​Author(s): Shepherd M.; Brook A.J.; Chakera A.J.; Hattersley A.T.
Source: Diabetic Medicine; Oct 2017; vol. 34 (no. 10); p. 1332-1339
Publication Date: Oct 2017
Publication Type(s): Review
Available  at Diabetic medicine : a journal of the British Diabetic Association -  from Wiley Online Library Medicine and Nursing Collection 2018 - NHS
Abstract:The optimum treatment for HNF1A/HNF4A maturity-onset diabetes of the young and ATP-sensitive potassium (KATP) channel neonatal diabetes, outside pregnancy, is sulfonylureas, but there is little evidence regarding the most appropriate treatment during pregnancy. Glibenclamide has been widely used in the treatment of gestational diabetes, but recent data have established that glibenclamide crosses the placenta and increases risk of macrosomia and neonatal hypoglycaemia. This raises questions about its use in pregnancy. We review the available evidence and make recommendations for the management of monogenic diabetes in pregnancy. Due to the risk of stimulating increased insulin secretion in utero, we recommend that in women with HNF1A/ HNF4A maturity-onset diabetes of the young, those with good glycaemic control who are on a sulfonylurea per conception either transfer to insulin before conception (at the risk of a short-term deterioration of glycaemic control) or continue with sulfonylurea (glibenclamide) treatment in the first trimester and transfer to insulin in the second trimester. Early delivery is needed if the fetus inherits an HNF4A mutation from either parent because increased insulin secretion results in ~800-g weight gain in utero, and prolonged severe neonatal hypoglycaemia can occur post-delivery. If the fetus inherits a KATP neonatal diabetes mutation from their mother they have greatly reduced insulin secretion in utero that reduces fetal growth by ~900 g. Treating the mother with glibenclamide in the third trimester treats the affected fetus in utero, normalising fetal growth, but is not desirable, especially in the high doses used in this condition, if the fetus is unaffected. Prospective studies of pregnancy in monogenic diabetes are needed.Copyright © 2017 Diabetes UK
Database: EMBASE

Author(s): Shepherd M.; Brook A.J.; Chakera A.J.; Hattersley A.T.

Source: Diabetic Medicine; 2017

Available in full text at Diabetic Medicine -  from John Wiley and Sons

Abstract:The optimum treatment for HNF1A/HNF4A maturity-onset diabetes of the young and ATP-sensitive potassium (KATP) channel neonatal diabetes, outside pregnancy, is sulfonylureas, but there is little evidence regarding the most appropriate treatment during pregnancy. Glibenclamide has been widely used in the treatment of gestational diabetes, but recent data have established that glibenclamide crosses the placenta and increases risk of macrosomia and neonatal hypoglycaemia. This raises questions about its use in pregnancy. We review the available evidence and make recommendations for the management of monogenic diabetes in pregnancy. Due to the risk of stimulating increased insulin secretion in utero, we recommend that in women with HNF1A/ HNF4A maturity-onset diabetes of the young, those with good glycaemic control who are on a sulfonylurea per conception either transfer to insulin before conception (at the risk of a short-term deterioration of glycaemic control) or continue with sulfonylurea (glibenclamide) treatment in the first trimester and transfer to insulin in the second trimester. Early delivery is needed if the fetus inherits an HNF4A mutation from either parent because increased insulin secretion results in ~800-g weight gain in utero, and prolonged severe neonatal hypoglycaemia can occur post-delivery. If the fetus inherits a KATP neonatal diabetes mutation from their mother they have greatly reduced insulin secretion in utero that reduces fetal growth by ~900 g. Treating the mother with glibenclamide in the third trimester treats the affected fetus in utero, normalising fetal growth, but is not desirable, especially in the high doses used in this condition, if the fetus is unaffected. Prospective studies of pregnancy in monogenic diabetes are needed.Copyright © 2017 Diabetes UK.
​
Database: EMBASE

Author(s): Ramtoola S.; Ploug U.J.; Kragh N.; Nyeland M.E.

Source: Diabetic Medicine; Mar 2017; vol. 34 ; p. 146

Publication Type(s): Journal: Conference Abstract

Available in full text at Diabetic Medicine -  from John Wiley and Sons

Abstract:Aims: To ascertain the body weight, body mass index (BMI) and comorbidities of adults with newly diagnosed Type 1 diabetes and assess the impact of initiating insulin therapy over the first 5 years after diagnosis. Methods: This was a non-interventional, retrospective, cohort study utilising data from the UK Clinical Practice Research Datalink database between 2001 and 2013. Included patients were aged 18-85 years, with a BMI of 11-50kg/m2 and a full medical history of >12 months prior to diagnosis. Glycated haemoglobin (HbA1c) and BMI levels were compared at baseline and 12, 24, 36 and 60 months after initiation of insulin therapy. Results: At baseline, patients had a mean +/- SD age of 40.8 +/- 16.1 years, HbA1c of 10.8 +/- 3.0%, and a BMI of 25.3 +/- 5.5kg/m2. Following initiation of insulin therapy, mean HbA1c declined from 10.8 +/- 3.0% to 7.7 +/- 2.0% at 12 months (p < 0.01), but subsequently increased to 8.1 +/- 2.0% at 24 months, remaining stable thereafter. Mean BMI consistently increased from 25.3 +/- 5.5 at baseline to 27.2 +/- 5.8, 27.4 +/- 5.7, 27.5 +/- 5.6, and 27.9 +/- 5.5kg/ m2 at 1, 2, 3 and 5 years, respectively. Conclusions: Whilst insulin therapy exerted an initial reduction in HbA1c at 12 months, mean HbA1c at 12 months was still above the National Institute for Health and Care Excellence (NICE) targets, and further deteriorated soon after. After beginning insulin therapy, patients with Type 1 diabetes were susceptible to longterm cumulative weight gain and increase in BMI. This study illustrates the need for greater emphasis on weight management in national Type 1 diabetes education programmes.
​
Database: EMBASE

Citation: Diabetologia, September 2015, vol./is. 58/1 SUPPL. 1(S476), 0012-186X (September 2015)
 
Author(s): Bilous R., Prager R., Pieber T.R., Ramtoola S., Narendran P., Barnard K.D., Kohler K., Gelchsheimer U., Petersen B., Amstutz L., Schutz-Fuhrmann I.
 
Language: English
 
Abstract: Background and aims: The Accu-Chek Insight diabetes therapy system combines a glucose meter with integrated bolus advice and extended data management capabilities with an insulin pump. The use of the new system was evaluated in a multicenter clinical trial conducted in Austria and the United Kingdom. Materials and methods: Individuals with type 1 (T1) or type 2 (T2) diabetes mellitus (DM) >18 years of age, and for >6 months on intensive insulin therapy were eligible for this 6-month study of the new system. All individuals received training on the use of the new system. HbA1c results were evaluated in a central laboratory. Pump signals were captured through data uploads using engineering software. User acceptance of the new system was assessed by means of a self-report questionnaire using an 11-point Likert Scale. Results: 90 individuals with T1DM were included in the intention-totreat analyses: age 41.8 (18-75) years, BMI 27.1 (19-41) kg/m², HbA1c 7.8 (5.8 - 10.8) %, T1DM since 23 (1-49) years. 76 individuals had been previously on insulin pump therapy, and 14 on multiple daily injection (MDI) therapy. 81 individuals completed the study, 9 individuals discontinued the study or were withdrawn. Insulin pump experienced users maintained their mean baseline HbA_1c levels (7.76+/-1.00%) at Month 3 (7.58+/-0.93%) and Month 6 (7.73+/-0.96) after switching from other insulin pump systems, most often the Accu-Chek Combo system, to the Accu-Chek Insight system.Mean HbA1c levels decreased in previous MDI users from 7.96+/-1.20% at baseline to 7.45+/-1.22% at Month 3 and 7.46+/-1.08% at Month 6. At month 6, the mean change from baseline was significantly different from 0: -0.50, 95% CI [-0.94; -0.06]. Two episodes each of severe hypoglycemia and diabetic ketoacidosis were reported. Most frequently recorded errors were electronic for the pump, and battery life time related for the meter. User acceptance of the new system was high, with highest ratings given for the ease of use of the insulin pump. Conclusion: In adults with type 1 diabetes, the new Accu-Chek Insight diabetes therapy system was effective and safe to use under routine practice conditions. Glycemic control improved when switching from MDI therapy, and was maintained in previous insulin pump users. User acceptance of the new system was high.
 
Publication Type: Journal: Conference Abstract
 
Source: EMBASE

​Citation: Diabetologia, September 2015, vol./is. 58/1 SUPPL. 1(S170), 0012-186X (September 2015)
 
Author(s): Ramtoola S., Ploug U.J., Kragh N., Nyeland M.E.
 
Language: English
 
Abstract: Background and aims: The aim of this study was to ascertain the weight, BMI characteristics and comorbidities of adults with newly diagnosed type 1 diabetes (T1D) in the UK and assess the impact of initiating insulin therapy on their glycaemic control and weight profile over the first 5 years after diagnosis. Materials and methods: This study was a non-interventional, retrospective, cohort study utilising data from the UK Clinical Practice Research Datalink (CPRD) database between 2001 and 2013. Patients were selected based on a recorded diagnosis (C10* read codes) of T1D or fulfilling the NHS criteria for T1D, in whom onset of continuous insulin treatment was within 12 months of diagnosis. Patients included were aged 18-85 years, with a body mass index (BMI) of 11-50 kg/m2 and a full medical history of at least 12 months prior to diagnosis (n=2430). Using this dataset, HbA1c and BMI levels were compared at baseline and 12, 24, 36 and 60 months after insulin therapy was initiated. Results: At baseline, patients (63.3% male, 36.7% female) had a mean +/- SD age of 40.8+/-16.1 years, HbA1c of 10.8%+/-3.0, and a BMI of 25.3+/-5.5. Mean BMI and BMI distribution of study patients were comparable to that of the UK general population. Following initiation of insulin therapy, mean HbA1c statistically significantly (only taking inter-subject variation into consideration) declined from 10.8%+/-3.0 to 7.7%+/-2.0 at 12 months (P<0.01), but subsequently statistically significantly increased to 8.1%+/-2.0 at 24 months, remaining stable thereafter at 8.2%+/-1.9 and 8.2%+/-1.7 at 3 and 5 years, respectively (Figure 1). Mean BMI consistently increased from 25.3 +/-5.5 at baseline, to 27.2+/-5.8, 27.4+/-5.7, 27.5+/-5.6, and 27.9+/-5.5 kg/m2 at 1, 2, 3 and 5 years, however, only the increase in the first 12 months was statistically significant (only taking inter-subject variation into consideration). Conclusion: Whilst insulin therapy exerted an initial reduction in HbA1c at 12 months, mean HbA1c at 12 months was still above the NICE targets, and further deteriorated soon after, stabilizing between 2 and 5 years after initiation of treatment. After beginning insulin therapy, T1D patients were susceptible to long-term cumulative weight gain and increase in BMI, with deeper entrenchment into pathophysiological BMI weight categories. This study supports the concept of "glycaemic streaming"and suggests that further intensification of efforts is required right from diagnosis and initiation of insulin therapy to support patients with T1D to achieve and maintain glycaemic control targets. Currently weight control is a side issue in UK T1D patient education and treatment strategies which focus primarily if not almost exclusively on the titration of insulin to achieve HbA1c targets. This study illustrates the need for greater emphasis on weight management in national T1D education programmes. (figure present).
 
Publication Type: Journal: Conference Abstract
 
Source: EMBASE

Citation: Journal of Diabetes and its Complications, January 2014, vol./is. 28/1(66-70), 1056-8727;1873-460X (January-February 2014)

Author(s): Alam U., Chan A.W.S., Buazon A., Van Zeller C., Berry J.L., Jugdey R.S., Asghar O., Cruickshank J.K., Petropoulos I.N., Malik R.A.

Institution: (Alam, Buazon, Van Zeller, Asghar, Petropoulos, Malik) Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester, 46 Grafton Street, Manchester, M13 9NT, United Kingdom, (Chan) Barts and London SMD, London, United Kingdom, (Berry) Vitamin D Research Group, School of Biomedicine, University of Manchester, United Kingdom, (Jugdey) Royal Blackburn Hospital, East Lancashire Hospitals NHS Trust, United Kingdom, (Cruickshank) Department of Diabetes and Nutritional Sciences, King's College and St Thomas' and Guy's Hospitals, United Kingdom

Language: English

Abstract: Background The optimal treatment regimen for correcting vitamin D insufficiency in diabetic patients has not been established. Methods Two hundred and forty four adult diabetic patients with vitamin D insufficiency were enrolled to receive: Ergocalciferol (D2) 50,000 IU daily over 10 days (500,000 IU) followed by Calcichew D3 (calcium carbonate/Cholecalciferol) BID (~ 24,000 IU cholecalciferol/month) (ECC) (n = 53); Cholecalciferol (D3) 40,000 IU daily over 10 days (400,000 IU) followed by Calcichew D3 BID (~ 24,000 IU cholecalciferol/month) (CCC) (n = 94) or Cholecalciferol 40,000 IU daily over 10 days (400,000 IU) followed by Cholecalciferol 40,000 IU monthly (CC) (n = 97). The 25(OH)D, HbA1c, lipids, blood pressure and eGFR were assessed at baseline and after a mean follow up of 8.0 +/- 4.0 months. Results Treatment increased 25(OH)D concentrations significantly in ECC (17.4 +/- 13.8 vs 29.9 +/- 9.6 ng/ml, P < 0.0001), CCC (14.2 +/- 6.6 vs 30.9 +/- 13.1 ng/ml, p < 0.0001) and CC (13.5 +/- 8.4 vs 33.9 +/- 14.4 ng/ml, P < 0.0001). The relative increase in 25(OH)D was significantly lower with ECC compared to CC (+ 14.6 +/- 12.2 vs + 20.6 +/- 15.0, P = 0.01) and the majority of subjects in the ECC group (63%) remained vitamin D deficient (25(OH)D < 30 ng/ml) compared to CCC (46%) and CC (36%) (P = 0.0005). Conclusion This study demonstrates that relatively aggressive treatment regimens of both vitamin D2 and D3 increase 25(OH)D concentrations in diabetic patients, but the ability to raise 25(OH)D status to 'sufficient' levels is inadequate in a large proportion of individuals. &#xa9; 2014 Elsevier Inc.

Country of Publication: United States

Source: EMBASE

Full Text:

Available from EBSCOhost in Journal of Diabetes & its Complications
Available from ProQuest in Journal of Diabetes and its Complications; Note: ; Collection notes: NHS OPEN ATHENS INSTITUTION NAME IS NHS ENGLAND