Search

Aim: To develop a structured education programme for individuals with Type 1 diabetes who are engaging in regular exercise. Method: A multidisciplinary team of experts in supporting exercise and physical activity for people with Type 1 diabetes, alongside researchers with experience of developing self‐management education, developed an exercise programme using the Medical Research Council framework. The programme was informed by a review of the evidence relating to Type 1 diabetes and exercise, the behaviour change literature (including the behaviour change taxonomy), and qualitative interviews with stakeholders. The programme and supporting resources were refined using an iterative process of testing, delivery and collecting feedback from participants and the wider development team. Results: The outcome of the intervention development was the design of a feasible and acceptable intervention for people with Type 1 diabetes to support safe exercise. The pilot allowed refinement of the intervention prior to testing in a two‐site feasibility randomized controlled trial. Key findings from the pilot informed minor restructuring of the timetable (timings and order) and adaptation of supporting educational materials (participant handbook and teaching materials). Conclusion: The 'EXercise in people with Type One Diabetes' (EXTOD) education programme has been developed using robust methodology for the generation of educational interventions. It now needs testing in a randomized controlled trial. What's new?: Currently there is no dedicated structured education programme that supports the management of Type 1 diabetes for exercise.A self‐management education programme to support safe and effective exercise for people with Type 1 diabetes has been developed using the Medical Research Council framework.In the exercise programme we developed, participants were able to adjust their regimens and plan their exercise in a more structured way.The programme was delivered by trained healthcare professionals, meaning it can be embedded into the specialist care setting.If demonstrated to be effective, this programme could potentially expand currently available support for adults with Type 1 diabetes who wish to exercise. [ABSTRACT FROM AUTHOR]

Aim: To review evidence on whether diet and exercise should be used as an alternative to drug therapy for the management of type 2 diabetes or alongside. Method: We present a narrative review that draws on evidence from other systematic reviews and meta‐analyses, narrative reviews, trials and cohort studies. We focused mainly on glycaemic control rather than control of blood pressure or cholesterol. Results: Good‐quality dietary advice that results in weight loss of >5% and physical activity interventions of >150 min/week of moderate to vigorous physical activity, combined with resistance exercise, can produce improvements in HbA1c similar to those produced by the addition of glucose‐lowering drugs. These improvements can be seen at all stages of the disease. There are recognized interactions between glucose‐lowering drugs and physical activity which may not be synergistic, but these are not well understood, and it is not clear if they are considered in clinical practice. Studies that explicitly compare drugs with diet or physical activity or control for drug use found that lifestyle could delay or reduce medication use, but most people eventually needed to progress to drug treatment. There are few studies, however, that provide strategies for the long‐term maintenance of weight loss or physical activity. Conclusion: Diet and physical activity are of key importance in type 2 diabetes management, and attention to them improves glycaemic control and cardiovascular disease risk, but it is not yet known whether maintained lifestyle changes provide an alternative to drug therapy in the long term. What's new?: Interactions between physical activity and glucose‐lowering medications have been observed but are not well understood, and there is little research into the interactions between medication and overall diet patterns.Few interventions compare lifestyle with drug therapy or a control for medication use. At present available evidence indicates that most people will eventually need drug therapy in addition to lifestyle.There is little evidence for how best to support people in maintaining weight loss or physical activity for the long term. Improving maintenance strategies may help more people delay or prevent medication use. [ABSTRACT FROM AUTHOR]

New Findings: What is the topic of this review?Hypoglycaemia is a commonly cited barrier to exercise in type 1 diabetes mellitus (T1D). Knowledge of approaches to prevent or manage exercise‐induced hypoglycaemia can support patients to exercise and help clinicians to give advice. This review presents evidence‐based strategies to prevent exercise‐induced hypoglycaemia in T1D.What advances does it highlight?This review highlights approaches that can be used before, during and after exercise to mitigate the risk of hypoglycaemia. The approaches include the timing of exercise, the type of exercise, adjustments to insulin and carbohydrate, use of novel technology and education. Exercise is a key component for the management of type 1 diabetes mellitus (T1D) and is associated with reduced risk of cardiovascular disease, decreased daily insulin requirements and improved quality of life. Owing to these benefits, people with T1D are recommended to undertake regular physical activity, 150 min per week for adults and 60 min per day for children and adolescents. Despite the recommendations, many people do not meet these targets. One of the commonly cited barriers to exercise is fear of hypoglycaemia along with limited knowledge of effective preventative strategies. Hypoglycaemia can be difficult to predict, and symptoms are often masked during exercise or stress of competition. For athletes with T1D, hypoglycaemia can also limit sporting success. Hypoglycaemia before an event increases the risks of hypoglycaemia during competition and can reduce performance. To avoid hypoglycaemia, people with T1D may avoid exercise altogether or consume excessive amounts of carbohydrates, which mitigates many of the health benefits of exercise. Increased understanding of approaches to prevent or manage hypoglycaemia is therefore important to help increase levels of physical activity in people with T1D and to support athletes with T1D to compete at the highest level. This review outlines the prevalence of exercise‐related hypoglycaemia, its underlying physiology and the strategies that can be used to prevent and manage exercise‐induced hypoglycaemia in T1D. Our hope is that this knowledge will be used by people with T1D and their clinicians to find individual approaches to manage exercise‐related hypoglycaemia. [ABSTRACT FROM AUTHOR]

Background Recruitment into surgical RCTs can be threatened if new interventions available outside the trial compete with those being evaluated. Adapting the trial to include the new intervention may overcome this issue, yet this is not often done in surgery. This paper describes the challenges, rationale and methods for adapting an RCT to include a new intervention. Methods The By-Band study was designed in the UK in 2009-2010 to compare the effectiveness of laparoscopic adjustable gastric band and Roux-en- Y gastric bypass for severe obesity. It contained a pilot phase to establish whether recruitment was possible, and the grant proposal specified that an adaptation to include sleeve gastrectomy would be considered if practice changed and recruitment was successful. Information on changing obesity surgery practice, updated evidence and expert opinion about trial design were used to inform the adaptation. Results The pilot phase recruited over 13 months in 2013-2014 and randomized 80 patients (79 anticipated). During this time, major changes in obesity practice in the UK were observed, with gastric band reducing from 32·6 to 15·8 per cent and sleeve gastrectomy increasing from 9·0 to 28·1 per cent. The evidence base had not changed markedly. The British Obesity and Metabolic Surgery Society and study oversight committees supported an adaptation to include sleeve gastrectomy, and a proposal to do so was approved by the funder. Conclusion Adaptation of a two-group surgical RCT can allow evaluation of a third procedure and maintain relevance of the RCT to practice. It also optimizes the use of existing trial infrastructure to answer an additional important research question. Registration number: ISRCTN00786323 (/). [ABSTRACT FROM AUTHOR]

Aims To determine if urine C-peptide/creatinine ratio is a useful tool for monitoring β-cell function in new-onset Type 1 diabetes. Methods Data were obtained from a prospective immunomodulation study in people with Type 1 diabetes ≤ 3 months from diagnosis, with a standard mixed-meal tolerance test and measurement of urine C-peptide/creatinine ratio carried out at 0, 3, 6, 9 and 12 months. The change in the insulin-dose-adjusted HbA1c level was also correlated with the change in serum/urine C-peptide level during the 12-month follow-up period. Results A significant reduction in urine C-peptide/creatinine ratio, measured after a mixed-meal, was reached at 9 months (−45.4%), whilst the reduction in stimulated serum C-peptide level reached significance after 3 months (−54.7%) in placebo-treated participants. Neither change in stimulated serum C-peptide nor change in urine C-peptide level correlated with each other, and nor did change in insulin-dose-adjusted HbA1c level in the first 6 months, but all measures correlated significantly in the second half of the 12-month follow-up period. Conclusion Mixed-meal-stimulated urine C-peptide/creatinine ratio was similar to, although less sensitive than, stimulated serum C-peptide level in monitoring β-cell function during the first year after diagnosis. Because the former is significantly less invasive, it warrants inclusion in further studies in Type 1 diabetes and may represent an attractive alternative outcome measure in cohort studies and in children. [ABSTRACT FROM AUTHOR]

Background and Aims: We investigated whether objectively measured sedentary time was associated with markers of inflammation in adults with newly diagnosed type 2 diabetes.Methods and Results: We studied 285 adults (184 men, 101 women, mean age 59.0 ± 9.7) who had been recruited to the Early ACTivity in Diabetes (Early ACTID) randomised controlled trial. C-reactive protein (CRP), adiponectin, soluble intracellular adhesion molecule-1 (sICAM-1), interleukin-6 (IL-6), and accelerometer-determined sedentary time and moderate-vigorous physical activity (MVPA) were measured at baseline and after six-months. Linear regression analysis was used to investigate the independent cross-sectional and longitudinal associations of sedentary time with markers of inflammation. At baseline, associations between sedentary time and IL-6 were observed in men and women, an association that was attenuated following adjustment for waist circumference. After 6 months of follow-up, sedentary time was reduced by 0.4 ± 1.2 h per day in women, with the change in sedentary time predicting CRP at follow-up. Every hour decrease in sedentary time between baseline and six-months was associated with 24% (1, 48) lower CRP. No changes in sedentary time between baseline and 6 months were seen in men.Conclusions: Higher sedentary time is associated with IL-6 in men and women with type 2 diabetes, and reducing sedentary time is associated with improved levels of CRP in women. Interventions to reduce sedentary time may help to reduce inflammation in women with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Objectives: Describe dietary intake of participants enrolled in a non-prescriptive dietary intervention and dietary changes at 6 months and explore whether these changes had a role in observed improvements in glycated haemoglobin (HbA1c), weight, lipids and blood pressure. Design: Secondary analysis of data from the Early ACTivity in Diabetes randomised controlled trial. Participants: 262 patients with newly diagnosed type 2 diabetes randomised to the dietary intervention. Outcomes and analysis: Changes in energy intake, macronutrients, fibre and alcohol and in weight, waist circumference, lipids, HbA1c and blood pressure at baseline and 6 months. Multivariate models were used to examine associations between dietary changes and metabolic variables. Results: Men reported reducing mean energy intake from 1903±462 kcal to 1685 kcal±439 kcal (p<0.001), increasing carbohydrate intake from 42.4±6.6% to 43.8 ±6.6% (p=0.002) and reducing median alcohol intake from 13 (0-27) g to 5 (0-18) g (p<0.001). Women reported reducing mean energy intake from 1582±379 kcal to 1459 ±326 kcal (p<0.001) with no change to macronutrient distribution and alcohol. Fibre intake was maintained. In men (n=148), weak and clinically insignificant associations were found between increased carbohydrates and reduction in HbA1c (b=-0.003 (-0.006, -0.001); p=0.009), increased fibre and reduction in total cholesterol (b=-0.023 (-0.044, -0.002); p=0.033), decreased total fat and reduction in low-density lipoprotein (LDL)-cholesterol (b=0.024 (0.006, 0.001); p=0.011), and decreased alcohol and reduction in diastolic blood pressure (b=0.276 (0.055, 0.497); p=0.015). In women (n=75), associations were found between a decrease in transfats and reductions in waist circumference (b=-0.029 (0.006, 0.052); p=0.015), total cholesterol (b=0.399 (0.028, 0.770); p=0.036) and LDL cholesterol (b=0.365 (0.042, 0.668); p=0.028). Conclusions: Clinically important metabolic improvements observed in a patient-centred dietary intervention were not explained by changes in macronutrients. However, a non-prescriptive approach may promote a reduction in total energy intake while maintaining fibre consumption. Trial registration number: The Early ACTID trial number ISRCTN92162869. [ABSTRACT FROM AUTHOR]

Granular media filtration is an important process in drinking water treatment to ensure the adequate removal of particle-bound pathogens (i.e., Giardia and Cryptosporidium). Filtration performance is typically monitored in terms of filtered water turbidity. However, particle counts may provide further insight into treatment efficiency, as they have a greater sensitivity for detecting small changes in filtration operation. Artificial neural networks (ANN) models were applied to optimize filtration at the Elgin Area water treatment plant (WTP) in terms of postfiltration particle counts. Process models were successfully developed to predict postfiltration particle counts. Two inverse-process models were developed to predict the optimal coagulant dosage required to attain target particle counts. Upon testing each model, a high correlation was observed between the actual and predicted data sets. The ANNs were then integrated into an optimization application to allow for the transfer of real-time data between the models and the online supervisory control and data acquisition (SCADA) system. [ABSTRACT FROM AUTHOR]

The article investigates the effects of diet and physical activity on blood glucose pressure and glucose concentrations in adults with type 2 diabetes in southwest England. Patients aged 30 to 80 years are assigned with usual care, intensive diet intervention, and a pedometer-based activity programme. It was found that in the control group, glycaemic control has worsened while in the diet group, it was improved. There are also improvements in bodyweight and insulin resistance in both groups.

North American drinking water utilities are currently re-evaluating their disinfection strategies for controlling microbiological growth in distribution systems. Most water systems in North America use free chlorine as a secondary disinfectant. Since chlorine is known to form potentially carcinogenic byproducts in drinking water, utilities are looking for an alternative to maintain a disinfectant residual in the distribution system. The objective of this study was to evaluate the response of model drinking water distribution systems to a change in disinfectant from either free chlorine or chloramines to chlorine dioxide, in terms of its impact on microbiological water quality (bulk water and biofilm), Switching from a chlorine residual of 0.5 mg/L to a chlorine dioxide residual of 0.25 m/L did not impact (negatively or positively) microbial water quality as quantified by heterotrophic and total cell counts (sample size = 8 data points). Thus, on the basis of the mass of disinfectant applied, chlorine dioxide was more efficient than free chlorine at controlling microbiological growth in the model distribution system. Similarly, chlorine dioxide was more efficient than chloramines, as a chlorine dioxide residual of 0.25 mg/L inactivated 0.75-1 log more suspended organisms than 1.0 mg/L residual of chloramines. Therefore, under the tested conditions, chlorine showed similar or better disinfection efficiency than free chlorine and chloramines, respectively. [ABSTRACT FROM AUTHOR]

This research was conducted to assess the impact of various disinfectants on bacterial water quality within model distribution systems (i.e. annular reactors). After colonization with non-disinfected water, annular reactors were treated with relatively low doses of chlorine (0.4 mg/I), chlorine dioxide (0.15 mg/I), or chloramines (0.9 mg/I). Under the tested conditions, bacterial inactivation varied as a function of disinfectant type (ranking by efficiency per mg of oxidant: ClO2 > Cl2 > ClNH2) and sample type (bulk water vs. biofilm). Depending on the disinfectant, the log inactivation of suspended and attached bacteria were 0.7-1.2 and 0.5-1.0, respectively. The characterization of microbial communities in drinking water can be performed using biochemical and/or molecular methods. In this study, biochemical tests were used, showing that pseudomonad and pseudomonad-like bacteria, as in other studies, were the most predominant micro-organisms (e.g. Pseudomonas fluorescens, Brevundimonas vescularis). The ratio Gram-positive to Gram-negative organisms was 1 to 3. No drastic differences were observed between the non-treated and disinfected pipes. Based on the bacteriological data presented in these experiments, chlorine dioxide represents an alternative to chlorine for certain distribution systems. [ABSTRACT FROM AUTHOR]

Drinking water utilities may be required to change disinfectant to improve water quality and meet more stringent disinfection regulations. This research was conducted to assess and compares chlorine dioxide to free chlorine and chloramines on bacterial water quality monitored within model distribution systems (i.e., annular reactors). Following colonization with nondisinfected water, annular reactors containing either polycarbonate or cast iron coupons were treated with free chlorine, chlorine dioxide or chloramines. Two disinfectant doses (low/high) were tested for each disinfectant. Under specific environmental conditions, bacterial inactivation varied as a function of the disinfectant type and dose, sample type (bulk water versus biofilm bacteria) and coupon material. The ranking by efficiency was as follows: chlorine dioxide > chlorine > chloramines. On preformed biofilms of 106–107 cfu/cm2, the continuous application of a disinfectant led to a log removal of heterotrophic bacteria concentrations for suspended and biofilm bacteria ranging from 1.1 to 4.0, and from 0.2 to 2.5, respectively. Doubling the amount of disinfectant doses led to an additional log inactivation of 1–2.5 of heterotrophic bacteria levels. This study demonstrates that bacterial inactivation in distribution systems is governed by various inter-related parameters. The data indicate that chlorine dioxide represents a viable alternative for secondary disinfection in distribution systems. [ABSTRACT FROM AUTHOR]