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Type 1 Diabetes Mellitus: HELP
Articles from University of Sheffield
Based on 68 articles published since 2008
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These are the 68 published articles about Diabetes Mellitus, Type 1 that originated from University of Sheffield during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Guideline Vitamin D supplementation in the prevention and management of major chronic diseases not related to mineral homeostasis in adults: research for evidence and a scientific statement from the European society for clinical and economic aspects of osteoporosis and osteoarthritis (ESCEO). 2017

Cianferotti, Luisella / Bertoldo, Francesco / Bischoff-Ferrari, Heike A / Bruyere, Olivier / Cooper, Cyrus / Cutolo, Maurizio / Kanis, John A / Kaufman, Jean-Marc / Reginster, Jean-Yves / Rizzoli, Rene / Brandi, Maria Luisa. ·Bone Metabolic Diseases Unit, Department of Surgery and Translational Medicine, University Hospital of Florence and University of Florence, Florence, Italy. · Department of Medicine, University of Verona, Verona, Italy. · Department of Geriatrics and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland. · Epidemiology and Public Health, University of Liege, CHU Sart Tilman, Liege, 4000, Belgium. · MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, Hants, UK. · Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genova, Genoa, Italy. · Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK. · Institute for Health and Aging, Catholic University of Australia, Melbourne, VIC, Australia. · Department of Endocrinology and Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium. · Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart-Tilman, Liège, Belgium. · Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. · Bone Metabolic Diseases Unit, Department of Surgery and Translational Medicine, University Hospital of Florence and University of Florence, Florence, Italy. marialuisa.brandi@unifi.it. ·Endocrine · Pubmed #28390010.

ABSTRACT: INTRODUCTION: Optimal vitamin D status promotes skeletal health and is recommended with specific treatment in individuals at high risk for fragility fractures. A growing body of literature has provided indirect and some direct evidence for possible extraskeletal vitamin D-related effects. PURPOSE AND METHODS: Members of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis have reviewed the main evidence for possible proven benefits of vitamin D supplementation in adults at risk of or with overt chronic extra-skeletal diseases, providing recommendations and guidelines for future studies in this field. RESULTS AND CONCLUSIONS: Robust mechanistic evidence is available from in vitro studies and in vivo animal studies, usually employing cholecalciferol, calcidiol or calcitriol in pharmacologic rather than physiologic doses. Although many cross-sectional and prospective association studies in humans have shown that low 25-hydroxyvitamin D levels (i.e., <50 nmol/L) are consistently associated with chronic diseases, further strengthened by a dose-response relationship, several meta-analyses of clinical trials have shown contradictory results. Overall, large randomized controlled trials with sufficient doses of vitamin D are missing, and available small to moderate-size trials often included people with baseline levels of serum 25-hydroxyvitamin D levels >50 nmol/L, did not simultaneously assess multiple outcomes, and did not report overall safety (e.g., falls). Thus, no recommendations can be made to date for the use of vitamin D supplementation in general, parental compounds, or non-hypercalcemic vitamin D analogs in the prevention and treatment of extra-skeletal chronic diseases. Moreover, attainment of serum 25-hydroxyvitamin D levels well above the threshold desired for bone health cannot be recommended based on current evidence, since safety has yet to be confirmed. Finally, the promising findings from mechanistic studies, large cohort studies, and small clinical trials obtained for autoimmune diseases (including type 1 diabetes, multiple sclerosis, and systemic lupus erythematosus), cardiovascular disorders, and overall reduction in mortality require further confirmation.

2 Review International Consensus on Risk Management of Diabetic Ketoacidosis in Patients With Type 1 Diabetes Treated With Sodium-Glucose Cotransporter (SGLT) Inhibitors. 2019

Danne, Thomas / Garg, Satish / Peters, Anne L / Buse, John B / Mathieu, Chantal / Pettus, Jeremy H / Alexander, Charles M / Battelino, Tadej / Ampudia-Blasco, F Javier / Bode, Bruce W / Cariou, Bertrand / Close, Kelly L / Dandona, Paresh / Dutta, Sanjoy / Ferrannini, Ele / Fourlanos, Spiros / Grunberger, George / Heller, Simon R / Henry, Robert R / Kurian, Martin J / Kushner, Jake A / Oron, Tal / Parkin, Christopher G / Pieber, Thomas R / Rodbard, Helena W / Schatz, Desmond / Skyler, Jay S / Tamborlane, William V / Yokote, Koutaro / Phillip, Moshe. ·Diabetes Centre for Children and Adolescents, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Germany. · University of Colorado Denver and Barbara Davis Center for Diabetes, Aurora, CO. · Keck School of Medicine of the University of Southern California, Los Angeles, CA. · University of North Carolina School of Medicine, Chapel Hill, NC. · Department of Endocrinology, UZ Gasthuisberg, KU Leuven, Leuven, Belgium. · Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Diego, San Diego, CA. · Alexander Associates LLC, Gwynedd Valley, PA. · Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital, University Medical Centre Ljubljana, and Faculty of Medicine, University of Ljubljana, Slovenia. · Clinic University Hospital of Valencia, Valencia, Spain. · Atlanta Diabetes Associates, Atlanta, GA. · Clinique d'endocrinologie, L'institut du thorax, CHU Nantes, CIC 1413 INSERM, Nantes, France. · The diaTribe Foundation, San Francisco, CA. · Division of Endocrinology, Diabetes and Metabolism, University at Buffalo, The State University of New York, Buffalo, NY. · JDRF International, New York, NY. · National Research Council (CNR) Institute of Clinical Physiology, Pisa, Italy. · Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Australia. · Grunberger Diabetes Institute, Bloomfield Hills, MI. · Academic Unit of Diabetes, Endocrinology & Metabolism, University of Sheffield, Sheffield, U.K. · Close Concerns, San Francisco, CA. · McNair Interests, Houston, TX. · Jesse Z and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel. · Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. · CGParkin Communications, Inc., Boulder City, NV chris@cgparkin.org. · Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria. · Endocrine and Metabolic Consultants, Rockville, MD. · Division of Endocrinology, Department of Pediatrics, University of Florida, Gainesville, FL. · Division of Endocrinology, Diabetes and Metabolism, Miller School of Medicine, University of Miami, Miami, FL. · Department of Pediatrics, Yale School of Medicine, New Haven, CT. · Department of Diabetes, Metabolism and Endocrinology, Chiba University Graduate School of Medicine, Chiba, Japan. ·Diabetes Care · Pubmed #30728224.

ABSTRACT: Sodium-glucose cotransporter (SGLT) inhibitors are new oral antidiabetes medications shown to effectively reduce glycated hemoglobin (A1C) and glycemic variability, blood pressure, and body weight without intrinsic properties to cause hypoglycemia in people with type 1 diabetes. However, recent studies, particularly in individuals with type 1 diabetes, have demonstrated increases in the absolute risk of diabetic ketoacidosis (DKA). Some cases presented with near-normal blood glucose levels or mild hyperglycemia, complicating the recognition/diagnosis of DKA and potentially delaying treatment. Several SGLT inhibitors are currently under review by the U.S. Food and Drug Administration and European regulatory agencies as adjuncts to insulin therapy in people with type 1 diabetes. Strategies must be developed and disseminated to the medical community to mitigate the associated DKA risk. This Consensus Report reviews current data regarding SGLT inhibitor use and provides recommendations to enhance the safety of SGLT inhibitors in people with type 1 diabetes.

3 Review Diagnosis and management of bone fragility in diabetes: an emerging challenge. 2018

Ferrari, S L / Abrahamsen, B / Napoli, N / Akesson, K / Chandran, M / Eastell, R / El-Hajj Fuleihan, G / Josse, R / Kendler, D L / Kraenzlin, M / Suzuki, A / Pierroz, D D / Schwartz, A V / Leslie, W D / Anonymous1841118. ·Division of Bone Diseases, Department of Internal Medicine Specialties, Geneva University Hospital & Faculty of Medicine, 1205, Geneva, Switzerland. serge.ferrari@unige.ch. · Department of Medicine, Holbaek Hospital, Holbaek, Denmark. · OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark. · Unit of Endocrinology and Diabetes, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy. · Division of Bone and Mineral Diseases, Washington University in St Louis, St Louis, MO, USA. · Department of Clinical Sciences, Clinical and Molecular Osteoporosis Unit, Lund University, Malmö, Sweden. · Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore, Singapore. · Academic Unit of Bone Metabolism, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK. · Department of Internal Medicine, Division of Endocrinology, Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, Riad El Solh, Beirut, Lebanon. · Department of Medicine and Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada. · Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON, Canada. · Department of Medicine, Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada. · Endonet, Endocrine Clinic and Laboratory, Basel, Switzerland. · Division of Endocrinology and Metabolism, Fujita Health University, Toyoake, Aichi, Japan. · International Osteoporosis Foundation, Nyon, Switzerland. · Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA. · Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. ·Osteoporos Int · Pubmed #30066131.

ABSTRACT: Fragility fractures are increasingly recognized as a complication of both type 1 and type 2 diabetes, with fracture risk that increases with disease duration and poor glycemic control. Yet the identification and management of fracture risk in these patients remains challenging. This review explores the clinical characteristics of bone fragility in adults with diabetes and highlights recent studies that have evaluated bone mineral density (BMD), bone microstructure and material properties, biochemical markers, and fracture prediction algorithms (i.e., FRAX) in these patients. It further reviews the impact of diabetes drugs on bone as well as the efficacy of osteoporosis treatments in this population. We finally propose an algorithm for the identification and management of diabetic patients at increased fracture risk.

4 Review The role of structured education in the management of hypoglycaemia. 2018

Iqbal, Ahmed / Heller, Simon R. ·Department of Oncology and Metabolism, Room EU38, E Floor, School of Medicine and Biomedical Sciences, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK. · Department of Oncology and Metabolism, Room EU38, E Floor, School of Medicine and Biomedical Sciences, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK. s.heller@sheffield.ac.uk. ·Diabetologia · Pubmed #28660491.

ABSTRACT: The role of intensive glycaemic control in preventing microvascular disease in diabetes is well established. Iatrogenic hypoglycaemia is, however, a major barrier to effective treatment. Hypoglycaemia is associated with a significant level of morbidity and, despite pharmacological and technological therapeutic advances, reported rates of severe hypoglycaemia in clinical practice have not fallen over the last 20 years. This suggests that human factors are of major relevance and that ensuring the effective self-management of diabetes is an important strategy for the reduction of hypoglycaemic risk. Most of the evidence for the impact of this strategy on hypoglycaemia risk is confined to adults with type 1 diabetes although, in this review, we also cite studies that have specifically addressed this in type 2 diabetes. There are relatively few adequately powered RCTs that have rigorously evaluated the effectiveness of structured education and training programmes on hypoglycaemia; however, the available data suggest a subsequent reduction in severe hypoglycaemia rates of around 50%, a rate reduction that is comparable with that observed following technological interventions. Furthermore, longitudinal observational cohorts support these data, showing similar reductions in rates of hypoglycaemia following structured education. Those who continue to experience recurrent hypoglycaemia and impaired awareness of hypoglycaemia despite education and training in diabetes self-management may benefit from technological interventions and/or interventions that specifically address psychological factors that contribute to hypoglycaemia risk; however, there is urgent need for further research in this area. In the meantime, structured education for effective self-management of diabetes should be part of routine therapy for all those with type 1 diabetes.

5 Review International Consensus on Use of Continuous Glucose Monitoring. 2017

Danne, Thomas / Nimri, Revital / Battelino, Tadej / Bergenstal, Richard M / Close, Kelly L / DeVries, J Hans / Garg, Satish / Heinemann, Lutz / Hirsch, Irl / Amiel, Stephanie A / Beck, Roy / Bosi, Emanuele / Buckingham, Bruce / Cobelli, Claudio / Dassau, Eyal / Doyle, Francis J / Heller, Simon / Hovorka, Roman / Jia, Weiping / Jones, Tim / Kordonouri, Olga / Kovatchev, Boris / Kowalski, Aaron / Laffel, Lori / Maahs, David / Murphy, Helen R / Nørgaard, Kirsten / Parkin, Christopher G / Renard, Eric / Saboo, Banshi / Scharf, Mauro / Tamborlane, William V / Weinzimer, Stuart A / Phillip, Moshe. ·Diabetes Centre for Children and Adolescents, Children's and Youth Hospital "Auf Der Bult," Hannover, Germany danne@hka.de. · The Myrtle and Henry Hirsch National Center for Childhood Diabetes, The Jesse and Sara Lea Shafer Institute of Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel. · Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital, Ljubljana University Medical Centre, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia. · International Diabetes Center at Park Nicollet, Minneapolis, MN. · Close Concerns, San Francisco, CA. · Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. · University of Colorado Denver and Barbara Davis Center for Diabetes, Aurora, CO. · Science & Co, Düsseldorf, Germany. · Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington School of Medicine, Seattle, WA. · Diabetes Research Group, King's College London, London, U.K. · Jaeb Center for Health Research, Tampa, FL. · Diabetes Research Institute, University "Vita-Salute" San Raffaele, Milan, Italy. · Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University Medical Center, Stanford, CA. · Department of Information Engineering, University of Padova, Padova, Italy. · John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA. · Academic Unit of Diabetes, Endocrinology & Metabolism, The University of Sheffield, Sheffield, U.K. · Wellcome Trust-MRC Institute of Metabolic Science and Department of Paediatrics, University of Cambridge, Cambridge, U.K. · Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center of Diabetes, Shanghai, China. · Telethon Kids Institute and School of Paediatrics and Child Health, The University of Western Australia, and Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, Australia. · Diabetes Centre for Children and Adolescents, Children's and Youth Hospital "Auf Der Bult," Hannover, Germany. · Center for Diabetes Technology, University of Virginia School of Medicine, Charlottesville, VA. · JDRF, New York, NY. · Pediatric, Adolescent and Young Adult Section and Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, MA. · Norwich Medical School, University of East Anglia, Norwich, U.K. · Department of Endocrinology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark. · CGParkin Communications, Boulder City, NV. · Department of Endocrinology, Diabetes, and Nutrition, Montpellier University Hospital, and Institute of Functional Genomics, University of Montpellier, and INSERM Clinical Investigation Centre, Montpellier, France. · DiaCare, Ahmedabad, Gujarat, India. · Centro de Diabetes Curitiba and Division of Pediatric Endocrinology, Hospital Nossa Senhora das Graças, Curitiba, Brazil. · Department of Pediatrics, Yale School of Medicine, New Haven, CT. ·Diabetes Care · Pubmed #29162583.

ABSTRACT: Measurement of glycated hemoglobin (HbA

6 Review Socioeconomic inequalities in mortality, morbidity and diabetes management for adults with type 1 diabetes: A systematic review. 2017

Scott, Anne / Chambers, Duncan / Goyder, Elizabeth / O'Cathain, Alicia. ·School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom. ·PLoS One · Pubmed #28489876.

ABSTRACT: AIMS: To systematically review the evidence of socioeconomic inequalities for adults with type 1 diabetes in relation to mortality, morbidity and diabetes management. METHODS: We carried out a systematic search across six relevant databases and included all studies reporting associations between socioeconomic indicators and mortality, morbidity, or diabetes management for adults with type 1 diabetes. Data extraction and quality assessment was undertaken for all included studies. A narrative synthesis was conducted. RESULTS: A total of 33 studies were identified. Twelve cohort, 19 cross sectional and 2 case control studies met the inclusion criteria. Regardless of healthcare system, low socioeconomic status was associated with poorer outcomes. Following adjustments for other risk factors, socioeconomic status was a statistically significant independent predictor of mortality in 9/10 studies and morbidity in 8/10 studies for adults with type 1 diabetes. There appeared to be an association between low socioeconomic status and some aspects of diabetes management. Although only 3 of 16 studies made adjustments for confounders and other risk factors, poor diabetes management was associated with lower socioeconomic status in 3/3 of these studies. CONCLUSIONS: Low socioeconomic status is associated with higher levels of mortality and morbidity for adults with type 1 diabetes even amongst those with access to a universal healthcare system. The association between low socioeconomic status and diabetes management requires further research given the paucity of evidence and the potential for diabetes management to mitigate the adverse effects of low socioeconomic status.

7 Review A systematic review of interventions to improve outcomes for young adults with Type 1 diabetes. 2017

O'Hara, M C / Hynes, L / O'Donnell, M / Nery, N / Byrne, M / Heller, S R / Dinneen, S F / Anonymous1550885. ·School of Medicine, NUI Galway, Galway, Ireland. · Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland. · School of Psychology, NUI Galway, Galway, Ireland. · Department of Human Metabolism, Academic Unit of Diabetes, Endocrinology and Metabolism, University of Sheffield, Sheffield, UK. ·Diabet Med · Pubmed #27761951.

ABSTRACT: BACKGROUND: Many young adults with Type 1 diabetes experience poor outcomes. The aim of this systematic review was to synthesize the evidence regarding the effectiveness of interventions aimed at improving clinical, behavioural or psychosocial outcomes for young adults with Type 1 diabetes. METHODS: Electronic databases were searched. Any intervention studies related to education, support, behaviour change or health service organizational change for young adults aged between 15-30 years with Type 1 diabetes were included. A narrative synthesis of all studies was undertaken due to the large degree of heterogeneity between studies. RESULTS: Eighteen studies (of a possible 1700) were selected and categorized: Health Services Delivery (n = 4), Group Education and Peer Support (n = 6), Digital Platforms (n = 4) and Diabetes Devices (n = 4). Study designs included one randomized controlled trial, three retrospective studies, seven feasibility/acceptability studies and eight studies with a pre/post design. Continuity, support, education and tailoring of interventions to young adults were the most common themes across studies. HbA CONCLUSION: Based on the heterogeneity among the studies, the effectiveness of interventions on clinical, behavioural and psychosocial outcomes among young adults is inconclusive. This review has highlighted a lack of high-quality, well-designed interventions, aimed at improving health outcomes for young adults with Type 1 diabetes.

8 Review Relationship of cardiometabolic parameters in non-smokers, current smokers, and quitters in diabetes: a systematic review and meta-analysis. 2016

Kar, Debasish / Gillies, Clare / Zaccardi, Francesco / Webb, David / Seidu, Samuel / Tesfaye, Solomon / Davies, Melanie / Khunti, Kamlesh. ·Diabetes Research Centre, University of Leicester, Leicester General Infirmary, Gwendolen Road, Leicester, LE5 4AW, UK. d.kar@nhs.net. · Derbyshire Community Health Services NHS Foundation Trust, Castle Street Medical Centre, Castle Street, Bolsover, Chesterfield, Derbyshire, UK. d.kar@nhs.net. · Diabetes Research Centre, University of Leicester, Leicester General Infirmary, Gwendolen Road, Leicester, LE5 4AW, UK. · Academic Unit of Diabetes and Endocrinology, University of Sheffield, Sheffield, UK. ·Cardiovasc Diabetol · Pubmed #27881170.

ABSTRACT: BACKGROUND: Smoking is associated with increased macrovascular and microvascular complications in people with diabetes. In addition to other concomitant vascular perturbations, it also seems to influence the cardiometabolic parameters, which may partly explain the accelerated rate of vascular complications in smokers with diabetes. While smoking cessation is advocated as a universal component of the management of diabetes, there is some anecdotal evidence that HbA1c could increase following smoking cessation. The aim of this review is to explore the relationship between smoking and its cessation on cardiometabolic parameters in diabetes. METHODS: Searches were conducted on Medline, EMBASE and CINAHL up to March 2016. After screening 6866 studies (Additional file 1), 14 observational studies with a total of 98,978 participants' with either type 1 or type 2 diabetes were selected for review. Narrative synthesis and meta-analyses were carried out to explore the relationship between smoking and its cessation. RESULTS: Meta-analysis showed that the pooled mean difference of HbA1c between non-smokers and smokers was -0.61% (95% CI -0.88 to -0.33, p < 0.0001). The difference in LDL cholesterol between non-smokers and smokers was -0.11 mmol/l (95% CI -0.21 to -0.01, p = 0.04). The difference in HDL cholesterol between non-smokers and smokers was 0.12 mmol/l (95% CI 0.08-0.15, p < 0.001). However, there was no statistically significant difference in blood pressure between the two groups. The difference in HbA1c between quitters and continued smokers was not statistically significant -0.10% (95% CI -0.42 to 0.21, p = 0.53). However, a narrative synthesis revealed that over a period of 10 years, the HbA1c was comparable between non-smokers and quitters. CONCLUSION: Non-smokers have a statistically significant lower HbA1c and more favourable lipid profile compared to smokers. Smoking cessation does not lead to an increase in HbA1c in long-term and may reduce vascular complications in diabetes by its favourable impact on lipid profile.

9 Review Transition of care for adolescents from paediatric services to adult health services. 2016

Campbell, Fiona / Biggs, Katie / Aldiss, Susie K / O'Neill, Philip M / Clowes, Mark / McDonagh, Janet / While, Alison / Gibson, Faith. ·School of Health and Related Research, University of Sheffield, Regent Street, Sheffield, UK, S1 4DA. ·Cochrane Database Syst Rev · Pubmed #27128768.

ABSTRACT: BACKGROUND: There is evidence that the process of transition from paediatric (child) to adult health services is often associated with deterioration in the health of adolescents with chronic conditions.Transitional care is the term used to describe services that seek to bridge this care gap. It has been defined as 'the purposeful, planned movement of adolescents and young adults with chronic physical and medical conditions from child-centred to adult-oriented health care systems'. In order to develop appropriate services for adolescents, evidence of what works and what factors act as barriers and facilitators of effective interventions is needed. OBJECTIVES: To evaluate the effectiveness of interventions designed to improve the transition of care for adolescents from paediatric to adult health services. SEARCH METHODS: We searched The Cochrane Central Register of Controlled Trials 2015, Issue 1, (including the Cochrane Effective Practice and Organisation of Care Group Specialised Register), MEDLINE, EMBASE, PsycINFO, and Web of Knowledge to 19 June 2015. We also searched reference lists of included studies and relevant reviews, and contacted experts and study authors for additional studies. SELECTION CRITERIA: We considered randomised controlled trials (RCTs), controlled before- and after-studies (CBAs), and interrupted time-series studies (ITSs) that evaluated the effectiveness of any intervention (care model or clinical pathway), that aimed to improve the transition of care for adolescents from paediatric to adult health services. We considered adolescents with any chronic condition that required ongoing clinical care, who were leaving paediatric services and going on to receive services in adult healthcare units, and their families. Participating providers included all health professionals responsible for the care of young people. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data from included papers, assessed the risk of bias of each study, and assessed the certainty of the evidence for the main comparisons using GRADE. Discrepancies were resolved by discussion. Authors were contacted for missing data. We reported the findings of the studies as pre- and post-intervention means and calculated the unadjusted absolute change from baseline with 95% confidence intervals (CI). MAIN RESULTS: We included four RCTs (N = 238 participants) that explored: a two-day workshop-based transition preparation training for adolescents with spina bifida; a nurse-led, one-on-one, teaching session with the additional support of a 'health passport' for adolescents with heart disease; a web- and SMS-based educational intervention for adolescents with a range of different conditions; and a structured comprehensive transition programme with a transition co-ordinator for adolescents with type 1 diabetes.One study evaluating a one-on-one nurse-led intervention, and one evaluating a technology-based intervention suggested that these interventions may lead to slight improvements in transitional readiness and chronic disease self-management measured at six- to eight-month follow-ups (low certainty evidence). Results with the TRAQ self-management tool were: MD 0.20; 95% CI -0.16 to 0.56 and MD 0.43; 95% CI; -0.09 to 0.95; with the TRAQ self-advocacy tool: MD 0.37; 95% CI -0.06 to 0.80; and with the PAM tool were: MD 10; 95% CI 2.96 to 17.04. In contrast, transition-preparation training delivered via a two-day workshop for patients with spina bifida may lead to little or no difference in measures of self-care practice and general health behaviours when measured using the DSCPI-90©.Two studies evaluated the use of health services. One study evaluated a technology-based intervention and another a comprehensive transition programme; these interventions may lead to slightly more young people taking positive steps to initiate contact with health professionals themselves (Relative risk (RR): 4.87; 95% CI 0.24 to 98.12 and RR 1.50; 95% CI 0.32 to 6.94, respectively; low certainty evidence.Young people's knowledge of their disease may slightly improve with a nurse-led, one-on-one intervention to prepare young people for transition to an adult congenital heart programme (MD 14; 95% CI 2.67 to 25.33; one study; low certainty evidence).Disease-specific outcome measures were reported in two studies, both of which led to little or no difference in outcomes (low certainty evidence). One study found little or no difference between intervention and control groups. A second study found that follow-up HbA1c in young people with type 1 diabetes mellitus increased by 1.2% for each percentage increase in baseline HbA1c, independent of treatment group (1.2%; 95% CI 0.4 to 1.9; P = 0.01).Transition interventions may lead to little or no difference in well-being or quality of life as measured with the PARS III or PedsQ (two studies; low certainty evidence). Both the technology-based intervention and the two-day workshop for young people with spina bifida found little or no difference between intervention and control groups (MD 1.29; 95% CI -4.49 to 7.07). One study did not report the data.Four telephone support calls from a transition co-ordinator may lead to little or no difference in rates of transfer from paediatric to adult diabetes services (one study; low certainty evidence). At 12-month follow-up, there was little or no difference between groups of young people receiving usual care or a telephone support (RR 0.80; 95% CI 0.59 to 1.08)). They may slightly reduce the risk of disease-related hospital admissions at 12-month follow-up (RR 0.29; 95% CI 0.03 to 2.40). AUTHORS' CONCLUSIONS: The available evidence (four small studies; N = 238), covers a limited range of interventions developed to facilitate transition in a limited number of clinical conditions, with only four to 12 months follow-up. These follow-up periods may not be long enough for any changes to become apparent as transition is a lengthy process. There was evidence of improvement in patients' knowledge of their condition in one study, and improvements in self-efficacy and confidence in another, but since few studies were eligible for this review, and the overall certainty of the body of this evidence is low, no firm conclusions can be drawn about the effectiveness of the evaluated interventions. Further research is very likely to have an important impact on our confidence in the intervention effect and likely could change our conclusions. There is considerable scope for the rigorous evaluation of other models of transitional care, reporting on clinical outcomes with longer term follow-up.

10 Review Developing a theoretical maintenance model for disordered eating in Type 1 diabetes. 2015

Treasure, J / Kan, C / Stephenson, L / Warren, E / Smith, E / Heller, S / Ismail, K. ·Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London. · Psychiatry Department, South London and Maudsley NHS Foundation Trust, London. · Diabetes Department, King's College Hospital, London. · Diabetes Department, University of Sheffield, Sheffield, UK. ·Diabet Med · Pubmed #26104138.

ABSTRACT: BACKGROUND: According to the literature, eating disorders are an increasing problem for more than a quarter of people with Type 1 diabetes and they are associated with accentuated diabetic complications. The clinical outcomes in this group when given standard eating disorder treatments are disappointing. The Medical Research Council guidelines for developing complex interventions suggest that the first step is to develop a theoretical model. AIM: To review existing literature to build a theoretical maintenance model for disordered eating in people with Type 1 diabetes. METHOD: The literature in diabetes relating to models of eating disorder (Fairburn's transdiagnostic model and the dual pathway model) and food addiction was examined and assimilated. RESULTS: The elements common to all eating disorder models include weight/shape concern and problems with mood regulation. The predisposing traits of perfectionism, low self-esteem and low body esteem and the interpersonal difficulties from the transdiagnostic model are also relevant to diabetes. The differences include the use of insulin mismanagement to compensate for breaking eating rules and the consequential wide variations in plasma glucose that may predispose to 'food addiction'. Eating disorder symptoms elicit emotionally driven reactions and behaviours from others close to the individual affected and these are accentuated in the context of diabetes. CONCLUSION: The next stage is to test the assumptions within the maintenance model with experimental medicine studies to facilitate the development of new technologies aimed at increasing inhibitory processes and moderating environmental triggers.

11 Review Efficacy of theory-based interventions for young people with type 1 diabetes: a systematic review and meta-analysis. 2015

Ayling, Kieran / Brierley, Samantha / Johnson, Barbara / Heller, Simon / Eiser, Christine. ·Department of Psychology, University of Sheffield, UK; Division of Primary Care, School of Medicine, University of Nottingham, UK; NIHR CLAHRC for South Yorkshire, Sheffield, UK. ·Br J Health Psychol · Pubmed #25557718.

ABSTRACT: PURPOSE: Theory-based behaviour change interventions have been recommended to improve outcomes for young people with type 1 diabetes. However, theory has exclusively been considered in a simplistic all-or-none fashion. We therefore (1) examined the nature and extent of explicit theory use in published interventions involving young people with type 1 diabetes and (2) the relationship between how theory is used and intervention outcomes. METHODS: We conducted systematic searches for randomized controlled trials (RCTs) published between 1999 and 2012. We used a detailed structured framework to code how theory was used and meta-analytic techniques to examine the relationships between theory use and intervention efficacy. RESULTS: We identified 34 articles comprising 27 RCTs. Thirty per cent (k = 8) did not use theory in any of the ways assessed. Where present, the most common use of theory was providing evidence that a targeted theoretical construct predicted behaviour (k = 15; 56%). Trials that used theory to some extent had marginally larger pooled effect sizes for both medical and psychological outcomes than those that did not. However, in meta-regression models, use of theory did not significantly predict intervention outcomes. CONCLUSIONS: Theory is under-utilized in intervention development for young people with type 1 diabetes. When employed, theory appears to be advantageous, but not necessarily predictive of intervention success. We argue that greater emphasis is needed on choosing appropriate theory, which should then become central to the process of intervention development. Statement of contribution What is already known on this subject? Interventions for young people with type 1 diabetes that explicitly cite a theoretical basis may be more effective than those that do not. Recommendations have been made for theory to be central to the intervention development process in this area. What does this study add? Theory use in recent interventions for young people with type 1 diabetes is extremely limited. Larger positive medical and psychological outcomes are observed in interventions making some use of theory. Greater use of theory does not necessarily guarantee intervention success.

12 Review Can diabetes prevention programmes be translated effectively into real-world settings and still deliver improved outcomes? A synthesis of evidence. 2013

Johnson, M / Jones, R / Freeman, C / Woods, H B / Gillett, M / Goyder, E / Payne, N. ·University of Sheffield, School of Health and Related Research, Sheffield, UK. m.johnson@sheffield.ac.uk ·Diabet Med · Pubmed #22998334.

ABSTRACT: OBJECTIVE: Randomized trials provide evidence that intensive lifestyle interventions leading to dietary and physical activity change can delay or prevent Type 2 diabetes. Translational studies have assessed the impact of interventions based on, but less intensive than, trial protocols delivered in community settings with high-risk populations. The aim of this review was to synthesize evidence from translational studies of any design to assess the impact of interventions delivered outside large randomized trials. METHODS: Medical and scientific databases were searched using specified inclusion and exclusion criteria. Studies were included that used a tested diabetes preventive study protocol with an adult population at risk from Type 2 diabetes. Included papers were quality assessed and data extracted using recommended methods. RESULTS: From an initial 793 papers, 19 papers reporting 17 studies were included. Translational studies from a range of settings utilized a variety of methods. All were based on the US Diabetes Prevention Programme protocol or the Finnish Diabetes Prevention Study, with modifications that increased feasibility and access. The main outcome that was reported in all studies was weight change. Weight loss, which occurred in all but one study, was greater in intervention arms than in control subjects. No consistent differences were found in blood glucose or waist circumference. CONCLUSIONS: Translational studies based on the intensive diabetes prevention programmes showed that there is potential for less intensive interventions both to be feasible and to have an impact on future progression to diabetes in at-risk individuals.

13 Review Eating problems in adolescents with Type 1 diabetes: a systematic review with meta-analysis. 2013

Young, V / Eiser, C / Johnson, B / Brierley, S / Epton, T / Elliott, J / Heller, S. ·Department of Psychology, NIHR CLAHRC for South Yorkshire, Medical School, University of Sheffield, Sheffield, UK. v.young@sheffield.ac.uk ·Diabet Med · Pubmed #22913589.

ABSTRACT: AIMS: We report a systematic review to determine (1) prevalence of eating problems compared with peers and (2) the association between eating problems and glycaemic control in young adults with Type 1 diabetes. METHOD:   We conducted a systematic literature search via electronic databases and meta-analysis. Cohen's d (the mean difference score between Type 1 diabetes and comparison groups) was calculated for 13 studies that met inclusion criteria. RESULTS:   Eating problems [both disordered eating behaviour (39.3 and 32.5%; d = 0.52, 95% CI 0.10-0.94) and eating disorders (7.0 and 2.8%; d = 0.46, 95% CI 0.10-0.81)] were more common in adolescents with Type 1 diabetes compared with peers and both were associated with poorer glycaemic control (d = 0.40, 95% CI 0.17-0.64). In restricted analyses involving measures adapted for diabetes, associations between eating problems and poorer glycaemic control remained (d = 0.54, 95% CI 0.32-0.76). Disordered eating behaviour (51.8 and 48.1%; d = 0.06, 95% CI -0.05 to 0.21) and eating disorders (6.4 and 3.0%; d = 0.43, 95% CI -0.06 to 0.91) were more common in adolescents with Type 1 diabetes compared with peers, but differences were non-significant. CONCLUSIONS:   Eating problems are common among this age group. Future work in populations with Type 1 diabetes should develop sensitive measures of eating problems and interventions, and establish predictors of eating problems. Screening in clinics is recommended.

14 Review Prevalence of depression among young people with Type 1 diabetes: a systematic review. 2013

Johnson, B / Eiser, C / Young, V / Brierley, S / Heller, S. ·NIHR CLAHRC for South Yorkshire, Department of Psychology, University of Sheffield, Sheffield, UK. b.johnson@sheffield.ac.uk ·Diabet Med · Pubmed #22698387.

ABSTRACT: AIMS:   To determine: (1) prevalence of depression among young people with Type 1 diabetes compared with control groups or population norms; (2) implications of depression for HbA(1c) level; and (3) the relationship between history of depressive symptoms and future depressive symptoms. BACKGROUND:   Among adults with Type 1 diabetes depression is higher than the general population, and has been associated with adverse implications for self-care and HbA(1c) level. The last published review of depression among young people with Type 1 diabetes only included studies up to 1999. METHOD:   Systematic searches were conducted for articles published from January 1999 to December 2011 including young people (up to 25 years old) with Type 1 diabetes. RESULTS:   Twenty-three articles met the inclusion criteria. Of five studies that reported prevalence of depression compared with control groups, three found no differences. Of the three studies that investigated prevalence of depression making reference to population norms, all three showed higher rates of depressive symptoms. Fourteen of 15 studies found associations between more depressive symptoms and higher HbA(1c) level either cross-sectionally or longitudinally. Past depressive symptoms were associated with later depressive symptoms. CONCLUSIONS:   Current evidence is inconclusive about whether there is increased prevalence of depression among young adults with Type 1 diabetes, as established among adults, but those who are more depressed have higher HbA(1c) level. This review is limited by methodological problems and no identified work in the UK met the inclusion criteria. Given the adverse clinical outcomes, we conclude there is a case for routine mental health screening for young adults with Type 1 diabetes.

15 Review Diversity in diabetes: the role of insulin aspart. 2012

Heller, Simon / McCance, David R / Moghissi, Etie / Nazeri, Avideh / Kordonouri, Olga. ·Department of Human Metabolism, School of Medicine and Biosciences, University of Sheffield, Sheffield, UK. s.heller@sheffield.ac.uk ·Diabetes Metab Res Rev · Pubmed #21695769.

ABSTRACT: Diabetes management is changing not only with novel treatments but also in patient demography. This presents clinical challenges and influences our view of diabetes therapies. Insulin analogues have been developed to overcome some of the limitations of traditional human insulins, with the aim of providing a more physiological pharmacokinetic/pharmacodynamic profile. The rapid-acting insulin analogue insulin aspart has been investigated in many clinical trials over the past 10 years and the aim of this review is to present the insulin aspart clinical trial data from across the spectrum of patients with diabetes. Five studies have looked at insulin aspart use (including continuous subcutaneous insulin infusion) in children and adolescents, where the analogue was as effective and well tolerated as soluble human insulin. One large-scale, randomized, controlled trial in pregnant women with type 1 diabetes observed trends towards a reduction in major hypoglycaemia, fewer preterm deliveries and lower birthweight with insulin aspart compared with soluble human insulin. Two 6-month, randomized, controlled, multicentre, multinational, parallel-group, open-label trials reported significant reductions in haemoglobin A(1c) and major nocturnal hypoglycaemia with insulin aspart compared with soluble human insulins in patients with type 1 diabetes. There are fewer data involving insulin analogue use in hospitals and in elderly patients with diabetes, but some recent studies have investigated insulin aspart in the emergency department, intensive/non-intensive care setting and in a pharmacokinetic/pharmacodynamic study in patients aged ≥ 65 years. In summary, the evidence would suggest that insulin aspart is suitable for use in a variety of patients with diabetes.

16 Review An alternative approach to medical genetics based on modern evolutionary biology. Part 3: HERVs in diseases. 2009

Ryan, Frank P. ·Sheffield Primary Care Trust and Department of Animal and Plant Sciences, Sheffield University UK. F.Ryan@sheffield.ac.uk ·J R Soc Med · Pubmed #19797599.

ABSTRACT: -- No abstract --

17 Review Minimizing hypoglycemia while maintaining glycemic control in diabetes. 2008

Heller, Simon R. ·Unit of Diabetes, Endocrinology, and Metabolism, University of Sheffield Medical School, Sheffield, UK. s.heller@sheffield.ac.uk ·Diabetes · Pubmed #19033404.

ABSTRACT: -- No abstract --

18 Clinical Trial Experiences of self-management among young adults with Type 1 diabetes in the context of a structured education programme: a qualitative study. 2018

Sanders, T / Elliott, J / Norman, P / Johnson, B / Heller, S. ·School of Health and Related Research, University of Sheffield, Sheffield, UK. · Academic Unit of Diabetes, Endocrinology and Metabolism, University of Sheffield, Sheffield, UK. · Department of Psychology, University of Sheffield, Sheffield, UK. ·Diabet Med · Pubmed #30030858.

ABSTRACT: AIMS: To explore the experiences of young adults with regard to self-management of Type 1 diabetes in the context of a structured education programme. METHODS: Qualitative interviews and focus groups were conducted with young adults attending a structured education course promoting a flexible and self-directed format. Participants attending the structured education courses were recruited using purposive sampling to acquire a broad mix of participants based on age and equal numbers of young men and women. Fifteen interviews were conducted 12 weeks after each course, whilst seven focus groups and observations of the course delivery were conducted at two course sites and were led by nurse/dietitian educators representing two different diabetes centres (paediatric and adult). The interview and focus group data were audio recorded and transcribed, coded, and analysed thematically to identify similarities and differences. RESULTS: The analysis revealed three themes, 'we're in it together', 'tacit benefits' and 'transitions beyond the structured education programme'. The findings show that structured education programmes can facilitate reflective critical thinking and greater engagement with diabetes self-management if they: a) foster maximal learning from fellow participants to decrease feelings of isolation, b) maximize engagement during the course by delivering the content in a flexible manner, and c) recognize the social and emotional needs of young adults. CONCLUSION: Structured education courses can result in improved critical thinking and engagement with diabetes self-management by empowering young adults through a flexible and self-directed learning style that encourages peer group discussion.

19 Clinical Trial Fast-Acting Insulin Aspart Improves Glycemic Control in Basal-Bolus Treatment for Type 1 Diabetes: Results of a 26-Week Multicenter, Active-Controlled, Treat-to-Target, Randomized, Parallel-Group Trial (onset 1). 2017

Russell-Jones, David / Bode, Bruce W / De Block, Christophe / Franek, Edward / Heller, Simon R / Mathieu, Chantal / Philis-Tsimikas, Athena / Rose, Ludger / Woo, Vincent C / Østerskov, Anne Birk / Graungaard, Tina / Bergenstal, Richard M. ·Diabetes and Endocrinology, Royal Surrey County Hospital, and University of Surrey, Guildford, U.K. davidrussell-jones@nhs.net. · Atlanta Diabetes Associates, Atlanta, GA. · Department of Endocrinology, Diabetology, and Metabolism, Antwerp University Hospital, Antwerp, Belgium. · Mossakowski Medical Research Center, Polish Academy of Sciences, Warsaw, Poland. · Department of Oncology and Metabolism, University of Sheffield, Sheffield, U.K. · Clinical and Experimental Endocrinology, University Hospital Leuven, Catholic University of Leuven, Leuven, Belgium. · Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA. · Institute of Diabetes Research, Münster, Germany. · Section of Endocrinology and Metabolism, University of Manitoba, Winnipeg, Manitoba, Canada. · Novo Nordisk A/S, Søborg, Denmark. · International Diabetes Center at Park Nicollet, Minneapolis, MN. ·Diabetes Care · Pubmed #28356319.

ABSTRACT: OBJECTIVE: This multicenter, treat-to-target, phase 3 trial evaluated the efficacy and safety of fast-acting insulin aspart (faster aspart) versus conventional insulin aspart (IAsp) in adults with type 1 diabetes. RESEARCH DESIGN AND METHODS: The primary end point was change from baseline in HbA RESULTS: HbA CONCLUSIONS: Faster aspart effectively improved HbA

20 Clinical Trial Insulin degludec, an ultra-longacting basal insulin, versus insulin glargine in basal-bolus treatment with mealtime insulin aspart in type 1 diabetes (BEGIN Basal-Bolus Type 1): a phase 3, randomised, open-label, treat-to-target non-inferiority trial. 2012

Heller, Simon / Buse, John / Fisher, Miles / Garg, Satish / Marre, Michel / Merker, Ludwig / Renard, Eric / Russell-Jones, David / Philotheou, Areti / Francisco, Ann Marie Ocampo / Pei, Huiling / Bode, Bruce / Anonymous780724. ·University of Sheffield, Sheffield, UK. s.heller@sheffi eld.ac.uk ·Lancet · Pubmed #22521071.

ABSTRACT: BACKGROUND: Intensive basal-bolus insulin therapy has been shown to improve glycaemic control and reduce the risk of long-term complications that are associated with type 1 diabetes mellitus. Insulin degludec is a new, ultra-longacting basal insulin. We therefore compared the efficacy and safety of insulin degludec and insulin glargine, both administered once daily with mealtime insulin aspart, in basal-bolus therapy for type 1 diabetes. METHODS: In an open-label, treat-to-target, non-inferiority trial, undertaken at 79 sites (hospitals and centres) in six countries, adults (aged ≥18 years) with type 1 diabetes (glycated haemoglobin [HbA(1c)] ≤10% [86 mmol/mol]), who had been treated with basal-bolus insulin for at least 1 year, were randomly assigned in a 3:1 ratio, with a computer-generated blocked allocation sequence, to insulin degludec or insulin glargine without stratification by use of a central interactive response system. The primary outcome was non-inferiority of degludec to glargine, assessed as a reduction in HbA(1c) after 52 weeks, with the intention-to-treat analysis. This trial is registered with ClinicalTrials.gov, number NCT00982228. FINDINGS: Of 629 participants, 472 were randomly assigned to insulin degludec and 157 to insulin glargine; all were analysed in their respective treatment groups. At 1 year, HbA(1c) had fallen by 0·40% points (SE 0·03) and 0·39% points (0·07), respectively, with insulin degludec and insulin glargine (estimated treatment difference -0·01% points [95% CI -0·14 to 0·11]; p<0·0001 for non-inferiority testing) and 188 (40%) and 67 (43%) participants achieved a target HbA(1c) of less than 7% (<53 mmol/mol). Rates of overall confirmed hypoglycaemia (plasma glucose <3·1 mmol/L or severe) were similar in the insulin degludec and insulin glargine groups (42·54 vs 40·18 episodes per patient-year of exposure; estimated rate ratio [degludec to glargine] 1·07 [0·89 to 1·28]; p=0·48). The rate of nocturnal confirmed hypoglycaemia was 25% lower with degludec than with glargine (4·41 vs 5·86 episodes per patient-year of exposure; 0·75 [0·59 to 0·96]; p=0·021). Overall serious adverse event rates (14 vs 16 events per 100 patient-years of exposure) were similar for the insulin degludec and insulin glargine groups. INTERPRETATION: Insulin degludec might be a useful basal insulin for patients with type 1 diabetes because it provides effective glycaemic control while lowering the risk of nocturnal hypoglycaemia, which is a major limitation of insulin therapy. FUNDING: Novo Nordisk.

21 Article Follow-Up Support for Effective type 1 Diabetes self-management (The FUSED Model): A systematic review and meta-ethnography of the barriers, facilitators and recommendations for sustaining self-management skills after attending a structured education programme. 2018

Campbell, Fiona / Lawton, Julia / Rankin, David / Clowes, Mark / Coates, Elizabeth / Heller, Simon / de Zoysa, Nicole / Elliott, Jackie / Breckenridge, Jenna P. ·School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, S1 4DA, Sheffield, England. f.campbell@sheffield.ac.uk. · The Usher Institute of Population Health Sciences and Informatics, Edinburgh Medical School of Molecular, Genetic and Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland. · School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, S1 4DA, Sheffield, England. · Sheffield University School of Medicine, Academic Unit of Diabetes, Endocrinology, and Metabolism, School of Medicine and Biomedical Sciences, Sheffield, UK. · Diabetes Centre, King's College Hospital, Denmark Hill, London, SE5 9RS, England. · School of Nursing and Health Sciences, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ, Scotland. ·BMC Health Serv Res · Pubmed #30482202.

ABSTRACT: BACKGROUND: People with type 1 diabetes who attend structured education training in self-management using flexible intensive therapy achieve improved blood glucose control and experience fewer episodes of severe hypoglycaemia. However, many struggle to sustain these improvements over time. To inform the design of more effective follow-up support we undertook a review of qualitative studies which have identified factors that influence and inform participants' self-management behaviours after attending structured education and their need for support to sustain improvements in glycaemic control. METHODS: We undertook a meta-ethnography of relevant qualitative studies, identified using systematic search methods. Studies were included which focused on participants' experiences of self-managing type 1 diabetes after attending structured education which incorporated training in flexible intensive insulin therapy. A line of argument approach was used to synthesise the findings. RESULTS: The search identified 18 papers from six studies. The studies included were judged to be of high methodological quality. The line of argument synthesis developed the Follow-Up Support for Effective type 1 Diabetes self-management (FUSED) model. This model outlines the challenges participants encounter in maintaining diabetes self-management practices after attending structured education, and describes how participants try to address these barriers by adapting, simplifying or personalising the self-management approaches they have learned. To help participants maintain the skills taught during courses, the FUSED model presents ten recommendations abstracted from the included papers to provide a logic model for a programme of individualised and responsive follow-up support. CONCLUSIONS: This meta-ethnography highlights how providing skills training using structured education to people with type 1 diabetes does not necessarily result in participants adopting and sustaining recommended changes in behaviour. To help people sustain diabetes self-management skills after attending structured education, it is recommended that support be provided over the longer-term by appropriately trained healthcare professionals which is responsive to individuals' needs. Although developed to inform support for people with type 1 diabetes, the FUSED model provides a framework that could also be applied to support individuals with other long term conditions which require complex self-management skills to be learned and sustained over time. TRIAL REGISTRATION: PROSPERO registration: CRD42017067961 .

22 Article Cost-effectiveness of insulin pumps compared with multiple daily injections both provided with structured education for adults with type 1 diabetes: a health economic analysis of the Relative Effectiveness of Pumps over Structured Education (REPOSE) randomised controlled trial. 2018

Pollard, Daniel John / Brennan, Alan / Dixon, Simon / Waugh, Norman / Elliott, Jackie / Heller, Simon / Lee, Ellen / Campbell, Michael / Basarir, Hasan / White, David / Anonymous1161082. ·School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK. · Population Evidence and Technologies, Warwick Medical School, University of Warwick, Coventry, UK. · Academic Unit of Diabetes, Endocrinology and Metabolism, Department of Oncology and Metabolism, School of Medicine and Biomedical Sciences, University of Sheffield, Sheffield, UK. · Clinical Trials Research Unit, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK. · RTI Health Solutions, Manchester, UK. ·BMJ Open · Pubmed #29627802.

ABSTRACT: OBJECTIVES: To assess the long-term cost-effectiveness of insulin pumps and Dose Adjustment for Normal Eating (pumps+DAFNE) compared with multiple daily insulin injections and DAFNE (MDI+DAFNE) for adults with type 1 diabetes mellitus (T1DM) in the UK. METHODS: We undertook a cost-utility analysis using the Sheffield Type 1 Diabetes Policy Model and data from the Relative Effectiveness of Pumps over Structured Education (REPOSE) trial to estimate the lifetime incidence of diabetic complications, intervention-based resource use and associated effects on costs and quality-adjusted life years (QALYs). All economic analyses took a National Health Service and personal social services perspective and discounted costs and QALYs at 3.5% per annum. A probabilistic sensitivity analysis was performed on the base case. Further uncertainties in the cost of pumps and the evidence used to inform the model were explored using scenario analyses. SETTING: Eight diabetes centres in England and Scotland. PARTICIPANTS: Adults with T1DM who were eligible to receive a structured education course and did not have a strong clinical indication or a preference for a pump. INTERVENTION: Pumps+DAFNE. COMPARATOR: MDI+DAFNE. MAIN OUTCOME MEASURES: Incremental costs, incremental QALYs gained and incremental cost-effectiveness ratios (ICERs). RESULTS: Compared with MDI+DAFNE, pumps+DAFNE was associated with an incremental discounted lifetime cost of +£18 853 (95% CI £6175 to £31 645) and a gain in discounted lifetime QALYs of +0.13 (95% CI -0.70 to +0.96). The base case mean ICER was £142 195 per QALY gained. The probability of pump+DAFNE being cost-effective using a cost-effectiveness threshold of £20 000 per QALY gained was 14.0%. All scenario and subgroup analyses examined indicated that the ICER was unlikely to fall below £30 000 per QALY gained. CONCLUSIONS: Our analysis of the REPOSE data suggests that routine use of pumps in adults without an immediate clinical need for a pump, as identified by National Institute for Health and Care Excellence, would not be cost-effective. TRIAL REGISTRATION NUMBER: ISRCTN61215213.

23 Article B cell depletion reduces T cell activation in pancreatic islets in a murine autoimmune diabetes model. 2018

Da Rosa, Larissa C / Boldison, Joanne / De Leenheer, Evy / Davies, Joanne / Wen, Li / Wong, F Susan. ·Division of Infection and Immunity, Cardiff University School of Medicine, Heath Park, Cardiff, CF14 4XN, UK. · Department of Structural and Functional Biology, Institute of Biology, State University of Campinas, Campinas, SP, Brazil. · University of Sheffield, New Spring House, Sheffield, UK. · Section of Endocrinology, School of Medicine, Yale University, New Haven, CT, USA. · Division of Infection and Immunity, Cardiff University School of Medicine, Heath Park, Cardiff, CF14 4XN, UK. WongFS@Cardiff.ac.uk. ·Diabetologia · Pubmed #29594371.

ABSTRACT: AIMS/HYPOTHESIS: Type 1 diabetes is a T cell-mediated autoimmune disease characterised by the destruction of beta cells in the islets of Langerhans, resulting in deficient insulin production. B cell depletion therapy has proved successful in preventing diabetes and restoring euglycaemia in animal models of diabetes, as well as in preserving beta cell function in clinical trials in the short term. We aimed to report a full characterisation of B cell kinetics post B cell depletion, with a focus on pancreatic islets. METHODS: Transgenic NOD mice with a human CD20 transgene expressed on B cells were injected with an anti-CD20 depleting antibody. B cells were analysed using multivariable flow cytometry. RESULTS: There was a 10 week delay in the onset of diabetes when comparing control and experimental groups, although the final difference in the diabetes incidence, following prolonged observation, was not statistically significant (p = 0.07). The co-stimulatory molecules CD80 and CD86 were reduced on stimulation of B cells during B cell depletion and repopulation. IL-10-producing regulatory B cells were not induced in repopulated B cells in the periphery, post anti-CD20 depletion. However, the early depletion of B cells had a marked effect on T cells in the local islet infiltrate. We demonstrated a lack of T cell activation, specifically with reduced CD44 expression and effector function, including IFN-γ production from both CD4 CONCLUSIONS/INTERPRETATION: Our findings suggest that B cell depletion can have an impact on T cell regulation, inducing a durable effect that is present long after repopulation. We suggest that this local effect of reducing autoimmune T cell activity contributes to delay in the onset of autoimmune diabetes.

24 Article Direct medical costs of diabetes mellitus in the year of mortality and year preceding the year of mortality. 2018

Wong, Carlos K H / Jiao, Fangfang / Tang, Eric H M / Tong, Thaison / Thokala, Praveen / Lam, Cindy L K. ·Department of Family Medicine and Primary Care, University of Hong Kong, Hong Kong. · Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK. ·Diabetes Obes Metab · Pubmed #29430799.

ABSTRACT: AIM: To report the health resource use and estimate the direct medical costs among patients with diabetes mellitus (DM) in the year of mortality and the year preceding the year of mortality. MATERIALS AND METHODS: We analysed data from a population-based, retrospective cohort study including all adults with a DM diagnosis in Hong Kong between 2009 and 2013, and who died between January 1, 2010 and December 31, 2013. The annual direct medical costs in the year of mortality and the year preceding the year of mortality were determined by summing the costs of health services utilized within the respective year. The costs were analysed by gender, the presence of comorbidities, diabetic complications and primary cause of death. RESULTS: A total of 10 649 patients met the eligibility criteria for analysis. On average, the direct medical costs in the year of death were 1.947 times higher than those in the year before death. Men and women with DM incurred similar costs in the year preceding the year of mortality and in the mortality year. Patients with any diabetic complications incurred greater costs in the year of mortality and the year before mortality than those without. CONCLUSIONS: This analysis provides new evidence on incorporating additional direct medical costs in the mortality year, and refining the structure of total cost estimates for use in costing and cost-effectiveness analyses of interventions for DM.

25 Article Developing a questionnaire to determine the impact of self-management in diabetes: giving people with diabetes a voice. 2017

Carlton, J / Elliott, J / Rowen, D / Stevens, K / Basarir, H / Meadows, K / Brazier, J. ·School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, Sheffield, S1 4DA, UK. j.carlton@sheffield.ac.uk. · School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, Sheffield, S1 4DA, UK. · Sheffield Teaching Hospitals NHS Trust, Sheffield, UK. · Department of Oncology and Metabolism, University of Sheffield, Medical School, Sheffield, S10 2JF, UK. · Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, IOEM Building, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. · DHP Research & Consultancy Ltd, Bloxham Mill Business Centre, Barford Road, Bloxham, Banbury, OX15 4FF, UK. ·Health Qual Life Outcomes · Pubmed #28720133.

ABSTRACT: BACKGROUND: The prevalence of diabetes mellitus (DM) is increasing dramatically, placing considerable financial burden on the healthcare budget of each country. Patient self-management is crucial for the control of blood glucose, which largely determines the chances of developing diabetes-related complications. Self-management interventions vary widely, and a method is required for assessing the impact of self-management. This paper describes the development of a questionnaire intended for use to measure the impact of self-management in diabetes. METHODS: An iterative development process was undertaken to identify the attributes of self-management using 5 steps. First, a literature review was undertaken to identify and understand themes relating to self-management of DM to inform a topic guide. Second, the topic guide was further refined following consultation with a Patient and Public Involvement group. Third, the topic guide was used to inform semi-structured interviews with patients with Type 1 DM (T1DM) and Type 2 DM (T2DM) to identify how self-management of DM affects individuals. Fourth, the research team considered potential attributes alongside health attributes from an existing measure (Diabetes Health Profile, DHP) to produce an instrument reflecting both health and self-management outcomes simultaneously. Finally, a draft instrument was tested in a focus group to determine the wording and acceptability. RESULTS: Semi-structured interviews were carried out with 32 patients with T1DM and T2DM. Eight potential attributes were identified: fear/worry/anxiety, guilt, stress, stigma, hassle, control, freedom, and feeling supported. Four of these self-management attributes were selected with four health attributes (mood, worry about hypos (hypoglycaemic episodes), vitality and social limitations) to produce the Health and Self-Management in Diabetes (HASMID CONCLUSIONS: HASMID

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