37 results on '"Blackbourn, Luke A. K."'
Search Results
2. Effect of serum sample storage temperature on metabolomic and proteomic biomarkers
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Valo, Erkka, Colombo, Marco, Sandholm, Niina, McGurnaghan, Stuart J., Blackbourn, Luke A. K., Dunger, David B., McKeigue, Paul M., Forsblom, Carol, Groop, Per-Henrik, Colhoun, Helen M., Turner, Charles, and Dalton, R. Neil
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- 2022
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3. Antidepressant and antipsychotic prescribing in patients with type 2 diabetes in Scotland: A time‐trend analysis from 2004 to 2021.
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Greene, Charlotte R. L., Blackbourn, Luke A. K., McGurnaghan, Stuart J., Mercer, Stewart W., Smith, Daniel J., Wild, Sarah H., Wu, Honghan, and Jackson, Caroline A.
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TYPE 2 diabetes , *DRUG prescribing , *ANTIDEPRESSANTS , *ANTIPSYCHOTIC agents - Abstract
Aims Methods Results Conclusions Prescribing of antidepressant and antipsychotic drugs in general populations has increased in the United Kingdom, but prescribing trends in people with type 2 diabetes (T2D) have not previously been investigated. The aim of this study was to describe time trends in annual prevalence of antidepressant and antipsychotic drug prescribing in adult patients with T2D.We conducted repeated annual cross‐sectional analysesof a population‐based diabetes registry with 99% coverage, derived from primary and secondary care data in Scotland, from 2004 to 2021. For each cross‐sectional calendar year time period, we calculated the prevalence of antidepressant and antipsychotic drug prescribing, overall and by sociodemographic characteristics and drug subtype.The number of patients with a T2D diagnosis in Scotland increased from 161 915 in 2004 to 309 288 in 2021. Prevalence of antidepressant and antipsychotic prescribing in patients with T2D increased markedly between 2004 and 2021 (from 20.0 per 100 person‐years to 33.3 per 100 person‐years and from 2.8 per 100 person‐years to 4.7 per 100 person‐years, respectively). We observed this pattern for all drug subtypes except for first‐generation antipsychotics, prescribing of which remained largely stable. The degree of increase, as well as the overall prevalence of prescribing, differed by age, sex, socioeconomic status and subtype of drug class.There has been a marked increase in the prevalence of antidepressant and antipsychotic prescribing in patients with T2D in Scotland. Further research should identify the reasons for this increase, including indication for use and the extent to which this reflects increases in incident prescribing rather than increased duration. [ABSTRACT FROM AUTHOR]
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- 2024
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4. Deep learning detection of diabetic retinopathy in Scotland's diabetic eye screening programme.
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Fleming, Alan D., Mellor, Joseph, McGurnaghan, Stuart J., Blackbourn, Luke A. K., Goatman, Keith A., Styles, Caroline, Storkey, Amos J., McKeigue, Paul M., and Colhoun, Helen M.
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Background/Aims Support vector machine-based automated grading (known as iGradingM) has been shown to be safe, cost-effective and robust in the diabetic retinopathy (DR) screening (DES) programme in Scotland. It triages screening episodes as gradable with no DR versus manual grading required. The study aim was to develop a deep learning-based autograder using images and gradings from DES and to compare its performance with that of iGradingM. Methods Retinal images, quality assurance (QA) data and routine DR grades were obtained from national datasets in 179 944 patients for years 2006-2016. QA grades were available for 744 images. We developed a deep learning-based algorithm to detect whether either eye contained ungradable images or any DR. The sensitivity and specificity were evaluated against consensus QA grades and routine grades. Results Images used in QA which were ungradable or with DR were detected by deep learning with better specificity compared with manual graders (p<0.001) and with iGradingM (p<0.001) at the same sensitivities. Any DR according to the DES final grade was detected with 89.19% (270 392/303 154) sensitivity and 77.41% (500 945/647 158) specificity. Observable disease and referable disease were detected with sensitivities of 96.58% (16 613/17 201) and 98.48% (22 600/22 948), respectively. Overall, 43.84% of screening episodes would require manual grading. Conclusion A deep learning-based system for DR grading was evaluated in QA data and images from 11 years in 50% of people attending a national DR screening programme. The system could reduce the manual grading workload at the same sensitivity compared with the current automated grading system. [ABSTRACT FROM AUTHOR]
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- 2024
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5. Prediction of retinopathy progression using deep learning on retinal images within the Scottish screening programme
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Mellor, Joseph, primary, Jiang, Wenhua, additional, Fleming, Alan, additional, McGurnaghan, Stuart J, additional, Blackbourn, Luke A K, additional, Styles, Caroline, additional, Storkey, Amos, additional, McKeigue, Paul M, additional, and Colhoun, Helen M, additional
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- 2024
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6. Risks of and risk factors for COVID-19 disease in people with diabetes: a cohort study of the total population of Scotland
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Whettlock, Alice, McLeod, Allan, Gasiorowski, Andrew, Merrick, Andrew, McAuley, Andy, Went, April, Purdie, Calum, Fischbacher, Colin, Ramsey, Colin, Bailey, David, Henderson, David, McDonald, Eisin, Drennan, Genna, Gowans, Graeme, Reid, Graeme, Murdoch, Heather, Carruthers, Jade, Murray, Josie, Heatlie, Karen, Donaldson, Lorraine, Paton, Martin, Reid, Martin, Llano, Melissa, Murphy-Hall, Michelle, Hall, Ross, Cameron, Ross, Brownlie, Susan, Gaffney, Adam, Milne, Aynsley, Sullivan, Christopher, McArdle, Edward, Glass, Elaine, Young, Johanna, Malcolm, William, McCoubrey, Jodie, McGurnaghan, Stuart J, Weir, Amanda, Bishop, Jen, Kennedy, Sharon, Blackbourn, Luke A K, McAllister, David A, Hutchinson, Sharon, Caparrotta, Thomas M, Mellor, Joseph, Jeyam, Anita, O'Reilly, Joseph E, Wild, Sarah H, Hatam, Sara, Höhn, Andreas, Colombo, Marco, Robertson, Chris, Lone, Nazir, Murray, Janet, Butterly, Elaine, Petrie, John, Kennon, Brian, McCrimmon, Rory, Lindsay, Robert, Pearson, Ewan, Sattar, Naveed, McKnight, John, Philip, Sam, Collier, Andrew, McMenamin, Jim, Smith-Palmer, Alison, Goldberg, David, McKeigue, Paul M, and Colhoun, Helen M
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- 2021
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7. Deep learning detection of diabetic retinopathy in Scotland’s diabetic eye screening programme
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Fleming, Alan D, primary, Mellor, Joseph, additional, McGurnaghan, Stuart J, additional, Blackbourn, Luke A K, additional, Goatman, Keith A, additional, Styles, Caroline, additional, Storkey, Amos J, additional, McKeigue, Paul M, additional, and Colhoun, Helen M, additional
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- 2023
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8. An analytical, phenomenological and numerical study of geophysical and magnetohydrodynamic turbulence in two dimensions
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Blackbourn, Luke A. K. and Tran, Chuong Van
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532 ,Fluid dynamics ,Turbulence ,Surface quasigeostrophic ,Magnetohydrodynamic ,Navier-Stokes ,Energy cascade ,QA913.B6 ,Fluid dynamics--Mathematical models ,Turbulence--Mathematical models ,Navier-Stokes equations--Numerical solutions ,Magnetohydrodynamics--Mathematical models - Abstract
In this thesis I study a variety of two-dimensional turbulent systems using a mixed analytical, phenomenological and numerical approach. The systems under consideration are governed by the two-dimensional Navier-Stokes (2DNS), surface quasigeostrophic (SQG), alpha-turbulence and magnetohydrodynamic (MHD) equations. The main analytical focus is on the number of degrees of freedom of a given system, defined as the least value $N$ such that all $n$-dimensional ($n$ ≥ $N$) volume elements along a given trajectory contract during the course of evolution. By equating $N$ with the number of active Fourier-space modes, that is the number of modes in the inertial range, and assuming power-law spectra in the inertial range, the scaling of $N$ with the Reynolds number $Re$ allows bounds to be put on the exponent of the spectrum. This allows the recovery of analytic results that have until now only been derived phenomenologically, such as the $k$[superscript(-5/3)] energy spectrum in the energy inertial range in SQG turbulence. Phenomenologically I study the modal interactions that control the transfer of various conserved quantities. Among other results I show that in MHD dynamo triads (those converting kinetic into magnetic energy) are associated with a direct magnetic energy flux while anti-dynamo triads (those converting magnetic into kinetic energy) are associated with an inverse magnetic energy flux. As both dynamo and anti-dynamo interacting triads are integral parts of the direct energy transfer, the anti-dynamo inverse flux partially neutralises the dynamo direct flux, arguably resulting in relatively weak direct energy transfer and giving rise to dynamo saturation. These theoretical results are backed up by high resolution numerical simulations, out of which have emerged some new results such as the suggestion that for alpha turbulence the generalised enstrophy spectra are not closely approximated by those that have been derived phenomenologically, and new theories may be needed in order to explain them.
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- 2013
9. Biomarker panels associated with progression of renal disease in type 1 diabetes
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Colombo, Marco, Valo, Erkka, McGurnaghan, Stuart J., Sandholm, Niina, Blackbourn, Luke A. K., Dalton, R. Neil, Dunger, David, Groop, Per-Henrik, McKeigue, Paul M., Forsblom, Carol, Colhoun, Helen M., and on behalf of the FinnDiane Study Group and the Scottish Diabetes Research Network (SDRN) Type 1 Bioresource Collaboration
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- 2019
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10. The effect of dapagliflozin on glycaemic control and other cardiovascular disease risk factors in type 2 diabetes mellitus: a real-world observational study
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McGurnaghan, Stuart J., Brierley, Liam, Caparrotta, Thomas M., McKeigue, Paul M., Blackbourn, Luke A. K., Wild, Sarah H., Leese, Graham P., McCrimmon, Rory J., McKnight, John A., Pearson, Ewan R., Petrie, John R., Sattar, Naveed, Colhoun, Helen M., and on behalf of the Scottish Diabetes Research Network Epidemiology Group
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- 2019
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11. Cohort profile: the Scottish Diabetes Research Network national diabetes cohort – a population-based cohort of people with diabetes in Scotland
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McGurnaghan, Stuart J., primary, Blackbourn, Luke A. K., additional, Caparrotta, Thomas M., additional, Mellor, Joseph, additional, Barnett, Anna, additional, Collier, Andy, additional, Sattar, Naveed, additional, McKnight, John, additional, Petrie, John, additional, Philip, Sam, additional, Lindsay, Robert, additional, Hughes, Katherine, additional, McAllister, David, additional, Leese, Graham P, additional, Pearson, Ewan R, additional, Wild, Sarah, additional, McKeigue, Paul M, additional, and Colhoun, Helen M, additional
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- 2022
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12. Calibrating a network meta-analysis of diabetes trials of sodium glucose cotransporter 2 inhibitors, glucagon-like peptide-1 receptor analogues and dipeptidyl peptidase-4 inhibitors to a representative routine population: a systematic review protocol
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Butterly, Elaine, primary, Wei, Lili, additional, Adler, Amanda I, additional, Almazam, Saleh A M, additional, Alsallumi, Khalid, additional, Blackbourn, Luke A K, additional, Dias, Sofia, additional, Hanlon, Peter, additional, Hughes, Katherine, additional, Lewsey, Jim, additional, Lindsay, Robert, additional, McGurnaghan, Stuart, additional, Petrie, John, additional, Phillippo, David, additional, Sattar, Naveed, additional, Tomlinson, Laurie A, additional, Welton, Nicky, additional, Wild, Sarah, additional, and McAllister, David, additional
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- 2022
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13. Large socioeconomic gap in period life expectancy and life years spent with complications of diabetes in the Scottish population with type 1 diabetes, 2013-2018
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Höhn, Andreas, McGurnaghan, Stuart J., Caparrotta, Thomas M., Jeyam, Anita, O'Reilly, Joseph E., Blackbourn, Luke A. K., Hatam, Sara, Dudel, Christian, Seaman, Rosie J., Mellor, Joseph, Sattar, Naveed, McCrimmon, Rory J., Kennon, Brian, Petrie, John R., Wild, Sarah, McKeigue, Paul M., Colhoun, Helen M., on behalf of the SDRN-Epi Group, and University of St Andrews. School of Geography & Sustainable Development
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Male ,Scotland/epidemiology ,Multidisciplinary ,GF Human ecology. Anthropogeography ,3rd-DAS ,Diabetes Complications/complications ,Middle Aged ,GF ,Diabetes Complications ,Diabetes Mellitus, Type 1 ,Life Expectancy ,Scotland ,SDG 3 - Good Health and Well-being ,Socioeconomic Factors ,RA0421 ,RA0421 Public health. Hygiene. Preventive Medicine ,Diabetes Mellitus, Type 1/complications ,Humans ,Female ,Aged ,Retrospective Studies - Abstract
Background We report the first study to estimate the socioeconomic gap in period life expectancy (LE) and life years spent with and without complications in a national cohort of individuals with type 1 diabetes. Methods This retrospective cohort study used linked healthcare records from SCI-Diabetes, the population-based diabetes register of Scotland. We studied all individuals aged 50 and older with a diagnosis of type 1 diabetes who were alive and residing in Scotland on 1 January 2013 (N = 8591). We used the Scottish Index of Multiple Deprivation (SIMD) 2016 as an area-based measure of socioeconomic deprivation. For each individual, we constructed a history of transitions by capturing whether individuals developed retinopathy/maculopathy, cardiovascular disease, chronic kidney disease, and diabetic foot, or died throughout the study period, which lasted until 31 December 2018. Using parametric multistate survival models, we estimated total and state-specific LE at an attained age of 50. Results At age 50, remaining LE was 22.2 years (95% confidence interval (95% CI): 21.6 − 22.8) for males and 25.1 years (95% CI: 24.4 − 25.9) for females. Remaining LE at age 50 was around 8 years lower among the most deprived SIMD quintile when compared with the least deprived SIMD quintile: 18.7 years (95% CI: 17.5 − 19.9) vs. 26.3 years (95% CI: 24.5 − 28.1) among males, and 21.2 years (95% CI: 19.7 − 22.7) vs. 29.3 years (95% CI: 27.5 − 31.1) among females. The gap in life years spent without complications was around 5 years between the most and the least deprived SIMD quintile: 4.9 years (95% CI: 3.6 − 6.1) vs. 9.3 years (95% CI: 7.5 − 11.1) among males, and 5.3 years (95% CI: 3.7 − 6.9) vs. 10.3 years (95% CI: 8.3 − 12.3) among females. SIMD differences in transition rates decreased marginally when controlling for time-updated information on risk factors such as HbA1c, blood pressure, BMI, or smoking. Conclusions In addition to societal interventions, tailored support to reduce the impact of diabetes is needed for individuals from low socioeconomic backgrounds, including access to innovations in management of diabetes and the prevention of complications.
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- 2022
14. Risks of and risk factors for COVID-19 disease in people with diabetes: a cohort study of the total population of Scotland
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McGurnaghan, Stuart J, primary, Weir, Amanda, additional, Bishop, Jen, additional, Kennedy, Sharon, additional, Blackbourn, Luke A K, additional, McAllister, David A, additional, Hutchinson, Sharon, additional, Caparrotta, Thomas M, additional, Mellor, Joseph, additional, Jeyam, Anita, additional, O'Reilly, Joseph E, additional, Wild, Sarah H, additional, Hatam, Sara, additional, Höhn, Andreas, additional, Colombo, Marco, additional, Robertson, Chris, additional, Lone, Nazir, additional, Murray, Janet, additional, Butterly, Elaine, additional, Petrie, John, additional, Kennon, Brian, additional, McCrimmon, Rory, additional, Lindsay, Robert, additional, Pearson, Ewan, additional, Sattar, Naveed, additional, McKnight, John, additional, Philip, Sam, additional, Collier, Andrew, additional, McMenamin, Jim, additional, Smith-Palmer, Alison, additional, Goldberg, David, additional, McKeigue, Paul M, additional, Colhoun, Helen M, additional, Whettlock, Alice, additional, McLeod, Allan, additional, Gasiorowski, Andrew, additional, Merrick, Andrew, additional, McAuley, Andy, additional, Went, April, additional, Purdie, Calum, additional, Fischbacher, Colin, additional, Ramsey, Colin, additional, Bailey, David, additional, Henderson, David, additional, McDonald, Eisin, additional, Drennan, Genna, additional, Gowans, Graeme, additional, Reid, Graeme, additional, Murdoch, Heather, additional, Carruthers, Jade, additional, Murray, Josie, additional, Heatlie, Karen, additional, Donaldson, Lorraine, additional, Paton, Martin, additional, Reid, Martin, additional, Llano, Melissa, additional, Murphy-Hall, Michelle, additional, Hall, Ross, additional, Cameron, Ross, additional, Brownlie, Susan, additional, Gaffney, Adam, additional, Milne, Aynsley, additional, Sullivan, Christopher, additional, McArdle, Edward, additional, Glass, Elaine, additional, Young, Johanna, additional, Malcolm, William, additional, and McCoubrey, Jodie, additional
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- 2021
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15. Time trends in deaths before age 50 years in people with type 1 diabetes: a nationwide analysis from Scotland 2004–2017
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O’Reilly, Joseph E., Blackbourn, Luke A. K., Caparrotta, Thomas M., Jeyam, Anita, Kennon, Brian, Leese, Graham P., Lindsay, Robert S., McCrimmon, Rory J., McGurnaghan, Stuart J., McKeigue, Paul M., McKnight, John A., Petrie, John R., Philip, Sam, Sattar, Naveed, Wild, Sarah H., and Colhoun, Helen M.
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Aims/hypothesis: \ud We aimed to examine whether crude mortality and mortality relative to the general population below 50 years of age have improved in recent years in those with type 1 diabetes.\ud \ud Methods: \ud Individuals with type 1 diabetes aged below 50 and at least 1 year old at any time between 2004 and 2017 in Scotland were identified using the national register. Death data were obtained by linkage to Scottish national death registrations. Indirect age standardisation was used to calculate sex-specific standardised mortality ratios (SMRs). Poisson regression was used to test for calendar-time effects as incidence rate ratios (IRRs).\ud \ud Results: \ud There were 1138 deaths in 251,143 person-years among 27,935 people with type 1 diabetes. There was a significant decline in mortality rate over time (IRR for calendar year 0.983 [95% CI 0.967, 0.998], p = 0.03), but the SMR remained approximately stable at 3.1 and 3.6 in men and 4.09 and 4.16 in women for 2004 and 2017, respectively. Diabetic ketoacidosis or coma (DKAoC) accounted for 22% of deaths and the rate did not decline significantly (IRR 0.975 [95% CI 0.94, 1.011], p = 0.168); 79.3% of DKAoC deaths occurred out of hospital. Circulatory diseases accounted for 27% of deaths and did decline significantly (IRR 0.946 [95% CI 0.914, 0.979], p = 0.002).\ud \ud Conclusions/interpretation: \ud Absolute mortality has fallen, but the relative impact of type 1 diabetes on mortality below 50 years has not improved. There is scope to improve prevention of premature circulatory diseases and DKAoC and to develop more effective strategies for enabling people with type 1 diabetes to avoid clinically significant hyper- or hypoglycaemia.
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- 2020
16. Flash monitor initiation is associated with improvements in HbA1c levels and DKA rates among people with type 1 diabetes in Scotland: a retrospective nationwide observational study.
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Jeyam, Anita, Gibb, Fraser W., McKnight, John A., O'Reilly, Joseph E., Caparrotta, Thomas M., Höhn, Andreas, McGurnaghan, Stuart J., Blackbourn, Luke A. K., Hatam, Sara, Kennon, Brian, McCrimmon, Rory J., Leese, Graham, Philip, Sam, Sattar, Naveed, McKeigue, Paul M., and Colhoun, Helen M.
- Abstract
Aims/hypothesis: We assessed the real-world effect of flash monitor (FM) usage on HbA
1c levels and diabetic ketoacidosis (DKA) and severe hospitalised hypoglycaemia (SHH) rates among people with type 1 diabetes in Scotland and across sociodemographic strata within this population. Methods: This study was retrospective, observational and registry based. Using the national diabetes registry, 14,682 individuals using an FM at any point between 2014 and mid-2020 were identified. Within-person change from baseline in HbA1c following FM initiation was modelled using linear mixed models accounting for within-person pre-exposure trajectory. DKA and SHH events were captured through linkage to hospital admission and mortality data. The difference in DKA and SHH rates between FM-exposed and -unexposed person-time was assessed among users, using generalised linear mixed models with a Poisson likelihood. In a sensitivity analysis, we tested whether changes in these outcomes were seen in an age-, sex- and baseline HbA1c -matched sample of non-users over the same time period. Results: Prevalence of ever-FM use was 45.9% by mid-2020, with large variations by age and socioeconomic status: 64.3% among children aged <13 years vs 32.7% among those aged ≥65 years; and 54.4% vs 36.2% in the least-deprived vs most-deprived quintile. Overall, the median (IQR) within-person change in HbA1c in the year following FM initiation was −2.5 (−9.0, 2.5) mmol/mol (−0.2 [−0.8, 0.2]%). The change varied widely by pre-usage HbA1c : −15.5 (−31.0, −4.0) mmol/mol (−1.4 [−2.8, −0.4]%) in those with HbA1c > 84 mmol/mol [9.8%] and 1.0 (−2.0, 5.5) mmol/mol (0.1 [−0.2, 0.5]%) in those with HbA1c < 54 mmol/mol (7.1%); the corresponding estimated fold change (95% CI) was 0.77 (0.76, 0.78) and 1.08 (1.07, 1.09). Significant reductions in HbA1c were found in all age bands, sexes and socioeconomic strata, and regardless of prior/current pump use, completion of a diabetes education programme or early FM adoption. Variation between the strata of these factors beyond that driven by differing HbA1c at baseline was slight. No change in HbA1c in matched non-users was observed in the same time period (median [IQR] within-person change = 0.5 [−5.0, 5.5] mmol/mol [0.0 (−0.5, 0.5)%]). DKA rates decreased after FM initiation overall and in all strata apart from the adolescents. Estimated overall reduction in DKA event rates (rate ratio) was 0.59 [95% credible interval (CrI) 0.53, 0.64]) after FM vs before FM initiation, accounting for pre-exposure trend. Finally, among those at higher risk for SHH, estimated reduction in event rates was rate ratio 0.25 (95%CrI 0.20, 0.32) after FM vs before FM initiation. Conclusions/interpretation: FM initiation is associated with clinically important reductions in HbA1c and striking reduction in DKA rate. Increasing uptake among the socioeconomically disadvantaged offers considerable potential for tightening the current socioeconomic disparities in glycaemia-related outcomes. [ABSTRACT FROM AUTHOR]- Published
- 2022
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17. Development and validation of a cardiovascular risk prediction model in type 1 diabetes.
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McGurnaghan, Stuart J., McKeigue, Paul M., Read, Stephanie H., Franzen, Stefan, Svensson, Ann-Marie, Colombo, Marco, Livingstone, Shona, Farran, Bassam, Caparrotta, Thomas M., Blackbourn, Luke A. K., Mellor, Joseph, Thoma, Ioanna, Sattar, Naveed, Wild, Sarah H., Gudbjörnsdottir, Soffia, and Colhoun, Helen M.
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Aims/hypothesis: We aimed to report current rates of CVD in type 1 diabetes and to develop a CVD risk prediction tool for type 1 diabetes. Methods: A cohort of 27,527 people with type 1 diabetes without prior CVD was derived from the national register in Scotland. Incident CVD events during 199,552 person-years of follow-up were ascertained using hospital admissions and death registers. A Poisson regression model of CVD was developed and then validated in the Swedish National Diabetes Register (n = 33,183). We compared the percentage with a high 10 year CVD risk (i.e., ≥10%) using the model with the percentage eligible for statins using current guidelines by age. Results: The age-standardised rate of CVD per 100,000 person-years was 4070 and 3429 in men and women, respectively, with type 1 diabetes in Scotland, and 4014 and 3956 in men and women in Sweden. The final model was well calibrated (Hosmer–Lemeshow test p > 0.05) and included a further 22 terms over a base model of age, sex and diabetes duration (C statistic 0.82; 95% CI 0.81, 0.83). The model increased the base model C statistic from 0.66 to 0.80, from 0.60 to 0.75 and from 0.62 to 0.68 in those aged <40, 40–59 and ≥ 60 years, respectively (all p values <0.005). The model required minimal calibration in Sweden and had a C statistic of 0.85. Under current guidelines, >90% of those aged 20–39 years and 100% of those ≥40 years with type 1 diabetes were eligible for statins, but it was not until age 65 upwards that 100% had a modelled risk of CVD ≥10% in 10 years. Conclusions/interpretation: A prediction tool such as that developed here can provide individualised risk predictions. This 10 year CVD risk prediction tool could facilitate patient discussions regarding appropriate statin prescribing. Apart from 10 year risk, such discussions may also consider longer-term CVD risk, the potential for greater benefits from early vs later statin intervention, the potential impact on quality of life of an early CVD event and evidence on safety, all of which could influence treatment decisions, particularly in younger people with type 1 diabetes. [ABSTRACT FROM AUTHOR]
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- 2021
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18. Marked improvements in glycaemic outcomes following insulin pump therapy initiation in people with type 1 diabetes: a nationwide observational study in Scotland.
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Jeyam, Anita, Gibb, Fraser W., McKnight, John A., Kennon, Brian, O'Reilly, Joseph E., Caparrotta, Thomas M., Höhn, Andreas, McGurnaghan, Stuart J., Blackbourn, Luke A. K., Hatam, Sara, McCrimmon, Rory J., Leese, Graham, Lindsay, Robert S., Petrie, John, Chalmers, John, Philip, Sam, Wild, Sarah H., Sattar, Naveed, McKeigue, Paul M., and Colhoun, Helen M.
- Abstract
Aims/hypothesis: Our aim was to assess the use of continuous subcutaneous insulin infusion (CSII) in people with type 1 diabetes in Scotland and its association with glycaemic control, as measured by HbA
1c levels, frequency of diabetic ketoacidosis (DKA) and severe hospitalised hypoglycaemia (SHH), overall and stratified by baseline HbA1c . Methods: We included 4684 individuals with type 1 diabetes from the national Scottish register, who commenced CSII between 2004 and 2019. We presented crude within-person differences from baseline HbA1c over time since initiation, crude DKA and SHH event-rates pre-/post-CSII exposure. We then used mixed models to assess the significance of CSII exposure, taking into account: (1) the diffuse nature of the intervention (i.e. structured education often precedes initiation); (2) repeated within-person measurements; and (3) background time-trends occurring pre-intervention. Results: HbA1c decreased after CSII initiation, with a median within-person change of −5.5 mmol/mol (IQR −12.0, 0.0) (−0.5% [IQR −1.1, 0.0]). Within-person changes were most substantial in those with the highest baseline HbA1c , with median −21.0 mmol/mol (−30.0, −11.0) (−1.9% [−2.7, −1.0]) change in those with a baseline >84 mmol/mol (9.8%) within a year of exposure, that was sustained: −19.0 mmol/mol (−27.6, −6.5) (−1.7% [−2.5, −0.6]) at ≥5 years. Statistical significance and magnitude of change were supported by the mixed models results. The crude DKA event-rate was significantly lower in post-CSII person-time compared with pre-CSII person-time: 49.6 events (95% CI 46.3, 53.1) per 1000 person-years vs 67.9 (64.1, 71.9); rate ratio from Bayesian mixed models adjusting for pre-exposure trend: 0.61 (95% credible interval [CrI] 0.47, 0.77; posterior probability of reduction pp = 1.00). The crude overall SHH event-rate in post-CSII vs pre-CSII person-time was also lower: 17.8 events (95% CI 15.8, 19.9) per 1000 person-years post-exposure vs 25.8 (23.5, 28.3) pre-exposure; rate ratio from Bayesian mixed models adjusting for pre-exposure trend: 0.67 (95% CrI 0.45, 1.01; pp = 0.97). Conclusions/interpretation: CSII therapy was associated with marked falls in HbA1c especially in those with high baseline HbA1c . CSII was independently associated with reduced DKA and SHH rates. CSII appears to be an effective option for intensive insulin therapy in people with diabetes for improving suboptimal glycaemic control. [ABSTRACT FROM AUTHOR]- Published
- 2021
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19. The association of polypharmacy and high-risk drug classes with adverse health outcomes in the Scottish population with type 1 diabetes.
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Höhn, Andreas, Jeyam, Anita, Caparrotta, Thomas M., McGurnaghan, Stuart J., O'Reilly, Joseph E., Blackbourn, Luke A. K., McCrimmon, Rory J., Leese, Graham P., McKnight, John A., Kennon, Brian, Lindsay, Robert S., Sattar, Naveed, Wild, Sarah H., McKeigue, Paul M., and Colhoun, Helen M.
- Abstract
Aims/hypothesis: The aim of this work was to map the number of prescribed drugs over age, sex and area-based socioeconomic deprivation, and to examine the association between the number of drugs and particular high-risk drug classes with adverse health outcomes among a national cohort of individuals with type 1 diabetes. Methods: Utilising linked healthcare records from the population-based diabetes register of Scotland, we identified 28,245 individuals with a diagnosis of type 1 diabetes on 1 January 2017. For this population, we obtained information on health status, predominantly reflecting diabetes-related complications, and information on the total number of drugs and particular high-risk drug classes prescribed. We then studied the association of these baseline-level features with hospital admissions for falls, diabetic ketoacidosis (DKA), and hypoglycaemia or death within the subsequent year using multivariate Cox proportional hazards models. Results: Not considering insulin and treatment for hypoglycaemia, the mean number of prescribed drugs was 4.00 (SD 4.35). The proportion of individuals being prescribed five or more drugs at baseline consistently increased with age (proportion [95% CI]: 0–19 years 2.04% [1.60, 2.49]; 40–49 years 28.50% [27.08, 29.93]; 80+ years 76.04% [67.73, 84.84]). Controlling for age, sex, area-based socioeconomic deprivation and health status, each additional drug at baseline was associated with an increase in the hazard for hospitalisation for falls, hypoglycaemia and death but not for DKA admissions (HR [95% CI]: falls 1.03 [1.01, 1.06]; DKA 1.01 [1.00, 1.03]; hypoglycaemia 1.05 [1.02, 1.07]; death 1.04 [1.02, 1.06]). We found a number of drug classes to be associated with an increased hazard of one or more of these adverse health outcomes, including antithrombotic/anticoagulant agents, corticosteroids, opioids, antiepileptics, antipsychotics, hypnotics and sedatives, and antidepressants. Conclusions: Polypharmacy is common among the Scottish population with type 1 diabetes and is strongly patterned by sociodemographic factors. The number of prescribed drugs and the prescription of particular high-risk drug classes are strong markers of an increased risk of adverse health outcomes, including acute complications of diabetes. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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20. Quantitative levels of serum N-glycans in type 1 diabetes and their association with kidney disease.
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Colombo, Marco, Shehni, Akram Asadi, Thoma, Ioanna, McGurnaghan, Stuart J, Blackbourn, Luke A K, Wilkinson, Hayden, Collier, Andrew, Patrick, Alan W, Petrie, John R, McKeigue, Paul M, Saldova, Radka, Colhoun, Helen M, and Investigators, the Scottish Diabetes Research Network (SDRN) Type 1 Bioresource
- Subjects
TYPE 1 diabetes ,DIABETIC nephropathies ,KIDNEY diseases ,EPIDERMAL growth factor receptors ,KIDNEY physiology - Abstract
We investigated associations of quantitative levels of N -glycans with hemoglobin A
1c (HbA1c ), renal function and renal function decline in type 1 diabetes. We measured 46 total N -glycan peaks (GPs) on 1565 serum samples from the Scottish Diabetes Research Network Type 1 Bioresource Study (SDRNT1BIO) and a pool of healthy donors. Quantitation of absolute abundance of each GP used 2AB-labeled mannose-3 as a standard. We studied cross-sectional associations of GPs and derived measures with HbA1c , albumin/creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR), and prospective associations with incident albuminuria and final eGFR. All GPs were 1.4 to 3.2 times more abundant in SDRTN1BIO than in the healthy samples. Absolute levels of all GPs were slightly higher with higher HbA1c , with strongest associations for triantennary trigalactosylated disialylated, triantennary trigalactosylated trisialylated structures with core or outer arm fucose, and tetraantennary tetragalactosylated trisialylated glycans. Most GPs showed increased abundance with worsening ACR. Lower eGFR was associated with higher absolute GP levels, most significantly with biantennary digalactosylated disialylated glycans with and without bisect, triantennary trigalactosylated trisialylated glycans with and without outer arm fucose, and core fucosylated biantennary monogalactosylated monosialylated glycans. Although several GPs were inversely associated prospectively with final eGFR, cross-validated multivariable models did not improve prediction beyond clinical covariates. Elevated HbA1c is associated with an altered N -glycan profile in type 1 diabetes. Although we could not establish GPs to be prognostic of future renal function decline independently of HbA1c , further studies to evaluate their impact in the pathogenesis of diabetic kidney disease are warranted. [ABSTRACT FROM AUTHOR]- Published
- 2021
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21. Time trends in deaths before age 50 years in people with type 1 diabetes: a nationwide analysis from Scotland 2004–2017.
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O'Reilly, Joseph E., Blackbourn, Luke A. K., Caparrotta, Thomas M., Jeyam, Anita, Kennon, Brian, Leese, Graham P., Lindsay, Robert S., McCrimmon, Rory J., McGurnaghan, Stuart J., McKeigue, Paul M., McKnight, John A., Petrie, John R., Philip, Sam, Sattar, Naveed, Wild, Sarah H., and Colhoun, Helen M.
- Abstract
Aims/hypothesis: We aimed to examine whether crude mortality and mortality relative to the general population below 50 years of age have improved in recent years in those with type 1 diabetes. Methods: Individuals with type 1 diabetes aged below 50 and at least 1 year old at any time between 2004 and 2017 in Scotland were identified using the national register. Death data were obtained by linkage to Scottish national death registrations. Indirect age standardisation was used to calculate sex-specific standardised mortality ratios (SMRs). Poisson regression was used to test for calendar-time effects as incidence rate ratios (IRRs). Results: There were 1138 deaths in 251,143 person-years among 27,935 people with type 1 diabetes. There was a significant decline in mortality rate over time (IRR for calendar year 0.983 [95% CI 0.967, 0.998], p = 0.03), but the SMR remained approximately stable at 3.1 and 3.6 in men and 4.09 and 4.16 in women for 2004 and 2017, respectively. Diabetic ketoacidosis or coma (DKAoC) accounted for 22% of deaths and the rate did not decline significantly (IRR 0.975 [95% CI 0.94, 1.011], p = 0.168); 79.3% of DKAoC deaths occurred out of hospital. Circulatory diseases accounted for 27% of deaths and did decline significantly (IRR 0.946 [95% CI 0.914, 0.979], p = 0.002). Conclusions/interpretation: Absolute mortality has fallen, but the relative impact of type 1 diabetes on mortality below 50 years has not improved. There is scope to improve prevention of premature circulatory diseases and DKAoC and to develop more effective strategies for enabling people with type 1 diabetes to avoid clinically significant hyper- or hypoglycaemia. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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22. Diabetic Neuropathy Is a Substantial Burden in People With Type 1 Diabetes and Is Strongly Associated With Socioeconomic Disadvantage: A Population-Representative Study From Scotland.
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Jeyam, Anita, McGurnaghan, Stuart J., Blackbourn, Luke A. K., McKnight, John M., Green, Fiona, Collier, Andrew, McKeigue, Paul M., Colhoun, Helen M., and SDRNT1BIO Investigators
- Subjects
DIABETIC neuropathies ,CROSS-sectional method ,TYPE 1 diabetes ,TYPE 2 diabetes ,SOCIOECONOMIC factors ,AT-risk people ,DISEASE prevalence ,RESEARCH funding ,DISEASE complications - Abstract
Objective: To assess the contemporaneous prevalence of diabetic peripheral neuropathy (DPN) in people with type 1 diabetes (T1D) in Scotland and study its cross-sectional association with risk factors and other diabetic complications.Research Design and Methods: We analyzed data from a large representative sample of adults with T1D (N = 5,558). We assessed the presence of symptomatic neuropathy using the dichotomized (≥4) Michigan Neuropathy Screening Instrument Patient Questionnaire score. Logistic regression models were used to investigate associations between DPN and risk factors, as well as with other complications.Results: The burden of DPN is substantial with 13% prevalence overall. Adjusting for attained age, diabetes duration, and sex, the odds of DPN increased mainly with waist-to-hip ratio, lipids, poor glycemic control (odds ratio 1.51 [95% CI 1.21-1.89] for levels of 75 vs. 53 mmol/mol), ever versus never smoking (1.67 [1.37-2.03]), and worse renal function (1.96 [1.03-3.74] for estimated glomerular filtration rate levels <30 vs. ≥90 mL/min/1.73 m2). The odds significantly decreased with higher HDL cholesterol (0.77 [0.66-0.89] per mmol/L). Living in more deprived areas was associated with DPN (2.17 [1.78-2.65]) for more versus less deprived areas adjusted for other risk factors. Finally, individuals with prevalent DPN were much more likely than others to have other diabetes complications.Conclusions: Diabetic neuropathy remains substantial, particularly affecting those in the most socioeconomically deprived groups. Those with clinically manifest neuropathy also have a higher burden of other complications and elevated levels of modifiable risk factors. These data suggest that there is considerable scope to reduce neuropathy rates and narrow the socioeconomic differential by better risk factor control. [ABSTRACT FROM AUTHOR]- Published
- 2020
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23. Comparison of serum and urinary biomarker panels with albumin/creatinine ratio in the prediction of renal function decline in type 1 diabetes.
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Colombo, Marco, McGurnaghan, Stuart J., Blackbourn, Luke A. K., Dalton, R. Neil, Dunger, David, Bell, Samira, Petrie, John R., Green, Fiona, MacRury, Sandra, McKnight, John A., Chalmers, John, Collier, Andrew, McKeigue, Paul M., and Colhoun, Helen M.
- Abstract
Aims/hypothesis: We examined whether candidate biomarkers in serum or urine can improve the prediction of renal disease progression in type 1 diabetes beyond prior eGFR, comparing their performance with urinary albumin/creatinine ratio (ACR). Methods: From the population-representative Scottish Diabetes Research Network Type 1 Bioresource (SDRNT1BIO) we sampled 50% and 25% of those with starting eGFR below and above 75 ml min
−1 [1.73 m]−2 , respectively (N = 1629), and with median 5.1 years of follow-up. Multiplexed ELISAs and single molecule array technology were used to measure nine serum biomarkers and 13 urine biomarkers based on our and others' prior work using large discovery and candidate studies. Associations with final eGFR and with progression to <30 ml min−1 [1.73] m−2 , both adjusted for baseline eGFR, were tested using linear and logistic regression models. Parsimonious biomarker panels were identified using a penalised Bayesian approach, and their performance was evaluated through tenfold cross-validation and compared with using urinary ACR and other clinical record data. Results: Seven serum and seven urine biomarkers were strongly associated with either final eGFR or progression to <30 ml min−1 [1.73 m]−2 , adjusting for baseline eGFR and other covariates (all at p<2.3 × 10−3 ). Of these, associations of four serum biomarkers were independent of ACR for both outcomes. The strongest associations with both final eGFR and progression to <30 ml min−1 [1.73 m]−2 were for serum TNF receptor 1, kidney injury molecule 1, CD27 antigen, α-1-microglobulin and syndecan-1. These serum associations were also significant in normoalbuminuric participants for both outcomes. On top of baseline covariates, the r2 for prediction of final eGFR increased from 0.702 to 0.743 for serum biomarkers, and from 0.702 to 0.721 for ACR alone. The area under the receiver operating characteristic curve for progression to <30 ml min−1 [1.73 m]−2 increased from 0.876 to 0.953 for serum biomarkers, and to 0.911 for ACR alone. Other urinary biomarkers did not outperform ACR. Conclusions/interpretation: A parsimonious panel of serum biomarkers easily measurable along with serum creatinine may outperform ACR for predicting renal disease progression in type 1 diabetes, potentially obviating the need for urine testing. [ABSTRACT FROM AUTHOR]- Published
- 2020
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24. N-Glycan Profile and Kidney Disease in Type 1 Diabetes.
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Bermingham, Mairead L., Colombo, Marco, McGurnaghan, Stuart J., Blackbourn, Luke A. K., Vučković, Frano, Baković, Maja Pučić, Trbojević-Akmačić, Irena, Lauc, Gordan, Agakov, Felix, Agakova, Anna S., Hayward, Caroline, Klarić, Lucija, Palmer, Colin N. A., Petrie, John R., Chalmers, John, Collier, Andrew, Green, Fiona, Lindsay, Robert S., Macrury, Sandra, and McKnight, John A.
- Subjects
DIABETIC nephropathies ,KIDNEY diseases ,DIABETES complications ,GLYCEMIC control ,PEOPLE with diabetes ,GLOMERULAR filtration rate - Abstract
Objective: Poorer glycemic control in type 1 diabetes may alter N-glycosylation patterns on circulating glycoproteins, and these alterations may be linked with diabetic kidney disease (DKD). We investigated associations between N-glycans and glycemic control and renal function in type 1 diabetes.Research Design and Methods: Using serum samples from 818 adults who were considered to have extreme annual loss in estimated glomerular filtration rate (eGFR; i.e., slope) based on retrospective clinical records, from among 6,127 adults in the Scottish Diabetes Research Network Type 1 Bioresource Study, we measured total and IgG-specific N-glycan profiles. This yielded a relative abundance of 39 total (GP) and 24 IgG (IGP) N-glycans. Linear regression models were used to investigate associations between N-glycan structures and HbA1c, albumin-to-creatinine ratio (ACR), and eGFR slope. Models were adjusted for age, sex, duration of type 1 diabetes, and total serum IgG.Results: Higher HbA1c was associated with a lower relative abundance of simple biantennary N-glycans and a higher relative abundance of more complex structures with more branching, galactosylation, and sialylation (GP12, 26, 31, 32, and 34, and IGP19 and 23; all P < 3.79 × 10-4). Similar patterns were seen for ACR and greater mean annual loss of eGFR, which were also associated with fewer of the simpler N-glycans (all P < 3.79 × 10-4).Conclusions: Higher HbA1c in type 1 diabetes is associated with changes in the serum N-glycome that have elsewhere been shown to regulate the epidermal growth factor receptor and transforming growth factor-β pathways that are implicated in DKD. Furthermore, N-glycans are associated with ACR and eGFR slope. These data suggest that the role of altered N-glycans in DKD warrants further investigation. [ABSTRACT FROM AUTHOR]- Published
- 2018
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25. Inertial-range dynamics and scaling laws of two-dimensional magnetohydrodynamic turbulence in the weak-field regime
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Blackbourn, Luke A. K., primary and Tran, Chuong V., additional
- Published
- 2014
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26. Two-dimensional magnetohydrodynamic turbulence in the limits of infinite and vanishing magnetic Prandtl number
- Author
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Tran, Chuong V., primary, Yu, Xinwei, additional, and Blackbourn, Luke A. K., additional
- Published
- 2013
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27. On energetics and inertial-range scaling laws of two-dimensional magnetohydrodynamic turbulence
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Blackbourn, Luke A. K., primary and Tran, Chuong V., additional
- Published
- 2012
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28. A dynamical systems approach to fluid turbulence
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Tran, Chuong V, primary and Blackbourn, Luke A K, additional
- Published
- 2012
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29. Effects of friction on forced two-dimensional Navier-Stokes turbulence
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Blackbourn, Luke A. K., primary and Tran, Chuong V., additional
- Published
- 2011
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30. Number of degrees of freedom and energy spectrum of surface quasi-geostrophic turbulence
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Tran, Chuong V., primary, Blackbourn, Luke A. K., additional, and Scott, Richard K., additional
- Published
- 2011
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31. Comparison of serum and urinary biomarker panels with albumin/creatinine ratio in the prediction of renal function decline in type 1 diabetes
- Author
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Colombo, Marco, McGurnaghan, Stuart J., Blackbourn, Luke A. K., Dalton, R. Neil, Dunger, David, Bell, Samira, Petrie, John R., Green, Fiona, MacRury, Sandra, McKnight, John A., Chalmers, John, Collier, Andrew, McKeigue, Paul M., and Colhoun, Helen M.
- Subjects
Proteomics ,Clinical science ,Epidemiology ,Metabolomics ,Article ,Nephropathy ,3. Good health - Abstract
Aims/hypothesis: We examined whether candidate biomarkers in serum or urine can improve the prediction of renal disease progression in type 1 diabetes beyond prior eGFR, comparing their performance with urinary albumin/creatinine ratio (ACR). Methods: From the population-representative Scottish Diabetes Research Network Type 1 Bioresource (SDRNT1BIO) we sampled 50% and 25% of those with starting eGFR below and above 75 ml min−1 [1.73 m]−2, respectively (N = 1629), and with median 5.1 years of follow-up. Multiplexed ELISAs and single molecule array technology were used to measure nine serum biomarkers and 13 urine biomarkers based on our and others’ prior work using large discovery and candidate studies. Associations with final eGFR and with progression to
32. Impact of COVID-19 and Non-COVID-19 Hospitalized Pneumonia on Longer-Term Cardiovascular Mortality in People With Type 2 Diabetes: A Nationwide Prospective Cohort Study From Scotland.
- Author
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McGurnaghan SJ, McKeigue PM, Blackbourn LAK, Mellor J, Caparrotta TM, Sattar N, Kennon B, McAllister D, Wild SH, and Colhoun HM
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- Humans, Male, Female, Aged, Middle Aged, Prospective Studies, Scotland epidemiology, Aged, 80 and over, SARS-CoV-2, Adult, COVID-19 mortality, COVID-19 epidemiology, COVID-19 complications, Diabetes Mellitus, Type 2 complications, Diabetes Mellitus, Type 2 mortality, Cardiovascular Diseases mortality, Cardiovascular Diseases epidemiology, Hospitalization statistics & numerical data, Pneumonia mortality, Pneumonia epidemiology
- Abstract
Objective: In this study we examine whether hospitalized coronavirus disease 2019 (COVID-19) pneumonia increases long-term cardiovascular mortality more than other hospitalized pneumonias in people with type 2 diabetes and aim to quantify the relative cardiovascular disease (CVD) mortality risks associated with COVID-19 versus non-COVID-19 pneumonia., Research Design and Methods: With use of the SCI-Diabetes register, two cohorts were identified: individuals with type 2 diabetes in 2016 and at the 2020 pandemic onset. Hospital and death records were linked for determination of pneumonia exposure and CVD deaths. Poisson regression estimated rate ratios (RRs) for CVD death associated with both pneumonia types, with adjustment for confounders. Median follow-up durations were 1,461 days (2016 cohort) and 700 days (2020 cohort)., Results: The adjusted RR for CVD death following non-COVID-19 pneumonia was 5.51 (95% CI 5.31-5.71) prepandemic and 7.3 (6.86-7.76) during the pandemic. For COVID-19 pneumonia, the RR was 9.13 (8.55-9.75). Beyond 30 days post pneumonia, the RRs converged, to 4.24 (3.90-4.60) for non-COVID-19 and 3.35 (3.00-3.74) for COVID-19 pneumonia, consistent even with exclusion of prior CVD cases., Conclusions: Hospitalized pneumonia, irrespective of causal agent, marks an increased risk for CVD death immediately and over the long-term. COVID-19 pneumonia poses a higher CVD death risk than other pneumonias in the short-term, but this distinction diminishes over time. These insights underscore the need for including pneumonia in CVD risk assessments, with particular attention to the acute impact of COVID-19 pneumonia., (© 2024 by the American Diabetes Association.)
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- 2024
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33. Ongoing burden and recent trends in severe hospitalised hypoglycaemia events in people with type 1 and type 2 diabetes in Scotland: A nationwide cohort study 2016-2022.
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Berthon W, McGurnaghan SJ, Blackbourn LAK, Mellor J, Gibb FW, Heller S, Kennon B, McCrimmon RJ, Philip S, Sattar N, McKeigue PM, and Colhoun HM
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- Male, Female, Humans, Cohort Studies, Scotland epidemiology, Diabetes Mellitus, Type 2 epidemiology, Diabetes Mellitus, Type 1 complications, Diabetes Mellitus, Type 1 epidemiology, Hypoglycemia epidemiology
- Abstract
Aims: We examined severe hospitalised hypoglycaemia (SHH) rates in people with type 1 and type 2 diabetes in Scotland during 2016-2022, stratifying by sociodemographics., Methods: Using the Scottish National diabetes register (SCI-Diabetes), we identified people with type 1 and type 2 diabetes alive anytime during 2016-2022. SHH events were determined through linkage to hospital admission and death registry data. We calculated annual SHH rates overall and by age, sex, and socioeconomic status. Summary estimates of time and stratum effects were obtained by fitting adjusted generalised additive models using R package mgcv., Results: Rates for those under 20 with type 1 diabetes reached their minimum at the 2020-2021 transition, 30% below the study period average. A gradual decline over time also occurred among 20-49-year-olds with type 1 diabetes. Overall, females had 15% higher rates than males with type 2 diabetes (rate ratio 1.15, 95% CI 1.08-1.22). People in the most versus least deprived quintile experienced 2.58 times higher rates (95% CI 2.27-2.93) in type 1 diabetes and 2.33 times higher (95% CI 2.08-2.62) in type 2 diabetes., Conclusions: Despite advances in care, SHH remains a significant problem in diabetes. Future efforts must address the large socioeconomic disparities in SHH risks., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: P.M.M. declares stock ownership in the following: Bayer and Roche Pharmaceuticals. H.M.C. declares grants from Juvenile Diabetes Research Foundation International, Diabetes UK, IQVIA, Chief Scientist Office, Medical Research Council (UK Research and Innovation), and European Union Commission, honoraria from Novo Nordisk, advisory board fees paid through her institution from Novo Nordisk and Bayer, and stock ownership in Bayer and Roche Pharmaceuticals. S.H. declares consulting fees paid through his institution from Vertex Pharma, Zucara Pharmaceuticals, and Zealand Pharma, honoraria from Medtronic and Novo Nordisk, and has served as Chair of DSMB for Eli Lilly development programme and as a Member of Novo Nordisk Independent Advisory Board. R.J.M. declares honoraria from Sanofi and Novo Nordisk for lectures and presentations, travel support from Sanofi, and is a non-executive member of NHS Tayside Health Board. F.W.G. declares advisory board fees from Abbott Diabetes and Insulet, speaker fees from Abbott Diabetes, Insulet, Novo Nordisk, and Lilly, and travel support from Abbott Diabetes and Novo Nordisk. S.P. declares grants from Novo Nordisk, Lilly, and Amgen, travel support from Novo Nordisk, and has participated on an Advisory board for Roche Pharmaceuticals. N.S. has consulted for and/or received speaker honoraria from Abbott Laboratories, Abbvie, Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Hanmi Pharmaceuticals, Janssen, Menarini-Ricerche, Novartis, Novo Nordisk, Pfizer, Roche Diagnostics, and Sanofi; and received grant support paid to his University from AstraZeneca, Boehringer Ingelheim, Novartis, and Roche Diagnostics outside the submitted work. No other potential conflicts of interest relevant to this article were reported., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)
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- 2024
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34. Incidence of Type 1 Diabetes in Children Has Fallen to Pre-COVID-19 Pandemic Levels: A Population-Wide Analysis From Scotland.
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Berthon W, McGurnaghan SJ, Blackbourn LAK, Bath LE, McAllister DA, Stockton D, Wild SH, McKeigue PM, and Colhoun HM
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- Child, Humans, Incidence, Pandemics, Scotland epidemiology, Diabetes Mellitus, Type 1 epidemiology, COVID-19 epidemiology
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- 2024
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35. Large socioeconomic gap in period life expectancy and life years spent with complications of diabetes in the Scottish population with type 1 diabetes, 2013-2018.
- Author
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Höhn A, McGurnaghan SJ, Caparrotta TM, Jeyam A, O'Reilly JE, Blackbourn LAK, Hatam S, Dudel C, Seaman RJ, Mellor J, Sattar N, McCrimmon RJ, Kennon B, Petrie JR, Wild S, McKeigue PM, and Colhoun HM
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- Aged, Female, Humans, Life Expectancy, Male, Middle Aged, Retrospective Studies, Scotland epidemiology, Socioeconomic Factors, Diabetes Complications complications, Diabetes Mellitus, Type 1 complications, Diabetes Mellitus, Type 1 epidemiology
- Abstract
Background: We report the first study to estimate the socioeconomic gap in period life expectancy (LE) and life years spent with and without complications in a national cohort of individuals with type 1 diabetes., Methods: This retrospective cohort study used linked healthcare records from SCI-Diabetes, the population-based diabetes register of Scotland. We studied all individuals aged 50 and older with a diagnosis of type 1 diabetes who were alive and residing in Scotland on 1 January 2013 (N = 8591). We used the Scottish Index of Multiple Deprivation (SIMD) 2016 as an area-based measure of socioeconomic deprivation. For each individual, we constructed a history of transitions by capturing whether individuals developed retinopathy/maculopathy, cardiovascular disease, chronic kidney disease, and diabetic foot, or died throughout the study period, which lasted until 31 December 2018. Using parametric multistate survival models, we estimated total and state-specific LE at an attained age of 50., Results: At age 50, remaining LE was 22.2 years (95% confidence interval (95% CI): 21.6 - 22.8) for males and 25.1 years (95% CI: 24.4 - 25.9) for females. Remaining LE at age 50 was around 8 years lower among the most deprived SIMD quintile when compared with the least deprived SIMD quintile: 18.7 years (95% CI: 17.5 - 19.9) vs. 26.3 years (95% CI: 24.5 - 28.1) among males, and 21.2 years (95% CI: 19.7 - 22.7) vs. 29.3 years (95% CI: 27.5 - 31.1) among females. The gap in life years spent without complications was around 5 years between the most and the least deprived SIMD quintile: 4.9 years (95% CI: 3.6 - 6.1) vs. 9.3 years (95% CI: 7.5 - 11.1) among males, and 5.3 years (95% CI: 3.7 - 6.9) vs. 10.3 years (95% CI: 8.3 - 12.3) among females. SIMD differences in transition rates decreased marginally when controlling for time-updated information on risk factors such as HbA1c, blood pressure, BMI, or smoking., Conclusions: In addition to societal interventions, tailored support to reduce the impact of diabetes is needed for individuals from low socioeconomic backgrounds, including access to innovations in management of diabetes and the prevention of complications., Competing Interests: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. TMC reports grants from Diabetes UK Grant: 18/0005786, during the conduct of the study. SHW reports meeting attendance supported by Novo Nordisk, outside the submitted work. RJM reports personal fees from Sanofi, personal fees from NovoNordisk, outside the submitted work. NS reports personal fees from Amgen, personal fees from AstraZeneca, grants and personal fees from Boehringer Ingelheim, personal fees from Eli Lilly, personal fees from Novo Nordisk, personal fees from Pfizer, personal fees from Sanofi, outside the submitted work; HMC reports grants, personal fees and other from Eli Lilly and Company, during the conduct of the study; grants from AstraZeneca LP, other from Novartis Pharmaceuticals, grants from Regeneron, grants from Pfizer Inc, other from Roche Pharmaceuticals, other from Sanofi Aventis, grants and personal fees from Novo Nordisk, outside the submitted work. This does not alter our adherence to PLOS ONE policies on sharing data and materials. No other disclosures were reported.
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- 2022
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36. Rising Rates and Widening Socioeconomic Disparities in Diabetic Ketoacidosis in Type 1 Diabetes in Scotland: A Nationwide Retrospective Cohort Observational Study.
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O'Reilly JE, Jeyam A, Caparrotta TM, Mellor J, Hohn A, McKeigue PM, McGurnaghan SJ, Blackbourn LAK, McCrimmon R, Wild SH, Petrie JR, McKnight JA, Kennon B, Chalmers J, Phillip S, Leese G, Lindsay RS, Sattar N, Gibb FW, and Colhoun HM
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- Bayes Theorem, Educational Status, Female, Humans, Incidence, Infant, Male, Retrospective Studies, Scotland epidemiology, Diabetes Mellitus, Type 1 drug therapy, Diabetes Mellitus, Type 1 epidemiology, Diabetic Ketoacidosis epidemiology
- Abstract
Objective: Whether advances in the management of type 1 diabetes are reducing rates of diabetic ketoacidosis (DKA) is unclear. We investigated time trends in DKA rates in a national cohort of individuals with type 1 diabetes monitored for 14 years, overall and by socioeconomic characteristics., Research Design and Methods: All individuals in Scotland with type 1 diabetes who were alive and at least 1 year old between 1 January 2004 and 31 December 2018 were identified using the national register ( N = 37,939). DKA deaths and hospital admissions were obtained through linkage to Scottish national death and morbidity records. Bayesian regression was used to test for DKA time trends and association with risk markers, including socioeconomic deprivation., Results: There were 30,427 DKA admissions and 472 DKA deaths observed over 393,223 person-years at risk. DKA event rates increased over the study period (incidence rate ratio [IRR] per year 1.058 [95% credibility interval 1.054-1.061]). Males had lower rates than females (IRR male-to-female 0.814 [0.776-0.855]). DKA incidence rose in all age-groups other than 10- to 19-year-olds, in whom rates were the highest, but fell over the study. There was a large socioeconomic differential (IRR least-to-most deprived quintile 0.446 [0.406-0.490]), which increased during follow-up. Insulin pump use or completion of structured education were associated with lower DKA rates, and antidepressant and methadone prescription were associated with higher DKA rates., Conclusions: DKA incidence has risen since 2004, except in 10- to 19-year-olds. Of particular concern are the strong and widening socioeconomic disparities in DKA outcomes. Efforts to prevent DKA, especially in vulnerable groups, require strengthening., (© 2021 by the American Diabetes Association.)
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- 2021
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37. Prescribing Paradigm Shift? Applying the 2019 European Society of Cardiology-Led Guidelines on Diabetes, Prediabetes, and Cardiovascular Disease to Assess Eligibility for Sodium-Glucose Cotransporter 2 Inhibitors or Glucagon-Like Peptide 1 Receptor Agonists as First-Line Monotherapy (or Add-on to Metformin Monotherapy) in Type 2 Diabetes in Scotland.
- Author
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Caparrotta TM, Blackbourn LAK, McGurnaghan SJ, Chalmers J, Lindsay R, McCrimmon R, McKnight J, Wild S, Petrie JR, Philip S, McKeigue PM, Webb DJ, Sattar N, and Colhoun HM
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- Aged, Cardiology organization & administration, Cardiology standards, Cross-Sectional Studies, Diabetes Mellitus, Type 2 epidemiology, Female, Glycated Hemoglobin analysis, Glycated Hemoglobin metabolism, History, 21st Century, Humans, Male, Middle Aged, Patient Selection, Practice Guidelines as Topic standards, Registries, Retrospective Studies, Risk Assessment, Risk Factors, Scotland epidemiology, Societies, Medical standards, Diabetes Mellitus, Type 2 drug therapy, Glucagon-Like Peptide-1 Receptor agonists, Guideline Adherence statistics & numerical data, Guideline Adherence trends, Hypoglycemic Agents therapeutic use, Practice Patterns, Physicians' history, Practice Patterns, Physicians' standards, Practice Patterns, Physicians' statistics & numerical data, Practice Patterns, Physicians' trends, Sodium-Glucose Transporter 2 Inhibitors therapeutic use
- Abstract
Objective: In 2019, the European Society of Cardiology led and released new guidelines for diabetes cardiovascular risk management, reflecting recent evidence of cardiovascular disease (CVD) reduction with sodium-glucose cotransporter 2 inhibitors (SGLT-2is) and some glucagon-like peptide 1 receptor agonists (GLP-1RAs) in type 2 diabetes (T2D). A key recommendation is that all those with T2D who are (antihyperglycemic) drug naïve or on metformin monotherapy should be CVD risk stratified and an SGLT-2i or a GLP-1RA initiated in all those at high or very high risk, irrespective of glycated hemoglobin. We assessed the impact of these guidelines in Scotland were they introduced as is., Research Design and Methods: Using a nationwide diabetes register in Scotland, we did a cross-sectional analysis, using variables in our register for risk stratification at 1 January 2019. We were conservative in our definitions, assuming the absence of a risk factor where data were not available. The risk classifications were applied to people who were drug naïve or on metformin monotherapy and the anticipated prescribing change calculated., Results: Of the 265,774 people with T2D in Scotland, 53,194 (20.0% of those with T2D) were drug naïve, and 56,906 (21.4%) were on metformin monotherapy. Of these, 74.5% and 72.4%, respectively, were estimated as at least high risk given the guideline risk definitions., Conclusions: Thus, 80,830 (30.4%) of all those with T2D ( n = 265,774) would start one of these drug classes according to table 7 and figure 3 of the guideline. The sizeable impact on drug budgets, enhanced clinical monitoring, and the trade-off with reduced CVD-related health care costs will need careful consideration., (© 2020 by the American Diabetes Association.)
- Published
- 2020
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