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":" ","pages":""},"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":" ","pages":""},"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}
People living with diabetes (DM) are at higher risk of developing periodontal disease than those without diabetes. This observation was first recorded in 1928. It is now believed that the risk is 3-4 times greater than for people without DM, and more for smokers. However, many doctors are not aware of this. DM and periodontal disease are bi-directionally linked, the one affecting the other and vice versa, although the mechanism is not fully understood. Periodontal disease has an adverse effect on glycaemic control. That improves when periodontitis is successfully treated. Doctors should consider periodontal disease when their patients have persistently high glycated haemoglobin (HbA1c) levels, and dentists should consider diabetes or pre-diabetes when they have patients with unstable periodontitis. Doctors and dentists, and their teams, need to share results. This paper considers what that shared information should be. A system of red, amber and green for both medical and dental risks is proposed. Until there are reliable methods of information exchanges and a paradigm shift in inter-professional working, patients should obtain their medical and dental results and share them with their respective advisors. Those patients who do not attend for dental care should be advised by their doctor about the potential benefits of dental screening for periodontitis.
{"title":"Diabetes mellitus and periodontal disease: education, collaboration and information sharing between doctors, dentists and patients","authors":"Chris Turner, P. Bouloux","doi":"10.15277/bjd.2023.403","DOIUrl":"https://doi.org/10.15277/bjd.2023.403","url":null,"abstract":"People living with diabetes (DM) are at higher risk of developing periodontal disease than those without diabetes. This observation was first recorded in 1928. It is now believed that the risk is 3-4 times greater than for people without DM, and more for smokers. However, many doctors are not aware of this.\u0000DM and periodontal disease are bi-directionally linked, the one affecting the other and vice versa, although the mechanism is not fully understood. Periodontal disease has an adverse effect on glycaemic control. That improves when periodontitis is successfully treated.\u0000Doctors should consider periodontal disease when their patients have persistently high glycated haemoglobin (HbA1c) levels, and dentists should consider diabetes or pre-diabetes when they have patients with unstable periodontitis.\u0000Doctors and dentists, and their teams, need to share results. This paper considers what that shared information should be. A system of red, amber and green for both medical and dental risks is proposed. Until there are reliable methods of information exchanges and a paradigm shift in inter-professional working, patients should obtain their medical and dental results and share them with their respective advisors.\u0000Those patients who do not attend for dental care should be advised by their doctor about the potential benefits of dental screening for periodontitis.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44821513","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, Farideh Shiraseb, Sara Hajishizari, Mena Farazi, Hadith Tangestani, Leila Khorraminezhad, C. Clark, K. Mirzaei
Background and aims: We sought to examine the interaction between CRY1 genotypes and low carbohydrate diet (LCD) score and the effect on insulin resistance, insulin sensitivity, homeostasis model assessment of insulin resistance (HOMA- IR) and quantitative insulin sensitivity check index (ISQUKI). Methods: This cross-sectional study was conducted with a total of 228 overweight and obese women. The data related to anthropometric and biochemical measures were collected and a food frequency questionnaire (FFQ), with 147 items, was used to assess dietary intake. Based on the FFQ, we calculated an LCD score for each study participant, ranging from 0 to 70. Biochemical assessments, including TC, HDL, LDL, TG, FBS, insulin and HOMA-IR, were performed. Deoxyribonucleic acid (DNA) samples were assessed to be genotyped for the rs2287161, which was genotyped by the restriction fragment length polymorphism (PCR-RFLP) method. A generalised linear model was performed for interaction analysis. Results: The results of the study demonstrated that, after controlling for several confounders, increased adherence to an LCD (T3 vs. T1) in the interaction with one risk allele genotype (CG) increases ISQUKI level (β: 0.001, CI: 0.00, 0.002, p=0.041). Also, there was a marginally negative interaction between higher adherence to LCD and two risk alleles genotype (CC) on insulin level (β: -0.012, CI: 0-0.024, 0.001, p=0.054). Conclusions: This study revealed a negative interaction of CRY1 genotypes with two risk allele and higher LCD adherence on insulin level, and a positive interaction on ISQUKI. However, the mechanism of interaction between LCDs and CRY1 genotypes remains unclear.
{"title":"CRY1 polymorphism may influence the association of low carbohydrate diet (LCD) score on glucose homeostasis in overweight and obese women","authors":"A. Mirzababaei, Farideh Shiraseb, Sara Hajishizari, Mena Farazi, Hadith Tangestani, Leila Khorraminezhad, C. Clark, K. Mirzaei","doi":"10.15277/bjd.2023.402","DOIUrl":"https://doi.org/10.15277/bjd.2023.402","url":null,"abstract":"Background and aims: We sought to examine the interaction between CRY1 genotypes and low carbohydrate diet (LCD) score and the effect on insulin resistance, insulin sensitivity, homeostasis model assessment of insulin resistance (HOMA- IR) and quantitative insulin sensitivity check index (ISQUKI).\u0000Methods: This cross-sectional study was conducted with a total of 228 overweight and obese women. The data related to anthropometric and biochemical measures were collected and a food frequency questionnaire (FFQ), with 147 items, was used to assess dietary intake. Based on the FFQ, we calculated an LCD score for each study participant, ranging from 0 to 70. Biochemical assessments, including TC, HDL, LDL, TG, FBS, insulin and HOMA-IR, were performed. Deoxyribonucleic acid (DNA) samples were assessed to be genotyped for the rs2287161, which was genotyped by the restriction fragment length polymorphism (PCR-RFLP) method. A generalised linear model was performed for interaction analysis.\u0000Results: The results of the study demonstrated that, after controlling for several confounders, increased adherence to an LCD (T3 vs. T1) in the interaction with one risk allele genotype (CG) increases ISQUKI level (β: 0.001, CI: 0.00, 0.002, p=0.041). Also, there was a marginally negative interaction between higher adherence to LCD and two risk alleles genotype (CC) on insulin level (β: -0.012, CI: 0-0.024, 0.001, p=0.054).\u0000Conclusions: This study revealed a negative interaction of CRY1 genotypes with two risk allele and higher LCD adherence on insulin level, and a positive interaction on ISQUKI. However, the mechanism of interaction between LCDs and CRY1 genotypes remains unclear.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":"1 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41731475","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}
Hybrid closed-loop systems are transforming the clinical management of T1DM. Large randomised controlled trials of hybrid closed-loop systems have demonstrated safety and efficacy, with significant improvements in glycaemic control compared to control therapy, and there are now several commercially approved hybrid closed-loop systems available in the UK. There is also a growing body of evidence demonstrating the quality of life benefits associated with hybrid closed-loop systems, both for users and also for parents/caregivers and other family members. We review the clinical evidence supporting currently available hybrid closed-loop systems in the UK and also new systems on the horizon. We discuss the emerging evidence for associated psychosocial benefits of hybrid closed-loop therapy. We also address future challenges around healthcare professional readiness to deliver closed-loop technology and ensuring equitable access across the UK.
{"title":"#We don't have to wait any more Closed-loop systems: transforming the landscape","authors":"C. Boughton, R. Hovorka","doi":"10.15277/bjd.2022.374","DOIUrl":"https://doi.org/10.15277/bjd.2022.374","url":null,"abstract":"Hybrid closed-loop systems are transforming the clinical management of T1DM. Large randomised controlled trials of hybrid closed-loop systems have demonstrated safety and efficacy, with significant improvements in glycaemic control compared to control therapy, and there are now several commercially approved hybrid closed-loop systems available in the UK. There is also a growing body of evidence demonstrating the quality of life benefits associated with hybrid closed-loop systems, both for users and also for parents/caregivers and other family members.\u0000We review the clinical evidence supporting currently available hybrid closed-loop systems in the UK and also new systems on the horizon. We discuss the emerging evidence for associated psychosocial benefits of hybrid closed-loop therapy. We also address future challenges around healthcare professional readiness to deliver closed-loop technology and ensuring equitable access across the UK.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2022-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44418737","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":"100 years of insulin; 50 years of diabetic life*","authors":"Maggie Loughran","doi":"10.15277/bjd.2022.379","DOIUrl":"https://doi.org/10.15277/bjd.2022.379","url":null,"abstract":"","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2022-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46529728","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}
While it is difficult to predict the next 100 years of development, the current Medtronic product innovation pipeline is changing the lives of people with diabetes. The MiniMedTM 780G system with GuardianTM 4 sensor and extended wear infusion set is the advanced hybrid closed-loop pump system currently available in the UK from Medtronic. It has been clinically proven to achieve >70% time in range and to lower HbA1c levels in people with diabetes. Medtronic continues to innovate in the hybrid closed-loop and insulin pump and sensor area. The company is developing new sensor technology and personalised closed-loop options for future patients. Medtronic recognises that not all people with diabetes will want to use an insulin pump and therefore is launching a Smart MDI system for people looking for more from MDI therapy. The Smart MDI system brings together a collection of tools that provides real-time insights and comprehensive reports. These make it easier for people with diabetes to manage life on multiple daily injections. The system combines predictive glucose management with the GuardianTM 4 sensor, with no finger pricks and personalised high and low alerts up to 60 minutes in advance. Personalised insulin management with the inpen device allows informed insulin dosing with integrated real-time glucose data trends and shareable insight reports. The Medtronic extended-wear infusion set is due to launch in the UK soon. It is focused on improving user experience. It is the only infusion set approved for longer wear (with a wear twice as long as standard infusion sets) without compromising comfort, safety or insulin delivery. This new set will also reduce traditional infusion set plastic waste by half.
{"title":"Gazing into the future. The next 100 years: the Medtronic perspective","authors":"D. Turner","doi":"10.15277/bjd.2022.376","DOIUrl":"https://doi.org/10.15277/bjd.2022.376","url":null,"abstract":"While it is difficult to predict the next 100 years of development, the current Medtronic product innovation pipeline is changing the lives of people with diabetes. The MiniMedTM 780G system with GuardianTM 4 sensor and extended wear infusion set is the advanced hybrid closed-loop pump system currently available in the UK from Medtronic. It has been clinically proven to achieve >70% time in range and to lower HbA1c levels in people with diabetes. Medtronic continues to innovate in the hybrid closed-loop and insulin pump and sensor area. The company is developing new sensor technology and personalised closed-loop options for future patients. Medtronic recognises that not all people with diabetes will want to use an insulin pump and therefore is launching a Smart MDI system for people looking for more from MDI therapy. The Smart MDI system brings together a collection of tools that provides real-time insights and comprehensive reports. These make it easier for people with diabetes to manage life on multiple daily injections. The system combines predictive glucose management with the GuardianTM 4 sensor, with no finger pricks and personalised high and low alerts up to 60 minutes in advance. Personalised insulin management with the inpen device allows informed insulin dosing with integrated real-time glucose data trends and shareable insight reports. The Medtronic extended-wear infusion set is due to launch in the UK soon. It is focused on improving user experience. It is the only infusion set approved for longer wear (with a wear twice as long as standard infusion sets) without compromising comfort, safety or insulin delivery. This new set will also reduce traditional infusion set plastic waste by half.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2022-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43976330","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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