A5069626807- Diabetes Management and Research
- Gestational Diabetes Research and Management
- Pancreatic function and diabetes
- Diabetes and associated disorders
- Diabetes Management and Education
- Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Pregnancy and preeclampsia studies
- Growth Hormone and Insulin-like Growth Factors
- Metabolism, Diabetes, and Cancer
- Mobile Health and mHealth Applications
- Hormonal Regulation and Hypertension
- Adrenal Hormones and Disorders
- Sexual Differentiation and Disorders
- Maternal and fetal healthcare
- Diabetes Treatment and Management
- Peroxisome Proliferator-Activated Receptors
- Mental Health Research Topics
- Primary Care and Health Outcomes
- Eosinophilic Disorders and Syndromes
- Behavioral Health and Interventions
- Cardiovascular Issues in Pregnancy
- Pregnancy and Medication Impact
- Botulinum Toxin and Related Neurological Disorders
- Neurological Complications and Syndromes
- Cancer Diagnosis and Treatment
St Thomas' Hospital
2016-2025
Guy's and St Thomas' NHS Foundation Trust
2013-2024
St. Thomas Hospital
2023
Sunnybrook Research Institute
2017
Sunnybrook Hospital
2017
Royal Surrey County Hospital
2005-2009
To evaluate the effect of continuous glucose monitoring (CGM) on frequency severe hypoglycemia (SH) in patients with established unawareness.We conducted a retrospective audit 35 type 1 diabetes and problematic unawareness, despite optimized medical therapy (continuous subcutaneous insulin infusion/multiple daily injections), who used CGM for >1 year.Over 1-year follow-up period, median rates SH were reduced from 4.0 (interquartile range [IQR] 0.75-7.25) episodes/patient-year to 0.0...
Little is known about the frequencies and types of nonmetabolic complications occurring in type 1 diabetes patients being treated by modern insulin pump therapy (continuous subcutaneous infusion [CSII]), when recorded standardized questionnaire rather than clinical experience.A self-report was completed successive subjects with attending an clinic, those a duration CSII ≥6 months were selected for analysis (n=92). Questions included manufacturer, insulin, set use, frequency site problems,...
We explored longitudinal changes associated with switching to hybrid closed-loop (HCL) insulin delivery systems in adults type 1 diabetes and elevated HbA1c levels despite the use of intermittently scanned continuous glucose monitoring (isCGM) pump therapy.We undertook a pragmatic, preplanned observational study participants included National Health Service England pilot. Adults using isCGM across 31 centers an ≥8.5% who were willing commence HCL therapy included. Outcomes change HbA1c,...
Aims: To explore healthcare professionals' views about the training and support needed to rollout closed-loop technology pregnant women with type 1 diabetes. Methods: We interviewed (n = 19) professionals who supported using CamAPS FX during Automated insulin Delivery Amongst Pregnant Type diabetes (AiDAPT) trial. Data were analyzed descriptively. An online workshop involving 15) trial team members was used inform recommendations. Ethics approvals obtained in conjunction those for wider...
Guidelines recommend that smoking cessation interventions are offered in all clinical settings to smokers willing make a quit attempt. Since the effectiveness of routine provision behavioural counselling and nicotine replacement therapy (NRT) admitted hospital has not been established, randomised controlled trial these given together compared with alone or minimal intervention was performed inpatients.Medical surgical inpatients who were current at time admission receive either usual care...
Pregnant women with type 1 diabetes strive for tight glucose targets (3.5-7.8 mmol/L) to minimise the risks of obstetric and neonatal complications. Despite using technologies including continuous monitoring (CGM), insulin pumps contemporary analogues, most struggle achieve maintain recommended pregnancy targets. This study aims evaluate whether use automated closed-loop delivery improves antenatal levels in pregnant diabetes.A multicentre, open label, randomized, controlled trial a HbA1c...
Advances in continuous glucose monitoring and insulin pumps have allowed people with type 1 diabetes (T1D) caregivers to accurately continuously measure their levels make adjustments infusion. In recent years, algorithms for subcutaneous dosing been developed that can respond changes an automated fashion "close the loop". At present, a first-generation 'hybrid closed-loop', 'artificial pancreas' or 'automated dosing' system, Medtronic 670G, is available commercially. Further systems are...
Hypoglycaemia is the commonest diabetic emergency and associated with considerable morbidity mortality. This study looked at use of services by people diabetes, particular reference to hypoglycaemia.Data were collected on all attendances related diabetes accident departments two district general hospitals in Surrey, UK, over a one year period.Hypoglycaemia was reason for attendance emergency. The management hypoglycaemia variable, most frequent method treatment being intramuscular glucagon...
OBJECTIVE We tested the hypothesis that impaired awareness of hypoglycemia (IAH) is independently associated with symptoms anxiety and depression in type 1 diabetes. RESEARCH DESIGN AND METHODS In this cross-sectional observational study 950 adults diabetes, associations were examined using multiple regression models, adjusting for sociodemographic clinical characteristics. RESULTS Prevalence probable anxiety, depression, IAH 9.4%, 9.8%, 22.6%, respectively. When included separate both an...
Heterozygous mutations in the transcription factors hepatocyte nuclear factor (HNF)-1α and -1β result MODY (maturity-onset diabetes of young). Despite structural similarity between HNF-1α -1β, HNF-1β mutation carriers have hyperinsulinemia, whereas normal or reduced insulin concentrations. We examined whether are resistant. The endogenous glucose production rate uptake were measured with a two-step, low-dose (0.3 mU · kg−1 min−1) high-dose (1.5 hyperinsulinemic-euglycemic clamp, an infusion...
Women with type 2 diabetes are at risk of commencing pregnancy while using medications that either not recommended for or known teratogenicity, which may contribute to adverse outcomes. In this study, we aimed characterize pregnancy-related factors and medication exposures among women diabetes. Individual health characteristics, sociodemographic information, prescription data were extracted from the primary care records aged 18-45 years in participating general practices UK. Prescribed...
Abstract Aims/Introduction Monogenic diabetes accounts for approximately 1–2% of all diabetes, and is difficult to distinguish from type 1 2 diabetes. Molecular diagnosis important, as the molecular subtype directs appropriate treatment. Patients are selected testing according clinical criteria, but up 80% monogenic in UK has not been correctly diagnosed. We investigated outcomes genetic our center compare methods selecting patients, consider avenues increase diagnostic efficiency. Materials...
Abstract Aim To elicit the views and experiences of women with Type 2 diabetes healthcare professionals relating to pregnancy pre‐pregnancy care they have received or provided. Methods A qualitative study using in‐depth semi‐structured interviews ( n =30) =22) from primary specialist care. Women were purposively sampled include different Data transcribed verbatim analysed thematically Framework Analysis. Results The median age was 37 years, most obese (median BMI 34.9 kg/m ), black Asian...
Currently, all pregnant women with diabetes are asked to attend screening at least twice during pregnancy, even if no retinopathy is detected in early pregnancy. We hypothesise that for diabetic the frequency of retinal may be safely reduced.
Abstract Aims Previous studies have suggested that plasma lipids are affected differently by the peroxisome proliferators‐activated receptor (PPAR)‐γ agonists pioglitazone and rosiglitazone. The aim of this study was to perform a quantitative lipoprotein turnover determine effects PPAR‐γ on metabolism. Methods Twenty‐four subjects with Type 2 diabetes treated diet and/or metformin were randomized in double‐blind receive 30 mg pioglitazone, 8 rosiglitazone or placebo once daily for 3 months....
We share our experience of using continuous subcutaneous insulin infusion (CSII) therapy and diabetes technology in six people (5 men) with type 1 (mean duration 36 years), who developed hyperglycemia post-simultaneous kidney/pancreas (n = 5) or pancreas only 1) transplant. All were on immunosuppression multiple daily injections prior to CSII. Four started automated delivery, two CSII intermittently scanned glucose monitoring. With technology, the median time range improved from 37% (24-49%)...
The number of women childbearing age with Type 2 diabetes(T2DM) is increasing, and they now account for > 50% pregnancies in pre-existing diabetes. Diabetes without adequate pre-pregnancy care have higher risk poor outcomes (miscarriages, birth-defects, stillbirths) are associated increased complications (caesarean deliveries, macrosomic babies, neonatal intensive-care admissions). risks costs these can be reduced pregnancy preparation (HbA1c, ≤ 6.5%, 5 mg folic acid stopping potentially...
Objectives To assess the feasibility of an ante- and post-natal lifestyle intervention for women with gestational diabetes mellitus (GDM) to reduce type 2 risk. Design A partially randomised patient preference trial. Setting Diabetes antenatal clinics in two inner-London hospitals, UK. Participants Pregnant ≥18 years a GDM diagnosis pre-pregnancy body mass index ≥25kg/m . Intervention group were offered four motivational interview-based sessions (two antenatally postnatally, at 3 6 months...
Key content The workings of the insulin pump. evidence behind use pumps in pregnancy. How dosage changes during pregnancy and labour. future pump technology. Learning objectives To understand basics therapy how to achieve good multidisciplinary care for pregnant women with diabetes who a Ethical issues Do improve outcomes diabetes? Should continuous glucose monitoring be available all an pump?