bluuebunny/crossref_metadata_2025 huggingface dataset:
Frequency of Flash Glucose Monitoring Scans and Hemoglobin A1c in Real Life
Authors: LAURENZI ANDREA , CARETTO AMELIA , BARRASSO MARILUCE , ANDREA MARIO BOLLA , MOLINARI CHIARA , ZANARDINI ANNA , DOZIO NICOLETTA C. , MENEGHINI ELENA , BOSI EMANUELE , SCAVINI MARINA
Published: June 2018

Introduction: In patients with type 1 diabetes mellitus (T1D) the relationship between low number of self-monitoring of blood glucose (SMBG) measurements and elevated hemoglobin A1c (HbA1c) levels has been reported. However, the optimal frequency of SMBG has not been defined. Flash glucose monitoring (FGM) is an emerging technology allowing patient with diabetes to measure interstitial glucose concentrations in a non-invasive manner, with patients obtaining more measurements than with SMBG.

Materials and Methods: We collected data from 103 adult T1D patients using FGM technology in real life for at least 28 days. We recorded patients demographics, diabetes duration, type of treatment (CSII or MDI) and we downloaded FGM data to the Abbott Freestyle Libre software, which provides the number of daily FGM scans and estimates of HbA1c based on continuous glucose profile readings. The correlation between median FGM scan frequency over 28 days and the estimated HbA1c was analyzed using Spearman rho. We also computed HbA1c median levels for quintiles of scan frequency and compared them using Kruskal-Wallis test.

Results: A significant correlation was found between median scan Spearman rho was -0.48 (p<0.0001). Moreover, median HbA1c level decreased significantly from the first (3-5) to the third (10-14) quintile of daily scan frequency [from 69 mmol/mol (IQR 62 to 78) to 54 mmol/mol (49 to 50), p#x003C0.0001] and remained unchanged thereafter, i.e., from the third to the fifth (24-50) quintile daily scan frequency [from 54 mmol/mol (49 to 50) to 53 mmol/mol (45 to 56), p=0.7638].

Conclusions: In T1D patients we confirmed that frequent measurements of interstitial glucose benefits glucose control in real life conditions. The maximum benefit in term of HbA1c decrease is obtained between 10 to 14 scans daily, a number of glucose measurements that would unlikely be sustainable with SMBG.

Disclosure

A. Laurenzi: Other Relationship; Self; Animas Corporation, LifeScan, Inc..A. Caretto: None.M. Barrasso: None. A. Bolla: Other Relationship; Self; Roche Diabetes Care Health and Digital Solutions. C. Molinari: Other Relationship; Self; Eli Lilly and Company, Sanofi. A. Zanardini: Other Relationship; Self; Roche Diagnostics Corporation.N.C. Dozio: None.E. Meneghini: None. E. Bosi: Consultant; Self; Abbott, AstraZeneca, Lexicon Pharmaceuticals, Inc., LifeScan, Inc.. Employee; Spouse/Partner; LifeScan, Inc.. Consultant; Self; Medtronic, Merck Sharp &Dohme Corp., Novartis AG, Roche Diabetes Care Health and Digital Solutions, Sanofi. M. Scavini: Consultant; Self; Sanofi, Roche Diabetes Care Health and Digital Solutions.
Automated Integration of Glucometer Data into the Electronic Health Record
Authors: WEATHERLY JAKE , KISHNANI SANIYA S. , AYE TANDY
Published: June 2018

Pediatric patients and families with T1D have difficulty meeting target HgbA1c. Providers encourage families to contact them with BG values between visits. Currently it is cumbersome to share BG with clinical providers creating a barrier to communication. Many applications on smart phones exist to help patients track BG, but most do not integrate with the electronic health record (EHR). Recent advances in technology can integrate the glucometer data into the EHR. This pilot and feasibility study aims to understand if automated integration of glucometer data into the EHR along with remote monitoring by health care providers improve patient initiated provider communication, self-management and HgbA1c. Patients and families with type 1 diabetes and an Apple iPod or iPhone (5s or higher) were invited to participate. Participants enrolled in MyChart, downloaded the HealthKit application and connected the AccuChek Aviva Connect (Roche) glucometer to the HealthKit. Through the EHR, BG values were automatically integrated to the EHR via WiFi. The number of patient initiated contacts via telephone or MyChart messages between clinic visits were recorded during each of the 3 phases (lasting 3 months each): run-in phase (providers waited for participant initiated phone calls), intervention phase (provider initiated calls to participants to review BG trends) and learned phase (providers waited for participant initiated phone calls). The number of participant initiated calls for each phase was measured and compared using a paired t test. Thirty-two families (mean Hgb A1c 8.5 ± SD 1.7, mean age 13.9 years ± SD 3.8) completed all phases. Despite automated integration of BG values and guided review of BG trends, the number of patient initiated calls (p=0.17) and HgbA1c values (p=0.67) did not improve. Families did felt safer knowing providers had automated integration of BG values into the EMR. However, barriers to adoption and effectiveness of this technology exist and patient motivation is still needed.

Disclosure

J. Weatherly: None. S.S. Kishnani: None. T. Aye: None.
Randomized, Multicentric, Prospective Study Assessing the Effect of Adding VILDagliptin to Insulin in Hemodialysed Type 2 Diabetic Patients—The VILDDIAL Study
Authors: MUNCH MARION , SMAGALA AGNÈS , MEYER LAURENT , MEYER NICOLAS , VERIER ODILE , FLEURY DOMINIQUE I. , GUERCI BRUNO , HANNEDOUCHE THIERRY , CRIDLIG JOELLE , BALTZINGER PHILIPPE , DUCLOUX DIDIER , BOROT SOPHIE , KUNZ KRISTIAN W. , ALENABI FARIDEH , WINISZEWSKI PATRICE , CHANTREL FRANCOIS , KESSLER LAURENCE
Published: June 2018

Introduction: Type 2 diabetic patients (T2D) undergoing chronic dialysis are at very high cardiovascular risk, requiring optimization of insulin treatment.

Vildagliptin (Galvus), can be used in severe and terminal renal impairment (eGFR<30 or <15ml/min/1,73m²) and protects against hypoglycemia.

The aim of this study was to evaluate the efficacy and safety of vildagliptin (50 mg/d) on top of insulin in hemodialysed T2D.

Methods: Sixty-five patients treated with multiple daily insulin injections were randomized (group 1-G1, n=33-usual insulin regimen, group 2-G2, n=32-addition of vildagliptin) in a multicentric, prospective, controlled, open-label, 12 weeks- study. Glucose control was evaluated using Continuous Glucose Monitoring (CGM, I-Pro Medtronic) for 48h, at Week 1 (W1) and Week 12 (W12), HbA1c and daily insulin needs. Statistical analysis was performed in intention to treat.

Results: Both groups were comparable (G1 vs. G2) for age (71.3 ± 7.4 vs. 69.7 ± 9.6 years), BMI (32.1 ± 6 vs. 34.5 ± 6.4 kg/m²), daily doses of insulin (47.7 ± 29.2 vs. 51.3 ± 25.4 IU), HbA1c (7.3 ± 1.1 vs. 7.3 ± 1.1%), and mean glucose at W1 (using CGM, 167.6 ± 58.3 vs. 149.4 ± 76.1 mg/dl). At W12 compared to W1, mean glucose decreased significantly only in G2 (149.4 to 136.9 mg/dl, p <0.05). At W12 in G2 vs. G1, time in range (70-180 mg/dl) was greater (77.2 vs. 69.5%, p <0.05), time spent > 180 mg/dl was lower (21.27 vs. 39.03%, p <0.05), there was no difference in time spent <70 mg/dl (1.54 vs. 1.45%, NS). At W12, HbA1C and insulin requirements were respectively 6.9 ± 0.9% vs. 7.2 ± 1.1% (NS) and 49 ± 32 IU/d vs. 46 ± 23 IU/d (NS). There was no difference in adverse events between both groups. Overall, 8 symptomatic hypoglycemia occurred in G1 and 13 in G2.

Conclusion: Adding vildagliptin (50 mg/d) to insulin in hemodialysed T2D improves glycemic control by increasing time spent in normoglycemia and reducing time in hyperglycemia, without increasing time in hypoglycemia.

Disclosure

M. Munch: None. A. Smagala: None. L. Meyer: None. N. Meyer: None. O. Verier: None. D.I. Fleury: None. B. Guerci: None. T. Hannedouche: None. J. Cridlig: None. P. Baltzinger: None. D. Ducloux: None. S. Borot: Consultant; Self; Abbott, Animas Corporation, Johnson & Johnson Diabetes Institute, LLC., Medtronic, Roche Diabetes Care Health and Digital Solutions. K.W. Kunz: None. F. Alenabi: None. P. Winiszewski: Other Relationship; Self; Abbott, Medtronic, Merck Sharp & Dohme Corp., Novo Nordisk Inc., Eli Lilly and Company, Sanofi. F. Chantrel: None. L. Kessler: None.
Metabolic Markers Associated with Increased Risk for Progression from Single to Multiple Autoantibodies in Type 1 Diabetes Relatives
Authors: BOSI EMANUELE , GEYER SUSAN , SOSENKO JAY , BECKER DOROTHY J. , BATTAGLIA MANUELA , ISMAIL HEBA M. , ATKINSON MARK A. , PHILIPSON LOUIS H. , PALMER JERRY P. , EVANS-MOLINA CARMELLA
Published: June 2018

Stage 1, defined as having ≥2 (i.e., multiple) autoantibodies (MA+) with normoglycemia, is currently identified as the earliest pathogenetic phase of type 1 diabetes. There is limited information of a possible β-cell function decline during the preceding phase, defined as single autoantibody positivity (SA+). Therefore, we evaluated metabolic measures at time of SA+ determination and assessed their predictive value for progression to MA+. Relatives participating in the TrialNet prospective Pathway to Prevention with SA+ (GADA, IAA, or IA-2A) were studied. Time from SA+ to MA+ was analyzed to assess risk of conversion. Measures evaluated during OGTT included: mean AUC for C-peptide, glucose, and insulin; fasting glucose and C-peptide; early insulin and C-peptide responses (30-0 min); peak C-peptide; glucose and C-peptide sums (30 to 120 min) and Index60 (incorporating fasting C-peptide, 1-hour glucose, and 1-hour C-peptide). Clinical factors included age, sex, ethnicity and autoantibody type. Of the 2,265 subjects identified as SA+, 57% were female, 83% white, 14% hispanic, with a median age of 14.8 years (range: 1.0 to 48.7 years). Most (71%) had GADA, 25% IAA and 4% IA-2A; 68% were tested also for ZnT8A. Overall, 407 (18%) SA+ progressed to MA+ during a median follow-up of 1.8 years. Adjusting for age, sex, and ethnicity we found that higher levels of mean AUC glucose (HR=2.4, p=0.004) significantly increased risk of progression to MA+. Index60 was significant both continuous (HR=1.17, p=0.004) and dichotomized (≥1 vs. <1; HR=2.28, p<0.0001). Reduced early C-peptide response was also significantly predictive (HR=0.94, p=0.007). Overall, we found that in early phase of SA+ there are already metabolic markers of beta cell dysfunction associated with increased risk of progression to MA+. These findings provide insights into early phases of the disease and provide the rationale for interventions at this stage.

Disclosure

E. Bosi: Consultant; Self; Abbott, AstraZeneca, Lexicon Pharmaceuticals, Inc., LifeScan, Inc.. Employee; Spouse/Partner; LifeScan, Inc.. Consultant; Self; Medtronic, Merck Sharp & Dohme Corp., Novartis AG, Roche Diabetes Care Health and Digital Solutions, Sanofi. S. Geyer: None. J. Sosenko: None. D.J. Becker: None. M. Battaglia: None. H.M. Ismail: None. M.A. Atkinson: Other Relationship; Self; Patent Issued. L.H. Philipson: Research Support; Self; Novo Nordisk Inc.. Speaker's Bureau; Self; Merck & Co., Inc.. Research Support; Self; JAEB Center For Health Research, JDRF, Janssen Pharmaceuticals, Inc., Medtronic MiniMed, Inc.. J.P. Palmer: None. C. Evans-Molina: None.
Pharmacokinetic and Pharmacodynamic Properties of a Novel "Superfast" Insulin Aspart Formulation
Authors: PIEBER THOMAS R. , HOWELL SARAH J. , JEZEK JAN , GERRING DAVID J.
Published: June 2018

Background: An insulin with a significantly faster onset of action compared to current state-of-the-art products will improve postprandial glycaemic control, reduce variability, improve HbA1c and increase flexibility. A superfast insulin is a key component for the development of efficient closed-loop pump systems.

Method: A superfast formulation, utilising excipients with metal ion binding constants critical in controlling injection site absorption, was investigated in diabetic mini swine in a randomized, cross-over experiment. Ten male animals received 0.2 U/kg insulin via subcutaneous injection. At standardized intervals post-injection, blood glucose and insulin were measured.

Results: Pharmacodynamic (PD) and pharmacokinetic (PK) properties of Superfast insulin were compared to an ultra-rapid control composition including nicotinamide. Tmax (22.5 minutes vs. 41.9 minutes) and T1/2max (7.9 minutes vs. 11.9 minutes) were significantly (P<0.01 and P<0.02) shorter for Superfast insulin, with a correspondingly faster glucose lowering action (Figure 1). Figure 1a) PD and 1b) PK profile of 100U/mL Superfast insulin (red) in comparison to an ultra-rapid acting insulin control containing nicotinamide (blue)1a.

Conclusion: This novel formulation represents a unique superfast prandial insulin that more closely matches a physiological response to blood glucose with the potential to be a major advancement for diabetes care.

Disclosure

T.R. Pieber: Consultant; Self; Arecor, AstraZeneca, Eli Lilly and Company, Novo Nordisk A/S, Sanofi. Employee; Self; CBmed. Research Support; Self; Novo Nordisk A/S, AstraZeneca. S.J. Howell: None. J. Jezek: None. D.J. Gerring: Employee; Self; Arecor Limited.
Identification of Cross Reactive Insulin Immunogenic Epitopes from Commensal Gut Microbes
Authors: ALTINDIS EMRAH , VOMUND ANTHONY N. , CHOW I-TING , DAMASIO MARCOS , KWOK WILLIAM , UNANUE EMIL R. , KAHN C. RONALD
Published: June 2018

Type 1 diabetes (T1D) is a chronic autoimmune disease characterized by destruction of pancreatic β-cells. Because studies suggest an environmental factor for the initiation of this autoimmunity, we hypothesized that intestinal microbes might carry peptides with sequences similarity to insulin, a major autoantigen. These peptides could modify the autoimmune response through molecular mimicry. Using a bioinformatics approach, we identified seventeen B:9-23 epitope-like sequences in different microbial proteins and investigated their capacity to stimulate insulin-specific reactive T cells obtained from T1D patients and NOD mice. In particular Parabacteroides distasonis contained a segment in the hypoxanthine phosphoribosyltransferase (HPRT) protein with high sequence similarities to the B:9-23 segment of the insulin B chain. When synthesized, this peptide stimulated both human and selected NOD mice T cells that recognized the B:9-23 peptide. Conversely, lymphocytes from mice immunized with this P. distasonis peptide showed increased secretion of cytokines when stimulated with the insulin B:9-23 peptide. P. distasonis is a commensal microbe in the human gut microbiome. Analysis of T1D metagenomic gut microbiome data from Finland, Estonia and Russia showed that the abundance of P. distasonis significantly differed between controls and seroconverting islet antibody-positive children at risk for T1D depending on the location of the study. In on-going analysis, compared to healthy control individuals, sera from T1D patients showed a significant antibody response against multiple P. distasonis proteins.

In summary, a peptide from HPRT of P. distasonis, a normal component of the gut microbiome, can elicit T-cell responses cross-reactive with human insulin-related peptides. We hypothesize that such cross-reactive peptides may become accessible to intestinal phagocytes for their presentation to T cells thus modulating T1D in genetically susceptible individuals.

Disclosure

E. Altindis: None. A.N. Vomund: None. I. Chow: None. M. Damasio: None. W. Kwok: None. E.R. Unanue: None. C. Kahn: Advisory Panel; Self; CohBar, ERX Therapeutics, AntriaBio, Inc.. Board Member; Self; Kaleio Biosciences.
Real-World Avoidance of Glucose Excursions with the Guardian Connect CGM System’s Predictive Alerts
Authors: COHEN OHAD , ABRAHAM SINU BESSY , MCMAHON CHANTAL M. , AGRAWAL PRATIK , VIGERSKY ROBERT
Published: June 2018

The Medtronic GuardianTM Connect continuous glucose monitoring (CGM) system, with predictive high and low glucose alerts, allows users to view sensor glucose (SG) data on a smartphone that notifies them 10-60 minutes before an excursion. The rates of alerts and outcomes of users on the GuardianTM Connect system were evaluated. We identified 2,541 users with >5 days of SG data in the CareLinkTM database from Jan 2, 2017-Sep 5, 2017 (data collected Jan 2, 2017-Dec 14, 2017). Excursions were identified when SG values were beyond the users’ preset SG threshold limit for ≥15 min. As a control, alerts were simulated during user alert-disabled periods to compare excursion frequency. Excursion durations following the alert times were segmented into avoided, ≤20min, 20-60 min, and >60min. Simulated SG limits were 202mg/dL (11.2mmol/L) for high and 70mg/dL (3.9mmol/L) for low. Simulated predictive times before excursions were 12.5min for high and 17.5min for low. The Table shows percentages of each alert resulting in an excursion. Users who enabled predictive alerts avoided 60% of low and 39% of high events. The percentage point improvement for excursions avoided was 28% and 31% following predicted low and high alerts vs. control. Stand alone CGM technology, like the GuardianTM Connect system, with predictive alerts are useful for tracking SG and enabling timely actions that help avoid high and low excursions.

Disclosure

O. Cohen: Employee; Self; Medtronic. S. Abraham: None. C.M. McMahon: Employee; Self; Medtronic MiniMed, Inc.. P. Agrawal: None. R. Vigersky: Employee; Self; Medtronic MiniMed, Inc..
Use of Real Time Continuous Glucose Monitoring (CGM) in Real Life Clinical Practice Compared with Finger-Stick Glucose Monitoring
Authors: TOSCHI ELENA , SLYNE CHRISTINE , ATAKOV-CASTILLO ASTRID , GREENBERG JORDAN , GREAVES TORI , CARL SAM P. , MUNSHI MEDHA
Published: June 2018

Background: Studies have shown benefits of CGM in management of type 1 diabetes (T1D), however, it is not yet clear if the benefits are maintained in a real-life clinical practice.

Methods: We evaluated 2 groups of adults (age 18-35 years) with T1D: One using CGM and the other using glucometer. Patients underwent either 2-week blinded CGM or assessment from personal CGM over 2 weeks. Patients also completed questionnaires for demographics, surveys for fear of hypoglycemia (HSF II), hypoglycemic unawareness, and problem areas in diabetes Questionnaire (PAID)). Glycemic control was measured by A1c.

Results: We evaluated 33 patients withT1D (15 using CGM and 18 using glucometer); average age 27 years, duration of diabetes 10 years, years of education 7 years. CGM users had better glycemic control as seen by A1C of 7.5% vs. 8.5 (p<0.05). 40% of patients using CGM had clinically significant hypoglycemia (glucose≤54 for > 15 mins/episode) compared to 66% in glucometer-users (mean duration 18 min/day vs. 27 min/day) (p=ns). CGM users spent longer time in range (70-180 mg/dl) compared to glucometer-users (14 hours/day vs. 12 hours/day). Hypoglycemia unawareness was reported by 44% of CGM users compared to 14% of glucometer-users. More CGM-users reported checking SMBG > 6 times per day, and worried more regarding nocturnal hypoglycemia (81% vs. 57%). Diabetes-related distress was lower in RT-CGM users (PAID score 27 vs. 34).

Conclusion: In a clinical setting, despite more hypoglycemic unawareness and more worry regarding hypoglycemia, T1D patients who used RT-CGM had better glycemic control, higher time spent in range, and lower risk of hypoglycemia compared to glucometer-users.

Disclosure

E. Toschi: None. C. Slyne: None. A. Atakov-Castillo: None. J. Greenberg: None. T. Greaves: None. S.P. Carl: None. M. Munshi: Consultant; Self; Sanofi.
Glucose-Responsive Insulin Delivery with Fast Response Using Charge-Switchable Polymeric Depot
Authors: GU ZHEN
Published: June 2018

The conventional method for controlling blood glucose levels (BGLs) involves the repeated subcutaneous injection of insulin, which is challenging to achieve satisfied blood glucose regulation and could often lead to hypoglycemia. Therefore, the development of self-regulated, glucose-triggered insulin delivery systems has attracted considerable attentions these years. Herein, we describe a new glucose-responsive insulin delivery formulation with ultrafast response both in vitro and in vivo, dependent on a glucose-triggered charge switch of a cationic polymer. A polymer (designated as poly(EDAA0.4-FPBA0.6)) with pendant amine and 4-carboxy-3-fluorophenylboronic acid was synthesized. Next, a stable complex with high insulin loading capacity (50%) and slow basal insulin release rate was prepared from an equal weight of insulin and polymer in PBS at 7.4. The addition of F-insulin to glucose solution led to decrease of the glucose level by 10 and 30 mg/dL for 100 and 400 mg/dL glucose solution, respectively, within 10 min. Meanwhile, the ζ-potential of poly(EDAA0.4-FPBA0.6) nanoparticles was decreased from the original +40 mV in the absence of glucose, to +22 mV in 100 mg/dL glucose solution, and further decreased to less than +8 mV in 400 mg/dL glucose solution. As a consequence, the insulin release kinetic from the complexes was highly glucose dependent. The in vivo therapeutic efficacy of F-insulin was evaluated in type 1 diabetic mouse model induced by streptozotocin. The BGLs of F-insulin treated group decreased to below 200 mg/dL within 30 min, and further maintained BGLs within the normal range (< 200 mg/dL) for more than 8 hours.

Disclosure

Z. Gu: None.
Learning to Close the Loop
Authors: CROCKET HAMISH
Published: June 2018

The Do-It-Yourself (DIY) Artificial Pancreas System (APS) community is growing very rapidly. Initially the community was composed of members with expertise in coding and other aspects of computing. It now includes a significant proportion of members without such expertise. Building and operating a DIY APS is a complex task that, in contrast to longer established and FDA-approved therapies, is not supported by Health Care Practitioners. In the absence of professional support, how do novices learn to build and maintain a DIY APS?

Objective: To identify the key enabling and constraining factors associated with learning to build and operate a DIY APS.

Method: A Participatory Action Research approach was used. Key members of the DIY APS community were consulted in developing this study about learning in relation to DIY APS. In-depth, semi-structured interviews were conducted with 10 users of DIY APS who had built their systems in 2017. The participants in this first cohort were from multiple countries. All were adult (18+) type 1 diabetics. A thematic analysis of the interview transcripts was undertaken.

Results: Five key themes were identified. 1) Learning was a continuation and deepening of participants’ previous peer-to-peer learning. 2) Persistence was central to all participants’ learning. 3) Learning was enmeshed with emotional and social support from the DIY APS community. 4) Learning challenges varied considerably between individuals and different DIY systems. 5) Learning extended beyond acquiring technical skills to incorporate the collaborative, ‘pay-it-forward’ ethos of the DIY APS community.

Conclusion: Preliminary findings suggest that learning in this technologically complex field is facilitated by social and relational practices between peers. Commercial and DIY hybrid and closed loop APSs will become increasingly common: it is therefore important to consider how people with diabetes learn to operate these systems, including the potential of peer-to-peer learning.

Disclosure

H. Crocket: None.
Evaluating Human Factors and Design Variables on Pen Injection Technique
Authors: RINI CHRISTOPHER , ROBERTS BRUCE C. , MOREL DIDIER , KLUG RICK , SELVAGE BENJAMIN L. , PETTIS RONALD J.
Published: June 2018

All parenteral delivery systems require a device/tissue site interface, where design, human factors, and tissue biomechanics impact successful function for consistent, reliable delivery. Limited published data exists quantifying these factors and their interaction effects on delivery success. This in vivo study examines pen needle (PN) hub design and skin application force impacts on needle penetration depth (NPD).

PN injections (2µl contrast agent) were administered to Yorkshire swine flanks at clinically measured skin application forces (0.25, 0.75, 1.25 and 2.0 lbf). In vivo NPD from four 32G x 4mm PN devices (investigational BD Nano™ PRO and three commercial PN devices; n=75/device/force, 1200 total) were measured by fluoroscopic imaging.

The BD Nano™ PRO more closely achieved the 4mm target NPD with significantly less variability (p<0.006) than the commercial PN devices across injection forces. Estimates of IM injection potential, calculated using human tissue measurements, displayed a commensurate reduction in IM risk.

Quantifiable differences observed between PN devices indicate that design features, coupled with aspects of variable use, influence injection consistency. The BD Nano™ PRO design may reduce impact of unintended individual injection technique differences and IM injection potential, which could decrease insulin absorption variability leading to more consistent glycemic control.

Disclosure

C. Rini: Employee; Self; Becton, Dickinson and Company. B.C. Roberts: Employee; Self; Becton, Dickinson and Company. D. Morel: Employee; Self; Becton, Dickinson and Company. R. Klug: None. B.L. Selvage: None. R.J. Pettis: Employee; Self; Becton, Dickinson and Company. Stock/Shareholder; Self; Becton, Dickinson and Company. Research Support; Self; JDRF. Board Member; Self; JDRF.
Gestational Diabetes Mellitus and Diet: A Systematic Review and Meta-analysis of Randomized Controlled Trials Examining the Impact of Modified Dietary Interventions on Maternal Glucose Control and Neonatal Birth Weight
Authors: Yamamoto Jennifer M. , Kellett Joanne E. , Balsells Montserrat , García-Patterson Apolonia , Hadar Eran , Solà Ivan , Gich Ignasi , van der Beek Eline M. , Castañeda-Gutiérrez Eurídice , Heinonen Seppo , Hod Moshe , Laitinen Kirsi , Olsen Sjurdur F. , Poston Lucilla , Rueda Ricardo , Rust Petra , van Lieshout Lilou , Schelkle Bettina , Murphy Helen R. , Corcoy Rosa
Published: June 2018

OBJECTIVE

Medical nutrition therapy is a mainstay of gestational diabetes mellitus (GDM) treatment. However, data are limited regarding the optimal diet for achieving euglycemia and improved perinatal outcomes. This study aims to investigate whether modified dietary interventions are associated with improved glycemia and/or improved birth weight outcomes in women with GDM when compared with control dietary interventions.

RESEARCH DESIGN AND METHODS

Data from published randomized controlled trials that reported on dietary components, maternal glycemia, and birth weight were gathered from 12 databases. Data were extracted in duplicate using prespecified forms.

RESULTS

From 2,269 records screened, 18 randomized controlled trials involving 1,151 women were included. Pooled analysis demonstrated that for modified dietary interventions when compared with control subjects, there was a larger decrease in fasting and postprandial glucose (−4.07 mg/dL [95% CI −7.58, −0.57]; P = 0.02 and −7.78 mg/dL [95% CI −12.27, −3.29]; P = 0.0007, respectively) and a lower need for medication treatment (relative risk 0.65 [95% CI 0.47, 0.88]; P = 0.006). For neonatal outcomes, analysis of 16 randomized controlled trials including 841 participants showed that modified dietary interventions were associated with lower infant birth weight (−170.62 g [95% CI −333.64, −7.60]; P = 0.04) and less macrosomia (relative risk 0.49 [95% CI 0.27, 0.88]; P = 0.02). The quality of evidence for these outcomes was low to very low. Baseline differences between groups in postprandial glucose may have influenced glucose-related outcomes. As well, relatively small numbers of study participants limit between-diet comparison.

CONCLUSIONS

Modified dietary interventions favorably influenced outcomes related to maternal glycemia and birth weight. This indicates that there is room for improvement in usual dietary advice for women with GDM.
The Human Placenta in Diabetes and Obesity: Friend or Foe? The 2017 Norbert Freinkel Award Lecture
Authors: Desoye Gernot
Published: June 2018

The placenta plays a key role in sustaining fetal growth and development. Due to its position between mother and fetus, it is exposed to changes in the intrauterine environment in both circulations. The relative influence of changes in those circulations depends on the period of gestation. Early in pregnancy, maternal influences prevail and may affect the complex biological processes characteristic for this pregnancy period, such as placentation, early cell differentiation, and spiral artery remodeling. It is still unclear whether the placenta early in pregnancy is a friend or foe for the fetus. Later in pregnancy, when the fetal circulation is gradually establishing, fetal signals gain importance in regulating placental structure and function. Many of the placental alterations seen at term of pregnancy are the result of fetoplacental interactions often driven by fetal signals associated with maternal diabetes or obesity. These alterations, such as hypervascularization or enhanced cholesterol removal from placental endothelial cells, can be regarded as adaptations to maintain homeostasis at the fetoplacental interface and, thus, to protect the fetus. However, extreme conditions such as poorly controlled diabetes or pronounced obesity may exceed placental homeostatic capacity, with potentially adverse consequences for the fetus. Thus, in late pregnancy, the placenta acts mostly as a friend as long as the environmental perturbations do not exceed placental capacity for mounting adaptive responses.
INVESTIGATION OF PHYSICAL AND CHEMICAL PROPERTIES OF MINCED FISH, DRY VEGETABLE PREMIXES AND THEIR MIXTURES
Authors: Nugmanov Albert Hamed-Harisovich , Aleksanian Artem Igorevic , Aleksanian Oxana Aleksandrovna , Maksimenko Yuriy Aleksandrovich
Published: June 2018

To provide efficient processing of fish assorted raw material (chilled or frozen) there have been studied the properties of formed combined fish and vegetable products. Pike perch and carp minced meat was chosen as samples for research, into which dry powder of white cabbage was added. The results of thermodynamic analysis of hygroscopic properties for determining the ratio of free and bound moisture in minced products have been presented. The obtained data prove that introduction of powdered premix leads to a decrease in free moisture in the mixture due to its partial binding by premix. The upper level of the content of the additive in the mixture is limited by sensory evaluation, because when this limit is exceeded, the indicators of the resulting semi-finished product may radically differ from the model sample. There are given the results of studying thermophysical properties of frozen objects at ordinary temperatures and below zero, structural and mechanical properties, in particular, density, conditional coefficient of effective dynamic viscosity, amount of frozen moisture, cryoscopic temperatures of cryopreservation objects. The established mathematical dependencies of the characteristics of products and concentrates can be used in engineering practice in the design of production processes and apparatuses in processing raw materials of animal and vegetable origin. The obtained research results are necessary for the scientific analysis of kinetics and dynamics of heat and mass exchange processes (cooling and freezing), their modeling and optimization for the purpose of energy and resource saving in processing food materials.
Confrontative Study between Past Perfect Indicative in German and Past Perfect and Aorist II Indicative in Albanian
Authors: Paheshti Edesa , Teichmann Emine
Published: June 2018

The present study represents a significant step forward to understand past perfect indicative in Albanian and German by comparing them in morphological, semantic and stilistic aspects. The semantic meaning of past perfect indicative in Albanian is very similar to that in German. But the Albanian language also alters another additional past tense called Aorist II, that it is not present in the standard German language. This work aims at giving practical and theoretical overview on approaches and differs of the past perfect between the two languages - we intend to show that by giving great argumentative examples, which help concretising and understanding better, and also offer a clear and detailed picture of uses and meanings of this tense in both languages. In particular, in this paper it is paid attention to the text grammar, as we think that is a very important and interested point of view by studying and comparing two grammars. Furthermore we consider the issue of translation from German in Albanian and controversialy. At this point we intend to find the grammar tools the German language uses for the translation of the albanian Aorist II. This publication will be a comprehensive and authorative reference work on complex past tenses bringing together the study on different linguistic aspects.
Interpreting Games: Meaning Creation in the Context of Temporality and Interactivity
Authors: Mhamdi Chaker
Published: June 2018

The concept of interpretation applied to texts, videos, pictures, posts and all other types of media is varied. Objects are open to different forms of interpretation and games, as objects of meaning, are no exception. Explicating meaning creation in games will create a better understanding of game functions and their effects. This study explores how games alter the process of meaning creation through investigating their detailed properties and differentiation from other forms of media as objects of interpretation. This study argues that understanding meaning creation in games entails more than an examination of the presentation layer by a deeper analysis that considers interactivity and temporality. It contends that due to the interactive nature of games, the role of player participation is vital because gamers influence the operative mechanics of games and hence their meanings.
Vitality of Public Open Space (Case Study: Taman Nostalgia Kupang)
Authors:   Hikmah, Nday Rosvitayati Umbu , Manu Ariency K.
Published: June 2018

The purpose of the study is to determine the condition of Taman Nostalgia in terms of vitality (the quality of function, physic (environment), and meaning). The study implements descriptive approach, by which the study presents and describes the condition of Taman Nostalgia based on the phenomenon found in the field. The data are collected through documentation, observation, and interviews and are analyzed using descriptive approach and Project for Public Space. The results showed that the condition of Taman Nostalgia in terms of vitality has decreased due to several causes, such as the direct connection between relaxing area and garden area, the location and capacity of the plaza which is limited and not functional, direct connection between playground and plant area, the absence of space marker and the division of sub space in the parking area, the placement of jogging track separated and not connected to the centre of park activity, unattractive culinary area and its forming activities, limited space of sports centre, and unavailability of supporting facilities. Likewise, seen from the aspects of forming quality of the area, the park showed the absence of management concerning the aspect of needs (comfort, relaxation, passive/active engagement, and discovery), user rights (access and ease of achievement, freedom of action, claim, and change), and meaning (legibility, relevance between cultural norms and the user, individual connection, group connection, connection to larger society, biological connection, and connection to other world).
Students’ Perception Towards National Examination 2017: Computer-Based Test or Paper-Based Test
Authors:   Jamiludin,   Darnawati, Uke Waode Ade Sarasmita
Published: June 2018

Today, technological development has given a new lease of life in language learning and teaching field. Particularly in terms of evaluation, some schools in Indonesia conduct national examination using computer-based test. Traditionally, testing in a class involves paper-based test which is familiar to students. A substantial number of studies have been conducted to compare both of the tests. The researcher investigated what activities were performed by the students throughout the tests, what kind of multiple choice tests the students prefer to do, and what the positive and negative side of those tests. This study presents a wonder share quiz creator (WSQC) program to facilitate the teachers to design a test. The data was collected by questionnaire, interview, observation, and quiz. In this study, the authors concluded that students in senior high school of Kendari prefer paper-based test for national examination.
Virtual Leadership: A Review Paper
Authors: Mehtab Khurram , Rehman Amjad ur , Ishfaq Saira , Jamil Raja Ahmed
Published: June 2018

In today’s competitive business environment, virtual work settings present a growing challenge for rapid solutions of organization’s complex problems. This enables an organization to pool talent and expert employees by eradicating the time and space barriers. In accordance, companies are profoundly investigating on virtual teams’ performance enhancement. Virtual work settings revolutionize workplace by providing high level of responsiveness and flexibility. Virtual work setting has also many issues and challenges which must be addressed in order to enhance the team’s performance. Hence one of the major challenge of modern work setting is virtual leadership. This review paper presents an introduction to virtual leaderships, advantages of virtual work environment, challenges and recommendations for virtual leaders to enhance the performance of virtual teams. This article also offers review of earlier published researches and reports the findings on virtual team leadership in a struggle to the present the current state of work on this topic.
Anti-Corruption Crusade in Nigeria: An Assessment of the Disposition of the National Assembly (1999-2013)
Authors: Nyewusira Vincent , Nweke Kenneth
Published: June 2018

Corruption has inadvertently been elevated to a state or national policy with all the symptoms of a hemorrhaging system. While any aggressive and purposeful anti-corruption crusade will always generate popular support and acclaim in Nigeria, it is sure to provoke anger, frustration and resistance among the political class with vested interest in the status quo. Periodically, the National Assembly, whose members largely belong to the latter group, is one of the institutions vested with the constitutional responsibility of preventing and exposing corruption, inefficiency and waste in the management of public funds within its legislative competence. This is specifically stipulated in section 88 (2) (b) of the 1999 Constitution (as amended). The study adopts the institutional approach to interrogate the efforts, capacity and political will of the National Assembly to function as the watchdog of public funds via legislations, inquiries or investigations, oversights, appropriations and resolutions. Our treatise includes a general survey and analysis of the Acts passed by the National Assembly establishing anti-corruption agencies such as the Independent Corrupt Practices and other related offences Commission (ICPC) and the Economic and Financial Crimes Commission (EFCC). We shall also do an exposition of some highprofile investigations conducted by the National Assembly over some federal government agencies pursuant to sections 88 and 89 of the constitution. Unfortunately, controversies and revelations arising from these exercises gravitated, in some cases, to narratives of sleaze in the National Assembly. It is also argued that the opaque and jumbo salaries and allowances associated with members of the National legislature significantly detract from any anti-corruption posturing of that institution. We conclude that mere sloganeering and platitudes on the powers of the National Assembly in combating corruption will yield little or no results until operators of the legislative arm of government at the national level understand and perform their critical role as the ‘soul and conscience of good governance’.
The framing of climate change discourse by Statoil
Authors: Kapranov Oleksandr
Published: June 2018

This article involves a qualitative framing analysis of climate change discourse by Statoil, a Norwegian-based energy corporation, which is considered to be a major actor in the Norwegian fossil fuels market. The corpus of the present framing analysis consists of Statoil’s annual sustainability reports from 2001 until 2015 available online at the official Statoil website www.statoil.com. The framing analysis is based upon the methodological approach to framing described by Dahl (2015). The specific research aim of the present investigation is twofold: i) to identify Statoil’s framing of climate change discourse and ii) to compare how the framing changed diachronically from the time of the first sustainability report published in 2001 until the 2015 Sustainability Report. The results of the framing analysis indicate that Statoil’s climate change discourse in 2001-2015 is framed by a number of qualitatively different frames that are unequally distributed in diachrony, e.g. “Anthropogenic Cause”, “Battle”, “Corporate Responsibility”, “Emissions Reduction” etc. These frames are further presented and discussed in the article.
Những vấn đề lý luận về phát triển bền vững và kinh tế xanh ở Việt Nam
Authors: Phú Hải Đỗ
Published: June 2018

Nghiên cứu đã làm sáng tỏ sự tương đồng và khác biệt, tính phổ quát và đặc thù trong lý luận phát triển bền vững tăng trưởng xanh, kinh tế xanh và ứng phó biến đổi khí hậu. Từ đó đề xuất các giải pháp và công cụ chính sách xanh trong quá trình hoạch định, xây dựng chính sách công để đạt được mục tiêu phát triển bền vững. Nghiên cứu về nhóm các công cụ chính sách xanh trong các ngành, lĩnh vực khác nhau là nhu cầu nghiên cứu mới phục vụ mục tiêu phát triển bền vững ở nước ta hiện nay.

Từ khóa: Phát triển bền vững, kinh tế xanh, tăng trưởng xanh, biến đổi khí hậu.
International cooporation in criminal procedure to meet the requirement of globalization trend and international intergration.
Authors: Nguyễn Ngọc Chí
Published: June 2018

On the basis of the new approach, especially the approach to rights in international cooperation in criminal procedures, the article mentions the theory and the practice to improve the efficiency of international cooperation in the criminal procedure in the context of globalization, international integration in Vietnam. The contents of the article include: and areas of international cooperation in criminal procedure; The practice of international cooperation in criminal procedure in Vietnam; Requiring to improve of law and raising the effectiveness of international cooperation in criminal procedure in the context of international integration.
Reliability of the Mechanical Diagnosis and Therapy System in Patients With Spinal Pain: A Systematic Review
Authors: Garcia Alessandra Narciso , Costa Lucíola da Cunha Menezes , de Souza Fabrício Soares , de Almeida Matheus Oliveira , Araujo Amanda Costa , Hancock Mark , Costa Leonardo Oliveira Pena
Published: June 2018

Background

An updated summary of the evidence for the reliability of the Mechanical Diagnosis and Therapy (MDT) system in patients with spinal pain is needed.

Objective

To investigate the evidence on the intrarater and interrater reliability of MDT in patients with spinal pain.

Methods

Searches in MEDLINE, CINAHL, Embase, PEDro, and Scopus were conducted for this systematic review. We included any study design as long as reliability of the MDT method was tested in patients with spinal pain. We collected data on the reliability of MDT to identify main and subsyndromes, directional preference, the centralization phenomenon, and lateral shift. The methodological quality of studies was assessed using the Quality Appraisal of Diagnostic Reliability and the Guidelines for Reporting Reliability and Agreement Studies checklists.

Results

Twelve studies were included (8 studies on back pain, pooled n = 2160 patients; 3 studies on neck pain, pooled n = 45 patients; and 3 studies recruited mixed spinal conditions, pooled n = 389 patients). Studies investigating patients with back pain reported kappa estimates ranging from 0.26 to 1.00 (main and subsyndromes), 0.27 to 0.90 (directional preference), and 0.11 to 0.70 (centralization phenomenon). Kappa estimates for studies investigating neck pain ranged from 0.47 to 0.84 (main and subsyndromes) and 0.46 (directional preference). In mixed populations, kappa estimates ranged from 0.56 to 0.96 (main and subsyndromes).

Conclusion

The MDT system appears to have acceptable interrater reliability for classifying patients with back pain into main and subsyndromes when applied by therapists who have completed the credentialing examination, but unacceptable reliability in other therapists. We found conflicting evidence regarding the reliability of the MDT system in patients with neck pain or mixed pain locations. J Orthop Sports Phys Ther 2018;48(12):923–933. Epub 22 Jun 2018. doi:10.2519/jospt.2018.7876
Agility Stimulators and Their Effects on Traditional Testing Protocols Case Selected Male Soccer Players
Authors: ZERF Mohammed
Published: June 2018

Baked on the theory, which
advance the assessment of agility performance in the real game would depend on
other factors such as Visual processing, Perception and Anticipation. To achieve this objective, we
based on 18-meter test with five delimiters spaced by 3 meters between them,
proposed in two situations.  Situation
(A), we refer to traditional agility tests, in which, we change the cone with
flex players. The opposite of the situation (B) 
in which we integrate the Hexagonal Obstacle Test as part of the initial
protocol  with five dynamic  players, asked to jump in four directions
(left- center -/ right- center -front- center -back) into a single rhythm,
coordinated by the examiner. For this proposal, 30 élite male Soccer Players
participated in this study. Tested during the regional selection Oran league.
Selected by attentional means based on their performance in 5-10-5 shuttle
test.The comparison of results achieved
in the two situations shows significant differences between them. Opposite of
correlations strongly significant between the tests used in this study. The main conclusion
of the study is that athletes regardless their Agility mental skills
improvement. Can use our protocol to test their difficulties, according to the
environment variables, for better concordances of perceptual motor skills to
operate simultaneously.  Record in the
present study as strategy to improve Dynamic Decision Making, which involves
continual decisions each with task-related tradeoffs, founded on cognitive
functions such as visual processing, Timing, Reaction time Perception, and
Anticipation as well as change of direction speed.