Risk of diabetic retinopathy at first screen in children at 12 and 13 years of age

AIMS: \ud \ud To investigate the relationships between age at diagnosis of diabetes, age at diabetic eye screening and severity of diabetic retinopathy at first and subsequent screenings in children aged 12 or 13 years.\ud \ud METHODS: \ud \ud Data were extracted from four English screening programmes and from the Scottish, Welsh and Northern Irish programmes on all children with diabetes invited for their first and subsequent screening episodes from the age of 12 years. Retinopathy levels at first and subsequent screens, time from diagnosis of diabetes to first screening and age at diagnosis in years were calculated.\ud \ud RESULTS: \ud \ud Data were available for 2125 children with diabetes screened for the first time at age 12 or 13 years. In those diagnosed with diabetes at 2 years of age or less, the proportion with retinopathy in one or both eyes was 20% and 11%, respectively, decreasing to 8% and 2% in those diagnosed between 2 and 12 years (P < 0.0001). Only three children (aged 8, 10 and 11 years at diagnosis of diabetes) had images graded with referable retinopathy and, of these, two had non-referable diabetic retinopathy at all subsequent screenings. Of 1703 children with subsequent images, 25 were graded with referable diabetic retinopathy over a mean follow-up of 3.1 years, an incidence rate of 4.7 (95% confidence interval, 3.1-7.0) per 1000 per year.\ud \ud CONCLUSIONS: \ud \ud In this large cohort of children, the low prevalence and incidence rates of referable diabetic retinopathy suggest that screening earlier than age 12 is not necessary

Long term effects of gestational hypertension and pre-eclampsia on kidney function: Record linkage study

Objective To assess the long term effects of hypertensive disorders of pregnancy on renal function. Design Cohort study where exposure was gestational hypertension or preeclampsia in the first pregnancy. Normotensive women formed the comparison group. Setting Aberdeen, Scotland. Participants All women with date of birth on or before 30th June 1969 and at least their first singleton delivery recorded in the Aberdeen Maternity and Neonatal Databank. Methods Participants were linked to the Renal Biochemistry Register, Scottish Morbidity Records, Scottish Renal Registry and National Register for deaths. Main outcome measures Occurrence of chronic kidney disease (CKD) as identified from renal function tests in later life, hospital admissions or death from kidney disease or recorded as receiving renal replacement therapy. Results CKD was diagnosed in 7.5% and 5.2% of women who previously had GH and PE respectively compared to 3.9% in normotensive women. The unadjusted odds ratio (95% confidence interval) of having CKD in PE was 2.04 (1.53, 2.71) and that for GH was 1.37 (1.15, 1.65), while the adjusted odds ratio (95% confidence interval) of CKD was 1.93 (1.44, 2.57) and 1.36 (1.13, 1.63) in women with PE and GH respectively. Kaplan–Meier curves of survival time to development of chronic kidney disease revealed that women with preeclampsia were susceptible to kidney function impairment earliest, followed by those with gestational hypertension. Conclusions There was an increased subsequent risk of CKD associated with hypertensive disorders of pregnancy. Women with GH and PE were also found to have CKD earlier than normotensive women

The effects of compression gloves on hand symptoms and hand function in rheumatoid arthritis and hand osteoarthritis : a systematic review

Objective: to evaluate the effects of compression gloves in adults with rheumatoid arthritis and hand osteoarthritis. Data sources: Systematic review of randomized controlled trials identified from MEDLINE, CINAHL, AMED, PEDro, OT Seeker, The Cochrane Library, ISI Web of Knowledge, Science Direct and PubMed from their inceptions to January 2015. Review methods: Methodological quality of identified trials was evaluated using the PEDro scale by three independent assessors. Effects were summarized descriptively. Results: Four trials (n=8-24; total n=74), comparing night wear of full-length finger compression gloves with placebo gloves, were assessed. Three were of moderate (PEDro score 4-5) and one low (score 3) methodological quality. Effect sizes or standardized mean differences could not be calculated to compare trials due to poor data reporting. In rheumatoid arthritis, finger joint swelling was significantly reduced, but results for pain and stiffness were inconclusive and no differences in grip strength and dexterity were identified. One study reported similar effects in pain, stiffness and finger joint swelling from both compression and thermal placebo gloves. Only one study evaluated gloves in hand osteoarthritis (n=5) with no differences. Conclusions: All the trials identified were small with a high risk of Type I and II errors. Evidence for the effectiveness of compression gloves worn at night is inconclusive in rheumatoid arthritis and hand osteoarthritis

Factors associated with initiation of antihyperglycaemic medication in UK patients with newly diagnosed type 2 diabetes

<p>Abstract</p> <p>Aim</p> <p>To assess the factors associated with antihyperglycaemic medication initiation in UK patients with newly diagnosed type 2 diabetes.</p> <p>Methods</p> <p>In a retrospective cohort study, patients with newly diagnosed type 2 diabetes were identified during the index period of 2003-2005. Eligible patients were ≥ 30 years old at the date of the first observed diabetes diagnosis (referred to as index date) and had at least 2 years of follow-up medical history (N = 9,158). Initiation of antihyperglycaemic medication (i.e., treatment) was assessed in the 2-year period following the index date. Adjusted Cox regression models were used to examine the association between time to medication initiation and patient age and other factors.</p> <p>Results</p> <p>Mean (SD) HbA_1cat diagnosis was 8.1% (2.3). Overall, 51% of patients initiated antihyperglycaemic medication within 2 years (65%, 55%, 46% and 40% for patients in the 30- < 45, 45- < 65, 65- < 75, 75+ age groups, respectively). Among the treated patients, median (25^th, 75^thpercentile) time to treatment initiation was 63 (8, 257) days. Of the patients with HbA_1c≥ 7.5% at diagnosis, 87% initiated treatment within 2 years. These patients with a higher HbA_1calso had shorter time to treatment initiation (adjusted hazard ratio (HR) = 2.44 [95% confidence interval (CI): 1.61, 3.70]; p < 0.0001). Increasing age (in years) was negatively associated with time to treatment initiation (HR = 0.98 [95% CI: 0.97, 0.99]; p < 0.001). Factors significantly associated with shorter time to treatment initiation included female gender and use of cardiovascular medications at baseline or initiated during follow up.</p> <p>Conclusions</p> <p>In this UK cohort of patients with newly diagnosed type 2 diabetes, only 51% had antihyperglycaemic medication initiated over a 2-year period following diagnosis. Older patients were significantly less likely to have been prescribed antihyperglycaemic medications. Elevated HbA_1cwas the strongest factor associated with initiating antihyperglycaemic medication in these patients.</p

Barriers and enablers to self-titration of insulin in adults with type 2 diabetes: a qualitative study

Aims The aim of this study was to identify the barriers and enablers to effective insulin selftitration in type 2 diabetes. Methods A qualitative semi-structured interview approach was employed. Questions were structured according to the Theoretical Domains Framework, which outlines 14 domains that can act as barriers and enablers to changing behaviour. Interviews were audio-recorded and transcribed verbatim. The data were coded according to the 14 domains, belief statements were created within each domain and a frequency count of the most reported barriers and enablers were then calculated. Analyses were conducted by two researchers, and discrepancies agreed with a third researcher. Results Eighteen adults with type 2 diabetes took part in an interview. A majority were South Asian (n=8), men (n=12), on average age 61 years old. Average duration of diabetes was 16 years and time on insulin 9 years. Inter-rater reliability for each of the domains varied (29%-100%). The most frequently reported domains were Social Influence and Beliefs about Consequences; the least frequently reported were Optimism and Reinforcement. Participants reported receiving support to self-titrate from a range of sources. Self-titrating was perceived to have a range of both positive and negative consequences, as was not titrating. Conclusions The findings highlight that participants experienced a range of barriers and enablers when attempting to self-titrate. Improved education and training when initiating insulin treatment among adults with type 2 diabetes, and throughout their journey on insulin therapy could help people identify and address these barriers in order to optimise self-titration. Novelty statement • This study is the first to comprehensively explore the reasons people with insulintreated type 2 diabetes struggle to self-titrate their insulin, using an established theoretical framework. • Important factors in facilitating self-titration were support from healthcare professionals and family members, having a target blood glucose reading and strategies to achieve this. • Barriers to self-titrating included difficulties experienced when at work or on holiday and concerns about the consequences of an increasing insulin dose. Holding strong but erroneous intentions to self-titrate, suggested a lack of knowledge about self-titration algorithms. • Providing educational resources and training when initiating insulin treatment in type 2 diabetes and throughout treatment, in order to address these barriers and enhance these facilitators is vital

Keeping physically active with rheumatoid arthritis: semi-structured interviews to explore patient perspectives, experiences and strategies

© 2018 Chartered Society of Physiotherapy Background: Regular physical activity is safe and beneficial for people with rheumatoid arthritis (RA) but the majority of people with RA are less active than the general population and have a higher risk of co-morbidities. Exploring strategies used by physically active people with RA could inform effective methods to support those who are less active. Objective: To explore the perspectives, experiences and strategies employed by people with RA who successfully engage with regular physical activity. Design: Individual semi-structured interviews and thematic analysis. Participants: A purposive sample of physically active people with RA. Results: Twelve females and three males participated (mean age 56, range 29 to 80; mean disease duration 13 years, range 10 months to 46 years). Analysis revealed eight constructs clustered into three themes. Theme 1: ‘the individual’ incorporated constructs of symptoms, feelings and role; theme 2: ‘management’ incorporated medical and self-management; theme 3: ‘physical activity’ incorporated constructs of type of physical activity, including barriers or facilitators. Participants reported a long history of physical activity prior to diagnosis and good support networks. All participants recognised that physical activity was key to their RA management, acknowledged the benefits from engaging in physical activity and were able to overcome barriers. Participants had strong beliefs that physical function would decline without regular physical activity. Conclusions: People with RA who successfully maintain physical activity are motivated by a desire to manage symptoms, resist functional decline and maintain health and independence. These findings should be explored with a wider range of people with RA