1
|
Henson J, Tziannou A, Rowlands AV, Edwardson CL, Hall AP, Davies MJ, Yates T. Twenty-four-hour physical behaviour profiles across type 2 diabetes mellitus subtypes. Diabetes Obes Metab 2024; 26:1355-1365. [PMID: 38186324 DOI: 10.1111/dom.15437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/05/2023] [Accepted: 12/17/2023] [Indexed: 01/09/2024]
Abstract
AIM To investigate how 24-h physical behaviours differ across type 2 diabetes (T2DM) subtypes. MATERIALS AND METHODS We included participants living with T2DM, enrolled as part of an ongoing observational study. Participants wore an accelerometer for 7 days to quantify physical behaviours across 24 h. We used routinely collected clinical data (age at onset of diabetes, glycated haemoglobin level, homeostatic model assessment index of beta-cell function, homeostatic model assessment index of insulin resistance, body mass index) to replicate four previously identified subtypes (insulin-deficient diabetes [INS-D], insulin-resistant diabetes [INS-R], obesity-related diabetes [OB] and age-related diabetes [AGE]), via k-means clustering. Differences in physical behaviours across the diabetes subtypes were assessed using generalized linear models, with the AGE cluster as the reference. RESULTS A total of 564 participants were included in this analysis (mean age 63.6 ± 8.4 years, 37.6% female, mean age at diagnosis 53.1 ± 10.0 years). The proportions in each cluster were as follows: INS-D: n = 35, 6.2%; INS-R: n = 88, 15.6%; OB: n = 166, 29.4%; and AGE: n = 275, 48.8%. Compared to the AGE cluster, the OB cluster had a shorter sleep duration (-0.3 h; 95% confidence interval [CI] -0.5, -0.1), lower sleep efficiency (-2%; 95% CI -3, -1), lower total physical activity (-2.9 mg; 95% CI -4.3, -1.6) and less time in moderate-to-vigorous physical activity (-6.6 min; 95% CI -11.4, -1.7), alongside greater sleep variability (17.9 min; 95% CI 8.2, 27.7) and longer sedentary time (31.9 min; 95% CI 10.5, 53.2). Movement intensity during the most active continuous 10 and 30 min of the day was also lower in the OB cluster. CONCLUSIONS In individuals living with T2DM, the OB subtype had the lowest levels of physical activity and least favourable sleep profiles. Such behaviours may be suitable targets for personalized therapeutic lifestyle interventions.
Collapse
Affiliation(s)
- Joseph Henson
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Aikaterina Tziannou
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Alex V Rowlands
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Charlotte L Edwardson
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Andrew P Hall
- Hanning Sleep Laboratory, Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| |
Collapse
|
2
|
Heathcote LE, Pollard DJ, Brennan A, Davies MJ, Eborall H, Edwardson CL, Gillett M, Gray LJ, Griffin SJ, Hardeman W, Henson J, Khunti K, Sharp S, Sutton S, Yates T. Cost-effectiveness analysis of two interventions to promote physical activity in a multiethnic population at high risk of diabetes: an economic evaluation of the 48-month PROPELS randomized controlled trial. BMJ Open Diabetes Res Care 2024; 12:e003516. [PMID: 38471669 DOI: 10.1136/bmjdrc-2023-003516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 01/25/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Physical activity (PA) is protective against type 2 diabetes (T2D). However, data on pragmatic long-term interventions to reduce the risk of developing T2D via increased PA are lacking. This study investigated the cost-effectiveness of a pragmatic PA intervention in a multiethnic population at high risk of T2D. MATERIALS AND METHODS We adapted the School for Public Health Research diabetes prevention model, using the PROPELS trial data and analyses of the NAVIGATOR trial. Lifetime costs, lifetime quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated for each intervention (Walking Away (WA) and Walking Away Plus (WA+)) versus usual care and compared with National Institute for Health and Care Excellence's willingness-to-pay of £20 000-£30 000 per QALY gained. We conducted scenario analyses on the outcomes of the PROPELS trial data and a threshold analysis to determine the change in step count that would be needed for the interventions to be cost-effective. RESULTS Estimated lifetime costs for usual care, WA, and WA+ were £22 598, £23 018, and £22 945, respectively. Estimated QALYs were 9.323, 9.312, and 9.330, respectively. WA+ was estimated to be more effective and cheaper than WA. WA+ had an ICER of £49 273 per QALY gained versus usual care. In none of our scenario analyses did either WA or WA+ have an ICER below £20 000 per QALY gained. Our threshold analysis suggested that a PA intervention costing the same as WA+ would have an ICER below £20 000/QALY if it were to achieve an increase in step count of 500 steps per day which was 100% maintained at 4 years. CONCLUSIONS We found that neither WA nor WA+ was cost-effective at a limit of £20 000 per QALY gained. Our threshold analysis showed that interventions to increase step count can be cost-effective at this limit if they achieve greater long-term maintenance of effect. TRIAL REGISTRATION NUMBER ISRCTN registration: ISRCTN83465245: The PRomotion Of Physical activity through structuredEducation with differing Levels of ongoing Support for those with pre-diabetes (PROPELS)https://doi.org/10.1186/ISRCTN83465245.
Collapse
Affiliation(s)
| | - Daniel J Pollard
- School for Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Alan Brennan
- School for Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Melanie J Davies
- Diabetes Research Department, University of Leicester, Leicester, UK
| | - Helen Eborall
- The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | | | - Michael Gillett
- School for Health and Related Research, The University of Sheffield, Sheffield, UK
| | | | | | | | - Joseph Henson
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Department, University of Leicester, Leicester, UK
| | | | - Stephen Sutton
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
| |
Collapse
|
3
|
Ibrahim M, Ba-Essa EM, Baker J, Cahn A, Ceriello A, Cosentino F, Davies MJ, Eckel RH, Van Gaal L, Gaede P, Handelsman Y, Klein S, Leslie RD, Pozzilli P, Del Prato S, Prattichizzo F, Schnell O, Seferovic PM, Standl E, Thomas A, Tuomilehto J, Valensi P, Umpierrez GE. Cardio-renal-metabolic disease in primary care setting. Diabetes Metab Res Rev 2024; 40:e3755. [PMID: 38115715 DOI: 10.1002/dmrr.3755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/26/2023] [Accepted: 11/23/2023] [Indexed: 12/21/2023]
Abstract
In the primary care setting providers have more tools available than ever before to impact positively obesity, diabetes, and their complications, such as renal and cardiac diseases. It is important to recognise what is available for treatment taking into account diabetes heterogeneity. For those who develop type 2 diabetes (T2DM), effective treatments are available that for the first time have shown a benefit in reducing mortality and macrovascular complications, in addition to the well-established benefits of glucose control in reducing microvascular complications. Some of the newer medications for treating hyperglycaemia have also a positive impact in reducing heart failure (HF). Technological advances have also contributed to improving the quality of care in patients with diabetes. The use of technology, such as continuous glucose monitoring systems (CGM), has improved significantly glucose and glycated haemoglobin A1c (HbA1c) values, while limiting the frequency of hypoglycaemia. Other technological support derives from the use of predictive algorithms that need to be refined to help predict those subjects who are at great risk of developing the disease and/or its complications, or who may require care by other specialists. In this review we also provide recommendations for the optimal use of the new medications; sodium-glucose co-transporter-2 inhibitors (SGLT2i) and Glucagon-like peptide-receptor agonists 1 (GLP1RA) in the primary care setting considering the relevance of these drugs for the management of T2DM also in its early stage.
Collapse
Affiliation(s)
- Mahmoud Ibrahim
- EDC, Centre for Diabetes Education, Charlotte, North Carolina, USA
| | | | - Jason Baker
- Weill Cornell Medicine, New York, New York, USA
| | - Avivit Cahn
- The Diabetes Unit & Endocrinology and Metabolism Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | | | - Francesco Cosentino
- Unit of Cardiology, Department of Medicine Solna, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Robert H Eckel
- University of Colorado Anschutz Medical Campus and University of Colorado Hospital, Aurora, Colorado, USA
| | - Luc Van Gaal
- Department of Endocrinology, Diabetology, and Metabolism, Antwerp University Hospital, Antwerp, Belgium
| | - Peter Gaede
- Department of Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Denmark
| | | | - Samuel Klein
- Washington University School of Medicine, Saint Louis, Missouri, USA
- Sansum Diabetes Research Institute, Santa Barbara, California, USA
| | - Richard David Leslie
- Blizard Institute, Centre of Immunobiology, Barts and the London School of Medicine, Queen Mary, University of London, London, UK
| | - Paolo Pozzilli
- Blizard Institute, Centre of Immunobiology, Barts and the London School of Medicine, Queen Mary, University of London, London, UK
- Campus Bio-Medico University, Rome, Italy
| | - Stefano Del Prato
- University of Pisa and Sant'Anna School of Advanced Studies, Pisa, Italy
| | | | - Oliver Schnell
- Forschergruppe Diabetes eV at the Helmholtz Centre, Munich-Neuherberg, Germany
| | - Petar M Seferovic
- Serbian Academy of Sciences and Arts, University of Belgrade Faculty of Medicine and Belgrade University Medical Center, Belgrade, Serbia
| | - Eberhard Standl
- Forschergruppe Diabetes eV at the Helmholtz Centre, Munich-Neuherberg, Germany
| | | | - Jaakko Tuomilehto
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Diabetes Research Unit, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Paul Valensi
- Polyclinique d'Aubervilliers, Aubervilliers and Paris Nord University, Bobigny, France
| | | |
Collapse
|
4
|
Henson J, Covenant A, Hall AP, Herring L, Rowlands AV, Yates T, Davies MJ. Waking Up to the Importance of Sleep in Type 2 Diabetes Management: A Narrative Review. Diabetes Care 2024; 47:331-343. [PMID: 38394635 DOI: 10.2337/dci23-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/27/2023] [Indexed: 02/25/2024]
Abstract
For the first time, the latest American Diabetes Association/European Association for the Study of Diabetes (ADA/EASD) consensus guidelines have incorporated a growing body of evidence linking health outcomes associated with type 2 diabetes to the movement behavior composition over the whole 24-h day. Of particular note, the importance of sleep as a key lifestyle component in the management of type 2 diabetes is promulgated and presented using three key constructs: quantity, quality, and timing (i.e., chronotype). In this narrative review we highlight some of the key evidence justifying the inclusion of sleep in the latest consensus guidelines by examining the associations of quantity, quality, and timing of sleep with measures of glycemia, cardiovascular disease risk, and mortality. We also consider potential mechanisms implicated in the association between sleep and type 2 diabetes and provide practical advice for health care professionals about initiating conversations pertaining to sleep in clinical care. In particular, we emphasize the importance of measuring sleep in a free-living environment and provide a summary of the different methodologies and targets. In summary, although the latest ADA/EASD consensus report highlights sleep as a central component in the management of type 2 diabetes, placing it, for the first time, on a level playing field with other lifestyle behaviors (e.g., physical activity and diet), the evidence base for improving sleep (beyond sleep disorders) in those living with type 2 diabetes is limited. This review should act as a timely reminder to incorporate sleep into clinical consultations, ongoing diabetes education, and future interventions.
Collapse
Affiliation(s)
- Joseph Henson
- NIHR Leicester Biomedical Research Centre, Diabetes Research Centre, College of Life Sciences, University of Leicester, U.K
| | - Alix Covenant
- NIHR Leicester Biomedical Research Centre, Diabetes Research Centre, College of Life Sciences, University of Leicester, U.K
| | - Andrew P Hall
- University Hospitals of Leicester NHS Trust, Leicester, U.K
- Hanning Sleep Laboratory, Leicester General Hospital, Leicester, U.K
| | - Louisa Herring
- NIHR Leicester Biomedical Research Centre, Diabetes Research Centre, College of Life Sciences, University of Leicester, U.K
- University Hospitals of Leicester NHS Trust, Leicester, U.K
| | - Alex V Rowlands
- NIHR Leicester Biomedical Research Centre, Diabetes Research Centre, College of Life Sciences, University of Leicester, U.K
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Thomas Yates
- NIHR Leicester Biomedical Research Centre, Diabetes Research Centre, College of Life Sciences, University of Leicester, U.K
| | - Melanie J Davies
- NIHR Leicester Biomedical Research Centre, Diabetes Research Centre, College of Life Sciences, University of Leicester, U.K
| |
Collapse
|
5
|
Yates T, Biddle GJH, Henson J, Edwardson CL, Arsenyadis F, Goff LM, Papamargaritis D, Webb DR, Khunti K, Davies MJ. Impact of weight loss and weight gain trajectories on body composition in a population at high risk of type 2 diabetes: A prospective cohort analysis. Diabetes Obes Metab 2024; 26:1008-1015. [PMID: 38093678 DOI: 10.1111/dom.15400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 02/06/2024]
Abstract
AIM In a primary care population at high risk of type 2 diabetes, 24-month weight change trajectories were used to investigate the impact of weight cycling on fat mass (FM) and fat-free mass (FFM). MATERIALS AND METHODS Cohort data from the Walking Away from Type 2 Diabetes trial was used, which recruited adults at-risk of type 2 diabetes from primary care in 2009/10. Annual weight change trajectories based on weight loss/gain of ≥5% were assessed over two 24-month periods. Body composition was measured by bioelectrical impedance analysis. Repeated measures were analysed using generalized estimating equations with participants contributing up to two 24-month observation periods. RESULTS In total, 622 participants were included (average age = 63.6 years, body mass index = 32.0 kg/m2 , 35.4% women), contributing 1163 observations. Most observations (69.2%) were from those that maintained their body weight, with no change to FM or FFM. A minority (4.6% of observations) lost over 5% of body weight between baseline and 12 months, which was then regained between 12 and 24 months. These individuals regained FM to baseline levels, but lost 1.50 (0.66, 2.35) kg FFM, adjusted for confounders. In contrast, those that gained weight between baseline and 12 months but lost weight between 12 and 24 months (5.5% of observations) had a net gain in FM of 1.70 (0.27, 3.12) kg with no change to FFM. CONCLUSION Weight cycling may be associated with a progressive loss in FFM and/or gain in FM in those with overweight and obesity at-risk of type 2 diabetes.
Collapse
Affiliation(s)
- T Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - G J H Biddle
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - J Henson
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - C L Edwardson
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - F Arsenyadis
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - L M Goff
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - D Papamargaritis
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - D R Webb
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - K Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - M J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| |
Collapse
|
6
|
Goldney J, Henson J, Edwardson CL, Khunti K, Davies MJ, Yates T. Long-term ambient air pollution exposure and prospective change in sedentary behaviour and physical activity in individuals at risk of type 2 diabetes in the UK. J Public Health (Oxf) 2024; 46:e32-e42. [PMID: 38103023 PMCID: PMC10901272 DOI: 10.1093/pubmed/fdad263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Air pollution may be a risk factor for physical inactivity and sedentary behaviour (SED) through discouraging active lifestyles, impairing fitness and contributing to chronic diseases with potentially important consequences for population health. METHODS Using generalized estimating equations, we examined the associations between long-term particulate matter with diameter ≤2.5 μm (PM2.5), ≤10 μm (PM10) and nitrogen dioxide (NO2) and annual change in accelerometer-measured SED, moderate-to-vigorous physical activity (MVPA) and steps in adults at risk of type 2 diabetes within the Walking Away from Type 2 Diabetes trial. We adjusted for important confounders including social deprivation and measures of the built environment. RESULTS From 808 participants, 644 had complete data (1605 observations; 64.7% men; mean age 63.86 years). PM2.5, NO2 and PM10 were not associated with change in MVPA/steps but were associated with change in SED, with a 1 ugm-3 increase associated with 6.38 (95% confidence interval: 0.77, 12.00), 1.52 (0.49, 2.54) and 4.48 (0.63, 8.34) adjusted annual change in daily minutes, respectively. CONCLUSIONS Long-term PM2.5, NO2 and PM10 exposures were associated with an annual increase in SED: ~11-22 min/day per year across the sample range of exposure (three standard deviations). Future research should investigate whether interventions to reduce pollution may influence SED.
Collapse
Affiliation(s)
- Jonathan Goldney
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Gwendolen Rd, Leicester LE5 4PW, UK
| | - Joseph Henson
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Gwendolen Rd, Leicester LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Gwendolen Rd, Leicester LE5 4PW, UK
| | - Charlotte L Edwardson
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Gwendolen Rd, Leicester LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Gwendolen Rd, Leicester LE5 4PW, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Gwendolen Rd, Leicester LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Gwendolen Rd, Leicester LE5 4PW, UK
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Gwendolen Rd, Leicester LE5 4PW, UK
| | - Melanie J Davies
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Gwendolen Rd, Leicester LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Gwendolen Rd, Leicester LE5 4PW, UK
| | - Thomas Yates
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Gwendolen Rd, Leicester LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Gwendolen Rd, Leicester LE5 4PW, UK
| |
Collapse
|
7
|
Kunutsor SK, Zaccardi F, Balasubramanian VG, Gillies CL, Aroda VR, Seidu S, Davies MJ, Khunti K. Glycaemic control and macrovascular and microvascular outcomes in type 2 diabetes: Systematic review and meta-analysis of cardiovascular outcome trials of novel glucose-lowering agents. Diabetes Obes Metab 2024. [PMID: 38379094 DOI: 10.1111/dom.15500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/31/2024] [Accepted: 01/31/2024] [Indexed: 02/22/2024]
Abstract
AIM Using a systematic review and meta-analysis of placebo-controlled cardiovascular outcome trials (CVOTs) of newer glucose-lowering agents [sodium-glucose cotransporter-2 inhibitors (SGLT-2is), glucagon-like peptide-1 receptor agonists (GLP-1RAs), and dipeptidyl peptidase-4 inhibitors (DPP-4is)] in type 2 diabetes (T2D), we aimed to determine the macrovascular and microvascular outcomes of these agents and clarify the relationships between glycated haemoglobin (HbA1c) reduction and risk of these outcomes. MATERIALS AND METHODS Randomized controlled trials were identified from MEDLINE, Embase and the Cochrane Library until September 2023. Study-specific hazard ratios with 95% confidence intervals (CIs) were pooled, and meta-regression was used to assess the relationships between outcomes and between trial arm HbA1c reductions. RESULTS Twenty unique CVOTs (six SGLT-2is, nine GLP-1RAs, five DPP-4is), based on 169 513 participants with T2D, were eligible. Comparing SGLT-2is, GLP-1RAs and DPP-4is with placebo, the hazard ratios (95% CIs) for 3-point major adverse cardiovascular events were 0.88 (0.82-0.94), 0.85 (0.79-0.92) and 1.00 (0.94-1.06), respectively. SGLT-2is and GLP-1RAs consistently reduced the risk of several macrovascular and microvascular complications, particularly kidney events. DPP-4is showed no macrovascular benefits. There was potential evidence of an inverse linear relationship between HbA1c reduction and 3-point major adverse cardiovascular event risk (estimated risk per 1% reduction in HbA1c: 0.84, 95% CI 0.67-1.06; p = .14; R2 = 14.2%), which was driven by the component of non-fatal stroke (R2 = 100.0%; p = .094). There were non-significant inverse linear relationships between HbA1c reduction and the risk of several vascular outcomes. CONCLUSIONS SGLT-2is and GLP-1RAs showed consistent risk reductions in macrovascular and microvascular outcomes. The vascular benefits of SGLT-2is and GLP-1RAs in patients with T2D extend beyond mere glycaemic control.
Collapse
Affiliation(s)
- Setor K Kunutsor
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Francesco Zaccardi
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Victoria G Balasubramanian
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- College of Life Sciences, University of Leicester, Leicester, UK
| | - Clare L Gillies
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Vanita R Aroda
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Samuel Seidu
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Melanie J Davies
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Kamlesh Khunti
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| |
Collapse
|
8
|
Abstract
Obesity is a chronic disease associated with serious complications and increased mortality. Weight loss (WL) through lifestyle changes results in modest WL long-term possibly due to compensatory biological adaptations (increased appetite and reduced energy expenditure) promoting weight gain. Bariatric surgery was until recently the only intervention that consistently resulted in ≥ 15% WL and maintenance. Our better understanding of the endocrine regulation of appetite has led to the development of new medications over the last decade for the treatment of obesity with main target the reduction of appetite. The efficacy of semaglutide 2.4 mg/week-the latest glucagon-like peptide-1 (GLP-1) receptor analogue-on WL for people with obesity suggests that we are entering a new era in obesity pharmacotherapy where ≥15% WL is feasible. Moreover, the WL achieved with the dual agonist tirzepatide (GLP-1/glucose-dependent insulinotropic polypeptide) for people with type 2 diabetes and most recently also obesity, indicate that combining the GLP-1 with other gut hormones may lead to additional WL compared with GLP-1 receptor analogues alone and in the future, multi-agonist molecules may offer the potential to bridge further the efficacy gap between bariatric surgery and the currently available pharmacotherapies.
Collapse
Affiliation(s)
- Dimitris Papamargaritis
- Diabetes Research Centre, Leicester General Hospital, University of Leicester College of Medicine Biological Sciences and Psychology, Leicester LE5 4PW, UK
| | - Carel W le Roux
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Dublin 4, Ireland
- Diabetes Research Centre, Ulster University, Coleraine BT52 1SA, UK
| | - Jens J Holst
- Department of Biomedical Sciences and the NNF Center for Basic Metabolic Research, University of Copenhagen Panum Institute, Copenhagen 2200, Denmark
| | - Melanie J Davies
- Diabetes Research Centre, Leicester General Hospital, University of Leicester College of Medicine Biological Sciences and Psychology, Leicester LE5 4PW, UK
| |
Collapse
|
9
|
Shabnam S, Abner S, Gillies CL, Davies MJ, Dex T, Khunti K, Webb DR, Zaccardi F, Seidu S. Effect of delay in treatment intensification in people with type 2 diabetes and suboptimal glycaemia after basal insulin initiation: A real-world observational study. Diabetes Obes Metab 2024; 26:512-523. [PMID: 37857573 DOI: 10.1111/dom.15337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/25/2023] [Accepted: 10/03/2023] [Indexed: 10/21/2023]
Abstract
AIM Despite global recommendations for type 2 diabetes mellitus treatment to maintain optimal glycaemic targets, a significant proportion of people remain in suboptimal glycaemic control. Our objective was to investigate the impact of intensification delay after basal insulin (BI) initiation on long-term complications in people with suboptimal glycaemia. MATERIALS AND METHODS We conducted a retrospective cohort study in individuals with type 2 diabetes mellitus initiated on BI. Those with suboptimal glycaemia (glycated haemoglobin ≥7% or ≥53 mmol/mol) within 12 months of BI initiation were divided into early (treatment intensified within 5 years), or late (≥5 years) intensification groups. We estimated the age-stratified risks of micro- and macrovascular complications among these groups compared with those with optimal glycaemia (glycated haemoglobin <7%). RESULTS Of the 13 916 people with suboptimal glycaemia, 52.5% (n = 7304) did not receive any treatment intensification. In those aged <65 years, compared with the optimal glycaemia group late intensification was associated with a 56% higher risk of macrovascular complications (adjusted hazard ratio 1.56; 95% confidence intervals 1.08, 2.26). In elderly people (≥65 years), late intensification was associated with a higher risk of cardiovascular-related death (1.62; 1.03, 2.54) and a lower risk of microvascular complications (0.26; 0.08, 0.83). CONCLUSIONS Those who had late intensification were at an increased risk of cardiovascular death if they were ≥65 years and an increased risk of macrovascular complications if they were <65 years. These findings highlight the critical need for earlier intensification of treatment and adopting personalized treatment strategies to improve patient outcomes.
Collapse
Affiliation(s)
- Sharmin Shabnam
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Sophia Abner
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
- IQVIA, London, UK
| | - Clare L Gillies
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Melanie J Davies
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Terry Dex
- Department of Medical Affairs, Sanofi, Bridgewater, New Jersey, USA
| | - Kamlesh Khunti
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - David R Webb
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Francesco Zaccardi
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Samuel Seidu
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| |
Collapse
|
10
|
Melson E, Ashraf U, Papamargaritis D, Davies MJ. What is the pipeline for future medications for obesity? Int J Obes (Lond) 2024:10.1038/s41366-024-01473-y. [PMID: 38302593 DOI: 10.1038/s41366-024-01473-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 02/03/2024]
Abstract
Obesity is a chronic disease associated with increased risk of obesity-related complications and mortality. Our better understanding of the weight regulation mechanisms and the role of gut-brain axis on appetite has led to the development of safe and effective entero-pancreatic hormone-based treatments for obesity such as glucagon-like peptide-1 (GLP-1) receptor agonists (RA). Semaglutide 2.4 mg once weekly, a subcutaneously administered GLP-1 RA approved for obesity treatment in 2021, results in 15-17% mean weight loss (WL) with evidence of cardioprotection. Oral GLP-1 RA are also under development and early data shows similar WL efficacy to semaglutide 2.4 mg. Looking to the next generation of obesity treatments, combinations of GLP-1 with other entero-pancreatic hormones with complementary actions and/or synergistic potential (such as glucose-dependent insulinotropic polypeptide (GIP), glucagon, and amylin) are under investigation to enhance the WL and cardiometabolic benefits of GLP-1 RA. Tirzepatide, a dual GLP-1/GIP receptor agonist has been approved for glycaemic control in type 2 diabetes as well as for obesity management leading in up to 22.5% WL in phase 3 obesity trials. Other combinations of entero-pancreatic hormones including cagrisema (GLP-1/amylin RA) and the triple agonist retatrutide (GLP-1/GIP/glucagon RA) have also progressed to phase 3 trials as obesity treatments and early data suggests that may lead to even greater WL than tirzepatide. Additionally, agents with different mechanisms of action to entero-pancreatic hormones (e.g. bimagrumab) may improve the body composition during WL and are in early phase clinical trials. We are in a new era for obesity pharmacotherapy where combinations of entero-pancreatic hormones approach the WL achieved with bariatric surgery. In this review, we present the efficacy and safety data for the pipeline of obesity pharmacotherapies with a focus on entero-pancreatic hormone-based treatments and we consider the clinical implications and challenges that the new era in obesity management may bring.
Collapse
Affiliation(s)
- Eka Melson
- Diabetes Research Centre, University of Leicester College of Life Sciences, Leicester, UK
| | - Uzma Ashraf
- Diabetes Research Centre, University of Leicester College of Life Sciences, Leicester, UK
| | - Dimitris Papamargaritis
- Diabetes Research Centre, University of Leicester College of Life Sciences, Leicester, UK.
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, LE5 4PW, UK.
- Department of Diabetes and Endocrinology, Kettering General Hospital NHS Foundation Trust, Kettering, NN16 8UZ, UK.
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester College of Life Sciences, Leicester, UK
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, LE5 4PW, UK
| |
Collapse
|
11
|
Henson J, Yates T, Bhattacharjee A, Chudasama YV, Davies MJ, Dempsey PC, Goldney J, Khunti K, Laukkanen JA, Razieh C, Rowlands AV, Zaccardi F. Walking pace and the time between the onset of noncommunicable diseases and mortality: a UK Biobank prospective cohort study. Ann Epidemiol 2024; 90:21-27. [PMID: 37820945 DOI: 10.1016/j.annepidem.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/05/2023] [Accepted: 10/06/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE To estimate time spent in various cardiovascular disease (CVD) and cancer states, according to self-reported walking pace. METHODS In total, 391,744 UK Biobank participants were included (median age = 57 years; 54.7% women). Data were collected 2006-2010, with follow-up collected in 2021. Usual walking pace was self-defined as slow, steady, average, or brisk. Multistate modeling determined the transition rate and mean sojourn time in and across three different states (healthy, CVD or cancer, and death) upon a time horizon of 10 years. RESULTS The mean sojourn time in the healthy state was longer, while that in the CVD or cancer state was shorter in individuals reporting an average or brisk walking pace (vs. slow). A 75-year-old woman reporting a brisk walking pace spent, on average, 8.4 years of the next 10 years in a healthy state; an additional 8.0 (95% CI: 7.3, 8.7) months longer than a 75-year-old woman reporting a slow walking pace. This corresponded to 4.3 (3.7, 4.9) fewer months living with CVD or cancer. Similar results were seen in men. CONCLUSIONS Adults reporting an average or brisk walking pace at baseline displayed a lower transition to disease development and a greater proportion of life lived without CVD or cancer. AVAILABILITY OF DATA AND MATERIALS Research was conducted using the UK Biobank resource under Application #33266. The UK Biobank resource can be accessed by researchers on application. Variables derived for this study have been returned to the UK Biobank for future applicants to request. No additional data are available.
Collapse
Affiliation(s)
- Joseph Henson
- NIHR Leicester Biomedical Research Centre (Lifestyle), Leicester, UK; Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK.
| | - Thomas Yates
- NIHR Leicester Biomedical Research Centre (Lifestyle), Leicester, UK; Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Atanu Bhattacharjee
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK; Leicester Real World Evidence Unit, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Yogini V Chudasama
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK; Leicester Real World Evidence Unit, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Melanie J Davies
- NIHR Leicester Biomedical Research Centre (Lifestyle), Leicester, UK; Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Paddy C Dempsey
- NIHR Leicester Biomedical Research Centre (Lifestyle), Leicester, UK; Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Jonathan Goldney
- NIHR Leicester Biomedical Research Centre (Lifestyle), Leicester, UK; Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK; NIHR Applied Health Research Collaboration-East Midlands (NIHR ARC-EM), Leicester Diabetes Centre, Leicester, UK
| | - Jari A Laukkanen
- Institute of Clinical Medicine and Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Department of Medicine, Wellbeing Services County of Central Finland, Jyväskylä, Finland
| | - Cameron Razieh
- NIHR Leicester Biomedical Research Centre (Lifestyle), Leicester, UK; Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK; Leicester Real World Evidence Unit, University of Leicester, Leicester General Hospital, Leicester, UK; Office for National Statistics, Data & Analysis for Social Care and Health (DASCH) Division, Newport, UK
| | - Alex V Rowlands
- NIHR Leicester Biomedical Research Centre (Lifestyle), Leicester, UK; Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK; Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Francesco Zaccardi
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK; Leicester Real World Evidence Unit, University of Leicester, Leicester General Hospital, Leicester, UK
| |
Collapse
|
12
|
Henson J, Davies MJ, Brady EM, Edwardson CL, Hall AP, Khunti K, Redman E, Rowlands AV, Sargeant J, Yates T. The potential blunting effect of metformin and/or statin therapy on physical activity-induced associations with HbA1c in type 2 diabetes. J Diabetes 2024; 16:e13495. [PMID: 37964490 PMCID: PMC10859307 DOI: 10.1111/1753-0407.13495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 09/22/2023] [Accepted: 10/21/2023] [Indexed: 11/16/2023] Open
Abstract
Highlights Our analysis indicates a potential blunting effect of metformin and/or statin therapy on physical activity-induced associations with HbA1c. The benefit of daily physical activity on glycemic control in people with type 2 diabetes is potentially more apparent in those prescribed neither metformin nor statin therapy. As physical activity is rarely prescribed in isolation of other background medications used to manage type 2 diabetes, the results of this analysis may help to maximize interventions delivered through routine clinical care, while allowing for personalization in prescribed physical activity and pharmacotherapy.
Collapse
Affiliation(s)
- Joseph Henson
- NIHRLeicester Biomedical Research CentreLeicesterUK
- Diabetes Research CentreCollege of Life Sciences, University of LeicesterLeicesterUK
| | - Melanie J. Davies
- NIHRLeicester Biomedical Research CentreLeicesterUK
- Diabetes Research CentreCollege of Life Sciences, University of LeicesterLeicesterUK
| | - Emer M. Brady
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
| | - Charlotte L. Edwardson
- NIHRLeicester Biomedical Research CentreLeicesterUK
- Diabetes Research CentreCollege of Life Sciences, University of LeicesterLeicesterUK
| | - Andrew P. Hall
- Hanning Sleep LaboratoryLeicester General HospitalLeicesterUK
| | - Kamlesh Khunti
- Diabetes Research CentreCollege of Life Sciences, University of LeicesterLeicesterUK
- NIHRApplied Health Research Collaboration – East Midlands (NIHR ARC‐EM), Leicester Diabetes CentreLeicesterUK
| | - Emma Redman
- Leicester Diabetes CentreUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | - Alex V. Rowlands
- NIHRLeicester Biomedical Research CentreLeicesterUK
- Diabetes Research CentreCollege of Life Sciences, University of LeicesterLeicesterUK
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human PerformanceUniversity of South Australia, Adelaide, AustraliaAdelaideSouth AustraliaAustralia
| | - Jack Sargeant
- NIHRLeicester Biomedical Research CentreLeicesterUK
- Diabetes Research CentreCollege of Life Sciences, University of LeicesterLeicesterUK
- Leicester Diabetes CentreUniversity Hospitals of Leicester NHS TrustLeicesterUK
| | - Thomas Yates
- NIHRLeicester Biomedical Research CentreLeicesterUK
- Diabetes Research CentreCollege of Life Sciences, University of LeicesterLeicesterUK
| |
Collapse
|
13
|
Lightfoot CJ, Wilkinson TJ, Vadaszy N, Graham-Brown MPM, Davies MJ, Yates T, Smith AC. Improving self-management behaviour through a digital lifestyle intervention: An internal pilot study. J Ren Care 2024. [PMID: 38296833 DOI: 10.1111/jorc.12488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/07/2023] [Accepted: 01/12/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Self-management is a key component of successful chronic kidney disease (CKD) management. Here, we present the findings from the internal pilot of a multicentre randomised controlled trial (RCT) aimed to test the effect of a digital self-management programme ('My Kidneys & Me' (MK&M)). METHODS Participants (aged ≥18 years and CKD stages 3-4) were recruited from hospital kidney services across England. Study processes were completed virtually. Participants were randomised 2:1 to either intervention (MK&M) or control group. The first 60 participants recruited were included in a 10-week internal pilot which assessed study feasibility and acceptability against pre-specified progression criteria: 1) eligibility and recruitment, acceptability of 2) randomisation and 3) outcomes, 4) MK&M activation, and 5) retention and attrition rates. Semi-structured interviews further explored views on trial participation. RESULTS Of the 60 participants recruited, 41 were randomised to MK&M and 19 to control. All participants completed baseline measures and 62% (n=37) completed post-intervention outcome measures. All progression criteria met the minimum thresholds to proceed. Nine participants were interviewed. The themes identified were satisfaction with study recruitment processes (openness to participate, reading and agreeing to "terms and conditions"), acceptability of study design (remote study participation, acceptability of randomisation, completion of online assessment(s)), and methods to improve recruitment and retention (personalised approach, follow-up communication). CONCLUSION This internal pilot demonstrated the feasibility and acceptability of a virtually run RCT. Progression criteria thresholds to proceed to the definitive RCT were met. Areas for improvement were identified and protocol amendments were made to improve trial delivery.
Collapse
Affiliation(s)
- Courtney J Lightfoot
- Leicester Kidney Lifestyle Team, Department of Population Health Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Thomas J Wilkinson
- Leicester Kidney Lifestyle Team, Department of Population Health Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Noemi Vadaszy
- Leicester Kidney Lifestyle Team, Department of Population Health Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Matthew P M Graham-Brown
- NIHR Leicester Biomedical Research Centre, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Department of Renal Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Melanie J Davies
- NIHR Leicester Biomedical Research Centre, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Thomas Yates
- NIHR Leicester Biomedical Research Centre, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Alice C Smith
- Leicester Kidney Lifestyle Team, Department of Population Health Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
| |
Collapse
|
14
|
Kosiborod MN, Verma S, Borlaug BA, Butler J, Davies MJ, Jon Jensen T, Rasmussen S, Erlang Marstrand P, Petrie MC, Shah SJ, Ito H, Schou M, Melenovský V, Abhayaratna W, Kitzman DW. Effects of Semaglutide on Symptoms, Function, and Quality of Life in Patients With Heart Failure With Preserved Ejection Fraction and Obesity: A Prespecified Analysis of the STEP-HFpEF Trial. Circulation 2024; 149:204-216. [PMID: 37952180 PMCID: PMC10782938 DOI: 10.1161/circulationaha.123.067505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/02/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Patients with heart failure (HF) with preserved ejection fraction (HFpEF) and obesity experience a high burden of symptoms and functional impairment, and a poor quality of life. In the STEP-HFpEF trial (Research Study to Investigate How Well Semaglutide Works in People Living With Heart Failure and Obesity), once-weekly semaglutide 2.4 mg improved symptoms, physical limitations, and exercise function, and reduced inflammation and body weight. This prespecified analysis investigated the effects of semaglutide on the primary and confirmatory secondary end points across the range of the Kansas City Cardiomyopathy Questionnaire (KCCQ) scores at baseline and on all key summary and individual KCCQ domains. METHODS STEP-HFpEF randomly assigned 529 participants with symptomatic HF, an ejection fraction of ≥45%, and a body mass index of ≥30 kg/m2 to once-weekly semaglutide 2.4 mg or placebo for 52 weeks. Dual primary end points change in KCCQ-Clinical Summary Score (CSS) and body weight. Confirmatory secondary end points included change in 6-minute walk distance, a hierarchical composite end point (death, HF events, and change in KCCQ-CSS and 6-minute walk distance) and change in C-reactive protein. Patients were stratified by KCCQ-CSS tertiles at baseline. Semaglutide effects on the primary, confirmatory secondary, and select exploratory end points (N-terminal pro-brain natriuretic peptide) were examined across these subgroups. Semaglutide effects on additional KCCQ domains (Total Symptom Score [including symptom burden and frequency], Physical Limitations Score, Social Limitations Score, Quality of Life Score, and Overall Summary Score) were also evaluated. RESULTS Baseline median KCCQ-CSS across tertiles was 37, 59, and 77 points, respectively. Semaglutide consistently improved primary end points across KCCQ tertiles 1 to 3 (estimated treatment differences [95% CI]: for KCCQ-CSS, 10.7 [5.4 to 16.1], 8.1 [2.7 to 13.4], and 4.6 [-0.6 to 9.9] points; for body weight, -11 [-13.2 to -8.8], -9.4 [-11.5 to -7.2], and -11.8 [-14.0 to -9.6], respectively; Pinteraction=0.28 and 0.29, respectively); the same was observed for confirmatory secondary and exploratory end points (Pinteraction>0.1 for all). Semaglutide-treated patients experienced improvements in all key KCCQ domains (estimated treatment differences, 6.7-9.6 points across domains; P≤0.001 for all). Greater proportion of semaglutide-treated versus placebo-treated patients experienced at least 5-, 10-, 15-, and 20-point improvements in all KCCQ domains (odds ratios, 1.6-2.9 across domains; P<0.05 for all). CONCLUSIONS In patients with HFpEF and obesity, semaglutide produced large improvements in HF-related symptoms, physical limitations, exercise function, inflammation, body weight, and N-terminal pro-brain natriuretic peptide, regardless of baseline health status. The benefits of semaglutide extended to all key KCCQ domains. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04788511.
Collapse
Affiliation(s)
- Mikhail N. Kosiborod
- Department of Cardiovascular Disease, Saint Luke’s Mid America Heart Institute, University of Missouri-Kansas City School of Medicine (M.N.K.)
| | - Subodh Verma
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Unity Health Toronto, University of Toronto, ON, Canada (S.V.)
| | - Barry A. Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.)
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX (J.B.)
- Department of Medicine, University of Mississippi, Jackson (J.B.)
| | - Melanie J. Davies
- Diabetes Research Centre, University of Leicester, and NIHR Leicester Biomedical Research Centre, UK (M.J.D.)
| | | | | | | | - Mark C. Petrie
- School of Cardiovascular and Metabolic Health, University of Glasgow, UK (M.C.P.)
| | - Sanjiv J. Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.)
| | - Hiroshi Ito
- Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan (H.I.)
| | - Morten Schou
- Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev, Denmark (M.S.)
| | - Vojtěch Melenovský
- Institute for Clinical and Experimental Medicine–IKEM, Prague, Czech Republic (V.M.)
| | - Walter Abhayaratna
- College of Health and Medicine, The Australian National University, Canberra, Australia (W.A.)
| | - Dalane W. Kitzman
- Department of Internal Medicine, Sections of Cardiovascular Medicine and Geriatrics, Wake Forest University School of Medicine, Winston-Salem, NC (D.W.K.)
| |
Collapse
|
15
|
Rizzi A, Kloecker DE, Pitocco D, Khunti K, Davies MJ, Zaccardi F. Effect of glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors on time to outcome in type 2 diabetes cardiorenal outcome trials. Diabetes Metab Syndr 2024; 18:102945. [PMID: 38262118 DOI: 10.1016/j.dsx.2024.102945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 01/25/2024]
Abstract
INTRODUCTION In randomized controlled trials (RCTs), treatment effects are commonly reported as hazard ratio, a measure often misinterpreted as a relative risk reduction. The acceleration factor (AF) indicates the extent to which a treatment increases/decreases the time before the occurrence of an outcome and gives useful insights in the interpretation of trials' results. METHODS Using individual time-to-event data reconstructed from Kaplan-Meier plots, we estimated AFs for the primary outcomes (POs) and all-cause mortality in glucagon-like peptide-1 receptor agonists (GLP1-RAs) or sodium-glucose cotransporter-2 inhibitors (SGLT2-is) cardiorenal outcome trials in subjects with type 2 diabetes. RESULTS AFs were estimated from 28 Kaplan-Meier plots of 19 RCTs. Compared to placebo, most GLP1-RAs increased the time before the onset of POs (from 9 % to 59 %) and all-cause mortality (from 8 to 13 %). Similarly, SGLT2-is increased time before the onset of POs (from 19 % to 87 %) and all-cause mortality (from 13 % to 42 %). CONCLUSIONS The AFs provide a complementary and easier-to-interpret measure of treatment effect that could be useful to improve the shared decision-making.
Collapse
Affiliation(s)
- Alessandro Rizzi
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK; Diabetes Care Unit, Catholic University, Fondazione Policlinico Agostino Gemelli, Rome, Italy.
| | - David E Kloecker
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Dario Pitocco
- Diabetes Care Unit, Catholic University, Fondazione Policlinico Agostino Gemelli, Rome, Italy
| | - Kamlesh Khunti
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK; NIHR Collaboration for Leadership in Applied Health Research and Care-East Midlands, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
| | - Melanie J Davies
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK; Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Francesco Zaccardi
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK; NIHR Collaboration for Leadership in Applied Health Research and Care-East Midlands, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK; NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Gwendolen Road, Leicester, LE5 4PW, UK
| |
Collapse
|
16
|
Brady EM, Cao TH, Moss AJ, Athithan L, Ayton SL, Redman E, Argyridou S, Graham-Brown MPM, Maxwell CB, Jones DJL, Ng L, Yates T, Davies MJ, McCann GP, Gulsin GS. Circulating sphingolipids and relationship to cardiac remodelling before and following a low-energy diet in asymptomatic Type 2 Diabetes. BMC Cardiovasc Disord 2024; 24:25. [PMID: 38172712 PMCID: PMC10765891 DOI: 10.1186/s12872-023-03623-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Heart failure with preserved ejection fraction (HFpEF) is a heterogenous multi-system syndrome with limited efficacious treatment options. The prevalence of Type 2 diabetes (T2D) continues to rise and predisposes patients to HFpEF, and HFpEF remains one of the biggest challenges in cardiovascular medicine today. Novel therapeutic targets are required to meet this important clinical need. Deep phenotyping studies including -OMIC analyses can provide important pathogenic information to aid the identification of such targets. The aims of this study were to determine; 1) the impact of a low-energy diet on plasma sphingolipid/ceramide profiles in people with T2D compared to healthy controls and, 2) if the change in sphingolipid/ceramide profile is associated with reverse cardiovascular remodelling. METHODS Post-hoc analysis of a randomised controlled trial (NCT02590822) including adults with T2D with no cardiovascular disease who completed a 12-week low-energy (∼810 kcal/day) meal-replacement plan (MRP) and matched healthy controls (HC). Echocardiography, cardiac MRI and a fasting blood for lipidomics were undertaken pre/post-intervention. Candidate biomarkers were identified from case-control comparison (fold change > 1.5 and statistical significance p < 0.05) and their response to the MRP reported. Association between change in biomarkers and change indices of cardiac remodelling were explored. RESULTS Twenty-four people with T2D (15 males, age 51.1 ± 5.7 years), and 25 HC (15 male, 48.3 ± 6.6 years) were included. Subjects with T2D had increased left ventricular (LV) mass:volume ratio (0.84 ± 0.13 vs. 0.70 ± 0.08, p < 0.001), increased systolic function but impaired diastolic function compared to HC. Twelve long-chain polyunsaturated sphingolipids, including four ceramides, were downregulated in subjects with T2D at baseline. Three sphingomyelin species and all ceramides were inversely associated with LV mass:volume. There was a significant increase in all species and shift towards HC following the MRP, however, none of these changes were associated with reverse cardiac remodelling. CONCLUSION The lack of association between change in sphingolipids/ceramides and reverse cardiac remodelling following the MRP casts doubt on a causative role of sphingolipids/ceramides in the progression of heart failure in T2D. TRIAL REGISTRATION NCT02590822.
Collapse
Affiliation(s)
- Emer M Brady
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
- Leicester Van Geest Multi-Omics Facility, University of Leicester, Leicester, UK
| | - Thong H Cao
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
- Leicester Van Geest Multi-Omics Facility, University of Leicester, Leicester, UK
| | - Alastair J Moss
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
- Leicester Van Geest Multi-Omics Facility, University of Leicester, Leicester, UK
| | - Lavanya Athithan
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Sarah L Ayton
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Emma Redman
- Diabetes Research Centre, NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Stavroula Argyridou
- Diabetes Research Centre, NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Matthew P M Graham-Brown
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Colleen B Maxwell
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
- Leicester Van Geest Multi-Omics Facility, University of Leicester, Leicester, UK
| | - Donald J L Jones
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
- Leicester Van Geest Multi-Omics Facility, University of Leicester, Leicester, UK
| | - Leong Ng
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
- Leicester Van Geest Multi-Omics Facility, University of Leicester, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
- Leicester Van Geest Multi-Omics Facility, University of Leicester, Leicester, UK
| | - Gaurav S Gulsin
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK.
| |
Collapse
|
17
|
Rizzi A, Kloecker DE, Pitocco D, Khunti K, Davies MJ, Zaccardi F. Translating trial results into interpretable risk estimates: Systematic analysis of cardiorenal outcome trials of glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors. Nutr Metab Cardiovasc Dis 2023:S0939-4753(23)00506-9. [PMID: 38336546 DOI: 10.1016/j.numecd.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND AND AIMS In a randomised controlled trial (RCT), the between-arm difference in the average probability of an event per unit of time (i.e., yearly incidence risk difference, YIRD) is an easy-to-interpret treatment effect metric. We aimed to quantify the YIRD in cardiorenal RCTs of GLP-1RAs or SGLT-2is. METHODS AND RESULTS We digitally searched for RCTs published up to March 1st, 2023, including subjects with type 2 diabetes randomised to GLP-1RAs or SGLT-2is and investigating cardiorenal outcomes or death. We extracted information from Kaplan-Meier (KM) plots to obtain time-to-event individual data and estimate within-arm yearly incidence risk and YIRD. Data from 19 RCTs (28 kM plots) were analysed: comparing treatment to placebo, in GLP-1RA RCTs the YIRD ranged from 0.2 % (95 % CI: -0.7 %, 1.1 %) to -1.9 % (-3.1, -0.7), for primary outcome; and from -0.2 % (-0.5, 0.2) to -0.4 % (-0.7 %, -0.0 %), for mortality. With the exception of SOLOIST-WHF (YIRD 11.9 % for primary outcome), corresponding estimates in SGLT-2is RCTs were: from -0.1 % (-0.4, 0.1) to -5.0 % (-7.7, -2.6), for primary outcome; and from -0.1 % (-0.2, 0.1) to -1.9 % (-4.4 %, 0.6 %), for mortality. CONCLUSION The YIRD metric complements other relative treatment effect estimates and helps quantify the absolute benefit of GLP-1RAs and SGLT-2is.
Collapse
Affiliation(s)
- Alessandro Rizzi
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK; Diabetes Care Unit, Catholic University, Fondazione Policlinico Agostino Gemelli, Rome, Italy.
| | - David E Kloecker
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK
| | - Dario Pitocco
- Diabetes Care Unit, Catholic University, Fondazione Policlinico Agostino Gemelli, Rome, Italy
| | - Kamlesh Khunti
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK; NIHR Collaboration for Leadership in Applied Health Research and Care-East Midlands, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - Melanie J Davies
- NIHR Collaboration for Leadership in Applied Health Research and Care-East Midlands, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK; NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | - Francesco Zaccardi
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester LE5 4PW, UK; NIHR Collaboration for Leadership in Applied Health Research and Care-East Midlands, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK; NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| |
Collapse
|
18
|
Bohoran TA, Parke KS, Graham-Brown MPM, Meisuria M, Singh A, Wormleighton J, Adlam D, Gopalan D, Davies MJ, Williams B, Brown M, McCann GP, Giannakidis A. Resource efficient aortic distensibility calculation by end to end spatiotemporal learning of aortic lumen from multicentre multivendor multidisease CMR images. Sci Rep 2023; 13:21794. [PMID: 38066222 PMCID: PMC10709583 DOI: 10.1038/s41598-023-48986-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 12/02/2023] [Indexed: 12/18/2023] Open
Abstract
Aortic distensibility (AD) is important for the prognosis of multiple cardiovascular diseases. We propose a novel resource-efficient deep learning (DL) model, inspired by the bi-directional ConvLSTM U-Net with densely connected convolutions, to perform end-to-end hierarchical learning of the aorta from cine cardiovascular MRI towards streamlining AD quantification. Unlike current DL aortic segmentation approaches, our pipeline: (i) performs simultaneous spatio-temporal learning of the video input, (ii) combines the feature maps from the encoder and decoder using non-linear functions, and (iii) takes into account the high class imbalance. By using multi-centre multi-vendor data from a highly heterogeneous patient cohort, we demonstrate that the proposed method outperforms the state-of-the-art method in terms of accuracy and at the same time it consumes [Formula: see text] 3.9 times less fuel and generates [Formula: see text] 2.8 less carbon emissions. Our model could provide a valuable tool for exploring genome-wide associations of the AD with the cognitive performance in large-scale biomedical databases. By making energy usage and carbon emissions explicit, the presented work aligns with efforts to keep DL's energy requirements and carbon cost in check. The improved resource efficiency of our pipeline might open up the more systematic DL-powered evaluation of the MRI-derived aortic stiffness.
Collapse
Affiliation(s)
- Tuan Aqeel Bohoran
- School of Science and Technology, Nottingham Trent University, Nottingham, NG11 8NS, UK
| | - Kelly S Parke
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Matthew P M Graham-Brown
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Mitul Meisuria
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Anvesha Singh
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Joanne Wormleighton
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - David Adlam
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Deepa Gopalan
- Imperial College London & Cambridge University Hospitals, Cambridge, CB2 0QQ, UK
| | - Melanie J Davies
- Leicester Diabetes Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Bryan Williams
- Institute of Cardiovascular Science, University College London (UCL), National Institute for Health Research (NIHR), UCL Hospitals Biomedical Research Centre, London, WC1E 6DD, UK
| | - Morris Brown
- Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University of London, London, EC1M 6BQ, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - Archontis Giannakidis
- School of Science and Technology, Nottingham Trent University, Nottingham, NG11 8NS, UK.
| |
Collapse
|
19
|
Davies MJ, Alibegovic AC, Kelkar P, Braae UC, Jensen AB. Glycaemic control and weight outcomes after adding or switching to biphasic insulin aspart 30/70 in people with type 2 diabetes mellitus previously treated with basal-bolus insulin in UK clinical practice. Diabetes Obes Metab 2023; 25:3841-3844. [PMID: 37722973 DOI: 10.1111/dom.15278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/18/2023] [Accepted: 08/28/2023] [Indexed: 09/20/2023]
Affiliation(s)
- Melanie J Davies
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | | | | | | | | |
Collapse
|
20
|
Edwardson CL, Maylor BD, Biddle SJH, Clarke-Cornwell AM, Clemes SA, Davies MJ, Dunstan DW, Granat MH, Gray LJ, Hadjiconstantinou M, Healy GN, Wilson P, Munir F, Yates T, Eborall H. Participant and workplace champion experiences of an intervention designed to reduce sitting time in desk-based workers: SMART work & life. Int J Behav Nutr Phys Act 2023; 20:142. [PMID: 38037043 PMCID: PMC10691052 DOI: 10.1186/s12966-023-01539-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND A cluster randomised controlled trial demonstrated the effectiveness of the SMART Work & Life (SWAL) behaviour change intervention, with and without a height-adjustable desk, for reducing sitting time in desk-based workers. Staff within organisations volunteered to be trained to facilitate delivery of the SWAL intervention and act as workplace champions. This paper presents the experiences of these champions on the training and intervention delivery, and from participants on their intervention participation. METHODS Quantitative and qualitative feedback from workplace champions on their training session was collected. Participants provided quantitative feedback via questionnaires at 3 and 12 month follow-up on the intervention strategies (education, group catch ups, sitting less challenges, self-monitoring and prompts, and the height-adjustable desk [SWAL plus desk group only]). Interviews and focus groups were also conducted at 12 month follow-up with workplace champions and participants respectively to gather more detailed feedback. Transcripts were uploaded to NVivo and the constant comparative approach informed the analysis of the interviews and focus groups. RESULTS Workplace champions rated the training highly with mean scores ranging from 5.3/6 to 5.7/6 for the eight parts. Most participants felt the education increased their awareness of the health consequences of high levels of sitting (SWAL: 90.7%; SWAL plus desk: 88.2%) and motivated them to change their sitting time (SWAL: 77.5%; SWAL plus desk: 85.77%). A high percentage of participants (70%) reported finding the group catch up session helpful and worthwhile. However, focus groups highlighted mixed responses to the group catch-up sessions, sitting less challenges and self-monitoring intervention components. Participants in the SWAL plus desk group felt that having a height-adjustable desk was key in changing their behaviour, with intrinsic as well as time based factors reported as key influences on the height-adjustable desk usage. In both intervention groups, participants reported a range of benefits from the intervention including more energy, less fatigue, an increase in focus, alertness, productivity and concentration as well as less musculoskeletal problems (SWAL plus desk group only). Work-related, interpersonal, personal attributes, physical office environment and physical barriers were identified as barriers when trying to sit less and move more. CONCLUSIONS Workplace champion and participant feedback on the intervention was largely positive but it is clear that different behaviour change strategies worked for different people indicating that a 'one size fits all' approach may not be appropriate for this type of intervention. The SWAL intervention could be tested in a broader range of organisations following a few minor adaptations based on the champion and participant feedback. TRIAL REGISTRATION ISCRCTN registry (ISRCTN11618007).
Collapse
Affiliation(s)
- Charlotte L Edwardson
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK.
- NIHR Leicester Biomedical Research Centre, Leicester, LE5 4PW, UK.
| | - Benjamin D Maylor
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Stuart J H Biddle
- Centre for Health Research, University of Southern Queensland, Springfield Central, QLD, 4350, Australia
- Faculty of Sport & Health Sciences, University of Jyväskylä, Jyväskylä, FI-40014, Finland
| | | | - Stacy A Clemes
- NIHR Leicester Biomedical Research Centre, Leicester, LE5 4PW, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, LE11 3TU, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester, LE5 4PW, UK
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, LE5 4PW, UK
| | - David W Dunstan
- Baker Heart and Diabetes Institute, Melbourne, VIC, 3004, Australia
- Mary MacKillop Institute for Health Research, The Australian Catholic University, Melbourne, VIC, 3000, Australia
| | - Malcolm H Granat
- School of Health & Society, University of Salford, Salford, Greater Manchester, M6 6PU, UK
| | - Laura J Gray
- NIHR Leicester Biomedical Research Centre, Leicester, LE5 4PW, UK
- Department of Population Health Sciences, University of Leicester, Leicester, LE1 7RH, UK
| | | | - Genevieve N Healy
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Panna Wilson
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, LE5 4PW, UK
| | - Fehmidah Munir
- School of Sport, Exercise and Health Sciences, Loughborough University, Leicestershire, LE11 3TU, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester, LE5 4PW, UK
| | - Helen Eborall
- Department of Population Health Sciences, University of Leicester, Leicester, LE1 7RH, UK
- Deanery of Molecular, Genetic and Population Health Sciences, The University of Edinburgh, Scotland, EH8 9AG, UK
| |
Collapse
|
21
|
Butler J, Abildstrøm SZ, Borlaug BA, Davies MJ, Kitzman DW, Petrie MC, Shah SJ, Verma S, Abhayaratna WP, Chopra V, Ezekowitz JA, Fu M, Ito H, Lelonek M, Núñez J, Perna E, Schou M, Senni M, van der Meer P, von Lewinski D, Wolf D, Altschul RL, Rasmussen S, Kosiborod MN. Semaglutide in Patients With Obesity and Heart Failure Across Mildly Reduced or Preserved Ejection Fraction. J Am Coll Cardiol 2023; 82:2087-2096. [PMID: 37993201 DOI: 10.1016/j.jacc.2023.09.811] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 09/21/2023] [Accepted: 09/21/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Many therapies for heart failure (HF) have shown differential impact across the spectrum of left ventricular ejection fraction (LVEF). OBJECTIVES In this prespecified analysis, the authors assessed the effects of semaglutide across the baseline LVEF strata in patients with the obesity phenotype of HF with preserved ejection fraction (HFpEF) in the STEP-HFpEF (Semaglutide Treatment Effect in People with obesity and HFpEF) trial. METHODS STEP-HFpEF randomized 529 patients (263 semaglutide; 266 placebo). For this prespecified analysis, patients were categorized into 3 groups based on LVEF: 45% to 49% (n = 85), 50% to 59% (n = 215), and ≥60% (n = 229). RESULTS At 52 weeks, semaglutide improved the dual primary endpoints of Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (estimated treatment difference: EF [ejection fraction] 45%-49%: 5.0 points [95% CI: -2.7 to 12.8 points], EF 50%-59%: 9.8 points [95% CI: 5.0 to 14.6 points], and EF ≥60%: 7.4 points [95% CI: 2.8 to 12.0 points]; P interaction = 0.56) and body weight (EF: 45%-49%: -7.6 [95% CI: -10.7 to -4.4], EF 50%-59%: -10.6 [95% CI: -12.6 to -8.6] and EF ≥60%: -11.9 [95% CI: -13.8 to -9.9]; P interaction = 0.08), to a similar extent across LVEF categories. Likewise, LVEF did not influence the benefit of semaglutide on confirmatory secondary endpoints: 6-minute walk distance (P interaction = 0.19), hierarchal composite endpoint (P interaction = 0.43), and high-sensitivity C-reactive protein (P interaction = 0.26); or exploratory endpoint of N-terminal pro-brain natriuretic peptide (P interaction = 0.96). Semaglutide was well-tolerated across LVEF categories. CONCLUSIONS In patients with HFpEF and obesity, semaglutide 2.4 mg improved symptoms, physical limitations, and exercise function, and reduced inflammation and body weight to a similar extent across LVEF categories. These data support treatment with semaglutide in patients with the obesity phenotype of HFpEF regardless of LVEF. (Research Study to Investigate How Well Semaglutide Works in People Living With Heart Failure and Obesity [STEP-HFpEF]; NCT04788511).
Collapse
Affiliation(s)
- Javed Butler
- Baylor Scott and White Research Institute, Dallas, Texas, USA; University of Mississippi, Jackson, Mississippi, USA.
| | | | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom; National Institute for Health and Care Research, Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - Dalane W Kitzman
- Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Mark C Petrie
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Subodh Verma
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Walter P Abhayaratna
- College of Health and Medicine, the Australian National University, Canberra, Australian Capital Territory, Canberra, Australia
| | | | | | - Michael Fu
- Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Ostra, Gothenburg, Sweden
| | - Hiroshi Ito
- Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan
| | - Małgorzata Lelonek
- Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland
| | - Julio Núñez
- Hospital Clínico Universitario de Valencia, INCLIVA, Universitat de Valencia, Valencia, Spain; CIBER Cardiovascular, Valencia, Spain
| | - Eduardo Perna
- Instituto de Cardiologia J. F. Cabral, Corrientes, Argentina
| | - Morten Schou
- Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | | | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Dennis Wolf
- Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | | | - Mikhail N Kosiborod
- Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA.
| |
Collapse
|
22
|
Sathish T, Khunti K, Narayan KV, Mohan V, Davies MJ, Yates T, Oldenburg B, Thankappan KR, Tapp RJ, Bajpai R, Anjana RM, Weber MB, Ali MK, Shaw JE. Effect of Conventional Lifestyle Interventions on Type 2 Diabetes Incidence by Glucose-Defined Prediabetes Phenotype: An Individual Participant Data Meta-analysis of Randomized Controlled Trials. Diabetes Care 2023; 46:1903-1907. [PMID: 37650824 PMCID: PMC10620543 DOI: 10.2337/dc23-0696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/11/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE To examine whether the effect of conventional lifestyle interventions on type 2 diabetes incidence differs by glucose-defined prediabetes phenotype. RESEARCH DESIGN AND METHODS We searched multiple databases until 1 April 2023 for randomized controlled trials that recruited people with isolated impaired fasting glucose (i-IFG), isolated impaired glucose tolerance (i-IGT), and impaired fasting glucose plus impaired glucose tolerance (IFG+IGT). Individual participant data were pooled from relevant trials and analyzed through random-effects models with use of the within-trial interactions approach. RESULTS Four trials with 2,794 participants (mean age 53.0 years, 60.7% men) were included: 1,240 (44.4%), 796 (28.5%), and 758 (27.1%) had i-IFG, i-IGT, and IFG+IGT, respectively. After a median of 2.5 years, the pooled hazard ratio for diabetes incidence in i-IFG was 0.97 (95% CI 0.66, 1.44), i-IGT 0.65 (0.44, 0.96), and IFG+IGT 0.51 (0.38, 0.68; Pinteraction = 0.01). CONCLUSIONS Conventional lifestyle interventions reduced diabetes incidence in people with IGT (with or without IFG) but not in those with i-IFG.
Collapse
Affiliation(s)
- Thirunavukkarasu Sathish
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, GA
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, U.K
| | - K.M. Venkat Narayan
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, GA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan’s Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Melanie J. Davies
- Diabetes Research Centre, University of Leicester, Leicester, U.K
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, U.K
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, U.K
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, U.K
| | - Brian Oldenburg
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Kavumpurathu R. Thankappan
- Department of Public Health, Amrita Institute of Medical Sciences & Research Center, Kochi, Kerala, India
| | - Robyn J. Tapp
- Research Institute for Health and Wellbeing, Coventry University, Coventry, U.K
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Ram Bajpai
- School of Medicine, Keele University, Staffordshire, U.K
| | - Ranjit Mohan Anjana
- Madras Diabetes Research Foundation and Dr. Mohan’s Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Mary B. Weber
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, GA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Mohammed K. Ali
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center, Emory University, Atlanta, GA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Jonathan E. Shaw
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| |
Collapse
|
23
|
Barker MM, Davies MJ, Sargeant JA, Chan JCN, Gregg EW, Shabnam S, Khunti K, Zaccardi F. Age at Type 2 Diabetes Diagnosis and Cause-Specific Mortality: Observational Study of Primary Care Patients in England. Diabetes Care 2023; 46:1965-1972. [PMID: 37625035 DOI: 10.2337/dc23-0834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVE To examine the associations between age at type 2 diabetes diagnosis and the relative and absolute risk of all-cause and cause-specific mortality in England. RESEARCH DESIGN AND METHODS In this cohort study using primary care data from the Clinical Practice Research Datalink, we identified 108,061 individuals with newly diagnosed type 2 diabetes (16-50 years of age), matched to 829,946 individuals without type 2 diabetes. We estimated all-cause and cause-specific mortality (cancer, cardiorenal, other [noncancer or cardiorenal]) by age at diagnosis, using competing-risk survival analyses adjusted for key confounders. RESULTS Comparing individuals with versus without type 2 diabetes, the relative risk of death decreased with an older age at diagnosis: the hazard ratio for all-cause mortality was 4.32 (95% CI 3.35-5.58) in individuals diagnosed at ages 16-27 years compared with 1.53 (95% CI 1.46-1.60) at ages 48-50 years. Smaller relative risks by increasing age at diagnosis were also observed for cancer, cardiorenal, and noncancer or cardiorenal death. Irrespective of age at diagnosis, the 10-year absolute risk of all-cause and cause-specific mortality were higher in individuals with type 2 diabetes; yet, the absolute differences were small. CONCLUSIONS Although the relative risk of death in individuals with versus without type 2 was higher at younger ages, the 10-year absolute risk of all investigated causes of death was small and similar in the two groups. Further multidecade studies could help estimate the long-term risk of complications and death in individuals with early-onset type 2 diabetes.
Collapse
Affiliation(s)
- Mary M Barker
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester, U.K
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, College of Life Sciences, Leicester General Hospital, Leicester, U.K
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, U.K
- National Institute for Health Research Leicester Biomedical Research Centre, Leicester, U.K
| | - Jack A Sargeant
- Diabetes Research Centre, University of Leicester, College of Life Sciences, Leicester General Hospital, Leicester, U.K
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, U.K
- National Institute for Health Research Leicester Biomedical Research Centre, Leicester, U.K
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Edward W Gregg
- School of Population Health, Royal College of Surgeons of Ireland, University of Medicine and Health Sciences, Dublin, Ireland
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College, London, U.K
| | - Sharmin Shabnam
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester, U.K
| | - Kamlesh Khunti
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester, U.K
- Diabetes Research Centre, University of Leicester, College of Life Sciences, Leicester General Hospital, Leicester, U.K
- National Institute for Health Research Leicester Biomedical Research Centre, Leicester, U.K
- National Institute for Health Research Applied Research Collaboration East Midlands, Leicester Diabetes Centre, University of Leicester, Leicester, U.K
| | - Francesco Zaccardi
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, Leicester, U.K
- Diabetes Research Centre, University of Leicester, College of Life Sciences, Leicester General Hospital, Leicester, U.K
- National Institute for Health Research Leicester Biomedical Research Centre, Leicester, U.K
| |
Collapse
|
24
|
Raman B, McCracken C, Cassar MP, Moss AJ, Finnigan L, Samat AHA, Ogbole G, Tunnicliffe EM, Alfaro-Almagro F, Menke R, Xie C, Gleeson F, Lukaschuk E, Lamlum H, McGlynn K, Popescu IA, Sanders ZB, Saunders LC, Piechnik SK, Ferreira VM, Nikolaidou C, Rahman NM, Ho LP, Harris VC, Shikotra A, Singapuri A, Pfeffer P, Manisty C, Kon OM, Beggs M, O'Regan DP, Fuld J, Weir-McCall JR, Parekh D, Steeds R, Poinasamy K, Cuthbertson DJ, Kemp GJ, Semple MG, Horsley A, Miller CA, O'Brien C, Shah AM, Chiribiri A, Leavy OC, Richardson M, Elneima O, McAuley HJC, Sereno M, Saunders RM, Houchen-Wolloff L, Greening NJ, Bolton CE, Brown JS, Choudhury G, Diar Bakerly N, Easom N, Echevarria C, Marks M, Hurst JR, Jones MG, Wootton DG, Chalder T, Davies MJ, De Soyza A, Geddes JR, Greenhalf W, Howard LS, Jacob J, Man WDC, Openshaw PJM, Porter JC, Rowland MJ, Scott JT, Singh SJ, Thomas DC, Toshner M, Lewis KE, Heaney LG, Harrison EM, Kerr S, Docherty AB, Lone NI, Quint J, Sheikh A, Zheng B, Jenkins RG, Cox E, Francis S, Halling-Brown M, Chalmers JD, Greenwood JP, Plein S, Hughes PJC, Thompson AAR, Rowland-Jones SL, Wild JM, Kelly M, Treibel TA, Bandula S, Aul R, Miller K, Jezzard P, Smith S, Nichols TE, McCann GP, Evans RA, Wain LV, Brightling CE, Neubauer S, Baillie JK, Shaw A, Hairsine B, Kurasz C, Henson H, Armstrong L, Shenton L, Dobson H, Dell A, Lucey A, Price A, Storrie A, Pennington C, Price C, Mallison G, Willis G, Nassa H, Haworth J, Hoare M, Hawkings N, Fairbairn S, Young S, Walker S, Jarrold I, Sanderson A, David C, Chong-James K, Zongo O, James WY, Martineau A, King B, Armour C, McAulay D, Major E, McGinness J, McGarvey L, Magee N, Stone R, Drain S, Craig T, Bolger A, Haggar A, Lloyd A, Subbe C, Menzies D, Southern D, McIvor E, Roberts K, Manley R, Whitehead V, Saxon W, Bularga A, Mills NL, El-Taweel H, Dawson J, Robinson L, Saralaya D, Regan K, Storton K, Brear L, Amoils S, Bermperi A, Elmer A, Ribeiro C, Cruz I, Taylor J, Worsley J, Dempsey K, Watson L, Jose S, Marciniak S, Parkes M, McQueen A, Oliver C, Williams J, Paradowski K, Broad L, Knibbs L, Haynes M, Sabit R, Milligan L, Sampson C, Hancock A, Evenden C, Lynch C, Hancock K, Roche L, Rees M, Stroud N, Thomas-Woods T, Heller S, Robertson E, Young B, Wassall H, Babores M, Holland M, Keenan N, Shashaa S, Price C, Beranova E, Ramos H, Weston H, Deery J, Austin L, Solly R, Turney S, Cosier T, Hazelton T, Ralser M, Wilson A, Pearce L, Pugmire S, Stoker W, McCormick W, Dewar A, Arbane G, Kaltsakas G, Kerslake H, Rossdale J, Bisnauthsing K, Aguilar Jimenez LA, Martinez LM, Ostermann M, Magtoto MM, Hart N, Marino P, Betts S, Solano TS, Arias AM, Prabhu A, Reed A, Wrey Brown C, Griffin D, Bevan E, Martin J, Owen J, Alvarez Corral M, Williams N, Payne S, Storrar W, Layton A, Lawson C, Mills C, Featherstone J, Stephenson L, Burdett T, Ellis Y, Richards A, Wright C, Sykes DL, Brindle K, Drury K, Holdsworth L, Crooks MG, Atkin P, Flockton R, Thackray-Nocera S, Mohamed A, Taylor A, Perkins E, Ross G, McGuinness H, Tench H, Phipps J, Loosley R, Wolf-Roberts R, Coetzee S, Omar Z, Ross A, Card B, Carr C, King C, Wood C, Copeland D, Calvelo E, Chilvers ER, Russell E, Gordon H, Nunag JL, Schronce J, March K, Samuel K, Burden L, Evison L, McLeavey L, Orriss-Dib L, Tarusan L, Mariveles M, Roy M, Mohamed N, Simpson N, Yasmin N, Cullinan P, Daly P, Haq S, Moriera S, Fayzan T, Munawar U, Nwanguma U, Lingford-Hughes A, Altmann D, Johnston D, Mitchell J, Valabhji J, Price L, Molyneaux PL, Thwaites RS, Walsh S, Frankel A, Lightstone L, Wilkins M, Willicombe M, McAdoo S, Touyz R, Guerdette AM, Warwick K, Hewitt M, Reddy R, White S, McMahon A, Hoare A, Knighton A, Ramos A, Te A, Jolley CJ, Speranza F, Assefa-Kebede H, Peralta I, Breeze J, Shevket K, Powell N, Adeyemi O, Dulawan P, Adrego R, Byrne S, Patale S, Hayday A, Malim M, Pariante C, Sharpe C, Whitney J, Bramham K, Ismail K, Wessely S, Nicholson T, Ashworth A, Humphries A, Tan AL, Whittam B, Coupland C, Favager C, Peckham D, Wade E, Saalmink G, Clarke J, Glossop J, Murira J, Rangeley J, Woods J, Hall L, Dalton M, Window N, Beirne P, Hardy T, Coakley G, Turtle L, Berridge A, Cross A, Key AL, Rowe A, Allt AM, Mears C, Malein F, Madzamba G, Hardwick HE, Earley J, Hawkes J, Pratt J, Wyles J, Tripp KA, Hainey K, Allerton L, Lavelle-Langham L, Melling L, Wajero LO, Poll L, Noonan MJ, French N, Lewis-Burke N, Williams-Howard SA, Cooper S, Kaprowska S, Dobson SL, Marsh S, Highett V, Shaw V, Beadsworth M, Defres S, Watson E, Tiongson GF, Papineni P, Gurram S, Diwanji SN, Quaid S, Briggs A, Hastie C, Rogers N, Stensel D, Bishop L, McIvor K, Rivera-Ortega P, Al-Sheklly B, Avram C, Faluyi D, Blaikely J, Piper Hanley K, Radhakrishnan K, Buch M, Hanley NA, Odell N, Osbourne R, Stockdale S, Felton T, Gorsuch T, Hussell T, Kausar Z, Kabir T, McAllister-Williams H, Paddick S, Burn D, Ayoub A, Greenhalgh A, Sayer A, Young A, Price D, Burns G, MacGowan G, Fisher H, Tedd H, Simpson J, Jiwa K, Witham M, Hogarth P, West S, Wright S, McMahon MJ, Neill P, Dougherty A, Morrow A, Anderson D, Grieve D, Bayes H, Fallon K, Mangion K, Gilmour L, Basu N, Sykes R, Berry C, McInnes IB, Donaldson A, Sage EK, Barrett F, Welsh B, Bell M, Quigley J, Leitch K, Macliver L, Patel M, Hamil R, Deans A, Furniss J, Clohisey S, Elliott A, Solstice AR, Deas C, Tee C, Connell D, Sutherland D, George J, Mohammed S, Bunker J, Holmes K, Dipper A, Morley A, Arnold D, Adamali H, Welch H, Morrison L, Stadon L, Maskell N, Barratt S, Dunn S, Waterson S, Jayaraman B, Light T, Selby N, Hosseini A, Shaw K, Almeida P, Needham R, Thomas AK, Matthews L, Gupta A, Nikolaidis A, Dupont C, Bonnington J, Chrystal M, Greenhaff PL, Linford S, Prosper S, Jang W, Alamoudi A, Bloss A, Megson C, Nicoll D, Fraser E, Pacpaco E, Conneh F, Ogg G, McShane H, Koychev I, Chen J, Pimm J, Ainsworth M, Pavlides M, Sharpe M, Havinden-Williams M, Petousi N, Talbot N, Carter P, Kurupati P, Dong T, Peng Y, Burns A, Kanellakis N, Korszun A, Connolly B, Busby J, Peto T, Patel B, Nolan CM, Cristiano D, Walsh JA, Liyanage K, Gummadi M, Dormand N, Polgar O, George P, Barker RE, Patel S, Price L, Gibbons M, Matila D, Jarvis H, Lim L, Olaosebikan O, Ahmad S, Brill S, Mandal S, Laing C, Michael A, Reddy A, Johnson C, Baxendale H, Parfrey H, Mackie J, Newman J, Pack J, Parmar J, Paques K, Garner L, Harvey A, Summersgill C, Holgate D, Hardy E, Oxton J, Pendlebury J, McMorrow L, Mairs N, Majeed N, Dark P, Ugwuoke R, Knight S, Whittaker S, Strong-Sheldrake S, Matimba-Mupaya W, Chowienczyk P, Pattenadk D, Hurditch E, Chan F, Carborn H, Foot H, Bagshaw J, Hockridge J, Sidebottom J, Lee JH, Birchall K, Turner K, Haslam L, Holt L, Milner L, Begum M, Marshall M, Steele N, Tinker N, Ravencroft P, Butcher R, Misra S, Walker S, Coburn Z, Fairman A, Ford A, Holbourn A, Howell A, Lawrie A, Lye A, Mbuyisa A, Zawia A, Holroyd-Hind B, Thamu B, Clark C, Jarman C, Norman C, Roddis C, Foote D, Lee E, Ilyas F, Stephens G, Newell H, Turton H, Macharia I, Wilson I, Cole J, McNeill J, Meiring J, Rodger J, Watson J, Chapman K, Harrington K, Chetham L, Hesselden L, Nwafor L, Dixon M, Plowright M, Wade P, Gregory R, Lenagh R, Stimpson R, Megson S, Newman T, Cheng Y, Goodwin C, Heeley C, Sissons D, Sowter D, Gregory H, Wynter I, Hutchinson J, Kirk J, Bennett K, Slack K, Allsop L, Holloway L, Flynn M, Gill M, Greatorex M, Holmes M, Buckley P, Shelton S, Turner S, Sewell TA, Whitworth V, Lovegrove W, Tomlinson J, Warburton L, Painter S, Vickers C, Redwood D, Tilley J, Palmer S, Wainwright T, Breen G, Hotopf M, Dunleavy A, Teixeira J, Ali M, Mencias M, Msimanga N, Siddique S, Samakomva T, Tavoukjian V, Forton D, Ahmed R, Cook A, Thaivalappil F, Connor L, Rees T, McNarry M, Williams N, McCormick J, McIntosh J, Vere J, Coulding M, Kilroy S, Turner V, Butt AT, Savill H, Fraile E, Ugoji J, Landers G, Lota H, Portukhay S, Nasseri M, Daniels A, Hormis A, Ingham J, Zeidan L, Osborne L, Chablani M, Banerjee A, David A, Pakzad A, Rangelov B, Williams B, Denneny E, Willoughby J, Xu M, Mehta P, Batterham R, Bell R, Aslani S, Lilaonitkul W, Checkley A, Bang D, Basire D, Lomas D, Wall E, Plant H, Roy K, Heightman M, Lipman M, Merida Morillas M, Ahwireng N, Chambers RC, Jastrub R, Logan S, Hillman T, Botkai A, Casey A, Neal A, Newton-Cox A, Cooper B, Atkin C, McGee C, Welch C, Wilson D, Sapey E, Qureshi H, Hazeldine J, Lord JM, Nyaboko J, Short J, Stockley J, Dasgin J, Draxlbauer K, Isaacs K, Mcgee K, Yip KP, Ratcliffe L, Bates M, Ventura M, Ahmad Haider N, Gautam N, Baggott R, Holden S, Madathil S, Walder S, Yasmin S, Hiwot T, Jackson T, Soulsby T, Kamwa V, Peterkin Z, Suleiman Z, Chaudhuri N, Wheeler H, Djukanovic R, Samuel R, Sass T, Wallis T, Marshall B, Childs C, Marouzet E, Harvey M, Fletcher S, Dickens C, Beckett P, Nanda U, Daynes E, Charalambou A, Yousuf AJ, Lea A, Prickett A, Gooptu B, Hargadon B, Bourne C, Christie C, Edwardson C, Lee D, Baldry E, Stringer E, Woodhead F, Mills G, Arnold H, Aung H, Qureshi IN, Finch J, Skeemer J, Hadley K, Khunti K, Carr L, Ingram L, Aljaroof M, Bakali M, Bakau M, Baldwin M, Bourne M, Pareek M, Soares M, Tobin M, Armstrong N, Brunskill N, Goodman N, Cairns P, Haldar P, McCourt P, Dowling R, Russell R, Diver S, Edwards S, Glover S, Parker S, Siddiqui S, Ward TJC, Mcnally T, Thornton T, Yates T, Ibrahim W, Monteiro W, Thickett D, Wilkinson D, Broome M, McArdle P, Upthegrove R, Wraith D, Langenberg C, Summers C, Bullmore E, Heeney JL, Schwaeble W, Sudlow CL, Adeloye D, Newby DE, Rudan I, Shankar-Hari M, Thorpe M, Pius R, Walmsley S, McGovern A, Ballard C, Allan L, Dennis J, Cavanagh J, Petrie J, O'Donnell K, Spears M, Sattar N, MacDonald S, Guthrie E, Henderson M, Guillen Guio B, Zhao B, Lawson C, Overton C, Taylor C, Tong C, Mukaetova-Ladinska E, Turner E, Pearl JE, Sargant J, Wormleighton J, Bingham M, Sharma M, Steiner M, Samani N, Novotny P, Free R, Allen RJ, Finney S, Terry S, Brugha T, Plekhanova T, McArdle A, Vinson B, Spencer LG, Reynolds W, Ashworth M, Deakin B, Chinoy H, Abel K, Harvie M, Stanel S, Rostron A, Coleman C, Baguley D, Hufton E, Khan F, Hall I, Stewart I, Fabbri L, Wright L, Kitterick P, Morriss R, Johnson S, Bates A, Antoniades C, Clark D, Bhui K, Channon KM, Motohashi K, Sigfrid L, Husain M, Webster M, Fu X, Li X, Kingham L, Klenerman P, Miiler K, Carson G, Simons G, Huneke N, Calder PC, Baldwin D, Bain S, Lasserson D, Daines L, Bright E, Stern M, Crisp P, Dharmagunawardena R, Reddington A, Wight A, Bailey L, Ashish A, Robinson E, Cooper J, Broadley A, Turnbull A, Brookes C, Sarginson C, Ionita D, Redfearn H, Elliott K, Barman L, Griffiths L, Guy Z, Gill R, Nathu R, Harris E, Moss P, Finnigan J, Saunders K, Saunders P, Kon S, Kon SS, O'Brien L, Shah K, Shah P, Richardson E, Brown V, Brown M, Brown J, Brown J, Brown A, Brown A, Brown M, Choudhury N, Jones S, Jones H, Jones L, Jones I, Jones G, Jones H, Jones D, Davies F, Davies E, Davies K, Davies G, Davies GA, Howard K, Porter J, Rowland J, Rowland A, Scott K, Singh S, Singh C, Thomas S, Thomas C, Lewis V, Lewis J, Lewis D, Harrison P, Francis C, Francis R, Hughes RA, Hughes J, Hughes AD, Thompson T, Kelly S, Smith D, Smith N, Smith A, Smith J, Smith L, Smith S, Evans T, Evans RI, Evans D, Evans R, Evans H, Evans J. Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study. Lancet Respir Med 2023; 11:1003-1019. [PMID: 37748493 PMCID: PMC7615263 DOI: 10.1016/s2213-2600(23)00262-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/16/2023] [Accepted: 06/30/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. METHODS In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. FINDINGS Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2-6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5-5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4-10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32-4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23-11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. INTERPRETATION After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification. FUNDING UK Research and Innovation and National Institute for Health Research.
Collapse
|
25
|
Goldney J, Dempsey PC, Henson J, Rowlands A, Bhattacharjee A, Chudasama YV, Razieh C, Laukkanen JA, Davies MJ, Khunti K, Yates T, Zaccardi F. Self-reported walking pace and 10-year cause-specific mortality: A UK biobank investigation. Prog Cardiovasc Dis 2023; 81:17-23. [PMID: 37778454 DOI: 10.1016/j.pcad.2023.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 09/24/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE To investigate associations of self-reported walking pace (SRWP) with relative and absolute risks of cause-specific mortality. PATIENTS AND METHODS In 391,652 UK Biobank participants recruited in 2006-2010, we estimated sex- and cause-specific (cardiovascular disease [CVD], cancer, other causes) mortality hazard ratios (HRs) and 10-year mortality risks across categories of SRWP (slow, average, brisk), accounting for confounders and competing risk. Censoring occurred in September 30, 2021 (England, Wales) and October 31, 2021 (Scotland). RESULTS Over a median follow-up of 12.6 years, 22,413 deaths occurred. In women, the HRs comparing brisk to slow SRWP were 0.74 (95% CI: 0.67, 0.82), 0.40 (0.33, 0.49), and 0.29 (0.26, 0.32) for cancer, CVD, and other causes of death, respectively, and 0.71 (0.64, 0.78), 0.38 (0.33, 0.44), and 0.29 (0.26, 0.32) in men. Compared to CVD, HRs were greater for other causes (women: 39.6% [6.2, 72.9]; men: 31.6% [9.8, 53.5]) and smaller for cancer (-45.8% [-58.3, -33.2] and - 45.9% [-54.8, -36.9], respectively). For all causes in both sexes, the 10-year mortality risk was higher in slow walkers, but varied across sex, age, and cause, resulting in different risk reductions comparing brisk to slow: the largest were for other causes of death at age 75 years [women: -6.8% (-7.7, -5.8); men: -9.5% (-10.6, -8.4)]. CONCLUSION Compared to slow walkers, brisk SRWP was associated with reduced cancer (smallest reduction), CVD, and other (largest) causes of death and may therefore be a useful clinical predictive marker. As absolute risk reductions varied across age, cause, and SRWP, certain groups may particularly benefit from interventions to increase SRWP.
Collapse
Affiliation(s)
- Jonathan Goldney
- Diabetes Research Centre, College of Life Sciences, University of Leicester, UK.
| | - Paddy C Dempsey
- Diabetes Research Centre, College of Life Sciences, University of Leicester, UK; NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester LE5 4PW, UK
| | - Joseph Henson
- Diabetes Research Centre, College of Life Sciences, University of Leicester, UK; NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester LE5 4PW, UK
| | - Alex Rowlands
- Diabetes Research Centre, College of Life Sciences, University of Leicester, UK; NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester LE5 4PW, UK
| | - Atanu Bhattacharjee
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, UK
| | - Yogini V Chudasama
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, UK
| | - Cameron Razieh
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, UK; Office for National Statistics, Newport, UK
| | - Jari A Laukkanen
- Institute of Clinical Medicine and Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Central Finland Health Care District Hospital District, Department of Medicine, Finland District, Jyväskylä, Finland
| | - Melanie J Davies
- Diabetes Research Centre, College of Life Sciences, University of Leicester, UK; NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester LE5 4PW, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, College of Life Sciences, University of Leicester, UK; NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester LE5 4PW, UK; Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, College of Life Sciences, University of Leicester, UK; NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester LE5 4PW, UK
| | - Francesco Zaccardi
- Diabetes Research Centre, College of Life Sciences, University of Leicester, UK; Leicester Real World Evidence Unit, Leicester Diabetes Centre, University of Leicester, UK
| |
Collapse
|
26
|
Athithan L, Gulsin GS, Henson J, Althagafi L, Redman E, Argyridou S, Parke KS, Yeo J, Yates T, Khunti K, Davies MJ, McCann GP, Brady EM. Response to a low-energy meal replacement plan on glycometabolic profile and reverse cardiac remodelling in type 2 diabetes: a comparison between South Asians and White Europeans. Ther Adv Endocrinol Metab 2023; 14:20420188231193231. [PMID: 37811525 PMCID: PMC10559709 DOI: 10.1177/20420188231193231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/21/2023] [Indexed: 10/10/2023] Open
Abstract
Background South Asians (SA) constitute a quarter of the global population and are disproportionally affected by both type 2 diabetes (T2D) and heart failure. There remains limited data of the acceptability and efficacy of low-energy meal replacement plans to induce remission of T2D in SA. Objectives The objective of this exploratory secondary analysis of the DIASTOLIC study was to determine if there was a differential uptake, glycometabolic and cardiovascular response to a low-energy meal replacement plan (MRP) between SA and White European (WE) people with T2D. Methods Obese adults with T2D without symptomatic cardiovascular disease were allocated a low-energy (~810 kcal/day) MRP as part of the DIASTOLIC study (NCT02590822). Comprehensive multiparametric cardiovascular magnetic resonance imaging, echocardiography, cardiopulmonary exercise testing and metabolic profiling were undertaken at baseline and 12 weeks. A comparison of change at 12 weeks between groups with baseline adjustment was undertaken. Results Fifteen WE and 12 SAs were allocated the MRP. All WE participants completed the MRP versus 8/12 (66%) SAs. The degree of concentric left ventricular remodelling was similar between ethnicities. Despite similar weight loss and reduction in liver fat percentage, SA had a lower reduction in Homeostatic Model Assessment for Insulin Resistance [-5.7 (95% CI: -7.3, -4.2) versus -8.6 (-9.7, -7.6), p = 0.005] and visceral adiposity compared to WE [-0.43% (-0.61, -0.25) versus -0.80% (-0.91, -0.68), p = 0.002]. Exercise capacity increased in WE with no change observed in SA. There was a trend towards more reverse remodelling in WE compared to SAs. Conclusions Compliance to the MRP was lower in SA versus WE. Overall, those completing the MRP saw improvements in weight, body composition and indices of glycaemic control irrespective of ethnicity. Whilst improvements in VAT and insulin resistance appear to be dampened in SA versus WE, given the small sample, larger studies are required to confirm or challenge this potential ethnic disparity. Trail registration NCT02590822.
Collapse
Affiliation(s)
- Lavanya Athithan
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Gaurav S. Gulsin
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Joseph Henson
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, General Hospital, Leicester, UK
| | - Loai Althagafi
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Emma Redman
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, General Hospital, Leicester, UK
| | - Stavroula Argyridou
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, General Hospital, Leicester, UK
| | - Kelly S. Parke
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Jian Yeo
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, General Hospital, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, General Hospital, Leicester, UK
| | - Melanie J. Davies
- Diabetes Research Centre, University of Leicester and the NIHR Leicester Biomedical Research Centre, General Hospital, Leicester, UK
| | - Gerry P. McCann
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - Emer M. Brady
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| |
Collapse
|
27
|
Verma S, Borlaug BA, Butler J, Davies MJ, Kitzman DW, Petrie MC, Shah SJ, Dhingra NK, Kosiborod MN. A big STEP for treatment of heart failure with preserved ejection fraction. Cell Metab 2023; 35:1681-1687. [PMID: 37643614 DOI: 10.1016/j.cmet.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/30/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023]
Abstract
In the STEP-HFpEF trial, 2.4 mg semaglutide produced marked improvements in heart failure-related symptoms, physical limitations, and exercise function, and reduced inflammation and body weight in individuals with obesity HFpEF phenotype. These data usher in a new paradigm of targeting obesity as a therapeutic strategy in HFpEF.
Collapse
Affiliation(s)
- Subodh Verma
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada.
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX, USA; Department of Medicine, University of Mississippi, Jackson, MS, USA
| | - Melanie J Davies
- Leicester Diabetes Research Centre, University of Leicester, Leicester, UK; Leicester National Institute for Health Research Biomedical Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Dalane W Kitzman
- Department of Internal Medicine, Sections of Cardiovascular Medicine and Geriatrics and Gerontology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Mark C Petrie
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, and Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nitish K Dhingra
- Division of Cardiac Surgery, St. Michael's Hospital of Unity Health Toronto, Toronto, ON, Canada
| | - Mikhail N Kosiborod
- Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
| |
Collapse
|
28
|
Jones PJ, Lavery L, Davies MJ, Webb D, Rowlands AV. Hotspots: Adherence in home foot temperature monitoring interventions for at-risk feet with diabetes-A narrative review. Diabet Med 2023; 40:e15189. [PMID: 37489103 DOI: 10.1111/dme.15189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/18/2023] [Accepted: 07/21/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Home foot temperature monitoring (HFTM) is recommended for those at moderate to high ulcer risk. Where a > 2.2°C difference in temperature between feet (hotspot) is detected, it is suggested that individuals (1) notify a healthcare professional (HCP); (2) reduce daily steps by 50%. We assess adherence to this and HFTM upon detecting a recurrent hotspot. METHODS PubMed and Google Scholar were searched until 9 June 2023 for English-language peer-reviewed HFTM studies which reported adherence to HFTM, daily step reduction or HCP hotspot notification. The search returned 1030 results excluding duplicates of which 28 were shortlisted and 11 included. RESULTS Typical adherence among HFTM study participants for >3 days per week was 61%-93% or >80% of study duration was 55.6%-83.1%. Monitoring foot temperatures >50% of the study duration was associated with decreased ulcer risk (Odds Ratio: 0.50, p < 0.001) in one study (n = 173), but no additional risk reduction was found for >80% adherence. Voluntary dropout was 5.2% (Smart mats); 8.1% (sock sensor) and 4.8%-35.8% (infrared thermometers). Only 16.9%-52.5% of participants notified an HCP upon hotspot detection. Objective evidence of adherence to 50% reduction in daily steps upon hotspot detection was limited to one study where the average step reduction was a pedometer-measured 51.2%. CONCLUSIONS Ulcer risk reduction through HFTM is poorly understood given only half of the participants notify HCPs of recurrent hotspots and the number of reducing daily steps is largely unknown. HFTM adherence and dropout are variable and more research is needed to determine factors affecting adherence and those likely to adhere.
Collapse
Affiliation(s)
- Petra J Jones
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Lawrence Lavery
- Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Melanie J Davies
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - David Webb
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester General Hospital, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Alex V Rowlands
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, Division of Health Sciences, University of South Australia, Adelaide, Australia
| |
Collapse
|
29
|
Goldney J, Sargeant JA, Davies MJ. Incretins and microvascular complications of diabetes: neuropathy, nephropathy, retinopathy and microangiopathy. Diabetologia 2023; 66:1832-1845. [PMID: 37597048 PMCID: PMC10474214 DOI: 10.1007/s00125-023-05988-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/17/2023] [Indexed: 08/21/2023]
Abstract
Glucagon-like peptide-1 receptor agonists (GLP-1RAs, incretin mimetics) and dipeptidyl peptidase-4 inhibitors (DPP-4is, incretin enhancers) are glucose-lowering therapies with proven cardiovascular safety, but their effect on microvascular disease is not fully understood. Both therapies increase GLP-1 receptor agonism, which is associated with attenuation of numerous pathological processes that may lead to microvascular benefits, including decreased reactive oxygen species (ROS) production, decreased inflammation and improved vascular function. DPP-4is also increase stromal cell-derived factor-1 (SDF-1), which is associated with neovascularisation and tissue repair. Rodent studies demonstrate several benefits of these agents in the prevention or reversal of nephropathy, retinopathy and neuropathy, but evidence from human populations is less clear. For nephropathy risk in human clinical trials, meta-analyses demonstrate that GLP-1RAs reduce the risk of a composite renal outcome (doubling of serum creatinine, eGFR reduction of 30%, end-stage renal disease or renal death), whereas the benefits of DPP-4is appear to be limited to reductions in the risk of albuminuria. The relationship between GLP-1RAs and retinopathy is less clear. Many large trials and meta-analyses show no effect, but an observed increase in the risk of retinopathy complications with semaglutide therapy (a GLP-1RA) in the SUSTAIN-6 trial warrants caution, particularly in individuals with baseline retinopathy. Similarly, DPP-4is are associated with increased retinopathy risk in both trials and meta-analysis. The association between GLP-1RAs and peripheral neuropathy is unclear due to little trial evidence. For DPP-4is, one trial and several observational studies show a reduced risk of peripheral neuropathy, with others reporting no effect. Evidence in other less-established microvascular outcomes, such as microvascular angina, cerebral small vessel disease, skeletal muscle microvascular disease and autonomic neuropathies (e.g. cardiac autonomic neuropathy, gastroparesis, erectile dysfunction), is sparse. In conclusion, GLP-1RAs are protective against nephropathy, whereas DPP-4is are protective against albuminuria and potentially peripheral neuropathy. Caution is advised with DPP-4is and semaglutide, particularly for patients with background retinopathy, due to increased risk of retinopathy. Well-designed trials powered for microvascular outcomes are needed to clarify associations of incretin therapies and microvascular diseases.
Collapse
Affiliation(s)
- Jonathan Goldney
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK.
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK.
| | - Jack A Sargeant
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| |
Collapse
|
30
|
Katsarova SS, Redman E, Arsenyadis F, Brady EM, Rowlands AV, Edwardson CL, Goff LM, Khunti K, Yates T, Hall AP, Davies MJ, Henson J. Differences in Dietary Intake, Eating Occasion Timings and Eating Windows between Chronotypes in Adults Living with Type 2 Diabetes Mellitus. Nutrients 2023; 15:3868. [PMID: 37764651 PMCID: PMC10537296 DOI: 10.3390/nu15183868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
Chronotype studies investigating dietary intake, eating occasions (EO) and eating windows (EW) are sparse in people with type 2 Diabetes mellitus (T2DM). This analysis reports data from the CODEC study. The Morningness-Eveningness questionnaire (MEQ) assessed chronotype preference. Diet diaries assessed dietary intake and temporal distribution. Regression analysis assessed whether dietary intake, EW, or EO differed by chronotype. 411 participants were included in this analysis. There were no differences in energy, macronutrient intake or EW between chronotypes. Compared to evening chronotypes, morning and intermediate chronotypes consumed 36.8 (95% CI: 11.1, 62.5) and 20.9 (95% CI: -2.1, 44.1) fewer milligrams of caffeine per day, respectively. Evening chronotypes woke up over an hour and a half later than morning (01:36 95% CI: 01:09, 02:03) and over half an hour later than intermediate chronotypes (00:45 95% CI: 00:21; 01:09. Evening chronotypes went to sleep over an hour and a half later than morning (01:48 95% CI: 01:23; 02:13) and an hour later than intermediate chronotypes (01:07 95% CI: 00:45; 01:30). Evening chronotypes' EOs and last caffeine intake occurred later but relative to their sleep timings. Future research should investigate the impact of chronotype and dietary temporal distribution on glucose control to optimise T2DM interventions.
Collapse
Affiliation(s)
- Stanislava S. Katsarova
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, College of Life Sciences, University of Leicester, Leicester LE5 4PW, UK (J.H.)
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
| | - Emma Redman
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, College of Life Sciences, University of Leicester, Leicester LE5 4PW, UK (J.H.)
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
| | - Franciskos Arsenyadis
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, College of Life Sciences, University of Leicester, Leicester LE5 4PW, UK (J.H.)
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
| | - Emer M. Brady
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Alex V. Rowlands
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, College of Life Sciences, University of Leicester, Leicester LE5 4PW, UK (J.H.)
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute for Health Research, Division of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia
| | - Charlotte L. Edwardson
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, College of Life Sciences, University of Leicester, Leicester LE5 4PW, UK (J.H.)
| | - Louise M. Goff
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, College of Life Sciences, University of Leicester, Leicester LE5 4PW, UK (J.H.)
| | - Kamlesh Khunti
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, College of Life Sciences, University of Leicester, Leicester LE5 4PW, UK (J.H.)
- NIHR Applied Health Research Collaboration—East Midlands (NUHR ARC-EM), Leicester Diabetes Centre, Leicester LE5 4PW, UK
| | - Thomas Yates
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, College of Life Sciences, University of Leicester, Leicester LE5 4PW, UK (J.H.)
| | - Andrew P. Hall
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
- Hanning Sleep Laboratory, Leicester General Hospital, Leicester LE5 4PW, UK
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Melanie J. Davies
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, College of Life Sciences, University of Leicester, Leicester LE5 4PW, UK (J.H.)
| | - Joseph Henson
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, College of Life Sciences, University of Leicester, Leicester LE5 4PW, UK (J.H.)
| |
Collapse
|
31
|
Engin B, Willis SA, Malaikah S, Sargeant JA, Biddle GJH, Razieh C, Argyridou S, Edwardson CL, Jelleyman C, Stensel DJ, Henson J, Rowlands AV, Davies MJ, Yates T, King JA. Sedentary Time Is Independently Related to Adipose Tissue Insulin Resistance in Adults With or at Risk of Type 2 Diabetes. Med Sci Sports Exerc 2023; 55:1548-1554. [PMID: 37093903 DOI: 10.1249/mss.0000000000003193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
INTRODUCTION This cross-sectional study examined associations of device-measured sedentary time and moderate-to-vigorous physical activity (MVPA) with adipose tissue insulin resistance in people with or at high risk of type 2 diabetes (T2DM). METHOD Data were combined from six previous experimental studies (within our group) involving patients with T2DM or primary risk factors (median (interquartile range) age, 66.2 (66.0-70.8) yr; body mass index (BMI), 31.1 (28.0-34.4) kg·m -2 ; 62% male; n = 179). Adipose tissue insulin resistance was calculated as the product of fasted circulating insulin and nonesterified fatty acids (ADIPO-IR), whereas sedentary time and MVPA were determined from wrist-worn accelerometery. Generalized linear models examined associations of sedentary time and MVPA with ADIPO-IR with interaction terms added to explore the moderating influence of ethnicity (White European vs South Asian), BMI, age, and sex. RESULTS In finally adjusted models, sedentary time was positively associated with ADIPO-IR, with every 30 min of sedentary time associated with a 1.80-unit (95% confidence interval, 0.51-3.06; P = 0.006) higher ADIPO-IR. This relationship strengthened as BMI increased ( β = 3.48 (95% confidence interval, 1.50-5.46), P = 0.005 in the upper BMI tertile (≥33.2 kg·m -2 )). MVPA was unrelated to ADIPO-IR. These results were consistent in sensitivity analyses that excluded participants taking statins and/or metformin ( n = 126) and when separated into the participants with T2DM ( n = 32) and those at high risk ( n = 147). CONCLUSIONS Sedentary time is positively related to adipose tissue insulin sensitivity in people with or at high risk of T2DM. This relationship strengthens as BMI increases and may help explain established relationships between greater sedentary time, ectopic lipid, and hyperglycemia.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Charlotte Jelleyman
- Human Potential Centre, School of Sport and Recreation, Auckland University of Technology, Auckland, NEW ZEALAND
| | | | | | | | | | | | | |
Collapse
|
32
|
Edwardson CL, Maylor BD, Biddle SJ, Clemes SA, Cox E, Davies MJ, Dunstan DW, Eborall H, Granat MH, Gray LJ, Hadjiconstantinou M, Healy GN, Jaicim NB, Lawton S, Mandalia P, Munir F, Richardson G, Walker S, Yates T, Clarke-Cornwell AM. A multicomponent intervention to reduce daily sitting time in office workers: the SMART Work & Life three-arm cluster RCT. Public Health Res (Southampt) 2023; 11:1-229. [PMID: 37786938 DOI: 10.3310/dnyc2141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Abstract
Background Office workers spend 70-85% of their time at work sitting. High levels of sitting have been linked to poor physiological and psychological health. Evidence shows the need for fully powered randomised controlled trials, with long-term follow-up, to test the effectiveness of interventions to reduce sitting time. Objective Our objective was to test the clinical effectiveness and cost-effectiveness of the SMART Work & Life intervention, delivered with and without a height-adjustable workstation, compared with usual practice at 12-month follow-up. Design A three-arm cluster randomised controlled trial. Setting Councils in England. Participants Office workers. Intervention SMART Work & Life is a multicomponent intervention that includes behaviour change strategies, delivered by workplace champions. Clusters were randomised to (1) the SMART Work & Life intervention, (2) the SMART Work & Life intervention with a height-adjustable workstation (i.e. SMART Work & Life plus desk) or (3) a control group (i.e. usual practice). Outcome measures were assessed at baseline and at 3 and 12 months. Main outcome measures The primary outcome was device-assessed daily sitting time compared with usual practice at 12 months. Secondary outcomes included sitting, standing, stepping time, physical activity, adiposity, blood pressure, biochemical measures, musculoskeletal issues, psychosocial variables, work-related health, diet and sleep. Cost-effectiveness and process evaluation data were collected. Results A total of 78 clusters (756 participants) were randomised [control, 26 clusters (n = 267); SMART Work & Life only, 27 clusters (n = 249); SMART Work & Life plus desk, 25 clusters (n = 240)]. At 12 months, significant differences between groups were found in daily sitting time, with participants in the SMART Work & Life-only and SMART Work & Life plus desk arms sitting 22.2 minutes per day (97.5% confidence interval -38.8 to -5.7 minutes/day; p = 0.003) and 63.7 minutes per day (97.5% confidence interval -80.0 to -47.4 minutes/day; p < 0.001), respectively, less than the control group. Participants in the SMART Work & Life plus desk arm sat 41.7 minutes per day (95% confidence interval -56.3 to -27.0 minutes/day; p < 0.001) less than participants in the SMART Work & Life-only arm. Sitting time was largely replaced by standing time, and changes in daily behaviour were driven by changes during work hours on workdays. Behaviour changes observed at 12 months were similar to 3 months. At 12 months, small improvements were seen for stress, well-being and vigour in both intervention groups, and for pain in the lower extremity and social norms in the SMART Work & Life plus desk group. Results from the process evaluation supported these findings, with participants reporting feeling more energised, alert, focused and productive. The process evaluation also showed that participants viewed the intervention positively; however, the extent of engagement varied across clusters. The average cost of SMART Work & Life only and SMART Work & Life plus desk was £80.59 and £228.31 per participant, respectively. Within trial, SMART Work & Life only had an incremental cost-effectiveness ratio of £12,091 per quality-adjusted life-year, with SMART Work & Life plus desk being dominated. Over a lifetime, SMART Work & Life only and SMART Work & Life plus desk had incremental cost-effectiveness ratios of £4985 and £13,378 per quality-adjusted life-year, respectively. Limitations The study was carried out in one sector, limiting generalisability. Conclusions The SMART Work & Life intervention, provided with and without a height-adjustable workstation, was successful in changing sitting time. Future work There is a need for longer-term follow-up, as well as follow-up within different organisations. Trial registration Current Controlled Trials ISRCTN11618007.
Collapse
Affiliation(s)
| | | | - Stuart Jh Biddle
- Centre for Health Research, University of Southern Queensland, Springfield Central, QLD, Australia
| | - Stacy A Clemes
- NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Edward Cox
- Centre for Health Economics, University of York, York, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - David W Dunstan
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Helen Eborall
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | | | | | - Sarah Lawton
- School of Health & Society, University of Salford, Salford, UK
| | - Panna Mandalia
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | - Fehmidah Munir
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | | | - Simon Walker
- Centre for Health Economics, University of York, York, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | | |
Collapse
|
33
|
Borlaug BA, Kitzman DW, Davies MJ, Rasmussen S, Barros E, Butler J, Einfeldt MN, Hovingh GK, Møller DV, Petrie MC, Shah SJ, Verma S, Abhayaratna W, Ahmed FZ, Chopra V, Ezekowitz J, Fu M, Ito H, Lelonek M, Melenovsky V, Núñez J, Perna E, Schou M, Senni M, van der Meer P, Von Lewinski D, Wolf D, Kosiborod MN. Semaglutide in HFpEF across obesity class and by body weight reduction: a prespecified analysis of the STEP-HFpEF trial. Nat Med 2023; 29:2358-2365. [PMID: 37635157 PMCID: PMC10504076 DOI: 10.1038/s41591-023-02526-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/01/2023] [Indexed: 08/29/2023]
Abstract
In the STEP-HFpEF trial, semaglutide improved symptoms, physical limitations and exercise function and reduced body weight in patients with obesity phenotype of heart failure and preserved ejection fraction (HFpEF). This prespecified analysis examined the effects of semaglutide on dual primary endpoints (change in Kansas City Cardiomyopathy Questionnaire-Clinical Summary Score (KCCQ-CSS) and body weight) and confirmatory secondary endpoints (change in 6-minute walk distance (6MWD), hierarchical composite (death, HF events, change in KCCQ-CSS and 6MWD) and change in C-reactive protein (CRP)) across obesity classes I-III (body mass index (BMI) 30.0-34.9 kg m-2, 35.0-39.9 kg m-2 and ≥40 kg m-2) and according to body weight reduction with semaglutide after 52 weeks. Semaglutide consistently improved all outcomes across obesity categories (P value for treatment effects × BMI interactions = not significant for all). In semaglutide-treated patients, improvements in KCCQ-CSS, 6MWD and CRP were greater with larger body weight reduction (for example, 6.4-point (95% confidence interval (CI): 4.1, 8.8) and 14.4-m (95% CI: 5.5, 23.3) improvements in KCCQ-CSS and 6MWD for each 10% body weight reduction). In participants with obesity phenotype of HFpEF, semaglutide improved symptoms, physical limitations and exercise function and reduced inflammation and body weight across obesity categories. In semaglutide-treated patients, the magnitude of benefit was directly related to the extent of weight loss. Collectively, these data support semaglutide-mediated weight loss as a key treatment strategy in patients with obesity phenotype of HFpEF. ClinicalTrials.gov identifier: NCT04788511 .
Collapse
Affiliation(s)
- Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Dalane W Kitzman
- Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
| | | | | | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX and Department of Medicine, University of Mississippi, Jackson, MS, USA
| | | | | | | | - Mark C Petrie
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Subodh Verma
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, ON, Canada
| | - Walter Abhayaratna
- College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | - Fozia Z Ahmed
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Vijay Chopra
- Clinical Cardiology, Heart Failure and Research, Max Super Specialty Hospital, Saket, New Delhi, India
| | | | - Michael Fu
- Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Ostra, Gothenburg, Sweden
| | - Hiroshi Ito
- Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan
| | - Małgorzata Lelonek
- Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland
| | - Vojtech Melenovsky
- Institute for Clinical and Experimental Medicine - IKEM, Prague, Czech Republic
| | - Julio Núñez
- Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, and CIBER Cardiovascular, Valencia, Spain
| | - Eduardo Perna
- Instituto de Cardiologia J. F. Cabral, Corrientes, Argentina
| | - Morten Schou
- Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Michele Senni
- Cardiovascular Department, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Dennis Wolf
- Cardiology and Angiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Mikhail N Kosiborod
- Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
| |
Collapse
|
34
|
Shabnam S, Gillies CL, Davies MJ, Dex T, Melson E, Khunti K, Webb DR, Zaccardi F, Seidu S. Factors associated with therapeutic inertia in individuals with type 2 diabetes mellitus started on basal insulin. Diabetes Res Clin Pract 2023; 203:110888. [PMID: 37604284 DOI: 10.1016/j.diabres.2023.110888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/10/2023] [Accepted: 08/18/2023] [Indexed: 08/23/2023]
Abstract
AIM In this study we aim to identify the factors associated with treatment inertia in patients with type 2 diabetes mellitus (T2DM) who have been recently started on basal insulin (BI). METHODS Using UK CPRD GOLD, we identified adults with T2DM with suboptimal glycaemia (HbA1c within 12 months of BI ≥ 7% (≥53 mmol/mol)). We used multivariable Cox regression model to describe the association between patient characteristics and the time to treatment intensification. RESULTS A total of 12,556 patients were analysed. Compared to individuals aged < 65 years, those aged ≥ 65 years had lower risk of treatment intensification (HR: 0.69; 95% CI: 0.64-0.73). Other factors included being female (0.93, 0.89-0.99), longer T2DM duration (0.99, 0.98-0.99), living in the most deprived areas (0.90, 0.83-0.98), being a current smoker (0.91, 0.84-0.98), having one (0.91, 0.85-0.97) or more than one comorbidity (0.88, 0.82-0.94), and patients who were on metformin (0.71, 0.63-0.80), or 2nd generation sulphonylureas (0.85; 0.79-0.92) or DPP4 inhibitors (0.87, 0.82-0.93) compared to those who were not. CONCLUSION Therapeutic inertia still remains a major barrier, with multiple factors associated with delay in intensification. Interventions to overcome therapeutic inertia need to be implemented at both patient and health care professional level.
Collapse
Affiliation(s)
- Sharmin Shabnam
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester LE5 4PW, UK; Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, UK
| | - Clare L Gillies
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester LE5 4PW, UK; Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, UK
| | - Melanie J Davies
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester LE5 4PW, UK; Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, UK
| | - Terry Dex
- Department of Medical Affairs, Sanofi, Bridgewater, NJ, USA
| | - Eka Melson
- Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, UK
| | - Kamlesh Khunti
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester LE5 4PW, UK; Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, UK
| | - David R Webb
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester LE5 4PW, UK; Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, UK
| | - Francesco Zaccardi
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester LE5 4PW, UK; Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, UK
| | - Samuel Seidu
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester LE5 4PW, UK; Leicester Diabetes Centre, Leicester General Hospital, Leicester LE5 4PW, UK.
| |
Collapse
|
35
|
McBride P, Henson J, Edwardson CL, Maylor B, Dempsey PC, Rowlands AV, Davies MJ, Khunti K, Yates T. Four-Year Increase in Step Cadence Is Associated with Improved Cardiometabolic Health in People with a History of Prediabetes. Med Sci Sports Exerc 2023; 55:1601-1609. [PMID: 37005498 DOI: 10.1249/mss.0000000000003180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
PURPOSE To investigate associations between 4-yr change in step cadence and markers of cardiometabolic health in people with a history of prediabetes and to explore whether these associations are modified by demographic factors. METHODS In this prospective cohort study, adults, with a history of prediabetes, were assessed for markers of cardiometabolic health (body mass index, waist circumference, high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], triglycerides, and glycated hemoglobin A1c [HbA1c]), and free-living stepping activity (activPAL3™) at baseline, 1 yr, and 4 yr. Brisk steps per day were defined as the number of steps accumulated at ≥100 steps per minute and slow steps per day as those accumulated at <100 steps per minute; the mean peak stepping cadence during the most active 10 minutes of the day was also derived. Generalized estimating equations examined associations between 4-yr change in step cadence and change in cardiometabolic risk factors, with interactions by sex and ethnicity. RESULTS Seven hundred ninety-four participants were included (age, 59.8 ± 8.9 yr; 48.7% women; 27.1% ethnic minority; total steps per day, 8445 ± 3364; brisk steps per day, 4794 ± 2865; peak 10-min step cadence, 128 ± 10 steps per minute). Beneficial associations were observed between change in brisk steps per day and change in body mass index, waist circumference, HDL-C, and HbA1c. Similar associations were found between peak 10-min step cadence and HDL-C and waist circumference. Interactions by ethnicity revealed change in brisk steps per day and change in peak 10-min step cadence had a stronger association with HbA1c in White Europeans, whereas associations between change in 10-min peak step cadence with measures of adiposity were stronger in South Asians. CONCLUSIONS Change in the number of daily steps accumulated at a brisk pace was associated with beneficial change in adiposity, HDL-C, and HbA1c; however, potential benefits may be dependent on ethnicity for outcomes related to HbA1c and adiposity.
Collapse
|
36
|
Jin Z, Thackray AE, King JA, Deighton K, Davies MJ, Stensel DJ. Analytical Performance of the Factory-Calibrated Flash Glucose Monitoring System FreeStyle Libre2 TM in Healthy Women. Sensors (Basel) 2023; 23:7417. [PMID: 37687871 PMCID: PMC10490447 DOI: 10.3390/s23177417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023]
Abstract
Continuous glucose monitoring (CGM) is used clinically and for research purposes to capture glycaemic profiles. The accuracy of CGM among healthy populations has not been widely assessed. This study assessed agreement between glucose concentrations obtained from venous plasma and from CGM (FreeStyle Libre2TM, Abbott Diabetes Care, Witney, UK) in healthy women. Glucose concentrations were assessed after fasting and every 15 min after a standardized breakfast over a 4-h lab period. Accuracy of CGM was determined by Bland-Altman plot, 15/15% sensor agreement analysis, Clarke error grid analysis (EGA) and mean absolute relative difference (MARD). In all, 429 valid CGM readings with paired venous plasma glucose (VPG) values were obtained from 29 healthy women. Mean CGM readings were 1.14 mmol/L (95% CI: 0.97 to 1.30 mmol/L, p < 0.001) higher than VPG concentrations. Ratio 95% limits of agreement were from 0.68 to 2.20, and a proportional bias (slope: 0.22) was reported. Additionally, 45% of the CGM readings were within ±0.83 mmol/L (±15 mg/dL) or ±15% of VPG, while 85.3% were within EGA Zones A + B (clinically acceptable). MARD was 27.5% (95% CI: 20.8, 34.2%), with higher MARD values in the hypoglycaemia range and when VPG concentrations were falling. The FreeStyle Libre2TM CGM system tends to overestimate glucose concentrations compared to venous plasma samples in healthy women, especially during hypoglycaemia and during glycaemic swings.
Collapse
Affiliation(s)
- Zhuoxiu Jin
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK; (Z.J.); (A.E.T.); (J.A.K.)
| | - Alice E. Thackray
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK; (Z.J.); (A.E.T.); (J.A.K.)
- National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester National Health Service (NHS) Trust and the University of Leicester, Leicester LE1 5WW, UK;
| | - James A. King
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK; (Z.J.); (A.E.T.); (J.A.K.)
- National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester National Health Service (NHS) Trust and the University of Leicester, Leicester LE1 5WW, UK;
| | | | - Melanie J. Davies
- National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester National Health Service (NHS) Trust and the University of Leicester, Leicester LE1 5WW, UK;
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
| | - David J. Stensel
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK; (Z.J.); (A.E.T.); (J.A.K.)
- National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester National Health Service (NHS) Trust and the University of Leicester, Leicester LE1 5WW, UK;
- Faculty of Sport Sciences, Waseda University, Tokorozawa 359-1192, Japan
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Ma Liu Shui, Hong Kong 999077, China
| |
Collapse
|
37
|
Maylor BD, Edwardson CL, Clarke-Cornwell AM, Davies MJ, Dawkins NP, Dunstan DW, Khunti K, Yates T, Rowlands AV. Physical Activity Assessed by Wrist and Thigh Worn Accelerometry and Associations with Cardiometabolic Health. Sensors (Basel) 2023; 23:7353. [PMID: 37687813 PMCID: PMC10489920 DOI: 10.3390/s23177353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/20/2023] [Accepted: 08/08/2023] [Indexed: 09/10/2023]
Abstract
Physical activity is increasingly being captured by accelerometers worn on different body locations. The aim of this study was to examine the associations between physical activity volume (average acceleration), intensity (intensity gradient) and cardiometabolic health when assessed by a thigh-worn and wrist-worn accelerometer. A sample of 659 office workers wore an Axivity AX3 on the non-dominant wrist and an activPAL3 micro on the right thigh concurrently for 24 h a day for 8 days. An average acceleration (proxy for physical activity volume) and intensity gradient (intensity distribution) were calculated from both devices using the open-source raw accelerometer processing software GGIR. Clustered cardiometabolic risk (CMR) was calculated using markers of cardiometabolic health, including waist circumference, triglycerides, HDL-cholesterol, mean arterial pressure and fasting glucose. Linear regression analysis assessed the associations between physical activity volume and intensity gradient with cardiometabolic health. Physical activity volume derived from the thigh-worn activPAL and the wrist-worn Axivity were beneficially associated with CMR and the majority of individual health markers, but associations only remained significant after adjusting for physical activity intensity in the thigh-worn activPAL. Physical activity intensity was associated with CMR score and individual health markers when derived from the wrist-worn Axivity, and these associations were independent of volume. Associations between cardiometabolic health and physical activity volume were similarly captured by the thigh-worn activPAL and the wrist-worn Axivity. However, only the wrist-worn Axivity captured aspects of the intensity distribution associated with cardiometabolic health. This may relate to the reduced range of accelerations detected by the thigh-worn activPAL.
Collapse
Affiliation(s)
- Benjamin D. Maylor
- Diabetes Research Centre, Population Health Sciences, College of Life Sciences, University of Leicester, Leicester LE1 7RH, UK; (B.D.M.); (M.J.D.); (N.P.D.); (K.K.); (T.Y.); (A.V.R.)
- Assessment of Movement Behaviours Group (AMBer), Leicester Lifestyle and Health Research Group, Diabetes Research Centre, University of Leicester, Leicester LE1 7RH, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
| | - Charlotte L. Edwardson
- Diabetes Research Centre, Population Health Sciences, College of Life Sciences, University of Leicester, Leicester LE1 7RH, UK; (B.D.M.); (M.J.D.); (N.P.D.); (K.K.); (T.Y.); (A.V.R.)
- Assessment of Movement Behaviours Group (AMBer), Leicester Lifestyle and Health Research Group, Diabetes Research Centre, University of Leicester, Leicester LE1 7RH, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
| | | | - Melanie J. Davies
- Diabetes Research Centre, Population Health Sciences, College of Life Sciences, University of Leicester, Leicester LE1 7RH, UK; (B.D.M.); (M.J.D.); (N.P.D.); (K.K.); (T.Y.); (A.V.R.)
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
| | - Nathan P. Dawkins
- Diabetes Research Centre, Population Health Sciences, College of Life Sciences, University of Leicester, Leicester LE1 7RH, UK; (B.D.M.); (M.J.D.); (N.P.D.); (K.K.); (T.Y.); (A.V.R.)
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
- School of Sport and Wellbeing, Leeds Trinity University, Leeds LS18 5HD, UK
| | - David W. Dunstan
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia;
- Institute for Physical Activity and Nutrition, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia
| | - Kamlesh Khunti
- Diabetes Research Centre, Population Health Sciences, College of Life Sciences, University of Leicester, Leicester LE1 7RH, UK; (B.D.M.); (M.J.D.); (N.P.D.); (K.K.); (T.Y.); (A.V.R.)
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
- NIHR Applied Research Collaboration East Midlands, Diabetes Research Centre, University of Leicester, Leicester LE1 7RH, UK
| | - Tom Yates
- Diabetes Research Centre, Population Health Sciences, College of Life Sciences, University of Leicester, Leicester LE1 7RH, UK; (B.D.M.); (M.J.D.); (N.P.D.); (K.K.); (T.Y.); (A.V.R.)
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
| | - Alex V. Rowlands
- Diabetes Research Centre, Population Health Sciences, College of Life Sciences, University of Leicester, Leicester LE1 7RH, UK; (B.D.M.); (M.J.D.); (N.P.D.); (K.K.); (T.Y.); (A.V.R.)
- Assessment of Movement Behaviours Group (AMBer), Leicester Lifestyle and Health Research Group, Diabetes Research Centre, University of Leicester, Leicester LE1 7RH, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
| |
Collapse
|
38
|
Barker MM, Chauhan R, Davies MJ, Brough C, Northern A, Stribling B, Schreder S, Khunti K, Hadjiconstantinou M. User Retention and Engagement in the Digital-Based Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (myDESMOND) Program: Descriptive Longitudinal Study. JMIR Diabetes 2023; 8:e44943. [PMID: 37477963 PMCID: PMC10403792 DOI: 10.2196/44943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/06/2023] [Accepted: 05/24/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Digital health interventions have the potential to improve the physical and psychosocial health of people living with type 2 diabetes. However, research investigating the long-term (≥1 year) retention and engagement of users within these programs is limited. OBJECTIVE The aim of this study was to evaluate long-term user retention and engagement in the digital-based Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (myDESMOND) program, using real-world data. METHODS Anonymized data from all myDESMOND users who registered with the program on or before November 16, 2020, were included in the analyses. User retention was defined as the period between the day a user registered with the myDESMOND program and their last day of access. The primary engagement outcome was defined as the total number of log-ins to the program per user. The associations between retention, engagement, and sociodemographic factors (age, sex, and ethnicity) were tested using Cox regression models and Wilcoxon rank sum tests. RESULTS A total of 9522 myDESMOND users were included in this analysis. Of the 9522 users, 5360 (56.29%) remained on the program for at least a month, whereas 1676 (17.6%) remained on the program for at least 1 year. Retention was significantly higher among older users; the adjusted hazard ratio (representing the risk of users leaving the program within the first year) among users aged ≥50 years, compared with those aged <50 years, was 0.79 (95% CI 0.75-0.84; P<.001). The median number of myDESMOND log-ins per user was 8 (IQR 4-8); however, this was significantly lower among users aged <50 years (P<.001). Engagement metrics also differed according to sociodemographic characteristics; the estimated time spent per log-in was 5.35 (IQR 2.22-11.80) minutes among all users; however, this was significantly higher among female users (P<.001), users aged ≥50 years (P<.001), and users of White ethnicity (P=.02). CONCLUSIONS Although retention and engagement of users within myDESMOND were found to be high, these findings highlight the need for age- and culture-specific implementation strategies and content adaptations to improve retention and engagement among all users of self-management programs.
Collapse
Affiliation(s)
- Mary M Barker
- Diabetes Research Centre, University of Leicester, NIHR Leicester Biomedical Research Centre, Leicester, United Kingdom
- Institute of Environmental Medicine, karolinska institutet, Stockholm, Sweden
| | - Radhika Chauhan
- Diabetes Research Centre, University of Leicester, NIHR Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, NIHR Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - Christopher Brough
- Leicester Diabetes Centre, University Leicester Hospitals Trust, Leicester, United Kingdom
| | - Alison Northern
- Leicester Diabetes Centre, University Leicester Hospitals Trust, Leicester, United Kingdom
| | - Bernie Stribling
- Leicester Diabetes Centre, University Leicester Hospitals Trust, Leicester, United Kingdom
| | - Sally Schreder
- Leicester Diabetes Centre, University Leicester Hospitals Trust, Leicester, United Kingdom
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, NIHR Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - Michelle Hadjiconstantinou
- Diabetes Research Centre, University of Leicester, NIHR Leicester Biomedical Research Centre, Leicester, United Kingdom
| |
Collapse
|
39
|
Perks J, Zaccardi F, Rayt H, Sayers R, Brady EM, Davies MJ, Rowlands AV, Edwardson CL, Hall A, Yates T, Henson J. Device-measured physical activity behaviours, and physical function, in people with type 2 diabetes mellitus and peripheral artery disease: A cross-sectional study. Exp Gerontol 2023; 178:112207. [PMID: 37196824 DOI: 10.1016/j.exger.2023.112207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/11/2023] [Accepted: 05/14/2023] [Indexed: 05/19/2023]
Abstract
AIM To quantify differences in device-measured physical activity (PA) behaviours, and physical function (PF), in people with type 2 diabetes mellitus (T2DM) with and without peripheral artery disease (PAD). MATERIALS AND METHODS Participants from the Chronotype of Patients with T2DM and Effect on Glycaemic Control cross-sectional study wore accelerometers on their non-dominant wrist for up to 8-days to quantify: volume and intensity distribution of PA, time spent inactive, time in light PA, moderate-to-vigorous PA in at least 1-minute bouts (MVPA1min), and the average intensity achieved during the most active continuous 2, 5, 10, 30, and 60-minute periods of the 24-h day. PF was assessed using the short physical performance battery (SPPB), the Duke Activity Status Index (DASI), sit-to-stand repetitions in 60 s (STS-60); hand-grip strength was also assessed. Differences between subjects with and without PAD were estimated using regressions adjusted for possible confounders. RESULTS 736 participants with T2DM (without diabetic foot ulcers) were included in the analysis, 689 had no PAD. People with T2DM and PAD undertake less PA (MVPA1min: -9.2 min [95 % CI: -15.3 to -3.0; p = 0.004]) (light intensity PA: -18.7 min [-36.4 to -1.0; p = 0.039]), spend more time inactive (49.2 min [12.1 to 86.2; p = 0.009]), and have reduced PF (SPPB score: -1.6 [-2.5 to -0.8; p = 0.001]) (DASI score: -14.8 [-19.8 to -9.8; p = 0.001]) (STS-60 repetitions: -7.1 [-10.5 to -3.8; p = 0.001]) compared to people without; some differences in PA were attenuated by confounders. Reduced intensity of activity for the most active continuous 2-30 min in the 24-h day, and reduced PF, persisted after accounting for confounders. There were no significant differences in hand-grip strength. CONCLUSIONS Findings from this cross-sectional study suggest that, the presence of PAD in T2DM may have been associated with lower PA levels and PF.
Collapse
Affiliation(s)
- Jemma Perks
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.
| | - Francesco Zaccardi
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Harjeet Rayt
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Robert Sayers
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Emer M Brady
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK; NIHR Leicester Biomedical Research Centre and Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Alex V Rowlands
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK; NIHR Leicester Biomedical Research Centre and Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Charlotte L Edwardson
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK; NIHR Leicester Biomedical Research Centre and Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Andrew Hall
- The Hanning Sleep Laboratory, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK; NIHR Leicester Biomedical Research Centre and Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| | - Joseph Henson
- Diabetes Research Centre, University Hospitals of Leicester NHS Trust, Leicester, UK; NIHR Leicester Biomedical Research Centre and Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK
| |
Collapse
|
40
|
Chudasama YV, Khunti K, Coles B, Gillies CL, Islam N, Rowlands AV, Seidu S, Razieh C, Davies MJ, Samani NJ, Yates T, Zaccardi F. Life expectancy following a cardiovascular event in individuals with and without type 2 diabetes: A UK multi-ethnic population-based observational study. Nutr Metab Cardiovasc Dis 2023; 33:1358-1366. [PMID: 37169664 DOI: 10.1016/j.numecd.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND AND AIMS We aimed to evaluate the life expectancy following the first cardiovascular disease (CVD) event by type 2 diabetes (T2D) status and ethnicity. METHODS AND RESULTS We used the Clinical Practice Research Datalink database in England (UK), linked to the Hospital Episode Statistics information, to identify individuals with and without T2D who survived a first CVD event between 1st Jan 2007 and 31st Dec 2017; subsequent death events were extracted from the Office for National Statistics database. Ethnicity was categorised as White, South Asian (SA), Black, or other. Flexible parametric survival models were used to estimate survival and predict life expectancy. 59,939 individuals with first CVD event were included: 7596 (12.7%) with T2D (60.9% men; mean age at event: 69.7 years [63.2 years in SA, 65.9 in Black, 70.2 in White]) and 52,343 without T2D (56.7% men; 65.9 years [54.7 in Black, 58.2 in SA, 66.3 in White]). Accounting for potential confounders (sex, deprivation, lipid-lowering medication, current smoking, and pre-existing hypertension), comparing individuals with vs without T2D the mortality rate was 53% higher in White (hazard ratio [HR]: 1.53 [95% CI: 1.44, 1.62]), corresponding to a potential loss of 3.87 (3.30, 4.44) life years at the age of 50 years in individuals with T2D. No evidence of a difference in life expectancy was observed in individuals of SA (HR: 0.82 [0.52, 1.29]; -1.36 [-4.58, 1.86] life years), Black (HR: 1.26 [0.59, 2.70]; 1.21 [-2.99, 5.41] life years); and other (HR: 1.64 [0.80, 3.39]; 3.89 [-2.28, 9.99] life years) ethnic group. CONCLUSION Following a CVD event, T2D is associated with a different prognosis and life years lost among ethnic groups.
Collapse
Affiliation(s)
- Yogini V Chudasama
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK.
| | - Kamlesh Khunti
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK.
| | - Briana Coles
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK.
| | - Clare L Gillies
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK.
| | - Nazrul Islam
- Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Alex V Rowlands
- NIHR Leicester Biomedical Research Centre, Leicester Diabetes Centre, Leicester, UK.
| | - Samuel Seidu
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK.
| | - Cameron Razieh
- NIHR Leicester Biomedical Research Centre, Leicester Diabetes Centre, Leicester, UK; Office for National Statistics, Newport, NP10 8XG, UK.
| | - Melanie J Davies
- NIHR Leicester Biomedical Research Centre, Leicester Diabetes Centre, Leicester, UK.
| | - Nilesh J Samani
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK.
| | - Thomas Yates
- NIHR Leicester Biomedical Research Centre, Leicester Diabetes Centre, Leicester, UK.
| | - Francesco Zaccardi
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK.
| |
Collapse
|
41
|
Davies MJ, Alibegovic AC, Jensen AB, Munikrishnappa R, Nordsborg RB, Braae UC. Real-world study of ethnic differences in glycaemic control and clinical characteristics among insulin-naïve people with type 2 diabetes initiating biphasic insulin aspart 30/70: A retrospective, observational cohort study in England. Diabetes Obes Metab 2023. [PMID: 37334526 DOI: 10.1111/dom.15165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/17/2023] [Accepted: 05/21/2023] [Indexed: 06/20/2023]
Abstract
AIMS This study investigated the ethnic differences in glycaemic levels and clinical characteristics among insulin-naïve people with type 2 diabetes (T2D) initiating biphasic insulin aspart 30/70 (BIAsp 30) in primary practice in England. MATERIALS AND METHODS Retrospective, observational cohort study utilizing data from the Clinical Practice Research Datalink Aurum database, including White, South Asian, Black and Chinese insulin-naïve adults with T2D, initiating BIAsp 30. The index date was that of the first BIAsp 30 prescription. Endpoints included change in glycated haemoglobin (HbA1c) and body mass index (BMI) 6 months post index. RESULTS In total, 11 186 eligible people were selected (9443 White, 1116 South Asian, 594 Black, 33 Chinese). HbA1c decreased across all subgroups 6 months post index: estimated %-point changes [95% CI of -2.32 (-2.36; -2.28) (White); -1.91 (-2.02; -1.80) (South Asian); -2.55 (-2.69; -2.40) (Black); and -2.64 (-3.24; -2.04) (Chinese)]. The BMI increased modestly 6 months post index in all subgroups [estimated changes (95% CI) kg/m2 : White, 0.92 (0.86; 0.99); South Asian, 0.60 (0.41; 0.78); Black, 1.41 (1.16; 1.65); and Chinese, 0.32 (-0.67; 1.30)]. In the overall population, hypoglycaemic event rates increased from 0.92 events per 100 patient-years before the index to 3.37 events per 100 patient-years post index; event numbers were too low to be analysed by subgroup. CONCLUSIONS Among insulin-naïve people with T2D initiating BIAsp 30, clinically meaningful HbA1c reductions in all ethnicities were observed. Some ethnic groups had larger reductions than others, but differences were small. In all groups, small BMI increases were seen, with small differences observed between groups. Hypoglycaemia rates were low.
Collapse
Affiliation(s)
- Melanie J Davies
- Diabetes Research Centre, College of Life Sciences, Leicester General Hospital, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | | | | | | | | | | |
Collapse
|
42
|
Rowlands AV, van Hees VT, Dawkins NP, Maylor BD, Plekhanova T, Henson J, Edwardson CL, Brady EM, Hall AP, Davies MJ, Yates T. Accelerometer-Assessed Physical Activity in People with Type 2 Diabetes: Accounting for Sleep when Determining Associations with Markers of Health. Sensors (Basel) 2023; 23:5382. [PMID: 37420551 DOI: 10.3390/s23125382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/03/2023] [Accepted: 06/05/2023] [Indexed: 07/09/2023]
Abstract
High physical activity levels during wake are beneficial for health, while high movement levels during sleep are detrimental to health. Our aim was to compare the associations of accelerometer-assessed physical activity and sleep disruption with adiposity and fitness using standardized and individualized wake and sleep windows. People (N = 609) with type 2 diabetes wore an accelerometer for up to 8 days. Waist circumference, body fat percentage, Short Physical Performance Battery (SPPB) test score, sit-to-stands, and resting heart rate were assessed. Physical activity was assessed via the average acceleration and intensity distribution (intensity gradient) over standardized (most active 16 continuous hours (M16h)) and individualized wake windows. Sleep disruption was assessed via the average acceleration over standardized (least active 8 continuous hours (L8h)) and individualized sleep windows. Average acceleration and intensity distribution during the wake window were beneficially associated with adiposity and fitness, while average acceleration during the sleep window was detrimentally associated with adiposity and fitness. Point estimates for the associations were slightly stronger for the standardized than for individualized wake/sleep windows. In conclusion, standardized wake and sleep windows may have stronger associations with health due to capturing variations in sleep durations across individuals, while individualized windows represent a purer measure of wake/sleep behaviors.
Collapse
Affiliation(s)
- Alex V Rowlands
- Assessment of Movement Behaviours Group (AMBer), Leicester Lifestyle and Health Research Group, Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE3 9QP, UK
| | | | - Nathan P Dawkins
- School of Sport and Wellbeing, Leeds Trinity University, Leeds LS18 5HD, UK
| | - Benjamin D Maylor
- Assessment of Movement Behaviours Group (AMBer), Leicester Lifestyle and Health Research Group, Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE3 9QP, UK
| | - Tatiana Plekhanova
- Assessment of Movement Behaviours Group (AMBer), Leicester Lifestyle and Health Research Group, Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE3 9QP, UK
| | - Joseph Henson
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE3 9QP, UK
- Leicester Lifestyle and Health Research Group, Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
| | - Charlotte L Edwardson
- Assessment of Movement Behaviours Group (AMBer), Leicester Lifestyle and Health Research Group, Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE3 9QP, UK
| | - Emer M Brady
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 7RH, UK
| | - Andrew P Hall
- Hanning Sleep Laboratory and Leicester General Hospital, University Hospitals of Leicester NHS Trust, Leicester LE5 4PW, UK
| | - Melanie J Davies
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE3 9QP, UK
| | - Thomas Yates
- National Institute for Health Research, Leicester Biomedical Research Centre, Leicester LE3 9QP, UK
- Leicester Lifestyle and Health Research Group, Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
| |
Collapse
|
43
|
Davies MJ, Ahmad E, Lim S, Lamptey R, Webb DR. Cancer is becoming the leading cause of death in diabetes - Authors' reply. Lancet 2023; 401:1849-1850. [PMID: 37270234 DOI: 10.1016/s0140-6736(23)00446-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/27/2023] [Indexed: 06/05/2023]
Affiliation(s)
- Melanie J Davies
- Diabetes Research Centre, University of Leicester and the Leicester NIHR Biomedical Research Centre, Leicester General Hospital, Leicester LE5 4PW, UK.
| | - Ehtasham Ahmad
- Diabetes Research Centre, University of Leicester and the Leicester NIHR Biomedical Research Centre, Leicester General Hospital, Leicester LE5 4PW, UK
| | - Soo Lim
- Seoul National University Bundang Hospital, Seoul, South Korea
| | - Roberta Lamptey
- Family Medicine Department, Korle Bu Teaching Hospital, Accra Ghana and Community Health Department, University of Ghana Medical School, Accra, Ghana
| | - David R Webb
- Diabetes Research Centre, University of Leicester and the Leicester NIHR Biomedical Research Centre, Leicester General Hospital, Leicester LE5 4PW, UK
| |
Collapse
|
44
|
Ioannidou E, Shabnam S, Abner S, Kaur N, Zaccardi F, Ray KK, Seidu S, Davies MJ, Khunti K, Gillies CL. Effect of more versus less intensive blood pressure control on cardiovascular, renal and mortality outcomes in people with type 2 diabetes: A systematic review and meta-analysis. Diabetes Metab Syndr 2023; 17:102782. [PMID: 37257222 DOI: 10.1016/j.dsx.2023.102782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/22/2023] [Accepted: 05/03/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND AND AIMS Currently, there is uncertainty as to whether blood pressure control in patients with type 2 diabetes should be treated to standard recommended levels or more intensively. METHODS Medline, EMBASE, CENTRAL, and Clinicaltrials.gov were searched between January 1, 2000 and April 20th, 2023. Outcomes considered were all-cause mortality, stroke, heart failure, cardiovascular disease, albuminuria, coronary heart disease, and renal outcomes. Random-effects meta-analyses estimated pooled relative risks and mean differences. RESULTS Nine trials enrolling 11,005 participants with type 2 diabetes were included. The pooled mean difference between the intensive and standard treatment groups at follow-up were -7.98 mmHg (95% CI: 12.19 to -3.76) in systolic blood pressure, and -5.08 mmHg (-7.00 to -3.17) in diastolic blood pressure; although between study heterogeneity was high for both meta-analyses (I2>85%). Intensive blood pressure lowering resulted in a reduction in risk of stroke (risk ratio 0.64; 0.52 to 0.79), and macro-albuminuria (0.77; 0.63 to 0.93). More intensive blood pressure control did not result in a statistically significant reduction in risk of all-cause mortality, heart failure, cardiovascular death, cardiovascular events, renal outcomes, and micro-albuminuria; although the direction of estimated effect was beneficial for all outcomes. CONCLUSIONS The use of intensive compared with standard blood pressure targets resulted in a significant reduction in blood pressure, stroke, and macro-albuminuria in patients with type 2 diabetes. The post-treatment blood pressure level in the intensive group was 125/73 mmHg, suggesting the current recommendations of 130/80 mmHg blood pressure or lower if tolerated, could be reduced further.
Collapse
Affiliation(s)
- Ekaterini Ioannidou
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, Leicester, LE5 4PW, UK
| | - Sharmin Shabnam
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK
| | - Sophia Abner
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK
| | - Navjot Kaur
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK
| | - Francesco Zaccardi
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK
| | - Kausik K Ray
- Imperial College London, South Kensington Campus, London, SW7 2AZ, UK
| | - Sam Seidu
- National Institute for Health Research (NIHR) Applied Research Collaboration - East Midlands (ARC-EM), Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK
| | - Melanie J Davies
- National Institute for Health Research (NIHR) Applied Research Collaboration - East Midlands (ARC-EM), Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK
| | - Kamlesh Khunti
- Professor of Primary Care Diabetes and Vascular Medicine, National Institute for Health Research (NIHR) Applied Research Collaboration - East Midlands (ARC-EM), Leicester Diabetes Centre, Leicester, LE5 4PW, UK.
| | - Clare L Gillies
- Leicester Real World Evidence Unit, Leicester Diabetes Centre, Leicester, LE5 4PW, UK
| |
Collapse
|
45
|
Dallosso H, Khunti K, Gray LJ, Hulley K, Ghaly M, Patel N, Kai J, Aujla N, Davies MJ, Yates T. Implementation of a diabetes prevention programme in a multi-ethnic community in primary care in England: An evaluation using constructs from the RE-AIM Framework. Prim Care Diabetes 2023:S1751-9918(23)00096-7. [PMID: 37246032 DOI: 10.1016/j.pcd.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/27/2023] [Accepted: 05/11/2023] [Indexed: 05/30/2023]
Abstract
AIMS To implement a diabetes prevention programme in primary care METHODS: The programme was implemented for 12 months in two neighbouring towns, served by eight general practices. Practices requested a referral pathway involving an external administrator running electronic searches and sending postal invitations. If interested, people called and booked a place on the programme. Practices were also provided with resources to refer people directly. Six Educators were trained to deliver the programme. The RE-AIM constructs "Adoption", "Reach" and "Uptake" were assessed. RESULTS All practices engaged in the searches and postal invitations. Overall, 3.9 % of those aged ≥ 25 years had an HbA1c level indicative of non-diabetic hyperglycaemia (NDH) and were invited. Overall uptake (attended as percentage of invited) was 16 % (practice range 10.5-26.6 %) and was highest in two practices where the invitation was followed by a telephone call. Four people were referred directly by their practice. Groups at risk of being excluded were the Bengali population and those unable to attend because of issues such as health, mobility and frailty. CONCLUSIONS Comprehensive electronic searches meant everyone previously diagnosed with NDH was invited to attend. Follow-up telephone call improved uptake and providing practices with resources to make these calls themselves would likely increase uptake further.
Collapse
Affiliation(s)
- Helen Dallosso
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK; NIHR Applied Research Collaboration East Midlands, UK
| | - Kamlesh Khunti
- NIHR Applied Research Collaboration East Midlands, UK; Diabetes Research Centre, University of Leicester, Leicester, UK.
| | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Kerry Hulley
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK; NIHR Applied Research Collaboration East Midlands, UK
| | - Mel Ghaly
- Charnwood Medical Group Practice, Loughborough, UK
| | - Naina Patel
- Research Development Service, University of Leicester, Leicester, UK
| | - Joe Kai
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Navneet Aujla
- Warwick Medical School, University of Warwick, Warwick, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK; NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Tom Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK; NIHR Leicester Biomedical Research Centre, Leicester, UK
| |
Collapse
|
46
|
Rowlands AV, Dempsey PC, Maylor B, Razieh C, Zaccardi F, Davies MJ, Khunti K, Yates T. Self-reported walking pace: A simple screening tool with lowest risk of all-cause mortality in those that 'walk the talk'. J Sports Sci 2023:1-9. [PMID: 37183448 DOI: 10.1080/02640414.2023.2209762] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
To determine whether the association between self-reported walking pace and all-cause mortality (ACM) persists across categories of accelerometer-assessed physical activity status. Data from 93,709 UK Biobank participants were included. Physical activity was assessed using wrist-worn accelerometers for 7-days. Participants accumulating <150 min/week moderate-to-vigorous- activity were classed as "inactive", ≥150 min/week moderate (≥3 METs) activity as "somewhat active" excluding those with ≥150 min/week upper-moderate-to-vigorous activity (≥4.3 METs), who were classed as "high-active". Over a 6.3 y (median) follow-up, 2,173 deaths occurred. More than half of slow walkers were "inactive", but only 26% of steady and 12% of brisk walkers. Associations between walking pace and ACM were consistent with those for activity. "High active" brisk walkers had the lowest risk of ACM (Hazard Ratio (HR) 0.22; 95% CI: 0.17,0.28), relative to "inactive" slow walkers. Within those classed as "inactive", steady (HR 0.54; 0.46,0.64) and brisk walkers (HR 0.42; 0.34,0.52) had lower risk than slow walkers. In conclusion, self-reported walking pace was associated with accelerometer-assessed physical activity with both exposures having similar associations with ACM. "inactive", steady, and brisk walkers had lower ACM risk than slow walkers. The pattern was similar for "High active" participants. Overall, "High active" brisk walkers had lowest risk.
Collapse
Affiliation(s)
- Alex V Rowlands
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, UK
| | - Paddy C Dempsey
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, UK
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Physical Activity & Behavioural Epidemiology Laboratories, Baker Heart & Diabetes Institute, Melbourne, Australia
| | - Benjamin Maylor
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, UK
| | - Cameron Razieh
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, UK
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
| | - Francesco Zaccardi
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
- NIHR Applied Research Collaboration - East Midlands (ARC-EM), Leicester General Hospital, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, UK
| |
Collapse
|
47
|
Thackray AE, Hinton EC, Alanazi TM, Dera AM, Fujihara K, Hamilton-Shield JP, King JA, Lithander FE, Miyashita M, Thompson J, Morgan PS, Davies MJ, Stensel DJ. Exploring the acute effects of running on cerebral blood flow and food cue reactivity in healthy young men using functional magnetic resonance imaging. Hum Brain Mapp 2023; 44:3815-3832. [PMID: 37145965 DOI: 10.1002/hbm.26314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/17/2023] [Accepted: 04/06/2023] [Indexed: 05/07/2023] Open
Abstract
Acute exercise suppresses appetite and alters food-cue reactivity, but the extent exercise-induced changes in cerebral blood flow (CBF) influences the blood-oxygen-level-dependent (BOLD) signal during appetite-related paradigms is not known. This study examined the impact of acute running on visual food-cue reactivity and explored whether such responses are influenced by CBF variability. In a randomised crossover design, 23 men (mean ± SD: 24 ± 4 years, 22.9 ± 2.1 kg/m2 ) completed fMRI scans before and after 60 min of running (68% ± 3% peak oxygen uptake) or rest (control). Five-minute pseudo-continuous arterial spin labelling fMRI scans were conducted for CBF assessment before and at four consecutive repeat acquisitions after exercise/rest. BOLD-fMRI was acquired during a food-cue reactivity task before and 28 min after exercise/rest. Food-cue reactivity analysis was performed with and without CBF adjustment. Subjective appetite ratings were assessed before, during and after exercise/rest. Exercise CBF was higher in grey matter, the posterior insula and in the region of the amygdala/hippocampus, and lower in the medial orbitofrontal cortex and dorsal striatum than control (main effect trial p ≤ .018). No time-by-trial interactions for CBF were identified (p ≥ .087). Exercise induced moderate-to-large reductions in subjective appetite ratings (Cohen's d = 0.53-0.84; p ≤ .024) and increased food-cue reactivity in the paracingulate gyrus, hippocampus, precuneous cortex, frontal pole and posterior cingulate gyrus. Accounting for CBF variability did not markedly alter detection of exercise-induced BOLD signal changes. Acute running evoked overall changes in CBF that were not time dependent and increased food-cue reactivity in regions implicated in attention, anticipation of reward, and episodic memory independent of CBF.
Collapse
Affiliation(s)
- Alice E Thackray
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
| | - Elanor C Hinton
- National Institute for Health and Care Research (NIHR) Bristol Biomedical Research Centre Nutrition Theme, University of Bristol, Bristol, UK
| | - Turki M Alanazi
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Al Ahsa, Saudi Arabia
- King Abdullah International Medical Research Center, Al Ahsa, Saudi Arabia
| | - Abdulrahman M Dera
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- College of Sport Sciences, Jeddah University, Saudi Arabia
| | - Kyoko Fujihara
- Graduate School of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Julian P Hamilton-Shield
- National Institute for Health and Care Research (NIHR) Bristol Biomedical Research Centre Nutrition Theme, University of Bristol, Bristol, UK
| | - James A King
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
| | - Fiona E Lithander
- National Institute for Health and Care Research (NIHR) Bristol Biomedical Research Centre Nutrition Theme, University of Bristol, Bristol, UK
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Department of Nutrition and Dietetics, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Julie Thompson
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, UK
| | - Paul S Morgan
- Radiological Sciences, School of Medicine, University of Nottingham, UK
- National Institute for Health and Care Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
| | - Melanie J Davies
- National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - David J Stensel
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Institute for Health and Care Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Ma Liu Shui, Hong Kong
| |
Collapse
|
48
|
Plekhanova T, Crawley E, Davies MJ, Gorely T, Harrington DM, Ioannidou E, Khunti K, Rowlands AV, Sherar LB, Yates T, Edwardson CL. Association between Chronotype and Physical Behaviours in Adolescent Girls. Children (Basel) 2023; 10:children10050819. [PMID: 37238367 DOI: 10.3390/children10050819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/05/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023]
Abstract
The aim of this study was to (1) describe accelerometer-assessed physical behaviours by chronotype, and (2) examine the association between chronotype and accelerometer-assessed physical behaviours in a cohort of adolescent girls. Chronotype (single question) and physical behaviours (GENEActiv accelerometer on the non-dominant wrist) were assessed in 965 adolescent girls (13.9 ± 0.8 years). Linear mixed-effects models examined the relationships among chronotype and physical behaviours (time in bed, total sleep time, sleep efficiency, sedentary time, overall, light and moderate-to-vigorous physical activity) on weekdays and weekend days. Over the 24 h day, participants spent 46% sedentary, 20% in light activity, 3% in moderate-to-vigorous physical activity, and 31% in 'time in bed'. Seventy percent of participants identified as 'evening' chronotypes. Compared to evening chronotypes, morning chronotypes engaged in less sedentary time (10 min/day) and had higher overall physical activity (1.3 mg/day, ~30 min of slow walking) on weekdays. Most girls identified as evening chronotypes with a large proportion of their day spent sedentary and a small amount in physical activities which may be exacerbated in evening chronotypes on weekdays. The results maybe be important for programmes aiming to promote physical activity in adolescent girls.
Collapse
Affiliation(s)
- Tatiana Plekhanova
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
| | - Emily Crawley
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
| | - Trish Gorely
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness IV2 3JH, UK
| | - Deirdre M Harrington
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow G1 1XQ, UK
| | | | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
| | - Alex V Rowlands
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
| | - Lauren B Sherar
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
| | - Tom Yates
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
| | - Charlotte L Edwardson
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, UK
- NIHR Leicester Biomedical Research Centre, Leicester LE5 4PW, UK
| |
Collapse
|
49
|
Bilak JM, Yeo JL, Gulsin GS, Marsh AM, Sian M, Dattani A, Ayton SL, Parke KS, Bain M, Pang W, Boulos S, Pierre TGS, Davies MJ, Yates T, McCann GP, Brady EM. Impact of the Remission of Type 2 Diabetes on Cardiovascular Structure and Function, Exercise Capacity and Risk Profile: A Propensity Matched Analysis. J Cardiovasc Dev Dis 2023; 10:191. [PMID: 37233158 PMCID: PMC10219263 DOI: 10.3390/jcdd10050191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/14/2023] [Accepted: 04/21/2023] [Indexed: 05/27/2023] Open
Abstract
Type 2 diabetes (T2D) confers a high risk of heart failure frequently with evidence of cardiovascular structural and functional abnormalities before symptom onset. The effects of remission of T2D on cardiovascular structure and function are unknown. The impact of the remission of T2D, beyond weight loss and glycaemia, on cardiovascular structure and function and exercise capacity is described. Adults with T2D without cardiovascular disease underwent multimodality cardiovascular imaging, cardiopulmonary exercise testing and cardiometabolic profiling. T2D remission cases (Glycated hemoglobin (HbA1c) < 6.5% without glucose-lowering therapy, ≥3 months) were propensity score matched 1:4 based on age, sex, ethnicity and time of exposure to those with active T2D (n = 100) with the nearest-neighbour method and 1:1 with non-T2D controls (n = 25). T2D remission was associated with a lower leptin-adiponectin ratio, hepatic steatosis and triglycerides, a trend towards greater exercise capacity and significantly lower minute ventilation/carbon dioxide production (VE/VCO2 slope) vs. active T2D (27.74 ± 3.95 vs. 30.52 ± 5.46, p < 0.0025). Evidence of concentric remodeling remained in T2D remission vs. controls (left ventricular mass/volume ratio 0.88 ± 0.10 vs. 0.80 ± 0.10, p < 0.025). T2D remission is associated with an improved metabolic risk profile and ventilatory response to exercise without concomitant improvements in cardiovascular structure or function. There is a requirement for continued attention to risk factor control for this important patient population.
Collapse
Affiliation(s)
- Joanna M. Bilak
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (J.M.B.); (J.L.Y.); (G.S.G.); (A.-M.M.); (A.D.); (S.L.A.)
| | - Jian L. Yeo
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (J.M.B.); (J.L.Y.); (G.S.G.); (A.-M.M.); (A.D.); (S.L.A.)
| | - Gaurav S. Gulsin
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (J.M.B.); (J.L.Y.); (G.S.G.); (A.-M.M.); (A.D.); (S.L.A.)
| | - Anna-Marie Marsh
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (J.M.B.); (J.L.Y.); (G.S.G.); (A.-M.M.); (A.D.); (S.L.A.)
| | - Manjit Sian
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (J.M.B.); (J.L.Y.); (G.S.G.); (A.-M.M.); (A.D.); (S.L.A.)
| | - Abhishek Dattani
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (J.M.B.); (J.L.Y.); (G.S.G.); (A.-M.M.); (A.D.); (S.L.A.)
| | - Sarah L. Ayton
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (J.M.B.); (J.L.Y.); (G.S.G.); (A.-M.M.); (A.D.); (S.L.A.)
| | - Kelly S. Parke
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (J.M.B.); (J.L.Y.); (G.S.G.); (A.-M.M.); (A.D.); (S.L.A.)
| | - Moira Bain
- Public and Patient Involvement Representative for National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK
| | - Wenjie Pang
- Resonance Health Ltd., Burswood, WA 6100, Australia
| | | | - Tim G. St Pierre
- School of Physics, The University of Western Australia, Perth, WA 6009, Australia
| | - Melanie J. Davies
- Diabetes Research Centre, NIHR Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (M.J.D.)
| | - Thomas Yates
- Diabetes Research Centre, NIHR Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (M.J.D.)
| | - Gerry P. McCann
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (J.M.B.); (J.L.Y.); (G.S.G.); (A.-M.M.); (A.D.); (S.L.A.)
| | - Emer M. Brady
- Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, Leicester LE3 9QP, UK; (J.M.B.); (J.L.Y.); (G.S.G.); (A.-M.M.); (A.D.); (S.L.A.)
| |
Collapse
|
50
|
Khunti K, Sukumar N, Waheed G, Gillies C, Dallosso H, Brough C, Davies MJ, Fitzpatrick C, Gray LJ, Highton P, Rowlands A, Schreder S, Yates T, Saravanan P. Structured group education programme and accompanying mHealth intervention to promote physical activity in women with a history of gestational diabetes: a randomized controlled trial. Diabet Med 2023:e15118. [PMID: 37062022 DOI: 10.1111/dme.15118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/04/2023] [Accepted: 04/12/2023] [Indexed: 04/17/2023]
Abstract
AIMS Assess effectiveness of a hybrid intervention targeting physical activity in women with prior gestational diabetes. METHODS Randomised controlled trial with parallel arms. 293 women (35.1±5.1 years; 40% ethnic minority) recruited from two hospitals and randomised to routine care or hybrid lifestyle intervention comprising two group sessions and access to a mobile-web-app. Primary outcome was change in objectively measured physical activity at 12 months. Secondary outcomes included self-efficacy for exercise, quality of life and anxiety and depression. Linear regression compared outcome measures between groups. RESULTS 83% of intervention participants attended at least one group session, of who 66% registered to use the app. There was a non-significant increase in physical activity at 12 months (between group difference of 0.95mg (95% CI: -0.46 to 2.37)), equivalent to approximately 500 steps per day. Intervention participants reported higher self-efficacy for exercise (0.54, 95%CI: 0.05 to 1.102; p=0.029), lower anxiety (-0.91, 95%CI: -1.74 to -0.09; p=0.031), and higher quality of life (0.05, 95%CI: 0.004 to 0.09; p=0.032), compared to controls. CONCLUSIONS The intervention improved confidence in exercise and quality of life. Further research is needed to improve participant engagement with physical activity interventions in multi-ethnic populations with a history of gestational diabetes.
Collapse
Affiliation(s)
- Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Applied Research Collaboration East Midlands, UK
| | - Nithya Sukumar
- Population, Evidence and Technologies, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Department of Diabetes, Endocrinology and Metabolism, George Eliot Hospital NHS Trust, Nuneaton, CV10 7DJ, UK
| | - Ghazala Waheed
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Clare Gillies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Helen Dallosso
- NIHR Applied Research Collaboration East Midlands, UK
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Chris Brough
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
- National Institute for Health Research, Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | | | - Laura J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Patrick Highton
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Applied Research Collaboration East Midlands, UK
| | - Alex Rowlands
- Diabetes Research Centre, University of Leicester, Leicester, UK
- National Institute for Health Research, Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Sally Schreder
- Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Tom Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
- National Institute for Health Research, Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | | |
Collapse
|