Pancreatic beta-cell secretory products in the diagnosis and risk stratification of gestational diabetes mellitus: a prospective longitudinal cohort study.

Introduction: Gestational diabetes mellitus (GDM) is common in pregnancy and is increasing in prevalence. It is associated with an increased risk of maternal and perinatal complications if not diagnosed and managed early. Most guidelines suggest making a diagnosis of GDM using an oral glucose tolerance test (OGTT) between 24 and 28 weeks of pregnancy at which stage there still is an increased risk of complications.

The Use of Non-i nvasive Biomarkers to Screen for Advanced Fibrosis Associated with Metabolic Dysfunction-associated Steatotic Liver Disease in People with Type 2 Diabetes: A Narrative Review.

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, advanced hepatic fibrosis and hepatocellular carcinoma. As such, various international bodies now advocate for routine screening for MASLD-related hepatic fibrosis in people with such risk factors.

A red nodule in the umbilicus of an older man.

This case report describes an interesting example of a syringocystadenoma papilliferum lesion presenting in a 72-year-old man. He presented with a 10-month history of a red nodule in his umbilicus with unexplained weight loss and reduced appetite. The patient had a background of chronic obstructive pulmonary disease, treated prostate cancer and pemphigus vulgaris that had previously been treated with azathioprine.

Assessing glycaemic impact of FreeStyle libre monitoring in patients with insulin-treated type 2 diabetes: a retrospective real-world analysis.

Objectives: 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 from using FSL, specifically improved glycaemic control and reduced hypoglycaemia.

Removing barriers to management of adults with type 2 diabetes on insulin using continuous glucose monitoring in UK primary care practice: An expert consensus.

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 within this frontline healthcare setting, along with major challenges and opportunities associated with managing these changes effectively.

Methods: The authors participated in two primary care consensus panels held on 28 November 2023 and on 21 May 2024.

Metformin Use and Vitamin B12 Deficiency in People with Type 2 Diabetes. What Are the Risk Factors? A Mini-systematic Review.

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.

Flash Glucose Monitoring is Associated with HbA1c Improvement in Type 2 Diabetes Managed with Multiple Daily Injections of Insulin in the UK: A Retrospective Observational Study.

Introduction: 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.

Methods: A retrospective observational study using data from ten clinical centres in the UK for adults with T2DM treated with multiple daily injections of insulin for at least 1 year was conducted.

Benefits in routinely measured liver function tests following bariatric surgery: a retrospective cohort study.

Background: 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.

Methods: One hundred patients who underwent bariatric surgery between 2007 and 2014 were included, and changes in liver enzymes, anthropometric measures and other parameters were observed over a mean 9.

Artificial Intelligence for Radiotherapy Auto-Contouring: Current Use, Perceptions of and Barriers to Implementation.

Aims: Artificial intelligence has the potential to transform the radiotherapy workflow, resulting in improved quality, safety, accuracy and timeliness of radiotherapy delivery. Several commercially available artificial intelligence-based auto-contouring tools have emerged in recent years. Their clinical deployment raises important considerations for clinical oncologists, including quality assurance and validation, education, training and job planning.

Glucagon-like Peptide-1 Receptor Analogues for the Treatment of Obesity.

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 receptor analogues (GLP-1RAs) are licensed for the treatment of type 2 diabetes (T2D), and there is substantial evidence that these drugs not only improve cardiovascular outcomes but also promote weight loss.

Changing practice to using pre-filled syringes for flushing IV cannulas.

In the UK, the Medicines and Healthcare products Regulatory Agency classifies 'pre-filled syringes' for flushing Intravenous (IV) cannulas and IV access devices as 'borderline' devices and offers some advice on how control measures can help mitigate risks. The Medicines Act (1968) and Medical Device Regulations try to address the legal position of these devices and allow each employer to identify those groups of staff allowed to use them. In turn, this may help address anomalies around the need to prescribe and document their use.

Survey of fertility counselling provision in UK licensed treatment centres during the first phase of the COVID-19 pandemic.

A survey of UK fertility counsellors' experiences of the impact on their service, including its availability, during the first phase of the COVID-19 pandemic in the spring of 2020 received 64 responses. Fifty three respondents had continued to provide a service. Forty now worked from a wholly/substantially different location to normal but many clinics provided no practical support for this ( = 17), or remote access to relevant clinic ( = 17) or client information ( = 12) and twenty five respondents reported reduced multi-disciplinary involvement.

Real-World Clinical Experience of Semaglutide in Secondary Care Diabetes: A Retrospective Observational Study.

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 in Wales.

Methods: A retrospective evaluation of 189 patients with T2D initiated on semaglutide between January 2019 and June 2020 with at least one follow-up visit was undertaken.

The Role of Tirzepatide, Dual GIP and GLP-1 Receptor Agonist, in the Management of Type 2 Diabetes: The SURPASS Clinical Trials.

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 thought to have no potential as a glucose-lowering therapy because of observations showing no insulinotropic effect from supraphysiological infusion in people with T2DM. However, emerging evidence has illustrated that co-infusion of GLP-1 and GIP has a synergetic effect, resulting in significantly increased insulin response and glucagonostatic response, compared with separate administration of each hormone.

Safety of injectable semaglutide for type 2 diabetes.

Introduction: Semaglutide is the most recently approved injectable glucagon-like peptide-1 receptor agonist (GLP-1RA) for people with type 2 diabetes (T2DM). It is one of the three currently marketed GLP-1RAs that can be administered once weekly.

Areas Covered: This review focusses on the safety of injectable semaglutide.

Cost-effectiveness of biennial screening for diabetes related retinopathy in people with type 1 and type 2 diabetes compared to annual screening.

Objective: Examine the health and economic impact of extending screening intervals in people with Type 2 diabetes (T2DM) and Type 1 diabetes (T1DM) without diabetes-related retinopathy (DR).

Setting: Diabetic Eye Screening Wales (DESW).

Study Design: Retrospective observational study with cost-utility analysis (CUA) and Decremental Cost-Effectiveness Ratios (DCER) study.

Non-invasive molecular assessment of human embryo development and implantation potential.

In vitro fertilization (IVF) is the most common assisted reproductive technology used to treat infertility. Embryo selection for transfer in IVF cycles relies on the morphological evaluation by embryologists, either by conventional microscopic assessment or more recently by time-lapse imaging systems. Despite the introduction of time-lapse imaging improvements in IVF success rates have failed to materialize, therefore alternative approaches are needed.

The Effect of Glucagon-Like Peptide-1 Receptor Agonists on Renal Outcomes in Type 2 Diabetes.

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). GLP-1RAs are proven to be safe in terms of CVD, and some of them have been shown to have a beneficial effect on cardiovascular outcomes.

Rapid cancer diagnosis for patients with vague symptoms: a cost-effectiveness study.

Background: A pilot rapid diagnosis centre (RDC) allows GPs within targeted clusters to refer adults with vague and/or non-specific symptoms suspicious of cancer, who do not meet criteria for referral under an urgent suspected cancer (USC) pathway, to a multidisciplinary RDC clinic where they are seen within 1 week.

Aim: To explore the cost-effectiveness of the RDC compared with standard clinical practice.

Design And Setting: Cost-effectiveness modelling using routine data from Neath Port Talbot Hospital, Wales.