Eric S Kilpatrick

Hull York Medical School, York, England, United Kingdom

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Publications (174)826.8 Total impact

  • Eric S Kilpatrick
    Nature Reviews Endocrinology 06/2015; DOI:10.1038/nrendo.2015.100 · 12.96 Impact Factor
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    ABSTRACT: The use of HbA1c for the diagnosis of diabetes is now widely advocated despite caveats to its use. Anaemia is cited as a major confounder to this use; however, the effect of erythrocyte indices and to what degree anaemia influences HbA1c levels is not known. A systematic electronic database search of MEDLINE, EMBASE, the Cumulative Index to Nursing & Allied Health Literature (CINAHL) and the Cochrane Library was conducted for relevant articles published between January 1990 and May 2014. Included studies had at least one measurement of HbA1c and glucose, and a least one index of haematinic deficiency, involving non-pregnant adults, not known to have diabetes. A total of 12 articles from 544 were included. The majority of studies focused on iron deficiency anaemia (IDA) and, in general, demonstrated that the presence of iron deficiency with or without anaemia led to an increase in HbA1c values compared with controls, with no concomitant rise in glucose indices. Data on the effects of other indices of erythrocyte abnormalities on HbA1c are limited but show a possible decrease in HbA1c values with non-iron deficiency forms of anaemia. HbA1c is likely to be affected by iron deficiency and IDA with a spurious increase in HbA1c values; conversely, non-IDA may lead to a decreased HbA1c value. This may lead to confusion when diagnosing diabetes using HbA1c. This review clearly identifies the need for more evidence, especially in identifying the types and degrees of anaemia likely to have significant impact on the reliability of HbA1c.
    Diabetologia 05/2015; 58(7). DOI:10.1007/s00125-015-3599-3 · 6.88 Impact Factor
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    ABSTRACT: Whether obesity is associated with a better prognosis in patients with type 2 diabetes mellitus is controversial. To investigate the association between body weight and prognosis in a large cohort of patients with type 2 diabetes followed for a prolonged period. Prospective cohort. National Health Service, England. Patients with diabetes. The relationship between body mass index (BMI) and prognosis in patients with type 2 diabetes without known cardiovascular disease at baseline was investigated. Information on all-cause mortality and cardiovascular morbidity (such as the acute coronary syndrome, cerebrovascular accidents, and heart failure) was collected. Cox regression survival analysis, corrected for potential modifiers, including cardiovascular risk factors and comorbid conditions (such as cancer, chronic kidney disease, and lung disease), was done. 10 568 patients were followed for a median of 10.6 years (interquartile range, 7.8 to 13.4). Median age was 63 years (interquartile range, 55 to 71), and 54% of patients were men. Overweight or obese patients (BMI >25 kg/m2) had a higher rate of cardiac events (such as the acute coronary syndrome and heart failure) than those of normal weight (BMI, 18.5 to 24.9 kg/m2). However, being overweight (BMI, 25 to 29.9 kg/m2) was associated with a lower mortality risk, whereas obese patients (BMI >30 kg/m2) had a mortality risk similar to that of normal-weight persons. Patients with low body weight had the worst prognosis. Data about cause of death were not available. In this cohort, patients with type 2 diabetes who were overweight or obese were more likely to be hospitalized for cardiovascular reasons. Being overweight was associated with a lower mortality risk, but being obese was not. National Institute for Health Research and University of Hull.
    Annals of internal medicine 05/2015; 162(9):610-618. DOI:10.7326/M14-1551 · 16.10 Impact Factor
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    ABSTRACT: Polyphenols and other compounds found in cocoa and chocolate have therapeutic potential in the management of diabetes in humans. Polyphenols benefits have been proposed supported by in vitro studies, animal work and clinical trials, which have been conducted mostly in healthy volunteers. The energy dense formulations of many cocoa and chocolate products which can be up to 50% sugar by weight have given the perception that chocolate may be harmful through its contribution to obesity. A review of both clinical trial databases and published literature yielded 15 registered trials and seven published studies. The published data interventions reported are diverse vary widely in quality, including poor selection of control products or inadequate blinding procedures. There are also inconsistencies in reporting of data with limited information on the effect of cocoa and chocolate supplementation on weight and glycemic control despite the potential benefits reported with respect to the cardiovascular risk factors of endothelial function and lipids. More studies are required powered for primary clinical outcomes together with the development of standardized product formulations that optimize the dose of polyphenols within a palatable and energy restricted product.
    Journal of Agricultural and Food Chemistry 03/2015; DOI:10.1021/acs.jafc.5b00776 · 3.11 Impact Factor
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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 12/2014; 3(1):e000706. DOI:10.1161/JAHA.113.000706 · 2.88 Impact Factor
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    ABSTRACT: Consumption of carbohydrate-containing foods leads to transient postprandial rises in blood glucose concentrations that vary between food types. Higher postprandial glycaemic exposures have particularly been implicated in the development of chronic cardiometabolic diseases. Reducing such diet-related exposures may be beneficial not only for diabetic patients but also for the general population. A variety of markers have been used to track different aspects of glycaemic exposures, with most of the relevant knowledge derived from diabetic patients. The assessment of glycaemic exposures among the non-diabetic population may require other, more sensitive markers. The present report summarises key messages of presentations and related discussions from a workshop organised by Unilever intended to consider currently applied markers of glycaemic exposure. The particular focus of the meeting was to identify the potential applicability of glycaemic exposure markers for studying dietary effects in the non-diabetic population. Workshop participants concluded that markers of glycaemic exposures are sparsely used in intervention studies among non-diabetic populations. Continuous glucose monitoring remains the optimal approach to directly assess glycaemic exposure. Markers of glycaemic exposure such as glycated Hb, fructosamine, glycated albumin, 1,5-anhydroglucitol and advanced glycation end products can be preferred dependent on the aspect of interest (period of exposure and glucose variability). For all the markers of glycaemia, the responsiveness to interventions will probably be smaller among the non-diabetic than among the diabetic population. Further validation and acceptance of existing glycaemic exposure markers applied among the non-diabetic population would aid food innovation and better design of dietary interventions targeting glycaemic exposure.
    British Journal Of Nutrition 12/2014; 113(02):1-10. DOI:10.1017/S0007114514003547 · 3.34 Impact Factor
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    ABSTRACT: Background. Hyponatraemia, the commonest electrolyte abnormality amongst in-patients, is associated with increased mortality. Until recently, there has been a lack of international consensus management of patients with severe hyponatraemia. Aim. We performed a retrospective study in two teaching hospitals in Yorkshire, UK, to evaluate the management of patients with severe hyponatraemia (serum Na ≤ 110 mmol/L) and to assess the frequency of complications observed in this group, in particular central pontine myelinolysis (CPM) and death. Methods. Retrospective data collection was performed on all of patients admitted with severe hyponatraemia in a calendar year in two teaching hospitals in Yorkshire. A detailed case note evaluation was conducted to determine the patient clinical characteristics, aetiology, investigations performed, treatment, complications and outcome of patients. Results. We identified 39 patients in total at both sites over a calendar year. There was a notable female predominance (n = 27), with the median (range) age being 65 (45–92) years and median sodium concentration 107 (94–110) mmol/L. Hyponatraemia was classified as acute (onset < 48 h) in six patients, chronic (onset > 48 h) in 20 patients and of unknown duration in 13 patients. Iatrogenic hyponatraemia secondary to drugs, especially thiazides was the most commonly observed aetiology. The mortality rate was 48.7% (n = 19) at the end of one year after admission episode and CPM was seen in 7.6% (n = 3) of patients. Conclusions. Severe hyponatraemia is associated with significant morbidity and mortality. Drug-induced hyponatraemia was the most common aetiology observed in our group of patients.
    Scandinavian Journal of Clinical and Laboratory Investigation 10/2014; 75(1). DOI:10.3109/00365513.2014.926563 · 2.01 Impact Factor
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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. DOI:10.1136/heartjnl-2014-306118.116 · 6.02 Impact Factor
  • Eric S Kilpatrick, Stephen L Atkin
    BMJ (online) 04/2014; 348:g2867. DOI:10.1136/bmj.g2867 · 16.38 Impact Factor
  • Thozhukat Sathyapalan, Stephen Atkin, Eric Stephen Kilpatrick
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    ABSTRACT: Background A new formula was recently proposed by Cordovo et al. that was more highly correlated with low-density lipoprotein (LDL) measured directly than the Friedewald LDL formula. We conducted this prospective study to establish whether the new formula allows true variations in LDL within the same individual to be tracked more closely than that of the Friedewald formula.
    Annals of Clinical Biochemistry 04/2014; 52(1). DOI:10.1177/0004563214533515 · 2.08 Impact Factor
  • 03/2014; DOI:10.1530/endoabs.34.P233
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    ABSTRACT: Polycystic ovary syndrome (PCOS) is associated with obesity and increased cardiovascular (CV) risk markers. In this study our aim was to assess the effects of six months treatment with liraglutide 1.8 mg od on obesity, and CV risk markers, particularly platelet function, in young obese women with PCOS compared to controls of similar age and weight. Carotid intima-media wall thickness (cIMT) was measured by B-mode ultrasonography, platelet function by flow cytometry, clot structure/lysis by turbidimetric assays and endothelial function by ELISA and post-ischaemic reactive hyperemia (RHI). Data presented as mean change (6-month - baseline) ± standard deviation. Nineteen obese women with PCOS and 17 controls, of similar age and weight, were recruited; baseline atherothrombotic risk markers did not differ between the two groups. Twenty five (69.4%) participants completed the study (13 PCOS, 12 controls). At six months, weight was significantly reduced by 3.0 ± 4.2 and 3.8 ± 3.4 kg in the PCOS and control groups, respectively; with no significant difference between the two groups, P = 0.56. Similarly, HOMA-IR, triglyceride, hsCRP, urinary isoprostanes, serum endothelial adhesion markers (sP-selectin, sICAM and sVCAM), and clot lysis area were equally significantly reduced in both groups compared to baseline. Basal platelet P-selectin expression was significantly reduced at six months in controls -0.17 ± 0.26 but not PCOS -0.12 ± 0.28; between groups difference, 95% confidence interval = -0.14 - 0.26, P = 0.41. No significant changes were noted in cIMT or RHI. Six months treatment with liraglutide (1.8 mg od) equally affected young obese women with PCOS and controls. In both groups, liraglutide treatment was associated with 3-4% weight loss and significant reduction in atherothrombosis markers including inflammation, endothelial function and clotting. Our data support the use of liraglutide as weight loss medication in simple obesity and suggest a potential beneficial effect on platelet function and atherothrombotic risk at 6 months of treatment. Clinical trial reg. no. ISRCTN48560305 . Date of registration 22/05/2012.
    03/2014; 15(1). DOI:10.1530/endoabs.34.P229
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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; 16(6). DOI:10.1111/dom.12255 · 5.46 Impact Factor
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    Eric S Kilpatrick, Zachary T Bloomgarden
    Diabetes care 12/2013; 36(12):e215. DOI:10.2337/dc13-1371 · 8.57 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; 24(3). DOI:10.1007/s11695-013-1100-2 · 3.74 Impact Factor
  • Antonio Ceriello, Eric S. Kilpatrick
    Diabetes Care 07/2013; 36(Supplement_2):S272-S275. DOI:10.2337/dcS13-2030 · 8.57 Impact Factor
  • Conference Paper: Paraproteins and lipids
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    ABSTRACT: http://www.atherosclerosis-journal.com/article/S0021-9150(13)00422-X/abstract
    HEART UK, Bristol; 07/2013
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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; 59(10). DOI:10.1373/clinchem.2013.206334 · 7.77 Impact Factor
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    ABSTRACT: AimsHbA(1c) 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. MethodsA prospective study of patients with Type2 diabetes and chronic kidney disease stageIIIB/IV undergoing intravenous iron or erythropoiesis-stimulating agent therapy. Glycaemic control was monitored using HbA(1c), seven-point daily glucose thrice weekly, continuous glucose monitoring, glycated albumin, fructosamine and 1,5 anhydroglucitol. ResultsFifteen patients [9 men; median age 72years (interquartile range 68-74), follow-up period (16.43.7weeks)] received parenteral iron; 15 patients [11 men; 70years (interquartile range 62-75), (17.33.3weeks)] received erythropoiesis-stimulating agent. HbA(1c) fell following treatment with both iron [57mmol/mol (7.4%) to 53mmol/mol (7.0%), P<0.001] and erythropoiesis-stimulating agent [56mmol/mol (7.3%) to 49mmol/mol (6.6%), P=0.01] despite mean blood glucose remaining unchanged (iron: 9.55 to 9.71mmol/l, P=0.07; erythropoiesis-stimulating agent: 8.72 to 8.78mmol/l, P=0.89). Unlike HbA(1c), 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 256mol/l, P=0.89); 1,5 anhydroglucitol (54.2 to 50.9mol/l, P=0.89)] or erythropoiesis-stimulating agent [glycated albumin (17.9 to 17.5%, P=0.29), fructosamine (324.3 to 306.0mol/l, P=0.52), 1,5 anhydroglucitol (58.2 to 46.7mol/l, P=0.35)]. Despite this, HbA(1c) 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 HbA(1c) 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.
    Diabetic Medicine 06/2013; 30(10). DOI:10.1111/dme.12249 · 3.06 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; DOI:10.1111/cen.12258 · 3.35 Impact Factor

Publication Stats

3k Citations
826.80 Total Impact Points

Institutions

  • 2006–2015
    • Hull York Medical School
      York, England, United Kingdom
  • 2005–2014
    • Hull and East Yorkshire Hospitals NHS Trust
      Kingston upon Hull, England, United Kingdom
  • 2002–2014
    • University of Hull
      • • Diabetes and Endocrinology
      • • Academic Cardiology
      Kingston upon Hull, England, United Kingdom
  • 2012
    • San Diego Zoo
      San Diego, California, United States
    • East Riding College
      Beverley, England, United Kingdom
  • 2006–2009
    • The Bracton Centre, Oxleas NHS Trust
      Дартфорде, England, United Kingdom
  • 2005–2009
    • University of Glasgow
      • Division of Biochemistry
      Glasgow, Scotland, United Kingdom
  • 1998
    • University Hospital Of South Manchester NHS Foundation Trust
      Manchester, England, United Kingdom