Patient-reported outcomes following islet cell or pancreas transplantation (alone or after kidney) in Type 1 diabetes: a systematic review

AIMS

For selected individuals with complex Type 1 diabetes, pancreatic islet transplantation (IT) offers the potential of excellent glycaemic control without significant hypoglycaemia, balanced by the need for ongoing systemic immunosuppression. Increasingly, patient-reported outcomes (PROs) are considered alongside biomedical outcomes as a measure of transplant success. PROs in IT have not previously been compared directly with the closest alternate treatment option, pancreas transplant alone (PTA) or pancreas after kidney (PAK).

METHODS

We used a Population, Intervention, Comparisons, Outcomes (PICO) strategy to search Scopus and screened 314 references for inclusion.

RESULTS

Twelve studies [including PRO assessment of PAK, PTA, islet-after kidney (IAK) and islet transplant alone (ITA); n = 7-205] used a total of nine specified and two unspecified PRO measures. Results were mixed but identified some benefits which remained apparent up to 36 months post-transplant, including improvements in fear of hypoglycaemia, as well as some aspects of diabetes-specific quality of life (QoL) and general health status. Negative outcomes included short-term pain associated with the procedure, immunosuppressant side effects and depressed mood associated with loss of graft function.

CONCLUSIONS

The mixed results may be attributable to limited sample sizes. Also, some PRO measures may lack sensitivity to detect actual changes, as they exclude issues and domains of life likely to be important for QoL post-transplantation and when patients may no longer perceive themselves to have diabetes. Thus, the full impact of islet/pancreas transplantation (alone or after kidney) on QoL is unknown. Furthermore, no studies have assessed patient satisfaction, which may highlight further advantages and disadvantages of transplantation.

Problems with the performance of the SF-36 among people with type 2 diabetes in general practice

OBJECTIVE

To validate the short form-36 (SF-36) among people with type 2 diabetes in general practice, and to make comparisons with the Audit of Diabetes Dependent Quality of Life (ADDQoL).

DESIGN

Postal survey with one reminder.

SETTING

Four general practices.

PATIENTS

One hundred and eighty-four eligible patients (30-70 years) with type 2 diabetes on 14 general practitioner lists.

MEASURES

SF-36 response rates, distribution of dimension scores and internal consistency. Median scores in relation to sociodemography and self-reported health. Comparisons with ADDQoL scores.

RESULTS

One hundred and thirty-one patients responded (71%). Distributions of SF-36 dimension scores were mostly skewed. Internal consistency and construct validity were acceptable, with predictable sociodemographic trends. People with illness related to or unrelated to diabetes scored significantly lower on most dimensions. SF-36 dimension scores correlated best with relevant diabetes-specific ADDQoL scores amongst respondents reporting no comorbidity.

CONCLUSIONS

Although valid and reliable, SF-36 scores are strongly affected by non-diabetic comorbidity in type 2 diabetes, supporting the complementary use of a diabetes-specific measure, providing information about the impact of diabetes specifically.

Diabetes care from diagnosis: effects of training in patient-centred care on beliefs, attitudes and behaviour of primary care professionals

In a randomised trial, general practitioners and nurses in 21 practices were trained in patient-centred consulting and use of materials for people with Type 2 diabetes (GPs 0.5 days; nurses 1.5 days; two optional follow-up half-days). Twenty practices formed the comparison group. Professional beliefs, attitudes and behaviour were measured (pre-trial, close-of-course and end-of-trial), supported by patient reports of nurse behaviour (141 trained: 108 comparison patients, 1 year after diagnosis). A total of 49 practice nurses responded (29 trained; 20 comparison). Trained nurses rated relative importance of patient-centred to professional-centred care as greater than comparison nurses. Trained nurses became less keen on the approach during the trial, and perceived time constraints persisted. Patients diagnosed later in the study were less likely to recognise intervention materials. Trained nurses rated delivery of important aspects of care and satisfaction with style of care as lower than comparison nurses, but patients were more positive about delivery of care from trained than comparison nurses. Although nurses rated patient-centred care as important, whether or not they had been trained as part of the trial, the short, generalizable training programme significantly reduced nurse perceptions of their ability to deliver it. Nonetheless, patients reported that important aspects of diabetes care were delivered more if their nurses had been trained in patient-centred consulting. This raises issues concerning measurement scales completed by trained professionals.

The first weeks of cohabitation of newly-formed heterosexual pairs of common marmosets (Callithrix jacchus)

16 pairs of common marmosets were formed, six of which were observed for 7 weeks, and ten for 4 weeks. A variety of behaviours was recorded, including sexual mounting, male tongue-smacking, female slit-eyed tongue-flicking, scent marks, huddling, allogrooming and autogrooming. Behaviours associated with sexual encounters occurred initially at high levels but declined during the study period. The incidence of sexual mounting was closely related to that of male tongue-smacking and female slit-eyed tongue-flicking. Other social behaviours including scent-marking and allogrooming did not show a consistent pattern of occurrence with respect to time or sexual activity.