Continuous intraperitoneal insulin infusion in patients with 'brittle' diabetes:Favourable effects on glycaemic control and hospital stay

Aims: To evaluate the effects of continuous intraperitoneal insulin infusion (CIPII) using implantable pumps on glycaemic control and duration of hospital stay in poorly controlled 'brittle' Dutch diabetes patients, and to assess their current quality of life. Methods: Thirty-three patients were included. Glycaemic control was retrospectively assessed with HbA1c levels acquired before implantation, 1 year later and at long-term follow up of 58 months. Duration of hospital stay the year before and the year following first implantation was extracted from hospital records. Determinants of long-term glycaemic response were sought. Self-report questionnaires were administered at 58 months follow-up only, to assess current psychopathology and quality of life. Results: Mean HbA1c decreased from 10.0 ± 2.3% to 9.0 ± 1.8% (P = 0.039) 1 year after implantation and stabilized at 9.0 ± 1.6% (P = 0.023) during long-term follow-up. Median number of hospital days in the 20 patients suffering from hospital admission before implantation decreased from 45 the year before implantation to 13 the year after (P = 0.005). Patients with a higher baseline HbA1c showed a larger long-term response (P ≤ 0.001). Relatively low levels for quality of life were found, as well as a higher than expected number of patients with psychiatric symptoms. Conclusions: CIPII proved effective in complex patients with a history of poor control and hospital admission. Despite a substantial long-term improvement in glycaemic control and diminished hospital stay, normal levels of glycaemic control and quality of life were not attained

Physiologically based modelling framework for prediction of pulmonary pharmacokinetics of antimicrobial target site concentrations

Prediction of antimicrobial target-site pharmacokinetics is of relevance to optimize treatment with antimicrobial agents. A physiologically based pharmacokinetic (PBPK) model framework was developed for prediction of pulmonary pharmacokinetics, including key pulmonary infection sites (i.e. the alveolar macrophages and the epithelial lining fluid).\nThe modelling framework incorporated three lung PBPK models: a general passive permeability-limited model, a drug-specific permeability-limited model and a quantitative structure-property relationship (QSPR)-informed perfusion-limited model. We applied the modelling framework to three fluoroquinolone antibiotics. Incorporation of experimental drug-specific permeability data was found essential for accurate prediction.\nIn the absence of drug-specific transport data, our QSPR-based model has generic applicability. Furthermore, we evaluated the impact of drug properties and pathophysiologically related changes on pulmonary pharmacokinetics. Pulmonary pharmacokinetics were highly affected by physiological changes, causing a shift in the main route of diffusion (i.e. paracellular or transcellular). Finally, we show that lysosomal trapping can cause an overestimation of cytosolic concentrations for basic compounds when measuring drug concentrations in cell homogenate.\nThe developed lung PBPK model framework constitutes a promising tool for characterization of pulmonary exposure of systemically administrated antimicrobials.Pharmacolog

Continuous subcutaneous insulin infusion therapy is associated with reduced retinopathy progression compared with multiple daily injections of insulin

AIMS/HYPOTHESIS: We aimed to compare diabetic retinopathy outcomes in people with type 1 diabetes following introduction of continuous subcutaneous insulin infusion (CSII) therapy with outcomes in people receiving continuing therapy with multiple daily insulin injections (MDI). METHODS: This is a retrospective cohort study using the Scottish Care Information – Diabetes database for retinal screening outcomes and HbA(1c) changes in 204 adults commenced on CSII therapy between 2013 and 2016, and 211 adults eligible for CSII during the same period but who continued on MDI therapy. Diabetic retinopathy progression (time to minimum one-grade worsening in diabetic retinopathy from baseline grading) was plotted for CSII and MDI cohorts using Kaplan–Meier curves, and outcomes were compared using multivariate Cox regression analysis adjusting for age, sex, baseline HbA(1c), blood pressure, cholesterol, smoking status and socioeconomic quintile. Impact of baseline HbA(1c) and change in HbA(1c) on diabetic retinopathy progression was assessed within CSII and MDI cohorts. RESULTS: CSII participants were significantly younger, were from less socially deprived areas, and had lower HbA(1c) and higher diastolic BP at baseline. There was a larger reduction in HbA(1c) at 1 year in those on CSII vs MDI (−6 mmol/mol [−0.6%] vs −2 mmol/mol [−0.2%], p < 0.01). Diabetic retinopathy progression occurred in a smaller proportion of adults following commencement of CSII vs continued MDI therapy over mean 2.3 year follow-up (26.5% vs 18.6%, p = 0.0097). High baseline HbA(1c) (75 mmol/mol [9%]) was associated with diabetic retinopathy progression in the MDI group (p = 0.0049) but not the CSII group (p = 0.93). Change in HbA(1c) at follow-up, irrespective of baseline glycaemic status, did not significantly affect diabetic retinopathy progression in either group. CONCLUSIONS/INTERPRETATION: CSII was associated with reduced diabetic retinopathy progression compared with continued MDI therapy, and may be protective against diabetic retinopathy progression for those with high baseline HbA(1c). Progression of diabetic retinopathy over 3 years was not associated with a change in HbA(1c). GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains peer-reviewed but unedited supplementary material available at 10.1007/s00125-021-05456-w

Bariatric surgery might aggravate proliferative diabetic retinopathy

Purpose This study aimed to assess the changes experienced by patients with proliferative diabetic retinopathy (PDR) after bariatric surgery (BS). Methods This retrospective observational study includes 37 eyes of 21 patients with PDR who underwent BS at a tertiary university hospital over the period of 2014-2018. The control group (CG) comprised 37 eyes of 27 patients with PDR who attended the same research hospital for diabetes care without undergoing BS. Preoperative and postoperative glycated haemoglobin (HbA1c) levels, weight and diabetic retinopathy screening results were collected from the medical records of the patients. Patients who had undergone preoperative retinal screening and at least one postoperative retinal screening were included in the analysis. Results Both groups exhibited statistically significant visual acuity (VA) loss at 6 months and 1 year (p < 0.001). At postoperative 6 months the VA loss experienced by the control BS group was significantly more severe than that experienced by the CG (p = 0.03). The first-year HbA1c levels of the BS group were significantly lower than those of the CG (p = 0.02). The BS group had significantly higher intraocular haemorrhage (p = 0.04), neovascular glaucoma (p = 0.04) and retinal vein occlusion (p = 0.04) rates than the CG group. All complications occurred at different patients. Conclusion Patients with PDR who received BS showed more severe retinopathy than patients who were matched for age, sex, HbA1c levels and follow-up duration and who did not receive BS

Belöningssystem -En fallstudie om belöning och motivation inom två svenska storbanker

Bakgrund och problem: Belöningssystem används i dagsläget av de flesta organisationer. Genom att motivera de anställda får företaget ökad kvalitet, produktivitet och effektivitet. Därför är det av stor vikt för företag att använda sig av belöningssystem som stimulerar medarbetarna på rätt sätt och motiverar denna att jobba mot företagets uppsatta mål, målkongruens. Utformningen av belöningssystem är dock en av företagets svåraste frågor och det finns många problem som kan uppstå. Det intressanta är att se hur de undersökta fallföretagen har lyckats med sitt belöningssystem och vad som motiverar de anställda att arbeta mot målkongruens. Syfte: Att undersöka om medarbetarna och ledare har samma uppfattning om hur medarbetarnas arbetsmotivation påverkas av det rådande belöningssystemet inom två svenska storbanker, samt vad som kan tänkas motivera de anställda att arbeta mot företagets mål och skapa en så kallad målkongruens. Avgränsning: Vi kommer att avgränsa oss till styrinstrumentet belöningssystem. För att komplettera våra teorier kommer vi studera Handelsbankens samt Swedbanks sätt att hantera belöningssystem, samt undersöka de olika perspektiven som finns i bankerna. Dessa specifika perspektiv är ledningens uppfattningar av belöningssystemet, samt vilken uppfattning de anställda har. Metod: Uppsatsen inleddes med en intervju med respektive chef från bankerna Handelsbanken och Swedbank för att bilda en uppfattning om syftet bakom de implementerade belöningssystemen i vardera bank. Därefter har enkätundersökning riktad till de anställda inom båda bankerna genomförts för att se hur belöningssystemet fungerar i verkligheten. Det empiriska materialet har analyserats utifrån en teoretisk referensram om belöningssystem och dess verkliga funktionalitet inom en organisation. Resultat: Handelsbanken använder sig av en vinstandelsstiftelse som belöningssystem som de kallar för Oktogonen. Denna ger utdelning då det går bra för banken och de anställda får utdelning när de går i pension. Swedbank använder sig även de av en vinstandelsstiftelse kallad Kopparmyntet. Deras anställda får ta ut sin belöning efter 5 år eller låta den ligga kvar. Detta tillsammans med hur prestationen mäts är de största skillnaderna mellan systemen. De anställda på Handelsbanken vill att den individuella prestationen ska mätas och anser inte att den personliga prestationen belönas rättvist, då företaget fokuserar på gruppens prestation. Swedbanks anställda är relativt nöjda men rådande belöningssystem men önskar fler gruppmål för att öka gemenskapen på arbetsplatsen