Staff Publication

Treatment-Induced Neuropathy in Diabetes Post Use of Hybrid Closed Loop Continuous Subcutaneous Insulin Infusion in Type 1 Diabetes (2025)

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Type of publication:

Conference abstract

Author(s):

*Basavaraju N.; *Beard N.; *Jones A.; *Moulik P.;

Citation:

Diabetes Technology and Therapeutics. Conference: 18th International Conference on Advanced Technologies and Treatments for Diabetes, ATTD 2025. Amsterdam Netherlands. 27(Supplement 2) (pp e264-e265), 2025. Date of Publication: 01 Feb 2025.

Abstract:

Background and Aims: Treatment-induced neuropathy in diabetes(TIND) is a transient, painful peripheral neuropathy occasionally with autonomic component, occurring with rapid glycaemic improvement. Hybrid closed loop(HCL) continuous subcutaneous insulin infusion(CSII) in type 1 diabetes(T1D) can improve glucose levels rapidly. Method(s): Retrospective review of two cases. Case 1: 27- year-old male, T1D for 16years, disengagement, maculopathy switched from basal-bolus insulin to HCL-CSII(Omnipod5- DexcomG6). Case 2: 44-year-old female, T1D for 42years, disengagement laser treated retinopathy, neuropathy, toe amputation switched from basal-bolus insulin to HCL-CSII(Omnipod5- DexcomG6). Result(s): Case 1: Pre-HCL HbA1c107mmol/mol. 3months post HCL HbA1c 69mmol/mol. He reported neuropathic pain in lower limbs, commenced amitriptyline for 3months with resolution. He also developed proliferative retinopathy. Case 2: Pre- HCL HbA1c96mmol/mol improved to 54mmol/mol in 6months. She developed severe neuralgic pain in both feet, improved with Pregabalin for 3months. There was no deterioration in retinopathy. Conclusion(s): TIND is more common in T1D, pathophysiology may be endoneurial ischaemia and microvascular changes due to relative hypoglycaemic state. Diagnostic criteria include (i)decrease in HbA1c by 2%(22mmol/mol) over 3months (ii)neuropathic pain and/or autonomic symptoms within 8weeks after decrease in HbA1c (iii)acute onset of neuropathic pain and/ or autonomic dysfunction for more than 2weeks requiring medical attention. It is self-limiting, lasting from weeks to months. Symptomatic treatment include antiepileptics(pregabalin) and tricyclic antidepressants are effective. There are no reported cases of TIND with HCL-CSII in literature. Our two cases highlight TIND, like worsening retinopathy, is a potential complication of rapid improvement in glycaemic control with HCL-CSII in patients with pre-existing hyperglycaemia and patients' needs counselling about the potential short-term risks.

DOI: 10.1089/dia.2024.78502.abstracts

Is There a Correlation Between Hybrid Closed Loop(HCL) Continuous Subcutaneous Insulin Infusion(CSII) Glycaemic Improvement in Type 1 Diabetes(T1D) and Worsening Sensorineural Hearing Loss? - A Case Report (2025)

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Type of publication:

Conference abstract

Author(s):

*Basavaraju N.; *Jones A.; *Wilkes V.; *Moulik P.

Citation:

Diabetes Technology and Therapeutics. Conference: 18th International Conference on Advanced Technologies and Treatments for Diabetes, ATTD 2025. Amsterdam Netherlands. 27(Supplement 2) (pp e265), 2025. Date of Publication: 01 Feb 2025.

Abstract:

Background and Aims: T1D is associated with various comorbidities including sensorineural hearing loss (SNHL). HCL CSII treatment in T1D improves glucose levels rapidly. This may cause short-term worsening of retinopathy and neuropathy (treatment-induced neuropathy in diabetes). We present a case of T1D on HCL CSII with worsening hearing loss. Method(s): A 46-year-old gentleman with T1D for 30 years with pre- proliferative retinopathy had mild right sided tinnitus and sensorineural hearing loss (on pure tone audiometry) diagnosed 8 years ago. MRI internal auditory meatus was normal. He was commenced on HCL CSII (Omnipod 5 with Dexcom G6). Result(s): Pre-HCL HbA1c was 75mmol/mol. Glucose management indicator (GMI) after 4weeks rapidly dropped to 53mmol/mol which further reduced to 48mmol/mol in 6months. He reported worsening of right sided tinnitus and hearing loss with development of new left sided tinnitus. He also developed maculopathy. Conclusion(s): Approximately 9.2/1000 people with T1D develop debilitating SNHL every year. In people aged 40-60- years with T1D, hearing threshold in high frequencies(4,000- 8,000Hz) was significantly higher (25-30dB) when compared to age-matched controls (5-10dB). The mechanisms are damage to outer and inner hair cells, loss of spiral ganglion neurons through apoptosis, thickening of basement membrane, and pathologies involving stria vascularis and spiral ligament of the cochlear lateral wall. Whilst causality cannot be inferred from this case, the temporal sequence of rapidly improved glycaemic control with worsening tinnitus and hearing loss raises a possibility of its association. This requires further study preferably with pure tone audiometry, in a randomised clinical trial setting.

DOI: 10.1089/dia.2024.78502.abstracts

Acute coronary syndrome rule-out strategies in the emergency department: an observational evaluation of clinical effectiveness and current UK practice (2025)

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Type of publication:

Journal article

Author(s):

Ingram A.; Boldovjakova D.; Wilson H.; Noble J.; Prentice J.E.B.; Brasnic L.; Papala P.; Waite R.; Hatem S.M.K.; Hamad H.H.M.A.; Lilani M.J.; Hardwick S.; Pritchard W.; Cairns D.; Lamuren E.; Thomas J.; Eve M.; Gabiana P.; Matias S.; Harris S.; Christmas E.; Brockbank J.; Mackinnon L.; Chrysikopoulou M.; Vo O.K.; George R.J.; Alsaarti R.; Mohrsen S.; Macleod C.; Grossi I.; Feetham J.; Almousa O.; Lyle A.; Victoria A.; Fox C.; Mitchell C.; Kara C.; Catley C.; Shea D.; Cranmer K.; Sach L.; Willsher L.; Vitaglione M.; Forsey M.; Fox N.; Arnold R.; Reid S.; Cotterell S.; Smolen S.; Lester Y.; Dean A.; Fitchett J.; Hoyle R.; Duberley S.; Goddard W.; Lunney C.; Ogbeide C.; Mcsorland D.; Gibson M.; Riley M.R.; Bradley P.; Thomas Z.; Giles E.; Patel H.; Pathirana J.; Chappel P.; Balasingam S.; Webb S.; Elshobaky E.; Challen K.; Ibrahim M.; Connor S.; Aprjanto A.; Ghosh A.; Amer E.; Sinclair J.; Smith T.; Freitas T.D.; Smith J.; Peachey J.; Clymer J.; Squire R.; Lee A.R.; Szekeres C.; Jessup-Dunton E.; Irvine G.; Brookman I.; Grant I.; Abbas K.; Wanigabadu L.; Futcher M.; Awadalkarim M.; Parker M.; Thammaiah Y.; Blows G.R.; Evans L.; Rebolledo M.; Macfarlane R.; Felix R.B.; Baker E.; Clarke J.; Dinglasan M.; Aldridge P.; Marshall S.; Helyar S.; Kunnath T.; Baldwin G.; Lowdell J.; Vallotton N.; Dasilva R.; Sharaf T.; Awe A.; Kerr-Winter B.; Anomelechi E.; Emond F.; Sennitt H.; Khan I.; Aderounmu I.; Bath J.; Woods J.; Dudden K.; Rupchandani K.; Mccafferty L.; Aaron L.; Al-Mousa M.; Okere N.; Scott O.; Edwards R.; Copson S.; Burke S.A.; Nawaz S.; Muhammad Y.; Noor A.; Tizon A.; Passalacqua C.; Qureshi E.F.; Malik F.I.; Jaafaru H.I.; Raees H.; Khaliq M.A.; Layawen N.; Shah R.; Torres S.L.G.; Guglani S.; Ramraj S.; Sharma S.; Hassan T.M.; Betos V.; Drexel A.; Sakutombo D.; Mendes F.; Furreed H.; Morris M.G.; James M.; Fong T.; Hartin D.; Lloyd G.; Sundarraj S.T.; Rivers V.; Kelly C.; Sutherland H.; Boast M.; Kisakye E.; Britton H.; Sebastian J.; Puscas M.R.; George S.; Olawale-Fasua W.; Wood D.; Kaur J.; King S.; Heeley C.; Davy G.; Wilson G.; Bennett K.; Allsop L.; Gill M.; Thorpe N.; Turner S.; Whitworth V.; Prendergast A.D.; Jones A.; Sheppard C.; Jones K.A.; Mcgregor K.; Sekar P.; Aeman S.; O'donnell S.P.; Griffin S.; Sheikh A.; Chintamani A.; Shrestha B.; Bisht D.; Saliu E.J.; Fadhlillah F.; Mahmoud M.Y.; Wasil M.; Ragupathy R.; Moghal Z.S.; John A.; Lockett C.; Tomkinson J.; Rose K.; Aziz M.; Keenan N.; Sandhu B.; Bentley C.; Phiri E.; Adams L.; Page M.; Seaman R.; Asnani S.; Taylor C.; Butt M.; Doherty W.J.; Da'costa A.; Adedeji A.D.; Ibeh C.O.; Oduware E.O.; Dolan H.; Ofori L.; Brassington L.; Olusoga O.; Nkala P.; Gurung S.; Williams S.; Ndlovu T.; Akhuemokhan Z.B.; Gulati D.; Akande M.; Oshiotse S.; Chilcott G.; Battishill W.; Wood J.M.; Hendry R.; Pottelbergh T.M.V.; T-Michael H.; Rothwell J.; Connolly K.; Cooper L.; Quli A.; Corr H.; Orourke L.; Pettet A.; Kariyadil B.; Pile J.; Gallamoza K.; Foo M.; O'connell P.; Kirkup A.; Hall J.; Hudson L.; Waddell G.; Mckie H.; Beck J.; Harrison M.; Ternent M.; Crispin P.; Aladesanmi A.; Ahmed A.; Thomson D.; Moth G.; Haslam J.; Killeen J.; Philbin J.; Howard-Sandy L.; Warran S.; Munt S.; Humphrey C.; Langridge E.; Otoole K.; Pule P.; Miln R.; Death Y.; Davies A.; Dunn E.; Brittain E.; Kohler G.; Stacey J.; Bloch M.; Murphy M.; Griffiths O.; Awbery H.; Oyindamola O.; Aor S.S.; Gribbin A.; Edwards C.; Vorwerk C.; Jackman D.; Brown G.; Daly Z.; Naiyeju A.A.; Arrayeh A.; Giubileo A.; Sarvesh B.; Jafferji D.; Thornton H.; Mckenzie I.; Okwori I.; Rudnicka J.; Nasr M.; Hassan M.; Aliu M.; Osunsanya O.; Abdulsalam S.; Mbaekwe S.; Shedwell S.; Wickramanayake U.; Abdullahi Y.; Mcclelland B.; Willshire K.; Knight A.; Beranova E.; Tutt G.; Ramos H.; Mcarthur C.; Khoo E.; Hughes E.; Austin K.; Doran K.; Gordon M.W.G.; Oshaughnessy O.; Worgan R.; Matthews A.; Baddeley A.; Morris A.; Ndungu A.; Peters C.; Walker L.; Tilbury N.; Lubbock S.; Mapatuna C.; Kehlenbeck E.; Curtis K.; Tonkins M.; King P.; Walker R.; Gabriel Z.; Titu H.; Coyle J.; Waddington N.; Chotai C.; Ward C.; Elliott L.; Henshall A.; Pogorodnaja A.; Knowles C.; Mascia G.; Rai S.G.; Bartley S.; Ko S.T.S.; Perera Y.; Conroy E.; Nicholson J.; Taylor J.; Flanagan R.; Wilce A.; Lindsay C.; Bascombe C.; Osey C.; Tiller H.; Rogers L.; Agius N.; Barratt N.; Pitts S.; Mohammed A.; Eihebholo A.; Olaifa A.; Bowyer C.; Sutcliffe E.; Bishop O.J.; Jenkins O.; Kyriakides O.; Thomas S.; Ali S.; Mason S.; Ripsher W.; Cousins E.; Dhande K.S.; Wright L.; Bolus A.; Sykes D.; Faronbi G.O.; Slade L.; Page R.; Maiti M.; Hekal M.; Khadka S.; Border T.; Wilson W.; Lowe A.; Evans C.; Moceivei C.; Mcavoy D.; Hay F.; Homyer K.; Dunne M.; Goldmann N.; Mitchell R.; Geoghegan A.; Entwistle J.; *Marsh A.; *Stephens A.; *O'connell G.; *Gibson H.; *Stickley J.; *Witt J.; *Beekes M.; *Sowailam M.; *Ali N.A.; Stan A.; Boalch A.; Demetriou C.; Flitney C.; Munday C.; Khoory C.; Carter D.; Gould E.; Evans G.; Elghonemy H.; Latham J.; Zamari K.; Ramos L.; Howie L.; Gunning S.; Haskins W.; Ayodeji Y.S.; Potts A.; Kay D.; Perez J.; Holden J.; Pendlebury J.; Cawley K.; Shahedy N.; Doonan R.; Blevings R.; Anthony A.; Trim F.; Hadebe B.; Pherson A.M.; Mphansi E.; Tysoe S.; Masunda B.; Galliford J.; Pestell S.; Patel S.; Pickard A.; Hoare B.; Cox C.; Hart D.; Amarnani D.; Fay E.; Khedarun F.M.; Collins F.; Sysum K.; Fung M.; Corbin N.; Patel N.; Moss P.; Marques R.; Johnson R.; Parmar S.; Sarker S.; Lawrence G.; Romero M.R.; Felix R.M.B.; Raju T.; Clarson S.; Clarke B.D.; Philp E.; Wren G.; Gallacher S.; Sharir A.; Andrews B.; Faint C.; Caines C.; Everett C.; Newman D.; Cruz G.D.L.; Hughes G.; Carey H.; Reavley H.; Ayre J.; Quan J.; Caines L.; Wedge-Bull M.; Alzaatreh M.; Chong N.; Anthony N.; Chandler S.; Walford S.; Sharir T.; White T.; Heslop-Harrison W.; Dunphy A.; Trenwith B.; Coelho B.; Hunter L.; Moran R.; Pemberton A.; Suggitt B.; Pimlott B.; Bates C.; Tibke C.; Pegler D.; Daniel D.; Lamond D.; Pureti G.; Baxter H.; Melville J.; Zai K.F.T.; Mullane K.; Phyu M.P.; Gabriels N.; Mills R.; Bennett S.; Blenkinsop S.; Vikramadhithyan S.; Barnes S.; Hopkins S.; Doherty-Walls T.; Coughlan T.; Kinder J.; Clark M.; Islam M.N.; Gray R.; Ford A.; Florey L.; O'neill M.; Aspa P.; Mercer P.; Ackerley A.; Ironside J.; Haynes L.; Garcia B.; Elkhodair S.; Enegela A.; Leech C.; Hassanali F.; Rashid H.; Lalji J.; Akpoghene M.; Enegela O.A.; Hafeez-Bore O.; Oluwaseun O.; Pelasur R.; Ayres R.; Tariq R.; Mchenry R.D.; Bains B.; Jones B.; Tarant E.; Mundy M.; Pearse R.; Sibtain S.; Day A.; Campbell B.; Stagg C.; Jones D.; Atwal I.; Tompkins K.; Parsons P.; Dancer R.; Balaican A.M.; Ellis C.; Ede C.H.; Joseph J.; Hardaker O.; Ridwan R.; Khan S.; Zhao X.; Wood L.; Tampsett R.; Rao S.; Castillo W.P.H.; Ticehurst F.; Rocha J.G.D.; Chivers K.; Vecchione N.; Kader N.; Wilson S.; Adhikari S.; Ramsundar S.; Felix F.; Johnston R.; Jin Y.; Ingall E.; Rand J.; Solly R.; Naeem S.; Stirrup S.; Priestley V.; Pun A.; Olosho O.Z.; Board S.;

Citation:

Emergency Medicine Journal. (no pagination), 2025. Article Number: 214616. Date of Publication: 2025. [epub ahead of print]

Abstract:

Background: Numerous strategies have been developed to rapidly rule-out acute coronary syndrome (ACS) using high-sensitivity troponin. We aimed to establish their performance in terms of emergency care length of stay (LOS) in real-world practice. Method(s): A multicentre observational cohort study in 94 UK sites between March and April 2023. Recruitment was preferably prospective, with retrospective recruitment also allowed. Adults presenting to the ED with chest pain triggering assessment for possible ACS were eligible. Primary outcome was emergency care LOS. Secondary outcomes were index rate of acute myocardial infarction (MI), time to be seen (TTBS), disposition and discharge diagnosis. Details of ACS rule-out strategies in use were collected from local guidelines. Mixed effects linear regression models tested the association between rule-out strategy and LOS. Result(s): 8563 eligible patients were recruited, representing 5.3% of all ED attendances. Median LOS for all patients was 333 min (IQR 225, 510.5), for admitted patients was 460 min (IQR 239.75, 776.25) and for discharged patients was 313 min (IQR 221, 451). Heterogeneity was seen in the rule-out strategies with regard to recommended troponin timing. There was no significant difference in LOS in discharged patients between rule-out strategies defined by single and serial troponin timing (p=0.23 and p=0.41). The index rate of acute MI was 15.2% (1301/8563). Median TTBS was 120 min (IQR 57, 212). 24.4% (2087/8563) of patients were partly managed in a same day emergency care unit and 70% (5934/8563) of patients were discharged from emergency care. Conclusion(s): Despite heterogeneity in the ACS rule-out strategies in use and widespread adoption of rapid rule-out approaches, this study saw little effect on LOS in real-world practice. Suspected cardiac chest pain still accounts for a significant proportion of UK ED attendances. ED system pressures are likely to be explanatory, but further research is needed to understand the reasons for the unrealised potential of these strategies.

DOI: 10.1136/emermed-2024-214616

Link to full-text [NHS OpenAthens account required]

Effects of Race, Ethnicity and Socioeconomic Deprivation on Postpartum Haemorrhage in High-Income Countries: A Systematic Review and Meta-Analysis (2025)

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Type of publication:

Systematic Review

Author(s):

*Elsmore, Amy; Alayande, Gbenga; Mainwaring, Elizabeth; Jafarpour, Mahfam; Rimmer, Michael P; Cockburn, Neil; *Curtis, Jason; *Ilaalagan, Ragave; Al-Wattar, Bassel; Bell, Sarah; *Karunakaran, Bala; *Parry-Smith, William; Wu, Pensee.

Citation:

BJOG: An International Journal of Obstetrics & Gynaecology.  2025 Jul 09.

Abstract:

BACKGROUND: Postpartum haemorrhage (PPH) is a leading cause of mortality and morbidity globally. While individual studies have revealed disparities in outcomes, a comprehensive summary of PPH risk across diverse groups is lacking.

OBJECTIVES: To quantify the association between ethnicity, deprivation and risk of PPH in high-income countries (HICs).

SEARCH STRATEGY: A systematic search of MEDLINE, CINAHL, EMBASE and Google Scholar from inception to 20 August 2024.

SELECTION CRITERIA: Observational and experimental studies from HICs that reported the outcome of PPH in at least two ethnic or socioeconomic groups.

DATA COLLECTION AND ANALYSIS: Two reviewers performed independent data extraction. A random-effects model was used to estimate the risk. A subgroup analysis was performed by geographical region and time period.

MAIN RESULTS: A total of 79 studies with 169 579 388 women were included, spanning 15 HICs. Ethnic minority women experienced a higher risk of PPH compared to the majority White or European group. This was seen across Black (OR 1.16, 95% CI 1.09, 1.23), Asian (OR 1.33, 95% CI 1.27, 1.39), Hispanic (OR 1.20, 95% CI 1.12, 1.29) and women from the minority ethnic group within a given study (OR 1.13, 95% CI 1.03,1.24). Due to data limitations, eight studies on PPH and socioeconomic status were summarised
narratively, indicating a higher PPH risk for those experiencing deprivation.

CONCLUSIONS: Women from an ethnic minority background or exposed to socioeconomic deprivation had an increased risk of PPH in HICs. Standardisation of data collection for ethnicity and socioeconomic status is recommended to accurately quantify and address these disparities.

DOI: 10.1111/1471-0528.18278

Link to full-text [open access - no password required]

Metformin for patients with metastatic prostate cancer starting androgen deprivation therapy: a randomised phase 3 trial of the STAMPEDE platform protocol (2025)

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Type of publication:

Randomised controlled trial

Author(s):

Gillessen, Silke; Murphy, Laura; James, Nicholas D; Sachdeva, Ashwin; El-Taji, Omar; Abdel-Aty, Hoda; Adler, Amanda I; Amos, Claire; Attard, Gerhardt; Varughese, Mohini; Gale, Joanna; Brown, Simon; *Srihari, Narayanan; Birtle, Alison J; Brown, Mick; Chan, Kitty; Chowdhury, Simon; Cross, William; Dearnaley, David P; Din, Omar; Dutey-Magni, Peter; Gilbert, Duncan C; Gilson, Clare; Gray, Struan; Grist, Emily; Hofmann, Uschi; Hudson, Andrew M; Jain, Yatin; Jeyasangar, Ganesan; Jones, Robert; Kayani, Mahaz; Langley, Ruth E; Malik, Zafar; Mason, Malcolm D; Matheson, David; McAlpine, Connor; Macnair, Archie; Millman, Robin; Murphy, Claire; Padden-Modi, Minal; Parikh, Omi; Parker, Chris; Rush, Hannah; Russell, Martin; Srinivasan, Rajaguru; Sundar, Santhanam; Tanguay, Jacob S; Turco, Fabio; Williams, Patrick; Sydes, Matthew R; Parmar, Mahesh K B; Brown, Louise C; Clarke, Noel W.

Citation:

Lancet Oncology. 2025 Jul 07.

Abstract:

BACKGROUND: Metformin is a widely used anti-diabetic drug. Several studies have suggested that metformin has anticancer activity in some malignancies, including prostate cancer. Metformin might also mitigate the adverse metabolic effects of androgen-deprivation therapy (ADT). We hypothesised that metformin might improve survival in patients with metastatic hormone-sensitive prostate cancer and reduce metabolic complications associated with ADT.

METHODS: The STAMPEDE multi-arm, multi-stage, randomised phase 3 trial recruited patients with high-risk locally advanced or metastatic adenocarcinoma of the prostate staged by conventional imaging with isotope bone and CT scanning. This publication reports findings for the most recent STAMPEDE research question, testing the addition of metformin to standard of care for non-diabetic (glycated haemoglobin [HbA1c] <48 mmol/mol [equivalent to <6.5%]) patients with metastatic disease with adequate renal function (glomerular filtration rate >=45 ml/min/1.73 m2) and WHO performance status 0-2. This trial recruited from 112 hospitals in the UK and Switzerland to the STAMPEDE protocol. Patients were randomly allocated (1:1) to standard of care or standard of care plus metformin 850 mg twice daily. Random assignment was by telephone using minimisation with a random element of 20% (developed and maintained by the MRC Clinical Trials Unit at UCL), stratified for randomising hospital, age (<70 years vs >=70 years), WHO performance status (0 vs 1 or 2), type of ADT, regular long-term use of aspirin or non-steroidal anti-inflammatory drugs (NSAIDs; yes vs no), pelvic nodal status (positive vs negative), planned radiotherapy (yes vs no), and planned docetaxel or androgen receptor pathway inhibitor (ARPI) use (docetaxel vs abiraterone, enzalutamide, or apalutamide vs none). Standard of care comprised ADT with or without radiotherapy and with or without docetaxel or ARPI. The primary outcome measure was overall survival, defined as the time to death from any cause, assessed in the intention-to-treat population. Safety was assessed in patients who started treatment. The trial is registered with ClinicalTrials.gov, NCT00268476 and ISRCTN, ISRCTN78818544.

FINDINGS: Between Sep 5, 2016, and Mar 31, 2023, 1874 patients with metastatic disease were randomly allocated to standard of care (n=938) or standard of care plus metformin (n=936). The median patient age was 69 years (IQR 63-73) and the median PSA was 84 ng/mL (24-352). 1758 (94%) of 1874 patients were newly diagnosed with metastatic disease and 116 (6%) were diagnosed with metachronous relapsing disease. 1543 (82%) of 1874 patients received ADT plus docetaxel and 52 (3%) received abiraterone, enzalutamide, or apalutamide. The median time to most recent case report form follow-up was 60 months (IQR 49-72). 473 deaths were reported in the standard of care group; median survival was 61.8 months (IQR 29.7 to not reached). There were 453 deaths in the metformin group; median survival was 67.4 months (32.5 to not reached; HR 0.91, 95% CI 0.80-1.03; p=0.15). Grade 3 or worse adverse events were reported in 487 (52%) of 938 patients in the standard of care group and 523 (57%) of 921 patients in the standard of care plus metformin group. 61 (7%) patients in the standard of care group and 84 (9%) patients in the standard of care plus metformin group reported at least one grade 3 or worse gastrointestinal adverse event; all other body systems showed no difference in grade 3 adverse events. There were six drug-related deaths in the standard of care group and one in the standard of care plus metformin group.

INTERPRETATION: We did not find significant evidence of an overall survival benefit of adding metformin to standard of care in the overall population of patients with metastatic hormone-sensitive prostate cancer. The side-effect profile of metformin was as expected and consisted mainly of diarrhoea. Adverse metabolic side-effects of ADT were significantly reduced in the metformin group compared with the standard of care group.

FUNDING: Cancer Research UK, Prostate Cancer UK, and UK Research and Innovation Medical Research Council.

DOI: 10.1016/S1470-2045(25)00231-1

Link to full-text [open access - no password required]

Artificial Intelligence and Digital Therapy for Adolescent Mental Health in the UK; Opportunities, Barriers, and Ethical Consideration (2025)

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Type of publication:

Journal article

Author(s):

Adindu K.N.; Akubue N.; Jude N.O.; Onakoya A.; Chukwunonye C.; Odion O.; *Okengwu C.G.; Uchechukwu N.; Osita-Obasi P.Z.; Ezike A.; Bello I.; Olenloa E.; Eruteya O.O.; Oyewole S.A.

Citation:

SSRN. (no pagination), 2025. Date of Publication: 20 May 2025. [preprint]

Abstract:

Background: Adolescence constitutes a critical developmental stage marked by the onset of mental health difficulties, yet timely access to effective mental health care remains a significant challenge for many adolescents in the United Kingdom (UK). Artificial intelligence (AI)-enabled digital therapies present innovative opportunities to address these gaps. Objective(s): This systematic review critically assesses current evidence on AI-driven digital interventions for adolescent mental health within the UK, highlighting their potential opportunities, barriers to implementation, and pertinent ethical considerations. Method(s): Employing a mixed-methods design, a systematic literature review adhering to PRISMA guidelines was combined with thematic analysis of semi-structured interviews. Comprehensive database searches (MEDLINE, PsycINFO, Web of Science; 2013-2023) targeted studies involving UK adolescents (ages 11-19) using AI-based mental health technologies. Included studies underwent rigorous quality appraisal (Cochrane RoB 2.0, ROBINS-I, CASP). Additional insights were gathered through stakeholder interviews (clinicians, AI developers, adolescent users). Result(s): Twenty-seven studies met inclusion criteria, investigating interventions such as AI chatbots, predictive analytics, mobile apps, and virtual environments targeting anxiety and depression. Key opportunities identified include enhanced accessibility for underserved populations, personalization through adaptive algorithms, proactive early-risk detection, scalability, cost-efficiency, and improved engagement via interactive interfaces. Significant implementation barriers encompassed technical infrastructure limitations, data security concerns, insufficient longitudinal efficacy data, socioeconomic disparities, and clinician scepticism. Ethical challenges emphasized informed consent, algorithm transparency, potential biases, unclear accountability, and clinician deskilling risks. Conclusion(s): AI-driven digital interventions offer substantial promise for augmenting adolescent mental health services in the UK. However, realizing their full potential necessitates addressing infrastructural, ethical, and evidentiary challenges through robust governance frameworks and continued rigorous research.

DOI: 10.2139/ssrn.5253224

Link to full-text [open access - no password required]

Mortality Related to Bariatric Surgery (MORSE Study): A Retrospective, International Collaborative Audit (2025)

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Type of publication:

Journal article

Author(s):

Balasubaramaniam V.; Wong G.Y.M.; Martinino A.; *Riera M.; Abouelazayem M.; Pereira J.P.S.; Said A.; Graham Y.; *Jain R.K.; Imseeh H.; Aljaiuossi O.; Jayyab M.A.A.; Alyacoubi S.N.A.; Mahawar K.; Singhal R.; Kalmoush A.-E.M.; Senjab A.; Nashidengo A.P.; Abu-Abeid A.; Adeyeye A.A.; Mohammed A.; Dogjani A.; Rodriguez A.; Nouh A.; Mahdi A.S.; Allawgalli A.N.; Chokshi A.; Alkaseek A.; Ads A.M.; Askari A.; Neimark A.; Boddy A.; Sanchez-Teran A.I.; Khamees A.; Souadka A.; Shariff A.H.; Diaz A.; Tidjane A.; Dash A.K.; Bhasker A.G.; Gunawardene A.R.; Bakri A.; Dulskas A.; Abouleid A.; Shabbir A.; Madhok B.; Wietzycoski C.R.; Toro-Huamanchumo C.J.; Parmar C.; Donohoe C.; Marques C.N.; Caruana C.; Kraljik D.; Lincango Naranjo E.P.; Lozada-Hernandez E.E.; Spartalis E.; Ruiz-Ucar E.; Goodman E.; Hazebroek E.J.; Pantaran F.C.; Frattini F.; Mulita F.; Clotilde F.-O.; Verras G.I.; Berardi G.; Alejandro G.-O.; Ballesteros G.P.D.L.; Kim G.; Perera H.M.R.; Elmaleh H.; Al-Naggar H.; Bakeer H.B.; Wadhawan H.; Roshan H.; Elghadban H.M.; Hamid H.K.S.; Hassan I.A.; Gerogiannis I.N.; Negoi I.; Wazir I.; Mbonicura J.C.; Wei J.; Valenzuela J.I.; Hong J.; Kosir J.A.; Voon K.; Sylvester K.R.; Lazaros L.; Noelia L.-B.E.; Antozzi L.; Ozmen M.M.; Waledziak M.; Musella M.; Uccelli M.; Zuluaga M.; Tokocin M.; Spartalis M.; ElFawal M.H.; Abu-Jeyyab M.; Aloulou M.; Kermansaravi M.; Kayyal M.Y.; Elhadi M.; Alabdallah N.B.; Martinez N.; Viswanath N.G.; Sakran N.; Liakopulos N.J.; Dalloul N.A.; Borges N.S.; Mouaqit O.; Petkov P.; Goel R.; Vilallonga R.; Masri R.J.; Taha S.A.; Erdene S.; Awad S.S.; Khan S.; Chowdhury S.; Olmi S.; Popat S.; Omarov T.; Sarodaya V.; Jain V.; Yang W.; Rajeev Y.; Viswanath Y.K.S.;

Citation:

Clinical Obesity. (no pagination), 2025. Date of Publication: 2025. [epub ahead of print]

Abstract:

Bariatric surgery is associated with low but definite early and late mortality. This study aims to further understand early (<= 90 days) and delayed (> 90 days) mortality related to bariatric surgery. This is a retrospective collaborative audit of patients who had undergone bariatric surgery and developed complications that ultimately led to death. Individuals who were 18 years or older and had undergone bariatric surgery (primary, revisional, and endoscopic procedures) and subsequently died within 90 days or after 90 days following the surgery between 1 January 2022, and 31 December 2022. A descriptive analysis was conducted. About 30 centres from 21 countries submitted data on 82 patients where patient death was deemed to be related to bariatric surgery. Mortality within 90 days post-surgery was observed in 58 individuals (70.7%), while 24 patients (29.3%) died after this period. Causes of mortality after SG include GI leak, PE, respiratory infection, and malnutrition. Causes of mortality after RYGB include GI leak, coronary heart disease, and bleeding. Reported common causes of early mortality in this study were gastrointestinal leaks, bleeding, coronary heart disease, and pulmonary embolism. Reported common causes of delayed mortality were gastrointestinal leaks and malnutrition. This study characterises patients where death was attributed to a bariatric procedure and identifies common causes of death in these patients. This could aid development of strategies for preventing and managing these complications in the future.

DOI: 10.1111/cob.70031

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Improving patients’ understanding about pleural effusion management options (2025)

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Type of publication:

Conference abstract

Author(s):

*Maimuna Adamu, *Greenway Tammy, *Jennifer Nixon

Citation:

Future Healthcare Journal. 2025 Volume 12, Issue 2, Supplement, June 2025. Abstracts from Medicine 2025: The future of medicine. RCP annual conference.

Abstract:

Introduction and objective
Various treatment options are available for managing recurrent pleural effusions, each with its merits. These include: (1) symptomatic control with medication; (2) ambulatory repeated pleural aspiration; (3) inpatient chest drain and talc pleurodesis; and (4) home-based indwelling pleural catheters. British Thoracic Society (BTS) guidelines recommend that, in the context of malignant pleural effusion (MPE), ‘decisions on the best treatment modality should be based on patient choice’.1 There are different factors to consider in choosing a treatment option, such as symptoms, availability of resources, need for hospitalisation and risk of requiring further pleural interventions. In our Trust, this information was given to patients in an unstructured verbal context, with variation between each practitioner. The objective of our project was to provide information on the different pleural effusion management options in a standardised written format as a tool to help patients reach an informed decision about their preferred option.

Methods
This quality improvement project was conducted in two cycles using the plan–do–study–act (PDSA) methodology. The patient population included were those attending our weekly outpatient pleural list within a 3-month period, who already had a diagnosis of MPE or if the clinical details (history, examination or imaging) were highly suggestive of MPE. The first cycle involved assessing our current practice against the BTS guidelines for pleural disease. A telephone-based questionnaire was administered, assessing how much patients understood and retained about the different methods of pleural effusion management after attending the pleural list. Our intervention involved designing and producing a pleural effusion management options patient information leaflet (Fig 1). The leaflet included information about pleural effusions and each of the management options listed above, with illustrative diagrams. We received input from our Trust’s health literacy team to ensure that the information was written in a way patients could understand. The leaflet was then given to clinically appropriate patients attending the pleural list. The same questionnaire was repeated after the leaflet had been in use for 4 months, and pre and post-intervention results were compared.

Results
Fig 2 summarises the findings. At baseline (n=21), only 48% of patients felt they had enough information to choose their preferred management option if their pleural effusion recurred. None knew about the option of symptomatic management with medication. After the intervention (n=20), there was a significant improvement in understanding of the pleural effusion management options, with 95% of patients now satisfied that they had enough information to choose their preferred management option.

Conclusion
This project demonstrates the benefits of providing structured, written information to patients with recurrent pleural effusion. This intervention enhanced patient understanding and helped patients to make informed choices about their treatment options, in alignment with the BTS guidelines

DOI: 10.1016/j.fhj.2025.100412

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Exploring the Association Between Myocardial Infarction and Cognitive Decline: A Narrative Review (2025)

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Type of publication:

Journal article

Author(s):

Issimdar, Iqrah A; Mudegowdar, Rohit; *Gupta, Anchal R; Patel, Keval B; Elshoura, Anas; Bhanushali, Vidhi Mahendra; Joseph, Joshua R; Meiyalagan Varalakshmi, Aishwarrya; Sahotra, Monika; Kashif, Mazin; Binny, Vivasvat; Pathan, Nahila A; Siddiqui, Humza F.

Citation:

Cureus. 17(5):e84957, 2025 May.

Abstract:

The association between cognitive impairment (CI) and myocardial infarction (MI) has been highlighted in recent years. Several studies have reported an increased incidence of cognitive decline (CD) following MI, emphasizing the need for early identification and intervention in such patients. Previous research findings have been inconsistent due to the presence of various unaccounted factors potentially contributing to CD and disparities in the methods utilized to assess cognition such as the Mini-Mental State Examination, Mini-Cog and self-evaluation questionnaires. This emphasizes the potential for a more standardized tool of assessment to investigate the onset of CD amongst MI patients in a reliable manner. This literature review delineates the correlation between MI and CI, exploring the pathogenesis, risk factors, management and preventive strategies. Cerebral hypoperfusion, underlying atherosclerosis and neuroinflammation are crucial in the development of CD after MI. Hence, it is important to consider the 'heart-brain axis' for targeted therapy of CD in MI patients. Old age is a common risk factor for CD and MI. However, the impact of variables including gender and comorbidities is underreported, which can potentially alter the relationship between cognitive outcomes and MI. The implementation of multidisciplinary-oriented cardiac rehabilitation programs and a universal screening tool to follow up on patients with established CI post-MI has shown favorable outcomes and has reduced the risk of adverse health consequences. Optimizing medical management and regular monitoring of serum brain natriuretic peptide (BNP) and hemoglobin levels are essential in preventing CD after MI. Psychological evaluation and counselling also help attenuate CD. Additionally, preventive strategies addressing modifiable risk factors and implementing anti-inflammatory diets have proven beneficial. Ongoing research is focused on the study of novel interventions targeting the neuroinflammatory process. Recently a new member of the C-reactive protein family, pentraxin 3, has been identified as a specific vascular inflammatory biomarker produced by cells in atherosclerotic lesions that can potentially aid in recognizing CD. It is imperative to establish uniform guidelines to recognize and manage CI among patients following MI to improve quality of life among the elderly population.

DOI: 10.7759/cureus.84957

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A systematic review and network meta-analysis of interventions to preserve insulin-secreting beta cell function in people newly diagnosed with type 1 diabetes: results from randomised controlled trials of immunomodulatory therapies (2025)

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Type of publication:

Systematic Review

Author(s):

Beese, Sophie E; Price, Malcolm J; Tomlinson, Claire; Sharma, Pawana; Harris, Isobel M; Adriano, Ada; Quinn, Lauren M; Gada, Ritu; *Horgan, Thomas J; Maggs, Fiona; Burrows, Martin; Nirantharakumar, Krishnarajah; Thomas, G Neil; Andrews, Robert C; Moore, David J; Narendran, Parth.

Citation:

BMC Medicine. 23(1):351, 2025 Jul 01.

Abstract:

BACKGROUND: Type 1 diabetes is characterised by the immune-mediated destruction of pancreatic beta cells. We aimed to determine the effectiveness of immunotherapies for preserving residual beta cell function in newly diagnosed (stage 3) type 1 diabetes.

METHODS: Searches were carried out in MEDLINE, Embase, Cochrane CENTRAL and trial registries until 31st Jul 2024. RCTs of immunotherapies to preserve beta cells in newly diagnosed type 1 diabetes were included. Data were extracted using a bespoke, piloted extraction sheet. Risk of bias was assessed using Cochrane Risk of Bias Tool 1. A random effects network meta-analysis was undertaken in R. The primary outcome was C-peptide. Interventions were analysed by class.

RESULTS: Sixty trials were included (4597 patients, 32 intervention classes). Forty-one trials of 42 interventions were eligible for network meta-analysis. Eleven interventions demonstrated statistically significantly higher levels of C-peptide than placebo at 12 months, mesenchymal stem cells (autologous and Wharton's jelly-derived cells), azathioprine, interferon-alpha (5000 IU), autologous dendritic cells, anti-TNF golimumab, low-dose ATG, 3 mg 1-course anti-CD3 teplizumab, baricitinib, cyclosporin and 9/11 mg 2-course anti-CD3 teplizumab but with substantial heterogeneity present (I2 = 66%). Azathioprine ranked highest (median ranking 3rd); however, rankings demonstrated relatively wide confidence intervals and thus uncertainty in exact rank order of near adjacent therapies. Risk of bias assessment identified poor reporting, particularly in older trials, but few studies demonstrated high risk overall.

CONCLUSIONS: Eleven of 42 interventions demonstrated statistically significantly higher C-peptide levels than placebo at 12 months in the network meta-analysis. These results have identified the 11 most promising therapies trialled and help to direct future head-to-head clinical trials to support approvals for interventions to treat those newly diagnosed with type 1 diabetes. However, data for some interventions originated from small studies (mesenchymal stem cell therapies, azathioprine, autologous dendritic cells) and findings should be considered as hypothesis generating and interpreted with caution due to evidence heterogeneity.

SYSTEMATIC REVIEW REGISTRATION: The protocol for the systematic review was registered on PROSPERO, the international database of prospectively registered systematic reviews (registration: CRD42018107904).

DOI: 10.1186/s12916-025-04201-z

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