Relationship between weight change and glycaemic control in patients with type 2 diabetes receiving once-weekly dulaglutide treatment.

AIM: To assess the relationship between weight change and glycated haemoglobin (HbA1c) change in dulaglutide-treated patients by analysing data from six head-to-head phase III AWARD clinical trials. METHODS: At 26 weeks, the relationship between weight and HbA1c was analysed in each trial rather than by pooling data because of differences in design and background therapy. The effect of baseline characteristics was also evaluated with regard to weight and HbA1c response. RESULTS: Across the studies, 87-97% and 83-95% of patients treated with dulaglutide 1.5 and 0.75 mg, respectively, had reductions in HbA1c levels, while 57-88% and 43-84% of patients treated with dulaglutide 1.5 and 0.75 mg, respectively, experienced weight loss. The majority (55-83%) of patients receiving dulaglutide 1.5 mg experienced weight loss and HbA1c reductions, while 41-79% of patients in the dulaglutide 0.75 mg arm lost weight and had reductions in HbA1c level. A weak and inconsistent correlation was observed between the changes in weight and HbA1c (range from -0.223 to 0.267) in patients treated with dulaglutide. The baseline characteristics of gender, age, duration of diabetes, HbA1c, body weight and BMI were not related to different combinations of weight and HbA1c responses. CONCLUSIONS: Dulaglutide is an effective treatment option across the type 2 diabetes treatment spectrum. Dulaglutide showed dose-dependent effects on both weight loss and HbA1c reduction. These effects had a weak correlation and appeared to be independent.

A review of private residential care in Hong Kong: implications for policy and practice.

Hong Kong government policy encourages and facilitates families to care for their older members as long as possible by providing families and their older relatives with community support services. Residential care for the elderly is viewed as a last resort. Due to the inadequate supply of community support services, the long period of care required, and the gradual breakdown of values of filial support, families may increasingly give up their caring roles and seek residential care for their dependent elderly relatives. A shortfall in subsidized residential care may lead to needy elderly persons' being cared for in private residential facilities. The demand for private residential care is projected to increase, despite criticism about the standard of care provided. Although an Ordinance, a Regulation, and a Code of Practice for residential care homes are in place to control, monitor, and upgrade private residential care in Hong Kong, problems remain that put the elderly at risk of receiving substandard services. These include the existence of substandard private aged care homes operating either with or without a license; the provision of substandard "places" to the elderly under the government's "bought place" scheme and "enhanced bought place" scheme; ineffective inspection; a lack of grading to indicate the quality of private aged care homes; and a general neglect of the quality of care. We provide recommendations to address these concerns. This requires paying attention to both the quality of care, as well as to the physical environment of homes.

Increased obese mRNA expression in omental fat cells from massively obese humans.

Obesity presents a significant challenge to the general health of affluent nations in terms of the number of people affected, the serious associated maladies and the lack of effective treatments. While common wisdom has held that obesity results from 'gluttony and sloth', a number of studies have indicated physiological causes of underlying the pathogenesis of obesity, with the degree of adiposity having a strong genetic component. Recently, the obese gene in the ob/ob mouse was cloned, along with its human homologue. The specific production of the obese protein by adipose tissue suggested that it may function in a feedback loop from fat tissue to the hypothalamus to control energy intake and/or energy expenditure, and that it may play a role in the pathogenesis of human obesity. In this study we report that obese mRNA expression is elevated in ex vivo omental adipocytes isolated from massively obese humans in the absence of an identifiable mutation. Therefore, we speculate that this increased expression may suggest that the massively obese are insensitive to the putative regulatory function(s) of the obese gene product.

Are health care professionals ready for Alzheimer's disease: a comparison of U.S. and Hong Kong nurses.

The Alzheimer's Disease Knowledge Test (ADK) was administered to samples of practicing nurses in the United States and Hong Kong. Nurses experienced with Alzheimer's Disease patients, having specific training on AD, and reporting greater knowledge about AD were, in fact, more knowledgeable. Overall, U.S. nurses were significantly more knowledgeable, but exhibited more negative bias than Hong Kong nurses. Findings suggest that nurses in Hong Kong, as well as in the United States, need more training about Alzheimer's disease.

A new type of lesion-induced synaptogenesis: I. Synaptic turnover in non-denervated zones of the dentate gyrus in young adult rats.

It is well established that partial denervation causes the formation of new synapses within denervated areas. It is also possible that synapse formation and remodeling occurs outside denervated zones. In this study we evaluate this possibility by examining the effect of a unilateral entorhinal lesion on the number and characteristics of synapses in non-denervated zones of the dentate gyrus within the hippocampal formation. A unilateral entorhinal lesion massively denervates the outer two-thirds of the ipsilateral dentate molecular layer and also causes a minor loss of synapses in the outer two-thirds of the contralateral dentate molecular layer. The inner one-third of the molecular layer is not denervated on either side. In the ipsilateral inner molecular layer the number of synapses rapidly decreases by about 20% and recovers by 10 days post-lesion. Similarly, in the contralateral inner molecular layer, synapses are lost and replaced, but the time course is slower. Loss is maximal at 60 days post-lesion and this recovers by 180 days post-lesion. Thus, a complete cycle of turnover occurs in both of the inner molecular layers. No degenerating terminals of any type were seen throughout the time course in these layers. Small synapses with non-complex synaptic junctions appear to account for most of the changes. Also the outer two-thirds of the contralateral molecular layer, which has lost less than 5% of its input, loses about 37% of its synapses and replaces the majority of them over time. However, the total number of synapses in the contralateral molecular layer never fully attains the value of unoperated animals. The total synaptic population reaches a value such that the ipsilateral and contralateral molecular layers are nearly equivalent. These changes, achieved through synaptic turnover, may represent a homeostatic response to nearby denervation which may facilitate restoration of bilateral function in the dentate gyrus.

A new type of lesion-induced synaptogenesis: II. The effect of aging on synaptic turnover in non-denervated zones.

Partial denervation of the dentate molecular layer causes sprouting and reinnervation by undamaged afferents within the denervated zones of young adult animals and to a lesser extent in aged animals. We have previously reported a non-degenerative remodeling of the dentate molecular layer in areas outside the primary denervated zone of young adult rats after a unilateral entorhinal lesion. In this study, we evaluate the response of aged rats under the same conditions, to see if aged animals also respond to injury in non-denervated zones. After a unilateral entorhinal lesion, the outer two-thirds of the ipsilateral dentate molecular layer loses about 85% of its input, while the outer two-thirds of the contralateral molecular layer loses less than 5% of its input (crossed temporo-dentate path). Denervation does not occur in the inner one-third of the molecular layer on either side. Within the ipsilateral inner molecular layer, the synaptic density rapidly drops 21% in the absence of degeneration and then recovers by 10 days post-lesion, as is the case in young adult animals. On the contralateral side, young adult animals show synapse turnover similar to the ipsilateral inner molecular layer. In contrast, no significant response in the total synaptic density was observed in the non-denervated contralateral inner molecular layer or the partially denervated outer two-thirds of the contralateral molecular layer. Thus, in aged animals, synaptic turnover is restricted to the massively denervated ipsilateral side. The small loss of input to the contralateral side apparently is not sufficient to initiate quantifiable turnover of synaptic contacts. This steady-state situation may be the result of an on-going stabilization of neuronal circuitry, which may limit restoration of function after injury in aged animals.