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Diabetic Medicine: a Journal of the British Diabetic Association

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https://www.readbyqxmd.com/read/30198580/screening-for-peripheral-artery-disease-in-people-with-diabetes
#1
J Hersant, Y Bigou, M Ammi, S Henni, P Abraham
We read with interest the recent article by Vriens et al. published in Diabetic Medicine [1]. The authors question the screening tools used to test for the presence of peripheral artery disease in people with diabetic foot ulcers. This is important because the complications of diabetes limit all commonly used, non-invasive, bedside tests for peripheral artery disease. The utility of these tests in consecutive people presenting with ulceration, with and without infection, provides important information to guide clinical practice in a clinically relevant environment...
September 10, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/30183104/national-guidelines-have-contributed-to-safer-care-for-inpatients-with-diabetes
#2
U Dashora, S George, M Sampson, E Walden
The Commentary by Levy et al. [1] argues that the high incidence of inpatient hypoglycaemia in the recent National Diabetes Inpatient Audit (NaDIA) is not simply down to 'errors' by clinicians, but also to 'system defects in national guidance'. We agree that inpatient hypoglycaemia and the wider issue of inpatient safety are extremely important, and recognize the importance of the unique anaesthetic perspective. This article is protected by copyright. All rights reserved.
September 5, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/30183102/alirocumab-safety-in-people-with-and-without-diabetes-mellitus-pooled-data-from-14-odyssey-trials
#3
L A Leiter, F J Tinahones, D G Karalis, M Bujas-Bobanovic, A Letierce, J Mandel, R Samuel, P H Jones
AIM: To evaluate the safety of the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor alirocumab according to diabetes mellitus status. METHODS: Safety data from 14 trials (8-104-week durations) were analysed by treatment (alirocumab or placebo/ezetimibe control) and diabetes status (yes/no, defined by medical history). Adverse event data were assessed using descriptive statistics and Cox models. RESULTS: Of the 5234 trial participants, 1554 (29...
September 5, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/30183100/inpatient-hypoglycaemia-should-we-should-we-focus-on-the-guidelines-the-targets-or-our-tools
#4
J M Yamamoto, H R Murphy
In their thought-provoking commentary, Levy et al. [1] explore the possible unintended consequences of United Kingdom (UK) guideline targets on the high frequency of hypoglycaemia in people with diabetes who are hospitalized. The authors cite the National Institute for Health and Care Excellence (NICE) and the Joint British Diabetes Societies (JBDS) guidelines pertaining to inpatient, surgical and pregnancy diabetes care. These guidelines suggest using lower limits of glucose targets varying from 4.0 to 6...
September 5, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/30183096/is-an-artificial-pancreas-closed-loop-system-for-type-1-diabetes-effective
#5
C K Boughton, R Hovorka
The artificial pancreas is now a viable treatment option for people with Type 1 diabetes and has demonstrated improved glycaemic outcomes while also reducing the onus of self-management of Type 1 diabetes. Closed-loop glucose-responsive insulin delivery guided by real-time sensor glucose readings can accommodate highly variable day-to-day insulin requirements and reduce the hypoglycaemia risk observed with tight glycaemic control in Type 1 diabetes. In 2011, the James Lind Alliance research priorities for Type 1 diabetes were produced and priority 3 was to establish whether an artificial pancreas (closed-loop system) for Type 1 diabetes is effective...
September 5, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/30175888/trajectories-of-obesity-by-spousal-diabetes-status-in-the-english-longitudinal-study-of-ageing
#6
O Silverman-Retana, A Hulman, R K Simmons, J Nielsen, D R Witte
AIMS: To examine whether the development of obesity with age was different for individuals with and without a spouse with diabetes. METHODS: We analysed data from the English Longitudinal Study of Ageing [n= 7123, median (interquartile range) age 59 (53-67) years, 51% men], which included four clinical examination waves between 1998 and 2012. The main exposure was having a spouse with diabetes. Outcomes of interest were BMI and waist circumference. We fitted quadratic age-related trajectories using mixed-effect models stratified by sex and adjusted for education, smoking and the corresponding interaction terms between age and spousal diabetes status...
September 3, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/30175873/-it-s-an-important-part-but-i-am-not-quite-sure-that-it-is-working-educators-perspectives-on-the-implementation-of-goal-setting-within-the-dafne-diabetes-structured-education-programme
#7
M Fredrix, M Byrne, S Dinneen, J McSharry
AIM: To explore educators' perspectives on the implementation of goal-setting and action-planning strategies within a structured diabetes self-management education programme. METHODS: Ten semi-structured interviews were conducted with diabetes self-management education providers delivering the 'Dose Adjustment for Normal Eating' (DAFNE) programme to people with Type 1 diabetes throughout Ireland. A pre-designed topic guide, focused on exploring educators' experiences of delivery and application and views on usefulness of goal-setting strategies, was used in all interviews...
September 3, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/30175871/timings-for-hba-1c-testing-in-people-with-diabetes-are-associated-with-incentive-payments-an-analysis-of-uk-primary-care-data
#8
J A Hirst, A J Farmer, M C Smith, R J Stevens
AIMS: Guidelines recommend testing HbA1c every 3-6 months in people with diabetes. In the United Kingdom (UK), primary care clinics are financially incentivized to monitor HbA1c at least annually and report proportions of patients meeting targets on 31 March. We explored the hypothesis that this reporting deadline may be associated with over-frequent or delayed HbA1c testing. METHODS: This analysis used HbA1c results from 100 000 people with diabetes during 2005-2014 in the Clinical Practice Research Datalink UK primary care database...
September 3, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/30175870/prevalence-and-predictors-of-delayed-clinical-diagnosis-of-type-2-diabetes-a-longitudinal-cohort-study
#9
A Gopalan, P Mishra, S E Alexeeff, M A Blatchins, E Kim, A H Man, R W Grant
AIMS: To examine the prevalence and person-level predictors of undiagnosed Type 2 diabetes among adults with elevated HbA1c values. METHODS: We identified adults without diabetes who had a first elevated HbA1c (index HbA1c ≥ 48 mmol/mol; ≥ 6.5%) between January 2014 and December 2015, and classified them by Type 2 diabetes diagnosis status at 1 year following this result. Multilevel modelling techniques were used to examine the association of individual demographic, clinical and utilization characteristics with remaining undiagnosed...
September 3, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/30175547/the-preferences-of-young-adults-with-type-1-diabetes-at-clinics-using-a-discrete-choice-experiment-approach-the-d1-now-study
#10
L Mc Morrow, M C O' Hara, L Hynes, Á Cunningham, A Caulfield, C Duffy, C Keighron, M Mullins, M Long, D Walsh, M Byrne, B Kennelly, P Gillespie, S F Dinneen, E Doherty
AIM: Attending routine outpatient clinic appointments is a central self-management behaviour of individuals living with Type 1 diabetes. A large number of young adults with Type 1 diabetes disengage from diabetes services, which may contribute to poor psychosocial and diabetes outcomes. The aim of this study is to elicit preferences from young adults with Type 1 diabetes regarding clinic-related services to inform service delivery. METHODS: A discrete choice experiment was developed to understand the preferences of young adults with Type 1 diabetes for clinic-related services...
September 3, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/30156335/barriers-and-facilitators-to-attendance-at-type-2-diabetes-structured-education-programmes-a-qualitative-study-of-educators-and-attendees
#11
J Mc Sharry, S F Dinneen, M Humphreys, M O'Donnell, M C O'Hara, S M Smith, K Winkley, M Byrne
AIMS: Attendance at structured diabetes education has been recommended internationally for all people with Type 2 diabetes mellitus. However, attendance rates are consistently low. This qualitative study aimed to explore experiences of attending and delivering Type 2 diabetes structured education programmes in Ireland and barriers and facilitators to attendance. METHODS: People with Type 2 diabetes who had attended one of the three programmes delivered in Ireland and educators from the three programmes took part in semi-structured telephone interviews...
August 29, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/30153351/health-service-utilization-and-related-costs-attributable-to-diabetes
#12
K N O'Neill, S M McHugh, M L Tracey, A P Fitzgerald, P M Kearney
AIMS: To estimate the health service use and direct healthcare costs attributable to diabetes using best available data and methods. METHODS: A nationally representative sample of adults aged ≥50 years was analysed (n=8107). Health service use in the previous 12 months included the number of general practitioner visits, outpatient department visits, hospital admissions, and accident and emergency department attendances. Multivariable negative binomial regression was used to estimate the associations between diabetes and frequency of visits...
August 28, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/30142228/acceptability-of-a-decision-support-electronic-health-record-system-and-its-impact-on-diabetes-care-goals-in-south-asia-a-mixed-methods-evaluation-of-the-carrs-trial
#13
K Singh, L Johnson, R Devarajan, R Shivashankar, P Sharma, D Kondal, V S Ajay, K M V Narayan, D Prabhakaran, M K Ali, N Tandon
AIMS: To describe physicians' acceptance of decision-support electronic health record system and its impact on diabetes care goals among people with Type 2 diabetes. METHODS: We analysed data from participants in the Centre for Cardiometabolic Risk Reduction in South Asia (CARRS) trial, who received the study intervention (care coordinators and use of a decision-support electronic health record system; n=575) using generalized estimating equations to estimate the association between acceptance/rejection of decision-support system prompts and outcomes (mean changes in HbA1c , blood pressure and LDL cholesterol) considering repeated measures across all time points available...
August 24, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/30118538/diagnosis-of-gestational-diabetes-a-teachable-moment
#14
J Okely, C Mason, A Collier, N Dunnachie, V Swanson
AIMS: Research regarding the determinants of concordance with gestational diabetes mellitus (GDM) treatment is limited. Here, we test whether the psychosocial changes outlined in the teachable moments model, as proposed by McBride et al. (McBride CM, Emmons KM, Lipkus IM. Understanding the potential of teachable moments: the case of smoking cessation. Health Educ Res 2003; 18: 156-170) are associated with following GDM treatment recommendations. METHODS: Fifty-nine women completed a baseline questionnaire (1 week after GDM diagnosis) in which they reported risk perception, social support, emotional response, the importance of their maternal identity and self-efficacy...
August 17, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/30117195/the-type-1-diabetes-honeymoon-period-is-five-times-longer-in-men-who-exercise-a-case-control-study
#15
M R Chetan, M H Charlton, C Thompson, R P Dias, R C Andrews, P Narendran
Type 1 diabetes mellitus is an autoimmune disorder characterized by the destruction of insulin-secreting β cells, and subsequent insulin deficiency. Shortly after diagnosis, 60% of adults with Type 1 diabetes experience a period of partial remission, or 'honeymoon' period, characterized by low insulin requirement and good glycaemic control [1]. Historically, the honeymoon period was defined as an insulin requirement of ≤ 0.5 units/kg/day together with HbA1c ≤ 58 mmol/mol (7.5%). Currently, the honeymoon period is defined as insulin dose-adjusted A1c (IDAA1c ) ≤ 9, where IDAA1c = HbA1c (%) + [4× insulin dose (units/kg/day)] [2]...
August 17, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/30103276/language-matters-a-uk-perspective
#16
REVIEW
C E Lloyd, A Wilson, R I G Holt, C Whicher, P Kar
AIM: To review the existing evidence regarding the use of language in clinical encounters. BACKGROUND: Awareness of the importance of language in clinical encounters is mostly lacking or located within broader discussions on communication. METHODS: A scoping study was conducted to review existing research that could increase our understanding of the role language plays as well as identify gaps in knowledge and inform the development of a position statement on language in diabetes care...
August 13, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/30102812/impact-of-different-glycaemic-treatment-targets-on-pregnancy-outcomes-in-gestational-diabetes
#17
S K Abell, J A Boyle, A Earnest, P England, A Nankervis, S Ranasinha, G Soldatos, E M Wallace, S Zoungas, H J Teede
AIM: With no current randomized trials, we explored the impact of tight compared with standard treatment targets on pregnancy outcomes in gestational diabetes mellitus (GDM). METHODS: This cohort study of singleton births ≥ 28 weeks' gestation was conducted at two major Australian maternity services (2009-2013). Standardized maternal, neonatal and birth outcomes were examined using routine healthcare data and compared for women with GDM at Service One (n = 2885) and Service Two (n = 1887)...
August 13, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/30102801/reduced-vitamin-d-levels-in-painful-diabetic-peripheral-neuropathy
#18
P Shillo, D Selvarajah, M Greig, R Gandhi, G Rao, I D Wilkinson, P Anand, S Tesfaye
AIM: Recent studies have reported an association between low vitamin D levels and diabetic peripheral neuropathy. However, many of these did not differentiate between people with painful diabetic peripheral neuropathy and those with painless diabetic peripheral neuropathy, or assess major confounding factors including sunlight exposure and daily activity. Our study addressed these limitations and evaluated vitamin D levels in people with carefully phenotyped diabetic peripheral neuropathy and controls...
August 13, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/30102422/the-development-and-validation-of-a-multivariable-prognostic-model-to-predict-foot-ulceration-in-diabetes-using-a-systematic-review-and-individual-patient-data-meta-analyses
#19
F Crawford, G Cezard, M Chappell
AIMS: Diabetes guidelines recommend screening for the risk of foot ulceration but vary substantially in the underlying evidence base. Our purpose was to derive and validate a prognostic model of independent risk factors for foot ulceration in diabetes using all available individual patient data from cohort studies conducted worldwide. METHODS: We conducted a systematic review and meta-analysis of individual patient data from 10 cohort studies of risk factors in the prediction of foot ulceration in diabetes...
August 13, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/30098219/is-insulin-pump-therapy-effective-in-type-1-diabetes
#20
REVIEW
J C Pickup
There continues to be uncertainty about the effectiveness in Type 1 diabetes of insulin pump therapy (continuous subcutaneous insulin infusion, CSII) vs. multiple daily insulin injections (MDI). This narrative review discusses the reasons for this uncertainty, summarizes the current evidence base for CSII and suggests some future research needs. There are difficulties in interpreting trials of CSII because effectiveness varies widely due to factors such as differing baseline control, suboptimal use of best CSII practices, and psychological factors, for example, high external locus of control, non-adherence and lack of motivation...
August 11, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
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