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Article: Frontiers in diagnostic and therapeutic approaches in diabetic sensorimotor neuropathy (DSPN).

Sharma, Sanjeev / Rayman, Gerry

2023 Volume 14, Page(s) 1165505

Abstract: Diabetes sensory polyneuropathy (DSPN) is a significant complication of diabetes affecting up to 50% of patients in their lifetime and approximately 20% of patients suffer from painful diabetes neuropathic pain. DSPN - both painless and painful - leads ... ...

Abstract	Diabetes sensory polyneuropathy (DSPN) is a significant complication of diabetes affecting up to 50% of patients in their lifetime and approximately 20% of patients suffer from painful diabetes neuropathic pain. DSPN - both painless and painful - leads to considerable morbidity including reduction of quality of life, increased lower limb amputations and is associated with worsening mortality. Significant progress has been made in the understanding of pathogenesis of DSPN and the last decade has seen newer techniques aimed at its earlier diagnosis. The management of painful DSPN remains a challenge despite advances made in the unravelling the pathogenesis of pain and its transmission. This article discusses the heterogenous clinical presentation of DSPN and the need to exclude key differential diagnoses. Furthermore, it reviews in detail the current diagnostic techniques involving both large and small neural fibres, their limitations and advantages and current place in the diagnosis of DSPN. Finally, the management of DSPN including newer pharmacotherapies are also discussed.
MeSH term(s)	Humans ; Quality of Life ; Diabetic Neuropathies/diagnosis ; Diabetic Neuropathies/etiology ; Diabetic Neuropathies/therapy ; Pain/etiology ; Nerve Fibers/pathology ; Diabetes Mellitus/pathology
Language	English
Publishing date	2023-05-18
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2592084-4
ISSN	1664-2392
ISSN	1664-2392
DOI	10.3389/fendo.2023.1165505
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Article ; Online: Reply to 'Glucometric benchmarking to aid refinement of multi-element peri-operative models of care'.

Rayman, Gerry / Page, Emma / Gray, William K

Diabetes research and clinical practice

2024 Volume 208, Page(s) 111129

Language	English
Publishing date	2024-02-03
Publishing country	Ireland
Document type	Letter
ZDB-ID	632523-3
ISSN	1872-8227 ; 0168-8227
ISSN (online)	1872-8227
ISSN	0168-8227
DOI	10.1016/j.diabres.2024.111129
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Article ; Online: Virtual Glucose Management in the Hospital Setting.

Rayman, Gerry

Annals of internal medicine

2017 Volume 166, Issue 9, Page(s) 673–674

Language	English
Publishing date	2017-05-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	336-0
ISSN	1539-3704 ; 0003-4819
ISSN (online)	1539-3704
ISSN	0003-4819
DOI	10.7326/M17-0590
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Article ; Online: Hypothyroxinaemia during gestation is associated with low ferritin and increased levels of inflammatory markers.

Pop, Victor J M / Krabbe, Johannes G / Broeren, Maarten / Wiersinga, Wilmar / Rayman, Margaret P

European thyroid journal

2024 Volume 13, Issue 2

Abstract: Objective: Pregnancy is a state of physiological inflammation facilitating implantation. Early isolated hypothyroxinaemia (IH) and increased inflammation (including obesity) have been associated with severe obstetric complications. The current study ... ...

Abstract	Objective: Pregnancy is a state of physiological inflammation facilitating implantation. Early isolated hypothyroxinaemia (IH) and increased inflammation (including obesity) have been associated with severe obstetric complications. The current study evaluated the association between IH, low ferritin and inflammation parameters (interleukin 6 (IL-6), C-reactive protein (CRP), human chorionic gonadotrophin (hCG) and obesity. Moreover, the course of these parameters throughout pregnancy was evaluated in relation to IH. Methods: In the cross-sectional study (A) at 12 weeks, 2759 women participated and 2433 participated in the longitudinal study (B) with assessments at 12, 20 and 28 weeks gestation. At the first trimester, 122 (4.4%) IH women (free thyroxine (FT4) <5th percentile, normal TSH levels) were compared with 2114 (76.6%) reference women (FT4 between tenth and 90th percentiles, normal thyrotrophin (TSH) levels), in study B these figures were 99 (4.1%) and 1847 (75.9%), respectively. Results: Cross-sectionally, compared to reference women, IH was independently associated with low ferritin (<5th percentile, OR: 2.6, 95% CI: 1.4-4.9), high CRP (>95th percentile: OR: 1.9, 95% CI: 1.04-3.7), low hCG (<median, OR: 2.1, 95% CI: 1.40-3.16), obesity (BMI > 30, OR: 1.7, 95% CI: 1.12.9) and higher age (OR: 1.1, 95% CI: 1.04-1.15). Longitudinally, compared to reference women, women with IH at 12 weeks gestation showed persistently and significantly lower ferritin and hCG levels, and persistently higher CRP and IL-6 levels throughout gestation. Conclusion: Gestational IH could be viewed as a condition of increased inflammation, as reported in non-thyroidal illness syndrome. Less favourable inflammation parameters and low iron status during early gestation in IH women seem to persist throughout gestation.
MeSH term(s)	Pregnancy ; Female ; Humans ; Thyroxine ; Cross-Sectional Studies ; Longitudinal Studies ; Interleukin-6 ; Thyrotropin ; Obesity ; Chorionic Gonadotropin ; Inflammation ; Ferritins
Chemical Substances	Thyroxine (Q51BO43MG4) ; Interleukin-6 ; Thyrotropin (9002-71-5) ; Chorionic Gonadotropin ; Ferritins (9007-73-2)
Language	English
Publishing date	2024-03-04
Publishing country	England
Document type	Journal Article
ZDB-ID	2659767-6
ISSN	2235-0802 ; 2235-0640
ISSN (online)	2235-0802
ISSN	2235-0640
DOI	10.1530/ETJ-23-0163
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Article ; Online: Closer to closing the loop on inpatient glycaemia.

Rayman, Gerry

The lancet. Diabetes & endocrinology

2016 Volume 5, Issue 2, Page(s) 81–83

MeSH term(s)	Blood Glucose ; Diabetes Mellitus, Type 1 ; Diabetes Mellitus, Type 2 ; Humans ; Inpatients ; Insulin ; Insulin Infusion Systems
Chemical Substances	Blood Glucose ; Insulin
Language	English
Publishing date	2016-11-09
Publishing country	England
Document type	Journal Article ; Comment
ISSN	2213-8595
ISSN (online)	2213-8595
DOI	10.1016/S2213-8587(16)30327-8
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Article ; Online: Insulin icodec use in hospital settings: Considerations for once-weekly basal insulin therapy in hospital glycaemic management practice.

Barmanray, Rahul D / Kyi, Mervyn / Rayman, Gerry / Rushakoff, Robert / Newland-Jones, Philip / Fourlanos, Spiros

Diabetes research and clinical practice

2024 Volume 211, Page(s) 111660

Language	English
Publishing date	2024-04-05
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	632523-3
ISSN	1872-8227 ; 0168-8227
ISSN (online)	1872-8227
ISSN	0168-8227
DOI	10.1016/j.diabres.2024.111660
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Article ; Online: Optimal staffing for a good quality inpatient diabetes service.

Dashora, U / Flanagan, D / Rayman, G / Mustafa, O G / Walden, E / Dhatariya, K

Diabetic medicine : a journal of the British Diabetic Association

2023 Volume 40, Issue 10, Page(s) e15151

Abstract: Introduction: Increasing numbers of people admitted to hospital have diabetes and need specialist support. To date, there is no mechanism which can help teams estimate the number of health care professionals they need to provide optimal care for people ... ...

Abstract	Introduction: Increasing numbers of people admitted to hospital have diabetes and need specialist support. To date, there is no mechanism which can help teams estimate the number of health care professionals they need to provide optimal care for people with diabetes in hospitals. Methods: The Joint British Diabetes Societies (JBDS) for Inpatient Care Group organised a survey of specialist inpatient diabetes teams in the UK for current staffing and the perception of optimal staffing using mailing lists available through their representative organisations. The results were verified and confirmed by one-to-one conversations with individual respondents and discussed in multiple expert-group meetings to agree on the results. Results: Responses were received from 17 Trusts covering 30 hospital sites. Current diabetes specialist staffing level per 100 people with diabetes in hospital (Median, IQR) for consultants was 0.24 (0.22-0.37), diabetes inpatient specialist nurses was 1.94 (1.22-2.6), dieticians was 0.00 (0.00-0.00), podiatrists was 0.19 (0.00-0.62), pharmacists was 0.00 (0.00-0.37), psychologists was 0.00 (0.00-0.00). The teams also reported that for optimal care the total staff needed for each group (Median, IQR) was much higher; consultants 0.65 (0.50-0.88), specialist nurses 3.38 (2.78-4.59), dieticians 0.48 (0.33-0.72), podiatrists, 0.93 (0.65-1.24), pharmacists, 0.65 (0.40-0.79) and psychologists 0.33 (0.27-0.58). Based on the results of the survey, the JBDS expert group produced an Excel calculator to estimate staffing needs of any hospital site in question just by populating a few of the cells. Conclusion: Current inpatient diabetes staffing is much lower than needed in most Trusts who responded to the survey. The JBDS calculator can provide an estimate of the staffing needs of any hospital.
MeSH term(s)	Humans ; Inpatients ; Diabetes Mellitus/epidemiology ; Diabetes Mellitus/therapy ; Hospitalization ; Hospitals ; Workforce
Language	English
Publishing date	2023-06-16
Publishing country	England
Document type	Journal Article
ZDB-ID	605769-x
ISSN	1464-5491 ; 0742-3071 ; 1466-5468
ISSN (online)	1464-5491
ISSN	0742-3071 ; 1466-5468
DOI	10.1111/dme.15151
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Article ; Online: Dietary factors that affect the risk of pre-eclampsia.

Perry, Abigail / Stephanou, Anna / Rayman, Margaret P

BMJ nutrition, prevention & health

2022 Volume 5, Issue 1, Page(s) 118–133

Abstract: ... of dietary modifications resulting from increased consumption of fruits and vegetables (≥400 g/day), plant-based foods and ... vegetable oils and a limited intake of foods high in fat, sugar and salt. Consuming a high-fibre diet (25-30 g ...

Abstract	Pre-eclampsia affects 3%-5% of pregnant women worldwide and is associated with a range of adverse maternal and fetal outcomes, including maternal and/or fetal death. It particularly affects those with chronic hypertension, pregestational diabetes mellitus or a family history of pre-eclampsia. Other than early delivery of the fetus, there is no cure for pre-eclampsia. Since diet or dietary supplements may affect the risk, we have carried out an up-to-date, narrative literature review to assess the relationship between nutrition and pre-eclampsia. Several nutrients and dietary factors previously believed to be implicated in the risk of pre-eclampsia have now been shown to have no effect on risk; these include vitamins C and E, magnesium, salt, ω-3 long-chain polyunsaturated fatty acids (fish oils) and zinc. Body mass index is proportionally correlated with pre-eclampsia risk, therefore women should aim for a healthy pre-pregnancy body weight and avoid excessive gestational and interpregnancy weight gain. The association between the risk and progression of the pathophysiology of pre-eclampsia may explain the apparent benefit of dietary modifications resulting from increased consumption of fruits and vegetables (≥400 g/day), plant-based foods and vegetable oils and a limited intake of foods high in fat, sugar and salt. Consuming a high-fibre diet (25-30 g/day) may attenuate dyslipidaemia and reduce blood pressure and inflammation. Other key nutrients that may mitigate the risk include increased calcium intake, a daily multivitamin/mineral supplement and an adequate vitamin D status. For those with a low selenium intake (such as those living in Europe), fish/seafood intake could be increased to improve selenium intake or selenium could be supplemented in the recommended multivitamin/mineral supplement. Milk-based probiotics have also been found to be beneficial in pregnant women at risk. Our recommendations are summarised in a table of guidance for women at particular risk of developing pre-eclampsia.
Language	English
Publishing date	2022-06-06
Publishing country	England
Document type	Journal Article ; Review
ISSN	2516-5542
ISSN (online)	2516-5542
DOI	10.1136/bmjnph-2021-000399
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Article ; Online: How Can Point-of-Care Technologies Support In-Hospital Diabetes Care?

Misra, Shivani / Avari, Parizad / Lumb, Alistair / Flanagan, Daniel / Choudhary, Pratik / Rayman, Gerry / Dhatariya, Ketan

Journal of diabetes science and technology

2023 Volume 17, Issue 2, Page(s) 509–516

Abstract: People with diabetes admitted to hospital are at risk of diabetes related complications including hypoglycaemia and diabetic ketoacidosis. Point-of-care (POC) tests undertaken at the patient bedside, for glucose, ketones, and other analytes, are a key ... ...

Abstract	People with diabetes admitted to hospital are at risk of diabetes related complications including hypoglycaemia and diabetic ketoacidosis. Point-of-care (POC) tests undertaken at the patient bedside, for glucose, ketones, and other analytes, are a key component of monitoring people with diabetes, to ensure safety. POC tests implemented with a quality framework are critical to ensuring accuracy and veracity of results and preventing erroneous clinical decision making. POC results can be used for self-management of glucose levels in those well-enough and/or by healthcare professionals to identify unsafe levels. Connectivity of POC results to electronic health records further offers the possibility of utilising these results proactively to identify patients 'at risk' in real-time and for audit purposes. In this article, the key considerations when implementing POC tests for diabetes in-patient management are reviewed and potential to drive improvements using networked glucose and ketone measurements are discussed. In summary, new advances in POC technology should allow people with diabetes and the teams looking after them whilst in hospital to integrate to provide safe and effective care.
MeSH term(s)	Humans ; Point-of-Care Systems ; Diabetic Ketoacidosis ; Point-of-Care Testing ; Glucose ; Hospitals ; Diabetes Mellitus/therapy
Chemical Substances	Glucose (IY9XDZ35W2)
Language	English
Publishing date	2023-02-21
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1932-2968
ISSN (online)	1932-2968
DOI	10.1177/19322968221137360
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Article ; Online: Variation in the Current Use of Technology to Support Diabetes Management in UK Hospitals: Results of a Survey of Health Care Professionals.

Lumb, Alistair / Misra, Shivani / Rayman, Gerry / Avari, Parizad / Flanagan, Daniel / Choudhary, Pratik / Dhatariya, Ketan

Journal of diabetes science and technology

2023 Volume 17, Issue 3, Page(s) 733–741

Abstract: Background: There has been a significant increase in the use of wearable diabetes technologies in the outpatient setting over recent years, but this has not consistently translated into inpatient use.: Methods: An online survey was undertaken to ... ...

Abstract	Background: There has been a significant increase in the use of wearable diabetes technologies in the outpatient setting over recent years, but this has not consistently translated into inpatient use. Methods: An online survey was undertaken to understand the current use of technology to support inpatient diabetes care in the United Kingdom. Results: Responses were received from 42 different organizations representing 104 hospitals across the United Kingdom. Significant variation was found between organizations in the use of technology to support safe, effective inpatient diabetes care. Benefits of the use of technology were reported, and areas of good practice identified. Conclusion: Technology supports good inpatient diabetes care, but there is currently variation in its use. Guidance has been developed which should drive improvements in the use of technology and hence improvements in the safety and effectiveness of inpatient diabetes care. Key recommendations include implementation of this guidance (especially for continuous glucose monitoring), ensuring specialist support is available for the use of wearable diabetes technology in hospital, optimizing information sharing across the health care system, and making full use of data from networked glucose and ketone meters.
MeSH term(s)	Humans ; Blood Glucose Self-Monitoring/methods ; Blood Glucose ; Diabetes Mellitus ; Hospitals ; United Kingdom ; Technology ; Health Personnel
Chemical Substances	Blood Glucose
Language	English
Publishing date	2023-03-22
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1932-2968
ISSN (online)	1932-2968
DOI	10.1177/19322968231161076
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