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Binkowski S, Roberts A, Fried L, Nicholas JA, Frearson K, Davis EA, Cherian S, Abraham MB. Perspectives of culturally and linguistically diverse families in the management of children with type 1 diabetes in Western Australia. Ethn Health 2023:1-14. [PMID: 36935189 DOI: 10.1080/13557858.2023.2190063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Children with Type 1 diabetes (T1D) from different ethnic backgrounds are growing in proportion in clinical practice and tend to have a higher risk of poor health outcomes. The study aimed to investigate the perspectives of culturally and linguistically diverse families in the management of children with T1D in Western Australia. DESIGN A generic qualitative approach was used. Families of children and adolescents with T1D with first-generation African, Asian or Middle Eastern background were invited to participate in a semi-structured interview. The interviews were audio-recorded, transcribed and analysed thematically. Demographic, clinical and socio-economic data were collected from all participants. RESULTS Fifteen families (27% African, 33% Middle Eastern, 40% Asian) participated in the study. The mean (SD) age of the child with T1D was 10.2 (5.1) years, had diabetes for 2.9 (1.6) years and an average HbA1c of 67 (15) mmol/mol. Four main themes were identified through qualitative analysis. 'Dietary challenges': lack of adequate food resources posed a barrier to determine carbohydrate amount in traditional meals; 'Linguistic challenges': inadequate reading and language skills affected comprehension of written information and the desire for pictorial resources was reported; 'Limited Support': absence of extended family made management of T1D difficult; and 'Knowledge': a key facilitator, which was acquired through clinic education, enabled families to develop skills to effectively manage T1D. CONCLUSION The study highlights the need to consider cultural diversity, psychosocial needs, English proficiency and health literacy when assessing and planning diabetes education. These findings will be useful to formulate a more culturally sensitive approach to diabetes education to improve care and outcomes for young people with T1D from culturally and linguistically diverse families.
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Affiliation(s)
- Sabrina Binkowski
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Alison Roberts
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
| | - Leanne Fried
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Jennifer A Nicholas
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
- Discipline of Paediatrics, The University of Western Australia, Perth, Australia
| | - Kingsley Frearson
- Discipline of Paediatrics, The University of Western Australia, Perth, Australia
| | - Elizabeth A Davis
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
- Discipline of Paediatrics, The University of Western Australia, Perth, Australia
| | - Sarah Cherian
- Discipline of Paediatrics, The University of Western Australia, Perth, Australia
- Refugee Health Service, Department of General Paediatrics, Perth Children's Hospital, Perth, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
| | - Mary B Abraham
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
- Discipline of Paediatrics, The University of Western Australia, Perth, Australia
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Harray AJ, Binkowski S, Keating BL, Horowitz M, Standfield S, Smith G, Paramalingam N, Jones T, King BR, Smart CEM, Davis EA. Effects of Dietary Fat and Protein on Glucoregulatory Hormones in Adolescents and Young Adults With Type 1 Diabetes. J Clin Endocrinol Metab 2022; 107:e205-e213. [PMID: 34410410 DOI: 10.1210/clinem/dgab614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Dietary fat and protein impact postprandial hyperglycemia in people with type 1 diabetes, but the underlying mechanisms are poorly understood. Glucoregulatory hormones are also known to modulate gastric emptying and may contribute to this effect. OBJECTIVE Investigate the effects of fat and protein on glucagon-like peptide (GLP-1), glucagon-dependent insulinotropic polypeptide (GIP) and glucagon secretion. METHODS 2 crossover euglycemic insulin clamp clinical trials at 2 Australian pediatric diabetes centers. Participants were 12-21 years (n = 21) with type 1 diabetes for ≥1 year. Participants consumed a low-protein (LP) or high-protein (HP) meal in Study 1, and low-protein/low-fat (LPLF) or high-protein/high-fat (HPHF) meal in Study 2, all containing 30 g of carbohydrate. An insulin clamp was used to maintain postprandial euglycemia and plasma glucoregulatory hormones were measured every 30 minutes for 5 hours. Data from both cohorts (n = 11, 10) were analyzed separately. The main outcome measure was area under the curve of GLP-1, GIP, and glucagon. RESULTS Meals low in fat and protein had minimal effect on GLP-1, while there was sustained elevation after HP (80.3 ± 16.8 pmol/L) vs LP (56.9 ± 18.6), P = .016, and HPHF (103.0 ± 26.9) vs LPLF (69.5 ± 31.9) meals, P = .002. The prompt rise in GIP after all meals was greater after HP (190.2 ± 35.7 pmol/L) vs LP (152.3 ± 23.3), P = .003, and HPHF (258.6 ± 31.0) vs LPLF (151.7 ± 29.4), P < .001. A rise in glucagon was also seen in response to protein, and HP (292.5 ± 88.1 pg/mL) vs LP (182.8 ± 48.5), P = .010. CONCLUSION The impact of fat and protein on postprandial glucose excursions may be mediated by the differential secretion of glucoregulatory hormones. Further studies to better understand these mechanisms may lead to improved personalized postprandial glucose management.
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Affiliation(s)
- Amelia J Harray
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- School of Population Health, Curtin University, Bentley, Perth, Western Australia, Australia
| | - Sabrina Binkowski
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Barbara L Keating
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Western Australia, Australia
| | | | | | - Grant Smith
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Nirubasini Paramalingam
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Western Australia, Australia
- Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Timothy Jones
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Western Australia, Australia
- Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Bruce R King
- John Hunter Children's Hospital, New Lambton Heights, New South Wales, Australia
- Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Carmel E M Smart
- John Hunter Children's Hospital, New Lambton Heights, New South Wales, Australia
- Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Elizabeth A Davis
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Western Australia, Australia
- Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
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Hope CM, Huynh D, Wong YY, Oakey H, Perkins GB, Nguyen T, Binkowski S, Bui M, Choo AYL, Gibson E, Huang D, Kim KW, Ngui K, Rawlinson WD, Sadlon T, Couper JJ, Penno MAS, Barry SC. Optimization of Blood Handling and Peripheral Blood Mononuclear Cell Cryopreservation of Low Cell Number Samples. Int J Mol Sci 2021; 22:ijms22179129. [PMID: 34502038 PMCID: PMC8431655 DOI: 10.3390/ijms22179129] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/14/2021] [Accepted: 08/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Rural/remote blood collection can cause delays in processing, reducing PBMC number, viability, cell composition and function. To mitigate these impacts, blood was stored at 4 °C prior to processing. Viable cell number, viability, immune phenotype, and Interferon-γ (IFN-γ) release were measured. Furthermore, the lowest protective volume of cryopreservation media and cell concentration was investigated. Methods: Blood from 10 individuals was stored for up to 10 days. Flow cytometry and IFN-γ ELISPOT were used to measure immune phenotype and function on thawed PBMC. Additionally, PBMC were cryopreserved in volumes ranging from 500 µL to 25 µL and concentration from 10 × 106 cells/mL to 1.67 × 106 cells/mL. Results: PBMC viability and viable cell number significantly reduced over time compared with samples processed immediately, except when stored for 24 h at RT. Monocytes and NK cells significantly reduced over time regardless of storage temperature. Samples with >24 h of RT storage had an increased proportion in Low-Density Neutrophils and T cells compared with samples stored at 4 °C. IFN-γ release was reduced after 24 h of storage, however not in samples stored at 4 °C for >24 h. The lowest protective volume identified was 150 µL with the lowest density of 6.67 × 106 cells/mL. Conclusion: A sample delay of 24 h at RT does not impact the viability and total viable cell numbers. When long-term delays exist (>4 d) total viable cell number and cell viability losses are reduced in samples stored at 4 °C. Immune phenotype and function are slightly altered after 24 h of storage, further impacts of storage are reduced in samples stored at 4 °C.
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Affiliation(s)
- Christopher M. Hope
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia; (C.M.H.); (D.H.); (Y.Y.W.); (H.O.); (G.B.P.); (T.N.); (T.S.); (J.J.C.); (M.A.S.P.)
- Women’s and Children’s Hospital, Adelaide, SA 5006, Australia
| | - Dao Huynh
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia; (C.M.H.); (D.H.); (Y.Y.W.); (H.O.); (G.B.P.); (T.N.); (T.S.); (J.J.C.); (M.A.S.P.)
| | - Ying Ying Wong
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia; (C.M.H.); (D.H.); (Y.Y.W.); (H.O.); (G.B.P.); (T.N.); (T.S.); (J.J.C.); (M.A.S.P.)
| | - Helena Oakey
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia; (C.M.H.); (D.H.); (Y.Y.W.); (H.O.); (G.B.P.); (T.N.); (T.S.); (J.J.C.); (M.A.S.P.)
| | - Griffith Boord Perkins
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia; (C.M.H.); (D.H.); (Y.Y.W.); (H.O.); (G.B.P.); (T.N.); (T.S.); (J.J.C.); (M.A.S.P.)
| | - Trung Nguyen
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia; (C.M.H.); (D.H.); (Y.Y.W.); (H.O.); (G.B.P.); (T.N.); (T.S.); (J.J.C.); (M.A.S.P.)
| | - Sabrina Binkowski
- Children’s Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA 6009, Australia; (S.B.); (A.Y.L.C.)
| | - Minh Bui
- Child Health Research Unit, Barwon Health, Geelong, VIC 3220, Australia;
| | - Ace Y. L. Choo
- Children’s Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA 6009, Australia; (S.B.); (A.Y.L.C.)
| | - Emily Gibson
- School of Women’s and Children’s Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia; (E.G.); (K.W.K.); (W.D.R.)
| | - Dexing Huang
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC 3052, Australia; (D.H.); (K.N.)
| | - Ki Wook Kim
- School of Women’s and Children’s Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia; (E.G.); (K.W.K.); (W.D.R.)
- Virology Research Laboratory, Serology and Virology Division, NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW 2031, Australia
| | - Katrina Ngui
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC 3052, Australia; (D.H.); (K.N.)
| | - William D. Rawlinson
- School of Women’s and Children’s Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia; (E.G.); (K.W.K.); (W.D.R.)
- Virology Research Laboratory, Serology and Virology Division, NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW 2031, Australia
| | - Timothy Sadlon
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia; (C.M.H.); (D.H.); (Y.Y.W.); (H.O.); (G.B.P.); (T.N.); (T.S.); (J.J.C.); (M.A.S.P.)
| | - Jennifer J. Couper
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia; (C.M.H.); (D.H.); (Y.Y.W.); (H.O.); (G.B.P.); (T.N.); (T.S.); (J.J.C.); (M.A.S.P.)
- Women’s and Children’s Hospital, Adelaide, SA 5006, Australia
| | - Megan A. S. Penno
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia; (C.M.H.); (D.H.); (Y.Y.W.); (H.O.); (G.B.P.); (T.N.); (T.S.); (J.J.C.); (M.A.S.P.)
| | - Simon C. Barry
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, SA 5005, Australia; (C.M.H.); (D.H.); (Y.Y.W.); (H.O.); (G.B.P.); (T.N.); (T.S.); (J.J.C.); (M.A.S.P.)
- Women’s and Children’s Hospital, Adelaide, SA 5006, Australia
- Correspondence:
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Binkowski S, Neumann J, Fahlenkamp H. Nutzung von Membrankontaktoren zur Gastrennung. CHEM-ING-TECH 2003. [DOI: 10.1002/cite.200390417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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