The impact of blood glucose monitoring on depression and distress in insulin-naïve patients with type 2 diabetes.

OBJECTIVE: To test whether a structured self-monitoring of blood glucose (SMBG) protocol reduces depressive symptoms and diabetes distress. RESEARCH DESIGN AND METHODS: A 12-month, cluster-randomised, clinical trial compared patients who received a collaborative, structured SMBG, physician/patient intervention with an active control. Studied were 483 insulin naïve type 2 diabetes patients (experimental = 256, control = 227) (≥ 7.5% HbA1c) from 34 primary care practices (experimental = 21, control = 13). Experimental patients used a paper tool to record a 7-point SMBG profile on each of three consecutive days prior to their quarterly physician visit. Patients and physicians interpreted SMBG results to make medication and lifestyle changes. CLINICAL TRIAL REGISTRATION: NIH Trial Registry Number: NCT00674986. MAIN OUTCOME MEASURES: Depressive symptoms (Patient Health Questionnaire: PHQ-8), diabetes-related distress (Diabetes Distress Scale: DDS). HbA1c and SMBG frequency were assessed quarterly; data were analysed using Linear Mixed Models (LMM) for intent-to-treat (ITT) and per protocol (PP) analyses. RESULTS: ITT analyses showed significant improvement in depression and disease-related distress among experimental and control patients from baseline to 12 months (p < 0.01 in both cases) with no between-group differences. Experimental patients displayed significantly greater reductions in distress related to regimen adherence than controls. Also, experimental patients with elevated diabetes distress or depressive symptoms at baseline showed significantly greater reductions in distress and depressive symptoms than control patients at 12 months. The greater improvement in mood in the experimental than control group was independent of improvements in glycaemic control and changes in SMBG frequency. CONCLUSIONS: Using well standardised measures, collaborative, structured SMBG leads to reductions, not increases, in depressive symptoms and diabetes distress over time, for the large number of moderately depressed or distressed type 2 patients in poor glycaemic control. Changes in affective status are independent of improvements in glycaemic control and changes in SMBG frequency for these patients.

Subcellular localization of glutaraldehyde.

Glutaraldehyde (GA) has been proposed as an alternative to formocresol for pulpotomies in primary teeth and as an irrigant in root canal therapy. These studies were undertaken to determine if GA can associate with the nucleus of living cells, thereby posing a mutagenic threat. Rats were infused IV with 14C-GA and killed 5 min and 1 h later. The cystolic, membrane, and nuclear fractions of harvested liver cells were separated and analyzed for radioactivity. We determined that significant radioactivity was located in the cytosol and membrane fractions, but not in the nuclear fraction. In an in vitro experiment, liver slices were incubated with 14C-GA in sealed vials in which 14C-CO2 was captured. After 1 h the nucleic acids of the liver slices were isolated and counted. In vitro the liver cells incorporated and metabolized GA to CO2 but no significant label could be detected in the isolated nucleic acids. We concluded from these experiments that GA which was incorporated into liver cells did not reach the nucleus to a significant extent, and that its potential for mutagenicity in the context of pulp treatment was nil.

Long-latency event-related potentials in the evaluation of cognitive function in children.

The endogenous auditory P300 event-related potential (P3) has been used to differentiate functional and organic cognitive disorders in adults. We found that children with organic cognitive impairments (as determined by the Halstead-Reitan [HR] test) had greater P3 latencies than children with normal HR evaluations. The P3 and HR showed 85% agreement in independent assessments of functional or organically based cognitive impairment in children. Mini-Mental-State, IQ, EEG evaluations, and clinical suspicions of "organicity" with respect to cognitive function were similarly associated with P3 latency.