Peninsula Medical Schoolhttps://pearl.plymouth.ac.uk/handle/10026.1/147612024-03-29T08:35:03Z2024-03-29T08:35:03ZRelationship of cardiometabolic parameters in non-smokers, current smokers, and quitters in diabetes: a systematic review and meta-analysisKar, DGillies, CZaccardi, FWebb, DSeidu, STesfaye, SDavies, MKhunti, Khttps://pearl.plymouth.ac.uk/handle/10026.1/221482024-03-08T11:02:25Z2016-12-01T00:00:00ZRelationship of cardiometabolic parameters in non-smokers, current smokers, and quitters in diabetes: a systematic review and meta-analysis
Kar, D; Gillies, C; Zaccardi, F; Webb, D; Seidu, S; Tesfaye, S; Davies, M; Khunti, K
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.
2016-12-01T00:00:00ZManaging vascular risk factors among obese quitters with diabetes: how intensive lifestyle intervention and novel pharmacotherapy can work in concert?Kar, DSeidu, SDavies, MKhunti, Khttps://pearl.plymouth.ac.uk/handle/10026.1/221472024-03-08T10:59:50ZManaging vascular risk factors among obese quitters with diabetes: how intensive lifestyle intervention and novel pharmacotherapy can work in concert?
Kar, D; Seidu, S; Davies, M; Khunti, K
Therapeutic inertia amongst general practitioners with interest in diabetesSeidu, SThan, TKar, DLamba, ABrown, PZafar, AHussain, RAmjad, ACapehorn, MMartin, EFernando, KMcMoran, JMillar-Jones, DKahn, SCampbell, NBrice, RMohan, RMistry, MKanumilli, NSt. John, JQuigley, RKenny, CKhunti, Khttps://pearl.plymouth.ac.uk/handle/10026.1/221462024-03-08T10:59:20Z2018-02-01T00:00:00ZTherapeutic inertia amongst general practitioners with interest in diabetes
Seidu, S; Than, T; Kar, D; Lamba, A; Brown, P; Zafar, A; Hussain, R; Amjad, A; Capehorn, M; Martin, E; Fernando, K; McMoran, J; Millar-Jones, D; Kahn, S; Campbell, N; Brice, R; Mohan, R; Mistry, M; Kanumilli, N; St. John, J; Quigley, R; Kenny, C; Khunti, K
INTRODUCTION: As the therapeutic options in the management of type 2 diabetes increase, there is an increase confusion among health care professionals, thus leading to the phenomenon of therapeutic inertia. This is the failure to escalate or de-escalate treatment when the clinical need for this is required. It has been studied extensively in various settings, however, it has never been reported in any studies focusing solely on primary care physicians with an interest in diabetes. This group is increasingly becoming the focus of managing complex diabetes care in the community, albeit with the support from specialists. METHODS: In this retrospective audit, we assessed the prevalence of the phenomenon of therapeutic inertia amongst primary care physicians with an interest in diabetes in UK. We also assessed the predictive abilities of various patient level characteristics on therapeutic inertia amongst this group of clinicians. RESULTS: Out of the 240 patients reported on, therapeutic inertia was judged to have occurred in 53 (22.1%) of patients. The full model containing all the selected variables was not statistically significant, p=0.59. So the model was not able to distinguish between situations in which therapeutic inertia occurred and when it did not occur. None of the patient level characteristics on its own was predictive of therapeutic inertia. CONCLUSION: Therapeutic inertia was present only in about a fifth of patient patients with diabetes being managed by primary care physicians with an interest in diabetes.
2018-02-01T00:00:00ZPrevalence and progression of diabetic nephropathy in South Asian, white European and African Caribbean people with type 2 diabetes: A systematic review and meta‐analysisJadawji, CCrasto, WGillies, CKar, DDavies, MJKhunti, KSeidu, Shttps://pearl.plymouth.ac.uk/handle/10026.1/221452024-03-08T10:57:49Z2019-03-01T00:00:00ZPrevalence and progression of diabetic nephropathy in South Asian, white European and African Caribbean people with type 2 diabetes: A systematic review and meta‐analysis
Jadawji, C; Crasto, W; Gillies, C; Kar, D; Davies, MJ; Khunti, K; Seidu, S
<jats:sec><jats:title>Aims</jats:title><jats:p>To conduct a systematic review and meta‐analysis of published observational evidence to assess the difference in the prevalence and progression of diabetic nephropathy, and the development of end‐stage renal disease (ESRD) in people from three different ethnic groups with type 2 diabetes (T2DM).</jats:p></jats:sec><jats:sec><jats:title>Materials and methods</jats:title><jats:p>Relevant studies were identified in a literature search of MEDLINE, EMBASE and reference lists of relevant studies published up to May 2018. We decided a priori that there were no differences in the prevalence and progression of diabetic nephropathy, and the development of ESRD in the three ethnicities with T2DM. Pooled relative risks of microalbuminuria by ethnicity were estimated by fitting three random effects meta‐analyses models. A narrative synthesis of the nephropathy progression in the studies was carried out. The review was registered in PROSPERO (CRD42018107350).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Thirty‐two studies with data on 153 827 unique participants were eligible for inclusion in the review. The pooled prevalence ratio of microalbuminuria in South Asian compared with white European participants was 1.14 (95% confidence interval [CI] 0.99, 1.32; <jats:italic>P</jats:italic> = 0.065), while for African Caribbean vs South Asian participants the pooled prevalence ratio was 1.08 (95% CI 0.93, 1.24; <jats:italic>P</jats:italic> = 0.327). Results for renal decline were inconsistent, with preponderance towards a high rate of disease progression in South Asian compared with white participants. The estimated pooled incidence rate ratio (IRR) for ESRD was significantly higher in African Caribbean vs white European participants: 2.75 (95% CI 2.01, 3.48; <jats:italic>P</jats:italic> < 0.001).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>The results of this review did not show a significant link between ethnicity (South Asian, white European and African Caribbean) and the prevalence of microalbuminuria; however, the IRR for ESRD in African Caribbean compared with white European participants was significantly higher. Further research is needed to explore the potential non‐albuminuric pathways of progression to ESRD.</jats:p></jats:sec>
2019-03-01T00:00:00Z