Near patient testing for glycated haemoglobin in people with Type 2 diabetes mellitus managed in primary care: acceptability and satisfaction.

AIMS: To assess the acceptability of and satisfaction with near patient testing for glycated haemoglobin in primary care in patients and health professionals. METHODS: A questionnaire survey and qualitative study were nested within a randomized controlled trial conducted in eight general practices in Leicester-shire, UK. Satisfaction with diabetes care was compared in the intervention group (near patient test) and in the control subjects (usual laboratory test), using the Diabetes Clinic Satisfaction Questionnaire. Semistructured interviews were conducted with a purposive sample of patients and healthcare professionals and analysed using thematic coding and framework charting. RESULTS: Questionnaire data for 344 patients were analysed and interviews were conducted with 15 patients and 11 health professionals. Interviews indicated that the near patient test was highly acceptable to patients and staff and confirmed that there may be potential benefits such as time saving, reduced anxiety and impact on patient management and job satisfaction. However, both the survey and the interviews identified high pre-existing levels of satisfaction with diabetes care in both intervention and control group patients and survey results failed to confirm increased patient satisfaction as a result of rapid testing. Limited patient understanding of glycated haemoglobin testing was noted. CONCLUSIONS: We were unable to confirm actual rather than potential advantages of the near patient test. Widespread adoption in primary care cannot be recommended without further evidence of benefit.

Psychological morbidity and problems of daily living in people with visual loss and diabetes: do they differ from people without diabetes?

AIMS: To examine psychological adjustment and changes in the activities of daily living in relation to visual loss in diabetes. METHODS: This was an incident cohort, longitudinal, observational study contrasting the adjustment of individuals with visual loss associated with diabetes and those whose visual loss arose from other conditions; in the year subsequent to registration for blindness and 12 months later, 124 individuals participated in the study (51 with diabetes and 73 without). Participants provided demographic and biomedical information, and completed the Brief COPE, Hospital Anxiety and Depression Scale, SF-36, Instrumental Activities of Daily Living scale and Social Avoidance and Distress Scale via interview. People with diabetes were compared with those without. RESULTS: Both diabetic and non-diabetic groups showed elevated and comparable levels of psychological morbidity, sustained over time. Significant differences in functional adjustment were found at initial interview: people with diabetes having more problems coping but these were no longer present 1 year later. CONCLUSIONS: There was a significant and enduring elevation of anxiety and depression in those who were newly registered blind or visually handicapped. Taking these findings into account, psychological assessment should be developed for all those experiencing visual loss.

What is the prevalence of visual impairment in the general and diabetic populations: are there ethnic and gender differences?

AIMS: To estimate the prevalence of blindness and partial sight in the general and diabetic populations and to measure the impact of ethnicity and gender on these rates. METHODS: Data on visual impairment in the population to be studied was obtained from the Royal Leicestershire Rutland and Wycliffe Society for the Blind (RLRWSB). Using the validated technique of capture-mark-recapture (CMR), a census day was set and data from four sources collected: hospital admissions data, GP returns, wards, and mass media. Computer cross-linkage to Leicestershire Health Authority data ensured patients were alive and resident in Leicestershire at the census date. Estimates of diabetes, ethnicity and gender prevalence were calculated using the 1991 census. RESULTS: CMR calculations revealed that there was under ascertainment of visual impairment in the RLRWSB data. The CMR calculations with direct age standardization estimate the prevalence of blindness and partial sight in the general and diabetic populations to be 51.8/10 000 (CI 50.6-53.0) and 148.8/10 000 (CI 122.1-175.5), respectively. In the diabetic population there was a higher proportion of visually impaired females than males (P < 0.05), with no overall ethnic differences; however, rates were lower than expected in female Indo-Asians. In the general population there was a higher proportion of visually impaired Indo-Asian people (P < 0.01). CONCLUSIONS: Our study has shown the prevalence of visual impairment in both the general and diabetic populations and has demonstrated both ethnic and gender differences. CMR allows the calculation of prevalence of blindness and partial sight from existing data. When comparing the prevalence of visual impairment, whether from diabetes or other causes, it is important to know the gender and ethnicity of the 'at risk' population, as well as the rates in the background population.

Comparative incidence of Type I diabetes in children aged under 15 years from South Asian and White or Other ethnic backgrounds in Leicestershire, UK, 1989 to 1998.

AIMS/HYPOTHESIS: Estimates of incidence of Type I (insulin-dependent) diabetes mellitus in childhood populations vary around the world. This study aimed to estimate and compare the incidence of Type I diabetes in Leicestershire of children of South Asian and White or Other ethnic backgrounds. METHODS: All new cases of childhood-onset Type I diabetes diagnosed before 15 years of age in Leicestershire during the period 1989-98 were studied. Population data for Leicestershire from the 1991 census was used. Ethnicity was assigned to all children in the study according to their surnames. Incidence rates (95%-Confidence limits) for the South Asian and white or other ethnic group were estimated and compared. RESULTS: Over the 10-year period, 46 South Asian children and 263 children who were white or from another ethnic group fulfilled the criteria for inclusion in the study. Crude incidence rates per 100,000 person-years were 19.2 (12.0, 29.1) girls and 20.3 (13.0, 30.3) boys for South Asians and 17.7 (14.8, 21.1) girls and 17.7 (14.8, 20.9) boys for whites/others. Age and sex-specific rates were higher for South Asians over 5 years of age but differences were not statistically significant. CONCLUSION/INTERPRETATION: Type I diabetes incidence rates for South Asian children in Leicestershire were very similar to those for children who were in the white/other ethnic group, in contrast to very low rates reported from Asia. The convergence of rates for South Asians with other ethnic groups in Leicestershire suggests that environmental factors are more important than genetic predisposition in causing Type I diabetes in people of South Asian ethnic background.

Diabetes-associated cardiovascular risk factors.

Cardiovascular disease is the biggest killer in the UK and diabetes puts people at increased risk of this disease. The role of nurses in reducing cardiovascular risk in diabetes is explored.

Culturally sensitive care: managing diabetes during Ramadan.

Diabetes and its treatments can cause problems for Muslims who wish to take part in the fast during the holy month of Ramadan. This article offers information about the impact of various diabetes treatments, including insulin, when fasting and some of the precautions that need to be in place. Some of the reasons people with diabetes might find it difficult to comply with advice are explored with some suggestions on how to work towards acceptable compromises. Through dialogue between health professionals and patients, it is usually possible to facilitate at least some safe fasting for those who wish to observe this annual ritual.

Younger and older adults' recall of typical and atypical actions from script-based text: evidence for interruption and bizarre-imagery effects.

In the present research, younger (mean age 20) and older (mean age 78) adults' perception and recall of scripted and nonscripted actions were examined. Two primary types of nonscripted or atypical actions were presented: those that interrupted the sequence of the script and those that were irrelevant to the script. Script-irrelevant actions also varied in terms of how plausible they were in relationship to both the sentence they were embedded in and the context of the story. Across experiments, both younger and older adults recalled script-interruptive actions better than all other actions, including script actions. In addition, an unexpected finding was that both younger and older adults recalled implausible (bizarre) script-irrelevant actions better than script actions. This latter finding suggests that a bizarre-imagery effect may operate in both younger and older adults. Older adults' better recall of atypical actions over script actions is noteworthy, as these results question the assumption that older adults show an increased reliance on their schematic knowledge structures to recall. Contrary to expectations, older adults showed better recall of actions that required more active story integration (interruptive and implausible atypical actions) than actions requiring less integration (script and plausible atypical actions).

Interruption and bizarreness effects in the recall of script-based text.

Recall of script, script-irrelevant, and script-interruptive actions in script-based stories was examined in four experiments. By varying the plausibility of the script-irrelevant and the script-interruptive actions, the bizarreness effect (i.e., enhanced recall for bizarre, implausible actions) was assessed within the context of script-based text. In addition, presentation of script-interruptive actions actions allowed for an assessment of the interruption effect (i.e., enhanced recall for interruptive actions). A bizarreness effect was found, to the extent that implausible script-irrelevant actions were better recalled than their more plausible counterparts and script actions. However, implausible actions were not better recalled than script-interruptive actions, nor did bizarreness significantly enhance recall of script-interruptive actions. These results are discussed in terms of recent assumptions underlying interruptions underlying interruption and bizarreness effects, and in terms of recent assumptions about how scripted and nonscripted actions are retained in memory.

GRID: a novel Grb-2-related adapter protein that interacts with the activated T cell costimulatory receptor CD28.

Adapter proteins such as Grb2 play a central role in the formation of signaling complexes through their association with multiple protein binding partners. These interactions are mediated by specialized domains such as the well-characterized Src homology SH2 and SH3 motifs. Using yeast three-hybrid technology, we have identified a novel adapter protein, expressed predominantly in T lymphocytes, that associates with the activated form of the costimulatory receptor, CD28. The protein is a member of the Grb2 family of adapter proteins and contains an SH3-SH2-SH3 domain structure. A unique glutamine/proline-rich domain (insert domain) of unknown function is situated between the SH2 and N-terminal SH3 domains. We term this protein GRID for Grb2-related protein with insert domain. GRID coimmunoprecipitates with CD28 from Jurkat cell lysates following activation of CD28. Using mutants of CD28 and GRID, we demonstrate that interaction between the proteins is dependent on phosphorylation of CD28 at tyrosine 173 and integrity of the GRID SH2 domain, although there are also subsidiary stabilizing contacts between the PXXP motifs of CD28 and the GRID C-terminal SH3 domain. In addition to CD28, GRID interacts with a number of other T cell signaling proteins, including SLP-76 (SH2 domain-containing leukocyte protein of 76 kDa), p62dok, and RACK-1 (receptor for activated protein kinase C-1). These findings suggest that GRID functions as an adapter protein in the CD28-mediated costimulatory pathway in T cells.

Regulation of AA-NAT and HIOMT gene expression by butyrate and cyclic AMP in Y79 human retinoblastoma cells.

Two key enzymes involved in the synthesis of melatonin, hydroxyindole-O-methyltransferase (HIOMT) and arylalkylamine N-acetyltransferase (AA-NAT), are present in Y79 human retinoblastoma cells. Under certain conditions these cells produce melatonin and secrete it into the culture medium. In a previous study, it was observed that melatonin levels increase dramatically over control levels after the addition of dibutyryl cyclic AMP (dbcAMP), whereas after treatment with butyrate melatonin levels decreased. The changes in melatonin levels appeared to be the result of increases in AA-NAT activity or decreases in HIOMT activity, following dbcAMP or butyrate treatment. In this study, mechanisms by which these agents influence HIOMT and AA-NAT gene expression were examined. Levels of AA-NAT and HIOMT RNA expression in response to treatment of Y79 cultures with 4 mM dbcAMP or 2 mM butyrate were measured by semi-quantitative reverse-transcription/polymerase chain reaction. Butyrate and dbcAMP showed no effect on AA-NAT gene expression, whereas HIOMT gene expression was reduced by treatment with these agents. Levels of beta-actin RNA were increased following dbcAMP or butyrate treatment. This analysis suggests that the reduction in HIOMT activity caused by dbcAMP or butyrate treatment is the result of a decrease in HIOMT RNA synthesis or accumulation. Conversely, since AA-NAT RNA levels were unaffected by dbcAMP or butyrate treatment, the increase in AA-NAT activity previously observed may be the result of changes in the activational state of the AA-NAT protein.

Screening for Type 2 diabetes mellitus in the UK Indo-Asian population.

AIMS: Type 2 diabetes mellitus (DM) has a high prevalence in Asian subjects. A simple method of screening using self-testing for postprandial glycosuria achieved a good response rate and a sensitivity which compared favourably to more expensive and invasive methods in a semirural Caucasian population. We examined its effectiveness in Asian subjects. METHODS: Caucasian and Indo-Asian subjects aged 35-70 years in two general practices in Leicester (n=9896 (6198=Asian subjects, 3698=Caucasian)) were screened. Those known to have diabetes were excluded. Subjects were asked to self-test for glycosuria 1 h after their main meal. Instruction and response cards were translated in Punjabi and Gujarati and sent to the Asian subjects, depending on age and surname. RESULTS: Response rate was 34.4% in Asian subjects compared to 54.0% in Caucasian subjects. Prevalence of glycosuria was 8.2% in Asian subjects and 3.2% in Caucasian subjects. Two hundred and thirty-nine subjects recorded glycosuria and 202 (84.5% of the total, 86.9% of Asian subjects, 78.1% of Caucasian) attended for oral glucose tolerance test (OGTT). Sixty-three (31.2%) were found to have diabetes (46, 73% Asian), 29 (14.4%) impaired glucose tolerance (24, 82.8% Asian) and 110 (54.4%) normal glucose tolerance (82, 74.6% Asian). Thus 30% of Asian subjects and 34% of Caucasian subjects had diabetes on OGTT. The prevalence of diabetes in 35-70 years in the total population after screening was 5.6% (6.8% in Asian subjects, 3.6% in Caucasian) and in the screened population was 12.7% (17.9% in Asian subjects, 6.3% in Caucasian). CONCLUSIONS: Screening for diabetes using this method, in terms of response rate, is not as effective in a large city setting, particularly in the Asian population. However, the yield of diabetes in the age group 35-64 years compares well to much more expensive and labour intensive approaches and its use in this population in a primary care setting is justified.

Approaches to managing diabetes in Asian people.

The prevalence of diabetes is four times higher in people of Asian origin than in Caucasians. Mary Burden discusses how the management of diabetes differs in Asians.