The use of mobile technology to facilitate self-management in adults with type 1 diabetes: A qualitative explorative approach

AIMS

(a) To explore how mobile technology can support self-management in adults with type 1 diabetes (T1DM). (b) To inform a usability study in the design of a mobile application to facilitate self-management of T1DM.

DESIGN

Qualitative exploratory design.

METHODS

Semi-structured interviews were undertaken with adults with T1DM (N = 8). The data collected were analysed using a thematic analysis approach.

RESULTS

Mobile technology has the potential to support adults in their self-management of T1DM through facilitating their decision-making, saving time and enabling them to easily share their data with their healthcare professional. Participants identified four main visualization characteristics for technology to aid in decision-making; relationships between inputs, trends, graphs and colours, and identified essential features such as ease of use, convenience and connectivity.

Paediatric type 2 diabetes in China-Pandemic, progression, and potential solutions

China is gradually taking its place as one of the world's economic giants and concurrently learning to cope with the burden of diseases that are more common in the developed world, such as paediatric type 2 diabetes mellitus. The prevalence of type 2 diabetes has been recently observed among children and adolescents in China; hence, there is a lack of information about the incidence, prevalence, pathogenesis, and pathophysiology of the disease. Diagnosis, treatment, and management have been standardized to a large degree, but there is still a need for data regarding optimal management protocols and how to achieve the best control over current state of the disease. The objective of this review is to consolidate the available information about paediatric diabetes, with a focus on the increasing prevalence of type 2 diabetes in Chinese youth. Here we emphasize the prevention strategies and have included literature with respect to pathogenesis, diagnosis, and treatment published in English and Chinese within the past 10 years.

Type 2 diabetes in adolescents and young adults

The prevalence of type 2 diabetes in adolescents and young adults is dramatically increasing. Similar to older-onset type 2 diabetes, the major predisposing risk factors are obesity, family history, and sedentary lifestyle. Onset of diabetes at a younger age (defined here as up to age 40 years) is associated with longer disease exposure and increased risk for chronic complications. Young-onset type 2 diabetes also affects more individuals of working age, accentuating the adverse societal effects of the disease. Furthermore, evidence is accumulating that young-onset type 2 diabetes has a more aggressive disease phenotype, leading to premature development of complications, with adverse effects on quality of life and unfavourable effects on long-term outcomes, raising the possibility of a future public health catastrophe. In this Review, we describe the epidemiology and existing knowledge regarding pathophysiology, risk factors, complications, and management of type 2 diabetes in adolescents and young adults.

Hypertension in pediatric dentistry practice

The authors discuss the factors coexistent with hypertension both in children and youth, as well as the treatment methods and possible symptoms that might appear in the oral cavity. In the work, the authors emphasize that there is a need for cooperation between the general practitioner, a cardiologist and a dentist, so as to provide an early diagnosis and effective treatment, as well as to prevent complications with regard to hypertension itself and the drugs used in treatment. The discussion is based on a review of the most recent works in the field.

The incidence of type 2 diabetes in the United Kingdom from 1991 to 2010

AIMS

To characterize the incidence of type 2 diabetes in the UK over the previous 20 years; and determine if there has been an increase in people aged 40 years or less at diagnosis.

METHODS

For this retrospective cohort study, patients newly diagnosed with type 2 diabetes between 1991 and 2010 were identified from the UK Clinical Practice Research Datalink (CPRD). Patient data were grouped into 5-year intervals by year of diagnosis and age at diagnosis. A standardized incidence ratio (SIR) was determined (1991-1995 = 100). The percentage of newly diagnosed patients for each age group and aged ≤40 years was calculated for each 5-year calendar period. The incidence rate by age and 5-year calendar period was also determined.

RESULTS

In 2010, the crude incidence rate of type 2 diabetes was 515 per 100,000 population. The overall SIR increased to 158 (95% CI 157-160, p < 0.001), 237 (235-238, p < 0.001) and 275 (273-276, p < 0.001) for 1996-2000, 2001-2005 and 2006-2010, respectively. For those ≤40, the respective values were 217 (209-226, p < 0.001), 327 (320-335, p < 0.001) and 598 (589-608, p < 0.001). An increase in incidence occurred with increasing 5-year calendar period. The incidence of type 2 diabetes was higher for males after the age of 40 and higher for females aged ≤40. The percentage of patients aged ≤40 years at diagnosis increased with each increasing 5-year calendar period (5.9, 8.4, 8.5 and 12.4%, respectively).

CONCLUSIONS

There was a significant increase in the incidence of diagnosed type 2 diabetes between 1991 and 2010 and the proportion of people diagnosed at a relatively early age has increased markedly.

Human islet amyloid polypeptide at the air-aqueous interface: a Langmuir monolayer approach

Human islet amyloid polypeptide (hIAPP) is the source of the major component of the amyloid deposits found in the islets of Langerhans of around 95 per cent type 2 diabetic patients. The formation of aggregates and mature fibrils is thought to be responsible for the dysfunction and death of the insulin-producing pancreatic β-cells. Investigation on the conformation, orientation and self-assembly of the hIAPP at time zero could be beneficial for our understanding of its stability and aggregation process. To obtain these insights, the hIAPP at time zero was studied at the air-aqueous interface using the Langmuir monolayer technique. The properties of the hIAPP Langmuir monolayer at the air-aqueous interface on a NaCl subphase with pH 2.0, 5.6 and 9.0 were examined by surface pressure- and potential-area isotherms, UV-Vis absorption, fluorescence spectroscopy and Brewster angle microscopy. The conformational and orientational changes of the hIAPP Langmuir monolayer under different surface pressures were characterized by p-polarized infrared-reflection absorption spectroscopy, and the results did not show any prominent changes of conformation or orientation. The predominant secondary structure of the hIAPP at the air-aqueous interface was α-helix conformation, with a parallel orientation to the interface during compression. These results showed that the hIAPP Langmuir monolayer at the air-aqueous interface was stable, and no aggregate or domain of the hIAPP at the air-aqueous interface was observed during the time of experiments.

HDL 2 particles are associated with hyperglycaemia, lower PON1 activity and oxidative stress in type 2 diabetes mellitus patients

OBJECTIVES

In this study we examined the relationship of oxidative stress and hyperglycaemia to antioxidative capacity of high-density cholesterol (HDL-C) particles in type 2 diabetes mellitus (DM).

DESIGN AND METHODS

Oxidative stress status parameters (superoxide anion (O2(-)), superoxide dismutase (SOD) activity and paraoxonase (PON1) status were assessed in 114 patients with type 2 DM and 91 healthy subjects. HDL particle diameters were determined by non-denaturing polyacrylamide gradient (3-31%) gel electrophoresis.

RESULTS

Patients had significantly higher concentrations of oxidative stress parameter O2(-)(p<0.001) and antioxidative defence, SOD activity (p<0.001). Paraoxonase activity was significantly lower in diabetics (p<0.001). The PON1(192) phenotype distribution among study groups was not significantly different. HDL 3 phenotype was significantly prevalent among patients (p<0.001). Paraoxonase activity was significantly lower in patients with predominantly HDL 2 particles than in controls.

CONCLUSIONS

The results of our current study indicate that the diabetic HDL 2 phenotype is associated with hyperglycaemia, lower PON1 activity and elevated oxidative stress.

Simple table to identify children and adolescents needing further evaluation of blood pressure

OBJECTIVE

The goal was to create a tool to screen more easily for children and adolescents who might have hypertension or prehypertension.

METHODS

We took the existing tables from The Fourth Report on the Diagnosis, Evaluation and Treatment of High Blood Pressure in Children and Adolescents, which contain hundreds of normal and abnormal blood pressure values based on gender, age, and height percentile, and analyzed this data to develop a much simplified table based only on gender and age.

RESULTS

In our simplified table we reduced the number of values from 476 to 64 and have only one threshold value of abnormal systolic and diastolic blood pressure, by gender, for each year of life (ages 3 to > or =18). This table makes it easy to identify abnormal blood pressure values in almost any potential care or screening setting. This approach is ideal when blood pressure is measured outside a physician's office or even at intake in a pediatrician's office, when the height percentile (which is required for the use of current tables) may not be easily obtainable.

CONCLUSIONS

This screening tool can quickly and easily identify children and adolescents whose blood pressure readings merit further evaluation by a physician and rule out abnormal blood pressure in children and adolescents.