Jonathan M Roland

Jonathan M Roland
Peterborough and Stamford Hospitals NHS Foundation Trust · Diabetes and Endocrinology

DM FRCP

About

62
Publications
8,274
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17,495
Citations
Citations since 2016
4 Research Items
3967 Citations
20162017201820192020202120220200400600
20162017201820192020202120220200400600
20162017201820192020202120220200400600
20162017201820192020202120220200400600
Introduction
Skills and Expertise

Publications

Publications (62)
Conference Paper
Objective: To evaluate the effect of intravenous (IV) and subcutaneous (SC) variable-rate insulin infusions (VRII) on glycaemic control in women with diabetes in pregnancy who are administered steroids to improve fetal lung maturity. Method: Fourteen cases (10 gestational and four pre-gestational) of pregnant women with diabetes admitted for ster...
Conference Paper
Full-text available
Objective: To evaluate the effect of intravenous (IV) and subcutaneous (SC) variable-rate insulin infusions (VRII) on glycaemic control in women with diabetes in pregnancy who are administered steroids to improve fetal lung maturity. Method: Fourteen cases (10 gestational and four pre-gestational) of pregnant women with diabetes admitted for ster...
Article
To compare obstetric and perinatal outcomes in women with Type 1 and Type 2 diabetes and relate these to maternal risk factors. Prospective cohort study of 682 consecutive diabetic pregnancies in East Anglia during 2006-2009. Relationships between congenital malformation, perinatal mortality and perinatal morbidity (large for gestational age, prete...
Article
A large number of studies have demonstrated that prepregnancy care for women with preconceptional diabetes improves glycemic control and reduces adverse pregnancy outcomes. However, only 2 regional centers, both nearly 20 years ago, have described the benefits of implementing prepregnancy care programs. A large study in the United Kingdom reported...
Article
Full-text available
To implement and evaluate a regional prepregnancy care program in women with type 1 and type 2 diabetes. Prepregnancy care was promoted among patients and health professionals and delivered across 10 regional maternity units. A prospective cohort study of 680 pregnancies in women with type 1 and type 2 diabetes was performed. Primary outcomes were...
Article
Aims: To explore the views of women who did not attend pre-pregnancy care (PPC), in particular their accounts of contraception, previous pregnancies and the influence of healthcare advice. Methods: We conducted semi-structured interviews with 29 pregnant women (21 with Type 1 diabetes, eight with Type 2 diabetes) at three UK specialist diabetes...
Article
A five year review (1981–1985) of the management and outcome of 85 diabetic pregnancies is presented. Management was based on self blood glucose monitoring and frequent outpatient attendances. With increasing experience of this system the median number of days spent as an inpatient during pregnancy progressively decreased. A good standard of diabet...
Article
Full-text available
To evaluate the impact of a Diabetes Specialist Nurse prescriber on insulin and oral hypoglycaemic agent medication errors and length of stay. The National Health Service has committed to a 40% reduction in the number of drug errors in the use of prescribed medicines. Drug errors in diabetes care are a common cause of significant morbidity and comp...
Article
To examine pregnancy outcome in women with Type 1 diabetes treated with glargine. Glargine use in pregnancy was surveyed over 2 years in 20 UK obstetric-diabetes centres. Outcomes, including maternal complications, miscarriage, congenital abnormalities, perinatal morbidity and mortality, were recorded in a standardized format. Outcomes on 109 babie...
Article
The aim of this study was to evaluate the impact of a diabetes specialist nurse (DSN) prescriber on insulin and oral hypoglycaemic agent medication errors, length of hospital stay, and patients' ability to self-manage their diabetes whilst in hospital.The setting was six wards in a single United Kingdom district general hospital trust. The standard...
Article
Full-text available
The pregnancy outcomes for women with type 1 diabetes remain poor with increased risk of major congenital malformation, stillbirth, premature delivery and perinatal death compared to the background maternity population. Despite clear evidence that women who attend prepregnancy care have improved blood glucose control with reduced risk of serious ad...
Article
To compare the outcomes of Type 1 and Type 2 diabetic pregnancies and identify risk factors for poor outcome of Type 2 pregnancies The data from all (389 Type 1 and 146 Type 2) pre-gestational diabetic pregnancies from 10 UK hospitals were collected prospectively. The Type 2 mothers were less likely to have documented pre-pregnancy counselling (28....
Article
Full-text available
Dr Jonathan Roland and colleagues describe an innovative addition to the diabetes care team. A new role, the Diabetes Care Technician (DCT), has been developed, evaluated and implemented in Peterborough. This role is highly cost effective, obtainable and a quality improving contribution to the Diabetes National Service Framework (NSF) implementatio...
Article
At our diabetes team meetings in Peterborough, which included a psychotherapist, the issues involved in who takes responsibility for the birth of a healthy baby from a diabetic mother were explored. Traditional prescriptive approaches were compared with the empowerment model in the specific instance of pregnancy, when the needs of the fetus have to...
Article
Childhood onset Type 2 diabetes in the UK has been reported in obese, insulin-resistant subjects. Investigation is necessary to exclude other aetiologies including genetic causes. The co-existence of diabetes and a chromosomal breakpoint may indicate the position of novel diabetes genes. We describe a novel unbalanced translocation between Xq and 1...
Article
Background The accuracy of blood glucose meters has been questioned and the quality control remains rudimentary. Collection of blood spots on filter paper strips allows laboratory estimations whilst maintaining the convenience of blood collection in the patient's own home.Method Patients provide blood spots on specially prepared filter paper strips...
Article
Full-text available
Juvenile haemochromatosis is a rare inborn error of iron metabolism with clinical manifestations before 30 years of age. Unlike adult haemochromatosis which principally affects men, juvenile haemochromatosis affects the sexes equally; it causes early endocrine failure, dilated cardiomyopathy and joint disease. We report four patients (two of each s...
Article
Full-text available
Background Improved blood-glucose control decreases the progression of diabetic microvascular disease, but the effect on macrovascular complications is unknown. There is concern that sulphonylureas may increase cardiovascular mortality in patients with type 2 diabetes and that high insulin concentrations may enhance atheroma formation. We compared...
Article
Objective: To determine whether tight control of blood pressure with either a beta blocker or an angiotensin converting enzyme inhibitor has a specific advantage or disadvantage in preventing the macrovascular and microvascular complications of type 2 diabetes. Design: Randomised controlled trial comparing an angiotensin converting enzyme inhibitor...
Article
Objectives: To estimate the economic efficiency of tight blood pressure control, with angiotensin converting enzyme inhibitors or beta blockers, compared with less tight control in hypertensive patients with type 2 diabetes. Design: Cost effectiveness analysis incorporating within trial analysis and estimation of impact on life expectancy through u...
Article
Full-text available
Haemochromatosis is well established as a cause of infertility in both men and women, usually because iron deposition in the pituitary or the gonads leads to hypogonadism. As haemochromatosis is a fairly common disorder it should be considered when subfertility from an endocrine disorder is being investigated. We report on two related patients bein...
Article
Background: Uncertainty exists about the suitability of oral hypoglycemic drugs and insulin therapy for patients with newly diagnosed type 2 diabetes. Objective: To assess and compare response to sulfonylurea, insulin, or metformin over 6 years in patients with newly diagnosed type 2 diabetes in whom disease could and could not be controlled wit...
Article
A psychotherapist, meeting regularly with a diabetes care team, helped them to devise a series of questions about feelings, control, and problems with diabetes. These questions were used when the team felt ‘stuck’ with patients or when reviewing their diabetes management. The questions were ones frequently used by counsellors and were adapted for u...
Article
As part of a District-based audit of diabetes care all attendances (of diabetic and non-diabetic patients) at a local Accident and Emergency department were monitored over a 3-month period. A total of 9505 attendances took place of which 62 (0.7%) were by people with diabetes. This was no different from the expected number of attendances (61.5) bas...
Article
Full-text available
We describe a case of paraproteinaemia in which there were high concentrations of four monoclonal bands shown on qualitative, and confirmed by quantitative, techniques. The disorder followed a pneumococcal infection and resolved spontaneously with the complete disappearance of all four bands.
Article
Heart disease responsive to steroids is well described in many disorders, including sarcoidosis, systemic lupus erythematosus, polyarteritis nodosa, myocarditis and Churg-Strauss syndrome. The underlying disorder is often obvious and the response is usually slow. We describe a woman who had severe left ventricular failure, cardiac dilatation and pe...
Article
A randomised crossover trial of Insulatard, Lentard and Mixtard insulins as once daily therapy was undertaken in 10 diabetics who had been on long term insulin and in 7 patients who were poorly controlled on oral hypoglycaemic agents and had not previously received insulin. The glycaemic control of those patients with prior insulin therapy was very...
Article
We have reviewed the hospital records of 24 patients with cystic fibrosis-associated diabetes, and 2 groups of CF patients (1 with normal and the other with abnormal oral glucose tolerance tests) who did not develop symptomatic fasting hyperglycemia, to define the clinical characteristics of the diabetes and to study its effects on the progression...
Article
In ten normal subjects thermoneutral neck-out water immersion produced a highly significant natriuresis and diuresis mediated via an induced central hypervolaemia. During immersion suppression of plasma noradrenaline and adrenaline was observed but no change occurred in plasma dopamine levels. No correlation was found between the suppression of nor...
Article
1. The renal response to volume expansion produced by water immersion to the neck at 35°C was examined in eight young normotensive uncomplicated insulin-dependent diabetic subjects and in eight matched normal control subjects. 2. Both the diabetic and normal subjects manifested a renal response of natriuresis and kaliuresis on immersion, but the na...
Article
We have reviewed the hospital records of 24 patients with cystic fibrosis-associated diabetes, and 2 groups of CF patients (1 with normal and the other with abnormal oral glucose tolerance tests) who did not develop symptomatic fasting hyperglycemia, to define the clinical characteristics of the diabetes and to study its effects on the progression...
Article
The response to a 21 infusion of physiological saline infusion was studied in 7 male uncomplicated insulin-dependent diabetics and in 7 non-diabetic male controls. The urinary sodium excretion in the diabetics in each of the 4 hr following the infusion was approximately half that of the controls. The total induced sodium excretion in controls was 3...
Article
Full-text available
The extent to which everyday walking activity is responsible for ventricular arrhythmias in the first 6 weeks after suspected myocardial infarction has been studied by simultaneous 24-hour recordings of electrocardiogram and walking activity. Forty-eight recordings from 46 patients were identified which contained couplets, ventricular tachycardia o...
Article
Full-text available
In ten human subjects water immersion produced a two-fold diuresis and a three-fold increase in sodium secretion together with a marked fall in plasma renin activity and aldosterone. In contrast, circulating and urinary (active and total kallikrein) remained unchanged throughout the immersion period. Our results indicate that the acute diuresis and...
Article
Acute hypoglycemia was induced using intravenous inulin in three groups of normal volunteers: (1) seventeen control subjects, (2) six subjects under beta-adrenergic blockade with propranolol, and (3) eight subjects given propranolol plus sodium lactate as an exogenous substrate for gluconeogenesis. Under propranolol blockade the recovery from hypog...
Article
1. In 10 normal subjects water immersion to the neck at 35°C produced a highly significant natriuresis and diuresis. 2. Urinary prostaglandin E levels did not change significantly throughout immersion. 3. During the diuresis of water immersion a suppression of urinary antidiuretic hormone occurred.
Article
A study of 15 insulin-dependent diabetics (IDD), 4 gestational diabetics (GDM), and 21 non-diabetic women was undertaken to assess non-enzymatic glycosylation in maternal hair, cord skin, and cord blood. Glycosylation of maternal hair was stable from tip to root in controls. In the IDD group, levels were highest at the tip, but were significantly l...
Article
The effect of the withdrawal of long-term beta-adrenoceptor blockade on pulse rate and finger tremor was studied in 27 patients who had been treated for 2 years following an uncomplicated myocardial infarction with either atenolol, propranolol or placebo. During treatment, pulse rate was significantly lower in patients treated with propranolol or a...
Article
Ten insulin-dependent diabetics taking twice-daily mixtures of soluble and isophane insulin were studied in a double-blind crossover trial to examine the effect on their glycaemic control of a fixed-mixture preparation (containing either 50% soluble, 50% isophane or 30% soluble, 70% isophane) given in the same total dose as each patient's usual mix...
Article
Full-text available
Three patients with insulin dependent diabetes mellitus who developed anorexia nervosa are described. Unlike the few cases already reported the patients' diabetes proved very difficult to control with dire consequences in each case.
Article
Full-text available
In a randomized cross-over trial the antihypertensive effect of metoprolol given once daily was compared with its effects after twice-daily dosage. Metoprolol given as a single morning dose had a useful antihypertensive effect for 24 hr and may be given in this way for the treatment of hypertension.
Article
Full-text available
All 662 patients admitted to the two coronary care units in Nottingham during 12 consecutive months were followed up prospectively for one year. At the time of discharge from hospital they were categorised according to set criteria into the following diagnostic groups: definite, probable, or possible myocardial infarction; ischaemia heart disease w...
Article
473 patients with suspected acute myocardial infarction were entered into a randomised, double-blind, placebo-controlled comparison of disopyramide phosphate, 150 mg three times a day, and oxprenolol, 40 mg three times a day. When analysed on an intension-to-treat basis there was no significant difference in 6-week mortality between the groups, but...
Article
Full-text available
The value of beta-blockade for suspected acute myocardial infarction was assessed by determining the six-week and one-year mortality rates in patients started on propranolol, atenolol, or placebo immediately on entry to a coronary care unit. A total of 388 patients entered this double-blind, randomised study, and when analysed on the basis of the i...
Article
Full-text available
Urinary concentrations of nicotine and its major metabolite cotinine were measured in volunteers whose smoking habits were known to test the reliability of the measurements as indicators of current smoking. In the non-smokers detectable concentrations were always below the confidence limits set for the method, while in smokers the concentrations we...
Article
Full-text available
Twenty-four-hour electrocardiographic tape-recording was used to investigate the incidence of arrhythmias in patients with suspected myocardial infarction who were receiving either propranolol, atenolol, or placebo. Recordings begun within 24 hours after admission to a coronary care unit showed that 76% of patients eventually found to have had a my...

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