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D A Milder, T Y Milder, P C A Kam
Sodium-glucose co-transporter 2 (SGLT2) inhibitors are an emerging class of oral hypoglycaemic agents with therapeutic benefits beyond better glycaemic control. A major concern of the sodium-glucose co-transporter 2 inhibitors is their propensity to cause euglycaemic ketoacidosis in the peri-operative period and the potential for this critical diagnosis to be delayed or missed entirely. This review attempts to collate the case reports of sodium-glucose co-transporter 2 inhibitor ketoacidosis associated with surgery to highlight and put a perspective on this peri-operative issue...
March 12, 2018: Anaesthesia
Adina Bachar, Gregory Livshits, Ruth Birk
AIM: In overweight/obese individuals, modest 5% weight loss and its maintenance promotes health; however, it is challenging and typically unachievable, especially in community settings. Established predictors of weight loss outcome in a community setting are lacking, hindering the development of practical interventions and prevention tools. Our aim was to identify predictors associated with 5% weight reduction (initial 6 months) and maintenance (1 year) in overweight and obese adults undergoing weight reduction treatment, free of charge, in a community setting...
March 8, 2018: Nutrition & Dietetics: the Journal of the Dietitians Association of Australia
S Fredheim, P Foli Andersen, G Laerkholm, J Svensson, C B Juhl, B Olsen, K Pilgaard, J Johannesen
AIM: We investigated children's counter regulatory hormone profiles during a hyperinsulinaemic hypoglycaemic clamp procedure at day and night. METHODS: In 2013 we assessed the counter regulatory response to hypoglycaemia in eight outpatients with type 1 diabetes, recruited from the Herlev Hospital, Denmark, at a mean age of 9.6 ±2.3 years. Hyperinsulinaemic 80 mU/m2 /min clamps were performed with a stepwise reduction in plasma glucose from euglycaemia (7-9 mmol/L) to hypoglycaemia (<3...
March 8, 2018: Acta Paediatrica
B Chacko, M Whitley, U Beckmann, K Murray, M Rowley
Sodium-glucose cotransporter 2 inhibitor (SGLT2i)-associated euglycaemic diabetic ketoacidosis (euDKA) is a serious and increasingly recognised complication of treatment with this class of oral hypoglycaemic agents and can present a diagnostic challenge, resulting in delayed recognition, inappropriate treatment and potentially life-threatening acidosis. We present two cases of patients developing SGLT2i-associated euDKA in the early postoperative period. We support ceasing SGLT2i for 72 hours preoperatively and would suggest continuing to withhold the medication until oral intake is restored, and recommend a wider awareness of SGLT2i-associated diabetic ketoacidosis (DKA) amongst patients and their healthcare providers with an emphasis on checking ketone levels irrespective of blood glucose levels in the postoperative setting...
March 2018: Anaesthesia and Intensive Care
Peter P Swoboda, Bara Erhayiem, Rachel Kan, Adam K McDiarmid, Pankaj Garg, Tarique A Musa, Laura E Dobson, Klaus K Witte, Mark T Kearney, Julian H Barth, Ramzi Ajjan, John P Greenwood, Sven Plein
BACKGROUND: We aimed to investigate in patients with type 2 diabetes whether aortic stiffness is: (i) associated with glycaemic control, (ii) associated with adverse outcomes and (iii) can be reversed on treatment with RAAS inhibition. METHODS: Patients with type 2 diabetes (N = 94) and low vascular risk underwent assessment of cardiovascular risk and CMR assessment of ascending aortic distensibility (AAD), descending aortic distensibility (DAD) and aortic pulse wave velocity (PWV)...
March 5, 2018: Cardiovascular Diabetology
Adam D Lewis, Ruth E Hogg, Manju Chandran, Lillian Musonda, Lorraine North, Usha Chakravarthy, Sobha Sivaprasad, Geeta Menon
AIMS: A paucity of literature exists on prevalence of diabetic retinopathy (DR) in sub-Saharan Africa. We aim to estimate the prevalence of DR and visual impairment in Zambia's Copperbelt province through a cross-sectional study. METHODS: All patients with a diagnosis of diabetes mellitus attending a DR screening programme were eligible to participate. Fundus photographs were graded in accordance with the DR grading system used in the UK National Health service (NHS)...
March 5, 2018: Eye
M F Nijhoff, V A L Huurman, J Dubbeld, A R van Erkel, T A Rabelink, M A Engelse, E J P de Koning
Pancreatic islet isolation and transplantation are complicated procedures, indicated for a carefully selected group of patients. After isolation from the pancreas, the islets are infused into the portal vein. Allogeneic islet transplantation is performed in patients with diabetes mellitus, who suffer from severe hypoglycaemic events and/or progressive complications. One or more donor pancreases are used, which necessitates immunosuppressive treatment. In autologous islet transplantation, which is performed in patients in whom the pancreas has to be removed due to a non-malignant disease, the patients' own islets are isolated and reinfused...
2018: Nederlands Tijdschrift Voor Geneeskunde
Franco Cosmi, Li Shen, Michela Magnoli, William T Abraham, Inder S Anand, John G Cleland, Jay N Cohn, Deborah Cosmi, Giorgia De Berardis, Kenneth Dickstein, Maria Grazia Franzosi, Lars Gullestad, Pardeep S Jhund, John Kjekshus, Lars Køber, Vito Lepore, Giuseppe Lucisano, Aldo P Maggioni, Serge Masson, John J V McMurray, Antonio Nicolucci, Vito Petrarolo, Fabio Robusto, Lidia Staszewsky, Luigi Tavazzi, Roberto Teli, Gianni Tognoni, John Wikstrand, Roberto Latini
AIMS: Up to one-third of patients with diabetes mellitus and heart failure (HF) are treated with insulin. As insulin causes sodium retention and hypoglycaemia, its use might be associated with worse outcomes. METHODS AND RESULTS: We examined two datasets: 24 012 patients with HF from four large randomized trials and an administrative database of 4 million individuals, 103 857 of whom with HF. In the former, survival was examined using Cox proportional hazards models adjusted for baseline variables and separately for propensity scores...
February 28, 2018: European Journal of Heart Failure
Shin-Ichi Harashima, Nobuya Inagaki, Kazuoki Kondo, Nobuko Maruyama, Makiko Otsuka, Yutaka Kawaguchi, Yumi Watanabe
Sodium glucose co-transporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1RAs) are antihyperglycaemic agents with weight-lowering effects. The efficacy and safety of the SGLT2 inhibitor canagliflozin as add-on therapy in Japanese patients with type 2 diabetes mellitus (T2DM) and inadequate glycaemic control with a GLP-1RA (≥12 weeks) were evaluated in this phase IV study. Patients received canagliflozin 100 mg once daily for 52 weeks. Efficacy endpoints included the change in glycated haemoglobin (HbA1c), fasting plasma glucose (FPG), bodyweight, systolic blood pressure (SBP), and high-density lipoprotein cholesterol (HDL-C) from baseline to Week 52...
February 23, 2018: Diabetes, Obesity & Metabolism
Cristian Guja, Juan P Frías, Aniko Somogyi, Serge Jabbour, Hui Wang, Elise Hardy, Julio Rosenstock
AIMS: To compare the efficacy and safety of adding the glucagon-like peptide-1 receptor agonist exenatide once weekly (QW) 2 mg or placebo among patients with type 2 diabetes inadequately controlled despite titrated insulin glargine (IG) ± metformin. METHODS: This multicentre, double-blind study randomized (1:1) patients with persistent hyperglycaemia after 8-week IG titration (glycated haemoglobin [HbA1c] 7.0-10.5% [53-91 mmol/mol]) to exenatide QW or placebo...
February 23, 2018: Diabetes, Obesity & Metabolism
Mangesh Kharjul, Rhiannon Braund, James Green
Background Adherence to treatment is important to achieve target outcomes, particularly for those with type 2 diabetes. Pharmacists are well placed to enhance adherence, however evidence of the impact on clinical outcomes is not well known. Objective To determine the impact of an adherence support service on adherence scores and subsequent clinical biomarkers (HbA1c). Setting Community pharmacies providing a Medicines Use Review (MUR) Service in a New Zealand locality. Methods Records of patients receiving MURs between 2007 and 2012 were obtained from a single locality...
February 21, 2018: International Journal of Clinical Pharmacy
Bogna Grygiel-Górniak, Elżbieta Kaczmarek, Maria Mosor, Juliusz Przysławski, Jerzy Nowak
As ageing and increased body fat are the signs of insulin resistance, we have studied whether the presence of Pro12Ala and C1431T of peroxisome proliferator-activated receptor gamma 2 gene and Trp64Arg of beta 3-adrenergic receptor gene may predispose to the hyperglycaemia development in postmenopausal women, who have never undergone hypoglycaemic treatment. The distributions of selected allele and genotype frequencies were determined by the PCR-RFLP method in normo- and hyperglycaemic, who have never been diagnosed and treated for diabetes mellitus were measured...
February 20, 2018: Journal of Applied Genetics
Anda Mihaela Naciu, Paolo Pozzilli
Therapy for type 1 diabetes (T1D) is mainly restricted to insulin treatment. The management of paediatric patients with T1D should tackle not only glucose control, but also insulin resistance, beta-cell preservation, quality of life and cardiovascular disease risk factors, which are increasingly recognized to occur in adolescents with T1D. Areas covered: This review examines the recently published literature from PubMed on non-insulin agents for the management of T1D in paediatric patients. Expert opinion: Few paediatric patients with T1D are achieving their metabolic targets...
February 20, 2018: Expert Opinion on Pharmacotherapy
Lutz Heinemann, Guido Freckmann, Dominic Ehrmann, Gabriele Faber-Heinemann, Stefania Guerra, Delia Waldenmaier, Norbert Hermanns
BACKGROUND: The effectiveness of real-time continuous glucose monitoring (rtCGM) in avoidance of hypoglycaemia among high-risk individuals with type 1 diabetes treated with multiple daily insulin injections (MDI) is unknown. We aimed to ascertain whether the incidence and severity of hypoglycaemia can be reduced through use of rtCGM in these individuals. METHODS: The HypoDE study was a 6-month, multicentre, open-label, parallel, randomised controlled trial done at 12 diabetes practices in Germany...
February 15, 2018: Lancet
J Lawton, M Blackburn, J Allen, F Campbell, D Elleri, L Leelarathna, D Rankin, M Tauschmann, H Thabit, R Hovorka
BACKGROUND: Continuous glucose monitoring (CGM) enables users to view real-time interstitial glucose readings and provides information on the direction and rate of change of blood glucose levels. Users can also access historical data to inform treatment decisions. While the clinical and psychological benefits of CGM are well established, little is known about how individuals use CGM to inform diabetes self-management. We explored participants' experiences of using CGM in order to provide recommendations for supporting individuals to make optimal use of this technology...
February 20, 2018: BMC Endocrine Disorders
Y K Cho, Y M Kang, S E Lee, J Lee, J-Y Park, W J Lee, Y-J Kim, C H Jung
BACKGROUND: This review evaluated the efficacy and safety of a combination therapy comprising a sodium-glucose cotransporter type 2 inhibitor (SGLT2i) and dipeptidyl peptidase-4 inhibitor (DPP4i) in type 2 diabetes. METHODS: A literature search through to May 2017 was carried out of PubMed, Embase and the Cochrane Central Register of Controlled Trials. Studies were eligible if they were randomized controlled trials (RCTs) comparing SGLT2i plus DPP4i (SGLT2i/DPP4i) against DPP4i±placebo or SGLT2i±placebo and published in English...
February 3, 2018: Diabetes & Metabolism
Edna Keeney, Dalia Dawoud, Sofia Dias
BACKGROUND: Clinical trials report severe hypoglycaemic events as the number of patients with at least one event out of the total randomised or number of events for a given total exposure. Different network meta-analysis models have been used to analyse these different data types. OBJECTIVE: This aim of this article was to establish the impact of using the different models on effectiveness, costs and health utility estimates. METHODS: We analysed a dataset used in a recent network meta-analysis of severe hypoglycaemic events conducted to inform National Institute for Health and Care Excellence recommendations regarding basal insulin choice for patients with type 1 diabetes mellitus...
February 14, 2018: PharmacoEconomics
Giuseppe Lepore, Riccardo Bonfanti, Lutgarda Bozzetto, Vincenzo Di Blasi, Angela Girelli, Giorgio Grassi, Dario Iafusco, Luigi Laviola, Ivana Rabbone, Riccardo Schiaffini, Daniela Bruttomesso
BACKGROUND AND AIM: The objective of this cross-sectional study was to evaluate the degree of glycaemic control and the frequency of diabetic complications in Italian people with diabetes who were treated with continuous subcutaneous insulin infusion (CSII). METHODS AND RESULTS: Questionnaires investigating the organisation of diabetes care centres, individuals' clinical and metabolic features and pump technology and its management were sent to adult and paediatric diabetes centres that use CSII for treatment in Italy...
December 9, 2017: Nutrition, Metabolism, and Cardiovascular Diseases: NMCD
Sabine Zenz, Julia K Mader, Werner Regittnig, Martina Brunner, Stefan Korsatko, Beate Boulgaropoulos, Christoph Magnes, Reingard Raml, Sophie H Narath, Philipp Eller, Thomas Augustin, Thomas R Pieber
Context: Complete loss of beta-cell function in type 1 diabetes (T1DM) patients may lead to an increased risk of severe hypoglycaemia. Objective: We aimed to determine the impact of C-peptide status on glucagon response and endogenous glucose production (EGP) during hypoglycaemia in T1DM patients. Design/ Setting: We conducted an open, comparative trial. Patients: 10 C-peptide positive (C-pos) and 11 matched C-peptide negative (C-neg) T1DM patients were enrolled...
February 1, 2018: Journal of Clinical Endocrinology and Metabolism
B T Corley, R W Carroll, R M Hall, M Weatherall, A Parry-Strong, J D Krebs
AIMS: To establish whether the risk of hypoglycaemia is greater with 2 consecutive days of very-low-calorie diet compared with 2 non-consecutive days of very-low-calorie diet in people with Type 2 diabetes. METHODS: This was a non-blinded randomized parallel group interventional trial of intermittent fasting in adults. The participants had a BMI of 30-45 kg/m2 , Type 2 diabetes treated with metformin and/or hypoglycaemic medications and an HbA1c concentration of 50-86 mmol/mol (6...
February 6, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
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