Pub Date : 2023-05-15DOI: 10.1007/s41066-023-00381-2
Guorou Wan, Yuan Rong, Harish Garg
The major objective of the current investigation is to build an integrated multiple criteria group decision-making (MCGDM) methodology based on combined compromise solution (CoCoSo) and spherical fuzzy set for determining the optimal solar power station. To begin with, an innovative spherical fuzzy score function is brought forward to strengthen the efficiency of the comparison for spherical fuzzy number (SFN). Secondly, several newly operational laws for SFN are defined and some novel aggregation operation based on them are propounded. The corresponding excellent properties of the novel operators are also explored at length. Further, the spherical fuzzy method on the removal effects of criteria (MEREC) technique is presented by the proposed score function to work out the importance of the criteria. Lastly, an MCGDM approach is propounded based on improved spherical fuzzy CoCoSo to obtain the ranking of the solar power station locations. The feasibility and practicability of the proposed SF-MEREC-CoCoSo method are investigated through the comparison study with the extant methods. The sensibility analysis is also executed to discuss the robustness and stability of the propounded methodology.
{"title":"An efficient spherical fuzzy MEREC-CoCoSo approach based on novel score function and aggregation operators for group decision making.","authors":"Guorou Wan, Yuan Rong, Harish Garg","doi":"10.1007/s41066-023-00381-2","DOIUrl":"10.1007/s41066-023-00381-2","url":null,"abstract":"<p><p>The major objective of the current investigation is to build an integrated multiple criteria group decision-making (MCGDM) methodology based on combined compromise solution (CoCoSo) and spherical fuzzy set for determining the optimal solar power station. To begin with, an innovative spherical fuzzy score function is brought forward to strengthen the efficiency of the comparison for spherical fuzzy number (SFN). Secondly, several newly operational laws for SFN are defined and some novel aggregation operation based on them are propounded. The corresponding excellent properties of the novel operators are also explored at length. Further, the spherical fuzzy method on the removal effects of criteria (MEREC) technique is presented by the proposed score function to work out the importance of the criteria. Lastly, an MCGDM approach is propounded based on improved spherical fuzzy CoCoSo to obtain the ranking of the solar power station locations. The feasibility and practicability of the proposed SF-MEREC-CoCoSo method are investigated through the comparison study with the extant methods. The sensibility analysis is also executed to discuss the robustness and stability of the propounded methodology.</p>","PeriodicalId":92116,"journal":{"name":"Practical diabetes international : the journal for diabetes care teams worldwide","volume":"5 1","pages":"1-23"},"PeriodicalIF":0.0,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10184975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72640228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-04DOI: 10.1007/s00018-022-04301-6
Juuli Raivola, Alice Dini, Kari Salokas, Hanna Karvonen, Wilhelmiina Niininen, Emilia Piki, Markku Varjosalo, Daniela Ungureanu
ROR1, ROR2, and PTK7 are Wnt ligand-binding members of the receptor tyrosine kinase family. Despite their lack of catalytic activity, these receptors regulate skeletal, cardiorespiratory, and neurological development during embryonic and fetal stages. However, their overexpression in adult tissue is strongly connected to tumor development and metastasis, suggesting a strong pharmacological potential for these molecules. Wnt5a ligand can activate these receptors, but lead to divergent signaling and functional outcomes through mechanisms that remain largely unknown. Here, we developed a cellular model by stably expressing ROR1, ROR2, and PTK7 in BaF3 cells that allowed us to readily investigate side-by-side their signaling capability and functional outcome. We applied proteomic profiling to BaF3 clones and identified distinctive roles for ROR1, ROR2, and PTK7 pseudokinases in modulating the expression of proteins involved in cytoskeleton dynamics, apoptotic, and metabolic signaling. Functionally, we show that ROR1 expression enhances cell survival and Wnt-mediated cell proliferation, while ROR2 and PTK7 expression is linked to cell migration. We also demonstrate that the distal C-terminal regions of ROR1 and ROR2 are required for receptors stability and downstream signaling. To probe the pharmacological modulation of ROR1 oncogenic signaling, we used affinity purification coupled to mass spectrometry (AP-MS) and proximity-dependent biotin identification (BioID) to map its interactome before and after binding of GZD824, a small molecule inhibitor previously shown to bind to the ROR1 pseudokinase domain. Our findings bring new insight into the molecular mechanisms of ROR1, ROR2, and PTK7, and highlight the therapeutic potential of targeting ROR1 with small molecule inhibitors binding to its vestigial ATP-binding site.
{"title":"New insights into the molecular mechanisms of ROR1, ROR2, and PTK7 signaling from the proteomics and pharmacological modulation of ROR1 interactome.","authors":"Juuli Raivola, Alice Dini, Kari Salokas, Hanna Karvonen, Wilhelmiina Niininen, Emilia Piki, Markku Varjosalo, Daniela Ungureanu","doi":"10.1007/s00018-022-04301-6","DOIUrl":"10.1007/s00018-022-04301-6","url":null,"abstract":"<p><p>ROR1, ROR2, and PTK7 are Wnt ligand-binding members of the receptor tyrosine kinase family. Despite their lack of catalytic activity, these receptors regulate skeletal, cardiorespiratory, and neurological development during embryonic and fetal stages. However, their overexpression in adult tissue is strongly connected to tumor development and metastasis, suggesting a strong pharmacological potential for these molecules. Wnt5a ligand can activate these receptors, but lead to divergent signaling and functional outcomes through mechanisms that remain largely unknown. Here, we developed a cellular model by stably expressing ROR1, ROR2, and PTK7 in BaF3 cells that allowed us to readily investigate side-by-side their signaling capability and functional outcome. We applied proteomic profiling to BaF3 clones and identified distinctive roles for ROR1, ROR2, and PTK7 pseudokinases in modulating the expression of proteins involved in cytoskeleton dynamics, apoptotic, and metabolic signaling. Functionally, we show that ROR1 expression enhances cell survival and Wnt-mediated cell proliferation, while ROR2 and PTK7 expression is linked to cell migration. We also demonstrate that the distal C-terminal regions of ROR1 and ROR2 are required for receptors stability and downstream signaling. To probe the pharmacological modulation of ROR1 oncogenic signaling, we used affinity purification coupled to mass spectrometry (AP-MS) and proximity-dependent biotin identification (BioID) to map its interactome before and after binding of GZD824, a small molecule inhibitor previously shown to bind to the ROR1 pseudokinase domain. Our findings bring new insight into the molecular mechanisms of ROR1, ROR2, and PTK7, and highlight the therapeutic potential of targeting ROR1 with small molecule inhibitors binding to its vestigial ATP-binding site.</p>","PeriodicalId":92116,"journal":{"name":"Practical diabetes international : the journal for diabetes care teams worldwide","volume":"6 1","pages":"276"},"PeriodicalIF":8.0,"publicationDate":"2022-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9064840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72642204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1002/j.1528-252X.1994.tb00030.x
D. Sandler, A. Maccuish, B. Fisher
Introduction Hypoglycaemia is a common occurrence in people with insulin-treated diabetes': The treatment which patients receive for hypoglycaemia depends to a large extent on the degree of hypoglycaemia-, Simple episodes are treated by the patient ingesting carbohydrate; more severe episodes by a relative or general practitioner; and profound episodes may require referral to a hospital Accident and Emergency department or diabetes unit. The aim of the present study was to determine the current practice of general practitioners when treating an episode of hypoglycaemia in the primary care situation.
{"title":"Treatment of hypoglycaemia by general practitioners","authors":"D. Sandler, A. Maccuish, B. Fisher","doi":"10.1002/j.1528-252X.1994.tb00030.x","DOIUrl":"https://doi.org/10.1002/j.1528-252X.1994.tb00030.x","url":null,"abstract":"Introduction Hypoglycaemia is a common occurrence in people with insulin-treated diabetes': The treatment which patients receive for hypoglycaemia depends to a large extent on the degree of hypoglycaemia-, Simple episodes are treated by the patient ingesting carbohydrate; more severe episodes by a relative or general practitioner; and profound episodes may require referral to a hospital Accident and Emergency department or diabetes unit. The aim of the present study was to determine the current practice of general practitioners when treating an episode of hypoglycaemia in the primary care situation.","PeriodicalId":92116,"journal":{"name":"Practical diabetes international : the journal for diabetes care teams worldwide","volume":"268 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/j.1528-252X.1994.tb00030.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50682910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1002/j.1528-252X.1994.tb00032.x
R. Elson
Over 95% patient acceptability recorded in the UK alone. Fully trained medically competent staff always available, Loan of instructional video on request. Unit return facility. The conference was chaired jointly by Dr Kenneth Shaw and Professor Anne-Louise Kinmonth. Professor John Gabbay (Director, Wessex Institute of Public Health) suggested that the aim in diabetes care should be to achieve an overall health gain. To do this it was necessary to increase the overlap between needs, demands and supply of care and he examined these three areas in terms of what purchasers would look at. Different approaches to the delivery of care were examined by Dr Brian Hurwitz (GP, London), He looked historically at initiatives in community care in the latter part of this century and at studies which showed that GP care did not match that delivered by hospitals. He described how, in response to these results, some GPs had set up computer recall systems to enable them to supply better service to patients. They had shown that properly structured GP care could deliver care equivalent to that of hospitals. However, it was important for GPs to have access to special services such as education, dietetics, chiropody and eye review, in order to supply this standard of care, Delegates were treated to a panel of patients giving their impressions of the care they had received over the years. Present issues of care were examined by Dr Kenneth Shaw (Consultant Physician, Portsmouth). He believed hospitals could
{"title":"Delivering diabetes care: all together now?","authors":"R. Elson","doi":"10.1002/j.1528-252X.1994.tb00032.x","DOIUrl":"https://doi.org/10.1002/j.1528-252X.1994.tb00032.x","url":null,"abstract":"Over 95% patient acceptability recorded in the UK alone. Fully trained medically competent staff always available, Loan of instructional video on request. Unit return facility. The conference was chaired jointly by Dr Kenneth Shaw and Professor Anne-Louise Kinmonth. Professor John Gabbay (Director, Wessex Institute of Public Health) suggested that the aim in diabetes care should be to achieve an overall health gain. To do this it was necessary to increase the overlap between needs, demands and supply of care and he examined these three areas in terms of what purchasers would look at. Different approaches to the delivery of care were examined by Dr Brian Hurwitz (GP, London), He looked historically at initiatives in community care in the latter part of this century and at studies which showed that GP care did not match that delivered by hospitals. He described how, in response to these results, some GPs had set up computer recall systems to enable them to supply better service to patients. They had shown that properly structured GP care could deliver care equivalent to that of hospitals. However, it was important for GPs to have access to special services such as education, dietetics, chiropody and eye review, in order to supply this standard of care, Delegates were treated to a panel of patients giving their impressions of the care they had received over the years. Present issues of care were examined by Dr Kenneth Shaw (Consultant Physician, Portsmouth). He believed hospitals could","PeriodicalId":92116,"journal":{"name":"Practical diabetes international : the journal for diabetes care teams worldwide","volume":"267 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/j.1528-252X.1994.tb00032.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50682919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1002/j.1528-252X.1994.tb00015.x
A. Burden
We have been made aware of the importance of glycated haemoglobin results now the DCCT results have been published. We need to know these measurements both for individual patients and for clinic populations so that we can compare the results of treatment and education. We need to know the significance of a patient's results so that we can suitably inform him. This is possible for all centres so long as centres can accurately compare their glycated haemoglobin results with those from the DCCT. In this issue Dr E H McLaren's group' uses the technique of Standard Deviation Scores (SDS) to do this. I thought this was so important that it deserved further comment. There are many different methods of measuring glycated haemoglobin. These different methods affect the results. The method used to collect the blood also alters the resultss.s. The reference intervals (normal ranges) differ widely from laboratory to laboratory, The consequence of all of these factors is that it is difficult to compare results between centres. The SDS should allow accurate comparison but only if performed correctly. To understand SDS you must first understand Standard Deviation. This is a way of quantifying variability. One Standard Deviation is roughly the average distance from the mean of all the observations made in a normal population. It is written ±1 SD. About 95% of a normally distributed population will fall between ±2 SD of the mean, and a little over 99% fall between ±3 SD. The number of Standard Deviations away from the mean allows a score to be produced: the SDS. To use the SDS the data must have a 'normal distribution'. Provided sufficient samples have been taken, a simple histogram will demonstrate if the distribution is normal or if the data are skewed. If the data are positively skewed there are a few very high values, but most fall in the lower levels. Another simple way to see if the data are skewed is to find the midpoint between the highest and the lowest values found in a population; this is called the median. This should be approximately the same as the mean (average). The data from many biological variables are positively skewed. The term 'reference population' is preferable to 'normal population' since it should consist of a large number of healthy individuals, as far as is known. People with diabetes who are not ill could be included, for instance. If these were included then glycated haemoglobin values would be positively skewed. Most positively skewed data require transformation before a reliable standard deviation can be found. This is particularly important for the SDS used to quantitate
{"title":"Glycated haemoglobin HbA1c or HbA1: expression of results","authors":"A. Burden","doi":"10.1002/j.1528-252X.1994.tb00015.x","DOIUrl":"https://doi.org/10.1002/j.1528-252X.1994.tb00015.x","url":null,"abstract":"We have been made aware of the importance of glycated haemoglobin results now the DCCT results have been published. We need to know these measurements both for individual patients and for clinic populations so that we can compare the results of treatment and education. We need to know the significance of a patient's results so that we can suitably inform him. This is possible for all centres so long as centres can accurately compare their glycated haemoglobin results with those from the DCCT. In this issue Dr E H McLaren's group' uses the technique of Standard Deviation Scores (SDS) to do this. I thought this was so important that it deserved further comment. There are many different methods of measuring glycated haemoglobin. These different methods affect the results. The method used to collect the blood also alters the resultss.s. The reference intervals (normal ranges) differ widely from laboratory to laboratory, The consequence of all of these factors is that it is difficult to compare results between centres. The SDS should allow accurate comparison but only if performed correctly. To understand SDS you must first understand Standard Deviation. This is a way of quantifying variability. One Standard Deviation is roughly the average distance from the mean of all the observations made in a normal population. It is written ±1 SD. About 95% of a normally distributed population will fall between ±2 SD of the mean, and a little over 99% fall between ±3 SD. The number of Standard Deviations away from the mean allows a score to be produced: the SDS. To use the SDS the data must have a 'normal distribution'. Provided sufficient samples have been taken, a simple histogram will demonstrate if the distribution is normal or if the data are skewed. If the data are positively skewed there are a few very high values, but most fall in the lower levels. Another simple way to see if the data are skewed is to find the midpoint between the highest and the lowest values found in a population; this is called the median. This should be approximately the same as the mean (average). The data from many biological variables are positively skewed. The term 'reference population' is preferable to 'normal population' since it should consist of a large number of healthy individuals, as far as is known. People with diabetes who are not ill could be included, for instance. If these were included then glycated haemoglobin values would be positively skewed. Most positively skewed data require transformation before a reliable standard deviation can be found. This is particularly important for the SDS used to quantitate","PeriodicalId":92116,"journal":{"name":"Practical diabetes international : the journal for diabetes care teams worldwide","volume":"61 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/j.1528-252X.1994.tb00015.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50682729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1002/j.1528-252X.1994.tb00018.x
A. Chalmers
The sites of atheromatous narrowing vary. Some people get apparently solitary stenoses while others get multiple lesions in many vessels. Large arteries only are affected, such as the common iliac artery, with entirely normal-looking vessels distally; or the disease may be in all the leg arteries, both large and small. It is known that diabetic patients are particularly prone to occlusion of small arteries in the feet, at the moment well beyond the reach of surgery or even interventional radiology, but they also get more atheroma in the medium-sized and large vessels of the pelvis and legs than non-diabetic patients". It is angioplasty of these lesions which can make all the difference to the relief of rest pain, the healing of ulcers distally and the general quality oflife.
{"title":"Angioplasty and patients with diabetes","authors":"A. Chalmers","doi":"10.1002/j.1528-252X.1994.tb00018.x","DOIUrl":"https://doi.org/10.1002/j.1528-252X.1994.tb00018.x","url":null,"abstract":"The sites of atheromatous narrowing vary. Some people get apparently solitary stenoses while others get multiple lesions in many vessels. Large arteries only are affected, such as the common iliac artery, with entirely normal-looking vessels distally; or the disease may be in all the leg arteries, both large and small. It is known that diabetic patients are particularly prone to occlusion of small arteries in the feet, at the moment well beyond the reach of surgery or even interventional radiology, but they also get more atheroma in the medium-sized and large vessels of the pelvis and legs than non-diabetic patients\". It is angioplasty of these lesions which can make all the difference to the relief of rest pain, the healing of ulcers distally and the general quality oflife.","PeriodicalId":92116,"journal":{"name":"Practical diabetes international : the journal for diabetes care teams worldwide","volume":"50 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/j.1528-252X.1994.tb00018.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50683070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1002/j.1528-252X.1994.tb00026.x
M. Powell
The performance of a new system for near‐patient monitoring of blood glucose levels based on the reference hexokinase/glucose‐6‐phosphate dehydrogenase method was evaluated in a routine out‐patient diabetes clinic. The system includes features designed to overcome operator dependency of results. Within‐batch precision was 1.1‐4.2% coefficient of variation, while between‐batch coefficients of variation of 2.6‐6.7% were achieved. The new system was assessed to be suitable for use by nurses and patients.
{"title":"An assessment of the suitability of the Glucometer 4 blood glucose system for near‐patient testing","authors":"M. Powell","doi":"10.1002/j.1528-252X.1994.tb00026.x","DOIUrl":"https://doi.org/10.1002/j.1528-252X.1994.tb00026.x","url":null,"abstract":"The performance of a new system for near‐patient monitoring of blood glucose levels based on the reference hexokinase/glucose‐6‐phosphate dehydrogenase method was evaluated in a routine out‐patient diabetes clinic. The system includes features designed to overcome operator dependency of results. Within‐batch precision was 1.1‐4.2% coefficient of variation, while between‐batch coefficients of variation of 2.6‐6.7% were achieved. The new system was assessed to be suitable for use by nurses and patients.","PeriodicalId":92116,"journal":{"name":"Practical diabetes international : the journal for diabetes care teams worldwide","volume":"279 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/j.1528-252X.1994.tb00026.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50683262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1002/j.1528-252X.1994.tb00016.x
R. Shillitoe
I would like to comment upon some of the issues raised by the Diabetes Control and Complications Trial! from a psychological point of view, and to discuss their broad clinical implications. First, and most importantly, the Trial demonstrated that good metabolic control can delay the onset and slow progression of diabetes-related complications. To do this, a complicated regimen was required. This raises the question of how much inconvenience patients are prepared to put up with for the sake of long-term future benefits. In the intensively-treated group, tight control was achieved by selfmonitoring blood glucose at least four times per day, three or more daily injections of insulin via syringe or pump, adjustment of insulin dosage where necessary, attention to the timing, content and frequency of meals together with changes in activity and exercise patterns. You might think that all of this, together with monthly clinic visits and regular telephone contacts would be regarded as unacceptably intrusive by many patients. However, only 1% of patients failed to complete the study; an astonishingly low drop-out figure. Further, patients completed a 46-item questionnaire that was specifically designed to measure the burden of the disease and the treatment regimen. It was found that the quality of life of patients receiving intensive therapy was no worse than that of patients receiving conventional treatment. Intensive therapy significantly increased the risk of severe hypoglycaemia. Patients in the intensively treated group experienced severe hypoglycaemia three times more frequently than conventionally managed patients. Half of all hypoglycaemic episodes occurred during sleep and about one third of daytime hypoglycaemic episodes occurred without warning. It is known from other studiesthat repeated severe hypoglycaemia can lead to slight but measurable impairments in some aspects of memory and cognitive functioning. However, as part of the Trial, patients completed tests of neuropsychological functioning: no patients experienced neuropsychological impairments. What are the lessons for everyday clinical practice? First, a note of caution. The patients who took part in the Trial are probably not typical of patients with Type 1 diabetes. They were self-selected, younger and highly motivated. They received close monitoring by highly skilled research teams. It will be difficult to achieve the same levels of attention and the same levels of glucose control in typical, unselected populations of patients. It is unrealistic to expect otherwise. The researchers themselves pointed out that the frequency of severe hypoglycaemia might be higher when tight control is sought in everyday clinic conditions. This will be a particular risk in certain groups such as youngsters, for whom the risk of brain damage makes repeated severe hypoglycaemia potentially dangerous. Furthermore, although quality of life was no different between the treatment groups, the links between such
{"title":"Psychological aspects of the Diabetes Control and Complications Trial","authors":"R. Shillitoe","doi":"10.1002/j.1528-252X.1994.tb00016.x","DOIUrl":"https://doi.org/10.1002/j.1528-252X.1994.tb00016.x","url":null,"abstract":"I would like to comment upon some of the issues raised by the Diabetes Control and Complications Trial! from a psychological point of view, and to discuss their broad clinical implications. First, and most importantly, the Trial demonstrated that good metabolic control can delay the onset and slow progression of diabetes-related complications. To do this, a complicated regimen was required. This raises the question of how much inconvenience patients are prepared to put up with for the sake of long-term future benefits. In the intensively-treated group, tight control was achieved by selfmonitoring blood glucose at least four times per day, three or more daily injections of insulin via syringe or pump, adjustment of insulin dosage where necessary, attention to the timing, content and frequency of meals together with changes in activity and exercise patterns. You might think that all of this, together with monthly clinic visits and regular telephone contacts would be regarded as unacceptably intrusive by many patients. However, only 1% of patients failed to complete the study; an astonishingly low drop-out figure. Further, patients completed a 46-item questionnaire that was specifically designed to measure the burden of the disease and the treatment regimen. It was found that the quality of life of patients receiving intensive therapy was no worse than that of patients receiving conventional treatment. Intensive therapy significantly increased the risk of severe hypoglycaemia. Patients in the intensively treated group experienced severe hypoglycaemia three times more frequently than conventionally managed patients. Half of all hypoglycaemic episodes occurred during sleep and about one third of daytime hypoglycaemic episodes occurred without warning. It is known from other studiesthat repeated severe hypoglycaemia can lead to slight but measurable impairments in some aspects of memory and cognitive functioning. However, as part of the Trial, patients completed tests of neuropsychological functioning: no patients experienced neuropsychological impairments. What are the lessons for everyday clinical practice? First, a note of caution. The patients who took part in the Trial are probably not typical of patients with Type 1 diabetes. They were self-selected, younger and highly motivated. They received close monitoring by highly skilled research teams. It will be difficult to achieve the same levels of attention and the same levels of glucose control in typical, unselected populations of patients. It is unrealistic to expect otherwise. The researchers themselves pointed out that the frequency of severe hypoglycaemia might be higher when tight control is sought in everyday clinic conditions. This will be a particular risk in certain groups such as youngsters, for whom the risk of brain damage makes repeated severe hypoglycaemia potentially dangerous. Furthermore, although quality of life was no different between the treatment groups, the links between such","PeriodicalId":92116,"journal":{"name":"Practical diabetes international : the journal for diabetes care teams worldwide","volume":"60 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/j.1528-252X.1994.tb00016.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50682770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1002/j.1528-252X.1994.tb00025.x
HR Wyllie, E. McLaren
Fifty‐nine insulin‐dependent diabetics attending the Young Diabetic Clinic at Stobhill Hospital, completed an open questionnaire survey asking how often they felt that they ought to be measuring their blood glucose, and how often they actually measured it. Despite 78% knowing that they ought to perform SMBG four times per day, on one or more days per week, only 17.9% actually did so. No difference in mean glycosylated haemoglobin (HbA1c) over 18 months was found between those who performed SMBG frequently and those who did not. The group's overall control (mean HbA1c 7.15/SD score 4.4) was not different to that achieved by groups using intensive insulin regimens. This suggests that routine frequent SMBG, even when practised, may contribute little to overall diabetes control.
{"title":"Self‐monitoring of blood glucose ‘a walking stick and not a cane‘","authors":"HR Wyllie, E. McLaren","doi":"10.1002/j.1528-252X.1994.tb00025.x","DOIUrl":"https://doi.org/10.1002/j.1528-252X.1994.tb00025.x","url":null,"abstract":"Fifty‐nine insulin‐dependent diabetics attending the Young Diabetic Clinic at Stobhill Hospital, completed an open questionnaire survey asking how often they felt that they ought to be measuring their blood glucose, and how often they actually measured it. Despite 78% knowing that they ought to perform SMBG four times per day, on one or more days per week, only 17.9% actually did so. No difference in mean glycosylated haemoglobin (HbA1c) over 18 months was found between those who performed SMBG frequently and those who did not. The group's overall control (mean HbA1c 7.15/SD score 4.4) was not different to that achieved by groups using intensive insulin regimens. This suggests that routine frequent SMBG, even when practised, may contribute little to overall diabetes control.","PeriodicalId":92116,"journal":{"name":"Practical diabetes international : the journal for diabetes care teams worldwide","volume":"285 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/j.1528-252X.1994.tb00025.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50683206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1002/j.1528-252X.1994.tb00022.x
S. Muzulu, M. Bodington, A. Burden
Data from the Leicestershire diabetes register were used to assess the risk of diabetes multiplex in childhood‐onset diabetes mellitus in the county. Nineteen out of 186 White Caucasian families with a Type I diabetic sibling diagnosed before the age of 15, between 1980 and 1990 inclusive, had diabetes multiplex. The overall empirical risk of Type I diabetes multiplex was 9.1%, with a parent/sibling risk of 5.4% and a sibling/sibling risk of 3.8%. The risk to siblings calculated by proband exclusion and the Li‐Mantel estimation were 2.8% and 5.1% respectively. These resu Its suggest that diabetes multiplex is uncommon and family members should be so counselled. Environment appears to be more important than genetics in the aetiology of Type I diabetes.
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