Endocrine Abstracts

The term Leaky Gut Syndrome (LGS) describes a collection of a range of symptoms, including abdominal pain, bloating, recurring diarrhoea, bloody stools and weight loss, when a diagnosis has not been, or cannot be, made. It can be associated with inflammatory bowel disease (IBD), celiac disease, chemotherapy and radiation therapies, and endocrine conditions including obesity and diabetes. The common underlying features of LGS are gut inflammation and an increase in gastrointest...

Introduction: The relationship between non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes is well-established. However, the precise impact of glucose control on the severity and progression of NAFLD remains largely unexplored. Currently, none of the non-invasive scoring systems used to assess NAFLD severity incorporate glucose control markers, such as glycated hemoglobin (HbA1c).Methods: Data were collected fr...

Background: Glucagon-like-peptide-1 (GLP-1) has been shown to improve body weight and glycaemic control in patients with common obesity and type 2 diabetes. Whether it confers the same metabolic benefits in monogenic syndromic obesity is unknown. This observational study aimed to examine the real-world efficacy of GLP-1 analogues in Alström syndrome (ALMS), a form of monogenic obesity.Method: We screened all 72 UK a...

The spinal cord dorsal horn acts as a hub for the modulation of sensory information, relying heavily upon the interplay of a heterogenous cell population (endothelial cells, astrocytes) with sensory neurons. We have identified in rodent models of hyperglycemic neuropathic pain that spinal microvasculature is damaged. A pathological hallmark of chronic pain is astrogliosis, acting as a potent source of inflammatory response and impacting vessel integrity and sensory neuronal ac...

Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the metabolic syndrome. It represents a spectrum of disease, ranging from steatosis to non-alcoholic steatohepatitis, progressing to fibrosis, cirrhosis, and hepatocellular carcinoma. BAs, as well as their intermediary products (oxysterols), are metabolic modulators exerting their effects through activation of nuclear receptors (NRs), including the farnesoid-X- (FXR) and liver-X-receptors (LXR). Cruciall...

Metabolic fluxes in the liver demonstrate circadian rhythms. The hepatic circadian clock is a cell- autonomous protein network that governs the switch between the fasted and fed states via a series of transcriptional-translational feedback loops (TTLs). Diet is a powerful zeitgeber which can reprogramme the liver clock to follow eating schedule rather than the geophysical day-night cycle. Diet- induced circadian disruption has been implicated in the pathogenesis of common meta...

Background: Children with pre-symptomatic type 1 diabetes (T1D) can be identified through testing for circulating islet autoantibodies (AAb). Identifying children at risk reduces diabetic ketoacidosis at onset and allows participation in trials aiming for immunoprevention. The EarLy Surveillance for Autoimmune diabetes (ELSA) study is exploring feasibility and acceptability of UK paediatric general population screening.Methods:</...

Introduction: Pharmacological targeting of skeletal muscle to enhance metabolism through signalling pathways independent of insulin could be effective in treating metabolic diseases such as obesity and type 2 diabetes. BI-9774 is an allosteric agonist which has been shown to have high potency in enhancing 5’ AMP-activated protein kinase (AMPK) activity. The purpose of these experiments was to establish the effects of BI-9774 on AMPK signalling and mitocho...

Background: A four-tiered system is currently in place for weight management in the National Health Service (NHS). Tier 3 comprises specialist weight management services and aims for a clinically meaningful weight loss of ≥5%, as recommended by the National Institute for Health and Care Excellence (NICE). Within the Imperial Weight Centre (IWC), patients receive support from a multi-disciplinary team including endocrinologists, surgeons, dietitians, nurs...

Neurotensin is expressed throughout the gastrointestinal tract and acts as a gut hormone. Recent work has established neurotensin modulates lipid absorption at the gastrointestinal lumen, but its role in the control of glucose homeostasis remains unclear. Neurotensin acts via three receptors, including the NtsR1 and is endogenously released following the ingestion of olive oil. Previous work in our group has identified that neurotensin acutely improves glucose tolerance in bot...

The Hydroxycarboxylic Acid Receptor 1 (HCAR1) is a Gαi/o-coupled GPCR known to be activated by both L- and D-lactate; metabolites produced by gut microbiota and anaerobic metabolism. Elevated D-lactate levels are indicative of dysbiosis and inflammatory bowel disease. As lactate can be transported into cells, it has the potential to activate HCAR1 at the plasma membrane and within intracellular locations resulting in diversified responses. Whether HCAR1 signalling is spat...

Polycystic ovarian syndrome (PCOS) is one of the most common endocrine disorders affecting 6-15% of women of reproductive age. The syndrome is characterised by a variety of reproductive and metabolic features, including hyperandrogenism, chronic anovulation and hirsutism as well as insulin resistance, dyslipidaemia, and non-alcoholic fatty liver disease (NAFLD). Specifically regarding NAFLD, androgen excess is hypothesised to have a direct effect on hepatic lipid storage, thus...

Bile acids and steroid hormones are potent regulators of metabolic phenotype. 5β-reductase (AKR1D1) is highly expressed in the liver where it catalyses a fundamental step in bile acid synthesis and inactivates steroid hormones. We have previously shown that male, but not female, AKR1D1 knockout (KO) mice on a normal chow diet are leaner than wildtype littermates but are not protected against diet induced obesity. Here we investigate the impact of a high fat diet on female...

Subpopulations of beta cells dictate overall ‘pacing’ of insulin secretion across the islet and therefore the control of glycaemia. Functional beta cell subpopulations also exist in human islets and have an altered subtype distribution in type 2 diabetes. However, the molecular control of the establishment and maintenance of beta cell hierarchy is poorly understood. We hypothesised that the epigenome would govern this heterogeneity. We have identified a novel subpopu...

Intra-articular (IA) glucocorticoids (GCs) injections are effective in controlling joint inflammation but limited by short duration of action and off-target side effects. Gellan sheared hydrogels (SHs) area drug delivery vehicle, with unique thinning properties and enhanced release kinetics. We hypothesise that a combination of SHs and pre-receptor metabolism activated GCs provide slow-release drug delivery to target inflammation and minimise side-effects. We the release kinet...

Dietary guidelines in the UK and worldwide recommend reducing the quantity of free sugars in the diet. The consumption of foods high in free sugars can lead to postprandial hyperglycaemia and hyperinsulinemia, which have been implicated in the development of metabolic diseases including type 2 diabetes and obesity. Rare sugars (naturally occurring monosaccharides which hardly exist in nature) have been found to suppress the postprandial elevation in blood glucose and improve g...

The regulation of insulin and glucagon secretion has traditionally been attributed to the gut-brain axis and direct sensing of blood glucose levels by pancreatic islets. However, the enteric nervous system may directly modulate pancreatic hormone release. This study focuses on a specific population of enteric neurons that exhibit the capability to transmit signals from the gut to the pancreas, potentially revealing new pathways of metabolic regulation. The gastrointestinal tra...

Introduction: The prevalence of type 2 diabetes mellitus (DM) is increasing worldwide. As a result, there is also an increased incidence of complications of diabetes at the clinics and emergency rooms. This study seeks to know the proportion of medical admissions due to diabetes-related causes, to determine the pattern of DM-related admissions, assess the pattern and outcome of diabetic foot syndrome (DMFS) and their determinants.<strong...

Background: Predictions estimate that the majority of the global population will be living with overweight and obesity by 2035. Due to its widespread use and ability to disseminate information, social media has a potentially prominent role in obesity care and education. Regulatory bodies issue ethical guidance on social media use. However, it is unknown how healthcare professionals’ (HCP) online activity affects people living with obesity. By exploring th...

Introduction: Inpatient admission presents an opportunity to deintensify treatment in people with diabetes and frailty. The Joint British Diabetes Society recommends checking HbA1c in people with diabetes and frailty during admission if it had not been checked in the preceding six months. The audit aimed to identify the proportion of people who had their HbA1c checked upon admission and, if appropriate, what proportion had their treatment deintensified.<p ...

Human papillomavirus (HPV) is one of the most common sexually transmitted viruses in reproductive age. About 80% of women will get at least one type of HPV at some point in their lifetime. Pregnancy is highly susceptible because decreased immunity during this period. There are few studies available from Indian sub-continent indicating a link between HPV infection and pregnancy. Association with various demographic factors in women would help in categorising those women who are...

Introduction: Pembrolizumab is an immune checkpoint inhibitor (ICI) used to treat advanced cancers. While improving survival rates, ICIs also cause immune-related adverse events (IRAEs). The endocrine system remains the most vulnerable to IRAEs: thyroid involvement is the commonest while pancreatic involvement is rare, affecting less than 1% of individuals. Risk factors for IRAEs include, personal or family history of autoimmune conditions, presence of another...

Hypoglycemia during hospital admission remains a common complication of diabetes. Hypoglycemia is associated with increased morbidity and mortality, increased length of stay, increased admission rate and increased cost to the NHS. Prompt treatment of inpatient hypoglycemia is imperative to avoid such complications. The Hypoglycemia box is an important tool to manage hypoglycemia on the wards. It is crucial for all clinical members to be aware of the hypoglycemia box; its conte...

Background: Hypoglycaemia unawareness is thought to be due to very tight control of diabetes but may also be due to very longstanding slowly progressive hypoglycaemia. We describe a patient who had no warning of very severe hypoinsulinaemic hypoglycaemia.Case Presentation: A 65-year-old gentleman presented with recurrent hypoglycemia that responded to IV glucose. A chest X-ray revealed a space occupying lesion and furthe...

Introduction: Major risk factors for cardiovascular disease and outcome include, though not limited to, hypertension, diabetes mellitus and obesity. In the wake of present urbanization, the prevalence of these risk factors has increased, impacting greatly on disease burden.Objectives: To determine the prevalence of undiagnosed Diabetes, Hypertension, Obesity and associated demographic factors in a market population in La...

Background: Hyponatremia is the most common electrolyte disorder encountered in clinical practice. Vulnerable cohorts tend to be hospitalised patients where it tends to occur in 15-20% of the patients and the other category being nursing home residents. Significant risk factors are increasing age, and polypharmacy.Aims: We aimed to look at the management of hyponatremia at our hospital, check adherence with the trust gui...

Introduction: Substrate accumulation, energy deficiency or complex molecule defects characterize inherited metabolic disorders (IMDs), accounting for their multi-system manifestations. One important aspect of this is endocrinopathy, which is relatively common but underestimated in IMDs, presenting in childhood following diagnosis or sometimes a presenting symptom in adults where there is multi-system or multi-gland involvement. Endocrinopathies may be secondar...

Aim: To know the compliance on management of inpatient hypoglycaemia among diabetic inpatients admitted for non-critical illness at Bronglais General Hospital based on JBDS guidelines Method: A retrospective collection of data of diabetes patients from EMR and patient files over the period of 6 months from September 2022 to March 2023, who were admitted for various conditions and developed hypoglycemia during their stay ...

High protein diets are hypothesised to improve glucose tolerance by modulating the secretion of gastroenteropancreatic hormones via amino-acid sensing. Glucagon, traditionally associated with hyperglycaemia, has beneficial effects on glucose homeostasis, potentially due to its role as an insulin secretagogue via intra-islet signalling and as a regulator of pulsatile insulin secretion. The calcium sensing receptor (CaSR), known for its role in calcium homeostasis, also function...

Background: Fasting hyperglycaemia and hypertriglyceridemia are characteristic of insulin resistance (IR), type 2 diabetes, and non-alcoholic fatty liver disease, but the underlying mechanisms remain unclear. Rodent work has suggested this is due to selective hepatic IR; defined by increased hepatic gluconeogenesis (GNG) and de novo lipogenesis (DNL). The aim of this study was to determine if signatures of selective hepatic IR were associated with hyp...

Introduction: Adipocytes have been shown to exhibit considerable heterogeneity. In humans, they vary in size from <20 to 300 µm in diameter, which equates to a several hundred-fold difference in cell volume within the same tissue. Population based studies indicate larger adipocytes are associated with metabolic diseases, but how cell size is related to metabolism is poorly understood. Recent studies measured glucose levels in individual cells in cultu...

Background: Cortisol is a hormone produced by the adrenal cortex and is essential for the maintenance of metabolic homeostasis. Cortisol activation is catalysed by 11β-hydroxysteroid dehydrogenase 1 (11β-HSD1) and excess cortisol is associated with insulin resistance and hyperglycaemia. Previous studies from our group have shown that Vertical Sleeve Gastrectomy, a gastrointestinal procedure known to improve insulin sensitivity, causes cortisol inhibi...

Background: The EarLy Surveillance for Autoimmune diabetes (ELSA) study is screening 20,000 children in the UK aged 3-13 years for type 1 diabetes through measurement of islet autoantibodies. Screening aims to prevent diabetic ketoacidosis at clinical onset of disease, reducing mortality, and identifies the population who could benefit from prevention trials. The ELSA-1 study aimed to explore the perspectives of parents and stakeholders on the relative benefit...

Introduction: National guidance states that people with diabetes and frailty require personalised targets and less aggressive treatments due to the limited evidence for benefits and the high risk of hypoglycaemia. Studies have shown a low rate of deintensification in this cohort of patients that may increase the risk of inpatient hypoglycaemia, contributing to morbidity and mortality. The audit aims to assess the frequency of inpatient hypoglycaemia and its as...

Background: Skeletal muscle wasting is a characteristic feature of chronic kidney disease (CKD), associated with increased hospitalisations and premature mortality. Excess glucocorticoid signalling is a major contributor to the pathogenesis of muscle wasting in conditions of renal impairment. This study aimed to validate a murine model of CKD and utilise this to determine if deletion of 11beta-hydroxysteroid dehydrogenase type 1 (11β-HSD1) provides protec...

Improved knowledge of adipogenesis is necessary to gain insight into brown and white fat physiology. Interest in adipocyte differentiation has increased markedly over the past few years with emphasis on intersection between microRNAs (miRNAs) and the transcriptional cascade that controls adipogenesis and metabolic dysfunction. The aim of this study is to identify miRNAs that regulate white and brown adipocyte differentiation and define miRNA action in a stem cell model of adip...

Background: Vitamin B12 is crucial for placental development and fetal growth. B12 deficiency is associated with maternal obesity and adverse pregnancy outcomes. B12 is essential for the synthesis of S-Adenosyl methionine (SAM) which serves as a methyl donor in various cellular processes including DNA and RNA methylation. Pregnant women with low B12 have higher triglycerides, lower HDL and lower DNA methylation of cholesterol transcription factor. However, the...

The gut plays an important role in energy homeostasis, and gut function is under intensive neuroendocrine control. The non-invasive imaging techniques contrast enhanced ultrasound (CEUS) imaging and super resolution ultrasound (SRUS) have the potential visualise the gut and provide novel insight into its structure and function. We aimed to demonstrate that changes in duodenal villi structure can be monitored using CEUS and SRUS, providing an insight into the structural of the ...

Introduction: Skeletal muscle (SkM) is a major site of carbohydrate and fatty acid (FA) utilisation, where efficient selection between these two substrates is paramount in maintaining metabolic homeostasis. The accumulation of FA in SkM has been suggested to contribute to metabolic diseases such as obesity and type 2 diabetes mellitus. Consequently, there is significant interest in SkM FA metabolism and importantly, how FAs contribute to the metabolic function...

Introduction: Joint British Diabetes Societies Inpatient (JBDS-IP) recommended reducing fixed-rate intravenous insulin infusion (FRIII) rate to 0.05units/kg/hr when blood glucose falls <14 mmol/l to avoid hypoglycaemia during diabetes-related ketoacidosis (DKA).Aim: We studied the impact of guideline change on complications and outcomes of DKA.Methods: We included all DKA episo...

Introduction: unior doctors (JDs) are important part of the multidisciplinary team when managing people admitted with diabetes and frailty. Several guidelines have recommended a target HbA1c of between 7.0-8.5% for this group of people with diabetes. We aimed to assess junior doctors’ knowledge and awareness of management guidelines for people with diabetes and moderate/severe frailty.Methods: Survey was conducted a...

Background: Endocrine-metabolic disorders, especially polycystic ovarian syndrome (PCOS) has been linked with increased risk of non-alcoholic fatty liver disease (NAFLD) among reproductive age and implicated hyperandrogenism-driven adipose/hepatic insulin resistance (IR). Gut microbial metabolites such as short chain fatty acids (SCFAs) are crucial modulators of metabolic regulation. However, the impact of SCFAs, in particular, acetate on hyperandrogenism and/...

Background: Endoplasmic reticulum (ER) stress and associated mitochondrial dysfunction contribute to the pathogenesis of obesity and type 2 diabetes mellitus (T2DM). Studies show broccoli can reduce inflammation in cancer and may therefore mitigate inflammation-induced cellular disruption that precedes insulin resistance in human adipocytes. Therefore these studies investigated the impact of freeze-dried broccoli extracts (BE) on ER stress and mitochondrial dy...

The complications of endocrine-metabolic disorders among women of reproductive age, such as polycystic ovarian syndrome (PCOS), are cascade of events leading to cardiovascular diseases, as well as non-alcoholic fatty liver disease (NAFLD) which is the leading cause of liver cirrhosis and hepatic carcinoma that often necessitates organ transplant. Paraoxonase-1 (PON-1) has been shown to be protective against metabolic assaults. However, its role in hepatic glucolipid regulation...

Fat distribution influences metabolic risk. Accumulation of fat in the upper body increases metabolic risk, while lower body adipose expansion is protective. Oestrogen promotes lower body adiposity; transgender women on oestrogen therapy show increases in gluteal adipose, while transition to the menopause is associated with a shift in fat distribution towards the upper body, concurrent with changes in metabolic risk. Still, mechanisms governing the depot-specific effects of oe...

Background: Most obesity management programs use short term weight loss as the main monitoring parameter. Change in weight can be a misleading measure as it can be impacted by various factors and most participants regain weight after exiting such programs1. The aim of this project is to assess the efficacy of focusing on self-selected, non-weight loss goals in encouraging long term obesity management.Methods: ...

Background: Metformin has been shown from observational studies to cause vitamin B12 deficiency and its complications. However there is no such study in Kano, Northwestern Nigeria which has a large population of patients with type 2 diabetes mellitus on metformin.Objective: To determine the prevalence of Vitamin B12 deficiency among patients with type 2 diabetes mellitus on metformin therapy compared with metformin-na&#2...

Aims: Epidemiological studies have demonstrated that Indian babies born to mothers with gestational diabetes mellitus (GDM) have adverse metabolic profiles. The anthropometric and metabolic profiles in children of women with and without GDM were compared at age 5 years.Methods: Children born to mothers with GDM (CGDM) and without GDM (WGDM) were included in this prospective study. We examined maternal gestational BMI, GD...

Introduction: Obesity, a chronic disease, is recognised as a major public health problem. In 2023, the National Institute for Health and Care Excellence (NICE) recommended semaglutide, a weekly glucagon-like peptide-1 (GLP-1) agonist, as a pharmacological option for weight management. This case series aims to evaluate the real-world effectiveness and safety profile of semaglutide therapy for weight loss.Methods: Retrospe...

Diabetic nephropathy is a major cause of end stage renal failure requiring haemodialysis. Diabetes patients undergoing haemodialysis are at a high risk of adverse cardiovascular outcomes and therefore require close follow-up and ongoing monitoring which involves clinical staff working on dialysis units, GPs and diabetic nurses/specialists. We conducted an audit to assess service provision given to dialysis patients at Doncaster Royal Infirmary as per JBDS guidelines. This was ...

Background: Carbohydrate loading is used to manage the neurovisceral attacks of the acute porphyrias. This presents difficulty when treating those with altered glucose homeostasis.Case history: A 17-year-old female presented with 5 days of abdominal pain and vomiting, her third acute presentation in eight months; the first with a seizure and second with bilateral lower limb weakness. All attendances were preceded by redu...

Introduction: Vitamin D deficiency is known to cause adverse outcomes in Pregnancy and has shown to have an association with Gestational Diabetes MellitusAim: To evaluate the relationship between GDM and Vitamin DMaterials and Methods: Retrospective study where we looked into the Vitamin D levels (deficient <25 nmol/l - G1, Insufficient 25-50 nmol/l - G2, Sufficient >50 nmo...

Non-diabetic euglycaemic ketoacidosis (NDEK) is a rare condition defined as euglycaemia, metabolic acidosis and elevated serum ketones occurring in patients without diabetes mellitus. It is less well known compared to diabetic ketoacidosis (DKA) and euglycaemic diabetic ketoacidosis (EDKA), both happening in patients with diabetes. Here we describe a case of a 35-year old woman, previously fit and well, who presented with unidentified cause of pancreatitis leading to severe me...

Introduction: Glucagon-like peptide-1(GLP-1) agonists are widely used for treatment of type 2 diabetes(T2D). To date a number of reports have described improvements in glucose control with the addition of a GLP-1 agonist to the insulin regime in treatment of type 1 diabetes(T1D). From a physiological perspective there is credence to the notion that a GLP-1 agonist will lower glucose levels in people with T1D as they do in T2D. GLP-1 is an endogenous hormone th...

Background: Drosophila Melanogaster is a prominent animal model due to its short life cycle, ease of culture, and genetic makeup similar to that of humans. Acrylamide (ACR) is a naturally occurring, widely used chemical that is generated during high-temperature carbohydrate-rich meal. Significant doses of ACR have been associated with a variety of health problems, including neurotoxicity, reproductive toxicity, and immunotoxicity. Garlic (Allium Sativum) is an...

Introduction: Type 2 diabetes is an important comorbidity during the course of COVID-19. However, the impact of blood glucose control on the degree of medical interventions required and on mortality in patients with COVID-19 remains uncertain.Methods: Single-center retrospective study of 306 cases of COVID-19, of which 43 had pre-existing type 2 diabetes for 6 months. Qualitative variables were assessed using the Chi-squ...

Objective: The NHS long term plan aims to identify 25% of the Familial Hypercholesterolaemia (FH) patients in England by 2025. This study aimed to identify patients with FH, assess their classification according to the Dutch Lipid Clinic Network (DLCN) criteria, and evaluate treatment outcomes.Methods: We conducted a retrospective analysis of patients referred for assessment of possible FH who went on to have genetic tes...

Defending body weight is a fundamental homeostatic process. Indeed, countless studies have demonstrated weight-maintaining hyperphagia in response to either increased energy expenditure or a reduction in the caloric density of available food. The principal effector of this adaptive food intake is thought to be the adipose tissue-derived hormone, leptin. According to the classical ’adipostat’ model, the hypoleptinemia resulting from weight loss drives food intake to r...

Background: The prevalence of obesity associated comorbidities, such as Type 2 Diabetes(T2D) and hypertension, continues to rise globally. Our study aimed to describe the long-term effects on blood pressure management in individuals with T2D post bariatric surgery in a single centre prospective observational cohort study in North-West England.Methods: We undertook a 10-year prospective cohort study on people who underwen...

Introduction: Chronic kidney disease (CKD) is characterised by an ongoing reduction in kidney function and is associated with comorbidities such as muscle wasting that greatly increase mortality. Both acidosis and elevated glucocorticoids levels are hallmarks of CKD and implicated as having a synergistic role in driving muscle wasting. We investigated the synergistic effects of acidosis and the glucocorticoid cortisol on muscle metabolism and fibre size using ...

Background: Drosophila Melanogaster is a prominent animal model due to its short life cycle, ease of culture, and genetic makeup similar to that of humans. Acrylamide (ACR) is a naturally occurring, widely used chemical that is generated during high-temperature carbohydrate-rich meal. Significant doses of ACR have been associated with a variety of health problems, including neurotoxicity, reproductive toxicity, and immunotoxicity. Garlic (Allium Sativum) is an...

Glucose is the primary source of energy for cells and its levels are tightly regulated by the hormone insulin. In people with diabetes, the body either doesn’t produce enough insulin or doesn’t respond to insulin properly. Hyperglycemia can occur which carries high morbidity and mortality. Some common signs and symptoms include polyuria, polydipsia, polyphagia and fatigue. Diabetic ketoacidosis and hyperosmolar hyperglycaemic state are serious medical emergencies ass...

Aim: To asses the role of oral semaglutide (Sm) on weight & cardiac biomarkers (CB) in 69 patients with hypothyroidism optimally controlled using Liothyronine (T3)+Levothyroxine combination (T4) therapy (T3/T4).Methods: Between January 2022 and March 2022, 69 hypothyroid patients, who were treated using T3/T4 while on regular follow up, initiated Sm with the intention of weight loss and were retrospectively analysed....

Diabetic Ketoacidosis (DKA) in patients with Type 2 Diabetes Mellitus (T2DM) is relatively rare and usually associated with intercurrent illness but can cause significant morbidity and mortality. SGLT2 inhibitor (SGLT2i) use has been implicated as a potential risk factor for developing euglycaemic DKA, particularly in sepsis, surgery and starvation. We aimed to investigate the common causes of DKA in T2DM in NHS Lothian to identify whether SGLT2i use was having a significant i...

Objective: Time-restricted eating (TRE) represents a novel intervention that may improve insulinaemia and reduce weight, but is untested in polycystic ovarian syndrome (PCOS). In a randomised interventional study (NCT05126199), we investigated the feasibility of TRE in PCOS. Secondary objectives included effects on insulin and metabolic indices.Methods: Participants were randomised to 12-week TRE (18h fast/6h eating wind...

Background and Aims: Obesity is a major risk factor for type 2 diabetes (T2D). Remission of diabetes can be achieved by dietary weight loss although the underlying molecular mechanism(s) are unknown. These beneficial effects could be related to decreasing hepatic fat delivery to the pancreas and eventually restoring β-cell function. We hypothesised that hepatic de novo lipogenesis (DNL) is the primary driver of pancreas “lipotoxicity” and the pr...

Introduction: Type 1 Diabetes Mellitus (T1DM) causes autoimmune destruction of insulin producing b-cells, affecting approximately 8.4 million individuals worldwide. Autologous stem cell derived b cell (sc-b cell) transplantation is a promising treatment, however receipient immunological responses remain a challenge. This pilot study utilised mass cytometry (CyTOF) to assess immune responses in co-cultures of peripheral blood mononuclear cells (PBMC) with autol...

The prevalence of type 2 diabetes (non-insulin dependent diabetes) has been universally acknowledged as a chronic public health concern and the leading cause of mortality on a global scale. Plant-based bioactive compounds have made significant contributions to the management of diabetes mellitus globally. Artocarpus heterophyllus, also known as “kathal” in the subcontinent, is rich in dietary fibre and has traditionally been used as a diabetes remedy. The current stu...

Background: The PCSK9 inhibitors (PCSKi), evolocumab and alirocumab, were approved by NICE in 2016, and have since proved to be efficacious in lowering LDL-C. Yet little is known about their long-term adverse effects. Genetic studies have shown patients with PCSK9 loss-of-function variants are at increased risk of T2DM. Similarly, analyses of an adverse event database found increased reports of PCSK9i-related hyperglycaemia. Meta-analyses have suggested that P...

We present an interesting case of a 50-year-old woman with previous history of alcohol dependence, depression & oesophagitis who was brought to the emergency department by ambulance with vomiting, back pain and feeling generally unwell. Her GCS was 14/15, HR128/min, RR 32/min, BP 111/60, temperature 35.2 & CBG 11.2mmol. She reported consuming one bottle of Vodka every day. Initial venous blood gas analysis showed severe metabolic acidosis (pH 6.79, HCO3 3, Lactate 15, ...