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Articles by N. Sattar
Total Records ( 8 ) for N. Sattar
  T. Yates , M. J. Davies , T. Gorely , D. Talbot , F. Bull , N. Sattar and K. Khunti
  Aims To investigate whether an exercise intervention programme, with or without pedometer use, is effective at reducing chronic low-grade inflammation in those with impaired glucose tolerance. Methods Using baseline and 12 month data from the Pre-diabetes Risk Education and Physical Activity Recommendation and Encouragement (PREPARE) programme randomized controlled trial, we investigated whether the pedometer or the standard version of the PREPARE programme is associated with reduced chronic low-grade inflammation. Outcomes included interleukin-6, C-reactive protein, fasting and 2 h post-challenge glucose values and objectively measured ambulatory activity. Results Sevety-four participants (31% female; mean age, 65 years; body mass index, 29.3 ± 4.8 kg/m2) were included, of which 26 were in the control group and 24 were in each intervention group. At 12 months there was an increase in ambulatory activity of 1351 and 1849 steps/day in the standard and pedometer group, respectively, compared with control conditions; however, there was no significant change in markers of chronic low-grade inflammation. Across the pooled study sample, change in ambulatory activity was significantly correlated with change in interleukin-6 (r = –0.32, P = 0.01) after adjustment for group, age, sex, ethnicity, aspirin and statin medication, baseline body mass index and change in body mass index. Change in interleukin-6 was also significantly correlated with change in 2 h glucose after adjustment for the same variables (r = 0.26, P = 0.03). Conclusions This study failed to show reductions in markers of chronic low-grade inflammation following an intervention that promoted modest increases in ambulatory activity; however, across the study sample, increased ambulatory activity was associated with reduced interleukin-6, independent of obesity.
  S. G. Wannamethee , O. Papacosta , P. H. Whincup , M. C. Thomas , C. Carson , D. A. Lawlor , S. Ebrahim and N. Sattar
  Aim: To develop strategies based on simple clinical assessment and blood markers to identify older individuals at high risk for Type 2 diabetes. Methods: A prospective study of non-diabetic men (n = 3523) and women (n = 3404) aged 60–79 years followed for 7 years, during which there were 297 incident cases of Type 2 diabetes. Logistic regression was used to develop scores to predict incident cases, starting with clinical predictors and adding blood markers that predicted the incidence of diabetes. Receiving operating characteristic analyses were used to assess improvement in prediction. Results: The area under the curve for a simple clinical assessment score, which included age, sex, family history of diabetes, smoking status, BMI, waist circumference, hypertension and recall of doctor diagnosis of coronary heart disease was 0.765 (0.740, 0.791); sensitivity and specificity in the top quintile of the score were 50.3 and 81.4%, respectively. Addition of simple fasting blood markers HDL cholesterol, triglyceride and glucose improved prediction [area under the curve = 0.817 (0.793, 0.840), P < 0.0001; sensitivity 63.8%; specificity 82.0%]. An alternative model adding blood markers not dependent on fasting yielded similar results. Further addition of C-reactive protein made no improvement. Blood measurements made small differences to reclassification of risk in those in the lowest three quintiles of the non-laboratory score. Conclusion: In large population settings, simple clinical assessments could be used in the first instance to identify older adults who would benefit from further testing with routine (non-fasting) blood markers to identify those at most likely to be at elevated diabetes risk.
  N. Sattar
  An ideal biomarker should refine identification of those at risk of disease occurrence or progression, improve prediction of complications of disease, and/or guide and help tailor responses to different therapies. Biomarkers that give insights into disease pathogenesis are also of interest. With this in mind, this review describes biomarker studies relevant to diabetes, focusing on those conducted by the author, his colleagues and collaborators. The review highlights several points. (1) Novel biomarkers may not improve prediction of new-onset diabetes in a meaningful way beyond what can be achieved with simple measures combined with HbA1c, and a sensible way ahead may be to combine diabetes and cardiovascular disease prediction using HbA1c and such measures. (2) In terms of disease pathogenesis, associations do not necessarily infer causality; potential for residual confounding and reverse causality should always be borne in mind. The potential relevance of such issues to understanding the relationship of some topical variables/pathways, namely adiponectin, inflammation and vitamin D, with diabetes will be highlighted. (3) How baseline and serial data on biomarkers arising from the liver have improved our understanding of the role of hepatic fat in diabetes pathogenesis will be explored. (4) Future goals for diabetes biomarker research should focus on predicting complications and determining subgroups who may respond better to particular therapies. (5) All novel biomarker research (regardless of analytical platforms used) needs to be tested against information available from commonly measured variables in clinical practice. Otherwise, many claims of clinical utility can be exaggerated. In summary, biomarker research in diabetes is continuing apace in a number of areas, but it remains to be seen whether the promise of biomarker research to improve the care of our patients becomes a reality.
  S. M. Nelson , D. J. Freeman , N. Sattar and R. S. Lindsay
  Aim  Maternal diabetes is associated with polycythaemia and thrombocytopaenia in the offspring; however, the relationship with fetal hormones is unknown. We assessed the association of maternal glycaemic control, birthweight and fetal hormones with haematological indices in pregnancies complicated by maternal diabetes.

Methods  Prospective study using cord blood samples from 89 offspring of mothers with Type 1 diabetes (OT1DM) and 34 control offspring. Full blood count, insulin, leptin, adiponectin, cortisol, insulin-like growth factor 1 (IGF-1), insulin-like growth factor binding protein 3, intercellular adhesion molecule 1 and C-reactive protein were measured in the umbilical vein at birth.

Results  Haematocrit was higher in OT1DM (OT1DM 0.55 ± 0.17%, control offspring 0.51 ± 0.06%; P = 0.02). The difference in platelets count was not statistically significant [OT1DM 214 x 109/l (173-259); control offspring 253 x 109/l (180-310), P = 0.06]. Maternal glycated haemoglobin (HbA1c) showed a moderate positive correlation with fetal haematocrit (r = 0.30, P = 0.02). Cord platelet counts were negatively associated with birthweight in OT1DM (r = −0.27, P = 0.01). In multivariate models, cord insulin was not associated with haematocrit, but cord leptin was negatively associated with platelets in control offspring (P < 0.001) and OT1DM (P = 0.046), with additional contributions from male sex (P = 0.08) in OT1DM, and IGF-1 (P = 0.04) and insulin (P = 0.04) in control offspring.

Conclusions  Fetal haematocrit is increased in response to diabetes in pregnancy and is related to maternal glycaemic control. Fetal hyperinsulinism, hyperleptinaemia or macrosomia, although readily demonstrable in this cohort, do not emerge as determinants of raised fetal haematocrit in OT1DM. Both increased birthweight and fetal leptin are negatively associated with platelet count.

  N. Ghouri , R. Gatrad , N. Sattar , S. Dhami and A. Sheikh
  Not available
  C. Saunders , C. D. Byrne , B. Guthrie , R. S. Lindsay , J. A. McKnight , S. Philip , N. Sattar , J. J. Walker and S. H. Wild
 

Aims

To describe the proportion of people with Type 2 diabetes living in Scotland who meet eligibility criteria for inclusion in several large randomized controlled trials of glycaemic control to inform physicians and guideline developers about the generalizibility of trial results.

Methods

A literature review was performed to identify large trials assessing the impact of glycaemic control on risk of macrovascular disease. Inclusion and exclusion criteria from each trial were applied to data on the population of people with a diagnosis of Type 2 diabetes living in Scotland in 2008 (n = 180 590) in a population-based cross-sectional study and the number and proportion of people eligible for each trial was determined.

Results

Seven trials were identified. The proportion of people with Type 2 diabetes who met the eligibility criteria for the trials ranged from 3.5 to 50.7%. Trial participants were younger at age of diagnosis of diabetes and at time of trial recruitment than in the Scottish study population. The application of upper age criteria excluded the largest proportion of patients, with up to 39% of people with Type 2 diabetes ineligible for a trial with the most stringent criteria based on age alone.

Conclusions

We found that many of the large trials of glycaemic control among people with Type 2 diabetes have limited external validity when applied to a population-based cohort of people with Type 2 diabetes. In particular, the age distribution of trial participants often does not reflect that of people with Type 2 diabetes in a contemporary British population.

  N. R. V. Jones , C. M. Fischbacher , B. Guthrie , G. Leese , R. S. Lindsay , J. A. McKnight , D. Pearson , S. Philip , N. Sattar and S. H. Wild
 

Aim

To describe characteristics associated with statin prescribing for the primary prevention of cardiovascular disease in people with newly diagnosed diabetes.

Methods

Data from the Scottish Care Information-Diabetes Collaboration data set for 2006-2008 were used. This data set contains socio-demographic and prescribing data for over 99% of people with diagnosed diabetes in Scotland. Analyses were conducted on people aged over 40 years diagnosed with Type 1 or Type 2 diabetes between 2006 and 2008 with complete data and no previous history of cardiovascular or statin prescription. Logistic regression was used to calculate odds ratios for statin prescription in the 2 years following diagnosis of diabetes.

Results

There were 7157 men and 5601 women who met the inclusion criteria, 68% of whom had a statin prescription recorded in the 2 years following diagnosis of diabetes. The proportions receiving statins were lower above 65 years of age in men and 75 years of age in women. People with Type 1 diabetes had lower odds of receiving statins than people with Type 2 diabetes [odds ratio (95% CI) 0.42 (0.29-0.61) for men and 0.48 (0.28-0.81) for women, after adjustment for age, BMI, smoking status, cholesterol level and deprivation]. Higher total cholesterol, BMI and being a current smoker were associated with greater odds of statin prescription.

Conclusion

Approximately one third of the study population had no record of statin prescription during the 2 years after diagnosis of diabetes. Cardiovascular disease risk reduction opportunities may be missed in some of these people.

  R. A. Maitland , P. T. Seed , A. L. Briley , M. Homsy , S. Thomas , D. Pasupathy , S. C. Robson , S. M. Nelson , N. Sattar and L. Poston
 

Aim

To examine the prediction of gestational diabetes in obese women using routine clinical measures and measurement of biomarkers related to insulin resistance in the early second trimester.

Methods

A total of 117 obese pregnant women participating in a pilot trial of a complex intervention of dietary advice and physical activity were studied. Blood samples were obtained at recruitment (15+0-17+6 weeks' gestation) and demographic, clinical history and anthropometric measures recorded. The biomarkers analysed were plasma lipids (HDL cholesterol, LDL cholesterol, triglycerides), high-sensitivity C-reactive protein, alanine transaminase, aspartate transaminase, ferritin, fructosamine, insulin, adiponectin, tissue plasminogen activator, interleukin-6, visfatin and leptin. Univariate and logistic regression analyses were performed to determine independent predictors and area under the receiver-operating curve was calculated for the model.

Results

Of the 106 participants included in the analysis, 29 (27.4%) developed gestational diabetes. Participants with gestational diabetes were older (= 0.002), more often of parity ≥ 2, had higher systolic (= 0.02) and diastolic blood pressure (= 0.02) and were more likely to be black (= 0.009). Amongst the blood biomarkers measured, plasma adiponectin alone remained independently associated with gestational diabetes in adjusted models (= 0.002). The area under the receiver-operating curve for clinical factors alone (0.760) increased significantly (area under the curve 0.834, chi-square statistic (1) = 4.00, = 0.046) with the addition of adiponectin.

Conclusions

A combination of routinely measured clinical factors and adiponectin measured in the early second trimester in obese women may provide a useful approach to the prediction of gestational diabetes. Validation in a large prospective study is required to determine the usefulness of this algorithm in clinical practice. (Clinical Trial Registry No: ISRCTN89971375)

 
 
 
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