Rationale and design of a cross-sectional study to investigate and describe the chronotype of patients with type 2 diabetes and the effect on glycaemic control: the CODEC study.

INTRODUCTION: A person's chronotype is their entrained preference for sleep time within the 24 hours clock. It is described by the well-known concept of the 'lark' (early riser) and 'owl' (late sleeper). Evidence suggests that the 'owl' is metabolically disadvantaged due to the standard organisation of our society which favours the 'lark' and places physiological stresses on this chronotype. The aim of this study is to explore cardiometabolic health between the lark and owl in a population with an established metabolic condition - type 2 diabetes. METHODS: This cross-sectional, multisite study aims to recruit 2247 participants from both secondary and primary care settings. The primary objective is to compare glycaemic control between late and early chronotypes. Secondary objectives include determining if late-chronotype is associated with poorer cardiometabolic health and other lifestyle factors, including well-being, compared with early-chronotype; describing the prevalence of the five different chronotypes in this cohort and examining the trends in glycaemic control, cardiometabolic health, well-being and lifestyle factors across chronotype. ANALYSIS: The primary outcome (glycated haemoglobin (HbA1c)), linear regression analysis will compare HbA1c between early and late chronotypes, with and without adjustment for confounding variables. Chronotype will be modelled as a categorical variable with all five levels (from extreme-morning to extreme-late type), and as a continuous variable to calculate p for trend across the five categories. A number of models will be created; unadjusted through to adjusted with age, sex, ethnicity, body mass index, duration of diabetes, family history of diabetes, current medication and dietary habits. All secondary outcomes will be analysed using the same method. ETHICS: Ethical approval from the West Midlands - Black Country Research Ethics Committee (16/WM/0457). DISSEMINATION: The results will be disseminated through publication in peer-reviewed medical journal, relevant medical/health conferences and a summary report sent to patients. TRIAL REGISTRATION NUMBER: NCT02973412 (Pre-Results)

Device-measured physical activity and its association with physical function in adults with type 2 diabetes mellitus.

AIM:To quantify how differences in metrics characterizing physical activity and sedentary behaviour in type 2 diabetes are associated with physical function METHODS: This analysis included participants' data from the Chronotype of Patients with Type 2 Diabetes and Effect on Glycaemic Control (CODEC) cross-sectional study. Data were stratified into two groups according to their short physical performance battery (SPPB) score (impaired physical function = SPPB < 10 and normal physical function = SPPB ≥ 10). Hand-grip strength, sit-to-stand 60 (STS-60) and the Duke Activity Status Index (DASI) score were used to assess functional capacity, while physical activity metrics were measured with a wrist-worn accelerometer. The associations between physical activity metrics and measures of functional capacity were analysed using generalized linear modelling. RESULTS:Some 635 adults (median age 66 years, 34% female) were included in this analysis. Overall, 29% of the cohort scored < 10 in the SPPB test indicating impaired physical function. This group spent more time in prolonged sedentary behaviour (600.7 vs. 572.5 min) and undertook less-intense physical activity. Each sd increase in physical activity volume and intensity gradients for those with impaired physical function was associated with 17% more repetitions for STS-60 with similar associations seen for DASI score. Each sd in sedentary time was associated with 15% fewer repetitions in STS-60 and 16% lower DASI score in those with impaired physical function, whereas in normal physical function group it was 2% and 1%, respectively. CONCLUSIONS:The strength of the associations for physical activity measures and functional capacity were modified by physical function status, with the strongest association seen in those with impaired physical function

Teaching Visual Texts with Multimodal Analysis Software

This exploratory study introduces the systemic approach and the explicit teaching of a meta-language to provide conceptual tools for students for the analysis and interpretation of multimodal texts. Equipping students with a set of specialised vocabulary with conventionalised meanings associated with specific choices in multimodal texts empowers them to support their interpretations with reference to textual evidence. The aim of the current study is to explore the extent to which the systemic approach may be supported by multimodal analysis software, in this case for the study of print advertisements in Singapore’s secondary schools. A mixed method approach is used to derive the findings from this study. Instruments used include lesson observations and interviews with teachers and students, as well as user-experience surveys. Findings from the study indicate that there is value in the systemic approach to teaching visual texts, and that it can be usefully supported by multimodal analysis software as an annotation and analytical tool. This is subject to further customisation of the learning packages, more in-depth professional development for teachers, and improvements to the technical functionalities in the software. The designed affordances for multimodal analysis software derived from the study, which have been implemented in the new version of the software, are discussed

Consumer Survey 2001 : July

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