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Anita NZ, Herrmann N, Ryoo SW, Major-Orfao C, Lin WZ, Kwan F, Noor S, Rabin JS, Marzolini S, Nestor S, Ruthirakuhan MT, MacIntosh BJ, Goubran M, Yang P, Cogo-Moreira H, Rapoport M, Gallagher D, Black SE, Goldstein BI, Lanctôt KL, Oh PI, Taha AY, Swardfager W. Cytochrome P450-soluble epoxide hydrolase oxylipins, depression and cognition in type 2 diabetes. J Diabetes Complications 2024; 38:108826. [PMID: 39059187 DOI: 10.1016/j.jdiacomp.2024.108826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/11/2024] [Accepted: 07/21/2024] [Indexed: 07/28/2024]
Abstract
AIMS This study examined serum cytochrome P450-soluble epoxide hydrolase (CYP450-sEH) oxylipins and depressive symptoms together in relation to cognitive performance in individuals with type 2 diabetes mellitus (T2DM). METHODS Clinically cognitively normal T2DM individuals were recruited (NCT04455867). Depressive symptom severity was assessed using the Beck Depression Inventory-II (BDI-II; total scores ≤13 indicated minimal depressive symptoms and ≥ 14 indicated significant depressive symptoms). Executive function and verbal memory were assessed. Fasting serum oxylipins were quantified by ultra-high-performance liquid chromatography tandem mass-spectrometry. RESULTS The study included 85 participants with minimal depressive symptoms and 27 with significant symptoms (mean age: 63.3 ± 9.8 years, 49 % women). In all participants, higher concentrations of linoleic acid derived sEH (12,13-dihydroxyoctadecamonoenoic acid; DiHOME) and CYP450 (12(13)-epoxyoctadecamonoenoic acid; EpOME) metabolites were associated with poorer executive function (F1,101 = 6.094, p = 0.015 and F1,101 = 5.598, p = 0.020, respectively). Concentrations of multiple sEH substrates interacted with depressive symptoms to predict 1) poorer executive function, including 9(10)-EpOME (F1,100 = 12.137, p < 0.001), 5(6)-epoxyeicosatrienoic acid (5(6)-EpETrE; F1,100 = 6.481, p = 0.012) and 11(12)-EpETrE (F1,100 = 4.409, p = 0.038), and 2) verbal memory, including 9(10)-EpOME (F1,100 = 4.286, p = 0.041), 5(6)-EpETrE (F1,100 = 6.845, p = 0.010), 11(12)-EpETrE (F1,100 = 3.981, p = 0.049) and 14(15)-EpETrE (F1,100 = 5.019, p = 0.027). CONCLUSIONS Associations of CYP450-sEH metabolites and depressive symptoms with cognition highlight the biomarker and therapeutic potential of the CYP450-sEH pathway in T2DM.
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Affiliation(s)
- Natasha Z Anita
- Department of Pharmacology & Toxicology, Temerty Faculty of Medicine - University of Toronto, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Canada
| | - Nathan Herrmann
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Psychiatry - University of Toronto, Canada
| | - Si Won Ryoo
- Department of Pharmacology & Toxicology, Temerty Faculty of Medicine - University of Toronto, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Canada
| | - Chelsi Major-Orfao
- Sunnybrook Research Institute, Toronto, Ontario, Canada; KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Canada
| | - William Z Lin
- Department of Pharmacology & Toxicology, Temerty Faculty of Medicine - University of Toronto, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Canada
| | - Felicia Kwan
- Department of Pharmacology & Toxicology, Temerty Faculty of Medicine - University of Toronto, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Canada
| | - Shiropa Noor
- Department of Pharmacology & Toxicology, Temerty Faculty of Medicine - University of Toronto, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Canada
| | - Jennifer S Rabin
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Canada
| | - Susan Marzolini
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Canada; Department of Exercise Sciences, Faculty of Kinesiology and Physical Education, University of Toronto, Canada
| | - Sean Nestor
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Psychiatry - University of Toronto, Canada
| | - Myuri T Ruthirakuhan
- Department of Pharmacology & Toxicology, Temerty Faculty of Medicine - University of Toronto, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Bradley J MacIntosh
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Medical Biophysics - University of Toronto, Canada
| | - Maged Goubran
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Medical Biophysics - University of Toronto, Canada
| | - Pearl Yang
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Hugo Cogo-Moreira
- Department of Education, Østfold University College, 1757 B R A Veien 4, Halden 1757, Norway
| | - Mark Rapoport
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Psychiatry - University of Toronto, Canada
| | - Damien Gallagher
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Psychiatry - University of Toronto, Canada
| | - Sandra E Black
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Canada
| | - Benjamin I Goldstein
- Department of Pharmacology & Toxicology, Temerty Faculty of Medicine - University of Toronto, Canada; Department of Psychiatry - University of Toronto, Canada; Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Krista L Lanctôt
- Department of Pharmacology & Toxicology, Temerty Faculty of Medicine - University of Toronto, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Canada; Department of Psychiatry - University of Toronto, Canada
| | - Paul I Oh
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Canada
| | - Ameer Y Taha
- Department of Food Science and Technology, College of Agriculture and Environmental Sciences, University of California, Davis, CA, USA; West Coast Metabolomics Center, Genome Center, University of California, Davis, CA, USA; Center for Neuroscience, One Shields Avenue, University of California, Davis, CA, USA
| | - Walter Swardfager
- Department of Pharmacology & Toxicology, Temerty Faculty of Medicine - University of Toronto, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada; KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Canada.
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Li S, Zhang L, Yang B, Huang Y, Guan Y, Huang N, Wu Y, Wang W, Wang Q, Cai H, Sun Y, Xu Z, Wu Q. Development and Validation of a Community-Based Prediction Model for Depression in Elderly Patients with Diabetes: A Cross-Sectional Study. Diabetes Metab Syndr Obes 2024; 17:2627-2638. [PMID: 38974949 PMCID: PMC11225955 DOI: 10.2147/dmso.s465052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/20/2024] [Indexed: 07/09/2024] Open
Abstract
Background In elderly diabetic patients, depression is often overlooked because professional evaluation requires psychiatrists, but such specialists are lacking in the community. Therefore, we aimed to create a simple depression screening model that allows earlier detection of depressive disorders in elderly diabetic patients by community health workers. Methods The prediction model was developed in a primary cohort that consisted of 210 patients with diabetes, and data were gathered from December 2022 to February 2023. The independent validation cohort included 99 consecutive patients from February 2023 to March 2023. Multivariable logistic regression analysis was used to develop the predictive model. We incorporated common demographic characteristics, diabetes-specific factors, family structure characteristics, the self-perceived burden scale (SPBS) score, and the family APGAR (adaptation, partnership, growth, affection, resolution) score. The performance of the nomogram was assessed with respect to its calibration (calibration curve, the Hosmer-Lemeshow test), discrimination (the area under the curve (AUC)), and clinical usefulness (Decision curve analysis (DCA)). Results The prediction nomogram incorporated 5 crucial factors such as glucose monitoring status, exercise status, monthly income, sleep disorder status, and the SPBS score. The model demonstrated strong discrimination in the primary cohort, with an AUC of 0.839 (95% CI, 0.781-0.897). This discriminative ability was further validated in the validation cohort, with an AUC of 0.857 (95% CI, 0.779-0.935). Moreover, the nomogram exhibited satisfactory calibration. DCA suggested that the prediction of depression in elderly patients with diabetes mellitus was of great clinical value. Conclusion The prediction model provides precise and user-friendly guidance for community health workers in preliminary screenings for depression among elderly patients with diabetes.
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Affiliation(s)
- Shanshan Li
- Medical College, Jiangsu Vocational College of Medicine, Yancheng, People’s Republic of China
- Jiangsu Engineering Research Centers for Cardiovascular and Cerebrovascular Disease and Cancer Prevention and Control, Jiangsu Vocational College of Medicine, Yancheng, People’s Republic of China
| | - Le Zhang
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Boyi Yang
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Yi Huang
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Yuqi Guan
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Nanbo Huang
- Medical College, Jiangsu Vocational College of Medicine, Yancheng, People’s Republic of China
| | - Yingnan Wu
- Medical College, Jiangsu Vocational College of Medicine, Yancheng, People’s Republic of China
| | - Wenshuo Wang
- Medical College, Jiangsu Vocational College of Medicine, Yancheng, People’s Republic of China
| | - Qing Wang
- Medical College, Jiangsu Vocational College of Medicine, Yancheng, People’s Republic of China
| | - Haochen Cai
- Medical College, Jiangsu Vocational College of Medicine, Yancheng, People’s Republic of China
| | - Yong Sun
- Medical College, Jiangsu Vocational College of Medicine, Yancheng, People’s Republic of China
| | - Zijun Xu
- Medical College, Jiangsu Vocational College of Medicine, Yancheng, People’s Republic of China
| | - Qin Wu
- Medical College, Jiangsu Vocational College of Medicine, Yancheng, People’s Republic of China
- Jiangsu Engineering Research Centers for Cardiovascular and Cerebrovascular Disease and Cancer Prevention and Control, Jiangsu Vocational College of Medicine, Yancheng, People’s Republic of China
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Kleine N, Kwan ATH, Le GH, Guo Z, Phan L, Subramaniapillai M, McIntyre RS. Impact of Baseline Anxiety on Well-being in People with Post-COVID-19 Condition: A Secondary Analysis. CNS Spectr 2024; 29:150-154. [PMID: 38453677 DOI: 10.1017/s1092852924000099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
BACKGROUND Post-COVID-19 condition (PCC) is associated with a host of psychopathological conditions including prominent anxiety symptoms. However, it is not known what effect anxious symptoms have on measures of well-being in individuals living with PCC. This study aims to evaluate anxiety's association with measures of well-being in people with PCC. METHODS This is a post hoc analysis utilizing data from a placebo-controlled, randomized, double-blind clinical trial assessing the effect of vortioxetine on cognitive impairment in individuals with PCC (NCT05047952). Baseline data with respect to anxiety and well-being were collected using the Generalized Anxiety Disorder Scale, 7-Item (GAD-7), and the World Health Organization (WHO) Well-Being Index, 5-Item (WHO-5), respectively. A generalized linear model (GLM) analysis on baseline GAD-7 and WHO-5 scores was conducted with age, sex, employment status, education level, previous major depressive disorder (MDD) diagnosis, and confirmed COVID-19 cases as covariates. RESULTS Data was analyzed in a sample of 144 participants (N = 144). After controlling for the aforementioned covariates, the results found that GAD-7 and WHO-5 scores had a significant negative correlation (β = -0.053, p = <0.001), signifying that increased anxiety had adverse effects on the overall well-being of individuals with PCC. CONCLUSION Herein, we observed a clinically meaningful level of anxiety in individuals with PCC. We also identified a robust correlation between anxiety in PCC and measures of general well-being. Our results require replication, providing the impetus for recommending screening and targeting anxious symptoms as a tactic to improve general well-being and outcomes in individuals with PCC.
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Affiliation(s)
- Nicholas Kleine
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Angela T H Kwan
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Gia Han Le
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Ziji Guo
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Lee Phan
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | | | - Roger S McIntyre
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Yelverton CA, Killeen SL, Feehily C, Moore RL, Callaghan SL, Geraghty AA, Byrne DF, Walsh CJ, Lawton EM, Murphy EF, Van Sinderen D, Cotter PD, McAuliffe FM. Maternal breastfeeding is associated with offspring microbiome diversity; a secondary analysis of the MicrobeMom randomized control trial. Front Microbiol 2023; 14:1154114. [PMID: 37720155 PMCID: PMC10502216 DOI: 10.3389/fmicb.2023.1154114] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 08/10/2023] [Indexed: 09/19/2023] Open
Abstract
Background Microbial dysbiosis in infancy can influence long-term health outcomes such as childhood obesity. The aim of this study is to explore relationships among maternal well-being during pregnancy, breastfeeding, and the infant gut microbiome. Methods This is a secondary analysis of healthy pregnant women from the MicrobeMom study, a double-blind randomized control trial of maternal probiotic supplementation (Bifidobacterium breve 702258) versus placebo antenatally and up to 3 months postpartum. Maternal well-being was assessed using the WHO-5 well-being index at 16 weeks' and 34 weeks' gestation. Breastfeeding practices were recorded at discharge from hospital and at 1 month postpartum. Infant stool samples were obtained at 1 month of age. Next generation shotgun sequencing determined infant microbial diversity. Independent sample t-tests and Mann-Whitney U tests informed adjusted regression analysis, which was adjusted for delivery mode, antibiotics during delivery, maternal age and body mass index (BMI), and probiotic vs. control study group. Results Women (n = 118) with at least one measure of well-being were on average 33 years (SD 3.93) of age and 25.09 kg/m2 (SD 3.28) BMI. Exclusive breastfeeding was initiated by 65% (n = 74). Any breastfeeding was continued by 69% (n = 81) after 1 month. In early and late pregnancy, 87% (n = 97/111) and 94% (n = 107/114) had high well-being scores. Well-being was not associated with infant microbial diversity at 1 month. In adjusted analysis, exclusive breastfeeding at discharge from hospital was associated with infant microbial beta diversity (PC2; 0.254, 95% CI 0.006, 0.038). At 1 month postpartum, any breastfeeding was associated with infant microbial alpha diversity (Shannon index; -0.241, 95% CI -0.498, -0.060) and observed species; (-0.325, 95% CI -0.307, -0.060), and infant microbial beta diversity (PC2; 0.319, 95% CI 0.013, 0.045). Exclusive breastfeeding at 1 month postpartum was associated with infant alpha diversity (Shannon index -0.364, 95% CI -0.573, -0.194; Simpson index 0.339, 95% CI 0.027, 0.091), and infant's number of observed microbial species (-0.271, 95% CI -0.172, -0.037). Conclusion Breastfeeding practices at 1 month postpartum were associated with lower microbial diversity and observed species in infants at 1 month postpartum, which is potentially beneficial to allow greater abundance of Bifidobacterium. Clinical trial registration ISRCTN53023014.
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Affiliation(s)
- Cara A. Yelverton
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Sarah Louise Killeen
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Conor Feehily
- APC Microbiome Ireland, National University of Ireland, Cork, Ireland
- Teagasc Food Research Centre, Moorepark, Fermoy, Cork, Ireland
| | - Rebecca L. Moore
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Shauna L. Callaghan
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Aisling A. Geraghty
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
- UCD Institute of Food and Health, School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | - David F. Byrne
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
| | - Calum J. Walsh
- APC Microbiome Ireland, National University of Ireland, Cork, Ireland
- Teagasc Food Research Centre, Moorepark, Fermoy, Cork, Ireland
| | - Elaine M. Lawton
- APC Microbiome Ireland, National University of Ireland, Cork, Ireland
- Teagasc Food Research Centre, Moorepark, Fermoy, Cork, Ireland
| | | | - Douwe Van Sinderen
- Teagasc Food Research Centre, Moorepark, Fermoy, Cork, Ireland
- School of Microbiology, University College Cork, Cork, Ireland
| | - Paul D. Cotter
- APC Microbiome Ireland, National University of Ireland, Cork, Ireland
- Teagasc Food Research Centre, Moorepark, Fermoy, Cork, Ireland
| | - Fionnuala M. McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
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Steinhardt J, Lokowandt L, Rasche D, Koch A, Tronnier V, Münte TF, Meyhöfer SM, Wilms B, Brüggemann N. Mechanisms and consequences of weight gain after deep brain stimulation of the subthalamic nucleus in patients with Parkinson's disease. Sci Rep 2023; 13:14202. [PMID: 37648732 PMCID: PMC10468527 DOI: 10.1038/s41598-023-40316-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 08/08/2023] [Indexed: 09/01/2023] Open
Abstract
Body weight gain in combination with metabolic alterations has been observed after deep brain stimulation (DBS) of subthalamic nucleus (STN) in patients with Parkinson's disease (PD), which potentially counteracts the positive effects of motor improvement. We aimed to identify stimulation-dependent effects on motor activities, body weight, body composition, energy metabolism, and metabolic blood parameters and to determine if these alterations are associated with the local impact of DBS on different STN parcellations. We assessed 14 PD patients who underwent STN DBS (PD-DBS) before as well as 6- and 12-months post-surgery. For control purposes, 18 PD patients under best medical treatment (PD-CON) and 25 healthy controls (H-CON) were also enrolled. Wrist actigraphy, body composition, hormones, and energy expenditure measurements were applied. Electrode placement in the STN was localized, and the local impact of STN DBS was estimated. We found that STN DBS improved motor function by ~ 40% (DBS ON, Med ON). Weight and fat mass increased by ~ 3 kg and ~ 3% in PD-DBS (all P ≤ 0.005). fT3 (P = 0.001) and insulin levels (P = 0.048) increased solely in PD-DBS, whereas growth hormone levels (P = 0.001), daily physical activity, and VO2 during walking were decreased in PD-DBS (all P ≤ 0.002). DBS of the limbic part of the STN was associated with changes in weight and body composition, sedentary activity, insulin levels (all P ≤ 0.040; all r ≥ 0.56), and inversely related to HOMA-IR (P = 0.033; r = - 0.62). Daily physical activity is decreased after STN DBS, which can contribute to weight gain and an unfavorable metabolic profile. We recommend actigraphy devices to provide feedback on daily activities to achieve pre-defined activity goals.
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Affiliation(s)
- Julia Steinhardt
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
- Institute of Endocrinology and Diabetes, University of Lübeck, Lübeck, Germany
- Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
| | - Laura Lokowandt
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
- Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
| | - Dirk Rasche
- Department of Neurosurgery, University of Lübeck, Lübeck, Germany
| | - Andreas Koch
- Section Maritime Medicine, Naval Medical Institute, Kiel, Germany
| | - Volker Tronnier
- Department of Neurosurgery, University of Lübeck, Lübeck, Germany
| | - Thomas F Münte
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
- Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
| | - Sebastian M Meyhöfer
- Institute of Endocrinology and Diabetes, University of Lübeck, Lübeck, Germany
- Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Britta Wilms
- Institute of Endocrinology and Diabetes, University of Lübeck, Lübeck, Germany
- Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
- Section Maritime Medicine, Naval Medical Institute, Kiel, Germany
| | - Norbert Brüggemann
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
- Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany.
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Cao F, Yang M, Cheng Y, Zhang X, Shi L, Li N. Correlation analysis of monocyte chemoattractant protein-1 and clinical characteristics and cognitive impairment in type 2 diabetes mellitus comorbid major depressive disorder. Front Aging Neurosci 2023; 15:1081393. [PMID: 37213540 PMCID: PMC10192629 DOI: 10.3389/fnagi.2023.1081393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 04/06/2023] [Indexed: 05/23/2023] Open
Abstract
Introduction Type 2 diabetes mellitus (T2DM) and major depressive disorder (MDD) are both chronic diseases, and they are often co-morbid. Usually, T2DM and MDD are associated with cognitive impairment, and the comorbidity status of both may increase the risk of cognitive impairment, but the underlying pathogenesis is not clear. Studies have shown that inflammation, especially monocyte chemoattractant protein-1 (MCP-1), could be associated with the pathogenesis of type 2 diabetes mellitus comorbid major depressive disorder. Aims To investigate the correlations of MCP-1 with clinical characteristics and cognitive impairment in type 2 diabetes mellitus patients combined with major depressive disorder. Methods A total of 84 participants were recruited in this study, including 24 healthy controls (HC), 21 T2DM patients, 23 MDD patients, and 16 T2DM combined with MDD (TD) patients, to measure the serum MCP-1 levels using Enzyme-linked Immunosorbent Assay (ELISA). And the cognitive function, depression, and anxiety degree were assessed using Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), 17-item Hamilton Depression Scale (HAMD-17), and Hamilton Anxiety Scale (HAMA), respectively. Results (1) Serum MCP-1 expression levels in the TD group were higher than HC, T2DM, and MDD groups, respectively (p < 0.05). And compared with HC and MDD groups, serum MCP-1 levels in the T2DM group were higher (p < 0.05) statistically. Receiver Operating Characteristic (ROC) curve showed that MCP-1 could diagnose T2DM at cut-off values of 503.8 pg./mL (sensitivity 80.95%, specificity 79.17%, AUC = 0.7956) and of 718.1 pg./mL for TD (sensitivity 81.25%, specificity 91.67%, AUC = 0.9271). (2) Group differences in cognitive function were significant. Compared with the HC group, total RBANS scores, attention scores, and language scores in the TD group were lower, respectively (p < 0.05), and total RBANS scores, attention scores, and visuospatial/constructional scores in the MDD group were lower, respectively (p < 0.05). Compared with the T2DM group, immediate memory scores in HC, MDD, and TD groups were lower, respectively, and total RBANS scores in TD were lower (p < 0.05). (3) Correlation analysis showed that hip circumference was negatively correlated with MCP-1 levels in the T2DM group (R = -0.483, p = 0.027), but the correlation disappeared after adjusting age and gender (r = -0.372; p = 0.117), and there were no significant correlations between MCP-1 and other variables. Conclusion MCP-1 may be involved in the pathophysiology of type 2 diabetes mellitus patients combined with major depressive disorder. And MCP-1 may be significant for the early evaluation and diagnosis of TD in the future.
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Affiliation(s)
- Fang Cao
- The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- The Third People’s Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Mei Yang
- The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yuqi Cheng
- The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xiuyue Zhang
- Department of Endocrine, The First Affiliated Hospital of Kunming Medical University, Yunnan, China
| | - Li Shi
- The First People’s Hospital of Yuxi, Yuxi, Yunnan, China
| | - Na Li
- The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- *Correspondence: Na Li,
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Büssing A, Recchia DR, Baumann K. Experience of nature and times of silence as a resource to cope with the COVID-19 pandemic and their effects on psychological wellbeing-Findings from a continuous cross-sectional survey in Germany. Front Public Health 2022; 10:1020053. [PMID: 36420008 PMCID: PMC9678082 DOI: 10.3389/fpubh.2022.1020053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/28/2022] [Indexed: 11/09/2022] Open
Abstract
Background The COVID-19 pandemic with its lockdowns affected social relations and mental health conditions of people worldwide. We aimed to analyze the relevance of nature and times of silence as resources to cope with the pandemic. Of interest were how experiences of nature and times of silence are related to the perception of wondering awe and gratitude and psychological wellbeing and how these have changed during the different phases of the pandemic. Finally, we asked whether Nature/Silence would mediate the link between Awe/Gratitude and wellbeing. Methods A cross-sectional survey with standardized questionnaires (i.e., PCQ, GrAw-7, BMLSS-10, WHO-5) enrolling participants during the different phases of the COVID-19 pandemic was conducted. The total sample of 5,155 participants from Germany consisted of 65% women and 34% men, with a mean age of 45.0 ± 14.0 years. Results Directly after the first lockdown, Nature/Silence and Awe/Gratitude scores were high and decreased along with wellbeing with the onset of the second lockdown in winter 2020, while perceived burden constantly increased. Nature/Silence was rated lowest by people with reduced wellbeing (eta2 = 0.058) and feeling lonely or socially isolated (eta2 = 0.042). Predictor analyses revealed that wellbeing as a dependent variable was predicted best by corona-related perception of burden, Awe/Gratitude, reflection of life, and Nature/Silence and further by perceived changes in terms of relationships and spirituality (R2 = 0.55). In mediation analyses, Awe/Gratitude proved to be a significant predictor for Nature/Silence (β = 0.55, p< 0.0001) and wellbeing (β = 0.05, p < 0.0001). The mediation analysis explained 37% of the variability in the data. The direct influence of Awe/Gratitude on wellbeing was estimated as β = 0.09 (p < 0.0001), and the mediation effect of Nature/Silence on the link between Awe/Gratitude and wellbeing was significant, too (β = 0.03, p < 0.0001), explaining 25% of the total effect. Conclusion Nature/Silence and Awe/Gratitude were used as relevant resources during the pandemic, although they cannot fully buffer the negative effects of the social restrictions that resulted in decreases in wellbeing and increases in perceived burden. Perception of nature as a sensitizer of positive experiences particularly during difficult phases of life could be trained to stabilize wellbeing and thus to contribute to public health.
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Affiliation(s)
- Arndt Büssing
- Professorship Quality of Life, Spirituality and Coping, Faculty of Health, Witten/Herdecke University, Herdecke, Germany
- IUNCTUS - Competence Center for Christian Spirituality, Philosophical-Theological Academy, Münster, Germany
| | - Daniela Rodrigues Recchia
- Department of Research Methods and Statistics in Psychology, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Klaus Baumann
- Caritas Science and Christian Social Work, Faculty of Theology, Albert-Ludwig-University, Freiburg, Germany
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Almeida LC, Grilo A, Carolino E, Tomás MT. Relationship between physical activity levels of Portuguese physical therapists and mental health during a COVID-19 pandemic: Being active is the key. Front Public Health 2022; 10:986158. [PMID: 36388292 PMCID: PMC9665837 DOI: 10.3389/fpubh.2022.986158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/03/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction Physical activity is essential for a healthy life and quality of life, representing a fundamental role in individuals' physical and mental health. Concomitantly, the physical therapist, through the promotion of physical activity and exercise, can improve mental health, an essential factor in the current pandemic, triggering anxiety, fear, and depression crisis. Objective To verify physical activity among Portuguese physical therapists and its association with mental health during pandemic times. Methods An online questionnaire was applied through social media to all Portuguese physical therapists between October 21, 2021, and January 14, 2022. It contained general characterization questions of the sample, the IPAQ-SF questionnaire to assess physical activity levels, the Goldberg General Health Questionnaire (GHQ-28), which assesses the levels of mental health and the WHO Well-Being Index (WHO-5) to assess the subjective wellbeing. Results The sample totaled 286 respondents (82% female), with a mean age of 33. Of the total answers, 82% practiced physical activity, 45% had moderate levels of physical activity, and 19% vigorous. Physical therapists in these categories had lower values in the GHQ-28 and higher in the WHO-5. Those with better mental health also showed better subjective wellbeing (r = -0.571, p = 0.000). Conclusion The data obtained showed that physical therapists mostly have moderate and vigorous levels of physical activity and that physical activity positively influences individuals' mental health and wellbeing, which proved to be a key factor due to the pandemic situation.
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Affiliation(s)
- Laura Cristina Almeida
- Unidade de Cuidados Continuados Integrados de Portel—Unidade de Média Duração e Reabilitação e Unidade de Longa Duração e Manutenção, Santa Casa da Misericórdia de Portel, Portel, Portugal,ESTeSL – Escola Superior de Tecnologia da Saude de Lisboa, Instituto Politécnico de Lisboa, Lisboa, Portugal,*Correspondence: Laura Cristina Almeida
| | - Ana Grilo
- H&TRC – Health and Technology Research Center, ESTeSL – Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisboa, Portugal,CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal
| | - Elisabete Carolino
- H&TRC – Health and Technology Research Center, ESTeSL – Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisboa, Portugal
| | - Maria Teresa Tomás
- H&TRC – Health and Technology Research Center, ESTeSL – Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisboa, Portugal
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Blonde L, Umpierrez GE, Reddy SS, McGill JB, Berga SL, Bush M, Chandrasekaran S, DeFronzo RA, Einhorn D, Galindo RJ, Gardner TW, Garg R, Garvey WT, Hirsch IB, Hurley DL, Izuora K, Kosiborod M, Olson D, Patel SB, Pop-Busui R, Sadhu AR, Samson SL, Stec C, Tamborlane WV, Tuttle KR, Twining C, Vella A, Vellanki P, Weber SL. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. Endocr Pract 2022; 28:923-1049. [PMID: 35963508 PMCID: PMC10200071 DOI: 10.1016/j.eprac.2022.08.002] [Citation(s) in RCA: 152] [Impact Index Per Article: 76.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective of this clinical practice guideline is to provide updated and new evidence-based recommendations for the comprehensive care of persons with diabetes mellitus to clinicians, diabetes-care teams, other health care professionals and stakeholders, and individuals with diabetes and their caregivers. METHODS The American Association of Clinical Endocrinology selected a task force of medical experts and staff who updated and assessed clinical questions and recommendations from the prior 2015 version of this guideline and conducted literature searches for relevant scientific papers published from January 1, 2015, through May 15, 2022. Selected studies from results of literature searches composed the evidence base to update 2015 recommendations as well as to develop new recommendations based on review of clinical evidence, current practice, expertise, and consensus, according to established American Association of Clinical Endocrinology protocol for guideline development. RESULTS This guideline includes 170 updated and new evidence-based clinical practice recommendations for the comprehensive care of persons with diabetes. Recommendations are divided into four sections: (1) screening, diagnosis, glycemic targets, and glycemic monitoring; (2) comorbidities and complications, including obesity and management with lifestyle, nutrition, and bariatric surgery, hypertension, dyslipidemia, retinopathy, neuropathy, diabetic kidney disease, and cardiovascular disease; (3) management of prediabetes, type 2 diabetes with antihyperglycemic pharmacotherapy and glycemic targets, type 1 diabetes with insulin therapy, hypoglycemia, hospitalized persons, and women with diabetes in pregnancy; (4) education and new topics regarding diabetes and infertility, nutritional supplements, secondary diabetes, social determinants of health, and virtual care, as well as updated recommendations on cancer risk, nonpharmacologic components of pediatric care plans, depression, education and team approach, occupational risk, role of sleep medicine, and vaccinations in persons with diabetes. CONCLUSIONS This updated clinical practice guideline provides evidence-based recommendations to assist with person-centered, team-based clinical decision-making to improve the care of persons with diabetes mellitus.
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Affiliation(s)
| | | | - S Sethu Reddy
- Central Michigan University, Mount Pleasant, Michigan
| | | | | | | | | | | | - Daniel Einhorn
- Scripps Whittier Diabetes Institute, La Jolla, California
| | | | | | - Rajesh Garg
- Lundquist Institute/Harbor-UCLA Medical Center, Torrance, California
| | | | | | | | | | | | - Darin Olson
- Colorado Mountain Medical, LLC, Avon, Colorado
| | | | | | - Archana R Sadhu
- Houston Methodist; Weill Cornell Medicine; Texas A&M College of Medicine; Houston, Texas
| | | | - Carla Stec
- American Association of Clinical Endocrinology, Jacksonville, Florida
| | | | - Katherine R Tuttle
- University of Washington and Providence Health Care, Seattle and Spokane, Washington
| | | | | | | | - Sandra L Weber
- University of South Carolina School of Medicine-Greenville, Prisma Health System, Greenville, South Carolina
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AlKandari S, Salman A, Al-Ghadban F, Ahmad R. A Cross-Sectional Study to Examine the Psychological Impact of the COVID-19 Pandemic on Healthcare Workers in Kuwait. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10464. [PMID: 36078180 PMCID: PMC9518443 DOI: 10.3390/ijerph191710464] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
In this study, we aimed to evaluate the psychological impact of the COVID-19 pandemic on healthcare workers to determine the prevalence of symptoms of depression, anxiety, and well-being, and to identify the factors associated with adverse psychological effects. This study was conducted 5 months into the COVID-19 pandemic. We used an online questionnaire to collect data from 378 healthcare workers. To examine the psychological impact, three standardized questionnaires were utilized. This includes the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder Scale (GAD-7), and the WHO Well-Being Scale (WHO-5) to measure depression, anxiety, and quality of life, respectively. More than half of the participants (52.9%) exhibited moderate or high levels of depression, and 40.5% reported moderate or high levels of anxiety. Unmarried HCWs reported more severe levels of depression; moderately severe depression (24.0% vs. 16.1%) and severe depression (12.4% vs. 6.8%). Unmarried HCWs also reported more severity of anxiety as well as lower overall wellbeing. Understanding how personal factors such as marital status can influence the degree of psychological distress can allow us to make better investments in supporting the mental health needs of HCWs in Kuwait. Governments and organizations must establish protective measures, such as continually assessing the mental health status of HCWs throughout the pandemic and providing support services for HCWs in need to minimize adverse consequences and ensure optimal health system operation.
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Affiliation(s)
- Sarah AlKandari
- Immunology and Microbiology Department, Dasman Diabetes Institute, Dasman 15462, Kuwait
| | | | - Fatima Al-Ghadban
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR 97331, USA
- Department of Public Health Practice, Faculty of Public Health, Kuwait University, Safat 13110, Kuwait
| | - Rasheed Ahmad
- Immunology and Microbiology Department, Dasman Diabetes Institute, Dasman 15462, Kuwait
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Grosser F, Herrmann S, Bretschneider M, Timpel P, Schildt J, Bentrup M, Schwarz PEH. Design of the DAVOS Study: Diabetes Smartphone App, a Fully Automatic Transmission of Data From the Blood Glucose Meter and Insulin Pens Using Wireless Technology to Enhance Diabetes Self-Management-A Study Protocol for a Randomized Controlled Trial. J Diabetes Sci Technol 2022; 17:742-750. [PMID: 35393874 DOI: 10.1177/19322968221075333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In the treatment of diabetes mellitus, the challenge is to integrate adequate self-management into clinical care. Customization including goal setting, monitoring, and feedback could be achieved through digitization. Digital linking between different devices could simplify and promote self-management. The aim of this study is to evaluate the outcome of diabetes treatment assisted by a digital health application compared with standard diabetes therapy. METHODS The DAVOS study is a 6-month-period prospective, multicentric, randomized controlled trial. In total, 154 diabetes patients (age ≥18; treated with insulin) will be recruited and randomized into control group or intervention group. Both groups will receive standard diabetes care. The intervention group will additionally use a diabetes app. HbA1c value will be monitored on three separate defined visits. Primary endpoint is the overall reduction of HbA1c value. Secondary endpoints (eg, usability of the app) will be determined through patient-reported outcome questionnaires. DISCUSSION Through enhanced interaction of health care professionals, providers of the app, and patients, the study aims to demonstrate improvement in the self-management of diabetes. As part of the closure management, all patients will be invited to use the examined application after completion of the study. The DAVOS study will be conducted in accordance with the valid version of the present study protocol and the internationally recognized International Conference on Harmonization-Good Clinical Practice (ICH-GCP) Guidelines. Special attention will be paid to European, national, and regional requirements for the approval, provision, and use of medical devices. The study was registered in the German Register of Clinical Trials (DRKS) with number DRKS00025996.
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Affiliation(s)
- Franziska Grosser
- Department of Prevention and Care of Diabetes, Department of Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Sandra Herrmann
- Department of Prevention and Care of Diabetes, Department of Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Maxi Bretschneider
- Department of Prevention and Care of Diabetes, Department of Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Patrick Timpel
- Department of Prevention and Care of Diabetes, Department of Medicine III, Technische Universität Dresden, Dresden, Germany
| | - Janko Schildt
- Emperra GmbH E-Health Technologies, Potsdam, Germany
| | | | - Peter E H Schwarz
- Department of Prevention and Care of Diabetes, Department of Medicine III, Technische Universität Dresden, Dresden, Germany
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Toschi E, Leblanc J, Hafida S, Mehta S, Ritholz M, Gabbay R, Laffel L. Caring for Young Adults With Diabetes in the Adult Care Setting: Summary of a Multidisciplinary Roundtable. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:830183. [PMID: 36992759 PMCID: PMC10012109 DOI: 10.3389/fcdhc.2022.830183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/31/2022] [Indexed: 01/09/2023]
Abstract
AimsA multidisciplinary team of clinicians and researchers, patients and family members, and representative from national advocacy groups and research organization met to review the literature, highlight gaps, and identify best practices to improve adult care delivery for young adults (YA) with diabetes.MethodsThe participants prepared presentations in advance, rotated through sessions, and contributed to group discussions in three areas: physical health, mental health, and quality of life (QoL). Session moderators and scribes used thematic analysis to summarize discussions for each topic.ResultsThematic analysis revealed four foci for addressing physical health, mental health and QoL: 1) best practices to facilitate the process of transfer; 2) age-specific curricula and guidelines for prevention and management of comorbidities and complications; 3) collaboration with behavioral health clinicians to address diabetes distress and mental health disorders; and 4) research on the impact of diabetes on QoL in YA.ConclusionThere was substantial interest and need among adult clinicians to work in concert with pediatric and mental health professionals to identify best practices and future directions to improve healthcare process and diabetes-related outcome measures in YA with diabetes.
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Affiliation(s)
- Elena Toschi
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
- Section on Clinical, Behavioral, and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
- *Correspondence: Elena Toschi,
| | - Jennifer Leblanc
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
| | - Samar Hafida
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
| | - Sanjeev Mehta
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
| | - Marilyn Ritholz
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
| | - Robert Gabbay
- American Diabetes Association, Alexandria, VA, United States
| | - Lori Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
- Section on Clinical, Behavioral, and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
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Papamichou D, Panagiotakos DB, Holmes E, Koutsakis P, Katsoulotos H, Loo RL, Itsiopoulos C. The rationale and design of a Mediterranean diet accompanied by time restricted feeding to optimise the management of type 2 diabetes: The MedDietFast randomised controlled trial. Nutr Metab Cardiovasc Dis 2022; 32:220-230. [PMID: 34836715 DOI: 10.1016/j.numecd.2021.09.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/07/2021] [Accepted: 09/24/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIMS Substantial scientific evidence supports the effectiveness of a Mediterranean diet (MedDiet) in managing type 2 diabetes mellitus (T2DM). Potential benefits of time restricted feeding (TRF) in T2DM are unknown. The MedDietFast trial aims to investigate the efficacy of a MedDiet with or without TRF compared to standard care diet in managing T2DM. METHODS AND RESULTS 120 adults aged 20-75 with a body mass index (BMI) of 20-35 kg/m2 and T2DM will be randomised in a 3-arm parallel design to follow an ad libitum MedDiet with or without 12-h TRF or the standard Australian Dietary Guidelines (ADG) for 24 weeks. All groups will receive dietary counselling fortnightly for 12 weeks and monthly thereafter. The primary outcome is changes in HbA1c from baseline to 12 and 24 weeks. Secondary outcomes include fasting blood glucose, insulin, blood lipids, weight loss, insulin resistance index (HOMA), Glucagon-like peptide 1 (GLP-1) and high-sensitivity C- reactive protein (hs-CRP). Data on medical history, anthropometry, wellbeing, MedDiet adherence and satiety will be measured at a private clinic via self-report questionnaires at baseline, 6, 12 and 24 weeks. Additionally, specimens (blood, urine and stool) will be collected at all time points for future omics analysis. CONCLUSION The MedDietFast trial will examine the feasibility and effectiveness of a MedDiet with/without TRF in T2DM patients. Potential synergistic effects of a MedDiet with TRF will be evaluated. Future studies will generate microbiomic and metabolomic data for translation of findings into simple and effective management plans for T2DM patients. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Register, ACTRN12619000246189.
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Affiliation(s)
- Dimitra Papamichou
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC 3083, Australia
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; Faculty of Health, University of Canberra, Australia
| | - Elaine Holmes
- Australian National Phenome Centre, Health Futures Institute, Murdoch University, Harry Perkins Building, Perth, WA 6150, Australia; Centre for Computational Systems Medicine, Health Futures Institute, Murdoch University, Harry Perkins Building, Perth, WA6150, Australia
| | - Polychronis Koutsakis
- Discipline of Information Technology, Media and Communications, Murdoch University, NSW, 2217, Australia
| | | | - Ruey L Loo
- Australian National Phenome Centre, Health Futures Institute, Murdoch University, Harry Perkins Building, Perth, WA 6150, Australia; Centre for Computational Systems Medicine, Health Futures Institute, Murdoch University, Harry Perkins Building, Perth, WA6150, Australia
| | - Catherine Itsiopoulos
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC 3083, Australia.
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Development and Validation of the Depression Inventory for Type 1 Diabetes (DID-1). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312529. [PMID: 34886259 PMCID: PMC8657055 DOI: 10.3390/ijerph182312529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/19/2021] [Accepted: 11/20/2021] [Indexed: 11/17/2022]
Abstract
People with type 1 diabetes (T1D) are more likely to have depression than the general population and their prognosis is worse. Unfortunately, the characteristics of persons with T1D lead to inadequate screening for depression in this population. To aid in the detection of depression in this population, this study was undertaken to develop a depressive symptoms assessment instrument specific to patients with T1D and to examine its psychometric properties. A total of 207 people with T1D participated in this study. The reliability of the new scale was assessed using Cronbach’s alpha and the Spearman-Brown split-half coefficient. The Depression Inventory for type 1 Diabetes (DID-1), composed of 45 items on a Likert scale (1–7), shows high internal and temporal consistency, as well as adequate concurrent, convergent and discriminant validity. Factor analysis identified 7 factors (Symptoms of depression, Diminished interest, Hopelessness and dissatisfaction, Guilt, Fear, frustration and irritability, Defenselessness, and Interference in daily life) that explained 61.612% of the total variability. The cut-off score for diagnosis was set at 155 points. It was concluded that the DID-1 scale is a reliable, valid and useful tool for the assessment of depressive symptoms, eliminating the bias of other nonspecific diabetes scales.
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Deters MA, Obarcanin E, Schwender H, Läer S. EMDIA Case Series-Effective Medication Therapy Management (MTM) for Diabetes Type 2 Patients-A Proof of Concept Study. PHARMACY 2021; 9:pharmacy9030137. [PMID: 34449695 PMCID: PMC8396324 DOI: 10.3390/pharmacy9030137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 12/01/2022] Open
Abstract
Background: A 2016 meta-analysis of pharmaceutical care for patients with diabetes mellitus showed that the following four components were most effective: (a) individual goal setting, (b) sending feedback to the physician, (c) reviewing the medication, and (d) reviewing blood glucose measurements. Methods: To formulate a hypothesis regarding the effect of these four pharmaceutical care components on glycemic control in patients with diabetes mellitus and the feasibility of these components in practice. Ten patients with type 2 diabetes were included in the case series and received medication therapy management over four months. Results: The four care components were feasible in everyday practice and could be implemented within one patient visit. The average visits were 49 and 28 min at the beginning and end of the study, respectively. The glycated hemoglobin values did not change over the study period, though the fasting blood glucose decreased from 142 to 120 mg/dl, and the number of unsolved drug-related problems decreased from 6.9 to 1.9 per patient by the study end. Conclusions: This case series supports the hypothesis that community pharmacists can implement structured pharmaceutical care in everyday pharmacy practice for patients with type 2 diabetes mellitus.
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Affiliation(s)
- Maira Anna Deters
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University, 40225 Duesseldorf, Germany; (E.O.); (S.L.)
- Correspondence: ; Tel.: +49-211-81-10740
| | - Emina Obarcanin
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University, 40225 Duesseldorf, Germany; (E.O.); (S.L.)
| | - Holger Schwender
- Mathematical Institute, Heinrich Heine University, 40225 Duesseldorf, Germany;
| | - Stephanie Läer
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University, 40225 Duesseldorf, Germany; (E.O.); (S.L.)
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Hernar I, Graue M, Richards DA, Strandberg RB, Nilsen RM, Rekdal M, Løvaas KF, Madsen TV, Tell GS, Haugstvedt A. Use of patient-reported outcome measures (PROMs) in clinical diabetes consultations: the DiaPROM randomised controlled pilot trial. BMJ Open 2021; 11:e042353. [PMID: 33853796 PMCID: PMC8054082 DOI: 10.1136/bmjopen-2020-042353] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 12/17/2020] [Accepted: 03/31/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To pilot test the proposed DiaPROM trial components and address uncertainties associated with conducting a full-scale randomised controlled trial (RCT) to evaluate whether such a trial is feasible. DESIGN Two-arm pilot RCT. PARTICIPANTS Adults aged ≥18-39 years, with minimum 1 year type 1 diabetes duration, attending outpatient follow-up. Exclusion criteria were pregnancy, severe cognitive, somatic or psychiatric conditions and impaired vision. RANDOMISATION AND INTERVENTION All participants completed electronic Patient-Reported Outcome Measures (PROMs) prior to the annual diabetes consultation. Using computer-generated block-randomisation without blinding, we assigned participants in a 1:1 ratio stratified by sex to receive standard care or an intervention. Physicians reviewed diabetes distress scores (Problem Areas In Diabetes scale) and referred individuals with scores ≥30 or single item(s) ≥3 to minimum two diabetes nurse consultations where reported problems were reviewed and discussed. OUTCOMES Recruitment and retention rates; participants perceptions about intervention components. Variance and estimated between-group differences in follow-up scores (Diabetes Distress Scale (DDS), WHO 5-Well-being Index, Perceived Competence for Diabetes Scale and glycaemic control) and DDS correlation with baseline scores, to assist sample size calculations. RESULTS We randomised 80 participants to the control or intervention arm (one participant was later excluded). 23/39 intervention arm participants qualified for additional consultations and 17 attended. 67/79 attended the 12-month follow-up (15.2% attrition); 5/17 referred to additional consultations were lost to follow-up (29.4% attrition). Participants reported PROMs as relevant (84.6%) and acceptable (97.4%) but rated the usefulness of consultations as moderate to low. Baseline mean±SD DDS score was 2.1±0.69; DDS SD was 0.71 (95% CI: 0.60 to 0.86) at follow-up; correlation between baseline and follow-up DDS scores was 0.8 (95% CI: 0.7 to 0.9). CONCLUSIONS The pilot trial revealed need for intervention modifications ahead of a full-scale trial to evaluate use of PROMs in diabetes consultations. Specifically, participant acceptability and intervention implementation need further investigation.
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Affiliation(s)
- Ingvild Hernar
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - David A Richards
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Institute for Health Research, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Ragnhild B Strandberg
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Roy Miodini Nilsen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway
| | | | - Karianne Fjeld Løvaas
- Norwegian Diabetes Register for Adults, Norwegian Organisation for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Tone V Madsen
- Norwegian Diabetes Register for Adults, Norwegian Organisation for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Anne Haugstvedt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Serum soluble epoxide hydrolase related oxylipins and major depression in patients with type 2 diabetes. Psychoneuroendocrinology 2021; 126:105149. [PMID: 33503568 DOI: 10.1016/j.psyneuen.2021.105149] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND People with type 2 diabetes mellitus (T2DM) are at increased risk for depression. Both conditions are associated with disturbances in polyunsaturated fatty acids. Omega-3 and omega-6 fatty acids can be converted into bioactive epoxides by cytochrome P450s (CYP450), which play pro-resolving roles in the inflammatory response; however, soluble epoxide hydrolase (sEH) metabolizes epoxides into diols, which lack pro-resolving functions and can be cytotoxic. Here, we survey serum CYP450- and sEH-derived metabolite concentrations in people with T2DM with and without a major depressive episode. METHODS Sunnybrook Type 2 Diabetes Study (NCT04455867) participants experiencing a major depressive episode (research version of the Structured Clinical Interview for DSM-5 criteria) were matched 1:1 for gender, glycosylated hemoglobin A1c and body mass index to participants without a current depressive episode. Depression severity was assessed using the Beck Depression Inventory 2nd Edition (BDI-II). From fasting morning blood, unesterified serum oxylipins were quantified by ultra-high-performance liquid chromatography tandem mass spectrometry following solid phase extraction, and interleukin-6 (IL-6) by enzyme-linked immunosorbent assay. RESULTS Between 20 depressed and 20 non-depressed participants (mean age 58.9 ± 8.5 years, 65% women) with T2DM, several sEH-derived fatty acid diols, but not IL-6, were higher among those with a depressive episode (effect sizes up to d = 0.796 for 17,18-DiHETE, a metabolite of eicosapentaenoic acid [EPA]; t = 2.516, p = 0.016). Among people with a depressive episode, two epoxides were correlated with lower BDI-II scores: 12(13)-EpOME (ρ = -0.541, p = 0.014) and 10(11)-EpDPE (ρ = -0.444, p = 0.049), metabolites of linoleic acid and docosahexaenoic acid (DHA), respectively, while the ratio of 12,13-DiHOME/12(13)-EpOME was correlated with higher BDI-II scores (ρ = 0.513, p = 0.021). CONCLUSIONS In people with T2DM, major depressive episodes and depressive symptom severity were associated with an oxylipin profile consistent with elimination of pro-resolving lipid mediators by sEH.
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Subba R, Sandhir R, Singh SP, Mallick BN, Mondal AC. Pathophysiology linking depression and type 2 diabetes: Psychotherapy, physical exercise, and fecal microbiome transplantation as damage control. Eur J Neurosci 2021; 53:2870-2900. [PMID: 33529409 DOI: 10.1111/ejn.15136] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/10/2021] [Accepted: 01/28/2021] [Indexed: 02/06/2023]
Abstract
Diabetes increases the likelihood of developing depression and vice versa. Research on this bidirectional association has somewhat managed to delineate the interplay among implicated physiological processes. Still, further exploration is required in this context. This review addresses the comorbidity by investigating suspected common pathophysiological mechanisms. One such factor is psychological stress which disturbs the hypothalamic-pituitary-adrenal axis causing hormonal imbalance. This includes elevated cortisol levels, a common biomarker of both depression and diabetes. Disrupted insulin signaling drives the hampered neurotransmission of serotonin, dopamine, and norepinephrine. Also, adipokine hormones such as adiponectin, leptin, and resistin and the orexigenic hormone, ghrelin, are involved in both depression and T2DM. This disarray further interferes with physiological processes encompassing sleep, the gut-brain axis, metabolism, and mood stability. Behavioral coping mechanisms, such as unhealthy eating, mediate disturbed glucose homeostasis, and neuroinflammation. This is intricately linked to oxidative stress, redox imbalance, and mitochondrial dysfunction. However, interventions such as psychotherapy, physical exercise, fecal microbiota transplantation, and insulin-sensitizing agents can help to manage the distressing condition. The possibility of glucagon-like peptide 1 possessing a therapeutic role has also been discussed. Nonetheless, there stands an urgent need for unraveling new correlating targets and biological markers for efficient treatment.
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Affiliation(s)
- Rhea Subba
- School of Life Sciences, Jawaharlal Nehru University, New Delhi, India
| | - Rajat Sandhir
- Dept. of Biochemistry, Panjab University, Chandigarh, Punjab, India
| | - Surya Pratap Singh
- Dept. of Biochemistry, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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19
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Lara-Cabrera ML, Mundal IP, De Las Cuevas C. Patient-reported well-being: psychometric properties of the world health organization well-being index in specialised community mental health settings. Psychiatry Res 2020; 291:113268. [PMID: 32629296 DOI: 10.1016/j.psychres.2020.113268] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 12/13/2022]
Abstract
The Five-item World Health Organization Well-being Index (WHO-5) is an increasingly used measure of generic well-being, but there is no evidence to support whether outpatients consider the questionnaire valuable. As the WHO-5 has not yet been psychometrically evaluated in specialised community mental health settings, an evaluation of its validity seems warranted. The aim of this cross-sectional study was to examine the psychometric properties of the WHO-5 in this type of setting. Data was collected from an outpatient center (N = 191 adults). Results indicate that the questionnaire was feasible to administer (n = 57 patients), it reported low mean Burden-scores and high Positive-Value scores, and had excellent internal consistency. No evidence of floor or ceiling effects was found. Results supported the unidimensional structure of the questionnaire. Significant differences were found concerning patients' diagnoses, with patients with schizophrenia diagnoses reporting higher scores and patients with depression and personality disorders reporting lower ones. When comparing the WHO-5 total score and patients' attitudes toward medication, negative correlations were observed with psychological reactance, as well as positive aspects of psychiatric medication. The present study demonstrates that the WHO-5 is feasible to administer and has robust psychometric properties in specialised community mental health centres.
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Affiliation(s)
- Mariela L Lara-Cabrera
- Department of Research and Development, Division of Mental Health, St Olav's University Hospital, Norway; Norwegian University of Science and Technology (NTNU), Faculty of medicine and health sciences, dept. of Mental Health, Trondheim, Norway; Tiller Community Mental Health Centre, Division of Psychiatry, St. Olav's University Hospital, Trondheim, Norway.
| | - Ingunn Pernille Mundal
- Faculty of Health and Social Sciences, Molde University College, Norway; Kristiansund Community Mental Health Centre, Møre og Romsdal Health Trust, Norway.
| | - Carlos De Las Cuevas
- University of La Laguna, Department of Internal Medicine, Dermatology and Psychiatry, Spain
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20
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The psychological well-being of physicians during COVID-19 outbreak in Oman. Psychiatry Res 2020; 289:113053. [PMID: 32388173 PMCID: PMC7203026 DOI: 10.1016/j.psychres.2020.113053] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 04/29/2020] [Indexed: 11/23/2022]
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21
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Li HQ, Chi S, Dong Q, Yu JT. Pharmacotherapeutic strategies for managing comorbid depression and diabetes. Expert Opin Pharmacother 2019; 20:1589-1599. [PMID: 31149850 DOI: 10.1080/14656566.2019.1622090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction: The increasing prevalence of comorbid depression and diabetes exerts a heavy burden on global health. Co-occurrence of depression and diabetes is common, affecting 14% to 35.8% of patients with diabetes, leading to a higher mortality and morbidity rate, more micro- and macro-vascular diseases and more cognitive decline. Areas covered: In this paper, the authors address various areas from epidemiology, the association between depression and diabetes, treatment strategies and future directions based on the currently available literature to provide novel insight into the pharmacotherapeutic management of comorbid depression and diabetes. Expert opinion: Pharmacotherapy can help patients with comorbid depression and diabetes by relieving depressive symptoms and improving glycemic control. When combined with psychological therapy, as a collaborative care effort, pharmacological therapy based on selective serotonin reuptake inhibitors (SSRIs) is recommended for comorbid depression with diabetes. Furthermore, studies with larger sample sizes that can help to define different subtypes of diabetes and severity of depression are needed so that clinicians can draw up a precise and applicable management guidelines for the personalized therapy of these diseases.
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Affiliation(s)
- Hong-Qi Li
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University , Shanghai , China
| | - Song Chi
- Department of Neurology, The Affiliated Hospital of Qingdao University , Qingdao , China
| | - Qiang Dong
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University , Shanghai , China
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University , Shanghai , China
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22
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Chen Y, Fang X, Shuai X, Fritzsche K, Leonhart R, Hoschar S, Li L, Ladwig KH, Ma W, Wu H. Psychometric Evaluation of the Major Depression Inventory (MDI) as a Depression Severity Scale in Chinese Patients With Coronary Artery Disease. Findings From the MEDEA FAR-EAST Study. Front Psychiatry 2019; 10:493. [PMID: 31379618 PMCID: PMC6656859 DOI: 10.3389/fpsyt.2019.00493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/24/2019] [Indexed: 12/19/2022] Open
Abstract
Background: It is highly recommended that all patients with coronary artery disease should be screened for depression. The Major Depression Inventory (MDI) is a widely used self-rating scale for the assessment of depression but is not valid in Chinese language. The present study was designed to assess the reliability and validity of a version of the MDI translated into Chinese among patients with acute myocardial infarction (AMI). Methods: Data were derived from the "Multicenter Delay in Patients Experiencing Acute Myocardial Infarction in Shanghai" (MEDEA FAR-EAST) study. Using a cross-sectional study design, the Chinese version of the MDI was administered to a total of 267 inpatients. The internal consistency reliability of the MDI scale was evaluated based on the Cronbach's coefficient and the binary coefficient for the whole scale. Exploratory factor analysis was performed to assess the internal consistency of the MDI. To examine discriminant validity, we analyzed the correlation of the MDI score with the General Anxiety Disorder-7 (GAD-7) and World Health Organization-5 Well-Being Index (WHO-5) scale scores. Results: The Chinese version of the MDI showed high reliability (Cronbach's alpha = 0.909, split-half reliability = 0.866). We identified one factor that explained 52% of the variance, which indicated that the MDI has satisfactory structural validity. The correlations of the MDI scores with the GAD-7 scores (r = 0.425) and the WHO-5 scores (r = -0.365) were moderate, suggesting that the MDI has acceptable discriminant validity. Conclusions: The MDI was proved to be a highly reliable and satisfactory valid diagnostic screening tool to assess depression in Chinese cardiac patients.
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Affiliation(s)
- Yixiao Chen
- Department of Psychosomatic Medicine, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaoyan Fang
- Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Technical University Munich, Munich, Germany
| | - Xueqian Shuai
- Department of Psychosomatic Medicine, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Kurt Fritzsche
- Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical Center University of Freiburg, Freiburg, Germany
| | - Rainer Leonhart
- Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Sophia Hoschar
- Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical Center University of Freiburg, Freiburg, Germany
| | - Li Li
- College of Electronics and Information Engineering, Tongji University, Shanghai, China
| | - Karl-Heinz Ladwig
- Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Technical University Munich, Munich, Germany
| | - Wenlin Ma
- Department of Cardiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Heng Wu
- Department of Psychosomatic Medicine, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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Affiliation(s)
- R I G Holt
- Editor-in-Chief, Diabetic Medicine, Southampton, UK
- University of Southampton, Southampton, UK
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