Diabetes and biomarkers

Biomarkers play an integral part in conducting clinical trials and treating patients. In most instances, they help medical practitioners, researchers, and regulatory officials make well-informed, scientifically sound decisions. However, in clinical studies, there is often uncertainty in how much weight to place on biomarker results versus clinical outcomes. This uncertainty emanates from opposing goals of the drug approval process. On one hand, the process must ensure that all therapeutics tested are safe and that the benefits outweigh the risks. On the other hand, the process should allow therapies to be accessible to patients as quickly as reasonably possible. Judicious use of biomarkers in the drug development process can bring these goals into alignment. More efficient discovery and use of biomarkers in the development of antidiabetes drugs will depend on advancing our understanding of the pathogenesis of diabetes and especially its macrovascular complications.     

Diabetes specialist nurses and role evolvement: a survey by Diabetes UK and ABCD of specialist diabetes services 2007

Aims To review the working practices of UK diabetes specialist nurses (DSNs), specific clinical roles, and to examine changes since 2000. Methods Postal questionnaires were sent to lead DSNs from all identifiable UK diabetes centres (n = 361). Quantitative and qualitative data were collected on the specific clinical roles, employment, and continual professional development of hospital and community DSNs, Nurse Consultants and Diabetes Healthcare Assistants. Results 159 centres (44%) returned questionnaires. 78% and 76% of DSNs plan and deliver education sessions compared with 13% in 2000 with a wider range of topics and with less input from medical staff. 22% of DSNs have a formal role in diabetes research compared with 48% in 2000. 49% of Hospital DSNs, 56% of Community DSNs and 66% of Nurse Consultants are involved in prescribing. 55% of DSNs carry out pump training, 72% participate in ante‐natal and 27% renal clinics. 90% of services have independent diabetes nurse‐led clinics. 93% of services have a dedicated Paediatric DSN. The mean number of children under the care of each PDSN is 109 (mode 120), which exceeds Royal College of Nursing recommendations. 48% of DSNs have protected time for continuing professional development of staff and 15% have a protected budget. One third of DSNs are on short‐term contracts funded by external sources. Conclusions The DSN role has evolved since 2000 to include complex service provision and responsibilities including specialist clinics, education of healthcare professionals and patients. The lack of substantive contracts and protected study leave may compromise these roles in the future.     

Diabetes UK funded surveys of the structural provision of primary care diabetes services in the UK

Aim To describe diabetes service provision in primary care in the UK. Methods Postal questionnaires were sent to all UK primary care organizations (PCOs), and to a sample of general practices in England and all practices in Wales and Scotland. The data collection period ended on 30 April 2001. Results Seventy‐nine per cent of the PCOs and 40% of the practices provided usable information. There is evidence that respondents were not significantly biased in relation to their interest in diabetes care. Diabetes was included as a Health Improvement Programme (or equivalent) priority by 62% of PCOs and had been identified as a clinical governance priority by 27%. Sixty‐five per cent had information about the ethnic composition of their general population, 57% had an estimate of the number of people with diabetes. Sixty‐nine per cent had a local diabetes register but this was said to cover the entire local population in only 64% of these. At least one audit of diabetes care had been carried out (in the previous 5 years) in 75% and, in 76%, clinical guidelines on diabetes care were made available to practices. In the practices, 80% had a designated lead person for diabetes. Seventy‐three per cent had at least one general practitioner with a special interest and 87% at least one nurse. Seventy‐two per cent of practices ran specific diabetes clinics and 51% had a screening policy. Eighty‐six per cent considered that they had adequate systems in place for the delivery of diabetes care. However, only 6% were able to offer a dedicated diabetes telephone help or advice line and only 9% an evening out of hours clinic. Regular practice meetings were held to discuss diabetes in 35%, whereas 39% had a formal shared care protocol. Fourteen per cent held regular joint meetings with the hospital‐based team and in 38% there was membership of Diabetes UK for at least one partner or the practice itself. A third (34%) of responding practices were unsure whether a Local Diabetes Services Advisory Group or equivalent existed in their area. Geographical differences in service provision were identified with, for example, practices in London having fewer components in place that were specifically related to the provision of diabetes care. Single‐handed practices, wherever they were situated, had in place fewer staff and facilities specifically for diabetes care.     

Computerized Learning Technologies for Diabetes: A Systematic Review

Background

The objective of this study was to evaluate computerized learning technology interventions that can empower patients in the self-management of diabetes and support diabetes education over a distance.

Methods

We searched Medline (1966–2006), CINAHL (1982–2006), and the Cochrane Central Register of Controlled Trials (first quarter 2007) databases. We also reviewed reference lists from included studies to identify additional studies. We included 25 articles representing 21 randomized controlled trials that evaluated a computerized learning technology and measured the outcome of patient care. We extracted patient sample, intervention, educational content topics, outcome measures, and statistical significance.

Results

Of 21 eligible trials, 18 trials (85.7%) reported significant positive outcomes. Almost 44% (43.8%) of the outcomes demonstrated significant improvements (49 of 112 outcomes).

Conclusions

Patient self-management behaviors are important in chronic disease management, and initial evidence suggests that computerized learning technology interventions can play a significant role in the future.     

关注卒中相关性肺炎

视神经脊髓炎(neuromyelitis optica,NMO)是以视神经和脊髓受累为主的中枢神经系统自身免疫脱髓鞘病.由于与多发性硬化(multiple sclerosis,MS)有很多相同点和不同点,NMO分类归属问题历经几次更改.直到最近NMO特异性抗体NMO-IgG和其靶抗原水通道蛋白4(aquaporin-4,AQP-4)的发现[1-2],打开了认识NMO的更广阔视野,使目前多数学者倾向于NMO是独立于多发性硬化的疾病,二者均属于中枢神经系统炎性脱髓鞘病的亚型,并且以往诊断多发性硬化者,按照目前应用Wingerchuk等[3]的诊断标准,也有一部分符合NMO,如伴有脑部病灶并不是NMO的排除标准等,使NMO所包括的疾病形式更广泛.     

Childhood diabetes, insulin, and Africa. DERI (Diabetes Epidemiology Research International) Study Group.

Mortality associated with Type 1 (insulin-dependent) diabetes has perceptually declined with the identification and widespread use of insulin. In the pre-insulin era, over 80% of all individuals developing diabetes died each year, now less than one in two hundred die. Sadly, this remarkable achievement has not reached the children who develop diabetes in sub-Saharan Africa where the onset of childhood diabetes is the equivalent of a death sentence. Two major issues of importance related to Type 1 diabetes in African and other developing countries are missed diagnosis and unavailability of insulin, issues which cannot be ignored.     

The Potential for Lifestyle Change to Influence the Progression of Impaired Glucose Tolerance to Non-insulin-dependent Diabetes Mellitus

Impaired glucose tolerance (IGT) is well recognized as a risk factor for the development of non-insulin-dependent diabetes mellitus (NIDDM). Detecting IGT offers a unique opportunity for targeting intervention to reduce the incidence of NIDDM. This article reviews current evidence for the efficacy of lifestyle intervention programmes involving people with IGT.     

Reporting of diabetes on death certificates using data from the UK Prospective Diabetes Study.

AIMS: To study the effect of age at death, sex, ethnic group, date of death, underlying cause of death and social class on the frequency of reporting diabetes on death certificates in known cases of diabetes. METHODS: Data were extracted from certificates recording 981 deaths which occurred between 1985 and 1999 in people aged 45 years or more who participated in the UK Prospective Diabetes Study, to which 23 English, Scottish and Northern Ireland centres contributed. Diabetes (9th revision of the International Classification of Diseases; ICD-9 250) entered on parts 1A-1C or 2A-2C of the death certificate was considered as reporting diabetes. Logistic regression analyses were used to determine independent factors associated with the reporting of diabetes. RESULTS: Diabetes was reported on 42% (419/981) of all death certificates and on 46% (249/546) of those with underlying cardiovascular disease causes. Reporting of diabetes was independently associated on all death certificates with per year of age increase (OR 1.02; 95% CI 1.001-1.04, P = 0.037), underlying cause of death (non-cardiovascular causes OR 0.76; 95% CI 0.59-0.98, P = 0.035) and social class (classes I-II OR 1.00; class III OR 1.35; 95% CI 0.96-1.89, P = 0.084, classes IV-V OR 1.48; 95% CI 1.05-2.10, P = 0.027). Stratification by age, sex, and underlying cause of death also revealed significant differences in the frequency of reporting diabetes over time. CONCLUSIONS: The rate of reporting of diabetes on cardiovascular disease death certificates remains poor. This may indicate a lack of awareness of the importance of diabetes as a risk factor for cardiovascular disease.     

A Review of Health Literacy and Diabetes: Opportunities for Technology

Background

The objective of this study was to assess the published literature on health literacy and diabetes, as well as identify opportunities for technology to strengthen information skills and modify behavior to improve diabetes health outcomes.

Methods

Medline (1990–2008), the Cumulative Index to Nursing and Allied Health Literature (1990-2008), and the Education Resources Information Center (1990–2008) were searched, and reference lists from included articles were reviewed to identify additional studies. Articles were included that presented measures of literacy or numeracy specific to diabetes, examined associations between health literacy and diabetes outcomes, or tested a health literacy intervention among persons with diabetes.

Results

Twenty-four articles were included in this review. Five articles reported on measures of literacy or numeracy specific to diabetes. Thirteen of the fifteen cross-sectional studies (87%) associated limited health literacy with poorer diabetes outcomes. Two of the four (50%) health literacy intervention studies lead to improved health outcomes.

Conclusions

The cross-sectional studies provide evidence of an association between health literacy and diabetes outcomes; however, there is a need to design and test strategies to improve diabetes health outcomes that consider health literacy. Information and communication technology opportunities could help to mediate the effect that limited health literacy has on diabetes-related health outcomes.     

糖尿病合并风湿性疾病的发病机制与临床研究

糖尿病是一组以血糖水平升高为特征的代谢性疾病,风湿性疾病是一种主要侵犯关节、肌肉、骨骼及肌腱、韧带、滑囊、筋膜等软组织,并可累及内脏的全身性慢性疾病。现已发现糖尿病对累及软骨、骨、韧带和肌腱等结缔组织病的发展和转归有重要影响。了解糖尿病对结缔组织新陈代谢的影响机制,可延缓疾病的发展,有利于预防和治疗。     

糖尿病微血管病变发生机制研究现状

糖尿病微血管病变是糖尿病慢性并发症的病理基础,病理机制涉及内皮受损及一氧化氮合成减少、多元醇代谢异常、糖化反应的亢进、氧化应激、蛋白激酶C激活等多个方面,现对糖尿病微血管病变的研究现状进行探讨,以提高对糖尿病微血管病变的认识水平。