Kamlesh Khunti

University of Leicester, Leiscester, England, United Kingdom

Are you Kamlesh Khunti?

Claim your profile

Publications (413)1519.49 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The legacy effect of early good glycaemic control in people with diabetes shows it is associated with reduction of microvascular and macrovascular complications. Insulin therapy is essential and lifesaving in individuals with type 1 diabetes and beneficial for those with type 2 diabetes who fail to achieve optimal glycaemic targets with other classes of glucose-lowering therapies. Since the introduction of insulin analogues, insulin management has changed. This follow-up review attempts to update our earlier publication from 2009 and discusses the role of new insulin analogues and newer insulin regimens. Recognising the advent of new quality and economic initiatives both in the UK and worldwide, this paper reviews current insulin prescribing and the pros and cons of prescribing analogues in comparison to the human insulins that are now gaining more acceptance in everyday clinical practice.
    No preview · Article · Feb 2016 · Postgraduate medical journal
  • [Show abstract] [Hide abstract]
    ABSTRACT: Religious identity can significantly influence the daily practices of individuals, thus impacting on their health. In 2010, a demographic study showed that Muslims constitute 23% of the world's population, some 1.6 billion people; this number is increasing at a rate of ~ 3% each year [1]. The International Diabetes Federation estimates that in 2013 there were 382 million people living with diabetes, a number predicted to rise to 592 million by 2035. If these figures are extrapolated globally there are ~ 90 million Muslims with diabetes. Considering specifically the UK, the current number of patients with diabetes is estimated at just fewer than 3 million [2]. Diabetes affects around 10-15% of the UK Muslim population, with South Asian people having the highest rates of diabetes mellitus [3]. Recent data suggest that there are ~ 2.9 million Muslims living in the UK [4], thus ~ 400 000 British Muslims have diabetes [3]. This article is protected by copyright. All rights reserved.
    No preview · Article · Jan 2016 · Diabetic Medicine
  • [Show abstract] [Hide abstract]
    ABSTRACT: To review the interventions targeting primary care or community based professionals on glycaemic and cardiovascular risk factor control in people with diabetes.
    No preview · Article · Jan 2016
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Multimorbidity has become one of the main challenges in the recent years for patients, health care providers and the health care systems globally. However, literature describing the burden of multimorbidity in the elderly population, especially longitudinal trends is very limited. Physical activity is recommended as one of the main lifestyle changes in the prevention and management of multiple chronic diseases worldwide; however, the evidence on its association with multimorbidity remains inconclusive. Therefore, we aimed to assess the longitudinal trends of multimorbidity and the association between multimorbidity and physical activity in a nationally representative cohort of the English population aged ≥50 years between 2002 and 2013. We used data on 15,688 core participants from six waves of the English Longitudinal Study of Ageing, with complete information on physical activity. Self-reported physical activity was categorised as inactive, mild, moderate and vigorous levels of physical activity. We calculated the number of morbidities and the prevalence of multimorbidity (more than 2 chronic conditions) between 2002 and 2013 overall and by levels of self-reported physical activity. We estimated the odds ratio (OR) and 95 % confidence intervals (CI) for multimorbidity by each category of physical activity, adjusting for potential confounders. There was a progressive decrease over time in the proportion of participants without any chronic conditions (33.9 % in 2002/2003 vs. 26.8 % in 2012/2013). In contrast, the prevalence of multimorbidity steadily increased over time (31.7 % in 2002/2003 vs. 43.1 % in 2012/2013). Compared to the physically inactive group, the OR for multimorbidity was 0.84 (95 % CI 0.78 to 0.91) in mild, 0.61 (95 % CI 0.56 to 0.66) in moderate and 0.45 (95 % CI 0.41 to 0.49) in the vigorous physical activity group. This study demonstrated an inverse dose-response association between levels of physical activity and multimorbidity, however, given the increasing prevalence of multimorbidity over time, there is a need to explore causal associations between physical activity and multimorbidity and its impact as a primary prevention strategy to prevent the occurrence of chronic conditions later in life and reduce the burden of multimorbidity.
    Preview · Article · Jan 2016 · International Journal of Behavioral Nutrition and Physical Activity
  • [Show abstract] [Hide abstract]
    ABSTRACT: Aims: Clinical inertia, the failure to intensify treatment regimens when required, can potentially have a negative impact upon patients' long-term outcomes. This study investigated whether clinical inertia exists in people with type 2 diabetes treated with basal insulin. Materials and methods: This was a retrospective cohort study involving patients with type 2 diabetes in the UK Clinical Practice Research Datalink database between January 2004 and December 2011, with follow-up until December 2013. Results: A total of 11,696 patients were included in the analysis. Among all patients, 36.5% were intensified during the study period; of these, 50.0%, 42.5% and 7.4% were intensified with bolus or premix insulin or glucagon-like peptide-1 receptor agonists, respectively. The median time from initiation of basal insulin to intensification was 4.3 years [95% CI: 4.1; 4.6]. Among patients clinically eligible for intensification (HbA1c ≥7.5% [58 mmol/mol]), 30.9% had their treatment regimen intensified. The median time to intensification in this group was 3.7 years [95% CI: 3.4; 4.0]. Increasing age, duration of diabetes, oral antihyperglycaemic agent usage, and Charlson Comorbidity Index score were associated with a significant delay in the time to intensification, p < 0.05. Among patients with HbA1c ≥7.5% [58 mmol/mol], 46.5% stopped basal insulin therapy. Conclusions: Strategies should be developed to increase the number of patients undergoing therapy intensification and to reduce the delay in intensifying therapy for suitable patients on basal insulin. Initiatives to support patients continuing on insulin are also required.
    No preview · Article · Jan 2016 · Diabetes Obesity and Metabolism
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: To compare the accuracy of the activPAL and ActiGraph GT3X+ (waist and thigh) proprietary postural allocation algorithms and an open source postural allocation algorithm applied to GENEActiv (thigh) and ActiGraph GT3X+ (thigh) data. Methods: 34 adults (≥18 years) wore the activPAL3, GENEActiv and ActiGraph GT3X+ on the right thigh and an ActiGraph on the right hip while performing four lying, seven sitting and five upright activities in the laboratory. Lying and sitting tasks incorporated a range of leg angles (e.g., lying with legs bent, sitting with legs crossed). Each activity was performed for five minutes while being directly observed. Percent time correctly classified was calculated. Results: Participants consisted of 14 males and 20 females (mean age 27.2±5.9 years; mean body mass index of 23.8±3.7kg/m). All postural allocation algorithms applied to monitors worn on the thigh correctly classified ≥93% of the time lying, ≥91% of the time sitting and ≥93% of the time upright. The ActiGraph waist proprietary algorithm correctly classified 72% of the time lying, 58% of the time sitting and 74% of the time upright. Both the activPAL and ActiGraph thigh proprietary algorithms misclassified sitting on a chair with legs stretched out (58% and 5% classified incorrectly respectively). The ActiGraph thigh proprietary and open source algorithm applied to the thigh worn ActiGraph misclassified participants lying on their back with their legs bent 27% and 9% of the time, respectively. Conclusion: All postural allocation algorithms when applied to devices worn on the thigh were highly accurate in identifying lying, sitting and upright posture. Given the poor accuracy of the waist algorithm for detecting sitting, caution should be taken if inferring sitting time from a waist-worn device.
    No preview · Article · Jan 2016 · Medicine and science in sports and exercise
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Mobile technologies for health (mHealth) represent a promising strategy for reducing type 2 diabetes (T2DM) risk. The PROPELS trial investigates whether structured group-based education alone or supplemented with a follow-on support program combining self-monitoring with pedometers and tailored text-messaging is effective in promoting and maintaining physical activity among people at high risk of T2DM. Objective: This paper describes the iterative development of the PROPELS follow-on support program and presents evidence on its acceptability and feasibility. Methods: We used a modified mHealth development framework with four phases: (1) conceptualization of the follow-on support program using theory and evidence, (2) formative research including focus groups (n=15, ages 39-79 years), (3) pre-testing focus groups using a think aloud protocol (n=20, ages 52-78 years), and (4) piloting (n=11). Analysis was informed by the constant comparative approach, with findings from each phase informing subsequent phases. Results: The first three phases informed the structure, nature, and content of the follow-on support program, including the frequency of text messages, the need for tailored content and two-way interaction, the importance of motivational messages based on encouragement and reinforcement of affective benefits (eg, enjoyment) with minimal messages about weight and T2DM risk, and the need for appropriate language. The refined program is personalized and tailored to the individual's perceived confidence, previous activity levels, and physical activity goals. The pilot phase indicated that the program appeared to fit well with everyday routines and was easy to use by older adults. Conclusions: We developed a feasible and innovative text messaging and pedometer program based on evidence and behavior change theory and grounded in the experiences, views, and needs of people at high diabetes risk. A large scale trial is testing the effectiveness of this 4-year program over and above structured group education alone. Trial registration: International Standard Randomized Controlled Trial Number (ISRCTN): 83465245; http://www.controlled-trials.com/ISRCTN83465245/83465245 (Archived by WebCite at http://www.webcitation.org/6dfSmrVAe).
    Full-text · Article · Dec 2015
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Once-weekly glucagon-like peptide-1 receptor agonists (GLP-1RAs) are new drugs for the treatment of type 2 diabetes. Purpose: To summarize evidence for the cardiometabolic efficacy and adverse effects of once-weekly GLP-1RAs in adults with type 2 diabetes. Data sources: Electronic databases (PubMed, Web of Science, Cochrane Central Register of Controlled Trials, U.S. Food and Drug Administration, European Medicines Agency, ClinicalTrials.gov) and congress abstracts from inception through 26 September 2015. Study selection: Randomized, controlled trials (≥24 weeks of follow-up) studying albiglutide, dulaglutide, once-weekly exenatide, semaglutide, and taspoglutide and reporting a cardiometabolic (primary outcome, hemoglobin A1c [HbA1c]) or safety outcome. Data extraction: Extraction was done in duplicate, and risk of bias was assessed. No language restriction was applied. Data synthesis: 34 trials (21 126 participants) were included. Compared with placebo, all once-weekly GLP-1RAs reduced HbA1c and fasting plasma glucose; taspoglutide, 20 mg, once-weekly exenatide, and dulaglutide, 1.5 mg, reduced body weight. Among once-weekly GLP-1RAs, the greatest differences were found between dulaglutide, 1.5 mg, and taspoglutide, 10 mg, for HbA1c (-0.4% [95% CI, -0.7% to -0.2%]), once-weekly exenatide and albiglutide for fasting plasma glucose (-0.7 mmol/L [CI, -1.1 to -0.2 mmol/L]; -12.6 mg/dL [CI, -19.8 to -3.6 mg/dL]), and taspoglutide, 20 mg, and dulaglutide, 0.75 mg, for body weight (-1.5 kg [CI, -2.2 to -0.8]). Clinically marginal or no differences were found for blood pressure, blood lipid levels, and C-reactive protein levels. Once-weekly exenatide increased heart rate compared with albiglutide and dulaglutide (1.4 to 3.2 beats/min). Among once-weekly GLP-1RAs, the risk for hypoglycemia was similar, whereas taspoglutide, 20 mg, had the greatest risk for nausea (odds ratios, 1.9 to 5.9). Limitation: Data were unavailable for semaglutide, definitions of outcomes were heterogeneous, the last-observation-carried-forward imputation method was used in 73% of trials, and publication bias is possible. Conclusion: Compared with other once-weekly GLP-1RAs, dulaglutide 1.5 mg, once-weekly exenatide, and taspoglutide, 20 mg, showed a greater reduction of HbA1c, fasting plasma glucose, and body weight. Taspoglutide, 20 mg, had the highest risk for nausea; risk for hypoglycemia among once-weekly GLP-1RAs was similar. Primary funding source: Sanofi Aventis (grant to the University of Leicester).
    No preview · Article · Dec 2015 · Annals of internal medicine
  • [Show abstract] [Hide abstract]
    ABSTRACT: Aims: Prevention of type 2 diabetes (T2DM) is a priority in healthcare, but there is a lack of evidence investigating how to effectively translate prevention research into a UK primary care setting. We assessed whether a structured education programme targeting lifestyle and behaviour change was effective at preventing progression to T2DM in people with prediabetes. Materials and methods: 44 General Practices were randomised to receive either standard care or a six hour group structured education programme with an annual refresher course, and regular phone contact. Participants were followed up for 3 years. The primary outcome was progression to T2DM. Results: Eight hundred and eighty participants were included (36% female, mean age 64 years, 16% ethnic minority group); 131 participants developed T2DM. There was a non-significant 26% reduced risk of developing T2DM in the intervention arm compared to standard care (HR 0.74, 95%CI 0.48, 1.14, p=0.18). The reduction in T2DM risk when excluding those who did not attend the initial education session was also non-significant (HR 0.65, 0.41, 1.03, p=0.07). There were statistically significant improvements in HbA1c (-0.06, -0.11, -0.01), LDL cholesterol (-0.08, -0.15, -0.01), sedentary time (-26.29, -45.26, -7.32) and step count (498.15, 162.10, 834.20) when data were analysed across all time points. Conclusions: This study suggests that a relatively low resource, pragmatic diabetes prevention programme resulted in modest benefits to biomedical, lifestyle and psychosocial outcomes, however the reduction to the risk of T2DM did not reach significance. The findings have important implications for future research and primary care.
    No preview · Article · Dec 2015 · Preventive Medicine
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: Cardiorespiratory fitness is a strong, independent predictor of health, whether it is measured in an exercise test or estimated in an equation. The purpose of this study was to develop and validate equations to estimate fitness in middle-aged white European and South Asian men. Methods: Multiple linear regression models (n=168, including 83 white European and 85 South Asian men) were created using variables that are thought to be important in predicting fitness (VO2 max, mL⋅kg⋅min): age (years); BMI (kg·m); resting heart rate (beats⋅min); smoking status (0=never smoked, 1=ex or current smoker); physical activity expressed as quintiles (0=quintile 1, 1=quintile 2, 2=quintile 3, 3=quintile 4, 4=quintile 5), categories of moderate- to vigorous-intensity physical activity (0=<75 min⋅wk, 1=75-150 min⋅wk, 2=>150-225 min⋅wk, 3=>225-300 min⋅wk, 4=>300 min⋅wk), or minutes of moderate- to vigorous-intensity physical activity (min⋅wk); and, ethnicity (0=South Asian, 1=white). The leave-one-out-cross-validation procedure was used to assess the generalizability and the bootstrap and jackknife resampling techniques were used to estimate the variance and bias of the models. Results: Around 70% of the variance in fitness was explained in models with an ethnicity variable, such as: VO2 max = 77.409 - (age*0.374) - (BMI*0.906) - (ex or current smoker*1.976) + (physical activity quintile coefficient) - (resting heart rate*0.066) + (white ethnicity*8.032), where physical activity quintile 1 is 1, 2 is 1.127, 3 is 1.869, 4 is 3.793, and 5 is 3.029. Only around 50% of the variance was explained in models without an ethnicity variable. All models with an ethnicity variable were generalizable and had low variance and bias. Conclusion: These data demonstrate the importance of incorporating ethnicity in non-exercise equations to estimate cardiorespiratory fitness in multi-ethnic populations.
    No preview · Article · Dec 2015 · Medicine & Science in Sports & Exercise
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To determine whether breaking up prolonged sitting with short bouts of standing or walking improves postprandial markers of cardiometabolic health in women at high risk of type 2 diabetes. Research design and methods: Twenty-two overweight/obese, dysglycemic, postmenopausal women (mean ± SD age 66.6 ± 4.7 years) each participated in two of the following treatments: prolonged, unbroken sitting (7.5 h) or prolonged sitting broken up with either standing or walking at a self-perceived light intensity (for 5 min every 30 min). Both allocation and treatment order were randomized. The incremental area under the curves (iAUCs) for glucose, insulin, nonesterified fatty acids (NEFA), and triglycerides were calculated for each treatment condition (mean ± SEM). The following day, all participants underwent the 7.5-h sitting protocol. Results: Compared with a prolonged bout of sitting (iAUC 5.3 ± 0.8 mmol/L ⋅ h), both standing (3.5 ± 0.8 mmol/L ⋅ h) and walking (3.8 ± 0.7 mmol/L ⋅ h) significantly reduced the glucose iAUC (both P < 0.05). When compared with prolonged sitting (548.2 ± 71.8 mU/L ⋅ h), insulin was also reduced for both activity conditions (standing, 437.2 ± 73.5 mU/L ⋅ h; walking, 347.9 ± 78.7 mU/L ⋅ h; both P < 0.05). Both standing (-1.0 ± 0.2 mmol/L ⋅ h) and walking (-0.8 ± 0.2 mmol/L ⋅ h) attenuated the suppression of NEFA compared with prolonged sitting (-1.5 ± 0.2 mmol/L ⋅ h) (both P < 0.05). There was no significant effect on triglyceride iAUC. The effects on glucose (standing and walking) and insulin (walking only) persisted into the following day. Conclusions: Breaking up prolonged sitting with 5-min bouts of standing or walking at a self-perceived light intensity reduced postprandial glucose, insulin, and NEFA responses in women at high risk of type 2 diabetes. This simple, behavioral approach could inform future public health interventions aimed at improving the metabolic profile of postmenopausal, dysglycemic women.
    Preview · Article · Dec 2015 · Diabetes Care
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Both physical activity and sedentary behaviour have been individually associated with health, however, the extent to which the combination of these behaviours influence health is less well-known. The aim of this study was to examine the associations of four mutually exclusive categories of objectively measured physical activity and sedentary time on markers of cardiometabolic health in a nationally representative sample of English adults. Methods Using the 2008 Health Survey for England dataset, 2131 participants aged ≥18 years, who provided valid accelerometry data, were included for analysis and grouped into one of four behavioural categories: (1) ‘Busy Bees’: physically active & low sedentary, (2) ‘Sedentary Exercisers’: physically active & high sedentary, (3) ‘Light Movers’: physically inactive & low sedentary, and (4) ‘Couch Potatoes’: physically inactive & high sedentary. ‘Physically active’ was defined as accumulating at least 150 min of moderate-to-vigorous physical activity (MVPA) per week. ‘Low sedentary’ was defined as residing in the lowest quartile of the ratio between the average sedentary time and the average light-intensity physical activity time. Weighted multiple linear regression models, adjusting for measured confounders, investigated the differences in markers of health across the derived behavioural categories. The associations between continuous measures of physical activity and sedentary levels with markers of health were also explored, as well as a number of sensitivity analyses. Results In comparison to ‘Couch Potatoes’, ‘Busy Bees’ [body mass index: −1.67 kg/m2 (p < 0.001); waist circumference: −1.17 cm (p = 0.007); glycated haemoglobin: −0.12 % (p = 0.003); HDL-cholesterol: 0.09 mmol/L (p = 0.001)], ‘Sedentary Exercisers’ [body mass index: −1.64 kg/m2 (p < 0.001); glycated haemoglobin: −0.11 % (p = 0.009); HDL-cholesterol: 0.07 mmol/L (p < 0.001)] and ‘Light Movers’ [HDL-cholesterol: 0.11 mmol/L (p = 0.004)] had more favourable health markers. The continuous analyses showed consistency with the categorical analyses and the sensitivity analyses indicated robustness and stability. Conclusions In this national sample of English adults, being physically active was associated with a better health profile, even in those with concomitant high sedentary time. Low sedentary time independent of physical activity had a positive association with HDL-cholesterol.
    Full-text · Article · Dec 2015 · BMC Public Health
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of the study was to evaluate the effect of delay in treatment intensification (IT; clinical inertia) in conjunction with glycaemic burden on the risk of macrovascular events (CVE) in type 2 diabetes (T2DM) patients. A retrospective cohort study was carried out using United Kingdom Clinical Practice Research Datalink, including T2DM patients diagnosed from 1990 with follow-up data available until 2012. In the cohort of 105,477 patients mean HbA1c was 8.1% (65 mmol/mol) at diagnosis, 11% had a history of cardiovascular disease, and 7.1% experienced at least one CVE during 5.3 years of median follow-up. In patients with HbA1c consistently above 7/7.5% (53/58 mmol/mol, n = 23,101/11,281) during 2 years post diagnosis, 26/22% never received any IT. Compared to patients with HbA1c <7% (<53 mmol/mol), in patients with HbA1c ≥7% (≥53 mmol/mol), a 1 year delay in receiving IT was associated with significantly increased risk of MI, stroke, HF and composite CVE by 67% (HR CI: 1.39, 2.01), 51% (HR CI: 1.25, 1.83), 64% (HR CI: 1.40, 1.91) and 62% (HR CI: 1.46, 1.80) respectively. One year delay in IT in interaction with HbA1c above 7.5% (58 mmol/mol) was also associated with similar increased risk of CVE. Among patients with newly diagnosed T2DM, 22% remained under poor glycaemic control over 2 years, and 26% never received IT. Delay in IT by 1 year in conjunction with poor glycaemic control significantly increased the risk of MI, HF, stroke and composite CVE.
    Full-text · Article · Dec 2015 · Cardiovascular Diabetology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Access to raw acceleration data should facilitate comparisons between accelerometer outputs regardless of monitor brand. Purpose: To evaluate the accuracy of posture classification using the Sedentary Sphere in data from two widely-used wrist-worn triaxial accelerometers. Methods: Laboratory: 34 adults wore a GENEActiv and an ActiGraph GT3X+ on their non-dominant wrist while performing four lying, seven sitting and five upright activities. Free-living: The same participants wore both accelerometers on their non-dominant wrist and an activPAL3 on their right thigh during waking hours for two days. Results: Laboratory: Using the Sedentary Sphere with 15-s epoch GENEActiv data, sedentary and upright postures were correctly identified 74% and 91% of the time, respectively. Corresponding values for the ActiGraph data were 75% and 90%. Free-living: Total sedentary time was estimated at 534±144 min, 523±143 min and 528±137 min by the activPAL, the Sedentary Sphere with GENEActiv data and with ActiGraph data, respectively. The mean bias, relative to the activPAL, was small with moderate limits of agreement (LoA) for both the GENEActiv (mean bias = -12.5 min, LoA = -117 to 92 min) and ActiGraph (mean bias = -8 min, LoA = -103 to 88 min). Strong intra-class correlations (ICC) were evident for the activPAL with the GENEActiv (0.93, 0.84-0.97 (95% confidence interval) and the ActiGraph (0.94, 0.86-0.97). Agreement between the GENEActiv and ActiGraph posture classifications was very high (ICC = 0.98 (0.94-0.99), mean bias = +3 min, LoA = -58 to 63 min). Conclusion: These data support the efficacy of the Sedentary Sphere for classification of posture from a wrist-worn accelerometer in adults. Importantly, the approach is equally valid with data from both the GENEActiv and ActiGraph accelerometers.
    No preview · Article · Nov 2015 · Medicine and science in sports and exercise
  • Source
    L S Levene · R Baker · K Khunti · M J G Bankart
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: In England, coronary heart disease (CHD) mortality has declined, but variations remain. Methods: This study aimed to describe under 75-year CHD mortality variations across geographically defined populations. Regression slopes for mortality data as a function of time were calculated for all 151 English primary care trusts (PCTs), giving the change in the expected age adjusted rate for each extra year. Results: Between 1993 and 2010, the mean age-standardized CHD mortality rate decreased from 107.76 to 35.12 per 100 000, but the coefficient of variation increased from 0.21 to 0.27. The slope of decline was significantly less after 2004 (β -4.91 for 1993-2003, -3.04 for 2004-2010). The proportion of smokers decreased by 24.6%. The estimated proportion of the population with controlled hypertension increased by 74.4% (2003-2010), but diabetes increased by 138% (1994-2010) and the proportion of obese people increased by 74.3% (1993-2010). There was a greater decline in CHD mortality in PCTs with greater deprivation and smoking (2006-2010). Conclusions: Since 2004, there has not been a relative reduction of variations in CHD mortality. Appropriate strategies to improve early detection and effective management of risk factors are needed to lower overall CHD mortality further and to reduce persistent variations across England.
    Preview · Article · Nov 2015 · Journal of Public Health
  • Simon Heller · Stephanie A. Amiel · Kamlesh Khunti

    No preview · Article · Nov 2015 · Diabetes research and clinical practice
  • Source
    Nuzhat Ashra · Melanie Davies · Kamlesh Khunti · Laura Gray

    Preview · Article · Nov 2015 · Trials
  • Kamlesh Khunti · Danielle H Bodicoat · Melanie J Davies

    No preview · Article · Nov 2015 · The Lancet Diabetes & Endocrinology
  • Zin Zin Htike · David Webb · Kamlesh Khunti · Melanie Davies

    No preview · Article · Nov 2015
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background The prevalence of chronic kidney disease (CKD) is high in general populations around the world. Targeted testing and screening for CKD are often conducted to help identify individuals that may benefit from treatment to ameliorate or prevent their disease progression. Aims This systematic review examines the methods used in economic evaluations of testing and screening in CKD, with a particular focus on whether test accuracy has been considered, and how analysis has incorporated issues that may be important to the patient, such as the impact of testing on quality of life and the costs they incur. Methods Articles that described model-based economic evaluations of patient testing interventions focused on CKD were identified through the searching of electronic databases and the hand searching of the bibliographies of the included studies. Results The initial electronic searches identified 2,671 papers of which 21 were included in the final review. Eighteen studies focused on proteinuria, three evaluated glomerular filtration rate testing and one included both tests. The full impact of inaccurate test results was frequently not considered in economic evaluations in this setting as a societal perspective was rarely adopted. The impact of false positive tests on patients in terms of the costs incurred in re-attending for repeat testing, and the anxiety associated with a positive test was almost always overlooked. In one study where the impact of a false positive test on patient quality of life was examined in sensitivity analysis, it had a significant impact on the conclusions drawn from the model. Conclusion Future economic evaluations of kidney function testing should examine testing and monitoring pathways from the perspective of patients, to ensure that issues that are important to patients, such as the possibility of inaccurate test results, are properly considered in the analysis.
    Preview · Article · Oct 2015 · PLoS ONE

Publication Stats

7k Citations
1,519.49 Total Impact Points

Institutions

  • 1997-2015
    • University of Leicester
      • Department of Health Sciences
      Leiscester, England, United Kingdom
  • 2013
    • University of Surrey
      • Department of Health Care Management and Policy
      Guilford, England, United Kingdom
  • 2008-2012
    • University Hospitals Of Leicester NHS Trust
      • Department of Diabetes and Endocrinology
      Leiscester, England, United Kingdom
  • 2001
    • The University of Warwick
      • Warwick Medical School (WMS)
      Coventry, England, United Kingdom