Changing illness perceptions in patients with poorly controlled type 2 diabetes, a randomised controlled trial of a family-based intervention: protocol and pilot study

<p>Abstract</p> <p>Background</p> <p>This paper presents the pilot study and protocol for a randomised controlled trial to test the effectiveness of a psychological, family-based intervention to improve outcomes in those with poorly controlled type 2 diabetes. The intervention has been designed to change the illness perceptions of patients with poorly controlled type 2 diabetes, and their family members. It is a complex psychological intervention, developed from the Self-Regulatory Model of Illness Behaviour. The important influence the family context can have in psychological interventions and diabetes management is also recognised, by the inclusion of patients' family members.</p> <p>Methods/design</p> <p>We aim to recruit 122 patients with persistently poorly controlled diabetes. Patients are deemed to have persistent poor control when at least two out of their last three HbA1c readings are 8.0% or over. Patients nominate a family member to participate with them, and this patient/family member dyad is randomly allocated to either the intervention or control group. Participants in the control group receive their usual care. Participants in the intervention group participate, with their family members, in three intervention sessions. Sessions one and two are delivered in the participant's home by a health psychologist. Session one takes place approximately one week after session two, with the third session, a follow-up telephone call, one week later. The intervention is based upon clarifying the illness perceptions of both the patient and the family member, examining how they influence self-management behaviours, improving the degree of similarity of patient and family member perceptions in a positive direction and developing personalized action plans to improve diabetes management.</p> <p>Discussion</p> <p>This study is the first of its kind to incorporate the evidence from illness perceptions research into developing and applying an intervention for people with poorly controlled diabetes and their families. This study also acknowledges the important role of family members in effective diabetes care.</p> <p>Trial registration</p> <p>ISRCTN62219234</p

Detection of Murine Post-Pneumonectomy Lung Regeneration by 18FDG PET Imaging

Background: An intriguing biologic process in most adult mammals is post-pneumonectomy lung regeneration, that is, the removal of one lung (pneumonectomy) results in the rapid compensatory growth of the remaining lung. The spatial dependence and metabolic activity of the rodent lung during compensatory lung regeneration is largely unknown. Methods: To determine if murine lung regeneration could be detected in vivo, we studied inbred mice 3, 7, 14, and 21 days after left pneumonectomy. The remaining lung was imaged using microCT as well as the glucose tracer 2-deoxy-2-[18 F]fluoro-d-glucose (18FDG) and positron-emission tomography (PET). Because of the compliance of the murine chest wall, reproducible imaging required orotracheal intubation and pressure-controlled ventilation during scanning. Results: After left pneumonectomy, the right lung progressively enlarged over the first 3 weeks. The cardiac lobe demonstrated the greatest percentage increase in size. Dry weights of the individual lobes largely mirrored the increase in lung volume. PET/CT imaging was used to identify enhanced metabolic activity within the individual lobes. In the cardiac lobe, 18FDG uptake was significantly increased in the day 14 cardiac lobe relative to preoperative values (p < .05). In contrast, the 18FDG uptake in the other three lobes was not statistically significant at any time point. Conclusions: We conclude that the cardiac lobe is the dominant contributor to compensatory growth after murine pneumonectomy. Further, PET/CT scanning can detect both the volumetric increase and the metabolic changes associated with the regenerative growth in the murine cardiac lobe

Gait Characteristics and Cognitive Function in Middle-Aged Adults With and Without Type 2 Diabetes Mellitus: Data from ENBIND

Type 2 Diabetes Mellitus (T2DM) in midlife is associated with a greater risk of dementia in later life. Both gait speed and spatiotemporal gait characteristics have been associated with later cognitive decline in community-dwelling older adults. Thus, the assessment of gait characteristics in uncomplicated midlife T2DM may be important in selecting-out those with T2DM at greatest risk of later cognitive decline. We assessed the relationship between Inertial Motion Unit (IMUs)- derived gait characteristics and cognitive function assessed via Montreal Cognitive Assessment (MOCA)/detailed neuropsychological assessment battery (CANTAB) in middle-aged adults with and without uncomplicated T2DM using both multivariate linear regression and a neural network approach. Gait was assessed under (i) normal walking, (ii) fast (maximal) walking and (iii) cognitive dual-task walking (reciting alternate letters of the alphabet) conditions. Overall, 138 individuals were recruited (n = 94 with T2DM; 53% female, 52.8 8.3 years; n = 44 healthy controls, 43% female, 51.9 8.1 years). Midlife T2DM was associated with significantly slower gait velocity on both slow and fast walks (both p \u3c 0.01) in addition to a longer stride time and greater gait complexity during normal walk (both p \u3c 0.05). Findings persisted following covariate adjustment. In analyzing cognitive performance, the strongest association was observed between gait velocity and global cognitive function (MOCA). Significant associations were also observed between immediate/delayed memory performance and gait velocity. Analysis using a neural network approach did not outperform multivariate linear regression in predicting cognitive function (MOCA) from gait velocity. Our study demonstrates the impact of uncomplicated T2DM on gait speed and gait characteristics in midlife, in addition to the striking relationship between gait characteristics and global cognitive function/memory performance in midlife. Further studies are needed to evaluate the longitudinal relationship between midlife gait characteristics and later cognitive decline, which may aid in selecting-out those with T2DM at greatest-risk for preventative interventions

Psychological Family Intervention for Poorly Controlled Type 2 Diabetes

OBJECTIVE: To evaluate the effectiveness of a psychological, family-based intervention to improve diabetes-related outcomes in patients with poorly controlled type 2 diabetes. METHODS: This study was a randomized controlled trial of a psychological family-based intervention targeted at individuals with poorly controlled type 2 diabetes. Recruitment and follow-up occurred at specialist diabetes clinics. Patients were randomly allocated to an intervention group (n=60) or a control group (n=61). Poor control was defined as at least 2 of the patient's last 3 glycated hemoglobin (A1C) readings at >8.0%. The intervention consisted of 2 sessions delivered by a health psychologist to the patient and a family member in the patient's home, with a third session involving a 15-minute follow-up telephone call. RESULTS: At 6-month follow-up, the intervention group reported significantly lower mean A1C levels than the control group (8.4% [SD=0.99%] vs 8.8% [SD=1.36%]; P=.04). The intervention was most effective in those with the poorest control at baseline (A1C>9.5%) (intervention 8.7% [SD=1.16%, n=15] vs control 9.9% [SD=1.31%, n=15]; P=.01). The intervention group also reported statistically significant improvements in beliefs about diabetes, psychological well-being, diet, exercise, and family support. CONCLUSIONS: After participating in a family-based intervention targeting negative and/or inaccurate illness perceptions, patients with poorly controlled type 2 diabetes showed improvements in A1C levels and other outcomes. Our results suggest that adding a psychological, family-based component to usual diabetes care may help improve diabetes management

Psychological Family Intervention for Poorly Controlled Type 2 Diabetes

OBJECTIVE: To evaluate the effectiveness of a psychological, family-based intervention to improve diabetes-related outcomes in patients with poorly controlled type 2 diabetes. METHODS: This study was a randomized controlled trial of a psychological family-based intervention targeted at individuals with poorly controlled type 2 diabetes. Recruitment and follow-up occurred at specialist diabetes clinics. Patients were randomly allocated to an intervention group (n=60) or a control group (n=61). Poor control was defined as at least 2 of the patient's last 3 glycated hemoglobin (A1C) readings at >8.0%. The intervention consisted of 2 sessions delivered by a health psychologist to the patient and a family member in the patient's home, with a third session involving a 15-minute follow-up telephone call. RESULTS: At 6-month follow-up, the intervention group reported significantly lower mean A1C levels than the control group (8.4% [SD=0.99%] vs 8.8% [SD=1.36%]; P=.04). The intervention was most effective in those with the poorest control at baseline (A1C>9.5%) (intervention 8.7% [SD=1.16%, n=15] vs control 9.9% [SD=1.31%, n=15]; P=.01). The intervention group also reported statistically significant improvements in beliefs about diabetes, psychological well-being, diet, exercise, and family support. CONCLUSIONS: After participating in a family-based intervention targeting negative and/or inaccurate illness perceptions, patients with poorly controlled type 2 diabetes showed improvements in A1C levels and other outcomes. Our results suggest that adding a psychological, family-based component to usual diabetes care may help improve diabetes management

Tissue Glucocorticoid Metabolism in Adrenal Insufficiency:A Prospective Study of Dual-release Hydrocortisone Therapy

Background: Patients with adrenal insufficiency (AI) require life-long glucocorticoid (GC) replacement therapy. Within tissues, cortisol (F) availability is under the control of the isozymes of 11β-hydroxysteroid dehydrogenase (11β-HSD). We hypothesize that corticosteroid metabolism is altered in patients with AI because of the nonphysiological pattern of current immediate release hydrocortisone (IR-HC) replacement therapy. The use of a once-daily dual-release hydrocortisone (DR-HC) preparation, (Plenadren®), offers a more physiological cortisol profile and may alter corticosteroid metabolism in vivo.Study Design and Methods: Prospective crossover study assessing the impact of 12 weeks of DR-HC on systemic GC metabolism (urinary steroid metabolome profiling), cortisol activation in the liver (cortisone acetate challenge test), and subcutaneous adipose tissue (microdialysis, biopsy for gene expression analysis) in 51 patients with AI (primary and secondary) in comparison to IR-HC treatment and age- and BMI-matched controls.Results: Patients with AI receiving IR-HC had a higher median 24-hour urinary excretion of cortisol compared with healthy controls (72.1 µg/24 hours [IQR 43.6-124.2] vs 51.9 µg/24 hours [35.5-72.3], P = .02), with lower global activity of 11β-HSD2 and higher 5-alpha reductase activity. Following the switch from IR-HC to DR-HC therapy, there was a significant reduction in urinary cortisol and total GC metabolite excretion, which was most significant in the evening. There was an increase in 11β-HSD2 activity. Hepatic 11β-HSD1 activity was not significantly altered after switching to DR-HC, but there was a significant reduction in the expression and activity of 11β-HSD1 in subcutaneous adipose tissue.Conclusion: Using comprehensive in vivo techniques, we have demonstrated abnormalities in corticosteroid metabolism in patients with primary and secondary AI receiving IR-HC. This dysregulation of pre-receptor glucocorticoid metabolism results in enhanced glucocorticoid activation in adipose tissue, which was ameliorated by treatment with DR-HC

Diaspora identification and long-distance nationalism among Tamil migrants of diverse state origins in the UK

Accounts of Tamil long-distance nationalism have focused on Sri Lankan Tamil migrants. But the UK is also home to Tamils of non-Sri Lankan state origins. While these migrants may be nominally incorporated into a 'Tamil diaspora', they are seldom present in scholarly accounts. Framed by Werbner's (2002) conception of diasporas as 'aesthetic' and 'moral' communities, this article explores whether engagement with a Tamil diaspora and long-distance nationalism is expressed by Tamil migrants of diverse state origins. While migrants identify with an aesthetic community, 'membership' of the moral community is contested between those who hold direct experience of suffering as central to belonging, and those who imagine the boundaries of belonging more fluidly - based upon primordial understandings of essential ethnicity and a narrative of Tamil 'victimhood' that incorporates experiences of being Tamil in Sri Lanka, India and in other sites, despite obvious differences in these experiences. © 2013 Taylor & Francis

Associations between nutritional properties of food and consumer perceptions related to weight management

Consumer perceptions of food (for example, how filling or healthy) influence eating behaviour and appetite control. Therefore approaches to understand the global nutritional attributes of foods that predict the strength of consumer perceptions are of academic and commercial interest. The current research describes the development of a flexible platform for systematically mapping the global nutritional attributes of foods (both objective and perceived) to consumer perceptions of those foods. The platform consists of a database of standardised UK food images (currently n= 300), linked to a catalogue of detailed perceptual, nutritional, sensory, cost, and psychological information ('nutritional attributes'). The platform also incorporates demographic and psychometric questionnaires to examine the importance of nutritional attributes on consumer perceptions within or between relevant target groups. In the current study, the platform was applied to a sample of dieting and non-dieting British men and women (n= 887) to examine the global attributes of a subset of foods (n= 75) and their association with successful weight management (i.e. supportive of weight loss, weight loss maintenance or prevention of weight gain). Generalised linear models identified energy density, cost (£/kcal), perceived energy content and satiating capacity as the main nutritional attributes underlying dieters' and non-dieters' perception of successful weight management food. Additionally, pleasantness, and desire not to (over) eat were uniquely associated with dieters' perception of food as good for weight management; pleasantness was positively associated with weight management and desire to eat was negatively associated with weight management. Therefore, global nutritional attributes of foods can predict and distinguish the extent consumers' perceive a food to be related to successful weight management. This platform will be extended to increase the variety of foods and specificity of nutritional attributes in the database suitable for a range of commercial, academic or clinical research applications