An Unsafe/Safe Typology in People with Type 2 Diabetes: Bridging Patients' Expectations, Personality Traits, Medication Adherence, and Clinical Outcomes.

Background: Support programs are provided to people with diabetes to help them manage their disease. However, adherence to and persistence in support programs are often low, making it difficult to demonstrate their effectiveness. Aim: To identify the determinants of patients' perceived interest in diabetes support programs because it may be a powerful determinant of effective participation in such programs. Patients and Methods: An online study conducted in April 2021 in metropolitan France on 600 people with diabetes recruited from a consumer panel. A 64-item psychosocial questionnaire including a question asking to evaluate the helpfulness of a support program was used. Univariate, multivariate, and multiple correspondence analyses were performed. Results: The existence of a typology, known as Unsafe/Safe, was discovered, in which patients with type 2 diabetes respond in two distinct ways. Type U (unsafe) patients, who believe that a support program would be helpful, are more likely to be nonadherent to their treatment, have high hemoglobin A1c levels, have at least one diabetic complication, lack information regarding their disease and treatment, rate the burden of their disease and impairment of their quality of life as high, worry about their future, and are pessimistic. Type S (safe) patients have the opposite characteristics. Type U patients can be dichotomized into two broad classes: one in which they lack information regarding disease and treatment and the other in which alterations in the quality of life and burden of the disease predominate. Insulin-treated patients give more importance to the lack of information, whereas noninsulin-treated patients complain primarily about the burden of the disease and impairment of quality of life. Conclusion: This study describes this new U/S typology, proposes a simple method based on a nine-item questionnaire to identify type U patients by calculating a Program Helpfulness Score described herein, and clarifies the nature of the intervention to be provided to them. This novel approach could be applied to other chronic diseases.

Mardivirus Infection and Persistence in Feathers of a Chicken Model Harboring a Local Autoimmune Response.

Herpesvirus of turkey (HVT) is commonly used as a vaccine to protect chickens against Marek's disease. Following vaccination, HVT infects feathers where it can be detected in all chicken lines examined. Unlike the parental Brown line (BL), Smyth line (SL) chickens develop vitiligo, due to autoimmune destruction of melanocytes in feathers. Previous reports showed a strong inflammatory response in Smyth chickens' feathers at vitiligo onset, that subsided once melanocytes were destroyed, and depigmentation was complete. Here, we questioned whether the local autoimmune response in the Smyth model influences HVT infection and persistence in feathers. For this, one-day-old SL and BL chickens were vaccinated with Newcastle disease (rHVT-ND). Vitiligo was scored and HVT loads in pigmented and non-pigmented growing feathers were quantified regularly over 20 weeks. Chickens of both lines showed moderate HVT loads in feathers. At the onset of active vitiligo, the HVT load was significantly higher in SL compared to BL feathers. However, no difference in HVT loads was noticed between pigmented and non-pigmented feathers from SL chickens. Therefore, surprisingly, the inflammatory response in feathers of SL chickens did not inhibit HVT infection and persistence, but on the contrary, temporarily promoted HVT infection in feathers.

Chickens can durably clear herpesvirus vaccine infection in feathers while still carrying vaccine-induced antibodies.

Marek's disease (MD) is a major disease of chickens induced by Marek's disease virus (MDV) associated to lethal lymphomas. Current MD vaccines protect against lymphomas, but fail to prevent infection and shedding. The control of MDV shedding is crucial in order to eradicate this highly contagious virus. Like pathogenic MDV, MD vaccines infect the feather follicles of the skin before being shed into the environment. MD vaccines constitute excellent models to study virus interaction with feathers, the unique excretion source of these viruses. Herein we studied the viral persistence in feathers of a MD vaccine, the recombinant turkey herpesvirus (rHVT-ND). We report that most of the birds showed a persistent HVT infection of feathers over 41 weeks with moderate viral loads. Interestingly, 20% of the birds were identified as low HVT producers, among which six birds cleared the infection. Indeed, after week 14-26, these birds named controllers had undetectable HVT DNA in their feathers through week 41. All vaccinated birds developed antibodies to NDV, which lasted until week 41 in 95% of the birds, including the controllers. No correlation was found between HVT loads in feathers and NDV antibody titers over time. Interestingly, no HVT DNA was detected in the spleens of four controllers. This is the first description of chickens that durably cleared MD vaccine infection of feathers suggesting that control of Mardivirus shedding is achievable by the host.

Perceptions of insulin therapy in people with type 2 diabetes and physicians: a cross-sectional survey conducted in France.

OBJECTIVE: To evaluate perceptions of people with type 2 diabetes (T2D) and treating physicians living in France toward insulin therapy. METHODS: Adults with T2D receiving oral glucose-lowering treatment alone (INS-) or basal insulin for ≥2 months (INS+) completed an online cross-sectional survey comprising 39 questions, including some regarding perceptions and fears of insulin therapy. Physicians were interviewed by telephone using eleven similar questions. The survey was designed by French clinicians experienced in treating diabetes and conducted under the auspices of an independent market-research agency. RESULTS: The questionnaire was completed by 590 adults with T2D (two-thirds INS+) and 130 physicians (65 diabetologists/endocrinologists, 65 general practitioners). INS+ adults reported fewer negative feelings and more positive feelings than INS- adults. Two-thirds of INS+ adults reported that transitioning to insulin therapy was less difficult than expected. Overall, 44% of INS+ adults and 26% of physicians reported a fear of diabetic complications as being important, and 80% of physicians and 21% of INS+ adults considered injections to be a major patient fear. CONCLUSION: Most people with T2D reported that transitioning to insulin therapy was less difficult than they had feared. People with T2D and physicians exhibited differing perceptions regarding the transition. Reasons for the apprehension surrounding the transition to insulin therapy in people with T2D need to be better identified. Support from insulin-treated peers may enable this transition to occur with fewer anxieties in insulin-naïve people with T2D.