{"title":"Insulin – the sharp end of the needle: experiences of 48 years with diabetes","authors":"H. Alban Davies","doi":"10.15277/bjd.2022.356","DOIUrl":"https://doi.org/10.15277/bjd.2022.356","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":"44084515","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":"1993 - The Diabetes Control and Complications Trial (DCCT)","authors":"B. Ryder","doi":"10.15277/bjd.2022.357","DOIUrl":"https://doi.org/10.15277/bjd.2022.357","url":null,"abstract":"2022;","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":"48678491","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":"Gazing into the future – the next 100 years. Perspectives from diabetologists","authors":"R. Ryder, E. Wilmot, T. Crabtree","doi":"10.15277/bjd.2022.399","DOIUrl":"https://doi.org/10.15277/bjd.2022.399","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":"48874059","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 In 2015 Dana Lewis, a person with diabetes, developed her own hybrid-closed loop system and began the #WeAreNotWaiting movement (Figure 1). These systems, often called “do-it-yourself” artificial pancreas systems (DIY APS) or open-source closed-loop automated insulin delivery systems, combine an insulin pump, a sensor and an algorithm to maintain glucose levels in range. Whilst early versions were “hybrid” – in other words they still required manual bolusing-the newer versions of the algorithm have been used as a fully-closed loop (no bolus required!) by some individuals. An article written in 2019 provides further detail on these systems and some of the issues associated with them.1 These systems filled a gap by circumnavigating the approvals that commercial companies require in order to launch similar systems. There are three systems commonly encountered: OpenAPS, AndroidAPS and Loop.1 At the time of writing all three systems are unapproved and unregulated. When these systems first entered UK services the evidence was limited. However, self-reported outcomes from users of the systems were encouraging from both glycaemia and safety points of view.2-4 At that time, the approach taken across UK diabetes services was inconsistent and guidelines from the General Medical Council and others were unclear.5 Work was undertaken to explore the opinions of UK healthcare professionals; initial position statements were produced by Diabetes UK and other organisations to support users of these systems.6,7 We also explored the concerns of individuals with diabetes commencing the use of these systems, and were able to demonstrate that they were less concerned with safety and
{"title":"#We are not waiting - DIY APS Do-It-Yourself Artificial Pancreas Systems: The story so far","authors":"T. Crabtree, B. Ryder, E. Wilmot","doi":"10.15277/bjd.2022.373","DOIUrl":"https://doi.org/10.15277/bjd.2022.373","url":null,"abstract":"Introduction In 2015 Dana Lewis, a person with diabetes, developed her own hybrid-closed loop system and began the #WeAreNotWaiting movement (Figure 1). These systems, often called “do-it-yourself” artificial pancreas systems (DIY APS) or open-source closed-loop automated insulin delivery systems, combine an insulin pump, a sensor and an algorithm to maintain glucose levels in range. Whilst early versions were “hybrid” – in other words they still required manual bolusing-the newer versions of the algorithm have been used as a fully-closed loop (no bolus required!) by some individuals. An article written in 2019 provides further detail on these systems and some of the issues associated with them.1 These systems filled a gap by circumnavigating the approvals that commercial companies require in order to launch similar systems. There are three systems commonly encountered: OpenAPS, AndroidAPS and Loop.1 At the time of writing all three systems are unapproved and unregulated. When these systems first entered UK services the evidence was limited. However, self-reported outcomes from users of the systems were encouraging from both glycaemia and safety points of view.2-4 At that time, the approach taken across UK diabetes services was inconsistent and guidelines from the General Medical Council and others were unclear.5 Work was undertaken to explore the opinions of UK healthcare professionals; initial position statements were produced by Diabetes UK and other organisations to support users of these systems.6,7 We also explored the concerns of individuals with diabetes commencing the use of these systems, and were able to demonstrate that they were less concerned with safety and","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":"45519088","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 100 years since insulin was discovered have seen major progress in understanding the aetiology of type 1 diabetes. In contrast, type 2 diabetes (T2DM) remained mysterious until recently. Clinical studies and clinical experience had resulted in widespread acceptance of the apparently lifelong, progressive nature of the condition. Discoveries over the last 16 years have permitted these rationalisations to be discarded and the aetiology of T2DM is not now in doubt. It is a condition of excess fat inside the liver and pancreas which can be countered by weight loss. A turbulent 16 years of study has led directly to a therapeutically useful understanding of the condition. Importantly, this can be tailored to the individual.
{"title":"Type 2 diabetes: the problem and the solution","authors":"Roy Taylor","doi":"10.15277/bjd.2022.366","DOIUrl":"https://doi.org/10.15277/bjd.2022.366","url":null,"abstract":"Introduction The 100 years since insulin was discovered have seen major progress in understanding the aetiology of type 1 diabetes. In contrast, type 2 diabetes (T2DM) remained mysterious until recently. Clinical studies and clinical experience had resulted in widespread acceptance of the apparently lifelong, progressive nature of the condition. Discoveries over the last 16 years have permitted these rationalisations to be discarded and the aetiology of T2DM is not now in doubt. It is a condition of excess fat inside the liver and pancreas which can be countered by weight loss. A turbulent 16 years of study has led directly to a therapeutically useful understanding of the condition. Importantly, this can be tailored to the individual.","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":"49362881","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}
L. Varadhan, P. Saravanan, Sarah N Ali, W. Hanif, Vinod Patel
A significant number of cardiovascular outcome trials have been published to support decision-making regarding treatment options after or alongside metformin in people with type 2 diabetes (T2DM), specifically targeting prevention of adverse cardiovascular and renal outcomes. The latest NICE guidelines recommend the use of sodium-glucose transport inhibitors (SGLT2i) in patients with cardiovascular diseases, heart failure and chronic kidney disease with diabetes and recommends the use of glucagon-like polypeptide receptor agonists (GLP-1RA) only in a selected group of patients. A comprehensive summary of the various trials, structured around patient characteristics and clinical outcomes, can help to compare the various classes of drugs and drugs within the class. Since the drug acquisition cost within a class is generally the same in the UK, the drug with the best available evidence in the class should be chosen to maximise clinical benefit for the patient. Clinical phenotyping, a process of aligning a patient to the inclusion criteria and the desired clinical outcomes of a trial, can guide the choice of the best drug within a class.
{"title":"Implementing the new NICE guidelines for type 2 diabetes (NG28): Focusing beyond HbA1c targets and clinically phenotyping patients to the appropriate second-line agent","authors":"L. Varadhan, P. Saravanan, Sarah N Ali, W. Hanif, Vinod Patel","doi":"10.15277/bjd.2022.385","DOIUrl":"https://doi.org/10.15277/bjd.2022.385","url":null,"abstract":"A significant number of cardiovascular outcome trials have been published to support decision-making regarding treatment options after or alongside metformin in people with type 2 diabetes (T2DM), specifically targeting prevention of adverse cardiovascular and renal outcomes. The latest NICE guidelines recommend the use of sodium-glucose transport inhibitors (SGLT2i) in patients with cardiovascular diseases, heart failure and chronic kidney disease with diabetes and recommends the use of glucagon-like polypeptide receptor agonists (GLP-1RA) only in a selected group of patients. A comprehensive summary of the various trials, structured around patient characteristics and clinical outcomes, can help to compare the various classes of drugs and drugs within the class. Since the drug acquisition cost within a class is generally the same in the UK, the drug with the best available evidence in the class should be chosen to maximise clinical benefit for the patient. Clinical phenotyping, a process of aligning a patient to the inclusion criteria and the desired clinical outcomes of a trial, can guide the choice of the best drug within a class.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2022-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49430097","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}
Amelia Simenacz, Rebekah Wilmington, C. Green, Arash Ardavani, I. Idris
Background: Glucagon-like peptide-1 analogues such as liraglutide 3.0 mg (Saxenda) have yielded significant weight loss in clinical trials when combined with lifestyle interventions. Despite the recent approval of liraglutide 3.0 mg, its success among patients attending specialist bariatric units remains uncertain. Objective: This study investigated the effectiveness of liraglutide 3.0 mg on weight, body mass index (BMI), treatment tolerability and its effects on glycated haemoglobin (HbA1c). Methods: Clinical data were retrospectively obtained from medical records within Tier 3-4 bariatric weight management clinics. Wilcoxon signed rank tests were employed to establish the statistical significance (p<0.05) of changes in weight and HbA1c. Results: 33 patients were identified (72.7% female with mean baseline age, weight and BMI of 44.8 years, 156.6 kg and 55.0 kg/m2, respectively). Eighteen patients had completed 26 weeks of treatment. Of the 18 patients, the discontinuation rate due to side effects was 15.2%, indicating substantial treatment tolerance. After 26 weeks of treatment, BMI (±standard deviation) was significantly reduced by 7.9±6.3% (p<0.05) and 72.2% of patients achieved at least 5% weight loss. Additionally, a significant decrease in median HbA1c (4.5±4.5 mmol/mol) was observed (p<0.05), concurrent with increased remission from prediabetes. Conclusion: This retrospective study revealed that liraglutide 3.0 mg, together with lifestyle management, reduced weight and improved glycaemic control. These results support liraglutide’s application in certain high-risk populations, including patients waiting for bariatric surgical intervention.
{"title":"Liraglutide 3.0 (Saxenda) in bariatric patients: a retrospective real-world clinical evaluation of effectiveness","authors":"Amelia Simenacz, Rebekah Wilmington, C. Green, Arash Ardavani, I. Idris","doi":"10.15277/bjd.2022.350","DOIUrl":"https://doi.org/10.15277/bjd.2022.350","url":null,"abstract":"Background: Glucagon-like peptide-1 analogues such as liraglutide 3.0 mg (Saxenda) have yielded significant weight loss in clinical trials when combined with lifestyle interventions. Despite the recent approval of liraglutide 3.0 mg, its success among patients attending specialist bariatric units remains uncertain.\u0000Objective: This study investigated the effectiveness of liraglutide 3.0 mg on weight, body mass index (BMI), treatment tolerability and its effects on glycated haemoglobin (HbA1c).\u0000Methods: Clinical data were retrospectively obtained from medical records within Tier 3-4 bariatric weight management clinics. Wilcoxon signed rank tests were employed to establish the statistical significance (p<0.05) of changes in weight and HbA1c.\u0000Results: 33 patients were identified (72.7% female with mean baseline age, weight and BMI of 44.8 years, 156.6 kg and 55.0 kg/m2, respectively). Eighteen patients had completed 26 weeks of treatment. Of the 18 patients, the discontinuation rate due to side effects was 15.2%, indicating substantial treatment tolerance. After 26 weeks of treatment, BMI (±standard deviation) was significantly reduced by 7.9±6.3% (p<0.05) and 72.2% of patients achieved at least 5% weight loss. Additionally, a significant decrease in median HbA1c (4.5±4.5 mmol/mol) was observed (p<0.05), concurrent with increased remission from prediabetes.\u0000Conclusion: This retrospective study revealed that liraglutide 3.0 mg, together with lifestyle management, reduced weight and improved glycaemic control. These results support liraglutide’s application in certain high-risk populations, including patients waiting for bariatric surgical intervention.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2022-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44730492","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":"Impressions from EASD 2022","authors":"C. Day","doi":"10.15277/bjd.2022.392","DOIUrl":"https://doi.org/10.15277/bjd.2022.392","url":null,"abstract":"","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2022-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44413616","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}
Elizabeth Fetherston, S. Tee, `Meilan Kwok, Satish Artham, P. Carey, R. Nayar, D. Bishop, A. Joshi
Background COVID-19, caused by the severe acute respiratory syndromecoronavirus-2 (SARS-CoV-2), was declared a pandemic on 11th March 2020. COVID-19 increases risk of hyperglycaemia regardless of prior diabetes diagnosis. Following results of the RECOVERY trial showing survival benefit in people with COVID-19 who required oxygen, dexamethasone has been used to improve outcomes.1 Dexamethasone (a glucocorticoid) may exacerbate hyperglycaemia in people with diabetes and can precipitate glucocorticoid-induced diabetes in others. In the context of COVID-19 infection, stress-related hyperglycaemia increases risk of mortality during hospitalization.2 In order to improve recognition and management of COVID-19-related hyperglycaemia, the National Diabetes Inpatient COVID response team published relevant guidance.3
{"title":"Use of a simplified local guideline improves “front door” management of diabetes and hyperglycaemia in people admitted to hospital with COVID-19","authors":"Elizabeth Fetherston, S. Tee, `Meilan Kwok, Satish Artham, P. Carey, R. Nayar, D. Bishop, A. Joshi","doi":"10.15277/bjd.2022.397","DOIUrl":"https://doi.org/10.15277/bjd.2022.397","url":null,"abstract":"Background COVID-19, caused by the severe acute respiratory syndromecoronavirus-2 (SARS-CoV-2), was declared a pandemic on 11th March 2020. COVID-19 increases risk of hyperglycaemia regardless of prior diabetes diagnosis. Following results of the RECOVERY trial showing survival benefit in people with COVID-19 who required oxygen, dexamethasone has been used to improve outcomes.1 Dexamethasone (a glucocorticoid) may exacerbate hyperglycaemia in people with diabetes and can precipitate glucocorticoid-induced diabetes in others. In the context of COVID-19 infection, stress-related hyperglycaemia increases risk of mortality during hospitalization.2 In order to improve recognition and management of COVID-19-related hyperglycaemia, the National Diabetes Inpatient COVID response team published relevant guidance.3","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2022-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49213399","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}
K. Mulla, S. Ravindran, Michele Cui, Simon Broadhurst, Laura Sharp, Zoe Bullock, M. Carroll, Chantal Kong
Background The 2018 National Diabetes Inpatient Audit (NaDIA) reported that people with diabetes mellitus (DM) experienced substantially longer hospital stays, poor glucose control and frequent medication errors.1 Intercurrent illnesses can impact blood glucose readings;2 therefore, DM management may need to be tailored when people with diabetes are hospital inpatients to prevent dysglycaemia, which is associated with harm.1 There has been an increased number of admissions relating to diabetes during the pandemic.3 Hospital admission may be an opportunity to improve glycaemic control, to educate people and potentially to reduce future complications. People who are on glucose-lowering medication(s) should monitor their capillary blood glucose (CBG).4 It is very important to display CBG and ketone readings in a clear, interpretable manner and to document them in a timely fashion to enable pattern recognition and titrate diabetes medications effectively. This allows one to determine the impact of change too. Sharma D et al concluded that a colour-coded CBG chart led to more actions being recorded when dysglycaemia occurred and to reduced mortality.5 Our aspiration was to achieve the same result at Watford General Hospital (WGH). Prior to this project, most people with diabetes had their CBG checked four times a day, but this was not necessarily before meals. It was randomly conducted, which led to an increase in adverse events audited by NaDIA-Harms and an increased number of referrals to the diabetes team. This required urgent intervention from the diabetes team. There were no clear instructions for ward staff outlining when to check the patient’s CBG or ketones at WGH. It is difficult to establish a pattern of hypoglycaemia or hyperglycaemia using the current line graph, which makes titration of diabetes medications tough. Moreover, there were no sections for nursing staff to add notes for any interventions carried out for dysglycaemia. After reviewing charts used at different hospitals, the team decided to develop a new chart, which looks similar to the one that people with diabetes use at home. The new Joint British Diabetes Society guidelines (JBDS) promote self-management of diabetes as an inpatient;4 a familiar chart would promote this.
{"title":"Enhancing inpatient diabetes care by developing a new Capillary Blood Glucose and ketone monitoring chart: a Quality Improvement Project (QIP)","authors":"K. Mulla, S. Ravindran, Michele Cui, Simon Broadhurst, Laura Sharp, Zoe Bullock, M. Carroll, Chantal Kong","doi":"10.15277/bjd.2022.396","DOIUrl":"https://doi.org/10.15277/bjd.2022.396","url":null,"abstract":"Background The 2018 National Diabetes Inpatient Audit (NaDIA) reported that people with diabetes mellitus (DM) experienced substantially longer hospital stays, poor glucose control and frequent medication errors.1 Intercurrent illnesses can impact blood glucose readings;2 therefore, DM management may need to be tailored when people with diabetes are hospital inpatients to prevent dysglycaemia, which is associated with harm.1 There has been an increased number of admissions relating to diabetes during the pandemic.3 Hospital admission may be an opportunity to improve glycaemic control, to educate people and potentially to reduce future complications. People who are on glucose-lowering medication(s) should monitor their capillary blood glucose (CBG).4 It is very important to display CBG and ketone readings in a clear, interpretable manner and to document them in a timely fashion to enable pattern recognition and titrate diabetes medications effectively. This allows one to determine the impact of change too. Sharma D et al concluded that a colour-coded CBG chart led to more actions being recorded when dysglycaemia occurred and to reduced mortality.5 Our aspiration was to achieve the same result at Watford General Hospital (WGH). Prior to this project, most people with diabetes had their CBG checked four times a day, but this was not necessarily before meals. It was randomly conducted, which led to an increase in adverse events audited by NaDIA-Harms and an increased number of referrals to the diabetes team. This required urgent intervention from the diabetes team. There were no clear instructions for ward staff outlining when to check the patient’s CBG or ketones at WGH. It is difficult to establish a pattern of hypoglycaemia or hyperglycaemia using the current line graph, which makes titration of diabetes medications tough. Moreover, there were no sections for nursing staff to add notes for any interventions carried out for dysglycaemia. After reviewing charts used at different hospitals, the team decided to develop a new chart, which looks similar to the one that people with diabetes use at home. The new Joint British Diabetes Society guidelines (JBDS) promote self-management of diabetes as an inpatient;4 a familiar chart would promote this.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2022-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44979938","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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