Vegetative growth response of young olive trees (Olea europaea L., cv. Arbequina) to soil salinity and waterlogging

28 Pag., 10 Fig. The definitive version is available at: http://www.springerlink.com/content/0032-079x/High-density olive orchards are increasing around the world, many of which may be potentially affected by salinity and waterlogging (hypoxia), two important stresses common in irrigated fields in arid and semi-arid climates. However, the response of olive to these stresses under field conditions is not well established. Therefore, our objective was to evaluate the vegetative growth response of young olive trees (Olea europaea L., cv. Arbequina) grown in a spatially-variable waterlogged, saline-sodic field. We monitored the growth in trunk diameter of 341 three-year’s old olives between September 1999 and September 2000. Field contour maps were developed delineating soil salinity (ECa), relative ground elevation (RGE) and water table depth (WTD). Soil samples were also collected and analyzed for ECe and SARe in order to characterize the salinity and sodicity profiles and develop the ECa-ECe calibration equation. The infiltration rate (IR) of the crusted and uncrusted soil and the penetration resistance (PR) were also measured. The field was characterized by spatially variable ECe (2 to 15 dS m-1), SARe (3 to 40), RGE (-4 to +4 cm) and WTD (0.5 to 1.9 m, with corresponding ground water EC values between 12 and 6 dS m-1). Steady-state IR of crusted soil was only 7% of the uncrusted soil. Since the field was heavily irrigated by flooding, waterlogging conditions were related to low RGE values. Soil salinity was negatively correlated (R2 = 0.83, P 10 dS m-1), low RGE ( 0.1 cm and > 1.6 m, respectively. Thus, very small changes in ground elevation had a significant effect on olive’s survival or death. The coupled effects of salinity and waterlogging (hypoxia) stresses were most detrimental for olive’s growth.This study was partially supported by INIA (Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria, Spain).Peer reviewe

The Diabetes Self-Management Questionnaire (DSMQ): development and evaluation of an instrument to assess diabetes self-care activities associated with glycaemic control

BACKGROUND: Though several questionnaires on self-care and regimen adherence have been introduced, the evaluations do not always report consistent and substantial correlations with measures of glycaemic control. Small ability to explain variance in HbA(1c) constitutes a significant limitation of an instrument’s use for scientific purposes as well as clinical practice. In order to assess self-care activities which can predict glycaemic control, the Diabetes Self-Management Questionnaire (DSMQ) was designed. METHODS: A 16 item questionnaire to assess self-care activities associated with glycaemic control was developed, based on theoretical considerations and a process of empirical improvements. Four subscales, ‘Glucose Management’ (GM), ‘Dietary Control’ (DC), ‘Physical Activity’ (PA), and ‘Health-Care Use’ (HU), as well as a ‘Sum Scale’ (SS) as a global measure of self-care were derived. To evaluate its psychometric quality, 261 patients with type 1 or 2 diabetes were assessed with the DSMQ and an established analogous scale, the Summary of Diabetes Self-Care Activities Measure (SDSCA). The DSMQ’s item and scale characteristics as well as factorial and convergent validity were analysed, and its convergence with HbA(1c) was compared to the SDSCA. RESULTS: The items showed appropriate characteristics (mean item-total-correlation: 0.46 ± 0.12; mean correlation with HbA(1c): -0.23 ± 0.09). Overall internal consistency (Cronbach’s alpha) was good (0.84), consistencies of the subscales were acceptable (GM: 0.77; DC: 0.77; PA: 0.76; HU: 0.60). Principal component analysis indicated a four factor structure and confirmed the designed scale structure. Confirmatory factor analysis indicated appropriate fit of the four factor model. The DSMQ scales showed significant convergent correlations with their parallel SDSCA scales (GM: 0.57; DC: 0.52; PA: 0.58; HU: n/a; SS: 0.57) and HbA(1c) (GM: -0.39; DC: -0.30; PA: -0.15; HU: -0.22; SS: -0.40). All correlations with HbA(1c) were significantly stronger than those obtained with the SDSCA. CONCLUSIONS: This study provides preliminary evidence that the DSMQ is a reliable and valid instrument and enables an efficient assessment of self-care behaviours associated with glycaemic control. The questionnaire should be valuable for scientific analyses as well as clinical use in both type 1 and type 2 diabetes patients

Local heating at the insulin injection site by the use of the InsuPad is able to reduce post-prandial glucose excursion in daily life

Background and aims: The insulin action profiles of subcutaneously injected short acting insulin analogues are still slow compared to physiologically released human insulin. Thus, postprandial glucose excursions cannot be avoided. InsuPad is a medical device designed to accelerate insulin delivery rate by applying local heat at the insulin injection site. Whenever an insulin injection is given, the skin surface temperature is heated up locally to 38.5 C° for 30 minutes. This pilot-study examines the impact of the InsuPad use on postprandial glucose excursions after breakfast and dinner in daily life conditions. Materials and methods: Insulin resistant diabetic patients were instructed to use the InsuPad when injecting bolus insulin prior to breakfast and dinner for one month and to measure their blood glucose at least five times per day (pre- and post-breakfast, pre-lunch and pre- and post-dinner). In the other study phase patients were instructed to maintain the same blood glucose measurement schedule for one month, without using the InsuPad. The order of the study phases was randomized. All blood glucose data were transmitted to a central computer using the DIASEND System. A valid pre-post-prandial measurement time difference was 75 - 135 minutes. An ANOVA, controlling for order of study phase, patient and meal (breakfast vs. dinner) was used to analyze the effect of the InsuPad on postprandial glucose excursions. In this study 10 diabetic patients took part (30% type 1 diabetes, age: 51.5 ±7.7 yrs., diabetes duration: 15.7 ± 7.7 yrs.; HbA1c: 8.2 ± 0.9%; bolus insulin dose: 51.7 ± 22.2 insulin units per day; total insulin dose 0.92 insulin units per kg). Results: Preprandial blood glucose levels were similar in the phase with (151.7 ±46.8 mg/dl) and without the InsuPad (148.5 ±38.6 mg/dl, p=.385). Postprandial glucose decreased by 0.05 ± 59.1 mg/dl, if InsuPad was used, whereas the postprandial glucose levels increased by 11.3 ± 56.3 mg/dl if the InsuPad was not used (p=.011). The number (283 vs. 257) and proportion of valid measurements (65.5% vs. 64.4%, p=.740) in the phase with and without InsuPad were highly comparable. The time differences between pre- and post-prandial glucose measurements were very similar in both study phases (102.7 ± 19.0 vs. 102.3 ± 15.6 minutes with and without InsuPad, p=.777). The overall glycaemic control (mean total blood glucose values) was significantly lower when using the InsuPad compared to the no-use-phase (149.7 ± 54.5 mg/dl vs. 158.7 ±57.7 mg/dl; p=.016). The percentage of hypoglycaemic (< 60 mg/dl) or hyperglycaemic values (> 300 mg/dl) was slightly decreased when using the InsuPad, but the difference was not statistically significant (% hypoglycaemic values 1.5% vs. 1.8%, p=.496; % hyperglycaemic values 1.6% vs. 2.1%, p=.250). Conclusion: This pilot-study indicates that local heating of the insulin injection site in insulin resistant diabetic patients by using the InsuPad is able to reduce post-prandial blood glucose excursions as well as mean daily glucose values significantly in daily life conditions. Safety parameters like the prevalence of hypoglycaemic and hyperglycaemic glucose measurements were not affected by the use of InsuPad

Detection of Inflammatory and Homeostasis Biomarkers after Selective Removal of Carious Dentin—An In Vivo Feasibility Study

Deep carious dentin lesions induce an immune reaction within the pulp-dentin complex, leading to the release of cytokines, which might be suitable biomarkers in pulp diagnostics. This in vivo feasibility study determines the concentration of different cytokines after selective removal of carious infected dentin (SCR). In our methodology, paired samples are obtained from 21 patients—each of them with two deep carious lesions at posterior teeth without clinical symptoms. After SCR, lesions are randomly assigned to treatment strategy: Group 1 (11 patients): Carious dentin is covered either with BiodentineTM (n = 11) or gutta-percha (n = 11) before using the adhesive OptibondTM FL. Group 2 (10 patients): The adhesives ClearfilTM SE Protect Bond (n = 10) or ClearfilTM SE Bond 2 (n = 10) are directly applied. Prepared cavities are rinsed with phosphate buffered saline containing 0.05% Tween 20 (10X) for five minutes immediately after SCR (visit 1) and eight weeks later (visit 2). Rinsing liquid is regained. Concentrations of IL-1β, IL-6, IL-10, C-reactive protein (CRP), TNF-α, IFN-γ, TIMP-1, -2, and MMP-7, -8, -9 are assessed by customized multiplex assays, evaluated with fluorescence analyzer. Non-parametric statistical analysis (Wilcoxon, Mann–Whitney U Test, p < 0.05) is performed (SPSS 25). Our results show that concentrations of CRP, IL-1β, IL-6, TIMP-1, -2, and MMPs were detectable. Median concentrations of CRP, IL-1β und IL-6 were significantly higher in visit 1 (304.9, 107.4, 3.8 pg/mL), compared to visit 2 (67.8, 2.3, 0.0 pg/mL; pi < 0.001). The study revealed that the non-invasive determination of cytokines from prepared dental cavities is possible

Einflussfaktoren auf die gesundheitsbezogene Lebensqualität bei Menschen mit Typ-2-Diabetes

Fragestellung: In dieser Studie wurde untersucht, inwieweit sich Typ-2-Diabetespatienten mit intensivierter (ICT) und nicht-intensivierter Insulintherapie (NIT) hinsichtlich ihrer gesundheitsbezogenen Lebensqualität unterscheiden und welche Faktoren diese beeinflussen. Methodik: Lebensqualität wurde mittels EQ-5D erfasst. Neben univariaten Analysen wurde eine multivariate Regressionsanalyse durchgeführt. Abhängige Variable war die Lebensqualität, unabhängige Variablen waren demographische und diabetesspezifische Parameter. Ergebnisse: Beide Gruppen (N = 356; 52% NIT vs. 48% ICT) wiesen die gleiche Alters- und Geschlechterverteilung (62,8 ± 8,2 Jahre; 45% weiblich) auf. ICT-Patienten zeigten eine signifikant längere Diabetesdauer 11,6 ± 6,9 vs. 13,7 ± 7,6 Jahre (p = 0,005) und Dauer der Insulintherapie 2,7 ± 4,1 vs. 5,4 ± 5,0 Jahre (p = 0,001), höheren BMI 31,5 ± 5,2 vs. 33,3 ± 5,9 kg/m2 (p = 0,003), häufigere BZSK/Tag 2,25 ± 1,49 vs. 3,33 ± 1,37 (p = 0,001) und Insulininjektionen/Tag 2,33 ± 4,15 vs. 3,93 ± 2,44 (p = 0,001) sowie einen höheren HbA1c 7,9 ± 1,2 vs. 8,3 ± 1,4% (p = 0,004) und geringere diabetesbezogene Belastungen 26,77 ± 19,39 vs. 23,61 ± 16,21 (p = 0,097). Gleichzeitig zeigte die ICT-Stichprobe eine signifikant geringere Lebensqualität als die NIT-Stichprobe (0,86 ± 0,16 vs. 0,81 ± 0,21; p = 0,019). In einer multivariaten Analyse hatten diabetesbezogene Belastungen den größten Einfluss auf die Lebensqualität (β=-0,24; p = 0,001), gefolgt von der Anzahl der Folgekomplikationen (β=-0,14; p = 0,005), weiblichem Geschlecht (β=-0,13; p = 0,013), erhöhtem BMI (β=-0,12; p = 0,018). Die Therapieform blieb ein signifikanter Prädiktor (β=-0,12; p = 0,028). Alter, Diabetesdauer, HbA1c und Blutzuckerselbstkontrollen/Tag hatten multivariat keinen signifikanten Einfluss auf die Lebensqualität. Schlussfolgerungen: Patienten mit einer ICT berichten eine signifikant geringere Lebensqualität als Patienten mit einer NIT. Dieser Unterschied bleibt auch multivariat nach Kontrolle demographischer und diabetesspezifischer Variablen bestehen. Aufgrund ihres großen Einflusses sollten diabetesbezogene Belastungen in der Behandlung von Typ-2-Diabetikern größere Beachtung finden. Übergewichtige Patienten mit Folgeerkrankungen scheinen eine Risikogruppe für eine reduzierte Lebensqualität zu bilden

The impact of continuous glucose monitoring (CGM) on low interstitial glucose values and low blood glucose values assessed by Point-of-Care glucose meters (POC-GM).

The impact of CGM on the duration of periods with low glucose measured in interstitial fl uid is well known. But studies showing an impact of CGM on low blood glucose values, measured by POC-GM are rare. This crossover study examines the impact of CGM on duration of periods spent in low interstitial glucose range (70 mg/dl) as well as on the proportion of low blood glucose (BG) values measured by POC-GM (Glukometer 3000, Bio Sensor Technology, Germany)and time until detection of low BG by use of POC-GM. 41 type 1 diabetic patients (age 42.0 ±11.3 yrs, diabetes duration 15.3 ±10.1; A1c 8.2 ±1.4%) used the DEXCOM 7 Plus CGM system twice; once participants were blinded against the results and in the other study phase (Open GCM) patients received real-time glucose values and current glucose trends, used the CGM data to determine their insulin dose, and were alerted if hypoglycaemic or hyperglycaemic glucose ranges were approached. In addition, BG was routinely measured 6 times a day by POC-GM. The order of study phases was randomized. The time spent in a hypoglycaemic glucose range (< 70 mg/dl) was reduced by open CGM from 180.6 ±125 to 125 ± 89.2 minutes per day (p=.005). Also time spent in the euglycemic glucose range was increased from 946 ±176 to 1023 ±168 minutes per day (p=.003). Open CGM reduced the proportion of low BG measurements by POC-GM from 10.3 ±7.6% to 7.4 ±5.8% (p=.039), whereas the euglycemic POC readings was increased from 68.3 ±12.1% to 73.7 ±12.1% (p=.007). The time until a hypoglycaemic BG value was detected by POC-GM was signifi cantly (p.028) shortened by 33.1 (95% CI 3.8 -62.3) minutes. These results demonstrate that CGM used for insulin dosing and hypoglycaemia alerts not only diminishes low interstitial glucose values but also reduces the proportion of low BG measured by POC-GM. In addition the time for the detection of a hypoglycaemic episode by POC-GM was signifi cantly shortene

The use of CGM to identify type 1 diabetic patients with hypoglycemia problems and its impact for avoidance of biochemical hypoglycemia.

This cross-over study used a CGM system (DexCom SEVEN PLUS CGM). In a randomized order, participants had either no access (CGM blind) or real time access to current glucose data (CGM open). One objective was to analyze if type 1 diabetic patients with hypoglycemia problems (at least one episode requiring third party assistance) could be identifi ed by the use of the blinded CGM data. We also analyzed the impact of CGM use on biochemical hypoglycemia. Type 1 diabetic patients with hypoglycemia problems had signifi cant longer diabetes duration (17.0 vs. 11.0 yrs.), a higher unawareness score (4.0 vs. 2.0) and lower thresholds for detecting hypoglycemia (50.0 vs. 65.0 mg/dl) than patients without hypoglycemia problems. During the blinded CGM phase patients with hypoglycemic problems had a signifi cant longer duration of low glucose phases 248 vs. 153 minutes per day (p=.037; <70 mg/dl) respectively 173 vs. 96 minutes per day (p=.041; <60 mg/dl). Area under the receiver operating curve (ROC 0.72 p=.03) indicated a suffi cient screening performance of the duration of low glucose periods (< 70 mg/dl) for the identifi cation of patients with hypoglycemia problems. A cut-off of 170 minutes per day of time spend in the low glucose range had a sensitivity of 75% and a specifi city of 70.3%; the positive predictive value was 52.9%, the negative predictive value was 86.4%. A comparison of blind vs. open CGM showed that time spend in a low glucose range could be signifi cantly more reduced in patients with hypoglycemia problems than in patients without hypoglycemia problems during CGM open (< 60 mg/dl; - 67.8 min per day p=.040; < 50 mg/dl; -50.6 min per day, p=.038; < 40 mg/dl; -41.4 min. per day, p=.03). This study shows that CGM has an unused potential for identifying type 1 diabetic patients at risk for hypoglycemia problems in clinical practice as well as for avoidance of biochemical hypoglycemia, which plays a pivotal role for the development of hypoglycemia associated autonomic failure

Entwicklung und Evaluation eines Assessment-Tools zur Erfassung von Barrieren der Blutzuckerselbstkontrolle.

Einleitung: Eine regelmäßige Blutzuckerselbstkontrolle ist ein wesentlicher Bestandteil für eine erfolgreiche Anpassung oder Überprüfung der Diabetestherapie. Viele Patienten berichten Barrieren, die einer regelmäßigen Blutzuckerselbstkontrolle im Alltag entgegenstehen. In dieser Studie wurde ein Assessment-Tool für die Erfassung solcher Barrieren entwickelt und evaluiert. Methodik: Patienteninterviews zu Erfahrungen mit der Blutzuckerselbstkontrolle wurden durchgeführt und ausgewertet. Folgende Aspekte erwiesen sich in Bezug auf die Blutzuckerselbstkontrolle als relevant: Handling im Alltag („Zu viele Utensilien sind notwendig“), psychologische Barrieren der Glukosekontrolle („Blutzuckerselbstkontrolle in der Öffentlichkeit ist peinlich“), Zuverlässigkeit der Blutzuckerselbstkontrolle („Vertrauen in die gemessenen Blutzuckerwerte“), aber auch Vorteile der Blutzuckerselbstkontrolle („Blutzuckermessungen vermitteln ein Sicherheitsgefühl“). Zur Evaluation wurden Faktoren- und Itemanalysen vorgenommen. Ergebnisse: 60 Fragebogenitems wurden einer diabetischen Stichprobe (n = 140) mit intensivierter Insulintherapie (Alter 43,6 ± 15,3J., 70% Typ-1-Diabetes, HbA1c 8,8 ± 2,1%; 53% weiblich) vorgegeben. Die Faktorenanalyse ergab 4 Skalen mit insgesamt 18 Items, die alle zufriedenstellende Reliabilitätskennwerte erreichten („Handling“ Cronbachs a = 0,84; „psychologische Barrieren“ a = 0,74, „Zuverlässigkeit“ a = 0,82 und „Vorteile der Blutzuckerselbstkontrolle“ a = 0,72). Ein hoher HbA1c Wert war signifikant mit höheren psychologischen Barrieren (r = 0,20) und geringerem Vertrauen in die Zuverlässigkeit (r = 0,32) sowie geringeren Vorteilen der Blutzuckerselbstkontrolle (r = 0,32) assoziiert. Höheres Lebensalter (r = 0,32) und längere Diabetesdauer (r = 0,19) waren mit weniger psychologischen Barrieren der Blutzuckerselbstkontrolle korreliert. Patienten, welche mehr psychologische Barrieren berichteten, testeten seltener ihren Blutzucker (r =-0,26). Schlussfolgerung: Das neue entwickelte Assessment-Tool zur Erfassung von Barrieren der Blutzuckerselbstkontrolle hat eine gute Reliabilität sowie Validität. Zudem ist es in der Lage, praktische Barrieren einer Blutzuckerselbstkontrolle bei Diabetespatienten zu identifizieren. Unterstützt durch Abbott Diabetes Care, German

Subtypen der Depression und deren Assoziation mit glykämischer Kontrolle

Fragestellung: Es gibt widersprüchliche Befunde zur Assoziation von Depressionen mit einer schlechteren glykämischen Kontrolle. Ein Grund dafür könnte in der Vielgestalt der depressiven Symptomatik liegen. Häufig findet eine Differenzierung in somatische (z.B. Appetit- und Schlafstörungen) und affektive Symptome (z.B. Niedergeschlagenheit, Traurigkeit) statt. Diese Studie untersuchte die Assoziationen dieser depressiven Subtypen mit der glykämischen Kontrolle. Methodik: 986 Menschen mit Typ-1 bzw. Typ-2-Diabetes bearbeiteten die Allgemeine Depressionsskala (ADS) sowie den Problem Areas in Diabetes (PAID) Fragebogen zur Erfassung diabetesbezogener Belastungen. Der ADS ermöglicht die Berechnung eines somatischen und eines affektiven Scores. Prädiktoren der linearen Regression auf den HbA1c waren der somatische und affektive Score, adjustiert für demographische (Alter, Geschlecht, BMI, Bildungsjahre) und medizinische Variablen (Diabetestyp, Diabetesdauer, Folgeerkrankungen, Blutzuckermessungen/Tag) sowie diabetesbezogene Belastungen. Ergebnisse: Eine erhöhte somatische Symptomatik war signifikant mit einem höheren HbA1c (β= 0,15; p = 0,001) assoziiert. Eine erhöhte affektive Symptomatik war signifikant mit einem niedrigeren HbA1c (β=-0,15; p = 0,001) assoziiert. Diabetesbezogene Belastungen waren ebenfalls assoziiert mit einem höheren HbA1c (β= 0,13; p = 0,001). Wurde die depressive Symptomatik insgesamt (ADS-Summenwert) als unabhängige Variable in die Analyse aufgenommen, zeigte sich keine signifikante Assoziation mit dem HbA1c (β=-0,01; p = 0,86). Schlussfolgerungen: Die Studie zeigte, dass die depressiven Subtypen entgegengesetzte Assoziationen mit der glykämische Kontrolle aufwiesen. Die Tatsache, dass kein Effekt des Gesamtscores der Depressivität vorlag, könnte dafür sprechen, dass sich die gegensätzlichen Effekte der depressiven Subtypen auf die glykämische Kontrolle gegenseitig aufheben. Eine differenzierte Betrachtung depressiver Subtypen kann möglicherweise dazu beitragen die Heterogenität der Assoziationen von Depressivität und glykämischer Kontrolle besser zu verstehen