We present a case of type 1 diabetes (T1DM) in a middle-aged Caucasian woman who initially presented with phenotypic characteristics of type 2 diabetes (T2DM) and whose type 2 phenotype contributed to accelerated progression of T1DM. This case illustrates the challenges in making a clinical diagnosis of T1DM in patients who also have phenotypic features of T2DM. Recognising such presentations is important in order to make the correct diagnosis and potentially to offer immunotherapy-based interventions while beta cell function is still relatively well preserved.
{"title":"Type 1 diabetes presenting initially as type 2 diabetes which remitted with lifestyle change","authors":"Ahmed Ali, Andrew Macklin, Adam Nicholls","doi":"10.15277/bjd.2025.489","DOIUrl":"https://doi.org/10.15277/bjd.2025.489","url":null,"abstract":"We present a case of type 1 diabetes (T1DM) in a middle-aged Caucasian woman who initially presented with phenotypic characteristics of type 2 diabetes (T2DM) and whose type 2 phenotype contributed to accelerated progression of T1DM. This case illustrates the challenges in making a clinical diagnosis of T1DM in patients who also have phenotypic features of T2DM. Recognising such presentations is important in order to make the correct diagnosis and potentially to offer immunotherapy-based interventions while beta cell function is still relatively well preserved.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjd-abcd.com/index.php/bjd/article/download/1373/1803","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147917949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Post-transplantation diabetes mellitus (PTDM) is a common complication seen after kidney transplantation and is associated with adverse outcomes. There is a lack of robust evidence-based medicine to guide clinical decision making in the prevention or management of PTDM. Despite the availability of professional society guidelines and expert consensus reports, this paucity of data translates into clinical challenges in day- to-day practice for transplant and diabetes professionals. In this article, four common clinical scenarios associated with PTDM are discussed which offer advice for bridging the gap between evidence- based guidelines and real-world practice.
{"title":"Post-transplantation diabetes: clinical challenges","authors":"Adnan Sharif","doi":"10.15277/bjd.2025.483","DOIUrl":"https://doi.org/10.15277/bjd.2025.483","url":null,"abstract":"Post-transplantation diabetes mellitus (PTDM) is a common complication seen after kidney transplantation and is associated with adverse outcomes. There is a lack of robust evidence-based medicine to guide clinical decision making in the prevention or management of PTDM. Despite the availability of professional society guidelines and expert consensus reports, this paucity of data translates into clinical challenges in day- to-day practice for transplant and diabetes professionals. In this article, four common clinical scenarios associated with PTDM are discussed which offer advice for bridging the gap between evidence- based guidelines and real-world practice.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":"25 1","pages":"50-53"},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://bjd-abcd.com/index.php/bjd/article/download/1391/1769","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147892785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Santo Colosimo, Yue Ruan, Alistair Lumb, Rustam Rea, Paula McDonald, Stephen C. Bain, Ralph Abraham, Ian Gallen, Robert E. J. Ryder
Insulin degludec is a long-acting basal insulin analog that is used as a single daily injection in people living with type 2 diabetes (T2DM) or in combination with rapid-acting analogs in basal-bolus regimens in people living with T2DM or type 1 diabetes (T1DM). Registration studies showed benefits of reduction of hypoglycaemia rate and severity compared to previously available long-acting insulins. The Association of British Clinical Diabetologists nationwide clinical audit of insulin degludec is a real-world data program which includes a secondary care prospective data collection and a primary care retrospective data collection. Data were used to investigate the effects of degludec initiation in people living with T1DM or T2DM on hypoglycaemia rate and severity, change in haemoglobin A1c (HbA1c) and weight change. From the secondary care prospective and the primary care retrospective data 432 (of whom T1DM=273) and 3,513 (of whom T1DM=2,040) patients, respectively, were included in the analysis. HbA1c change was non-significant in people with T1DM and T2DM who were switched to insulin degludec due to hypoglycaemia in the secondary care cohort. A significant reduction of 3 and 10 mmol/mol was observed in people with T1DM and T2DM, respectively, when the switch to degludec was prompted by reasons other than hypoglycaemia, and in people with T1DM this was also associated with a 2.5 kg weight gain. There was a clinically significant reduction in minor, severe and nocturnal hypoglycaemia in 62%, 45% and 54% of T1DM and in minor hypoglycaemia in 44% of T2DM in the prospective cohort. Insulin degludec reduced HbA1c in people with diabetes who were started for non-hypoglycaemia reasons and in people in the retrospective cohort. The extent of reduction in HbA1c was similar in both cohorts, even after stratification for T1DM and T2DM. Overall, insulin degludec resulted in lower HbA1c and modest weight gain in people starting for non- hypoglycaemia reasons and lower hypoglycaemia without any change in HbA1c or weight in people switching due to hypoglycaemia.
{"title":"Exploratory outcomes of the use of insulin degludec in the real world: data from the Association of British Clinical Diabetologists nationwide degludec audit","authors":"Santo Colosimo, Yue Ruan, Alistair Lumb, Rustam Rea, Paula McDonald, Stephen C. Bain, Ralph Abraham, Ian Gallen, Robert E. J. Ryder","doi":"10.15277/bjd.2024.448","DOIUrl":"https://doi.org/10.15277/bjd.2024.448","url":null,"abstract":"Insulin degludec is a long-acting basal insulin analog that is used as a single daily injection in people living with type 2 diabetes (T2DM) or in combination with rapid-acting analogs in basal-bolus regimens in people living with T2DM or type 1 diabetes (T1DM). Registration studies showed benefits of reduction of hypoglycaemia rate and severity compared to previously available long-acting insulins. The Association of British Clinical Diabetologists nationwide clinical audit of insulin degludec is a real-world data program which includes a secondary care prospective data collection and a primary care retrospective data collection. Data were used to investigate the effects of degludec initiation in people living with T1DM or T2DM on hypoglycaemia rate and severity, change in haemoglobin A1c (HbA1c) and weight change. From the secondary care prospective and the primary care retrospective data 432 (of whom T1DM=273) and 3,513 (of whom T1DM=2,040) patients, respectively, were included in the analysis. HbA1c change was non-significant in people with T1DM and T2DM who were switched to insulin degludec due to hypoglycaemia in the secondary care cohort. A significant reduction of 3 and 10 mmol/mol was observed in people with T1DM and T2DM, respectively, when the switch to degludec was prompted by reasons other than hypoglycaemia, and in people with T1DM this was also associated with a 2.5 kg weight gain. There was a clinically significant reduction in minor, severe and nocturnal hypoglycaemia in 62%, 45% and 54% of T1DM and in minor hypoglycaemia in 44% of T2DM in the prospective cohort. Insulin degludec reduced HbA1c in people with diabetes who were started for non-hypoglycaemia reasons and in people in the retrospective cohort. The extent of reduction in HbA1c was similar in both cohorts, even after stratification for T1DM and T2DM. Overall, insulin degludec resulted in lower HbA1c and modest weight gain in people starting for non- hypoglycaemia reasons and lower hypoglycaemia without any change in HbA1c or weight in people switching due to hypoglycaemia.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":"24 1","pages":"45-50"},"PeriodicalIF":0.0,"publicationDate":"2024-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.bjd-abcd.com/index.php/bjd/article/download/1101/1537","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147914865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amy Elizabeth Morrison, Dabean Faraj, Marie-France Kong
{"title":"Congenital hyperinsulinism: a family case report","authors":"Amy Elizabeth Morrison, Dabean Faraj, Marie-France Kong","doi":"10.15277/bjd.2023.422","DOIUrl":"https://doi.org/10.15277/bjd.2023.422","url":null,"abstract":"","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":"51 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138965188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fibrates have been in use to modify serum lipids since the 1960s. This review seeks to ascertain their present place in lipid-modifying therapy and prevention of cardiovascular disease, particularly in type 2 diabetes (T2DM).
{"title":"Fibrates: past history or renaissance?","authors":"Robert Elkeles","doi":"10.15277/bjd.2023.415","DOIUrl":"https://doi.org/10.15277/bjd.2023.415","url":null,"abstract":"Fibrates have been in use to modify serum lipids since the 1960s. This review seeks to ascertain their present place in lipid-modifying therapy and prevention of cardiovascular disease, particularly in type 2 diabetes (T2DM).","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":" 4","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138994767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Homelessness is a significant public health concern, with a substantial homeless population in England. Homeless individuals face unique challenges, including a heightened risk of violence, inadequate nutrition, limited healthcare access and increased prevalence of co-morbidities. Type 2 diabetes (T2DM) is notably more prevalent among homeless individuals compared to the general population, leading to higher rates of diabetes-related emergency department visits and hospitalisations. There is limited research examining diabetes management specifically in homeless populations, and a comprehensive review addressing the barriers and targeted interventions for this vulnerable group is currently lacking. This article aims to explore the health inequalities experienced by homeless individuals in relation to T2DM management, and to evaluate the Housing First approach as a potential intervention. Housing First, which provides immediate access to permanent housing, has demonstrated efficacy in enhancing housing stability and healthcare behaviours among homeless populations. Moreover, the available evidence suggests that Housing First programmes may improve diabetes-related outcomes, including HbA1c testing and medication adherence, and may lead to fewer hospitalisations.
{"title":"Type 2 diabetes management in the homeless population: health inequality and the Housing First approach","authors":"Fee Benz","doi":"10.15277/bjd.2023.421","DOIUrl":"https://doi.org/10.15277/bjd.2023.421","url":null,"abstract":"Homelessness is a significant public health concern, with a substantial homeless population in England. Homeless individuals face unique challenges, including a heightened risk of violence, inadequate nutrition, limited healthcare access and increased prevalence of co-morbidities. Type 2 diabetes (T2DM) is notably more prevalent among homeless individuals compared to the general population, leading to higher rates of diabetes-related emergency department visits and hospitalisations. There is limited research examining diabetes management specifically in homeless populations, and a comprehensive review addressing the barriers and targeted interventions for this vulnerable group is currently lacking. This article aims to explore the health inequalities experienced by homeless individuals in relation to T2DM management, and to evaluate the Housing First approach as a potential intervention. Housing First, which provides immediate access to permanent housing, has demonstrated efficacy in enhancing housing stability and healthcare behaviours among homeless populations. Moreover, the available evidence suggests that Housing First programmes may improve diabetes-related outcomes, including HbA1c testing and medication adherence, and may lead to fewer hospitalisations.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":"95 ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139174712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Hybrid closed-loop therapy: the calm before the storm","authors":"Tom Crabtree","doi":"10.15277/bjd.2023.426","DOIUrl":"https://doi.org/10.15277/bjd.2023.426","url":null,"abstract":"","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":"85 ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139173791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kevin Drew, Catherine Homer, Duncan Radley, Charlotte Freeman, Karina Kinsella, Maria Maynard, C. Bakhai, Louisa J Ells
Background: Obesity and type 2 diabetes (T2DM) can both profoundly impact health and wellbeing. Their prevalence largely follows a social gradient. The National Health Service Low Calorie Diet programme in England aims to support people to achieve T2DM remission while also reducing health inequalities. We aimed to explore the experiences of local health service leads and identify barriers and facilitators in relation to the equitable mobilisation of the Low Calorie Diet programme. Methods: Twenty semi-structured interviews were completed with 24 locality leads across the first two years of the Low Calorie Diet programme. Interviewees were purposively sampled from the 10 localities who undertook the Low Calorie Diet programme pilot. Each interview explored a number of topics of interest, including referrals, training, communication, incentivisation, governance and engagement, before being subjected to a thematic analysis. Results: From the data, seven core themes were identified: COVID-19 and primary care capacity and engagement; methods of communication; approaches to training; approaches to incentivisation; approaches to referrals; barriers to referrals; and the importance of collaboration. COVID-19 presented a specific challenge to the mobilisation and delivery of the Low Calorie Diet programme; however, our findings demonstrate the large variation and differences in the approaches taken when delivering the programme across 10 geographically and demographically distinct pilot sites. We also identified a lack of a recognised approach or strategy to mobilisation and delivery support for the Low Calorie Diet programme, such as proportionate universalism, which is a social policy response to tackling health inequalities by ensuring that service delivery is equitable. Conclusions: Health inequalities remain a significant challenge, and health service leads have the potential to adopt an equity perspective from the start of programme mobilisation. In doing so, resources at their disposal can be managed equitably and can therefore contribute to efforts to reduce the potential occurrence of intervention-generated inequalities.
{"title":"Equity and local health systems: a qualitative evaluation of the experiences of local health service leads during the first two years of the NHS Low Calorie Diet programme pilot","authors":"Kevin Drew, Catherine Homer, Duncan Radley, Charlotte Freeman, Karina Kinsella, Maria Maynard, C. Bakhai, Louisa J Ells","doi":"10.15277/bjd.2023.416","DOIUrl":"https://doi.org/10.15277/bjd.2023.416","url":null,"abstract":"Background: Obesity and type 2 diabetes (T2DM) can both profoundly impact health and wellbeing. Their prevalence largely follows a social gradient. The National Health Service Low Calorie Diet programme in England aims to support people to achieve T2DM remission while also reducing health inequalities. We aimed to explore the experiences of local health service leads and identify barriers and facilitators in relation to the equitable mobilisation of the Low Calorie Diet programme. Methods: Twenty semi-structured interviews were completed with 24 locality leads across the first two years of the Low Calorie Diet programme. Interviewees were purposively sampled from the 10 localities who undertook the Low Calorie Diet programme pilot. Each interview explored a number of topics of interest, including referrals, training, communication, incentivisation, governance and engagement, before being subjected to a thematic analysis. Results: From the data, seven core themes were identified: COVID-19 and primary care capacity and engagement; methods of communication; approaches to training; approaches to incentivisation; approaches to referrals; barriers to referrals; and the importance of collaboration. COVID-19 presented a specific challenge to the mobilisation and delivery of the Low Calorie Diet programme; however, our findings demonstrate the large variation and differences in the approaches taken when delivering the programme across 10 geographically and demographically distinct pilot sites. We also identified a lack of a recognised approach or strategy to mobilisation and delivery support for the Low Calorie Diet programme, such as proportionate universalism, which is a social policy response to tackling health inequalities by ensuring that service delivery is equitable. Conclusions: Health inequalities remain a significant challenge, and health service leads have the potential to adopt an equity perspective from the start of programme mobilisation. In doing so, resources at their disposal can be managed equitably and can therefore contribute to efforts to reduce the potential occurrence of intervention-generated inequalities.","PeriodicalId":42951,"journal":{"name":"British Journal of Diabetes","volume":"83 ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139173068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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