A pilot study to evaluate a self-management algorithm for people with Type 1 diabetes participating in moderate intensity exercise in laboratory and real-life environments

BackgroundLimited evidence is available to advise people with Type 1 diabetes about self-management strategies for maintaining acceptable glycaemic control when exercising. It is recognized that hypoglycaemia is a potential risk and this is a major barrier towards exercise participation for these people. Related research exploring this topic has mostly been performed in laboratory environments.AimFollowing a specifically designed self-management algorithm, the impact of the algorithm and environment (real-life versus laboratory) was investigated regarding the attainment of acceptable glucose concentrations during and after 40 minutes exercise at 70% VO2 max.MethodsNine individuals with Type 1 diabetes (five male, four female) completed the pilot study over a 2 week period. All used a basal bolus analogue insulin regimen and exercised regularly. On Days 1 and 3 of each week they undertook 40 minutes of moderate intensity exercise (day 1 and 8 in the laboratory, and day 3 and 10 in real-life environments). All were instructed to follow the self-management algorithm. Data were collected for glucose concentrations at 10 time-points during and after exercise.ResultsStatistical analysis used a 3-way repeated measures ANOVA for time-points, environment and day, which demonstrated a highly significant main effect on time-points [F(9, 72) = 4.088, p = < 0.005, partial eta squared = 0.338. During exercise the mean blood glucose difference was significantly lower from baseline to: 20 minutes during, 2.21mmol/l (SE±0.354) (p=0.011), and 40 minutes at end 3.41mmol/l (SE±0.511) (p=0.007). However, the different environments did not have a significant main effect on the mean glucose concentration of participants [F(1, 8) = 1.489, p = 0.257]. For the study period, 8 out of 9 participants experienced at least one hypoglycaemic episode. For hypoglycaemic episodes, the main differences between environments occurred: during exercise (laboratory n=5, real-life n=1), and during 8-12 hours post-exercise (laboratory n=3, real-life n=8).ConclusionThere were differences in glycaemic patterns between environments when using a descriptive analysis. Despite post-exercise insulin reduction, nocturnal hypoglycaemia occurred in the real-life environment, and algorithm adjustments regarding carbohydrate consumption at bedtime were required for prevention. Therefore, a self-management recommendation for evening exercisers would be to perform blood glucose monitoring 8-12 hours after post-exercise insulin and consumption of carbohydrate. A larger study with the sample size to demonstrate significance, using the adjusted algorithm would clarify the reliability and efficacy of the algorithm in real-life

To legislate or not to legislate? A comparison of the UK and South African approaches to the development and implementation of salt reduction programs

The World Health Organization promotes salt reduction as a best-buy strategy to reduce chronic diseases, and Member States have agreed to a 30% reduction target in mean population salt intake by 2025. Whilst the UK has made the most progress on salt reduction, South Africa was the first country to pass legislation for salt levels in a range of processed foods. This paper compares the process of developing salt reduction strategies in both countries and highlights lessons for other countries. Like the UK, the benefits of salt reduction were being debated in South Africa long before it became a policy priority. Whilst salt reduction was gaining a higher profile internationally, undoubtedly, local research to produce context-specific, domestic costs and outcome indicators for South Africa was crucial in influencing the decision to legislate. In the UK, strong government leadership and extensive advocacy activities initiated in the early 2000s have helped drive the voluntary uptake of salt targets by the food industry. It is too early to say which strategy will be most effective regarding reductions in population-level blood pressure. Robust monitoring and transparent mechanisms for holding the industry accountable will be key to continued progress in each of the countries

Estimating the active space of male koala bellows: propagation of cues to size and identity in a Eucalyptus forest

Examining how increasing distance affects the information content of vocal signals is fundamental for determining the active space of a given species’ vocal communication system. In the current study we played back male koala bellows in a Eucalyptus forest to determine the extent that individual classification of male koala bellows becomes less accurate over distance, and also to quantify how individually distinctive acoustic features of bellows and size-related information degrade over distance. Our results show that the formant frequencies of bellows derived from Linear Predictive Coding can be used to classify calls to male koalas over distances of 1–50 m. Further analysis revealed that the upper formant frequencies and formant frequency spacing were the most stable acoustic features of male bellows as they propagated through the Eucalyptus canopy. Taken together these findings suggest that koalas could recognise known individuals at distances of up to 50 m and indicate that they should attend to variation in the upper formant frequencies and formant frequency spacing when assessing the identity of callers. Furthermore, since the formant frequency spacing is also a cue to male body size in this species and its variation over distance remained very low compared to documented inter-individual variation, we suggest that male koalas would still be reliably classified as small, medium or large by receivers at distances of up to 150 m

Editorial

South Africa’s salt reduction strategy: Are we on track, and what lies ahead

A review of the challenges, glycaemic risks and self-care for people with type 1 diabetes when consuming alcoholic beverages

Evidence‐based information for people with type 1 diabetes mellitus (T1DM) when consuming alcoholic beverages is sparse and simplistic. In clinical practice, erratic blood glucose levels with hypoglycaemia and hyperglycaemia are regularly observed, with episodes of severe hypoglycaemia being a potential risk. Preventative health behaviour strategies are often based on trial and error, with deliberately caused hyperglycaemia being a common tactic. Although important, there are no systematic reviews that synthesise the research evidence on the acute effects of alcohol on blood glucose and the impact in real‐life.We aimed to investigate the acute effect of alcoholic beverages on blood glucose, and to use appropriate evidence to recommend self‐care advice to help maintain safe glycaemic control in people with T1DM.A literature search from eight bibliographic databases was performed. Fifteen appropriate publications were identified. Most original research was performed in a laboratory environment and demonstrated inconsistencies in the effects of alcohol on blood glucose. Few studies were conducted in the real‐life environment, with advice from ‘diabetes associations’ focusing on abstinence rather than alcohol harm reduction strategies.In conclusion, key components to consider when designing future interventions include: the biochemical response to alcohol; the role of exogenous insulin; the presence and timing of carbohydrate foodstuffs in relation to alcohol; the impact of the constituents and amount of an alcoholic beverage consumed; and the effects of alcohol on cognition and behaviours

Monitoring and implementation of salt reduction initiatives in Africa: A systematic review

This systematic review aims to document salt consumption patterns and the implementation status and potential impact of salt reduction initiatives in Africa, from studies published between January 2009 and November 2019. Studies were sourced using MEDLINE, Embase, Cochrane Library electronic databases, and gray literature. Of the 887 records retrieved, 38 studies conducted in 18 African countries were included. Twelve studies measured population salt intake, 11 examined salt level in foods, 11 assessed consumer knowledge, attitudes, and behaviors, 1 study evaluated a behavior change intervention, and 3 studies modeled potential health gains and cost savings of salt reduction interventions. The population salt intake studies determined by 24-hour urine collections showed that the mean (SD) salt intake in African adults ranged from 6.8 (2.2) g to 11.3 (5.4) g/d. Salt levels in foods were generally high, and consumer knowledge was fairly high but did not seem to translate into salt lowering behaviors. Modeling studies showed that interventions for reducing dietary sodium would generate large health gains and cost savings for the health system. Despite this evidence, adoption of population salt reduction strategies in Africa has been slow, and dietary consumption of sodium remains high. Only South Africa adopted legislation in 2016 to reduce population salt intake, but success of this intervention has not yet been fully evaluated. Thus, rigorous evaluation of the salt reduction legislation in South Africa and initiation of salt reduction programs in other African countries will be vital to achieving the targeted 30% reduction in salt intake by 2025

Innovation in Diabetes - Ideas and Initiatives

A collection of multiple reports on MyDiabetesMyWay (MDMW). Included reports are: MyDiabetesMyWay Patient Portal; MyDiabetesMyWay e-learning hub (Moodle) ; SCI-diabetes/ MDMW Communication Portal- Tools for Remote Communication/ Consultation; Risk Modelling for Care Planning- integration into Informatics Dashboard for Clinical Use; Access to Chronic Medication Service (CMS) and Pharmaceutical Care Planning Medication and Lifestyle Coaching; Multi-media Diabetes Resources; Promoting Diabetes Education; Tele-Pharmacy; Understanding my diabetes medication; Pharmaceutical Industry and Medical Technology (PIMTs); An on-line and interactive education system for young people with type 1 diabetes to understand self-management for their lifestyle; Proof of Concept study to deliver personalised use of information to support diabetes management and behaviour change; right information; right time; right way; Virtual promotion of physical activity for people with type 2 diabetes; Remote foot ulcer management: RAPID (Reducing Amputation in People with Diabetes); Diabetic foot screening – development of technology; Portable capillary HbA1c testing for diagnosis and self-monitoring of diabetes; Possibility of mobile phone adaption for testing; Web app for decision support for patients with type 1 diabetes undertaking sport or exercise; Online level 3 structured education for type 1 diabetes; My Diabetes My Way electronic personal health record – uptake at scale; TeleClinics for diabetes; Develop a diabetes sim / game in which the main character has diabetes. Young people need to keep the sim / character alive as they face the various challenges of life or the game; Development of meaningful automated glucose data to in-patient clinical areas; In-patient Care: Integrated eHealth solutions to improve patient care, safety and outcomes; Innovative model of care to address the 'process of care' in managing people with long term conditions; Young Persons Remote Clinic Consultation; Maximise use of the data to support self-management of patients with co-morbidities; Virtual practice outreach and education in primary care

Perception of Male Caller Identity in Koalas (Phascolarctos cinereus): Acoustic Analysis and Playback Experiments

The ability to signal individual identity using vocal signals and distinguish between conspecifics based on vocal cues is important in several mammal species. Furthermore, it can be important for receivers to differentiate between callers in reproductive contexts. In this study, we used acoustic analyses to determine whether male koala bellows are individually distinctive and to investigate the relative importance of different acoustic features for coding individuality. We then used a habituation-discrimination paradigm to investigate whether koalas discriminate between the bellow vocalisations of different male callers. Our results show that male koala bellows are highly individualized, and indicate that cues related to vocal tract filtering contribute the most to vocal identity. In addition, we found that male and female koalas habituated to the bellows of a specific male showed a significant dishabituation when they were presented with bellows from a novel male. The significant reduction in behavioural response to a final rehabituation playback shows this was not a chance rebound in response levels. Our findings indicate that male koala bellows are highly individually distinctive and that the identity of male callers is functionally relevant to male and female koalas during the breeding season. We go on to discuss the biological relevance of signalling identity in this species' sexual communication and the potential practical implications of our findings for acoustic monitoring of male population levels

Salt Reduction Initiatives around the World – A Systematic Review of Progress towards the Global Target

Objective To quantify progress with the initiation of salt reduction strategies around the world in the context of the global target to reduce population salt intake by 30% by 2025. Methods A systematic review of the published and grey literature was supplemented by questionnaires sent to country program leaders. Core characteristics of strategies were extracted and categorised according to a pre-defined framework. Results A total of 75 countries now have a national salt reduction strategy, more than double the number reported in a similar review done in 2010. The majority of programs are multifaceted and include industry engagement to reformulate products (n = 61), establishment of sodium content targets for foods (39), consumer education (71), front-of-pack labelling schemes (31), taxation on high-salt foods (3) and interventions in public institutions (54). Legislative action related to salt reduction such as mandatory targets, front of pack labelling, food procurement policies and taxation have been implemented in 33 countries. 12 countries have reported reductions in population salt intake, 19 reduced salt content in foods and 6 improvements in consumer knowledge, attitudes or behaviours relating to salt. Conclusion The large and increasing number of countries with salt reduction strategies in place is encouraging although activity remains limited in low- and middle-income regions. The absence of a consistent approach to implementation highlights uncertainty about the elements most important to success. Rigorous evaluation of ongoing programs and initiation of salt reduction programs, particularly in low- and middle- income countries, will be vital to achieving the targeted 30% reduction in salt intake