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15. COVID-19 trajectories among 57 million adults in England: a cohort study using electronic health records

Author

Abbasizanjani, Hoda, Ahmed, Nida, Ahmed, Badar, Akbari, Ashley, Akinoso-Imran, Abdul Qadr, Allara, Elias, Allery, Freya, Angelantonio, Emanuele Di, Ashworth, Mark, Ayyar-Gupta, Vandana, Babu-Narayan, Sonya, Bacon, Seb, Ball, Steve, Banerjee, Ami, Barber, Mark, Barrett, Jessica, Bennie, Marion, Berry, Colin, Beveridge, Jennifer, Birney, Ewan, Bojanić, Lana, Bolton, Thomas, Bone, Anna, Boyle, Jon, Braithwaite, Tasanee, Bray, Ben, Briffa, Norman, Brind, David, Brown, Katherine, Buch, Maya, Canoy, Dexter, Caputo, Massimo, Carragher, Raymond, Carson, Alan, Cezard, Genevieve, Chang, Jen-Yu Amy, Cheema, Kate, Chin, Richard, Chudasama, Yogini, Cooper, Jennifer, Copland, Emma, Crallan, Rebecca, Cripps, Rachel, Cromwell, David, Curcin, Vasa, Curry, Gwenetta, Dale, Caroline, Danesh, John, Das-Munshi, Jayati, Dashtban, Ashkan, Davies, Alun, Davies, Joanna, Davies, Gareth, Davies, Neil, Day, Joshua, Delmestri, Antonella, Denaxas, Spiros, Denholm, Rachel, Dennis, John, Denniston, Alastair, Deo, Salil, Dhillon, Baljean, Docherty, Annemarie, Dong, Tim, Douiri, Abdel, Downs, Johnny, Dregan, Alexandru, Ellins, Elizabeth A, Elwenspoek, Martha, Falck, Fabian, Falter, Florian, Fan, Yat Yi, Firth, Joseph, Fraser, Lorna, Friebel, Rocco, Gavrieli, Amir, Gerstung, Moritz, Gilbert, Ruth, Gillies, Clare, Glickman, Myer, Goldacre, Ben, Goldacre, Raph, Greaves, Felix, Green, Mark, Grieco, Luca, Griffiths, Rowena, Gurdasani, Deepti, Halcox, Julian, Hall, Nick, Hama, Tuankasfee, Handy, Alex, Hansell, Anna, Hardelid, Pia, Hardy, Flavien, Harris, Daniel, Harrison, Camille, Harron, Katie, Hassaine, Abdelaali, Hassan, Lamiece, Healey, Russell, Hemingway, Harry, Henderson, Angela, Herz, Naomi, Heyl, Johannes, Hidajat, Mira, Higginson, Irene, Hinchliffe, Rosie, Hippisley-Cox, Julia, Ho, Frederick, Hocaoglu, Mevhibe, Hollings, Sam, Horne, Elsie, Hughes, David, Humberstone, Ben, Inouye, Mike, Ip, Samantha, Islam, Nazrul, Jackson, Caroline, Jenkins, David, Jiang, Xiyun, Johnson, Shane, Kadam, Umesh, Kallis, Costas, Karim, Zainab, Kasan, Jake, Katsoulis, Michalis, Kavanagh, Kim, Kee, Frank, Keene, Spencer, Kent, Seamus, Khalid, Sara, Khawaja, Anthony, Khunti, Kamlesh, Killick, Richard, Kinnear, Deborah, Knight, Rochelle, Kolamunnage-Dona, Ruwanthi, Kontopantelis, Evan, Kurdi, Amanj, Lacey, Ben, Lai, Alvina, Lambarth, Andrew, Larzjan, Milad Nazarzadeh, Lawler, Deborah, Lawrence, Thomas, Lawson, Claire, Li, Qiuju, Li, Ken, Llinares, Miguel Bernabeu, Lorgelly, Paula, Lowe, Deborah, Lyons, Jane, Lyons, Ronan, Machado, Pedro, Macleod, Mary Joan, Macleod, John, Malgapo, Evaleen, Mamas, Mamas, Mamouei, Mohammad, Manohar, Sinduja, Mapeta, Rutendo, Martelli, Javiera Leniz, Martos, David Moreno, Mateen, Bilal, McCarthy, Aoife, Melville, Craig, Milton, Rebecca, Mizani, Mehrdad, Moncusi, Marta Pineda, Morales, Daniel, Mordi, Ify, Morrice, Lynn, Morris, Carole, Morris, Eva, Mu, Yi, Mueller, Tanja, Murdock, Lars, Nafilyan, Vahé, Nicholson, George, Nikiphorou, Elena, Nolan, John, Norris, Tom, Norris, Ruth, North, Laura, North, Teri-Louise, O'Connell, Dan, Oliver, Dominic, Oluyase, Adejoke, Olvera-Barrios, Abraham, Omigie, Efosa, Onida, Sarah, Padmanabhan, Sandosh, Palmer, Tom, Pasea, Laura, Patel, Riyaz, Payne, Rupert, Pell, Jill, Petitjean, Carmen, Pherwani, Arun, Pickrell, Owen, Pierotti, Livia, Pirmohamed, Munir, Priedon, Rouven, Prieto-Alhambra, Dani, Proudfoot, Alastair, Quinn, Terry, Quint, Jennifer, Raffetti, Elena, Rahimi, Kazem, Rao, Shishir, Razieh, Cameron, Roberts, Brian, Rogers, Caroline, Rossdale, Jennifer, Salim, Safa, Samani, Nilesh, Sattar, Naveed, Schnier, Christian, Schwartz, Roy, Selby, David, Seminog, Olena, Shabnam, Sharmin, Shah, Ajay, Shelton, Jon, Sheppard, James, Sinha, Shubhra, Skrypak, Mirek, Slapkova, Martina, Sleeman, Katherine, Smith, Craig, Sofat, Reecha, Sosenko, Filip, Sperrin, Matthew, Steeg, Sarah, Sterne, Jonathan, Stoica, Serban, Sudell, Maria, Sudlow, Cathie, Sun, Luanluan, Suseeladevi, Arun Karthikeyan, Sweeting, Michael, Sydes, Matt, Takhar, Rohan, Tang, Howard, Thygesen, Johan, Tilston, George, Tochel, Claire, Toit, Clea du, Tomlinson, Christopher, Toms, Renin, Torabi, Fatemeh, Torralbo, Ana, Townson, Julia, Tufail, Adnan, Tungamirai, Tapiwa, Varma, Susheel, Vollmer, Sebastian, Walker, Venexia, Wang, Tianxiao, Wang, Huan, Warwick, Alasdair, Watkinson, Ruth, Watson, Harry, Whiteley, William, Whittaker, Hannah, Wilde, Harry, Wilkinson, Tim, Williams, Gareth, Williams, Michelle, Williams, Richard, Withnell, Eloise, Wolfe, Charles, Wood, Angela, Wright, Lucy, Wu, Honghan, Wu, Jinge, Wu, Jianhua, Yates, Tom, Zaccardi, Francesco, Zhang, Haoting, Zhang, Huayu, Zuccolo, Luisa, Thygesen, Johan H, Mizani, Mehrdad A, Banerjee, Amitava, Lai, Alvina G, Li, Kezhi, Mateen, Bilal A, Sterne, Jonathan A C, Pagel, Christina, and Whiteley, William N

Published
2022
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19. COVID-19-related morbidity and mortality in people with multiple long-term conditions: a systematic review and meta-analysis of over 4 million people.

Author

Salisu-Olatunji, Shukrat O, Chudasama, Yogini V, Kaur, Navjot, Kayani, Zara, Odugbemi, Babatunde A, Bolodeoku, Olasope Esther, Konnor, Shirley Akua, Vounzoulaki, Elpida, Bhattacharjee, Atanu, Fahami, Radia, Valabhji, Jonathan, Banerjee, Amitava, Zaccardi, Francesco, Gillies, Clare L, and Khunti, Kamlesh

Abstract

Objectives: To describe the direct impact of coronavirus disease 2019 (COVID-19) infection on morbidity and mortality in people with multiple long-term conditions (MLTCs). Design: A systematic review and meta-analysis including observational studies. Setting: Studies conducted between 1 January 2020 and 4 May 2023 across 51 countries were identified from five databases. Participants: A total of 4,084,469 patients with confirmed COVID-19 infection. Main outcome measures: Pooled risk ratios (RRs) for mortality, hospitalisation, severe disease, intensive care unit (ICU) admission and mechanical ventilation were estimated with random effect meta-analysis models. Results: A total of 38,356 studies were identified and 111 included. In most (74%) of the studies, MLTCs referred to having two or more long-term conditions. Others described MLTCs by high weighted indices: the Charlson Comorbidity Index in 11% and the Clinical Frailty Score in 7%. Using the National Institutes of Health quality assessment tool for observational studies, the risk of bias was judged as low and moderate in 86 and 25 studies, respectively. Having MLTCs was associated with increased mortality (RR: 2.61 [95% CI: 2.27 to 3.0]); hospitalisation (2.4 [1.92 to 2.99]); severe disease (2.61 [1.92 to 3.54]); ICU admission (1.22 [1.07 to 1.39]) and mechanical ventilation (1.83 [1.18 to 2.84]) compared with those with no MLTCs. Pooled RRs for adverse outcomes were higher in children and young people compared with all age groups. In meta-regression analyses, men were more likely to need ICU admission (p = 0.013) and mechanical ventilation (p = 0.002). Conclusions: Public health policies, clinical and preventative interventions should prioritise people with MLTCs to minimise direct adverse outcomes from COVID-19 disease. [ABSTRACT FROM AUTHOR]

Published
2024
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20. Patient‐reported outcomes in diabetes‐related foot conditions: Is patient experience influenced by ethnicity? A mixed‐methods systematic review.

Author

Highton, Patrick, Jeffers, Shavez, Butt, Ayesha, O'Mahoney, Lauren, Jenkins, Sian, Abdala, Ruksar, Haddon, Louise, Gillies, Clare, Curtis, Ffion, Hadjiconstantinou, Michelle, and Khunti, Kamlesh

Subjects
TREATMENT of diabetic foot, ETHNIC groups, MEDICAL information storage & retrieval systems, RESEARCH funding, SELF-management (Psychology), CINAHL database, DESCRIPTIVE statistics, EMOTIONS, SYSTEMATIC reviews, MEDLINE, RESEARCH methodology, QUALITY of life, HEALTH behavior, HEALTH outcome assessment, SOCIODEMOGRAPHIC factors, SOCIAL support, HEALTH equity, DATA analysis software, PATIENTS' attitudes, PSYCHOSOCIAL factors, WELL-being, DEPENDENCY (Psychology), HOPE, EMPLOYMENT, EVALUATION
Abstract

Aims: Research in diabetes‐related foot conditions (DRFC) often focuses on ulcer‐related care, whilst the patient experience and influence of sociodemographic factors are under‐researched. This systematic review investigated patient‐reported outcomes and experience in people with DRFC. Methods: Multiple databases were searched from inception to 16 August 2023. All original articles that assessed any patient‐reported outcome or experience in DRFC and reported participant ethnicity were included. Data were synthesized using a sequential contingent approach. Study quality was assessed using study design‐specific tools. Results: Twenty‐three studies were included (11 qualitative, 11 quantitative and one mixed‐methods). DRFC had a largely negative impact on various life dimensions, including social and daily life, work, emotional and psychological well‐being, necessitating dependence on others in the form of emotional, social and/or religious support, which were experienced differently by different groups. Patient DRFC knowledge and self‐care habits were typically suboptimal, and levels of hope and feeling of control over their condition varied between groups. Outcomes varied slightly between ethnicities across studies, with some ethnicity‐specific themes identified such as beliefs about disease cause and footwear habits. Quantitative and qualitative findings were mostly congruent. Conclusions: DRFC profoundly and negatively impacts patient‐reported outcomes and experience, with limited evidence suggesting an influence of ethnicity. [ABSTRACT FROM AUTHOR]

Published
2024
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25. Risk of lower extremity amputation in patients with type 2 diabetes mellitus and peripheral arterial disease receiving sodium‐glucose cotransporter‐2 inhibitors versus other medications: A systematic review and meta‐analysis of observational cohort studies

Author

Hodgson, Anna, primary, Gillies, Clare L., additional, Highton, Patrick, additional, Haddon, Louise, additional, Gharibzadeh, Safoora, additional, Zaccardi, Francesco, additional, and Khunti, Kamlesh, additional

Published
2024
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30. The effect of high‐fibre diets on glycaemic control in women with diabetes in pregnancy: A systematic review and meta‐analysis.

Author

Jones, Danielle, Kyriakidou, Anna, Cooper, Louise, Atta, Nooria, Tobolska, Patrycja, Smith, Suzanne, Turner, Elizabeth, Petry, Clive, Gillies, Clare, and Meek, Claire L.

Subjects
INSULIN therapy, MEDICAL information storage & retrieval systems, GLYCEMIC control, TREATMENT effectiveness, DESCRIPTIVE statistics, META-analysis, MEDLINE, BLOOD sugar, SYSTEMATIC reviews, TYPE 2 diabetes, DIETARY fiber, MEDICAL databases, CONFIDENCE intervals, BIOMARKERS, PREGNANCY
Abstract

Dietary fibre improves glycaemic control in type 2 diabetes, but its therapeutic role in women with diabetes in pregnancy is unclear. We assessed the effect of dietary fibre on markers of glycaemic control in women with diabetes in pregnancy. Methods: We searched four databases (Cochrane Library, MEDLINE, Embase and Web of Science) to identify RCTs exploring the effect of dietary fibre, high‐fibre diets or fibre supplementation on fasting blood glucose (FBG), 2‐h postprandial blood glucose (PBG) and requirement for insulin therapy, among other glycaemic makers in pregnant women with diabetes. Data were pooled for each outcome to calculate change from baseline mean (SD) and overall mean difference (MD) between control and intervention groups. Results: Of 1462 identified studies, data from 20 eligible trials containing 1061 participants were pooled. On meta‐analysis, a higher fibre intake was associated with reduced FBG (MD: −0.35 mmol/L, 95% CI: −0.53, −0.18, p < 0.01), PBG (MD: −0.90 mmol/L, 95% CI: −1.39, −0.40, p < 0.01) and requirement for insulin (OR: 0.24, 95% CI: 0.13, 0.46, p < 0.01). There was significant heterogeneity for FBG and PBG (>90%), attributable to differences in Intervention type for PBG (Dietary Approach to Stop Hypertension [DASH] diet, low glycaemic index, supplement; p < 0.01) and study duration (for FBG: p = 0.002; not for PBG). Studies were mostly scored as high risk of bias due to lack of blinding (Cochrane Risk of Bias Tool v.2.0). Conclusion: High‐quality dietary intervention studies in pregnancy are lacking. Our results suggest that high‐fibre diets improve fasting and postprandial glycaemia and reduce the likelihood of requiring insulin in women with diabetes in pregnancy. [ABSTRACT FROM AUTHOR]

Published
2025
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32. Differential associations of risk factors with severe and non‐severe hypoglycaemia: the Hypoglycaemia Assessment Tool prospective observational study in people with insulin‐treated type 1 diabetes and type 2 diabetes.

Author

He, Ying, Kunutsor, Setor K., Kingsnorth, Andrew P., Gillies, Clare, Choudhary, Pratik, Khunti, Kamlesh, and Zaccardi, Francesco

Subjects
TYPE 2 diabetes, TYPE 1 diabetes, HYPOGLYCEMIA, CONTINUOUS glucose monitoring, INSULIN therapy, SUBCUTANEOUS infusions, ARTIFICIAL pancreases
Abstract

Aim: To assess the differential association of risk factors with severe and non‐severe hypoglycaemia. Materials and Methods: The Hypoglycaemia Assessment Tool study evaluated the risk of hypoglycaemia over a 4‐week period in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D) on insulin in 24 countries. Negative binomial regressions were applied to examine the associations of several risk factors with severe and non‐severe hypoglycaemia. Results: The median age was 41 years in 5949 patients with T1D and 62 years in 12 914 patients with T2D. The 4‐week rates of non‐severe hypoglycaemic were 5.57 and 1.40 episodes per person in T1D and T2D, respectively; the corresponding rates for severe hypoglycaemia were 0.94 and 0.30. The excess risk was 42% higher for severe than non‐severe hypoglycaemia in females versus males with T2D; 27% higher in patients with T2D with versus without a continuous glucose monitoring (CGM); and 47% lower in patients with T1D with versus without an insulin pump. The excess risk also differed across geographical areas and was marginally lower for severe than non‐severe hypoglycaemia for higher values of HbA1c in patients with T2D. Associations with severity of hypoglycaemia were not different for age, diabetes and insulin therapy duration, previous hypoglycaemic episodes and insulin regimen. Conclusions: The risk of severe versus non‐severe hypoglycaemia differs in patients with T1D and T2D; sex, the use of a CGM and insulin pump, and geographical areas were differently associated with one type of hypoglycaemia than the other. [ABSTRACT FROM AUTHOR]

Published
2024
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35. Socioeconomic inequalities in risk of infection with SARS-CoV-2 delta and omicron variants in the UK, 2020-22: analysis of the longitudinal COVID-19 Infection Survey

Author

Razieh, Cameron, primary, Shabnam, Sharmin, additional, Dambha-Miller, Hajira, additional, Morris, Eva J A, additional, Yates, Tom, additional, Chudasama, Yogini, additional, Zaccardi, Francesco, additional, Gillies, Clare, additional, Banerjee, Amitava, additional, Pareek, Manish, additional, Lacey, Ben, additional, White, Martin, additional, Khunti, Kamlesh, additional, and Islam, Nazrul, additional

Published
2024
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42. Taste perception genomics in gestational diabetes mellitus: A systematic review.

Author

Shivam, Vishnu, Gillies, Clare L., Goff, Louise M., Zaccardi, Francesco, and Khunti, Kamlesh

Subjects
*GESTATIONAL diabetes, *TASTE perception, *GENOMICS, *SWEETNESS (Taste), *UMAMI (Taste), *BITTERNESS (Taste), *TRP channels
Abstract

This article is a systematic review that examines the relationship between taste perception and genetic variation in taste receptors in pregnant women with gestational diabetes mellitus (GDM). The review found that pregnant women with GDM have an increased preference for sweet, salty, and fat tastes compared to pregnant women without GDM. Genetic studies also suggest that certain genetic variations in taste receptor genes may be associated with an increased risk of GDM. However, more research is needed to further understand the role of genetic variations in taste perception among pregnant women with GDM. [Extracted from the article]

Published
2024
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43. Deintensification of potentially inappropriate medications amongst older frail people with type 2 diabetes: Protocol for a cluster randomised controlled trial (D-MED study).

Author

O'Mahoney, Lauren, Highton, Patrick, Abdala, Ruksar, Dallosso, Helen, Gillies, Clare L., Ragha, Seema, Munday, Fiona, Robinson, John, Marshall, Andrew, Sheppard, James P., Khunti, Kamlesh, and Seidu, Samuel

Abstract

Amongst elderly people with type 2 diabetes (T2D) over prescribing can result in emergency ambulance call-outs, falls and fractures and increased mortality, particularly in frail patients. Current clinical guidelines, however, remain focused on medication intensification rather than deintensification where appropriate. This study aims to evaluate the effectiveness of an electronic decision-support system and training for the deintensification of potentially inappropriate medications amongst older frail people with T2D, when compared to 'usual' care at 12-months. This study is an open-label, multi-site, two-armed pragmatic cluster-randomised trial. GP practices randomised to the 'enhanced care' group have an electronic decision support system installed and receive training on the tool and de-intensification of diabetes medications. The system flags eligible patients for possible deintensification of diabetes medications, linking the health care professional to a clinical algorithm. The primary outcome will be the number of patients at 12-months who have had potentially inappropriate diabetes medications de-intensified. Study recruitment commenced in June 2022. Data collection commenced in January 2023. Baseline data have been extracted from 40 practices (3145 patients). Digital technology, involving computer decision systems, may have the potential to reduce inappropriate medications and aid the process of de-intensification. International Standard Randomised Controlled Trial Number: ISRCTN53221378. Available at: https://www.isrctn.com/ISRCTN53221378. • Overprescribing of diabetes medications causes hypoglycaemia, falls. • Problem in older, frail patients, yet limited guidance for deprescribing. • Limited long-term benefit of tight glycaemic control in older patients. • Electronic decision support and training may guide deprescribing. [ABSTRACT FROM AUTHOR]

Published
2024
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48. Development of evidence synthesis methods for health policy decision making - A chain of evidence approach

Author

Gillies, Clare Louise

Subjects
361
Abstract

This project comprises a critical exploration and development of methods for the synthesis of evidence, using a chain of evidence approach, from diverse, yet inter-related, sources. The methodologies were explored through the development of a comprehensive decision model to assess different health policies in respect to screening for type 2 diabetes mellitus (T2DM). Four strategies were compared which were, no screening (current policy), screening for T2DM alone allowing for early diagnosis and treatment of the condition, and two strategies whereby both impaired glucose tolerance (IGT) and T2DM were screened for, allowing for early treatment of T2DM and for either lifestyle or pharmacological interventions to be applied to those with IGT in an attempt to delay the onset of T2DM. The comprehensive decision model developed here was innovative when compared to current published models in a number of ways. Firstly the entire model was encompassed within a single flexible framework, which has a number of advantages, and secondly as much of the available data as was feasible to use, was incorporated into the model inputs. A number of methodological issues and techniques were explored during the development of the comprehensive decision model. These included mixed treatment comparison analyses, assessment of baseline risk on intervention effects and the use of individual patient data. A number of sensitivity analyses and model extensions were carried out to assess the parameters with most influence on model results, and to adapt the model to different screening scenarios. The results of the model provide evidence that a screening strategy for IGT and T2DM, followed by appropriate treatment and interventions appears to be a cost-effective screening strategy. Uncertainty still surrounds the cost-effectiveness of screening for T2DM alone and further research is required. Running decision models within a Bayesian, comprehensive decision modelling framework, allows for model flexibility and has advantages over more conventional modelling techniques.

Published
2007

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