{"title":"Overview of the hybrid 82nd Scientific Sessions of the American Diabetes Association","authors":"C. Day","doi":"10.15277/bjd.2022.391","DOIUrl":"https://doi.org/10.15277/bjd.2022.391","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":"41467176","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 article by Miles Fisher in this edition of the British Journal of Diabetes discusses cardiovascular outcome trials (CVOTs) which have examined the impact of GLP-1RAs in type 2 diabetes (T2DM). He queries ‘why updated guidance from NICE...fails to acknowledge the evidence-based cardiovascular benefits’. Indeed, clinicians in the UK will be puzzled as to why this class of glucose-lowering therapy is now a first-line option in European and North American guidelines for people with T2DM at high cardiovascular risk, but remains well down the pecking order in NICE guideline (NG) 28.1-3 This editorial will provide a short précis of the history of GLP-1RAs and NICE and try to explain the current impasse. The National Institute of Clinical Excellence (NICE) was established in 1999 to ‘diffuse the postcode lottery’ of healthcare (for example, varying access to medicines according to where people lived) and serves the National Health Services (NHS) in England, Northern Ireland and Wales. Since its set-up, there have been two changes in name, the National Institute for Health and Clinical Excellence (2005) and the National Institute for Health and Care Excellence (2013) but the abbreviation of NICE has stood the test of time and is a globally recognised brand. Well over fifty countries world-wide access guidelines produced by NICE rather than doing their own in-depth assessment of new medicines.4 When it was launched, NICE inherited various guidelines for the management of T2DM, which were rebadged. It produced its first clinical guideline for T2DM (CG66) in 2008.5 This was rapidly followed by the release of CG87 in May 2009, which was a short update on the ‘newer agents’ for blood glucose lowering.6 This guideline included exenatide, given twice daily, which was the first GLP-1RA to be licensed in the UK (in 2007). Exenatide was positioned as a third-line ‘alternative’ add-on therapy to be considered after insulin, a thiazolidinedione or a dipeptidyl peptase-4 inhibitor and it was only sanctioned for use with metformin and a sulfonylurea. CG87 introduced the body mass index (BMI) cut-off of 35 Kg/m2 for GLP-1RAs, which was not based on data from clinical trials but was the BMI at which the average cost of a long-acting insulin analogue was the same as BD exenatide. NICE also introduced ‘stopping rules’ where exenatide should be withheld when a reduction of at least 1% (11mmol/mol) in HbA1c and weight loss of at least 3% initial body weight was not achieved after six months. Stopping rules have not been recommended for any other glucose-lowering class. The next NICE guidance for the management of T2DM (NG28) was published in 2015 and is best remembered for the furore created by the recommendation of repaglinide as firstline treatment for people intolerant of metformin.7,8 In the preceding six years, GLP-1RAs had been added to the glucoselowering algorithm by means of single technology appraisals (TAs). These individual assessments by NICE had a more bind
Miles Fisher在本期《英国糖尿病杂志》上发表的文章讨论了心血管结果试验（CVOT），该试验检测了GLP-1RA对2型糖尿病（T2DM）的影响。他质疑“为什么NICE更新了指南。。。未能承认循证心血管益处”。事实上，英国的临床医生会感到困惑，为什么这类降糖治疗现在是欧洲和北美指南中针对心血管高危T2DM患者的一线选择，但在NICE指南（NG）28.1-3中排名靠后。这篇社论将简要介绍GLP-1RA和NICE的历史，并试图解释目前的僵局。国家临床卓越研究所（NICE）成立于1999年，旨在“分散医疗保健的邮政编码抽签”（例如，根据人们的居住地不同获得药物的机会），并为英格兰、北爱尔兰和威尔士的国家医疗服务体系（NHS）服务。自成立以来，名称发生了两次变化，即国家健康与临床卓越研究所（2005年）和国家健康与护理卓越研究院（2013年），但NICE的缩写经受住了时间的考验，是一个全球公认的品牌。全球有50多个国家制定了NICE获得指南，而不是自己对新药进行深入评估。4当它推出时，NICE继承了T2DM管理的各种指南，这些指南被重新调整了。它于2008年制定了首个T2DM临床指南（CG66）。5随后，CG87于2009年5月迅速发布，这是对降血糖“新药物”的简短更新。6该指南包括艾塞那肽，每天两次，这是第一个在英国获得许可的GLP-1RA（2007年）。艾塞那肽被定位为继胰岛素、噻唑烷二酮或二肽基肽酶-4抑制剂之后考虑的第三线“替代”添加疗法，它只被批准与二甲双胍和磺酰脲一起使用。CG87引入了GLP-1RA的体重指数（BMI）临界值35 Kg/m2，这不是基于临床试验的数据，而是长效胰岛素类似物的平均成本与BD艾塞那肽相同的BMI。NICE还引入了“停止规则”，即当HbA1c减少至少1%（11mmol/mol），且六个月后初始体重未减少至少3%时，应停止使用艾塞那肽。停止规则没有被推荐用于任何其他降血糖类别。下一份NICE关于T2DM（NG28）管理的指南于2015年发布，人们最怀念的是瑞格列奈作为二甲双胍不耐受人群一线治疗的推荐所引起的轰动。7,8在过去的六年里，GLP-1RA通过单一技术评估（TA）被添加到葡萄糖代谢算法中。NICE的这些个人评估比其指导方针具有更具约束力的法律地位，因为TA的积极建议要求临床委托小组提供资金。因此，利拉鲁肽（TA2032010）、艾塞那肽缓释剂（TA2482012）和利西那肽（2013）都被批准使用，尽管NICE将利拉鲁的剂量限制在最大1.2mg OD，因为该剂量与BD艾塞那苷的获取成本相同。9-11然而，GLP-1RA在降糖算法中的总体地位没有变化。在各种三重口服组合或胰岛素后，它们仍然是一种可供考虑的第三线选择，甚至没有提到不能耐受二甲双胍或二甲双胍禁忌的人。证明其优越性的第一个降血糖治疗CVOT是对恩帕列嗪（一种钠-葡萄糖共转运蛋白2（SGLT2）抑制剂）的EMPA-REG结果研究，该试验在2015年12月NG28上市前三个月发表。12 NG28没有考虑这些阳性数据，但这并不重要，因为NICE承诺每两年定期更新一次，而且更多的CVOT数据正在酝酿中。事实上，2016年利拉鲁肽（LEADER）和每周一次的西格鲁肽（SUSTAIN 6）都有阳性CVOT。13,14杜拉鲁肽（REWIND）的阳性优势CVOT于2019年发表，英国斯旺西斯旺西大学医学院1所
{"title":"The place of Glucagon-like 1 peptide receptor agonists (GLP-1RAs) in the new NICE guidelines – what is going on?","authors":"Stephen C. Bain","doi":"10.15277/bjd.2022.381","DOIUrl":"https://doi.org/10.15277/bjd.2022.381","url":null,"abstract":"The article by Miles Fisher in this edition of the British Journal of Diabetes discusses cardiovascular outcome trials (CVOTs) which have examined the impact of GLP-1RAs in type 2 diabetes (T2DM). He queries ‘why updated guidance from NICE...fails to acknowledge the evidence-based cardiovascular benefits’. Indeed, clinicians in the UK will be puzzled as to why this class of glucose-lowering therapy is now a first-line option in European and North American guidelines for people with T2DM at high cardiovascular risk, but remains well down the pecking order in NICE guideline (NG) 28.1-3 This editorial will provide a short précis of the history of GLP-1RAs and NICE and try to explain the current impasse. The National Institute of Clinical Excellence (NICE) was established in 1999 to ‘diffuse the postcode lottery’ of healthcare (for example, varying access to medicines according to where people lived) and serves the National Health Services (NHS) in England, Northern Ireland and Wales. Since its set-up, there have been two changes in name, the National Institute for Health and Clinical Excellence (2005) and the National Institute for Health and Care Excellence (2013) but the abbreviation of NICE has stood the test of time and is a globally recognised brand. Well over fifty countries world-wide access guidelines produced by NICE rather than doing their own in-depth assessment of new medicines.4 When it was launched, NICE inherited various guidelines for the management of T2DM, which were rebadged. It produced its first clinical guideline for T2DM (CG66) in 2008.5 This was rapidly followed by the release of CG87 in May 2009, which was a short update on the ‘newer agents’ for blood glucose lowering.6 This guideline included exenatide, given twice daily, which was the first GLP-1RA to be licensed in the UK (in 2007). Exenatide was positioned as a third-line ‘alternative’ add-on therapy to be considered after insulin, a thiazolidinedione or a dipeptidyl peptase-4 inhibitor and it was only sanctioned for use with metformin and a sulfonylurea. CG87 introduced the body mass index (BMI) cut-off of 35 Kg/m2 for GLP-1RAs, which was not based on data from clinical trials but was the BMI at which the average cost of a long-acting insulin analogue was the same as BD exenatide. NICE also introduced ‘stopping rules’ where exenatide should be withheld when a reduction of at least 1% (11mmol/mol) in HbA1c and weight loss of at least 3% initial body weight was not achieved after six months. Stopping rules have not been recommended for any other glucose-lowering class. The next NICE guidance for the management of T2DM (NG28) was published in 2015 and is best remembered for the furore created by the recommendation of repaglinide as firstline treatment for people intolerant of metformin.7,8 In the preceding six years, GLP-1RAs had been added to the glucoselowering algorithm by means of single technology appraisals (TAs). These individual assessments by NICE had a more bind","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":"48885119","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}
J. Dales, R. Jogia, R. Berrington, D. Modha, M. Kong
{"title":"Outcomes from day case surgery performed by one podiatric surgeon during the COVID-19 pandemic in patients from a multidisciplinary diabetic foot clinic","authors":"J. Dales, R. Jogia, R. Berrington, D. Modha, M. Kong","doi":"10.15277/bjd.2022.390","DOIUrl":"https://doi.org/10.15277/bjd.2022.390","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":"44537612","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}
R. Ryder, Mahender Yadagiri, W. Burbridge, S. Irwin, H. Gandhi, T. Bashir, Rachael A Allden, Melanie C. Wyres, M. Cull, Jo Bleasdale, E. Fogden, Mark R. Anderson, P. Sen Gupta
Background and aims: EndoBarrier is a 60cm duodenal-jejunal bypass liner endoscopically implanted for up to one year and designed to mimic the bypass part of roux-en-Y bariatric surgery. There is uncertainty concerning the extent to which improvements associated with EndoBarrier treatment are sus-tained once the liner has been removed. We aimed therefore to establish an EndoBarrier service for refractory diabesity and to continue to monitor the people with diabetes after EndoBarrier removal. Methods: Between October 2014 and November 2017, we implanted 62 EndoBarriers in our NHS service. All had been removed by November 2018. Outcomes were monitored in a registry. Results: As of November 2021, all patients reached three years after EndoBarrier removal and of these 43/62 (69%) (mean±SD age 51.6 ± 7.6 years, 55.8% male, 55.8% white ethnicity, median [IQR] diabetes duration 14.6 [8 – 21] years, 62.8% insulin-treated, mean±SD BMI 41.7±7.3 kg/m2) attended follow-up. In those who attended, during EndoBarrier implantation mean±SD HbA1c fell by 20.6±19.6 mmol/mol from 76.3±19.2 to 55.7±11.1 mmol/mol (p<0.001) (by 1.9±1.8% from 9.1±1.8% to 7.2±1.0% [p<0.001]), weight fell by 17.4±9.1 kg from 123.3±30.0 kg to 105.9±30.8 kg (p<0.001), BMI fell from 41.7±7.3 to 35.6±7.7 kg/m2 (p<0.001), systolic blood pressure from 138.7±14.4 to 125.4±14.7 mmHg (p<0.001), cholesterol from 4.6±1.0 to 3.7±0.7mmol/L (p<0.001), and serum alanine aminotransferase from 30.8±17.2 to 19.3±11.2 U/L (p<0.001). In those taking insulin median (IQR) total daily insulin dose reduced from 114 (54–180) to 20 (0–65) units (n=27, p<0.001); 10/27 (37%) insulin-treated people were able to discontinue insulin. Three years after EndoBarrier removal 33/43 (77%) maintained most of the improvement achieved with EndoBarrier whilst 10/43(23%) reverted to baseline. Of those deteriorating 9/10(90%) had depression and/or bereavement and/or major health problems/disability. 10/62(16%) required early Endo-Barrier removal for adverse events or symptoms; all 10 fully recovered after removal and most derived significant benefit. Conclusions: Our data demonstrate that EndoBarrier is highly effective in people with refractory diabesity, with mainte-nance of significant improvement three years after removal in 77% of cases.
{"title":"Duodenal-jejunal bypass liner for treatment of T2DM and obesity: 4-year outcomes in the first National Health Service (NHS) EndoBarrier service","authors":"R. Ryder, Mahender Yadagiri, W. Burbridge, S. Irwin, H. Gandhi, T. Bashir, Rachael A Allden, Melanie C. Wyres, M. Cull, Jo Bleasdale, E. Fogden, Mark R. Anderson, P. Sen Gupta","doi":"10.15277/bjd.2022.351","DOIUrl":"https://doi.org/10.15277/bjd.2022.351","url":null,"abstract":"Background and aims: EndoBarrier is a 60cm duodenal-jejunal bypass liner endoscopically implanted for up to one year and designed to mimic the bypass part of roux-en-Y bariatric surgery. There is uncertainty concerning the extent to which improvements associated with EndoBarrier treatment are sus-tained once the liner has been removed. We aimed therefore to establish an EndoBarrier service for refractory diabesity and to continue to monitor the people with diabetes after EndoBarrier removal.\u0000Methods: Between October 2014 and November 2017, we implanted 62 EndoBarriers in our NHS service. All had been removed by November 2018. Outcomes were monitored in a registry.\u0000Results: As of November 2021, all patients reached three years after EndoBarrier removal and of these 43/62 (69%) (mean±SD age 51.6 ± 7.6 years, 55.8% male, 55.8% white ethnicity, median [IQR] diabetes duration 14.6 [8 – 21] years, 62.8% insulin-treated, mean±SD BMI 41.7±7.3 kg/m2) attended follow-up. In those who attended, during EndoBarrier implantation mean±SD HbA1c fell by 20.6±19.6 mmol/mol from 76.3±19.2 to 55.7±11.1 mmol/mol (p<0.001) (by 1.9±1.8% from 9.1±1.8% to 7.2±1.0% [p<0.001]), weight fell by 17.4±9.1 kg from 123.3±30.0 kg to 105.9±30.8 kg (p<0.001), BMI fell from 41.7±7.3 to 35.6±7.7 kg/m2 (p<0.001), systolic blood pressure from 138.7±14.4 to 125.4±14.7 mmHg (p<0.001), cholesterol from 4.6±1.0 to 3.7±0.7mmol/L (p<0.001), and serum alanine aminotransferase from 30.8±17.2 to 19.3±11.2 U/L (p<0.001). In those taking insulin median (IQR) total daily insulin dose reduced from 114 (54–180) to 20 (0–65) units (n=27, p<0.001); 10/27 (37%) insulin-treated people were able to discontinue insulin. Three years after EndoBarrier removal 33/43 (77%) maintained most of the improvement achieved with EndoBarrier whilst 10/43(23%) reverted to baseline. Of those deteriorating 9/10(90%) had depression and/or bereavement and/or major health problems/disability. 10/62(16%) required early Endo-Barrier removal for adverse events or symptoms; all 10 fully recovered after removal and most derived significant benefit.\u0000Conclusions: Our data demonstrate that EndoBarrier is highly effective in people with refractory diabesity, with mainte-nance of significant improvement three years after removal in 77% of cases.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2022-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42872178","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 century after the life-transforming discovery and purification of insulin, many people living with type 1 diabetes (T1D) are not reaching glycaemic goals.1,2 Therapeutic approaches to help people with T1D achieve glucose targets and (equally importantly) reduce the burden of living with diabetes include structured education, new insulins and technology for delivering insulin, measuring glucose, decision support and closed loop technology to automate insulin delivery. The Freestyle Libre was first launched in Europe in 2014 with uptake in UK use having increased since it was made available on NHS prescription in 2017. There have been changes from the original device with the introduction of an algorithm to improve accuracy and the launch of the second generation Libre2 device allowing the optional use of alarms. Current UK T1D penetrance is around 50% in England (with a marked increase since April 2019 facilitated by NHS England as part of the NHS Long Term Plan), with higher rates in Scotland, Wales and Northern Ireland. A recent Health Technology Wales guidance has recommended broader use for all people with insulin-treated diabetes, not just T1D.3 Worldwide use is also increasing markedly. This global growth in the use of the Libre has occurred despite the lack of a supporting body of evidence from randomised controlled trials (RCTs) showing lowering of HbA1c, the traditional outcome metric for diabetes trials.4 For readers’ interest, an RCT (FLASH-UK) has been examining this in the UK, with participants with T1D randomised to Libre2 versus control finger prick testing.5 At the time of writing, FLASHUK had just completed follow-up and the results are eagerly anticipated. Despite the current absence of RCT data, there are, however, many real-world observations showing improved clinical outcomes with the Libre.6 In the UK, data show reductions in HbA1c and a striking reduction in severe hypoglycaemia and diabetic ketoacidosis with use of the Libre in Scotland.7 The Association of British Clinical Diabetologists (ABCD) has been running nationwide audits of medications introduced into real-world use in the UK since 2004. An ABCD audit of Libre outcomes has been running since 2017, reporting reduced HbA1c, improved hypoglycaemia awareness and reductions in hospital attendances for dysglycaemia.8 This edition of the journal contains an examination of data from the ABCD Libre audit, asking whether prior structured education affects the outcomes with flash glucose monitoring. In particular, clinical outcomes were compared between those who had undergone Dose Adjustment for Normal Eating (DAFNE) structured education, other structured education or neither. Structured education to support self-management of T1D includes a variety of programmes across the UK and elsewhere with variable approaches/ quality assurance, evidence and governance/structure.9 DAFNE is currently delivered in 99 centres and based on principles of therapeutic education with a writt
{"title":"benefits of flash glucose monitoring in the UK","authors":"Masa Josipovic, M. Evans","doi":"10.15277/bjd.2021.323","DOIUrl":"https://doi.org/10.15277/bjd.2021.323","url":null,"abstract":"A century after the life-transforming discovery and purification of insulin, many people living with type 1 diabetes (T1D) are not reaching glycaemic goals.1,2 Therapeutic approaches to help people with T1D achieve glucose targets and (equally importantly) reduce the burden of living with diabetes include structured education, new insulins and technology for delivering insulin, measuring glucose, decision support and closed loop technology to automate insulin delivery. The Freestyle Libre was first launched in Europe in 2014 with uptake in UK use having increased since it was made available on NHS prescription in 2017. There have been changes from the original device with the introduction of an algorithm to improve accuracy and the launch of the second generation Libre2 device allowing the optional use of alarms. Current UK T1D penetrance is around 50% in England (with a marked increase since April 2019 facilitated by NHS England as part of the NHS Long Term Plan), with higher rates in Scotland, Wales and Northern Ireland. A recent Health Technology Wales guidance has recommended broader use for all people with insulin-treated diabetes, not just T1D.3 Worldwide use is also increasing markedly. This global growth in the use of the Libre has occurred despite the lack of a supporting body of evidence from randomised controlled trials (RCTs) showing lowering of HbA1c, the traditional outcome metric for diabetes trials.4 For readers’ interest, an RCT (FLASH-UK) has been examining this in the UK, with participants with T1D randomised to Libre2 versus control finger prick testing.5 At the time of writing, FLASHUK had just completed follow-up and the results are eagerly anticipated. Despite the current absence of RCT data, there are, however, many real-world observations showing improved clinical outcomes with the Libre.6 In the UK, data show reductions in HbA1c and a striking reduction in severe hypoglycaemia and diabetic ketoacidosis with use of the Libre in Scotland.7 The Association of British Clinical Diabetologists (ABCD) has been running nationwide audits of medications introduced into real-world use in the UK since 2004. An ABCD audit of Libre outcomes has been running since 2017, reporting reduced HbA1c, improved hypoglycaemia awareness and reductions in hospital attendances for dysglycaemia.8 This edition of the journal contains an examination of data from the ABCD Libre audit, asking whether prior structured education affects the outcomes with flash glucose monitoring. In particular, clinical outcomes were compared between those who had undergone Dose Adjustment for Normal Eating (DAFNE) structured education, other structured education or neither. Structured education to support self-management of T1D includes a variety of programmes across the UK and elsewhere with variable approaches/ quality assurance, evidence and governance/structure.9 DAFNE is currently delivered in 99 centres and based on principles of therapeutic education with a writt","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2021-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44610658","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}
With the improvement of haematopoietic stem cell transplantation (HSCT) and radiotherapy, the population of cancer survivors is increasing and therefore increasing the number of patients living with late metabolic complications. We describe a case of a childhood acute lymphoblastic leukaemia survivor who developed insulin resistance 10 years after HSCT and total body radiation requiring a high dose of insulin (>1,500 IU). Using insulin-sensitising agents metformin and thiazolidinediones improved the control and reduced the insulin requirement – eventually stopping insulin. We describe for the first time the phenomenon of reverse diurnal variation in insulin sensitivity based on the clinical picture alone, which has not previously been described in the literature. We have reviewed the plausible mechanisms of developing insulin resistance, reverse diurnal variation and the role of thiazolidinediones in reducing lipotoxicity and adipocyte differentiation resulting in improved insulin sensitivity in such cases.
{"title":"Severe insulin resistance in long-term acute leukaemia survivors: lesson learned from a clinical case and review of the literature","authors":"B. Bashir, M. Banerjee","doi":"10.15277/bjd.2021.326","DOIUrl":"https://doi.org/10.15277/bjd.2021.326","url":null,"abstract":"With the improvement of haematopoietic stem cell transplantation (HSCT) and radiotherapy, the population of cancer survivors is increasing and therefore increasing the number of patients living with late metabolic complications. We describe a case of a childhood acute lymphoblastic leukaemia survivor who developed insulin resistance 10 years after HSCT and total body radiation requiring a high dose of insulin (>1,500 IU). Using insulin-sensitising agents metformin and thiazolidinediones improved the control and reduced the insulin requirement – eventually stopping insulin. We describe for the first time the phenomenon of reverse diurnal variation in insulin sensitivity based on the clinical picture alone, which has not previously been described in the literature. We have reviewed the plausible mechanisms of developing insulin resistance, reverse diurnal variation and the role of thiazolidinediones in reducing lipotoxicity and adipocyte differentiation resulting in improved insulin sensitivity in such cases.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2021-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45603449","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}
Speakers: For the Motion: Dr Stephen Wheatcroft, Consultant Cardiologist and Professor of Cardiometabolic Medicine, University of Leeds, West Yorkshire Against the Motion: Professor John Wilding. Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Clinical Sciences Centre, Aintree University Hospital, Liverpool
{"title":"ABCD debate at the annual ABCD virtual meeting 18 December 2020","authors":"D. Nagi, U. Dashora","doi":"10.15277/bjd.2021.330","DOIUrl":"https://doi.org/10.15277/bjd.2021.330","url":null,"abstract":"Speakers: \u0000For the Motion: Dr Stephen Wheatcroft, Consultant Cardiologist and Professor of Cardiometabolic Medicine, University of Leeds, West Yorkshire\u0000Against the Motion: Professor John Wilding. Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, Clinical Sciences Centre, Aintree University Hospital, Liverpool","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2021-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46015502","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}
Background: Hyperglycaemia is a recognised complication of COVID-19 disease and is associated with increased morbidity and mortality. Effects are noted in individuals with and without diabetes and potentiated by the use of recognised COVID-19 treatments such as corticosteroids. Early glycaemic control in the inpatient with COVID-19 disease impacts significantly on outcomes. Methods: A three-phase improvement project evaluated the recognition and management of hyperglycaemia in 120 adult inpatients with COVID-19 disease over a 4-month period. A local guideline and a separate acute care ‘bundle’ were implemented to improve performance. The main outcomes of the project were evaluated in a repeated cross- sectional design; assessing the performance of regular capillary blood glucose monitoring and appropriate treatment of hyperglycaemia where indicated. Results: Prior to intervention, 78.6% of patients had appropriate capillary blood glucose monitoring and no patients were deemed to receive appropriate treatment. Following interventions, 83–100% of patients had appropriate monitoring and 75–100% received appropriate treatment. Conclusions: In this setting, implementation of a guideline and a care bundle contributed towards improved recognition and management of hyperglycaemia in patients with COVID-19 disease. Future study could assess the impact of interventions on a larger scale whilst investigating variation in the subtype of diabetes, patient sex and other demographics on outcomes such as length of stay, morbidity and mortality.
{"title":"Hyperglycaemia in COVID-19: improving recognition and management in a single centre","authors":"Jordan Wardrope, I. McKenzie, N. Barwell","doi":"10.15277/bjd.2021.324","DOIUrl":"https://doi.org/10.15277/bjd.2021.324","url":null,"abstract":"Background: Hyperglycaemia is a recognised complication of COVID-19 disease and is associated with increased morbidity and mortality. Effects are noted in individuals with and without diabetes and potentiated by the use of recognised COVID-19 treatments such as corticosteroids. Early glycaemic control in the inpatient with COVID-19 disease impacts significantly on outcomes.\u0000Methods: A three-phase improvement project evaluated the recognition and management of hyperglycaemia in 120 adult inpatients with COVID-19 disease over a 4-month period. A local guideline and a separate acute care ‘bundle’ were implemented to improve performance. The main outcomes of the project were evaluated in a repeated cross- sectional design; assessing the performance of regular capillary blood glucose monitoring and appropriate treatment of hyperglycaemia where indicated.\u0000Results: Prior to intervention, 78.6% of patients had appropriate capillary blood glucose monitoring and no patients were deemed to receive appropriate treatment. Following interventions, 83–100% of patients had appropriate monitoring and 75–100% received appropriate treatment.\u0000Conclusions: In this setting, implementation of a guideline and a care bundle contributed towards improved recognition and management of hyperglycaemia in patients with COVID-19 disease. Future study could assess the impact of interventions on a larger scale whilst investigating variation in the subtype of diabetes, patient sex and other demographics on outcomes such as length of stay, morbidity and mortality.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2021-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42551379","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":"Overview of the 81st Scientific Sessions of the American Diabetes Association","authors":"C. Day","doi":"10.15277/bjd.2021.331","DOIUrl":"https://doi.org/10.15277/bjd.2021.331","url":null,"abstract":"","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2021-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42562639","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 the EASD 2021","authors":"C. Day","doi":"10.15277/bjd.2021.332","DOIUrl":"https://doi.org/10.15277/bjd.2021.332","url":null,"abstract":"","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2021-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47288330","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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