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Introduction: Metformin and diets aimed at promoting healthy body weight are the first line in treating type 2 diabetes mellitus (T2DM). Clinical practice, backed by clinical trials, suggests that many individuals do not reach glycaemic targets using this approach alone. The primary aim of the Personalised Medicine in Pre-diabetes-Towards Preventing Diabetes in Individuals at Risk (PREDICT) Study is to test the efficacy of personalised diet as adjuvant to metformin in improving glycaemic control in individuals with dysglycaemia., Methods and Analysis: PREDICT is a two-arm, parallel group, single-masked randomised controlled trial in adults with pre-diabetes or early-stage T2DM (with glycated haemoglobin (HbA1c) up to 8.0% (64 mmol/mol)), not treated with glucose-lowering medication. PREDICT is conducted at the Clinical Research Facility at the Garvan Institute of Medical Research (Sydney). Enrolment of participants commenced in December 2018 and expected to complete in December 2021. Participants are commenced on metformin (Extended Release, titrated to a target dose of 1500 mg/day) and randomised with equal allocation to either (1) the Personalised Nutrition Project algorithm-based diet or (2) low-fat high-dietary fibre diet, designed to provide caloric restriction (75%) in individuals with body mass index >25 kg/m 2 . Treatment duration is 6 months and participants visit the Clinical Research Facility five times over approximately 7 months. The primary outcome measure is HbA1c. The secondary outcomes are (1) time of interstitial glucose <7.8 mmol/L and (2) glycaemic variability (continuous glucose monitoring), (3) body weight, (4) fat mass and (5) abdominal visceral fat volume (dual-energy X-ray absorptiometry), serum (6) low-density lipoprotein cholesterol (7) high-density lipoprotein cholesterol and (8) triglycerides concentrations, (9) blood pressure, and (10) liver fat (Fibroscan)., Ethics and Dissemination: The study has been approved by the St Vincent's Hospital Human Research Ethics Committee (File 17/080, Sydney, Australia) and the Weizmann Institutional Review Board (File 528-3, Rehovot, Israel). The findings will be published in peer-reviewed open access medical journals., Trial Registration Number: NCT03558867; Pre-results., Competing Interests: Competing interests: EE and ES are paid consultants of the company DayTwo. MD has received travel support and speaker fees from Gilead, Abbvie and Merck. All other authors declare they have no conflict of interest., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Teriparatide, used for treatment of osteoporosis in patients at high risk of fracture risk, sometimes results in mild and transient hypercalcemia. There have been two recent reports of worsening dystrophic calcification in patients with autoimmune disorders following teriparatide treatment. We report a patient with severe osteoporosis and without a pre-existing autoimmune disorder, who developed symptomatic worsening of dystrophic calcification 4 months after teriparatide was initiated. Symptoms resolved within 1 week of teriparatide cessation.

Recent research suggests that women with polycystic ovary syndrome (PCOS) may have a higher prevalence of asthma. However, there are no epidemiological studies aimed primarily at exploring the relationship between PCOS and asthma, and the effect of body mass index (BMI) on this association.This study is a cross-sectional analyses of data from the Australian Longitudinal Study on Women's Health, a large, community-based, prospective study to examine the association between PCOS and asthma in women aged 28-33 years (n=478 PCOS and n=8134 controls).The prevalence of asthma was 15.2% in women with PCOS and 10.6% in women without PCOS (p=0.004). Women with PCOS who had asthma had a trend for a higher BMI compared with women without asthma (29.9±0.9 versus 27.7±0.4 kg·m -2 ; p=0.054). Women without PCOS who had asthma had a higher BMI compared with women without asthma (26.4±0.2 versus 24.9±0.1 kg·m -2 ; p<0.001). After adjusting for age, BMI and smoking status, PCOS was associated with increased odds of asthma (odds ratio 1.34, 95% CI 1.004-1.79; p=0.047).This study showed both PCOS status and overweight/obese status were independently associated with asthma. Further prospective studies are required to explore the possible mechanisms underpinning the association between asthma and PCOS., Competing Interests: Conflict of interest: None declared., (Copyright ©ERS 2017.)