Endocrinology and Diabetes

GLP-1 receptor agonists in type 2 diabetes: An underused asset? (2020)

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Type of publication:
Journal article

Author(s):
*Morris, David

Citation:
Journal of Diabetes Nursing; Aug 2020; vol. 24 (no. 5); p. 1-11

Abstract:
As our understanding of the incretin hormone system has increased, a number of drugs targeting this system have been developed. The realisation of this potential has developed rapidly, and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are now a standard feature in management guidelines for type 2 diabetes. This article reviews the operation of the incretin system and the mechanism by which GLP-1 RAs act to provide benefit in type 2 diabetes. The availability and indications for use of the GLP-1 RAs, and their clinical benefits and disadvantages, are summarised. The position of GLP-1 RAs in the management of type 2 diabetes is discussed pragmatically, with reference to various key guidelines.

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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