Pam Brown

GP in Swansea

Citation: Brown P (2024) Diabetes Distilled: Diabetes remission in the real world. Diabetes & Primary Care 26: 145–7

      Diabetes remission is achievable at scale in the real world, according to early results from the NHS Type 2 Diabetes Path to Remission programme published in Lancet Diabetes & Endocrinology. Of 7540 people referred to the programme between September 2020 and December 2022, a total of 1740 started the total diet replacement section of the programme before January 2022, and 960 (55%) completed the programme. Mean weight loss for the 1710 who started the programme and had follow-up data available was 9.4 kg (8.3%), with a mean weight loss of 10.3 kg (9.3%) among the 945 who completed the programme. Amongst the 945 who completed the programme and had two HbA1c measurements, 32% achieved remission, with mean weight loss of 15.9 kg (14.4%), while overall 27% of those who started the programme achieved remission regardless of whether they completed. Remission rates are lower than in trials such as DiRECT and DIADEM-I, despite similar levels of weight loss. The authors highlight that an additional 17% of participants met the HbA1c targets for remission but continued on metformin and may otherwise have achieved remission. These early results confirm that type 2 diabetes remission is indeed possible at scale in the real world, outside of clinical trials.

  Pam Brown GP in Swansea

Citation: Brown P (2024) Diabetes Distilled: Impact of metformin timing on glucose and GLP-1 response. Diabetes & Primary Care 26: 143–4

  Glucose-lowering effects in response to normal-release metformin are greater when the drug is given 30 or 60 minutes before, rather than with, food, according to this small study in people with well-controlled type 2 diabetes published in Diabetologia. Endogenous GLP-1 secretion increased when metformin 1000 mg was given 30 or 60 minutes prior to a glucose infusion, whereas there was no increase when the metformin was administered at the same time as the glucose. The results suggest that, if tolerated, administering standard release metformin before meals may lead to improved postprandial glycaemic control.

Jane Diggle Specialist Diabetes Nurse Practitioner, West Yorkshire

Citation: Diggle J (2024) The importance of getting the correct diabetes diagnosis. Diabetes & Primary Care 26: 111–2

Bulent M Ertugrul, Saime Irkoren, Ender Ceylan and Oner Savk

Split thickness skin grafting (STSG) is a simple surgical technique in wound reconstruction, but various factors including inadequate wound bed preparation may cause partial or total graft loss. Ensuring infection-free healthy granulation tissue is essential before operation. Epidermal growth factor (EGF) has a critical role in angiogenesis and formation of healthy granulation tissue. This study retrospectively investigated the value of intralesional EGF in patients with a chronic foot ulcer due to diabetes who underwent reconstruction with an autologous skin graft. Patients treated with intralesional EGF had a higher rate of graft survival, significantly fewer postoperative complications and reduced hospitalisation times. These results suggest we should undertake a need prospective study of this issue with a larger case series.

Citation: Ertugrul BM, Irkoren S, Ceylan E, Savk O (2024) Split thickness skin graft and intralesional epidermal growth factor for patients with diabetic foot wounds. The Diabetic Foot Journal 27(1): 34–9

Key words

- Diabetic foot

- Epidermal growth factor

- Skin graft

- Wound treatment

Article points

1. Healthy granulation tissue is essential to the success of split-thickness skin grafting

2. Epidermal growth factor (EGF) has a critical role in the angiogenesis and formation of healthy granulation tissue

3. Patients with diabetic foot ulcers treated with EGF had a higher rate of graft survival.

Authors

     Bulent M Ertugrul MD is Professor of Infectious Diseases and Clinical Microbiology, University of Adnan Menderes School of Medicine, Aydin, Turkey; Saime Irkoren MD is Associate Professor of Plastic, Reconstructive and Esthetic Surgery, University of Adnan Menderes School of Medicine, Aydin, Turkey; Ender Ceylan MD is Assistant Professor of Plastic, Reconstructive and Esthetic Surgery, University of Adnan Menderes School of Medicine, Aydin, Turkey; Oner Savk MD is Professor of Orthopedics and Traumatology, University of Adnan Menderes School of Medicine, Aydin, Turkey