Glucose testing and insufficient follow-up of abnormal results: a cohort study

BACKGROUND: More than 6 million Americans have undiagnosed diabetes. Several national organizations endorse screening for diabetes by physicians, but actual practice is poorly understood. Our objectives were to measure the rate, the predictors and the results of glucose testing in primary care, including rates of follow-up for abnormal values. METHODS: We conducted a retrospective cohort study of 301 randomly selected patients with no known diabetes who received care at a large academic general internal medicine practice in New York City. Using medical records, we collected patients' baseline characteristics in 1999 and followed patients through the end of 2002 for all glucose tests ordered. We used multivariate logistic regression to measure associations between diabetes risk factors and the odds of glucose testing. RESULTS: Three-fourths of patients (78%) had at least 1 glucose test ordered. Patient age (≥45 vs. <45 years), non-white ethnicity, family history of diabetes and having more primary care visits were each independently associated with having at least 1 glucose test ordered (p < 0.05), whereas hypertension and hyperlipidemia were not. Fewer than half of abnormal glucose values were followed up by the patients' physicians. CONCLUSION: Although screening for diabetes appears to be common and informed by diabetes risk factors, abnormal values are frequently not followed up. Interventions are needed to trigger identification and further evaluation of abnormal glucose tests

Callosal responses in a retrosplenial column

The axons forming the corpus callosum sustain the interhemispheric communication across homotopic cortical areas. We have studied how neurons throughout the columnar extension of the retrosplenial cortex integrate the contralateral input from callosal projecting neurons in cortical slices. Our results show that pyramidal neurons in layers 2/3 and the large, thick-tufted pyramidal neurons in layer 5B showed larger excitatory callosal responses than layer 5A and layer 5B thin-tufted pyramidal neurons, while layer 6 remained silent to this input. Feed-forward inhibitory currents generated by fast spiking, parvalbumin expressing interneurons recruited by callosal axons mimicked the response size distribution of excitatory responses across pyramidal subtypes, being larger in those of superficial layers and in the layer 5B thick-tufted pyramidal cells. Overall, the combination of the excitatory and inhibitory currents evoked by callosal input had a strong and opposed effect in different layers of the cortex; while layer 2/3 pyramidal neurons were powerfully inhibited, the thick-tufted but not thin-tufted pyramidal neurons in layer 5 were strongly recruited. We believe that these results will help to understand the functional role of callosal connections in physiology and disease.This work was supported by: Spanish Ministerio de Ciencia e Innovación (Severo Ochoa program, Grant SEV-2013-0317; Fondos FEDER SAF2014-59347-C2-1-R) and Generalitat Valenciana (PROMETEO II program Grant 2014/014). ASF was supported by a JAE-PREDOC Grant (CSIC, BOE-A-2011-10745).Peer reviewe

Single-cell RNA sequencing identifies distinct mouse medial ganglionic eminence cell types

Many subtypes of cortical interneurons (CINs) are found in adult mouse cortices, but the mechanism generating their diversity remains elusive. We performed single-cell RNA sequencing on the mouse embryonic medial ganglionic eminence (MGE), the major birthplace for CINs, and on MGE-like cells differentiated from embryonic stem cells. Two distinct cell types were identified as proliferating neural progenitors and immature neurons, both of which comprised sub-populations. Although lineage development of MGE progenitors was reconstructed and immature neurons were characterized as GABAergic, cells that might correspond to precursors of different CINs were not identified. A few non-neuronal cell types were detected, including microglia. In vitro MGE-like cells resembled bona fide MGE cells but expressed lower levels of Foxg1 and Epha4. Together, our data provide detailed understanding of the embryonic MGE developmental program and suggest how CINs are specified