Kamlesh Khunti

University of Leicester, Leiscester, England, United Kingdom

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Publications (332)1282.85 Total impact

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    ABSTRACT: To estimate the benefits of screening and early treatment of type 2 diabetes compared with no screening and late treatment using a simulation model with data from the ADDITION-Europe study. We used the Michigan Model, a validated computer simulation model, and data from the ADDITION-Europe study to estimate the absolute risk of cardiovascular outcomes and the relative risk reduction associated with screening and intensive treatment, screening and routine treatment, and no screening with a 3- or 6-year delay in the diagnosis and routine treatment of diabetes and cardiovascular risk factors. When the computer simulation model was programmed with the baseline demographic and clinical characteristics of the ADDITION-Europe population, it accurately predicted the empiric results of the trial. The simulated absolute risk reduction and relative risk reduction were substantially greater at 5 years with screening, early diagnosis, and routine treatment compared with scenarios in which there was a 3-year (3.3% absolute risk reduction [ARR], 29% relative risk reduction [RRR]) or a 6-year (4.9% ARR, 38% RRR) delay in diagnosis and routine treatment of diabetes and cardiovascular risk factors. Major benefits are likely to accrue from the early diagnosis and treatment of glycemia and cardiovascular risk factors in type 2 diabetes. The intensity of glucose, blood pressure, and cholesterol treatment after diagnosis is less important than the time of its initiation. Screening for type 2 diabetes to reduce the lead time between diabetes onset and clinical diagnosis and to allow for prompt multifactorial treatment is warranted. © 2015 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 05/2015; DOI:10.2337/dc14-2459 · 8.57 Impact Factor
  • Patient Education and Counseling 05/2015; DOI:10.1016/j.pec.2015.04.018 · 2.60 Impact Factor
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    ABSTRACT: An estimated 850,000 people have diabetes without knowing it and as many as 7 million more are at high risk of developing it. Within the NHS Health Checks programme, blood glucose testing can be undertaken using a fasting plasma glucose (FPG) or a glycated haemoglobin (HbA1c) test but the relative cost-effectiveness of these is unknown. To estimate and compare the cost-effectiveness of screening for type 2 diabetes using a HbA1c test versus a FPG test. In addition, to compare the use of a random capillary glucose (RCG) test versus a non-invasive risk score to prioritise individuals who should undertake a HbA1c or FPG test. Cost-effectiveness analysis using the Sheffield Type 2 Diabetes Model to model lifetime incidence of complications, costs and health benefits of screening. England; population in the 40-74-years age range eligible for a NHS health check. The Leicester Ethnic Atherosclerosis and Diabetes Risk (LEADER) data set was used to analyse prevalence and screening outcomes for a multiethnic population. Alternative prevalence rates were obtained from the literature or through personal communication. (1) Modelling of screening pathways to determine the cost per case detected followed by long-term modelling of glucose progression and complications associated with hyperglycaemia; and (2) calculation of the costs and health-related quality of life arising from complications and calculation of overall cost per quality-adjusted life-year (QALY), net monetary benefit and the likelihood of cost-effectiveness. Based on the LEADER data set from a multiethnic population, the results indicate that screening using a HbA1c test is more cost-effective than using a FPG. For National Institute for Health and Care Excellence (NICE)-recommended screening strategies, HbA1c leads to a cost saving of £12 and a QALY gain of 0.0220 per person when a risk score is used as a prescreen. With no prescreen, the cost saving is £30 with a QALY gain of 0.0224. Probabilistic sensitivity analysis indicates that the likelihood of HbA1c being more cost-effective than FPG is 98% and 95% with and without a risk score, respectively. One-way sensitivity analyses indicate that the results based on prevalence in the LEADER data set are insensitive to a variety of alternative assumptions. However, where a region of the country has a very different joint HbA1c and FPG distribution from the LEADER data set such that a FPG test yields a much higher prevalence of high-risk cases relative to HbA1c, FPG may be more cost-effective. The degree to which the FPG-based prevalence would have to be higher depends very much on the uncertain relative uptake rates of the two tests. Using a risk score such as the Leicester Practice Database Score (LPDS) appears to be more cost-effective than using a RCG test to identify individuals with the highest risk of diabetes who should undergo blood testing. We did not include rescreening because there was an absence of required relevant evidence. Based on the multiethnic LEADER population, among individuals currently attending NHS Health Checks, it is more cost-effective to screen for diabetes using a HbA1c test than using a FPG test. However, in some localities, the prevalence of diabetes and high risk of diabetes may be higher for FPG relative to HbA1c than in the LEADER cohort. In such cases, whether or not it still holds that HbA1c is likely to be more cost-effective than FPG depends on the relative uptake rates for HbA1c and FPG. Use of the LPDS appears to be more cost-effective than a RCG test for prescreening. The National Institute for Health Research Health Technology Assessment programme.
    05/2015; 19(33):1-80. DOI:10.3310/hta19330
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    ABSTRACT: The cardiovascular and mortality risk in patients with incident type 2 diabetes in relation to smoking status and concurrent use of metformin is not well known. The risks of myocardial infarction (MI), stroke and mortality in incident type 2 diabetes patients were evaluated in relation to their smoking status with and without concurrent use of metformin. Cohort study in 82205 incident type 2 diabetes patients from the United Kingdom Clinical Practice Research Datalink. During 5.4 years of median follow-up, among patients without cardiovascular disease (CVD) history before diagnosis of diabetes (n=63166), compared to non-smokers without metformin treatment, current smokers with and without metformin had 8% (HR: 1.08; 95% CI: 0.81, 1.45) and 32% (HR: 1.32; 95% CI: 1.07, 1.65) increased risk of MI or stroke respectively. The respective HR (95% CI) for mortality in these patients were 0.96 (0.83, 1.11) and 1.86 (1.68, 2.07). The HR for mortality among ex-smokers with and without concurrent metformin treatment were 0.92 (0.83, 1.11) and 1.19 (1.10, 1.30) respectively. Ex-smokers did not have elevated risk of MI or stroke, irrespective of metformin treatment. Similar beneficial modifiable effects of metformin among ex- and current smokers were observed in patients with cardiovascular disease before diagnosis of diabetes (n=19039). In type 2 diabetes patients, concurrent treatment with metformin attenuates the observed higher cardiovascular and mortality risk in ex- and current smokers. In addition to smoking cessation support, treatment with metformin, particularly in ex- and current smokers, should be encouraged. This article is protected by copyright. All rights reserved.
    Journal of Diabetes 04/2015; DOI:10.1111/1753-0407.12302 · 2.35 Impact Factor
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    ABSTRACT: To quantify associations between objectively measured sedentary time and markers of insulin sensitivity by considering allocation into light-intensity physical activity or moderate- to vigorous-intensity physical activity (MVPA). Participants with an increased risk of impaired glucose regulation (IGR) were recruited (Leicestershire, United Kingdom, 2010-2011). Sedentary, light-intensity physical activity and MVPA time were measured using accelerometers. Fasting and 2-hour post-challenge insulin and glucose were assessed; insulin sensitivity was calculated by HOMA-IS and Matsuda-ISI. Isotemporal substitution regression models were used. Data were analysed in 2014. 508 participants were included (average age = 65 years, female = 34%). Reallocating 30 minutes of sedentary time into light-intensity physical activity was associated a 5% (95% CI 1, 9%; p = 0.024) difference in Matsuda-ISI after adjustment for measured confounding variables. Reallocation into MVPA was associated with a 15% (7, 25%; p < 0.001) difference in HOMA-IS and 18% (8, 28%; p <0.001) difference in Matsuda-ISI. Results for light-intensity physical activity were modified by IGR status with stronger associations seen in those with IGR. Reallocating sedentary time into light-intensity physical activity or MVPA was associated with differences in insulin sensitivity, with stronger and more consistent associations seen for MVPA. Copyright © 2015. Published by Elsevier Inc.
    Preventive Medicine 04/2015; DOI:10.1016/j.ypmed.2015.04.005 · 2.93 Impact Factor
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    ABSTRACT: To understand the phenotypic presentation of women with polycystic ovary syndrome (PCOS) of different ethnicities and at different ages. Cross-sectional, retrospective data analysis (1988 - 2009) SETTING: Specialist clinic in a University Hospital, Leicestershire, UK PARTICIPANTS: Women with PCOS; n=1310 (mean age 26.2 years), 70.9% white and 29.1% South Asian (SA) attending a speciality clinic in Leicester UK. Clinical and demographic characteristics of women with PCOS including age at first clinic appointment, signs and symptoms, body mass index (BMI), and blood pressure (BP). Compared to white women, the SA were younger (24.3 vs. 27.1 years, p<0.001), less likely to smoke (3.7% vs. 17.9% p<0.001) and had a higher prevalence of Acanthosis Nigricans (AN) (16.8% vs. 3.1% p<0.001), type 2 diabetes (T2DM) (8.1% vs. 5.6%, p<0.01), and hirsutism (88.5% vs. 77.4%, P<0.001), with lower systolic(126.5 vs. 133.0 mmHg, p<0.001),diastolic BP (71.8 vs. 75.1 mmHg p=0.008) and BMI (29.3 vs. 31.5 kg/m(2) p=0.002).Differences in body weight remained when participants were classified as obese, overweight and normal according to ethnicity specific cut-off points (P=0.048).In both ethnicities those aged ≥30 years old had higher rates of obesity, T2DM, hypertension and infertility, and less acne, and oligomenorrhoea. Obesity was associated with increased T2DM, AN, systolic/diastolic BP, hirsutism and infertility. The phenotypic and metabolic presentations of women with PCOS appear to be significantly different depending on ethnicity, obesity and age. This has implications for management strategies in these groups. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Clinical Endocrinology 03/2015; DOI:10.1111/cen.12784 · 3.35 Impact Factor
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    Collaboration for Leadership in Applied Health Research and Care East Midlands, Annual Meeting.; 03/2015
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    ABSTRACT: To determine which non-insulin glucose lowering treatment regimens are most appropriate in people with type 2 diabetes who choose to fast during Ramadan. Electronic databases were searched for randomised controlled trials (RCT) and observational studies comparing non-insulin glucose lowering agents in people with type 2 diabetes fasting during Ramadan reporting hypoglycaemia, weight and HbA1c change were included. Data were pooled using random effects models. Sixteen studies included; nine RCTs and seven observational studies. There was evidence that DPP-4 inhibitors led to less hypoglycaemic events compared to sulphonylureas. Sitagliptin significantly reduced the number of patients ≥1 hypoglycaemic episodes during Ramadan (RR 0.48, 95%CI 0.36, 0.64, p > 0.0001), this was not replicated in the RCTs of vildagliptin but a significant reduction was found in the observational studies (RR 0.28, 95%CI 0.10, 0.75, p = 0.01) with high heterogeneity (I(2) =86.7%). Significant reductions in HbA1c and weight were seen in the observational studies of vildagliptin vs. sulfonylureas. The use of liraglutide led to significant weight loss (-1.81 kg, 95%CI -2.91, -0.71, p = 0.001) compared to sulfonylureas. Pioglitazone significantly increased weight compared to placebo (3.48 kg, 95%CI 2.82, 4.14, p < 0.0001). The analysis supports the use of DPP-4 inhibitors during Ramadan over sulfonylureas for reduction in hypoglycaemic episodes without a cost to diabetes control and weight. The GLP-1 agonist liraglutide provides clinical benefits, but more studies are required. RCTs of DPP-4 inhibitors against GLP-1 agonists and novel therapies including the SGLT-2 and alpha-glucosidase inhibitors are needed to inform evidence based guidelines. This article is protected by copyright. All rights reserved.
    Diabetes Obesity and Metabolism 03/2015; DOI:10.1111/dom.12462 · 5.46 Impact Factor
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    ABSTRACT: Previous prospective studies showing a positive association between serum calcium and incidence of type 2 diabetes mellitus (T2DM) have relied on total calcium or an indirect estimate of active, ionized calcium (iCa). We aimed to assess this relationship using a direct measurement of iCa. iCa and cardiometabolic risk factors were measured in a population-based sample of 2350 men without a known history of T2DM at baseline. Associations between iCa levels and incident cases of T2DM (self-reported, ascertained with a glucose tolerance test, or determined by record linkage to national registers) were estimated using Cox regression analyses adjusted for potential confounders. At baseline, mean (standard deviation) age was 53 (5) years and mean iCa 1.18 (0.05) mmol/L. During a median follow-up of 23.1 years, 140 new cases of T2DM were recorded. In a multivariable analysis adjusted for age, body mass index, systolic blood pressure, serum HDL-cholesterol, and family history of T2DM, there was no association comparing second (hazard ratio 0.84; 95% confidence interval 0.59-1.18), third (0.77; 0.52-1.14), or fourth (0.98; 0.69-1.39) vs first quartile of iCa (p for trend 0.538); further adjustment for C-reactive protein, physical activity level, and triglycerides did not change the estimates (p for trend 0.389). In this study, we did not find evidence of an association between direct measurement of active calcium and risk of T2DM. Further studies are needed to confirm our findings and define the relationship between factors influencing indirect calcium estimation and incident T2DM. Copyright © 2015 Elsevier B.V. All rights reserved.
    Nutrition, metabolism, and cardiovascular diseases: NMCD 03/2015; DOI:10.1016/j.numecd.2015.02.013 · 3.88 Impact Factor
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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; 101(8). DOI:10.1136/heartjnl-2014-305730 · 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; DOI:10.1111/dme.12711 · 3.06 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; 107(3). DOI:10.1016/j.diabres.2015.01.027 · 2.54 Impact Factor
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    ABSTRACT: Introduction. Previous observational studies have shown conflicting results between plasma K(+) concentrations and risk of type 2 diabetes. To help clarify the evidence we aimed to determine whether an association existed between serum K(+) and glucose regulation within a UK multiethnic population. Methods. Participants were recruited as part of the ADDITION Leicester study, a population based screening study. Individuals from primary care between the age of 40 and 75 years if White European or 25 and 75 years if South Asian or Afro Caribbean were recruited. Tests for associations between baseline characteristics and K(+) quartiles were conducted using linear regression models. Results. Data showed individuals in the lowest K(+) quartile had significantly greater 2-hour glucose levels (0.53 mmol/L, 95% CI: 0.36 to 0.70, P ≤ 0.001) than those in the highest K(+) quartile. This estimation did not change with adjustment for potential confounders. Conversely, participants in the lowest K(+) quartile had a 0.14% lower HbA1c (95% CI -0.19 to -0.10: P ≤ 0.001) compared to those in the highest K(+) quartile. Conclusion. This cross-sectional analysis demonstrated that lower K(+) was associated with greater 2 hr glucose. The data supports the possibility that K(+) may influence glucose regulation and further research is warranted.
    Journal of Diabetes Research 01/2015; 2015:923749. DOI:10.1155/2015/923749 · 3.54 Impact Factor
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    ABSTRACT: Peroxisome proliferator-activated receptor gamma (PPARγ) is an important regulator of metabolic health and a common polymorphism in the PPAR-γ2 gene (PPARG2) may modify associations between lifestyle behaviour and health. To investigate whether the PPARG2 Pro12Ala genotype modifies the associations of sedentary behaviour and moderate-to-vigorous intensity physical activity (MVPA) with common measures of insulin sensitivity. Participants with a high risk of impaired glucose regulation were recruited, United Kingdom, 2010-2011. Sedentary and MVPA time were objectively measured using accelerometers. Fasting and 2-hour post-challenge insulin and glucose were assessed; insulin sensitivity was calculated using Matsuda-ISI and HOMA-IS. DNA was extracted from whole blood. Linear regression examined associations of sedentary time and MVPA with insulin sensitivity and examined interactions by PPARG2 Pro12Ala genotype. 541 subjects were included (average age = 65 years, female = 33%); 18% carried the Ala12 allele. Both sedentary time and MVPA were strongly associated with HOMA-IS and Matsuda-ISI after adjustment for age, sex, ethnicity, medication, smoking status and accelerometer wear time. After further adjustment for each other and BMI, only associations with Matsuda-ISI were maintained. Every 30 minute difference in sedentary time was inversely associated with a 4% (0, 8%; p = 0.043) difference in Matsuda-ISI, whereas every 30 minutes in MVPA was positively associated with a 13% (0, 26%; p = 0.048) difference. The association of MVPA with Matsuda-ISI was modified by genotype (p = 0.005) and only maintained in Ala12 allele carriers. Conversely, sedentary time was not modified by genotype and remained inversely associated with insulin sensitivity in Pro12 allele homozygotes. The association of MVPA with Matsuda-ISI was modified by PPARG2 Pro12Ala genotype with significant associations only observed in the 18% of the population who carried the Ala12 allele, whereas associations with sedentary time were unaffected.
    PLoS ONE 01/2015; 10(5):e0124062. DOI:10.1371/journal.pone.0124062 · 3.53 Impact Factor
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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; 38(2). DOI:10.2337/dc14-0920 · 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. DOI:10.1136/bmjopen-2014-006076 · 2.06 Impact Factor
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    ABSTRACT: Purpose: 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). Methods: Participants were recruited from primary care to two diabetes prevention programmes. Sedentary time (<25 counts per 15 seconds) was measured using Actigraph GT3X accelerometers. Heart, liver, visceral, subcutaneous and total body fat were quantified using magnetic resonance images (MRI). Fat volumes were calculated by multiplying the cross-sectional areas of the fat-containing pixels by the slice thickness. The liver fat percentage was measured using a representative region of interest created in the right lobe of the liver avoiding the main portal veins. Linear regression models examined the association of sedentary time with markers of regional fat deposition. Results: Sixty-six participants (age = 47.9+/-16.2 years; male = 50.0%) were included. Following adjustment for several covariates, including glycaemia, whole body fat and moderate-to-vigorous physical activity (MVPA), each 30 minutes of sedentary time was associated with 15.7cm3 higher heart fat (p=0.008), 1.2% higher liver fat (p=0.026) and 183.7cm3 higher visceral fat (p=0.039). Conclusion: This study provides new evidence suggesting that objectively measured sedentary behaviour may have an independent association upon heart, liver and visceral fat in individuals at a high risk of T2DM.
    Medicine &amp Science in Sports &amp Exercise 11/2014; DOI:10.1249/MSS.0000000000000572 · 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; 32(5). DOI:10.1111/dme.12648 · 3.06 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; DOI:10.1017/S1368980014002316 · 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; 17(3). DOI:10.1089/dia.2014.0260 · 2.29 Impact Factor

Publication Stats

5k Citations
1,282.85 Total Impact Points


  • 1997–2015
    • University of Leicester
      • Department of Health Sciences
      Leiscester, England, United Kingdom
  • 2012–2013
    • University of Surrey
      • Department of Health Care Management and Policy
      Guilford, England, United Kingdom
  • 2008–2013
    • University Hospitals Of Leicester NHS Trust
      • Department of Diabetes and Endocrinology
      Leiscester, England, United Kingdom
    • Imperial College London
      • Department of Primary Care and Public Health
      London, ENG, United Kingdom
  • 2010
    • The University of Sheffield
      • School of Health and Related Research (ScHARR)
      Sheffield, ENG, United Kingdom
  • 2008–2009
    • The University of Warwick
      Coventry, England, United Kingdom
  • 2004
    • Office for National Statistics
      Londinium, England, United Kingdom
  • 2002
    • University College London
      Londinium, England, United Kingdom