Type 1 and type 2 diabetes mellitus (DM) are often accompanied by mild forms of pancreatic exocrine insufficiency (PEI). The prevalence rates of PEI in diabetic patients are unclear and variable depending on the testing modality and the studies published. The clinical consequences of PEI in diabetics are also not well defined. We aimed to determine the prevalence of PEI in a diabetic cohort using the faecal elastase-1 (FE-1) assay as a screening test and to validate a patient-reported symptom-based scoring system, the (PEI-S) for diagnosing PEI within this patient population. Two hundred and three diabetic patients attending diabetic and gastroenterology outpatients of a university hospital without previously known PEI were recruited for the study. Demographic parameters, PEI score (PEI-S), and glycated hemoglobin (HBA1c) were documented in standardized data sheets, and a stool sample was obtained. A FE-1 value < 200 μg/g and or a PEIS of > 0.6 was used as the screening cut-off for PEI. One hundred sixty-six patients returned faecal samples. The prevalence of PEI, as measured by low FE-1, was 12

Background & Objective. Polycystic ovarian syndrome (PCOS) is the most common reproductive endocrinopathy in women of reproductive age with many associated metabolic symptoms, in particular hyperinsulinemia, insulin resistance, and a high lifetime risk of type 2 diabetes mellitus. The effects of time-restricted eating on metabolic profiles have been investigated in many endocrinopathies, but there is minimal data for PCOS. Here we explore the potential role of time-restricted eating in the nonpharmacological management of PCOS. Designs & Methods. Medline, CINAHL, EMBASE, Web of Science, and Cochrane Library were searched for controlled trials of effects of time-restricted eating regimens on insulin levels in patients with PCOS. A further narrative discussion on the time-restricted eating in PCOS was conducted. Results. 2662 papers were identified with 37 selected for full-text review and one paper meeting criteria for inclusion. Ramadan fasting was the only time-restricted eating regimen trialled in this population with no strong evidence of a significant effect on insulin levels. Conclusion. As the systematic review retrieved only one study investigating time-restricted eating to reduce insulin in patients with PCOS, there is no evidence to suggest that this intervention is effective. From the narrative review, based on studies in other patient groups, time-restricted eating could improve insulin resistance in those with PCOS; however, well-designed studies are required before this intervention can be recommended.

AIMS:To establish the impact of uncomplicated type 2 diabetes on cognitive and neuropsychological performance in midlife. METHODS:We performed a cross-sectional study of middle-aged adults with uncomplicated type 2 diabetes and a cohort of healthy control participants. General cognition was assessed using the Montreal Cognitive Assessment test and neuropsychological assessment was undertaken using a detailed neuropsychological assessment battery. RESULTS:A total of 152 participants (102 with type 2 diabetes and 50 controls) were recruited (mean age 52 ± 8 years, 51% women). Participants with midlife type 2 diabetes were more than twice as likely to make an error on the Montreal Cognitive Assessment test [incidence rate ratio 2.44 (95% CI 1.54 to 3.87); P < 0.001]. Further, type 2 diabetes was also associated with significantly lower memory composite score [β: -0.20 (95% CI -0.39 to -0.01); P = 0.04] and paired associates learning score [β: = -1.97 (95% CI -3.51, -0.43); P = 0.01] on the neuropsychological assessment battery following adjustment for age, sex, BMI, educational attainment and hypercholesterolaemia. CONCLUSIONS:Even in midlife, type 2 diabetes was associated with small but statistically significant cognitive decrements. These statistically significant decrements, whilst not clinically significant in terms of objective cognitive impairment, may have important implications in selecting out individuals most at risk of later cognitive decline for potential preventative interventions in midlife.

Introduction: Patients with pancreatic disease commonly develop endocrine impairment and pancreatogenic diabetes(type 3c). However, precise definition and diagnostics are not yet clearly defined. Patients with type3c diabetes behave differently and have different healthcare requirements than those with types1&2 diabetes. Correct identification and classification is therefore crucial to ensure good management and outcomes. Method: Following ethical approval, a Diabetes Database (DD) maintained by the Department of Endocrinology and Department of Surgery Pancreatic Database (PD) in atertiary referral university hospital, were interrogated between the years 2004-2017. Both were cross-matched for common patients. Data on demographics, management, and complications were recorded. Results: There were 11,216 patients on the DD and 3,865 patients on the PD. Of these, n=327 cases were deemed to have pancretogenic diabetes. A minority (23.5%)were correctly labelled as type3c diabetes,while 63.9% classified as type 2 and 12.3% as type 1. Pancreatogenic diabetes patients were predominatly male (69%), with a mean age of 55 years (range:18-98 years), and a mean BMI of 29 37% had chronic pancreatitis, while 32% had acute pancreatitis and 31% had pancreatic cancer. Almost half (45%) were insulin-dependant, with 55% on oral hypoglycaemic agents. More than half (51%) had confirmed exocrine insufficiency, although faecal-elastase-1 was infrequently reported (12%). Fewer (41%) took enzyme replacement therapy. Frequent hypoglycaemiaoccurred in 17%. The majority of patients (54%) had at least one diabetic complication, while 10% had >3 complications. Conclusion: Type 3c diabetes is poorly recognised in patients with pancreatic diseases, increasing the risk of mismanagement. Hypo- and hyper-glycaemia, compounded by malabsorption, malnutrition, and frequent diabetic complications result in a difficult-to-manage group. Appropriate and timely diagnosis is crucial to ensure optimal outcomes.

Midlife Type II diabetes mellitus (T2DM) is an important yet often unrecognized risk factor for the later development of dementia. We conducted a systematic review to assess the efficacy of non-pharmacological interventions (namely diet, exercise and cognitive training) for T2DM on cognition. A search strategy was constructed and applied to four databases: EMBASE, Medline, CINAHL and Web of Science. Peer-reviewed journal articles in English were considered assessing the effect of exercise, dietary or cognitive training/stimulation-based interventions (or any combination of these) in patients with T2DM on cognition. Results were dual-screened and extracted by two independent reviewers. Of 4820 results, 3782 remained after de-duplication. Forty full-texts were screened and two studies were included in the final review. The first assessed the impact of a 10-year intensive lifestyle intervention on T2DM-related complications (Look-AHEAD study) and the second was a post hoc analysis of T2DM patients from a trial of a physical activity intervention in older non-demented adult with functional limitations (LIFE study). Whilst the Look-AHEAD study found no impact on diagnosis of mild cognitive impairment or dementia, the LIFE study demonstrated beneficial effects on global cognitive function and delayed memory specifically in older adults with T2DM. There is insufficient evidence to fully assess the effect of non-pharmacological interventions on cognition in T2DM. Well-constructed trials must be designed to specifically assess the effect of non-pharmacological and multi-domain interventions for cognition in patients with T2DM in midlife. All trials examining interventions in T2DM should consider cognition as at least a secondary outcome.

Background and Aims: Men with diabetes have a 2-fold higher risk of cardiovascular disease (CVD), while women with diabetes have a 3-fold higher risk. HDL-C levels are often unchanged/raised in T1DM and reduced in T2DM. HDL cholesterol efflux capacity (CEC) is a stronger predictor of CVD than HDL-C. Within this study we investigated the impact of diabetes on HDL-CEC in males and females, and age/BMI-matched control groups.