Historical Insights and Current Perspectives on the Diagnosis and Management of Presymptomatic Type 1 Diabetes

Objective: The article provides practical guidance for (1) interpreting and confirming islet autoantibody screening results for type 1 diabetes (T1D) and (2) follow-up of individuals with early stages of T1D with the goal of ensuring medical safety and providing patients and their families with an assessment of risk for progression to a clinical diagnosis of T1D. Research Design and Methods: We used an explicit a priori methodology to identify areas of agreement and disagreement in how to manage patients with early T1D. We used a modified Delphi method, which is a systematic, iterative approach to identifying consensus. We developed a list of topic questions, ranked them by importance, and developed consensus statements based on available evidence and expert opinion around each of the 30 topic questions consistently ranked as being most important. Results: Consensus statements for screening and monitoring are supported with figures proposing an algorithm for confirmation of T1D diagnosis and management of early T1D until clinical diagnosis. Conclusions: Disseminating and increasing knowledge related to how to interpret T1D screening tests, confirm early T1D diagnosis and monitor for medical safety and clinical disease risk prediction is critically important as there are currently no clinical recommendations. Published guidance will promote better management of T1D screening-detected individuals.

Racial Disparities in Diabetes Technology Adoption and Their Association with HbA1c and Diabetic Ketoacidosis

Aim

Poorer glycemic control and higher diabetic ketoacidosis (DKA) rates are seen in racial/ethnic minorities with type 1 diabetes (T1D). Use of diabetes technologies such as continuous glucose monitors (CGM), continuous subcutaneous insulin infusion (CSII) and automated insulin delivery (AID) systems has been shown to improve glycemic control and reduce DKA risk. We examined race/ethnicity differences in diabetes technology use and their relationship with HbA1c and DKA.

Methods

Data from patients aged ≥12 years with T1D for ≥1 year, receiving care from a single diabetes center, were examined. Patients were classified as Non-Hispanic White (n=3945), Non-Hispanic Black (Black, n=161), Hispanic (n=719), and Multiracial/Other (n=714). General linear models and logistic regression were used.

Results

Black (OR=0.22, 0.15-0.32) and Hispanic (OR=0.37, 0.30-0.45) patients were less likely to use diabetes technology. This disparity was greater in the pediatric population (p-interaction=0.06). Technology use associated with lower HbA1c in each race/ethnic group. Among technology users, AID use associated with lower HbA1c compared to CGM and/or CSII (HbA1c of 8.4% vs 9.2%, respectively), with the greatest difference observed for Black adult AID users. CSII use associated with a lower odds of DKA in the past year (OR=0.73, 0.54-0.99), a relationship that did not vary by race (p-interaction =0.69); this inverse association with DKA was not observed for CGM or AID.

Conclusion

Disparities in diabetes technology use, DKA, and glycemic control were apparent among Black and Hispanic patients with T1D. Differences in technology use ameliorated but did not fully account for disparities in HbA1c or DKA.

Bridging the LatinX community care gap

PURPOSE OF REVIEW

To summarize current developments aimed at improving diabetes care utilizing novel and culturally sensitive strategies to bridge the care gap in the LatinX community.

RECENT FINDINGS

There is more than a decade of literature describing disparities in diabetes care and outcomes particularly involving ethnic and racial minorities leading to higher incidence of acute and long-term complications. Social determinants of health including language and cultural barriers in the LatinX community are important determining factors. We found three novel strategies reported in the current literature aimed at closing the diabetes care gap in LatinX patients: community-based efforts: community health workers (CHWs) and peer-led; shared medical and educational models; and adapting telehealth group appointments.

SUMMARY

Here we review relevant but limited published articles found in the literature addressing the diabetes care gap in the LatinX community utilizing cost effective, novel and culturally sensitive strategies and reinforce the importance of continued work and publications on this very important field.

Cost and healthcare utilization analysis of culturally sensitive, shared medical appointment model for Latino children with type 1 diabetes

OBJECTIVE

This study evaluated costs and healthcare utilization associated with a culturally-sensitive, medical and education program for pediatric Latino patients with type 1 diabetes.

RESEARCH DESIGN AND METHODS

Program participants included Latino children ages 1-20 years old diagnosed with type 1 diabetes (n = 57). Control subjects with type 1 diabetes were matched by age, sex, and zip code to intervention participants from the Colorado All Payer Claims Database. Data included emergency department (ED) visits, hospitalizations, demographic information, and health insurance claims data 180 days prior to program start/index date through 1 year after program start/index date. We tracked program staff time and estimated costs for healthcare utilization using data from the scientific literature. Generalized Estimating Equation (GEE) models with logit link were used to estimate group differences in probabilities of ED visits and hospitalizations over 6-month periods pre/post-study, accounting for correlation of within-subject data across time points. Sensitivity analyses modeled longer-term cost differences under different assumptions.

RESULTS

The intervention group had fewer hospitalizations, 2% versus 12% of controls (p = 0.047,OR = 0.13;95%CI: 0.02-0.97) for 6 months following start date. The intervention group had fewer ED visits, 19% versus 32% in controls (n.s.; p = 0.079,OR = 0.52;95%CI:0.25-1.08) and significantly fewer hospitalizations, 4% versus 15% of controls (p = 0.039,OR = 0.21;95%CI: 0.05-0.93) 6-12 months post-start date. One-year per-patient program costs of $633 and healthcare cost savings of $2710 yielded total per-patient savings of $2077, or a 5-year cost savings of $14,106.

CONCLUSION

This unique type 1 diabetes management program altered health service utilization of program participants, reducing major healthcare cost drivers, ED visits, and hospitalizations.

Novel, culturally sensitive, shared medical appointment model for Hispanic pediatric type 1 diabetes patients

BACKGROUND/OBJECTIVE

Latino patients with type 1 diabetes (T1D) face cultural and language barriers leading to poor outcomes. Shared medical appointments (SMAs) are recognized as effective models of care. Our aim is to develop a culturally sensitive, cost effective SMA program for Latino T1D.

SUBJECTS

Spanish speaking Latinos 1 to 20 years with T1D (n = 88) and their families.

METHODS

Routine care alternating with SMAs that included group education was provided. Teens, ages >11 received the SMA separate from parents. Younger children were seen together. Hemoglobin A1c (HbA1c), behavioral questionnaires, and use of diabetes technology were measured at baseline and every 3 to 6 months.

RESULTS

57.7% of children and 77.27% of teens completed the 2 years of the Program. There was a significant association between age and change in HbA1c from baseline to year 1 (P = .001) and baseline to year 2 (P = <.0001). For participants <12 years, there was a significant improvement in HbA1c from baseline to year 1 (P = .0146) and from year 1 to year 2 (P = .0069). Participants ≥12 years, had an increase in HbA1c from year 1 to year 2 (P = .0082). Technology use increased significantly from baseline to year 2 for participants <12 years of age (19%-60%, P = .0455) and for participants who were ≥12 years of age (10%-23%, P = .0027). Participants reported a 98% satisfaction rate.

CONCLUSIONS

The culturally sensitive SMA proved to be an appreciated, feasible, and effective alternative to care for Latinos with T1D.

Chemical and structural status of copper associated with oxygenic and anoxygenic phototrophs and heterotrophs: possible evolutionary consequences

Copper adsorption on the surface and intracellular uptake inside the cells of four representative taxons of soil and aquatic micro-organisms: aerobic rhizospheric heterotrophs (Pseudomonas aureofaciens), anoxygenic (Rhodovulum steppense) and oxygenic (cyanobacteria Gloeocapsa sp. and freshwater diatoms Navicula minima) phototrophs were studied in a wide range of pH, copper concentration, and time of exposure. Chemical status of adsorbed and assimilated Cu was investigated using in situ X-ray absorption spectroscopy. In case of adsorbed copper, XANES spectra demonstrated significant fractions of Cu(I) likely in the form of tri-coordinate complexes with O/N and/or S ligands. Upon short-term reversible adsorption at all four studied micro-organisms' cell surface, Cu(II) is coordinated by 4.0 ± 0.5 planar oxygens at an average distance of 1.97 ± 0.02 Å, which is tentatively assigned to the carboxylate groups. The atomic environment of copper incorporated into diatoms and cyanobacteria during long-term growth is similar to that of the adsorbed metal with slightly shorter distances to the first O/N neighbor (1.95 Å). In contrast to the common view of Cu status in phototrophic micro-organisms, XAFS failed to detect sulfur in the nearest atomic environment of Cu assimilated by freshwater plankton (cyanobacteria) and periphyton (diatoms). The appearance of S in Cu 1st coordination shell at 2.27-2.32 Å was revealed only after long-term interaction of Cu with anoxygenic phototrophs (and Cu uptake by soil heterotrophs), suggesting Cu scavenging in the form of sulfhydryl, histidine/carboxyl or a mixture of carboxylate and sulfhydryl complexes. These new structural constraints suggest that adsorbed Cu(II) is partially reduced to Cu(I) already at the cell surface, where as intracellular Cu uptake and storage occur in the form of both Cu(I)-S linked proteins and Cu(II) carboxylates. Obtained results allow to better understand how, in the course of biological evolution, micro-organisms elaborated various mechanisms of Cu uptake and storage, from passive adsorption and uptake to active, protein-controlled surface reduction, and intracellular storage.

Repeated red wine consumption and changes on plasma antioxidant capacity and endogenous antioxidants (uric acid and protein thiol groups)

This study aims to ascertain the in vivo antioxidant properties of red wine by determining how it affects antioxidant biomarkers (plasma antioxidant capacity (PAC) and endogenous antioxidants such as uric acid or protein thiol groups). Antioxidant biomarkers have been assessed in eight healthy human volunteers after repeated intakes of 300 mL of red wine every day for a week. During this intervention period, volunteers followed a low phenolic diet designed to prevent the phenolic compounds in wine from interfering with the phenolics from other foods or beverages. This diet was followed throughout the week that the volunteers drank wine and for another control week when they drank water. Biomarkers were determined before the subjects taking part in the study started the intervention period with red wine (Monastrell variety) and 1, 3, and 7 days after. PAC was evaluated by the Ferric Reducing Ability of Plasma assay (FRAP), and the Oxygen Radical Absorbance Capacity assay using fluorescein (ORAC-FL). In addition, the concentrations of endogenous antioxidants such as uric acid, albumin, bilirubin, and protein thiol groups were analyzed. The FRAP method shows that PAC increased after the week of wine consumption but decreased after the week without wine consumption. The uric acid concentration did not show any changes that were significantly different from our results in acute wine intake studies. Protein thiol groups decreased significantly (p < 0.05) with the low phenolic diet, but this decrease was not statistically significant if the diet was taken with red wine (p < 0.05).

Sesquiterpene polyol esters from the leaves of maytenus macrocarpa

The aerial parts of Maytenus macrocarpa yielded three new beta-dihydroagarofuran sesquiterpene polyol esters. Their structures were elucidated by spectroscopic analyses including 2D NMR techniques as 6beta,8beta,15-triacetoxy-1alpha, 9alpha-dibenzoyloxy-4beta-hydroxy-beta-dihydroagarofuran (1); 1alpha, 6beta,8beta, 15-tetraacetoxy-9alpha-benzoyloxy-4beta-hydroxy-beta-dihydroagarofura n (2) and (1S,4S,6R,7R,8R,9R)-1,6,15-triacetoxy-8, 9-dibenzoyloxy-4-hydroxy-beta-dihydroagarofuran (3). Compounds 1 and 2 showed marginal antitumor activity against four cell lines.

Biological activities of some Argyranthemum species

Seven species of the genus Argyranthemum were studied for antimicrobial and cytotoxic activities. Argyranthemum adauctum, A. foeniculaceum and A. frutescens showed antimicrobial activity against Gram-positive and Gram-negative and cytotoxic activity against HeLa and Hep-2 cell lines. Two new acetylenic compounds, frutescinol isovalerate and 3'-demethyl frutescinol isovalerate, were isolated from A. frutescens and their structures elucidated by spectroscopic studies.

Bioactive anthraquinone glycosides from Picramnia antidesma spp. fessonia

A bioactivity guided fractionation, using KB cells and brine shrimp assays, of the methanolic extract from the leaves of Picramnia antidesma yielded two known anthraquinones, aloe-emodin and aloe-emodin anthrone, and three new aloe-emodin C-glycosides, named picramnioside A, picramnioside B and picramnioside C. Structures were established by spectroscopic methods (UV, IR, mass spectrometry, 1H and 13C and 2D NMR including COSY 45, HMQC, HMBC and ROESY). CD was used to establish the absolute configuration of the picramniosides.

Antibiotic activity and absolute configuation of 8S-heptadeca-2(Z),9(Z)-diene-4,6-diyne-1,8-diol from Bupleurum salicifolium

A polyacetylene has been isolated from Bupleurum salicifolium. Its structure and absolute configuration were determined to be 8S-heptadeca-2(Z),9(Z)-diene-4,6-diyne-1,8-diol [1] by means of 1H- and 13C-nmr spectroscopic studies, including 1H-13C heteronuclear correlation (HMQC) and long-range correlation spectra with inverse detection (HMBC). Its absolute configuration was determined by application of the Horeau method. This compound exhibited significant antibiotic activity against the Gram-positive bacteria Staphylococcus aureus and Bacillus subtilis. Also isolated during this investigation were the known compounds; betulin, herniarin, 6,7,8-trimethoxycoumarin, p-hydroxyphenethyl alcohol, pluviatolide, guamaroline, bursehernin, guayadequiol, kaerophyllin, and matairesinol dimethyl ether.

Examination of spinal cord in diseases of the craniocervical junction and high cervical spine

A simple necropsy technique for the removal of the craniocervical junction was devised: a relatively small specimen comprising part of the clivus, the foramen magnum, and cervical vertebral canal is removed in one piece with the medulla and spinal cord inside, and examined systematically after fixation. This method, used in a series of patients with chronic craniocervical instability, allows both good clinicopathological correlations to be made and histological changes in the lower medulla or upper cervical cord segments to be related to sites of extrinsic compression.

A One- and Two-Dimensional 1H and 13C N.M.R. Study of Some Fernene Triterpenoids

A complete assignment of the 1H and 13C n.m.r. signals of the lichen triterpenoid 12α-acetoxyfern-9(11)-en-3 β-ol (lb) has been achieved by using one- and two-dimensional n.m.r. techniques. Evidence in support of one of two recently advanced assignments of the methyl group resonances of fern-9(11)-en-3-β-ol (1a) is presented.

Pharmacological study of uzarigenin-glucoside-canaroside

Uzarigenin-glucoside-canaroside (UGC) is a steroid glycoside isolated from the leaves of ISOPLEXIS CHALCANTHA whose pharmacological properties have not been so far studied. In this paper the effect of UGC on isolated auricle of rabbits, urinary excretion of rats, isolated jejunum of rabbits, (86)Rb (+) uptake by erythrocytes as well as its emetic effect in pigeons are presented, using digoxin as standard. The pharmacological activity of UGC was similar to that of digoxin, UGC possessing, however, a lesser vomiting action.

Asbestosis in the industries of the Barcelona area

This presentation is the result of the survey of eight industries with asbestosis risk in the Barcelona area (two of fibro-cement, three of auto brakes, two of textiles, and one of insulation materials). Of 1,472 workers, 271 or 18.5% have asbestosis. Pleural involvement in asbestosis is twice as common as that of the lung, 15.7% versus 8.5%. Pulmonary asbestosis without pleural participation is seen in only 2.6% of cases. Pleural plaques, calcified and not calcified, are detected in only a few cases. There is a definite correlation between the incidence of asbestosis and the exposure time: from 1% in the group of workers with less than five years of exposure up to 64.58% for those with 30 or more years of exposure. Clinical symptoms (cough, and/or expectoration, and/or dyspnea) were present in 68% of the studied population. Pulmonary crepitations are the most significant physical sign detected, observed in one quarter to one third of the patients. Pulmonary function tests in asbestos workers revealed restrictive and mixed type syndromes in 17% of the cases and obstructive syndrome in 36%. The percentages for those workers without asbestosis are 9% and 16%, respectively. It seems, therefore, that a bronchial factor plays a role in asbestosis. The bronchial pathology would be manifested clinically by the appearance or the exaggeration of the chronic bronchitis symptoms, and physiologically by the presence of the obstructive syndrome. There is no doubt that smoking enhances the incidence of asbestosis, aggravates the respiratory symptoms in those affected, and is a cause of further deterioration of pulmonary function.