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Daly H.,Leicester Diabetes Center
Practical Diabetes | Year: 2014

Achieving better patient outcomes is something that often eludes us. We sail together with our patients through the rough seas of diabetes and its complications. As in the Bermuda triangle, both patient and health care professional can get lost at times; however, this process of being lost and finding our way back again can provide us with valuable lessons to become better at what we do and thus improve outcomes for the person with diabetes. This paper addresses the key elements of effective treatments for diabetes, the qualities needed to be a clinical champion, and the components needed to deliver high quality care. The paper delves into issues around leadership, passion and vision. It also addresses effective service delivery models, structured self-management education and health care professional training. Copyright © 2014 John Wiley & Sons, Ltd. Source


Gilani A.,NHS Glasgow | Davies M.,Leicester Diabetes Center | Khunti K.,Leicester Diabetes Center
Diabetic Hypoglycemia | Year: 2014

Most Muslims with diabetes will take part in Ramadan even though they may be exempt from doing so. In some countries a religious fast can last between 10 and 21 hours. The main risk of fasting to people with diabetes is hypoglycemia. People with diabetes who fast may have to alter the dose of their medications or modify their therapeutic regimen to avoid hypoglycemia, which can have adverse effects on glycemic control. Therapies which pose a high risk of hypoglycemia when used during fasting are sulfonylureas and insulin therapy. Metformin, incretin therapies and the newer sodium glucose co-transporter 2 inhibitor class have a low risk of hypoglycemia. The practice of fasting during Ramadan is advocated for all healthy individuals. If deemed detrimental to health then a person can be considered exempt from fasting; this includes frail and elderly people, pregnant and breast feeding women, children and people with multi-morbidities. Source


Yates T.,Lifestyle and Physical Activity Biomedical Research Unit | Yates T.,University of Leicester | Yates T.,Leicester Diabetes Center | Schulte P.J.,Duke University | And 13 more authors.
The Lancet | Year: 2014

Background The extent to which change in physical activity can modify the risk of cardiovascular disease in individuals at high cardiovascular risk is uncertain. We investigated whether baseline and change in objectively-assessed ambulatory activity is associated with the risk of a cardiovascular event in individuals at high cardiovascular risk with impaired glucose tolerance. Methods We assessed prospective data from the NAVIGATOR trial involving 9306 individuals with impaired glucose tolerance who were recruited in 40 countries between January, 2002, and January, 2004. Participants also either had existing cardiovascular disease (if age ≥50 years) or at least one additional cardiovascular risk factor (if age =55 years). Participants were followed-up for cardiovascular events (defi ned as cardiovascular mortality, non-fatal stroke, or myocardial infarction) for 6 years on average and had ambulatory activity assessed by pedometer at baseline and 12 months. Adjusted Cox proportional hazard models quantifi ed the association of baseline and change in ambulatory activity (from baseline to 12 months) with the risk of a subsequent cardiovascular event, after adjustment for each other and potential confounding variables. This study is registered with ClinicalTrials.gov NCT00097786. Findings During 45 211 person-years follow-up, 531 cardiovascular events occurred. Baseline ambulatory activity (hazard ratio [HR] per 2000 steps per day 0.90, 95% CI 0.84-0.96) and change in ambulatory activity (0.92, 0.86-0.99) were inversely associated with the risk of a cardiovascular event. Results for change in ambulatory activity were unaff ected when also adjusted for changes in body-mass index and other potential confounding variables at 12 months. Interpretation In individuals at high cardiovascular risk with impaired glucose tolerance, both baseline levels of daily ambulatory activity and change in ambulatory activity display a graded inverse association with the subsequent risk of a cardiovascular event. Funding Novartis Pharmaceuticals. Source


Webb D.R.,University of Leicester | Webb D.R.,Leicester Diabetes Center | Khunti K.,Leicester Diabetes Center | Khunti K.,University of Leicester | And 4 more authors.
Journal of Diabetes Research | Year: 2013

Aims. Adipocytokines are implicated in the pathogenesis of type 2 diabetes and may represent identifiable precursors of metabolic disease within high-risk groups. We investigated adiponectin, leptin, and TNF-α and assessed the contribution of these molecules to insulin resistance in south Asians. Hypothesis. South Asians have adverse adipocytokine profiles which associate with an HOMA-derived insulin resistance phenotype. Methods. We measured adipocytokine concentrations in south Asians with newly diagnosed impaired glucose tolerance or Type 2 Diabetes Mellitus in a case-control study. 158 (48.5% males) volunteers aged 25-75 years with risk factors for diabetes but no known vascular or metabolic disease provided serum samples for ELISA and bioplex assays. Results. Total adiponectin concentration progressively decreased across the glucose spectrum in both sexes. A reciprocal trend in leptin concentration was observed only in south Asian men. Adiponectin but not leptin independently associated with HOMA-derived insulin resistance after logistic multivariate regression. Conclusion. Diasporic south Asian populations have an adverse adipocytokine profile which deteriorates further with glucose dysregulation. Insulin resistance is inversely associated with adiponectin independent of BMI and waist circumference in south Asians, implying that adipocytokine interplay contributes to the pathogenesis of metabolic disease in this group. © 2013 D. R. Webb et al. Source


Seidu S.,Leicester Diabetes Center | Davies M.J.,Leicester Diabetes Center | Mostafa S.,Leicester Diabetes Center | de Lusignan S.,University of Surrey | Khunti K.,Leicester Diabetes Center
Postgraduate Medical Journal | Year: 2014

Introduction Approximately 366 million people worldwide live with diabetes and this figure is expected to rise. Among the correct diagnosis, there will be errors in the diagnosis, classification and coding, resulting in adverse health and financial implications. Aim To determine the prevalence and characteristics of diagnostic errors in people with diabetes managed in primary care settings. Methods We conducted a cross-sectional study in nine general practices in Leicester, UK, from May to August 2011, using a validated electronic toolkit. Searches identified cases with potential errors which were manually checked for accuracy. Results There were 54 088 patients and 2434 (4.5%) diagnosed with diabetes. Out of 316 people identified with potential errors with the toolkit, 180 (57%) had confirmed errors after manually reviewing the records, resulting in an error prevalence of 7.4%. Correctly coded people on registers had significantly greater glycated haemoglobin (HbA1c) reductions. There were no significant differences between patients with and without errors in their HbA1C, body mass index, age and size of practice. There was also no significant association of the errors with pay-for-performance initiatives; however, those patients not on disease register had worse glycaemic control. Conclusions A high prevalence of diabetic diagnostic errors was confirmed using medication, biochemical and demographic data. Larger studies are needed to more accurately assess the scale of this problem. Automation of these processes might be possible, which would allow searches to be even more user friendly. Source

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