bluuebunny/crossref_metadata_2025 huggingface dataset:
Online, Direct-to-Consumer Access to Insulin: Patient Safety Considerations and Reform
Authors: Lovett Kimberly M. , Liang Bryan A. , Mackey Timothy K.
Published: January 2014

The online, direct-to-consumer (DTC) medical marketplace is proliferating more rapidly than regulation is evolving to ensure proper patient safety and public health controls. Along with this growing body of unrestrained medical testing and pharmaceuticals offered DTC online, most types of insulin and insulin administration products may now be purchased without prescriptions or physician guidance. Given the relatively significant risks of insulin use, the abuse potential, the high prevalence of diabetes mellitus, and the rising population of uninsured and underinsured, it is imperative to reform the online DTC medical marketplace to ensure that patient safety and public health are protected.
Blood Glucose Self-Monitoring with a Long-Term Subconjunctival Glucose Sensor
Authors: Müller Achim Josef , Knuth Monika , Nikolaus Katharina Sibylle , Krivánek Roland , Küster Frank , Hasslacher Christoph , Auffarth Gerd Uwe
Published: January 2014

Background:

To evaluate the feasibility of an implantable subconjunctival glucose monitoring system (SGMS) for long-term glucose monitoring, we investigated the in vivo performance of the system.

Method:

The SGMS consists of an implantable ocular mini implant (OMI) and a handheld fluorescence photometer. A clinical study was performed on 47 diabetes patients split into two cohorts. Two different types of OMI were used, with and without a biocompatible surface coating. Duration of the study was 1 year. Correlation between capillary blood glucose and SGMS-derived interstitial fluid glucose was investigated during the first 6 months of the study.

Results:

Both OMI types were tolerated well in the eyes of the patients. At the beginning of the study, the SGMS of both cohorts revealed a high accuracy with mean absolute relative difference (MARD) values of 7–12%. The performance of the uncoated OMIs deteriorated within 3 months of wearing time, exhibiting a MARD value of 20%. The performance of the surface-coated OMIs was preserved longer. Glucose correlation measurement with reasonable results (MARD of 14%) could be performed for up to 6 months of wear.

Conclusions:

The biocompatible surface coating on the OMIs enabled a longer duration of action of up to 6 months compared with 3 months for uncoated implants in a clinical trial.
Harnessing a Nanostructured Fluorescence Energy Transfer Sensor for Quick Detection of Extremely Small Amounts of Glucose
Authors: Zhang Jin , Wang Xianbin , Chen Longyan , Li Jiaxin , Luzak Kevin
Published: January 2014

Fluorescence technique is one of the major solutions for achieving the continuous and noninvasive glucose sensor for diabetes. In this article, a highly sensitive nanostructured sensor is developed to detect extremely small amounts of aqueous glucose by applying fluorescence energy transfer (FRET). A one-pot method is applied to produce the dextran-fluorescein isothiocyanate (FITC)-conjugating mesoporous silica nanoparticles (MSNs), which afterward interact with the tetramethylrhodamine isothiocyanate (TRITC)-labeled concanavalin A (Con A) to form the FRET nanoparticles (FITC-dextran-Con A-TRITC@MSNs). The nanostructured glucose sensor is then formed via the self-assembly of the FRET nanoparticles on a transparent, flexible, and biocompatible substrate, e.g., poly(dimethylsiloxane). Our results indicate the diameter of the MSNs is 60 ± 5 nm. The difference in the images before and after adding 20 μl of glucose (0.10 mmol/liter) on the FRET sensor can be detected in less than 2 min by the laser confocal laser scanning microscope. The correlation between the ratio of fluorescence intensity, I(donor)/I(acceptor), of the FRET sensor and the concentration of aqueous glucose in the range of 0.04–4 mmol/liter has been investigated; a linear relationship is found. Furthermore, the durability of the nanostructured FRET sensor is evaluated for 5 days. In addition, the recorded images can be converted to digital images by obtaining the pixels from the resulting matrix using Matlab image processing functions. We have also studied the in vitro cytotoxicity of the device. The nanostructured FRET sensor may provide an alternative method to help patients manage the disease continuously.
Gel Encapsulation of Glucose Nanosensors for Prolonged In Vivo Lifetime
Authors: Balaconis Mary K. , Clark Heather A.
Published: January 2014

Background:

Fluorescent glucose-sensitive nanosensors have previously been used in vivo to track glucose concentration changes in interstitial fluid. However, this technology was limited because of loss of fluorescence intensity due to particle diffusion from the injection site. In this study, we encapsulated the nanosensors into injectable gels to mitigate nanosensor migration in vivo.

Methods:

Glucose-sensitive nanosensors were encapsulated in two different commercially available gelling agents: gel 1 and gel 2. Multiple formulations of each gel were assessed in vitro for their nanosensor encapsulation efficiency, permeability to glucose, and nanosensor retention over time. The optimal formulation for each gel, as determined from the in vitro assessment, was then tested in mice, and the lifetime of the encapsulated nanosensors was compared with controls of nanosensors without gel.

Results:

Five gel formulations had encapsulation efficiencies of the nanosensors greater than 90%. Additionally, they retained up to 20% and 40% of the nanosensors over 24 h for gel 1 and gel 2, respectively. In vivo, both gels prevented diffusion of glucose nanosensors at least three times greater than the controls.

Conclusions:

Encapsulating glucose nanosensors in two injectable gels prolonged nanosensor lifetime in vivo; however, the lifetime must still be increased further to be applicable for diabetes monitoring.
A Novel Fasting Blood Test for Insulin Resistance and Prediabetes
Authors: Cobb Jeff , Gall Walter , Adam Klaus-Peter , Nakhle Pamela , Button Eric , Hathorn James , Lawton Kay , Milburn Michael , Perichon Regis , Mitchell Matthew , Natali Andrea , Ferrannini Ele
Published: January 2014

Background:

Insulin resistance (IR) can precede the dysglycemic states of prediabetes and type 2 diabetes mellitus (T2DM) by a number of years and is an early marker of risk for metabolic and cardiovascular disease. There is an unmet need for a simple method to measure IR that can be used for routine screening, prospective study, risk assessment, and therapeutic monitoring. We have reported several metabolites whose fasting plasma levels correlated with insulin sensitivity. These metabolites were used in the development of a novel test for IR and prediabetes.

Methods:

Data from the Relationship between Insulin Sensitivity and Cardiovascular Disease Study were used in an iterative process of algorithm development to define the best combination of metabolites for predicting the M value derived from the hyperinsulinemic euglycemic clamp, the gold standard measure of IR. Subjects were divided into a training set and a test set for algorithm development and validation. The resulting calculated M score, MQ, was utilized to predict IR and the risk of progressing from normal glucose tolerance to impaired glucose tolerance (IGT) over a 3 year period.

Results:

MQ correlated with actual M values, with an r value of 0.66. In addition, the test detects IR and predicts 3 year IGT progression with areas under the curve of 0.79 and 0.70, respectively, outperforming other simple measures such as fasting insulin, fasting glucose, homeostatic model assessment of IR, or body mass index.

Conclusions:

The result, Quantose™, is a simple test for IR based on a single fasting blood sample and may have value as an early indicator of risk for the development of prediabetes and T2DM.
Within-Individual Hematocrit Variations and Self-Monitoring of Blood Glucose
Authors: Topping Kaila A. , Cembrowski George S.
Published: January 2014

Many self-monitoring of blood glucose (SMBG) systems have generated artefactually increased glucose results in low-hematocrit patients (e.g., intensive care unit and renal failure patients); conversely, these devices could produce artefactually decreased glucose results in high-hematocrit patients (e.g., neonates). The introduction of hematocrit-independent SMBG systems permits more accurate testing in anemic or polycythemic individuals. In this issue of Journal of Diabetes Science and Technology, Ramljak and coauthors have created glucose bias graphs for 19 common SMBG devices and declared certain systems to be optimally accurate because of insensitivity to hematocrit variation over a broad hematocrit range. Luckily, the average within-individual variation of hematocrit is low (between 2.9 and 3.3%). As such, a larger spectrum of SMBG devices can be regarded as optimally hematocrit independent.
Insulin Depot Formation in Subcutaneous Tissue
Authors: Jockel James P. Leuenberger , Roebrock Philipp , Shergold Oliver A.
Published: January 2014

Background:

The size and geometry of an insulin depot that is formed during subcutaneous administration by an insulin pump is evaluated. A novel method is used to visualize accurately the depot formation for small volumes of insulin (of the order of 10–100 μl) at a given point in time. Conventional visualization methods such as magnetic resonance imaging are unable to provide such accurate measurements because of their coarse imaging resolution and long measurement time.

Methods:

The described method consists of subcutaneously infusing dyed insulin into porcine tissue and subsequently shock freezing it with liquid nitrogen. The frozen sample is then sliced into thin layers using a cryomicrotome. A digital image of each layer is taken and then processed with proprietary software, which identifies the dyed areas on each layer and reconstructs a three-dimensional model of the insulin depot with a planar resolution of 30 × 30 μm2 and a depth resolution of 100 μm. Since this process is not viable for living organisms, porcine tissue was used immediately following slaughter of the animal.

Results:

To date, it is most often assumed that the insulin depot takes the shape of a sphere around the tip of the cannula (e.g., 50 μl insulin equates to a spherical radius of 2.3 mm). However, in practice, such a depot form is never observed. Instead, the insulin depot initially spreads laterally (i.e., parallel) to the skin surface and in the collagen matrix that binds the adipose cells together. The depot outreach increases with larger infused volumes, e.g., maximum outreach measured at 5.0/5.7/7.1 mm (quartiles, n = 17) for 50 μl of infused insulin. Beyond a given infused volume (approximately 100 μl), the insulin also starts to spread perpendicular to the skin surface.

Conclusions:

It is concluded that formation of the insulin depot depends on the opening of channels at the boundaries between adipose cells. Hence the insulin follows a path of least resistance and depot formation is determined by the local structure of the subcutaneous tissue.
Swimming Upstream: Developing and Commercializing Diabetes Products in a Patent Protected World
Authors: Hopkins Brian P. , Miller Katherine J.
Published: January 2014

Many, if not most, commercially available diabetes treatment products are protected by some form of intellectual property. This article discusses the development and commercialization of products in view of the state of intellectual property for the diabetes treatment market, with respect to possible discouragement, for some, from seeking patent protection or commercializing a new product under the belief that patent protection is either unavailable or difficult to come by, or for fear of infringing existing patents. Upon closer investigation, the evolution of technology almost always creates opportunities for new improvements, which likely can be patent protected. Furthermore, while avoiding the claims of existing patents is sometimes challenging and opinion based, and thus not a guarantee of avoiding a patent litigation, patent litigation may be delayed and is often settled early on.
Driving with Diabetes: Precaution, Not Prohibition, is the Proper Approach
Authors: Kohrman Daniel B.
Published: January 2014

Safety issues posed by driving with diabetes are primarily related to severe hypoglycemia, yet some public authorities rely on categorical restrictions on drivers with diabetes. This approach is misguided. Regulation of all drivers with diabetes, or all drivers using insulin, ignores the diversity of people with diabetes and fails to focus on the subpopulation posing the greatest risk. Advances in diabetes care technology and understanding of safety consequences of diabetes have expanded techniques available to limit risks of driving with diabetes. New means of insulin administration and blood glucose monitoring offer greater ease of anticipating and preventing hypoglycemia, and thus, limit driving risk for persons with diabetes. So too do less sophisticated steps taken by people with diabetes and the health care professionals they consult. These include adoption and endorsement of safety-sensitive behaviors, such as testing before a drive and periodic testing on longer trips. Overall, and in most individual cases, driving risks for persons with diabetes are less than those routinely tolerated by our society. Examples include freedom to drive in dangerous conditions and lax regulation of drivers in age and medical cohorts with elevated overall rates of driving mishaps. Data linking specific diabetes symptoms or features with driving risk are quite uncertain. Hence, there is much to recommend: A focus on technological advances, human precautions, and identifying individuals with diabetes with a specific history of driving difficulty. By contrast, available evidence does not support unfocused regulation of all or most drivers with diabetes.
Understanding Heterogeneity in Response to Antidiabetes Treatment: A Post Hoc Analysis Using SIDES, a Subgroup Identification Algorithm
Authors: Hardin Dana S. , Rohwer Rachelle D. , Curtis Bradley H. , Zagar Anthony , Chen Lei , Boye Kristina S. , Jiang Honghua H. , Lipkovich Ilya A.
Published: January 2014

Background:

Treatment response in patients with type 2 diabetes mellitus (T2DM) varies because of different genotypic and phenotypic characteristics. Results of clinical trials are based largely on aggregated estimates of treatment effect rather than individualized outcomes. This research assessed heterogeneity and differential treatment response using the subgroup identification based on differential effect search (SIDES) algorithm with data from a large multinational study.

Methods:

This was a retrospective analysis of the DURABLE trial, a randomized, open-label, two-arm, parallel study. The trial enrolled 2091 insulin-naïve T2DM patients aged 30 to 80 years. Patients received twice-daily insulin lispro mix 75/25 (LM75/25) or once-daily insulin glargine (insulin glargine). The SIDES methodology was used to find subgroups where the treatment effect was substantially different from what was observed in the full population of the clinical trial. A subgroup identification tool implementing the SIDES algorithm was used to examine data for 1092 patients (584 LM75/25 and 508 insulin glargine), achieving at-goal 12- or 24-week glycated hemoglobin A1c (A1C) (≤7.0%).

Results:

The overall at-goal population treatment difference (A1C reduction) was not clinically meaningful, but a clinically meaningful difference was observed (A1C reduction 2.31% ± 0.06% LM75/25 versus 2.01% ± 0.07% insulin glargine; p = .001) in patients with a baseline fasting insulin level >11.4 μIU/ml and age ≤56 years.

Conclusion:

The observation that younger patients with higher levels of fasting insulin may benefit from a regimen that includes short-acting insulin targeting postprandial glycemia helps explain the heterogeneity in response and warrants further investigation.
Enhancing the Sensitivity of Needle-Implantable Electrochemical Glucose Sensors via Surface Rebuilding
Authors: Vaddiraju Santhisagar , Legassey Allen , Qiang Liangliang , Wang Yan , Burgess Diane J. , Papadimitrakopoulos Fotios
Published: January 2014

Objective:

Needle-implantable sensors have shown to provide reliable continuous glucose monitoring for diabetes management. In order to reduce tissue injury during sensor implantation, there is a constant need for device size reduction, which imposes challenges in terms of sensitivity and reliability, as part of decreasing signal-to-noise and increasing layer complexity. Herein, we report sensitivity enhancement via electrochemical surface rebuilding of the working electrode (WE), which creates a three-dimensional nanoporous configuration with increased surface area.

Methods:

The gold WE was electrochemically rebuilt to render its surface nanoporous followed by decoration with platinum nanoparticles. The efficacy of such process was studied using sensor sensitivity against hydrogen peroxide (H2O2). For glucose detection, the WE was further coated with five layers, namely (1) polyphenol (2)glucose oxidase(3) polyurethane (4)catalase, and (5) dexamethasone-releasing poly(vinyl alcohol)/poly(lactic-co-glycolic acid) composite. The amperometric response of the glucose sensor was noted in vitro and in vivo.

Results:

Scanning electron microscopy revealed that electrochemical rebuilding of the WE produced a nanoporous morphology that resulted in a 20-fold enhancement in H2O2 sensitivity, while retaining >98% selectivity. This afforded a 4–5-fold increase in overall glucose response of the glucose sensor when compared with a control sensor with no surface rebuilding and fittable only within an 18 G needle. The sensor was able to reproducibly track in vivo glycemic events, despite the large background currents typically encountered during animal testing.

Conclusion:

Enhanced sensor performance in terms of sensitivity and large signal-to-noise ratio has been attained via electrochemical rebuilding of the WE. This approach also bypasses the need for conventional and nanostructured mediators currently employed to enhance sensor performance.
Practical Use of Self-Monitoring of Blood Glucose Data
Authors: Ginsberg Barry H.
Published: January 2014

Self-monitoring of blood glucose provides information about blood glucose control. The data become useful information and knowledge through careful analysis for patterns that are appropriate or can be corrected. Some analyses can be performed on newer blood glucose meters, but most often, this needs to be done on a computer, tablet, or smartphone. There are a few established methods of presenting the data that make analysis easier. In this article, we discuss four types of data presentations and the methods for utilizing them.
Insulin Bolusing Software: The Potential to Optimize Health Outcomes in Type 1 Diabetes Mellitus
Authors: Driscoll Kimberly A. , Johnson Suzanne Bennett , Hogan John , Gill Elizabeth , Wright Nancy , Deeb Larry C.
Published: January 2014

Background:

Insulin bolusing calculators alleviate the burden of having to calculate insulin bolus doses for patients with type 1 diabetes mellitus (T1DM). Three important pieces of information are needed: A blood glucose monitoring (BGM) result, carbohydrates to be consumed, and the amount of insulin bolus delivered. The purpose of this study was to describe insulin pump adherence behaviors associated with the use of bolus calculators in youth who use Medtronic insulin pumps.

Methods:

Data were downloaded from the MiniMed Paradigm insulin pumps (Medtronic) of 31 youth with T1DM. Areas of adherence that were evaluated included fundamental insulin pump adherence behaviors (e.g., BGM, carbohydrate entry, and insulin bolusing), decisions about Wizard® recommendations, and three Wizard steps: BGM result-carbohydrate input-insulin bolus.

Results:

On average, patients conducted BGM ≤4 times/day on 69% of days, inputted carbohydrates ≤3 times/day on 63% of days, and insulin bolused ≤3 times/day on 85% of days. Participants generally followed Wizard recommendations. Finally, participants completed all three Wizard steps (BGM, carbohydrate input, insulin bolus) within 30 min for an average of 29% of boluses. Almost 3% of boluses that were preceded by Wizard use were delivered without conducting BGM or inputting carbohydrates.

Conclusion:

There was substantial variability in insulin pump adherence behaviors (e.g., days when no BGM occurred, reliance on basal insulin). Interventions targeting insulin pump adherence behaviors have the potential to optimize diabetes health outcomes and glycemic control. Improving insulin pump software reports is one promising avenue for improving adherence.
The Impact of a Decision Support Tool Linked to an Electronic Medical Record on Glycemic Control in People with Type 2 Diabetes
Authors: Gunathilake Waruna , Gunawardena Sajith , Fernando Ranga , Thomson George , Fernando Devaka
Published: January 2014

Aims:

We retrospectively compared glycemic control and glycemic burden in type 2 diabetes patients treated by general physicians with access to decision support with those treated by general physicians without access to decision support.

Methods:

A total of 875 patients [471 (53.8%) males] aged 54.3 [standard deviation (SD) 13.1] years followed up over 84 months. A total of 342 patients (39%) were managed with decision support, and effects on glycosylated hemoglobin (HbA1c) were assessed.

Results:

There was no difference between groups in starting HbA1c [7.6 (SD 1.8) versus 7.5 (SD 1.5); p = not significant] at baseline. Patients treated with decision support were more likely to have planned review of HbA1c, adjustment of medication, prescription of statins, dietetic and nurse educator inputs (71.3% versus 58.5%; Chi squared = 14.7; p = .001). The mean HbA1c in the group treated with decision support was not significantly reduced within the first year [7.5% (SD 1.8) versus 7.6% (SD 1.5); p = not significant; 95% confidence interval (CI) −0.33 to 0.17], but statistically significant differences were apparent at year 2 [7.2% (SD 2.0) versus 8% (SD 3.4); p = .0001; 95% CI −1.3 to −0.5] and sustained through year 3 [7.2% (SD 2.0) versus 8.0% (SD 2.0); p = .0001; 95% CI −1.2 to −0.6], year 4 [7.2% (SD 2.3) versus 8.2% (SD 2.5); p = .0001; 95% CI −1.2 to −0.6], year 5 [7.0% (SD 2.3) versus 8.3% (SD 2.6); p = .001; 95% CI −1.5 to −0.8], year 6 [7.0% (SD 2.0) versus 8.2% (SD 2.4); p = .001; 95% CI −1.5 to −0.9], and year 7 [6.9% (SD 1.2) versus 8% (SD 1.8); p = .001; 95% CI −1.4 to −1.0].

Conclusion:

Use of a decision support system showed benefits in adherence to clinical care pathways and achieving significant improvements in glycemic control.
Impact of Glucose Measurement Processing Delays on Clinical Accuracy and Relevance
Authors: Jangam Sujit R. , Hayter Gary , Dunn Timothy C.
Published: January 2014

Background:

In a hospital setting, glucose is often measured from venous blood in the clinical laboratory. However, laboratory glucose measurements are typically not available in real time. In practice, turn-around times for laboratory measurements can be minutes to hours. This analysis assesses the impact of turn-around time on the effective clinical accuracy of laboratory measurements.

Methods:

Data obtained from an earlier study with 58 subjects with type 1 diabetes mellitus (T1DM) were used for this analysis. In the study, glucose measurements using a YSI glucose analyzer were obtained from venous blood samples every 15 min while the subjects were at the health care facility. To simulate delayed laboratory results, each YSI glucose value from a subject was paired with one from a later time point (from the same subject) separated by 15, 30, 45, and 60 min. To assess the clinical accuracy of a delayed YSI result relative to a real-time result, the percentage of YSI pairs that meet the International Organization for Standardization (ISO) 15197:2003(E) standard for glucose measurement accuracy (±15 mg/dl for blood glucose < 75 mg/dl, ± 20% for blood glucose ≤ 75 mg/dl) was calculated.

Results:

It was observed that delays of 15 min or more reduce clinical accuracy below the ISO 15197:2003(E) recommendation of 95%. The accuracy was less than 65% for delays of 60 min.

Conclusion:

This analysis suggests that processing delays in glucose measurements reduce the clinical relevance of results in patients with T1DM and may similarly degrade the clinical value of measurements in other patient populations.
Nasogastric Aspiration as an Indicator for Feed Absorption in Model-Based Glycemic Control in Neonatal Intensive Care
Authors: Gunn Cameron A. , Dickson Jennifer L. , Hewett James N. , Lynn Adrienne , Rose Hamish J. , Clarkson Sooji H. , Shaw Geoffrey M. , Chase J. Geoffrey
Published: January 2014

Background:

STAR (stochastic targeted) is a glycemic control model-based framework for critically ill neonates that has shown benefits in reducing hypoglycemia and hyperglycemia. STAR uses a stochastic matrix method to forecast future changes in a patient's insulin sensitivity and then applies this result to a physiological model to select an optimal insulin treatment. Nasogastric aspiration may be used as an indicator to suggest periods of care when enteral feed absorption is compromised, improving the performance of glycemic control. An analysis has been carried out to investigate the effect of poorly absorbed feeds on glycemic control.

Method:

Clinical data were collected from eight patients on insulin therapy and enteral feed, which included large or significantly milky aspirates. Patients had a median gestational age of 25 weeks and postnatal age of 5.5 days. Virtual patients were created using the NICING model, and insulin sensitivity ( SI) profiles were fit. Alternative feed profiles were generated whereby enteral feed absorption was redistributed with time to account for poor feed absorption. The effect of poor feed absorption, as indicated by aspirates, is investigated.

Results:

The average percentage change of SI 4 h before a significant aspirate was 1.16%, and 1.49% in the 4 h following the aspirate. No distinct relationship was found between the fractional change in SI and the volume of the aspirate. Accounting for aspirates had a clinically negligible impact on glycemic control in virtual trials. Conclusion: Accounting for aspirates by manipulating enteral feed profiles had a minimal influence on both modeling and controlling glycemia in neonates. The impact of this method is clinically insignificant, suggesting that a population constant for the rate of glucose absorption in the gut adequately models feed absorption within the STAR framework.
Behavioral Health Care for Adolescents with Poorly Controlled Diabetes via Skype: Does Working Alliance Remain Intact?
Authors: Freeman Kurt A. , Duke Danny C. , Harris Michael A.
Published: January 2014

Background:

Increasingly various technologies are being tested to deliver behavioral health care. Delivering services via videoconferencing shows promise. Given that the patient-provider relationship is a strong predictor of patient adherence to medical regimens, addressing relationship quality when services are not delivered face-to-face is critical. To that end, we compared the therapeutic alliance when behavioral health care was delivered to youth with poorly controlled type 1 diabetes mellitus (T1DM) and their caregivers in-clinic with the same services delivered via Internet-based videoconferencing (i.e., Skype™).

Methods:

Seventy-one adolescents with poorly controlled T1DM (hemoglobin A1c ≤9%) and one of their caregivers received up to 10 sessions of a family-based behavioral health intervention previously shown to improve adherence to diabetes regimens and family functioning; 32 were randomized to the Skype condition. Youth and caregivers completed the working alliance inventory (WAI), a 36-item measure of therapeutic alliance, at the end of treatment. Additionally, the number of behavioral health sessions completed was tracked.

Results:

No significant differences in WAI scores were found for those receiving behavioral health care via Skype versus in-clinic. Youth WAI goal and total scores were significantly associated with the number of sessions completed for those in the clinic group.

Conclusion:

Behavioral health can be delivered to youth with T1DM via Internet-based videoconferencing without significantly impacting the therapeutic relationship. Thus, for those adolescents with T1DM who require specialized behavioral health care that targets T1DM management, Internet-based teleconferencing represents a viable alternative to clinic-based care.
Resource Consumption and Costs of Treatment in Patients with Type 1 Diabetes under Intensified Conventional Therapy under German Real-Life Conditions
Authors: Kostev Karel , Dippel Franz-Werner , Bierwirth Ralph
Published: January 2014

Introduction:

The aim of this study was to compare, from the perspective of the statutory health insurance, resource consumption and the associated adjusted treatment costs of intensified conventional therapy (ICT) with long-acting insulins in patients with type 1 diabetes mellitus (T1DM).

Methods:

We identified patients with T1DM who started ICT with either insulin glargine or neutral protamine Hagedorn (NPH) insulin between July 2000 and February 2008 using a representative German database (IMS® Disease Analyzer). The variables age, gender, insurance status, diabetes duration, hemoglobin A1c level, body mass index, and geographic region and specialization of practice were collected. Resource consumption was evaluated over a time period of 12 months and included the quantities of applied basal and bolus insulin, blood glucose test strips, lancets and needles, physician visits (general practitioner, specialist), hospitalization, and antihypoglycemic therapy (intravenous glucose/glucagon).

Results:

A total of 2297 patients with T1DM were included; 1079 received ICT with insulin glargine and 1218 with NPH insulin. After adjustment, annual cost savings in favor of insulin glargine amounted to £423.94 compared with NPH insulin ( p = .3019).

Discussion:

The adjusted results show that an ICT with insulin glargine results in lower annual costs than ICT with NPH insulin (this difference was not statistically significant). However, in the context of glucose-lowering effect and a lower hypoglycemia rate, insulin glargine is preferred to NPH insulin for patients with T1DM undergoing ICT.
Common Standards of Basal Insulin Titration in T2DM
Authors: Arnolds Sabine , Heise Tim , Flacke Frank , Sieber Jochen
Published: January 2014

Type 2 diabetes mellitus has become a worldwide major health problem, and the number of people affected is steadily increasing. Thus, not all patients suffering from the disease can be treated by specialized diabetes centers or outpatient clinics, but by primary care physicians. The latter, however, might have time constraints and have to deal with many kinds of diseases or with multimorbid patients, so their focus is not so much on lowering high blood glucose values. Thus, the physicians, as well as the patients themselves, are often reluctant to initiate and adjust insulin therapy, although basal insulin therapy is considered the appropriate strategy after oral antidiabetic drug failure, according to the latest international guidelines. A substantial number of clinical studies have shown that insulin initiation and optimization can be managed successfully by using titration algorithms—even in cases where patients themselves are the drivers of insulin titration. Nevertheless, tools and strategies are needed to facilitate this process in the daily life of both primary health care professionals and patients with diabetes.
Earnings Announcements and Investor Focus in the Hospitality Industry
Authors: Moulton Pamela C. , Leow Sarah
Published: January 2014

This study examines how the release of multiple firms’ earnings announcements on the same day combines with human attention constraints to affect the trading of hospitality stocks. We document two opposing effects. We find that a rush of earnings announcements from nonhospitality firms leads to investor distraction and reduces the reaction of hospitality stocks to earnings news. Conversely, we find that multiple announcements by firms within the hospitality sector lead to increased investor focus and larger hospitality stock reactions to news. Our results show that multiple announcements can either diminish or enhance investors’ reactions to company news, which directly affects the incorporation of new information into hospitality stock prices.
The Impact of Frontline Employees’ Work–Family Conflict on Customer Satisfaction
Authors: Zhao Xinyuan (Roy) , Mattila Anna S. , Ngan Nei Na
Published: January 2014

When hotel employees feel stress from conflicts between work and family, some of the resulting exhaustion is inevitably reflected in their interactions with customers. This study paired two hundred hotel employees and customers in an analysis of customer satisfaction as it relates to employees’ service behavior, which is affected by the emotional, mental, and physical toll of work–family conflict. Employees’ exhaustion and emotional displays contain a mixed set of effects on customer satisfaction. The findings reveal that employees’ family interfering with work is linked to physical, emotional, and mental exhaustion, while work interfering with family does not have the same effect. Higher levels of physical exhaustion increased the likelihood that employees would display faked positive emotions and simultaneously suppress negative emotions. Customers could spot the fakery, but they judged that the fake positive emotions enhanced the employees’ role performance. At the same time, however, customer satisfaction was diminished when employees’ emotional displays were obviously not genuine. Thus, hotel managers may be interested in determining whether family issues are impinging on employees’ work responsibilities, given that the outcome may be reduced customer satisfaction.
Acquiring Intangible Resources through Entrepreneurs’ Network Ties
Authors: Hsu Cathy H. C. , Liu Zhaoping (George) , Huang Songshan (Sam)
Published: January 2014

Based on two phases of in-depth interviews with entrepreneurs who own China’s economy hotel chains, this research explored these entrepreneurs’ strategies for acquiring intangible resources through network ties and summarized the mix of strong and weak network ties that they used to acquire those resources at different development stages of their new firms. In the early start-up stage, the interviewed entrepreneurs used a mixture of strong and weak ties; in the establishment stage, they relied on strong ties; and in the final growth stage, they did not value network ties and only used weak business ties. Moreover, the network mixes used by these entrepreneurs to acquire different types of intangible resources are not identical. Sourcing human capital was a particularly valuable use of the network ties, both strong and weak, and many of the respondents used their ties to gain essential information and skills for running their hotels. The two-stage data collection revealed the dynamics of entrepreneurs’ network mixes as firms progressed to new development stages.
Smoking Cessation Counseling in Family Medicine
Authors: Johns Tracy L. , Metzger Karl , Lawrence Elizabeth
Published: January 2014

Background: Tobacco use causes significant morbidity and mortality. Although studies show that people who smoke cigarettes are more likely to quit when health care providers recommend cessation, many patients may not perceive that advice was given. Purpose: Using a survey, to determine if a provider visual cue improves patient perception that smoking cessation counseling occurred. Another objective is to evaluate effects on frequency of specific counseling elements. Methods: This was a quasi-experimental intervention study with a pre–post test design. The intervention was a quitline reference card attached to the billing form as a prompt for providers to address smoking cessation. The patient survey included 6 elements, each assigned 1 point. The outcomes were the mean survey summary score preintervention compared to postintervention and the distribution of individual elements. Results: Preintervention, 40 patients who smoke cigarettes completed the survey; 46 patients were enrolled postintervention. The groups were similar, with no significant differences in age, gender, or race/ethnicity. Mean survey summary scores pre- and postintervention were 4.1 and 5.1, respectively ( P < .05). Compared with preintervention, more patients perceived the recommendation for a smoking cessation course postintervention (40% vs 83%, P < .05). No significant differences in perceptions of other counseling elements were found. Conclusions: Providing a visual cue such as a quitline card is an effective and inexpensive means of prompting a provider to discuss smoking cessation and can be easily integrated into practice. Our results indicate that this strategy improves patient perceptions of counseling with potential to improve community health through education.
Factor XII inhibition reduces thrombus formation in a primate thrombosis model
Authors: Matafonov Anton , Leung Philberta Y. , Gailani Adam E. , Grach Stephanie L. , Puy Cristina , Cheng Qiufang , Sun Mao-fu , McCarty Owen J. T. , Tucker Erik I. , Kataoka Hiroaki , Renné Thomas , Morrissey James H. , Gruber Andras , Gailani David
Published: January 2014

Key Points

Factor XII can contribute to thrombus formation in human and nonhuman primate blood. An antibody that blocks factor XII activation (15H8) produces an antithrombotic effect in a primate thrombosis model.
The genetic structure of Arabidopsis thaliana in the south-western Mediterranean range reveals a shared history between North Africa and southern Europe
Authors: Brennan Adrian C , Méndez-Vigo Belén , Haddioui Abdelmajid , Martínez-Zapater José M , Picó F Xavier , Alonso-Blanco Carlos
Published: January 2014

Background

Deciphering the genetic structure of Arabidopsis thaliana diversity across its geographic range provides the bases for elucidating the demographic history of this model plant. Despite the unique A. thaliana genomic resources currently available, its history in North Africa, the extreme southern limit in the biodiversity hotspot of the Mediterranean Basin, remains virtually unknown.

Results

To approach A. thaliana evolutionary history in North Africa, we have analysed the genetic diversity and structure of 151 individuals collected from 20 populations distributed across Morocco. Genotyping of 249 genome-wide SNPs indicated that Morocco contains substantially lower diversity than most analyzed world regions. However, IBD, STRUCTURE and PCA clustering analyses showed that genetic variation is strongly geographically structured. We also determined the genetic relationships between Morocco and the closest European region, the Iberian Peninsula, by analyses of 201 populations from both regions genotyped with the same SNPs. These analyses detected four genetic groups, but all Moroccan accessions belonged to a common Iberian/Moroccan cluster that appeared highly differentiated from the remaining groups. Thus, we identified a genetic lineage with an isolated demographic history in the south-western Mediterranean region. The existence of this lineage was further supported by the study of several flowering genes and traits, which also found Moroccan accessions similar to the same Iberian group. Nevertheless, genetic diversity for neutral SNPs and flowering genes was higher in Moroccan than in Iberian populations of this lineage. Furthermore, we analyzed the genetic relationships between Morocco and other world regions by joint analyses of a worldwide collection of 337 accessions, which detected an additional weak relationship between North Africa and Asia.

Conclusions

The patterns of genetic diversity and structure of A. thaliana in Morocco show that North Africa is part of the species native range and support the occurrence of a glacial refugium in the Atlas Mountains. In addition, the identification of a genetic lineage specific of Morocco and the Iberian Peninsula indicates that the Strait of Gibraltar has been an A. thaliana migration route between Europe and Africa. Finally, the genetic relationship between Morocco and Asia suggests another migration route connecting north-western Africa and Asia.
RETRACTED ARTICLE: Prevalence of
complications among Chinese diabetic patients in urban primary care clinics: a
cross-sectional study
Authors: Kung Kenny , Chow Kai Ming , Hui Eric Ming-Tung , Leung Maria , Leung Shuk Yun , Szeto Cheuk Chun , Lam Augustine , Li Philip Kam-Tao
Published: January 2014

Background

A territory-wide diabetes management program (Risk Assessment Management
Program – RAMP) was recently established, providing comprehensive management for
all diabetics, helping to delineate current level of control and complications
prevalence among primary care diabetic patients in Hong Kong.

Method

This cross-sectional study captured anonymous clinical data from RAMP
patients. Data obtained include sociodemographic details, type of diabetes,
illness duration, family history, drug usage, coexisting illnesses, diabetic
complications and other clinical parameters.

Results

Data from 15,856 type 2 diabetic patients were analyzed. 57.1% were above 60
years old, with mean disease duration of 7.3 years. Hypertension was the commonest
coexisting chronic illness (57.6%). 30.2% and 61.8% have their systolic and
diastolic pressure controlled to below 130 mmHg and 80 mmHg respectively. Over
half (51.5%) had an HbA1c level of less than 7.0%. 88.4% did not achieve target
lipid level. 15% were on diet control alone. Only 22.2% were on statins. In
patients with microalbuminuria and macroalbuminuria, 40.7% and 54.5% were on
angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker
(ARB) respectively. 12.9%, 38.8% and 2.4% had diabetic retinopathy, nephropathy
and neuropathy respectively. Overall, 37.9%, 7.3% and 0.4% had single, two and
three concurrent microvascular complications respectively.

Conclusion

The level of diabetic control is comparable with other developed countries. We
demonstrated a high prevalence of microvascular complications among Chinese
primary care patients despite achieving adequate HbA1c levels, highlighting the
importance of managing all aspects of diabetes including weight, lipid and blood
pressure. Efforts to improve holistic management must be tailored according to the
needs of our population, with the challenges that the majority have low
educational background and in the older age group.
Relationship between menopause and health-related quality of life in middle-aged Chinese women: a cross-sectional study
Authors: Liu Kuo , He Liu , Tang Xun , Wang Jinwei , Li Na , Wu Yiqun , Marshall Roger , Li Jingrong , Zhang Zongxin , Liu Jianjiang , Xu Haitao , Yu Liping , Hu Yonghua
Published: January 2014

Background

Chinese menopausal women comprise a large population and the women in it experience menopausal symptoms in many different ways. Their health related quality of life (HRQOL) is not particularly well studied. Our study intends to evaluate the influence of menopause on HRQOL and explore other risk factors for HRQOL in rural China.

Methods

An interview study was conducted from June to August 2010 in Beijing based on cross-sectional design. 1,351 women aged 40–59 were included in the study. HRQOL was measured using the EuroQol Group’s 5-domain (EQ5D) questionnaire. Comparison of HRQOL measures (EQ5D index and EQ5D-VAS scores) was done between different menopausal groups. Logistic regression and multiple regression analysis were performed to adjust potential confounders and explore other risk factors for health problems and HRQOL measures.

Results

Postmenopausal women who had menopause for 2–5 years (+1b stage) were more likely to suffer mobility problems (OR = 1.835, p = 0.008) after multiple adjustment. Menopause was also related to impaired EQ5D index and EQ5D-VAS scores after adjustment for age. Among menopausal groups categorized by menopausal duration, a consistent decrement in EQ5D index and EQ5D-VAS scores, that is, worsening HRQOL, was observed (p < 0.05). Multiple regression analysis revealed low education level and physical activity were associated with EQ5D index (β = -0.080, p = 0.003, and β = 0.056, p = 0.040, respectively). Cigarette smoking and chronic disease were associated with EQ5D index (β = -0.135, p < 0.001 and β = -0.104, p < 0.001, respectively) and EQ5D-VAS (β = -0.057, P = 0.034 and β = -0.214, p < 0.001, respectively).

Conclusions

Reduction in physical function was found within the first five years after menopause. Worsening EQ5D index and EQ5D-VAS scores were related to menopause. Education level, physical activity, cigarette smoking, and chronic disease history were associated with HRQOL in middle aged Chinese rural women.
Glucosidase inhibitory activity and antioxidant activity of flavonoid compound and triterpenoid compound from Agrimonia Pilosa Ledeb
Authors: Liu Xi , Zhu Liancai , Tan Jun , Zhou Xuemei , Xiao Ling , Yang Xian , Wang Bochu
Published: January 2014

Background

In Chinese traditional medicine, Agrimonia pilosa Ledeb (APL) exhibits great effect on treatment of type 2 diabetes mellitus (T2DM), however its mechanism is still unknown. Considering that T2DM are correlated with postprandial hyperglycemia and oxidative stress, we investigated the α-glucosidase inhibitory activity and the antioxidant activity of flavonoid compound (FC) and triterpenoid compound (TC) from APL.

Methods

Entire plants of APL were extracted using 95% ethanol and 50% ethanol successively. The resulting extracts were partitioned and isolated by applying liquid chromatography using silica gel column and Sephadex LH 20 column to give FC and TC. The content of total flavonoids in FC and the content of total triterpenoids in TC were determined by using UV spectrophotometry. HPLC analysis was used to identify and quantify the monomeric compound in FC and TC. The α-glucosidase inhibitory activities were determined using the chromogenic method with p-nitrophenyl-α-D-glucopyranoside as substrate. Antioxidant activities were assessed through three kinds of radical scavenging assays (DPPH radical, ABTS radical and hydroxyl radical) & β-carotene-linoleic acid assay.

Results

The results indicate FC is abundant of quercitrin, and hyperoside, and TC is abundant of 1β, 2β, 3β, 19α-tetrahydroxy-12-en-28-oic acid (265.2 mg/g) and corosolic acid (100.9 mg/g). The FC & the TC have strong α-glucosidase inhibitory activities with IC50 of 8.72 μg/mL and 3.67 μg/mL, respectively. We find that FC show competitive inhibition against α-glucosidase, while the TC exhibits noncompetitive inhibition. Furthermore, The FC exhibits significant radical scavenging activity with the EC50 values of 7.73 μg/mL, 3.64 μg/mL and 5.90 μg/mL on DPPH radical, hydroxyl radical and ABTS radical, respectively. The FC also shows moderate anti-lipid peroxidation activity with the IC50 values of 41.77 μg/mL on inhibiting β-carotene bleaching.

Conclusion

These results imply that the FC and the TC could be responsible for the good clinical effects of APL on T2MD through targeting oxidative stress and postprandial hyperglycaemia. So APL may be good sources of natural antioxidants and α-glucosidase inhibitors exhibiting remarkable potential value for the therapy of T2DM.