Publications
385 results found
Ngaosuwan K, Johnston DG, Godsland IF, et al., 2021, Cardiovascular disease in patients with primary and secondary adrenal insufficiency and the role of comorbidities, Journal of Clinical Endocrinology and Metabolism, Vol: 106, Pages: 1284-1293, ISSN: 0021-972X
CONTEXT: Mortality studies have established that cardiovascular disease is the leading cause of death in patients with adrenal insufficiency and the risk is greater than that observed in individually-matched controls. OBJECTIVE: Here we have performed a detailed analysis of cardiovascular morbidity and mortality, taking account of the role of co-morbidities. DESIGN: Retrospective cohort study. SETTING: UK general practitioner database (CPRD). PARTICIPANTS: 6821 patients with adrenal insufficiency (primary, 2052; secondary, 3948) compared with 67564 individually-matched controls, with and without adjustment for comorbidities (diabetes, hypertension, dyslipidaemia, previous cardiovascular disease, and smoking). MAIN OUTCOME MEASURES: Composite cardiovascular events recorded in CPRD and cardiovascular mortality in those participants with linked national mortality data. RESULTS: Hazard ratios (95%CI) for composite cardiovascular events in patients with adrenal insufficiency of any cause were 1.28 (1.20-1.36, unadjusted) and 1.07 (1.01-1.14, adjusted). Increased cerebrovascular events in patients with secondary adrenal insufficiency accounted for most of the increased hazard (1.53 (1.34-1.74, adjusted)) and were associated with cranial irradiation therapy. Cardiovascular mortality data were available for 3547 patients and 34944 controls. The adjusted hazard ratio for ischaemic heart disease mortality was 1.86 (1.25-2.78) for primary adrenal insufficiency and 1.39 (1.02-1.89) for secondary. CONCLUSION: Co-morbidities largely accounted for the increased cardiovascular events but in secondary adrenal insufficiency, cerebrovascular events were independently increased and associated with irradiation treatment. However, the risk of cardiovascular mortality remained increased even following adjustment for co-morbidities in both primary and secondary adrenal insufficiency.
Oliver N, 2021, Holding steady, DIABETIC MEDICINE, Vol: 38, ISSN: 0742-3071
Rilstone S, Reddy M, Oliver N, 2021, A Pilot Study of Flat and Circadian Insulin Infusion Rates in Continuous Subcutaneous Insulin Infusion (CSII) in Adults with Type 1 Diabetes (FIRST1D), JOURNAL OF DIABETES SCIENCE AND TECHNOLOGY, Vol: 15, Pages: 666-671, ISSN: 1932-2968
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- Citations: 1
Oliver N, 2021, Best foot forward, DIABETIC MEDICINE, Vol: 38, ISSN: 0742-3071
von Herrath M, Bain SC, Bode B, et al., 2021, Anti-interleukin-21 antibody and liraglutide for the preservation of β-cell function in adults with recent-onset type 1 diabetes: a randomised, double-blind, placebo-controlled, phase 2 trial, LANCET DIABETES & ENDOCRINOLOGY, Vol: 9, Pages: 212-224, ISSN: 2213-8587
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- Citations: 53
Moser O, Riddell MC, Eckstein ML, et al., 2021, Glucose management for exercise using continuous glucose monitoring: should sex and prandial state be additional considerations? Reply to Yardley JE and Sigal RJ [letter], DIABETOLOGIA, Vol: 64, Pages: 935-938, ISSN: 0012-186X
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- Citations: 2
Grace SL, Walkey HC, Kaur A, et al., 2021, Glutamate decarboxylase and islet antigen-2 autoantibody titres at diagnosis in people with type 1 diabetes showed bimodal distribution and an association with age at diagnosis and HLA genotype, Publisher: WILEY, ISSN: 0742-3071
Thomas NJ, Walkey HC, Kaur A, et al., 2021, The absence of islet autoantibodies in clinically diagnosed older-adult onset type 1 diabetes suggests an alternative pathology, advocating for routine testing in this age group
<jats:title>Abstract</jats:title><jats:sec><jats:title>Objective</jats:title><jats:p>Islet autoantibodies at diagnosis are not well studied in older-adult onset (>30years) type 1 diabetes due to difficulties of accurate diagnosis. We used a type 1 diabetes genetic risk score (T1DGRS) to identify type 1 diabetes aiming to evaluate the prevalence and pattern of autoantibodies in older-adult onset type 1 diabetes.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We used a 30 variant T1DGRS in 1866 white-European individuals to genetically confirm a clinical diagnosis of new onset type 1 diabetes. We then assessed the prevalence and pattern of GADA, IA2A and ZnT8A within genetically consistent type 1 diabetes across three age groups (<18years (n=702), 18-30years (n=524) and >30years (n=588)).</jats:p></jats:sec><jats:sec><jats:title>Findings</jats:title><jats:p>In autoantibody positive cases T1DGRS was consistent with 100% type 1 diabetes in each age group. Conversely in autoantibody negative cases, T1DGRS was consistent with 93%(56/60) of <18years, 55%(37/67) of 18-30years and just 23%(34/151) of >30years having type 1 diabetes. Restricting analysis to genetically consistent type 1 diabetes showed similar proportions of positive autoantibodies across age groups (92% <18years, 92% 18-30years, 93% >30years)[p=0.87]. GADA was the most common autoantibody in older-adult onset type 1 diabetes, identifying 95% of autoantibody positive cases versus 72% in those <18years.</jats:p></jats:sec><jats:sec><jats:title>Interpretation</jats:title><jats:p>Older adult-onset type 1 diabetes has identical rates but different patterns of positive autoantibodies to childhood onset. In clinically suspected type 1 diabetes in older-adults, absence of autoantibodies strongly su
Avari P, Leal Y, Herrero Vinas P, et al., 2021, Safety and feasibility of the PEPPER adaptive bolus advisor and safety system; a randomized control study, Diabetes Technology and Therapeutics, Vol: 23, Pages: 175-186, ISSN: 1520-9156
Background: The Patient Empowerment through Predictive Personalized Decision Support (PEPPER) system provides personalized bolus advice for people with type 1 diabetes. The system incorporates an adaptive insulin recommender system (based on case-based reasoning, an artificial intelligence methodology), coupled with a safety system, which includes predictive glucose alerts and alarms, predictive low-glucose suspend, personalized carbohydrate recommendations, and dynamic bolus insulin constraint. We evaluated the safety and efficacy of the PEPPER system compared to a standard bolus calculator.Methods: This was an open-labeled multicenter randomized controlled crossover study. Following 4-week run-in, participants were randomized to PEPPER/Control or Control/PEPPER in a 1:1 ratio for 12 weeks. Participants then crossed over after a washout period. The primary end-point was percentage time in range (TIR, 3.9–10.0 mmol/L [70–180 mg/dL]). Secondary outcomes included glycemic variability, quality of life, and outcomes on the safety system and insulin recommender.Results: Fifty-four participants on multiple daily injections (MDI) or insulin pump completed the run-in period, making up the intention-to-treat analysis. Median (interquartile range) age was 41.5 (32.3–49.8) years, diabetes duration 21.0 (11.5–26.0) years, and HbA1c 61.0 (58.0–66.1) mmol/mol. No significant difference was observed for percentage TIR between the PEPPER and Control groups (62.5 [52.1–67.8] % vs. 58.4 [49.6–64.3] %, respectively, P = 0.27). For quality of life, participants reported higher perceived hypoglycemia with the PEPPER system despite no objective difference in time spent in hypoglycemia.Conclusions: The PEPPER system was safe, but did not change glycemic outcomes, compared to control. There is wide scope for integrating PEPPER into routine diabetes management for pump and MDI users. Further studies are required to confir
Oliver N, 2021, A complex archetype, DIABETIC MEDICINE, Vol: 38, ISSN: 0742-3071
Agha-Jaffar R, Oliver NS, Kostoula M, et al., 2021, Hyperglycemia Recognized in Early Pregnancy Is Phenotypically Type 2 Diabetes Mellitus Not Gestational Diabetes Mellitus: A Case Control Study, OBSTETRICAL & GYNECOLOGICAL SURVEY, Vol: 76, Pages: 133-135, ISSN: 0029-7828
Oliver N, 2021, Taking measure, DIABETIC MEDICINE, Vol: 38, ISSN: 0742-3071
Ilesanmi I, Tharakan G, Alexiadou K, et al., 2021, Roux-en-Y Gastric Bypass Increases Glycemic Variability and Time in Hypoglycemia in Patients With Obesity and Prediabetes or Type 2 Diabetes: A Prospective Cohort Study, DIABETES CARE, Vol: 44, Pages: 614-617, ISSN: 0149-5992
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- Citations: 8
Izzi-Engbeaya C, Distaso W, Amin A, et al., 2021, Adverse outcomes in COVID-19 and diabetes – a retrospective cohort study from three London Teaching hospitals, BMJ Open Diabetes Research and Care, Vol: 9, Pages: 1-10, ISSN: 2052-4897
INTRODUCTION: Patients with diabetes mellitus admitted to hospital with COVID-19 have poorer outcomes. However, the drivers for this are not fully elucidated. We performed detailed characterisation of COVID-19 patients to determine clinical and biochemical factors that may be the drivers of poorer outcomes. RESEARCH DESIGN AND METHODS: Retrospective cohort study of 889 consecutive inpatients diagnosed with COVID-19 between 9th March 2020 and 22nd April 2020 in a large London NHS Trust. Unbiased multivariate logistic regression analysis was performed to determine variables that were independently and significantly associated with increased risk of death and/or ICU admission within 30 days of COVID-19 diagnosis. RESULTS: 62% of patients in our cohort were of non-White ethnic backgrounds and the diabetes prevalence was 38%. 323 (36%) patients met the primary outcome of death/admission to the intensive care unit (ICU) within 30 days of COVID-19 diagnosis. Male gender, lower platelet count, advancing age and higher Clinical Frailty Scale (CFS) score (but not diabetes) independently predicted poor outcomes on multivariate analysis. Antiplatelet medication was associated with a lower risk of death/ICU admission. Factors that were significantly and independently associated with poorer outcomes in patients with diabetes were co-existing ischaemic heart disease, increasing age and lower platelet count. CONCLUSIONS: In this large study of a diverse patient population, comorbidity (i.e. diabetes with ischaemic heart disease; increasing CFS score in older patients) were major determinants of poor outcomes with COVID-19. Antiplatelet medication should be evaluated in randomised clinical trials amongst high-risk patient groups.
Ranjani H, Nitika S, Hariharan R, et al., 2021, Systematic review and scientific rating of commercial apps available in India for diabetes prevention, JOURNAL OF DIABETOLOGY, Vol: 12, Pages: 285-+, ISSN: 2543-3288
Oliver N, Persaud S, 2021, Happy New Year, DIABETIC MEDICINE, Vol: 38, ISSN: 0742-3071
Agha-Jaffar R, Oliver NS, Kostoula M, et al., 2020, Hyperglycemia recognised in early pregnancy is phenotypically type 2 diabetes mellitus not gestational diabetes mellitus: a case control study, Journal of Maternal-Fetal and Neonatal Medicine, Vol: 33, Pages: 3977-3983, ISSN: 1476-4954
OBJECTIVE: Gestational diabetes mellitus is defined as "diabetes recognized in the second or third trimester that is not clearly overt diabetes". Evidence relating to women with hyperglycemia early in pregnancy is limited. We aimed to evaluate women diagnosed with hyperglycemia early in pregnancy (eGDM) and compared them to those with pregestational established type 2 diabetes mellitus (T2DM) and gestational diabetes diagnosed routinely at 24-28-week gestation (rtGDM) to determine if the length of exposure to hyperglycemia adversely affected outcomes. METHODS: Forty consecutive women with eGDM who attended a multidisciplinary antenatal clinic were reviewed. Two separate BMI-matched control groups were identified, recognized pregestational T2DM (n = 80) and rtGDM (n = 80). Baseline demographics and outcomes were compared. RESULTS: A higher proportion of women in the eGDM and T2DM group required insulin and the incidence of hypertensive disorders was similarly increased compared with the rtGDM group (88.6, 77.0 versus 8.1%, p < .001 and 42.5%, 37.5 versus 12.5% p < .001, respectively). The proportion of infants born small for gestational age varied (eGDM 11.1%, T2DM 13.0%, and rtGDM 2.5%, p=.049). Postpartum, 7.5% of eGDM women were diagnosed with T2DM versus 1.3% in the rtGDM group (p<.001). CONCLUSIONS: These novel data demonstrate that the length of exposure to glucose adversely affects materno-foetal outcomes independent of maternal adiposity.
Unsworth R, Wallace S, Oliver NS, et al., 2020, New-Onset Type 1 Diabetes in Children During COVID-19: Multicenter Regional Findings in the UK, DIABETES CARE, Vol: 43, Pages: E170-E171, ISSN: 0149-5992
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- Citations: 220
Moser O, Riddell MC, Eckstein ML, et al., 2020, Glucose Management during physical Activity/Sport by Using continuous Glucose Meters (CGM/isCGM) in Type 1 Diabetes - EASD/ISPAD Position Statement, supported by ADA and JDRF, Publisher: SPRINGER WIEN, Pages: S340-S341, ISSN: 0043-5325
Moser O, Riddell MC, Eckstein ML, et al., 2020, Glucose management for exercise using continuous glucose monitoring (CGM) and intermittently scanned CGM (isCGM) systems in type 1 diabetes: position statement of the European Association for the Study of Diabetes (EASD) and of the International Society for Pediatric and Adolescent Diabetes (ISPAD) endorsed by JDRF and supported by the American Diabetes Association (ADA)., Diabetologia
Physical exercise is an important component in the management of type 1 diabetes across the lifespan. Yet, acute exercise increases the risk of dysglycaemia, and the direction of glycaemic excursions depends, to some extent, on the intensity and duration of the type of exercise. Understandably, fear of hypoglycaemia is one of the strongest barriers to incorporating exercise into daily life. Risk of hypoglycaemia during and after exercise can be lowered when insulin-dose adjustments are made and/or additional carbohydrates are consumed. Glycaemic management during exercise has been made easier with continuous glucose monitoring (CGM) and intermittently scanned continuous glucose monitoring (isCGM) systems; however, because of the complexity of CGM and isCGM systems, both individuals with type 1 diabetes and their healthcare professionals may struggle with the interpretation of given information to maximise the technological potential for effective use around exercise (i.e. before, during and after). This position statement highlights the recent advancements in CGM and isCGM technology, with a focus on the evidence base for their efficacy to sense glucose around exercise and adaptations in the use of these emerging tools, and updates the guidance for exercise in adults, children and adolescents with type 1 diabetes. Graphical abstract.
Moser O, Riddell MC, Eckstein ML, et al., 2020, Glucose management for exercise using continuous glucose monitoring (CGM) and intermittently scanned CGM (isCGM) systems in type 1 diabetes: position statement of the European Association for the Study of Diabetes (EASD) and of the International Society for Pediatric and Adolescent Diabetes (ISPAD) endorsed by JDRF and supported by the American Diabetes Association (ADA)., Pediatr Diabetes
Physical exercise is an important component in the management of type 1 diabetes across the lifespan. Yet, acute exercise increases the risk of dysglycaemia, and the direction of glycaemic excursions depends, to some extent, on the intensity and duration of the type of exercise. Understandably, fear of hypoglycaemia is one of the strongest barriers to incorporating exercise into daily life. Risk of hypoglycaemia during and after exercise can be lowered when insulin-dose adjustments are made and/or additional carbohydrates are consumed. Glycaemic management during exercise has been made easier with continuous glucose monitoring (CGM) and intermittently scanned continuous glucose monitoring (isCGM) systems; however, because of the complexity of CGM and isCGM systems, both individuals with type 1 diabetes and their healthcare professionals may struggle with the interpretation of given information to maximise the technological potential for effective use around exercise (ie, before, during and after). This position statement highlights the recent advancements in CGM and isCGM technology, with a focus on the evidence base for their efficacy to sense glucose around exercise and adaptations in the use of these emerging tools, and updates the guidance for exercise in adults, children and adolescents with type 1 diabetes.
Muniangi-Muhitu H, Akalestou E, Salem V, et al., 2020, Covid-19 and diabetes: a complex bidirectional relationship, Frontiers in Endocrinology, Vol: 11, ISSN: 1664-2392
Covid-19 is a recently-emerged infectious disease caused by the novel severe acute respiratory syndrome coronavirus SARS-CoV2. SARS-CoV2 differs from previous coronavirus infections (SARS and MERS) due to its high infectivity (reproduction value, R0, typically 2-4) and pre- or asymptomatic transmission, properties that have contributed to the current global Covid-19 pandemic. Identified risk factors for disease severity and death from SARS-Cov2 infection include older age, male sex, diabetes, obesity and hypertension. The reasons for these associations are still largely obscure. Evidence is also emerging that SARS-CoV2 infection exacerbates the underlying pathophysiology of hyperglycemia in people with diabetes. Here, we discuss potential mechanisms through which diabetes may affect the risk of more severe outcomes in Covid-19 and, additionally, how diabetic emergencies and longer term pathology may be aggravated by infection with the virus. We consider roles for the immune system, the observed phenomenon of microangiopathy in severe Covid-19 infection and the potential for direct viral toxicity on metabolically-relevant tissues including pancreatic beta cells and targets of insulin action.
Misra S, Hassanali N, Bennett AJ, et al., 2020, Response to comment on Misra et al. homozygous hypomorphic HNF1A alleles are a novel cause of young-onset diabetes and result in sulfonylurea-sensitive diabetes. diabetes care 2020;43:909-912, Diabetes Care, Vol: 43, Pages: E155-E156, ISSN: 0149-5992
Moscardo V, Herrero P, Reddy M, et al., 2020, Assessment of Glucose Control Metrics by Discriminant Ratio, DIABETES TECHNOLOGY & THERAPEUTICS, Vol: 22, Pages: 719-726, ISSN: 1520-9156
Moscardó V, Giménez M, Oliver N, et al., 2020, Updated Software for Automated Assessment of Glucose Variability and Quality of Glycemic Control in Diabetes., Diabetes Technol Ther, Vol: 22, Pages: 701-708
Background: Glycemic variability is an important factor to consider in diabetes management. It can be assessed with multiple glycemic variability metrics and quality of control indices based on continuous glucose monitoring (CGM) recordings. For this, a robust repeatable calculation is important. A widely used tool for automated assessment is the EasyGV software. The aim of this work is to implement new methods of glycemic variability assessment in EasyGV and to validate implementation of each glucose metric in EasyGV against a reference implementation of the calculations. Methods: Validation data used came from the JDRF CGM study. Validation of the implementation of metrics that are available in EasyGV software v9 was carried out and the following new methods were added and validated: personal glycemic state, index of glycemic control, times in ranges, and glycemic variability percentage. Reference values considered gold standard calculations were derived from MATLAB implementation of each metric. Results: The Pearson correlation coefficient was above 0.98 for all metrics, except for mean amplitude of glycemic excursion (r = 0.87) as EasyGV implements a fuzzy logic approach to assessment of variability. Bland-Altman plots demonstrated validation of the new software. Conclusions: The new freely available EasyGV software v10 (www.phc.ox.ac.uk/research/technology-outputs/easygv) is a validated robust tool for analyzing different glycemic variabilities and control metrics.
Hill NE, Oliver NS, 2020, DISTINGUISHING BETWEEN TYPE 1 AND TYPE 2 DIABETES Evolving type 1 diabetes in distinguishing between type 1 and type 2 diabetes, BMJ-BRITISH MEDICAL JOURNAL, Vol: 370, ISSN: 1756-1833
Mader JK, Oliver N, Vesper I, et al., 2020, First results from PRO Solo: patient reported outcomes from a clinical trial comparing a new patch pump with MDI and an established patch pump, 56th Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD), Publisher: SPRINGER, Pages: S341-S342, ISSN: 0012-186X
Misra S, Humayra H, Busbridge M, et al., 2020, Type 2 diabetes diagnosed between 18 and 30 years in south Asian (SA) and White individuals is clinically similar but treated differently, Publisher: WILEY, Pages: 62-62, ISSN: 0742-3071
Johnson A, Powell H, Chew S, et al., 2020, The imperial physical activity and diabetes clinic: Four years on, Publisher: WILEY, Pages: 71-71, ISSN: 0742-3071
Rilstone S, Oliver N, 2020, A survey of UK dietitians on current advice to people with type 1 diabetes using insulin pump in 2019 compared with 2015, Publisher: WILEY, Pages: 114-114, ISSN: 0742-3071
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