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Daniel E, Aylwin S, Mustafa O, Ball S, Munir A, Boelaert K, Chortis V, Cuthbertson DJ, Daousi C, Rajeev SP, Davis J, Cheer K, Drake W, Gunganah K, Grossman A, Gurnell M, Powlson AS, Karavitaki N, Huguet I, Kearney T, Mohit K, Meeran K, Hill N, Rees A, Lansdown AJ, Trainer PJ, Minder AEH, Newell-Price J. Effectiveness of Metyrapone in Treating Cushing's Syndrome: A Retrospective Multicenter Study in 195 Patients. J Clin Endocrinol Metab 2015; 100:4146-54. [PMID: 26353009 PMCID: PMC5393433 DOI: 10.1210/jc.2015-2616] [Citation(s) in RCA: 134] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cushing's syndrome (CS) is a severe condition with excess mortality and significant morbidity necessitating control of hypercortisolemia. There are few data documenting use of the steroidogenesis inhibitor metyrapone for this purpose. OBJECTIVE The objective was to assess the effectiveness of metyrapone in controlling cortisol excess in a contemporary series of patients with CS. DESIGN This was designed as a retrospective, multicenter study. SETTING Thirteen University hospitals were studied. PATIENTS We studied a total of 195 patients with proven CS: 115 Cushing's disease, 37 ectopic ACTH syndrome, 43 ACTH-independent disease (adrenocortical carcinoma 10, adrenal adenoma 30, and ACTH-independent adrenal hyperplasia 3). MEASUREMENTS Measurements included biochemical parameters of activity of CS: mean serum cortisol "day-curve" (CDC) (target 150-300 nmol/L); 9 am serum cortisol; 24-hour urinary free cortisol (UFC). RESULTS A total of 164/195 received metyrapone monotherapy. Mean age was 49.6 ± 15.7 years; mean duration of therapy 8 months (median 3 mo, range 3 d to 11.6 y). There were significant improvements on metyrapone, first evaluation to last review: CDC (91 patients, 722.9 nmol/L [26.2 μg/dL] vs 348.6 nmol/L [12.6 μg/dL]; P < .0001); 9 am cortisol (123 patients, 882.9 nmol/L [32.0 μg/dL] vs 491.1 nmol/L [17.8 μg/dL]; P < .0001); and UFC (37 patients, 1483 nmol/24 h [537 μg/24 h] vs 452.6 nmol/24 h [164 μg/24 h]; P = .003). Overall, control at last review: 55%, 43%, 46%, and 76% of patients who had CDCs, UFCs, 9 am cortisol less than 331 nmol/L (12.0 μg/dL), and 9 am cortisol less than upper limit of normal/600 nmol/L (21.7 μg/dL). Median final dose: Cushing's disease 1375 mg; ectopic ACTH syndrome 1500 mg; benign adrenal disease 750 mg; and adrenocortical carcinoma 1250 mg. Adverse events occurred in 25% of patients, mostly mild gastrointestinal upset and dizziness, usually within 2 weeks of initiation or dose increase, all reversible. CONCLUSIONS Metyrapone is effective therapy for short- and long-term control of hypercortisolemia in CS.
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Affiliation(s)
- Eleni Daniel
- The Medical School (E.D., J.N.-P.), University of Sheffield, S10 2RX Sheffield, United Kingdom; King's College Hospital NHS Foundation Trust (S.A., O.M.), B15 2TT London, United Kingdom; The Medical School (S.B.), Newcastle University, NE2 4HH Newcastle, United Kingdom; Royal Victoria Infirmary (S.B., A.M.), SE5 9RS Newcastle, United Kingdom; College of Medical and Dental Sciences (K.B., V.C., N.K.), Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, M13 9PT Birmingham, United Kingdom; Department of Obesity and Endocrinology (D.J.C., C.D., S.P.R.), University of Liverpool, NE1 4LP Liverpool, United Kingdom; Centre for Endocrinology and Diabetes (J.D.), University of Manchester, L69 3GA Manchester, United Kingdom; Manchester Royal Infirmary (K.C.), M13 9WL Manchester, United Kingdom; Department of Endocrinology (W.D., K.G.), St Bartholomew's Hospital, EC1A 7BE London, United Kingdom; Oxford Centre for Diabetes (A.G., N.K., I.H.), Endocrinology and Metabolism, Churchill Hospital, M6 8HD Oxford, United Kingdom; Wellcome Trust-MRC Institute of Metabolic Science (M.G., A.S.P.), University of Cambridge, Addenbrooke's Hospital, OX3 7LE Cambridge, United Kingdom; Salford Royal Foundation Trust (T.K., K.Mo.), CB2 0QQ Salford, United Kingdom; Imperial College (K.Me., N.H.), SW7 2AZ London, United Kingdom; School of Medicine (A.R., A.J.L.), Cardiff University, CF14 4XN Cardiff, United Kingdom; and The Christie NHS Foundation Trust (P.J.T., A.-E.H.M.), M20 4BX Manchester, United Kingdom
| | - Simon Aylwin
- The Medical School (E.D., J.N.-P.), University of Sheffield, S10 2RX Sheffield, United Kingdom; King's College Hospital NHS Foundation Trust (S.A., O.M.), B15 2TT London, United Kingdom; The Medical School (S.B.), Newcastle University, NE2 4HH Newcastle, United Kingdom; Royal Victoria Infirmary (S.B., A.M.), SE5 9RS Newcastle, United Kingdom; College of Medical and Dental Sciences (K.B., V.C., N.K.), Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, M13 9PT Birmingham, United Kingdom; Department of Obesity and Endocrinology (D.J.C., C.D., S.P.R.), University of Liverpool, NE1 4LP Liverpool, United Kingdom; Centre for Endocrinology and Diabetes (J.D.), University of Manchester, L69 3GA Manchester, United Kingdom; Manchester Royal Infirmary (K.C.), M13 9WL Manchester, United Kingdom; Department of Endocrinology (W.D., K.G.), St Bartholomew's Hospital, EC1A 7BE London, United Kingdom; Oxford Centre for Diabetes (A.G., N.K., I.H.), Endocrinology and Metabolism, Churchill Hospital, M6 8HD Oxford, United Kingdom; Wellcome Trust-MRC Institute of Metabolic Science (M.G., A.S.P.), University of Cambridge, Addenbrooke's Hospital, OX3 7LE Cambridge, United Kingdom; Salford Royal Foundation Trust (T.K., K.Mo.), CB2 0QQ Salford, United Kingdom; Imperial College (K.Me., N.H.), SW7 2AZ London, United Kingdom; School of Medicine (A.R., A.J.L.), Cardiff University, CF14 4XN Cardiff, United Kingdom; and The Christie NHS Foundation Trust (P.J.T., A.-E.H.M.), M20 4BX Manchester, United Kingdom
| | - Omar Mustafa
- The Medical School (E.D., J.N.-P.), University of Sheffield, S10 2RX Sheffield, United Kingdom; King's College Hospital NHS Foundation Trust (S.A., O.M.), B15 2TT London, United Kingdom; The Medical School (S.B.), Newcastle University, NE2 4HH Newcastle, United Kingdom; Royal Victoria Infirmary (S.B., A.M.), SE5 9RS Newcastle, United Kingdom; College of Medical and Dental Sciences (K.B., V.C., N.K.), Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, M13 9PT Birmingham, United Kingdom; Department of Obesity and Endocrinology (D.J.C., C.D., S.P.R.), University of Liverpool, NE1 4LP Liverpool, United Kingdom; Centre for Endocrinology and Diabetes (J.D.), University of Manchester, L69 3GA Manchester, United Kingdom; Manchester Royal Infirmary (K.C.), M13 9WL Manchester, United Kingdom; Department of Endocrinology (W.D., K.G.), St Bartholomew's Hospital, EC1A 7BE London, United Kingdom; Oxford Centre for Diabetes (A.G., N.K., I.H.), Endocrinology and Metabolism, Churchill Hospital, M6 8HD Oxford, United Kingdom; Wellcome Trust-MRC Institute of Metabolic Science (M.G., A.S.P.), University of Cambridge, Addenbrooke's Hospital, OX3 7LE Cambridge, United Kingdom; Salford Royal Foundation Trust (T.K., K.Mo.), CB2 0QQ Salford, United Kingdom; Imperial College (K.Me., N.H.), SW7 2AZ London, United Kingdom; School of Medicine (A.R., A.J.L.), Cardiff University, CF14 4XN Cardiff, United Kingdom; and The Christie NHS Foundation Trust (P.J.T., A.-E.H.M.), M20 4BX Manchester, United Kingdom
| | - Steve Ball
- The Medical School (E.D., J.N.-P.), University of Sheffield, S10 2RX Sheffield, United Kingdom; King's College Hospital NHS Foundation Trust (S.A., O.M.), B15 2TT London, United Kingdom; The Medical School (S.B.), Newcastle University, NE2 4HH Newcastle, United Kingdom; Royal Victoria Infirmary (S.B., A.M.), SE5 9RS Newcastle, United Kingdom; College of Medical and Dental Sciences (K.B., V.C., N.K.), Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, M13 9PT Birmingham, United Kingdom; Department of Obesity and Endocrinology (D.J.C., C.D., S.P.R.), University of Liverpool, NE1 4LP Liverpool, United Kingdom; Centre for Endocrinology and Diabetes (J.D.), University of Manchester, L69 3GA Manchester, United Kingdom; Manchester Royal Infirmary (K.C.), M13 9WL Manchester, United Kingdom; Department of Endocrinology (W.D., K.G.), St Bartholomew's Hospital, EC1A 7BE London, United Kingdom; Oxford Centre for Diabetes (A.G., N.K., I.H.), Endocrinology and Metabolism, Churchill Hospital, M6 8HD Oxford, United Kingdom; Wellcome Trust-MRC Institute of Metabolic Science (M.G., A.S.P.), University of Cambridge, Addenbrooke's Hospital, OX3 7LE Cambridge, United Kingdom; Salford Royal Foundation Trust (T.K., K.Mo.), CB2 0QQ Salford, United Kingdom; Imperial College (K.Me., N.H.), SW7 2AZ London, United Kingdom; School of Medicine (A.R., A.J.L.), Cardiff University, CF14 4XN Cardiff, United Kingdom; and The Christie NHS Foundation Trust (P.J.T., A.-E.H.M.), M20 4BX Manchester, United Kingdom
| | - Atif Munir
- The Medical School (E.D., J.N.-P.), University of Sheffield, S10 2RX Sheffield, United Kingdom; King's College Hospital NHS Foundation Trust (S.A., O.M.), B15 2TT London, United Kingdom; The Medical School (S.B.), Newcastle University, NE2 4HH Newcastle, United Kingdom; Royal Victoria Infirmary (S.B., A.M.), SE5 9RS Newcastle, United Kingdom; College of Medical and Dental Sciences (K.B., V.C., N.K.), Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, M13 9PT Birmingham, United Kingdom; Department of Obesity and Endocrinology (D.J.C., C.D., S.P.R.), University of Liverpool, NE1 4LP Liverpool, United Kingdom; Centre for Endocrinology and Diabetes (J.D.), University of Manchester, L69 3GA Manchester, United Kingdom; Manchester Royal Infirmary (K.C.), M13 9WL Manchester, United Kingdom; Department of Endocrinology (W.D., K.G.), St Bartholomew's Hospital, EC1A 7BE London, United Kingdom; Oxford Centre for Diabetes (A.G., N.K., I.H.), Endocrinology and Metabolism, Churchill Hospital, M6 8HD Oxford, United Kingdom; Wellcome Trust-MRC Institute of Metabolic Science (M.G., A.S.P.), University of Cambridge, Addenbrooke's Hospital, OX3 7LE Cambridge, United Kingdom; Salford Royal Foundation Trust (T.K., K.Mo.), CB2 0QQ Salford, United Kingdom; Imperial College (K.Me., N.H.), SW7 2AZ London, United Kingdom; School of Medicine (A.R., A.J.L.), Cardiff University, CF14 4XN Cardiff, United Kingdom; and The Christie NHS Foundation Trust (P.J.T., A.-E.H.M.), M20 4BX Manchester, United Kingdom
| | - Kristien Boelaert
- The Medical School (E.D., J.N.-P.), University of Sheffield, S10 2RX Sheffield, United Kingdom; King's College Hospital NHS Foundation Trust (S.A., O.M.), B15 2TT London, United Kingdom; The Medical School (S.B.), Newcastle University, NE2 4HH Newcastle, United Kingdom; Royal Victoria Infirmary (S.B., A.M.), SE5 9RS Newcastle, United Kingdom; College of Medical and Dental Sciences (K.B., V.C., N.K.), Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, M13 9PT Birmingham, United Kingdom; Department of Obesity and Endocrinology (D.J.C., C.D., S.P.R.), University of Liverpool, NE1 4LP Liverpool, United Kingdom; Centre for Endocrinology and Diabetes (J.D.), University of Manchester, L69 3GA Manchester, United Kingdom; Manchester Royal Infirmary (K.C.), M13 9WL Manchester, United Kingdom; Department of Endocrinology (W.D., K.G.), St Bartholomew's Hospital, EC1A 7BE London, United Kingdom; Oxford Centre for Diabetes (A.G., N.K., I.H.), Endocrinology and Metabolism, Churchill Hospital, M6 8HD Oxford, United Kingdom; Wellcome Trust-MRC Institute of Metabolic Science (M.G., A.S.P.), University of Cambridge, Addenbrooke's Hospital, OX3 7LE Cambridge, United Kingdom; Salford Royal Foundation Trust (T.K., K.Mo.), CB2 0QQ Salford, United Kingdom; Imperial College (K.Me., N.H.), SW7 2AZ London, United Kingdom; School of Medicine (A.R., A.J.L.), Cardiff University, CF14 4XN Cardiff, United Kingdom; and The Christie NHS Foundation Trust (P.J.T., A.-E.H.M.), M20 4BX Manchester, United Kingdom
| | - Vasileios Chortis
- The Medical School (E.D., J.N.-P.), University of Sheffield, S10 2RX Sheffield, United Kingdom; King's College Hospital NHS Foundation Trust (S.A., O.M.), B15 2TT London, United Kingdom; The Medical School (S.B.), Newcastle University, NE2 4HH Newcastle, United Kingdom; Royal Victoria Infirmary (S.B., A.M.), SE5 9RS Newcastle, United Kingdom; College of Medical and Dental Sciences (K.B., V.C., N.K.), Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, M13 9PT Birmingham, United Kingdom; Department of Obesity and Endocrinology (D.J.C., C.D., S.P.R.), University of Liverpool, NE1 4LP Liverpool, United Kingdom; Centre for Endocrinology and Diabetes (J.D.), University of Manchester, L69 3GA Manchester, United Kingdom; Manchester Royal Infirmary (K.C.), M13 9WL Manchester, United Kingdom; Department of Endocrinology (W.D., K.G.), St Bartholomew's Hospital, EC1A 7BE London, United Kingdom; Oxford Centre for Diabetes (A.G., N.K., I.H.), Endocrinology and Metabolism, Churchill Hospital, M6 8HD Oxford, United Kingdom; Wellcome Trust-MRC Institute of Metabolic Science (M.G., A.S.P.), University of Cambridge, Addenbrooke's Hospital, OX3 7LE Cambridge, United Kingdom; Salford Royal Foundation Trust (T.K., K.Mo.), CB2 0QQ Salford, United Kingdom; Imperial College (K.Me., N.H.), SW7 2AZ London, United Kingdom; School of Medicine (A.R., A.J.L.), Cardiff University, CF14 4XN Cardiff, United Kingdom; and The Christie NHS Foundation Trust (P.J.T., A.-E.H.M.), M20 4BX Manchester, United Kingdom
| | - Daniel J Cuthbertson
- The Medical School (E.D., J.N.-P.), University of Sheffield, S10 2RX Sheffield, United Kingdom; King's College Hospital NHS Foundation Trust (S.A., O.M.), B15 2TT London, United Kingdom; The Medical School (S.B.), Newcastle University, NE2 4HH Newcastle, United Kingdom; Royal Victoria Infirmary (S.B., A.M.), SE5 9RS Newcastle, United Kingdom; College of Medical and Dental Sciences (K.B., V.C., N.K.), Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, M13 9PT Birmingham, United Kingdom; Department of Obesity and Endocrinology (D.J.C., C.D., S.P.R.), University of Liverpool, NE1 4LP Liverpool, United Kingdom; Centre for Endocrinology and Diabetes (J.D.), University of Manchester, L69 3GA Manchester, United Kingdom; Manchester Royal Infirmary (K.C.), M13 9WL Manchester, United Kingdom; Department of Endocrinology (W.D., K.G.), St Bartholomew's Hospital, EC1A 7BE London, United Kingdom; Oxford Centre for Diabetes (A.G., N.K., I.H.), Endocrinology and Metabolism, Churchill Hospital, M6 8HD Oxford, United Kingdom; Wellcome Trust-MRC Institute of Metabolic Science (M.G., A.S.P.), University of Cambridge, Addenbrooke's Hospital, OX3 7LE Cambridge, United Kingdom; Salford Royal Foundation Trust (T.K., K.Mo.), CB2 0QQ Salford, United Kingdom; Imperial College (K.Me., N.H.), SW7 2AZ London, United Kingdom; School of Medicine (A.R., A.J.L.), Cardiff University, CF14 4XN Cardiff, United Kingdom; and The Christie NHS Foundation Trust (P.J.T., A.-E.H.M.), M20 4BX Manchester, United Kingdom
| | - Christina Daousi
- The Medical School (E.D., J.N.-P.), University of Sheffield, S10 2RX Sheffield, United Kingdom; King's College Hospital NHS Foundation Trust (S.A., O.M.), B15 2TT London, United Kingdom; The Medical School (S.B.), Newcastle University, NE2 4HH Newcastle, United Kingdom; Royal Victoria Infirmary (S.B., A.M.), SE5 9RS Newcastle, United Kingdom; College of Medical and Dental Sciences (K.B., V.C., N.K.), Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, M13 9PT Birmingham, United Kingdom; Department of Obesity and Endocrinology (D.J.C., C.D., S.P.R.), University of Liverpool, NE1 4LP Liverpool, United Kingdom; Centre for Endocrinology and Diabetes (J.D.), University of Manchester, L69 3GA Manchester, United Kingdom; Manchester Royal Infirmary (K.C.), M13 9WL Manchester, United Kingdom; Department of Endocrinology (W.D., K.G.), St Bartholomew's Hospital, EC1A 7BE London, United Kingdom; Oxford Centre for Diabetes (A.G., N.K., I.H.), Endocrinology and Metabolism, Churchill Hospital, M6 8HD Oxford, United Kingdom; Wellcome Trust-MRC Institute of Metabolic Science (M.G., A.S.P.), University of Cambridge, Addenbrooke's Hospital, OX3 7LE Cambridge, United Kingdom; Salford Royal Foundation Trust (T.K., K.Mo.), CB2 0QQ Salford, United Kingdom; Imperial College (K.Me., N.H.), SW7 2AZ London, United Kingdom; School of Medicine (A.R., A.J.L.), Cardiff University, CF14 4XN Cardiff, United Kingdom; and The Christie NHS Foundation Trust (P.J.T., A.-E.H.M.), M20 4BX Manchester, United Kingdom
| | - Surya P Rajeev
- The Medical School (E.D., J.N.-P.), University of Sheffield, S10 2RX Sheffield, United Kingdom; King's College Hospital NHS Foundation Trust (S.A., O.M.), B15 2TT London, United Kingdom; The Medical School (S.B.), Newcastle University, NE2 4HH Newcastle, United Kingdom; Royal Victoria Infirmary (S.B., A.M.), SE5 9RS Newcastle, United Kingdom; College of Medical and Dental Sciences (K.B., V.C., N.K.), Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, M13 9PT Birmingham, United Kingdom; Department of Obesity and Endocrinology (D.J.C., C.D., S.P.R.), University of Liverpool, NE1 4LP Liverpool, United Kingdom; Centre for Endocrinology and Diabetes (J.D.), University of Manchester, L69 3GA Manchester, United Kingdom; Manchester Royal Infirmary (K.C.), M13 9WL Manchester, United Kingdom; Department of Endocrinology (W.D., K.G.), St Bartholomew's Hospital, EC1A 7BE London, United Kingdom; Oxford Centre for Diabetes (A.G., N.K., I.H.), Endocrinology and Metabolism, Churchill Hospital, M6 8HD Oxford, United Kingdom; Wellcome Trust-MRC Institute of Metabolic Science (M.G., A.S.P.), University of Cambridge, Addenbrooke's Hospital, OX3 7LE Cambridge, United Kingdom; Salford Royal Foundation Trust (T.K., K.Mo.), CB2 0QQ Salford, United Kingdom; Imperial College (K.Me., N.H.), SW7 2AZ London, United Kingdom; School of Medicine (A.R., A.J.L.), Cardiff University, CF14 4XN Cardiff, United Kingdom; and The Christie NHS Foundation Trust (P.J.T., A.-E.H.M.), M20 4BX Manchester, United Kingdom
| | - Julian Davis
- The Medical School (E.D., J.N.-P.), University of Sheffield, S10 2RX Sheffield, United Kingdom; King's College Hospital NHS Foundation Trust (S.A., O.M.), B15 2TT London, United Kingdom; The Medical School (S.B.), Newcastle University, NE2 4HH Newcastle, United Kingdom; Royal Victoria Infirmary (S.B., A.M.), SE5 9RS Newcastle, United Kingdom; College of Medical and Dental Sciences (K.B., V.C., N.K.), Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, M13 9PT Birmingham, United Kingdom; Department of Obesity and Endocrinology (D.J.C., C.D., S.P.R.), University of Liverpool, NE1 4LP Liverpool, United Kingdom; Centre for Endocrinology and Diabetes (J.D.), University of Manchester, L69 3GA Manchester, United Kingdom; Manchester Royal Infirmary (K.C.), M13 9WL Manchester, United Kingdom; Department of Endocrinology (W.D., K.G.), St Bartholomew's Hospital, EC1A 7BE London, United Kingdom; Oxford Centre for Diabetes (A.G., N.K., I.H.), Endocrinology and Metabolism, Churchill Hospital, M6 8HD Oxford, United Kingdom; Wellcome Trust-MRC Institute of Metabolic Science (M.G., A.S.P.), University of Cambridge, Addenbrooke's Hospital, OX3 7LE Cambridge, United Kingdom; Salford Royal Foundation Trust (T.K., K.Mo.), CB2 0QQ Salford, United Kingdom; Imperial College (K.Me., N.H.), SW7 2AZ London, United Kingdom; School of Medicine (A.R., A.J.L.), Cardiff University, CF14 4XN Cardiff, United Kingdom; and The Christie NHS Foundation Trust (P.J.T., A.-E.H.M.), M20 4BX Manchester, United Kingdom
| | - Kelly Cheer
- The Medical School (E.D., J.N.-P.), University of Sheffield, S10 2RX Sheffield, United Kingdom; King's College Hospital NHS Foundation Trust (S.A., O.M.), B15 2TT London, United Kingdom; The Medical School (S.B.), Newcastle University, NE2 4HH Newcastle, United Kingdom; Royal Victoria Infirmary (S.B., A.M.), SE5 9RS Newcastle, United Kingdom; College of Medical and Dental Sciences (K.B., V.C., N.K.), Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, M13 9PT Birmingham, United Kingdom; Department of Obesity and Endocrinology (D.J.C., C.D., S.P.R.), University of Liverpool, NE1 4LP Liverpool, United Kingdom; Centre for Endocrinology and Diabetes (J.D.), University of Manchester, L69 3GA Manchester, United Kingdom; Manchester Royal Infirmary (K.C.), M13 9WL Manchester, United Kingdom; Department of Endocrinology (W.D., K.G.), St Bartholomew's Hospital, EC1A 7BE London, United Kingdom; Oxford Centre for Diabetes (A.G., N.K., I.H.), Endocrinology and Metabolism, Churchill Hospital, M6 8HD Oxford, United Kingdom; Wellcome Trust-MRC Institute of Metabolic Science (M.G., A.S.P.), University of Cambridge, Addenbrooke's Hospital, OX3 7LE Cambridge, United Kingdom; Salford Royal Foundation Trust (T.K., K.Mo.), CB2 0QQ Salford, United Kingdom; Imperial College (K.Me., N.H.), SW7 2AZ London, United Kingdom; School of Medicine (A.R., A.J.L.), Cardiff University, CF14 4XN Cardiff, United Kingdom; and The Christie NHS Foundation Trust (P.J.T., A.-E.H.M.), M20 4BX Manchester, United Kingdom
| | - William Drake
- The Medical School (E.D., J.N.-P.), University of Sheffield, S10 2RX Sheffield, United Kingdom; King's College Hospital NHS Foundation Trust (S.A., O.M.), B15 2TT London, United Kingdom; The Medical School (S.B.), Newcastle University, NE2 4HH Newcastle, United Kingdom; Royal Victoria Infirmary (S.B., A.M.), SE5 9RS Newcastle, United Kingdom; College of Medical and Dental Sciences (K.B., V.C., N.K.), Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, M13 9PT Birmingham, United Kingdom; Department of Obesity and Endocrinology (D.J.C., C.D., S.P.R.), University of Liverpool, NE1 4LP Liverpool, United Kingdom; Centre for Endocrinology and Diabetes (J.D.), University of Manchester, L69 3GA Manchester, United Kingdom; Manchester Royal Infirmary (K.C.), M13 9WL Manchester, United Kingdom; Department of Endocrinology (W.D., K.G.), St Bartholomew's Hospital, EC1A 7BE London, United Kingdom; Oxford Centre for Diabetes (A.G., N.K., I.H.), Endocrinology and Metabolism, Churchill Hospital, M6 8HD Oxford, United Kingdom; Wellcome Trust-MRC Institute of Metabolic Science (M.G., A.S.P.), University of Cambridge, Addenbrooke's Hospital, OX3 7LE Cambridge, United Kingdom; Salford Royal Foundation Trust (T.K., K.Mo.), CB2 0QQ Salford, United Kingdom; Imperial College (K.Me., N.H.), SW7 2AZ London, United Kingdom; School of Medicine (A.R., A.J.L.), Cardiff University, CF14 4XN Cardiff, United Kingdom; and The Christie NHS Foundation Trust (P.J.T., A.-E.H.M.), M20 4BX Manchester, United Kingdom
| | - Kirun Gunganah
- The Medical School (E.D., J.N.-P.), University of Sheffield, S10 2RX Sheffield, United Kingdom; King's College Hospital NHS Foundation Trust (S.A., O.M.), B15 2TT London, United Kingdom; The Medical School (S.B.), Newcastle University, NE2 4HH Newcastle, United Kingdom; Royal Victoria Infirmary (S.B., A.M.), SE5 9RS Newcastle, United Kingdom; College of Medical and Dental Sciences (K.B., V.C., N.K.), Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, M13 9PT Birmingham, United Kingdom; Department of Obesity and Endocrinology (D.J.C., C.D., S.P.R.), University of Liverpool, NE1 4LP Liverpool, United Kingdom; Centre for Endocrinology and Diabetes (J.D.), University of Manchester, L69 3GA Manchester, United Kingdom; Manchester Royal Infirmary (K.C.), M13 9WL Manchester, United Kingdom; Department of Endocrinology (W.D., K.G.), St Bartholomew's Hospital, EC1A 7BE London, United Kingdom; Oxford Centre for Diabetes (A.G., N.K., I.H.), Endocrinology and Metabolism, Churchill Hospital, M6 8HD Oxford, United Kingdom; Wellcome Trust-MRC Institute of Metabolic Science (M.G., A.S.P.), University of Cambridge, Addenbrooke's Hospital, OX3 7LE Cambridge, United Kingdom; Salford Royal Foundation Trust (T.K., K.Mo.), CB2 0QQ Salford, United Kingdom; Imperial College (K.Me., N.H.), SW7 2AZ London, United Kingdom; School of Medicine (A.R., A.J.L.), Cardiff University, CF14 4XN Cardiff, United Kingdom; and The Christie NHS Foundation Trust (P.J.T., A.-E.H.M.), M20 4BX Manchester, United Kingdom
| | - Ashley Grossman
- The Medical School (E.D., J.N.-P.), University of Sheffield, S10 2RX Sheffield, United Kingdom; King's College Hospital NHS Foundation Trust (S.A., O.M.), B15 2TT London, United Kingdom; The Medical School (S.B.), Newcastle University, NE2 4HH Newcastle, United Kingdom; Royal Victoria Infirmary (S.B., A.M.), SE5 9RS Newcastle, United Kingdom; College of Medical and Dental Sciences (K.B., V.C., N.K.), Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, M13 9PT Birmingham, United Kingdom; Department of Obesity and Endocrinology (D.J.C., C.D., S.P.R.), University of Liverpool, NE1 4LP Liverpool, United Kingdom; Centre for Endocrinology and Diabetes (J.D.), University of Manchester, L69 3GA Manchester, United Kingdom; Manchester Royal Infirmary (K.C.), M13 9WL Manchester, United Kingdom; Department of Endocrinology (W.D., K.G.), St Bartholomew's Hospital, EC1A 7BE London, United Kingdom; Oxford Centre for Diabetes (A.G., N.K., I.H.), Endocrinology and Metabolism, Churchill Hospital, M6 8HD Oxford, United Kingdom; Wellcome Trust-MRC Institute of Metabolic Science (M.G., A.S.P.), University of Cambridge, Addenbrooke's Hospital, OX3 7LE Cambridge, United Kingdom; Salford Royal Foundation Trust (T.K., K.Mo.), CB2 0QQ Salford, United Kingdom; Imperial College (K.Me., N.H.), SW7 2AZ London, United Kingdom; School of Medicine (A.R., A.J.L.), Cardiff University, CF14 4XN Cardiff, United Kingdom; and The Christie NHS Foundation Trust (P.J.T., A.-E.H.M.), M20 4BX Manchester, United Kingdom
| | - Mark Gurnell
- The Medical School (E.D., J.N.-P.), University of Sheffield, S10 2RX Sheffield, United Kingdom; King's College Hospital NHS Foundation Trust (S.A., O.M.), B15 2TT London, United Kingdom; The Medical School (S.B.), Newcastle University, NE2 4HH Newcastle, United Kingdom; Royal Victoria Infirmary (S.B., A.M.), SE5 9RS Newcastle, United Kingdom; College of Medical and Dental Sciences (K.B., V.C., N.K.), Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, M13 9PT Birmingham, United Kingdom; Department of Obesity and Endocrinology (D.J.C., C.D., S.P.R.), University of Liverpool, NE1 4LP Liverpool, United Kingdom; Centre for Endocrinology and Diabetes (J.D.), University of Manchester, L69 3GA Manchester, United Kingdom; Manchester Royal Infirmary (K.C.), M13 9WL Manchester, United Kingdom; Department of Endocrinology (W.D., K.G.), St Bartholomew's Hospital, EC1A 7BE London, United Kingdom; Oxford Centre for Diabetes (A.G., N.K., I.H.), Endocrinology and Metabolism, Churchill Hospital, M6 8HD Oxford, United Kingdom; Wellcome Trust-MRC Institute of Metabolic Science (M.G., A.S.P.), University of Cambridge, Addenbrooke's Hospital, OX3 7LE Cambridge, United Kingdom; Salford Royal Foundation Trust (T.K., K.Mo.), CB2 0QQ Salford, United Kingdom; Imperial College (K.Me., N.H.), SW7 2AZ London, United Kingdom; School of Medicine (A.R., A.J.L.), Cardiff University, CF14 4XN Cardiff, United Kingdom; and The Christie NHS Foundation Trust (P.J.T., A.-E.H.M.), M20 4BX Manchester, United Kingdom
| | - Andrew S Powlson
- The Medical School (E.D., J.N.-P.), University of Sheffield, S10 2RX Sheffield, United Kingdom; King's College Hospital NHS Foundation Trust (S.A., O.M.), B15 2TT London, United Kingdom; The Medical School (S.B.), Newcastle University, NE2 4HH Newcastle, United Kingdom; Royal Victoria Infirmary (S.B., A.M.), SE5 9RS Newcastle, United Kingdom; College of Medical and Dental Sciences (K.B., V.C., N.K.), Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, M13 9PT Birmingham, United Kingdom; Department of Obesity and Endocrinology (D.J.C., C.D., S.P.R.), University of Liverpool, NE1 4LP Liverpool, United Kingdom; Centre for Endocrinology and Diabetes (J.D.), University of Manchester, L69 3GA Manchester, United Kingdom; Manchester Royal Infirmary (K.C.), M13 9WL Manchester, United Kingdom; Department of Endocrinology (W.D., K.G.), St Bartholomew's Hospital, EC1A 7BE London, United Kingdom; Oxford Centre for Diabetes (A.G., N.K., I.H.), Endocrinology and Metabolism, Churchill Hospital, M6 8HD Oxford, United Kingdom; Wellcome Trust-MRC Institute of Metabolic Science (M.G., A.S.P.), University of Cambridge, Addenbrooke's Hospital, OX3 7LE Cambridge, United Kingdom; Salford Royal Foundation Trust (T.K., K.Mo.), CB2 0QQ Salford, United Kingdom; Imperial College (K.Me., N.H.), SW7 2AZ London, United Kingdom; School of Medicine (A.R., A.J.L.), Cardiff University, CF14 4XN Cardiff, United Kingdom; and The Christie NHS Foundation Trust (P.J.T., A.-E.H.M.), M20 4BX Manchester, United Kingdom
| | - Niki Karavitaki
- The Medical School (E.D., J.N.-P.), University of Sheffield, S10 2RX Sheffield, United Kingdom; King's College Hospital NHS Foundation Trust (S.A., O.M.), B15 2TT London, United Kingdom; The Medical School (S.B.), Newcastle University, NE2 4HH Newcastle, United Kingdom; Royal Victoria Infirmary (S.B., A.M.), SE5 9RS Newcastle, United Kingdom; College of Medical and Dental Sciences (K.B., V.C., N.K.), Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, M13 9PT Birmingham, United Kingdom; Department of Obesity and Endocrinology (D.J.C., C.D., S.P.R.), University of Liverpool, NE1 4LP Liverpool, United Kingdom; Centre for Endocrinology and Diabetes (J.D.), University of Manchester, L69 3GA Manchester, United Kingdom; Manchester Royal Infirmary (K.C.), M13 9WL Manchester, United Kingdom; Department of Endocrinology (W.D., K.G.), St Bartholomew's Hospital, EC1A 7BE London, United Kingdom; Oxford Centre for Diabetes (A.G., N.K., I.H.), Endocrinology and Metabolism, Churchill Hospital, M6 8HD Oxford, United Kingdom; Wellcome Trust-MRC Institute of Metabolic Science (M.G., A.S.P.), University of Cambridge, Addenbrooke's Hospital, OX3 7LE Cambridge, United Kingdom; Salford Royal Foundation Trust (T.K., K.Mo.), CB2 0QQ Salford, United Kingdom; Imperial College (K.Me., N.H.), SW7 2AZ London, United Kingdom; School of Medicine (A.R., A.J.L.), Cardiff University, CF14 4XN Cardiff, United Kingdom; and The Christie NHS Foundation Trust (P.J.T., A.-E.H.M.), M20 4BX Manchester, United Kingdom
| | - Isabel Huguet
- The Medical School (E.D., J.N.-P.), University of Sheffield, S10 2RX Sheffield, United Kingdom; King's College Hospital NHS Foundation Trust (S.A., O.M.), B15 2TT London, United Kingdom; The Medical School (S.B.), Newcastle University, NE2 4HH Newcastle, United Kingdom; Royal Victoria Infirmary (S.B., A.M.), SE5 9RS Newcastle, United Kingdom; College of Medical and Dental Sciences (K.B., V.C., N.K.), Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, M13 9PT Birmingham, United Kingdom; Department of Obesity and Endocrinology (D.J.C., C.D., S.P.R.), University of Liverpool, NE1 4LP Liverpool, United Kingdom; Centre for Endocrinology and Diabetes (J.D.), University of Manchester, L69 3GA Manchester, United Kingdom; Manchester Royal Infirmary (K.C.), M13 9WL Manchester, United Kingdom; Department of Endocrinology (W.D., K.G.), St Bartholomew's Hospital, EC1A 7BE London, United Kingdom; Oxford Centre for Diabetes (A.G., N.K., I.H.), Endocrinology and Metabolism, Churchill Hospital, M6 8HD Oxford, United Kingdom; Wellcome Trust-MRC Institute of Metabolic Science (M.G., A.S.P.), University of Cambridge, Addenbrooke's Hospital, OX3 7LE Cambridge, United Kingdom; Salford Royal Foundation Trust (T.K., K.Mo.), CB2 0QQ Salford, United Kingdom; Imperial College (K.Me., N.H.), SW7 2AZ London, United Kingdom; School of Medicine (A.R., A.J.L.), Cardiff University, CF14 4XN Cardiff, United Kingdom; and The Christie NHS Foundation Trust (P.J.T., A.-E.H.M.), M20 4BX Manchester, United Kingdom
| | - Tara Kearney
- The Medical School (E.D., J.N.-P.), University of Sheffield, S10 2RX Sheffield, United Kingdom; King's College Hospital NHS Foundation Trust (S.A., O.M.), B15 2TT London, United Kingdom; The Medical School (S.B.), Newcastle University, NE2 4HH Newcastle, United Kingdom; Royal Victoria Infirmary (S.B., A.M.), SE5 9RS Newcastle, United Kingdom; College of Medical and Dental Sciences (K.B., V.C., N.K.), Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, M13 9PT Birmingham, United Kingdom; Department of Obesity and Endocrinology (D.J.C., C.D., S.P.R.), University of Liverpool, NE1 4LP Liverpool, United Kingdom; Centre for Endocrinology and Diabetes (J.D.), University of Manchester, L69 3GA Manchester, United Kingdom; Manchester Royal Infirmary (K.C.), M13 9WL Manchester, United Kingdom; Department of Endocrinology (W.D., K.G.), St Bartholomew's Hospital, EC1A 7BE London, United Kingdom; Oxford Centre for Diabetes (A.G., N.K., I.H.), Endocrinology and Metabolism, Churchill Hospital, M6 8HD Oxford, United Kingdom; Wellcome Trust-MRC Institute of Metabolic Science (M.G., A.S.P.), University of Cambridge, Addenbrooke's Hospital, OX3 7LE Cambridge, United Kingdom; Salford Royal Foundation Trust (T.K., K.Mo.), CB2 0QQ Salford, United Kingdom; Imperial College (K.Me., N.H.), SW7 2AZ London, United Kingdom; School of Medicine (A.R., A.J.L.), Cardiff University, CF14 4XN Cardiff, United Kingdom; and The Christie NHS Foundation Trust (P.J.T., A.-E.H.M.), M20 4BX Manchester, United Kingdom
| | - Kumar Mohit
- The Medical School (E.D., J.N.-P.), University of Sheffield, S10 2RX Sheffield, United Kingdom; King's College Hospital NHS Foundation Trust (S.A., O.M.), B15 2TT London, United Kingdom; The Medical School (S.B.), Newcastle University, NE2 4HH Newcastle, United Kingdom; Royal Victoria Infirmary (S.B., A.M.), SE5 9RS Newcastle, United Kingdom; College of Medical and Dental Sciences (K.B., V.C., N.K.), Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, M13 9PT Birmingham, United Kingdom; Department of Obesity and Endocrinology (D.J.C., C.D., S.P.R.), University of Liverpool, NE1 4LP Liverpool, United Kingdom; Centre for Endocrinology and Diabetes (J.D.), University of Manchester, L69 3GA Manchester, United Kingdom; Manchester Royal Infirmary (K.C.), M13 9WL Manchester, United Kingdom; Department of Endocrinology (W.D., K.G.), St Bartholomew's Hospital, EC1A 7BE London, United Kingdom; Oxford Centre for Diabetes (A.G., N.K., I.H.), Endocrinology and Metabolism, Churchill Hospital, M6 8HD Oxford, United Kingdom; Wellcome Trust-MRC Institute of Metabolic Science (M.G., A.S.P.), University of Cambridge, Addenbrooke's Hospital, OX3 7LE Cambridge, United Kingdom; Salford Royal Foundation Trust (T.K., K.Mo.), CB2 0QQ Salford, United Kingdom; Imperial College (K.Me., N.H.), SW7 2AZ London, United Kingdom; School of Medicine (A.R., A.J.L.), Cardiff University, CF14 4XN Cardiff, United Kingdom; and The Christie NHS Foundation Trust (P.J.T., A.-E.H.M.), M20 4BX Manchester, United Kingdom
| | - Karim Meeran
- The Medical School (E.D., J.N.-P.), University of Sheffield, S10 2RX Sheffield, United Kingdom; King's College Hospital NHS Foundation Trust (S.A., O.M.), B15 2TT London, United Kingdom; The Medical School (S.B.), Newcastle University, NE2 4HH Newcastle, United Kingdom; Royal Victoria Infirmary (S.B., A.M.), SE5 9RS Newcastle, United Kingdom; College of Medical and Dental Sciences (K.B., V.C., N.K.), Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, M13 9PT Birmingham, United Kingdom; Department of Obesity and Endocrinology (D.J.C., C.D., S.P.R.), University of Liverpool, NE1 4LP Liverpool, United Kingdom; Centre for Endocrinology and Diabetes (J.D.), University of Manchester, L69 3GA Manchester, United Kingdom; Manchester Royal Infirmary (K.C.), M13 9WL Manchester, United Kingdom; Department of Endocrinology (W.D., K.G.), St Bartholomew's Hospital, EC1A 7BE London, United Kingdom; Oxford Centre for Diabetes (A.G., N.K., I.H.), Endocrinology and Metabolism, Churchill Hospital, M6 8HD Oxford, United Kingdom; Wellcome Trust-MRC Institute of Metabolic Science (M.G., A.S.P.), University of Cambridge, Addenbrooke's Hospital, OX3 7LE Cambridge, United Kingdom; Salford Royal Foundation Trust (T.K., K.Mo.), CB2 0QQ Salford, United Kingdom; Imperial College (K.Me., N.H.), SW7 2AZ London, United Kingdom; School of Medicine (A.R., A.J.L.), Cardiff University, CF14 4XN Cardiff, United Kingdom; and The Christie NHS Foundation Trust (P.J.T., A.-E.H.M.), M20 4BX Manchester, United Kingdom
| | - Neil Hill
- The Medical School (E.D., J.N.-P.), University of Sheffield, S10 2RX Sheffield, United Kingdom; King's College Hospital NHS Foundation Trust (S.A., O.M.), B15 2TT London, United Kingdom; The Medical School (S.B.), Newcastle University, NE2 4HH Newcastle, United Kingdom; Royal Victoria Infirmary (S.B., A.M.), SE5 9RS Newcastle, United Kingdom; College of Medical and Dental Sciences (K.B., V.C., N.K.), Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, M13 9PT Birmingham, United Kingdom; Department of Obesity and Endocrinology (D.J.C., C.D., S.P.R.), University of Liverpool, NE1 4LP Liverpool, United Kingdom; Centre for Endocrinology and Diabetes (J.D.), University of Manchester, L69 3GA Manchester, United Kingdom; Manchester Royal Infirmary (K.C.), M13 9WL Manchester, United Kingdom; Department of Endocrinology (W.D., K.G.), St Bartholomew's Hospital, EC1A 7BE London, United Kingdom; Oxford Centre for Diabetes (A.G., N.K., I.H.), Endocrinology and Metabolism, Churchill Hospital, M6 8HD Oxford, United Kingdom; Wellcome Trust-MRC Institute of Metabolic Science (M.G., A.S.P.), University of Cambridge, Addenbrooke's Hospital, OX3 7LE Cambridge, United Kingdom; Salford Royal Foundation Trust (T.K., K.Mo.), CB2 0QQ Salford, United Kingdom; Imperial College (K.Me., N.H.), SW7 2AZ London, United Kingdom; School of Medicine (A.R., A.J.L.), Cardiff University, CF14 4XN Cardiff, United Kingdom; and The Christie NHS Foundation Trust (P.J.T., A.-E.H.M.), M20 4BX Manchester, United Kingdom
| | - Aled Rees
- The Medical School (E.D., J.N.-P.), University of Sheffield, S10 2RX Sheffield, United Kingdom; King's College Hospital NHS Foundation Trust (S.A., O.M.), B15 2TT London, United Kingdom; The Medical School (S.B.), Newcastle University, NE2 4HH Newcastle, United Kingdom; Royal Victoria Infirmary (S.B., A.M.), SE5 9RS Newcastle, United Kingdom; College of Medical and Dental Sciences (K.B., V.C., N.K.), Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, M13 9PT Birmingham, United Kingdom; Department of Obesity and Endocrinology (D.J.C., C.D., S.P.R.), University of Liverpool, NE1 4LP Liverpool, United Kingdom; Centre for Endocrinology and Diabetes (J.D.), University of Manchester, L69 3GA Manchester, United Kingdom; Manchester Royal Infirmary (K.C.), M13 9WL Manchester, United Kingdom; Department of Endocrinology (W.D., K.G.), St Bartholomew's Hospital, EC1A 7BE London, United Kingdom; Oxford Centre for Diabetes (A.G., N.K., I.H.), Endocrinology and Metabolism, Churchill Hospital, M6 8HD Oxford, United Kingdom; Wellcome Trust-MRC Institute of Metabolic Science (M.G., A.S.P.), University of Cambridge, Addenbrooke's Hospital, OX3 7LE Cambridge, United Kingdom; Salford Royal Foundation Trust (T.K., K.Mo.), CB2 0QQ Salford, United Kingdom; Imperial College (K.Me., N.H.), SW7 2AZ London, United Kingdom; School of Medicine (A.R., A.J.L.), Cardiff University, CF14 4XN Cardiff, United Kingdom; and The Christie NHS Foundation Trust (P.J.T., A.-E.H.M.), M20 4BX Manchester, United Kingdom
| | - Andrew J Lansdown
- The Medical School (E.D., J.N.-P.), University of Sheffield, S10 2RX Sheffield, United Kingdom; King's College Hospital NHS Foundation Trust (S.A., O.M.), B15 2TT London, United Kingdom; The Medical School (S.B.), Newcastle University, NE2 4HH Newcastle, United Kingdom; Royal Victoria Infirmary (S.B., A.M.), SE5 9RS Newcastle, United Kingdom; College of Medical and Dental Sciences (K.B., V.C., N.K.), Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, M13 9PT Birmingham, United Kingdom; Department of Obesity and Endocrinology (D.J.C., C.D., S.P.R.), University of Liverpool, NE1 4LP Liverpool, United Kingdom; Centre for Endocrinology and Diabetes (J.D.), University of Manchester, L69 3GA Manchester, United Kingdom; Manchester Royal Infirmary (K.C.), M13 9WL Manchester, United Kingdom; Department of Endocrinology (W.D., K.G.), St Bartholomew's Hospital, EC1A 7BE London, United Kingdom; Oxford Centre for Diabetes (A.G., N.K., I.H.), Endocrinology and Metabolism, Churchill Hospital, M6 8HD Oxford, United Kingdom; Wellcome Trust-MRC Institute of Metabolic Science (M.G., A.S.P.), University of Cambridge, Addenbrooke's Hospital, OX3 7LE Cambridge, United Kingdom; Salford Royal Foundation Trust (T.K., K.Mo.), CB2 0QQ Salford, United Kingdom; Imperial College (K.Me., N.H.), SW7 2AZ London, United Kingdom; School of Medicine (A.R., A.J.L.), Cardiff University, CF14 4XN Cardiff, United Kingdom; and The Christie NHS Foundation Trust (P.J.T., A.-E.H.M.), M20 4BX Manchester, United Kingdom
| | - Peter J Trainer
- The Medical School (E.D., J.N.-P.), University of Sheffield, S10 2RX Sheffield, United Kingdom; King's College Hospital NHS Foundation Trust (S.A., O.M.), B15 2TT London, United Kingdom; The Medical School (S.B.), Newcastle University, NE2 4HH Newcastle, United Kingdom; Royal Victoria Infirmary (S.B., A.M.), SE5 9RS Newcastle, United Kingdom; College of Medical and Dental Sciences (K.B., V.C., N.K.), Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, M13 9PT Birmingham, United Kingdom; Department of Obesity and Endocrinology (D.J.C., C.D., S.P.R.), University of Liverpool, NE1 4LP Liverpool, United Kingdom; Centre for Endocrinology and Diabetes (J.D.), University of Manchester, L69 3GA Manchester, United Kingdom; Manchester Royal Infirmary (K.C.), M13 9WL Manchester, United Kingdom; Department of Endocrinology (W.D., K.G.), St Bartholomew's Hospital, EC1A 7BE London, United Kingdom; Oxford Centre for Diabetes (A.G., N.K., I.H.), Endocrinology and Metabolism, Churchill Hospital, M6 8HD Oxford, United Kingdom; Wellcome Trust-MRC Institute of Metabolic Science (M.G., A.S.P.), University of Cambridge, Addenbrooke's Hospital, OX3 7LE Cambridge, United Kingdom; Salford Royal Foundation Trust (T.K., K.Mo.), CB2 0QQ Salford, United Kingdom; Imperial College (K.Me., N.H.), SW7 2AZ London, United Kingdom; School of Medicine (A.R., A.J.L.), Cardiff University, CF14 4XN Cardiff, United Kingdom; and The Christie NHS Foundation Trust (P.J.T., A.-E.H.M.), M20 4BX Manchester, United Kingdom
| | - Anna-Elisabeth H Minder
- The Medical School (E.D., J.N.-P.), University of Sheffield, S10 2RX Sheffield, United Kingdom; King's College Hospital NHS Foundation Trust (S.A., O.M.), B15 2TT London, United Kingdom; The Medical School (S.B.), Newcastle University, NE2 4HH Newcastle, United Kingdom; Royal Victoria Infirmary (S.B., A.M.), SE5 9RS Newcastle, United Kingdom; College of Medical and Dental Sciences (K.B., V.C., N.K.), Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, M13 9PT Birmingham, United Kingdom; Department of Obesity and Endocrinology (D.J.C., C.D., S.P.R.), University of Liverpool, NE1 4LP Liverpool, United Kingdom; Centre for Endocrinology and Diabetes (J.D.), University of Manchester, L69 3GA Manchester, United Kingdom; Manchester Royal Infirmary (K.C.), M13 9WL Manchester, United Kingdom; Department of Endocrinology (W.D., K.G.), St Bartholomew's Hospital, EC1A 7BE London, United Kingdom; Oxford Centre for Diabetes (A.G., N.K., I.H.), Endocrinology and Metabolism, Churchill Hospital, M6 8HD Oxford, United Kingdom; Wellcome Trust-MRC Institute of Metabolic Science (M.G., A.S.P.), University of Cambridge, Addenbrooke's Hospital, OX3 7LE Cambridge, United Kingdom; Salford Royal Foundation Trust (T.K., K.Mo.), CB2 0QQ Salford, United Kingdom; Imperial College (K.Me., N.H.), SW7 2AZ London, United Kingdom; School of Medicine (A.R., A.J.L.), Cardiff University, CF14 4XN Cardiff, United Kingdom; and The Christie NHS Foundation Trust (P.J.T., A.-E.H.M.), M20 4BX Manchester, United Kingdom
| | - John Newell-Price
- The Medical School (E.D., J.N.-P.), University of Sheffield, S10 2RX Sheffield, United Kingdom; King's College Hospital NHS Foundation Trust (S.A., O.M.), B15 2TT London, United Kingdom; The Medical School (S.B.), Newcastle University, NE2 4HH Newcastle, United Kingdom; Royal Victoria Infirmary (S.B., A.M.), SE5 9RS Newcastle, United Kingdom; College of Medical and Dental Sciences (K.B., V.C., N.K.), Centre for Endocrinology, Diabetes and Metabolism, University of Birmingham, M13 9PT Birmingham, United Kingdom; Department of Obesity and Endocrinology (D.J.C., C.D., S.P.R.), University of Liverpool, NE1 4LP Liverpool, United Kingdom; Centre for Endocrinology and Diabetes (J.D.), University of Manchester, L69 3GA Manchester, United Kingdom; Manchester Royal Infirmary (K.C.), M13 9WL Manchester, United Kingdom; Department of Endocrinology (W.D., K.G.), St Bartholomew's Hospital, EC1A 7BE London, United Kingdom; Oxford Centre for Diabetes (A.G., N.K., I.H.), Endocrinology and Metabolism, Churchill Hospital, M6 8HD Oxford, United Kingdom; Wellcome Trust-MRC Institute of Metabolic Science (M.G., A.S.P.), University of Cambridge, Addenbrooke's Hospital, OX3 7LE Cambridge, United Kingdom; Salford Royal Foundation Trust (T.K., K.Mo.), CB2 0QQ Salford, United Kingdom; Imperial College (K.Me., N.H.), SW7 2AZ London, United Kingdom; School of Medicine (A.R., A.J.L.), Cardiff University, CF14 4XN Cardiff, United Kingdom; and The Christie NHS Foundation Trust (P.J.T., A.-E.H.M.), M20 4BX Manchester, United Kingdom
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