Professional flash glucose monitoring and health service utilisation in type 2 diabetes: A secondary analysis of the GP-OSMOTIC study

AimProfessional flash glucose monitoring involves people with diabetes wearing a glucose monitor for up to two weeks, with the data downloaded by their health professional, and the information used to help guide treatment. This study describes if professional flash glucose monitoring was associated with a change in health services utilisation.MethodsAdministrative claims data from three data sources were linked to 288 participants from the GP-OSMOTIC study, a randomised controlled trial evaluating the use of professional flash glucose monitoring versus usual care in people with type 2 diabetes in primary care. Generalised linear models with the Poisson family speci?ed and log link function were used to compare general practice consultations between the intervention and control groups at 0?6- and 6?12-month time points, with adjustment for baseline health services utilisation.ResultsGP consultations increased in the flash glucose monitoring group in the 6 months following initial flash glucose monitoring sensor application from a median (IQR) 6 (4,9) to 8 (5,11); (P < 0.001). Participants in the professional FGM group were 1.2 times (95 % CI 1.1–1.4 (P = 0.0014)) more likely at 6?12 months to have GP consultation visits.ConclusionsAdministrative claims data identified changes in health services utilisation associated with professional flash glucose monitoring, despite minimal changes in glycaemic control.     

Identifying risk factors for very preterm birth: A reference for clinicians

Objective

to provide an accessible list of individual and population-based risk factors associated with very preterm birth to assist care providers in planning appropriate pregnancy care.

Design

a population-based case-control study.

Setting

Victoria, Australia.

Participants

women were recruited from April 2002 to 2004. Cases had a singleton birth between 20 and 31+6 weeks gestation and controls were a random selection of women having a birth of at least 37 weeks gestation in the same time period as the cases.

Measurements and findings

structured interviews were conducted within a few weeks postpartum with 603 cases and 796 controls. Data were collected on sociodemographic factors; obstetric and gynaecological history; and maternal health problems, both pre-existing and occurring during the index pregnancy. Risk factors were calculated.

Key conclusions

when correlated, risk factors were grouped as either lifestyle or maternal health factors. The majority of the risks were obstetric or gynaecological factors. Risks occurring in pregnancy may precipitate preterm birth.

Implications for practice

knowing the risk factors for very preterm birth is likely to be helpful for pregnancy care providers. The development of a risk factor checklist based on the findings presented here may enable more informed planning of care and timely intervention.     

Draft genome of the globally widespread and invasive Argentine ant (Linepithema humile)

Ants are some of the most abundant and familiar animals on Earth, and they play vital roles in most terrestrial ecosystems. Although all ants are eusocial, and display a variety of complex and fascinating behaviors, few genomic resources exist for them. Here, we report the draft genome sequence of a particularly widespread and well-studied species, the invasive Argentine ant (Linepithema humile), which was accomplished using a combination of 454 (Roche) and Illumina sequencing and community-based funding rather than federal grant support. Manual annotation of >1,000 genes from a variety of different gene families and functional classes reveals unique features of the Argentine ant's biology, as well as similarities to Apis mellifera and Nasonia vitripennis. Distinctive features of the Argentine ant genome include remarkable expansions of gustatory (116 genes) and odorant receptors (367 genes), an abundance of cytochrome P450 genes (>110), lineage-specific expansions of yellow/major royal jelly proteins and desaturases, and complete CpG DNA methylation and RNAi toolkits. The Argentine ant genome contains fewer immune genes than Drosophila and Tribolium, which may reflect the prominent role played by behavioral and chemical suppression of pathogens. Analysis of the ratio of observed to expected CpG nucleotides for genes in the reproductive development and apoptosis pathways suggests higher levels of methylation than in the genome overall. The resources provided by this genome sequence will offer an abundance of tools for researchers seeking to illuminate the fascinating biology of this emerging model organism.     

Bactericidal/permeability-increasing protein (rBPI21) and fluoroquinolone mitigate radiation-induced bone marrow aplasia and death

Identification of safe, effective treatments to mitigate toxicity after extensive radiation exposure has proven challenging. Only a limited number of candidate approaches have emerged, and the U.S. Food and Drug Administration has yet to approve any agent for a mass-casualty radiation disaster. Because patients undergoing hematopoietic stem cell transplantation undergo radiation treatment that produces toxicities similar to radiation-disaster exposure, we studied patients early after such treatment to identify new approaches to this problem. Patients rapidly developed endotoxemia and reduced plasma bactericidal/permeability-increasing protein (BPI), a potent endotoxin-neutralizing protein, in association with neutropenia. We hypothesized that a treatment supplying similar endotoxin-neutralizing activity might replace the BPI deficit and mitigate radiation toxicity and tested this idea in mice. A single 7-Gy radiation dose, which killed 95% of the mice by 30 days, was followed 24 hours later by twice-daily, subcutaneous injections of the recombinant BPI fragment rBPI21 or vehicle alone for 14 or 30 days, with or without an oral fluoroquinolone antibiotic with broad-spectrum antibacterial activity, including that against endotoxin-bearing Gram-negative bacteria. Compared to either fluoroquinolone alone or vehicle plus fluoroquinolone, the combined rBPI21 plus fluoroquinolone treatment improved survival, accelerated hematopoietic recovery, and promoted expansion of stem and progenitor cells. The observed efficacy of rBPI21 plus fluoroquinolone initiated 24 hours after lethal irradiation, combined with their established favorable bioactivity and safety profiles in critically ill humans, suggests the potential clinical use of this radiation mitigation strategy and supports its further evaluation.     

Cytochrome P450 2D6 phenotyping in an elderly population with dementia and response to galantamine in dementia: a pilot study

Background

The cytochrome P450 (CYP) 2D6 enzyme is involved in the metabolism of many drugs used by the elderly population. Variations in its activity can lead to altered drug response. However, few studies on the activity of this enzyme system have enrolled the elderly population.

Objective

The goal of this pilot study was to assess the feasibility of in vivo phenotyping of CYP2D6 in an elderly population with dementia and to determine if part of the variability in response to treatment with galantamine is attributable to CYP2D6 phenotype.

Methods

Patients with dementia attending geriatric clinics and receiving galantamine treatment for at least 6 months were enrolled in this case-control study. CYP2D6 phenotype was determined by analysis of the urinary concentrations of the probe drug dextromethorphan and its primary metabolite dextrorphan after ingestion of 30 mg of dextromethorphan. Patients were classified as robust responders to galantamine if their cognitive testing, as measured by using scores on the Mini–Mental State Examination or Alzheimer's Disease Assessment Scale–Cognitive subscale, had not changed or had improved after 6 months of treatment.

Results

Forty-three patients (23 men, 20 women; mean age, 78.4 years; 98% white) underwent phenotyping. The mean number of concomitantly prescribed medications was 5.7, and 16 patients (37%) were receiving other CYP2D6 substrate or inhibitor drugs. The distribution of CYP2D6 phenotype was similar to that seen in other white populations. There was no correlation between the phenotypic metabolic ratio and age, the number of routinely taken medications, whether patients were receiving other prescribed substrate or inhibitor drugs of CYP2D6 (P = 0.63), or whether they were a robust responder (P = 0.47).

Conclusions

Urinary assays of CYP2D6 phenotype are technically feasible in older individuals with dementia who are taking multiple medications, and may be a useful clinical tool in this population. However, the study was unable to make inferences about an association between CYP2D6 phenotype and galantamine responsiveness.     

Investigation into stutter ratio variance

The number of criminal cases involving Turkish juveniles has increased in recent years. To date, there is no method for chronological age estimation according to third-molar mineralization in Western Turkish children and adolescents. The aim of this study was to investigate the mandibular third molar development according to the eight stages (A–H) of the Demirjian method and to compare third-molar development according to gender and age with previous data. The digital orthopantomograms of 1120 white Turkish children (406 boys, mean age 15.17 ± 3.80 years, and 714 girls, mean age 16.83 ± 3.59 years) aged 7 to 22 years, from the Western Anatolia region were retrospectively reviewed. The Turkish population reached stage H at a mean age of 20 years in both genders. Dental mineralization in Western Turkish children was delayed at stages D–G but advanced at stage H compared with that in Turkish children in other regions. Third molar root development can reliably estimate the mean age and age range for a juvenile of unknown chronological age, especially compared with the standard deviation obtained using other techniques for calculating the skeletal age of the hand-wrist or long bones.