To describe the effect of the stringent lockdown measures, introduced in the UK on 23 March 2020 to curtail the transmission of COVID‐19, on glycaemic control in people with type 1 diabetes using flash glucose monitoring.

Aims Hyperglycaemia, a side-effect of acute glucocorticoid exposure, is associated with poor outcome in those undergoing chemotherapy. The incidence, risk factors and diurnal profile of glucocorticoid-induced glucose dysregulation in the context of chemotherapy treatment remain incompletely understood. MethodsResultsBlinded continuous interstitial glucose monitoring was performed on 16 women without diabetes for 24 h prior to and 5 days following carboplatin/paclitaxel chemotherapy combined with dexamethasone treatment for gynaecological cancer. At the end of the treatment period, glucose data were analysed and integrated with baseline metabolic and anthropomorphic variables. 15/16 (94%) women exhibited elevated glucose levels (> 11.1 mmol/l). Peak glucose levels were highest on the day of treatment (median 14.45 mmol/l, range 10.2-22.2 mmol/l) and total time spent with an elevated interstitial glucose level was highly variable (median 3.6 h, range 0.0-55.1 h). Peak interstitial glucose levels occurred predominantly, but not exclusively, in the afternoon (13.00-15.00) and evening (19.00-22.00); however elevated levels were noted throughout the 24-h period. Baseline HbA(1c) was independently associated with severity and duration of elevated glucose levels in a regression adjusted for baseline BMI. ConclusionsWhat's new?These data report for the first time that high glucose levels are encountered by nearly all women following this regimen, the severity and duration of which are independently associated with HbA(1c). Further work is required to determine if controlling glucose levels during treatment influences outcome. Hyperglycaemia during chemotherapy treatment is associated with negative health outcomes. The incidence, severity and diurnal profile of glucose dysregulation during chemotherapy are unclear, limiting development of screening and treatment protocols. Utilizing continuous glucose monitoring, these data demonstrate that elevated glucose levels affect nearly all women treated with a standard carboplatin/paclitaxel/dexamethasone chemotherapeutic regimen for gynaecological cancer. The diurnal profile is described with peak glucose windows for opportunistic monitoring. HbA(1c) was independently associated with the severity and duration of glucose excursions.

Diabetes & Metabolism - In Press.Proof corrected by the author Available online since jeudi 12 janvier 2017

Diabetic MedicineVolume 28, Issue 10 p. 1280-1280 Book Review Understanding Diabetes and Endocrinology—A Problem-Orientated Approach A. Dover, A. DoverSearch for more papers by this authorJ. McKnight, J. McKnightSearch for more papers by this author A. Dover, A. DoverSearch for more papers by this authorJ. McKnight, J. McKnightSearch for more papers by this author First published: 14 June 2011 https://doi.org/10.1111/j.1464-5491.2011.03355.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume28, Issue10October 2011Pages 1280-1280 RelatedInformation

. The ability of glucocorticoids to directly alter arterial function, structure and the inflammatory response to vascular injury may contribute to their well-established link with the development of cardiovascular disease. Recent studies have emphasised the importance of tissue-specific regulation of glucocorticoid availability by the 11 β-hydroxysteroid dehydrogenase (11HSD) isozymes, which inter-convert active glucocorticoids and their inactive metabolites. The expression of both type 1 and type 2 11HSDs in the arterial wall suggests that prereceptor metabolism of glucocorticoids may have a direct impact on vascular physiology. Indeed there is evidence that 11HSDs influence glucocorticoid-mediated changes in vascular contractility, vascular structure, the inflammatory response to injury and the growth of new blood vessels. Hence, inhibition of 11HSD isozymes may provide a novel therapeutic target in vascular disease.

Measurement and Treatment of Lipids in the over 80s with Coronary Heart Disease (CHD) C Isles,1 A Jones2 1Medical Unit, Dumfries and Galloway Royal Infirmary, Dumfries, DG1 4AP and 2Cairnsmore Medical Practice, Newton Stewart, DG8 6NR Quality markers for CHD in the new General Medical Services contract (nGMS) include the recommendation that 90% of patients should have cholesterol measured and that 60% should have serum cholesterol less than 5 mmol/l. The very elderly are not automatically excluded from this recommendation. Against this background we conducted a survey of the impact of the nGMS on the measurement of lipids and prescription of statins in octogenarians with CHD in south west Scotland. All 119 GPs currently in post responded to our questionnaire, the results of which are shown in the table. Most of those who said they were more likely to measure cholesterol in this age group were also more likely to prescribe statins. One practice with a list size of 3750, 214 (5.7%) patients aged 80 and over, 63 (29.4%) of whom had CHD

Background: Overexpression of inducible nitric oxide synthase (iNOS) and increased nitric oxide generation may be associated with the hyperdynamic circulation of patients with cirrhosis. We have, for the first time, used the highly selective iNOS inhibitor, 1400W, to determine whether iNOS activity contributes to the regulation of vascular tone in patients with cirrhosis and ascites. Methods: Bilateral forearm blood flow was measured using strain gauge plethysmography in eight patients with cirrhosis and ascites, and eight matched healthy volunteers during intrabrachial infusion of 1400W (0.1–1 μmol/min), NG-monomethyl-L-arginine (L-NMMA, a non-selective NOS inhibitor; 2–8 μmol), and norepinephrine (a control vasoconstrictor; 60–480 pmol/min). Results: In patients with cirrhosis, 1400W, L-NMMA, and norepinephrine caused dose dependent reductions in forearm blood flow: peak reductions of 11 (5)%, 37 (4)%, and 48 (5)%, respectively (p<0.05 for all). In contrast, 1400W had no effect on blood flow (+4 (8)%; NS) in healthy controls despite similar reductions in blood flow with L-NMMA and norepinephrine (39 (5)% and 49 (5)%, respectively; p<0.05 for both). Conclusions: We have, for the first time, demonstrated that 1400W causes peripheral vasoconstriction in patients with cirrhosis but not healthy matched controls. This suggests that iNOS contributes to the regulation of peripheral vascular tone in patients with cirrhosis and ascites, and may contribute towards the hyperdynamic circulation associated with this condition.

Angiogenesis restores blood flow to healing tissues, a process that is inhibited by high doses of glucocorticoids. However, the role of endogenous glucocorticoids and the potential for antiglucocorticoid therapy to enhance angiogenesis is unknown. Using in vitro and in vivo models of angiogenesis in mice, we examined effects of (i) endogenous glucocorticoids, (ii) blocking endogenous glucocorticoid action with the glucocorticoid receptor antagonist RU38486, and (iii) abolishing local regeneration of glucocorticoids by the enzyme 11beta-hydroxysteroid dehydrogenase type 1 (11betaHSD1). Glucocorticoids, administered at physiological concentrations, inhibited angiogenesis in an in vitro aortic ring model and in vivo in polyurethane sponges implanted s.c. RU38486-enhanced angiogenesis in s.c. sponges, in healing surgical wounds, and in the myocardium of mice 7 days after myocardial infarction induced by coronary artery ligation. 11betaHSD1 knockout mice showed enhanced angiogenesis in vitro and in vivo within sponges, wounds, and infarcted myocardium. Endogenous glucocorticoids, including those generated locally by 11betaHSD1, exert tonic inhibition of angiogenesis. Inhibition of 11betaHSD1 in liver and adipose has been advocated to reduce cardiovascular risk in the metabolic syndrome: these data suggest that 11betaHSD1 inhibition offers a previously uncharacterized therapeutic approach to improve healing of ischemic or injured tissue.