Recruitment challenges in a diabetes prevention trial in a low- and middle-income setting.

AIM: To describe recruitment challenges in a randomized controlled translational trial (RCTT) of diabetes prevention in India. METHODS: The Diabetes Community Lifestyle Improvement Program (D-CLIP) is a RCTT, comparing standard of care to a step-wise model of diabetes prevention. Overweight adults with prediabetes were identified through a two-step screening process (1) field-based screening: minimal testing with a random capillary glucose measurement and (2) clinic-based screening including an Oral Glucose Tolerance Test (OGTT). RESULTS: Individuals from the community (n=19377) were screened at residential locations, offices, educational institutions, places of worship, parks and beaches. Of these, 3535 (18.2%) 'high-risk' participants based on capillary glucose values were eligible for step 2 screening with OGTT. However, only 21.5% participated. An additional 521 participants directly entered step 2 via direct referrals from our clinical/research databases, study participant referrals and targeted advertisements. Of the 1285 individuals who underwent an OGTT, 710 (55.3%) were eligible for randomization, and 602 (84.8%) were randomized into the trial. The ratio of participants entering from step 1 to step 2 was 25:1 (3.9%) and from step 2 to randomization 2:1 (47%). Average staff time for recruitment was 350 h per week for an 11-person team. CONCLUSIONS: Nearly 55 people needed to be screened with a questionnaire plus capillary glucose test to randomize one participant with prediabetes. Using a 2-step strategy requires additional staff time, but considerably reduces the need for OGTT's, thereby minimizing participant burden and study costs.

Exercise patterns and behaviour in Asian Indians: data from the baseline survey of the Diabetes Community Lifestyle Improvement Program (D-CLIP).

AIMS: This paper attempts to describe the patterns of exercise and the perceived benefits and barriers to exercise in an urban south Indian population. METHODS: Study participants were recruited from the baseline survey of the D-CLIP (Diabetes Community Lifestyle Improvement Program). Frequency, duration, type and location of exercise were assessed using a questionnaire, while a Likert type scale was used to assess perceived benefits of and barriers to exercise. Quality of life was measured using the EQ-5D. RESULTS: Out of 1281 participants (63.7% males), 24.1% reported doing ≥150min of exercise/week ("exercisers") compared to 75.9% "non-exercisers". Exercisers were significantly older (47 vs. 43 years), better educated (68.8% vs. 60%), had a higher monthly income (41% vs. 29.2%), consumed more fruits (38.2% vs. 25.6%) and vegetables (84.1% vs. 77.7%) and had better perceived state of health (81.1% vs. 76.8%), compared to non-exercisers. Exercisers had significantly lower HOMA-IR, higher Matsuda index and lower prevalence of low HDL cholesterol compared to non-exercisers. However, there were no significant differences in cardio-metabolic risk factors like diabetes, hypertension and obesity between the two groups. Walking was the most common type of exercise. Both exercisers and non-exercisers perceived the benefits of exercising, but barriers weighed more heavily on exercise behaviour. CONCLUSIONS: Urgent steps are needed to improve overall exercise levels in India by addressing barriers and improving the quality of exercise performed so as to enhance overall metabolic health.

Evaluation of an oral disease control program administered to a clinic population at a suburban dental school.

This study included 99 patients. Seventy-four of these participated in the Oral Disease Control program at Emory University School of Dentistry and 25 control patients did not. Those who completed the Oral Disease Control program were examined and scored from 2 to 24 months afterward. The Patient Hygiene Performance Scoring was used. It was found that there was no significant difference in levels of plaque between subjects who completed the Oral Disease Program and those who did not participate. Also, the patient's knowledge of the causes of dental caries and gingival disease bore no significant relationship to the amount of plaque present. Further, certain selected hygiene habits had no significant effect on plaque level. The patients studied were enthusiastic about the control program and developed an increased awareness of oral disease control. However, this study confirms others that demonstrate the need for repeated professional reinforcement in any effective oral disease control program.

The management of an epileptic disorder.

Successful management of a patient with a seizure disorder requires both a descriptive and etiological diagnosis. Anticonvulsant drugs then provide the key to treatment. Recently developed methods to measure serum anticonvulsant drug levels offer an excellent monitoring procedure enabling the physician to achieve optimum control. Limitations on recreational and occupational activities, the operation of a motor vehicle, what to do in the event of a seizure, questions of personality aberration and inheritance of epilepsy are other areas which need be defined for the epileptic patient.

The role of 'slow virus' infections in neurological disease.

The conventional concept of an acute virus infection is contrasted with the newer concept of a "slow virus infection". The author describes several neurological diseases of animals and man with a "proven" slow viral etiology. The epidemiological, clinical laboratory and pathological features of these diseases are placed parallel to several idiopathic degenerative and demyelinating diseases of man and remarkable similarities are noted. Dr. Weber suggests that diseases such as Parkinsonism, Creutzfeldt-Jakob disease, amyotrophic lateral sclerosis and multiple sclerosis may result from slow viral infections.