Publications by category
Journal articles
Witham MD, Heslop P, Dodds RM, Clegg AP, Hope SV, McDonald C, Smithard D, Storey B, Tan AL, Thornhill A, et al (2022). Performance of the SarQoL quality of life tool in a UK population of older people with probable sarcopenia and implications for use in clinical trials: findings from the SarcNet registry.
BMC Geriatr,
22(1).
Abstract:
Performance of the SarQoL quality of life tool in a UK population of older people with probable sarcopenia and implications for use in clinical trials: findings from the SarcNet registry.
BACKGROUND: the Sarcopenia Quality of Life (SarQoL) questionnaire is a disease-specific sarcopenia quality of life tool. We aimed to independently assess SarQoL with a particular focus on its suitability as a clinical trial outcome measure. METHODS: We analysed data from the UK Sarcopenia Network and Registry. Measures of physical performance and lean mass were collected at baseline. SarQoL and the Strength, Assistance, Rise, Climb - Falls (SARC-F) questionnaire (to assess functional ability) were collected at both baseline and six-month follow-up. Global changes in fitness and quality of life at 6 months were elicited on seven-point Likert scales. Internal consistency was assessed using Cronbach's alpha. Responsiveness (Cohen's d and Guyatt coefficients) and minimum clinically important differences were calculated for participants reporting slight improvement or worsening in their global scores. Concurrent validity was assessed by correlating baseline SarQoL scores with measures of physical performance and functional ability. RESULTS: We analysed data from 147 participants, 125 of whom underwent follow up assessment; mean age 78 years; 72 (49%) were women. Internal consistency was good; Cronbach's alpha was 0.944 at baseline and 0.732 at telephone follow-up. Correlation between baseline and follow-up SarQoL was weak (r = 0.27; p = 0.03). The minimum clinically important improvement ranged from 5 to 21 points giving trial sample size estimates of 25-100 participants. SarQoL scores were moderately correlated with handgrip (r = 0.37; p
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Toback S, Galiza E, Cosgrove C, Galloway J, Goodman AL, Swift PA, Rajaram S, Graves-Jones A, Edelman J, Burns F, et al (2022). Safety, immunogenicity, and efficacy of a COVID-19 vaccine (NVX-CoV2373) co-administered with seasonal influenza vaccines: an exploratory substudy of a randomised, observer-blinded, placebo-controlled, phase 3 trial. The Lancet Respiratory Medicine, 10(2), 167-179.
De Spiegeleer A, Kahya H, Sanchez-Rodriguez D, Piotrowicz K, Surquin M, Marco E, Detremerie C, Hussein D, Hope S, Dallmeier D, et al (2021). Acute sarcopenia changes following hospitalization: influence of pre-admission care dependency level.
Age and Ageing,
50(6), 2140-2146.
Abstract:
Acute sarcopenia changes following hospitalization: influence of pre-admission care dependency level
Abstract
.
. Introduction
. Hospitalization is associated with acute changes in sarcopenia status in older people, but the influencing factors are not fully understood. Pre-admission care dependency level as a risk factor has not yet been investigated.
.
.
. Objective
. Evaluate if pre-admission care dependency level is an independent predictor of sarcopenia changes following hospitalization.
.
.
. Setting and subjects
. Data came from the Sarcopenia 9+ EAMA Project, a European prospective multi-centre study. For this study, 227 hospitalised older people were included from four different hospitals in Belgium, Spain and Poland, between 18 February 2019 and 5 September 2020.
.
.
. Methods
. Sarcopenia status at admission and discharge were calculated using a combined score (desirability value) based on muscle mass (calf circumference), strength (grip) and function (walking speed). Ratio of admission to discharge status was the outcome (desirability ratio; 1.00 meaning no difference). Predictor variable was the pre-admission care dependency level, classified into three groups: independent older people living at home, dependent older people living at home and older people living in a care home. Linear regression models were applied, considering potential confounders.
.
.
. Results
. Mean desirability ratio for dependent older people living at home (‘middle dependent group’) was lower (0.89) compared to independent older people (0.98; regression coefficient −0.09 [95% CI −0.16, −0.02]) and care home patients (1.05; −0.16 [95% CI −0.01, −0.31]). Adjusting for potential confounders or using another statistical approach did not affect the main results.
.
.
. Conclusion
. Dependent older people living at home were at higher risk of deterioration in sarcopenia status following hospitalization. In-depth studies investigating causes and potential interventions of these findings are needed.
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Miralles O, Sanchez-Rodriguez D, Marco E, Annweiler C, Baztan A, Betancor É, Cambra A, Cesari M, Fontecha BJ, Gąsowski J, et al (2021). Correction to: Unmet needs, health policies, and actions during the COVID-19 pandemic: a report from six European countries (European Geriatric Medicine, (2021), 12, 1, (193-204), 10.1007/s41999-020-00415-x).
European Geriatric Medicine,
12(3).
Abstract:
Correction to: Unmet needs, health policies, and actions during the COVID-19 pandemic: a report from six European countries (European Geriatric Medicine, (2021), 12, 1, (193-204), 10.1007/s41999-020-00415-x)
The original version of this article, published on October 15, 2020, contained a mistake. The correct information is given below. The original article has been corrected. On date of the revision on July 1, 2020, 23% of those infected (confirmed with RT-PCR, 38,107 out of 165,719 cases) and 35% of those who died (10,497 out of 29,861deaths) were NH residents, indicating a case fatality rate of 27.5%.
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Witham MD, Heslop P, Dodds RM, Clegg AP, Hope SV, McDonald C, Smithard D, Storey B, Tan AL, Thornhill A, et al (2021). Developing a UK sarcopenia registry: recruitment and baseline characteristics of the SarcNet pilot.
Age Ageing,
50(5), 1762-1769.
Abstract:
Developing a UK sarcopenia registry: recruitment and baseline characteristics of the SarcNet pilot.
BACKGROUND: sarcopenia registries are a potential method to meet the challenge of recruitment to sarcopenia trials. We tested the feasibility of setting up a UK sarcopenia registry, the feasibility of recruitment methods and sought to characterise the pilot registry population. METHODS: six diverse UK sites took part, with potential participants aged 65 and over approached via mailshots from local primary care practices. Telephone pre-screening using the SARC-F score was followed by in-person screening and baseline visit. Co-morbidities, medications, grip strength, Short Physical Performance Battery, bioimpedance analysis, Geriatric Depression Score, Montreal Cognitive Assessment, Sarcopenia Quality of Life score were performed and permission sought for future recontact. Descriptive statistics for recruitment rates and baseline measures were generated; an embedded randomised trial examined the effect of a University logo on the primary care mailshot on recruitment rates. RESULTS: sixteen practices contributed a total of 3,508 letters. In total, 428 replies were received (12% response rate); 380 underwent telephone pre-screening of whom 215 (57%) were eligible to attend a screening visit; 150 participants were recruited (40% of those pre-screened) with 147 contributing baseline data. No significant difference was seen in response rates between mailshots with and without the logo (between-group difference 1.1% [95% confidence interval -1.0% to 3.4%], P = 0.31). The mean age of enrollees was 78 years; 72 (49%) were women. In total, 138/147 (94%) had probable sarcopenia on European Working Group on Sarcopenia 2019 criteria and 145/147 (98%) agreed to be recontacted about future studies. CONCLUSION: recruitment to a multisite UK sarcopenia registry is feasible, with high levels of consent for recontact.
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Attwood D, Boorer J, Ellis W, Earley M, Denovan J, Calkoen A, Hart G, Williams M, Burdett N, Lemon M, et al (2021). Erratum to: the Pathfields Tool: a frailty case-finding tool using primary care IT-implications for population health management.
Age Ageing,
50(6), e17-e18.
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Heath PT, Galiza EP, Baxter DN, Boffito M, Browne D, Burns F, Chadwick DR, Clark R, Cosgrove C, Galloway J, et al (2021). Safety and Efficacy of NVX-CoV2373 Covid-19 Vaccine.
NEW ENGLAND JOURNAL OF MEDICINE,
385(13), 1172-1183.
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Goodwin V, Swancutt D, Kent B, Robinson M, Hope S (2021). ‘I can’t get up and it's really annoying’: a qualitative investigation of getting up following a fall. Physiotherapy, 113
Hope SV, Koutsouri A, Nguyen S, Piotrowicz K, Petrovic M, Gasowski J (2020). EuGMS 2019 Congress report: evidence-based medicine in geriatrics.
European Geriatric Medicine,
11(6), 915-918.
Abstract:
EuGMS 2019 Congress report: evidence-based medicine in geriatrics
AbstractThe 2019 EuGMS Congress “Evidence-Based Medicine in Geriatrics” was held in Krakow, Poland, and attended by over 1600 participants from 64 different countries. A summary and reflection on the congress was presented in the Closing Ceremony by European Academy for Medicine of Aging graduates, and summarised in this article. Keynote lectures, ‘state of the art’ sessions and symposia presented the evidence relating to different age-related conditions, their prevention, management and treatments. Hot topic areas included frailty and multimorbidity, and evidence-based attempts to address these conditions at different life stages. The field of geriatrics represents unique challenges for evidence-based medicine practice. There is much research going on. Clear leadership is needed to facilitate consensus agreements on standard definitions, methods and relevant outcomes, in collaboration with older people themselves, to maximise the opportunities and benefits of doing this research, and benefiting our patients and society at large.
Abstract.
Swancutt D, Hope S, Kent B, Robinson M, Goodwin V (2020). Knowledge, skills and attitudes of older people and staff about getting up from the floor following a fall: a qualitative investigation. BMC Geriatrics
Attwood D, Boorer J, Ellis W, Earley M, Denovan J, Calkoen A, Hart G, Williams M, Nicholas B, Lemon M, et al (2020). The Pathfields Tool: a frailty case-finding tool using primary care IT—implications for population health management. Age and Ageing
Miralles O, Sanchez-Rodriguez D, Marco E, Annweiler C, Baztan A, Betancor É, Cambra A, Cesari M, Fontecha BJ, Gąsowski J, et al (2020). Unmet needs, health policies, and actions during the COVID-19 pandemic: a report from six European countries. European Geriatric Medicine, 12(1), 193-204.
Sanchez-Rodriguez D, Annweiler C, Marco E, Hope S, Piotrovicz K, Surquin M, Ranhoff A, Van Den Noortgate N (2019). European Academy for Medicine of Ageing Session Participants’ Report on Malnutrition Assessment and Diagnostic Methods; an International Survey. Clinical Nutrition
Sanchez-Rodriguez D, Hope S, Piotrowicz K, Benoit F, Czesak J, Dallmeier D, Decker G, Hansen Hojmann A, Hrnciarikova D, Marco E, et al (2019). Sarcopenia in Acute Care Patients: Protocol for the European Collaboration
of Geriatric Surveys: Sarcopenia 9+ EAMA Project. Journal of the American Medical Directors Association (JAMDA): long-term care: management, applied research and clinical issues
Green J, Kirby K, Hope SV (2018). Ambulance clinicians’ perceptions, assessment and management of frailty: thematic analysis of focus groups. British Paramedic Journal, 3(3), 23-33.
Pearce C, Hope S, Butchart J (2018). Intravascular lymphoma presenting with postural hypotension.
BMJ Case Rep,
2018Abstract:
Intravascular lymphoma presenting with postural hypotension.
An 84-year-old woman presented with severe postural hypotension. Further assessment revealed weight loss, fatigue and fever at night. On examination, she had bilateral skin lesions on the inner thighs and skin biopsy revealed intravascular high grade B cell lymphoma. This was successfully treated with curative chemotherapy. The cause of the postural hypotension in this case was felt likely to be autonomic neuropathy caused by neurovascular infiltration by intravascular lymphoma. Treatment of the lymphoma has resolved the postural hypotension, although some symptoms of postural instability persist.
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Strain WD, Hope SV, Green A, Kar P, Valabhji J, Sinclair AJ (2018). Type 2 diabetes mellitus in older people: a brief statement of key principles of modern day management including the assessment of frailty. A national collaborative stakeholder initiative.
Diabet Med,
35(7), 838-845.
Abstract:
Type 2 diabetes mellitus in older people: a brief statement of key principles of modern day management including the assessment of frailty. A national collaborative stakeholder initiative.
Rates of population ageing are unprecedented and this, combined with the progressive urbanization of lifestyles, has led to a dramatic shift in the epidemiology of diabetes towards old age, particularly to those aged 60-79 years. Both ageing and diabetes are recognized as important risk factors for the development of functional decline and disability. In addition, diabetes is associated with a high economic, social and health burden. Traditional macrovascular and microvascular complications of diabetes appear to account for less than half of the diabetes-related disability observed in older people. Despite this, older adults are under-represented in clinical trials. Guidelines from organizations such as the National Institute for Health and Care Excellence (NICE), the European Association for the Study of Diabetes, and the American Diabetes Association acknowledge the need for individualized care, but the glycaemic targets that are suggested to constitute good control [HbA1c 53-59 mmol/mol (7-7.5%)] are too tight for frail older individuals. We present a framework for the assessment of older adults and guidelines for the management of this population according to their frailty status, with the intention of reducing complications and improving quality of life for these people.
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Hope SV, Taylor PJ, Shields BM, Hattersley AT, Hamilton W (2017). Are we missing hypoglycaemia?. Elderly patients with insulin-treated diabetes present to. primary care frequently with non-specific symptoms. associated with hypoglycaemia. Primary Care Diabetes
Gadsby R, Hope S, Hambling C, Carnegie A (2017). Frailty, older people and type 2 diabetes.
Journal of Diabetes Nursing,
21(4), 138-142.
Abstract:
Frailty, older people and type 2 diabetes
It is estimated that over half of all those living with diabetes are over 65 years of age. Diabetes management becomes increasingly complex as people age, and clinicians and people with diabetes can find it difficult to balance treatment benefits and risks. With increasing age, there is an increasing risk of dementia and frailty in people with diabetes, which impact on appropriate drug regimens. In this article, the authors recommend strategies for reducing the risk of hypoglycaemia in older people who are frail and have cognitive impairment or dementia.
Abstract.
Gadsby R, Hope SV, Hambling C, Carnegie A (2017). Frailty, older people and type 2 diabetes. Diabetes and Primary Care, 19, 18-22.
Hope SV, Knight BA, Shields BM, Hill AV, Choudhary P, Strain WD, McDonald TJ, Jones AG (2017). Random non-fasting C-peptide testing can identify patients with insulin-treated type 2 diabetes at high risk of hypoglycaemia. Diabetologia
Hope SV, Wienand-Barnett S, Shepherd M, King SM, Fox C, Khunti K, Oram RA, Knight BA, Hattersley AT, Jones AG, et al (2016). Practical Classification Guidelines for Diabetes in patients treated with insulin: a cross-sectional study of the accuracy of diabetes diagnosis.
British Journal of General Practice,
66(646), e315-e322.
Abstract:
Practical Classification Guidelines for Diabetes in patients treated with insulin: a cross-sectional study of the accuracy of diabetes diagnosis
Background Differentiating between type 1 and type 2 diabetes is fundamental to ensuring appropriate management of patients, but can be challenging, especially when treating with insulin. The 2010 UK Practical Classification Guidelines for Diabetes were developed to help make the differentiation. Aim to assess diagnostic accuracy of the UK guidelines against gold standard definitions of type 1 and type 2 diabetes based on measured C-peptide levels. Design and setting in total, 601 adults with insulin-treated diabetes and diabetes duration ≥5 years were recruited in Devon, Northamptonshire, and Leicestershire. Method Baseline information and home urine sample were collected. Urinary C-peptide creatinine ratio (UCPCR) measures endogenous insulin production. Gold standard type 1 diabetes was defined as continuous insulin treatment within 3 years of diagnosis and absolute insulin deficiency (UCPCR
Abstract.
Hope SV, Knight BA, Shields BM, Hattersley AT, McDonald TJ, Jones AG (2016). Random non-fasting C–peptide: bringing robust assessment of endogenous insulin secretion to the clinic.
Diabetic Medicine,
33(11), 1554-1558.
Abstract:
Random non-fasting C–peptide: bringing robust assessment of endogenous insulin secretion to the clinic
Background: Measuring endogenous insulin secretion using C–peptide can assist diabetes management, but standard stimulation tests are impractical for clinical use. Random non-fasting C–peptide assessment would allow testing when a patient is seen in clinic. Methods: We compared C–peptide at 90 min in the mixed meal tolerance test (sCP) with random non-fasting blood C–peptide (rCP) and random non-fasting urine C–peptide creatinine ratio (rUCPCR) in 41 participants with insulin-treated diabetes [median age 72 (interquartile range 68–78); diabetes duration 21 (14–31) years]. We assessed sensitivity and specificity for previously reported optimal mixed meal test thresholds for severe insulin deficiency (sCP < 200 pmol//l) and Type 1 diabetes/inability to withdraw insulin (< 600 pmol//l), and assessed the impact of concurrent glucose. Results: rCP and sCP levels were similar (median 546 and 487 pmol//l, P = 0.92). rCP was highly correlated with sCP, r = 0.91, P < 0.0001, improving to r = 0.96 when excluding samples with concurrent glucose < 8 mmol//l. An rCP cut-off of 200 pmol//l gave 100% sensitivity and 93% specificity for detecting severe insulin deficiency, with area under the receiver operating characteristic curve of 0.99. rCP < 600 pmol//l gave 87% sensitivity and 83% specificity to detect sCP < 600 pmol//l. Specificity improved to 100% when excluding samples with concurrent glucose < 8 mmol//l. rUCPCR (0.52 nmol/mmol) was also well-correlated with sCP, r = 0.82, P < 0.0001. A rUCPCR cut-off of < 0.2 nmol/ mmol gave sensitivity and specificity of 83% and 93% to detect severe insulin deficiency, with area under the receiver operating characteristic curve of 0.98. Conclusions: Random non-fasting C–peptide measures are strongly correlated with mixed meal C–peptide, and have high sensitivity and specificity for identifying clinically relevant thresholds. These tests allow assessment of C–peptide at the point patients are seen for clinical care.
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Hope SV, Strain WD (2013). Hypoglycemia in the elderly.
Diabetic Hypoglycemia,
6(1), 3-10.
Abstract:
Hypoglycemia in the elderly
Hypoglycemia is a common, under-recognized complication of the management of type 2 diabetes. Elderly individuals have a higher burden of co-morbidities, cognitive impairment, physical dysfunction and frailty, which makes them more vulnerable to complications of hypoglycemia, such as falls, fractures, cognitive impairment and cardiovascular events, than younger patients. Furthermore, with ageing comes impairment of autoregulatory responses, which means the symptoms of hypoglycemia are often less specific, and are therefore either missed or incorrectly diagnosed as transient ischemic attacks or other cerebrovascular events. Older adults with diabetes have a greater risk of hypoglycemia associated with the physiological decline of ageing, and the extended duration of diabetes and insulin treatment. The elderly are also more prone to the effects of hypoglycemia such as the increased risk of accidents, falls and fractures, hospitalizations, in-hospital mortality, and long-term impairment of cognition. Using individualized treatment targets to base treatment strategies around individual circumstances may reduce the risk of hypoglycemia.
Abstract.
Hope SV, Jones AG, Goodchild E, Shepherd M, Besser REJ, Shields B, Mcdonald T, Knight BA, Hattersley A (2013). Urinary C-peptide creatinine ratio detects absolute insulin deficiency in Type 2 diabetes.
Diabetic Medicine,
30(11), 1342-1348.
Abstract:
Urinary C-peptide creatinine ratio detects absolute insulin deficiency in Type 2 diabetes
Aims: to determine the prevalence and clinical characteristics of absolute insulin deficiency in long-standing Type 2 diabetes, using a strategy based on home urinary C-peptide creatinine ratio measurement. Methods: We assessed the urinary C-peptide creatinine ratios, from urine samples taken at home 2 h after the largest meal of the day, in 191 insulin-treated subjects with Type 2 diabetes (diagnosis age ≥45 years, no insulin in the first year). If the initial urinary C-peptide creatinine ratio was ≤0.2 nmol/mmol (representing absolute insulin deficiency), the assessment was repeated. A standardized mixed-meal tolerance test with 90-min stimulated serum C-peptide measurement was performed in nine subjects with a urinary C-peptide creatinine ratio ≤ 0.2 nmol/mmol (and in nine controls with a urinary C-peptide creatinine ratio >0.2 nmol/mmol) to confirm absolute insulin deficiency. Results: a total of 2.7% of participants had absolute insulin deficiency confirmed by a mixed-meal tolerance test. They were identified initially using urinary C-peptide creatinine ratio: 11/191 subjects (5.8%) had two consistent urinary C-peptide creatinine ratios ≤ 0.2 nmol/mmol; 9 of these 11 subjects completed a mixed-meal tolerance test and had a median stimulated serum C-peptide of 0.18 nmol/l. Five of these 9 had stimulated serum C-peptide 0.2 had endogenous insulin secretion confirmed by the mixed-meal tolerance test. Compared with subjects with a urinary C-peptide creatinine ratio >0.2 nmol/mmol, those with confirmed absolute insulin deficiency had a shorter time to insulin treatment (median 2.5 vs. 6 years, P=0.005) and lower BMI (25.1 vs. 29.1 kg/m2, P=0.04). Two out of the five patients with absolute insulin deficiency were glutamic acid decarboxylase autoantibody-positive. Conclusions: Absolute insulin deficiency may occur in long-standing Type 2 diabetes, and cannot be reliably predicted by clinical features or autoantibodies. Absolute insulin deficiency in Type 2 diabetes may increase the risk of hypoglycaemia and ketoacidosis, as in Type 1 diabetes. Its recognition should help guide treatment, education and management. The urinary C-peptide creatinine ratio is a practical non-invasive method to aid detection of absolute insulin deficiency, with a urinary C-peptide creatinine ratio > 0.2 nmol/mmol being a reliable indicator of retained endogenous insulin secretion. © 2013 the Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.
Abstract.
Hope SV, Jones AG, Goodchild E, Shepherd M, Besser REJ, Shields B, McDonald T, Knight BA, Hattersley A (2013). Urinary C-peptide creatinine ratio detects absolute insulin deficiency in Type 2 diabetes.
Diabet Med,
30(11), 1342-1348.
Abstract:
Urinary C-peptide creatinine ratio detects absolute insulin deficiency in Type 2 diabetes.
AIMS: to determine the prevalence and clinical characteristics of absolute insulin deficiency in long-standing Type 2 diabetes, using a strategy based on home urinary C-peptide creatinine ratio measurement. METHODS: We assessed the urinary C-peptide creatinine ratios, from urine samples taken at home 2 h after the largest meal of the day, in 191 insulin-treated subjects with Type 2 diabetes (diagnosis age ≥45 years, no insulin in the first year). If the initial urinary C-peptide creatinine ratio was ≤0.2 nmol/mmol (representing absolute insulin deficiency), the assessment was repeated. A standardized mixed-meal tolerance test with 90-min stimulated serum C-peptide measurement was performed in nine subjects with a urinary C-peptide creatinine ratio ≤ 0.2 nmol/mmol (and in nine controls with a urinary C-peptide creatinine ratio >0.2 nmol/mmol) to confirm absolute insulin deficiency. RESULTS: a total of 2.7% of participants had absolute insulin deficiency confirmed by a mixed-meal tolerance test. They were identified initially using urinary C-peptide creatinine ratio: 11/191 subjects (5.8%) had two consistent urinary C-peptide creatinine ratios ≤ 0.2 nmol/mmol; 9 of these 11 subjects completed a mixed-meal tolerance test and had a median stimulated serum C-peptide of 0.18 nmol/l. Five of these 9 had stimulated serum C-peptide 0.2 had endogenous insulin secretion confirmed by the mixed-meal tolerance test. Compared with subjects with a urinary C-peptide creatinine ratio >0.2 nmol/mmol, those with confirmed absolute insulin deficiency had a shorter time to insulin treatment (median 2.5 vs. 6 years, P=0.005) and lower BMI (25.1 vs. 29.1 kg/m(2) , P=0.04). Two out of the five patients with absolute insulin deficiency were glutamic acid decarboxylase autoantibody-positive. CONCLUSIONS: Absolute insulin deficiency may occur in long-standing Type 2 diabetes, and cannot be reliably predicted by clinical features or autoantibodies. Absolute insulin deficiency in Type 2 diabetes may increase the risk of hypoglycaemia and ketoacidosis, as in Type 1 diabetes. Its recognition should help guide treatment, education and management. The urinary C-peptide creatinine ratio is a practical non-invasive method to aid detection of absolute insulin deficiency, with a urinary C-peptide creatinine ratio > 0.2 nmol/mmol being a reliable indicator of retained endogenous insulin secretion.
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Jones AG, Besser REJ, Shields BM, McDonald TJ, Hope SV, Knight BA, Hattersley AT (2012). Assessment of endogenous insulin secretion in insulin treated diabetes predicts postprandial glucose and treatment response to prandial insulin.
BMC Endocrine Disorders,
12Abstract:
Assessment of endogenous insulin secretion in insulin treated diabetes predicts postprandial glucose and treatment response to prandial insulin
Background: in patients with both Type 1 and Type 2 diabetes endogenous insulin secretion falls with time which changes treatment requirements, however direct measurement of endogenous insulin secretion is rarely performed. We aimed to assess the impact of endogenous insulin secretion on postprandial glucose increase and the effectiveness of prandial exogenous insulin.Methods: We assessed endogenous insulin secretion in 102 participants with insulin treated diabetes (58 Type 1) following a standardised mixed meal without exogenous insulin. We tested the relationship between endogenous insulin secretion and post meal hyperglycaemia. In 80 participants treated with fast acting breakfast insulin we repeated the mixed meal with participants' usual insulin given and assessed the impact of endogenous insulin secretion on response to exogenous prandial insulin.Results: Post meal glucose increment (90 minute - fasting) was inversely correlated with endogenous insulin secretion (90 minute C-peptide) (Spearman's r = -0.70, p < 0.001). Similar doses of exogenous prandial insulin lowered glucose increment more when patients had less endogenous insulin; by 6.4(4.2-11.1) verses 1.2(0.03-2.88) mmol/L (p < 0.001) for patients in the lowest verses highest tertiles of endogenous insulin.Conclusions: in insulin treated patients the measurement of endogenous insulin secretion may help predict the degree of postprandial hyperglycaemia and the likely response to prandial insulin. © 2012 Jones et al.; licensee BioMed Central Ltd.
Abstract.
Geneste J, Pereira B, Arnaud B, Christol N, Liotier J, Blanc O, Teissedre F, Hope S, Schwan R, Llorca PM, et al (2012). CAGE, RAPS4, RAPS4-QF and AUDIT screening tests for men and women admitted for acute alcohol intoxication to an emergency department: Are standard thresholds appropriate?.
Alcohol and Alcoholism,
47(3), 273-281.
Abstract:
CAGE, RAPS4, RAPS4-QF and AUDIT screening tests for men and women admitted for acute alcohol intoxication to an emergency department: Are standard thresholds appropriate?
Aims: a number of screening instruments are routinely used in Emergency Department (ED) situations to identify alcohol-use disorders (AUD). We wished to study the psychometric features, particularly concerning optimal thresholds scores (TSs), of four assessment scales frequently used to screen for abuse and/or dependence, the cut-down annoyed guilty eye-opener (CAGE), Rapid Alcohol Problem Screen 4 (RAPS4), RAPS4-quantity-frequency and AUD Identification Test (AUDIT) questionnaires, particularly in the sub-group of people admitted for acute alcohol intoxication (AAI). Methods: all included patients [AAI admitted to ED (blood alcohol level ≥0.8 g/l)] were assessed by the four scales, and with a gold standard (alcohol dependence/abuse section of the Mini International Neuropsychiatric Interview), to determine AUD status. To investigate the TSs of the scales, we used Youden's index, efficiency, receiver operating characteristic (ROC) curve techniques and quality ROC curve technique for optimized TS (indices of quality). Results: a total of 164 persons (122 males, 42 females) were included in the study. Nineteen (11.60%) were identified as alcohol abusers alone and 128 (78.1%) as alcohol dependents (DSM-IV). Results suggest a statistically significant difference between men and women (P < 0.05) in performance of the screening tests RAPS4 (≥1) and CAGE (≥2) for detecting abuse. Also, in this population, we show an increase in TSs of RAPS4 (≥2) and CAGE (≥3) for detecting dependence compared with those typically accepted in non-intoxicated individuals. The AUDIT test demonstrates good performance for detecting alcohol abuse and/ or alcohol-dependent patients (≥7 for women and ≥12 for men) and for distinguishing alcohol dependence (≥11 for women and ≥14 for men) from other conditions. Conclusion: Our study underscores for the first time the need to adapt, taking into account gender, the thresholds of tests typically used for detection of abuse and dependence in this population. © the Author 2012. Medical Council on Alcohol and Oxford University Press. All rights reserved.
Abstract.
Jones AG, Besser REJ, McDonald TJ, Shields BM, Hope SV, Bowman P, Oram RA, Knight BA, Hattersley AT (2011). Urine C-peptide creatinine ratio is an alternative to stimulated serum C-peptide measurement in late-onset, insulin-treated diabetes.
Diabet Med,
28(9), 1034-1038.
Abstract:
Urine C-peptide creatinine ratio is an alternative to stimulated serum C-peptide measurement in late-onset, insulin-treated diabetes.
AIMS: Serum C-peptide measurement can assist clinical management of diabetes, but practicalities of collection limit widespread use. Urine C-peptide creatinine ratio may be a non-invasive practical alternative. The stability of C-peptide in urine allows outpatient or community testing. We aimed to assess how urine C-peptide creatinine ratio compared with serum C-peptide measurement during a mixed-meal tolerance test in individuals with late-onset, insulin-treated diabetes. METHODS: We correlated the gold standard of a stimulated serum C-peptide in a mixed-meal tolerance test with fasting and stimulated (mixed-meal tolerance test, standard home meal and largest home meal) urine C-peptide creatinine ratio in 51 subjects with insulin-treated diabetes (diagnosis after age 30 years, median age 66 years, median age at diagnosis 54, 42 with Type 2 diabetes, estimated glomerular filtration rate > 60 ml min(-1) 1.73 m(-2) ). RESULTS: Ninety-minute mixed-meal tolerance test serum C-peptide is correlated with mixed-meal tolerance test-stimulated urine C-peptide creatinine ratio (r = 0.82), urine C-peptide creatinine ratio after a standard breakfast at home (r = 0.73) and urine C-peptide creatinine ratio after largest home meal (r = 0.71). A stimulated (largest home meal) urine C-peptide creatinine ratio cut-off of 0.3 nmol/mmol had a 100% sensitivity and 96% specificity (area under receiver operating characteristic curve = 0.99) in identifying subjects without clinically significant endogenous insulin secretion (mixed-meal tolerance test-stimulated C-peptide < 0.2 nmol/l). In detecting a proposed serum C-peptide threshold for insulin requirement (stimulated serum C-peptide < 0.6 nmol/l), a stimulated (largest home meal) urine C-peptide creatinine ratio cut-off of 0.6 nmol/mmol had a sensitivity and specificity of 92%. CONCLUSION: in patients with insulin-treated diabetes diagnosed after age 30 years, urine C-peptide creatinine ratio is well correlated with serum C-peptide and may provide a practical alternative measure to detect insulin deficiency for use in routine clinical practice.
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Conferences
Jordan AN, Aizawa K, Gooding KM, Llewellyn D, Casanova F, Mawson DM, Gates PE, Adingupu DD, Elyas S, Hope S, et al (2022). Arterial haemodynamic parameters linked to arterial pulsatility, excess wave propagation and cognitive function. European Society of Hypertension. 17th - 20th Jun 2022.
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Arterial haemodynamic parameters linked to arterial pulsatility, excess wave propagation and cognitive function
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Attwood D, Vafidis J, Boorer J, Ellis W, Earley M, Denovan J, Hart G, Williams M, Burdett N, Lemon M, et al (2022). Proactive, community-based, IT-assisted comprehensive geriatric assessment (i-CGA) reduces unplanned hospitalisation and mortality rates for older people living with frailty in residential homes. 18th Congress of the European Geriatric Medicine Society. 28th - 30th Sep 2022.
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Proactive, community-based, IT-assisted comprehensive geriatric assessment (i-CGA) reduces unplanned hospitalisation and mortality rates for older people living with frailty in residential homes
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Brackley SM, Thomas N, Carr A, Andrews R, Hope SV, Jones AG (2022). Random c-peptide is a pragmatic measure of beta cell function, predicting glucose variability and hypoglycaemia risk.
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Swancutt D, Hope SV, Kent B, Robinson M, Goodwin V (2021). I'M ON THE FLOOR AND CAN'T GET UP AND IT'S REALLY ANNOYING: a QUALITATIVE INVESTIGATION OF PATIENT AND STAFF PERCEPTIONS OF OPTIONS FOR GETTING UP FROM THE FLOOR FOLLOWING a FALL.
Author URL.
Hope SV, Green J (2018). Assessment, referral and management of frail elderly patients by ambulance clinicians - exploratory investigation. British Society of Gerontology. 4th - 6th Jul 2018.
Abstract:
Assessment, referral and management of frail elderly patients by ambulance clinicians - exploratory investigation
Abstract.
Green J, Hope SV (2018). How do ambulance clinicians, in the South West of England, perceive frailty, its assessment and the management of patients with frailty? Focus group thematic analysis. British Society of Gerontology. 4th - 6th Jul 2018.
Abstract:
How do ambulance clinicians, in the South West of England, perceive frailty, its assessment and the management of patients with frailty? Focus group thematic analysis
Abstract.
Sanchez-Rodriguez D, Benoit F, Dallmeier D, Hope SV, Marco E, Mastaviciute A, Surquin M, Toscano-Rico M, Van Den Noortgate N, Landi F, et al (2018). In-hospital sarcopenia: sarcopenia 7+ EAMA study. From research into clinical practice. 14th International Congress of the EuropeanGeriatric Medicine Society. 10th - 12th Oct 2018.
Abstract:
In-hospital sarcopenia: sarcopenia 7+ EAMA study. From research into clinical practice
Abstract.
Hope SV, Kerminen H, Koutsouri A, Marien S, Mellingsaeter MR, Roitto HM, Saka B, Tarazona-Santabalbina FJ, Singler K (2018). What things in life are most important to older adults? and what do they know about geriatricians?. 14th International Congress of the European Geriatric Medicine Society. 10th - 12th Oct 2018.
Abstract:
What things in life are most important to older adults? and what do they know about geriatricians?
Abstract.
Bhaskaran B, Saulat A, Hope SV (2017). A rare case of concurrent spinal and posterior circulation stroke. 3rd European Stroke Organisation Conference (ESOC 2017). 16th - 18th May 2017.
Abstract:
A rare case of concurrent spinal and posterior circulation stroke
Abstract.
Hope SV, Knight BA, Shields BM, Hill AV, Choudhary P, Strain WD, Hattersley AT, McDonald TJ, Jones AG (2017). Random non-fasting C-peptide can be used as a risk assessment tool for hypoglycaemia in elderly insulin-treated patients with type 2 diabetes. British Geriatrics Society. 23rd - 25th Nov 2016.
Author URL.
Hope SV, Knight BA, Shields BM, Strain WD, Hattersley AT, Choudhary P, Jones AG (2016). Low c-peptide is associated with high glycaemic variability and hypoglycaemia in insulin-treated patients with Type 2 diabetes. Diabetes UK Professional Conference 2016. 2nd - 4th Mar 2016.
Author URL.
Hope SV, Knight BA, Shields BM, Hattersley AT, McDonald TJ, Jones AG (2016). Random non-fasting c-peptide provides an accurate measure of endogenous insulin secretion for clinical practice. Diabetes UK Professional Conference 2016. 2nd - 4th Mar 2016.
Author URL.
Hope SV, McDonald TJ, Hill AV, Strain WD, Hattersley AT (2015). Low c-peptide is associated in insulin-treated patients with hypoglycaemia unawareness as well as hypoglycaemia frequency. Diabetes UK Professional Conference 2015. 11th - 13th Mar 2015.
Author URL.
Hope SV, Taylor PJ, Shields BM, Oram RA, Chakera A, Hattersley AT (2014). Are we missing hypoglycaemia in elderly people?. 10th Congress of the European Union Geriatric Medicine Society. 17th - 19th Sep 2014.
Hope SV, Taylor PJ, Shields BM, Oram RA, Chakera AJ, Strain WD, Hattersley AT (2014). Non-specific symptoms associated with hypoglycaemia in the elderly are common in patients treated with metformin only, as well as those treated with insulin or sulphonylureas. Diabetes UK Professional Conference 2014. 5th - 7th Mar 2014.
Author URL.
Hope SV, Sword JE (2014). Referrals for Independent Medical Capacity Advocates: exploratory survey for appropriate audit data collection method. British Geriatrics Society. 20th - 22nd Nov 2013.
Abstract:
Referrals for Independent Medical Capacity Advocates: exploratory survey for appropriate audit data collection method
Abstract.
Stevens D, Campbell C, Hope SV, Morris A (2013). Improving end of life care on dementia inpatient wards. British Geriatrics Society. 28th - 30th Nov 2012.
Abstract:
Improving end of life care on dementia inpatient wards
Abstract.
Author URL.
Campbell C, Hope SV, Stevens D, Morris A (2013). Improving end of life care on inpatient dementia wards. Help the Hospices. 21st - 23rd Oct 2013.
Abstract:
Improving end of life care on inpatient dementia wards
Abstract.
Hope SV, Jones AG, Shepherd M, Shields BM, Strain WD, McDonald T, Knight BA, Hattersley AT (2013). Urinary C-peptide creatinine ratio to detect absolute insulin deficiency in type 2 diabetes. Spring Meeting for Clinician Scientists in Training. 27th - 27th Feb 2013.
Author URL.
Jones AG, Besser REJ, McDonald TJ, Shields BM, Hope SV, Bowman PA, Oram RA, Knight BA, Hattersley AT (2011). Measuring endogenous insulin secretion: does it matter in insulin treated patients?. Diabetes UK Annual Professional Conference 2011. 30th Mar - 1st Apr 2011.
Jones AG, Besser REJ, Shields BM, McDonald TJ, Hope SV, Oram RA, Knight BA, Hattersley AT (2011). Practical alternatives to the mixed meal tolerance test in insulin treated diabetes. Diabetes UK Annual Professional Conference 2011. 30th Mar - 1st Apr 2011.
Hope SV, Jones AG, Goodchild E, Shepherd M, Besser REJ, Shields BM, McDonald TJ, Knight BA, Hattersley AT (2011). Urinary C-Peptide Creatinine Ratio (UCPCR) can be used as a screening tool to detect absolute insulin deficiency in type 2 diabetes. Diabetes UK Annual Professional Conference 2011. 30th Mar - 1st Apr 2011.
Hope SV, Jones AG, Goodchild E, Shepherd M, Besser REJ, Shields BM, McDonald TJ, Knight BA, Hattersley AT (2011). Urinary C-Peptide Creatinine Ratio (UCPCR) can be used as a screening tool to detect absolute insulin deficiency in type 2 diabetes. British Geriatrics Society. 6th - 8th Apr 2011.
Author URL.
Jones AG, Hope SV, Shepherd M, Shields BM, Besser REJ, Wensley KJ, Githens-Mazer G, McDonald TJ, Knight BA, Hattersley AT, et al (2010). Do patients with Long-Standing Type 2 Diabetes Develop Absolute Insulin Deficiency?. American Diabetes Association 70th Scientific Sessions (2010). 25th - 29th Jun 2010.
Author URL.
Hope SV, Shepherd M, Shields BM, McDonald T, Knight BA, Hattersley AT (2010). Patients with long-standing type 2 diabetes can develop absolute insulin deficiency. European Association for the Study of Diabetes. 20th - 24th Sep 2010.
Author URL.
Publications by year
2022
Jordan AN, Aizawa K, Gooding KM, Llewellyn D, Casanova F, Mawson DM, Gates PE, Adingupu DD, Elyas S, Hope S, et al (2022). Arterial haemodynamic parameters linked to arterial pulsatility, excess wave propagation and cognitive function. European Society of Hypertension. 17th - 20th Jun 2022.
Abstract:
Arterial haemodynamic parameters linked to arterial pulsatility, excess wave propagation and cognitive function
Abstract.
Witham MD, Heslop P, Dodds RM, Clegg AP, Hope SV, McDonald C, Smithard D, Storey B, Tan AL, Thornhill A, et al (2022). Performance of the SarQoL quality of life tool in a UK population of older people with probable sarcopenia and implications for use in clinical trials: findings from the SarcNet registry.
BMC Geriatr,
22(1).
Abstract:
Performance of the SarQoL quality of life tool in a UK population of older people with probable sarcopenia and implications for use in clinical trials: findings from the SarcNet registry.
BACKGROUND: the Sarcopenia Quality of Life (SarQoL) questionnaire is a disease-specific sarcopenia quality of life tool. We aimed to independently assess SarQoL with a particular focus on its suitability as a clinical trial outcome measure. METHODS: We analysed data from the UK Sarcopenia Network and Registry. Measures of physical performance and lean mass were collected at baseline. SarQoL and the Strength, Assistance, Rise, Climb - Falls (SARC-F) questionnaire (to assess functional ability) were collected at both baseline and six-month follow-up. Global changes in fitness and quality of life at 6 months were elicited on seven-point Likert scales. Internal consistency was assessed using Cronbach's alpha. Responsiveness (Cohen's d and Guyatt coefficients) and minimum clinically important differences were calculated for participants reporting slight improvement or worsening in their global scores. Concurrent validity was assessed by correlating baseline SarQoL scores with measures of physical performance and functional ability. RESULTS: We analysed data from 147 participants, 125 of whom underwent follow up assessment; mean age 78 years; 72 (49%) were women. Internal consistency was good; Cronbach's alpha was 0.944 at baseline and 0.732 at telephone follow-up. Correlation between baseline and follow-up SarQoL was weak (r = 0.27; p = 0.03). The minimum clinically important improvement ranged from 5 to 21 points giving trial sample size estimates of 25-100 participants. SarQoL scores were moderately correlated with handgrip (r = 0.37; p
Abstract.
Author URL.
Attwood D, Vafidis J, Boorer J, Ellis W, Earley M, Denovan J, Hart G, Williams M, Burdett N, Lemon M, et al (2022). Proactive, community-based, IT-assisted comprehensive geriatric assessment (i-CGA) reduces unplanned hospitalisation and mortality rates for older people living with frailty in residential homes. 18th Congress of the European Geriatric Medicine Society. 28th - 30th Sep 2022.
Abstract:
Proactive, community-based, IT-assisted comprehensive geriatric assessment (i-CGA) reduces unplanned hospitalisation and mortality rates for older people living with frailty in residential homes
Abstract.
Brackley SM, Thomas N, Carr A, Andrews R, Hope SV, Jones AG (2022). Random c-peptide is a pragmatic measure of beta cell function, predicting glucose variability and hypoglycaemia risk.
Author URL.
Toback S, Galiza E, Cosgrove C, Galloway J, Goodman AL, Swift PA, Rajaram S, Graves-Jones A, Edelman J, Burns F, et al (2022). Safety, immunogenicity, and efficacy of a COVID-19 vaccine (NVX-CoV2373) co-administered with seasonal influenza vaccines: an exploratory substudy of a randomised, observer-blinded, placebo-controlled, phase 3 trial. The Lancet Respiratory Medicine, 10(2), 167-179.
2021
De Spiegeleer A, Kahya H, Sanchez-Rodriguez D, Piotrowicz K, Surquin M, Marco E, Detremerie C, Hussein D, Hope S, Dallmeier D, et al (2021). Acute sarcopenia changes following hospitalization: influence of pre-admission care dependency level.
Age and Ageing,
50(6), 2140-2146.
Abstract:
Acute sarcopenia changes following hospitalization: influence of pre-admission care dependency level
Abstract
.
. Introduction
. Hospitalization is associated with acute changes in sarcopenia status in older people, but the influencing factors are not fully understood. Pre-admission care dependency level as a risk factor has not yet been investigated.
.
.
. Objective
. Evaluate if pre-admission care dependency level is an independent predictor of sarcopenia changes following hospitalization.
.
.
. Setting and subjects
. Data came from the Sarcopenia 9+ EAMA Project, a European prospective multi-centre study. For this study, 227 hospitalised older people were included from four different hospitals in Belgium, Spain and Poland, between 18 February 2019 and 5 September 2020.
.
.
. Methods
. Sarcopenia status at admission and discharge were calculated using a combined score (desirability value) based on muscle mass (calf circumference), strength (grip) and function (walking speed). Ratio of admission to discharge status was the outcome (desirability ratio; 1.00 meaning no difference). Predictor variable was the pre-admission care dependency level, classified into three groups: independent older people living at home, dependent older people living at home and older people living in a care home. Linear regression models were applied, considering potential confounders.
.
.
. Results
. Mean desirability ratio for dependent older people living at home (‘middle dependent group’) was lower (0.89) compared to independent older people (0.98; regression coefficient −0.09 [95% CI −0.16, −0.02]) and care home patients (1.05; −0.16 [95% CI −0.01, −0.31]). Adjusting for potential confounders or using another statistical approach did not affect the main results.
.
.
. Conclusion
. Dependent older people living at home were at higher risk of deterioration in sarcopenia status following hospitalization. In-depth studies investigating causes and potential interventions of these findings are needed.
.
Abstract.
Miralles O, Sanchez-Rodriguez D, Marco E, Annweiler C, Baztan A, Betancor É, Cambra A, Cesari M, Fontecha BJ, Gąsowski J, et al (2021). Correction to: Unmet needs, health policies, and actions during the COVID-19 pandemic: a report from six European countries (European Geriatric Medicine, (2021), 12, 1, (193-204), 10.1007/s41999-020-00415-x).
European Geriatric Medicine,
12(3).
Abstract:
Correction to: Unmet needs, health policies, and actions during the COVID-19 pandemic: a report from six European countries (European Geriatric Medicine, (2021), 12, 1, (193-204), 10.1007/s41999-020-00415-x)
The original version of this article, published on October 15, 2020, contained a mistake. The correct information is given below. The original article has been corrected. On date of the revision on July 1, 2020, 23% of those infected (confirmed with RT-PCR, 38,107 out of 165,719 cases) and 35% of those who died (10,497 out of 29,861deaths) were NH residents, indicating a case fatality rate of 27.5%.
Abstract.
Witham MD, Heslop P, Dodds RM, Clegg AP, Hope SV, McDonald C, Smithard D, Storey B, Tan AL, Thornhill A, et al (2021). Developing a UK sarcopenia registry: recruitment and baseline characteristics of the SarcNet pilot.
Age Ageing,
50(5), 1762-1769.
Abstract:
Developing a UK sarcopenia registry: recruitment and baseline characteristics of the SarcNet pilot.
BACKGROUND: sarcopenia registries are a potential method to meet the challenge of recruitment to sarcopenia trials. We tested the feasibility of setting up a UK sarcopenia registry, the feasibility of recruitment methods and sought to characterise the pilot registry population. METHODS: six diverse UK sites took part, with potential participants aged 65 and over approached via mailshots from local primary care practices. Telephone pre-screening using the SARC-F score was followed by in-person screening and baseline visit. Co-morbidities, medications, grip strength, Short Physical Performance Battery, bioimpedance analysis, Geriatric Depression Score, Montreal Cognitive Assessment, Sarcopenia Quality of Life score were performed and permission sought for future recontact. Descriptive statistics for recruitment rates and baseline measures were generated; an embedded randomised trial examined the effect of a University logo on the primary care mailshot on recruitment rates. RESULTS: sixteen practices contributed a total of 3,508 letters. In total, 428 replies were received (12% response rate); 380 underwent telephone pre-screening of whom 215 (57%) were eligible to attend a screening visit; 150 participants were recruited (40% of those pre-screened) with 147 contributing baseline data. No significant difference was seen in response rates between mailshots with and without the logo (between-group difference 1.1% [95% confidence interval -1.0% to 3.4%], P = 0.31). The mean age of enrollees was 78 years; 72 (49%) were women. In total, 138/147 (94%) had probable sarcopenia on European Working Group on Sarcopenia 2019 criteria and 145/147 (98%) agreed to be recontacted about future studies. CONCLUSION: recruitment to a multisite UK sarcopenia registry is feasible, with high levels of consent for recontact.
Abstract.
Author URL.
Attwood D, Boorer J, Ellis W, Earley M, Denovan J, Calkoen A, Hart G, Williams M, Burdett N, Lemon M, et al (2021). Erratum to: the Pathfields Tool: a frailty case-finding tool using primary care IT-implications for population health management.
Age Ageing,
50(6), e17-e18.
Author URL.
Swancutt D, Hope SV, Kent B, Robinson M, Goodwin V (2021). I'M ON THE FLOOR AND CAN'T GET UP AND IT'S REALLY ANNOYING: a QUALITATIVE INVESTIGATION OF PATIENT AND STAFF PERCEPTIONS OF OPTIONS FOR GETTING UP FROM THE FLOOR FOLLOWING a FALL.
Author URL.
Heath PT, Galiza EP, Baxter DN, Boffito M, Browne D, Burns F, Chadwick DR, Clark R, Cosgrove C, Galloway J, et al (2021). Safety and Efficacy of NVX-CoV2373 Covid-19 Vaccine.
NEW ENGLAND JOURNAL OF MEDICINE,
385(13), 1172-1183.
Author URL.
Goodwin V, Swancutt D, Kent B, Robinson M, Hope S (2021). ‘I can’t get up and it's really annoying’: a qualitative investigation of getting up following a fall. Physiotherapy, 113
2020
Hope SV, Koutsouri A, Nguyen S, Piotrowicz K, Petrovic M, Gasowski J (2020). EuGMS 2019 Congress report: evidence-based medicine in geriatrics.
European Geriatric Medicine,
11(6), 915-918.
Abstract:
EuGMS 2019 Congress report: evidence-based medicine in geriatrics
AbstractThe 2019 EuGMS Congress “Evidence-Based Medicine in Geriatrics” was held in Krakow, Poland, and attended by over 1600 participants from 64 different countries. A summary and reflection on the congress was presented in the Closing Ceremony by European Academy for Medicine of Aging graduates, and summarised in this article. Keynote lectures, ‘state of the art’ sessions and symposia presented the evidence relating to different age-related conditions, their prevention, management and treatments. Hot topic areas included frailty and multimorbidity, and evidence-based attempts to address these conditions at different life stages. The field of geriatrics represents unique challenges for evidence-based medicine practice. There is much research going on. Clear leadership is needed to facilitate consensus agreements on standard definitions, methods and relevant outcomes, in collaboration with older people themselves, to maximise the opportunities and benefits of doing this research, and benefiting our patients and society at large.
Abstract.
Swancutt D, Hope S, Kent B, Robinson M, Goodwin V (2020). Knowledge, skills and attitudes of older people and staff about getting up from the floor following a fall: a qualitative investigation. BMC Geriatrics
Attwood D, Boorer J, Ellis W, Earley M, Denovan J, Calkoen A, Hart G, Williams M, Nicholas B, Lemon M, et al (2020). The Pathfields Tool: a frailty case-finding tool using primary care IT—implications for population health management. Age and Ageing
Miralles O, Sanchez-Rodriguez D, Marco E, Annweiler C, Baztan A, Betancor É, Cambra A, Cesari M, Fontecha BJ, Gąsowski J, et al (2020). Unmet needs, health policies, and actions during the COVID-19 pandemic: a report from six European countries. European Geriatric Medicine, 12(1), 193-204.
2019
Sanchez-Rodriguez D, Annweiler C, Marco E, Hope S, Piotrovicz K, Surquin M, Ranhoff A, Van Den Noortgate N (2019). European Academy for Medicine of Ageing Session Participants’ Report on Malnutrition Assessment and Diagnostic Methods; an International Survey. Clinical Nutrition
Sanchez-Rodriguez D, Hope S, Piotrowicz K, Benoit F, Czesak J, Dallmeier D, Decker G, Hansen Hojmann A, Hrnciarikova D, Marco E, et al (2019). Sarcopenia in Acute Care Patients: Protocol for the European Collaboration
of Geriatric Surveys: Sarcopenia 9+ EAMA Project. Journal of the American Medical Directors Association (JAMDA): long-term care: management, applied research and clinical issues
2018
Green J, Kirby K, Hope SV (2018). Ambulance clinicians’ perceptions, assessment and management of frailty: thematic analysis of focus groups. British Paramedic Journal, 3(3), 23-33.
Hope SV, Green J (2018). Assessment, referral and management of frail elderly patients by ambulance clinicians - exploratory investigation. British Society of Gerontology. 4th - 6th Jul 2018.
Abstract:
Assessment, referral and management of frail elderly patients by ambulance clinicians - exploratory investigation
Abstract.
Green J, Hope SV (2018). How do ambulance clinicians, in the South West of England, perceive frailty, its assessment and the management of patients with frailty? Focus group thematic analysis. British Society of Gerontology. 4th - 6th Jul 2018.
Abstract:
How do ambulance clinicians, in the South West of England, perceive frailty, its assessment and the management of patients with frailty? Focus group thematic analysis
Abstract.
Sanchez-Rodriguez D, Benoit F, Dallmeier D, Hope SV, Marco E, Mastaviciute A, Surquin M, Toscano-Rico M, Van Den Noortgate N, Landi F, et al (2018). In-hospital sarcopenia: sarcopenia 7+ EAMA study. From research into clinical practice. 14th International Congress of the EuropeanGeriatric Medicine Society. 10th - 12th Oct 2018.
Abstract:
In-hospital sarcopenia: sarcopenia 7+ EAMA study. From research into clinical practice
Abstract.
Pearce C, Hope S, Butchart J (2018). Intravascular lymphoma presenting with postural hypotension.
BMJ Case Rep,
2018Abstract:
Intravascular lymphoma presenting with postural hypotension.
An 84-year-old woman presented with severe postural hypotension. Further assessment revealed weight loss, fatigue and fever at night. On examination, she had bilateral skin lesions on the inner thighs and skin biopsy revealed intravascular high grade B cell lymphoma. This was successfully treated with curative chemotherapy. The cause of the postural hypotension in this case was felt likely to be autonomic neuropathy caused by neurovascular infiltration by intravascular lymphoma. Treatment of the lymphoma has resolved the postural hypotension, although some symptoms of postural instability persist.
Abstract.
Author URL.
Strain WD, Hope SV, Green A, Kar P, Valabhji J, Sinclair AJ (2018). Type 2 diabetes mellitus in older people: a brief statement of key principles of modern day management including the assessment of frailty. A national collaborative stakeholder initiative.
Diabet Med,
35(7), 838-845.
Abstract:
Type 2 diabetes mellitus in older people: a brief statement of key principles of modern day management including the assessment of frailty. A national collaborative stakeholder initiative.
Rates of population ageing are unprecedented and this, combined with the progressive urbanization of lifestyles, has led to a dramatic shift in the epidemiology of diabetes towards old age, particularly to those aged 60-79 years. Both ageing and diabetes are recognized as important risk factors for the development of functional decline and disability. In addition, diabetes is associated with a high economic, social and health burden. Traditional macrovascular and microvascular complications of diabetes appear to account for less than half of the diabetes-related disability observed in older people. Despite this, older adults are under-represented in clinical trials. Guidelines from organizations such as the National Institute for Health and Care Excellence (NICE), the European Association for the Study of Diabetes, and the American Diabetes Association acknowledge the need for individualized care, but the glycaemic targets that are suggested to constitute good control [HbA1c 53-59 mmol/mol (7-7.5%)] are too tight for frail older individuals. We present a framework for the assessment of older adults and guidelines for the management of this population according to their frailty status, with the intention of reducing complications and improving quality of life for these people.
Abstract.
Author URL.
Hope SV, Kerminen H, Koutsouri A, Marien S, Mellingsaeter MR, Roitto HM, Saka B, Tarazona-Santabalbina FJ, Singler K (2018). What things in life are most important to older adults? and what do they know about geriatricians?. 14th International Congress of the European Geriatric Medicine Society. 10th - 12th Oct 2018.
Abstract:
What things in life are most important to older adults? and what do they know about geriatricians?
Abstract.
2017
Bhaskaran B, Saulat A, Hope SV (2017). A rare case of concurrent spinal and posterior circulation stroke. 3rd European Stroke Organisation Conference (ESOC 2017). 16th - 18th May 2017.
Abstract:
A rare case of concurrent spinal and posterior circulation stroke
Abstract.
Hope SV, Taylor PJ, Shields BM, Hattersley AT, Hamilton W (2017). Are we missing hypoglycaemia?. Elderly patients with insulin-treated diabetes present to. primary care frequently with non-specific symptoms. associated with hypoglycaemia. Primary Care Diabetes
Gadsby R, Hope S, Hambling C, Carnegie A (2017). Frailty, older people and type 2 diabetes.
Journal of Diabetes Nursing,
21(4), 138-142.
Abstract:
Frailty, older people and type 2 diabetes
It is estimated that over half of all those living with diabetes are over 65 years of age. Diabetes management becomes increasingly complex as people age, and clinicians and people with diabetes can find it difficult to balance treatment benefits and risks. With increasing age, there is an increasing risk of dementia and frailty in people with diabetes, which impact on appropriate drug regimens. In this article, the authors recommend strategies for reducing the risk of hypoglycaemia in older people who are frail and have cognitive impairment or dementia.
Abstract.
Gadsby R, Hope SV, Hambling C, Carnegie A (2017). Frailty, older people and type 2 diabetes. Diabetes and Primary Care, 19, 18-22.
Hope SV, Knight BA, Shields BM, Hill AV, Choudhary P, Strain WD, Hattersley AT, McDonald TJ, Jones AG (2017). Random non-fasting C-peptide can be used as a risk assessment tool for hypoglycaemia in elderly insulin-treated patients with type 2 diabetes. British Geriatrics Society. 23rd - 25th Nov 2016.
Author URL.
Hope SV, Knight BA, Shields BM, Hill AV, Choudhary P, Strain WD, McDonald TJ, Jones AG (2017). Random non-fasting C-peptide testing can identify patients with insulin-treated type 2 diabetes at high risk of hypoglycaemia. Diabetologia
2016
Hope SV, Knight BA, Shields BM, Strain WD, Hattersley AT, Choudhary P, Jones AG (2016). Low c-peptide is associated with high glycaemic variability and hypoglycaemia in insulin-treated patients with Type 2 diabetes. Diabetes UK Professional Conference 2016. 2nd - 4th Mar 2016.
Author URL.
Hope SV, Wienand-Barnett S, Shepherd M, King SM, Fox C, Khunti K, Oram RA, Knight BA, Hattersley AT, Jones AG, et al (2016). Practical Classification Guidelines for Diabetes in patients treated with insulin: a cross-sectional study of the accuracy of diabetes diagnosis.
British Journal of General Practice,
66(646), e315-e322.
Abstract:
Practical Classification Guidelines for Diabetes in patients treated with insulin: a cross-sectional study of the accuracy of diabetes diagnosis
Background Differentiating between type 1 and type 2 diabetes is fundamental to ensuring appropriate management of patients, but can be challenging, especially when treating with insulin. The 2010 UK Practical Classification Guidelines for Diabetes were developed to help make the differentiation. Aim to assess diagnostic accuracy of the UK guidelines against gold standard definitions of type 1 and type 2 diabetes based on measured C-peptide levels. Design and setting in total, 601 adults with insulin-treated diabetes and diabetes duration ≥5 years were recruited in Devon, Northamptonshire, and Leicestershire. Method Baseline information and home urine sample were collected. Urinary C-peptide creatinine ratio (UCPCR) measures endogenous insulin production. Gold standard type 1 diabetes was defined as continuous insulin treatment within 3 years of diagnosis and absolute insulin deficiency (UCPCR
Abstract.
Hope SV, Knight BA, Shields BM, Hattersley AT, McDonald TJ, Jones AG (2016). Random non-fasting C–peptide: bringing robust assessment of endogenous insulin secretion to the clinic.
Diabetic Medicine,
33(11), 1554-1558.
Abstract:
Random non-fasting C–peptide: bringing robust assessment of endogenous insulin secretion to the clinic
Background: Measuring endogenous insulin secretion using C–peptide can assist diabetes management, but standard stimulation tests are impractical for clinical use. Random non-fasting C–peptide assessment would allow testing when a patient is seen in clinic. Methods: We compared C–peptide at 90 min in the mixed meal tolerance test (sCP) with random non-fasting blood C–peptide (rCP) and random non-fasting urine C–peptide creatinine ratio (rUCPCR) in 41 participants with insulin-treated diabetes [median age 72 (interquartile range 68–78); diabetes duration 21 (14–31) years]. We assessed sensitivity and specificity for previously reported optimal mixed meal test thresholds for severe insulin deficiency (sCP < 200 pmol//l) and Type 1 diabetes/inability to withdraw insulin (< 600 pmol//l), and assessed the impact of concurrent glucose. Results: rCP and sCP levels were similar (median 546 and 487 pmol//l, P = 0.92). rCP was highly correlated with sCP, r = 0.91, P < 0.0001, improving to r = 0.96 when excluding samples with concurrent glucose < 8 mmol//l. An rCP cut-off of 200 pmol//l gave 100% sensitivity and 93% specificity for detecting severe insulin deficiency, with area under the receiver operating characteristic curve of 0.99. rCP < 600 pmol//l gave 87% sensitivity and 83% specificity to detect sCP < 600 pmol//l. Specificity improved to 100% when excluding samples with concurrent glucose < 8 mmol//l. rUCPCR (0.52 nmol/mmol) was also well-correlated with sCP, r = 0.82, P < 0.0001. A rUCPCR cut-off of < 0.2 nmol/ mmol gave sensitivity and specificity of 83% and 93% to detect severe insulin deficiency, with area under the receiver operating characteristic curve of 0.98. Conclusions: Random non-fasting C–peptide measures are strongly correlated with mixed meal C–peptide, and have high sensitivity and specificity for identifying clinically relevant thresholds. These tests allow assessment of C–peptide at the point patients are seen for clinical care.
Abstract.
Hope SV, Knight BA, Shields BM, Hattersley AT, McDonald TJ, Jones AG (2016). Random non-fasting c-peptide provides an accurate measure of endogenous insulin secretion for clinical practice. Diabetes UK Professional Conference 2016. 2nd - 4th Mar 2016.
Author URL.
2015
Hope SV, McDonald TJ, Hill AV, Strain WD, Hattersley AT (2015). Low c-peptide is associated in insulin-treated patients with hypoglycaemia unawareness as well as hypoglycaemia frequency. Diabetes UK Professional Conference 2015. 11th - 13th Mar 2015.
Author URL.
2014
Hope SV, Taylor PJ, Shields BM, Oram RA, Chakera A, Hattersley AT (2014). Are we missing hypoglycaemia in elderly people?. 10th Congress of the European Union Geriatric Medicine Society. 17th - 19th Sep 2014.
Hope SV, Taylor PJ, Shields BM, Oram RA, Chakera AJ, Strain WD, Hattersley AT (2014). Non-specific symptoms associated with hypoglycaemia in the elderly are common in patients treated with metformin only, as well as those treated with insulin or sulphonylureas. Diabetes UK Professional Conference 2014. 5th - 7th Mar 2014.
Author URL.
Hope SV, Sword JE (2014). Referrals for Independent Medical Capacity Advocates: exploratory survey for appropriate audit data collection method. British Geriatrics Society. 20th - 22nd Nov 2013.
Abstract:
Referrals for Independent Medical Capacity Advocates: exploratory survey for appropriate audit data collection method
Abstract.
2013
Hope SV, Strain WD (2013). Hypoglycemia in the elderly.
Diabetic Hypoglycemia,
6(1), 3-10.
Abstract:
Hypoglycemia in the elderly
Hypoglycemia is a common, under-recognized complication of the management of type 2 diabetes. Elderly individuals have a higher burden of co-morbidities, cognitive impairment, physical dysfunction and frailty, which makes them more vulnerable to complications of hypoglycemia, such as falls, fractures, cognitive impairment and cardiovascular events, than younger patients. Furthermore, with ageing comes impairment of autoregulatory responses, which means the symptoms of hypoglycemia are often less specific, and are therefore either missed or incorrectly diagnosed as transient ischemic attacks or other cerebrovascular events. Older adults with diabetes have a greater risk of hypoglycemia associated with the physiological decline of ageing, and the extended duration of diabetes and insulin treatment. The elderly are also more prone to the effects of hypoglycemia such as the increased risk of accidents, falls and fractures, hospitalizations, in-hospital mortality, and long-term impairment of cognition. Using individualized treatment targets to base treatment strategies around individual circumstances may reduce the risk of hypoglycemia.
Abstract.
Stevens D, Campbell C, Hope SV, Morris A (2013). Improving end of life care on dementia inpatient wards. British Geriatrics Society. 28th - 30th Nov 2012.
Abstract:
Improving end of life care on dementia inpatient wards
Abstract.
Author URL.
Campbell C, Hope SV, Stevens D, Morris A (2013). Improving end of life care on inpatient dementia wards. Help the Hospices. 21st - 23rd Oct 2013.
Abstract:
Improving end of life care on inpatient dementia wards
Abstract.
Hope SV, Jones AG, Goodchild E, Shepherd M, Besser REJ, Shields B, Mcdonald T, Knight BA, Hattersley A (2013). Urinary C-peptide creatinine ratio detects absolute insulin deficiency in Type 2 diabetes.
Diabetic Medicine,
30(11), 1342-1348.
Abstract:
Urinary C-peptide creatinine ratio detects absolute insulin deficiency in Type 2 diabetes
Aims: to determine the prevalence and clinical characteristics of absolute insulin deficiency in long-standing Type 2 diabetes, using a strategy based on home urinary C-peptide creatinine ratio measurement. Methods: We assessed the urinary C-peptide creatinine ratios, from urine samples taken at home 2 h after the largest meal of the day, in 191 insulin-treated subjects with Type 2 diabetes (diagnosis age ≥45 years, no insulin in the first year). If the initial urinary C-peptide creatinine ratio was ≤0.2 nmol/mmol (representing absolute insulin deficiency), the assessment was repeated. A standardized mixed-meal tolerance test with 90-min stimulated serum C-peptide measurement was performed in nine subjects with a urinary C-peptide creatinine ratio ≤ 0.2 nmol/mmol (and in nine controls with a urinary C-peptide creatinine ratio >0.2 nmol/mmol) to confirm absolute insulin deficiency. Results: a total of 2.7% of participants had absolute insulin deficiency confirmed by a mixed-meal tolerance test. They were identified initially using urinary C-peptide creatinine ratio: 11/191 subjects (5.8%) had two consistent urinary C-peptide creatinine ratios ≤ 0.2 nmol/mmol; 9 of these 11 subjects completed a mixed-meal tolerance test and had a median stimulated serum C-peptide of 0.18 nmol/l. Five of these 9 had stimulated serum C-peptide 0.2 had endogenous insulin secretion confirmed by the mixed-meal tolerance test. Compared with subjects with a urinary C-peptide creatinine ratio >0.2 nmol/mmol, those with confirmed absolute insulin deficiency had a shorter time to insulin treatment (median 2.5 vs. 6 years, P=0.005) and lower BMI (25.1 vs. 29.1 kg/m2, P=0.04). Two out of the five patients with absolute insulin deficiency were glutamic acid decarboxylase autoantibody-positive. Conclusions: Absolute insulin deficiency may occur in long-standing Type 2 diabetes, and cannot be reliably predicted by clinical features or autoantibodies. Absolute insulin deficiency in Type 2 diabetes may increase the risk of hypoglycaemia and ketoacidosis, as in Type 1 diabetes. Its recognition should help guide treatment, education and management. The urinary C-peptide creatinine ratio is a practical non-invasive method to aid detection of absolute insulin deficiency, with a urinary C-peptide creatinine ratio > 0.2 nmol/mmol being a reliable indicator of retained endogenous insulin secretion. © 2013 the Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.
Abstract.
Hope SV, Jones AG, Goodchild E, Shepherd M, Besser REJ, Shields B, McDonald T, Knight BA, Hattersley A (2013). Urinary C-peptide creatinine ratio detects absolute insulin deficiency in Type 2 diabetes.
Diabet Med,
30(11), 1342-1348.
Abstract:
Urinary C-peptide creatinine ratio detects absolute insulin deficiency in Type 2 diabetes.
AIMS: to determine the prevalence and clinical characteristics of absolute insulin deficiency in long-standing Type 2 diabetes, using a strategy based on home urinary C-peptide creatinine ratio measurement. METHODS: We assessed the urinary C-peptide creatinine ratios, from urine samples taken at home 2 h after the largest meal of the day, in 191 insulin-treated subjects with Type 2 diabetes (diagnosis age ≥45 years, no insulin in the first year). If the initial urinary C-peptide creatinine ratio was ≤0.2 nmol/mmol (representing absolute insulin deficiency), the assessment was repeated. A standardized mixed-meal tolerance test with 90-min stimulated serum C-peptide measurement was performed in nine subjects with a urinary C-peptide creatinine ratio ≤ 0.2 nmol/mmol (and in nine controls with a urinary C-peptide creatinine ratio >0.2 nmol/mmol) to confirm absolute insulin deficiency. RESULTS: a total of 2.7% of participants had absolute insulin deficiency confirmed by a mixed-meal tolerance test. They were identified initially using urinary C-peptide creatinine ratio: 11/191 subjects (5.8%) had two consistent urinary C-peptide creatinine ratios ≤ 0.2 nmol/mmol; 9 of these 11 subjects completed a mixed-meal tolerance test and had a median stimulated serum C-peptide of 0.18 nmol/l. Five of these 9 had stimulated serum C-peptide 0.2 had endogenous insulin secretion confirmed by the mixed-meal tolerance test. Compared with subjects with a urinary C-peptide creatinine ratio >0.2 nmol/mmol, those with confirmed absolute insulin deficiency had a shorter time to insulin treatment (median 2.5 vs. 6 years, P=0.005) and lower BMI (25.1 vs. 29.1 kg/m(2) , P=0.04). Two out of the five patients with absolute insulin deficiency were glutamic acid decarboxylase autoantibody-positive. CONCLUSIONS: Absolute insulin deficiency may occur in long-standing Type 2 diabetes, and cannot be reliably predicted by clinical features or autoantibodies. Absolute insulin deficiency in Type 2 diabetes may increase the risk of hypoglycaemia and ketoacidosis, as in Type 1 diabetes. Its recognition should help guide treatment, education and management. The urinary C-peptide creatinine ratio is a practical non-invasive method to aid detection of absolute insulin deficiency, with a urinary C-peptide creatinine ratio > 0.2 nmol/mmol being a reliable indicator of retained endogenous insulin secretion.
Abstract.
Author URL.
Hope SV, Jones AG, Shepherd M, Shields BM, Strain WD, McDonald T, Knight BA, Hattersley AT (2013). Urinary C-peptide creatinine ratio to detect absolute insulin deficiency in type 2 diabetes. Spring Meeting for Clinician Scientists in Training. 27th - 27th Feb 2013.
Author URL.
2012
Jones AG, Besser REJ, Shields BM, McDonald TJ, Hope SV, Knight BA, Hattersley AT (2012). Assessment of endogenous insulin secretion in insulin treated diabetes predicts postprandial glucose and treatment response to prandial insulin.
BMC Endocrine Disorders,
12Abstract:
Assessment of endogenous insulin secretion in insulin treated diabetes predicts postprandial glucose and treatment response to prandial insulin
Background: in patients with both Type 1 and Type 2 diabetes endogenous insulin secretion falls with time which changes treatment requirements, however direct measurement of endogenous insulin secretion is rarely performed. We aimed to assess the impact of endogenous insulin secretion on postprandial glucose increase and the effectiveness of prandial exogenous insulin.Methods: We assessed endogenous insulin secretion in 102 participants with insulin treated diabetes (58 Type 1) following a standardised mixed meal without exogenous insulin. We tested the relationship between endogenous insulin secretion and post meal hyperglycaemia. In 80 participants treated with fast acting breakfast insulin we repeated the mixed meal with participants' usual insulin given and assessed the impact of endogenous insulin secretion on response to exogenous prandial insulin.Results: Post meal glucose increment (90 minute - fasting) was inversely correlated with endogenous insulin secretion (90 minute C-peptide) (Spearman's r = -0.70, p < 0.001). Similar doses of exogenous prandial insulin lowered glucose increment more when patients had less endogenous insulin; by 6.4(4.2-11.1) verses 1.2(0.03-2.88) mmol/L (p < 0.001) for patients in the lowest verses highest tertiles of endogenous insulin.Conclusions: in insulin treated patients the measurement of endogenous insulin secretion may help predict the degree of postprandial hyperglycaemia and the likely response to prandial insulin. © 2012 Jones et al.; licensee BioMed Central Ltd.
Abstract.
Geneste J, Pereira B, Arnaud B, Christol N, Liotier J, Blanc O, Teissedre F, Hope S, Schwan R, Llorca PM, et al (2012). CAGE, RAPS4, RAPS4-QF and AUDIT screening tests for men and women admitted for acute alcohol intoxication to an emergency department: Are standard thresholds appropriate?.
Alcohol and Alcoholism,
47(3), 273-281.
Abstract:
CAGE, RAPS4, RAPS4-QF and AUDIT screening tests for men and women admitted for acute alcohol intoxication to an emergency department: Are standard thresholds appropriate?
Aims: a number of screening instruments are routinely used in Emergency Department (ED) situations to identify alcohol-use disorders (AUD). We wished to study the psychometric features, particularly concerning optimal thresholds scores (TSs), of four assessment scales frequently used to screen for abuse and/or dependence, the cut-down annoyed guilty eye-opener (CAGE), Rapid Alcohol Problem Screen 4 (RAPS4), RAPS4-quantity-frequency and AUD Identification Test (AUDIT) questionnaires, particularly in the sub-group of people admitted for acute alcohol intoxication (AAI). Methods: all included patients [AAI admitted to ED (blood alcohol level ≥0.8 g/l)] were assessed by the four scales, and with a gold standard (alcohol dependence/abuse section of the Mini International Neuropsychiatric Interview), to determine AUD status. To investigate the TSs of the scales, we used Youden's index, efficiency, receiver operating characteristic (ROC) curve techniques and quality ROC curve technique for optimized TS (indices of quality). Results: a total of 164 persons (122 males, 42 females) were included in the study. Nineteen (11.60%) were identified as alcohol abusers alone and 128 (78.1%) as alcohol dependents (DSM-IV). Results suggest a statistically significant difference between men and women (P < 0.05) in performance of the screening tests RAPS4 (≥1) and CAGE (≥2) for detecting abuse. Also, in this population, we show an increase in TSs of RAPS4 (≥2) and CAGE (≥3) for detecting dependence compared with those typically accepted in non-intoxicated individuals. The AUDIT test demonstrates good performance for detecting alcohol abuse and/ or alcohol-dependent patients (≥7 for women and ≥12 for men) and for distinguishing alcohol dependence (≥11 for women and ≥14 for men) from other conditions. Conclusion: Our study underscores for the first time the need to adapt, taking into account gender, the thresholds of tests typically used for detection of abuse and dependence in this population. © the Author 2012. Medical Council on Alcohol and Oxford University Press. All rights reserved.
Abstract.
2011
Jones AG, Besser REJ, McDonald TJ, Shields BM, Hope SV, Bowman PA, Oram RA, Knight BA, Hattersley AT (2011). Measuring endogenous insulin secretion: does it matter in insulin treated patients?. Diabetes UK Annual Professional Conference 2011. 30th Mar - 1st Apr 2011.
Jones AG, Besser REJ, Shields BM, McDonald TJ, Hope SV, Oram RA, Knight BA, Hattersley AT (2011). Practical alternatives to the mixed meal tolerance test in insulin treated diabetes. Diabetes UK Annual Professional Conference 2011. 30th Mar - 1st Apr 2011.
Hope SV, Jones AG, Goodchild E, Shepherd M, Besser REJ, Shields BM, McDonald TJ, Knight BA, Hattersley AT (2011). Urinary C-Peptide Creatinine Ratio (UCPCR) can be used as a screening tool to detect absolute insulin deficiency in type 2 diabetes. Diabetes UK Annual Professional Conference 2011. 30th Mar - 1st Apr 2011.
Hope SV, Jones AG, Goodchild E, Shepherd M, Besser REJ, Shields BM, McDonald TJ, Knight BA, Hattersley AT (2011). Urinary C-Peptide Creatinine Ratio (UCPCR) can be used as a screening tool to detect absolute insulin deficiency in type 2 diabetes. British Geriatrics Society. 6th - 8th Apr 2011.
Author URL.
Jones AG, Besser REJ, McDonald TJ, Shields BM, Hope SV, Bowman P, Oram RA, Knight BA, Hattersley AT (2011). Urine C-peptide creatinine ratio is an alternative to stimulated serum C-peptide measurement in late-onset, insulin-treated diabetes.
Diabet Med,
28(9), 1034-1038.
Abstract:
Urine C-peptide creatinine ratio is an alternative to stimulated serum C-peptide measurement in late-onset, insulin-treated diabetes.
AIMS: Serum C-peptide measurement can assist clinical management of diabetes, but practicalities of collection limit widespread use. Urine C-peptide creatinine ratio may be a non-invasive practical alternative. The stability of C-peptide in urine allows outpatient or community testing. We aimed to assess how urine C-peptide creatinine ratio compared with serum C-peptide measurement during a mixed-meal tolerance test in individuals with late-onset, insulin-treated diabetes. METHODS: We correlated the gold standard of a stimulated serum C-peptide in a mixed-meal tolerance test with fasting and stimulated (mixed-meal tolerance test, standard home meal and largest home meal) urine C-peptide creatinine ratio in 51 subjects with insulin-treated diabetes (diagnosis after age 30 years, median age 66 years, median age at diagnosis 54, 42 with Type 2 diabetes, estimated glomerular filtration rate > 60 ml min(-1) 1.73 m(-2) ). RESULTS: Ninety-minute mixed-meal tolerance test serum C-peptide is correlated with mixed-meal tolerance test-stimulated urine C-peptide creatinine ratio (r = 0.82), urine C-peptide creatinine ratio after a standard breakfast at home (r = 0.73) and urine C-peptide creatinine ratio after largest home meal (r = 0.71). A stimulated (largest home meal) urine C-peptide creatinine ratio cut-off of 0.3 nmol/mmol had a 100% sensitivity and 96% specificity (area under receiver operating characteristic curve = 0.99) in identifying subjects without clinically significant endogenous insulin secretion (mixed-meal tolerance test-stimulated C-peptide < 0.2 nmol/l). In detecting a proposed serum C-peptide threshold for insulin requirement (stimulated serum C-peptide < 0.6 nmol/l), a stimulated (largest home meal) urine C-peptide creatinine ratio cut-off of 0.6 nmol/mmol had a sensitivity and specificity of 92%. CONCLUSION: in patients with insulin-treated diabetes diagnosed after age 30 years, urine C-peptide creatinine ratio is well correlated with serum C-peptide and may provide a practical alternative measure to detect insulin deficiency for use in routine clinical practice.
Abstract.
Author URL.
2010
Jones AG, Hope SV, Shepherd M, Shields BM, Besser REJ, Wensley KJ, Githens-Mazer G, McDonald TJ, Knight BA, Hattersley AT, et al (2010). Do patients with Long-Standing Type 2 Diabetes Develop Absolute Insulin Deficiency?. American Diabetes Association 70th Scientific Sessions (2010). 25th - 29th Jun 2010.
Author URL.
Hope SV, Shepherd M, Shields BM, McDonald T, Knight BA, Hattersley AT (2010). Patients with long-standing type 2 diabetes can develop absolute insulin deficiency. European Association for the Study of Diabetes. 20th - 24th Sep 2010.
Author URL.
