{"title":"Reflections from IDF 2022","authors":"C. Day","doi":"10.15277/bjd.2022.400","DOIUrl":"https://doi.org/10.15277/bjd.2022.400","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":"45042351","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 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}
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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