Featured Reagent – Adiponectin

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Featured Reagent – Adiponectin

Adiponectin | Featured Reagent

1st October 2019

Physiological Significance

Adiponectin (ADPN) (adipocyte complement-related protein of 30kDa (Acrp30)) is an adipokine (protein hormone) produced and secreted by the adipose tissue, an endocrine organ 1. ADPN acts as a messenger in the communication of adipose tissue and metabolic organs. In doing so, ADPN suppresses the production of glucose in the liver through inhibiting the genes involved in glucose production and enhances fatty acid oxidation in skeletal muscle 2.

Consequently, ADPN is a strong protector against several pathological events in various cells through inhibiting inflammation, suppressing cell death and enhancing cell survival 2.

ADPN has been identified as having pleiotropic functions widely associated with anti-atherogenic, anti-diabetic, cardioprotective and anti-inflammatory effects. ADPN levels inversely correlate with insulin levels, BMI, triglyceride levels, insulin resistance (IR), glucose, and most importantly, visceral fat accumulation 3. Moreover, physiological functions of adiponectin have also been observed in inflammation and cardiovascular disease (CVD), especially in atherosclerosis 2.

Fig. 1. Proposed salutary effects of adiponectin 1

Did you know?

Obesity causes altercations in the adipose tissue promoting metabolic dysregulation. Consequently, these alterations are the precursors in the development of IR and CVD 4.

Adiponectin Testing

  • Benefits of the Randox Adiponectin Assay
  • Visceral Fat
  • T2DM
  • Metabolic & Insulin Concerns
  • Cardiac
  • Cancer
Reduce labour copy

Latex Enhanced Immunoturbidimetric Method
The automated latex enhanced immunoturbidimetric method produces results in as little as ten minutes, facilitating faster patient diagnosis and treatment plan implementation compared to traditional ELISA based testing.

correlation

Exceptional correlation
correlation coefficient of r=0.989 was displayed when compared to commercially available methods.

measuring range

Extensive measuring range
The healthy range for adiponectin is 2 – 22μg/ml. The Randox adiponectin assay can comfortably detect levels outside of the healthy range, measuring between 0.32 – 23.8μg/ml.

liquid

Liquid ready-to-use assay
The Randox adiponectin assay is available in a liquid ready-to-use format for convenience and ease-of-use.

stability

Stability
The Randox adiponectin assay is stable to expiry date when stored at +2 to +8°C and has an onboard stability of 28 days when stored at +10oC.

applications

Applications are available
Applications are available detailing instrument-specific settings for the convenient use of the Randox adiponectin assay on a variety of clinical chemistry analysers. Contact us to enquire about your specific analyser.

APDN has an inverse correlation with abdominal visceral fat (AVF). Low levels of ADPN increases the risk of metabolic abnormalities. Furthermore, excess adipose tissue, especially visceral adipose tissue (VAT) is an important risk factor for IR, correlating with an increased risk of CVD 5.

The most commonly utilised methods for the assessment of AVF are waist circumference and BMI. Waist circumference does not measure total AVF reliably as the visceral fat / subcutaneous fat ratios vary by gender and ethnicity 6 and BMI cannot distinguish between muscle and fat and so classes those with high muscle and low fat mass as being overweight. Moreover, BMI also cannot distinguish between visceral fat and fat that sits beneath the skin 7.

Adiponectin levels are inversely correlated with AVF, proving to be a reliable indicator of at-risk patients.

The traditional biomarkers utilised in the assessment of T2DM risk include: oral glucose tolerance test (OGTT), fasting plasma glucose (FPG) and HbA1c. However, each of these tests are inadequate and a superior biomarker for T2DM risk assessment is vital.

1. JAMA (2009): Adiponectin levels and risk of type 2 diabetes: A systematic review and meta-analysis 8

Higher ADPN levels are associated with a lower risk of T2DM across diverse populations and is currently the strongest and most consistent biomarker of T2DM risk assessment.

2. BMJ Open Diabetes Research & Care (2016): Adiponectin levels predict prediabetes risk: The pathobiology in a biracial cohort (POP-ABC) study 9

Baseline ADPN levels were inversely related to the risk of pre-diabetes among the healthy African Americans and European Americans with a parental history of T2DM enrolled on the POP-ABC study. Despite gender and ethnic difference, this predictive relationship was evident.

The most commonly observed component of metabolic syndrome (MetS) is abdominal obesity. MetS encompasses several conditions
including: hypercholesterolemia, triglyceridemia, glycaemia, hypertension, abdominal obesity and dyslipidaemia. The prevalence of MetS is 31% and is associated with a 1.5-fold increased risk of all-cause mortality, a 2-fold increased risk of coronary heart disease (CHD) and cerebrovascular accident (CVA), and a 5-fold increased risk of T2DM 10, 11, 12.

Adiponectin has been identified as a glucose regulator and lipid homeostasis through its insulin sensitising properties which are associated with MetS.

1. Nutrition and Diabetes (2011): Serum adiponectin level is not only decreased in metabolic syndrome but also in borderline metabolic abnormalities 13

Decreasing ADPN levels begins at an early stage before the onset of hypertension, diabetes, MetS or dyslipidaemia. Moreover, in those with metabolic abnormalities / physiological abnormalities, adiponectin is an important biomarker for the risk assessment of atherosclerosis, both independently and as a reflection of the accumulation of AVF.

2. Cardiovascular Diabetology (2015): Role of adiponectin and free fatty acids on the association between abdominal visceral fat and insulin    resistance 14

Subjects with high AVF or low ADPN had a 3-fold increased risk of IR. The combination of low ADPN with high AVF doubled this probability.

It has been recognised that mRNA expression of the ADPN gene and the section of high molecular weight (HMW) oligomeric ADPN are impaired in adipose tissue of obese patients. Epidemiological studies undertaken in different ethnic groups established that low ADPN levels, especially in HMW oligomer, is an independent risk factor for CVD 15. Fig. 2 illustrates the pleiotropic role of adiponectin in the cardiovascular system.

1. PLOS ONE (2013): Adiponectin provides additional information to conventional cardiovascular risk factors for assessing the risk of atherosclerosis in both genders 16

The risk of carotid intima media thickness (CIMT) inversely correlates with ADPN levels in both genders. Adiponectin testing is a significant marker of atherosclerosis and can provide additional information in the assessment of atherosclerotic risk in both genders, independent of conventional cardiovascular risk factors.

2. European Journal of Preventive Cardiology (2015): Adiponectin, type 2 diabetes and cardiovascular risk 17

Increasing ADPN levels in plasma is associated with a decreased risk of T2DM and subsequently, a reduced risk of CVD.

Fig. 2. The pleiotropic role of adiponectin in the cardiovascular system 15

Excess body fat is not only associated with T2DM and CVD, but also with various types of malignancies. Many cancer cell lines express ADPN receptors, and adiponectin in vitro limits cell proliferation and induces apoptosis. Evidence exists supporting adiponectin as a novel risk marker in the diagnosis and prognosis of cancer 17. Fig. 3 illustrates the association between obesity, low levels of adiponectin and cancer progression.

1. Medicine (2018): Serum adiponectin in breast cancer: A meta – analysis 19

The meta-analysis indicates an intriguing association between low levels of ADPN and an increased risk of breast cancer (BC). Furthermore, APDN has the potential to serve as a biomarker of BC risk and aid in the identification of those at a high risk of developing BC.

Fig. 3. The association between obesity, low adiponectin levels and cancer progression 18

2. International Brazilian Journal of Urology (2019): Role of adiponectin in prostate cancer 20

Oxidative stress has been identified as a key event in the initiation, development and progression of PC. ADPN increased cellular anti-oxidative defence mechanisms and inhibited oxidative stress through increasing the NADPH oxidase NOX2 and NOX4 expressions in human 22Rv1 and DU – 145 PC cell lines. The review support ADPN as a protective and safe factor to prevent the progression of PC.

Obesity: The Risk Factor

Obesity, a major global health epidemic that burdens on healthcare systems, has increased at an alarming rate with 39% of adults (18+) classed as overweight and 13% classed as obese in 2016. Moreover, in the same year, 340 million children aged between 5 and 16 were identified as overweight or obese and 41 million children under 5 years of age were also classed as overweight or obese. Worldwide, obesity prevalence rates have almost tripled between 1975 and 2016 21, 22.

The main reason obesity is a massive health problem is because of the secondary diseases that develop due to obesity. Obesity has contributed to 23% of ischaemic heart disease cases, 7 – 41% of specific cancer cases and 44% of diabetes cases. Obesity is now no longer confined to developed countries. As the industrialisation of developing countries continues to emerge, high calorie diets and subsequently obesity increases 23.

Obesity reduces the number of disease free years. It was uncovered that those who were mildly obese lost 3 – 4 more disease – free years and those who were severely obese lost 7-8 more disease free years than non-obese individuals. Consequently, at least 2.8 million deaths per year are attributed to obesity 24, 25.

Obesity is a major risk factor for T2DM, IR, CVD and various types of malignancies. These secondary health-related problems cost the economy “$2 trillion annually and roughly 2.8% of the global gross domestic product (GDP)”. Moreover, childhood obesity costs the economy $14.1 billion annually 26, 27, 23. Whilst there are numerous parties involved to aid in the prevention of obesity, urgent actions are required to prevent obesity and the subsequent secondary health – related problems.

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Diabetes: The Role of Fructosamine

13 June 2019

Diabetes: The Role of Fructosamine

Diabetes Week is an annual week to raise awareness of diabetes. This year, the aim is to increase the public’s understanding of diabetes 1. Diabetes mellitus (DM) is a global epidemic, increasing at an alarming rate and burdening healthcare systems 2.  DM is a life-long condition characterised by the body’s inability to produce / respond to insulin resulting in the abnormal metabolism of carbohydrates and elevated blood glucose levels.

Whilst it is important to increase the public’s understanding of DM, it is imperative that clinicians and physicians are aware of the different in vitro diagnostic tests to diagnose and monitor DM. Not only is this vital, but is also important that clinicians and physicians also understand the different methodologies available when choosing the diagnostic test.

It has been highlighted in numerous clinical studies that diabetic complications may be reduced through the long-term monitoring and tight control of blood glucose levels. Both fasting plasma glucose (FPG) and glycated haemoglobin A1c (HbA1c) tests are universally accepted as reliable measurements of diabetic control. However, studies have emerged highlighting the role of fructosamine in diabetes monitoring. Whilst HbA1c provides an index of glycaemia over 2 to 3 months, fructosamine provides this index over the course of 2 to 3 weeks, enabling closer monitoring of diabetic control 1.

Did you know?

Diabetes is estimated to be the seventh leading cause of death with 1.6 million deaths attributed to diabetes in 2016 3

Drawbacks of Traditional Diabetes Tests

The FPG test measures the level of blood sugars which is used to diagnose and monitor diabetes based on insulin function. The main drawback of this test is that a hormone called glucagon, produced in the pancreas, is triggered during prolonged fasting, signalling the liver to release glucose into the bloodstream. In diabetic conditions, either the body is unable to generate enough insulin or cannot appropriately respond to insulin. Consequently, FPG levels remain high 4.

In the 1980’s, HbA1c was incorporated into clinical practice as HbA1c levels correlated well with glycaemic control over a 2 to 3-month period. The main drawback of this test is that any condition that reduces the survival rate of erythrocytes such as haemolytic anaemia will falsely lower the HbA1c test results, regardless of the assay method utilised 5.

Fructosamine Testing

In a diabetic patient where blood glucose levels are abnormally elevated, the concentration levels of fructosamine also increase as fructosamine is formed by a non-enzymatic Maillard reaction between glucose and amino acid residues of proteins. During this glycation process, an intermediate labile Schiff base is produced which is converted to a more stable ketoamine (fructosamine) via an Amadori rearrangement 2.

Fructosamine has been identified as an early indicator of diabetic control compared to other markers such as HbA1c. Red blood cells live for approximately 120 days, HbA1c represents the average blood glucose levels for the previous 2 to 3 months. Conversely fructosamine has a shorter lifespan, about 14 to 21 days, reflecting average blood glucose levels from the previous 2 to 3 weeks. Due to the shorter time span of fructosamine, it is also used to evaluate the effectiveness of medication changes and to monitor the treatment of gestational diabetes. The test is also particularly useful in situations where HbA1c cannot be reliably measured e.g. haemolytic anaemia, thalassemia or with genetic haemoglobin variants 5.

Fructosamine Assay Methodology

The most commonly utilised method for fructosamine testing is the colorimetric method. Whilst widely available, automated and inexpensive, the main drawback is the lack of standardisation across the different fructosamine assays 4.

Randox, on the other hand, utilise an enzymatic method, offering improved specificity and reliability compared to conventional NBT-based methods. The Randox enzymatic method does not suffer from non-specific interferences unlike existing methods which can also be time consuming and difficult to automate.

The Randox fructosamine assay is also standardised to the highest level as the Randox fructosamine calibrator and control is assigned relative to human serum glycated with 14C-glucose, which directly reflects the nature of the patient sample.

With an excellent stability of 28 days on-board the analyser, the Randox fructosamine assay is developed in a liquid ready-to-use format for convenience and ease-of-use.

Randox offer fully automated applications detailing instrument-specific settings for the convenient use of the Randox fructosamine assay on a wide range of clinical chemistry analysers.

Want to know more?

Contact us or download our diabetes brochure

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Tim Cogley Foundation and Randox Health partner with Liverpool universities to bring cardiac health awareness to the city

 An event on preventative healthcare and cardiac screening is being delivered in Liverpool this week by a wealth of world-leading industry and academic speakers.

Hosted by the sponsor of the Randox Health Grand National, in association with Liverpool John Moores University, Liverpool Hope University and the Tim Cogley Cardiac Screening Foundation, the event, entitled the Preventative Cardiac and Metabolic Health Seminar, runs on Wednesday 3rd April and is open to the public.

It follows a morning of engaging fitness programmes, including boxing, taekwondo and indoor cycling, for local pupils and teachers from across Merseyside and Cheshire. During these exercises, which will also include the opportunity to experience life as a jockey by having a go on a horse simulator, the children will also have some physiological measurements taken, including their heart rate.

Prevention is always better than cure”, says Managing Director Dr Peter FitzGerald. “Our aim is to empower people to take control of their health, to live longer and more healthy lives.

“We are delighted to be teaming up with Liverpool John Moores, Liverpool Hope and the Tim Cogley Cardiac Screening Foundation ahead of the Randox Health Grand National. The world’s greatest race offers us the perfect platform to spread our message of preventative health, and we look forward to sharing our knowledge with the audiences at this exciting event.”

This is the third year that the educational event from Randox Health has been held in the city, and for the second time will be championed by Frank Cogley of the Tim Cardiac Screening Foundation, whose son suffered a fatal heart attack due to a genetic condition. Frank is now working to raise the profile of cardiac health checks for young people.

He commented;

“It’s been recently reported that at least 12 under-35s die from undiagnosed heart conditions every week in the UK. The current lack of routine screening of 18 to 40-year-olds leaves a gaping chasm in our healthcare provision.

“With our highly motivated partners, through events like this, we hope to redress this through lifestyle changes and preventative medical programmes.

 “The Tim Cogley Cardiac Screening Foundation is committed to delivery positive, action-focused and life-changing programmes. I can’t imagine a legacy more in tune with the generous, kind and supportive person that was Tim.”

Tickets for the Randox Health seminar, which focuses on health screening and how the right approach can deliver significant benefits, are priced at £3 and are available at https://www.eventbrite.co.uk/e/preventative-cardiac-and-metabolic-health-seminar-tickets-59041545853?aff=ebdshpsearchautocomplete

£2.27 of each ticket payment will go towards the ‘Tim Cogley Cardiac Screening Foundation’ charity. Each attendee at the event will also be entered into a raffle on the day, with the winning prize being general admission tickets for the Randox Health Grand National on Saturday 6th April.

For further information please contact the Randox PR team by emailing randoxpr@randox.com or phoning 028 9442 2413

 

 

 

 

 

 


Diagnosing prediabetes with the Randox Adiponectin Assay

Talking about diabetes can be tough, but it doesn’t have to be.

This month, we’re joining the conversation on diabetes to help raise awareness of the condition, and importantly, how it can be diagnosed, managed, and even prevented.

Today, our focus is on a lesser-known variant of the chronic illness and one which you may not have heard of – prediabetes.

A third of all adults in the UK have prediabetes and with the UK’s estimated 3.8million diabetics estimated to climb to 5million by 2025 – largely as a result of obesity and the ageing population – it’s more important than ever to check if you’re suffering from this pre-cursor to diabetes.

WHAT IS PREDIABETES?

Illness doesn’t just happen overnight. Over time, your body begins to display symptoms but, often, irregularly has been present for some time. Prediabetes is an early indicator of type 2 diabetes which is characterised by the presence of blood glucose levels that are higher than normal but not yet high enough to be classed as diabetes.

For this reason, prediabetes is often described as the “grey area” between normal blood sugar and diabetic levels. In the UK, around 7 million people are estimated to have prediabetes and thus have a high risk for developing type 2 diabetes.

WHAT ARE THE SYMPTOMS OF PREDIABETES?

93% of the 60 million people with prediabetes globally are unaware they have it. This is because the condition often develops gradually without any warning signs or symptoms. In many cases, the sufferer only learns of their diabetic state once the symptoms of type 2 diabetes start to appear.

TESTING FOR PREDIABETES

Traditional biomarker tests used to diagnose type 2 diabetes include Fasting Plasma Glucose, Oral Glucose Tolerance Test, and HbA1c.  However, these cannot be utilised as tests for prediabetes, as beta cell damage has already occurred, and insulin insensitivity is already underway.

Adiponectin, a hormone responsible for regulating glucose metabolism has proven to be a strong predictor of type 2 diabetes at a crucial stage – before it has fully manifested.

Adiponectin’s ability to diagnose prediabetes is due to its relationship with a hazardous type of fat within the body which wraps around internal organs. This visceral fat is particularly dangerous because it can occur even within individuals deemed to have a healthy waist circumference, making them appear deceptively healthy simply because they are slim.

By measuring Adiponectin levels, clinicians can identify someone with high levels of visceral fat and therefore at risk of type 2 diabetes long before they would be identified by tests which measure blood sugar levels.

THE BENEFIT OF A PREDIABETES DIAGNOSIS

Whilst being diagnosed with prediabetes may come as a real shock, it offers a unique opportunity for lifestyle modification and prevention that is often not possible with other illnesses.

And this is because prediabetes is reversible. In fact, up to 80% of all cases of type 2 diabetes are preventable – if detected early. We want to help more and more people understand their health as early as possible so they can take reversible action now when there’s the best chance of a positive outcome.

With this information at your disposal, you can then take the necessary action to stop diabetes in its tracks.

For more information about Adiponectin; please visit https://www.randox.com/adiponectin/

To book the world’s most advanced health check which assess up to 350 different indicators of disease at their very earliest stage, including diabetes, visit www.randoxhealth.com

For further information, please contact Randox PR by emailing randoxpr@randox.com or phoning 028 9442 2413.

 

 

 

 

 


Detecting the earliest possible signs of type 2 diabetes

Randox Laboratories is this month driving awareness of diabetes and the need for early and accurate diagnosis to enable patients to take preventive action before the condition worsens.

Diabetes UK have stated that diabetes is the fastest growing health threat of our times and an urgent public health issue. Statistics show that since 1996, the number of people living with diabetes has more than doubled. It has been estimated that there are 1.1 million people living with diabetes in the UK that have yet to be diagnosed, including 84,836 people in Northern Ireland.

According to Diabetes UK around 700 people a day are diagnosed with diabetes, which equates to one person every two minutes. If nothing changes, it is estimated that diabetes will affect one in ten people by 2040. This will raise diabetes prevalence from 415 million to 642 million by 2040.  With current treatment taking up almost 9% of the annual NHS budget – roughly £8.8bn a year – the implications for future healthcare budgets are clear if this dangerous trend persists.

The good news however, is that recent research has found that type 2 diabetes is preventable through lifestyle changes. The NHS recently released the UK’s National Diabetes Prevention Programme which is aimed at tackling the increasing growing threat of diabetes.

However, following a warning raised by an Oxford University study, which looked into efforts of this Prevention Programme, it was found that it is unlikely to have much impact because the blood tests used were inaccurate at detecting pre-diabetes – the stage at which diabetes is reversible.

The blood tests used in the National Diabetes Prevention Programme were only effective at detecting diabetes at a stage when damage had already been done.

At Randox, we have developed a number of tests that can help detect the earliest possible signs of diabetes, often before symptoms have even manifested – including a pioneering test for the hormone Adiponectin.

Assessing Adiponectin levels allows doctors to calculate a patient’s levels of visceral fat – a dangerous, internal fat stored around organs. This deep fat, which is not visible to the naked eye, is linked to health problems including Type-2 diabetes.

Low levels of adiponectin equate to high levels of visceral fat which can be combated by improving your diet, exercise habits and even stress levels. Given that 70% of Type-2 diabetes can be prevented by lifestyle changes, there is strong correlation that by detecting low levels of Adiponectin and taking corrective and preventive action, it could result in a decrease in the numbers of people who develop the life-altering condition.

In addition to a test for the Adiponectin biomarker, Randox Biosciences have created a Metabolic Syndrome Array that measures 12 markers associated with metabolic syndrome and cardiovascular disease. Metabolic Syndrome is a is a group of cardiovascular risk factors that affects over 20% of adults and results in a person being three times more likely to have a stroke or heart attack, and five times more likely to develop diabetes.

Ultimately, we would like to see all medical professionals who are at the forefront of patient care armed with the most accurate diagnostic tools available. Updating traditional practice may not be easy but we believe it is imperative to do so, if we are to effectively challenge this global epidemic.

Randox remains focused on providing early diagnoses and preventing illnesses by providing innovative diagnostics tests that will continue to revolutionise the healthcare landscape.

For further information, please contact Randox PR by emailing randoxpr@randox.com or phoning 028 9442 2413.

 

 

 


Randox – Diabetes

During December, we aim to highlight how the Randox product portfolio can be used for accurate diagnosis and monitoring of diabetes, with a focus on the Randox Reagents diabetes panel which offers a total of 12 assays for accurate and reliable diabetes testing.

Diabetes is one of the leading causes of death worldwide and it is estimated by WHO (World Health Organisation) that 2.2 million additional deaths are being caused by the condition each year.  The number of people with the condition has being growing rapidly in the last 30 years, the International Diabetes Federation predicts that approximately 438 million people will have diabetes by 2030. Early diagnosis and constant monitoring of diabetes is essential in order to manage the condition, as diabetes can lead to other health problems such as heart disease, kidney damage or failure, nerve damage and even blindness.

Randox knows that this condition cannot be ignored as each year it is increasingly becoming a burden on the health service. Randox Reagents are committed to advancing diabetes related testing and offer an extensive range of high quality reagents: from diabetes diagnosis, to the monitoring of diabetes-related complications, the Randox Reagents diabetes testing panel covers the full spectrum of clinical testing requirements.

Reagents Diabetes Testing Assays

To aid with the growing concern of diabetes, Randox Reagents offer a comprehensive range of 12 assays within their diabetes testing panel including assays for the diagnosis and monitoring of diabetes which includes fructosamine, glucose and HbA1c and also those which monitor diabetes-related complications such as adiponectincystatin c, microalbumin and NEFA. The Randox diabetes reagents offer a range liquid ready-to-use and lyophilised formats for increased efficiency, applications are also available for a wide range of biochemistry analysers.

Randox Reagents

RX series Direct HbA1c Testing Capabilities

Renowned for quality and reliability the RX series range of clinical chemistry analysers boasts a world leading test menu with an extensive range of high performing and unique assays available. In addition to NEFA, D-3-Hydroxybutyrate (Ranbut) and Fructosamine the RX series welcomes Direct HbA1c testing on the RX Daytona +, RX imola and RX modena. The latex enhanced immunoturbidimetric method improves laboratory performance and time, highly improving accuracy and precision by revolutionising your diabetes testing capabilities.

Direct HbA1c Testing

Quality Control

Designed for use in the Quality Control of both HbA1c and Total Haemoglobin assays, our Acusera HbA1c controls are an ideal match for laboratories running these parameters and POCT testing. Available in liquid ready-to-use or lyophilised formats, these controls offer attractive stability and flexibility for labs and healthcare practices of any size. Manufactured using human whole blood which ensures commutability, our controls directly mimic the performance of real patient samples helping deliver reliable results. 

Quality Control

RIQAS Glycated Haemoglobin Programme

Designed to monitor the performance of HbA1c, our RIQAS glycated haemoglobin EQA program is suitable for both qualitative and quantitative methods of analysis.  As the largest EQA scheme in the world, access to large peer groups is guaranteed.  Additional benefits include; monthly analysis, user-friendly reports allowing at-a-glance performance assessment, ability to register up to five instruments per programme and cost savings via our unrivalled consolidation.

EQA

World Diabetes Day: The Biggest Burden on the NHS

14 November 2018

World Diabetes Day

Diabetes

Approximately 400,000 people in the UK are living with type 1 diabetes, with over 29,000 being children and young people [1]. Type 1 diabetes affects 96% of all children with diabetes in England and Wales, with incidences increasing by approximately 4% each year.

Globally, the UK has the fifth highest rate of type 1 diabetes diagnosis in children (aged up to 14) with 85% of these children having no family history of the condition. Whilst the condition isn’t fatal and can be managed, it cannot be cured. Type 1 diabetes increases the risk of developing other health problems such as heart disease, stroke, foot and circulation problems, sight problems including blindness, nerve damage and kidney problems. However, many of these related conditions are preventable and it is recommended to stabilise blood sugar levels, attend diabetes appointments regularly and complete a diabetes course to educate patients and family members and prevent the risk of further help complications[2].

Diabetes in children

Children under five are at the highest risk of developing diabetic ketoacidosis due to a late diagnosis and it is also thought to be due to of lack of public knowledge of the signs and symptoms attributed to type 1 diabetes. Such symptoms include:

  • Frequent urination as the kidneys are trying to expel excess sugar in the blood, resulting in dehydration which leads to extreme thirst.
  • Increased hunger or unexpected weight loss because the body is unable to attain enough energy from food
  • Slow healing cuts as high blood sugar levels can affect blood flow which can cause nerve damage.
  • Fatigue as the body is unable to convert sugar into energy
  • Irritable behaviour combined with other symptoms can be a means of concern

Diabetes and the NHS

Diabetes costs the NHS approximately £9.8 billion per year, an estimate of 10% of total expenditures. Hospital admissions of children and young people with diabetes presents a considerable burden on themselves, their families and the NHS. It is estimated that approximately 80% of these cases are potentially avoidable.

A report produced by the National Paediatric Diabetes Audit found that although the numbers of admissions didn’t significantly differ year to year, it highlighted differences in terms of socio-economic risk factors:

  • Living in a deprived area increases the risk of hospital admissions which can be attributed to lack of education in the community about diabetic symptoms and the management of diabetes.
  • Children below 5 years of age have a 35% increased risk of hospitalisation compared to those aged 5-9
  • Females have a 33% increased risk of developing type 1 diabetes compared to males.
  • Children with poor diabetes control have a twelve-fold increased risk of hospital admission
  • Insulin pump users have a 27% increased risk of hospital admission compared to those who use insulin injections.
Figure A. Number of preventable paediatric diabetes admissions  [3] 

Prevention

There are campaigns in place to aid in the early diagnosis of type 1 diabetes which mainly focus on raising awareness of the signs and symptoms of diabetes. On this World Diabetes Day, it is important to know that it is not just simply the responsibility of the diabetic patient to prevent admission but the main responsibility lies with the diabetic teams that inform the families with children who are diagnosed with type 1 diabetes.

Paediatric diabetes teams should ensure that the families and the children receive structured education for self-management when diagnosed and throughout the illness. In doing so, the diabetic teams should implement blood ketone testing from diagnosis and utilise the nationally agreed hypoglycaemia management guidelines. It is also important that diabetic teams are fully aware of the patient characteristics associated with a greater risk of admission and that they use this knowledge to develop anti-admission strategies specifically tailored to the needs of each individual group.

Primary care practitioners should seek access to a specialist diabetic team who they can refer to when deciding if a patient requires admission to hospital. Furthermore, they should access blood glucose and ketone testing to identify patients at risk of diabetic ketoacidosis that require hospital admission.

How Randox can Help

Randox offer a range of assays to diagnosis and monitor diabetes and to monitor associated complications.  Some of these tests are unique to Randox, including:

Fructosamine

The Randox fructosamine assay employs the enzymatic method which offers improved specificity and reliability compared to conventional NBT-based methods. The Randox enzymatic method does not suffer from non-specific interferences unlike other commercially available fructosamine assays.

Learn more about the Randox Fructosamine test

D-3-Hydroxybutyrate (Ranbut)

The Randox D-3-Hydroxybutyrate (Ranbut) assay detects the most abundant and sensitive ketone in the body, D-3-Hydroxybutyrate. The Randox Ranbut assay is used for the diagnosis of ketosis, more specifically diabetic ketoacidosis. Other commercially available tests, such as the nitroprusside method, are less sensitive as they only detect acetone and acetoacetate, not D-3-Hydroxybutyrate.

Learn more about the Randox D-3-Hydroxybutyrate test

Adiponectin

The Randox adiponectin assay is a biomarker in diabetes testing as adiponectin is a protein hormone responsible for regulating the metabolism of lipids and glucose and influences the body’s response to insulin. Adiponectin levels inversely correlates with abdominal visceral fat levels.

Want to know more?

Contact us or visit our Diabetes panel page to learn more.




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  • References

    [1] National Paediatric Diabetes Audit and Royal College of Paediatrics and Child Health, National Paediatric Diabetes Audit Report 2012-15: Part 2, 2017

    [2] NHS, “Avoiding Complications” – Type 1 Diabetes, Available at: https://www.nhs.uk/conditions/type-1-diabetes/avoiding-complications/ [Accessed on 24th October 2018].

    [3] “Potentially Preventable Pediatric Hospital Inpatient Stays for Asthma and Diabetes, 2003-2012”, www.hcup-us.ahrq.gov, 2015. [Online] Available: https://www.hcup-us.ahrq.gov/reports/statbriefs/sb192-Pediatric-Preventable-Hospitalizations-Asthma-Diabetes.jsp [Accessed 08-Nov-18]


Securing the future with in vitro diagnostic tests

The aim of Biomedical Science Day is to raise the public’s awareness of the importance of biomedical science and the vital role it plays in the world.  Randox are dedicated to improving healthcare worldwide through placing a major focus on research and development.  The Randox scientists work in pioneering research into a range of common illnesses such as cancer, cardiovascular disease and Alzheimer’s disease.

A recent blog from Doris-Ann Williams, the Chief Executive at BIVDA, explains how “increased funding is not enough to sustain the NHS” and how “we need to make better use of in vitro diagnostics to ensure a successful future”.

The National Health Service (NHS) is a publicly funded, primarily taxation, national healthcare system in the United Kingdom.  It was first set-up on July 5th, 1948 by Aneurin Bevan as he believed that everyone, regardless of wealth, should have access to good healthcare.  Whilst the NHS is an extremely important aspect of healthcare in the UK, in vitro diagnostics are the heart and soul of the healthcare system as healthcare professionals not only rely on blood tests to diagnose and treat patients, but also to rule out the different contributing causes to a disease state.  In vitro diagnostics also plays a key role in monitoring chronic disease states.  In vitro diagnostics can also aid in reducing hospital stays, reduce misdiagnosis and support patients in looking after their own health and to deliver personalised treatment plans.

The Randox scientists have developed several niche assays to improve patient diagnosis, monitor treatment and eliminate misdiagnosis.

Adiponectin

Adiponectin is a protein hormone secreted by adipocytes with anti-inflammatory and insulin-sensitising properties.  It plays an important role in a number of metabolic processes including glucose regulation and fatty acid oxidation.  Adiponectin levels are inversely correlated with abdominal visceral fat which have proven to be a strong predictor of several pathologies, including: metabolic syndrome, type 2 diabetes mellitus (T2DM), cancers and cardiovascular disease (CVD).  For more information on the importance of testing Adiponectin levels, check out our Adiponectin Whitepaper.

Cystatin C

Cystatin C is an early risk marker for renal impairment.  The most commonly run test for renal impairment is Creatinine.  Creatinine measurements have proven to be inadequate as certain factors must be taken into consideration, including age, gender, ethnicity etc.  The National Institute for Health and Care Excellence (NICE) have updated their guidelines, which now recommends Cystatin C as a more superior test for renal impairment due to its higher specificity for significant disease outcomes than those based on Creatinine.  For more information on the importance of testing Cystatin C levels, check out our Cystatin C Whitepaper.

Small-dense LDL Cholesterol (sdLDL-C)

LDL Cholesterol (LDL-C) consists of two parts: the large and buoyant LDL Cholesterol and the small and dense LDL Cholesterol.  Whilst all LDL-C transports triglycerides and cholesterol to bodily tissues, their atherogensis varies according to their size.  As sdLDL-C is small and dense, they can more readily permeate the arterial wall and are more susceptible to oxidation.  Research indicates that individuals with a predominance of sdLDL-C have a 3-fold increased risk of myocardial infarction.  It has been noted that sdLDL-C carries less Cholesterol than large LDL, therefore a patient with predominately sdLDL-C particle may require nearly 70% more sdLDL-C particles to carry the same amount of cholesterol as the patient with predominately LDL-C particles.  For more information on the importance of testing sdLDL-C levels, check out our sdLDL-C Whitepaper.

These three niche in vitro diagnostics tests developed by Randox scientists can aid in reducing NHS costs due to their higher performance compared to the traditional tests.  Randox are constantly striving to improve healthcare worldwide.

For more information on the extensive range of Randox third-party in vitro diagnostic reagents, visit: https://www.randox.com/diagnostic-reagents/ or contact reagents@randox.com.

diagnostic tests

Could there be 5 types of diabetes?

A peer-reviewed study, published in The Lancet Medical Journal suggests there are five types of diabetes. Could diabetes be more complex than we once thought? Could diabetes be segmented into five separate diseases?

 

What is diabetes?

Diabetes is an incurable disease which prohibits the body’s ability to produce and respond to insulin.  Currently, diabetes is classified into two main forms, type 1 and type 2.

Type 1 diabetes is an autoimmune disease which manifests in childhood.  In type 1 diabetes, the body’s white blood cells attack the insulin-producing cells in the pancreas.  As a result, individuals with Type 1 diabetes rely on the injection of insulin for the remainder of their lives.

Type 1 diabetes affects 10 percent of individuals with diabetes.  96 percent of children diagnosed with diabetes have type 1.  Type 1 diabetes in children is commonly diagnosed between the ages of 10 and 14.  The prevalence of type 1 diabetes in children and young people (under the age of 19) is 1 in every 430-530 and the incidence of type 1 in children under 14 years of age is 24.5/100,000 (Diabetes UK, 2014).

Type 2 diabetes is the result of insulin resistance, meaning that the pancreas does not produce enough insulin or the body’s cells do not respond to the insulin produced.  As type 2 diabetes is a mixed condition, with varying degrees of severity, there are a few methods to manage the disease, including dietary control, medication and insulin injections.

Type 2 diabetes is the most common form of diabetes, affecting 90 percent of individuals with diabetes, and has now become a global burden.  The global prevalence of diabetes has almost doubled from 4.7 percent in 1980 to 8.5 percent in 2014, with a total of 422 million adults living with diabetes in 2014.  It is expected to rise to 592 million by 2035.  In 2012, diabetes accounted for 1.5 million deaths globally with hypertension causing a further 2.2 million deaths.  43 percent of these deaths occurred before 70 years of age.  Previously type 2 diabetes was commonly seen in young adults but is now commonly seen in children as well.  In 2017, 14% more children and teenagers in the UK were treated for diabetes compared to the year before (World Health Organization, 2016).

In both forms of diabetes, hyperglycemia can occur which can lead to number of associated complications including renal disease, cardiovascular disease, nerve damage and retinopathy.

 

The novel subgroups of adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables – peer-review study

This new research studied 13,270 individuals from different demographic cohorts with newly diagnosed diabetes, taking into consideration body weight, blood sugar control and the presence of antibodies, in Sweden and Finland.

This peer-reviewed study identified 5 disease clusters of diabetes, which have significantly different patient characteristics and risk of diabetic complications.  The researchers also noted that the genetic associations in the clusters differed from those seen in traditional type 2 diabetes.

Cluster One – Severe autoimmune diabetes (SAID)

SAID is similar to type 1 diabetes.  SAID manifests in childhood, in patients with a low BMI, have poor blood sugar and metabolic control due to insulin deficiency and GADA.  6% of individuals studied in the ANDIS study were identified with having SAID.

Cluster Two – Severe insulin-deficient diabetes (SIDD)

SIDD is similar to SAID, however, GADA is negative.  This means that the characteristics of SIDD are the same as SAID, young, of a healthy weight and struggled to make insulin, however, SIDD is not the result of an autoimmune disorder as no autoantibodies are present.  Patients have a higher risk of diabetic retinopathy.  18% of subjects in the ANDIS study were identified with having SIDD.

Cluster Three – Severe insulin-resistant diabetes (SIRD)

SIRD is similar to that of type 2 diabetes and is characterised by insulin-resistance and a high BMI.  Patients with SIRD are the most insulin resistant and have a significantly higher risk of kidney disease, and microalbuminuria, and non-alcoholic fatty liver disease.  15% of subjects in the ANDIS study were identified as having SIRD.

Cluster Four – Mild obesity-related diabetes (MOD)

MOD is a mild form of diabetes which generally affects a younger age group. This is not characterised by insulin resistance but by obesity as their metabolic rates are close to normal.  22% of subjects in the ANDIS study were identified as having MOD.

Cluster Five – Mild age-related diabetes (MARD)

MARD is the most common form of diabetes manifesting later in life compared to the previous four clusters.  Patients with MARD have mild problems with glucose regulation, similar to MOD.  39% of subjects in the ANDIS study were identified with having MARD.

This new sub-classification of diabetes could potentially enable doctors to effectively diagnose diabetes earlier, through the characterisation of each cluster, including: BMI measurements, age, presence of autoantibodies, measuring HbA1c levels, ketoacidosis, and measuring fasting blood glucose levels.  This will enable a reduction in the incidence of diabetes complications and the early identification of associated complications, and so patient care can be tailored, thus improving healthcare (NHS, 2018) (The Week, 2018) (Ahlqvist, et al., 2018) (Collier, 2018) (Gallagher, 2018).

The Randox diabetes reagents cover the full spectrum of laboratory testing requirements from risk assessment, using our Adiponectin assay, to disease diagnosis and monitoring, using our HbA1c, glucose and fructosamine assays, to the monitoring of associated complications, using our albumin, beta-2 microglobulin, creatinine, cystatin c, d-3-hydroxybutyrate, microalbumin and NEFA assays.

Whilst this study is valuable, alone it is not sufficient for changes in the diabetes treatment guidelines to be implemented, as the study only represents a small proportion of those with diabetes.  For this study to lead the way, the clusters and associated complications will need to be verified in ethnicities and geographical locations to determine whether this new sub-stratification is scientifically relevant.

 

References

Ahlqvist, E. et al., 2018. Novel subgroups of adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables. [Online]
Available at: http://www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30051-2/fulltext?elsca1=tlpr
[Accessed 16 April 2018].

Collier, J., 2018. Diabetes: Study proposes five types, not two. [Online]
Available at: https://www.medicalnewstoday.com/articles/321097.php
[Accessed 16 April 2018].

Diabetes UK, 2014. Diabetes: Facts and Stats. [Online]
Available at: https://www.diabetes.org.uk/resources-s3/2017-11/diabetes-key-stats-guidelines-april2014.pdf
[Accessed 16 April 2018].

Gallagher, J., 2018. Diabetes is actually five seperate diseases, research suggests. [Online]
Available at: http://www.bbc.co.uk/news/health-43246261
[Accessed 16 April 2018].

NHS, 2018. Are there actually 5 types of diabetes?. [Online]
Available at: https://www.nhs.uk/news/diabetes/are-there-actually-5-types-diabetes/
[Accessed 16 April 2018].

The Week, 2018. What are the five types of diabetes?. [Online]
Available at: http://www.theweek.co.uk/health/92048/what-are-the-five-types-of-diabetes
[Accessed 16 April 2018].

World Health Organization, 2016. Global Report on Diabetes, Geneva: World Health Organization.

If you are a clinician, dietitian or laboratory who are interested in running diabetes assays, Randox offer a wide range of high-quality routine and niche assays including: fructosamine, glucose, HbA1c for diagnosing and monitoring diabetes, albumin, beta-2 microglobulin, creatinine, cystatin c, NEFA, microalbumin, and d-3-hydroxybutyrate to monitor associated complications, and adiponectin  as a biomarker for diabetes risk assessment.  These assays can be run on most automated biochemistry analysers.

Instrument Specific Applications (ISA’s) are available for a wide range of biochemistry analysers. Contact us to enquire about your specific analyser.

For more information, visit: https://www.randox.com/diabetes-reagents or email: reagents@randox.com 


How Randox is helping to diagnose metabolic conditions

Metabolic health is a term used to describe a collection of required chemical reactions that take place in all living organisms. A metabolic disorder develops when an abnormal chemical reaction occurs which alters the normal metabolic process.

A common misconception surrounding metabolic health is that it refers solely to your weight, and if you are overweight you are considered to be unhealthy. But in actual fact this may not be entirely true. Good metabolism means that your body is in good overall health, which doesn’t account for just your weight! Common metabolic disorders include genetic metabolic disorders, diabetes and metabolic syndrome. Understanding and testing to see how well your metabolism is functioning is key to ensuring long lasting health.

Genetics

There are a number of genetic metabolic disorders caused by mutations of single genes. Examples of common disorders include Gaucher’s disease, hemochromatosis and cystic fibrosis. Gaucher’s disease is a genetic disorder that affects the body’s ability to break down fat that can accumulate in the liver/spleen and bone marrow. Hemochromatosis is a condition that is caused by the over-absorption and build-up of iron while cystic fibrosis is a metabolic disorder that appears as a result of a build-up of mucus in lungs/liver and intestines. Each of these metabolic disorders affect certain organs from functioning properly and therefore your overall healthiness.

Diabetes

Type 2 diabetes is one of the most common types of  metabolic disorders in the world that is expected to affect 592 million people by 2035. It is characterised by high blood sugar, insulin resistance or a lack of insulin being produced by the pancreas. Insulin resistance occurs when the body isn’t able to use insulin the right way which increases blood glucose levels. Insulin is needed for cells to take in glucose (sugar) from the bloodstream and convert it into energy. Over time this lack of insulin can damage the organs in your body.

Metabolic Syndrome

Metabolic syndrome (also known as syndrome X, Reaven’s syndrome, and CHAOS) is not a disease but a collection of risk factors that affect your health; these include high blood pressure, high blood sugar/cholesterol and abdominal fat. Left untreated, these risk factors, together, can lead to long term serious problems including an increased risk of heart disease, stroke and developing type 2 diabetes.

Can you improve your metabolic health?

Yes! The good news is that if you discover that your metabolic health is not up to scratch you can improve it through a combination of diet, exercise and lifestyle adjustments such as:

  • 30 minutes of moderate to intense exercise 5-7 times a week
  • Low-dose aspirin to reduce your risk of stroke or heart attack
  • Quit smoking
  • Medication for blood pressure/cholesterol/ blood sugar
  • Limit alcohol intake
  • Eat a healthy balanced diet

Related Products 

Randox has developed the RX series of clinical chemistry analysers for superior semi-automated and fully automated testing. The RX series extensive dedicated test menu goes beyond routine testing and has many unique and high-performance tests available. Our range of tests covers several parameters to assess your overall metabolic health.

Metabolic Health Profile

Albumin Chloride Potassium
Alkaline Phosphatase  C0Total Sodium
ALT Creatinine Total Bilirubin
AST (GOT) Glucose Total Protein
Direct Bilirubin Lactate Urea
Calcium

The RX series clinical chemistry analysers provide laboratories with a robust and smart solution ensuring you maintain a consistent workflow and can provide accurate results first time, every time. Offering excellent customer support services, our trained engineers are on hand to work with you in preserving the continuity of your operations while maximising the potential of your RX series instrument. Our world-famous test menu of high quality reagents ensures excellence in patient care, guaranteeing unrivalled precision and accuracy reducing costly test re-runs or misdiagnosis and offering complete confidence in results.

For more information visit: https://www.randox.com/clinical-chemistry-analysers/

 

 

 


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