Publications
385 results found
Esdaile H, Hill N, Mayet J, et al., 2023, Glycaemic control in people with diabetes following acute myocardial infarction, Diabetes Research and Clinical Practice, Vol: 199, ISSN: 0168-8227
Diabetes is a highly prevalent disease associated with considerable cardiovascular end organ damage and mortality. Despite significant changes to the management of acute myocardial infarction over the last two decades, people with diabetes remain at risk of complications and mortality following a myocardial infarct for a multitude of reasons, including increased coronary atherosclerosis, associated coronary microvascular dysfunction, and diabetic cardiomyopathy. Dysglycaemia causes significant endothelial dysfunction and upregulation of inflammation within the vasculature and epigenetic changes mean that these deleterious effects may persist despite subsequent efforts to tighten glycaemic control. Whilst clinical guidelines advocate for the avoidance of both hyper- and hypoglcyaemia in the peri-infarct period, the evidence base is lacking, and currently there is no consensus on the benefits of glycaemic control beyond this period. Glycaemic variability contributes to the glycaemic milieu and may have prognostic importance following myocardial infarct. The use of continuous glucose monitoring means that glucose trends and parameters can now be captured and interrogated, and its use, along with newer medicines, may provide novel opportunities for intervention after myocardial infarction in people with diabetes.
Oliver N, 2023, Being fearless, DIABETIC MEDICINE, Vol: 40, ISSN: 0742-3071
Oliver N, Chow E, Luk AOY, et al., 2023, Applications of continuous glucose monitoring across settings and populations: Report from the 23rd Hong Kong diabetes and cardiovascular risk factors-East meets west symposium, DIABETIC MEDICINE, Vol: 40, ISSN: 0742-3071
Unsworth R, Armiger R, Jugnee N, et al., 2023, Safety and efficacy of an adaptive bolus calculator for Type 1 diabetes: a randomised control cross over study, Diabetes Technology and Therapeutics, Vol: 25, Pages: 414-425, ISSN: 1520-9156
Background The Advanced Bolus Calculator for Type 1 Diabetes (ABC4D) is a decision support system employing the artificial intelligence technique of case-based reasoning to adapt and personalise insulin bolus doses. The integrated system comprises a smartphone application and clinical web portal. We aimed to assess safety and efficacy of the ABC4D (intervention) compared to a non-adaptive bolus calculator (control). Methods This was a prospective randomised controlled crossover study. Following a 2-week run-in period, participants were randomised to ABC4D or control for 12 weeks. After a 6-week washout period, participants crossed over for 12 weeks. The primary outcome was difference in percentage (%) time in range (TIR) (3.9-10.0 mmol/L (70-180mg/dL)) change during the daytime (07:00-22:00) between groups. Results 37 adults with type 1 diabetes on multiple daily injections of insulin were randomised, median (IQR) age 44.7 (28.2-55.2) years, diabetes duration 15.0 (9.5-29.0) years, HbA1C 61.0 (58.0-67.0) mmol/mol (7.7 (7.5-8.3)%). Data from 33 participants were analysed. There was no significant difference in daytime %TIR change with ABC4D compared to control (median (IQR) +0.1 (-2.6 to + 4.0)% versus +1.9 (-3.8 to + 10.1)%; p = 0.53). Participants accepted fewer meal dose recommendations in the intervention compared to control (78.7 (55.8-97.6)% versus 93.5 (73.8-100)%; p = 0.009) with a greater reduction in insulin dosage from that recommended. Conclusion The ABC4D is safe for adapting insulin bolus doses and provided the same level of glycaemic control as the non-adaptive bolus calculator. Results suggest that participants did not follow ABC4D recommendations as frequently as control, impacting its effectiveness.
Avari P, O'Regan A, Preechasuk L, et al., 2023, Adjustment of Maternal Variable Rate Insulin Infusions Using Real-Time Continuous Glucose Monitoring in Pregnant Women with Type 1 Diabetes, DIABETES TECHNOLOGY & THERAPEUTICS, Vol: 25, Pages: 293-297, ISSN: 1520-9156
Pemberton JS, Wilmot EG, Barnard-Kelly K, et al., 2023, CGM accuracy: Contrasting CE marking with the governmental controls of the USA (FDA) and Australia (TGA): A narrative review, DIABETES OBESITY & METABOLISM, Vol: 25, Pages: 916-939, ISSN: 1462-8902
Oliver N, 2023, Screen test, DIABETIC MEDICINE, Vol: 40, ISSN: 0742-3071
Avari P, Eng PC, Hu M, et al., 2023, A novel somatic mutation implicates ATP6V0D1 in proinsulin processing, Journal of the Endocrine Society, Vol: 7, Pages: 1-5, ISSN: 2472-1972
ContextProhormone convertase 1/3 (PC1/3), encoded by protein convertase subtilisin kexin type 1 (PCSK1), converts inactive prohormones into biologically active peptides. Somatic mutations of insulinomas are associated with genetic defects interfering with control of insulin secretion from pancreatic beta cells. However, somatic mutations in proinsulinomas have not been described.ObjectiveWe report a case of a proinsulinoma, with suppressed insulin and C-peptide levels.MethodsA 70-year-old woman presented with a 20-year history of “blackouts.” During a 72-hour fast, blood glucose level dropped to 1.9 mmol/L with suppressed plasma insulin and C-peptide levels, but proinsulin levels were raised at 37 pmol/L (<10 pmol/L).ResultsImaging revealed 3 distinct DOTATATE-avid pancreatic lesions. Laparoscopic spleen-preserving distal pancreatomy was performed. In view of discordant insulin, C-peptide, and proinsulin levels, whole exome sequencing analysis was performed on the tumor. In the somatic exome of the tumor, we found mutations in PCSK expression regulators, as well as a novel truncating somatic mutation in ATP6V0D1, a subunit of the ion pump that acidifies the β-cell compartments where the PCSKs act.ConclusionAppropriately suppressed insulin levels in the context of hypoglycemia do not always indicate the absence of a neuroendocrine islet cell tumor and proinsulin levels may be indicated to solidify the diagnosis. In the context of elevated proinsulin levels, low insulin and C-peptide levels might be explained by somatic mutations that likely implicate proinsulin processing within the tumor. Furthermore, we propose several mechanistic candidates, including ATP6V0D1. Experimental validation using cellular approaches may in future confirm pathomechanisms involved in this rare condition.
Oliver N, 2023, Climate of change, EUROPEAN ENVIRONMENTAL LAW, Publisher: WILEY, Pages: 257-297, ISBN: 978-1-107-64044-3
Daultrey H, Chihota B, Oliver N, et al., 2023, Discrepancy between interstitial glucose and HbA1c in people with HIV compared to people without HIV in a Zambian cohort, Publisher: ELSEVIER IRELAND LTD, ISSN: 0168-8227
Al-Ozairi E, Reem AA, El Samad A, et al., 2023, A randomised crossover trial: Exploring the dose-response effect of carbohydrate restriction on glycaemia in people with well-controlled type 2 diabetes, JOURNAL OF HUMAN NUTRITION AND DIETETICS, Vol: 36, Pages: 51-61, ISSN: 0952-3871
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- Citations: 2
Shah VN, Akturk HK, Vigers T, et al., 2023, Relationship Between Daytime Versus Nighttime Continuous Glucose Monitoring Metrics with A1C in Adults with Type 1 Diabetes, DIABETES TECHNOLOGY & THERAPEUTICS, Vol: 25, Pages: 62-68, ISSN: 1520-9156
Sourij C, Aziz F, Kojzar H, et al., 2023, Severe acute respiratory syndrome coronavirus 2 spike antibody level decline is more pronounced after the second vaccination, but response to the third vaccination is similar in people with type 1 and type 2 diabetes compared with healthy controls: The prospective COVAC-DM cohort study, DIABETES OBESITY & METABOLISM, Vol: 25, Pages: 314-318, ISSN: 1462-8902
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- Citations: 3
Oliver N, 2023, No mean feat, DIABETIC MEDICINE, Vol: 40, ISSN: 0742-3071
Oliver N, 2023, Diabetes Therapy Podcast: Real-World Data for Glucose Sensing Technologies in Type 1 Diabetes, DIABETES THERAPY, Vol: 14, Pages: 1-10, ISSN: 1869-6953
Sivasubramanian M, Avari P, Gilbert C, et al., 2023, Accuracy and impact on quality of life of real-time continuous glucose monitoring in children with hyperinsulinaemic hypoglycaemia., Front Endocrinol (Lausanne), Vol: 14, ISSN: 1664-2392
OBJECTIVE: Continuous glucose monitoring (CGM) is the standard of care for glucose monitoring in children with diabetes, however there are limited data reporting their use in hyperinsulinaemic hypoglycaemia (HH). Here, we evaluate CGM accuracy and its impact on quality of life in children with HH. METHODS: Real-time CGM (Dexcom G5 and G6) was used in children with HH aged 0-16years. Data from self-monitoring capillary blood glucose (CBG) and CGM were collected over a period of up to 28days and analysed. Quality of life was assessed by the PedsQL4.0 general module and PedsQL2.0 family impact module, completed by children and their parents/carers before and after CGM insertion. Analysis of accuracy metrics included mean absolute relative difference (MARD) and proportion of CGM values within 15, 20, and 30% or 15, 20, and 30 mg/dL of reference glucose values >100 mg/dL or ≤100 mg/dL, respectively (% 15/15, % 20/20, % 30/30). Clinical reliability was assessed with Clarke error grid (CEG) analyses. RESULTS: Prospective longitudinal study with data analysed from 40 children. The overall MARD between reference glucose and paired CGM values (n=4,928) was 13.0% (Dexcom G5 12.8%, Dexcom G6 13.1%). The proportion of readings meeting %15/15 and %20/20 were 77.3% and 86.4%, respectively, with CEG analysis demonstrating 97.4% of all values in zones A and B. Within the hypoglycaemia range (<70 mg/dL), the median ARD was 11.4% with a sensitivity and specificity of 64.2% and 91.3%, respectively. Overall PedsQL child report at baseline and endpoint were 57.6 (50.5 - 75.8) and 87.0 (82.9 - 91.2), and for parents were 60.3 (44.8 - 66.0) and 85.3 (83.7 - 91.3), respectively (both p<0.001). CONCLUSION: Use of CGM for children with HH is feasible, with clinically acceptable accuracy, particularly in the hypoglycaemic range. Quality of life measures demonstrate significant improvement after CGM use. These data are important to explore use of CGM in disease indications, includin
Thomas NJ, Walkey HC, Kaur A, et al., 2022, The relationship between islet autoantibody status and the genetic risk of type 1 diabetes in adult-onset type 1 diabetes, Diabetologia, Vol: 66, Pages: 310-320, ISSN: 0012-186X
Aims/hypothesisThe reason for the observed lower rate of islet autoantibody positivity in clinician-diagnosed adult-onset vs childhood-onset type 1 diabetes is not known. We aimed to explore this by assessing the genetic risk of type 1 diabetes in autoantibody-negative and -positive children and adults.MethodsWe analysed GAD autoantibodies, insulinoma-2 antigen autoantibodies and zinc transporter-8 autoantibodies (ZnT8A) and measured type 1 diabetes genetic risk by genotyping 30 type 1 diabetes-associated variants at diagnosis in 1814 individuals with clinician-diagnosed type 1 diabetes (1112 adult-onset, 702 childhood-onset). We compared the overall type 1 diabetes genetic risk score (T1DGRS) and non-HLA and HLA (DR3-DQ2, DR4-DQ8 and DR15-DQ6) components with autoantibody status in those with adult-onset and childhood-onset diabetes. We also measured the T1DGRS in 1924 individuals with type 2 diabetes from the Wellcome Trust Case Control Consortium to represent non-autoimmune diabetes control participants.ResultsThe T1DGRS was similar in autoantibody-negative and autoantibody-positive clinician-diagnosed childhood-onset type 1 diabetes (mean [SD] 0.274 [0.034] vs 0.277 [0.026], p=0.4). In contrast, the T1DGRS in autoantibody-negative adult-onset type 1 diabetes was lower than that in autoantibody-positive adult-onset type 1 diabetes (mean [SD] 0.243 [0.036] vs 0.271 [0.026], p<0.0001) but higher than that in type 2 diabetes (mean [SD] 0.229 [0.034], p<0.0001). Autoantibody-negative adults were more likely to have the more protective HLA DR15-DQ6 genotype (15% vs 3%, p<0.0001), were less likely to have the high-risk HLA DR3-DQ2/DR4-DQ8 genotype (6% vs 19%, p<0.0001) and had a lower non-HLA T1DGRS (p<0.0001) than autoantibody-positive adults. In contrast to children, autoantibody-negative adults were more likely to be male (75% vs 59%), had a higher BMI (27 vs 24 kg/m2) and were less likely to have other autoimmune conditions (2% vs 10%) than autoantib
Rilstone S, Spurway P, Oliver N, et al., 2022, Nutritional support for a person with type 1 diabetes undertaking endurance swimming, Frontiers in Endocrinology, Vol: 13, Pages: 1-9, ISSN: 1664-2392
Long distance and open water swimming have increased in popularity over recent years. Swimming a long distance in lakes, rivers and the sea present numerous challenges, including cold water exposure and maintaining adequate nutritional intake to fuel exercising muscles. Guidelines exist outlining issues to consider and potential solutions to overcome the difficulties in feeding athletes. Exercising with type 1 diabetes adds further complexity, mostly around matching insulin to the recommended high carbohydrate intake, but also because of the way in which higher circulating insulin levels affect glucose utilisation and fat oxidation. This paper describes the nutritional considerations for people with type 1 diabetes intending to undertake long distance open water events, and insulin management suggestions to trial alongside. In addition, we include personal testimony from a swimmer with type 1 diabetes describing the challenges and considerations he faced when undertaking marathon swimming.
Sourij C, Aziz F, Kojzar H, et al., 2022, SARS-CoV-2S antibody formation is not impaired in people with type 1 or type 2 diabetes, but the antibody level falls more rapidly in this collective - the -COVAC-DM study, Publisher: SPRINGER WIEN, Pages: 259-260, ISSN: 0043-5325
Oliver N, 2022, Finding positives, DIABETIC MEDICINE, Vol: 39, ISSN: 0742-3071
Fallon C, Jones E, Oliver N, et al., 2022, The impact of socio-economic deprivation on access to diabetes technology in adults with type 1 diabetes, Publisher: WILEY, Pages: A212-A212, ISSN: 0742-3071
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- Citations: 4
Akturk HK, Herrero P, Oliver N, et al., 2022, Impact of Different Types of Data Loss on Optimal Continuous Glucose Monitoring Sampling Duration, DIABETES TECHNOLOGY & THERAPEUTICS, Vol: 24, Pages: 749-753, ISSN: 1520-9156
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- Citations: 7
Fallon C, Jones E, Oliver N, et al., 2022, The impact of socio-economic deprivation on access to diabetes technology in adults with type 1 diabetes., Diabet Med, Vol: 39
BACKGROUND: With advances in technology, there is an emerging concern that inequalities exist in provision and diabetes outcomes in areas of greater deprivation. We assess the relationship between socio-economic status and deprivation with access to diabetes technology and their outcomes in adults with type 1 diabetes. METHODS: Retrospective, observational analysis of adults attending a tertiary centre, comprising three urban hospitals in the UK. Socio-economic deprivation was assessed by the English Indices of Deprivation 2019. Data analysis was performed using one-way ANOVAs and chi-squared tests. RESULTS: In total, 1631 adults aged 44 ± 15 years and 758 (47%) women were included, with 391 (24%) using continuous subcutaneous insulin infusion, 312 (19%) using real-time continuous glucose monitoring and 558 (34%) using intermittently scanned continuous glucose monitoring. The highest use of diabetes technology was in the least deprived quintile compared to the most deprived quintile (67% vs. 45%, respectively; p < 0.001). HbA1c outcomes were available in 400 participants; no association with deprivation was observed (p = 0.872). Participation in structured education was almost twice as high from the most deprived to the least deprived groups (23% vs. 43%; p < 0.001). Adults with white or mixed ethnicity were more likely to use technology compared to black ethnicity (60% vs. 40%; p < 0.001). CONCLUSIONS: Adults living in the most deprived quintile had less technology use. Irrespective of socio-economic status or ethnicity, glycaemia was positively affected in all groups. It is imperative that health disparities are further addressed.
Oliver N, 2022, Fuelling inequality, DIABETIC MEDICINE, Vol: 39, ISSN: 0742-3071
Distaso W, Malik MMAH, Semere S, et al., 2022, Diabetes self-management during the COVID-19 pandemic and its associations with COVID-19 anxiety syndrome, depression and health anxiety, Publisher: WILEY, ISSN: 0742-3071
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- Citations: 3
Acciaroli G, van der Linden J, Chao C, et al., 2022, Longitudinal analysis of users transitioning from the Dexcom G5 to the G6 RT-CGM system in Germany, Sweden and the United Kingdom (2018-2020), DIABETIC MEDICINE, ISSN: 0742-3071
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- Citations: 1
Grace SL, Bowden J, Walkey HC, et al., 2022, Islet autoantibody level distribution in Type 1 diabetes and their association with genetic and clinical characteristics, Journal of Clinical Endocrinology and Metabolism, Vol: 107, Pages: E4341-E4349, ISSN: 0021-972X
ContextThe importance of the autoantibody level at diagnosis of type 1 diabetes (T1D) is not clear.ObjectiveWe aimed to assess the association of glutamate decarboxylase (GADA), islet antigen-2 (IA-2A), and zinc transporter 8 (ZnT8A) autoantibody levels with clinical and genetic characteristics at diagnosis of T1D.MethodsWe conducted a prospective, cross-sectional study. GADA, IA-2A, and ZnT8A were measured in 1644 individuals with T1D at diagnosis using radiobinding assays. Associations between autoantibody levels and the clinical and genetic characteristics for individuals were assessed in those positive for these autoantibodies. We performed replication in an independent cohort of 449 people with T1D.ResultsGADA and IA-2A levels exhibited a bimodal distribution at diagnosis. High GADA level was associated with older age at diagnosis (median 27 years vs 19 years, P = 9 × 10−17), female sex (52% vs 37%, P = 1 × 10−8), other autoimmune diseases (13% vs 6%, P = 3 × 10−6), and HLA-DR3-DQ2 (58% vs 51%, P = .006). High IA-2A level was associated with younger age of diagnosis (median 17 years vs 23 years, P = 3 × 10−7), HLA-DR4-DQ8 (66% vs 50%, P = 1 × 10−6), and ZnT8A positivity (77% vs 52%, P = 1 × 10−15). We replicated our findings in an independent cohort of 449 people with T1D where autoantibodies were measured using enzyme-linked immunosorbent assays.ConclusionIslet autoantibody levels provide additional information over positivity in T1D at diagnosis. Bimodality of GADA and IA-2A autoantibody levels highlights the novel aspect of heterogeneity of T1D. This may have implications for T1D prediction, treatment, and pathogenesis.
Rilstone S, Oliver N, Tanushi B, et al., 2022, The impact of CGM with a predictive hypoglycaemia alert function on hypoglycaemia in physical activity for people with type 1 diabetes: PACE study, 58th Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD), Publisher: SPRINGER, Pages: S72-S72, ISSN: 0012-186X
Oliver N, 2022, Learning a language, DIABETIC MEDICINE, Vol: 39, ISSN: 0742-3071
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