Diabetic Medicine最新文献

{"title":"Enhanced glucose processing in gestational diabetes diagnosis: Effects on health equity and clinical outcomes","authors":"Danielle L. Jones,&nbsp;Laura C. Kusinski,&nbsp;Peter Barker,&nbsp;Keith Burling,&nbsp;Ian Halsall,&nbsp;Elizabeth Turner,&nbsp;Coralie Glenn-Sansum,&nbsp;Abby Rand,&nbsp;Jenny Finch,&nbsp;Genessa Peters,&nbsp;Geraldine Upson,&nbsp;Edward Mullins,&nbsp;Claire L. Meek","doi":"10.1111/dme.15476","DOIUrl":"10.1111/dme.15476","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Gestational diabetes is diagnosed using an oral glucose tolerance test (OGTT), which has limited accuracy, reproducibility and practicality. We assessed the effect of enhanced pre-analytical glucose processing upon glucose concentrations, gestational diabetes diagnosis, health equity and pregnancy outcomes, and if HbA1c was a suitable alternative.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We recruited pregnant women with ≥1 risk factor to a prospective observational cohort study of pregnancy hyperglycaemia, endocrine causes, lipids, insulin and autoimmunity (OPHELIA), from nine UK centres. During a 75 g antenatal OGTT (National Institute of Health and Care Excellence criteria), standard glucose processing was compared to enhanced glucose processing (storage on ice, rapid centrifugation, aliquoting and freezing &lt;2.5 h).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We recruited 1308 participants of mean (SD) age 31.5 years (5.0) and BMI 33.0 kg/m² (6.8) of 82.5% white ethnicity, representative of the UK population. Enhanced glucose processing resulted in glucose levels ~0.6 mmol/L higher than standard glucose processing, increasing gestational diabetes diagnosis from 9% to 22%. Women with gestational diabetes on enhanced but not standard glucose processing (<i>n</i> = 165) were younger (31.9 vs. 33.2 years, <i>p</i> = 0.035), with a higher BMI (36.5 vs. 33.9 kg/m²; <i>p</i> = 0.003), different ethnic distribution (<i>p</i> = 0.025) and delivered more large-for-gestational age infants (37.0% vs. 22.3%; <i>p</i> = 0.006) compared to women with gestational diabetes on standard processing alone. HbA1c was not a suitable alternative predictor of gestational diabetes diagnosis (Area under receiver operator curve 0.74; 95% CI 0.68–0.79).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>An OGTT with enhanced glucose processing would support more accurate, equitable diagnosis of gestational diabetes, but with increased diagnosis rates.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 3","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.15476","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Removing barriers to management of adults with type 2 diabetes on insulin using continuous glucose monitoring in UK primary care practice: An expert consensus","authors":"Samuel Seidu,&nbsp;Lorraine Avery,&nbsp;Heather Bell,&nbsp;Pam Brown,&nbsp;Jane Diggle,&nbsp;Su Down,&nbsp;Ritesh Dua,&nbsp;Patrick Holmes,&nbsp;Rahul Mohan,&nbsp;Nicola Milne,&nbsp;Thinzar Min,&nbsp;James Ridgeway,&nbsp;Waqas Tahir,&nbsp;Sanjay Tanna","doi":"10.1111/dme.15500","DOIUrl":"10.1111/dme.15500","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aims&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This expert consensus reviews the reality of primary care clinical management of people with type 2 diabetes (T2D) on non-intensive insulin therapy, with an emphasis on the use of continuous glucose monitoring (CGM) technology for effective care in this participant group. Here, we identify key unmet needs for skills and systems development within this frontline healthcare setting, along with major challenges and opportunities associated with managing these changes effectively.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The authors participated in two primary care consensus panels held on 28 November 2023 and on 21 May 2024. The focus for these expert panels was to understand the unmet needs within primary care to manage adults with T2D treated with non-intensive insulin therapy and incorporating the use of CGM systems. A Delphi Survey was undertaken among a wider group of Primary Care Diabetes Technology Network members in the United Kingdom, to understand prevalent attitudes to management of adults with T2D on insulin and using CGM in primary care. Based on these activities, a series of consensus statements were tested in a second Delphi Survey.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The activities described, involving primary care healthcare professionals (HCPs) with expertise in diabetes management, identified a series of training and educational needs within UK general practice that are central to skills development for the care of adults with T2D on insulin therapy and the application of CGM technology. Potential barriers to effective primary care management of people with T2D using CGM devices were identified. Areas of concern included confidence in national and local guidelines for the management of T2D using CGM systems, lack of experience on the part both of HCPs and people with T2D, clinical workflows and systems, as well as inbuilt resistance to change among primary care teams. However, the expert group were clear that the goal of providing care for people with T2D on non-intensive insulin therapy using CGM technology as standard of care could be met (94.3%, &lt;i&gt;n&lt;/i&gt; = 33). This will deliver clinical benefits for people with T2D, and improvements to clinical workflows in primary care. Cost-savings to the health service were also identified as an outcome.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;The need to adapt to the management of people with T2D on insulin therapy puts significant pressure on current workflows and skills for primary care teams. Steps in overcoming these immediate pr","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 3","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.15500","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A special issue on from bench to bedside: An integrated and multidisciplinary approach to tackling diabetic kidney disease","authors":"Janaka Karalliedde,&nbsp;Claire E. Hills","doi":"10.1111/dme.15501","DOIUrl":"10.1111/dme.15501","url":null,"abstract":"","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 2","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetic foot disease: Assessing adherence of national acute and screening referral pathways with NICE guidelines","authors":"Amy Jones,&nbsp;Aleksandra Staniszewska,&nbsp;Robert Hinchliffe","doi":"10.1111/dme.15478","DOIUrl":"10.1111/dme.15478","url":null,"abstract":"","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 4","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between glycaemic variability and sleep quality and quantity in adults with type 1 and type 2 diabetes: A systematic review","authors":"Cecilia T. Pham,&nbsp;Aleena Ali,&nbsp;Leonid Churilov,&nbsp;Sara Baqar,&nbsp;Christel Hendrieckx,&nbsp;David N. O'Neal,&nbsp;Mark E. Howard,&nbsp;Elif I. Ekinci","doi":"10.1111/dme.15485","DOIUrl":"10.1111/dme.15485","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Individuals with diabetes frequently encounter sleep disturbances, which can detrimentally impact glycaemic management. We reviewed the relationship between sleep outcomes and glycaemic variability in adults with diabetes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We systematically searched Medline, EMBASE and Cochrane Library (2002-March 2023) for studies evaluating sleep and glycaemic variability in adults with type 1 and type 2 diabetes. Among the 3049 records, 27 met the inclusion criteria (type 1 diabetes studies = 22). Due to methodological heterogeneity, a qualitative analysis was conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Most studies measuring sleep quality (5 out 7; 71%) reported a significant association with glycaemic variability in type 1 and type 2 diabetes. Sleep duration was not significantly associated with glycaemic variability in type 1 diabetes, whereas other sleep metrics yielded inconclusive results. Hybrid closed-loop pump interventions (<i>n</i> = 12) demonstrated varying sleep outcomes with improved glycaemic variability. Similarly, sleep interventions (<i>n</i> = 3) consistently enhanced sleep but not glycaemic variability. Limitations included moderate to high risk of study bias, confounders, methodological heterogeneity and limited type 2 diabetes data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A potential association between sleep quality and glycaemic variability exists. However, associations with other sleep metrics remain elusive, with no discernible association between sleep duration and glycaemic variability in type 1 diabetes. Despite advancements in continuous glucose monitoring and ambulatory sleep monitoring, standardised sleep assessment methodologies are lacking in real-world studies. Establishing standard protocols for sleep assessment and defining optimal sleep targets are crucial for meaningful comparisons between studies. Understanding the complex interplay between sleep and glycaemic variability holds promise in improving diabetes management and sleep health.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 4","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Freestyle Libre 2.0 in children with type 1 diabetes mellitus and elevated HbA1c: Extension phase results after a 12-week randomized controlled trial","authors":"Yongwen Zhou,&nbsp;Benjamin J. Wheeler,&nbsp;Alisa Boucsein,&nbsp;Sara E. Styles,&nbsp;Bronte Chamberlain,&nbsp;Venus R. Michaels,&nbsp;Hamish R. Crockett,&nbsp;Anita Lala,&nbsp;Vicki Cunningham,&nbsp;Esko J. Wiltshire,&nbsp;Anna S. Serlachius,&nbsp;Craig Jefferies","doi":"10.1111/dme.15494","DOIUrl":"10.1111/dme.15494","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To investigate extension phase outcomes with intermittently scanned continuous glucose monitoring (isCGM 2.0) in children with type 1 diabetes mellitus (T1DM) and elevated HbA_1c (7.5–12.2% [58–110 mmol/mol]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>One hundred children with T1DM aged 4–13 years were initially in a 12-week randomised controlled trial (RCT) comparing glycaemic outcomes with isCGM 2.0 (intervention group, <i>n</i> = 49) with self-monitored blood glucose (Control group, <i>n</i> = 51). After the 12-week RCT both groups were offered an extension phase with isCGM 2.0 for another 12 weeks. HbA_1c, CGM metrics, psychological outcomes and device utilization attitudes were measured.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>After the initial 12-week RCT, 66 participants completed this 12-week extension: 36/49 (73%) and 30/51 (58.8%) from the isCGM/isCGM and Control/isCGM groups, respectively. In the isCGM/isCGM group, time below range 70 mg/dL (3.9 mmol/L) (TBR70) reduced from 10.7 ± 11.3% at baseline to 2.8 ± 2.8% and 2.1 ± 2.4% at 12 and 24 weeks, respectively (<i>p</i> &lt; 0.01 for both 12 and 24 weeks). Glucose test frequency increased from 4.7 (2.7) at baseline to 10.7 (4.6) and 9.2 (4.7) at 12 and 24 weeks, respectively (<i>p</i> &lt; 0.01 for both 12 and 24 weeks). The Control/isCGM group decreased TBR70 from 10.7 ± 7.4% at 12 weeks to 2.9 ± 2.8% at 24 weeks and increased daily glucose test frequency from 3.2 (1.6) to 10.7 (5.4) from 12 to 24 weeks (both <i>p</i> &lt; 0.01). However, HbA_1c and time in range (TIR) were non-significant at 24 weeks in both groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Extension phase outcomes with intermittently scanned continuous glucose monitoring (isCGM 2.0) in children with T1DM and elevated HbA_1c showed a sustained reduction in hypoglycaemia and increased testing frequency at 24 weeks.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 5","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.15494","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142805615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"OptimAAPP, a smartphone insulin dose calculator for carbohydrate, fat, and protein: A cross-over, randomised controlled trial in adolescents and adults with type 1 diabetes using multiple daily injection therapy","authors":"Tenele A. Smith,&nbsp;Nisha Venkatesh,&nbsp;Kerryn Roem,&nbsp;Jean C. Lu,&nbsp;Emma Netzer,&nbsp;Adrian Medioli,&nbsp;Stuart Szwec,&nbsp;David N. O'Neal,&nbsp;Bruce R. King,&nbsp;Carmel E. Smart","doi":"10.1111/dme.15487","DOIUrl":"10.1111/dme.15487","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To (1) evaluate the efficacy of OptimAAPP, a smartphone insulin dose calculator for carbohydrate, fat, and protein in managing glycaemia compared with carbohydrate counting in adolescents and adults with type 1 diabetes using flexible multiple daily injection therapy (MDI, ≥4 injections/day) and (2) assess user acceptability of OptimAAPP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this free-living trial, participants aged 12–50 years were randomised to use carbohydrate counting or OptimAAPP for meal insulin dose calculation for 3 months, then use the alternate method for 3 months. The primary outcome, time-in-range (3.9–10.0 mmol/L) was measured in weeks 3–4 of each arm using continuous glucose monitoring. The acceptability of OptimAAPP was assessed at end intervention using a purpose-designed questionnaire.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>An intention-to-treat analysis of 41 participants, mean age 28 ± 12 years and HbA1c 56 ± 10 mmol/mol (7.3 ± 0.9%) found no significant difference in glycaemic outcomes when using OptimAAPP compared with carbohydrate counting including time-in-range (70.5 vs. 67.6%, <i>p</i> = 0.102), above range (24.5% vs. 28.0%, <i>p</i> = 0.068), below range (4.9% vs. 4.4%, <i>p</i> = 0.318), and coefficient of variation (32.2% vs. 33.3%, <i>p</i> = 0.136). There was no severe hypoglycaemia. Participants reported that OptimAAPP was easy to use (79%), and they were confident in giving the recommended doses (82%). Barriers to use were the small food database and the time associated with food entry.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In adolescents and adults using flexible MDI therapy, OptimAAPP use did not produce glycaemic outcomes that were significantly different from carbohydrate counting. Participant views of OptimAAPP indicate a high level of acceptability. Increasing the size of the food database will likely enhance the user experience.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 4","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fear of hypoglycemia relates to glycemic levels during and after real-world physical activity in adolescents with type 1 diabetes","authors":"Susana R. Patton,&nbsp;Simon Bergford,&nbsp;Robin L. Gal,&nbsp;Peter Calhoun,&nbsp;Mark A. Clements,&nbsp;Jennifer L. Sherr,&nbsp;Michael C. Riddell","doi":"10.1111/dme.15482","DOIUrl":"10.1111/dme.15482","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>We explore the association between hypoglycaemia fear (FH) and glycaemia during and after exercise sessions in a large sample of physically active youth with type 1 diabetes (T1D).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used data from the Type 1 Diabetes Exercise Initiative Paediatric (T1DEXIP) Study. Youth self-reported on FH using the Hypoglycaemia Fear Survey-Child (HFS-C). They used a smart phone application to self-report food intake and insulin dosing (multiple daily injection only). We collected pump and continuous glucose monitoring data directly from the device.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our sample included <i>n</i> = 251 youth (mean age: 14 ± 2 years, 55% closed loop pump; 42% women). Youth reporting higher <i>HFS-C Total</i> and <i>Helplessness/Worry</i> scores (HFS-C subscale) had slightly fewer competitive and fewer high intensity exercise events compared to youth with lower <i>HFS-C</i> Total and Helplessness<i>/Worry</i> scores. Youth reporting the highest <i>Maintain High Blood Glucose</i> scores (HFS-C subscale) had the lowest percent glucose time in range, higher mean glucose levels, and higher percent time above range during exercise. Youth reporting the highest <i>Maintain High Blood Glucose</i> scores also tended to have higher mean glucose levels post-exercise and a smaller drop in glucose during exercise.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>FH relates to glycaemia during and after exercise in adolescents with T1D and may signal an inclination for some youth to engage in avoidance behaviours to reduce their vulnerability to exercise-induced hypoglycaemia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 4","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of attitudes towards and experiences with physician Associates in Diabetes and Endocrinology from a survey of Association of British Clinical Diabetologists members","authors":"Saika Hussain,&nbsp;Oliver Hope,&nbsp;Ketan Dhatariya,&nbsp;Kate Fayers,&nbsp;Vijay Jayagopal,&nbsp;Hermione Price","doi":"10.1111/dme.15493","DOIUrl":"10.1111/dme.15493","url":null,"abstract":"","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 5","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical utility of liver function tests for resolution of metabolic dysfunction-associated steatotic liver disease after weight loss in the Diabetes Remission Clinical Trial","authors":"S. V. Zhyzhneuskaya,&nbsp;A. H. Al-Mrabeh,&nbsp;C. Peters,&nbsp;A. C. Barnes,&nbsp;K. G. Hollingsworth,&nbsp;P. Welsh,&nbsp;N. Sattar,&nbsp;M. E. J. Lean,&nbsp;R. Taylor","doi":"10.1111/dme.15462","DOIUrl":"10.1111/dme.15462","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Ectopic fat is reduced by effective weight management, but difficult to assess clinically.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We evaluated paired data on 42 participants in the intervention group of the Diabetes Remission Clinical Trial (DiRECT) at baseline, 12 and 24 months after weight loss as indicators of liver fat content measured by 3-point Dixon MRI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Baseline liver fat was elevated at 13.0 [7.8–23.3]% with fasting plasma glucose 7.9 [7.1–10.1] mmol/L. Prevalence of baseline MASLD was 86.4%. After weight loss of 11.9 ± 1.2 kg (0–37 kg) at 12 months, remission of MASLD occurred in 74% and liver fat normalised for many (1.8 [1.2–5.2]%; <i>p</i> &lt; 0.0001) as did fasting glucose (5.9 [5.5–7.2] mmol/L; <i>p</i> &lt; 0.0001). Alanine aminotransferase (ALT) and gamma glutamyl transferase (GGT) decreased at 12 months by 38 [19–60]% (<i>p</i> &lt; 0·0001) and 38 [16–53]% (<i>p</i> &lt; 0.0001) respectively. The positive predictive value for decrease in liver fat, with baseline values of &gt;40 IU/L, was 100% for ALT and 87.5% for GGT. As expected, change in liver fat correlated with change in ALT (<i>r</i> = 0.64; <i>p</i> &lt; 0.0001), GGT (<i>r</i> = 0.38; <i>p</i> = 0.013), AST (<i>r</i> = 0.36; <i>p</i> = 0.018), fatty liver index (<i>r</i> = 0.50; <i>p</i> &lt; 0.0001) and hepatic steatosis index (<i>r</i> = 0.44; <i>p</i> &lt; 0.0001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Metabolic dysfunction-associated steatotic liver disease, an important marker of ill-health is improved by intentional weight loss. If enzyme levels are raised at baseline, following weight loss, changes in ALT and GGT usefully reflect change in liver fat content, with high positive predictive value. Monitoring liver enzymes can provide a simple way to assess change in liver fat following weight loss in day-to-day clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11251,"journal":{"name":"Diabetic Medicine","volume":"42 3","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dme.15462","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}