Effectiveness of a self-management intervention with personalised genetic and lifestyle-related risk information on coronary heart disease and diabetes-related risk in type 2 diabetes (CoRDia): study protocol for a randomised controlled trial

Background

Many patients with type 2 diabetes fail to achieve good glycaemic control. Poor control is associated with complications including coronary heart disease (CHD). Effective self-management and engagement in health behaviours can reduce risks of complications. However, patients often struggle to adopt and maintain these behaviours. Self-management interventions have been found to be effective in improving glycaemic control. Recent developments in the field of genetics mean that patients can be given personalised information about genetic- and lifestyle-associated risk of developing CHD. Such information may increase patients’ motivation to engage in self-management. The Coronary Risk in Diabetes (CoRDia) trial will compare the effectiveness of a self-management intervention, with and without provision of personalised genetic- and lifestyle-associated risk information, with usual care, on clinical and behavioural outcomes, the cognitive predictors of behaviour, and psychological wellbeing.

Methods/Design

Participants will be adults aged 25–74 years registered with general practices in the East of England, diagnosed with type 2 diabetes, with no history of heart disease, and with a glycated haemoglobin level of ≥6.45 % (47 mmol/mol). Consenting participants will be randomised to one of three arms: usual care control, group self-management only, group self-management plus personalised genetic- and lifestyle-associated risk information. The self-management groups will receive four weekly 2-hour group sessions, focusing on knowledge and information sharing, problem solving, goal setting and action planning to promote medication adherence, healthy eating, and physical activity. Primary outcomes are glycaemic control and CHD risk. Clinical data will be collected from GP records, including HbA1c, weight, body mass index, blood pressure, and HDL and total cholesterol. Self-reported health behaviours, including medication adherence, healthy eating and physical activity, and cognitive outcomes will be assessed by questionnaire. Measures will be taken at baseline, 3 months (questionnaire only), 6 months and 12 months post-baseline.

Discussion

This study will determine whether the addition of personalised genetic- and lifestyle-associated CHD risk information to a group self-management intervention improves diabetes control and CHD risk compared with group self-management and usual care. Effectiveness of the combined intervention on health behaviours cognitions theorised to predict them, and psychological outcomes will also be investigated.

Trial registration

This study has been registered at ClinicalTrials.gov; registration identifier NCT01891786, registered 28 June 2013.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-015-1073-7) contains supplementary material, which is available to authorized users.

The effect of acknowledging mock jurors' feelings on affective and cognitive biases: it depends on the sample

An intervention designed to correct affective and cognitive biases was tested in the context of a civil commitment hearing of a sexually violent predator. Potential differences between a college student mock jury sample and a more representative, juror venire sample in reaction to these bias correction interventions were explored. In the first of two experiments, undergraduate mock jurors (n = 130) demonstrated a leniency effect when the sex offender's attorney acknowledged jurors' emotional reactions and motivated them to thoughtfully weigh the evidence. The second experiment failed to replicate these findings with a more ecologically valid sample (n = 300). Several differences between samples were found: representative jurors, as opposed to undergraduates, were sensitive to differences between pure clinical and actuarial expert testimony; and measures of intrinsic cognitive effort predicted verdicts for undergraduates, but not for representative jurors. Copyright © 2011 John Wiley & Sons, Ltd.

Reality check: a comparison of college students and a community sample of mock jurors in a simulated sexual violent predator civil commitment

Despite concerns about generalizability, past mock trial research has concluded that effects of sample (i.e., students versus representative mock jurors) are negligible. The current study was conducted to explore this conclusion within the conceptual framework of cognitive-experiential self-theory (CEST). Through a mock civil commitment hearing of a sexually violent predator, responses of student (n = 138) and representative (n = 240) mock jurors were compared. Results revealed several important differences between samples: (a) the student sample scored higher on the rational processing measure (i.e., need for cognition); (b) students' verdicts were also significantly correlated to a measure of their cognitive processing style, an enduring personal characteristic related to the extent to which an individual engages in either effortful/effortless cognition; and (c) the representative sample was more punitive, was more persuaded by clinical expert testimony, and evidenced a greater gender effect in its decisions. Implications for jury decision-making research are discussed.

Antigen-specific human antibodies from mice comprising four distinct genetic modifications

Human sequence monoclonal antibodies, which in theory combine high specificity with low immunogenicity, represent a class of potential therapeutic agents. But nearly 20 years after Köhler and Milstein first developed methods for obtaining mouse antibodies, no comparable technology exists for reliably obtaining high-affinity human antibodies directed against selected targets. Thus, rodent antibodies, and in vitro modified derivatives of rodent antibodies, are still being used and tested in the clinic. The rodent system has certain clear advantages; mice are easy to immunize, are not tolerant to most human antigens, and their B cells form stable hybridoma cell lines. To exploit these advantages, we have developed transgenic mice that express human IgM, IgG and Ig kappa in the absence of mouse IgM or Ig kappa. We report here that these mice contain human sequence transgenes that undergo V(D)J joining, heavy-chain class switching, and somatic mutation to generate a repertoire of human sequence immunoglobulins. They are also homozygous for targeted mutations that disrupt V(D)J rearrangement at the endogenous heavy- and kappa light-chain loci. We have immunized the mice with human proteins and isolated hybridomas secreting human IgG kappa antigen-specific antibodies.