{"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":null,"pages":null},"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}
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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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}
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":null,"pages":null},"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}
S. Manley, Andreas Karwath, John A. Williams, P. Nightingale, J. Webber, R. Raghavan, Alison Barratt, C. Webster, R. Round, I. Stratton, G. Gkoutos, G. Roberts, Samiul Mostafa, Sandip Ghosh
The prevalence of diabetes in Birmingham is 11% but it is 22% in hospital inpatients. Queen Elizabeth Hospital in Birmingham (QEHB) serves a multi-ethnic population with 6% Afro-Caribbean, 19% South Asian and 70% White European. A clinical audit of 18,965 emergency admissions to QEHB showed that 5% were undiagnosed but had admission glucose in the ‘diabetes’ range and 16% were in the ‘at risk’ range. The proportion of Afro-Caribbeans (7%) and South Asians (8%) in the ‘diabetes’ range was higher than White Europeans (5%). Given the magnitude of the problem, this paper explores the issues concerning the use of reflex HbA1c testing in the UK for diagnosis of diabetes in hospital admissions. HbA1c testing is suitable for most patients but conditions affecting red blood cell turnover invalidate the results in a small number of people. However, there are pertinent questions relating to the introduction of such testing in the NHS on a routine basis. Literature searches on a topical question ‘Is hyperglycaemia identified during emergency admission/attendance acted upon?’, were performed from 2016 to 2021 and 2016 to 2022. They identified 21 different, relevant, research papers - 5 from Australia, 9 from Europe including 4 from the UK, 5 from America and 1 each from Canada and Africa. These papers revealed an absence of established procedures for the management and follow-up of routinely detected hyperglycaemia using HbA1c when no previous diabetes diagnosis was recorded. Further work is required to determine the role of reflex HbA1c testing for diagnosis of diabetes in admissions with hyperglycaemia, and the cost-effectiveness and role of point-of-care HbA1c testing.
{"title":"use of HbA1c for new diagnosis of diabetes in those with hyperglycaemia on admission to or attendance at hospital urgently requires research","authors":"S. Manley, Andreas Karwath, John A. Williams, P. Nightingale, J. Webber, R. Raghavan, Alison Barratt, C. Webster, R. Round, I. Stratton, G. Gkoutos, G. Roberts, Samiul Mostafa, Sandip Ghosh","doi":"10.15277/bjd.2022.386","DOIUrl":"https://doi.org/10.15277/bjd.2022.386","url":null,"abstract":"The prevalence of diabetes in Birmingham is 11% but it is 22% in hospital inpatients. Queen Elizabeth Hospital in Birmingham (QEHB) serves a multi-ethnic population with 6% Afro-Caribbean, 19% South Asian and 70% White European.\u0000A clinical audit of 18,965 emergency admissions to QEHB showed that 5% were undiagnosed but had admission glucose in the ‘diabetes’ range and 16% were in the ‘at risk’ range. The proportion of Afro-Caribbeans (7%) and South Asians (8%) in the ‘diabetes’ range was higher than White Europeans (5%). Given the magnitude of the problem, this paper explores the issues concerning the use of reflex HbA1c testing in the UK for diagnosis of diabetes in hospital admissions. HbA1c testing is suitable for most patients but conditions affecting red blood cell turnover invalidate the results in a small number of people.\u0000However, there are pertinent questions relating to the introduction of such testing in the NHS on a routine basis. Literature searches on a topical question ‘Is hyperglycaemia identified during emergency admission/attendance acted upon?’, were performed from 2016 to 2021 and 2016 to 2022. They identified 21 different, relevant, research papers - 5 from Australia, 9 from Europe including 4 from the UK, 5 from America and 1 each from Canada and Africa. These papers revealed an absence of established procedures for the management and follow-up of routinely detected hyperglycaemia using HbA1c when no previous diabetes diagnosis was recorded.\u0000Further work is required to determine the role of reflex HbA1c testing for diagnosis of diabetes in admissions with hyperglycaemia, and the cost-effectiveness and role of point-of-care HbA1c testing.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2022-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45434919","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":null,"pages":null},"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}
{"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":null,"pages":null},"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}
L. Rengarajan, Katrina Nash, E. Ooi, Catherine Cooper, Amy Birchenough, M. Owen, Sanjay Saraf, A. Karamat, P. De, S. Krishnasamy, P. Narendran, P. Kempegowda
Introduction Diabetes-related ketoacidosis (DKA) is a life-threatening complication of diabetes which requires rapid assessment and treatment.1 Although mortality has decreased over the years, DKA still causes considerable morbidity and mortality amongst adults, adolescents and children.2 Existing quality improvement projects (QIP) have demonstrated that use of evidence-based protocols and order sets is able to improve outcomes associated with DKA management.3,4 However, we did not find any studies demonstrating sustainable improvements over a long period. People presenting with DKA represent a considerable financial and resource burden.5 Reducing the duration of DKA would therefore substantially reduce the disease and resource burden associated with diabetes.
{"title":"Sustaining improvement in diabetes-related ketoacidosis management through a Quality Improvement ProjectSustaining improvement in diabetic ketoacidosis management through Quality Improvement Project","authors":"L. Rengarajan, Katrina Nash, E. Ooi, Catherine Cooper, Amy Birchenough, M. Owen, Sanjay Saraf, A. Karamat, P. De, S. Krishnasamy, P. Narendran, P. Kempegowda","doi":"10.15277/bjd.2022.398","DOIUrl":"https://doi.org/10.15277/bjd.2022.398","url":null,"abstract":"Introduction Diabetes-related ketoacidosis (DKA) is a life-threatening complication of diabetes which requires rapid assessment and treatment.1 Although mortality has decreased over the years, DKA still causes considerable morbidity and mortality amongst adults, adolescents and children.2 Existing quality improvement projects (QIP) have demonstrated that use of evidence-based protocols and order sets is able to improve outcomes associated with DKA management.3,4 However, we did not find any studies demonstrating sustainable improvements over a long period. People presenting with DKA represent a considerable financial and resource burden.5 Reducing the duration of DKA would therefore substantially reduce the disease and resource burden associated with diabetes.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2022-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44857234","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}
The origins of diabetes medications provide an intriguing catalogue of clinical serendipity and scientific design. Use of insulin (beyond 1922) gave recognition to insulin resistance and the categorisation of type 2 diabetes (T2DM). The first sulphonylurea (carbutamide, 1956) emerged from its use as an antibacterial sulphonamide prone to cause hypoglycaemia, and biguanides were first used to treat diabetes in 1957 despite their glucose-lowering properties having been known since the 1920s. Alpha-glucosidase inhibitors arose from a screening programme for amylase inhibitors by Bayer in the 1970s and acarbose was introduced in 1990. The first thiazolidinedione (ciglitazone; not developed) was identified in a screening programme for triglyceride-lowering compounds by Takeda in the late 1970s and gave rise to pioglitazone (approved 1999), although first to market was troglitazone (from Warner Lambert 1997, withdrawn 2000). Exendin, an analogue of the incretin hormone glucagon-like peptide-1 (GLP-1), was identified in 1992 in the saliva of a lizard (Heloderma suspectum), and took until 2005 to be marketed as exenatide. To promote the efficacy of endogenous GLP-1, its rapid inactivation by the enzyme dipeptidylpeptidase-4 (DPP4) was blocked by clever molecular design of the first DPP4 inhibitors (vildagliptin and sitagliptin, approved in 2006). SGLT2 inhibitors are based on phlorizin, identified in apple tree bark (1835) and modified (2000) to avoid intestinal degradation: further modifications to increase selectivity against SGLT2 gave dapagliflozin and canagliflozin - approved 2012 and 2013, respectively, in Europe.
{"title":"origins of type 2 diabetes medications","authors":"Clifford J Bailey","doi":"10.15277/bjd.2022.388","DOIUrl":"https://doi.org/10.15277/bjd.2022.388","url":null,"abstract":"The origins of diabetes medications provide an intriguing catalogue of clinical serendipity and scientific design. Use of insulin (beyond 1922) gave recognition to insulin resistance and the categorisation of type 2 diabetes (T2DM). The first sulphonylurea (carbutamide, 1956) emerged from its use as an antibacterial sulphonamide prone to cause hypoglycaemia, and biguanides were first used to treat diabetes in 1957 despite their glucose-lowering properties having been known since the 1920s. Alpha-glucosidase inhibitors arose from a screening programme for amylase inhibitors by Bayer in the 1970s and acarbose was introduced in 1990. The first thiazolidinedione (ciglitazone; not developed) was identified in a screening programme for triglyceride-lowering compounds by Takeda in the late 1970s and gave rise to pioglitazone (approved 1999), although first to market was troglitazone (from Warner Lambert 1997, withdrawn 2000). Exendin, an analogue of the incretin hormone glucagon-like peptide-1 (GLP-1), was identified in 1992 in the saliva of a lizard (Heloderma suspectum), and took until 2005 to be marketed as exenatide. To promote the efficacy of endogenous GLP-1, its rapid inactivation by the enzyme dipeptidylpeptidase-4 (DPP4) was blocked by clever molecular design of the first DPP4 inhibitors (vildagliptin and sitagliptin, approved in 2006). SGLT2 inhibitors are based on phlorizin, identified in apple tree bark (1835) and modified (2000) to avoid intestinal degradation: further modifications to increase selectivity against SGLT2 gave dapagliflozin and canagliflozin - approved 2012 and 2013, respectively, in Europe.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2022-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48001130","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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