Diabetes

Managing diabetes during the COVID-19 pandemic (2020)

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Type of publication:
Journal article

Author(s):
*Morris, David

Citation:
Practice Nursing; Nov 2020; vol. 31 (no. 11); p. 450-455

Abstract:
People with diabetes are known to be more severely affected by COVID-19 than the general population. David
Morris provides an overview of how to manage the illness in this group The outbreak of a new viral infection in
Wuhan, a city in Habei Province, China, became evident in December 2019. For most individuals who contract
COVID-19 the disease is mild to moderate. Older people are disproportionately affected with serious disease,
while children appear less likely to experience serious illness. A number of conditions are linked to increased
severity of disease and poorer outcomes including both type 1 and type 2 diabetes. This article looks at why
those with diabetes are at higher risk, and how to manage diabetes during the pandemic.

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Managing diabetes in primary care during Ramadan (2020)

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Type of publication:
Journal article

Author(s):
*Morris, David

Citation:
Practice Nursing; Apr 2020; vol. 31 (no. 4); p. 148-154

Abstract:
Individuals with diabetes may wish to fast during the holy month of Ramadan. David Morris provides an overview of the key considerations for practice nurses helping people with diabetes to manage their condition Ramadan is the holiest month of the Islamic calendar, during which healthy adult Muslims fast. Vulnerable people with diabetes can be exempted from fasting during Ramadan; however, many Muslims with diabetes feel strongly committed to observing Ramadan. The adoption of fasting together with alteration of mealtimes, sleeping arrangements and exercise, places physiological demands on the individual that are likely to be greater in those with diabetes. Health professionals involved in the care of these patients need to offer timely advice on the risks associated with fasting in those with diabetes and, where fasting is planned, support and empower these individuals.

SGLT2 inhibitors - moving on with the evidence (2019)

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Type of publication:
Journal article

Author(s):
*Morris, David

Citation:
Journal of Diabetes Nursing; Jun 2019; vol. 23 (no. 4); p. 1-9

Abstract:
The evidence base on the benefits and risks of using sodium-glucose cotransporter 2 (SGLT2) inhibitors for the management of hyperglycaemia has grown in recent years, with data showing potential cardiovascular and renal benefits, along with safety concerns that warrant cautious use and monitoring in certain users. This article reviews the benefits and difficulties associated with the use of SGLT2 inhibitors in people with type 2 diabetes and, potentially, type 1 diabetes.

1200-P: Diabetes. Predictors of glycaemic and weight gain response to empagliflozin treatment: The ABCD Nationwide Empagliflozin Audit. (2019)

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Type of publication:
Poster presentation

Author(s):
Thong K, Chung-wah-Cheong J, Yadagiri M, Cull ML, Bickerton A, Phillips SM, Evans A, Sennik DK, Rohilla A, Reid H, *Morris DS, Atkin M, Robinson AM, Williams DM, Stephens JW, Adamson K, Gallen IW, Ryder RE.

Citation:
Diabetes 2019 Jun; 68 (Supplement 1)

Abstract:
Introduction: We investigated clinical parameters that are potentially associated with improved empagliflozin treatment response.

Methods: We obtained data from a large-scale audit of empagliflozin use in the UK. We analyzed the association between patients’ baseline age, HbA1c, weight, diabetes duration, alanine aminotransferase (ALT), sex, chronic kidney disease (CKD) stage, empagliflozin dose (25 vs. 10mg), use of GLP-1RAs and use of insulin with HbA1c and weight changes at 26 weeks of treatment.

Results: Among 1436 patients, HbA1c reduced by, mean[95% CI], 1.35%[1.27,1.42] (p<0.0001) from a baseline of, mean±SD, 9.41±1.41%. Among 1381 patients, weight reduced by 3.6 kg[3.3,3.9] (p<0.0001) from a baseline of 100.2±20.7 kg. Results of univariate analyses are shown in Table 1. In multivariate analysis, higher baseline HbA1c (p<0.0001), lower CKD stage (p=0.002) and higher ALT (log transformed)(p=0.02) were associated with greater HbA1c reduction. Higher baseline weight (p<0.001) and non-insulin use (p<0.0001) were associated with greater weight reduction.

Conclusion: As expected, HbA1c reduction was associated with baseline HbA1c and background renal function, while weight reduction was associated with baseline weight. The interactions between HbA1c reduction and ALT levels, and weight reduction with insulin treatment status warrant further investigations.

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1201-P: Characteristics and Treatment Outcomes of Patients Treated with Empagliflozin in the ABCD Nationwide Empagliflozin Audit (2019)

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Type of publication:
Poster presentation

Author(s):
Thong K, Chung-wah-Cheong J, Yadagiri M, Cull ML, Bickerton A, Phillips SM, Evans A, Sennik DK, Rohilla A, Reid H, *Morris DS, Atkin M, Robinson AM, Williams DM, Stephens JW, Adamson K, Gallen IW, Ryder RE.

Citation:
Diabetes 2019 Jun; 68 (Supplement 1)

Abstract:

Introduction: We investigated characteristics and treatment outcomes of patients treated with empagliflozin in a large-scale audit of routine clinical practice in the UK.

Methods: Data was obtained from the Association of British Clinical Diabetologists Nationwide Empagliflozin Audit. Between December 2014 to September 2018, multiple sites submitted data through 10 major centers on 1947 patients with at least one follow-up visit after empagliflozin initiation.

Results: Baseline characteristics of patients were, mean±SD, age 59.9±9.9 years, diabetes duration 6.4±5.4 years, HbA1c 9.41±1.43%, weight 99.6±20.8 years, BMI 33.6±9.1 kg/m2and 62.1% were male. Proportion of use of empagliflozin 25mg (vs. 10mg), GLP-1 receptor agonist, and insulin were 63.7%, 13.7% and 20.1%, respectively. There were 44.9%, 49.9%, 5.1% and 0.1% of patients with eGFR>90, 60-89, 45-59 and <45 ml/min/1.73m2, respectively. By 26 weeks, treatment with empagliflozin was associated with, mean±SD, HbA1c reduction of 1.35±1.49% (p<0.0001), weight reduction of 3.6±5.1 kg (p<0.0001) and systolic blood pressure reduction of 5±14 mmHg (p<0.0001).

Conclusions: An audit of empagliflozin use in the UK revealed poorly controlled diabetes being frequently encountered in practice in contrast to randomized clinical trials. There was a preponderance of empagliflozin 25mg dose use, disproportionate prescribing to men rather than women, and frequent co-prescription with GLP-1 receptor agonists and insulin. The audit showed excellent adherence to prescribing guidelines in relation to avoiding empagliflozin use in patients with eGFR<45 ml/min/1.73m2. There was similar treatment efficacy with empaglilfozin as was seen in clinical trials.

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Ketoacidosis in patients on SGLT2 inhibitor: Experience from a district general hospital (2019)

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Type of publication:
Conference abstract

Author(s):
*Kandaswamy L.; *Al-Salihi A.; *Singh P.K.; *Rangan S.; *Moulik P.K.

Citation:
Diabetic Medicine; Mar 2019; vol. 36 ; p. 174

Abstract:
Introduction: European Medicines Agency recognised diabetic ketoacidosis (DKA) as a rare and serious side effect of SGLT2 inhibitors (SGLT-2i). In six months, five cases of DKA in Type 2 diabetes on SGLT-2i were diagnosed at Royal Shrewsbury hospital. Case reports: Case 1: A 63 year old lady on metformin, dapagloflozin, gliclazide with HbA1c-102mmol/mol presented with nausea, vomiting and breathlessness was treated for DKA and pneumonia with pH 7.24, blood sugar-16mmol/l, bicarbonate-17 and ketones-3.6. Case 2: A 61 year old lady on liraglutide, gliclazide, canagliflozin with HbA1c 98mmol/mol presented with nausea, vomiting and polyuria had pH 6.9, blood sugar-16.4mmol/l, bicarbonate-<3 and ketones-5.4. Cases 3, 4 and 5: Patients established on insulin treatment with compliance issues (significantly reducing and missing insulin) had DKA. One of them had associated infection.
Discussion(s): Infection predisposed to DKA in two patients. Two patients had long duration of diabetes and poorly controlled glucose on maximum oral therapy indicating reduced beta cell reserve and three were already on insulin but reduced or missed the doses. All patients were treated according to DKA protocol and made full recovery, SGLT2i was stopped and insulin commenced in two of them and continued with others. Sick day rules emphasised.
Conclusion(s): SGLT2i lowers plasma glucose through glycosuria and promotes ketogenesis. Declining beta cell reserve with increasing duration of diabetes and relative insulin deficiency at the time of stress increases the risk of DKA. Patients on SGLT-2I should be educated of these risks particularly when they have a long duration of diabetes and are established in insulin therapy.

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