Kamlesh Khunti

University of Leicester, Leiscester, England, United Kingdom

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Publications (287)1103.52 Total impact

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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;
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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; · 2.39 Impact Factor
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    ABSTRACT: People with stroke or transient ischaemic attack (TIA) are at increased risk of future stroke and other cardiovascular events. Evidence-based strategies for secondary stroke prevention have been established. However, the implementation of prevention strategies could be improved. To assess the effects of stroke service interventions for implementing secondary stroke prevention strategies on modifiable risk factor control, including patient adherence to prescribed medications, and the occurrence of secondary cardiovascular events. We searched the Cochrane Stroke Group Trials Register (April 2013), the Cochrane Effective Practice and Organisation of Care Group Trials Register (April 2013), CENTRAL (The Cochrane Library 2013, issue 3), MEDLINE (1950 to April 2013), EMBASE (1981 to April 2013) and 10 additional databases. We located further studies by searching reference lists of articles and contacting authors of included studies. We included randomised controlled trials (RCTs) that evaluated the effects of organisational or educational and behavioural interventions (compared with usual care) on modifiable risk factor control for secondary stroke prevention. Two review authors selected studies for inclusion and independently extracted data. One review author assessed the risk of bias for the included studies. We sought missing data from trialists. This review included 26 studies involving 8021 participants. Overall the studies were of reasonable quality, but one study was considered at high risk of bias. Fifteen studies evaluated predominantly organisational interventions and 11 studies evaluated educational and behavioural interventions for patients. Results were pooled where appropriate, although some clinical and methodological heterogeneity was present. The estimated effects of organisational interventions were compatible with improvements and no differences in the modifiable risk factors mean systolic blood pressure (mean difference (MD) -2.57 mmHg; 95% confidence interval (CI) -5.46 to 0.31), mean diastolic blood pressure (MD -0.90 mmHg; 95% CI -2.49 to 0.68), blood pressure target achievement (OR 1.24; 95% CI 0.94 to 1.64) and mean body mass index (MD -0.68 kg/m(2); 95% CI -1.46 to 0.11). There were no significant effects of organisational interventions on lipid profile, HbA1c, medication adherence or recurrent cardiovascular events. Educational and behavioural interventions were not generally associated with clear differences in any of the review outcomes, with only two exceptions. Pooled results indicated that educational interventions were not associated with clear differences in any of the review outcomes. The estimated effects of organisational interventions were compatible with improvements and no differences in several modifiable risk factors. We identified a large number of ongoing studies, suggesting that research in this area is increasing. The use of standardised outcome measures would facilitate the synthesis of future research findings.
    Cochrane database of systematic reviews (Online) 05/2014; 5:CD009103. · 5.70 Impact Factor
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    ABSTRACT: Aims/hypothesisTo determine the stability of type 2 diabetes patients’ beliefs about their diabetes over three years, following diagnosis.Methods Data were collected as part of a multicentre cluster randomised controlled trial of a 6 hour self-management program, across 207 general practices in the UK. Participants in the original trial were eligible for follow-up with biomedical data (glycated haemoglobin (HbA1c) levels, blood pressure, weight, blood lipid levels) collected at the practice and questionnaire data collected by postal distribution and return. Psychological outcome measures were depression (HADS) and diabetes distress (PAID). Illness beliefs were assess by scales from the Illness Perceptions Questionnaire- Revised and the Diabetes Illness Representations Questionnaire.ResultsAt 3 year follow-up, all post intervention differences in illness beliefs between intervention and control group remained significant, with perceptions of the duration of diabetes, seriousness of diabetes and perceived impact of diabetes unchanged over the course of the 3 years follow-up. The control group reported greater understanding of diabetes over follow-up, and the intervention group reported decreased responsibility for diabetes outcomes over follow-up. After controlling for 4 month levels of distress and depression, perceived impact of diabetes at 4 months remained a significant predictor of distress and depression at 3-year follow-up.Conclusions/interpretationPeoples’ beliefs about diabetes are formed quickly after diagnosis, and thereafter seem to be relatively stable over extended follow-up. These early illness beliefs are predictive of later psychological distress, and emphasize the importance of initial context and provision of diabetes care in shaping participants’ future well-beingThis article is protected by copyright. All rights reserved.
    Diabetic Medicine 05/2014; · 3.24 Impact Factor
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    ABSTRACT: OBJECTIVE To determine the benefit of multifactorial treatment on microvascular complications among people with type 2 diabetes detected by screening.RESEARCH DESIGN AND METHODS This study was a multicenter cluster randomized controlled trial in primary care with randomization at the practice level. In four centers in Denmark; Cambridge, U.K.; The Netherlands; and Leicester, U.K., 343 general practices participated in the trial. Eligible for follow-up were 2,861 of the 3,057 people with diabetes detected by screening included in the original trial. Biomedical data on nephropathy were collected in 2,710 (94.7%) participants, retinal photos in 2,190 (76.6%), and questionnaire data on peripheral neuropathy in 2,312 (80.9%). The prespecified microvascular end points were analyzed by intention to treat. Results from the four centers were pooled using fixed-effects meta-analysis.RESULTSFive years after diagnosis, any kind of albuminuria was present in 22.7% of participants in the intensive treatment (IT) group and in 24.4% in the routine care (RC) group (odds ratio 0.87 [95% CI 0.72-1.07]). Retinopathy was present in 10.2% of the IT group and 12.1% of the RC group (0.84 [0.64-1.10]), and severe retinopathy was present in one patient in the IT group and seven in the RC group. Neuropathy was present in 4.9% and 5.9% (0.95 [0.68-1.34]), respectively. Estimated glomerular filtration rate increased between baseline and follow-up in both groups (4.31 and 6.44 mL/min, respectively).CONCLUSIONS Compared with RC, an intervention to promote target-driven, intensive management of patients with type 2 diabetes detected by screening was not associated with significant reductions in the frequency of microvascular events at 5 years.
    Diabetes care 05/2014; · 7.74 Impact Factor
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    ABSTRACT: AimTo develop and test a format of delivery of diabetes self-management education by paired professional and lay educators.Methods We conducted an equivalence trial with non-randomized participant allocation to a Diabetes Education and Self Management for Ongoing and Newly Diagnosed Type 2 diabetes (DESMOND) course, delivered in the standard format by two trained healthcare professional educators (to the control group) or by one trained lay educator and one professional educator (to the intervention group). A total of 260 people with Type 2 diabetes diagnosed within the previous 12 months were referred for self-management education as part of routine care and attended either a control or intervention format DESMOND course. The primary outcome measure was change in illness coherence score (derived from the Diabetes Illness Perception Questionnaire-Revised) between baseline and 4 months after attending education sessions. Secondary outcome measures included change in HbA1c level. The trial was conducted in four primary care organizations across England and Scotland.ResultsThe 95% CI for the between-group difference in positive change in coherence scores was within the pre-set limits of equivalence (difference = 0.22, 95% CI 1.07 to 1.52). Equivalent changes related to secondary outcome measures were also observed, including equivalent reductions in HbA1c levels.Conclusion Diabetes education delivered jointly by a trained lay person and a healthcare professional educator with the same educator role can provide equivalent patient benefits. This could provide a method that increases capacity, maintains quality and is cost-effective, while increasing access to self-management education.This article is protected by copyright. All rights reserved.
    Diabetic Medicine 05/2014; · 3.24 Impact Factor
  • Diabetes care 05/2014; 37(5):e114. · 7.74 Impact Factor
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    ABSTRACT: OBJECTIVE To summarize the evidence on effectiveness of translational diabetes prevention programs, based on promoting lifestyle change to prevent type 2 diabetes in real-world settings and to examine whether adherence to international guideline recommendations is associated with effectiveness. RESEARCH DESIGN AND METHODS Bibliographic databases were searched up to July 2012. Included studies had a follow-up of ≥12 months and outcomes comparing change in body composition, glycemic control, or progression to diabetes. Lifestyle interventions aimed to translate evidence from previous efficacy trials of diabetes prevention into real-world intervention programs. Data were combined using random-effects meta-analysis and meta-regression considering the relationship between intervention effectiveness and adherence to guidelines. RESULTS Twenty-five studies met the inclusion criteria. The primary meta-analysis included 22 studies (24 study groups) with outcome data for weight loss at 12 months. The pooled result of the direct pairwise meta-analysis shows that lifestyle interventions resulted in a mean weight loss of 2.12 kg (95% CI -2.61 to -1.63; I(2) = 91.4%). Adherence to guidelines was significantly associated with a greater weight loss (an increase of 0.3 kg per point increase on a 12-point guideline-adherence scale). CONCLUSIONS Evidence suggests that pragmatic diabetes prevention programs are effective. Effectiveness varies substantially between programs but can be improved by maximizing guideline adherence. However, more research is needed to establish optimal strategies for maximizing both cost-effectiveness and longer-term maintenance of weight loss and diabetes prevention effects.
    Diabetes care 04/2014; 37(4):922-33. · 7.74 Impact Factor
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    ABSTRACT: There is little evidence to inform the targeted treatment of individuals found early in the diabetes disease trajectory. To describe cardiovascular disease (CVD) risk profiles and treatment of individual CVD risk factors by modelled CVD risk at diagnosis; changes in treatment, modelled CVD risk, and CVD risk factors in the 5 years following diagnosis; and how these are patterned by socioeconomic status. Cohort analysis of a cluster-randomised trial (ADDITION-Europe) in general practices in Denmark, England, and the Netherlands. A total of 2418 individuals with screen-detected diabetes were divided into quartiles of modelled 10-year CVD risk at diagnosis. Changes in treatment, modelled CVD risk, and CVD risk factors were assessed at 5 years. The largest reductions in risk factors and modelled CVD risk were seen in participants who were in the highest quartile of modelled risk at baseline, suggesting that treatment was offered appropriately. Participants in the lowest quartile of risk at baseline had very similar levels of modelled CVD risk at 5 years and showed the least variation in change in modelled risk. No association was found between socioeconomic status and changes in CVD risk factors, suggesting that treatment was equitable. Diabetes management requires setting of individualised attainable targets. This analysis provides a reference point for patients, clinicians, and policymakers when considering goals for changes in risk factors early in the course of the disease that account for the diverse cardiometabolic profile present in individuals who are newly diagnosed with type 2 diabetes.
    British Journal of General Practice 04/2014; 64(621):e208-16. · 1.83 Impact Factor
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    ABSTRACT: AimA pilot study to phenotype young adults (< 40 years) with Type 2 diabetes mellitus. Methods Twenty people with Type 2 diabetes (aged 18–40 years), 10 lean and 10 obese control subjects underwent detailed assessment, including tagged cardiac magnetic resonance imaging, inflammatory proteins, lipids, vitamin D and maximal oxygen uptake. Outcomes were compared between the group with Type 2 diabetes and the control group. Results Mean (standard deviation) age, Type 2 diabetes duration and BMI in the group with Type 2 diabetes were 31.8 (6.6) years, 4.7 (4.0) years and 33.9 (5.8) kg/m2 respectively. Compared with lean control subjects, those with Type 2 diabetes had more deleterious profiles of hyperlipidaemia, vitamin D deficiency, inflammation and maximal oxygen uptake relative to body mass. However, there was no difference between the group with Type 2 diabetes and the obese control group. The group with Type 2 diabetes had a higher left ventricular mass and a trend towards concentric remodelling compared with the lean control group (P = 0.002, P = 0.052) but not the obese control group (P > 0.05). Peak early diastolic strain rate was reduced in the group with Type 2 diabetes [1.51 (0.24)/s] compared with the lean control [1.97 (0.34)/s, P = 0.001] and obese control [1.78 (0.39)/s, P = 0.042] group. Conclusions Young adults with Type 2 diabetes and those with obesity have similar adverse cardiovascular risk profiles, higher left ventricular mass and a trend towards left ventricular concentric remodelling. In addition, those with Type 2 diabetes demonstrate diastolic dysfunction, a known risk marker for future heart failure and mortality.This article is protected by copyright. All rights reserved.
    Diabetic Medicine 03/2014; · 3.24 Impact Factor
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    ABSTRACT: Little is known about the long-term effects of intensive multifactorial treatment early in the diabetes disease trajectory. In the absence of long-term data on hard outcomes, we described change in 10-year modelled cardiovascular risk in the 5 years following diagnosis, and quantified the impact of intensive treatment on 10-year modelled cardiovascular risk at 5 years. In a pragmatic, cluster-randomized, parallel-group trial in Denmark, the Netherlands and the UK, 3057 people with screen-detected Type 2 diabetes were randomized by general practice to receive (1) routine care of diabetes according to national guidelines (1379 patients) or (2) intensive multifactorial target-driven management (1678 patients). Ten-year modelled cardiovascular disease risk was calculated at baseline and 5 years using the UK Prospective Diabetes Study Risk Engine (version 3β). Among 2101 individuals with complete data at follow up (73.4%), 10-year modelled cardiovascular disease risk was 27.3% (sd 13.9) at baseline and 21.3% (sd 13.8) at 5-year follow-up (intensive treatment group difference -6.9, sd 9.0; routine care group difference -5.0, sd 12.2). Modelled 10-year cardiovascular disease risk was lower in the intensive treatment group compared with the routine care group at 5 years, after adjustment for baseline cardiovascular disease risk and clustering (-2.0; 95% CI -3.1 to -0.9). Despite increasing age and diabetes duration, there was a decline in modelled cardiovascular disease risk in the 5 years following diagnosis. Compared with routine care, 10-year modelled cardiovascular disease risk was lower in the intensive treatment group at 5 years. Our results suggest that patients benefit from intensive treatment early in the diabetes disease trajectory, where the rate of cardiovascular disease risk progression may be slowed. This article is protected by copyright. All rights reserved.
    Diabetic Medicine 02/2014; · 3.24 Impact Factor
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    ABSTRACT: Physical activity has been hypothesised to cause adverse metabolic responses in a minority of participants. We use secondary analysis of a randomised controlled trial to investigate rates of adverse metabolic responses in a population at high risk of type 2 diabetes. We investigate data from the PREPARE trial; individuals with impaired glucose tolerance were randomized to: control (advice leaflet); Intervention 1, a three-hour group-based structured education programme aimed at promoting physical activity; or Intervention 2, a three-hour structured education programme with personalized pedometer use. Intervention 2, but not Intervention 1, resulted in increased physical activity at 3, 6 and 12 months. An adverse response was defined as a change of ≥ 0.8 mmol/l for fasting glucose, ≥ 1.3 mmol/l for 2-hour glucose, ≥0.42 mmol/l for triglycerides and ≤ -0.12 for HDL-cholesterol. Each group included 29 participants. Data were collected between 2006 and 2008, analysed in 2013. In total 12 (41%) participants in Intervention 2 had an adverse response; rates in Intervention 1 and the control group were 23 (79%) and 22 (76%) respectively. The odds of an adverse response were reduced in Intervention 2 compared to control [OR = 0.22; 95% CI, 0.07 - 0.69]. For the combined cohort, those who had increased physical activity at each time point had reduced odds of an adverse response compared to those who did not; [OR = 0.30; 95% CI, 0.10 - 0.93]. Although some individuals suffered an adverse metabolic response following a successful physical activity intervention, rates were higher under control conditions. This study does not support the hypothesis that increased physical activity per se increases the risk of an adverse metabolic response.
    Medicine and science in sports and exercise 02/2014; · 4.48 Impact Factor
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    ABSTRACT: Uncertainty exists regarding the optimal method to estimate glomerular filtration rate (GFR) for disease detection and monitoring. Widely used GFR estimates have not been validated in British ethnic minority populations.Methods/design: Iohexol measured GFR will be the reference against which each estimating equation will be compared. The estimating equations will be based upon serum creatinine and/or cystatin C. The eGFR-C study has 5 components:1)A prospective longitudinal cohort study of 1300 adults with stage 3 chronic kidney disease followed for 3 years with reference (measured) GFR and test (estimated GFR [eGFR] and urinary albumin-to-creatinine ratio) measurements at baseline and 3 years. Test measurements will also be undertaken every 6 months. The study population will include a representative sample of south-Asians and African-Caribbeans. People with diabetes and proteinuria (ACR >=30 mg/mmol) will comprise 20-30% of the study cohort.2)A sub-study of patterns of disease progression of 375 people (125 each of Caucasian, Asian and African-Caribbean origin; in each case containing subjects at high and low risk of renal progression). Additional reference GFR measurements will be undertaken after 1 and 2 years to enable a model of disease progression and error to be built.3)A biological variability study to establish reference change values for reference and test measures.4)A modelling study of the performance of monitoring strategies on detecting progression, utilising estimates of accuracy, patterns of disease progression and estimates of measurement error from studies 1), 2) and 3).5)A comprehensive cost database for each diagnostic approach will be developed to enable cost-effectiveness modelling of the optimal strategy.The performance of the estimating equations will be evaluated by assessing bias, precision and accuracy. Data will be modelled as a linear function of time utilising all available (maximum 7) time points compared with the difference between baseline and final reference values. The percentage of participants demonstrating large error with the respective estimating equations will be compared. Predictive value of GFR estimates and albumin-to-creatinine ratio will be compared amongst subjects that do or do not show progressive kidney function decline. The eGFR-C study will provide evidence to inform the optimal GFR estimate to be used in clinical practice.Trial registration: ISRCTN42955626.
    BMC Nephrology 01/2014; 15(1):13. · 1.64 Impact Factor
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    ABSTRACT: Aims People who experience biochemical hypoglycaemia during an oral glucose tolerance test (OGTT) may be insulin resistant, but this has not been investigated robustly, therefore we examined this in a population-based multi-ethnic UK study. Methods Cross-sectional data from 6478 diabetes-free participants (849 with fasting insulin data available) who had an OGTT in the ADDITION-Leicester screening study (2005-2009) were analysed. People with biochemical hypoglycaemia (2-hour glucose <3.3 mmol/l) were compared with people with normal glucose tolerance (NGT) or impaired glucose regulation (IGR) using regression methods. Results 359 participants (5.5%) had biochemical hypoglycaemia, 1079 (16.7%) IGR and 5040 (77.8%) NGT. Biochemical hypoglycaemia was associated with younger age (P < 0.01), white European ethnicity (P < 0.001), higher HDL cholesterol (P < 0.01), higher insulin sensitivity (P < 0.05), and lower body mass index (P < 0.001), blood pressure (P < 0.01), fasting glucose (P < 0.001), HbA1 C (P < 0.01), and triglycerides (P < 0.01) compared with NGT and IGR separately in both unadjusted and adjusted (age, sex, ethnicity, body mass index, smoking status) models. Conclusions Biochemical hypoglycaemia during an OGTT in the absence of diabetes or IGR was not associated with insulin resistance, but instead appeared to be associated with more favourable glycaemic risk profiles than IGR and NGT. Thus, clinicians may not need to intervene due to biochemical hypoglycaemia on a 2-hour OGTT.
    Diabetes research and clinical practice 01/2014; · 2.74 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 01/2014; · 2.74 Impact Factor
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    ABSTRACT: Configuring high quality care for the rapidly increasing number of people with type 2 diabetes (T2D) is a major challenge worldwide for both providers and commissioners. In the UK, about two thirds of people with T2D are managed entirely in primary care, with wide variation in management strategies and achievement of targets. Pay for performance, introduced in 2004, initially resulted in improvements but disparities exist in ethnic minorities and the improvements are levelling off. Community based, intermediate care clinics for diabetes (ICCDs) were considered one solution and are functioning across the UK. However, there is no randomised trial evidence for the effectiveness of such clinics. This is a cluster-randomised trial, involving 3 primary care trusts, with 49 general practices randomised to usual care (n = 25) or intervention (ICCDs; n = 24). All eligible adult patients with T2D were invited; 1997 were recruited and 1280 followed-up after 18-months intervention. Primary outcome: achievement of all three of the NICE targets [(HbA1c≤7.0%/53 mmol/mol; Blood Pressure <140/80 mmHg; cholesterol <154 mg/dl (4 mmol/l)]. Primary outcome was achieved in 14.3% in the intervention arm vs. 9.3% in the control arm (p = 0.059 after adjustment for covariates). The odds ratio (95% CI) for achieving primary outcome in the intervention group was 1.56 (0.98, 2.49). Primary care and community clinic costs were significantly higher in the intervention group, but there were no significant differences in hospital costs or overall healthcare costs. An incremental cost-effectiveness ratio (ICER) of +£7,778 per QALY gained, indicated ICCD was marginally more expensive at producing health gain. Intermediate care clinics can contribute to improving target achievement in patients with diabetes. Further work is needed to investigate the optimal scale and organisational structure of ICCD services and whether, over time, their role may change as skill levels in primary care increase. ClinicalTrials.gov NCT00945204; National Research Register (NRR) M0014178167.
    PLoS ONE 01/2014; 9(4):e93964. · 3.73 Impact Factor
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    ABSTRACT: Aims To examine the association between health status, diabetes-specific quality of life (QoL) and glycaemic control among individuals with type 2 diabetes. Methods 1876 individuals with screen-detected diabetes and a mean age of 66 years underwent assessment of self-reported health status (SF-36), diabetes-specific QoL (the Audit of Diabetes Dependent Quality of Life (ADDQoL19)) and glycated haemoglobin (HbA1c) at five years post-diagnosis in the ADDITION-Europe trial. Multivariable linear regression was used to quantify the cross-sectional association between health status, diabetes-specific QoL and HbA1c, adjusting for age, sex, education, alcohol consumption, physical activity, BMI, intake of any glucose-lowering drugs, and trial arm. Results The mean (SD) SF-36 physical and mental health summary scores were 46.2 (10.4) and 54.6 (8.6), respectively. The median average weighted impact ADDQoL score was -0.32 (IQR -0.89 to -0.06), indicating an overall negative impact of diabetes on QoL. Individuals who reported a negative impact of diabetes on their QoL had higher HbA1c levels at five years after diagnosis compared with those who reported a positive or no impact of diabetes (b-coefficient [95% CI]: b = 0.2 [0.1, 0.3]). Physical and mental health summary SF-36 scores were not significantly associated with HbA1c in multivariable analysis. Conclusions Diabetes-specific QoL but not health status was independently associated with HbA1c. Practitioners should take account of the complex relationship between diabetes-specific QoL and glucose, particularly with regard to dietary behaviour. Future research should attempt to elucidate via which pathways this association might act.
    Diabetes research and clinical practice 01/2014; · 2.74 Impact Factor
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    ABSTRACT: Risk factors for cardiovascular disease including diabetes have seen a large rise in prevalence in recent years. This has prompted interest in prevention through the identifying individuals at risk of both diabetes and cardiovascular disease and has seen increased investment in screening interventions taking place in primary care. Community pharmacies have become increasingly involved in the provision of such interventions and this systematic review and meta-analysis aims to gather and analyse the existing literature assessing community pharmacy based screening for risk factors for diabetes and those with a high cardiovascular disease risk. We conducted systematic searches of electronic databases using MeSH and free text terms from 1950 to March 2012. For our analysis two outcomes were assessed. They were the percentage of those screened who were referred for further assessment by primary care and the uptake of this referral. Sixteen studies fulfilled our inclusion criteria comprising 108,414 participants screened. There was significant heterogeneity for all included outcomes. Consequently we have not presented summary statistics and present forest plots with I2 and p values to describe heterogeneity. We found that all included studies suffered from high rates of attrition between pharmacy screening and follow up. We have also identified a strong trend towards higher rates for referral in more recent studies. Our results show that pharmacies are feasible sites for screening for diabetes and those at risk of cardiovascular disease. A significant number of previously unknown cases of cardiovascular disease risk factors such as hypertension, hypercholesterolemia and diabetes are identified, however a significant number of referred participants at high risk do not attend their practitioner for follow up. Research priorities should include methods of increasing uptake to follow up testing and early intervention, to maximise the efficacy of screening interventions based in community pharmacies.
    PLoS ONE 01/2014; 9(4):e91157. · 3.73 Impact Factor
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    ABSTRACT: Aims To externally validate the Leicester Practice Risk Score (LPRS) and the Leicester Risk Assessment score (LRAS) in a young South Asian population. Methods South Asian participants aged 25-39 years inclusive from a population based screening study were included. The risk scores were calculated and compared to the diagnosis of type 2 diabetes mellitus (T2DM) or T2DM and Impaired Glucose Regulation (IGR, including IFG and IGT) using either an oral glucose tolerance test (OGTT) or a HbA1c (≤48 mmol/mol/6.5% and ≤42 mmol/mol/6.0% respectively). Measures of discrimination and calibration were calculated. Results Of the 331 participants 8 (2.4%) had undiagnosed T2DM and 30 (9.1%) had IGR using an OGTT, 11 (3.4%) and 39 (12.1%) were found using HbA1c. Using the LPRS to detect T2DM on an OGTT gives an area under the ROC curve of 0.91 (95% CI 0.86, 0.97), including those with IGR gives an ROC of 0.72 (0.62-0.81), these values are 0.93 (0.88, 0.98) and 0.68 (0.60, 0.77) when using an HbA1c to define outcome. Acceptable levels of calibration were seen. Similar results are found for the LRAS. Conclusions These scores can be used to identify those with undiagnosed T2DM and/or IGR in a young South Asian population. This is the first study to externally validate scores developed for prevalent undiagnosed disease in this age group using both OGTT and HbA1c.
    Diabetes research and clinical practice 01/2014; · 2.74 Impact Factor

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  • 1997–2014
    • University of Leicester
      • • Department of Health Sciences
      • • Department of Cardiovascular Sciences
      Leiscester, England, United Kingdom
  • 2008–2013
    • University Hospitals Of Leicester NHS Trust
      • • Department of Nephrology
      • • Department of Diabetes and Endocrinology
      Leiscester, England, United Kingdom
  • 2012
    • University of Nottingham
      Nottigham, England, United Kingdom
    • 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
    • The University of Sheffield
      • School of Health and Related Research (ScHARR)
      Sheffield, ENG, United Kingdom
    • Loyola University Maryland
      • Department of Sociology
      Baltimore, MD, United States
  • 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
      • Warwick Medical School (WMS)
      Coventry, England, United Kingdom
  • 2007–2010
    • Loughborough University
      • School of Sport, Exercise and Health Sciences
      Loughborough, England, United Kingdom
  • 2005–2008
    • University of Southampton
      • • Wessex Institute for Health Research and Development
      • • Department of Psychology
      Southampton, ENG, United Kingdom
    • University of Birmingham
      Birmingham, England, United Kingdom
  • 2004
    • Office for National Statistics
      Londinium, England, United Kingdom
  • 2002
    • University College London
      Londinium, England, United Kingdom