Wellington, New Zealand
Wellington, New Zealand

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Krebs J.D.,University of Otago | Krebs J.D.,Diabetes and Research Center | Parry-Strong A.,Diabetes and Research Center | Gamble E.,University of Otago | And 8 more authors.
Primary Care Diabetes | Year: 2013

Background: Group-based diabetes self-management education (DSME) programmes have been shown to be effective. A programme tailored for the unique social and ethnic environment of New Zealand (NZ) was developed using concepts from internationally developed programmes. Aim: To assess the effectiveness of a 6 week New Zealand specific DSME programme. Methods: In this observational study people with type 2 diabetes (aged 18-80 years) from diverse cultural backgrounds were recruited from primary care. Seventeen groups of six education sessions were run. Clinical data were collected from primary care at baseline, 3, 6 and 9 months. Participants also completed a self-administered questionnaire on diabetes knowledge, and self-management behaviours. Results: 107 participants, mean age 56.7 ± 11.3 years and mean duration of diabetes 7.5 ± 7 years (NZ European (44%), Maori (24%), Pacific (16%) and Indian (16%)), were enrolled. Confidence in self-managing diabetes, regular examination of feet, physical activity levels and smoking rates all improved. Glycaemic control improved between baseline and 6 months (HbA1C 64.9 ± 20.0 mmol/mol to 59.9 ± 13.9 mmol/mol (p < 0.05) (baseline 8.07% ± 1.80, 6 months 7.62% ± 1.25)), but was no different to baseline at 9 months. Systolic BP reduced from 131.9 ± 16.4 to 127.4 ± 18.2 mmHg (p < 0.05) at 6 months, but increased to baseline levels by 9 months. Diastolic BP, triglycerides and urine microalbumin:creatinine ratio were significantly reduced at 3, 6 and 9 months. Conclusion: A group-based DSME programme designed specifically for the NZ population was effective at improving aspects of diabetes care at 6 months. The attenuation of these improvements after 6 months suggests a refresher course at that time may be beneficial.


Krebs J.D.,University of Otago | Krebs J.D.,Diabetes and Research Center | Elley C.R.,University of Auckland | Parry-Strong A.,University of Otago | And 6 more authors.
Diabetologia | Year: 2012

Aims/hypothesis To compare the effectiveness of low-fat high-protein and low-fat high-carbohydrate dietary advice on weight loss, using group-based interventions, among overweight people with type 2 diabetes. Study design Multicentre parallel (1:1) design, blinded randomised controlled trial. Methods Individuals with type 2 diabetes aged 30-75 years and a BMI >27 kg/m 2 were randomised, by an independent statistician using sequentially numbered sealed envelopes, to be prescribed either a low-fat high-protein (30% of energy as protein, 40% as carbohydrate, 30% as fat) or a low-fat highcarbohydrate (15% of energy as protein, 55%as carbohydrate, 30% as fat) diet. Participants attended 18 group sessions over 12 months. Primary outcomes were change in weight and waist circumference assessed at baseline, 6 and 12 months. Secondary outcomes were body fatness, glycaemic control, lipid profile, blood pressure and renal function. A further assessment was undertaken 12 months after the intervention. Research assessors remained blinded to group allocation throughout. Intention-to-treat analysis was performed. Results A total of 419 participants were enrolled (mean±SD age 58±9.5 years,BMI 36.6±6.5 kg/m 2 and HbA 1c 8.1±1.2% (65 mmol/mol)). The study was completed by 70%(294/419). No differences between groups were found in change in weight or waist circumference during the intervention phase or the 12-month follow-up. Both groups had lost weight (2-3 kg, p<0.001) and reduced their waist circumference (2-3 cm, p<0.001) by 12 months and largely maintained this weight loss for the following 12 months. By 6 months, the difference in self-reported dietary protein between groups was small (1.1%total energy; p<0.001). No significant differences between groups were found in secondary outcomes: body fatness, HbA 1c, lipids, blood pressure and renal function. There were no important adverse effects. Conclusions/interpretation In a 'real-world' setting, prescription of an energy-reduced low-fat diet, with either increased protein or carbohydrate, results in similar modest losses in weight and waist circumference over 2 years. Trial registration: Australia New Zealand Clinical Trials Register ACTRN12606000490572 Funding: The Health Research Council of New Zealand (06/337). © 2012 Springer-Verlag.


Foo J.,Wakefield Clinic | Foo J.,University of Otago | Krebs J.,University of Otago | Krebs J.,Diabetes and Research Center | And 7 more authors.
Obesity Surgery | Year: 2011

The explanation for the rapid improvement in insulin resistance after Roux-en Y gastric bypass (RYGB) may involve mechanisms additional to caloric restriction and improvements in peripheral glucose disposal. 8 severely obese patients underwent a 6-day very low calorie diet (VLCD) (456 kcal/day) followed 1-3 weeks later by RYGB. Insulin resistance was measured by short intravenous insulin tolerance test (IVITT) and by homeostasis model assessment (HOMA) before and again 6 days after the VLCD and after RYGB. In a group of 24 matched patients, HOMA assessments were made before and six days after RYGB. HOMA-IR fell significantly from 6.84.9 to 4.32.9 (p<0.05) following VLCD, but this was less than the subsequent fall following RYGB (6.8±4.9 to 1.50.4, p<0.01). Control patients who underwent RYGB alone, reduced their HOMA-IR to 1.50.9 following the operation which was not significantly different from the VLCD then RYGB group. Following VLCD, IVITT showed no significant change. However, 6 days after RYGB, IVITT showed worsened insulin induced glucose uptake (p<0.05). Patients undergoing VLCD over six days had a reduction in HOMA-IR which was half that of patients undergoing RYGB. Patients who underwent both VLCD and RYGB had a total reduction in HOMA similar to those who underwent the RYGB alone. In contrast, IVITT showed a worsening in insulin induced glucose disposal following RYGB, which suggests worsening peripheral insulin resistance. This study supports the hypothesis that mechanisms other than caloric restriction are involved in the acute improvement in HOMA-IR following RYGB. © 2011 Springer Science + Business Media, LLC.


Haeusler S.,Victoria University of Wellington | Parry-Strong A.,Diabetes and Research Center | Krebs J.D.,University of Otago
New Zealand Medical Journal | Year: 2014

Aim Metformin, the most common hypoglycaemic agent used in type 2 diabetes, is associated with reduced serum vitamin B12 concentrations. This cross sectional observational study determines the prevalence of low vitamin B12 status in people with type 2 diabetes on metformin therapy in both primary and secondary care in New Zealand. Method All eligible patients seen in a secondary-care clinic over a 15-month timeframe were screened for low serum vitamin B12 concentrations. Additionally, patients from four primary health care providers were identified using metformin prescription data and offered the chance to participate in the audit. Results Prevalence of serum Vitamin B12 level <220 pmol/L was 18.7%. Positive correlations were observed between B 12 concentration, age and dosage and duration of metformin treatment. Māori and Pacific Islanders had higher mean serum B12 concentrations than Europeans but no difference in prevalence of low serum B12 concentrations. Conclusion Low serum B12 concentration is a common occurrence in people with type 2 Diabetes treated with Metformin. Age is an important factor which explains some of this association. Systematic screening in those receiving metformin is advisable, particularly for patients older than 50 years. © NZMA.


Mctavish L.,Diabetes and Research Center | Krebs J.D.,Diabetes and Research Center | Krebs J.D.,University of Otago | Weatherall M.,University of Otago | Wiltshire E.,University of Otago
Diabetic Medicine | Year: 2015

Aim: To determine whether a weight-based hypoglycaemia treatment using 0.3 g/kg (or 0.2 g/kg) glucose effectively treats adults with Type 1 diabetes mellitus compared with an internationally recommended 15-g treatment. Methods: Patients with frequent hypoglycaemia were recruited from hospital-based diabetes clinics. The treatment for each hypoglycaemic episode, defined as capillary glucose <4.0 mmol/l, was randomly assigned to one of three protocols: 0.2 g/kg, 0.3 g/kg, or 15 g, using DextroTM glucose tablets (Dextro Energy, Krefeld, Germany). Each participant received each treatment in random order for up to 15 hypoglycaemic episodes. Capillary glucose was re-tested 10 min after treatment, with a repeat dose if still < 4 mmol/l. Results: The study recruited 34 participants aged 22-71 years, whose mean (sd) BMI was 25.2 (3.1) kg/m2 and HbA1c 63 (10.4) mmol/mol [7.9 (0.9)%]. Two people withdrew because they did not like the taste of the Dextro tablets and one was excluded because they used their own glucose preparation. Unadjusted for clustering within participants, the mean (sd) capillary glucose after 10 min was 4.67 (1.25) mmol/l for 0.3 g/kg (141 episodes), 4.29 (0.94) mmol/l for 0.2 g/kg (132 episodes), and 4.37(0.99) mmol/l for 15 g (136 episodes). Capillary glucose, adjusted for clusters and baseline, was higher after 10 min for 0.3 g/kg glucose compared with 15 g glucose; a difference of 0.26 (95% CI 0.04-0.48) mmol/l (P = 0.02), but not for 0.2 g/kg; -0.07 (95% CI -0.29-0.16) mmol/l (P = 0.56). Capillary glucose for only three hypoglycaemic episodes rose above 8 mmol/l. Conclusions: A weight-based protocol of 0.3 g/kg glucose appears more effective for treating symptomatic hypoglycaemia in adults with Type 1 diabetes than either the most common current recommendation of 15 g glucose or a 0.2 g/kg glucose dose. © 2015 Diabetes UK.


PubMed | Diabetes and Research Center
Type: Editorial | Journal: The New Zealand medical journal | Year: 2014

Metformin, the most common hypoglycaemic agent used in type 2 diabetes, is associated with reduced serum vitamin B12 concentrations. This cross sectional observational study determines the prevalence of low vitamin B12 status in people with type 2 diabetes on metformin therapy in both primary and secondary care in New Zealand.All eligible patients seen in a secondary-care clinic over a 15-month timeframe were screened for low serum vitamin B12 concentrations. Additionally, patients from four primary health care providers were identified using metformin prescription data and offered the chance to participate in the audit.Prevalence of serum Vitamin B12 level <220 pmol/L was 18.7%. Positive correlations were observed between B 12 concentration, age and dosage and duration of metformin treatment. Maori and Pacific Islanders had higher mean serum B12 concentrations than Europeans but no difference in prevalence of low serum B12 concentrations.Low serum B12 concentration is a common occurrence in people with type 2 Diabetes treated with Metformin. Age is an important factor which explains some of this association. Systematic screening in those receiving metformin is advisable, particularly for patients older than 50 years.


PubMed | University of Otago and Diabetes and Research Center
Type: Journal Article | Journal: Diabetic medicine : a journal of the British Diabetic Association | Year: 2015

To determine whether a weight-based hypoglycaemia treatment using 0.3g/kg (or 0.2g/kg) glucose effectively treats adults with Type 1 diabetes mellitus compared with an internationally recommended 15-g treatment.Patients with frequent hypoglycaemia were recruited from hospital-based diabetes clinics. The treatment for each hypoglycaemic episode, defined as capillary glucose <4.0mmol/l, was randomly assigned to one of three protocols: 0.2g/kg, 0.3g/kg, or 15g, using Dextro(TM) glucose tablets (Dextro Energy, Krefeld, Germany). Each participant received each treatment in random order for up to 15 hypoglycaemic episodes. Capillary glucose was re-tested 10min after treatment, with a repeat dose if still < 4mmol/l.The study recruited 34 participants aged 22-71years, whose mean (sd) BMI was 25.2 (3.1) kg/m(2) and HbA1c 63 (10.4) mmol/mol [7.9 (0.9)%]. Two people withdrew because they did not like the taste of the Dextro tablets and one was excluded because they used their own glucose preparation. Unadjusted for clustering within participants, the mean (sd) capillary glucose after 10min was 4.67 (1.25) mmol/l for 0.3g/kg (141 episodes), 4.29 (0.94) mmol/l for 0.2g/kg (132 episodes), and 4.37(0.99) mmol/l for 15g (136 episodes). Capillary glucose, adjusted for clusters and baseline, was higher after 10min for 0.3g/kg glucose compared with 15g glucose; a difference of 0.26 (95% CI 0.04-0.48) mmol/l (P=0.02), but not for 0.2g/kg; -0.07 (95% CI -0.29-0.16) mmol/l (P=0.56). Capillary glucose for only three hypoglycaemic episodes rose above 8mmol/l.A weight-based protocol of 0.3g/kg glucose appears more effective for treating symptomatic hypoglycaemia in adults with Type 1 diabetes than either the most common current recommendation of 15g glucose or a 0.2g/kg glucose dose.

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