Diabetes is one of the most common diseases worldwide where a cure is not found for it yet. Annually it cost a lot of money to care for people with diabetes. Thus the most important issue is the prediction to be very accurate and to use a reliable method for that. One of these methods is using artificial intelligence systems and in particular is the use of Artificial Neural Networks (ANN). So in this paper, we used artificial neural (...) networks to predict whether a person is diabetic or not. The criterion was to minimize the error function in neural network training using a neural network model. After training the ANN model, the average error function of the neural network was equal to 0.01 and the accuracy of the prediction of whether a person is diabetics or not was 87.3%. (shrink)

Diabetes is a major public health issue that affects the nations of our time to a large extent and is described as a non-communicable epidemic. Diabetes mellitus is a common disease where there is too much sugar (glucose) floating around in your blood. This occurs because either the pancreas can’t produce enough insulin or the cells in body have become resistant to insulin. The concentration in this paper is on diagnosis diabetes by designing a proposed expert system. (...) The main goal of this expert system is to get the appropriate diagnosing of the illness, dealing with it quickly, and tips for permanent treatment whenever possible is given out. SL5 object expert system language was used for designing and implementing the proposed expert system. (shrink)

Purpose: The method of diagnosing diabetic retinopathy (DR) through artificial intelligence (AI)-based systems has been commercially available since 2018. This introduces new ethical challenges with regard to obtaining informed consent from patients. The purpose of this work is to develop a checklist of items to be disclosed when diagnosing DR with AI systems in a primary care setting. -/- Methods: Two systematic literature searches were conducted in PubMed and Web of Science databases: a narrow search focusing on DR and a (...) broad search on general issues of AI-based diagnosis. An ethics content analysis was conducted inductively to extract two features of included publications: (1) novel information content for AI-aided diagnosis and (2) the ethical justification for its disclosure. -/- Results: The narrow search yielded n = 537 records of which n = 4 met the inclusion criteria. The information process was scarcely addressed for primary care setting. The broad search yielded n = 60 records of which n = 11 were included. In total, eight novel elements were identified to be included in the information process for ethical reasons, all of which stem from the technical specifics of medical AI. -/- Conclusions: Implications for the general practitioner are two-fold: First, doctors need to be better informed about the ethical implications of novel technologies and must understand them to properly inform patients. Second, patient's overconfidence or fears can be countered by communicating the risks, limitations, and potential benefits of diagnostic AI systems. If patients accept and are aware of the limitations of AI-aided diagnosis, they increase their chances of being diagnosed and treated in time. (shrink)

The global “diabetes monitoring devices market size” is expected to rise owing to increasing awareness about the self-management of diabetes. Fortune Business Insights in a report, titled “Diabetes Monitoring Devices: Global Market Analysis, Insights and Forecast, 2019-2026” offers valuable insights into the market, highlighting opportunities and threats alike. The global market is expected to yield huge profits facilitated by remarkable developments in diabetes management. As per the International Diabetes Foundation (IDF), the number of people suffering (...) from diabetes was 415 million in 2015 and is expected to reach 642 million by the year 2040. The rising prevalence of diabetes across the globe is a major factor driving the market. (shrink)

Pre-diabetes is a risk factor for the development of diabetes, not a disease in its own right. The prevalence increases with age and reaches nearly 50% of those aged over 75 years in the USA. While lifestyle modification and treatment are likely to benefit those with many years of life ahead of them, they are unlikely to benefit patients with a limited life expectancy. Despite this, some very elderly patients in the UK and elsewhere are being labelled as (...) pre-diabetic. While ideal practice would be to carefully consider the impact of any potentially abnormal blood test before it is taken, this is not always possible in routine practice. In this paper, we discuss a pragmatic, ethical approach for clinicians managing pre-diabetic blood tests in very elderly patients. We argue that a ‘see-saw’ model of paternalism should be used in deciding which patients to inform that they can be labelled as pre-diabetic. Those patients that may benefit from the label should be informed, and those that will not, should not. Where the benefits/drawbacks are unclear, the result and its potential significance should be discussed in depth with the individual patient. We do not advocate withholding information from any patient. Instead we suggest clinicians use individual patient circumstances to contextualise the relevance of pre-diabetes to the patient and consider the benefits and drawbacks before informing them. This approach has the potential to be used for other pre-conditions and risk factors in addition to pre-diabetes. (shrink)

In this article, we investigate the role of scientific and patient narratives on perceptions of the medical debate around gestational diabetes testing. Among medical scientists, we show that the narrative surrounding GDM testing affirms that future research and data will lead to medical consensus. We call this narrative trajectory the “deferred quest.” For patients, however, diagnosis and their subsequent discovery that biomedicine does not speak in one voice ruptures their trust in medical authority. This new distrust creates space for (...) patients to develop a Frankian quest narrative where they become the protagonist in their story. Additionally, across these different narratives, we observe how character is constructed and employed to negotiate trust. We conclude that healthcare providers should assess the narrative trajectory adopted by patients after diagnosis. Also, we suggest that providers acknowledge the lack of medical consensus to their patients. This veracity would foster women’s sense of trust in their provider as well as allow women to be active interlocutors in a debate that ultimately plays out in their deliberation about their body, pregnancy, and risk. (shrink)

Hurricane Katrina offered a revealing snapshot of the historical vulnerability that New Orleans and Gulf Coast residents have long experienced and continue to face. In particular, population groups with special health needs—those suffering from debilitating chronic diseases—were among those most at risk during the storm. Focusing specifically on diabetic evacuees during and after Katrina, this essay examines how the lack of planning during the disaster led to diminished access to dialysis as well as poor food and inadequate insulin management in (...) evacuation shelters. In so doing, it underscores the strong links between disasters and public health concerns such as elevated risks for complications, emergency room visits, hospitalizations, and reduced life expectancy for individuals with diabetes. As the case of Katrina powerfully illustrates, populations suffering from chronic diseases like diabetes suffer disproportionately from disasters and other disruptive events. (shrink)

Insulin‐dependent diabetes mellitus (IDDM) is an autoimmune disease whose etiology is complex. Both genetic susceptibility, which is polygenic, and environmental factors, including virus infections, appear to be involved in the development of IDDM. In this review, we have tried to balance the discussion of diabetes by examining both immunological and virological perspectives. Several mouse models, including viral and non‐viral models, have been used to study diabetes. For this review, we include lessons gleaned from the non‐obese diabetic (NOD) (...) mouse and from mouse models of coxsackievirus‐ and encephalomyocarditis‐virus‐induced diabetes. Finally, we present a multi‐stage model in which several viral infections, including the coxsackieviruses, are postulated to play a role in the autoimmune destruction of pancreatic beta cells. (shrink)

This article studies the phenomenology of chronic illness in light of phenomenology’s insights into ecstatic temporality and freedom. It shows how a chronic illness can, in lived experience, manifest itself as a disturbance of our usual relation to ecstatic temporality and thence as a disturbance of freedom. This suggests that ecstatic temporality is related to another sort of time—“provisional time”—that is in turn rooted in the body. The article draws on Merleau-Ponty’s Phenomenology of Perception and Heidegger’s Being and Time , (...) shedding light on the latter’s concept of ecstatic temporality. It also discusses implications for self-management of chronic illness, especially in children. (shrink)

In 1936, the journalist Hannah Lees published “Two Million Tightrope Walkers,” drawing attention to the significant number of people in the United States estimated to have diabetes. Focusing on how people with diabetes should live, she emphasized the importance of recording the exact values of everything they ate and avoiding all “riotous living” lest they be unable to keep careful measurements of calories, insulin, and sleep. Employing two meanings of measured – as counted and as moderate – Lees (...) was doing more than communicating how someone might control their disease; she was also calling for a “controlled and self-reliant citizenry.” Indeed, Lees insisted that diabetics who followed a regime of measurement “make a good deal better citizens than the average.” Drawing on the writings of Lees and other social commentators, I explore the link between biometrics, citizenship, and diabetes in the United States in the interwar years. In particular, I look at how this disease came to symbolize both the regimes of discipline thought to be necessary in a society moving to consumption as its economic motor, and the fears of what could happen if consumption ran amok. Biometrics, I argue, offered clinicians and patients a potent tool for measuring deviance and, potentially, for restoring a person to the “norm.”. (shrink)

Objective Diabetes is a global public health concern. Management of diabetes depends on successful implementation of strategies to alleviate decline in executive functions (EFs), a characteristic of diabetes progression. In this review, we describe recent research on the relationship between diabetes and EF, summarize the existing evidence, and put forward future research directions and applications. Methods Herein, we provide an overview of recent studies, to elucidate the relationship between DM and EF. We identified new screening objectives, (...) management tools, and intervention targets for diabetes management. We also discuss the implications for clinical practice. Results In both types 1 and 2 diabetes mellitus (DM), hyperglycemia substantially impairs EF in people of all age groups and ethnicities. Hypoglycemia can similarly impair EF. Interestingly, a decline in EF contributes to DM progression. Glucose dysregulation and EF decline exacerbate each other in a vicious cycle: poor blood glucose control, impaired EF, diabetes management task failure, then back to poor blood glucose control. Many pathophysiological indexes (e.g., obesity, metabolic index, inflammatory and immune factors), neuropsychological indexes (e.g., compliance, eating habits, physical exercise, sleep, and depression), and genetic factors are changed by this pathological interaction between DM and EF. These changes can provide insight into the pathophysiological mechanisms of diabetes-related EF decline. Conclusion Further studies, including large-scale prospective and randomized controlled trials, are needed to elucidate the mechanism of the interaction between diabetes and EF and to develop novel strategies for breaking this cycle. (shrink)

My research explores Maya perspectives on neo-traditional farming as a source of metabolic health and resilience to the global epidemic of type-two diabetes. This article is based on long-term ethnographic research and interviews in Maya Mountains Reservation communities in southern Belize, an area with low diabetes prevalence relative to national and global populations. Research participants see lower rates of diabetes in the MMR as the result of neo-traditional peasant and subsistence farming on ancestral lands. Good metabolic health (...) represents the embodiment of food systems that routinize healthy material and social relationships to the landscape. This research suggests that diabetes is endemic to modern food systems and proposes neo-traditional food ways as a societal antidote to nutritional disease. My research demonstrates and responds to a need for further disaggregated data on diabetes prevalence in Indigenous communities, contributes to the social scientific literature on the importance of small-scale agricultural models for community health, and provides a case study of success in diabetes prevention. I engage Maya perspectives with anthropological literature on embodiment and small-scale agriculture to suggest neo-traditional food ways as healthier alternatives to capitalist agricultural development. (shrink)

Background: Diabetes mellitus (DM) is a noncommunicable disease that stills being a burden in health system. Some trace minerals such as selenium and zinc was postulated having role in blood and insulin regulation in Type 2 Diabetes Mellitus. The objective of this study is conducted to determine the level of selenoium and zinc serum in Type 2 Diabetes Mellitus patient, and its correlation with glycemic control parameter. Methods: A cross sectional study was conducted at Abdul Moeloek and (...) Hasan Sadikin Hospital from endocrinology outpatient clinic from october to december 2022 with random sampling. Patient was tested for glycated albumin, fasting blood glucose, and glycated hemoglobin as marker od glycemic control Data then analyzed descriptively and underwent bivariate analysis with Spearman Rank Correlation. Results: Low level of Zinc, but with normal level of selenium was found among research subject. Bivariate analysis between the variables showed that there is positive, weak, and insignificant correlation of zinc and selenium with fasting blood glucose, HbA1C, and glycated albumin. (Selenium with HbA1C: r:0,131, p:0.099, Selenium with FBG: r:0,135, p:0.092, Selenium with glycated albumin: r: 0.084, p:0,223, Zinc with HbA1C: r:0.069, p:0,389, Zinc with FBG: r:0,084, r:0,544, Zinc with glycated albumin: r:0.007, p:0,920) Conclusion: There is a positive, weak, and insignificant correlation of serum selenium and zinc with glycemic control parameters. (shrink)

MENDENHALL TJ, BERGE JM, HARPER P, GREENCROW B, LITTLEWALKER N, WHITEEAGLE S and BROWNOWL S. Nursing Inquiry 2010; 17: 359–372 The Family Education Diabetes Series (FEDS): community‐based participatory research with a midwestern American Indian communityIndigenous people around the globe tend to struggle with poorer health and well‐being than their non‐indigenous counterparts. One area that this is especially evident is in the epidemic of diabetes in North America’s American Indians (AIs) – who evidence higher prevalence rates and concomitant disease‐related (...) complications than any other racial/ethnic group. As researchers and AI communities work together to transcend conventional top‐down, service‐delivery approaches to care, community‐based participatory research is beginning to show promise as a way to partner contemporary biomedical knowledge with the lived‐experience, wisdom, and customs of Indigenous people. This study describes the Family Education Diabetes Series (FEDS) as an example of such effort, and highlights pilot findings assessing its value and impact across key diabetes‐relevant variables. Following 36 intervention participants across baseline, 3‐month, and 6‐month time periods, data show significant improvements in weight, blood pressure, and metabolic control (A1c). Strengths and limitations of this investigation are presented, along with suggestions about how to further advance and empirically test the work across other Indigenous communities. (shrink)

Diabetes is one of the most common metabolic diseases that cause high blood sugar. Early diagnosis of such a condition is challenging due to its complex interdependence on various factors. There is a need to develop critical decision support systems to assist medical practitioners in the diagnosis process. This research proposes developing a predictive model that can achieve a high classification accuracy of type 2 diabetes. The study consisted of two fundamental parts. Firstly, the study investigated handling missing (...) data adopting data imputation, namely, median value imputation, K-nearest neighbor imputation, and iterative imputation. Consequently, the study validated the implications of these imputations using various classification algorithms, i.e., linear, tree-based, and ensemble algorithms, to see how each method affected classification accuracy. Secondly, Artificial Neural Network was employed to model the best performing imputed data, balanced with SMOTETomek ensuring each class is represented fairly. This approach provided the best accuracy of 98% on the test data, outperforming accuracies achieved in prior studies using the same dataset. The dataset used in this study is concerned with gender and population. As a prospect, the study recommends adopting a larger population sample without geographic boundaries. Additionally, as the developed Artificial Neural Network model did not undergo any specific hyperparameter tuning, it would be interesting to explore tuning on top of normalized data to optimize accuracy further. (shrink)

Development of the vertebrate pancreas is a complex stepwise process comprising regionalization, cell differentiation, and morphogenesis. Studies in zebrafish are contributing to an emerging picture of pancreas development in which extrinsic signaling molecules influence intrinsic transcriptional programs to allow ultimate differentiation of specific pancreatic cell types. Zebrafish experiments have revealed roles for several signaling molecules in aspects of this process; for example our own work has shown that retinoic acid signals specify the pre‐pancreatic endoderm. Time‐lapse imaging of live zebrafish embryos (...) has started to provide detailed information about early pancreas morphogenesis. In addition to modeling embryonic development, the zebrafish has recently been used as a model for pancreas regeneration studies. Here, we review the significant progress in these areas and consider the future potential of zebrafish as a diabetes research model. (shrink)

My experience with the California Department of Motor Vehicles offers a case to explore how bureaucratic institutions monitor, classify, and control individuals. By examining artifacts created for and used by the DMV through the lens of literacy studies, I discuss the variety of rhetorical strategies used in each document and the effects and implications of those strategies, for example on subjectivity or identity, and move beyond the language of the artifacts themselves to attend to how they are invested with power (...) in the management and control of populations. (shrink)

ObjectiveType 2 diabetes mellitus (T2DM) is a high risk of cognitive decline and dementia, but the underlying mechanisms are not yet clearly understood. This study aimed to explore the functional connectivity (FC) and topological properties among whole brain networks and correlations with impaired cognition and distinguish T2DM from healthy controls (HC) to identify potential biomarkers for cognition abnormalities.MethodsA total of 80 T2DM and 55 well-matched HC were recruited in this study. Subjects’ clinical data, neuropsychological tests and resting-state functional magnetic (...) resonance imaging data were acquired. Whole-brain network FC were mapped, the topological characteristics were analyzed using a graph-theoretic approach, the FC and topological characteristics of the network were compared between T2DM and HC using a general linear model, and correlations between networks and clinical and cognitive characteristics were identified. The support vector machine (SVM) model was used to identify differences between T2DM and HC.ResultsIn patients with T2DM, FC was higher in two core regions [precuneus/posterior cingulated cortex (PCC)_1 and later prefrontal cortex_1] in the default mode network and lower in bilateral superior parietal lobes (within dorsal attention network), and decreased between the right medial frontal cortex and left auditory cortex. The FC of the right frontal medial-left auditory cortex was positively correlated with the Montreal Cognitive Assessment scales and negatively correlated with the blood glucose levels. Long-range connectivity between bilateral auditory cortex was missing in the T2DM. The nodal degree centrality and efficiency of PCC were higher in T2DM than in HC (P < 0.005). The nodal degree centrality in the PCC in the SVM model was 97.56% accurate in distinguishing T2DM patients from HC, demonstrating the reliability of the prediction model.ConclusionFunctional abnormalities in the auditory cortex in T2DM may be related to cognitive impairment, such as memory and attention, and nodal degree centrality in the PCC might serve as a potential neuroimaging biomarker to predict and identify T2DM. (shrink)

Intersectoral collaboration (IC) plays a significant role in the delivery of diabetes care and treatment of patients with type 2 diabetes (DM2), as the treatment and care of these patients take place in both primary care and specialist settings. The collaboration involves a large number of actors from primary and secondary healthcare sectors, who are expected to fulfil various roles when they engage in IC. We explored the actors' roles by applying the framework of positioning theory with the (...) aim of revealing seemingly embedded understandings of such roles. The empirical data consisted of individual and focus group interviews. Our results indicate that naturalised understandings of the roles of actors interact with the way in which health professionals, patients, managers and relatives strive to develop IC that aims to help and guide patients who live with DM2. (shrink)

Approaches to self‐management traditionally focus upon individual capacity to make behavioural change. In this paper, we use Bourdieu's concepts of habitus and capital to demonstrate the impact of structural inequalities upon chronic illness self‐management through exploring findings from 28 semi‐structured interviews conducted with people from a lower socioeconomic region of Adelaide, South Australia who have type 2 diabetes. The data suggests that access to capital is a significant barrier to type 2 diabetes self‐management. While many participants described having (...) sufficient cultural capital to access and assess health information, they often lacked economic capital and social capital in the form of support networks who promote health. Participants were often involved in social networks in which activities which are contrary to self‐management have symbolic value. As a consequence, they entered relationships with health professionals at a disadvantage. We conclude that structural barriers to self‐management arising from habitus resulting in the performance of health behaviours rooted in cultural and class background and limited access to capital in the form of economic resources, social networks, health knowledge and prestige may have a negative impact on capacity for type 2 diabetes self‐management. (shrink)

The concept of quality of life is the basis for a new paradigm of clinical medicine. Its assessment is considered to be an important instrument in determining disease severity and effectiveness of different treatment modalities. Our studies are devoted to the problem of diabetes complications especially anemia in patients with diabetic kidney disease. Anemia in subjects with diabetic nephropathy may result from various pathogenic factors including erythropoietin deficiency, iron deficiency, vitamin B12 and/or folate deficiencies, the effects of proinflammatory cytokines (...) etc. Diabetic patients with anemia are at increased risk of cardiovascular accidents and death. The aim of this study was to assess the influence of anemia on the quality of life of patients with early stages of diabetic nephropathy. We investigated 127 patients with type 2 diabetes mellitus and early diabetic nephropathy. Anemia was defined according to the World Health Organization criteria. Anemic patients were divided into three groups according to the stage of chronic kidney disease. Patients’ quality of life was assessed with SF-36 health survey. Anemic patients had lower scores of physical role functioning and emotional role functioning as compared to the patients with normal hemoglobin level, irrespective of the stage of chronic kidney disease. Patients with anemia and chronic kidney disease stage 3 had lower scores of general health perceptions, physical functioning, bodily pain, vitality and mental health than patients in the non-anemic group. Social role functioning was similar in anemic and non-anemic patients. The possible mechanisms and implications of the above mentioned findings are discussed with a medical and humanitarian perspective. The directions of further studies are proposed. (shrink)

The present study investigates the association between diabetes-related distress and work outcomes among employed people with type 1 diabetes. Employed adults with type 1 diabetes completed an online survey. Measures assessed emotional, social, food- and treatment-related DD, burnout, and job satisfaction, as well as the type of insulin treatment. We conducted multiple regression analyses to test our hypotheses. Emotional DD was significantly and positively associated with burnout. Social DD was significantly and negatively associated with job satisfaction. The (...) type of treatment had no significant effect on the outcomes. This study sets the stage for research on the interactions between working conditions, work outcomes and illness symptoms, and problems of people with type 1 diabetes, and, generally, employees with chronic illnesses. The findings have implications for individual health and illness management, burnout prevention, and occupational health measures. (shrink)

Diabetes is a chronic and systemic disease that has reached epidemic proportions. An estimated 17 million Americans have diabetes, and an additional 16 million individuals are considered to have pre-diabetes. Studies have shown that timely screening and referral are necessary to maintain healthy blood glucose levels and slow the progression of diabetes-related complications. Furthermore, lifestyle changes can prevent or delay the onset of Type 2 diabetes for high-risk individuals.The Division of Diabetes Translation at the (...) Centers for Disease Control and Prevention undertook an analysis of diabetes-related legislation across the nation. More specifically, state laws, rules and regulations mandating health insurance coverage for diabetes-related supplies and services were examined according to Sample Purchasing Specifications for Services Related to Diabetes—an evidence-based model of standards of care for persons with diabetes. (shrink)

Diabetic ketoacidosis is a serious, medical emergency that can be fatal but treatable, we aimed to evaluate the clinical profile of patients admitted with diabetic ketoacidosis. This case series study enrolled 213 non-pregnant adult and adolescent patients admitted with diabetic ketoacidosis at Tripoli Diabetes Hospital from January to September 2023. Demographic data, clinical characteristics, laboratory findings, precipitating factors, and patient outcomes were extracted from medical records and analyzed. Type 1 diabetes mellitus was present in 187 (87.8%) of patients, (...) the age range 11-84 years, (30.26±13.28), with 130 patients ≤30 years old (61.0%), females accounting for 110 of the patients (51.6%), 109 had a diabetes duration of less than 10 years (51.2%). The most common precipitating factor was insulin omission 92 (43.2%) in patients with known diabetes mellitus, whereas, diabetic ketoacidosis as the first presentation of diabetes mellitus in 24 patients (11.7%), systolic blood pressure ranged 50-160 mmHg (112.82±16.19), diastolic blood pressure varied 30-100 mmHg (70.24±11.32). Plasma glucose at presentation ranged 183-1494 mg/dl (462.92±169.85), with Eu-glycemic diabetic ketoacidosis 100-249 mg/dl were in nine patients (4.2%), whereas most of cases (135 patients, 63.4%) present with plasma glucose 250-500 mg/dl, while hyperosmolar status (≥701 mg/dl) were present in 13 patients (6.1%). Venous pH varied from 6.7-7.42 (7.13±0.14), 132 (62.0%) patients presented with pH <7.24, while severe acidosis was pH < 7 in 32 of patients (14.6%), serum bicarbonate with 10.93±4.95, severe (<5 mmol) in 91 patients (42.7%) and moderate (5-10 mmol) were in 79 patients (37.08%). The mean length of hospital stay was 3.33 days, with an average of 2.11 days spent in the high-dependent unit. Serum potassium varied from 2.4-6.7 meq/L with 3.66± 0.63, most common complications of diabetic ketoacidosis treatment were hypokalemia observed in 82 (35.7%) of cases, and hypoglycemia was detected in 41 patients (19.2%). 170 patients were discharged in good condition (79.8%), and 17.8% of patients were transferred to another hospital to receive further management for co-morbid diseases with diabetes after controlling their hyperglycemic crises. The majority of patients presented with the critical status of diabetic ketoacidosis. The findings emphasize the importance of patient education about prevention measures prompt presentation to the hospital, and clinicians' awareness for early and aggressive treatment of hyperglycemic crises. (shrink)

This paper explores the condition of stultitia, which is described by Michel Foucault in The Hermeneutics of the Subject as a condition one is in, before having started to care for the self. The purpose is to shed light on one of the paradoxes of patient education by introducing and elaborating an aspect of Foucault’s literary activities, which has not, to my knowledge, been investigated empirically before. To illustrate this condition, the paper targets the relation between type 2 diabetes, (...) contemporary norms of healthy living, diabetes education, and the situation that sometimes occurs when individuals are not capable of, or motivated to, taking care of themselves. It specifically targets a situation, which is both incomprehensible to health professionals and patients alike; when patients desire a healthy life, but at the same time do not pursue it according to the recommendations. Thus, it is a condition of madness, which is investigated; madness in the sense that patients have internalised a rationality, against which their own behaviour rebels. (shrink)

Children diagnosed with type 1 diabetes mellitus (T1DM) are at risk for neurocognitive sequelae, including impaired attention functioning. The specific nature of the cognitive deficit varies; current literature underscores early age of diabetes diagnosis and increased disease duration as primary risk factors for this neurocognitive decline. Forty-three children with T1DM were evaluated for Attention Deficit/Hyperactivity Disorder (ADHD) symptomatology using the MOXO continuous performance test (MOXO-CPT) performed during a routine outpatient evaluation. The study cohort demonstrated a significant decline in (...) all four domains of attention functioning. The effect was most pronounced with early age at T1DM diagnosis, a longer disease duration and with poorer glycemic control (represented by higher HbA1c values). With increased disease duration (of 5 plus years), acute hyperglycemia was associated with inattention in the real-time setting. These findings highlight the need for routine screening of neurocognitive function in children with T1DM so that early intervention can be employed during this crucial period of cognitive development. (shrink)

Pancreatic β‐cells in the islet of Langerhans produce the hormone insulin, which maintains blood glucose homeostasis. Perturbations in β‐cell function may lead to impairment of insulin production and secretion and the onset of diabetes mellitus. Several essential β‐cell factors have been identified that are required for normal β‐cell function, including six genes that when mutated give rise to inherited forms of diabetes known as Maturity Onset Diabetes of the Young (MODY). However, the intracellular signaling pathways that control (...) expression of MODY and other factors continue to be revealed. Post‐transplant diabetes mellitus in patients taking the calcineurin inhibitors tacrolimus (FK506) or cyclosporin A indicates that calcineurin and its substrate the Nuclear Factor of Activated T‐cells (NFAT) may be required for β‐cell function. Here recent advances in our understanding of calcineurin and NFAT signaling in the β‐cell are reviewed. Novel therapeutic approaches for the treatment of diabetes are also discussed. BioEssays 29:1011–1021, 2007. © 2007 Wiley Periodicals, Inc. (shrink)

Introduction: Early recognition of prediabetes may prevent progression to diabetes, yet not all adults are aware of their prediabetes risk. To reach all adults unaware of their risk, additional risk assessment strategies are warranted. Objectives: The objective of this study was to evaluate the potential scope of benefit from prediabetes risk assessment in the dental care setting and to identify characteristics of dental patients likely to unknowingly have prediabetes or diabetes. Methods: Data from 10,472 adults in the National (...) Health and Nutrition Examination Survey from 2013 to 2014 and 2015 to 2016 were analyzed for associations among prediabetes/diabetes risk factors, health care use, and hemoglobin A1C levels according to chi-square tests and multivariate logistic regression. Results: A total of 7.73% of US adults had seen a dentist but not a medical provider in the past 12 mo. The composition of this subpopulation was significantly different from that who saw a medical provider, in ways that might affect their diabetes risk. In addition, 31.27% of this subpopulation would be identified as being at high risk for prediabetes according to the CDC Prediabetes Screening Test, and 15.83% had hemoglobin A1C levels indicative of undiagnosed prediabetes or diabetes. Screening in a dental setting would have the highest odds of identifying someone unaware of his or her diabetes risk among those who were non-White, obese, or ≥45 y old. Conclusion: Extrapolation from this analysis indicates that screening for prediabetes at dental visits has the potential to alert an estimated 22.36 million adults of their risk for prediabetes or diabetes. Incorporating prediabetes or diabetes risk assessment into routine dental visits may enable 1) those with prediabetes to take action to decrease their risk of developing diabetes and 2) those with diabetes to engage in treatment to decrease their risk of diabetes-related complications. Knowledge Transfer Statement: Screening for prediabetes and diabetes during dental visits has the potential to raise patients’ awareness of diabetes risk and prevent prediabetes from progressing to diabetes. For some patients, the dental visit may be the only point of contact with the health care system, which heightens the importance of including diabetes risk assessment for patient well-being. (shrink)

Due to the potential ethical and psychological implications of screening, and especially inregard of screening on children without available and acceptable therapeutic measures, there is a common view that such procedures are not advisable. As part of an independent research- and bioethical case study, our aim was therefore to explore and describe bioethical issues among a representative sample of participant families (n = 17,055 children) in the ABIS (All Babies In South-east Sweden) research screening for Type 1 diabetes (IDDM).The (...) primary aim is the identification of risk factors important for the development of diabetes and other multifactorial immune-mediated diseases. Four hundred, randomly chosen, participant mothers were asked to complete a questionnaire exploring issues of information, informed consent, bio-material, confidentiality and autonomy, and of prevention/intervention. 293 completed the questionnaire, resulting in a response rate of 73.3%. The majority of questions had the form of 6-point Likert-type response scales (1–6).We found that the majority of respondents felt calm in regard of samples and written material, and also concerning the possibility of their child in the future being identified as having high risk of developing Type 1 diabetes. An important finding concerning access and control of mainly biological data was indicated, with the respondents expressing concern for potential future use. We believe our findings indicate that this kind of empirical studies can substantially contribute to our understanding of bioethical issues of medical research involving genetics. Issues, such as safeguards ensuring theethical criteria of autonomy and respect, were emphasised by our respondents. We believe theissues brought up may promote further discussion, and do suggest issues for consideration by, among others, researchers, bioethicists and Institutional Review Boards. (shrink)

While not rare, films that represent diabetes must work around the disease’s banal invisibility, and images of diabetics in film are especially susceptible to metaphor and exaggeration. This essay is the first to outline a diabetic filmography, discussing medical and cinematic strategies for visualizing the disease as well as how the illness informs family plots and heroic characters in horror films. Doing so, it participates in a larger discussion of the manner in which film images of ill or disabled (...) groups sustain notions of “normalcy” by both representing and denying otherness. (shrink)

The aims of this study were to measure the readability of Australian based informed consent documents and determine whether informed consent readability guidelines have been established by Australian human research ethics committees (HRECs). A total of 20 informed consent documents, 10 HIV/AIDS and 10 type 2 diabetes, were measured for readability using the Simple Measure of Gobbledygook (SMOG) and Gunning Fog Index (Fog). Published guidelines and policy statements of the two local HREC who approved the 20 clinical trials under (...) study where examined to identify whether they had any formal policies/guidelines on the readability of informed consent documents. The two HRECs were contacted via e-mail to also determine whether they utilised any informal readability standards or “rules of thumb” that may not have been mentioned in the published documents. The HIV/AIDS and type 2 diabetes informed consent documents were, on average, written at a grade 13 reading level. Formal readability standards had not been established by the two local HRECs, however, they did verify the use of informal rules for assessing readability of informed consent documents. Based on Australian literacy data, the majority of informed consent documents were written well beyond the reading ability of many Australians. Unreadable informed consent documents may result in patients rejecting trial participation altogether or conversely may result in their participating in a trial with inadequate consent. Therefore, a step toward reducing the complexity of informed consent documents may be to implement objective readability assessments into the human research ethics application and review process. (shrink)