Publications
385 results found
Avari P, Ramli R, Reddy M, et al., 2019, Rationale and protocol for the Assessment of Impact of Real-time Continuous Glucose Monitoring on people presenting with severe hypoglycaemia (AIR-CGM) study, BMC Endocrine Disorders, Vol: 19, ISSN: 1472-6823
Background: Severe hypoglycaemia carries a significant risk of morbidity and mortality for people with type 1 diabetes. Economic costs are also high, estimated at approximately £13 million annually in England, UK. Continuous glucose monitoring (CGM) has been shown to reduce hypoglycaemia and associated fear, improve overall glycaemia and quality of life, and is cost-effective. Despite effective pathways in place with high levels of resource utilization, it has been reported there are low levels of follow-up, therapy change and specialist intervention after severe hypoglycaemia. This study is designed to assess the impact of providing real-time CGM to people with type 1 diabetes, who have had a recent episode of severe hypoglycaemia (within 72hours), compared to standard care.Methods/Design: Fifty-five participants with type 1 diabetes and a recent episode of severe hypoglycaemia, who are CGM naïve, will be recruited to the study. Participants will be randomised to CGM or standard care. The primary outcome is percentage time spent in hypoglycaemia (<3.0mmol/L, 55mg/dL). Secondary outcomes include other measures of hypoglycaemia, time in euglycaemia, overall glucose status and patient reported qualitative measures.Discussion: This study assesses the impact of providing continuous glucose monitoring at the outset in individuals at highest risk of hypoglycaemia. Changing demand means that novel approaches need to be taken to healthcare provision. This study has the potential to shape future national standards.
Liu C, Vehí J, Avari P, et al., 2019, Long-term glucose forecasting using a physiological model and deconvolution of the continuous glucose monitoring signal, Sensors, Vol: 19, Pages: 1-19, ISSN: 1424-8220
(1) Objective: Blood glucose forecasting in type 1 diabetes (T1D) management is a maturing field with numerous algorithms being published and a few of them having reached the commercialisation stage. However, accurate long-term glucose predictions (e.g., >60 min), which are usually needed in applications such as precision insulin dosing (e.g., an artificial pancreas), still remain a challenge. In this paper, we present a novel glucose forecasting algorithm that is well-suited for long-term prediction horizons. The proposed algorithm is currently being used as the core component of a modular safety system for an insulin dose recommender developed within the EU-funded PEPPER (Patient Empowerment through Predictive PERsonalised decision support) project. (2) Methods: The proposed blood glucose forecasting algorithm is based on a compartmental composite model of glucose–insulin dynamics, which uses a deconvolution technique applied to the continuous glucose monitoring (CGM) signal for state estimation. In addition to commonly employed inputs by glucose forecasting methods (i.e., CGM data, insulin, carbohydrates), the proposed algorithm allows the optional input of meal absorption information to enhance prediction accuracy. Clinical data corresponding to 10 adult subjects with T1D were used for evaluation purposes. In addition, in silico data obtained with a modified version of the UVa-Padova simulator was used to further evaluate the impact of accounting for meal absorption information on prediction accuracy. Finally, a comparison with two well-established glucose forecasting algorithms, the autoregressive exogenous (ARX) model and the latent variable-based statistical (LVX) model, was carried out. (3) Results: For prediction horizons beyond 60 min, the performance of the proposed physiological model-based (PM) algorithm is superior to that of the LVX and ARX algorithms. When comparing the performance of PM against the secondly ranked method (ARX) on a 120 min
Dimakopoulou A, Jayasena CN, Radia UK, et al., 2019, Animal models of diabetes-related male hypogonadism, Frontiers in Endocrinology, Vol: 10, ISSN: 1664-2392
Hypogonadism is the clinical syndrome associated with low testosterone secretion in men. Hypogonadism affects ~37–57% men with diabetes mellitus (1). Male reproduction is orchestrated by the hypothalamo-pituitary-gonadal (HPG) axis, which regulates the biosynthesis of testosterone from the testes. Diabetes may cause hypogonadism through multiple mechanisms including suppression of hypothalamic gonadotrophin-releasing hormone (GnRH) secretion, or direct disruption of spermatogenesis (2). Clinical stigmata of hypogonadism include reduced libido, erectile dysfunction (ED) and reduced physical strength. This article will summarize the evidence from animal models including how diabetes affects male reproductive endocrine function and predisposes to hypogonadism.
Oliver N, Gimenez M, Calhoun P, et al., 2019, Continuous glucose monitoring in people with type 1 diabetes on multiple-dose injection therapy: the relationship between glycemic control and hypoglycemia, Diabetes Care, Vol: 43, Pages: 53-58, ISSN: 0149-5992
OBJECTIVE: The inverse relationship between overall glucose control and hypoglycemia risk is weakened by the use of real-time continuous glucose monitoring (rtCGM). We assess the relationship between glucose control and hypoglycemia in people with type 1 diabetes using multiple-dose injection (MDI) regimens, including those at highest risk of hypoglycemia. RESEARCH DESIGN AND METHODS: CGM data from the intervention (rtCGM) and control (self-monitored blood glucose [SMBG]) phases of the Multiple Daily Injections and Continuous Glucose Monitoring in Diabetes (DIAMOND) and HypoDE studies were analyzed. The relationship between glucose control (HbA1c and mean rtCGM glucose levels) and percentage time spent in hypoglycemia was explored for thresholds of 3.9 mmol/L (70 mg/dL) and 3.0 mmol/L (54 mg/dL), and ANOVA across the range of HbA1c and mean glucose was performed. RESULTS: A nonlinear relationship between mean glucose and hypoglycemia was identified at baseline, with the steepest relationship seen at lower values of mean glucose. The use of rtCGM reduces the exposure to hypoglycemia at all thresholds and flattens the relationship between overall glucose and hypoglycemia, with the most marked impact at lower values of mean glucose and HbA1c. Exposure to hypoglycemia varied at all thresholds across the range of overall glucose at baseline, in the SMBG group, and with rtCGM, but the relationships were weaker in the rtCGM group. CONCLUSIONS: Usage of rtCGM can flatten and attenuate the relationship between overall glucose control and hypoglycemia, exerting its greatest impact at lower values of HbA1c and mean glucose in people with type 1 diabetes using MDI regimens and at highest risk of hypoglycemia.
Bhattarai S, Godsland IF, Misra S, et al., 2019, Metabolic health and vascular complications in type 1 diabetes, Journal of Diabetes and its Complications, Vol: 33, Pages: 634-640, ISSN: 1056-8727
AIMS: Optimal glycaemic control benefits risk of microvascular and macrovascular complications in type 1 diabetes (T1DM) but the importance of other components of metabolic health is less certain, particularly in the context of routine clinical practice. METHODS: Data for this cross-sectional analysis derived from a database covering inner North West London adult diabetes clinics. People with T1DM and with complete information for height, weight, blood pressure and serum high and low-density lipoprotein cholesterol (HDL-c and LDL-c) and triglyceride concentration measurements were included. RESULTS: Among the 920 participants, those with complications were older and had longer duration of diabetes but had similar HbA1c to people without complications. Systolic hypertension and low HDL-c were independently associated with complications. From having 0 risk factors, the prevalence of micro and macrovascular disease increased with increasing number of risk factors. Relative to those with ≥1 risk factor, those with 0 risk factors (n = 179) were at lower risk of retinopathy (OR 0.6 (0.4-0.9), p = 0.01) and nephropathy [OR 0.1 (0.04-0.3), p = 0.002], independent of individual characteristics. CONCLUSIONS: In routine clinical management of T1DM, associations between lipid and blood pressure risk factors and prevalent micro and macrovascular disease remain, implying that more intensive risk factor management may be beneficial.
Humphreys A, Bravis V, Kaur A, et al., 2019, Individual and diabetes presentation characteristics associated with partial remission status in children and adults evaluated up to 12 months following diagnosis of type 1 diabetes: An ADDRESS-2 (After Diagnosis Diabetes Research Support System-2) study analysis, Diabetes Research and Clinical Practice, Vol: 155, ISSN: 0168-8227
AIMS: People with recently-diagnosed type 1 diabetes mellitus (T1D) may undergo a transient period of glycaemic control with less exogenous insulin. Identification of predictors of this 'remission' could inform a better understanding of glycaemic control. METHODS: Participants in the ADDRESS-2 study were included who had 1 or 2 assessments of remission status (coincident insulin dose and HbA1c measurement, with remission defined by ≤0.4 units insulin/kg-body-weight/day with HbA1c < 53 mmol/mol). Demographic and clinical presentation characteristics were compared according to remission status and predictors of remission were explored by logistic regression analysis. RESULTS: 1470 first and 469 second assessments of remission status were recorded within 12 months of diagnosis of T1D. Step increases in the probability of remission were identified at age-at-diagnosis 20 years and 3 months after diagnosis (both p < 0.001). Among those aged < 20 years, remission was associated with male gender (p = 0.02), no ketoacidosis (p = 0.02) and fewer than 2 symptoms at presentation (p = 0.004). None of these characteristics predicted remission in those aged ≥ 20 years. In the subgroup with two assessments, transition to remission was independently associated with first remission assessment in months 1-2 post-diagnosis (p = 0.01), with age-at-diagnosis ≥ 20 years (p = 0.01) and, in those aged < 20 years, with an early HbA1c of <57 mmol/mol. Adiposity, ethnicity, autoantibody status and other autoimmune disease were unrelated to remission. CONCLUSIONS: For those diagnosed before 20 years of age, males, ketoacidosis-free, with fewer symptoms and low early HbA1c were more likely to experience remission, but remission was most likely in anyone aged ≥ 20 at diagnosis.
Gimenez M, Moscardo V, Reddy M, et al., 2019, The relationship between HbA<sub>1c</sub> and hypoglycaemia in the IMPACT trial, 55th Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD), Publisher: SPRINGER, Pages: S411-S411, ISSN: 0012-186X
Groom O, McLaughlin K, Johns J, et al., 2019, Utility of anti-tetraspanin 7 auto-antibodies in adults and children with type 1 diabetes: insights from the ADDRESS-2 study, 55th Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD), Publisher: SPRINGER, Pages: S204-S205, ISSN: 0012-186X
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Sivapatham S, Walkey HC, Kaur A, et al., 2019, Changes in beta cell function 6 and 12 months after a diagnosis of type 1 diabetes: insights from the ADDRESS-2 study, 55th Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD), Publisher: SPRINGER, Pages: S155-S155, ISSN: 0012-186X
Gehr B, Muehlen H, Renard E, et al., 2019, Continuous intraperitoneal insulin infusion shows a great benefit-risk ratio under long-term real-world use in a vulnerable population with diabetes, 55th Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD), Publisher: SPRINGER, Pages: S426-S426, ISSN: 0012-186X
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Avari P, Moscardo V, Jugnee N, et al., 2019, Glycemic variability and hypoglycemic excursions with continuous glucose monitoring compared to intermittently scanned continuous glucose monitoring in adults With highest risk type 1 diabetes, Journal of Diabetes Science and Technology, Vol: 14, Pages: 567-574, ISSN: 1932-2968
BACKGROUND: The I-HART CGM study has shown that real-time continuous glucose monitoring (rtCGM) has greater beneficial impact on hypoglycemia than intermittently scanned continuous glucose monitoring (iscCGM) in adults with type 1 diabetes at high risk (Gold score ≥4 or recent severe hypoglycemia using insulin injections). In this subanalysis, we present the impact of rtCGM and iscCGM on glycemic variability (GV). METHODS: Forty participants were recruited to this parallel group study. Following two weeks of blinded rtCGM (DexcomG4), participants were randomized to rtCGM (Dexcom G5; n = 20) or iscCGM (Freestyle Libre; n = 20) for eight weeks. An open-extension phase enabled participants on rtCGM to continue for a further eight weeks and those on iscCGM to switch to rtCGM over this period. Glycemic variability measures at baseline, 8- and 16-week endpoints were compared between groups. RESULTS: At the eight-week endpoint, between-group differences demonstrated significant reduction in several GV measures with rtCGM compared to iscCGM (GRADE%hypoglycemia, index of glycemic control [IGC], and average daily risk range [ADRR]; P < .05). Intermittently scanned continuous glucose monitoring reduced mean average glucose and glycemic variability percentage and GRADE%hyperglycemia compared with rtCGM (P < .05). At 16 weeks, the iscCGM group switching to rtCGM showed significant improvement in GRADE%hypoglycemia, personal glycemic status, IGC, and ADRR. CONCLUSION: Our data suggest most, but not all, GV measures improve with rtCGM compared with iscCGM, particularly those measures associated with the risk of hypoglycemia. Selecting appropriate glucose monitoring technology to address GV in this high-risk cohort is important to minimize the risk of glucose extremes and severe hypoglycemia. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT03028220.
Rilstone S, Reddy M, Oliver N, 2019, Glycemic index, extended bolusing, and diabetes education in insulin pump therapy (GLIDE: A pilot study), Diabetes Technology and Therapeutics, Vol: 21, Pages: 452-455, ISSN: 1520-9156
Background: There is no published evidence on whether advanced bolus education affects outcomes in insulin pump-treated type 1 diabetes. We assess the feasibility of delivering a clinical education program on rates of digestion and bolusing, and to assess its preliminary impact.Methods: An interactive education session on glycemic index (GI), extended bolusing, and superbolusing was developed and assessed in a nonrandomized single-arm study for 12 weeks. Insulin pump-treated participants with type 1 diabetes were recruited. Glucose outcomes were assessed by blinded continuous glucose monitoring after the consumption of high-fat and high-GI test meal. The primary outcome measure was 8-h glucose area under the curve (AUC) after high-fat meals, before and after intervention. Secondary outcomes included time spent in hypoglycemia, quality of life, treatment satisfaction, HbA1c, frequency of use of extended boluses, and postprandial AUC.Results: Eleven participants completed the study [mean (SD) age 42.3 (12.8) years, baseline HbA1c 57.3 (10.0) mmol/mol, duration of diabetes 19.5 (9.9) years]. AUC for glucose after test meals did not differ significantly after education except for in the first 2 h after the high-GI meal [precourse 83.1 (0.23–88.9), postcourse 5.38 (−16.2 to 50.8)]. Percentage time spent in hypoglycemia (<3.9 and <3.3 mmol/L) fell at week 12 compared with baseline [5.8 (IQR 2.1–8.3) % to 4.3 (IQR 2.1–5.4) %, P = 0.013, and 2.9 (IQR 1.2–3.9) % to 1.6 (IQR 0.7–2.4) %, P = 0.029, respectively].Conclusion: Delivering an education program to support advanced boluses is feasible and may reduce exposure to hypoglycemia. A further trial is required to confirm the findings.
Ramli R, Reddy M, Oliver N, 2019, Artificial pancreas: current progress and future outlook in the treatment of type 1 diabetes., Drugs, Vol: 79, Pages: 1089-1101, ISSN: 1179-1950
Type 1 diabetes is characterised by insulin deficiency caused by autoimmune destruction of the pancreatic beta cells. The treatment of type 1 diabetes is exogenous insulin in the form of multiple daily injections or continuous subcutaneous insulin infusion. Advances in diabetes technology have been exponential in the past few decades, culminating in studies to develop an automated artificial pancreas, also known as the closed-loop system. This has recently led to a commercially available, hybrid artificial pancreas in the USA and Europe. This review article aims to provide an overview of the rationale for an artificial pancreas system and an update of the current state of artificial pancreas development. We explore the different types of artificial pancreas systems being studied, including the use of adjunctive therapy, and the use of these systems in different groups of users. In addition, we discuss the potential psychosocial impact and the challenges and limitations of implementing artificial pancreas use into clinical practice.
Rilstone SK, Reddy M, Oliver N, 2019, A Study of Flat and Circadian Insulin infusion Rates in Continuous Subcutaneous Insulin Infusion (CSII) in Adults with Type 1 Diabetes (FIRST1D), 79th Scientific Sessions of the American-Diabetes-Association (ADA), Publisher: AMER DIABETES ASSOC, ISSN: 0012-1797
Walkey HC, Kaur A, Godsland IF, et al., 2019, The impact of ethnicity on clinical characteristics and autoantibody status at clinical onset of Type 1 diabetes-from the ADDRESS-2 study, 79th Scientific Sessions of the American-Diabetes-Association (ADA), Publisher: AMER DIABETES ASSOC, Pages: 1-2, ISSN: 0012-1797
Introduction: The phenotype of type 1 diabetes (T1D) has been explored mainly in white populations. People of non-white ethnicity are reportedly less likely to be antibody positive, but phenotypic differences are not well characterised. We investigated ethnic group differences in the clinical characteristics and antibody (Ab) status at clinical onset of T1D.Methods: We studied people of white European (WE), Asian (A) and black African/Caribbean (AC) ethnicity with clinically-assigned T1D, age ≥5 years, recruited ≤ 6 months after diagnosis, and with Abs (GADA, IA-2A and ZnT8A) measured by radioimmunoassay.Results: Ethnic breakdown: WE n=1,997, A n=50, AC n=41. Median (IQR) ages were: WE 23(14-24), A 18(12-29), AC 26 (15-41) years p=0.007. Presentation with DKA was more common in AC (65%) than WE (42%) or A (53%) p=0.006; otherwise clinical presentation (polyuria/dipsia, weight loss, fatigue, symptom duration) was similar. Proportions with 0, 1 and ≥2 Abs differed by ethnicity: WE (15%, 24%, 61%); A (28%, 26%, 46%); AC (36%, 32%, 32%) p<0.001. For Ab negative (0 Abs), ethnic groups differed in BMI (p=0.001) and presentation with DKA (<0.001), but other characteristics, including daily insulin dose, were similar. For Ab positive (≥1 Ab), there were differences in parental history of diabetes p=0.02; otherwise ethnicity had no impact. Also, differences were seen in the frequency of IA-2A: WE (67%), A (53%), AC (50%) p=0.03 and ZnT8A: WE (60%), A (39%), AC (42%) p=0.01, but not GADA: WE (83%), A (94%) AC (92%) p=0.09.Conclusion: Although clinical presentation of T1D was remarkably similar across ethnic groups, variations were found in the proportions with Ab positivity and frequencies of individual Abs. Antibody negativity was more common in non-white ethnic groups and the presence of >1 Ab most common in white ethnicity. Practitioners should be alert to differences in phenotype according to antibody status that may impact classification in some ethn
Patel KA, Thomas N, Weedon MN, et al., 2019, Analysis of Type 1 Diabetes Genetic Risk Score Shows 1 in 8 People with Clinically Diagnosed Adult-Onset T1D Are Misdiagnosed, and Presenting Features at Diagnosis Do Not Identify Those Misdiagnosed, 79th Scientific Sessions of the American-Diabetes-Association (ADA), Publisher: AMER DIABETES ASSOC, ISSN: 0012-1797
Tharakan G, Ilesanmi II, Behary P, et al., 2019, Changes in Glycaemic Variability after RYGB: A One-Year Prospective Study with Comparison to Patients with Post-bariatric Hypoglycaemia, 79th Scientific Sessions of the American-Diabetes-Association (ADA), Publisher: AMER DIABETES ASSOC, ISSN: 0012-1797
Srivanichakorn W, Godsland IF, Washirasaksiri C, et al., 2019, Cardiometabolic risk factors in Thai individuals with prediabetes treated in a high-risk, prevention clinic - unexpected relationship between HDL cholesterol and glycaemia in men, Journal of Diabetes Investigation, Vol: 10, Pages: 771-779, ISSN: 2040-1124
BACKGROUND: Relationships between cardiometabolic risk and glycaemia have been rarely studied in people under clinical evaluation and treatment for cardiometabolic risk and with prediabetes. We investigated relationships between glycaemia and cardiometabolic risk factors in clinic participants with prediabetes. METHODS: This was a cross-sectional analysis of data collected at a centre in Thailand. Clinic attendees were at high-risk of diabetes or cardiovascular disease, with HbA1c 39-<48 mmol/mol or fasting plasma glucose (FPG) 5.6-<7.0 mmol/L. The relationships between glycaemia and cardiometabolic risk factors were explored. RESULTS: Of 357 participants, two or more insulin resistance-related metabolic disturbances were present in 84%; 61% took a statin and 75% an antihypertensive agent. Independently of age, gender, adiposity, medication use, possible NAFLD and gender-glycaemia interaction, neither FPG nor HbA1c were associated with variation in any other cardiometabolic risk factors. HDL cholesterol decreased with HbA1c in women (female*HbA1c interaction, p=0.03) but, unexpectedly, increased with FPG in men (male*FPG interaction, p=0.02). CONCLUSION: Overall, in Thai people treated for high-cardiometabolic risk and with prediabetes defined by FPG and/or HbA1c, neither FPG nor HbA1c were associated with other cardiometabolic risk factors. However, according to gender, HDL cholesterol showed the expected relationship with glycaemia in women but the reverse in men.
Patel KA, Thomas N, Walkey H, et al., 2019, The initial clinical diagnosis of Type 1 diabetes is incorrect in one in eight people: Islet autoantibodies but not presenting features help identifying misdiagnosed people, Publisher: WILEY, Pages: 167-168, ISSN: 0742-3071
Oliver N, Holt RIG, 2019, The James Lind Alliance research priorities for diabetes., Diabet Med, Vol: 36, Pages: 267-268
Reddy M, Oliver N, 2019, Reply to Letter by Seibold regarding Monika Reddy, Narvada Jugnee, Sinthuka Anantharaja, and Nick Oliver, Switching from Flash Glucose Monitoring to Continuous Glucose Monitoring on Hypoglycemia in Adults with Type 1 Diabetes at High Hypoglycemia Risk: The Extension Phase of the I HART CGM Study., Diabetes Technol Ther, Vol: 21, Pages: 99-100
Gimenez M, Moscardo V, Beato-Vibora P, et al., 2019, THE IMPACT OF PREDICTIVE-SUSPEND FEATURE ON THE RELATIONSHIP BETWEEN HBA1C AND HYPOGLYCEMIA IN PATIENTS WITH TYPE 1 DIABETES TREATED WITH SAP AND LOW-GLUCOSE SUSPEND FUNCTION, Publisher: MARY ANN LIEBERT, INC, Pages: A97-A98, ISSN: 1520-9156
Martin C, Aldea A, Alshaigy B, et al., 2019, APPLICATION OF USABILITY ENGINEERING TO THE DEVELOPMENT OF A PERSONALISED DECISION SUPPORT SYSTEM FOR TYPE 1 DIABETES SELF-MANAGEMENT, Publisher: MARY ANN LIEBERT, INC, Pages: A73-A73, ISSN: 1520-9156
Liu C, Avari PE, Oliver N, et al., 2019, COORDINATING LOW-GLUCOSE INSULIN SUSPENSION AND CARBOHYDRATE RECOMMENDATIONS FOR HYPOGLYCAEMIA MINIMISATION, Publisher: MARY ANN LIEBERT, INC, Pages: A85-A85, ISSN: 1520-9156
Avari P, Moscardo V, Jugnee N, et al., 2019, AMBULATORY GLUCOSE PROFILING AND GLYCAEMIC OUTCOMES WHEN SWITCHING FLASH TO CONTINUOUS GLUCOSE MONITORING: THE I-HART CGM STUDY, Publisher: MARY ANN LIEBERT, INC, Pages: A108-A109, ISSN: 1520-9156
Uduku C, Li K, Daniiels J, et al., 2019, DEVELOPMENT OF AN ADAPTIVE, REAL-TIME, INTELLIGENT SYSTEM TO ENHANCE SELF-CARE OF CHRONIC DISEASE (ARISES), Publisher: MARY ANN LIEBERT, INC, Pages: A69-A69, ISSN: 1520-9156
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Avari P, Leal Y, Wos M, et al., 2019, FEASIBILITY OF SAFETY SYSTEM WITHIN A NOVEL PERSONALISED DECISION SUPPORT TOOL FOR INSULIN DOSING, Publisher: MARY ANN LIEBERT, INC, Pages: A16-A16, ISSN: 1520-9156
Hill NE, Rilstone S, Stacey M, et al., 2018, Changes in northern hemisphere male international rugby union players body mass and height between 1955 and 2015, BMJ Open Sport and Exercise Medicine, Vol: 4, ISSN: 2055-7647
Objectives We sought to establish the effects of professionalism, which officially began in 1995, on the body mass and height of northern hemisphere male international rugby union (RU) players. We hypothesised that mass would significantly increase following professionalism. We also investigated the changes in size of players according to their playing position, and we compared changes to rugby league (RL) players and the public.Methods The body mass and height of players representing their international team for that country’s first game of the Five Nations in 1955, 1965, 1975, 1985 and 1995 and, for 2005 and 2015, the Six Nations, were collected from matchday programmes. RL players’ data were collected from the Challenge Cup final games played in the same years.Results International RU player body mass has significantly increased since 1995. In 1955 mean (±SD) player body mass was 84.8 kg (±8.2); in 2015, it was 105.4 kg (±12.1), an increase of 24.3%. Between 1955 and 2015, the body mass of forwards increased steadily, whereas that of backs has mostly gone up since 1995. RU player body mass gain has exceeded that of RL, but the age-matched difference between RU players and the public has remained relatively constant.Conclusions The factors influencing the gain in body mass of rugby players are legion; however, we believe that the interpretation of the law relating to the scrum put-in and changes allowing substitutions have, at least in part, contributed to the observed changes. Injury severity is increasing, and this may be linked to greater forces (caused by greater body mass) occurring in contact. RU law makers should adjust the rules to encourage speed and skill at the expense of mass.
Oliver N, Reddy M, 2018, Reply to Seibold and Schlaeger: Comparison of continuous and flash glucose monitoring in Type 1 diabetes: methodological inconsistency precludes hypoglycaemia conclusions, Diabetic Medicine, Vol: 35, Pages: 1619-1620, ISSN: 0742-3071
Perera R, Oliver N, Wilmot E, et al., 2018, Variations in access to and reimbursement for continuous glucose monitoring systems for people living with Type 1 diabetes across England, DIABETIC MEDICINE, Vol: 35, Pages: 1617-1618, ISSN: 0742-3071
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