Diabetes remission in the real world

Pam Brown

GP in Swansea

Citation: Brown P (2024) Diabetes Distilled: Diabetes remission in the real world. Diabetes & Primary Care 26: 145–7

      Diabetes remission is achievable at scale in the real world, according to early results from the NHS Type 2 Diabetes Path to Remission programme published in Lancet Diabetes & Endocrinology. Of 7540 people referred to the programme between September 2020 and December 2022, a total of 1740 started the total diet replacement section of the programme before January 2022, and 960 (55%) completed the programme. Mean weight loss for the 1710 who started the programme and had follow-up data available was 9.4 kg (8.3%), with a mean weight loss of 10.3 kg (9.3%) among the 945 who completed the programme. Amongst the 945 who completed the programme and had two HbA1c measurements, 32% achieved remission, with mean weight loss of 15.9 kg (14.4%), while overall 27% of those who started the programme achieved remission regardless of whether they completed. Remission rates are lower than in trials such as DiRECT and DIADEM-I, despite similar levels of weight loss. The authors highlight that an additional 17% of participants met the HbA1c targets for remission but continued on metformin and may otherwise have achieved remission. These early results confirm that type 2 diabetes remission is indeed possible at scale in the real world, outside of clinical trials.

Impact of metformin timing on glucose and GLP-1 response

  Pam Brown GP in Swansea

Citation: Brown P (2024) Diabetes Distilled: Impact of metformin timing on glucose and GLP-1 response. Diabetes & Primary Care 26: 143–4

  Glucose-lowering effects in response to normal-release metformin are greater when the drug is given 30 or 60 minutes before, rather than with, food, according to this small study in people with well-controlled type 2 diabetes published in Diabetologia. Endogenous GLP-1 secretion increased when metformin 1000 mg was given 30 or 60 minutes prior to a glucose infusion, whereas there was no increase when the metformin was administered at the same time as the glucose. The results suggest that, if tolerated, administering standard release metformin before meals may lead to improved postprandial glycaemic control.

The importance of getting the correct diabetes diagnosis

Jane Diggle Specialist Diabetes Nurse Practitioner, West Yorkshire

Citation: Diggle J (2024) The importance of getting the correct diabetes diagnosis. Diabetes & Primary Care 26: 111–2

Split-thickness skin graft and intralesional epidermal growth factor for patients with diabetic foot wounds

Bulent M Ertugrul, Saime Irkoren, Ender Ceylan and Oner Savk

Split thickness skin grafting (STSG) is a simple surgical technique in wound reconstruction, but various factors including inadequate wound bed preparation may cause partial or total graft loss. Ensuring infection-free healthy granulation tissue is essential before operation. Epidermal growth factor (EGF) has a critical role in angiogenesis and formation of healthy granulation tissue. This study retrospectively investigated the value of intralesional EGF in patients with a chronic foot ulcer due to diabetes who underwent reconstruction with an autologous skin graft. Patients treated with intralesional EGF had a higher rate of graft survival, significantly fewer postoperative complications and reduced hospitalisation times. These results suggest we should undertake a need prospective study of this issue with a larger case series.

Citation: Ertugrul BM, Irkoren S, Ceylan E, Savk O (2024) Split thickness skin graft and intralesional epidermal growth factor for patients with diabetic foot wounds. The Diabetic Foot Journal 27(1): 34–9

Key words

- Diabetic foot

- Epidermal growth factor

- Skin graft

- Wound treatment

Article points

1. Healthy granulation tissue is essential to the success of split-thickness skin grafting

2. Epidermal growth factor (EGF) has a critical role in the angiogenesis and formation of healthy granulation tissue

3. Patients with diabetic foot ulcers treated with EGF had a higher rate of graft survival.

Authors

     Bulent M Ertugrul MD is Professor of Infectious Diseases and Clinical Microbiology, University of Adnan Menderes School of Medicine, Aydin, Turkey; Saime Irkoren MD is Associate Professor of Plastic, Reconstructive and Esthetic Surgery, University of Adnan Menderes School of Medicine, Aydin, Turkey; Ender Ceylan MD is Assistant Professor of Plastic, Reconstructive and Esthetic Surgery, University of Adnan Menderes School of Medicine, Aydin, Turkey; Oner Savk MD is Professor of Orthopedics and Traumatology, University of Adnan Menderes School of Medicine, Aydin, Turkey

Hypertension case finding and treatment to target as part of the NHS diabetes eye screening programme

Suneeta Kochhar, Marcia Excell

This article reviews a service pathway offering people attending their diabetes eye screening appointments an opportunistic blood pressure check to support hypertension case finding and treatment to target. The pathway promotes patient choice and facilitates primary and secondary care collaboration, as well as utilisation of home blood pressure readings. From the 200 participants in the study, 91 (45.5%) had clinic blood pressure readings above 140/90 mmHg, of whom 48 agreed to undertake home blood pressure monitoring. Of those, 33 individuals had elevated home blood pressure readings – 13 with newly diagnosed hypertension and 20 requiring treatment to target of their pre-existing hypertension. All 33 were contacted to ensure that they had been followed up by their GP practice. Participant feedback was positive.

Citation: Kochhar S, Excell M (2024) Hypertension case finding and treatment to target as part of the NHS diabetes eye screening programme. Diabetes & Primary Care 26: [Early view publication]

Article points

1. People attending their diabetes eye screening appointments may be offered an opportunistic blood pressure check to support case finding and treatment to target of hypertension.

2. Pathways for raised blood pressure may utilise home blood pressure readings to facilitate supported self-management.

3. Interface working with community providers/secondary care and primary care providers may result in early treatment of hypertension, and treatment to target is known to improve cardiovascular outcomes especially in people with diabetes.

Key words

– Cardiovascular disease

– Hypertension

– Service delivery

Authors

Suneeta Kochhar, GP Principal and Clinical Lead for CVD Prevention, NHS Sussex; Marcia Excell, RN, East Sussex Healthcare NHS Trust, and Chief Nurse Fellow, University Hospitals Sussex NHS Foundation Trust.

SIRT6 Is Responsible for More Efficient DNA DoubleStrand Break Repair in Long-Lived Species

Highlights

● DSB repair, but not NER, coevolves with maximum lifespan (MLS) in rodents

● The activity of SIRT6 in stimulating DSB repair coevolves with MLS in rodent species

● Five amino acids determine the differential activities of mouse and beaver SIRT6

● Stronger SIRT6 leads to a longer lifespan

Authors

Xiao Tian, Denis Firsanov, Zhihui Zhang, ..., Vadim N. Gladyshev, Andrei Seluanov, Vera Gorbunova

Correspondence

该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。 (A.S.), 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。 (V.G.)

In Brief

A comparative analysis of 18 rodent species identifies a role for SIRT6-dependent DNA double strand break repair as a major factor in organismal lifespan

Xiao Tian,1 Denis Firsanov,1 Zhihui Zhang,1 Yang Cheng,2 Lingfeng Luo,1 Gregory Tombline,1 Ruiyue Tan,1 Matthew Simon,1 Steven Henderson,1 Janine Steffan,1 Audrey Goldfarb,1 Jonathan Tam,1 Kitty Zheng,1 Adam Cornwell,1 Adam Johnson,1 Jiang-Nan Yang,3 Zhiyong Mao,4 Bruno Manta,5 Weiwei Dang,6 Zhengdong Zhang,7 Jan Vijg,7 Aaron Wolfe,8 Kelsey Moody,8 Brian K. Kennedy,9,10 Dirk Bohmann,2 Vadim N. Gladyshev,5 Andrei Seluanov,1,* and Vera Gorbunova1,11,*

1 Department of Biology, University of Rochester, Rochester, NY 14627, USA

2 Department of Biomedical Genetics, University of Rochester Medical Center, Rochester, NY 14642, USA

3 Leibniz Institute on Aging - Fritz Lipmann Institute, Beutenbergstraße 11, Jena D-07745, Germany

4 School of Life Sciences and Technology, Tongji University, Shanghai 200092, China

5 Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

6 Huffington Center on Aging, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA

7 Department of Genetics, Albert Einstein College of Medicine, Bronx, NY, USA

8 Ichor Therapeutics, 2521 US-11, Lafayette, NY 13084, USA

9 Departments of Biochemistry and Physiology, National University Singapore, Singapore

10 Centre for Healthy Aging, National University Health System, Singapore

11 Lead Contact

*Correspondence: 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。 (A.S.), 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。 (V.G.) https://doi.org/10.1016/j.cell.2019.03.043