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Wherrett DK, Ho J, Huot C, Legault L, Nakhla M, Rosolowsky E. Type 1 Diabetes in Children and Adolescents. Can J Diabetes 2018; 42 Suppl 1:S234-S246. [DOI: 10.1016/j.jcjd.2017.10.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Walsh DMJ, Hynes L, O'Hara MC, Mc Sharry J, Dinneen SF, Byrne M. Embedding a user-centred approach in the development of complex behaviour change intervention to improve outcomes for young adults living with type 1 diabetes: The D1 Now Study. HRB Open Res 2018. [PMID: 32002502 DOI: 10.12688/hrbopenres.12803.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Type 1 diabetes (T1D) is an auto-immune condition which requires intensive self-management. Diabetes self-management is challenging, especially during young adulthood. Effective interventions to improve outcomes for young adults with T1D are needed. This paper describes the development of the D1 Now intervention, employing a user-centred approach to engage with stakeholders in parallel with the application of theory. Methods: Intervention development consisted of 4 phases: 1) the formation of a public and patient involvement (PPI) Young Adult Panel (YAP); 2) a systematic review to synthesise evidence regarding the effectiveness of interventions aimed at improving outcomes for young adults with T1D; 3) understand young adults' diabetes self-management behaviour through engagement with key stakeholders; and 4) an expert consensus meeting to discuss self-management strategies identified in Phase 1 and 3 that would form the core components of the D1 Now intervention. Results: The YAP resulted in meaningful involvement between young adults, researchers and service providers. The systematic review highlighted a lack of quality intervention studies. Qualitative findings highlighted how young adult self-management is driven by complex interactions between external resources, which influence capability, and motivation. The expert panel in Phase 4 highlighted focus areas to improve outcomes for young adults and implementation strategies. Subsequent to these 4 phases, 3 intervention components have been identified: 1) a key worker to liaise with the young adult; 2) an online portal to facilitate relationship building between staff and young adults; and 3) an agenda setting tool to facilitate joint decision-making. Conclusions: This study described the systematic development of an intervention underpinned by theoretical frameworks and PPI, and has identified components for the D1 Now intervention. The resulting intervention content will now be subject to an intervention optimisation process.
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Affiliation(s)
- Deirdre M J Walsh
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, H91 EV56, Ireland.,School of Medicine, National University of Ireland, Galway, Galway, H91 V4AY, Ireland
| | - Lisa Hynes
- SPLAT (Pediatric Lab for Adherence and Transition), West Virginia University, Morgantown, WV, 26506, USA
| | - Mary Clare O'Hara
- Research and Development, Strategic Planning and Transformation, Health Service Executive, Dublin 8, D08 W2A8, Ireland
| | - Jenny Mc Sharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, H91 EV56, Ireland
| | | | - Séan F Dinneen
- School of Medicine, National University of Ireland, Galway, Galway, H91 V4AY, Ireland.,Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, H91 YR71, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, H91 EV56, Ireland
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Walsh DMJ, Hynes L, O'Hara MC, Mc Sharry J, Dinneen SF, Byrne M. Embedding a user-centred approach in the development of complex behaviour change intervention to improve outcomes for young adults living with type 1 diabetes: The D1 Now Study. HRB Open Res 2018; 1:8. [PMID: 32002502 PMCID: PMC6973524 DOI: 10.12688/hrbopenres.12803.2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Type 1 diabetes (T1D) is an auto-immune condition which requires intensive self-management. Diabetes self-management is challenging, especially during young adulthood. Effective interventions to improve outcomes for young adults with T1D are needed. This paper describes the development of the D1 Now intervention, employing a user-centred approach to engage with stakeholders in parallel with the application of theory. Methods: Intervention development consisted of 4 phases: 1) the formation of a public and patient involvement (PPI) Young Adult Panel (YAP); 2) a systematic review to synthesise evidence regarding the effectiveness of interventions aimed at improving outcomes for young adults with T1D; 3) understand young adults' diabetes self-management behaviour through engagement with key stakeholders; and 4) an expert consensus meeting to discuss self-management strategies identified in Phase 1 and 3 that would form the core components of the D1 Now intervention. Results: The YAP resulted in meaningful involvement between young adults, researchers and service providers. The systematic review highlighted a lack of quality intervention studies. Qualitative findings highlighted how young adult self-management is driven by complex interactions between external resources, which influence capability, and motivation. The expert panel in Phase 4 highlighted focus areas to improve outcomes for young adults and implementation strategies. Subsequent to these 4 phases, 3 intervention components have been identified: 1) a key worker to liaise with the young adult; 2) an online portal to facilitate relationship building between staff and young adults; and 3) an agenda setting tool to facilitate joint decision-making. Conclusions: This study described the systematic development of an intervention underpinned by theoretical frameworks and PPI, and has identified components for the D1 Now intervention. The resulting intervention content will now be subject to an intervention optimisation process.
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Affiliation(s)
- Deirdre M J Walsh
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, H91 EV56, Ireland.,School of Medicine, National University of Ireland, Galway, Galway, H91 V4AY, Ireland
| | - Lisa Hynes
- SPLAT (Pediatric Lab for Adherence and Transition), West Virginia University, Morgantown, WV, 26506, USA
| | - Mary Clare O'Hara
- Research and Development, Strategic Planning and Transformation, Health Service Executive, Dublin 8, D08 W2A8, Ireland
| | - Jenny Mc Sharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, H91 EV56, Ireland
| | | | - Séan F Dinneen
- School of Medicine, National University of Ireland, Galway, Galway, H91 V4AY, Ireland.,Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, H91 YR71, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, H91 EV56, Ireland
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Chatterjee S, Davies MJ, Heller S, Speight J, Snoek FJ, Khunti K. Diabetes structured self-management education programmes: a narrative review and current innovations. Lancet Diabetes Endocrinol 2018; 6:130-142. [PMID: 28970034 DOI: 10.1016/s2213-8587(17)30239-5] [Citation(s) in RCA: 202] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/13/2017] [Accepted: 06/26/2017] [Indexed: 12/17/2022]
Abstract
Both type 1 and type 2 diabetes are associated with long-term complications that can be prevented or delayed by intensive glycaemic management. People who are empowered and skilled to self-manage their diabetes have improved health outcomes. Over the past 20 years, diabetes self-management education programmes have been shown to be efficacious and cost-effective in promotion and facilitation of self-management, with improvements in patients' knowledge, skills, and motivation leading to improved biomedical, behavioural, and psychosocial outcomes. Diabetes self-management education programmes, developed robustly with an evidence-based structured curriculum, vary in their method of delivery, content, and use of technology, person-centred philosophy, and specific aims. They are delivered by trained educators, and monitored for quality by independent assessors and routine audit. Self-management education should be tailored to specific populations, taking into consideration the type of diabetes, and ethnic, social, cognitive, literacy, and cultural factors. Ways to improve access to and uptake of diabetes self-management programmes are needed globally.
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Affiliation(s)
- Sudesna Chatterjee
- Diabetes Research Centre, University of Leicester, Leicester, UK; Department of Diabetes and Endocrinology, University Hospitals of Leicester, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Simon Heller
- Academic Unit of Diabetes, Endocrinology, and Metabolism, University of Sheffield, Sheffield, UK
| | - Jane Speight
- School of Psychology, Faculty of Health, Deakin University, Geelong, VIC, Australia; Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia; AHP Research, Hornchurch, Essex, UK
| | - Frank J Snoek
- Department of Medical Psychology, Academic Medical Centre and VU University Medical Centre, Amsterdam, Netherlands
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK.
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Byrne M, O’Connell A, Egan AM, Dinneen SF, Hynes L, O’Hara MC, Holt RIG, Willaing I, Vallis M, Hendrieckx C, Coyne I. A core outcomes set for clinical trials of interventions for young adults with type 1 diabetes: an international, multi-perspective Delphi consensus study. Trials 2017; 18:602. [PMID: 29258565 PMCID: PMC5735534 DOI: 10.1186/s13063-017-2364-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 11/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Achieving consensus from a range of relevant stakeholders about an agreed set of core outcomes to be measured and reported as a minimum in clinical trials has the potential to enhance evidence synthesis and make findings more relevant and applicable. Intervention research to improve outcomes for young adults with type 1 diabetes (T1DM) is hampered by inconsistent use of outcome measures. This population frequently struggles to manage their condition and reports suboptimal clinical outcomes. Our aim was to conduct an international, e-Delphi consensus study to identify a core outcome set (COS) that key stakeholders (young adults with T1DM, diabetes health professionals, diabetes researchers and diabetes policy makers) consider as essential outcomes for future intervention research. METHODS Using a list of 87 outcomes generated from a published systematic review, we administered two online surveys to a sample of international key stakeholders. Participants in the first survey (survey 1; n = 132) and the second survey (survey 2; n = 81) rated the importance of the outcomes. Survey 2 participants received information on total mean rating for each outcome and a reminder of their personal outcome ratings from Survey 1. Survey 2 results were discussed at a consensus meeting and participants (n = 12: three young adults with T1DM, four diabetes health professionals, four diabetes researchers and one diabetes policy maker) voted on outcomes. Final core outcomes were included provided that 70% of consensus group participants voted for their inclusion. RESULTS Eight core outcomes were agreed for inclusion in the final COS: measures of diabetes-related stress; diabetes-related quality of life; number of severe hypoglycaemic events; self-management behaviour; number of instances of diabetic ketoacidosis (DKA); objectively measured glycated haemoglobin (HbA1C); level of clinic engagement; and perceived level of control over diabetes. CONCLUSIONS This study is the first to identify a COS for inclusion in future intervention trials to improve outcomes for young adults with T1DM. Use of this COS will improve the quality of future research and increase opportunities for evidence synthesis. Future research is necessary to identify the most robust outcome measure instruments.
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Affiliation(s)
- Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - Anthony O’Connell
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - Aoife M. Egan
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Sean F. Dinneen
- School of Medicine, National University of Ireland, Galway, Ireland
- Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland
| | - Lisa Hynes
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - Mary Clare O’Hara
- School of Medicine, National University of Ireland, Galway, Ireland
- Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland
| | - Richard I. G. Holt
- Human Development and Health Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | - Ingrid Willaing
- Health Promotion Research, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Michael Vallis
- Department of Family Medicine, Dalhousie University, Halifax, NS Canada
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, VIC Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC Australia
| | - Imelda Coyne
- Trinity College Dublin, School of Nursing and Midwifery, Dublin, Ireland
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O’Hara MC, Hynes L, O’Donnell M, Keighron C, Allen G, Caulfield A, Duffy C, Long M, Mallon M, Mullins M, Tonra G, Byrne M, Dinneen SF. Strength in Numbers: an international consensus conference to develop a novel approach to care delivery for young adults with type 1 diabetes, the D1 Now Study. RESEARCH INVOLVEMENT AND ENGAGEMENT 2017; 3:25. [PMID: 29214056 PMCID: PMC5713095 DOI: 10.1186/s40900-017-0076-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 10/27/2017] [Indexed: 06/07/2023]
Abstract
PLAIN ENGLISH SUMMARY Many young adults with type 1 diabetes struggle with the day-to-day management of their condition. They often find it difficult to find the time to attend their clinic appointments and to meet with their diabetes healthcare team. Young adults living with type 1 diabetes are not routinely involved in research that may help improve health services other than being invited to take part in studies as research participants. A 3-day international conference was held in Galway in June 2016 called "Strength In Numbers: Teaming up to improve the health of young adults with type 1 diabetes". It aimed to bring together people from a broad variety of backgrounds with an interest in young adults with type 1 diabetes. Young people with type 1 diabetes came together with healthcare professionals, researchers, software developers and policy makers to come up with and agree on a new approach for engaging young adults with type 1 diabetes with their health services and to improve how they manage their diabetes.The people involved in the conference aimed to reach agreement (consensus) on a fixed set of outcome measures called a core outcome set (COS) that the group would recommend future studies involving young adults with type 1 diabetes to use, to suggest a new approach (intervention) for providing health services to young adults with type 1 diabetes, and to come up with health technology ideas that could help deliver the new intervention. Over the 3 days, this diverse international group of people that included young adults living with type 1 diabetes, agreed on a COS, 3 key parts of a new intervention and 1 possible health technology idea that could help with how the overall intervention could be delivered.Involving young adults living with type 1 diabetes in a 3-day conference along with other key groups is an effective method for coming up with a new approach to improve health services for young adults with type 1 diabetes and better support their self-management. ABSTRACT Background A 3-day international consensus meeting was hosted by the D1 Now study team in Galway on June 22-24, 2016 called "Strength In Numbers: Teaming up to improve the health of young adults with type 1 diabetes". The aim of the meeting was to bring together young adults with type 1 diabetes, healthcare providers, policy makers and researchers to reach a consensus on strategies to improve engagement, self-management and ultimately outcomes for young adults living with type 1 diabetes. Methods This diverse stakeholder group participated in the meeting to reach consensus on (i) a core outcome set (COS) to be used in future intervention studies involving young adults with type 1 diabetes, (ii) new strategies for delivering health services to young adults and (iii) potential digital health solutions that could be incorporated into a future intervention. Results A COS of 8 outcomes and 3 key intervention components that aim to improve engagement between young adults with type 1 diabetes and service providers were identified. A digital health solution that could potentially compliment the intervention components was proposed. Conclusion The outputs from the 3-day consensus conference, that held patient and public involvement at its core, will help the research team further develop and test the D1 Now intervention for young adults with type 1 diabetes in a pilot and feasibility study and ultimately in a definitive trial. The conference represents a good example of knowledge exchange among different stakeholders for health research and service improvement.
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Affiliation(s)
- M. C. O’Hara
- School of Medicine, National University of Ireland, Galway, Galway, Ireland
- Health and Wellbeing Division, Health Service Executive, Merlin Park University Hospital, 2nd Floor, Block A H91 N973, Galway, Ireland
| | - L. Hynes
- SPLAT (Pediatric Lab for Adherence and Transition), West Virginia University, Morgantown, USA
| | - M. O’Donnell
- School of Medicine, National University of Ireland, Galway, Galway, Ireland
| | - C. Keighron
- Member of the D1 Now Young Adult Panel, Galway, Ireland
| | - G. Allen
- Member of the D1 Now Young Adult Panel, Galway, Ireland
| | - A. Caulfield
- Member of the D1 Now Young Adult Panel, Galway, Ireland
| | - C. Duffy
- Member of the D1 Now Young Adult Panel, Galway, Ireland
| | - M. Long
- Member of the D1 Now Young Adult Panel, Galway, Ireland
| | - M. Mallon
- Member of the D1 Now Young Adult Panel, Galway, Ireland
| | - M. Mullins
- Member of the D1 Now Young Adult Panel, Galway, Ireland
| | - G. Tonra
- Member of the D1 Now Young Adult Panel, Galway, Ireland
| | - M. Byrne
- School of Psychology, National University of Ireland, Galway, Galway, Ireland
| | - S. F. Dinneen
- School of Medicine, National University of Ireland, Galway, Galway, Ireland
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
| | - with the D1 Now Type 1 Diabetes Young Adult Study Group
- School of Medicine, National University of Ireland, Galway, Galway, Ireland
- Health and Wellbeing Division, Health Service Executive, Merlin Park University Hospital, 2nd Floor, Block A H91 N973, Galway, Ireland
- SPLAT (Pediatric Lab for Adherence and Transition), West Virginia University, Morgantown, USA
- Member of the D1 Now Young Adult Panel, Galway, Ireland
- School of Psychology, National University of Ireland, Galway, Galway, Ireland
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
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Ridderstråle M. Comparison Between Individually and Group-Based Insulin Pump Initiation by Time-Driven Activity-Based Costing. J Diabetes Sci Technol 2017; 11:759-765. [PMID: 28366085 PMCID: PMC5588822 DOI: 10.1177/1932296816684858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Depending on available resources, competencies, and pedagogic preference, initiation of insulin pump therapy can be performed on either an individual or a group basis. Here we compared the two models with respect to resources used. METHODS Time-driven activity-based costing (TDABC) was used to compare initiating insulin pump treatment in groups (GT) to individual treatment (IT). Activities and cost drivers were identified, timed, or estimated at location. Medical quality and patient satisfaction were assumed to be noninferior and were not measured. RESULTS GT was about 30% less time-consuming and 17% less cost driving per patient and activity compared to IT. As a batch driver (16 patients in one group) GT produced an upward jigsaw-shaped accumulative cost curve compared to the incremental increase incurred by IT. Taking the alternate cost for those not attending into account, and realizing the cost of opportunity gained, suggested that GT was cost neutral already when 5 of 16 patients attended, and that a second group could be initiated at no additional cost as the attendance rate reached 15:1. CONCLUSIONS We found TDABC to be effective in comparing treatment alternatives, improving cost control and decision making. Everything else being equal, if the setup is available, our data suggest that initiating insulin pump treatment in groups is far more cost effective than on an individual basis and that TDABC may be used to find the balance point.
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Affiliation(s)
- Martin Ridderstråle
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Martin Ridderstråle, MD, Department of Clinical Sciences, Lund University, Malmö S-205 02, Sweden.
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O'Hara MC, Hynes L, O'Donnell M, Nery N, Byrne M, Heller SR, Dinneen SF. A systematic review of interventions to improve outcomes for young adults with Type 1 diabetes. Diabet Med 2017; 34:753-769. [PMID: 27761951 PMCID: PMC5484309 DOI: 10.1111/dme.13276] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Many young adults with Type 1 diabetes experience poor outcomes. The aim of this systematic review was to synthesize the evidence regarding the effectiveness of interventions aimed at improving clinical, behavioural or psychosocial outcomes for young adults with Type 1 diabetes. METHODS Electronic databases were searched. Any intervention studies related to education, support, behaviour change or health service organizational change for young adults aged between 15-30 years with Type 1 diabetes were included. A narrative synthesis of all studies was undertaken due to the large degree of heterogeneity between studies. RESULTS Eighteen studies (of a possible 1700) were selected and categorized: Health Services Delivery (n = 4), Group Education and Peer Support (n = 6), Digital Platforms (n = 4) and Diabetes Devices (n = 4). Study designs included one randomized controlled trial, three retrospective studies, seven feasibility/acceptability studies and eight studies with a pre/post design. Continuity, support, education and tailoring of interventions to young adults were the most common themes across studies. HbA1c was the most frequently measured outcome, but only 5 of 12 studies that measured it showed a significant improvement. CONCLUSION Based on the heterogeneity among the studies, the effectiveness of interventions on clinical, behavioural and psychosocial outcomes among young adults is inconclusive. This review has highlighted a lack of high-quality, well-designed interventions, aimed at improving health outcomes for young adults with Type 1 diabetes.
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Affiliation(s)
- M. C. O'Hara
- School of MedicineNUI GalwayGalwayIreland
- Endocrinology and Diabetes CentreGalway University HospitalsGalwayIreland
| | - L. Hynes
- School of PsychologyNUI GalwayGalwayIreland
| | | | - N. Nery
- School of MedicineNUI GalwayGalwayIreland
| | - M. Byrne
- School of PsychologyNUI GalwayGalwayIreland
| | - S. R. Heller
- Department of Human MetabolismAcademic Unit of DiabetesEndocrinology and MetabolismUniversity of SheffieldSheffieldUK
| | - S. F. Dinneen
- School of MedicineNUI GalwayGalwayIreland
- Endocrinology and Diabetes CentreGalway University HospitalsGalwayIreland
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