Search PubMed⌕ Search

Biomedical subjects

Richard I G Holt

Publications and source records attributed to Richard I G Holt.

18 recordsLinked to original sources
PubMed2026

The management of type 1 diabetes in adults. The updated 2026 consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).

This 2026 consensus report from the European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) builds on the 2021 consensus report to provide guidance for managing type 1 diabetes in adults. Reflecting the rapid advances in the field, this update places particular emphasis on the integration of new technologies, while all sections have been revised to incorporate new evidence, advances in clinical practice and novel therapies, including interventions to delay the onset of stage 3 type 1 diabetes. It also broadens its scope to screening for long-term diabetes complications, and the management of obesity and cardiovascular risk factors. Psychosocial care and diabetes self-management education and support (DSMES) remain key elements. The report was developed using the Accurate Consensus Reporting Document (ACCORD) framework. The guidance aligns with the current ADA 'Standards of Care in Diabetes' (Standards of Care) and relevant EASD and ADA documents and aims to support clinicians globally in delivering high-quality, personalised care for adults with type 1 diabetes, with recommendations that can be adapted across diverse healthcare systems and resource settings.

Adjunctive therapy↗
PubMed2026

The Management of Type 1 Diabetes in Adults. The Updated 2026 Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).

This 2026 consensus report from the European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) builds on the 2021 consensus report to provide guidance for managing type 1 diabetes in adults. Reflecting the rapid advances in the field, this update places particular emphasis on the integration of new technologies, while all sections have been revised to incorporate new evidence, advances in clinical practice, and novel therapies, including interventions to delay the onset of stage 3 type 1 diabetes. It also broadens its scope to screening for long-term diabetes complications, and the management of obesity and cardiovascular risk factors. Psychosocial care and diabetes self-management education and support (DSMES) remain key elements.

Journal Article↗
PubMed2006

Exercising in the cold inhibits growth hormone secretion by reducing the rise in core body temperature.

OBJECTIVE: Ambient temperature alters exercise induced GH secretion. It is unknown whether temperature affects GH secretion at exercise intensities above the anaerobic threshold when other factors may override the relationship seen at lower intensities. METHODS DESIGN: Cross-over study of ambient temperature on exercise induced GH in swimmers and rowers. SETTING: St Thomas Hospital, London. SUBJECTS: Ten healthy men (age 21.7+/-0.8 yrs). Five swimmers and five rowers. INTERVENTION: Forty-minute exercise test at 105% of anaerobic threshold at room temperature (RT) and at 4 degrees C. MEASUREMENTS: Cutaneous and core body temperature. Serum GH concentration. RESULTS: Cutaneous body temperature increased during exercise at RT but decreased in the cold. Although core temperature rose in both settings, the rise was greater at RT (p=0.021). GH increased at both temperatures but the onset was delayed by the cold. Peak GH tended to be higher at RT (17.4+/-3.6 microg/L vs. 9.5+/-1.5 microg/L, p=0.07). Total GH secretion was greater at RT (353.3+/-99.1 microg min/L) than 4 degrees C (128.3+/-21.0 microg min/L), p=0.038. Change in core temperature correlated with log peak GH (r=0.66, p=0.039) and log incremental GH (r=0.67, p=0.032) when exercising at 4 degrees C. There was no difference between swimmers and rowers. CONCLUSIONS: Exercise at 4 degrees C reduces GH secretion during exercise at intensities above the anaerobic threshold. A change in core body temperature may be one mechanism by which exercise induces GH secretion. The difference in GH between swimmers and rowers during their respective events relates to the conditions under which they compete.

Adult↗
PubMed2006

Association between antipsychotic drugs and diabetes.

The link between atypical antipsychotic drugs and the development of diabetes has been hotly debated in the literature. In this review, we attempt to classify the various types of data published and presented in a hierarchical basis. Case reports and retrospective pharmacoepidemiological studies suggest that both conventional and atypical antipsychotic medications are associated with an increased risk of glucose abnormalities or diabetes. Prospective data examining the relationship between atypical antipsychotic drugs and diabetes began to emerge in 2003 and are much less conclusive. Estimates of the attributable risk associated with atypical antipsychotic drugs are low. The few studies that have included a placebo group suggest that we cannot necessarily blame antipsychotic medication when diabetes develops in an individual with schizophrenia.

Adult↗
PubMed2005

Challenges in detecting the abuse of growth hormone in sport.

BACKGROUND: Growth hormone (GH) is reputed to be in widespread use in the sporting arena as a performance-enhancing agent and is on the list of banned substances published by the World Anti-Doping Agency. The detection of GH abuse poses many challenges. Unlike many substances of abuse, such as synthetic anabolic steroids, GH is a naturally occurring substance; therefore, demonstration of exogenous administration must rely on detecting concentrations in excess of an established reference interval. The purpose of this review is to discuss the methodologies being developed to detect GH abuse. METHODS: We undertook a comprehensive search using multiple electronic databases and hand searches of reference lists of articles. The data for this review reflect our academic interests and experience through work on the GH-2000 and GH-2004 projects. RESULTS: Two approaches have been taken to detect GH abuse. The first is based on assessment of the effect of exogenous GH on pituitary GH isoforms, and the second is based on measurement of markers of GH action. The advantages of each approach and the difficulties encountered with each technique, as well as future concepts in detection, are discussed. CONCLUSION: Although there are substantial challenges for the detection of GH, methodologies now exist to detect GH abuse with reasonable sensitivity and specificity.

Anabolic Agents↗
PubMed2005

Alternative site self blood glucose testing is preferred by women with gestational diabetes.

BACKGROUND: Women with gestational diabetes (GDM) need to assimilate information and management skills rapidly for their diabetes to prevent adverse pregnancy outcomes. Strict glycaemic control is necessary and is improved by regular self-monitoring of blood glucose. The Softsense meter (MediSense Products, Witney, UK) is used on less sensitive body sites and combines lancing with testing. The study aim was to compare alternative site testing with traditional blood glucose monitoring in pregnancy. SUBJECTS AND METHODS: An open-label randomised crossover study using Softsense and Optium (MediSense Products) meters was performed in 33 women with GDM and 19 women with pre-existing diabetes. Each meter was used for 2 weeks. Ease of use and learning, pain, convenience, and effect on daily activities were assessed by a visual analogue questionnaire. RESULTS: Women with GDM found the Softsense less painful (P = 0.0001) and easier to use (P = 0.03). At the end of the study, 25 chose the Softsense meter in preference to the Optium meter for further testing (P = 0.0001). In contrast, women with pre-existing diabetes found the Optium significantly less messy, less disruptive, and easier to use outside the home. CONCLUSIONS: Women with GDM preferred the Softsense meter because of its ease of use and painlessness. Women with pre-existing diabetes found this meter less convenient, primarily because of its bulkiness.

Blood Glucose Self-Monitoring↗
PubMed2005

Obesity - an epidemic of the twenty-first century: an update for psychiatrists.

Obesity is a chronic relapsing condition associated with significant morbidity and premature mortality. The prevalence of obesity has increased dramatically over the last 20 years and continues to do so, primarily as a result of changes in dietary intake and exercise patterns. There are considerable challenges associated with the management of the obesity epidemic involving both public health policies and individual treatment. Management of the obese individual involves lifelong lifestyle change for all, drugs for some, and surgery for a few. Appropriate selection of patients and the setting of realistic goals are crucial to the success of any weight-reducing programme. The aim of obesity management is to reduce associated morbidity and mortality, not necessarily to restore normal body weight. While the current trends in obesity are depressing, a better understanding of the pathophysiology and treatment of the condition should allow the clinician to be more optimistic for the future.

Anti-Obesity Agents↗
PubMed2005

Diabetes and schizophrenia 2005: are we any closer to understanding the link?

The association between schizophrenia and diabetes has been recognized for well over a century, but the underlying reasons for this association are unclear. In October 2003, an international group of diabetologists and psychiatrists met to review the literature relating to the association, and to create pragmatic guidelines for the management of diabetic risk in patients with severe mental illness. Since that meeting, over 100 additional papers have been published on the association between glucose abnormalities and schizophrenia, and this is a clear reflection of the level of interest in this clinically important area. Diabetes is highly prevalent among the schizophrenia population, but most sufferers remain undiagnosed in the community. The reasons why individuals with schizophrenia are more prone to developing diabetes than the general population are poorly defined, but likely to be multifactorial. The role of antipsychotic medications in the development of diabetes and other pre-diabetic states remains controversial, but it appears that the attributable risk is low. Traditional risk factors most probably account for much of the diabetes seen in schizophrenia populations, suggesting that routine screening and aggressive risk factor management are especially important in this patient group.

Antipsychotic Agents↗
PubMed2004

Which statin?

Explore the source record for details and available documents.

Cardiovascular Diseases↗
PubMed2004

Diagnosis, epidemiology and pathogenesis of diabetes mellitus: an update for psychiatrists.

BACKGROUND: Diabetes mellitus is a complex metabolic disorder characterised by persistent hyperglycaemia. The prevalence of diabetes is increased in people with schizophrenia. AIMS: To provide an update of current thinking in diabetes for practising psychiatrists. METHOD: Literature review. RESULTS: Diabetes is a costly condition in individual, social and economic terms, and the global burden of diabetes is increasing in most populations. The insidious onset and asymptomatic nature of diabetes results in many people remaining undiagnosed and at great risk of developing life-threatening vascular complications. Lifestyle and pharmacological interventions can reduce incident diabetes and delay its progression. CONCLUSIONS: Public health policies are urgently required to encourage people to follow a healthy lifestyle. Primary prevention strategies for diabetes should target individuals at especially high risk of developing type 2 diabetes, including those with severe mental illness.

Diabetes Mellitus, Type 2↗
PubMed2003

Serum insulin-like growth factor (IGF)-I and IGF-binding protein-1 in elderly people: relationships with cardiovascular risk factors, body composition, size at birth, and childhood growth.

The IGF system is important in regulation of fetal and childhood growth. In later life, IGF-I and IGF-binding protein-1 (IGFBP-1) have been implicated in the pathogenesis of arteriosclerosis. They are, thus, potential candidates in explaining the link between early growth and adult cardiovascular disease. We measured fasting serum IGF-I and IGFBP-1 concentrations in 394 men and women from a cohort of 7086 individuals, born between 1924 and 1933 in Helsinki, Finland, whose weight and height were recorded at birth and from 7 to 15 yr of age. They also underwent clinical examination, including measurement of body fat using bioimpedance, blood pressure, glucose tolerance, and plasma insulin and fibrinogen concentrations. Serum IGF-I was positively correlated with fasting glucose (r = 0.10, P = 0.06) and fibrinogen (r = 0.19, P = 0.0001) concentrations and blood pressure (systolic and diastolic r = 0.10, P </= 0.05) and inversely with percentage body fat (r = -0.13, P = 0.01) and waist circumference (r = -0.11, P = 0.03). IGFBP-1 was inversely correlated with adult body mass index (BMI) (r = -0.46, P < 0.0001), fasting glucose and insulin concentrations, and blood pressure. There were correlations between the adult level of IGFBP-1 and birth weight (r = 0.11, P = 0.03) and ponderal index (weight/length(3)) at birth (r = 0.13, P = 0.01), but IGF-I was not related to birth measurements. There were interactive effects between childhood height or BMI and adult BMI on IGF-I and IGFBP-1 in adulthood. Tall height and high BMI at 7 yr were associated with low IGF-I (P = 0.03 for height and P = 0.003 for BMI) and high IGFBP-1 (P = 0.02 and P = 0.06) in adulthood but only in those subjects whose current BMI was below median. On further analysis these interactive effects were particularly strong for height in childhood and adult lean BMI (lean body mass/height(2)). Among men and women of below-average lean BMI, tall height at 7 yr was associated with low adult IGF-I (P = 0.007) and high IGFBP-1 (P = 0.0004) concentrations [interaction (7-yr height x adult lean BMI); P = 0.008 for IGF-I and 0.001 for IGFBP-1]. There is no evidence that reduced fetal growth programs IGF-I concentrations in old age. An association between small size at birth and low IGFBP-1 concentrations may in part reflect fetal programming effects on insulin resistance. Given the anabolic effects of the GH-IGF-I axis, subjects with tall height in childhood but low adult lean body mass may be at risk of late-life GH-IGF-I axis dysfunction. Prospective studies should address whether this group is susceptible to type 2 diabetes, coronary heart disease, and osteoporosis.

Adolescent↗
PubMed2002

Fetal programming of the growth hormone-insulin-like growth factor axis.

Epidemiological studies have shown that small body size at birth and during infancy is associated with increased rates of chronic diseases in adulthood, including cardiovascular disease and osteoporosis. Fetal programming of the growth hormone-insulin-like growth factor (GH-IGF) axis has been proposed as a potential candidate mechanism to explain the link between low birth weight and adult disease. The IGFs and IGF-binding proteins are nutritionally regulated in the fetus and fetal growth retardation leads to abnormalities in the GH-IGF axis. There are also abnormalities in the GH-IGF axis in many of the adult diseases that are associated with low birth weight, including cardiovascular disease and osteoporosis. Finally, there are data from both animals and humans suggesting that programming of the GH-IGF axis might exist.

Adult↗
PubMed2002

Intrauterine growth, the vascular system, and the metabolic syndrome.

There is substantial evidence linking birth size with the risk of developing cardiovascular disease and its major biological risk factors in adulthood. The fetal origins hypothesis proposes that these diseases originate through adaptations, which the fetus makes when it is undernourished. These adaptations may be cardiovascular, metabolic, or endocrine. They permanently change the structure and function of the body. Prevention of the diseases may depend on prevention of imbalances in fetal growth or imbalances between prenatal and postnatal growth, or imbalances in nutrient supply to the fetus. The purpose of this article is to examine some of the more recent epidemiological associations between low birth weight and adult atherosclerotic vascular disease and its risk factors. We will also discuss mechanisms that might explain these associations.

Adaptation, Physiological↗