Accessing diabetes care in rural Uganda: Economic and social resources

Non-communicable diseases including type 2 diabetes (T2D) are increasing rapidly in most Sub-Saharan African (SSA) countries like Uganda. Little attention has been given to how patients with T2D try to achieve treatment when the availability of public health care for their disease is limited, as is the case in most SSA countries. In this paper we focus on the landscape of availability of care and the therapeutic journeys of patients within that landscape. Based on fieldwork in south-western Uganda including 10 case studies, we explore the diabetes treatment options in the area and what it takes to access the available treatment. We analyse the resources patients need to use the available treatment options, and demonstrate that the patients’ journeys to access and maintain treatment are facilitated by the knowledge and support of their therapy management groups. Patients access treatment more effectively, if they and their family have money, useful social relations, and knowledge, together with the capacity to communicate with health staff. Patients coming from households with high socio-economic status (SES) are more likely to have all of these resources, while for patients with low or medium SES, lack of economic resources increases the importance of connections within the health system.     

Secondary Prevention of Cardiovascular Disease in Older Adults

Atherosclerotic cardiovascular disease is extremely common in older adults and the potential benefits of secondary prevention are perhaps greater in this population than in younger patients. While there is good evidence that secondary prevention efforts are justified in patients up to 80 years of age, limited data are available on secondary prevention in octogenarians and there is no evidence to guide treatment in patients ≥ 90 years of age. Further, the value of secondary prevention may be confounded by prevalent comorbidities, polypharmacy, and limited life expectancy. It is therefore essential that all management decisions be made in relation to individual preferences and goals of care, with understanding by patients that benefits as well as risks may increase with age. Furthermore, research is needed to refine markers to better delineate which older adults are most likely to benefit from preventive therapies.     

大连地区冬春季孕早期维生素D水平与妊娠期糖尿病的关系研究

目的 探讨大连地区冬春季孕早期维生素D(vitamin D,VD)水平对妊娠期糖尿病发病率的影响.方法 选择2016年10月至2017年5月于大连市妇幼保健院产检的初产、单胎孕妇470例,测定其体内维生素D、空腹静脉血糖水平,根据其体内维生素D水平,分为正常组53例、不足组241例和缺乏组176例.对于不足组及缺乏组随机分为试验组和对照组,试验组(分别记为不足试验组,缺乏试验组)每日给予VD滴剂胶囊1200IU(3粒),口服.对照组(分别记为不足对照组,缺乏对照组)及正常组给予每日VD滴剂胶囊400 IU(1粒),口服.随访各组至孕24 ～ 28周妊娠期糖尿病的发生及维生素D缺乏的改善情况.结果 正常组GDM发生率低于不足及缺乏组(P＜0.05),试验组孕妇GDM的发生率较对照组有所降低,但差异不具有统计学意义(P＞0.05).试验组维生素D水平较治疗前显著升高,差异具有统计学意义(P＜0.01).正常组和对照组治疗后维生素D水平有所提高,但与治疗前比较,差异不具有统计学意义(P＞0.05).结论 孕早期VD水平缺乏、不足孕妇妊娠期糖尿病发生率较高;每日补充维生素D 1200 IU,可提高体内维生素D水平,但未降低妊娠期糖尿病发病率.     

Vascular and metabolic effects of angiotensin II receptor blockers

Angiotensin II receptor blockers (ARBs) are widely used in patients with hypertension, heart failure and type 2 diabetes mellitus (T2DM). Several large clinical trials have demonstrated that these agents are effective in reducing cardiovascular mortality and morbidity. These benefits are partly independent of the degree of blood pressure reduction and most likely related to ARBs' anti-inflammatory, metabolic and vascular effects. Clinical studies showed that the anti-inflammatory effect of ARBs could be related to the dosage and/or the length of the treatment. In large clinical trials, ARBs have inconsistently reduced the risk of new-onset T2DM. Among ARBs, only losartan significantly reduced serum uric acid levels. Moreover, it has been demonstrated that ARBs improve endothelial dysfunction in patients with hypertension and/or coronary artery disease (CAD), while all but one of the studies proved that these agents could usually, after 6 – 12 months of therapy, induce regression of vascular hypertrophy in hypertensive patients. These positive effects could be relevant to vascular protection and, together with the blood pressure reduction, constitute the background of the improved outcome observed in clinical studies on mortality and/or morbidity in hypertensive, high-risk and CAD patients. The clinical significance of the different potency of ARBs needs to be investigated further in specific and adequately powered trials.     

CCR2 and CCR5 chemokine receptors differentially influence the development of autoimmune diabetes in the NOD mouse

The infiltration of monocytes represents an important early event in the development of autoimmune diabetes in NOD mice. Given that chemokines are key regulators of leukocyte trafficking, we examined the requirement for the chemokine receptors β(CC)-chemokine receptor-5 (CCR5) and β(CC)-chemokine receptor-2 (CCR2), which recruit monocytes, in disease development in the NOD mouse. Whereas the onset of diabetes was significantly delayed in CCR2-/-NOD mice (25% at 30 weeks) compared to NOD mice (50% at 28 weeks), the pathogenesis of diabetes was accelerated in CCR5-/-NOD mice (75% at 23 weeks). The rapid development of diabetes in CCR5-/-NOD mice was associated with aggressive destructive insulitis and was accompanied by altered leukocyte migration into islets. In contrast, CCR2-/- NOD mice exhibited delayed inflammatory cell recruitment. Nevertheless, total diabetogenic splenocytes from CCR2-/-NOD and CCR5-/-NOD showed similar capability to adoptively transfer diabetes into NOD.scid recipients. Importantly, our data suggest that targeting of CCR2 may lead to therapies against Type 1 diabetes.     

A baffling case of bulging belly

PREVIEW

Although primary pulmonary hypertension is rare, its incidence has increased with use of dexfenfluramine-derived anorexigens. Therefore, physicians should be alert for signs of the condition, which usually progresses rapidly and leads to right ventricular failure within a few years. In this article, the authors discuss triggers and presentation of primary pulmonary hypertension. They also provide a diagnostic algorithm and a summary of therapeutic methods that can improve quality of life and extend survival. Part 1 of this article, which described normal pulmonary vascular physiology and secondary pulmonary hypertension, appeared in the February 1999 issue.     

Dipeptidyl peptidase-4 inhibitors for the treatment of type 2 diabetes: comparison,efficacy and safety

Introduction: Dipeptidyl peptidase (DPP)-4 inhibitors belong to one class of drugs that have been approved for treatment of type 2 diabetes (T2D) based on the glucose-lowering actions of the gastrointestinal hormone glucagon-like peptide (GLP)-1. Several different compounds are now available, and although their mechanism of action (inhibition of the catalytic activity of DPP-4) is the same, there are fundamental differences between them.

Areas covered: The authors discuss the differences between different DPP-4 inhibitors and review their therapeutic efficacy and key safety data. The literature covered includes original studies and meta-analyses identified in PubMed, recent abstracts presented at major diabetes scientific conferences, and clinical trials registered at ClinicalTrials.gov.

Expert opinion: Although there are some differences in the pharmacokinetic and pharmacodynamic profiles of the different DPP-4 inhibitors, all are small orally active compounds with broadly similar HbA1c-lowering efficacy. They improve glycaemic control in T2D, without increasing the risk of hypoglycaemia or causing weight gain. They can be used as monotherapy or in combination with other anti-diabetic therapies, including insulin, regardless of renal or hepatic function, and are efficacious across the spectrum of patients with T2D, including those with long-standing disease duration. DPP-4 inhibitors may also have beneficial effects beyond glycaemic control, although this remains to be demonstrated in purpose-designed clinical trials.     

On Prediction of Hearing Disability

The present investigation was performed in order to evaluate the pure-tone frequency and/or averages of frequencies best correlated with speech intelligibility measured by the discrimination score (DS) in quiet and in background noise, and, in addition, indicate a valid low fence of the DS when correlated to a self-assessment procedure. The material comprises 158 male subjects with a median age of 60 years, range 52-72 years, drawn from an ongoing longitudinal epidemiological investigation. By self-assessment 36% indicated hearing disability in noisy backgrounds, while 64% had no hearing problems. The pure-tone frequency that correlated best with the speech intelligibility in quiet was the 2-kHz pure-tone frequency. In background noise the best correlation was found with the 3–kHz pure-tone frequency. In the group of subjects with complaints of hearing problems, the median discrimination score in background noise was 84% (IQR 72-92), while in the group of subjects with no complaints the median discrimination score in noise was 92% (IQR 88-96). Based on the results it is concluded that DS in background noise is a valuable measure in the assessment of hearing disability, but no low fence value can be indicated on the basis of the present results.

Le présent projet de recherche fut réalisé en vue d'évaluer la fréquence de son pur et/ou la moyenne des fréquences qui reflètent le mieux l'intelligibilité de la parole mesurée par le score de discrimination dans le silence et dans le bruit, et qui en outre indiquent une limite inférieure valable du score de discrimination lorsqu'on établit une corrélation entre ces fréquences par un processus d'autoévaluation. L'échantillon est extrait d'une investigation épidémiologique longitudinale en cours de réalisation portant sur 158 sujets de sexe masculin, aˇges de 52 à 72 ans (moyenne = 60 ans). Il ressort de l'autoévaluation que 36% des sujets ont indiqué une gěne auditive en ambiance bruyante, alors que 64% des sujets n'ont pas fait état de problèmes auditifs. La fréquence tonale qui donnait le meilleur accord avec l'intelligibilité de la parole dans le silence fut la fréquence 2 kHz. Dans le bruit, la meilleure corrélation a été obtenue avec la fréquence 3 kHz. Dans le groupe de sujets qui font état de problèmes auditifs, le score moyen de discrimination dans le bruit se situe à 84% (IQR 72 à 92), alors que dans le groupe de sujets sans problèmes, le měme score est de 92% (IQR 88 à 96). Sur la base des résultats acquis, on conclut que le score de discrimination dans le bruit donne une mesure valable dans l'étude d'un trouble auditif, mais il n'est pas possible d'indiquer une limite inférieure à partir de ces résultats.     

高校教职工2型糖尿病59例临床分析

目的：探讨2型糖尿病（T2DM）患者的发病情况和综合治疗效果及影响因素。方法：对59例T2DM患者的一般情况、合并症、并发症、ECG表现以及临床综合治疗情况进行分析。结果：高校教职工T2DM患者年龄多为中老年，60岁以上占74．58％，且合并症多，其中合并高血压76．27％，高血脂57．63％，体重异常47．46％，眼病变33．90％，肾病变30．50％。结论：高校T2DM患者教职工T2DM多为中老年患者，绝大多数合并有“三高”及其它并发症，ECG改变明显，同时患者对糖尿病知识的掌握不全面。