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Shapey IM, Summers A, Yiannoullou P, Fullwood C, Augustine T, Rutter MK, van Dellen D. Donor noradrenaline use is associated with better allograft survival in recipients of pancreas transplantation. Ann R Coll Surg Engl 2024; 106:19-28. [PMID: 36927080 PMCID: PMC10757882 DOI: 10.1308/rcsann.2022.0161] [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] [Accepted: 12/09/2022] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION Outcomes following pancreas transplantation are suboptimal and better donor selection is required to improve this. Vasoactive drugs (VaD) are commonly used to correct the abnormal haemodynamics of organ donors in intensive care units. VaDs can differentially affect insulin secretion positively (dobutamine) or negatively (noradrenaline). The hypothesis was that some VaDs might induce beta-cell stress or rest and therefore impact pancreas transplant outcomes. The aim of the study was to assess relationships between VaD use and pancreas transplant graft survival. METHODS Data from the UK Transplant Registry on all pancreas transplants performed between 2004 and 2016 with complete follow-up data were included. Univariable- and multivariable-adjusted Cox regression analyses determined risks of graft failure associated with VaD use. RESULTS In 2,183 pancreas transplants, VaDs were used in the following numbers of donors: dobutamine 76 (3.5%), dopamine 84 (3.8%), adrenaline 161 (7.4%), noradrenaline 1,589 (72.8%) and vasopressin 1,219 (55.8%). In multivariable models, adjusted for covariates and the co-administration of other VaDs, noradrenaline use (vs non-use) was a strong predictor of better graft survival (hazard ratio [95% confidence interval] 0.77 [0.64-0.94], p = 0.01). CONCLUSIONS Noradrenaline use was associated with better graft survival in models adjusted for donor and recipient variables - this may be related to inhibition of pancreatic insulin secretion initiating pancreatic beta-cell 'rest'. Further research is required to replicate these findings and establish whether relationships are causal. Identification of alternative methods of inducing beta-cell rest could be valuable in improving graft outcomes.
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Affiliation(s)
- IM Shapey
- University of Manchester, UK
- Manchester University NHS Foundation Trust, UK
| | - A Summers
- Manchester University NHS Foundation Trust, UK
| | | | - C Fullwood
- University of Manchester, UK
- Manchester University NHS Foundation Trust, UK
| | - T Augustine
- Manchester University NHS Foundation Trust, UK
| | - MK Rutter
- University of Manchester, UK
- Manchester University NHS Foundation Trust, UK
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Rungapiromnan W, Mason KJ, Lunt M, McElhone K, Burden AD, Rutter MK, Warren RB, Griffiths CEM, Ashcroft DM. Risk of major cardiovascular events in patients with psoriasis receiving biologic therapies: a prospective cohort study. J Eur Acad Dermatol Venereol 2019; 34:769-778. [PMID: 31633837 PMCID: PMC7155017 DOI: 10.1111/jdv.16018] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 09/30/2019] [Indexed: 12/21/2022]
Abstract
Background The cardiovascular safety profile of biologic therapies used for psoriasis is unclear. Objectives To compare the risk of major cardiovascular events (CVEs; acute coronary syndrome, unstable angina, myocardial infarction and stroke) in patients with chronic plaque psoriasis treated with adalimumab, etanercept or ustekinumab in a large prospective cohort. Methods Prospective cohort study examining the comparative risk of major CVEs was conducted using the British Association of Dermatologists Biologics and Immunomodulators Register. The main analysis compared adults with chronic plaque psoriasis receiving ustekinumab with tumour necrosis‐α inhibitors (TNFi: etanercept and adalimumab), whilst the secondary analyses compared ustekinumab, etanercept or methotrexate against adalimumab. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using overlap weights by propensity score to balance baseline covariates among comparison groups. Results We included 5468 biologic‐naïve patients subsequently exposed (951 ustekinumab; 1313 etanercept; and 3204 adalimumab) in the main analysis. The secondary analyses also included 2189 patients receiving methotrexate. The median (p25–p75) follow‐up times for patients using ustekinumab, TNFi, adalimumab, etanercept and methotrexate were as follows: 2.01 (1.16–3.21), 1.93 (1.05–3.34), 1.94 (1.09–3.32), 1.92 (0.93–3.45) and 1.43 (0.84–2.53) years, respectively. Ustekinumab, TNFi, adalimumab, etanercept and methotrexate groups had 7, 29, 23, 6 and 9 patients experiencing major CVEs, respectively. No differences in the risk of major CVEs were observed between biologic therapies [adjusted HR for ustekinumab vs. TNFi: 0.96 (95% CI 0.41–2.22); ustekinumab vs. adalimumab: 0.81 (0.30–2.17); etanercept vs. adalimumab: 0.81 (0.28–2.30)] and methotrexate against adalimumab [1.05 (0.34–3.28)]. Conclusions In this large prospective cohort study, we found no significant differences in the risk of major CVEs between three different biologic therapies and methotrexate. Additional studies, with longer term follow‐up, are needed to investigate the potential effects of biologic therapies on incidence of major CVEs. Linked Commentary: K. Kridin and A.D. Cohen. J Eur Acad Dermatol Venereol 2020; 34: 668–669. https://doi.org/10.1111/jdv.16345.
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Affiliation(s)
- W Rungapiromnan
- Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - K J Mason
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - M Lunt
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - K McElhone
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - A D Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - M K Rutter
- Division of Endocrinology, Diabetes and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - R B Warren
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Dermatology Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - C E M Griffiths
- Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Dermatology Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - D M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Heald A, Lunt M, Rutter MK, Anderson SG, Cortes G, Edmonds M, Jude E, Boulton A, Dunn G. Developing a foot ulcer risk model: what is needed to do this in a real-world primary care setting? Diabet Med 2019; 36:1412-1416. [PMID: 30320946 DOI: 10.1111/dme.13837] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Accepted: 10/12/2018] [Indexed: 12/24/2022]
Abstract
AIM To determine how routinely collected data can inform a risk model to predict de novo foot ulcer presentation in the primary care setting. METHODS Data were available on 15 727 individuals without foot ulcers and 1125 individuals with new foot ulcers over a 12-year follow-up in UK primary care. We examined known risk factors and added putative risk factors in our logistic model. RESULTS People with foot ulcers were 4.2 years older (95% CI 3.1-5.2) than those without, and had higher HbA1c % (mean 7.9 ± 1.9 vs 7.5 ± 1.7) / HbA1c mmol/mol (63 ± 21 vs 59 ± 19) (p<0.0001) concentration [+0.45 (95% CI 0.33-0.56), creatinine level [+6.9 μmol/L (95% CI 4.1-9.8)] and Townsend score [+0.055 (95% CI 0.033-0.077)]. Absence of monofilament sensation was more common in people with foot ulcers (28% vs 21%; P<0.0001), as was absence of foot pulses (6.4% vs 4.8%; P=0.017). There was no difference between people with or without foot ulcers in smoking status, gender, history of stroke or foot deformity, although foot deformity was extremely rare (0.4% in people with foot ulcers, 0.6% in people without foot ulcers). Combining risk factors in a single logistic regression model gave modest predictive power, with an area under the receiver-operating characteristic curve of 0.65 (95% CI 0.62-0.67). The prevalence of ulceration in the bottom decile of risk was 1.8% and in the top decile it was 13.4% (compared with an overall prevalence of 6.5%); thus, the presence of all six risk factors gave a relative risk of 7.4 for development of a foot ulcer over 12 years. CONCLUSION We have made some progress towards defining a variable set that can be used to create a foot ulcer prediction model. More accurate determination of foot deformity/pedal circulation in primary care may improve the predictive value of such a future risk model, as will identification of additional risk variables.
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Affiliation(s)
- A Heald
- School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester
- Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford
| | - M Lunt
- School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester
| | - M K Rutter
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - S G Anderson
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester
| | - G Cortes
- Medical Department, High Speciality Regional Hospital of Ixtapaluca, Mexico City, Mexico
| | - M Edmonds
- Department of Diabetes, Kings College Hospital, London
| | - E Jude
- Tameside Hospital NHS Foundation Trust, Ashton-under-Lyme
| | - A Boulton
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - G Dunn
- East Cheshire Trust, Cheshire, UK
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Zghebi SS, Panagioti M, Rutter MK, Ashcroft DM, van Marwijk H, Salisbury C, Chew-Graham CA, Buchan I, Qureshi N, Peek N, Mallen C, Mamas M, Kontopantelis E. Assessing the severity of Type 2 diabetes using clinical data-based measures: a systematic review. Diabet Med 2019; 36:688-701. [PMID: 30672017 DOI: 10.1111/dme.13905] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Accepted: 01/21/2019] [Indexed: 01/11/2023]
Abstract
AIMS To identify and critically appraise measures that use clinical data to grade the severity of Type 2 diabetes. METHODS We searched MEDLINE, Embase and PubMed between inception and June 2018. Studies reporting on clinical data-based diabetes-specific severity measures in adults with Type 2 diabetes were included. We excluded studies conducted solely in participants with other types of diabetes. After independent screening, the characteristics of the eligible measures including design and severity domains, the clinical utility of developed measures, and the relationship between severity levels and health-related outcomes were assessed. RESULTS We identified 6798 studies, of which 17 studies reporting 18 different severity measures (32 314 participants in 17 countries) were included: a diabetes severity index (eight studies, 44%); severity categories (seven studies, 39%); complication count (two studies, 11%); and a severity checklist (one study, 6%). Nearly 89% of the measures included diabetes-related complications and/or glycaemic control indicators. Two of the severity measures were validated in a separate study population. More severe diabetes was associated with increased healthcare costs, poorer cognitive function and significantly greater risks of hospitalization and mortality. The identified measures differed greatly in terms of the included domains. One study reported on the use of a severity measure prospectively. CONCLUSIONS Health records are suitable for assessment of diabetes severity; however, the clinical uptake of existing measures is limited. The need to advance this research area is fundamental as higher levels of diabetes severity are associated with greater risks of adverse outcomes. Diabetes severity assessment could help identify people requiring targeted and intensive therapies and provide a major benchmark for efficient healthcare services.
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Affiliation(s)
- S S Zghebi
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester
| | - M Panagioti
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester
| | - M K Rutter
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre (MAHSC), Manchester, Manchester
| | - D M Ashcroft
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester
- Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester
| | - H van Marwijk
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, Brighton
| | - C Salisbury
- Centre for Academic Primary Care, Department of Population Health Sciences, Bristol Medical School, Bristol
| | - C A Chew-Graham
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire
| | - I Buchan
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester
- Health eResearch Centre, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester
- Department of Public Health and Policy, Institute of Population Health Sciences, University of Liverpool, Liverpool
| | - N Qureshi
- Primary Care Stratified Medicine (PriSM) group, Division of Primary Care, School of Medicine, University of Nottingham, Nottingham
| | - N Peek
- Health eResearch Centre, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester
| | - C Mallen
- Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire
| | - M Mamas
- Keele Cardiovascular Research group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | - E Kontopantelis
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester
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Nadeem F, Urwin A, Marshall M, Doughty I, Thabit H, Rutter MK, Leelarathna L. Risk factor control and outpatient attendance in young adults with diabetes. Acta Diabetol 2019; 56:597-600. [PMID: 30574663 PMCID: PMC6451702 DOI: 10.1007/s00592-018-1261-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 11/16/2018] [Indexed: 11/29/2022]
Affiliation(s)
- F Nadeem
- School of Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - A Urwin
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - M Marshall
- Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - I Doughty
- Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - H Thabit
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - M K Rutter
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - L Leelarathna
- Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
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Piasecki M, Ireland A, Piasecki J, Degens H, Stashuk DW, Swiecicka A, Rutter MK, Jones DA, McPhee JS. Long-Term Endurance and Power Training May Facilitate Motor Unit Size Expansion to Compensate for Declining Motor Unit Numbers in Older Age. Front Physiol 2019; 10:449. [PMID: 31080415 PMCID: PMC6497749 DOI: 10.3389/fphys.2019.00449] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [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] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/01/2019] [Indexed: 11/15/2022] Open
Abstract
The evidence concerning the effects of exercise in older age on motor unit (MU) numbers, muscle fiber denervation and reinnervation cycles is inconclusive and it remains unknown whether any effects are dependent on the type of exercise undertaken or are localized to highly used muscles. MU characteristics of the vastus lateralis (VL) were assessed using surface and intramuscular electromyography in eighty-five participants, divided into sub groups based on age (young, old) and athletic discipline (control, endurance, power). In a separate study of the biceps brachii (BB), the same characteristics were compared in the favored and non-favored arms in eleven masters tennis players. Muscle size was assessed using MRI and ultrasound. In the VL, the CSA was greater in young compared to old, and power athletes had the largest CSA within their age groups. Motor unit potential (MUP) size was larger in all old compared to young (p < 0.001), with interaction contrasts showing this age-related difference was greater for endurance and power athletes than controls, and MUP size was greater in old athletes compared to old controls. In the BB, thickness did not differ between favored and non-favored arms (p = 0.575), but MUP size was larger in the favored arm (p < 0.001). Long-term athletic training does not prevent age-related loss of muscle size in the VL or BB, regardless of athletic discipline, but may facilitate more successful axonal sprouting and reinnervation of denervated fibers. These effects may be localized to muscles most involved in the exercise.
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Affiliation(s)
- M. Piasecki
- Clinical, Metabolic and Molecular Physiology, MRC-ARUK Centre for Musculoskeletal Ageing Research, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, United Kingdom
| | - A. Ireland
- School of Healthcare Science, Manchester Metropolitan University, Manchester, United Kingdom
| | - J. Piasecki
- Musculoskeletal Physiology Research Group, Sport, Health and Performance Enhancement Research Centre, School of Science and Technology, Nottingham Trent University, Nottingham, United Kingdom
| | - H. Degens
- School of Healthcare Science, Manchester Metropolitan University, Manchester, United Kingdom
- Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania
| | - D. W. Stashuk
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
| | - A. Swiecicka
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - M. K. Rutter
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - D. A. Jones
- School of Healthcare Science, Manchester Metropolitan University, Manchester, United Kingdom
| | - J. S. McPhee
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, Manchester Metropolitan University, Manchester, United Kingdom
- Department of Physiology, University of Padova, Padova, Italy
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Paisley AN, Beynon J, Fullwood C, Hindle A, Alam T, Urwin A, Chapman A, Morris J, Thabit H, Rutter MK, Leelarathna L. Impact of social deprivation, demographics and centre on HbA 1c outcomes with continuous subcutaneous insulin infusion. Diabet Med 2019; 36:383-387. [PMID: 30307056 DOI: 10.1111/dme.13833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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] [Accepted: 10/09/2018] [Indexed: 01/16/2023]
Abstract
AIMS To assess the impact of social deprivation, demographics and centre on HbA1c outcomes with continuous subcutaneous insulin infusion (CSII) in adults with Type 1 diabetes. METHODS Demographic data, postcode-derived English Index of Multiple Deprivation data and 12-month average HbA1c (mmol/mol) pre- and post-CSII were collated from three diabetes centres in the north west of England, University Hospital of South Manchester (UHSM), Salford Royal Foundation Hospital (SRFT) and Manchester Royal Infirmary (MRI). Univariable and multivariable regression models explored relationships between demographics, Index of Multiple Deprivation, centre and HbA1c outcomes. RESULTS Data were available for 693 (78%) individuals (UHSM, n = 90; SRFT, n = 112; and MRI, n = 491) of whom 59% were women. Median age at CSII start was 39 (IQR 29.5-49.0) years and median diabetes duration was 20 (11-29) years. Median Index of Multiple Deprivation was 15 193 (6313-25 727). Overall median HbA1c improved from 69 to 64 mmol/mol (8.5% to 8.0%) within the first year of CSII. In multivariable analysis, higher pre-CSII HbA1c was significantly associated with higher deprivation (P = 0.036), being female (P < 0.001), and centre (MRI; P = 0.005). Following pre-CSII HbA1c adjustment, post-CSII HbA1c or HbA1c change were not related to demographic factors and deprivation, but remained significantly related to the centre; UHSM and SRFT had larger reductions in HbA1c with CSII compared with MRI [median -7.0 (-0.6%) vs. -6.0 (-0.55%) vs. -4.5 (-0.45%) mmol/mol; P = 0.005]. CONCLUSIONS Higher pre-CSII HbA1c levels were associated with higher deprivation and being female. CSII improves HbA1c irrespective of social deprivation and demographics. Significant differences in HbA1c improvements were observed between centres. Further work is warranted to explain these differences and minimize variation in clinical outcomes with CSII.
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Affiliation(s)
| | - J Beynon
- University Hospital of South Manchester, Manchester, UK
| | - C Fullwood
- Research and Innovation, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Centre for Biostatistics, Manchester, UK
| | - A Hindle
- The School of Medical Sciences, University of Manchester, Manchester, UK
| | - T Alam
- The School of Medical Sciences, University of Manchester, Manchester, UK
| | - A Urwin
- Manchester Diabetes Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - A Chapman
- Manchester Diabetes Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - J Morris
- Manchester Diabetes Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - H Thabit
- Manchester Diabetes Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
| | - M K Rutter
- Manchester Diabetes Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
| | - L Leelarathna
- Manchester Diabetes Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
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Dashti HS, Jones S, Lane JM, Wang H, Song Y, Patel K, Gill S, Gottlieb D, Tiemeier H, Ray DW, Frayling TM, Rutter MK, Weedon MN, Saxena R. 0013 Genome-wide Association Analysis Identifies >75 Genetic Loci Associated With Sleep Duration In UK Biobank Participants. Sleep 2018. [DOI: 10.1093/sleep/zsy061.012] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- H S Dashti
- Massachusetts General Hospital, Boston, MA
| | - S Jones
- University of Exeter Medical School, Exeter, UNITED KINGDOM
| | - J M Lane
- Massachusetts General Hospital, Boston, MA
| | - H Wang
- Brigham and Women’s Hospital, Boston, MA
| | - Y Song
- Massachusetts General Hospital, Boston, MA
| | - K Patel
- Massachusetts General Hospital, Boston, MA
| | - S Gill
- Massachusetts General Hospital, Boston, MA
| | - D Gottlieb
- Brigham and Women’s Hospital, Boston, MA
| | - H Tiemeier
- Harvard Chan School of Public Health, Boston, MA
| | - D W Ray
- The University of Manchester, Manchester, UNITED KINGDOM
| | - T M Frayling
- University of Exeter Medical School, Exeter, UNITED KINGDOM
| | - M K Rutter
- The University of Manchester, Manchester, UNITED KINGDOM
| | - M N Weedon
- University of Exeter Medical School, Exeter, UNITED KINGDOM
| | - R Saxena
- Massachusetts General Hospital, Boston, MA
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Lane JM, Jones S, Dashti HS, Wood A, Van Hees V, Spiegelhalder K, Wang H, Bowden J, Kyle SD, Ray D, Frayling TM, Lawlor DA, Rutter MK, Weedon M, Saxena R. 0015 Biological And Clinical Insights from Genetics of Insomnia Symptoms. Sleep 2018. [DOI: 10.1093/sleep/zsy061.014] [Citation(s) in RCA: 2] [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: 11/14/2022] Open
Affiliation(s)
- J M Lane
- Massachusetts General Hospital, Boston, MA
| | - S Jones
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UNITED KINGDOM
| | - H S Dashti
- Massachusetts General Hospital, Boston, MA
| | - A Wood
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UNITED KINGDOM
| | - V Van Hees
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UNITED KINGDOM
| | | | - H Wang
- Brigham and Women’s Hospital, Boston, MA
| | - J Bowden
- University of Bristol, Bristol, UNITED KINGDOM
| | - S D Kyle
- University of Oxford, Oxford, UNITED KINGDOM
| | - D Ray
- University of Manchester, Manchester, UNITED KINGDOM
| | - T M Frayling
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UNITED KINGDOM
| | - D A Lawlor
- University of Bristol, Bristol, UNITED KINGDOM
| | - M K Rutter
- University of Manchester, Manchester, UNITED KINGDOM
| | - M Weedon
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UNITED KINGDOM
| | - R Saxena
- Massachusetts General Hospital, Boston, MA
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Wang H, Lane JM, Dashti HS, Jones S, Cade BE, Song Y, Patel K, Frayling TM, Weedon MN, Lawlor DA, Rutter MK, Redline S, Saxena R. 0014 Genome-wide Association Analysis Of Excessive Daytime Sleepiness In The Uk Biobank Identifies 42 Novel Loci. Sleep 2018. [DOI: 10.1093/sleep/zsy061.013] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H Wang
- Division of Sleep and Circadian Disorder, Brigham and Women’s Hospital, Boston, MA
| | - J M Lane
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
| | - H S Dashti
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
| | - S Jones
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UNITED KINGDOM
| | - B E Cade
- Division of Sleep and Circadian Disorder, Brigham and Women’s Hospital, Boston, MA
| | - Y Song
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
| | - K Patel
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
| | - T M Frayling
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UNITED KINGDOM
| | - M N Weedon
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UNITED KINGDOM
| | - D A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UNITED KINGDOM
| | - M K Rutter
- Division of Endocrinology, Diabetes and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UNITED KINGDOM
| | - S Redline
- Division of Sleep and Circadian Disorder, Brigham and Women’s Hospital, Boston, MA
| | - R Saxena
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA
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11
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Piasecki M, Ireland A, Piasecki J, Stashuk DW, Swiecicka A, Rutter MK, Jones DA, McPhee JS. Failure to expand the motor unit size to compensate for declining motor unit numbers distinguishes sarcopenic from non-sarcopenic older men. J Physiol 2018. [PMID: 29527694 PMCID: PMC5924831 DOI: 10.1113/jp275520] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Key points The age‐related loss of muscle mass is related to the loss of innervating motor neurons and denervation of muscle fibres. Not all denervated muscle fibres are degraded; some may be reinnervated by an adjacent surviving neuron, which expands the innervating motor unit proportional to the numbers of fibres rescued. Enlarged motor units have larger motor unit potentials when measured using electrophysiological techniques. We recorded much larger motor unit potentials in relatively healthy older men compared to young men, but the older men with the smallest muscles (sarcopenia) had smaller motor unit potentials than healthy older men. These findings suggest that healthy older men reinnervate large numbers of muscle fibres to compensate for declining motor neuron numbers, but a failure to do so contributes to muscle loss in sarcopenic men.
Abstract Sarcopenia results from the progressive loss of skeletal muscle mass and reduced function in older age. It is likely to be associated with the well‐documented reduction of motor unit numbers innervating limb muscles and the increase in size of surviving motor units via reinnervation of denervated fibres. However, no evidence exists to confirm the extent of motor unit remodelling in sarcopenic individuals. The aim of the present study was to compare motor unit size and number between young (n = 48), non‐sarcopenic old (n = 13), pre‐sarcopenic (n = 53) and sarcopenic (n = 29) men. Motor unit potentials (MUPs) were isolated from intramuscular and surface EMG recordings. The motor unit numbers were reduced in all groups of old compared with young men (all P < 0.001). MUPs were higher in non‐sarcopenic and pre‐sarcopenic men compared with young men (P = 0.039 and 0.001 respectively), but not in the vastus lateralis of sarcopenic old (P = 0.485). The results suggest that extensive motor unit remodelling occurs relatively early during ageing, exceeds the loss of muscle mass and precedes sarcopenia. Reinnervation of denervated muscle fibres probably expands the motor unit size in the non‐sarcopenic and pre‐sarcopenic old, but not in the sarcopenic old. These findings suggest that a failure to expand the motor unit size distinguishes sarcopenic from pre‐sarcopenic muscles. The age‐related loss of muscle mass is related to the loss of innervating motor neurons and denervation of muscle fibres. Not all denervated muscle fibres are degraded; some may be reinnervated by an adjacent surviving neuron, which expands the innervating motor unit proportional to the numbers of fibres rescued. Enlarged motor units have larger motor unit potentials when measured using electrophysiological techniques. We recorded much larger motor unit potentials in relatively healthy older men compared to young men, but the older men with the smallest muscles (sarcopenia) had smaller motor unit potentials than healthy older men. These findings suggest that healthy older men reinnervate large numbers of muscle fibres to compensate for declining motor neuron numbers, but a failure to do so contributes to muscle loss in sarcopenic men.
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Affiliation(s)
- M Piasecki
- School of Healthcare Science, Manchester Metropolitan University, Manchester, M15GD, UK
| | - A Ireland
- School of Healthcare Science, Manchester Metropolitan University, Manchester, M15GD, UK
| | - J Piasecki
- School of Healthcare Science, Manchester Metropolitan University, Manchester, M15GD, UK
| | - D W Stashuk
- Department of Systems Design Engineering, University of Waterloo, Ontario, N2L 3G1, Canada
| | - A Swiecicka
- Andrology Research Unit, Cardiovascular, Metabolic and Nutritional Sciences Domain, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - M K Rutter
- Andrology Research Unit, Cardiovascular, Metabolic and Nutritional Sciences Domain, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - D A Jones
- School of Healthcare Science, Manchester Metropolitan University, Manchester, M15GD, UK
| | - J S McPhee
- School of Healthcare Science, Manchester Metropolitan University, Manchester, M15GD, UK
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12
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Leelarathna L, Roberts SA, Hindle A, Markakis K, Alam T, Chapman A, Morris J, Urwin A, Jinadev P, Rutter MK. Comparison of different insulin pump makes under routine care conditions in adults with Type 1 diabetes. Diabet Med 2017. [PMID: 28636773 DOI: 10.1111/dme.13412] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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] [Indexed: 01/17/2023]
Abstract
AIMS To compare long-term HbA1c changes associated with different insulin pumps during routine care in a large cohort of adults with Type 1 diabetes representative of other clinic populations. METHODS Observational, retrospective study of 508 individuals starting pump therapy between 1999 and 2014 (mean age, 40 years; 55% women; diabetes duration, 20 years; 94% Type 1 diabetes; median follow-up, 3.7 years). Mixed linear models compared covariate-adjusted HbA1c changes associated with different pump makes. RESULTS The pumps compared were: 50% Medtronic, 24% Omnipod, 14% Roche and 12% Animas. Overall HbA1c levels improved and improvements were maintained during a follow-up extending to 10 years (HbA1c : pre-continuous subcutaneous insulin infusion (pre-CSII) vs. 12 months post CSII, 71 (61, 82) vs. 66 (56, 74) mmol/mol; 8.7 (7.7, 9.6) vs. 8.2 (7.3, 8.9)%; P < 0.0001). The percentage of individuals with HbA1c ≥ 64 mmol/mol (8.0%) reduced from a pre-CSII level of 68% to 55%. After adjusting for baseline confounders, there were no between-pump differences in HbA1c lowering (P = 0.44), including a comparison of patch pumps with traditional catheter pumps (P = 0.63). There were no significant (P < 0.05) between-pump differences in HbA1c lowering in pre-specified subgroups stratified by pre-pump HbA1c , age or diabetes duration. HbA1c lowering was positively related to baseline HbA1c (P < 0.001) and diabetes duration (P = 0.017), and negatively related to the number of years of CSII use (P = 0.024). CONCLUSIONS Under routine care conditions, there were no covariate-adjusted differences in HbA1c lowering when comparing different pump makes, including a comparison of patch pumps vs. traditional catheter pumps. Therefore, the choice of CSII make should not be influenced by the desired degree of HbA1c lowering.
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Affiliation(s)
- L Leelarathna
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester
| | - S A Roberts
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - A Hindle
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester
| | - K Markakis
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre
| | - T Alam
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester
| | - A Chapman
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre
| | - J Morris
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre
| | - A Urwin
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre
| | - P Jinadev
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre
| | - M K Rutter
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester
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13
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Vetter C, Dashti HS, Lane JM, Anderson SG, Schernhammer ES, Rutter MK, Saxena R, Scheer FA. 1013 SHIFT WORK, CHRONOTYPE, AND TYPE 2 DIABETES IN THE UK BIOBANK AND TYPE 2 DIABETES IN THE UK BIOBANK. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.1012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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14
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Shapey IM, Summers AM, Augustine T, Rutter MK, van Dellen D. Circulating Cell-Free Unmethylated DNA as a Marker of Graft Dysfunction in Pancreas Transplantation. Am J Transplant 2016; 16:3064-3065. [PMID: 27376346 DOI: 10.1111/ajt.13949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- I M Shapey
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester, UK.,Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | - A M Summers
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester, UK
| | - T Augustine
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester, UK
| | - M K Rutter
- Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.,Manchester Diabetes Centre, Manchester Royal Infirmary, Manchester, UK
| | - D van Dellen
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester, UK
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15
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Zghebi SS, Steinke DT, Rutter MK, Emsley RA, Ashcroft DM. Comparative risk of major cardiovascular events associated with second-line antidiabetic treatments: a retrospective cohort study using UK primary care data linked to hospitalization and mortality records. Diabetes Obes Metab 2016; 18:916-24. [PMID: 27177784 DOI: 10.1111/dom.12692] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 02/11/2016] [Revised: 05/09/2016] [Accepted: 05/11/2016] [Indexed: 02/05/2023]
Abstract
AIMS To examine the risk of major cardiovascular events associated with second-line diabetes therapies, in patients with type 2 diabetes, after adjusting for known cardiovascular risk factors. METHODS This was a retrospective cohort study of patients prescribed second-line regimens between 1998 and 2011 after first-line metformin. The UK Clinical Practice Research Datalink, with linked national hospitalization and mortality data, for the period up to December 2013, was used. Inverse probability of treatment-weighted time-varying Cox regression models was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for developing a major cardiovascular event (cardiovascular death, myocardial infarction, stroke, acute coronary syndrome, unstable angina, or coronary revascularization) associated with second-line therapies. Analyses adjusted for patient demographic characteristics, comorbidities, glycated haemoglobin, socio-economic status, ethnicity, smoking status and concurrent medications. RESULTS A total of 10 118 initiators of a second-line add-on to metformin of either a sulphonylurea (n = 6740), dipeptidyl peptidase-4 (DPP-4) inhibitor (n = 1030) or thiazolidinedione (n = 2348) were identified. After a mean (standard deviation) of 2.4 (1.9) years of follow-up, 386, 36 and 95 major cardiovascular events occurred in sulphonylurea-, DPP-4 inhibitor- and thiazolidinedione-initiators, respectively. In comparison with the metformin-sulphonylurea regimen, adjusted HRs were 0.78 (95% CI 0.55; 1.11) for the metformin-DPP-4 inhibitor regimen and 0.68 (95% CI 0.54; 0.85) for the metformin-thiazolidinedione regimen. CONCLUSIONS Thiazolidinedione add-on treatments to metformin were associated with lower risks of major cardiovascular disease or cardiovascular death compared with sulphonylurea add-on treatment to metformin. Lower, but non-statistically significant, risks were also found with DPP-4 inhibitor add-on therapies.
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Affiliation(s)
- S S Zghebi
- Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, University of Manchester, Manchester, UK
- Department of Pharmaceutics, Faculty of Pharmacy, University of Tripoli, Tripoli, Libya
| | - D T Steinke
- Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, University of Manchester, Manchester, UK
| | - M K Rutter
- Endocrinology and Diabetes Research Group, Institute of Human Development, University of Manchester, Manchester, UK
- Manchester Diabetes Centre, Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - R A Emsley
- Centre for Biostatistics, Institute of Population Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - D M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, University of Manchester, Manchester, UK
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16
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Rutter MK, Kane K, Lunt M, Cordingley L, Littlewood A, Young HS, Chew-Graham CA, Hilton R, Symmons DPM, Griffiths CEM. Primary care-based screening for cardiovascular risk factors in patients with psoriasis. Br J Dermatol 2016; 175:348-56. [PMID: 26990294 PMCID: PMC5113692 DOI: 10.1111/bjd.14557] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2016] [Indexed: 01/05/2023]
Abstract
Background Studies assessing cardiovascular disease (CVD) risk factors in patients with psoriasis have been limited by selection bias, inappropriate controls or a reliance on data collected for clinical reasons. Objectives To investigate whether screening for CVD risk factors in patients with psoriasis in primary care augments the known prevalence of CVD risk factors in a cross‐sectional study. Methods Patients listed as having psoriasis in primary care were recruited, screened and risk assessed by QRISK2. Results In total, 287 patients attended (mean age 53 years, 57% women, 94% white British, 22% severe disease, 33% self‐reported psoriatic arthritis). The proportion with known and screen‐detected (previously unknown) risk factors was as follows: hypertension 35% known and 13% screen‐detected; hypercholesterolaemia 32% and 37%; diabetes 6·6% and 3·1% and chronic kidney disease 1·1% and 4·5%. At least one screen‐detected risk factor was found in 48% and two or more risk factors were found in 21% of patients. One in three patients (37%) not previously known to be at high risk were found to have a high (> 10%) 10‐year CVD risk. Among the participants receiving treatment for known CVD risk factors, nearly half had suboptimal levels for blood pressure (46%) and cholesterol (46%). Conclusions Cardiovascular risk factor screening of primary care‐based adults with psoriasis identified a high proportion of patients (i) at high CVD risk, (ii) with screen‐detected risk factors and (iii) with suboptimally managed known risk factors. These findings need to be considered alongside reports that detected limited responses of clinicians to identified risk factors before universal CVD screening can be recommended. What's already known about this topic? Several studies have suggested that patients with psoriasis have a greater number of risk factors for cardiovascular disease (CVD) and a higher risk for vascular events compared with the general population. However, the prevalence data used to support systematic CVD risk factor screening in psoriasis have been limited by selection bias, inappropriate choice of control groups or reliance on risk factors measured for other clinical reasons.
What does this study add? Cardiovascular risk factor screening of primary care‐based adults with psoriasis identified a high proportion of patients (i) at high CVD risk, (ii) with screen‐detected risk factors and (iii) with suboptimally managed known risk factors. These findings need to be considered alongside reports that detected limited responses of clinicians to identified risk factors before universal CVD screening can be recommended.
Plain language summary available online
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Affiliation(s)
- M K Rutter
- The Endocrinology and Diabetes Research Group, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K.,Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
| | - K Kane
- Centre for Dermatology Research, Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K
| | - M Lunt
- Arthritis Research U.K. Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester, U.K
| | - L Cordingley
- Centre for Dermatology Research, Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K.,Manchester Centre for Health Psychology, School of Psychological Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K
| | - A Littlewood
- Centre for Dermatology Research, Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K
| | - H S Young
- Centre for Dermatology Research, Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K.,Centre for Dermatology Research, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
| | - C A Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, U.K.,South Staffordshire and Shropshire Healthcare NHS Foundation Trust, Stafford, U.K
| | - R Hilton
- Bridgewater Community Healthcare NHS Trust, Wigan, U.K
| | - D P M Symmons
- Arthritis Research U.K. Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K.,NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester, U.K
| | - C E M Griffiths
- Centre for Dermatology Research, Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Science Centre, Manchester, U.K.,Centre for Dermatology Research, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
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17
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Speight J, Barendse SM, Singh H, Little SA, Inkster B, Frier BM, Heller SR, Rutter MK, Shaw JAM. Characterizing problematic hypoglycaemia: iterative design and preliminary psychometric validation of the Hypoglycaemia Awareness Questionnaire (HypoA-Q). Diabet Med 2016; 33:376-85. [PMID: 26042777 DOI: 10.1111/dme.12824] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [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] [Accepted: 06/01/2015] [Indexed: 11/27/2022]
Abstract
AIMS To design and conduct preliminary validation of a measure of hypoglycaemia awareness and problematic hypoglycaemia, the Hypoglycaemia Awareness Questionnaire. METHODS Exploratory and cognitive debriefing interviews were conducted with 17 adults (nine of whom were women) with Type 1 diabetes (mean ± sd age 48 ± 10 years). Questionnaire items were modified in consultation with diabetologists/psychologists. Psychometric validation was undertaken using data from 120 adults (53 women) with Type 1 diabetes (mean ± sd age 44 ± 16 years; 50% with clinically diagnosed impaired awareness of hypoglycaemia), who completed the following questionnaires: the Hypoglycaemia Awareness Questionnaire, the Gold score, the Clarke questionnaire and the Problem Areas in Diabetes questionnaire. RESULTS Iterative design resulted in 33 items eliciting responses about awareness of hypoglycaemia when awake/asleep and hypoglycaemia frequency, severity and impact (healthcare utilization). Psychometric analysis identified three subscales reflecting 'impaired awareness', 'symptom level' and 'symptom frequency'. Convergent validity was indicated by strong correlations between the 'impaired awareness' subscale and existing measures of awareness: (Gold: rs =0.75, P < 0.01; Clarke: rs =0.76, P < 0.01). Divergent validity was indicated by weaker correlations with diabetes-related distress (Problem Areas in Diabetes: rs =0.25, P < 0.01) and HbA1c (rs =-0.05, non-significant). The 'impaired awareness' subscale and other items discriminated between those with impaired and intact awareness (Gold score). The 'impaired awareness' subscale and other items contributed significantly to models explaining the occurrence of severe hypoglycaemia and hypoglycaemia when asleep. CONCLUSIONS This preliminary validation shows the Hypoglycaemia Awareness Questionnaire has robust face and content validity; satisfactory structure; internal reliability; convergent, divergent and known groups validity. The impaired awareness subscale and other items contribute significantly to models explaining recall of severe and nocturnal hypoglycaemia. Prospective validation, including determination of a threshold to identify impaired awareness, is now warranted.
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Affiliation(s)
- J Speight
- AHP Research, Hornchurch, UK
- The Australian Centre for Behavioural Research in Diabetes, Diabetes, Victoria, Melbourne, Australia
- School of Psychology, Deakin University, Burwood, Australia
| | | | - H Singh
- Department of Psychiatry and Neurobehavioral Sciences, Division of Behavioral Health and Technology, University of Virginia School of Medicine, Charlottesville, USA
| | - S A Little
- Institute of Cellular Medicine, Newcastle University, Newcastle, UK
| | - B Inkster
- Department of Diabetes, Royal Infirmary, Edinburgh, UK
| | - B M Frier
- Department of Diabetes, Royal Infirmary, Edinburgh, UK
| | - S R Heller
- Academic Unit of Diabetes, Endocrinology & Metabolism, University of Sheffield, UK
| | - M K Rutter
- Endocrinology and Diabetes Research Group, Institute of Human Development, Faculty of Medical and Human Sciences, University of Manchester, UK
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - J A M Shaw
- Institute of Cellular Medicine, Newcastle University, Newcastle, UK
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18
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Han TS, Lee DM, Lean MEJ, Finn JD, O'Neill TW, Bartfai G, Forti G, Giwercman A, Kula K, Pendleton N, Punab M, Rutter MK, Vanderschueren D, Huhtaniemi IT, Wu FCW, Casanueva FF. Associations of obesity with socioeconomic and lifestyle factors in middle-aged and elderly men: European Male Aging Study (EMAS). Eur J Endocrinol 2015; 172:59-67. [PMID: 25326134 DOI: 10.1530/eje-14-0739] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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] [Indexed: 11/08/2022]
Abstract
BACKGROUND Social and lifestyle influences on age-related changes in body morphology are complex because lifestyle and physiological response to social stress can affect body fat differently. OBJECTIVE In this study, we examined the associations of socioeconomic status (SES) and lifestyle factors with BMI and waist circumference (WC) in middle-aged and elderly European men. DESIGN AND SETTING A cross-sectional study of 3319 men aged 40-79 years recruited from eight European centres. OUTCOMES We estimated relative risk ratios (RRRs) of overweight/obesity associated with unfavourable SES and lifestyles. RESULTS The prevalence of BMI ≥ 30 kg/m(2) or WC ≥ 102 cm rose linearly with age, except in the eighth decade when high BMI, but not high WC, declined. Among men aged 40-59 years, compared with non-smokers or most active men, centre and BMI-adjusted RRRs for having a WC between 94 and 101.9 cm increased by 1.6-fold in current smokers, 2.7-fold in least active men and maximal at 2.8-fold in least active men who smoked. Similar patterns but greater RRRs were observed for men with WC ≥ 102 cm, notably 8.4-fold greater in least active men who smoked. Compared with men in employment, those who were not in employment had increased risk of having a high WC by 1.4-fold in the 40-65 years group and by 1.3-fold in the 40-75 years group. These relationships were weaker among elderly men. CONCLUSION Unfavourable SES and lifestyles associate with increased risk of obesity, especially in middle-aged men. The combination of inactivity and smoking was the strongest predictor of high WC, providing a focus for health promotion and prevention at an early age.
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Affiliation(s)
- T S Han
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - D M Lee
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - M E J Lean
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - J D Finn
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - T W O'Neill
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - G Bartfai
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - G Forti
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - A Giwercman
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - K Kula
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - N Pendleton
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - M Punab
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - M K Rutter
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The Un
| | - D Vanderschueren
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - I T Huhtaniemi
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - F C W Wu
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain
| | - F F Casanueva
- Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The University of Manchester, Manchester, UKDepartment of ObstetricsGynaecology and Andrology, Albert Szent-György Medical University, Szeged, HungaryEndocrinology UnitUniversity of Florence, Florence, ItalyReproductive Medicine CentreSkåne University Hospital, University of Lund, Lund, SwedenDepartment of Andrology and Reproductive EndocrinologyMedical University of Łódź, Łódź, PolandSchool of Community Based MedicineSalford Royal NHS Trust, University of Manchester, Salford, UKAndrology UnitUnited Laboratories of Tartu University Clinics, Tartu, EstoniaThe Endocrinology and Diabetes Research GroupFaculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UKManchester Diabetes CentreManchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UKDepartment of Andrology and EndocrinologyCatholic University of Leuven, Leuven, BelgiumDepartment of Surgery and CancerImperial College London, Hammersmith Campus, London, UKDepartment of MedicineInstituto Salud Carlos III, Complejo Hospitalario Universitario de Santiago (CHUS) CIBER de Fisiopatologia Obesidad y Nutricion (CB06/03)Santiago de Compostela University, Santiago de Compostela, Spain Department of EndocrinologyAshford and St Peter's NHS Foundation Trust, Surrey, UKSchool of Social SciencesCathie Marsh Institute for Social Research, The University of Manchester, Manchester, UKDepartment of Human NutritionUniversity of Glasgow, Glasgow, UKAndrology Research UnitArthritis Research UK Epidemiology UnitManchester Academic Health Science Centre, The Un
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Pye SR, Huhtaniemi IT, Finn JD, Lee DM, O'Neill TW, Tajar A, Bartfai G, Boonen S, Casanueva FF, Forti G, Giwercman A, Han TS, Kula K, Lean ME, Pendleton N, Punab M, Rutter MK, Vanderschueren D, Wu FCW. Late-onset hypogonadism and mortality in aging men. J Clin Endocrinol Metab 2014; 99:1357-66. [PMID: 24423283 DOI: 10.1210/jc.2013-2052] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [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] [Indexed: 11/19/2022]
Abstract
CONTEXT Late-onset hypogonadism (LOH) has recently been defined as a syndrome in middle-aged and elderly men reporting sexual symptoms in the presence of low T. The natural history of LOH, especially its relationship to mortality, is currently unknown. OBJECTIVE The aim of this study was to clarify the associations between LOH, low T, and sexual symptoms with mortality in men. DESIGN, SETTING, AND PARTICIPANTS Prospective data from the European Male Aging Study (EMAS) on 2599 community-dwelling men aged 40-79 years in eight European countries was used for this study. MAIN OUTCOME MEASURE(S) All-cause, cardiovascular, and cancer-related mortality was measured. RESULTS One hundred forty-seven men died during a median follow-up of 4.3 years. Fifty-five men (2.1%) were identified as having LOH (31 moderate and 24 severe). After adjusting for age, center, body mass index (BMI), current smoking, and poor general health, compared with men without LOH, those with severe LOH had a 5-fold [hazard ratio (HR) 5.5; 95% confidence interval (CI) 2.7, 11.4] higher risk of all-cause mortality. Compared with eugonadal men, the multivariable-adjusted risk of mortality was 2-fold higher in those with T less than 8 nmol/L (irrespective of symptoms; HR 2.3; 95% CI 1.2, 4.2) and 3-fold higher in those with three sexual symptoms (irrespective of serum T; compared with asymptomatic men; HR 3.2; 95% CI 1.8, 5.8). Similar risks were observed for cardiovascular mortality. CONCLUSIONS Severe LOH is associated with substantially higher risks of all-cause and cardiovascular mortality, to which both the level of T and the presence of sexual symptoms contribute independently. Detecting low T in men presenting with sexual symptoms offers an opportunity to identify a small subgroup of aging men at particularly high risk of dying.
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Affiliation(s)
- S R Pye
- Andrology Research Unit (S.R.P., J.D.F., F.C.W.W.) and Manchester Diabetes Centre (M.K.R.), The University of Manchester, and Arthritis Research UK Epidemiology Unit (S.R.P., D.M.L., T.W.O., A.T.), Manchester Academic Health Science Centre, The University of Manchester, Manchester M13 9WL, United Kingdom; Department of Surgery and Cancer (I.T.H.), Imperial College London, Hammersmith Campus, London W12 ONN, United Kingdom; Department of Obstetrics, Gynaecology, and Andrology (G.B.), Albert Szent-György Medical University, H-6721 Szeged, Hungary; Departments of Geriatric Medicine (S.B.) and Andrology and Endocrinology (D.V.), Catholic University of Leuven, Leuven B-3000, Belgium; Department of Medicine (F.F.C.), Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago, and Centro de Investigación Biomédica en Red de Fisiopatologia Obesidad y Nutricion (CB06/03), Instituto Salud Carlos III, 15705 Santiago de Compostela, Spain; Endocrinology Unit (G.F.), Department of Clinical Physiopathology, University of Florence, 50121 Florence, Italy; Reproductive Medicine Centre (A.G.), Skåne University Hospital, University of Lund, SE-22 184 Lund, Sweden; Department of Endocrinology (T.S.H.), University College London, London W1T 3AA, United Kingdom; Department of Andrology and Reproductive Endocrinology (K.K.), Medical University of Łódź, 90-419 Łódź, Poland; Department of Human Nutrition (M.E.L.), University of Glasgow, Glasgow G12 8TA, United Kingdom; School of Community-Based Medicine (N.P.), University of Manchester, Salford Royal National Health Service Trust, Salford M6 8HD, United Kingdom; and Andrology Unit (M.P.), United Laboratories of Tartu University Clinics, 51014 Tartu, Estonia
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20
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Brooks AM, Walker N, Aldibbiat A, Hughes S, Jones G, de Havilland J, Choudhary P, Huang GC, Parrott N, McGowan NWA, Casey J, Mumford L, Barker P, Burling K, Hovorka R, Walker M, Smith RM, Forbes S, Rutter MK, Amiel S, Rosenthal MJ, Johnson P, Shaw JAM. Attainment of metabolic goals in the integrated UK islet transplant program with locally isolated and transported preparations. Am J Transplant 2013; 13:3236-43. [PMID: 24119216 DOI: 10.1111/ajt.12469] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 08/02/2013] [Accepted: 08/10/2013] [Indexed: 01/25/2023]
Abstract
The objective was to determine whether metabolic goals have been achieved with locally isolated and transported preparations over the first 3 years of the UK's nationally funded integrated islet transplant program. Twenty islet recipients with C-peptide negative type 1 diabetes and recurrent severe hypoglycemia consented to the study, including standardized meal tolerance tests. Participants received a total of 35 infusions (seven recipients: single graft; 11 recipients: two grafts: two recipients: three grafts). Graft function was maintained in 80% at [median (interquartile range)] 24 (13.5-36) months postfirst transplant. Severe hypoglycemia was reduced from 20 (7-50) episodes/patient-year pretransplant to 0.3 (0-1.6) episodes/patient-year posttransplant (p < 0.001). Resolution of impaired hypoglycemia awareness was confirmed [pretransplant: Gold score 6 (5-7); 24 (13.5-36) months: 3 (1.5-4.5); p < 0.03]. Target HbA1c of <7.0% was attained/maintained in 70% of recipients [pretransplant: 8.0 (7.0-9.6)%; 24 (13.5-36) months: 6.2 (5.7-8.4)%; p < 0.001], with 60% reduction in insulin dose [pretransplant: 0.51 (0.41-0.62) units/kg; 24 (13.5-36) months: 0.20 (0-0.37) units/kg; p < 0.001]. Metabolic outcomes were comparable 12 months posttransplant in those receiving transported versus only locally isolated islets [12 month stimulated C-peptide: transported 788 (114-1764) pmol/L (n = 9); locally isolated 407 (126-830) pmol/L (n = 11); p = 0.32]. Metabolic goals have been attained within the equitably available, fully integrated UK islet transplant program with both transported and locally isolated preparations.
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Affiliation(s)
- A M Brooks
- Institute of Cellular Medicine, Newcastle University, Newcastle, UK
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Rutter MK, Sattar N, Tajar A, O'Neill TW, Lee DM, Bartfai G, Boonen S, Casanueva FF, Finn JD, Forti G, Giwercman A, Han TS, Huhtaniemi IT, Kula K, Lean MEJ, Pendleton N, Punab M, Silman AJ, Vanderschueren D, Lowe G, O'Rahilly S, Morris RW, Wu FC, Wannamethee SG. Epidemiological evidence against a role for C-reactive protein causing leptin resistance. Eur J Endocrinol 2013; 168:101-6. [PMID: 23047304 DOI: 10.1530/eje-12-0348] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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] [Indexed: 01/02/2023]
Abstract
OBJECTIVE It has been suggested that elevated levels of C-reactive protein (CRP) might interfere with leptin signalling and contribute to leptin resistance. Our aim was to assess whether plasma levels of CRP influence leptin resistance in humans, and our hypothesis was that CRP levels would modify the cross-sectional relationships between leptin and measures of adiposity. DESIGN AND METHODS W assessed four measures of adiposity: BMI, waist circumference, fat mass and body fat (%) in 2113 British Regional Heart Study (BRHS) men (mean (s.d.) age 69 (5) years), with replication in 760 (age 69 (6) years) European Male Ageing Study (EMAS) subjects. RESULTS IN BRHS subjects, leptin correlated with CRP (SPEARMAN'S R=0.22, P0.0001). Leptin and crp correlated with all four measures of adiposity (R VALUE RANGE: 0.22-0.57, all P<0.0001). Age-adjusted mean levels for adiposity measures increased in relation to leptin levels, but CRP level did not consistently influence the β-coefficients of the regression lines in a CRP-stratified analysis. In BRHS subjects, the BMI vs leptin relationship demonstrated a weak statistical interaction with CRP (P=0.04). We observed no similar interaction in EMAS subjects and no significant interactions with other measures of adiposity in BRHS or EMAS cohorts. CONCLUSION We have shown that plasma CRP has little influence on the relationship between measures of adiposity and serum leptin levels in these middle-aged and elderly male European cohorts. This study provides epidemiological evidence against CRP having a significant role in causing leptin resistance.
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Affiliation(s)
- M K Rutter
- University of Manchester, Manchester, UK.
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Abstract
This commentary provides an overview of the clinically important data linking low or lowered HbA(1c) to increased total and CVD mortality in the general population, and in patients with diabetes. This sets the scene for a contribution in this issue of Diabetologia by Andersson et al (DOI: 10.1007/s00125-012-2584-3 ) that suggests that BMI might modify the relationship between HbA(1c) and mortality in patients with type 2 diabetes. The commentary provides a framework for the interpretation of epidemiological data from observational studies and clinical trials, and it addresses the clinical implications of this work. Finally, it highlights new research that is likely to advance this field.
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Affiliation(s)
- M K Rutter
- Cardiovascular Research Group, School of Biomedicine, University of Manchester, Core Technology Facility, 46 Grafton Street, Manchester M13 9NT, UK.
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Natarajan A, Marshall SM, Kesteven PJ, McComb JM, Rutter MK. Impact of biomarkers for endothelial dysfunction and procoagulant state on 10-year cardiovascular risk in Type 2 diabetes. Diabet Med 2011; 28:1201-5. [PMID: 21480978 DOI: 10.1111/j.1464-5491.2011.03311.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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] [Indexed: 11/27/2022]
Abstract
AIMS To estimate the coronary heart disease and cardiovascular disease risk associated with novel biomarkers in Type 2 diabetes mellitus. METHODS We measured baseline peripheral blood concentrations of soluble E-selectin, factor XIIa, thrombin-antithrombin III complex and plasminogen activator inhibitor-1 in 86 patients with Type 2 diabetes free of known coronary heart disease. We used Cox proportional hazard models to estimate multivariable-adjusted hazard ratios associated with biomarker levels for 10-year coronary heart disease risk (n = 33 events) or total cardiovascular disease risk (n = 45 events). RESULTS At baseline, mean (sd) age was 62 years (7 years); 62 were men; and 43 had microalbuminuria. Soluble E-selectin demonstrated cross-sectional relationships with glucose and factor XIIa was related to plasminogen activator inhibitor-1 and triglycerides (all P < 0.05). Baseline log soluble E-selectin was significantly related to incident coronary heart disease and cardiovascular disease. Hazard ratios (95% CIs) associated with a 1-unit increase in log soluble E-selectin in age- and sex-adjusted models were: coronary heart disease : 4.6 (95% CI 1.9-11.3), P = 0.001; cardiovascular disease: 3.6 (95% CI 1.7-7.4, P = 0.001); and in multivariable-adjusted models were: coronary heart disease: 2.9 (95% CI 1.2-7.1, P = 0.02); cardiovascular disease: 2.3 (95% CI 1.1-4.8), P = 0.02. Factor XIIa was significantly related to incident cardiovascular disease. The hazard ratios associated with a 1-unit increase in factor XIIa in age- and sex-adjusted models was 1.5 (95% CI 1.1-1.9, P = 0.003) and in a multivariable-adjusted model was 1.3 (95% CI 1.0-1.6, P = 0.047). Plasminogen activator inhibitor-1 and thrombin-antithrombin III complex were not related to cardiovascular disease events. CONCLUSIONS In our study, soluble E-selectin and factor XIIa were significantly related to 10-year incident macrovascular events in patients with Type 2 diabetes. These preliminary findings call for replication in larger studies.
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Affiliation(s)
- A Natarajan
- Department of Cardiology, Essex Cardiothoracic Centre, Basildon, UK
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Rutter MK, Prais HR, Charlton-Menys V, Gittins M, Roberts C, Davies RR, Moorhouse A, Jinadev P, France M, Wiles PG, Gibson JM, Dean J, Kalra PA, Cruickshank JK, Durrington PN. Protection Against Nephropathy in Diabetes with Atorvastatin (PANDA): a randomized double-blind placebo-controlled trial of high- vs. low-dose atorvastatin(1). Diabet Med 2011; 28:100-8. [PMID: 21166851 DOI: 10.1111/j.1464-5491.2010.03139.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [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] [Indexed: 11/27/2022]
Abstract
AIMS To compare the renal effects of low- vs. high-dose atorvastatin in patients with Type 2 diabetes mellitus and optimally managed early renal disease. METHODS We compared the 2-year progression of nephropathy in a double-blind randomized controlled trial of atorvastatin 80 mg/day (n = 60) vs. 10 mg/day (n = 59) in patients with Type 2 diabetes with microalbuminuria or proteinuria [mean (sd): age 64 years (10 years); HbA(1c) 7.7% (1.3%), 61 mmol/mol (10 mmol/mol); blood pressure 131/73 mmHg; renin-angiotensin system blocker use > 80%; dual blockade > 67%] recruited from diabetes clinics in Greater Manchester. RESULTS Over (mean) 2.1 years of follow-up, the Modification of Diet in Renal Disease estimated glomerular filtration rate declined by 3 ml min(-1) 1.73 m(-2) in the combined group. The mean (95% CI) between-group difference during follow-up was not significant [2.2 ml min(-1) 1.73 m(-2) (-1.1 to 5.4 ml min(-1) 1.73: m(-2) ), P = 0.20] after adjusting for baseline differences in renal function; positive difference favours 80 mg dose. Similarly, there was no significant difference in creatinine clearance by Cockcroft and Gault [2.5 ml/min (-2.4 to 7.3 ml/min), P = 0.32]; serum creatinine/24-h urine collections [4.0 ml/min (-4.8 to 12.7 ml/min), P = 0.38]; cystatin C (P = 0.69); or 24-h urine protein or albumin excretion (P = 0.92; P = 0.93). We recorded no significant between-group differences in deaths or adverse events. CONCLUSIONS In patients with Type 2 diabetes with early renal disease, we found no statistical difference in renal function between those taking high- or low-dose atorvastatin over 2 years. We cannot exclude a beneficial effect of < 1.6 ml min(-1) 1.73 m(-2) year(-1) on Modification of Diet in Renal Disease estimated glomerular filtration rate, or if blood pressure management or if renin-angiotensin system blocker use had not been optimized.
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Affiliation(s)
- M K Rutter
- Cardiovascular Medicine Research Group, School of Biomedicine, University of Manchester, Manchester, UK
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Srinivas-Shankar U, Somauroo JD, Delduca AM, Jordan TS, Bowles SA, Rutter MK. Temporal change in glucose tolerance in non-ST-elevation myocardial infarction. Diabetes Res Clin Pract 2008; 82:310-6. [PMID: 18842319 DOI: 10.1016/j.diabres.2008.08.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 04/02/2008] [Revised: 07/05/2008] [Accepted: 08/21/2008] [Indexed: 01/08/2023]
Abstract
We assessed the prevalence and 3-month change in glucose tolerance status in consecutive non-ST-elevation myocardial infarction (NSTEMI; European Society of Cardiology 2007 definition) patients (N=49; mean (S.D.) age 65 (11) years) admitted to a coronary care unit, without known diabetes. These patients underwent an oral glucose tolerance test (OGTT) 36-hour (median, IQR: 18-72) after admission and at 3 months. Undiagnosed abnormal glucose tolerance (AGT: impaired fasting glucose (IFG), impaired glucose tolerance (IGT) or new diabetes) was common (61% at admission and 41% at 3 months, p<0.05) and the majority (approximately 3/4) had IGT. Glucose tolerance status improved in a higher proportion of patients than it worsened (31% vs. 8%, p=0.04). At 3 months, fasting glucose was unchanged but 2-hour OGTT glucose was lower (mean (S.D.): 8.5 (2.7) mmol/L vs. 7.7 (2.7) mmol/L, p=0.004). 'Stress hyperglycaemia' could explain higher admission glucose levels and this raises the question about the optimal timing of OGTT in relation to myocardial infarction. Newly diagnosed diabetes was present in approximately 10% of patients and this was not reliably detected by fasting plasma glucose. In NSTEMI patients OGTT is the only reliable strategy to identify subjects with IGT and diabetes.
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Affiliation(s)
- U Srinivas-Shankar
- Department of Diabetes and Endocrinology, Countess of Chester NHS Hospital Trust, Liverpool Road, Chester CH2 1UL, UK.
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Fischbacher CM, Bhopal R, Rutter MK, Unwin NC, Marshall SM, White M, Alberti KGMM. Microalbuminuria is more frequent in South Asian than in European origin populations: a comparative study in Newcastle, UK. Diabet Med 2003; 20:31-6. [PMID: 12519317 DOI: 10.1046/j.1464-5491.2003.00822.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [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] [Indexed: 11/20/2022]
Abstract
AIMS We aimed to compare levels of urinary albumin excretion and the prevalence of microalbuminuria in UK South Asians and Europeans. Microalbuminuria predicts cardiovascular disease in European origin populations, but evidence from the general population of South Asians is lacking. Coronary heart disease (CHD) mortality is 40-50% higher in UK South Asians compared with the whole population, for reasons that are incompletely understood. METHODS Microalbuminuria was measured using the albumin-creatinine ratio in an age- and sex-stratified random sample of 1509 adults from European (n = 825), Indian (n = 259), Pakistani (n = 305) and Bangladeshi (n = 120) ethnic groups. RESULTS Levels of urinary albumin excretion were substantially higher in South Asians (geometric mean albumin creatinine ratio (95% confidence interval) 0.83 (0.75, 0.91)) than in Europeans (0.55 (0.51, 0.60)). Microalbuminuria was associated with older age, hypertension and diabetes, but independently of these risk factors urinary albumin excretion was higher in South Asians than Europeans. CONCLUSIONS Urinary albumin excretion is higher and microalbuminuria more frequent in UK South Asians compared with the majority ethnic population. Microalbuminuria may be relevant to the causal pathways leading to the excess of cardiovascular mortality and possibly renal failure in UK South Asians.
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Affiliation(s)
- C M Fischbacher
- Department of Epidemiology and Public Health, The Medical School, University of Newcastle-upon-Tyne, Newcastle, UK.
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Abstract
Between 120 and 140 million people suffer from diabetes mellitus (type 1 and type 2) worldwide, and this number may well double by the year 2025. Patients with diabetes are at increased risk of atherosclerosis and its clinical sequelae: coronary, peripheral vascular, and cerebrovascular diseases. Concurrently, the most common cause of death in persons with diabetes is myocardial infarction. The pathogenesis, progression, and epidemiology of atherosclerotic disease are distinct in patients with diabetes. Atherosclerosis can develop much earlier in life, and at an accelerated rate, compared with non-diabetic individuals. One of the factors responsible for increased atherosclerosis is related to the atherogenic lipid profile in diabetes. The pathobiological processes that are responsible for transforming dormant atherosclerotic plaques into active rupture-prone plaques may be enhanced in diabetes as well. It follows that a major challenge in the treatment of patients with diabetes is to reduce the risk of atherosclerotic disease. The third National Cholesterol Education Program (NCEP) report recently recommended that the management of dyslipidaemia in patients with diabetes should be as aggressive as in those with established coronary heart disease (CHD). The NCEP Adult Treatment Panel III guidelines recommend statins for patients at elevated risk for CHD.
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Affiliation(s)
- R W Nesto
- Department of Cardiovascular Medicine, Lahey Clinic Medical Center, Burlington, MA 01805, USA
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Rutter MK, McComb JM, Forster J, Brady S, Marshall SM. Increased left ventricular mass index and nocturnal systolic blood pressure in patients with Type 2 diabetes mellitus and microalbuminuria. Diabet Med 2000; 17:321-5. [PMID: 10821300 DOI: 10.1046/j.1464-5491.2000.00262.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [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] [Indexed: 11/20/2022]
Abstract
AIMS To compare left ventricular mass (LVM) index and function in patients with Type 2 diabetes mellitus with and without microalbuminuria and to investigate the clinical determinants of left ventricular hypertrophy. METHODS Echocardiography, electrocardiography and 24-h ambulatory blood pressure monitoring were performed in microalbuminuric (n = 29) and normoalbuminuric (n = 29) patients with Type 2 diabetes and no clinical evidence of heart disease. Groups were individually matched for age, sex and diabetes duration and smoking status. RESULTS LVM index (62 (34-87) vs. 52 (33-89) g/m2.7, P = 0.04) and LVH prevalence, using two out of three definitions, were greater in patients with microalbuminuria (LVM/height2.7: 72 vs. 59%, P = 0.27, LVM/height: 66 vs. 38%, P = 0.04, LVM/body surface area: 59 vs. 31%, P = 0.03). Night-time systolic blood pressure (126 (99-163) vs. 120 (104-157) mmHg, P = 0.005) and the night/day systolic blood pressure ratio (0.92 (0.08) vs. 0.88 (0.06), P = 0.04) were higher in those with microalbuminuria. Systolic and diastolic function were similar in both groups. Linear regression analyses showed that body mass index (BMI) was significantly related to loge LVM index (R2 = 11.8%, P = 0.005) and a relationship with night/day systolic blood pressure was also suggested (R2 = 4.6%, P = 0.057). CONCLUSIONS In patients with Type 2 diabetes, LVH is more common and severe in those with microalbuminuria. Its presence may be related to raised night/day systolic blood pressure ratio and is significantly related to BMI. The high prevalence of LVH strengthens the case for echocardiographic screening in Type 2 diabetes to identify high risk patients who might benefit from aggressive cardiovascular risk factor intervention.
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Affiliation(s)
- M K Rutter
- Department of Medicine, University of Newcastle upon Tyne, UK.
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Abstract
Microalbuminuria is an increase in urinary albumin not detected by conventional dipstick testing and is present in 20% of patients with non-insulin-dependent diabetes mellitus (NIDDM). Mortality in NIDDM patients with microalbuminuria is 60% at 8 years and is mainly due to cardiovascular disease. Because many deaths occur without warning symptoms, we have compared the prevalence and severity of silent myocardial ischemia in asymptomatic NIDDM patients with and without microalbuminuria. We have performed a cross-sectional, case-control study of asymptomatic NIDDM patients attending hospital diabetes clinics. Forty-three patients with microalbuminuria were matched for age, gender, diabetes duration, and smoking status with 43 normoalbuminuric patients. A symptom-limited exercise stress test was performed and reported blind to patient status. The degree of electrocardiographic ST-segment depression, exercise time, work performed, and maximum heart rate with exercise were recorded. Patients with microalbuminuria had a higher prevalence of ischemic response (>1 mm ST depression) (65% vs 40%, p = 0.016), reduced total exercise time (5 vs 7 minutes, p <0.001), reduced work (6 vs 8 METs, p <0.001), and reduced age-predicted maximum heart rate (94% vs 101%, p = 0.004). In multiple logistic regression, albumin excretion rate was shown to be the strongest independent predictor of ischemic response (p = 0.03). Silent myocardial ischemia is common in asymptomatic NIDDM patients but is more common in those with microalbuminuria. In these subjects, the higher prevalence of ischemic response at low workloads suggests a higher probability of future coronary events, and possibly a higher probability of potentially treatable coronary artery disease.
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Affiliation(s)
- M K Rutter
- Department of Medicine, University of Newcastle upon Tyne, United Kingdom
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Rutter MK, McComb JM, Brady S, Marshall SM. Autonomic neuropathy in asymptomatic subjects with non-insulin-dependent diabetes mellitus and microalbuminuria. Clin Auton Res 1998; 8:251-7. [PMID: 9801845 DOI: 10.1007/bf02277970] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [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: 01/28/2023]
Abstract
Patients with non-insulin-dependent diabetes mellitus (NIDDM) and microalbuminuria (MA) are at increased risk of early death. In NIDDM patients without evidence of heart disease, we examined the links between MA and autonomic neuropathy (AN) and reduced heart rate variability (HRV), both of which have been linked to a poor prognosis. We have studied 43 asymptomatic NIDDM patients with MA and have matched them with 43 normoalbuminuric patients for age, gender, diabetes duration, and smoking status. AN was assessed by heart rate changes to deep breathing, Valsalva, and posture and blood pressure changes to posture and hand grip. Twenty-four hour Holter monitoring was used to evaluate HRV. Patients with MA showed evidence of AN and reduced HRV when compared with normoalbuminuric patients. In multivariate analysis, with measures of AN and HRV as outcome variables, Log albumin excretion rate was a significant independent predictor but stronger predictors were the presence of diabetic retinopathy, age, body mass index, claudication, alcohol consumption, and calcium channel blocker use. The presence of MA is linked to AN and reduced HRV in asymptomatic NIDDM patients. The nature of the relationship is complex, involving multiple relationships with other clinical parameters.
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Affiliation(s)
- M K Rutter
- Department of Medicine, University of Newcastle upon Tyne, UK
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