No abstract

This study aimed to observe the effect of the novel combination of dual add‐on therapy of a sodium‐glucose co‐transporter‐2 (SGLT2) inhibitor to a glucagon‐like peptide‐1 receptor agonist (GLP‐1 RA) on glycaemic control and weight in patients with suboptimal diabetes control who are already on antidiabetic treatment after failure of a GLP‐1 RA therapy alone. We conducted a retrospective observational case note review of patients who had a minimum of 12 weeks’ treatment with a GLP‐1 RA added onto their previous regimen followed by the addition of an SGLT2 inhibitor. HbA1c and weight were measured routinely. Dual therapy with a GLP‐1 RA and an SGLT2 inhibitor was associated with a significantly larger reduction in HbA1c than therapy with a GLP‐1 RA (25.5mmol/mol vs 8mmol/mol; p < 0.05) on the background of the usual diabetic regimen at week 20; this effect was sustained at week 48. There was an additional benefit of further weight loss in 58% of the patients on dual add‐on therapy compared to single GLP‐1 therapy at 48 weeks. In conclusion, patients with type 2 diabetes who require further improvement in glycaemic control despite the addition of a GLP‐1 RA to their regimen can be considered for an SGLT2 inhibitor. The mechanism of action may be synergistic and has the advantage of promoting further weight loss. Copyright © 2016 John Wiley & Sons.

Uptake of postpartum glycaemic assessment in women with gestational diabetes (GDM) has been shown to be low, with six weeks postpartum testing (as recommended by the UK National Institute for Health and Care Excellence) inconvenient for new mothers who prioritise their new baby over their own health at this time. As pregnancy‐related insulin resistance returns to pre‐pregnancy levels immediately after placental delivery, we hypothesised that early postpartum fasting blood glucose testing, while the mother is likely to be still in hospital, would increase uptake of postpartum glycaemic assessment. A novel protocol for early postpartum fasting blood glucose testing in women with GDM was implemented and prospectively evaluated looking at uptake of postpartum glycaemic testing in the first year after implementation. In all, 118 consecutive patients with GDM delivered in our trust between September 2015 and September 2016. Mean (SD) age was 32(5.7) years; mean (SD) body mass index was 30.6(6.5)kg/m2. A total of 107 patients (90.7%) had a fasting glucose test while in hospital, five re‐attended the maternity unit for a fasting glucose within four weeks, giving a total uptake of postpartum glycaemic testing of 94.9%. Two (1.8%) patients had impaired fasting glucose and no patients had a fasting glucose of 7mmol/L or greater detected by early postpartum testing. It was concluded that early postpartum glycaemic assessment in women with GDM, using fasting blood glucose measurement while still in hospital after delivery, is an effective strategy that improves the follow‐up rate to near complete uptake. Copyright © 2017 John Wiley & Sons.

OBJECTIVE We explored longitudinal changes associated with switching to hybrid closed loop (HCL) insulin delivery systems in adults with type 1 diabetes and elevated HbA1c levels despite the use of intermittently scanned continuous glucose monitoring (isCGM) and insulin pump therapy. RESEARCH DESIGN AND METHODS We undertook a pragmatic, preplanned observational study of participants included in the National Health Service England closed loop pilot. Adults using isCGM and insulin pump across 31 diabetes centers in England with an HbA1c ≥8.5% who were willing to commence HCL therapy were included. Outcomes included change in HbA1c, sensor glucometrics, diabetes distress score, Gold score (hypoglycemia awareness), acute event rates, and user opinion of HCL. RESULTS In total, 570 HCL users were included (median age 40 [IQR 29–50] years, 67% female, and 85% White). Mean baseline HbA1c was 9.4 ± 0.9% (78.9 ± 9.1 mmol/mol) with a median follow-up of 5.1 (IQR 3.9–6.6) months. Of 520 users continuing HCL at follow-up, mean adjusted HbA1c reduced by 1.7% (95% CI 1.5, 1.8; P &lt; 0.0001) (18.1 mmol/mol [95% CI 16.6, 19.6]; P &lt; 0.0001). Time in range (70–180 mg/dL) increased from 34.2 to 61.9% (P &lt; 0.001). Individuals with HbA1c of ≤58 mmol/mol rose from 0 to 39.4% (P &lt; 0.0001), and those achieving ≥70% glucose time in range and &lt;4% time below range increased from 0.8 to 28.2% (P &lt; 0.0001). Almost all participants rated HCL therapy as having a positive impact on quality of life (94.7% [540 of 570]). CONCLUSIONS Use of HCL is associated with improvements in HbA1c, time in range, hypoglycemia, and diabetes-related distress and quality of life in people with type 1 diabetes in the real world.

Objectives:To explore whether (direct) referrals from GPs to two Community Mental Health Team (CMHT) clinical psychologists differed from those received from both ‘Psychiatric’ (eg. consultant psychiatrists) and ‘Other’ sources.Method:The two psychologists retrospectively examined and coded the case files of all clients who attended them during a 12-month period. The six measures used were diagnostic prevalence and groups, co-morbidity, chronicity, previous hospital admission and CMHT contact Separate cross-tabulations and chi squared tests were conducted for the various dependent variables to profile differences across the three referral sources.Results:There was no difference in prevalence of Axis I disorders, co-morbidity and chronicity of disorders between ‘GP’ and ‘Psychiatric’ referrals to the two CMHT psychologists. However, although low in number, there were more eating and psychotic disorders among the ‘Psychiatric’ referrals, and more of these referrals had previous hospital admission and CMHT contact.Conclusions:‘GP’ referrals were similar to ‘Psychiatric’ referrals on some measures but differed on others. Hence, as to whether an ‘open access’ model of (direct) referral to CMHT clinical psychologists lowers the clinical threshold for referrals depends on which measures are deemed most critical. Consistently applying a composite index of referral ‘severity’ could prevent the former.