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Tan L, Wang J, Han J, Sainsbury C, Denniston AK, Crowe FL, Toulis KA, Karamat MA, Yao M, Nirantharakumar K. Socioeconomic Deprivation and the Risk of Sight-Threatening Diabetic Retinopathy: A Population-Based Cohort Study in the U.K. Diabetes Care 2024; 47:844-848. [PMID: 38387082 DOI: 10.2337/dc23-1626] [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: 08/30/2023] [Accepted: 02/04/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE To evaluate the associations between socioeconomic deprivation and sight-threatening diabetic retinopathy (STDR) in individuals with type 1 diabetes (T1D) and type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS Data from 175,628 individuals with diabetes in the Health Improvement Network were used to assess the risk of STDR across Townsend Deprivation Index quantiles using Cox proportional hazard regression. RESULTS Among individuals with T1D, the risk of STDR was three times higher (adjusted hazard ratio [aHR] 2.67, 95% CI 1.05-7.78) in the most deprived quintile compared with the least deprived quintile. In T2D, the most deprived quintile had a 28% higher risk (aHR 1.28; 95% CI 1.15-1.43) than the least deprived quintile. CONCLUSIONS Increasing socioeconomic deprivation is associated with a higher risk of developing STDR in people with diabetes. This underscores persistent health disparities linked to poverty, even within a country offering free universal health care. Further research is needed to address health equity concerns in socioeconomically deprived regions.
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Affiliation(s)
- Luyuan Tan
- Institute of Applied Health Research, University of Birmingham, Birmingham, U.K
| | - Jingya Wang
- Institute of Applied Health Research, University of Birmingham, Birmingham, U.K
| | - Jieun Han
- Institute of Applied Health Research, University of Birmingham, Birmingham, U.K
| | | | - Alastair K Denniston
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, U.K
- National Institute for Health Research Birmingham Biomedical Research Centre, Birmingham, U.K
| | - Francesca L Crowe
- Institute of Applied Health Research, University of Birmingham, Birmingham, U.K
| | | | - Muhammad Ali Karamat
- Diabetes and Endocrinology Specialist Training Committee, Health Education West Midlands, Birmingham, U.K
| | - Mi Yao
- Department of General Practice, Peking University First Hospital, Beijing, China
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2
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Phillips K, Hazlehurst JM, Sheppard C, Bellary S, Hanif W, Karamat MA, Crowe FL, Stone A, Thomas GN, Peracha J, Fenton A, Sainsbury C, Nirantharakumar K, Dasgupta I. Inequalities in the management of diabetic kidney disease in UK primary care: A cross-sectional analysis of a large primary care database. Diabet Med 2024; 41:e15153. [PMID: 37223892 DOI: 10.1111/dme.15153] [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: 11/30/2022] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 05/25/2023]
Abstract
AIMS To determine differences in the management of diabetic kidney disease (DKD) relevant to patient sex, ethnicity and socio-economic group in UK primary care. METHODS A cross-sectional analysis as of January 1, 2019 was undertaken using the IQVIA Medical Research Data dataset, to determine the proportion of people with DKD managed in accordance with national guidelines, stratified by demographics. Robust Poisson regression models were used to calculate adjusted risk ratios (aRR) adjusting for age, sex, ethnicity and social deprivation. RESULTS Of the 2.3 million participants, 161,278 had type 1 or 2 diabetes, of which 32,905 had DKD. Of people with DKD, 60% had albumin creatinine ratio (ACR) measured, 64% achieved blood pressure (BP, <140/90 mmHg) target, 58% achieved glycosylated haemoglobin (HbA1c, <58 mmol/mol) target, 68% prescribed renin-angiotensin-aldosterone system (RAAS) inhibitor in the previous year. Compared to men, women were less likely to have creatinine: aRR 0.99 (95% CI 0.98-0.99), ACR: aRR 0.94 (0.92-0.96), BP: aRR 0.98 (0.97-0.99), HbA1c : aRR 0.99 (0.98-0.99) and serum cholesterol: aRR 0.97 (0.96-0.98) measured; achieve BP: aRR 0.95 (0.94-0.98) or total cholesterol (<5 mmol/L) targets: aRR 0.86 (0.84-0.87); or be prescribed RAAS inhibitors: aRR 0.92 (0.90-0.94) or statins: aRR 0.94 (0.92-0.95). Compared to the least deprived areas, people from the most deprived areas were less likely to have BP measurements: aRR 0.98 (0.96-0.99); achieve BP: aRR 0.91 (0.8-0.95) or HbA1c : aRR 0.88 (0.85-0.92) targets, or be prescribed RAAS inhibitors: aRR 0.91 (0.87-0.95). Compared to people of white ethnicity; those of black ethnicity were less likely to be prescribed statins aRR 0.91 (0.85-0.97). CONCLUSIONS There are unmet needs and inequalities in the management of DKD in the UK. Addressing these could reduce the increasing human and societal cost of managing DKD.
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Affiliation(s)
- Katherine Phillips
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jonathan M Hazlehurst
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Srikanth Bellary
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- School of Health and Life Sciences, Aston University, Birmingham, UK
| | - Wasim Hanif
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Muhammad Ali Karamat
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Francesca L Crowe
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Anna Stone
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - G Neil Thomas
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Javeria Peracha
- Renal Unit, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Anthony Fenton
- Department of Renal Medicine, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Christopher Sainsbury
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Department of Diabetes, Gartnavel General Hospital, Glasgow, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Midlands Health Data Research UK, University of Birmingham, Birmingham, UK
| | - Indranil Dasgupta
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Warwick Medical School, University of Warwick, Coventry, UK
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Crabtree TS, Griffin TP, Yap YW, Narendran P, Gallen G, Furlong N, Cranston I, Chakera A, Philbey C, Karamat MA, Saraf S, Kamaruddin S, Gurnell E, Chapman A, Hussain S, Elliott J, Leelarathna L, Ryder RE, Hammond P, Lumb A, Choudhary P, Wilmot EG. Hybrid Closed-Loop Therapy in Adults With Type 1 Diabetes and Above-Target HbA1c: A Real-world Observational Study. Diabetes Care 2023; 46:1831-1838. [PMID: 37566697 PMCID: PMC10516256 DOI: 10.2337/dc23-0635] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 04/11/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVE We explored longitudinal changes associated with switching to hybrid closed-loop (HCL) insulin delivery systems in adults with type 1 diabetes and elevated HbA1c levels despite the use of intermittently scanned continuous glucose monitoring (isCGM) and insulin pump therapy. RESEARCH DESIGN AND METHODS We undertook a pragmatic, preplanned observational study of participants included in the National Health Service England closed-loop pilot. Adults using isCGM and insulin pump across 31 diabetes centers in England with an HbA1c ≥8.5% who were willing to commence HCL therapy were included. Outcomes included change in HbA1c, sensor glucometrics, diabetes distress score, Gold score (hypoglycemia awareness), acute event rates, and user opinion of HCL. RESULTS In total, 570 HCL users were included (median age 40 [IQR 29-50] years, 67% female, and 85% White). Mean baseline HbA1c was 9.4 ± 0.9% (78.9 ± 9.1 mmol/mol) with a median follow-up of 5.1 (IQR 3.9-6.6) months. Of 520 users continuing HCL at follow-up, mean adjusted HbA1c reduced by 1.7% (95% CI 1.5, 1.8; P < 0.0001) (18.1 mmol/mol [95% CI 16.6, 19.6]; P < 0.0001). Time in range (70-180 mg/dL) increased from 34.2 to 61.9% (P < 0.001). Individuals with HbA1c of ≤58 mmol/mol rose from 0 to 39.4% (P < 0.0001), and those achieving ≥70% glucose time in range and <4% time below range increased from 0.8 to 28.2% (P < 0.0001). Almost all participants rated HCL therapy as having a positive impact on quality of life (94.7% [540 of 570]). CONCLUSIONS Use of HCL is associated with improvements in HbA1c, time in range, hypoglycemia, and diabetes-related distress and quality of life in people with type 1 diabetes in the real world.
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Affiliation(s)
- Thomas S.J. Crabtree
- Department of Diabetes and Endocrinology, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Trusts, Derby, U.K
- School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, U.K
| | - Tomás P. Griffin
- Leicester Diabetes Center, University Hospitals of Leicester, Leicester, U.K
- Diabetes Research Center, College of Health Sciences, University of Leicester, Leicester, U.K
| | - Yew W. Yap
- Department of Diabetes and Endocrinology, Aintree University Hospital, Liverpool University Hospital NHS Foundation Trust, Liverpool, U.K
| | - Parth Narendran
- Department of Diabetes, The Queen Elizabeth Hospital, Birmingham, Birmingham, U.K
- The Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, U.K
| | | | - Niall Furlong
- Diabetes Center, St. Helens Hospital, St. Helens and Knowsley Teaching Hospitals NHS Trust, Merseyside, U.K
| | - Iain Cranston
- Academic Department of Endocrinology and Diabetes Portsmouth Hospitals University NHS Trust, Queen Alexandra Hospital, Portsmouth, U.K
| | - Ali Chakera
- Department of Diabetes and Endocrinology, University Hospitals Sussex, Brighton, U.K
- Brighton and Sussex Medical School, Brighton, U.K
| | - Chris Philbey
- Department of Diabetes and Endocrinology, Harrogate and District NHS Trust, Harrogate, U.K
| | - Muhammad Ali Karamat
- Department of Diabetes and Endocrinology, Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, U.K
| | - Sanjay Saraf
- Department of Diabetes and Endocrinology, Good Hope Hospital, University Hospitals Birmingham NHS Foundation Trust, Sutton Coldfield, U.K
| | - Shafie Kamaruddin
- Department of Diabetes and Endocrinology, County Durham and Darlington Foundation Trust, Darlington, U.K
| | - Eleanor Gurnell
- Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Trust, Cambridge, U.K
| | - Alyson Chapman
- Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Manchester, U.K
| | - Sufyan Hussain
- Department of Diabetes, School of Cardiovascular, Metabolic Medicine and Sciences, King’s College London, London, U.K
- Department of Diabetes and Endocrinology, Guy’s and St. Thomas’ NHS Foundation Trust, London, U.K
| | - Jackie Elliott
- Diabetes and Endocrine Center, Sheffield Teaching Hospitals, Department of Oncology and Metabolism, The University of Sheffield, Sheffield, U.K
| | - Lalantha Leelarathna
- Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Manchester, U.K
| | - Robert E.J. Ryder
- Department of Diabetes and Endocrinology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, U.K
| | - Peter Hammond
- Department of Diabetes and Endocrinology, Harrogate and District NHS Trust, Harrogate, U.K
| | - Alistair Lumb
- Oxford Center for Diabetes Endocrinology and Metabolism, Oxford University Hospitals NHS Trust, Oxford, U.K
- National Institute for Health and Care Research, Oxford Biomedical Research Center, Oxford, U.K
| | - Pratik Choudhary
- Leicester Diabetes Center, University Hospitals of Leicester, Leicester, U.K
- Diabetes Research Center, College of Health Sciences, University of Leicester, Leicester, U.K
| | - Emma G. Wilmot
- Department of Diabetes and Endocrinology, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Trusts, Derby, U.K
- School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, U.K
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4
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Alshehri Z, Subramanian A, Adderley NJ, Gokhale KM, Karamat MA, Ray CJ, Kumar P, Nirantharakumar K, Tahrani AA. Risk of incident obstructive sleep apnoea in patients with type 1 diabetes: a population-based retrospective cohort study. Diabetologia 2022; 65:1353-1363. [PMID: 35608616 PMCID: PMC9283161 DOI: 10.1007/s00125-022-05714-5] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 02/02/2022] [Indexed: 11/29/2022]
Abstract
AIMS/HYPOTHESIS People with type 2 diabetes are at increased risk of developing obstructive sleep apnoea. However, it is not known whether people with type 1 diabetes are also at an increased risk of obstructive sleep apnoea. This study aimed to examine whether people with type 1 diabetes are at increased risk of incident obstructive sleep apnoea compared with a matched cohort without type 1 diabetes. METHODS We used a UK primary care database, The Health Improvement Network (THIN), to perform a retrospective cohort study between January 1995 and January 2018 comparing sleep apnoea incidence between patients with type 1 diabetes (exposed) and without type 1 diabetes (unexposed) (matched for age, sex, BMI and general practice). The outcome was incidence of obstructive sleep apnoea. Baseline covariates and characteristics were assessed at the start of the study based on the most recent value recorded prior to the index date. The Cox proportional hazards regression model was used to estimate unadjusted and adjusted hazard ratios, based on a complete-case analysis. RESULTS In total, 34,147 exposed and 129,500 matched unexposed patients were included. The median follow-up time was 5.43 years ((IQR 2.19-10.11), and the mean BMI was 25.82 kg/m2 (SD 4.33). The adjusted HR for incident obstructive sleep apnoea in patients with type 1 diabetes vs those without type 1 diabetes was 1.53 (95% CI 1.25, 1.86; p<0.001). Predictors of incident obstructive sleep apnoea in patients with type 1 diabetes were older age, male sex, obesity, being prescribed antihypertensive or lipid-lowering drugs, atrial fibrillation and depression. CONCLUSIONS/INTERPRETATION Individuals with type 1 diabetes are at increased risk of obstructive sleep apnoea compared with people without diabetes. Clinicians should suspect obstructive sleep apnoea in patients with type 1 diabetes if they are old, have obesity, are male, have atrial fibrillation or depression, or if they are taking lipid-lowering or antihypertensive drugs.
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Affiliation(s)
- Ziyad Alshehri
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK.
- Respiratory Therapy Department, Taibah University, Medina, Saudi Arabia.
| | | | - Nicola J Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Krishna M Gokhale
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Muhammad Ali Karamat
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Clare J Ray
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Prem Kumar
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | | | - Abd A Tahrani
- Department of Diabetes and Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
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5
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Wallett L, Kempegowda P, Melson E, Juszczak A, Thomas L, Zhou D, Holmes C, Karamat MA, Ghosh S, Hanif W, Johnson A, Narendran P, Bellary S. Differences in presentation, severity and management of DKA in type 1 and type 2 diabetes during the COVID-19 pandemic. Clin Med (Lond) 2021; 21:1-2. [PMID: 34078672 DOI: 10.7861/clinmed.21-2-s1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Lucy Wallett
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Punith Kempegowda
- University of Birmingham, Birmingham, UK, and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Eka Melson
- University of Birmingham, Birmingham, UK, and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Agata Juszczak
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | - Catherine Holmes
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Sandip Ghosh
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Wasim Hanif
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Parth Narendran
- University of Birmingham, Birmingham, UK, and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Srikanth Bellary
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK, and Aston University, Birmingham, UK
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6
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Hanif W, Ali SN, Bellary S, Patel V, Farooqi A, Karamat MA, Saeed M, Sivaprasad S, Patel K, Khunti K. Pharmacological management of South Asians with type 2 diabetes: Consensus recommendations from the South Asian Health Foundation. Diabet Med 2021; 38:e14497. [PMID: 33301625 DOI: 10.1111/dme.14497] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 07/25/2020] [Revised: 10/27/2020] [Accepted: 11/30/2020] [Indexed: 12/27/2022]
Abstract
South Asians constitute approximately 1.6 billion people from the Indian subcontinent, comprising Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka; and make up the largest diaspora globally. Compared to the White European population, this group is at a higher risk of developing type 2 diabetes along with cardiovascular, renal and eye complications. Over the recent years, a number of new therapies for type 2 diabetes have become available for which cardiovascular outcome trials (CVOTs) have been published. The recent ADA/EASD consensus guidelines on diabetes, pre-diabetes and cardiovascular diseases' offer a transitional shift in type 2 diabetes management. The new consensus recommendations are based on recent CVOTs, many of which had a representation of South Asian cohorts. In light of this new evidence, there is urgent need for an integrated, evidence-based, cost-effective and individualised approach specific for South Asians. This review takes into consideration the evidence from these CVOTs and provides best practice recommendations for optimal management of South Asian people with type 2 diabetes, alongside the previously published consensus report from South Asian Health Foundation in 2014 [1].
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Affiliation(s)
- Wasim Hanif
- Diabetes & Endocrinology, CSL Diabetes, University Hospitals of Birmingham, South Asian Health Foundation, Birmingham, UK
| | - Sarah N Ali
- Diabetes and Endocrinology, Royal Free London NHS Foundation Trust, Diabetes Working Group, South Asian Health Foundation, Birmingham, UK
| | - Srikanth Bellary
- School of Life and Health Sciences, Aston University, University Hospitals Birmingham, Birmingham, UK
| | - Vinod Patel
- Diabetes and Clinical Skills, Warwick Medical School, University of Warwick, Coventry, UK
- South Asian Health Foundation, Birmingham, UK
| | - Azhar Farooqi
- East Leicester Medical Practice, Leicester City CCG, BME Centre for Health, ARC East Midlands, Leicester, UK
| | - Muhammad Ali Karamat
- Diabetes and Endocrinology, UHB TPD Diabetes and Endocrinology, Health Education, Birmingham, UK
| | - Mujahid Saeed
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham, University of Birmingham, Birmingham, UK
| | - Sobha Sivaprasad
- NIHR Moorfields Biomedical Research Centre and UCL Institute of Ophthalmology, London, UK
| | - Kiran Patel
- South Asian Health Foundation, Birmingham, UK
- University Hospitals Coventry & Warwickshire NHS Trust, Warwick Medical School, University of Warwick, Coventry University, Coventry, UK
| | - Kamlesh Khunti
- South Asian Health Foundation, Birmingham, UK
- Primary Care Diabetes & Vascular Medicine, Diabetes Research Centre and The Centre for Black Minority Health, University of Leicester, Leicester, UK
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7
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Melson E, Davitadze M, Aftab M, Ng CY, Ooi E, Blaggan P, Chen W, Hanania T, Thomas L, Zhou D, Chandan JS, Senthil L, Arlt W, Sankar S, Ayuk J, Karamat MA, Kempegowda P. Simulation via instant messaging-Birmingham advance (SIMBA) model helped improve clinicians' confidence to manage cases in diabetes and endocrinology. BMC Med Educ 2020; 20:274. [PMID: 32811488 PMCID: PMC7437058 DOI: 10.1186/s12909-020-02190-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 08/04/2020] [Indexed: 05/09/2023]
Abstract
BACKGROUND Simulation-based learning (SBL) has been increasingly used in both undergraduate and postgraduate medical training curricula. The aim of Simulation via Instant Messaging-Birmingham Advance (SIMBA) is to create a simple virtual learning environment to improve trainees' self-reported confidence in diabetes and Endocrinology. METHODS This study was done as part of the continuous professional development for Health Education England West Midlands speciality trainees in diabetes and Endocrinology. Standardized transcripts of anonymized real-life endocrinology (endocrine session) and diabetes cases (diabetes session) were used in the simulation model. Trainees interacted with moderators through WhatsApp® in this model. All cases were then discussed in detail by a consultant endocrinologist with reference to local, national and international guidelines. Trainee acceptance rate and improvement in their self-reported confidence levels post-simulation were assessed. RESULTS 70.8% (n = 17/24) and 75% (n = 18/24) strongly agreed the simulation session accommodated their personal learning style and the session was engaging. 66.7% (n = 16/24) strongly felt that the simulation was worth their time. In the endocrine session, there was a significant improvement in trainees' confidence in the management of craniopharyngioma (p = 0.0179) and acromegaly (p = 0.0025). There was a trend towards improved confidence levels to manage Cushing's disease and macroprolactinoma. In diabetes session, there was a significant improvement in trainees' confidence to interpret continuous glucose monitor readings (p = 0.01). There was a trend towards improvement for managing monogenic diabetes, hypoglycaemic unawareness and interpreting Libre readings. Overall, there was a significant improvement in trainees' confidence in managing cases that were discussed post-simulation. CONCLUSION SIMBA is an effective learning model to improve trainees' confidence to manage various diabetes and endocrine case scenarios. More sessions with a variety of other speciality case scenarios are needed to further assess SIMBA's effectiveness and application in other areas of medical training.
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Affiliation(s)
- Eka Melson
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Meri Davitadze
- Clinic "Cardio", Tbilisi, Georgia
- Georgian-American Family Medicine Clinic "Medical House", Tbilisi, Georgia
| | - Manal Aftab
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Cai Ying Ng
- RCSI & UCD Malaysia Campus, George Town, Malaysia
| | - Emma Ooi
- RCSI & UCD Malaysia Campus, George Town, Malaysia
| | | | - Wentin Chen
- University of Birmingham Medical School, Birmingham, UK
| | - Thia Hanania
- University of Birmingham Medical School, Birmingham, UK
| | | | - Dengyi Zhou
- University of Birmingham Medical School, Birmingham, UK
| | - Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Latha Senthil
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sailesh Sankar
- Diabetes and Endocrinology Specialist Training Committee, Health Education West Midlands, Birmingham, UK
| | - John Ayuk
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Muhammad Ali Karamat
- Diabetes and Endocrinology Specialist Training Committee, Health Education West Midlands, Birmingham, UK
| | - Punith Kempegowda
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
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Chen W, Kempegowda P, Melson E, Davitadze M, Aftab M, Ooi E, Ng CY, Blaggan P, Hanania T, Thomas L, Zhou D, Sankar S, Ayuk J, Karamat MA. Simulation training using WhatsApp (Sim-thru-WhatsApp) improves doctors' confidence in endocrine and diabetes case management. Clin Med (Lond) 2020; 20:s62-s63. [PMID: 32409381 DOI: 10.7861/clinmed.20-2-s62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Wentin Chen
- University of Birmingham Medical School, Birmingham, UK
| | | | - Eka Melson
- Institute of Metabolism and Systems Research, Birmingham, UK
| | - Meri Davitadze
- Georgian-American Family Medicine Clinic 'Medical House', Tbilisi, Georgia
| | - Manal Aftab
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Emma Ooi
- RCSI & UCD Malaysia Campus, Pulau Pinang, Malaysia
| | - Cai Ying Ng
- RCSI & UCD Malaysia Campus, Pulau Pinang, Malaysia
| | | | - Thia Hanania
- University of Birmingham Medical School, Birmingham, UK
| | | | - Dengyi Zhou
- University of Birmingham Medical School, Birmingham, UK
| | - Sailesh Sankar
- Health Education England (West Midlands), Birmingham, UK
| | - John Ayuk
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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9
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Almulhem M, Susarla R, Alabdulaali L, Khunti K, Karamat MA, Rasiah T, Tahrani AA, Hanif W, Nirantharakumar K. The effect of Ramadan fasting on cardiovascular events and risk factors in patients with type 2 diabetes: A systematic review. Diabetes Res Clin Pract 2020; 159:107918. [PMID: 31711857 DOI: 10.1016/j.diabres.2019.107918] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 05/01/2019] [Revised: 10/02/2019] [Accepted: 11/05/2019] [Indexed: 12/21/2022]
Abstract
Ramadan is the fasting month in Islam. Muslims around the world observe Ramadan every year, including people with diabetes. Data on the association of fasting in people with diabetes are sparse. The purpose of this study is to assess the association of fasting on cardiovascular risk factors and events in people with diabetes. A comprehensive search was conducted in the following database: Embase, Medline, Cochrane library and CINAHL. The following key terms were used: Ramadan, Ramazan, Ramadhan, Muslim, Islam and fasting. Studies were eligible if they included people with Type 2 diabetes who fasted during Ramadan and reporting results on cardiovascular risk factors or events. Overall 22 studies met inclusion criteria for the review; five studies reported cardiovascular outcomes and 17 reported changes in risk factors. There is insufficient evidence to link Ramadan fasting with increased or reduced incidence of cardiovascular events in people with diabetes, though there were some indication stroke risk may be increased. Findings were inconsistent in term of risk factors as some favoured Ramadan and others did not..
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Affiliation(s)
- Munerah Almulhem
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, UK
| | - Radhika Susarla
- Institute of Translational Medicine, University of Birmingham, UK
| | - Luluh Alabdulaali
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
| | | | | | - Thayakaran Rasiah
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, UK
| | - Abd A Tahrani
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, UK.
| | - Wasim Hanif
- Diabetes Department, University Hospitals Birmingham NHS Foundation Trust, UK.
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Karamat MA, Dar S, Bellary S, Tahrani AA. Clinical and Cost Implications of Insulin Degludec in Patients with Type 1 Diabetes and Problematic Hypoglycemia: A Quality Improvement Project. Diabetes Ther 2018; 9:839-849. [PMID: 29549574 PMCID: PMC6104283 DOI: 10.1007/s13300-018-0400-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 01/23/2018] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION To assess the real-life clinical benefits and cost implications of switching from another basal insulin to insulin degludec (degludec) in patients with type 1 diabetes (T1D) on basal-bolus regimens with recurrent hypoglycemia and/or hypoglycemia unawareness. METHODS Patients with T1D who were aged ≥ 18 years, were on a basal-bolus regimen, and had switched to degludec plus bolus insulin for at least 6 months were included. Patients had to have switched to degludec as a result of recurrent hypoglycemia and/or hypoglycemia unawareness. RESULTS Six months of follow-up data were available for 42 patients. At 6 months, there was a significant reduction in median (interquartile range) HbA1c, from 8.6 (8.0-9.3)% [70 (64-78) mmol/mol] to 8.4 (7.9-8.9)% [68 (63-74) mmol/mol]; p < 0.05. Median daily basal insulin dose reduced significantly from 30.0 (14.7-45.0) to 25.5 (14.0-30.2) units; p < 0.0001. Data from hospital records showed reductions in the frequency of episodes of severe hypoglycemia from eight in the 6 months preceding degludec initiation to two in the 6 months following initiation. In the same period, diabetic ketoacidosis (DKA) episodes reduced from two before degludec initiation to no episodes after initiation. No patients reported worsening treatment satisfaction after switching to degludec. Considering the reductions in the basal dose required and the frequency of hypoglycemia episodes, we estimate that switching such patients to degludec from other basal insulins could provide significant savings in direct healthcare costs. CONCLUSION In patients with T1D, switching to degludec was associated with an improvement in HbA1c and reductions in basal insulin dose, severe hypoglycemia, and DKA. When used in appropriate patients, degludec could lead to significant cost savings. FUNDING Novo Nordisk.
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Affiliation(s)
- Muhammad Ali Karamat
- Department of Diabetes and Endocrinology, Diabetes Centre, Heartlands Hospital, Birmingham, UK.
- Institute of Metabolism and Systems, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK.
- Centre of Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK.
| | - Shujah Dar
- Department of Diabetes and Endocrinology, Queen Elizabeth Hospital, Birmingham, UK
| | - Srikanth Bellary
- Department of Diabetes and Endocrinology, Diabetes Centre, Heartlands Hospital, Birmingham, UK
- School of Life and Health Sciences, Aston University, Aston Triangle, Birmingham, UK
| | - Abd A Tahrani
- Department of Diabetes and Endocrinology, Diabetes Centre, Heartlands Hospital, Birmingham, UK
- Institute of Metabolism and Systems, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
- Centre of Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
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Khunti K, Bellary S, Karamat MA, Patel K, Patel V, Jones A, Gray J, Shepherd P, Hanif W. Representation of people of South Asian origin in cardiovascular outcome trials of glucose-lowering therapies in Type 2 diabetes. Diabet Med 2017; 34:64-68. [PMID: 26926478 DOI: 10.1111/dme.13103] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 08/20/2015] [Revised: 01/18/2016] [Accepted: 02/25/2016] [Indexed: 11/29/2022]
Abstract
AIMS Our aim was to investigate the proportional representation of people of South Asian origin in cardiovascular outcome trials of glucose-lowering drugs or strategies in Type 2 diabetes, noting that these are among the most significant pieces of evidence used to formulate the guidelines on which clinical practice is largely based. METHODS We searched for cardiovascular outcome trials in Type 2 diabetes published before January 2015, and extracted data on the ethnicity of participants. These were compared against expected values for proportional representation of South Asian individuals, based on population data from the USA, from the UK, and globally. RESULTS Twelve studies met our inclusion criteria and, of these, eight presented a sufficiently detailed breakdown of participant ethnicity to permit numerical analysis. In general, people of South Asian origin were found to be under-represented in trials compared with UK and global expectations and over-represented compared with US expectations. Among the eight trials for which South Asian representation could be reliably estimated, seven under-represented this group relative to the 11.2% of the UK diabetes population estimated to be South Asian, with the representation in these trials ranging from 0.0% to 10.0%. CONCLUSIONS Clinicians should exercise caution when generalizing the results of trials to their own practice, with regard to the ethnicity of individuals. Efforts should be made to improve reporting of ethnicity and improve diversity in trial recruitment, although we acknowledge that there are challenges that must be overcome to make this a reality.
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Affiliation(s)
- K Khunti
- Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - S Bellary
- Aston Research Centre for Healthy Ageing, Aston University, Birmingham, UK
| | - M A Karamat
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - K Patel
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - V Patel
- Warwick Medical School, University of Warwick, Coventry, UK
| | - A Jones
- SB Communications Group, London, UK
| | - J Gray
- SB Communications Group, London, UK
| | | | - W Hanif
- University Hospital Birmingham, Birmingham, UK
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