S L Atkin

Hull York Medical School, York, England, United Kingdom

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Publications (226)925.48 Total impact

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    ABSTRACT: Obese patients with type two diabetes mellitus (T2DM) may have a better prognosis than patients of normal weight, but reports are limited by study size, duration and confounders.
    Heart (British Cardiac Society) 06/2014; 100(Suppl 3):A66. · 5.01 Impact Factor
  • Annals of Clinical Biochemistry 04/2014; · 1.92 Impact Factor
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    ABSTRACT: Polycystic ovary syndrome (PCOS) is commonly associated with insulin resistance (IR), dyslipidaemia and subsequent risk of diabetes and cardiovascular (CV) disease. Lowering triglycerides by atorvastatin in PCOS was associated with improved IR and CV risk. This study investigated the effect of long-term niacin/laropiprant therapy on CV risk and IR in obese women with PCOS. In this double-blind randomized placebo-controlled trial, 13 and 12 PCOS women completed a 12 week course of niacin/laropiprant or placebo respectively. Fasted subjects had an endothelial function test (EndoPat2000) and then consumed a mixed meal with blood sampled postprandially for 6 hour before and after intervention. Changes in High density lipoprotein cholesterol (HDL-c), triglycerides, Reactive hyperaemic index (RHI), high sensitivity c reactive protein (hsCRP) and insulin sensitivity were measured. By 12 weeks, niacin/laropiprant lowered low density lipoprotein-cholesterol (13%) and increased HDL-c (17%). Despite a reduction in fasting triglycerides (21%), the drug had no effect on their postprandial rise (2.69 ±1.44 vs. 2.49 ± 1.14 mmol/L, p = 0.72). However, following the mixed meal, plasma glucose area under the curve increased from 13.1 ± 2.9 to 14.0 ±mmol/L, p = 0.05, as a consequence of both increased insulin resistance (HOMA-IR: 2.2 (1.2, 4.2) vs. 3.8(1.3, 5.5), p = 0.02) and a reduced acute insulin response to glucose (424 (211,975) vs. 257(122,418) pmol/mmoL, p = 0.04). Niacin/laropiprant did not improve RHI (1.97 ± 0.40 vs. 2.05 ± 0.58, p = 0.33) or hsCRP. In PCOS, Niacin/laropiprant had a significant negative impact on postprandial glucose and no improvement in postprandial hypertriglyceridaemia, with at least the former mediated through increased insulin resistance and reduced beta cell function. This data may help explain why the improvement in fasting lipids has not translated into improved cardiovascular risk markers in PCOS. Clinical trial registration Number (www.clinicaltrials.gov): NCT01118598.
    Diabetes Obesity and Metabolism 01/2014; · 5.18 Impact Factor
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    ABSTRACT: Pollen grain and spore shells are natural microcapsules designed to protect the genetic material of the plant from external damage. The shell is made up of two layers, the inner layer (intine), made largely of cellulose, and the outer layer (exine), composed mainly of sporopollenin. The relative proportion of each varies according to the plant species. The structure of sporopollenin has not been fully characterised but different studies suggest the presence of conjugated phenols, which provide antioxidant properties to the microcapsule and UV (ultraviolet) protection to the material inside it. These microcapsule shells have many advantageous properties, such as homogeneity in size, resilience to both alkalis and acids, and the ability to withstand temperatures up to 250 °C. These hollow microcapsules have the ability to encapsulate and release actives in a controlled manner. Their mucoadhesion to intestinal tissues may contribute to the extended contact of the sporopollenin with the intestinal mucosa leading to an increased efficiency of delivery of nutraceuticals and drugs. The hollow microcapsules can be filled with a solution of the active or active in a liquid form by simply mixing both together, and in some cases operating a vacuum. The active payload can be released in the human body depending on pressure on the microcapsule, solubility and/or pH factors. Active release can be controlled by adding a coating on the shell, or co-encapsulation with the active inside the shell.
    Pharmaceutics 01/2014; 6(1):80-96.
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    Myint M Aye, Stephen L Atkin
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    ABSTRACT: Diabetes is a lifelong condition requiring ongoing medical care and patient self-management. Exogenous insulin therapy is essential in type 1 diabetes and becomes a necessity in patients with longstanding type 2 diabetes who fail to achieve optimal control with lifestyle modification, oral agents, and glucagon-like peptide 1-based therapy. One of the risks that hinders insulin use is hypoglycemia. Optimal insulin therapy should therefore minimize the risk of hypoglycemia while improving glycemic control. Insulin degludec (IDeg) is a novel basal insulin that, following subcutaneous injection, assembles into a depot of soluble multihexamer chains. These subsequently release IDeg monomers that are absorbed at a slow and steady rate into the circulation, with the terminal half-life of IDeg being ~25 hours. Thus, it requires only once-daily dosing unlike other basal insulin preparations that often require twice-daily dosing. Despite its long half-life, once-daily IDeg does not cause accumulation of insulin in the circulation after reaching steady state. IDeg once a day will produce a steady-state profile with a lower peak:trough ratio than other basal insulins. In clinical trials, this profile translates into a lower frequency of nocturnal hypoglycemia compared with insulin glargine, as well as an ability to allow some flexibility in dose timing without compromising efficacy and safety. Indeed, a study that tested the extremes of dosing intervals of 8 and 40 hours showed no detriment in either glycemic control or hypoglycemic frequency versus insulin glargine given at the same time each day. While extreme flexibility in dose timing is not recommended, these findings are reassuring. This may be particularly beneficial to elderly patients, patients with learning difficulties, or others who have to rely on health-care professionals for their daily insulin injections. Further studies are required to confirm whether this might benefit adherence to treatment, reduce long-term hypoglycemia or reduce diabetes-related complications.
    Drug, Healthcare and Patient Safety 01/2014; 6:55-67.
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    ABSTRACT: Atherothrombosis is associated with platelet hyperactivity. Hypertriglyceridemia and insulin resistance (IR) are features of polycystic ovary syndrome (PCOS). The effect of induced hypertriglyceridemia on IR and platelet function was examined in young women with PCOS. Following overnight fasting, 13 PCOS and 12 healthy women were infused with saline or 20% intralipid for 5 hours on separate days. Insulin sensitivity was measured using a hyperinsulinemic euglycaemic clamp in the final 2 hours of each infusion. Platelet responses to adenosine diphosphate (ADP) and prostacyclin (PGI2) were measured by flow cytometric analysis of platelet fibrinogen binding and P-selectin expression using whole blood taken during each infusion (at 2 hours) and at the end of each clamp. Lipid infusion increased triglycerides and reduced insulin sensitivity in both controls (median, interquartile range ) (5.25 [3.3, 6.48] versus 2.60 [0.88, 3.88] mg kg(-1) min(-1), P<0.001) and PCOS (3.15 [2.94, 3.85] versus 1.06 [0.72, 1.43] mg kg(-1) min(-1), P<0.001). Platelet activation by ADP was enhanced and ability to suppress platelet activation by PGI2 diminished during lipid infusion in both groups when compared to saline. Importantly, insulin infusion decreased lipid-induced platelet hyperactivity by decreasing their response to 1 μmol/L ADP (78.7% [67.9, 82.3] versus 62.8% [51.8, 73.3], P=0.02) and increasing sensitivity to 0.01 μmol/L PGI2 (67.6% [39.5, 83.8] versus 40.9% [23.8, 60.9], P=0.01) in controls, but not in PCOS. Acute hypertriglyceridemia induced IR, and increased platelet activation in both groups that was not reversed by insulin in PCOS subjects compared to controls. This suggests that platelet hyperactivity induced by acute hypertriglyceridemia and IR could contribute athero-thrombotic risk. www.isrctn.org. Unique Identifier: ISRCTN42448814.
    Journal of the American Heart Association. 01/2014; 3(1):e000706.
  • Eric S Kilpatrick, Stephen L Atkin
    BMJ (online) 01/2014; 348:g2867. · 17.22 Impact Factor
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    ABSTRACT: Sporopollenin exine capsules (SECs) derived from plant spores and pollen grains have been proposed as adsorption, remediation and drug delivery agents. Despite many studies there is scant structural data available. This X-ray absorption investigation represents the first direct structural data on the interaction of metals with SECs and allows elucidation of their structure-property relationships. Fe K-edge XANES and EXAFS data have shown that the iron local environment in SECs (derived from Lycopodium clavatum) reacted with aqueous ferric chloride solutions is similar to that of ferrihydrite (FeOOH) and by implication ferritin. Fe K a XRF micro-focus experiments show that there is a poor correlation between the iron distribution and the underlying SEC structure indicating that the SEC is coated in the FeOOH material. In contrast, the Fe K a XRF micro-focus experiments on SECs reacted with aqueous ferrous chloride solutions show that there is a very high correlation between the iron distribution and the SEC structure, indicating a much more specific form of interaction of the iron with the SEC surface functional groups. Fe K-edge XANES and EXAFS data show that the Fe(II) can be easily oxidised to give a structure similar to, but not identical to that in the Fe(III) case, and that even if anaerobic conditions are used there is still partial oxidation to Fe(III).
    Journal of Materials Chemistry B. 01/2014; 2:945-959.
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    ABSTRACT: The results of weight maintenance after initial weight loss are reported infrequently, although, when they have been reported, the outcomes are generally poor and weight regain is common. After an initial 12-week randomised intervention comparing all meal provision against a self-directed energy restriction, participants re-consented to participate in a follow-on study. Participants were given the option to choose to continue with the same dietary intervention (either all meal provision (provided free of charge) or self-directed diet) or change to the other diet for a further 12 weeks. Participants were followed up at 4-weekly intervals during both intervention periods (a total of 24 weeks), with a final follow up at 12 months. Eighty-five out of 86 individuals who completed the original 12-week randomised phase chose to continue on to the follow-up study. No significant differences in further weight loss between groups (P = 0.138) [mean (SEM): -3.4% (1.1%) for all meal provision only; -3.4% (0.6%) self-directed then all meal provision; -1.1% (1.2%) all meal provision then self-directed] were seen after a further 12 weeks. Meal provision for a total of 24 weeks resulted in 67% of individuals losing at least 10% body weight. The groups switching from self-directed dieting to meal provision (or vice versa) were the only groups to have a lower mean weight at 12 months than at the start of the follow-on study. Structured support for 24 weeks followed by 28 weeks of self-care can result in weight maintenance, with initial weight loss maintained at 12 months from enrolling on a 12-week weight loss intervention, with a 12-week follow-on period.
    Journal of Human Nutrition and Dietetics 11/2013; · 1.97 Impact Factor
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    ABSTRACT: Insulin resistance (IR) after bariatric surgery is significantly lower than controls matched for body mass index (BMI) and is indistinguishable from lean subjects however it is not known if this is the same for associated cardiovascular risk (CVR) markers (endothelial function (EF) and clot structure and function (maximum absorbance (MA) lysis potential (LT) and clot formation time (FT). We sought to determine if IR and associated CVR markers one year after bariatric surgery were comparable to post surgery age and BMI matched controls. Ten patients had before and 12 months after Roux-en-Y surgery CVR measurements compared to controls. BMI reduced after surgery to 33.3±1.7 kg/m(2) p<0.001 comparable to controls 32.6±1.6 kg/m(2) p=0.87. Fasting glucose reduced after surgery to 4.6±0.1 mmol/L, lower than controls 5.0±0.1 mmol/L p=0.03. IR (calculated using HOMA-IR) reduced 0.77±0.14 p=0.03 and was lower than controls 2.35±0.32 p= 0.02. Systolic blood pressure (BP) reduced to 114.2±3.6 mmHg which was lower than controls 127.7±4.1 mmHg p=0.04, but diastolic BP was unaffected by surgery and no different to controls. EF, hsCRP and HDL-cholesterol improved after surgery and did not differ to controls. Markers of blood clotting: MA and FT were unaffected by surgery and no different to controls, LT improved after surgery 3078±580 to 1665±330s p= 0.04) and was no different to controls (2088±556s p=0.12) CONCLUSIONS: Bariatric surgery improved cardiovascular risk parameters to that of the equivalent controls post surgery for weight including EF, hsCRP and LT supporting bariatric surgery as an effective management of obesity.
    Obesity Surgery 11/2013; · 3.10 Impact Factor
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    ABSTRACT: Effective approaches are needed to address the increasing prevalence of overweight and obesity. The present study investigated whether all meal provision was a more effective and acceptable method for weight loss than a self-directed diet. This randomised controlled trial recruited 112 men and women with a body mass index in the range 27-35 kg m(-2) , who had no comorbidities, from the local area of Hull. Participants were randomised to receive either meal provision or follow a self-directed diet for a 12-week period that resulted in an estimated 2928 kJ day(-1) (700 kcal day(-1) ) deficit. A dietitian supervised both dietary interventions. At 12 weeks [mean (SEM)], percentage weight loss in the meal provision group was 6.6% (0.5%) compared to 4.3% (0.6%) for those on the self-directed diet. In terms of clinically relevant weight loss, 61% of participants lost 5% or more of their body weight with meal provision compared to 22% on the self-directed diet (P < 0.001). Weight loss was associated with wellbeing in both groups. Attrition was less apparent with 7% of those participants receiving meal provision withdrawing from the study compared to 41% of those following the self-directed diet (P < 0.001). Meal provision was a more effective and accepted method for weight loss over a 12-week period compared to a self-directed diet. This may in part represent the difference between being given the meal provision food free of charge. However, longer-term maintenance studies need to be undertaken to ascertain their effects on the maintenance of weight loss.
    Journal of Human Nutrition and Dietetics 10/2013; · 1.97 Impact Factor
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    ABSTRACT: BACKGROUND:Many countries have implemented, or are considering, a change in hemoglobin A1c (Hb A1c) units from traditional percentage values [Diabetes Control and Complications Trial (DCCT)] to the new Système International d'Unités (SI) unit in millimoles per mole. Concern exists that such a large alteration in numeric values might lead, through confusion, to a deterioration in patients' glycemia. This study has assessed Hb A1c in the year before and after the change of units in a UK diabetes population.METHODS:The Hb A1c in the 12 months immediately before the unit change (October 2010 to September 2011) was compared with the 12 months after (October 2011 to September 2012). Also, the subsequent change in Hb A1c in patients who had poor glycemic control [Hb A1c >8% (64 mmol/mol)], either before or after the unit change, was compared.RESULTS:Over the 2 years, 44 721 Hb A1c measurements were requested on 13 197 (7247 male, 5950 female) known diabetes patients. The population Hb A1c was no different between years, with a median [interquartile range (IQR)] value of 7.5% (6.6%-8.7%) after the change and 7.5% (6.5-8.7) before (P = 0.34). The subsequent change in Hb A1c following a raised (>8%) result was the same regardless of whether the initial value reported was in DCCT or SI units [median (IQR) change in Hb A1c -0.2% (-0.9% to 0.3%), n = 4316, following a DCCT result, vs -0.2% (-0.8% to 0.3%), n = 4396, following SI; P = 0.44].CONCLUSIONS:In this UK diabetes population, a move to SI Hb A1c reporting did not lead to any marked short-term deterioration in glycemia or a different Hb A1c outcome in patients with initial poor glucose control.
    Clinical Chemistry 06/2013; · 7.15 Impact Factor
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    ABSTRACT: Background: The role of total thyroidectomy in the management of patients with Graves' disease remains controversial. However, there is increasing evidence to support the role of the procedure as a safe and definitive treatment for Graves' disease. Method: Patients were identified from a prospective thyroid database of the multidisciplinary thyroid clinic at Hull Royal Infirmary. All case notes were independently reviewed to confirm the data held on the database. Results: Over a 7-year period, the senior author has performed 206 total thyroidectomies for Graves' disease. The incidence of temporary recurrent laryngeal nerve palsy and hypoparathyroidism was 3.4 per cent and 24 per cent respectively. There was one case of permanent unilateral recurrent laryngeal nerve palsy, and 3.9 per cent of patients developed permanent hypoparathyroidism. There has been no relapse of thyrotoxicosis. Conclusion: In the context of a multidisciplinary thyroid clinic, total thyroidectomy should be offered as a safe and effective first-line treatment option for Graves' disease.
    The Journal of Laryngology & Otology 06/2013; · 0.68 Impact Factor
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    ABSTRACT: AIMS: HbA1c values are unreliable in patients with diabetes who have chronic kidney disease who receive iron and/or erythropoiesis stimulating agents. The study aimed to evaluate the utility of the complementary glycaemic markers glycated albumin, fructosamine and 1,5 anhydroglucitol in this group of patients. METHODS: A prospective study of patients with Type 2 diabetes and chronic kidney disease stage IIIB/IV undergoing intravenous iron or erythropoiesis-stimulating agent therapy. Glycaemic control was monitored using HbA1c , seven-point daily glucose thrice weekly, continuous glucose monitoring, glycated albumin, fructosamine and 1,5 anhydroglucitol. RESULTS: Fifteen patients [9 men; median age 72 years (interquartile range 68-74), follow-up period (16.4 ± 3.7 weeks)] received parenteral iron; 15 patients [11 men; 70 years (interquartile range 62-75), (17.3 ± 3.3 weeks)] received erythropoiesis-stimulating agent. HbA1c fell following treatment with both iron [57 mmol/mol (7.4%) to 53 mmol/mol (7.0%), P < 0.001] and erythropoiesis-stimulating agent [56 mmol/mol (7.3%) to 49 mmol/mol (6.6%), P = 0.01] despite mean blood glucose remaining unchanged (iron: 9.55 to 9.71 mmol/l, P = 0.07; erythropoiesis-stimulating agent: 8.72 to 8.78 mmol/l, P = 0.89). Unlike HbA1c , the glycated albumin, fructosamine and 1,5 anhydroglucitol levels did not change following iron [glycated albumin (16.8 to 16.3%, P = 0.10); fructosamine (259.5 to 256 μmol/l, P = 0.89); 1,5 anhydroglucitol (54.2 to 50.9 μmol/l, P = 0.89)] or erythropoiesis-stimulating agent [glycated albumin (17.9 to 17.5%, P = 0.29), fructosamine (324.3 to 306.0 μmol/l, P = 0.52), 1,5 anhydroglucitol (58.2 to 46.7 μmol/l, P = 0.35)]. Despite this, HbA1c was consistently the marker most closely related to mean blood glucose before and after each treatment (R range 0.7-0.88). CONCLUSIONS: These data indicate that HbA1c was statistically most closely related to mean blood glucose, but clinical trends in glycaemia in patients undergoing iron or erythropoiesis-stimulating agent therapy are likely best assessed by including one of these additional glycaemic markers. This article is protected by copyright. All rights reserved.
    Diabetic Medicine 06/2013; · 3.24 Impact Factor
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    ABSTRACT: BACKGROUND: Women with polycystic ovary syndrome (PCOS) have an adverse cardiovascular risk profile and an increased prevalence of non-alcoholic fatty liver disease (NAFLD) which is also associated with an adverse cardiovascular risk profile. OBJECTIVE: To compare the cardiovascular risk profile of women with PCOS alone and women with PCOS and NAFLD. DESIGN, SETTING AND PARTICIPANTS: Twenty-five oligoanovulatory women with PCOS were screened for NAFLD (including liver biopsy if appropriate) and had their cardiovascular risk factors measured which included the inflammatory marker (CRP), endothelial function (measured using endoPAT 2000 and serum markers (ICAM-1, VCAM-1, E-selectin and P-selectin)) and clot structure and function (maximum absorbance (MA), and lysis potential (LT)). RESULTS: 12 patients had confirmed PCOS without evidence of NAFLD and 13 patients had confirmed PCOS with evidence of NAFLD. The PCOS and NAFLD group were heavier (BMI 43.9±2.2 kg/m(2) ) compared to the PCOS alone group (BMI 37.6±1.4 kg/m(2) p=0.03). There was no difference in CRP (7.57±0.95 vs 6.59±1.87 mmol/L p=0.62) or endothelial function (RH-PAT 1.96±0.1 vs 1.74±0.16 p=0.25, ICAM-1 (221±48 vs 250±60 ng/ml p=0.19), VCAM-1 (2124±78 vs 2314±91 ng/ml p=0.13), E-selectin (33.9±3.3 vs 39.5±15.5 ng/ml p=0.31) and P-selectin (101.0±6.6 vs 95.9±10.2 ng/ml p=0.69)). There was no difference in clot formation or lysis. CONCLUSION: The patients with PCOS and NAFLD were heavier compared to patients with PCOS alone. Despite this we were unable to demonstrate differences in inflammatory markers, endothelial function or clot structure and function, suggesting that severity of steatosis is not the most important determinant of cardiovascular risk in PCOS. This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 06/2013; · 3.40 Impact Factor
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    ABSTRACT: Somatostatin analogues are commercially available and used for the management of acromegaly and neuroendocrine tumours, but the expression of the receptors as a target in thyroid disease has not been explored. To assess somatostatin (SST) and somatostatin receptor (SSTR1-5) expression in both normal and thyroid disorders, as a potential target for somatostatin analogue therapy, 67 thyroid tissue specimens were reviewed: 12 differentiated thyroid carcinomas, 14 follicular adenomas, 17 multinodular goitres, 14 Graves disease, 10 Hashimotos thyroiditis specimens and five normal thyroids. Tissue was immunostained for SST and SSTR1-5. Positivity and the degree of positivity were recorded by double-blinded observers. Somatostatin receptor expression was highly expressed in normal tissue for SSTR1, 3, 4 and 5 (5 of 5, 4 of 5, 4 of 5 and 5 of 5 respectively) whilst SST and SSTR 2a and b were not expressed at all. The commonest receptor expressed for all pathological subtypes grouped together was SSTR2b (63 specimens). The commonest receptors expressed in differentiated thyroid cancer were SSTR5 (11 of 12 specimens) and SSTR2b (10 of 12 specimens). The commonest receptor expressed in benign disease was SSTR2b (53 of 55 specimens). SSTR5 was significantly under-expressed in Graves disease (P < 0.05). This study illustrates that SSTR 1, 3, 4 and 5 are highly expressed in normal, benign and malignant thyroid tissue. SSTR 2a and 2b appear absent in normal tissue and present in benign and malignant thyroid tissue (P < 0.02). This suggests that focussed SSTR2 treatment may be a potential therapeutic target.
    International Journal of Experimental Pathology 06/2013; 94(3):226-229. · 2.04 Impact Factor
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    ABSTRACT: Revascularisation strategies involving coronary artery bypass grafting or percutaneous interventions are the main treatments for stable coronary artery disease, particularly for patients with ongoing symptoms despite medical therapy and/or extensive ischaemia as demonstrated by either non-invasive or invasive means. Irrespective of whether revascularisation is being undertaken, all patients with stable coronary disease require optimal medical therapy in order to reduce the risk of subsequent adverse cardiac events, particularly acute myocardial infarction. The role of medical management has been very actively investigated and reported, particularly because of the global disease burden and the associated high morbidity and mortality. In this review, the current available medical management for the treatment of coronary atherosclerosis is described together with the role and prospects of the newer classes of drugs that are coming into use, and future perspectives in this field.
    Current Atherosclerosis Reports 04/2013; 15(4):313. · 2.92 Impact Factor
  • Primary Care Diabetes. 04/2013; 7(1):85.
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    ABSTRACT: Biological variation refers to the natural fluctuations found when repeated measurements are made in a biological system. Generally, biological variation remains within narrow boundaries in health, but may differ in pathological states, with implications for the diagnosis and monitoring of disease processes. In disease, biological variation may alter such that any subsequent measurement may need to have a greater difference compared with a healthy control to be biologically relevant. Treatments such as insulin or anti-hypertensive therapy have been shown to reduce biological variability closer to normal levels and theoretically this may help prevent complication development or progression in conditions such as diabetes. This article reviews how biological variation can influence our identification and assessment of vascular risk factors in a person with diabetes. The role of biological variation in the diagnosis of diabetes (glucose and HbA(1c) ) is then examined. Finally, the influence that common treatments in diabetes have in modifying biological variation is described. © 2013 The Authors. Diabetic Medicine © 2013 Diabetes UK.
    Diabetic Medicine 02/2013; · 3.24 Impact Factor
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    ABSTRACT: The pleiotropic effect of statins may be mediated in part through raising vitamin D (25OHD) concentrations. It has also been shown that an increase in oxidative stress and inflammatory markers are a feature of patients with type 2 diabetes (T2DM). A cross-over study of 26 patients with T2DM taking either simvastatin 40mg or atorvastatin 10mg was undertaken. After 3 months on one statin, lipids, hsCRP, 25OHD and MDA were measured repeatedly. The same procedure was then followed taking the other statin. Despite similar lipid lowering, the mean 25OHD was higher on atorvastatin compared to simvastatin and the mean MDA and hsCRP levels lower, irrespective of which statin the patients were taking before crossover. The changes in 25OHD predicted changes in CRP and MDA levels. Thus, compared to simvastatin, atorvastatin demonstrates apparently beneficial pleiotropic effects in respect of 25OHD concentrations as well as markers of oxidative stress and inflammation in patients with T2DM.
    Diabetes Obesity and Metabolism 01/2013; · 5.18 Impact Factor

Publication Stats

2k Citations
925.48 Total Impact Points


  • 2006–2014
    • Hull York Medical School
      York, England, United Kingdom
  • 1994–2014
    • University of Hull
      • • Diabetes and Endocrinology
      • • Hull York Medical School (HYMS)
      • • Division of Academic Medicine
      Kingston upon Hull, England, United Kingdom
    • Liverpool Hospital
      Liverpool, New South Wales, Australia
  • 2013
    • University of Nottingham
      • Division of Nutritional Sciences
      Nottigham, England, United Kingdom
  • 2008–2013
    • Hull and East Yorkshire Hospitals NHS Trust
      Kingston upon Hull, England, United Kingdom
    • St George's, University of London
      Londinium, England, United Kingdom
  • 2012
    • University of Western Sydney
      • School of Science and Health
      Penrith, New South Wales, Australia
    • San Diego Zoo
      San Diego, California, United States
    • University of Chester
      • Clinical Sciences
      Chester, ENG, United Kingdom
    • Bradford Teaching Hospitals NHS Foundation Trust
      Bradford, England, United Kingdom
    • The University of York
      • Hull York Medical School
      York, England, United Kingdom
  • 2002–2011
    • The Australian Society of Otolaryngology Head & Neck Surgery
      Evans Head, New South Wales, Australia
  • 2010
    • Centre For Diabetes And Endocrinology
      Johannesburg, Gauteng, South Africa
  • 2006–2010
    • The Bracton Centre, Oxleas NHS Trust
      Дартфорде, England, United Kingdom
  • 2009
    • University of Glasgow
      Glasgow, Scotland, United Kingdom
  • 2004
    • Newcastle University
      Newcastle-on-Tyne, England, United Kingdom
  • 1994–1997
    • Kingston Hospital
      Kingston Seymour, England, United Kingdom
  • 1993–1995
    • Royal Liverpool and Broadgreen University Hospitals NHS Trust
      • Department of Endocrinology
      Liverpool, England, United Kingdom
    • University of Liverpool
      • School of Medicine
      Liverpool, England, United Kingdom