Postprandial urinary C-peptide creatinine ratios before and during liraglutide treatment were weakly associated with the glycaemic response to treatment. Low pretreatment urinary C-peptide creatinine ratio may be more useful than higher values by predicting poorer glycaemic response.

Background There is a lack of information regarding the provision of parental leave for surgical careers. This survey study aims to evaluate the experience of maternity/paternity leave and views on work–life balance globally. Methods A 55-item online survey in 24 languages was distributed via social media as per CHERRIES guideline from February to March 2020. It explored parental leave entitlements, attitude towards leave taking, financial impact, time spent with children and compatibility of parenthood with surgical career. Results Of the 1393 (male : female, 514 : 829) respondents from 65 countries, there were 479 medical students, 349 surgical trainees and 513 consultants. Consultants had less than the recommended duration of maternity leave (43.8 versus 29.1 per cent), no paid maternity (8.3 versus 3.2 per cent) or paternity leave (19.3 versus 11.0 per cent) compared with trainees. Females were less likely to have children than males (36.8 versus 45.6 per cent, P = 0.010) and were more often told surgery is incompatible with parenthood (80.2 versus 59.5 per cent, P < 0.001). Males spent less than 20 per cent of their salary on childcare and fewer than 30 hours/week with their children. More than half (59.2 per cent) of medical students did not believe a surgical career allowed work–life balance. Conclusion Surgeons across the globe had inadequate parental leave. Significant gender disparity was seen in multiple aspects.

There is mounting evidence that elevated circulating concentrations of glycated insulin play a role in insulin resistance in type 2 diabetes. This study evaluated the secretion of glycated insulin in response to enteral stimulation in type 2 diabetic subjects. Following a mixed meal (450 kcal; 44 % carbohydrate; 40 % fat; 16 % protein), glycated insulin rose 10-fold to peak (60 min) at 104.5 +/- 25.0 pmol/l (p < 0.001), representing 22 % total circulating insulin. The response paralleled early rises in insulin and C-peptide, which peaked at 90 min and were more protracted. Maximum glucose concentrations were observed at 50 min. These data indicate that type 2 diabetic subjects exhibit a rapid meal-induced release of glycated insulin from readily releasable pancreatic beta-cell stores, which might contribute to impaired glucose homeostasis following enteral nutrition.

There was no demonstrable priming effect derived from overnight pulsatile insulin compared with constant insulin infusion on subsequent insulin sensitivity in Type 2 diabetic subjects. The failure of 7-min pulses to exhibit an advantageous effect over 13-min pulses raises questions about the natural frequency of basal insulin pulses and their biological effect.

This study provides information on the prevalence of diabetes mellitus in a group of elderly Chinese subjects aged 60 and above living in the community in Hong Kong, and investigates the sensitivity of the urine sugar, random blood glucose, glycosylated haemoglobin, and fructosamine measurements compared to a glucose tolerance test in screening for diabetes mellitus in this population. Four hundred twenty-seven subjects aged 60 and above were studied. The National Diabetes Data Group Criteria were used for the diagnosis of diabetes. Those with a random blood glucose exceeding 12.5 mmol/1 were considered diabetic , and all of these patients had glycosuria together with elevated total glycosylated haemoglobin and fructosamine concentrations. A diagnostic 75 g oral glucose tolerance test was performed on patients with one or more of the following abnormalities: glycosuria, random plasma blood glucose 7.8 retool/1 to 12.5 mmol/1, glycosylated haemoglobin 8.5%, and fructosamine 2.20 mmol/1. By these criteria, the prevalence of diabetes in this community was found to be 9.8%. An elevated random glucose greater than 11.1 mmol/1 proved to be the only specific method of screening and glycosuria was found to be at least as good as fructosamine and HbAv However, HbA1 is more sensitive than random glucose, glycosuria or fructosamine in detecting impaired glucose tolerance. On the basis of this study, a higher reference range for glycosylated haemoglobin for the elderly alone is also suggested (5.74-9.34%).