Kamlesh Khunti

University of Leicester, Leiscester, England, United Kingdom

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Publications (309)1191.85 Total impact

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    ABSTRACT: To examine the association between ethnicity and survival following acute myocardial infarction (AMI) in White European (WE) and South Asian (SA) patients from a multiethnic UK population. Retrospective, cohort study of 4111 (N=730, 17.8% of SA ethnicity) hospitalised patients, with AMI from a tertiary coronary care centre in the UK, admitted between October 2002 and September 2008. The primary end point was all-cause mortality. The association of ethnicity with survival post AMI was assessed using the Cox regression analysis. Compared with WE patients, SA patients were on average younger (62.0 years vs 67.3 years) and had higher prevalence of cardiovascular risk factors including diabetes (39.7% vs 16.1%). During follow-up (median 912, range 1-2556, days), crude mortality rate was 22.6% in SA patients and 26.0% in WE patients (p=0.061). SA ethnicity did not show univariate (HR 0.85 (0.72 to 1.01)) or multivariate (HR, 1.12 (0.94 to 1.34)) association with mortality. Findings were similar for mortality during 0-30 days (1.30 (0.99 to 1.70)), >30 days-1 year (0.97 (0.67 to 1.40)), >1 year-3 years (1.21 (0.83 to 1.76)), >3 years (0.82 (0.47 to 1.41)), and for long-term mortality in survivors from 30 days (1.02 (0.81 to 1.29)). When adjusted for differing prevalence of cardiovascular risk factors in the two ethnic groups, survival following AMI was similar for SA and WE patients in the UK. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    Heart (British Cardiac Society) 02/2015; · 6.02 Impact Factor
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    ABSTRACT: To examine the short- and long-term cost-effectiveness of intensive multifactorial treatment compared with routine care among people with screen-detected Type 2 diabetes. Cost-utility analysis in ADDITION-UK, a cluster-randomized controlled trial of early intensive treatment in people with screen-detected diabetes in 69 UK general practices. Unit treatment costs and utility decrement data were taken from published literature. Accumulated costs and quality-adjusted life years (QALYs) were calculated using ADDITION-UK data from 1 to 5 years (short-term analysis, n = 1024); trial data were extrapolated to 30 years using the UKPDS outcomes model (version 1.3) (long-term analysis; n = 999). All costs were transformed to the UK 2009/10 price level. Adjusted incremental costs to the NHS were £285, £935, £1190 and £1745 over a 1-, 5-, 10- and 30-year time horizon, respectively (discounted at 3.5%). Adjusted incremental QALYs were 0.0000, -0.0040, 0.0140 and 0.0465 over the same time horizons. Point estimate incremental cost-effectiveness ratios (ICERs) suggested that the intervention was not cost-effective although the ratio improved over time: the ICER over 10 years was £82 250, falling to £37 500 over 30 years. The ICER fell below £30 000 only when the intervention cost was below £631 per patient: we estimated the cost at £981. Given conventional thresholds of cost-effectiveness, the intensive treatment delivered in ADDITION was not cost-effective compared with routine care for individuals with screen-detected diabetes in the UK. The intervention may be cost-effective if it can be delivered at reduced cost. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Diabetic Medicine 02/2015; · 3.24 Impact Factor
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    ABSTRACT: Individuals with impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) have an increased risk of progression to Type 2 diabetes mellitus. The objective of this review was to quantify the effectiveness of lifestyle, pharmacological and surgical interventions in reducing the progression to Type 2 diabetes mellitus in people with IFG or IGT.
    Diabetes Research and Clinical Practice. 01/2015;
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    ABSTRACT: Hypoglycemia has been associated with an increased risk of cardiovascular (CV) events and all-cause mortality. This study assessed whether, in a nationally representative population, there is an association between hypoglycemia, the risk of CV events, and all-cause mortality among insulin-treated people with type 1 diabetes (T1D) or type 2 diabetes (T2D). This retrospective cohort study used data from the Clinical Practice Research Datalink database, and included all insulin-treated patients (≥30 years of age) with a diagnosis of diabetes. In patients who experienced hypoglycemia, hazard ratios (HRs) for CV events in people with T1D were 1.51 (95% CI 0.83, 2.75; P = ns) and 1.61 (1.17, 2.22), respectively, for those with and without a history of CV disease (CVD) before the index date. In people with T2D, the HRs for patients with and without a history of CVD were 1.60 (1.21, 2.12) and 1.49 (1.23, 1.82), respectively. For all-cause mortality, HRs in people with T1D were 1.98 (1.25, 3.17), and 2.03 (1.66, 2.47), respectively, for those with and without a history of CVD. Among people with T2D, HRs were 1.74 (1.39, 2.18) and 2.48 (2.21, 2.79), respectively, for those with and without a history of CVD. The median time (interquartile range) from first hypoglycemia event to first CV event was 1.5 years (0.5, 3.5 years) and 1.5 years (0.5, 3.0 years), respectively, for people with T1D and T2D. Hypoglycemia is associated with an increased risk of CV events and all-cause mortality in insulin-treated patients with diabetes. The relationship between hypoglycemia and CV outcomes and mortality exists over a long period. © 2014 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.
    Diabetes Care 12/2014; · 8.57 Impact Factor
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    ABSTRACT: To investigate the relationship between neighbourhood greenspace and type 2 diabetes. Cross-sectional. 3 diabetes screening studies conducted in Leicestershire, UK in 2004-2011. The percentage of greenspace in the participant's home neighbourhood (3 km radius around home postcode) was obtained from a Land Cover Map. Demographic and biomedical variables were measured at screening. 10 476 individuals (6200 from general population; 4276 from high-risk population) aged 20-75 years (mean 59 years); 47% female; 21% non-white ethnicity. Screen-detected type 2 diabetes (WHO 2011 criteria). Increased neighbourhood greenspace was associated with significantly lower levels of screen-detected type 2 diabetes. The ORs (95% CI) for screen-detected type 2 diabetes were 0.97 (0.80 to 1.17), 0.78 (0.62 to 0.98) and 0.67 (0.49 to 0.93) for increasing quartiles of neighbourhood greenspace compared with the lowest quartile after adjusting for ethnicity, age, sex, area social deprivation score and urban/rural status (Ptrend=0.01). This association remained on further adjustment for body mass index, physical activity, fasting glucose, 2 h glucose and cholesterol (OR (95% CI) for highest vs lowest quartile: 0.53 (0.35 to 0.82); Ptrend=0.01). Neighbourhood greenspace was inversely associated with screen-detected type 2 diabetes, highlighting a potential area for targeted screening as well as a possible public health area for diabetes prevention. However, none of the risk factors that we considered appeared to explain this association, and thus further research is required to elicit underlying mechanisms. This study uses data from three studies (NCT00318032, NCT00677937, NCT00941954). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
    BMJ Open 12/2014; 4(12):e006076. · 2.06 Impact Factor
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    ABSTRACT: The effect of sedentary behaviour on regional fat deposition, independent of physical activity remains equivocal. We examined the cross-sectional associations between objectively measured sedentary time and markers of regional fat distribution (heart, liver, visceral, subcutaneous and total body fat) in a population at a high risk of type 2 diabetes mellitus (T2DM).
    Medicine &amp Science in Sports &amp Exercise 11/2014; · 4.46 Impact Factor
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    ABSTRACT: AimTo explore attitudes towards insulin treatment in an ethnically diverse population of people with Type 2 diabetes.Methods We conducted semi-structured interviews using a topic guide based on a literature review and findings from our previous study, which explored the perspectives of healthcare professionals on insulin initiation and management. Analysis of data involved undertaking an abductive reasoning approach in response to emerging themes.ResultsParticipants discussed not only their concerns about insulin therapy, but also their views and beliefs about the necessity of insulin. Their attitudes to insulin treatment could be mapped into four main typologies. These fitted with an attitudinal scale based on the Necessity-Concerns Framework described in the medication adherence literature, comprising four attitudes: accepting, sceptical, ambivalent and indifferent. Decisions about accepting insulin involved balancing concerns (such as needle size) against the perceived necessity of insulin (generally, inadequacy of oral medication). The South Asian and white participants had similar concerns, but these were sometimes greater in South Asian participants, because of the influence of negative views and experiences of other insulin users.Conclusions When discussing insulin with people with Type 2 diabetes, healthcare providers need to ensure that they explore and contribute to patients’ understanding and interpretation of the necessity of insulin as well as discussing their concerns. Furthermore, they should be aware of how an individual's social context can influence his/her perceptions about the necessity of insulin as well as their concerns, and that this influence may be greater in some South Asian populations.This article is protected by copyright. All rights reserved.
    Diabetic Medicine 11/2014; · 3.24 Impact Factor
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    ABSTRACT: We investigated whether a higher number of fast-food outlets in an individual's home neighbourhood is associated with increased prevalence of type 2 diabetes mellitus and related risk factors, including obesity.
    Public Health Nutrition 10/2014; · 2.48 Impact Factor
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    ABSTRACT: Abstract Background: Optimal glucose-lowering therapy in type 2 diabetes mellitus requires a patient-specific approach. Although a good framework, current guidelines are insufficiently detailed to address the different phenotypes and individual needs of patients seen in daily practice. We developed a patient-specific decision support tool based on a systematic analysis of expert opinion. Materials and Methods: Based on the American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) 2012 position statement, a panel of 12 European experts rated the appropriateness (RAND/UCLA Appropriateness Method) of treatment strategies for 930 clinical scenarios, which were permutations of clinical variables considered relevant to treatment choice. These included current treatment, hemoglobin A1c difference from individualized target, risk of hypoglycemia, body mass index, life expectancy, and comorbidities. Treatment options included addition of a second or third agent, drug switches, and replacement by monotherapies if the patient was metformin-intolerant. Treatment costs were not considered. Appropriateness (appropriate, inappropriate, uncertain) was based on the median score and expert agreement. The panel recommendations were embedded in an online decision support tool (DiaScope(®); Novo Nordisk Health Care AG, Zürich, Switzerland). Results: Treatment appropriateness was associated with (combinations of) the patient variables mentioned above. As second-line agents, dipeptidyl peptidase-4 inhibitors were considered appropriate in all scenarios, followed by glucagon-like peptide-1 receptor agonists (50%), insulins (33%), and sulfonylureas (25%), but not pioglitazone (0%). Ratings of third-line combinations followed a similar pattern. Disagreement was highest for regimens including pioglitazone, sulfonylureas, or insulins and was partly due to differences in panelists' opinions and in drug availability and reimbursement across European countries (although costs were disregarded in the rating process). Conclusions: A novel decision support tool based on the ADA/EASD 2012 position statement and a systematic analysis of expert opinion has been developed to help healthcare professionals to individualize glucose-lowering therapy in daily clinical situations.
    Diabetes Technology &amp Therapeutics 10/2014; · 2.29 Impact Factor
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    ABSTRACT: AimsTo compare the effectiveness and acceptability of self-monitoring of blood glucose with self-monitoring of urine glucose in adults with newly diagnosed Type 2 diabetes.Methods We conducted a multi-site cluster randomized controlled trial with practice-level randomization. Participants attended a structured group education programme, which included a module on self-monitoring using blood glucose or urine glucose monitoring. HbA1c and other biomedical measures as well as psychosocial data were collected at 6, 12 and 18 months. A total of 292 participants with Type 2 diabetes were recruited from 75 practices.ResultsHbA1c levels were significantly lower at 18 months than at baseline in both the blood monitoring group [mean (se) -12 (2) mmol/mol; -1.1 (0.2) %] and the urine monitoring group [mean (se) -13 (2) mmol/mol; -1.2 (0.2)%], with no difference between groups [mean difference adjusted for cluster effect and baseline value = -1 mmol/mol (95% CI -3, 2); -0.1% (95% CI -0.3, 0.2)]. Similar improvements were observed for the other biomedical outcomes, with no differences between groups. Both groups showed improvements in total treatment satisfaction, generic well-being, and diabetes-specific well-being, and had a less threatening view of diabetes, with no differences between groups at 18 months. Approximately one in five participants in the urine monitoring arm switched to blood monitoring, while those in the blood monitoring arm rarely switched (18 vs 1% at 18 months; P<0.001).Conclusions Participants with newly diagnosed Type 2 diabetes who attended structured education showed similar improvements in HbA1c levels at 18 months, regardless of whether they were assigned to blood or urine self-monitoring.This article is protected by copyright. All rights reserved.
    Diabetic Medicine 10/2014; · 3.24 Impact Factor
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    ABSTRACT: Rationale, aims and objectivesContinuous quality improvement programmes often target several aspects of care, some of which may be more effective meaning that resources could be focussed on these. The objective was to identify the effective and ineffective aspects of a successful continuous quality improvement programme for individuals with type 2 diabetes in primary care.Methods Data were from a series of cross-sectional studies (GEDAPS) in primary care, Catalonia, Spain, in 55 centres (2239 participants) in 1993, and 92 centres (5819 participants) in 2002. A structural equation modelling approach was used.ResultsThe intervention was associated with improved microvascular outcomes through microalbuminuria and funduscopy screening, which had a direct effect on microvascular outcomes, and through attending 2–4 nurse visits and having ≥1 blood pressure measurement, which acted through reducing systolic blood pressure. The intervention was associated with improved macrovascular outcomes through blood pressure measurement and attending 2–4 nurse visits (through systolic blood pressure) and having ≥3 education topics, ≥1 HbA1c measurement and adequate medication (through HbA1c). Cholesterol measurement, weight measurement and foot examination did not contribute towards the effectiveness of the intervention.Conclusions The pathways through which a continuous quality improvement programme appeared to act to reduce microvascular and macrovascular complications were driven by reductions in systolic blood pressure and HbA1c, which were attained through changes in nurse and education visits, measurement and medication. This suggests that these factors are potential areas on which future quality improvement programmes should focus.
    Journal of Evaluation in Clinical Practice 10/2014; 20(6). · 1.58 Impact Factor
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    ABSTRACT: The use of lay people to deliver education programmes for people with chronic conditions is a potential method of addressing healthcare staff capacity and increasing the cost efficiency of delivering education. This qualitative substudy is embedded within an equivalence trial (2008-2011 including development stage).
    Postgraduate Medical Journal 09/2014; · 1.55 Impact Factor
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    ABSTRACT: We report trends in type 2 diabetes mellitus and obesity in adults residing in the Arabian Gulf States. Among the Saudi population, the prevalence of diabetes increased from 10.6% in 1989 to 32.1% in 2009. Prevalence of the disease increased faster among Saudi men than women, with growth rates of 0.8% and 0.6% per year, respectively.
    Diabetes Research and Clinical Practice 09/2014; · 2.54 Impact Factor
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    ABSTRACT: Aims We investigated whether a continuous quality improvement programme in primary care for people with type 2 diabetes led to better care and outcomes in hard to reach groups. Methods GEDAPS was implemented in Catalonia, Spain between 1993 (n = 2239) and 2002 (n = 5819). Process (e.g. education), intermediate (e.g. HbA1c) and final (e.g. retinopathy) outcomes were compared between urban and rural areas, and between younger (≤74 years) and older (≥75 years) individuals as examples of harder to reach groups. Results In 1993, people in urban areas had significantly better or similar outcomes to rural areas; by 2002, most outcomes improved in urban and rural areas. For all outcomes, the improvement in rural areas was similar to or better than urban areas. Similarly, for most outcomes, the younger and older group improved, with the older group experiencing similar or better improvements than the younger group for all indicators, except coronary artery disease. Conclusions A quality improvement programme was associated with equivalent or better outcomes in hard to reach groups, regardless of whether they were specifically targeted. The ability to apply one programme to all populations could save time and money.
    Primary Care Diabetes 09/2014; · 1.29 Impact Factor
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    ABSTRACT: AimsFailure to intensify treatment in patients with Type 2 diabetes with suboptimal blood glucose control has been termed clinical inertia and has been shown to contribute to poorer patient outcomes. We aimed to identify and explore perceptions about clinical inertia from the perspective of primary healthcare providers.MethodsA qualitative study was conducted in Leicestershire and Northamptonshire, UK. Purposive sampling was based on healthcare providers working in primary care settings with ‘higher’ and ‘lower’ target achievement based on routine data. Twenty semi-structured interviews were conducted, face-to-face or by telephone. Thematic analysis was informed by the constant comparative approach.ResultsAn important broad theme that emerged during the analysis was related to attribution and explanation of responsibility for clinical inertia. This included general willingness to accept a degree of responsibility for clinical inertia. In some cases, however, participants had inaccurate perceptions about levels of target achievement in their primary care centres, as indicated by routine data. Participants sought to lessen their own sense of accountability by highlighting patient-level barriers such as comorbidities and human fallibility, and also system-level barriers, particularly time constraints. Perceptions about ways of addressing the problem of clinical inertia were not seen as straightforward, further emphasizing a complex and cumulative pattern of barriers.Conclusions In order to understand and address the problem of clinical inertia, provider, patient- and system-level barriers should be considered together rather than as separate issues. Acknowledgement of responsibility should be regarded positively as a motivator for change.This article is protected by copyright. All rights reserved.
    Diabetic Medicine 09/2014; · 3.24 Impact Factor
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    ABSTRACT: In the United Kingdom, it is estimated that there are over 300 000 Muslim people with diabetes. Observance of Ramadan is an integral part of being a Muslim that involves abstinence from food and drink from dawn till dusk. In the UK over the next 10 years, Ramadan will fall in the heart of the summer months, resulting in longer fasting periods. For people with diabetes fasting can be problematic, yet few individuals receive advice from health care professionals on how to manage their diabetes during the Ramadan period. A ‘whole systems’ approach, involving community awareness, health care professional training and patient education, was used to develop and implement an educational intervention to address the needs of individuals with type 2 diabetes during the Ramadan period.This practice point paper details this service improvement project and lists a number of recommendations to improve the uptake and sustainability of such interventions to support safer fasting and feasting for people with type 2 diabetes during religious events. Copyright © 2014 John Wiley & Sons, Ltd.
    Practical Diabetes. 09/2014; 31(7).
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    ABSTRACT: Data suggest increased rates of chronic kidney disease (CKD) in those with undiagnosed hypertension (HTN). Our study aimed to determine the prevalence of CKD in undiagnosed hypertensives in a previously unreported subgroup of individuals of South Asian ethnicity. We analysed data from subjects in the ADDITION-Leicester study, a UK based multiethnic, community diabetes screening study. Standard definitions included: HTN-mean recorded BP of ⩾140/90 mm Hg, CKD stage 3 and above-estimated glomerular filtration rate (eGFR) <60 ml min(-1) per 1.73 m(2) and microalbuminuria as albumin creatinine ratio ⩾3 mg mmol(-1). Logistic regression was performed with age, gender and body mass index (kg m(-2)) as co-variates. 6082 individuals (52.5% female, mean age, 57.2 years; White European, 77.8% and South Asian, 22.0%), 31.1% had undiagnosed HTN. Overall, individuals with undiagnosed HTN compared with normotensives had an odds ratio for microalbuminuria of 2.24 (95% confidence interval (CI): 1.72-2.94). For South Asians, the odds ratio was 3.81. (95% CI: 2.24-6.47) for microalbuminuria with a trend towards an eGFR<60 ml min(-1) per 1.73 m(2). Future studies should consider intensified screening for HTN to refine the population suitable for CKD screening, particularly in the South Asian ethnic group.Journal of Human Hypertension advance online publication, 14 August 2014; doi:10.1038/jhh.2014.62.
    Journal of Human Hypertension 08/2014; · 2.69 Impact Factor
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    ABSTRACT: Aim To describe and evaluate risk assessment tools which detect those with pre-diabetes defined as either impaired glucose tolerance or impaired fasting glucose using an OGTT or as a raised HbA1c. Methods Tools were identified through a systematic search of PubMed and EMBASE for articles which developed a risk tool to detect those with pre-diabetes. Data were extracted using a standardised data extraction form. Results Eighteen tools met the inclusion criteria. Eleven tools were derived using logistic regression, six using decision trees and one using support vector machine methodology. Age, body mass index, family history of diabetes and hypertension were the most frequently included variables. The size of the datasets used and the number of events per variable considered were acceptable in all the tools. Missing data were not discussed for eight (44%) of the tools, 10 (91%) of the logistic tools categorised continuous variables, external validation was carried out for only seven (39%) of the tools and only three tools reported calibration levels. Conclusions Several risk scores are available to identify those with pre-diabetes. Before these are used in practice, the level of calibration and validity of the tools in the population of interest should be assessed.
    Diabetes research and clinical practice 07/2014; · 2.74 Impact Factor
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    ABSTRACT: To assess the cardiac, vascular, anthropometric, and biochemical determinants of subclinical diastolic dysfunction in younger adults with Type 2 diabetes mellitus (T2DM) using multiparametric contrast-enhanced cardiovascular magnetic resonance (CMR) imaging.
    European Heart Journal – Cardiovascular Imaging 06/2014; · 2.65 Impact Factor

Publication Stats

5k Citations
1,191.85 Total Impact Points

Institutions

  • 1997–2015
    • University of Leicester
      • Department of Health Sciences
      Leiscester, England, United Kingdom
  • 2008–2013
    • University Hospitals Of Leicester NHS Trust
      • • Department of Diabetes and Endocrinology
      • • Department of Nephrology
      Leiscester, England, United Kingdom
    • University of Southampton
      • Wessex Institute for Health Research and Development
      Southampton, ENG, United Kingdom
  • 2012
    • Heart of England NHS Foundation Trust
      Birmingham, England, United Kingdom
    • University of Washington Seattle
      • Department of Oral Health Sciences
      Seattle, WA, United States
  • 2011–2012
    • University of Surrey
      • Department of Health Care Management and Policy
      Guildford, ENG, United Kingdom
  • 2007–2012
    • Imperial College London
      • Department of Primary Care and Public Health
      London, ENG, United Kingdom
    • University Medical Center Utrecht
      • Julius Center for Health Sciences and Primary Care
      Utrecht, Provincie Utrecht, Netherlands
  • 2010–2011
    • The Bracton Centre, Oxleas NHS Trust
      Дартфорде, England, United Kingdom
    • Loyola University Maryland
      • Department of Sociology
      Baltimore, MD, United States
    • The University of Sheffield
      • School of Health and Related Research (ScHARR)
      Sheffield, ENG, United Kingdom
  • 2009–2010
    • St George's, University of London
      • Division of Population Health Sciences and Education
      Londinium, England, United Kingdom
  • 2008–2010
    • The University of Warwick
      Coventry, England, United Kingdom
  • 2007–2010
    • Loughborough University
      • School of Sport, Exercise and Health Sciences
      Loughborough, England, United Kingdom
  • 2005
    • University of Birmingham
      Birmingham, England, United Kingdom
  • 2004
    • Office for National Statistics
      Londinium, England, United Kingdom
  • 2002
    • University College London
      Londinium, England, United Kingdom