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Articles by A. H. Barnett
Total Records ( 4 ) for A. H. Barnett
  C. Daousi , S. C. Bain , A. H. Barnett and G. V. Gill

Aims  To explore the association between dyslipidaemia and albuminuria at the extreme of diabetes duration.

Methods Data and samples were collected from 400 patients with extreme duration (> 50 years) of Type 1 diabetes in the UK (Golden Years Cohort). Urinary albumin–creatinine ratio (ACR), glycated haemoglobin (HbA1c), creatinine, non-fasting triglycerides, total cholesterol, high-density lipoprotein- and low-density lipoprotein-cholesterol were analysed in all patients.

Results Thirty-six percent of patients had albuminuria (micro- or macroalbuminuria). After adjusting for age, gender, HbA1c, disease duration and presence of macrovascular disease, hypertriglyceridaemia was more likely to be associated with the presence of albuminuria.

Conclusions High triglycerides may be a potential risk factor for progression of diabetic nephropathy at the extreme of diabetes duration, but the benefit of targeting this aggressively remains to be evaluated further.

  S. D. Rees , M. Islam , M. Z. I. Hydrie , B. Chaudhary , S. Bellary , S. Hashmi , J. P. O`Hare , S. Kumar , D. K. Sanghera , N. Chaturvedi , A. H. Barnett , A. S. Shera , M. N. Weedon , A. Basit , T. M. Frayling , M. A. Kelly and T. H. Jafar
  Aims  A common variant, rs9939609, in the FTO (fat mass and obesity) gene is associated with adiposity in Europeans, explaining its relationship with diabetes. However, data are inconsistent in South Asians. Our aim was to investigate the association of the FTO rs9939609 variant with obesity, obesity-related traits and Type 2 diabetes in South Asian individuals, and to use meta-analyses to attempt to clarify to what extent BMI influences the association of FTO variants with diabetes in South Asians.

Methods  We analysed rs9939609 in two studies of Pakistani individuals: 1666 adults aged ≥ 40 years from the Karachi population-based Control of Blood Pressure and Risk Attenuation (COBRA) study and 2745 individuals of Punjabi ancestry who were part of a Type 2 diabetes case-control study (UK Asian Diabetes Study/Diabetes Genetics in Pakistan; UKADS/DGP). The main outcomes were BMI, waist circumference and diabetes. Regression analyses were performed to determine associations between FTO alleles and outcomes. Summary estimates were combined in a meta-analysis of 8091 South Asian individuals (3919 patients with Type 2 diabetes and 4172 control subjects), including those from two previous studies.

Results  In the 4411 Pakistani individuals from this study, the age-, sex- and diabetes-adjusted association of FTO variant rs9939609 with BMI was 0.45 (95% CI 0.24-0.67) kg/m2 per A-allele (= 3.0 x 10−5) and with waist circumference was 0.88 (95% CI 0.36-1.41) cm per A-allele (= 0.001). The A-allele (30% frequency) was also significantly associated with Type 2 diabetes [per A-allele odds ratio (95% CI) 1.18 (1.07-1.30); = 0.0009]. A meta-analysis of four South Asian studies with 8091 subjects showed that the FTO A-allele predisposes to Type 2 diabetes [1.22 (95% CI 1.14-1.31); = 1.07 x 10-8] even after adjusting for BMI [1.18 (95% CI 1.10-1.27); = 1.02 x 10-5] or waist circumference [1.18 (95% CI 1.10-1.27); = 3.97 x 10−5].

Conclusions  The strong association between FTO genotype and BMI and waist circumference in South Asians is similar to that observed in Europeans. In contrast, the strong association of FTO genotype with diabetes is only partly accounted for by BMI.

  A. H. Barnett
  This paper is dedicated to young researchers in diabetes. One such person was Frederick Banting who, with his colleagues, isolated insulin in 1921, saving the lives of literally millions of people. What factors allowed Banting and other scientists to produce work that has immensely benefited the human race? I propose that it is the combination of good scientific background (the ‘prepared mind’), commonly some serendipity taken with a good dose of common sense and supplemented by enthusiasm, tenacity and good mentoring, which drives the ‘power of observation’ and the ability to take forward the good idea. I give examples from history to support this and then discuss some of the ‘truths, perspectives and controversies’ within the diabetes arena when I first started in diabetes research in the late 1970s. I describe how my appetite was initially ‘whetted’ for research by moving to an excellent clinical research environment with encouragement to test ideas and controversies initially in a clinical research programme, followed by more scientific/basic research. The work that I performed as a young doctor and research fellow led to a lifelong professional interest in three major areas-causes and interventions for diabetes vascular disease, studies of the molecular genetics of Type 1 and Type 2 diabetes and work on diabetes in different ethnic groups. I provide a summation of my own and other people's work to demonstrate how research can be progressed and lead to patient benefit as well as providing an incredibly rewarding career. I believe that we need to encourage and put more resources into development of young doctors and scientists wishing to undertake research in our discipline. Areas ripe for much-needed clinical research programmes, for example, include work on best practice/provision of health care, application of the evidence base from clinical trials to achieve public health gains, attention to adherence issues and better-tolerated therapies. Most importantly, a greater emphasis on prevention through public health measures and ‘buy in’ from the whole population is urgently required.
  M. Peyrot , A. H. Barnett , L. F. Meneghini and P.-M. Schumm-Draeger
  Aims  To examine patient and physician beliefs regarding insulin therapy and the degree to which patients adhere to their insulin regimens.

Methods  Internet survey of 1250 physicians (600 specialists, 650 primary care physicians) who treat patients with diabetes and telephone survey of 1530 insulin-treated patients (180 with Type 1 diabetes, 1350 with Type 2 diabetes) in China, France, Japan, Germany, Spain, Turkey, the UK or the USA.

Results  One third (33.2%) of patients reported insulin omission/non-adherence at least 1 day in the last month, with an average of 3.3 days. Three quarters (72.5%) of physicians report that their typical patient does not take their insulin as prescribed, with a mean of 4.3 days per month of basal insulin omission/non-adherence and 5.7 days per month of prandial insulin omission/non-adherence. Patients and providers indicated the same five most common reasons for insulin omission/non-adherence: too busy; travelling; skipped meals; stress/emotional problems; public embarrassment. Physicians reported low patient success at initiating insulin in a timely fashion and adjusting insulin doses. Most physicians report that many insulin-treated patients do not have adequate glucose control (87.6%) and that they would treat more aggressively if not for concern about hypoglycaemia (75.5%). Although a majority of patients (and physicians) regard insulin treatment as restrictive, more patients see insulin treatment as having positive than negative impacts on their lives.

Conclusions  Glucose control is inadequate among insulin-treated patients, in part attributable to insulin omission/non-adherence and lack of dose adjustment. There is a need for insulin regimens that are less restrictive and burdensome with lower risk of hypoglycaemia.

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