Comparison of the HAT study, the largest global hypoglycaemia study to date, with similar large real-world studies.

AIMS: Optimal diabetes care requires clear understanding of the incidence of hypoglycaemia in real-world clinical practice. Current data on hypoglycaemia are generally limited to those reported from randomised controlled clinical trials. The Hypoglycaemia Assessment Tool (HAT) study, a non-interventional real-world study of hypoglycaemia, assessed hypoglycaemia in 27,585 people across 24 countries. The present study compared the incidence of hypoglycaemia from the HAT study with other similarly designed, large, real-world studies. MATERIALS AND METHODS: A literature search of PubMed (1995-2017) for population-based studies of insulin-treated patients with type 1 or type 2 diabetes (T1D, T2D), excluding clinical trials and reviews, identified comparable population-based studies reporting the incidence of hypoglycaemia. RESULTS: The 24 comparative studies, including >24,000 participants with T1D and >160,000 participants with T2D, varied in design, size, inclusion criteria, definitions of hypoglycaemia and method for recording hypoglycaemia. Reported rates (events/per patient-year [PPY]) of hypoglycaemia were higher in patients with T1D than in those with T2D (overall T1D 21.8-73.3, T2D 1.3-37.7; mild/non-severe T1D 29.0-126.7, T2D 1.3-41.5; severe T1D 0.7-5.8, T2D 0.0-2.5; nocturnal T1D 2.6-11.3, T2D 0.38-9.7), and were similar to the ranges found in the HAT study. CONCLUSIONS: The HAT data on hypoglycaemia incidence were comparable with those from other real-world studies and indicate a high incidence of hypoglycaemia among insulin-treated patients. Differences in rates between studies are mostly explained by differences in patient populations and study methodology. The goal of reducing hypoglycaemia should be a target for continued educational and evidence-based pharmacological interventions

Reproductive, dispersal and recruitment strategies in Australian seagrasses

Seagrasses are a relatively small group of marine angiosperms that have successfully colonised the oceans and includes monecious, dioecious and hermaphroditic species. They display a range of mating systems, dispersal mechanisms and recruitment strategies that have allowed them to adapt and survive within the marine environment. This includes a general reduction in the size and complexity of floral structures, and subsurface pollination (hydrophily) in the majority of species. Fertilisation occurs through water-dispersed pollen that is typically filamentous and sticky, however, recent work has also suggested that marine invertebrates may play a role in pollen movement and fertilisation. Seed size and morphology varies widely among species, from fleshy floating fruit (e.g. Posidonia) to small negatively buoyant seeds less than 0.5 mm (e.g. Halophila). Nearly all species retain some capacity of asexual reproduction through rhizome elongation or the production of asexual fragment or propagules that can be more widely dispersed. These differences in reproductive strategies have important effects on recruitment and dispersal potential and subsequent population dynamics. Direct estimates of dispersal and recruitment are inherently difficult to assess in seagrasses, but the use of novel genetic and predictive modelling approaches are providing new insights into these important processes. This chapter highlights the main reproductive strategies and adaptations seagrass have undergone in response to reproducing in a marine environment, with an emphasis on Australian seagrass species. We highlight the current state of knowledge in Australian seagrass reproductive biology and future directions in seagrass reproductive biology research