15 research outputs found

    Assessing physicians’ satisfaction with diabetes therapy: development and evaluation of a new questionnaire.

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    Questionnaires assessing the satisfaction of patients already exist, but no questionnaire assesses the satisfaction of physicians. However, physicians’ satisfaction with patient-communication and with diabetes therapy is a crucial factor for the effi cacy of diabetes therapy. A relevant part of patientcommunication is the discussion of blood glucose values with the patient. In order to systematically assess the perspective of physicians, we developed WITHDRAWN A232 For author disclosure information, see page A810. CATEGORY & Guided Audio Tour poster ADA-Funded Research Behavioral Medicine, Clinical Nutrition, Education, and Exercise POSTERS PSYCHOSOCIAL, BEHAVIORAL MEDICINE a questionnaire that assesses satisfaction of physicians with diabetes therapy in general (Sat-DT) and with the discussion of blood glucose values (SatBG) in particular. Data from 188 physicians who completed the questionnaire was analyzed. The fi nal Sat-DT scale comprised 13 items and achieved a Cronbach’s Alpha of 0.93 wit a mean item-total correlation of r=0.71. The fi nal Sat-BG scale comprised 10 items and achieved a Cronbach’s Alpha of 0.92 with a mean item-total correlation of r=0.73. Factor analysis (Varimax rotation) revealed two factors within the Sat-DT scale (65% explained variance): “Effects of diabetes therapy” and “costs and benefi ts.” The Sat-BG scale could be divided into “Usage of blood glucose data” and “effi cacy of the discussion” by factor analysis (76% explained variance). A greater satisfaction in both scales was associated with a greater satisfaction with the work as a physician (Sat-DT: r=0.2, p<.05; Sat-BG: r=0.32, p<.05), a greater satisfaction with therapy outcomes (Sat-DT: r=0.34, p<.05; Sat-BG: r=0.3, p<.05), and with a greater satisfaction with the results of working as a physician (Sat-DT: r=0.27, p<.05; Sat-BG: r=0.25, p<.05). This new questionnaire with its two scales is a reliable and valid assessment tool to measure the satisfaction of physicians. In future studies, this questionnaire can be used to investigate the infl uence of physicians’ satisfaction on diabetes therapy as well as how physicians’ satisfaction can be altered

    A new assessment tool to measure the ability of Bolus Calculation and Carbohydrate Estimation (SMART) in people with diabetes performing an intensive insulin therapy

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    Background and aims: Intensive insulin therapy relies on correct prandial insulin dose adaptation dependent from current glucose level, amount of planned carbohydrate intake and the consideration of other situational factors like physical activity or circadian fluctuation of insulin sensitivity. People with diabetes and intensive insulin therapy should be able to estimate carbohydrates and calculate insulin bolus correctly, while regarding the factors mentioned above. An assessment tool for the measurement of the ability of carbohydrate estimation and bolus calculation is missing. The objective of this study was the development and psychometric evaluation of an assessment tool for carbohydrate estimation and bolus calculation (“aSsessMent of the Ability of Bolus Calculation and CaRbohydrate esTimation” SMART). Of special interest were the associations of both abilities with glycaemic control. Materials and methods: The SMART consisted of one scale for the assessment of bolus calculation (BOLUS) with 10 items and a scale for carbohydrate estimation (CARB) with 12 items. People with type 1 or type 2 diabetes on an intensive insulin regimen were invited to participate. HbA1c and stored data of blood glucose meters were used to determine glycaemic control. Results: 411 patients participated (age 42.9 ±15.7, 58% female, HbA1c 8.6 ±1.8%, 28% with CSII-treatment) and approx. 56,000 blood glucose meter readings could be obtained. The reliability of both scales was sufficient (Cron-bachs alpha for BOLUS r= 0.78 and the CARB r = 0.67). Better bolus calculation was associated with a higher level of education (r = 0.24, p<.05), lower HbA1c (r = -0.27, p<.05), lower mean blood glucose (r = -0.29, p<.05), and a lower standard deviation of blood glucose values (r = -0.43, p<.05). Better carbohydrate estimation was associated with a lower body mass index (r = -0.2, p<.05), lower mean blood glucose (r = -0.3, p<.05), a lower frequency of hyperglycaemia (r = -0.27, p<.05), and a higher frequency of euglycaemia (r = 0.26, p<.05). Patients with an insulin pump were better on both scales than patients with multiple daily insulin injections (BOLUS: 7.2 ± 2.4 vs. 6.4 ± 2.7, p<.01; CARB: 7.8 ± 2.1 vs. 7.1 ± 2.6, p<.01). Patients with previous diabetes education performed significantly better on both scales (BOLUS: 6.8 ± 2.5 vs. 5.7 ± 2.8, p<.01; CARB: 7.4 ± 2.4 vs. 6.5 ± 2.6, p<.01). Conclusion: SMART provides a reliable and valid assessment of the ability to estimate the correct amount of carbohydrates and to calculate the appropriate prandial insulin dose. SMART is also sensitive to depict effects of diabetes education and of CSII treatment in comparison to multiple daily insulin injections. In summary SMART can assist the identification of people with diabetes on an intensive insulin regimen, who are in need for improvements in carbohydrate estimation and/or calculation of prandial insulin dos

    Organizers and activators : Cytosolic Nox proteins impacting on vascular function

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    NADPH oxidases of the Nox family are important enzymatic sources of reactive oxygen species (ROS) in the cardiovascular system. Of the 7 members of the Nox family, at least three depend for their activation on specific cytosolic proteins. These are p47phox and its homologue NoxO1 and p67phox and its homologue NoxA1. Also the Rho-GTPase Rac is important but as this protein has many additional functions, it will not be covered here. The Nox1 enzyme is preferentially activated by the combination of NoxO1 with NoxA1, whereas Nox2 gains highest activity with p47phox together with p67phox. As p47phox, different to NoxO1 contains an auto inhibitory region it has to be phosphorylated prior to complex formation. In the cardio-vascular system, all cytosolic Nox proteins are expressed but the evidence for their contribution to ROS production is not well established. Most data have been collected for p47phox, whereas NoxA1 has basically not yet been studied. In this article the specific aspects of cytosolic Nox proteins in the cardiovascular system with respect to Nox activation, their expression and their importance will be reviewed. Finally, it will be discussed whether cytosolic Nox proteins are suitable pharmacological targets to tamper with vascular ROS production

    Development of a new tool to assess bolus calculation and carbohydrate estimation

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    Background: Carbohydrate estimation and bolus calculation are two important skills for handling intensive insulin therapy and effectively using bolus calculators. Structured assessment of both skills is lacking. A new tool for the assessment of skills in carbohydrate estimation and bolus calculation was developed and evaluated. Materials and Methods: A new assessment tool (SMART) was developed that included 10 items for bolus calculation and 12 items for carbohydrate estimation. In total, 411 patients on intensive insulin treatment were recruited. Different parameters of glycemic control were used as validity criteria. Results: The SMART tool achieved good reliability for the assessment of bolus calculation (Cronbach's α = 0.78) and sufficient reliability for the assessment of carbohydrate estimation (Cronbach's α = 0.67). A good bolus calculation skill was significantly associated with lower glycated hemoglobin values (r = –0.27), lower mean blood glucose levels (r = –0.29), and higher fluctuation of blood glucose control (r = –0.43). A good carbohydrate estimation skill was significantly associated with a lower frequency of severe hyperglycemia (r = –0.27) and a higher frequency of euglycemia (r = 0.26). Conclusions: SMART is a reliable and valid tool for the assessment of both skills. Bolus calculation as well as carbohydrate estimation was associated with glycemic control. With the help of SMART, important skills for the management of intensive insulin therapy can be assessed separately. Thus, in clinical practice patients in need of assistance from a bolus calculator can be identified

    Knock out of the NADPH oxidase Nox4 has no impact on life span in mice

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    The free radical theory of aging suggests reactive oxygen species as a main reason for accumulation of damage events eventually leading to aging. Nox4, a member of the family of NADPH oxidases constitutively produces ROS and therefore has the potential to be a main driver of aging. Herein we analyzed the life span of Nox4 deficient mice and found no difference when compared to their wildtype littermates. Accordingly neither Tert expression nor telomere length was different in cells isolated from those animals. In fact, Nox4 mRNA expression in lungs of wildtype mice dropped with age. We conclude that Nox4 has no influence on lifespan of healthy mice. Keywords: Nox4, Agin

    Sestrin-2, a repressor of PDGFRβ signalling, promotes cigarette-smoke-induced pulmonary emphysema in mice and is upregulated in individuals with COPD

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    Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. COPD is caused by chronic exposure to cigarette smoke and/or other environmental pollutants that are believed to induce reactive oxygen species (ROS) that gradually disrupt signalling pathways responsible for maintaining lung integrity. Here we identify the antioxidant protein sestrin-2 (SESN2) as a repressor of PDGFRβ signalling, and PDGFRβ signalling as an upstream regulator of alveolar maintenance programmes. In mice, the mutational inactivation of Sesn2 prevents the development of cigarette-smoke-induced pulmonary emphysema by upregulating PDGFRβ expression via a selective accumulation of intracellular superoxide anions (O2−). We also show that SESN2 is overexpressed and PDGFRβ downregulated in the emphysematous lungs of individuals with COPD and to a lesser extent in human lungs of habitual smokers without COPD, implicating a negative SESN2-PDGFRβ interrelationship in the pathogenesis of COPD. Taken together, our results imply that SESN2 could serve as both a biomarker and as a drug target in the clinical management of COPD

    Sestrin-2, a repressor of PDGFRβ signalling, promotes cigarette smokeinduced pulmonary emphysema in mice and is upregulated in patients with COPD

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    Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. COPD is caused by chronic exposure to cigarette smoke and/or other environmental pollutants that are believed to induce reactive oxygen species (ROS) that gradually disrupt signalling pathways responsible for maintaining lung integrity. Here we identify the antioxidant protein Sestrin 2 (Sesn2) as a repressor of PDGFRβ signalling and PDGFRβ signalling as an upstream regulator of alveolar maintenance programs. In mice, the mutational inactivation of Sesn2 prevents the development of cigarette-smoke induced pulmonary emphysema by upregulating PDGFRβ expression via a selective accumulation of intracellular superoxide anions (O2-). We also show that SESN2 is overexpressed and PDGFRβ downregulated in the emphysematous lungs of patients with COPD and to a lesser extent in human lungs of habitual smokers without COPD, implicating a negative SESN2/PDGFRβ interrelationship in the pathogenesis of COPD. Taken together, our results imply that SESN2 could serve as both a biomarker and as a drug target in the clinical management of COPD
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