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Publication Predictors of response to injectable once weekly Semaglutide: Insights from the association of British Clinical Diabetologists Nationwide Audit(Wiley, 2024-04-16) Field, Benjamin; Crabtree, Tom; Adamson, Karen; Bickerton, Alex; Evans, Alison; Phillips, Suzanne; Gallagher, Alison; Dhatariya, Ketan; Idris, Iskander; Ryder, Robert; Evans, Alison; Phillips, Suzanne; Medical and DentalIntroduction: Trials have observed individual differences in response to glucagon-like peptide-1 receptor agonists (GLP1RA) according to baseline characteristics. The ABCD audit launched in January 2019 to assess the clinical utility, efficacy and safety of injectable Semaglutide in routine practice. The aim of this analysis was to explore which baseline characteristics might predict larger weight or HbA1c reductions in the real-world. Methods: Data were extracted from the secure online tool and individuals with baseline and follow-up data available within a defined six (3–9) month window were included. Variables were assessed as both continuous variables and categorical variables in a multivariate regression model. Missing data were multiply imputed. Results: Six hundred twenty individuals with baseline (mean ± SD) age 58.7 ± 10.7 years, HbA1c 81.6 ± 18.5 mmol/mol (9.5 ± 1.7%), weight 108.2 ± 24.2 kg and BMI 37.6 ± 7.6 kg/m2. Median diabetes duration was 11.2 years (IQR 6.6–16) and 50.5% (313/620) were male. The median follow-up 0.5 years. HbA1c reduced by 14.9 mmol/mol (95% CI 13.5, 16.1, p < 0.001) and weight reduced by 4.2 kg (95% CI 3.6, 4.8; p < 0.001). Individuals with higher HbA1c, who were younger or GLP1RA naive had the largest HbA1c reductions. Higher baseline weight/BMI and being GLP1RA naïve were associated with larger weight reductions. Conclusion: In this real-world study, baseline HbA1c and weight are predictors of the respective outcomes following initiation of Semaglutide. Additionally, individuals who are younger may get more glycaemic benefit from Semaglutide. Individuals switching to Semaglutide from alternative GLP1RAs had smaller additional HbA1c and weight reductions. Our data mirror existing randomised control trial data and may have implications in view of current supply issues. Further evidence over a longer follow-up period is being collected.Publication Effects of canagliflozin are mostly observed at first follow-up, within 6 months of commencement: results for the ABCD canagliflozin audit(Association of British Clinical Diabetologists, 2020-12-13) Crabtree, Thomas; Winocour, Peter; Darzy, Ken; Phillips, Suzanne; Evans, Alison; Rohilla, Anurita; Raghavan, Rajeev; Sennik, Devesh; Bickerton, Alex; Idris, Iskandar; Yadagiri, Mahender; Ryder, Robert; Phillips, Suzanne; Evans, Alison; Medical and DentalIntroduction: Canagliflozin was initially approved for use in the UK in March 2013. Randomised control trial evidence has demonstrated multiple beneficial effects. Many of these are present at initial follow-up and within 26 weeks of randomised control trial data. Our aim was to assess whether the beneficial effects of canagliflozin on multiple clinical and biochemical parameters occurred prior to first follow-up and, if so, whether these continued to improve or simply persisted at second follow-up. Methods: Data were extracted from the ABCD nationwide canagliflozin audit to include a minimum dataset of a baseline value and one (or two) follow-ups for each value. Results: A total of 1,214 patient datasets were identified and used in the analysis: mean±SD age 60.1±10.6 years; median duration of diabetes 8 (IQR 2.4–12.6 years); baseline HbA1c 75.1±17.4 mmol/mol (9.0±1.59%) and weight 97.8±22.0 kg. 68.3% of the patients were Caucasian where this was known (n=183). At first follow-up (median 0.7 years) from baseline: change in HbA1c −9.3 mmol/mol (95% CI −8.2 to −10.4; p<0.0001), weight −2.3 kg (95% CI −1.9 to −2.5; p<0.0001); BMI −0.7 kg/m2 (95% CI −0.6 to −0.8; p<0.0001); alanine aminotransferase −2 U/L (95% CI −1.3 to −2.7; p<0.0001); eGFR −0.9 mL/min/1.73 m2 (95% CI −0.4 to −1.4; p<0.001); systolic blood pressure (BP) −2.6 mmHg (95% CI −1.6 to −3.5; p<0.0001) and diastolic BP −0.9 mmHg (95% CI −0.2 to −1.6; p<0.001). Significant differences persisted comparing second follow-up (median 1.2 years) to baseline, but no further significant changes were noted between first follow-up and second follow-up other than in weight and BMI with further change in weight −0.65 kg (95% CI −0.2 to −1.1; p=0.047). Conclusion: The improvements following canagliflozin in this real-world cohort seem to occur within the first 0.7 years of treatment, which is similar to randomised controlled trial data. These improvements seem to be maintained over the next 6 months, with significant further weight loss occurring between 0.7 years and 1.2 years, although the mechanism of this is unclear and might be due to confounders. More evidence on this point is needed.Publication Prevalence of admission plasma glucose in 'diabetes' or 'at risk' ranges in hospital emergencies with no prior diagnosis of diabetes by gender, age and ethnicity(Wiley, 2020-05-15) Ghosh, Sandip; Manley, Susan; Nightingale, Peter; Williams, John; Susarla, Radhika; Alonso-Perez, Irene; stratton, irene; Gkoutos, Georgios; Webber, Jonathan; Luzio, Stephen; Hanif, Wasim; Roberts, Graham; Stratton, Irene; Additional Professional Scientific and TechnicalAims: To establish the prevalence of admission plasma glucose in 'diabetes' and 'at risk' ranges in emergency hospital admissions with no prior diagnosis of diabetes; characteristics of people with hyperglycaemia; and factors influencing glucose measurement. Methods: Electronic patient records for 113 097 hospital admissions over 1 year from 2014 to 2015 included 43 201 emergencies with glucose available for 31 927 (74%) admissions, comprising 22 045 people. Data are presented for 18 965 people with no prior diagnosis of diabetes and glucose available on first attendance. Results: Three quarters (14 214) were White Europeans aged 62 (43-78) years, median (IQ range); 12% (2241) South Asians 46 (32-64) years; 9% (1726) Unknown/Other ethnicities 43 (29-61) years; and 4% (784) Afro-Caribbeans 49 (33-63) years, P < .001. Overall, 5% (1003) had glucose in the 'diabetes' range (≥11.1 mmol/L) higher at 8% (175) for South Asians; 16% (3042) were 'at risk' (7.8-11.0 mmol/L), that is 17% (2379) White Europeans, 15% (338) South Asians, 14% (236) Unknown/Others and 11% (89) Afro-Caribbeans, P < .001. The prevalence for South Asians aged <30 years was 2.1% and 5.2%, respectively, 2.6% and 8.6% for Afro-Caribbeans <30 years, and 2.0% and 8.4% for White Europeans <40 years. Glucose increased with age and was more often in the 'diabetes' range for South Asians than White Europeans with South Asian men particularly affected. One third of all emergency admissions were for <24 hours with 58% of these having glucose measured compared to 82% with duration >24 hours. Conclusions: Hyperglycaemia was evident in 21% of adults admitted as an emergency; various aspects related to follow-up and initial testing, age and ethnicity need to be considered by professional bodies addressing undiagnosed diabetes in hospital admissions.Publication Increasing initial follow-up improves glycaemic control in children with type 1 diabetes(OmniaMed Communications, 2021-08-18) Mander, Rebecca; Kujambal, Vellore; Balapatabendi, Mihrani; Matthai, Susan; Cheney, Sarah; Kujambal, Vellore; Balapatabendi, Mihirani; Matthai, Susan; Cheney, Sarah; Medical and DentalGood quality education following the diagnosis of type 1 diabetes is important in helping individuals understand their diabetes and how best to control their glucose levels. This can result in fewer microvascular and macrovascular complications. The paediatric diabetes multidisciplinary team in Gloucestershire wanted to improve education following diagnosis of type 1 diabetes, with an aim to improve glycaemic control. The intervention was for all children and young people (CYP) with type 1 diabetes to have at least four face-to-face contacts in the first 60 days following diagnosis. This retrospective study analysed the HbA1c of 64 CYP to see whether improvements in glycaemic control were more evident in those with a greater number of initial face-to-face contacts.Publication Effect of empagliflozin on albuminuria, eGFR and serum creatinine: updated results from the ABCD nationwide empagliflozin audit(Association of British Clinical Diabetologists, 2021-05-28) Crabtree, Thomas; Bickerton, Alex; Elliott, Jackie; Raghavan, Rajeev; Barnes, Dennis; Sivappriyan, Siva; Phillips, Suzanne; Evans, Alison; Sennik, Devesh; Rohilla, Anurita; Gallen, Ian; Ryder, Robert; Phillips, Suzanne; Evans, Alison; Medical and DentalIntroduction: Evidence from phase III and the EMPA-REG OUTCOME trials have demonstrated improvements in renal endpoints with empagliflozin use. The EMPA-KIDNEY trial is currently underway and is assessing whether there are benefits of empagliflozin in improving renal outcomes in people both with and without diabetes, and the mechanism has been suggested to be similar to that of ACE inhibitors with the haemodynamic effects of sodium-glucose co-transporter-2 inhibition reducing intraglomerular pressure. Aim: To assess the impacts of empagliflozin use on albuminuria and estimated glomerular filtration rate (eGFR) in a real-world UK-based audit. Methods: Data were collated via the ABCD nationwide audit programme, with analyses performed using either t-tests/ ANOVA or Wilcoxon signed rank/Kruskal–Wallis tests. Pre-specified stratified subgroup analyses by baseline eGFR and baseline albuminuria levels were also performed. Results: Our results demonstrated significant reductions in albuminuria across the population as a whole. When stratified by baseline albuminuria levels, those with microalbuminuria (30–300 μg/mg) or macroalbuminuria (>300 μg/mg) had significant improvements in urine albumin levels at 6-month (3–9-month) follow-up, with median changes of −17.7 μg/mg (p<0.0001; 95% CI −17.4 to −23.7) and 379.4 μg/mg (p=0.03; 95% CI −269.9 to −725.4), respectively. Across the population as a whole, eGFR reduced initially (at 6 months, −1.26 mL/min/1.73 m3; p<0.0001; 95% CI −0.87 to −1.64) before recovering to baseline by 24 months. When stratified by baseline eGFR, those with reduced renal function (eGFR <90) recovered quickest, with improvements in eGFR noted from baseline by 24 months. Conclusion: In this real-world analysis, the results are comparable to those in randomised controlled trials and are likely more generalisable to UK clinical practice. Unfortunately, we do not have clinical endpoints such as end-stage renal failure, renal death or dialysis as part of our dataset. Future audits could consider including these data to establish clinical as well as biochemical outcomes.Publication Slow-Growing Pituitary Metastasis from Renal Cell Carcinoma: Literature Review(Elsevier, 2020-09-03) Moon, Richard; Singleton, Will; Smith, Paul; Urankar, Kathryn; Evans, Alison; Evans, Alison; Medical and DentalBackground: Tumor metastasis to the pituitary is rare, most commonly reported with either breast or lung cancer metastasizing to the neurohypophysis. Pituitary metastases of renal cell carcinoma (RCC) are by contrast infrequently described even within this scarce literature. We present an illustrative case of RCC pituitary metastasis 15 years after radical nephrectomy for primary disease and a review of the published literature. Case description: A 69-year-old female was diagnosed with a large sellar mass with suprasellar extension. The initial radiologic diagnosis was most in keeping with pituitary macroadenoma, although prominent vascular flow voids were noted. Endoscopic endonasal transsphenoidal adenectomy was challenging on account of significant intraoperative hemorrhage from an unusually vascular tumor. Pathologic examination supported a diagnosis of metastatic clear cell renal carcinoma. Literature review identified 41 cases of RCC pituitary metastasis since 1984. The mean age at time of diagnosis with pituitary metastasis was 59.5 years (range 35-81 years, 73% male). Pituitary metastasis was the initial presentation of RCC in 10 patients. The median time from RCC diagnosis to pituitary metastasis was 1 year (range 0-27 years). Surgical resection was performed for 30 patients, of which 47% reported a highly vascular tumor. Conclusions: We highlight the potential for delayed metastasis to the pituitary to masquerade as a macroadenoma. Imaging consistent with rich vascularity should bring the diagnosis of RCC metastasis into the differential and is important to note when planning surgical resection in such cases.Publication A drive-through blood-testing clinic for young patients with diabetes(EMAP, 2022-10-03) Maller, Kiera; Cro, Suzie; Maller, Kiera; Cro, Suzie; Nursing and Midwifery RegisteredDuring the Covid-19 pandemic, almost all of Gloucestershire Hospitals NHS Foundation Trustâ s outpatient appointments became virtual rather than face-to-face. However, children and young people with diabetes still needed routine glycated haemoglobin (HbA1c) tests; the diabetes department, therefore, set up a drive-through clinic to enable testing. This article describes the process of setting up and trialling the clinic, including its aims, challenges and benefits.Publication P123 Use of real time continuous glucose monitoring to assess daily glucose profiles in a girl diagnosed with a novel variant HNF1A gene HNFIA-MODY (MODY 3)(Wiley, 2022-10-20) Bisbinas, Vasiliki; Arvanitaki, Theodosia; Karabouta, Zacharoula; Bisbinas, Vasiliki; Medical and DentalNo abstract availablePublication The factors predicting glucose and weight response to injectable semaglutide (Ozempic): real-world data from the Association of British Clinical Diabetologists’ audit programme(Association of British Clinical Diabetologists, 2023-12-18) Crabtree, Thomas; Adamson, Karen; Bickerton, Alex; Evans, Alison; Phillips, Suzanne; Gallagher, Alison; Larsen, Niels; Barnes, Dennis; Dhatariya, Ketan; Field, Benjamin; Idris, Iskander; Ryder, Robert; Evans, Alison; Phillips, Suzanne; Medical and DentalBackground: Previous randomised controlled trials haveobserved individual differences in response to Glucagon-LikePeptide-1 Receptor Agonists (GLP1RA) according to baselinecharacteristics such as glycated haemoglobin (HbA1c) andweight. The Association of British Clinical Diabetologists (ABCD)launched a nationwide UK audit in January 2019 to assess theclinical utility, efficacy and safety of injectable semaglutide inroutine practice. The aim of this analysis was to investigateassociations between baseline characteristics and HbA1c andweight reductions with semaglutide in real-world use. Methods: Data were extracted from the secure online tool andindividuals who had baseline and follow-up data availablewithin a defined 6 (3-9) month window were included.Variables were assessed as both continuous variables andcategorical variables in a multivariate regression model. Missingdata were multiply imputed. Results: In total, 620 individuals were included. Baselinecharacteristics: (mean±SD) age was 58.7±10.7 years, HbA1c81.6±18.5 mmol/mol (9.5±1.7%), weight 108.2±24.2 kg and bodymass index (BMI) 37.6±7.6 kg/m2. Median diabetes durationwas 11.2 years (IQR 6.6-16) and 50.5% (313/620) of subjectswere male. The median follow-up time was 0.5 years. HbA1creduced by 14.9 mmol/mol (95% CI 13.5, 16.1) [-1.4% (95% CI -1.2, -1.5)]; p<0.001; and weight reduced by 4.2kg (95% CI 3.6,4.8; p<0.001). Higher HbA1c, younger age and GLP1RA naïvetywere associated with larger HbA1c reduction. Higher baselineweight/BMI and GP1RA naïvety were associated with largerweight reduction. Conclusion: In this real-world study, baseline HbA1c and weightwere important predictors of HbA1c and weight reductionoutcomes following initiation of semaglutide in routine clinicalpractice. Our data mirror existing randomised controlled trialdata, but further evidence is being collected over a longerfollow-up periodPublication Determinants of Poor Glycemic Control Among Type 2 Diabetes Patients: A Systematic Review(Springer, 2025-04-17) Ahmed, Yasir; Abuelass, Fatema; Abdelwahab, Salah; Mukhtar, Musab; Ahmed, Yousri; Elfahal, Mohamed; Elhussein, Nahid; Abdelwahab, Salah; Medical and DentalPoor glycemic control remains a pervasive challenge in type 2 diabetes mellitus (T2DM) management, contributing to elevated risks of complications and healthcare burdens globally. This systematic review aimed to synthesize evidence on the determinants of poor glycemic control (hemoglobin A1C (HbA1c) >7%) among adults with T2DM. We followed PRISMA guidelines to search for relevant studies across five different databases, where we found 239 studies. First, the studies were screened for duplicates and then assessed for eligibility by screening through titles, abstracts, and ultimately full text. Upon carefully assessing for eligibility using inclusion and exclusion criteria, only 12 studies were found relevant and were included in this systematic review. The review found that most studies had a moderate risk of bias based on the Newcastle-Ottawa Scale, with only three rated as low risk. Key factors linked to poor glycemic control included low socioeconomic status, medication non-adherence, longer diabetes duration, obesity, insulin-based regimens, and limited access to healthcare. Insulin use, in particular, was paradoxically associated with worse control due to its complexity and adherence challenges, especially in low-resource settings. Regional differences highlighted unique barriers like cultural practices in Ethiopia and gaps in diabetes education in Eritrea. These findings reflect the complex and context-specific nature of glycemic control, especially in low- and middle-income countries. The review calls for simplified treatments, affordable medications, and better management of comorbidities, while encouraging future research using longitudinal and mixed-methods approaches to guide more effective, patient-centered interventionsPublication Expanded endoscopic endonasal approach for resection of residual parasellar growth hormone-secreting pituitary adenoma in a patient with kissing internal carotid arteries: Technical nuances(Scientific Scholar, 2024-07-12) Motiwala, Mustafa; Gimenez, Patricio; Baqai, Muhammad Waqas Saeed; Sajjad, Jahangir; Hasan, Faisal; Bradley, Karin; Evans, Alison; Williams, Adam; Bennett, Warren; Abhinav, Kumar; Evans, Alison; Medical and DentalBackground: Growth hormone (GH)--secreting pituitary adenomas can be aggressive and difficult to manage. Surgical resection for GH-secreting tumors remains the gold standard with increasing use of expanded endoscopic endonasal (EEA) techniques. Certain anatomical considerations make postsurgical biochemical remission challenging. Case description: We describe the case of a 43-year-old male presenting with acromegaly after a lack of biochemical remission from a previous surgery. Resection of the residual tumor invading the retrogenu compartment of the cavernous sinus was challenging for several reasons: (a) its location adjacent to the right parasellar horizontal internal carotid artery (ICA) with involvement of the medial wall, (b) the large kissing bilateral ICAs reducing the intercarotid distance, and (c) potential scar tissue. EEA was undertaken with key surgical steps, including wide bilateral sphenoidotomies, right middle clinoidectomy to access the clinoidal ICA and the retrogenu compartment, identification of the top of the paraclival ICA by drilling across the sella floor, division of the sellar floor dura to increase the intercarotid distance and transcavernous mobilization of medial wall, and the tumor capsule away from the horizontal parasellar ICA and across to the diaphragm and pituitary gland. Postoperatively, biochemical remission was achieved with no new endocrine deficits. Conclusion: These surgical nuances permit biochemical remission in complex revisional cases with acromegaly.