Food supplements for type 2 diabetics

With more than 382 million patients being diagnosed with type 2 diabetes and even more unknowingly suffering of diabetes and pre-diabetes, health burden will continue to grow. Diabetes is a chronic disease, characterized by an unbalanced glucose metabolism. Insulin resistance, inhibited insulin production and rising glucose levels are on the onset of diabetes type 2. The major complications occurring in diabetics are cardiovascular disease, diabetic nephropathy, diabetic retinopathy and cognitive decline resulting in depressions and loss of memory. The pathophysiology of the complications show similarities. High glucose concentrations lead to oxidative stress and endothelial dysfunction, which is amplified by the formation of advanced glycation products. Endothelial dysfunction increases a bunch of intracellular cascades resulting in the onset of inflammation, vasoconstriction, cell expansion and thrombosis. This bachelor thesis hands a solution to prevent or delay the onset of these major diabetes complications by the design of a range of food supplements, especially for diabetics. Every major complication is linked to an own food supplement. Methods. The active ingredients were chosen based on the pathophysiology of both diabetes type 2 and the complication (part 1). When the active ingredients were chosen, the excipients were discussed; a body, lubricants, moisture scavengers, firmness agents and binding agent are used to make the supplement manufacturable. To test if the excipients were added in the right amount and proportions, several tests were done. These tests include a friability test, a disintegration test and a hardness test (part 2). Results. The active ingredients include polyphenols, vitamins, plant extracts, herbs and minerals. All supplements resulted in the acceptable ranges set for every test, contain at least one health claim and are supported by scientific evidence. Discussion. When selecting the ingredients, several requirements were taken into account; every product should contain at least one related health claim and should be supported by scientific evidence, also affordability is taken into account. Based on these requirements, some ingredients have been rejected. Points of discussion of these nutritional supplements are the bioavailability and interactions of some of the ingredients, such as polyphenols. Thereby, size of the tablet and quality of the used herbal extracts are points of improvements. Conclusion. The food supplement range has reached the three most important requirements: scientific evidence, health claim and manufacturability. The range is ready for production

Social cognition impairment in genetic frontotemporal dementia within the GENFI cohort

A key symptom of frontotemporal dementia (FTD) is difficulty interacting socially with others. Social cognition problems in FTD include impaired emotion processing and theory of mind difficulties, and whilst these have been studied extensively in sporadic FTD, few studies have investigated them in familial FTD. Facial Emotion Recognition (FER) and Faux Pas (FP) recognition tests were used to study social cognition within the Genetic Frontotemporal Dementia Initiative (GENFI), a large familial FTD cohort of C9orf72, GRN, and MAPT mutation carriers. 627 participants undertook at least one of the tasks, and were separated into mutation-negative healthy controls, presymptomatic mutation carriers (split into early and late groups) and symptomatic mutation carriers. Groups were compared using a linear regression model with bootstrapping, adjusting for age, sex, education, and for the FP recognition test, language. Neural correlates of social cognition deficits were explored using a voxel-based morphometry (VBM) study. All three of the symptomatic genetic groups were impaired on both tasks with no significant difference between them. However, prior to onset, only the late presymptomatic C9orf72 mutation carriers on the FER test were impaired compared to the control group, with a subanalysis showing differences particularly in fear and sadness. The VBM analysis revealed that impaired social cognition was mainly associated with a left hemisphere predominant network of regions involving particularly the striatum, orbitofrontal cortex and insula, and to a lesser extent the inferomedial temporal lobe and other areas of the frontal lobe. In conclusion, theory of mind and emotion processing abilities are impaired in familial FTD, with early changes occurring prior to symptom onset in C9orf72 presymptomatic mutation carriers. Future work should investigate how performance changes over time, in order to gain a clearer insight into social cognitive impairment over the course of the disease

How are medication related problems managed in primary care? An exploratory study in patients with diabetes and primary care providers.

Background Medication self-management is important for patients who are controlling diabetes. Achieving medication self-management goals, may depend on treatment complexity and patients’ capacities such as health literacy, knowledge and attitude. Objectives The aims of this study were to explore how patients with diabetes self-manage their medications, how patients seek support when experiencing problems and how primary healthcare providers identify patients’ medication related problems and provide support. Methods Semi-structured interviews were conducted among patients with diabetes receiving primary care and with their primary healthcare providers – GPs, nurses, pharmacists and technicians – between January and June 2017. A purposive sampling strategy was used to identify and select participants. An interview guide based on the Cycle of Complexity model was developed. Interviews were audiotaped and transcribed verbatim. Transcripts were coded with a combination of deductive and inductive codes. A thematic analysis was performed to identify categories and themes in the data. Findings were compared with the Cycle of Complexity model. Results Twelve patients and 27 healthcare providers were included in the study. From the transcripts 95 codes, 6 categories and 2 major themes were extracted. Patients used practical solutions and gaining knowledge to manage their medication. Their problems were often related to stress and concerns about using medications. A trusted relationship with the healthcare provider was essential for patients to share problems and ask for support. Informal support was sought from family and peer-patients. Healthcare providers perceive problem identification as challenging. They relied on patients coming forward, computer notifications, clinical parameters and gut-feeling. Healthcare providers were able to offer appropriate support if a medication management problem was known. Conclusion Patients are confident of finding their way to manage their medications. However, sharing problems with healthcare providers requires a trusted relationship. This is acknowledged by both patients and healthcare providers

Fucoidan hydrogels significantly alleviate oxidative stress and enhance the endocrine function of encapsulated beta cells

Microencapsulating pancreatic islets in immunoprotective hydrogels is a promising cellular therapy for type 1 diabetes. However, a major factor limiting the encapsulated islet efficacy is inflammatory/hypoxia mediated oxidative stress, resulting in impaired insulin secretion and ultimately islet cell death. Fucoidan, a natural polysaccharide, possess strong anti-oxidant properties but its effects on beta cells and encapsulation is unknown. Here, we assessed the anti-oxidant effect of fucoidan on beta cells and its effect on encapsulated beta cell viability and function, using fucoidans extracted from two different seaweeds, namely Fucus vesiculosus (FF) and Ascophyllum nodosum (FA). FF exhibited significantly higher total antioxidant capacity and free radical scavenging activity, significantly alleviating intracellular oxidative stress in INS1E beta cells, when compared to FA. In presence of high glucose, FF fucoidans significantly increased insulin secretion both in a dose- and time-dependent manner. Viability, ATP levels and high-glucose responsiveness of rat islets encapsulated in fucoidan-containing hydrogel (Fucogel) microcapsules were significantly higher compared to those encapsulated in pure alginate microcapsules. Similar results were obtained with INS1E pseudo-islets and neonatal pig islets. Fucogels can provide a redox-modulatory niche and an immune barrier in the same time, presenting as an outstanding biomaterial for bioengineered immunoprotective beta cell replacement devices