Effect of Case Management on Glycemic Control and Behavioral Outcomes for Chinese People with Type 2 Diabetes: A 2-year Study

Objective: To examine the effect of case management on glycemic control and behavioral outcomes in adults with Type 2 diabetes in China. Methods: Participants were randomly assigned to a 1-year case management (CM) group (n = 60) or control group (n = 60). Monthly case management visits included identifying individuals’ diabetesrelated problems, setting goals, planning self-care, and evaluating progress. During a 1-year follow-up, all participants attended visits every 3 months without intervention. Results: In the CM vs. the control group, HbA1c was reduced at 6 months compared to baseline (P = 0.034), with trends at 12 and 24 months, and empowerment ability improved (P \u3c 0.05). Also in the CM vs. controls, total self-care behaviors, the frequency of exercise, blood glucose testing, and foot care were higher (P \u3c 0.001) at 12 months, and the percentage of individuals with HbA1c 7.0% was higher (P = 0.035) at 24 months. Conclusion: The case managementintervention in China was effective at 6 months and, based on trends in HbA1c at 12 and 24 months and results for behavioral outcomes, the intervention shows promise and warrants more research. Practice implications: A case management approach can enhance behavior change and glycemic control in Chinese with diabetes

Radiolabeled Rhein as Small-Molecule Necrosis Avid Agents for Imaging of Necrotic Myocardium

A rapid and accurate identification of necrotic myocardium is of great importance for diagnosis, risk stratification, clinical decision-making, and prognosis evaluation of myocardial infarction. Here, we explored technetium-99m labeled rhein derivatives for rapid imaging of the necrotic myocardium. Three hydrazinonicotinic acid-linker-rhein (HYNIC-linker-rhein) derivatives were synthesized, and then, these synthetic compounds were labeled with technetium-99m using ethylenediaminediacetic acid (EDDA) and tricine as coligands [^99mTc­(EDDA)-HYNIC-linker-rhein]. The necrosis avidity of the three ^99mTc-labeled rhein derivatives was tested in a mouse model of ethanol-induced muscular necrosis by gamma counting, histochemical staining, and autoradiography. A lead tracer for visualization of necrotic myocardium was assessed by single photon emission computed tomography/computed tomography (SPECT/CT) imaging in a rat model with reperfused myocardial infarction. The necrosis avidity mechanism of the tracer was explored by DNA binding studies <i>in vitro</i> and blocking experiments <i>in vivo</i>. Results showed that the uptake in necrotic muscles of the three ^99mTc-compounds was higher than that in viable muscles (<i>P</i> < 0.001). Autoradiography and histochemical staining results were consistent with selective uptake of the radiotracer in the necrotic regions. Among the these tracers, ^99mTc­(EDDA)-HYNIC-ethylenediamine-rhein [^99mTc­(EDDA)-HYNIC-2C-rhein] displayed the best distribution profiles for imaging. The necrotic myocardium lesions were clearly visualized by SPECT/CT using ^99mTc­(EDDA)-HYNIC-2C-rhein at 1 h after injection. The necrotic-to-viable myocardium and necrotic myocardium-to-blood uptake ratios of ^99mTc­(EDDA)-HYNIC-2C-rhein were 4.79 and 3.02 at 1 h after injection. DNA binding studies suggested HYNIC-linker-rhein bound to DNA through intercalation. The uptake of ^99mTc­(EDDA)-HYNIC-2C-rhein in necrotic muscle was significantly blocked by excessive unlabeled rhein, with 77.61% decline at 1 h after coinjection. These findings suggested ^99mTc­(EDDA)-HYNIC-2C-rhein emerged as a “hot spot” imaging probe that has a potential for rapid imaging of necrotic myocardium. The necrosis avidity mechanism of ^99mTc­(EDDA)-HYNIC-linker-rhein may be due to its interaction with exposed DNA in necrotic tissues