Search

Introduction: 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 μ g/mg) or macroalbuminuria (>300 μ g/mg) had significant improvements in urine albumin levels at 6-month (3–9-month) follow-up, with median changes of −17.7 μ g/mg (p

Aims: EndoBarrier, a 60cm proximal intestinal liner, endoscopically implanted for up to one-year, reduces weight and HbA1c. As the risk of progressive chronic kidney disease (CKD) is increased by high BMI, we assessed the impact of EndoBarrier on renal function. Methods: Between October 2014 and November 2017 we implanted EndoBarriers in 62 patients with sub-optimally controlled diabesity in our NHS service; by November 2018 all were explanted. Clinical and laboratory outcomes, including routinely performed kidney function testing by serum creatinine and MDRD eGFR, were collected in a registry Results: In 61 patients (aged 51.4±7.2 years, 54.1% male, 57.4% europid, diabetes duration 12.0 (8.0-19.5) years, 57.4% insulin-treated, BMI 41.9±7.4 kg/m2) with implant and explant data, weight fell by 15.9±8.5 kg from 122.6±27.9 to 106.7±28.9 kg (p133 μmol/L) prior to Endobarrier; after implantation in four of these creatinine reduced and in two normalised. The four patients with renal impairment who sustained improvement had large weight loss (19.3-34.4 kg), the patient without improvement had only 6.6 kg weight loss. Conclusion: As well as previously documented improvements in weight, HbA1c, BP, ALT and cholesterol, EndoBarrier was associated with improvements in renal function. These observational findings warrant further investigation through prospective study of the impact of such bariatric interventions on progressive CKD.

People with type 2 diabetes mellitus experience an increased prevalence of non-alcoholic fatty liver disease (NAFLD) compared with the general population and often with worse outcomes. As part of the ABCD Liraglutide Nationwide Audit Programme, we obtained and analysed data from 2009 to 2018 to assess the impact of liraglutide on alanine aminotransferase (ALT) levels as a marker of liver inflammation (often used in clinical trials as a marker of NAFLD). After excluding those with insufficient or incomplete data, we analysed the results from 1,759 patients treated in the real-world clinical setting. Our results demonstrated an overall significant decrease in median ALT (−1 U/L, 95% CI −1 to −2, p

Background: People with diabetes and coronavirus disease 2019 (COVID-19) have a significantly greater risk of death and/or intensive care unit (ICU) admission. The Association of British Clinical Diabetologists (ABCD) recently audited outcomes for people hospitalised in the UK with diabetes and COVID-19. Methods: The ABCD COVID-19 and diabetes audit was a retrospective audit of patients admitted to UK hospitals with diabetes and COVID-19 between March and December 2020. Data related to patients admitted in Wales were compared with patients admitted in England and Scotland. Results: In Wales, 40/82 (48.7%) patients with diabetes had COVID-19-related mortality compared with 1,149/2,916 (39.1%) in the UK group (p=0.08). The Welsh cohort were more likely to be Caucasian, have a higher body mass index and HbA1c, be diagnosed with diabetic retinopathy and prescribed a sodium-glucose co-transporter 2 inhibitor or insulin than those in England and Scotland. Patients admitted to the ICU in Wales were more likely to be male and have type 2 diabetes. Conclusions: Patients admitted to hospital with diabetes and COVID-19 in Wales had a poorer outcome compared with England and Scotland. This disparity may reflect social inequality, differences in cardiovascular risk factors and/or differences in diabetes medications between hospitalised patients in Wales and the UK.

To assess the impact of pre-admission renin-angiotensin-aldosterone system inhibitor (RAASi) and statin use on mortality following COVID-19 hospitalization in adults with pre-existing diabetes.Retrospective cohort study of adults with diabetes admitted to ninety-nine participating hospitals in the United Kingdom, France and Spain during the first wave of the COVID-19 pandemic. Logistic regression models adjusted for demographic factors and comorbidity were used to describe associations with mortality in hospital or within 28 days of admission and individual or combined RAASi and statin therapy prescription followed by a country level meta-analysis.Complete data were available for 3474 (42.6%) individuals. Prescribing patterns varied by country: 25-50% neither RAASi nor statin therapy, 14-36% both RAASi and statin therapy, 9-24% RAASi therapy alone, 12-36% statin alone. Overall, 20-37% of patients died within 28 days. Meta-analysis found no evidence of an association between mortality and prescription of RAASi therapy (OR 1.09, CI 0.78-1.52 (IThis large multicentre, multinational study found no evidence of an association between mortality from COVID-19 infection in people with diabetes and use of either RAASi, statin or combination therapy. This provides reassurance that clinicians should not change their RAASi and statin therapy prescribing practice in people with diabetes during the COVID-19 pandemic.