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October 2014 - present
Publications
Publications (80)
FreeStyle Libre (FSL) monitoring is available for all patients in Wales with insulin-treated diabetes. English guidance permits FSL in patients with type 1 diabetes mellitus (T1D) and type 2 diabetes mellitus (T2D) requiring multiple daily insulin doses (MDI) (National Institute for Health and Care Excellence 2023). The literature suggests benefits...
Background and Aims: There is mounting debate around need to screen for steatotic liver disease (SLD) in people with type 2 diabetes (T2D). We aimed to pilot a screening programme for advanced fibrosis secondary to SLD in people with T2D.
Methods: This prospective study enrolled adults with T2D in secondary care diabetes clinics without pre-existin...
Background: An essential part of developing a screening pathway is to ensure acceptability within the intended population. We aim to determine the views of people with diabetes about additional screening for steatotic liver disease (SLD).
Methods: Patients attending secondary care diabetes clinics in Swansea Bay University Health Board with type 1...
There is growing interest in metabolic dysfunction-associated steatotic liver disease (MASLD), given its increasing prevalence and our developing understanding of the disease. People living with type 2 diabetes or obesity have a greater risk of developing significant hepatic steatosis and a greater risk of more rapid progression to steatohepatitis,...
Introduction
Type 2 diabetes (T2D) and metabolic dysfunction-associated steatotic liver disease (MASLD) have shared pathophysiology. We aim to explore associations between these diseases and the impact of T2D therapies on MASLD-related outcomes in a real-world population.
Methods
A retrospective cohort study included 153 patients with biopsy-prove...
Aims
This expert consensus reviews the reality of primary care clinical management of people with type 2 diabetes (T2D) on non‐intensive insulin therapy, with an emphasis on the use of continuous glucose monitoring (CGM) technology for effective care in this participant group. Here, we identify key unmet needs for skills and systems development wit...
Background and Aim: Metformin is recommended as the first-line agent for the management of type 2 diabetes following lifestyle and dietary changes. The long-term use of metformin has been associated with vitamin B12 deficiency. The aim of this review is to investigate the effect of metformin on vitamin B12 levels and identify any risk factors. Meth...
Background and aims: There is growing discussion concerning the need to screen for steatotic liver disease (SLD) in at-risk groups, such as people living with type 2 diabetes (T2D). We aim to evaluate the prevalence of SLD and advanced fibrosis in a cohort of people with T2D.
Materials and methods: This prospective study enrolled adults with T2D a...
There is a growing body of evidence demonstrating the benefit of flash glucose monitoring in people living with type 2 diabetes mellitus (T2DM). This real-world study aimed to evaluate the effect of initiating flash glucose monitoring on change in HbA1c after 3–6 months in adults living with T2DM treated with multiple daily injections of insulin.
A...
Aims: Some treatments for type 2 diabetes (T2D) improve non-alcoholic fatty liver disease (NAFLD) outcomes in trials, including sodium-glucose transporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptor analogues (GLP-1RA). We aimed to establish their real-world impact on non-invasive measures of NAFLD.
Methods: A retrospective study in...
Background and Aims
Concerns about the relative accuracy of non-invasive tests for metabolic dysfunction-associated steatotic liver disease (MASLD)-related advanced fibrosis continues in people with features of the metabolic syndrome. We aimed to determine whether increasing body mass index (BMI) impacted upon the accuracy of non-invasive tests for...
Background and Aims
Debate continues around the need and practicality of screening for metabolic dysfunction-associated steatotic liver disease (MASLD) in people with type 2 diabetes (T2D). We aimed to determine the accuracy of non-invasive tests for MASLD-related advanced fibrosis in people with T2D.
Method
A retrospective study included patients...
Introduction: Levothyroxine, the standard therapy for hypothyroidism, is usually well tolerated and very few cases of true allergy to levothyroxine have been reported to date. Here we report two cases of rare occurrence of levothyroxine allergy.
Case 1: A 56-year-old woman with no previous history of allergies started levothyroxine post-thyroidect...
Introduction: Endocrine society guidelines advocate early colonoscopy and monitoring for acromegaly-associated complications and recurrence. We aimed to establish whether people with acromegaly under our care received appropriate monitoring.
Methods: Patients under follow-up with acromegaly diagnosed 1989-2021 were included. Electronic health reco...
Oral semaglutide improves cardiovascular risk factors in people with type 2 diabetes (T2D) in clinical trials, though real-world evidence is limited. We aimed to determine the real-world impact of oral semaglutide on routinely collected clinical data in our practice.
People with T2D initiated on oral semaglutide in secondary care diabetes clinics a...
Aims: Debate continues around screening for non-alcoholic fatty liver disease (NAFLD) in people with high-risk. We aimed to determine the accuracy of non-invasive tests for NAFLD-fibrosis in people with type 2 diabetes (T2D).
Method: A retrospective study included patients with NAFLD on liver biopsy between November 2011-September 2022. The AST:ALT...
Objectives: The impact of FSL in type 1 diabetes is established; however, data in people with type 2 diabetes is lacking. In Wales, FSL has been available for patients with insulin-treated type 2 diabetes since July 2021. We assessed the glycaemic impact of FSL in patients with insulin-treated type 2 diabetes.
Methods: A retrospective analysis incl...
Aims: Some treatments for type 2 diabetes (T2D) improve non-alcoholic fatty liver disease (NAFLD) outcomes in trials, including sodium-glucose transporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptor analogues (GLP-1RA). We aimed to establish their real-world impact on non-invasive measures of NAFLD.
Methods: A retrospective study in...
Background
Recent evidence suggests shared pathophysiology and potential for shared treatment options in people with type 2 diabetes (T2D) and non-alcoholic fatty liver disease (NAFLD). Further studies may observe further treatment opportunities.
Aim
The study aims to explore the bidirectional relationship between NAFLD and T2D. Firstly, to establi...
Background
NAFLD is an increasingly recognised cause of liver cirrhosis in people with T2D. Non-invasive tests for NAFLD-fibrosis are of interest to identify those with advanced disease to permit intervention and monitoring.
Aim
To determine the accuracy of non-invasive measures of NAFLD-related fibrosis in people with T2D and NAFLD.
Method
A multi...
Bariatric surgery is well-established to support long-term metabolic health benefits associated with considerable weight loss. Here, we aim to determine the longer-term impact of bariatric surgery on liver enzymes and associations with other metabolic improvements.
One hundred patients who underwent bariatric surgery between 2007 and 2014 were incl...
Prevention of cardiovascular disease (CVD) is one of the main objectives in the management of people with type 2 diabetes (T2DM). New glucose-lowering therapies such as glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 (SGLT-2) inhibitors have demonstrated not only cardiovascular safety but also cardiovascular...
Background: Recent trial evidence for non- alcoholic steatohepatitis (NASH) treatment has fuelled the debate for NASH screening in people with type 2 diabetes. We aimed to determine whether people with type 2 diabetes have greater hepatic steatosis, inflammation, fibrosis, or renal dysfunction.
Methods: Patients diagnosed with NASH at liver biopsy...
Objectives: Type 2 diabetes is an established risk factor for the development of non- alcoholic steatohepatitis (NASH). This study aimed to determine whether the re-verse was also significant, to quantify the risk of developing type 2 diabetes in people with NASH.
Methods: A multi- centre retrospective cohort study included patients diagnosed with...
Aims: To investigate the effect of the FreeStyle Libre (FSL) glucose monitoring device on glycaemic control in adults with type 2 diabetes prescribed a basal- bolus insulin (BBI) regime.
Methods: A retrospective evaluation of medical records of people with type 2 diabetes prescribed a BBI regimen at Morriston, Singleton or Neath Port Talbot hospita...
Introduction:
Despite therapeutic advances in the field of diabetes management since the discovery of insulin 100 years ago, there are still unmet clinical needs for people with T1DM.
Areas covered:
Genetic testing and islet autoantibodies testing allow researchers to design prevention studies. This review will discuss the emerging therapy for p...
Agranulocytosis secondary to anti-thyroid drugs (ATD) is uncommon, though associated with high mortality requiring a great index of clinical suspicion. We report on two cases; agranulocytosis caused by carbimazole and propylthiouracil (PTU) respectively. The first case is of a 92-year-old woman who developed agranulocytosis associated with an incre...
Background: Despite risk of progression to liver cirrhosis and/or hepatocellular carcinoma, there remains no recommended screening for non-alcoholic fatty liver disease (NAFLD) in people with diabetes. The primary aim of the study is to determine the number of patients in a secondary care diabetes clinic who require further investigation of liver d...
There is an increasing prevalence of obesity worldwide, associated with significant morbidity and mortality, which frequently reduces quality of life and life expectancy. Consequently, there is a substantial and growing personal and economic burden necessitating the development of more effective therapies for obesity. Glucagon-like peptide-1 recept...
Background: People with diabetes and coronavirus disease 2019 (COVID-19) have a significantly greater risk of death and/or intensive care unit (ICU) admission. The Association of British Clinical Diabetologists (ABCD) recently audited outcomes for people hospitalised in the UK with diabetes and COVID-19. Methods: The ABCD COVID-19 and diabetes audi...
Background & aims: Despite a major risk of progression to liver cirrhosis and/or hepatocellular carcinoma, there remains no recommended screening for non-alcoholic fatty liver disease (NAFLD) in people with diabetes. Whilst robust NAFLD prevalence studies are lacking in people with type 1 diabetes (T1D) or type 2 diabetes (T2D), prevalence estimate...
Background: People with diabetes and coronavirus disease 2019 (COVID-19) have significantly greater risk of death and/or intensive care unit (ICU) admission. The Association of British Clinical Diabetologists (ABCD) recently audited outcomes for people hospitalised in the UK with diabetes and COVID-19.
Methods: The ABCD COVID-19 and diabetes audit...
Hyponatraemia is the most common electrolyte disturbance observed in hospital inpatients. We report a 90-year-old woman admitted generally unwell following a fall with marked confusion. Examination revealed a tender suprapubic region, and investigations observed elevated inflammatory markers and bacteriuria. Admission investigations demonstrated a...
Spontaneous intracranial hypotension (SIH) is characterised by postural headache and a cerebrospinal fluid (CSF) pressure of ≤6 cmH 2 0 measured with the patient in the lateral decubitus position. Other symptoms include tinnitus, altered hearing, diplopia, photophobia, nausea and neck stiffness, and must not have occurred within a month of dural pu...
We applaud the recently published article from Tsyrulnik and colleagues titled ‘Socially distanced, virtually connected: Faculty and resident perceptions of virtual didactics’1. In this multicenter, cross‐sectional study, the authors sought the views of emergency medicine (EM) residents and faculty on virtual learning during the COVID‐19 pandemic....
The glucagon-like peptide-1 receptor analogue (GLP-1RA) semaglutide improves cardiovascular risk factors and glycaemia in clinical trials 1. Relatively little is known about the real-world impact of once weekly (OW) injectable semaglutide. The aims of this study were to determine: • The impact of injectable semaglutide on HbA1c, weight, BP, lipids...
Introduction: The glucagon-like peptide-1 receptor analogue (GLP-1RA) semaglutide is associated with improvements in glycaemia and cardiovascular risk factors in clinical trials. The aim of this study was to examine the real-world impact of semaglutide administered by injection in people with type 2 diabetes (T2D) across three secondary care sites...
Glucagon-like peptide 1 (GLP-1) based therapy is an established treatment option for the management of type 2 diabetes mellitus (T2DM) and is recommended early in the treatment algorithm owing to glycaemic efficacy, weight reduction and favourable cardiovascular outcomes. Glucose-dependent insulinotropic polypeptide (GIP), on the other hand, was th...
Background
Bariatric surgery is an effective treatment for morbid obesity and glycaemic dysfunction.Objectives
The aim of the work was to examine both the static and dynamic changes of glucose-insulin homeostasis and incretin hormone response following sleeve gastrectomy (SG) in a sample of 55 participants preoperatively and 1 month and 6 months po...
Background
Previous studies have examined changes in plasma markers of inflammation and oxidative stress up to 24 months following bariatric surgery, but there is limited evidence on the long-term effects of bariatric surgery.
Objectives
To examine the effects of bariatric surgery on adipokines (adiponectin, leptin), inflammatory cytokines [C-reac...
This review examines the current literature relating to diabetes related kidney disease (DKD) and the optimal management of cardio-renal risk. DKD develops in approximately 40% of patients with type 2 diabetes mellitus. The mainstay of therapy is to reduce the progression of DKD by optimising hyperglycaemia, blood pressure, lipids and lifestyle. Ev...
This review examines the available literature on the effect of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on renal outcomes in type 2 diabetes mellitus. Diabetes is an important cause of end-stage renal disease requiring renal replacement therapy, and diabetic kidney disease is an independent risk factor for cardiovascular disease (CVD)....
Introduction
There is limited literature available on the long-term effect of bariatric surgery especially laparoscopic sleeve gastrectomy (LSG) on the incretin hormone response.
Aim
Our primary aim was to investigate changes in glucose metabolism and incretin hormone responses in participants with impaired glucose regulation approximately 4 years...
Background:
Bariatric surgery is an effective treatment for morbid obesity and metabolic dysfunction.
Objectives:
The aim of this work was to examine the early temporal effects of laparoscopic sleeve gastrectomy (LSG) on adipokines (adiponectin, leptin), inflammatory cytokines (interleukin-6, C-reactive protein, interleukin-10), and global plasm...
Universal thyroid screening in pregnancy is a key debate in thyroidology and obstetrics. It is well-established that thyroid hormones are essential for maintaining pregnancy and optimal fetal development. Thyroid dysfunction is common in women of child-bearing age and also results in substantial adverse obstetric and child neurodevelopmental outcom...
Background:
Bariatric surgery markedly reduces fat mass with beneficial effects on cardiometabolic health but the mechanisms involved are not fully understood. Extracellular vesicles (EVs) are secreted by a variety of cells, including adipocytes, and may mediate some of these benefits. However, the effects of bariatric surgery on circulating EVs a...
Aims:
Chronic kidney disease (CKD) is common in type 2 diabetes and limits the treatment choices for glycaemic control. Our aim was to examine real-world prescribing for managing hyperglycaemia in the presence of CKD.
Methods:
The SAIL (Secure Anonymised Information Linkage) databank was used to examine prescribing during the period from the 1st...
Aims: In this study, we aimed to assess the diagnostic accuracy of clinical examination, routinely used inflammatory markers and abdominal ultrasound in differentiating biliary colic from acute cholecystitis.
Methods: We retrospectively collected the data of the patients who underwent emergency laparoscopic cholecystectomy for clinically diagnosed...
Aims: While there are isolated incidents of deterioration in renal function due to sodium glucose cotransporter 2 (SGLT-2) inhibitors in clinical trials, there is experimental evidence supporting that SGLT-2 inhibitors are nephroprotective rather than nephrotoxic. Our aim was to investigate changes in renal function before and during treatment with...
Background and aims:
Cardiovascular (CV) risk equations are routinely used to predict risk in nonbariatric populations, but have not been studied in depth in patients undergoing bariatric surgery and specifically those with impaired glucose regulation. The aim of this pilot study was to investigate changes in the 10-year and lifetime predicted CV...
Background: Bariatric surgery aims to decrease cardiovascular risk factors. The Swedish Obese Subjects study reported that bariatric surgery was associated with reduction in long-term cardiovascular (CV) event. However, uncertainty remains regarding the effect of bariatric surgery on long-term CV risk. One way to predict long-term CV risk after bar...
Background:
Laparoscopic sleeve gastrectomy (LSG) is an effective treatment for obesity and associated metabolic complications. Obesity and type 2 diabetes are associated with increased oxidative stress. Previous studies have examined changes in plasma oxidative stress after laparoscopic Roux-en-Y gastric bypass, but there is limited evidence of t...
Background: Bariatric surgery aims to provide long term weight loss and improved glycaemic control and amelioration of cardiovascular risk factors in obese patients with Type 2 diabetes. Aim: The aim of the study was to investigate the clinical measures of obesity, glycaemic control and cardiovascular risk factors in patients with Type 2 diabetes 5...
Background: Published clinical trials of SGLT2 inhibitors have typically recruited participants with modest elevations of HbA1c. Our aim was to evaluate the efficacy of dapagliflozin in patients with uncontrolled glycaemia in a routine clinic setting where patients are taking a range of other therapies.
In 2011, the Driver and Vehicle Licensing Agency (DVLA) amended its regulations regarding drivers with insulin-treated diabetes, based on the amended Third European Commission Driving Licence Directive [1,2]. This has led to significant changes for drivers with insulin-treated diabetes: the introduction of stricter rules for Group 1 licence holders...
Background and aims:
Bariatric surgery results in the remission of type 2 diabetes mellitus (T2DM) in morbidly obese subjects. The aim of the study was to investigate the predictive value of both static and dynamic measures of C-peptide in relation to T2DM resolution 6months after bariatric surgery regardless of the operation type.
Methods and re...
Over recent years, there has been a better understanding of the role of that visceral adipose tissue plays in the pathogenesis of insulin resistance, Type 2 diabetes and the metabolic syndrome. Studies have consistently demonstrated that intra-abdominal fat accumulation, in other words, abdominal obesity is independently associated with Type 2 diab...
Drivers with diabetes have restrictions on their driving licences. The main reasons for these restrictions are the risk of hypoglycaemia and hypoglycaemia unawareness. Recent changes in the European Driving Licence Directive have brought significant changes to UK rules and regulations. This article summarises the legal requirements for drivers with...
No abstract is available for this article.
Background: Bariatric surgery results in type 2 diabetes mellitus (T2DM) remission in morbidly obese subjects. Certain preoperative clinical and biochemical information might provide potential predictors in relation to T2DM outcome postoperatively.
Aim: The aim of the study was to investigate the predictive value of both static and dynamic measures...
Reductions in plasma endocannabinoids following bariatric surgery in morbidly obese females with impaired glucose homeostasis: A non-randomized prospective study • Endocannabinoids (ECs) are bioactive lipid mediators − N-arachidonyl ethanolamine (AEA) − N-palmitoyl ethanolamine (PEA) − N-oleoyl ethanolamine (OEA) − related N-acylethanolamine (NAE)...
Bariatric surgery has become an established evidence-based treatment option for diabetes associated with obesity. Numerous studies have demonstrated that bariatric surgery is superior to conventional medical treatment and is effective in achieving resolution of hyperglycaemia or improvement in glycaemic control in type 2 diabetes. However, diabetes...
A 46-year-old woman presented with 2 months history of thirst, polydipsia, polyuria, constipation, 3-stone weight loss, and abdominal pain. She had no other significant medical problem except from personality disorder, which was controlled with antipsychotic medications. She denied use of over-counter medications. She had been off lithium for 5 yea...
Thyroid storm is a rare but potentially life-threatening complication of hyperthyroidism. Early recognition and prompt treatment are essential. Atrial fibrillation can occur in up to 40% of patients with thyroid storm. Studies have shown that hyperthyroidism increases the risk of thromboembolic events. There is no consensus with regard to the initi...
Introduction:
Diabetic nephropathy is a leading cause of chronic kidney disease (CKD) in the UK. These patients are at significantly increased risk of cardiovascular disease and of progression to end-stage renal disease. We review the epidemiology, pathogenesis and natural history of diabetic nephropathy and evaluate the therapeutic options availa...
