High level of clinical inertia in insulin initiation in type 2 diabetes across Central and South-Eastern Europe: insights from SITIP study.

AIMS: Little is known regarding initiation of insulin therapy in type 2 diabetes (T2D) in Central and South-Eastern European countries. Therefore, we conducted a survey to characterise the prescribing practices of specialist diabetes healthcare professionals in this region and assessed factors that influence clinical decision-making regarding insulin initiation in T2D. METHODS: A cross-sectional survey sampled 211 specialist diabetes healthcare prescribers from five Central and South-Eastern European countries (Bulgaria, Croatia, Greece, Hungary, and Slovenia). A structured questionnaire was developed which surveyed current clinical practices and influencing factors, barriers to insulin initiation, and combination therapy prescribing preferences. RESULT: Only 9.4% (20 of out of 211 respondents) of healthcare professionals would initiate insulin therapy in T2D patients at the recommended HbA1c threshold of 7-7.9% [53-63 mmol/mol]. Large regional differences were evident in insulin initiation thresholds (≥ 9.0% [≥ 75 mmol/mol]: Bulgaria 80.8% vs. Slovenia 13.3%). Psychological distress was recorded as the major barrier to insulin initiation. Health insurance regulations were ranked more important than personal clinical experience and clinical guidelines in clinical decision-making. Information from peers was more influential than manufacturer information, clinical experience, and continuous medical education, respectively, for insulin initiation. CONCLUSIONS: Despite large regional variation, there is widespread delay of insulin initiation from specialist diabetes healthcare professionals in Central and South-Eastern Europe.

Lower crop load for Cv. Jonagold apples (Malus x domestica Borkh.) increases polyphenol content and fruit quality.

The influence of crop load on fruit quality was investigated on 7-year-old slender spindle cv. Jonagold/M.9 apple trees. In mid June five different crop loads per tree were prepared by reducing the fruit number to average 30, 59, 104, 123, and 157 fruits per crown. The fruit from low-cropping trees had more red blush, a higher percentage of soluble solids in fruit flesh, and better flesh firmness in comparison to fruit from high-cropping trees. As the crop load decreased, the concentration of all phenolic compounds in the fruit samples (cortex plus skin) increased; concentrations of the most important individual fruit phenolics were also higher. When crop load fell from 157 to 30 fruits per crown, total polyphenols increased from an average of 1300 to 1680 mg/kg of fruit fresh weight (FW) (+29%), low molecular weight polyphenols increased from 1140 to 1570 mg/kg of FW (+38%), and high molecular weight polyphenols increased from 1740 to 2070 mg/kg of FW (+19%). The average increases in single polyphenols were even greater: chlorogenic acid (+82%); 4'-p-coumaroylquinic acid (+22%); catechin (+178%); and epicatechin (+71%). Ascorbic acid was not significantly dependent on crop load.