risk groups include individuals residing at high latitude, dark-skinned populations and those who avoid the sun for medical or cosmetic reasons or who wear full body clothing for religious reasons.1 The classic role of vitamin D in optimising bone health through mineral homeostasis is undisputable. Deficiency causes rickets (impaired mineralisation of the growth plates) in children and osteomalacia (impaired mineralisation of pre-formed bone) in children and adults, which can manifest as muscle pain, weakness, delayed development and bony deformities.2 However, over the last three decades or so understanding of the nonclassic role of vitamin D against inflammation and infection has evolved. A growing body of evidence suggests a role for vitamin D in immune modulation through 1,25 dihydroxyvitamin D [1,25(OH)2D], the active form of 25OHD, regulating the expression of vitamin D-responsive genes which influence immune cell signalling pathways.3 Vitamin D deficiency has been linked to autoimmune conditions such as type 1 diabetes mellitus (T1DM), multiple sclerosis, Crohn’s disease and infections such as tuberculosis. The article by Harvey JN4 proposes food fortification with vitamin D to reduce the incidence of T1DM. In autoimmune conditions, it is challenging to conclude causality given the observational nature of the majority of studies and also the widespread prevalence of vitamin D deficiency globally. Due to the practical difficulties in excluding the influence of confounding environmental factors on disease incidence, the results of most studies can only be speculative at best. Through monozygotic twin studies we understand that environmental factors play a key role in the pathogenesis of T1DM. Childhood obesity, seasonal infections, enterovirus exposure, gut microbiome and vaccination programmes are some of the factors that have been considered to influence the incidence of T1DM. Studies evaluating vitamin D receptor polymorphisms in T1DM have been small and heterogenous, thereby providing conflicting results.5 Moreover, ethnic minority groups, who are disproportionately affected by vitamin D deficiency, are often under-represented in these studies. Whether optimising 25OHD levels beyond those essential for bone health through vitamin D supplementation and fortification protects against autoimmune disease onset or supports its treatment is yet to be elucidated. Clarifying the specific role of vitamin D in prevention or treatment of autoimmune diseases would require prospective randomised clinical trials which poses several logistic challenges. Despite increased numbers of cases of nutritional rickets and growing evidence that vitamin D deficiency is a major public
{"title":"Food fortification to tackle vitamin D deficiency: to address classic or non-classic effects?","authors":"S. Uday","doi":"10.15277/bjd.2023.408","DOIUrl":"https://doi.org/10.15277/bjd.2023.408","url":null,"abstract":"Vitamin D is a hormone synthesised in the skin from 7-dehydrocholesterol following ultraviolet B (UVB) radiation exposure from sunlight. Limited dietary sources of vitamin D make it difficult for certain groups to maintain optimum serum 25hydroxyvitamin D (25OHD) levels. These high-risk groups include individuals residing at high latitude, dark-skinned populations and those who avoid the sun for medical or cosmetic reasons or who wear full body clothing for religious reasons.1 The classic role of vitamin D in optimising bone health through mineral homeostasis is undisputable. Deficiency causes rickets (impaired mineralisation of the growth plates) in children and osteomalacia (impaired mineralisation of pre-formed bone) in children and adults, which can manifest as muscle pain, weakness, delayed development and bony deformities.2 However, over the last three decades or so understanding of the nonclassic role of vitamin D against inflammation and infection has evolved. A growing body of evidence suggests a role for vitamin D in immune modulation through 1,25 dihydroxyvitamin D [1,25(OH)2D], the active form of 25OHD, regulating the expression of vitamin D-responsive genes which influence immune cell signalling pathways.3 Vitamin D deficiency has been linked to autoimmune conditions such as type 1 diabetes mellitus (T1DM), multiple sclerosis, Crohn’s disease and infections such as tuberculosis. The article by Harvey JN4 proposes food fortification with vitamin D to reduce the incidence of T1DM. In autoimmune conditions, it is challenging to conclude causality given the observational nature of the majority of studies and also the widespread prevalence of vitamin D deficiency globally. Due to the practical difficulties in excluding the influence of confounding environmental factors on disease incidence, the results of most studies can only be speculative at best. Through monozygotic twin studies we understand that environmental factors play a key role in the pathogenesis of T1DM. Childhood obesity, seasonal infections, enterovirus exposure, gut microbiome and vaccination programmes are some of the factors that have been considered to influence the incidence of T1DM. Studies evaluating vitamin D receptor polymorphisms in T1DM have been small and heterogenous, thereby providing conflicting results.5 Moreover, ethnic minority groups, who are disproportionately affected by vitamin D deficiency, are often under-represented in these studies. Whether optimising 25OHD levels beyond those essential for bone health through vitamin D supplementation and fortification protects against autoimmune disease onset or supports its treatment is yet to be elucidated. Clarifying the specific role of vitamin D in prevention or treatment of autoimmune diseases would require prospective randomised clinical trials which poses several logistic challenges. Despite increased numbers of cases of nutritional rickets and growing evidence that vitamin D deficiency is a major public ","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46103429","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. Raja, Saarah Ebrahim, R. Mamidanna, K. Patel, A. Askari, C. Arhi, A. Munasinghe, F. Rashid, O. Al-Taan, P. Jambulingam, D. Whitelaw, V. Jain, A. Zalin, T. Rehman, MD Tanveer Asil
Introduction: Bariatric surgery is an effective treatment for type 2 diabetes mellitus (T2DM) in patients with morbid obesity. This study investigates whether duration of diabetes and anti-diabetes therapy are associated with glycaemic control after surgery in a routine clinical setting. Method: A cohort analysis of a prospectively maintained database was carried out for consecutive bariatric operations performed between April 2017 and March 2018 for patients with T2DM. Results: A total 105 patients with T2DM underwent bariatric surgery (89 Roux-en-Y gastric bypass and 16 sleeve gastrectomy). Median follow-up was 19 months ([interquartile range] IQR 13-24 months). Median weight and body mass index (BMI) on the day of surgery were 125 kg (IQR 103.9- 138.7) and 42.4 kg/m2 (IQR 39-46.8), respectively. At follow- up, 68 patients (64.8%) had achieved remission of diabetes. Patients who were pre-operatively on more than one glucose-lowering medication were less likely to go into remission (odds ratio [OR] 0.13, 95% CI 0.04-0.44, p=0.001) compared to those that were on a single glucose-lowering medication agent. Pre-operative use of insulin therapy (OR 0.09, 95% CI 0.03-0.31, p=<0.001) and SGLT2 inhibitors (OR 0.23, 95% CI 0.05-0.92, p=0.038) were significant negative predictors of remission. Type of operation (p=0.34), pre-operative BMI (p=0.99), and % total weight loss (TWL) (p=0.83) did not predict remission from T2DM after surgery. Conclusions: Most patients who are medicated for T2DM can stop their glucose-lowering medication after bariatric surgery. Patients who are on multiple glucose-lowering medication agents or those dependent on insulin or SGLT2 inhibitors before bariatric surgery are less likely to undergo complete remission >12 months after bariatric surgery.
{"title":"Association between preoperative glucose- lowering medication agents and the status of type 2 diabetes mellitus after bariatric surgery","authors":"H. Raja, Saarah Ebrahim, R. Mamidanna, K. Patel, A. Askari, C. Arhi, A. Munasinghe, F. Rashid, O. Al-Taan, P. Jambulingam, D. Whitelaw, V. Jain, A. Zalin, T. Rehman, MD Tanveer Asil","doi":"10.15277/bjd.2023.409","DOIUrl":"https://doi.org/10.15277/bjd.2023.409","url":null,"abstract":"Introduction: Bariatric surgery is an effective treatment for type 2 diabetes mellitus (T2DM) in patients with morbid obesity. This study investigates whether duration of diabetes and anti-diabetes therapy are associated with glycaemic control after surgery in a routine clinical setting.\u0000Method: A cohort analysis of a prospectively maintained database was carried out for consecutive bariatric operations performed between April 2017 and March 2018 for patients with T2DM.\u0000Results: A total 105 patients with T2DM underwent bariatric surgery (89 Roux-en-Y gastric bypass and 16 sleeve gastrectomy). Median follow-up was 19 months ([interquartile range] IQR 13-24 months). Median weight and body mass index (BMI) on the day of surgery were 125 kg (IQR 103.9- 138.7) and 42.4 kg/m2 (IQR 39-46.8), respectively. At follow- up, 68 patients (64.8%) had achieved remission of diabetes. Patients who were pre-operatively on more than one glucose-lowering medication were less likely to go into remission (odds ratio [OR] 0.13, 95% CI 0.04-0.44, p=0.001) compared to those that were on a single glucose-lowering medication agent. Pre-operative use of insulin therapy (OR 0.09, 95% CI 0.03-0.31, p=<0.001) and SGLT2 inhibitors (OR 0.23, 95% CI 0.05-0.92, p=0.038) were significant negative predictors of remission. Type of operation (p=0.34), pre-operative BMI (p=0.99), and % total weight loss (TWL) (p=0.83) did not predict remission from T2DM after surgery.\u0000Conclusions: Most patients who are medicated for T2DM can stop their glucose-lowering medication after bariatric surgery. Patients who are on multiple glucose-lowering medication agents or those dependent on insulin or SGLT2 inhibitors before bariatric surgery are less likely to undergo complete remission >12 months after bariatric surgery.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42675928","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 The advent of immunotherapy has revolutionised the management of certain malignancies, and its use has increased over the past decade. Monoclonal antibody therapies known as checkpoint inhibitors work by enhancing the immune response against malignant cells by blocking the pathways that inhibit T-cell regulation. Checkpoint inhibitors can be administered alone or in combination as an intravenous infusion every 3-6 weeks for a maximum of two years. However, about 10% of patients may experience endocrine adverse effects. Thyroid disease and hypophysitis are those most commonly encountered; there are also reports of diabetes mellitus and primary adrenal insufficiency as well as rarer endocrinopathies. Pembrolizumab, an immune checkpoint inhibitor, received FDA approval in 2014 for advanced melanoma, and in 2015 for metastatic non-small cell lung cancer. It is also approved for recurrent/metastatic head and neck cancer, and for refractory classical Hodgkin’s lymphoma. We report the case of a 75-year-old man who developed new-onset diabetes mellitus and diabetic ketoacidosis while undergoing pembrolizumab chemotherapy for metastatic melanoma. He was not taking steroids.
{"title":"Pembrolizumab and diabetes: a case of diabetic ketoacidosis in a patient with metastatic melanoma","authors":"Songo Lolomari, S. Thayyil, M. Kong","doi":"10.15277/bjd.2023.410","DOIUrl":"https://doi.org/10.15277/bjd.2023.410","url":null,"abstract":"Introduction The advent of immunotherapy has revolutionised the management of certain malignancies, and its use has increased over the past decade. Monoclonal antibody therapies known as checkpoint inhibitors work by enhancing the immune response against malignant cells by blocking the pathways that inhibit T-cell regulation. Checkpoint inhibitors can be administered alone or in combination as an intravenous infusion every 3-6 weeks for a maximum of two years. However, about 10% of patients may experience endocrine adverse effects. Thyroid disease and hypophysitis are those most commonly encountered; there are also reports of diabetes mellitus and primary adrenal insufficiency as well as rarer endocrinopathies. Pembrolizumab, an immune checkpoint inhibitor, received FDA approval in 2014 for advanced melanoma, and in 2015 for metastatic non-small cell lung cancer. It is also approved for recurrent/metastatic head and neck cancer, and for refractory classical Hodgkin’s lymphoma. We report the case of a 75-year-old man who developed new-onset diabetes mellitus and diabetic ketoacidosis while undergoing pembrolizumab chemotherapy for metastatic melanoma. He was not taking steroids.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43141030","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}
Abbas See, Manjula Mallikage, Jacqueline Mildred, Andrea Friel, Mary Gray, S. Kirmani, M. Pierides
{"title":"Cost-effective analysis of using total contact casting for diabetic foot ulcer management","authors":"Abbas See, Manjula Mallikage, Jacqueline Mildred, Andrea Friel, Mary Gray, S. Kirmani, M. Pierides","doi":"10.15277/bjd.2023.404","DOIUrl":"https://doi.org/10.15277/bjd.2023.404","url":null,"abstract":"","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2023-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45087314","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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