E S Kilpatrick

University of Hull, Kingston upon Hull, England, United Kingdom

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Publications (96)343.52 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. DOI:10.1136/heartjnl-2014-306118.116 · 6.02 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
  • A J Dawson, T Sathyapalan, S L Atkin, E S Kilpatrick
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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; 30(10). DOI:10.1111/dme.12160 · 3.06 Impact Factor
  • E S Kilpatrick, A S Rigby, R E Warren, S L Atkin
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    ABSTRACT: AIMS: Recurrent severe hypoglycaemia in a patient with diabetes is strongly associated with a crash risk while driving. To help ensure road safety, recent changes were made to European Union driving regulations for patients with diabetes. These included the recommendation that more than one episode of severe hypoglycaemia within 12 months would lead to the loss of a driving licence. This study has assessed the impact of this regulation if applied to patients who participated in the Diabetes Control and Complications Trial. METHODS: All patients in the Diabetes Control and Complications Trial were assumed to be drivers. Repeated hypoglycaemic episodes within a year were determined during the mean 6.5 years of the study. RESULTS: Of the 1441 patients in the Diabetes Control and Complications Trial, 439 (30%) had more than one severe hypoglycaemic episode during a 12-month period of their study participation. Amongst the study groups, 312/711 (44%) of intensively treated and 127/730 (17%) of conventionally treated patients would have lost their licence at some point during the trial. The risk of licence loss increased with lower mean HbA(1c) , longer duration of diabetes and younger age (all P < 0.001). CONCLUSIONS: More than one episode of severe hypoglycaemia within a year was a frequent event in subjects in the Diabetes Control and Complications Trial, especially in intensively treated patients. If applied to current practice, improving road safety through these changes to European Union regulations could have a substantial impact on drivers who have Type 1 diabetes. This emphasizes the need to take into account the potential effects of severe hypoglycaemia in those who rely on a driving licence. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.
    Diabetic Medicine 12/2012; 30(5). DOI:10.1111/dme.12075 · 3.06 Impact Factor
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    ABSTRACT: AIMS: To investigate the effects of high-polyphenol chocolate upon endothelial function and oxidative stress in Type 2 diabetes mellitus during acute transient hyperglycaemia induced following a 75-g oral glucose challenge. METHODS: Ten subjects with Type 2 diabetes underwent a double-blinded randomized controlled crossover study. A 75-g oral glucose load was used to induce hyperglycaemia, which was administered to participants 60 min after they had ingested either low (control) or high-polyphenol chocolate. Participants undertook testing at weekly intervals, following an initial cocoa-free period. Endothelial function was assessed by both functional [reactive hyperaemia peripheral artery tonometry (EndoPAT-2000) and serum markers (including intercellular adhesion molecule 1, P-selectin and P-selectin glycoprotein ligand 1]. Urinary 15-F2t-isoprostane adjusted for creatinine was used as an oxidative stress marker. Measurements were made at baseline and 2 h post-ingestion of the glucose load. RESULTS: Prior consumption of high-polyphenol chocolate before a glucose load improved endothelial function (1.7 ± 0.1 vs. 2.3 ± 0.1%, P = 0.01), whereas prior consumption of control chocolate resulted in a significant increase in intercellular adhesion molecule 1 (321.1 ± 7.6 vs. 373.6 ± 10.5 ng/ml, P = 0.04) and 15-F2t-isoprostane (116.8 ± 5.7 vs. 207.1 ± 5.7 mg/mol, P = 0.02). Analysis of percentage changes from baseline comparing control and high-polyphenol chocolate showed a significant improvement for high-polyphenol chocolate in both measures of endothelial function (P < 0.05) and for urinary 15-F2t-isoprostane (P = 0.04). CONCLUSION: High-polyphenol chocolate protected against acute hyperglycaemia-induced endothelial dysfunction and oxidative stress in individuals with Type 2 diabetes mellitus. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK.
    Diabetic Medicine 10/2012; 30(4). DOI:10.1111/dme.12030 · 3.06 Impact Factor
  • D. Narayanan, H. Kahal, K. Mohammed, E. S. Kilpatrick
    The British Journal of Diabetes & Vascular Disease 09/2012; 12(4):200-202. DOI:10.1177/1474651412454308
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    E S Kilpatrick
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    ABSTRACT: It is still unclear whether short-term, within-day, variability in glycaemic control is contributory to the development of diabetes micro- or macrovascular complications. However, consistent and compelling data are emerging that longer term fluctuations in glucose, as evidenced by increases in HbA(1c) variability, do indeed add to the mean HbA(1c) value in predicting the risk of microvascular disease. Until now, studies have found this to be the case mainly in type 1 diabetes, but in this issue of Diabetologia (DOI: 10.1007/s00125-012-2572-7 ) an analysis of the Tsukuba Kawai Diabetes Registry in Japan has found that HbA(1c) variability also predicts the risk of nephropathy in type 2 diabetic patients. These observations raise the possibility that reducing rises and falls in HbA(1c) may help avoid hyperglycaemia-related vascular disease without running the same risk of hypoglycaemia that a strategy focusing purely on lower HbA(1c) might incur.
    Diabetologia 06/2012; 55(8):2089-91. DOI:10.1007/s00125-012-2610-5 · 6.88 Impact Factor
  • A Wakil, K A Smith, S L Atkin, E S Kilpatrick
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    ABSTRACT: It is unknown whether glycaemic variability adds to the risk of microvascular complications of diabetes over and above the mean glucose value for a patient. We examined the effect of purposefully induced short-term glycaemic variability on oxidative stress markers. Eleven healthy subjects underwent three sequential glycaemic states; sustained hyperglycaemia, sustained euglycaemia and variable glycaemia, using glycaemic clamps for 3 h. Twenty-four hours urinary 8-isoprostane-PGF2α was measured before and after each glycaemic state to assess oxidative stress. The median and interquartile range of the urinary 8-iso-PGF2α in ng/24 h were (1373, 513), (996, 298) and (1227, 472) for the euglycaemic, hyperglycaemic and variable states, respectively. There was no significant difference in urinary isoprostanes between the three different states; mean ranks 20.9, 11.9 and 18.2 for the euglycaemic state, hyperglycaemic state and glycaemic variability state, respectively, p = 0.083. In conclusion, we did not see a significant increase in the urinary isoprostanes when glycaemic variability was induced under controlled conditions in healthy individuals.
    Diabetes Obesity and Metabolism 05/2012; 14(11):1047-9. DOI:10.1111/j.1463-1326.2012.01625.x · 5.46 Impact Factor
  • E S Kilpatrick, A S Rigby, S L Atkin, B M Frier
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    ABSTRACT: Severe hypoglycaemia may have a role in aggravating micro- and macrovascular disease in diabetes. Data from the Diabetes Control and Complication Trial have been reanalysed to ascertain whether the frequency of severe hypoglycaemia exerted an influence on the development and progression of retinopathy or nephropathy in people with Type 1 diabetes. Using binary longitudinal multiple logistic regression, HbA(1c) at study baseline, mean HbA(1c) throughout the study and the number of severe hypoglycaemic episodes during the trial were compared to examine the risk of development/progression of retinopathy and nephropathy. Average HbA(1c) during the study and/or HbA(1c) at baseline were independently predictive of retinopathy and nephropathy both in the intensively and the conventionally treated patients (all P ≤ 0.001). However, the number of hypoglycaemic episodes did not add to HbA(1c) in predicting retinopathy [odds ratio (95% CI) 0.99 (0.96-1.01), P = 0.51 in intensively treated patients, 0.94 (0.89-1.00), P = 0.05, conventional] or nephropathy [odds ratio (95% CI) 0.98 (0.95-1.01), P = 0.48 intensive, 1.03 (0.98-1.10), P = 0.17 conventional]. The frequency of exposure to severe hypoglycaemia did not predict a different risk of developing retinopathy or nephropathy in either treatment group of the Diabetes Control and Complications Trial at any given HbA(1c) .
    Diabetic Medicine 02/2012; 29(9):1195-8. DOI:10.1111/j.1464-5491.2012.03612.x · 3.06 Impact Factor
  • American Chemistry SocietyAmerican Chemistry Society; 01/2012
  • Practical Diabetes International 06/2011; 28(5). DOI:10.1002/pdi.1601
  • J Ng, S L Atkin, A S Rigby, C Walton, E S Kilpatrick
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    ABSTRACT: To examine the impact of extensive flooding in a UK city in 2007 on the glycaemic control of patients with diabetes mellitus. This was a longitudinal study in patients with diabetes mellitus 12 months before and after the floods in Hull and East Yorkshire, UK. All patients registered with diabetes mellitus were sent questionnaires about their experiences during and after the floods. Glycaemic control for patients directly affected by the floods was compared against those unaffected. Of 1743 respondents, 296 patients had been affected by the floods (110 insulin treated, 186 lifestyle and oral agents) and 1447 unaffected (482 insulin treated, 965 lifestyle and oral agents). There was a rise in mean HbA(1c) of affected individuals comparing 12 months before the floods with 12 months after [mean (95% confidence interval), 7.6% (7.5-7.7) vs. 7.9% (7.7-8.0), P = 0.002], but not those unaffected [7.5% (7.4-7.6) vs. 7.5% (7.4-7.6), P = 0.46]. The difference was mainly in insulin-treated patients [8.6% (8.3, 8.9) affected vs. 8.2% (8.1, 8.3) unaffected, (P = 0.002)]. Glycaemic control deteriorated in diabetes patients following the floods but was almost exclusively confined to patients taking insulin and was worst at 6-9 months following the event. Insulin-treated patients may need specific targeting in the event of a natural disaster.
    Diabetic Medicine 05/2011; 28(5):519-24. DOI:10.1111/j.1464-5491.2011.03228.x · 3.06 Impact Factor
  • K A Smith, J Shepherd, A Wakil, E S Kilpatrick
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    ABSTRACT: Oxidative stress describes the cellular damage caused by excess reactive oxygen species not adequately inactivated by antioxidants. Oxidative stress has been implicated in playing a role in many disorders. Lipid peroxidation end-products are employed as markers of oxidative stress, of which the isoprostane, 8-iso-PGF(2α), is widely used. 8-iso-PGF(2α) is measured in plasma or urine by gas chromatography-mass spectrometry (GC/MS), liquid chromatography-mass spectrometry (LC/MS), tandem-mass spectrometry or enzyme-linked immunosorbent assay (ELISA). However, discrepancies between the specificity of these methods means correlation is poor. A tandem-mass spectrometric (LC/MS/MS) method, using immunoaffinity purification, for urinary 8-iso-PGF(2α) was developed and compared with two commercial ELISAs (A--Cayman Chemicals, B--Oxford Biomedical Research) in urine samples (n = 156). An LC/MS/MS method coupled to immunoaffinity purification was developed with satisfactory performance and comparison to ELISAs A and B. Spearman rank correlation demonstrated significant correlation between all methods (P = <0.0001); however, r² values ranged from 0.68 to 0.72. Bland-Altman plots revealed a proportional positive bias of ELISA B when compared with ELISA A and LC/MS/MS. Furthermore, the agreement between ELISA A and LC/MS/MS was poor. The poor agreement between methods for measurement of 8-iso-PGF(2α) highlights differences in selectivity. 8-iso-PGF(2α) is an isoprostane, a family of isomeric end-products of arachidonic acid peroxidation, which are produced by peroxidation or enzymatically. This makes avoiding cross-reactivity between 8-iso-PGF(2α) and related isomers challenging. When assessing oxidative stress studies, the selectivity of the methods used should be taken into account, particularly when comparing studies.
    Annals of Clinical Biochemistry 02/2011; 48(Pt 2):147-54. DOI:10.1258/acb.2010.010151 · 2.08 Impact Factor
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    ABSTRACT: Women with polycystic ovary syndrome (PCOS) were found to have a higher biological variability in insulin resistance (IR) compared to controls, but it is unknown whether this variability in IR differs between PCOS who are anovulatory compared to those who have an ovulatory cycle. The primary aim of this study was to compare and contrast the variability of IR in women with ovulatory and anovulatory PCOS, in comparison to normal subjects. 53 Caucasian women with PCOS and 22 normal ovulating women were recruited. Fasting blood was collected each day on 10 consecutive occasions at 3-4 day intervals for analysis of insulin, glucose, progesterone, and testosterone. Analysis of progesterone levels showed 22 of 53 women with PCOS to have had an ovulatory cycle. Insulin resistance was calculated by HOMA method. Women with anovulatory PCOS had higher mean and variability of IR compared to those having an ovulatory cycle, and both were significantly higher than controls (mean ± SEM; HOMA-IR 4.14 ± 0.14 vs. 3.65 ± 0.15 vs. 2.21 ± 0.16, respectively) after adjustment or BMI. The mean BMI for individual PCOS patients correlated with mean HOMA-IR (p=0.009). Insulin resistance in women with anovulatory PCOS is both higher and more variable than in ovulatory PCOS. Since anovulatory PCOS therefore mimics the IR features of type 2 diabetes more closely, anovulation may be particularly associated with a higher cardiovascular risk compared to PCOS patients who ovulate.
    Hormone and Metabolic Research 02/2011; 43(2):141-5. DOI:10.1055/s-0030-1270450 · 2.04 Impact Factor
  • Diabetic Medicine 01/2011; 28 (Suppl. 1):99 Poster Presentation at Diabetes UK APC (P222).. · 3.06 Impact Factor
  • Diabetic Medicine 01/2011; 28(1):124-5. DOI:10.1111/j.1464-5491.2010.03145.x · 3.06 Impact Factor
  • DD Mellor, ES Kilpatrick, SL Atkin
    Diabetic Medicine 01/2011; 28 (Suppl. 1):46 Poster Presentation at Diabetes UK APC (P51).. · 3.06 Impact Factor
  • DD Mellor, N Bolsover, ES Kilpatrick, SL Atkin
    Diabetic Medicine 01/2011; 28 (Suppl. 1):178 Poster Presentation at Diabetes UK APC (P486).. · 3.06 Impact Factor
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    ABSTRACT: To examine the effects of chocolate on lipid profiles, weight and glycaemic control in individuals with Type 2 diabetes. Twelve individuals with Type 2 diabetes on stable medication were enrolled in a randomized, placebo-controlled double-blind crossover study. Subjects were randomized to 45 g chocolate with or without a high polyphenol content for 8 weeks and then crossed over after a 4-week washout period. Changes in weight, glycaemic control, lipid profile and high-sensitivity C-reactive protein were measured at the beginning and at the end of each intervention. HDL cholesterol increased significantly with high polyphenol chocolate (1.16 ± 0.08 vs. 1.26 ± 0.08 mmol/l, P = 0.05) with a decrease in the total cholesterol: HDL ratio (4.4 ± 0.4 vs. 4.1 ± 0.4 mmol/l, P = 0.04). No changes were seen with the low polyphenol chocolate in any parameters. Over the course of 16 weeks of daily chocolate consumption neither weight nor glycaemic control altered from baseline. High polyphenol chocolate is effective in improving the atherosclerotic cholesterol profile in patients with diabetes by increasing HDL cholesterol and improving the cholesterol:HDL ratio without affecting weight, inflammatory markers, insulin resistance or glycaemic control.
    Diabetic Medicine 11/2010; 27(11):1318-21. DOI:10.1111/j.1464-5491.2010.03108.x · 3.06 Impact Factor
  • E S Kilpatrick, A S Rigby, S L Atkin
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    ABSTRACT: There is still a debate as to whether or not glucose variability contributes to diabetes complication risk. There is much in vitro laboratory evidence that glycaemic instability gives rise to increased production of reactive oxygen species and has a detrimental effect on endothelial dysfunction. While some in vivo studies have also shown similar findings in patients with or without diabetes, others have been unable to confirm any association. Furthermore, clinical studies which have sought to translate this possible risk into an increased likelihood of developing micro- or macrovascular complications have so far not demonstrated an effect. However, few of these trials were specifically designed to establish any influence of glucose fluctuations. This issue is now one of the largest remaining unanswered questions in diabetes. While this article focuses on the data which do not support a role for glucose variability in the development of complications, it also highlights the need for further studies to be performed which will definitively resolve the matter.
    Diabetic Medicine 08/2010; 27(8):868-71. DOI:10.1111/j.1464-5491.2010.02929.x · 3.06 Impact Factor

Publication Stats

1k Citations
343.52 Total Impact Points

Institutions

  • 2002–2014
    • University of Hull
      • • Diabetes and Endocrinology
      • • Academic Cardiology
      Kingston upon Hull, England, United Kingdom
  • 2005–2013
    • Hull and East Yorkshire Hospitals NHS Trust
      Kingston upon Hull, England, United Kingdom
  • 2012
    • San Diego Zoo
      San Diego, California, United States
    • Hull York Medical School
      York, England, United Kingdom
  • 2005–2009
    • University of Glasgow
      • Division of Biochemistry
      Glasgow, Scotland, United Kingdom
  • 2006
    • The Bracton Centre, Oxleas NHS Trust
      Дартфорде, England, United Kingdom
  • 1998
    • University Hospital Of South Manchester NHS Foundation Trust
      Manchester, England, United Kingdom