The NHS Practitioner Health Programme - once only for doctors in London, now it’s being rolled out across the NHS to provide the largest, publicly funded, comprehensive physician health service, in the world. However, while helping the individual is essential, systemic change needs to be made to support doctors in our healthcare system. Clare...

UK general election has been called - polling day is on the 12th of December, and from now until then we’re going to be bringing you a weekly election-themed podcast. We want to help you make sense of the promises and pledges, claims and counter-claims, that are being made around healthcare and the NHS out on the campaign trail. This week we're...

The UK general election is happening this week, and you’ve probably made your mind up which MP you’re voting for already - and maybe the NHS has influenced that decision. This year has seen an increase in the number of doctors running for parliament, and in this podcast we find out what motivates doctors to step away from clinical practice, and...

The internecine takes on medical specialty are a common thread in the Christmas BMJ, and this year we're doing it through the lens of driving. Which speciality speeds the most, who has the nicest cars? André Zimerman, soon to be cardiologist, and researcher lets us know - and also why you can't rely on being a doctor to get off a speeding ticket....

If you’re lucky enough to not be back at work, you might be feeling like you need to quickly refresh your medical knowledge - and this podcast the BMJ’s education editors take you on a whistlestop tour through the BMJ’s education articles of 2019. Tom Nolan (GP in London) is joined by Navjoyt Ladher (GP in London), Anita Jain (GP in India) and...

Michael West is professor of organisational psychology, at Lancaster University, and co-author of a new GMC report into the wellbeing of NHS staff. The review he led together with the clinical psychiatrist Denise Coia, focused on primary interventions related to workplace factors and the systems that doctors work in, rather than secondary...

Is it possible to have a fair price for medicines? Yes, according to a new collection just published on bmj.com. The authors set out to evaluate how we could improve the functioning of the market for medicines, to honestly compensate industry for innovation, whilst allowing the poorest to afford them. Suerie Moon, co-director of global health at...

There comes a tipping point in all campaigns when the evidence is overwhelming and the only way to proceed is with action. According to David Williams, it’s time to tackle the disproportionate effects of race on patients in the UK. David Williams, from Harvard University, developed the Everyday Discrimination Scale that, in 1997, launched a new...

We're taking a break from the usual Talk Evidence to focus on the new corona virus that has emerged in China. With a brand new disease, we have to build our evidence base from scratch - basic virology, epidemiology, pathogenicity, transmissibility, and ultimately treatment are all unknowns. In this episode of Talk Evidence, we're trying to get...

Last week the BMJ published it’s first special edition into Racism in Medicine. The issues tacked ranged from differential attainment in medical school, to the physiological effects that experiencing everyday discrimination has. The issue was guest edited by Victor Adebowale, the Chief Executive of the social care enterprise Turning Point, and...

We know that the number of people living with multiple health conditions is rising year on year, and yet training, guidelines, organisations and physical spaces in healthcare still largely focus on single diseases or organ systems. The means that patients in the NHS are often treated as if their conditions exist in isolation, and that their care...

The NHS is a world leader in sustainable healthcare - and it's the staff who have have been leading the charge. The For A Greener NHS campaign is asking everyone who has made a change to the way they work, to submit evidence and help shape the whole organisation's response to the climate emergency. In this podcast, Isobel Braithwaite, public...

Reports from Italy, and more recently from the U.S. show the strain the healthcare system is under during this pandemic. We know that staff will step up in an emergency, but this isn’t a fire or a bombing, this is going to last for months. So how can organisations be proactive in supporting staff, and how can leaders try to mitigate the...

Wellbeing might not seem the obvious place to talk about PPE - but lack of appropriate PPE is causing healthcare staff a great deal of stress now. Mary Brindle is a pediatric surgeon and the director of The EQuIS (Efficiency Quality Innovation and Safety) Research platform at Alberta Children’s hospital. In this podcast she reflects on the use...

For the next few months Talk Evidence is going to focus on the new corona virus pandemic. There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing. We're going to try to get away from the headlines and talk about what we need to know - to hopefully give...

As we cover the covid-19 outbreak, we want to hear some of the stories from the frontline - And who better to heart of what this pandemic is doing to the profession in the UK, than some of the people who write regularly for The BMJ? In this first one, we wanted to look specifically at acute care - those at the sharp end of the response, so we're...

We’ve published info on Telehealth in primary care - and have been overwhelmed by the response from GPs who are finding it useful. But it’s not only primary care that is dramatically shifting to remote care - routine hospital care is moving online too, so we’ve asked Rowena McCash - GP and out of hours triage trainer joins us to give some tips...

As the pandemic plays out - the way in which doctors in the UK practice is changing, hospitals are reconfigured to increase critical care capacity, GPs are working from home and doing their day to day work remotely. Some of the changes have come at the detriment of staff and patient wellbeing but covid-19 has also helped cut through some of the...

How can we help frontline clinicians? Sometimes medics may feel uneasy or even guilty and that they could be doing more. That was what a junior doctor in Abergavenny in Wales felt and she did something about it. In this podcast, we speak to Josie Cheetham about how she started her initiative to provide support boxes in hospitals for her...

As the pandemic plays out - hospitals are reconfigured to increase critical care capacity, outpatient clinics become virtual, and elective procedures delayed. How are these affecting care for those who are in hospital but don't have covid-19? In this podcast, Matt Morgan,honorary senior research fellow at Cardiff University, consultant in...

For the next few months Talk Evidence is going to focus on the new corona virus pandemic. There is an enormous amount of uncertainty about the disease, what the symptoms are, fatality rate, treatment options, things we shouldn't be doing. We're going to try to get away from the headlines and talk about what we need to know - to hopefully give you...

Dilys J. Freeman
May 1, 2002; 51:1596-1600
Complications

Joseph G. Yu
Oct 1, 2002; 51:2968-2974
Obesity Studies

Mariano J Garcia
Feb 1, 1974; 23:105-111
Original Contribution

Shane Rea
Nov 1, 1997; 46:1667-1677
Perspectives in Diabetes

Cindy J.M. Loomans
Jan 1, 2004; 53:195-199
Complications

Christophe Bonny
Jan 1, 2001; 50:77-82
Islet Studies

Joachim Spranger
Mar 1, 2003; 52:812-817
Pathophysiology

Franz M Matschinsky
Feb 1, 1996; 45:223-241
Banting Lecture 1995

R A DeFronzo
Dec 1, 1981; 30:1000-1007
Original Contribution

Charles M. Alexander
May 1, 2003; 52:1210-1214
Complications

Gökhan S Hotamisligil
Nov 1, 1994; 43:1271-1278
Perspectives in Diabetes

D Dabelea
Dec 1, 2000; 49:2208-2211
Articles

Tatsuya Hayashi
Aug 1, 1998; 47:1369-1373
Rapid Publications

Eve Van Cauter
Mar 1, 1992; 41:368-377
Original Article

Ralph A. DeFronzo
Apr 1, 2009; 58:773-795
Banting Lecture

Paul E Lacy
Jan 1, 1967; 16:35-39
Original Contribution

Andreas Festa
Apr 1, 2002; 51:1131-1137
Complications

Ralph A DeFronzo
Jun 1, 1988; 37:667-687
Lilly Lecture 1987

Steven E Kahn
Nov 1, 1993; 42:1663-1672
Original Article

BM Spiegelman
Apr 1, 1998; 47:507-514
Articles

National Diabetes Data Group
Dec 1, 1979; 28:1039-1057
Articles

Night shift work, behavioral rhythms, and the common MTNR1B risk single nucleotide polymorphism (SNP), rs10830963, associate with type 2 diabetes; however, whether they exert joint effects to exacerbate type 2 diabetes risk is unknown. Among employed participants of European ancestry in the UK Biobank (N = 189,488), we aimed to test the cross-sectional independent associations and joint interaction effects of these risk factors on odds of type 2 diabetes (n = 5,042 cases) and HbA_1c levels (n = 175,156). Current shift work, definite morning or evening preference, and MTNR1B rs10830963 risk allele associated with type 2 diabetes and HbA_1c levels. The effect of rs10830963 was not modified by shift work schedules. While marginal evidence of interaction between self-reported morningness-eveningness preference and rs10830963 on risk of type 2 diabetes was seen, this interaction did not persist when analysis was expanded to include all participants regardless of employment status and when accelerometer-derived sleep midpoint was used as an objective measure of morningness-eveningness preference. Our findings suggest that MTNR1B risk allele carriers who carry out shift work or have more extreme morningness-eveningness preference may not have enhanced risk of type 2 diabetes.

Lipodystrophies are a group of disorders characterized by absence or loss of adipose tissue and abnormal fat distribution, commonly accompanied by metabolic dysregulation. Although considered rare disorders, their prevalence in the general population is not well understood. We aimed to evaluate the clinical and genetic prevalence of lipodystrophy disorders in a large clinical care cohort. We interrogated the electronic health record (EHR) information of >1.3 million adults from the Geisinger Health System for lipodystrophy diagnostic codes. We estimate a clinical prevalence of disease of 1 in 20,000 individuals. We performed genetic analyses in individuals with available genomic data to identify variants associated with inherited lipodystrophies and examined their EHR for comorbidities associated with lipodystrophy. We identified 16 individuals carrying the p.R482Q pathogenic variant in LMNA associated with Dunnigan familial partial lipodystrophy. Four had a clinical diagnosis of lipodystrophy, whereas the remaining had no documented clinical diagnosis despite having accompanying metabolic abnormalities. We observed a lipodystrophy-associated variant carrier frequency of 1 in 3,082 individuals in our cohort with substantial burden of metabolic dysregulation. We estimate a genetic prevalence of disease of ~1 in 7,000 in the general population. Partial lipodystrophy is an underdiagnosed condition. and its prevalence, as defined molecularly, is higher than previously reported. Genetically guided stratification of patients with common metabolic disorders, like diabetes and dyslipidemia, is an important step toward precision medicine.

Children at increased genetic risk for type 1 diabetes (T1D) after environmental exposures may develop pancreatic islet autoantibodies (IA) at a very young age. Metabolic profile changes over time may imply responses to exposures and signal development of the first IA. Our present research in The Environmental Determinants of Diabetes in the Young (TEDDY) study aimed to identify metabolome-wide signals preceding the first IA against GAD (GADA-first) or against insulin (IAA-first). We profiled metabolomes by mass spectrometry from children’s plasma at 3-month intervals after birth until appearance of the first IA. A trajectory analysis discovered each first IA preceded by reduced amino acid proline and branched-chain amino acids (BCAAs), respectively. With independent time point analysis following birth, we discovered dehydroascorbic acid (DHAA) contributing to the risk of each first IA, and -aminobutyric acid (GABAs) associated with the first autoantibody against insulin (IAA-first). Methionine and alanine, compounds produced in BCAA metabolism and fatty acids, also preceded IA at different time points. Unsaturated triglycerides and phosphatidylethanolamines decreased in abundance before appearance of either autoantibody. Our findings suggest that IAA-first and GADA-first are heralded by different patterns of DHAA, GABA, multiple amino acids, and fatty acids, which may be important to primary prevention of T1D.

The cardiovascular benefits of fibrates have been shown to be heterogeneous and to depend on the presence of atherogenic dyslipidemia. We investigated whether genetic variability in the PPARA gene, coding for the pharmacological target of fibrates (PPAR-α), could be used to improve the selection of patients with type 2 diabetes who may derive cardiovascular benefit from addition of this treatment to statins. We identified a common variant at the PPARA locus (rs6008845, C/T) displaying a study-wide significant influence on the effect of fenofibrate on major cardiovascular events (MACE) among 3,065 self-reported white subjects treated with simvastatin and randomized to fenofibrate or placebo in the ACCORD-Lipid trial. T/T homozygotes (36% of participants) experienced a 51% MACE reduction in response to fenofibrate (hazard ratio 0.49; 95% CI 0.34–0.72), whereas no benefit was observed for other genotypes (P_interaction = 3.7 x 10^–4). The rs6008845-by-fenofibrate interaction on MACE was replicated in African Americans from ACCORD (N = 585, P = 0.02) and in external cohorts (ACCORD-BP, ORIGIN, and TRIUMPH, total N = 3059, P = 0.005). Remarkably, rs6008845 T/T homozygotes experienced a cardiovascular benefit from fibrate even in the absence of atherogenic dyslipidemia. Among these individuals, but not among carriers of other genotypes, fenofibrate treatment was associated with lower circulating levels of CCL11—a proinflammatory and atherogenic chemokine also known as eotaxin (P for rs6008845-by-fenofibrate interaction = 0.003). The GTEx data set revealed regulatory functions of rs6008845 on PPARA expression in many tissues. In summary, we have found a common PPARA regulatory variant that influences the cardiovascular effects of fenofibrate and that could be used to identify patients with type 2 diabetes who would derive benefit from fenofibrate treatment, in addition to those with atherogenic dyslipidemia.

Western Bureau: Some displaced Iberostar employees in Rose Hall, St James, are angry with their employer, charging that they have been unable to benefit from the Government’s COVID-19 relief programme because of the hotel’s failure to pay over...

Sandra Ferguson resides with her children and grandchildren in a concrete dwelling that is sectioned into four living quarters in the Fort George Road area of Annotto Bay. With 10 of them sharing kitchen and bathroom facilities, Ferguson said...

Edmond Campbell/Senior Parliamentary Reporter Conceding that healthcare workers in the public sector are burnt out as they combat COVID-19, Health and Wellness Minister Dr Christopher Tufton says the Government is taking steps to boost its...

It was not the landing the Jamaicans who arrived at Kingston’s Norman Manley International Airport on Wednesday evening would want again. The 43 Jamaican ship workers of the Marella Discovery 2 were among the 115 people aboard the TUI charter flight that touched down amid the Kingston breeze and evening sunset.