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BackgroundMobile health (mHealth) provides a unique modality for improving access to and awareness of palliative care among patients, families, and caregivers from diverse backgrounds. Some mHealth palliative care apps exist, both commercially available and established by academic researchers. However, the elements of family support and family caregiving tools offered by these early apps is unknown. ObjectiveThe objective of this scoping review was to use social convoy theory to describe the inclusion and functionality of family, social relationships, and caregivers in palliative care mobile apps. MethodsUsing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review guidelines, a systematic search of palliative care mHealth included (1) research-based mobile apps identified from academic searches published between January 1, 2010, and March 31, 2019 and (2) commercially available apps for app stores in April 2019. Two reviewers independently assessed abstracts, app titles, and descriptions against the inclusion and exclusion criteria. Abstracted data covered app name, research team or developer, palliative care element, target audience, and features for family support and caregiving functionality as defined by social convoy theory. ResultsOverall, 10 articles describing 9 individual research-based apps and 22 commercially available apps were identified. Commercially available apps were most commonly designed for both patients and social convoys, whereas the majority of research apps were designed for patient use only. ConclusionsResults suggest there is an emerging presence of apps for patients and social convoys receiving palliative care; however, there are many needs for developers and researchers to address in the future. Although palliative care mHealth is a growing field, additional research is needed for apps that embrace a team approach to information sharing, target family- and caregiver-specific issues, promote access to palliative care, and are comprehensive of palliative needs.

Measurement of glycated hemoglobin (HbA1c), the most widely accepted indicator of long-term glycemic exposure, is central for the diagnosis and management of diabetes mellitus. Levels of HbA1c track epidemiologically with diabetic complications, and glycemic control, as reflected by HbA1c reduction, results in decreased risk of microvascular complications, including diabetic kidney disease, neuropathy, and retinopathy. The relationship between HbA1c reduction and cardiovascular disease prevention in patients with diabetes is more complex, with data from large randomized trials published over the past decade providing clear evidence that lowering of HbA1c per se is an inadequate marker for a therapeutic regimen's impact on cardiovascular outcomes and patient survival. Recent revisions in professional society guidelines moved away from uniform recommendations and toward a more nuanced, patient-centered approach to HbA1c therapeutic targets. The context and key evidence underpinning these recent changes are discussed in this paper, alongside a brief overview of HbA1c contemporary assays and their limitations. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of intermediate-term treatment with rosiglitazone on high-sensitivity cardiac troponin T levels among patients with type 2 diabetes mellitus with or at high risk of coronary artery disease. Methods: High-sensitivity cardiac troponin T level was measured at baseline and after 6 months of study treatment in a randomized trial comparing rosiglitazone versus placebo in patients with type 2 diabetes and prevalent cardiovascular disease or multiple cardiovascular disease risk factors. Univariable and multivariable linear regression analyses were performed to assess the effect of rosiglitazone versus placebo on high-sensitivity cardiac troponin T levels. Results: The study included 150 randomized participants, of whom 106 had paired baseline and end-of-study blood samples for analysis (mean age: 56 ± 8 years, 42% women; 8.8 years average type 2 diabetes duration; mean haemoglobin A1c of 7.5). Almost all study participants (93%) had detectable high-sensitivity cardiac troponin T (⩾3 ng/L) at baseline, including 23% with high-sensitivity cardiac troponin T levels exceeding the threshold commonly used to diagnose myocardial infarction (⩾14 ng/L). Change in high-sensitivity cardiac troponin T levels from baseline to follow-up was not significantly different between rosiglitazone and placebo groups (p = 0.316). Conclusion: Rosiglitazone did not impact high-sensitivity cardiac troponin T levels, adding to the growing body of literature suggesting that the incremental heart failure risk associated with rosiglitazone is not mediated by direct myocardial injury. [ABSTRACT FROM AUTHOR]

The article presents a study on recent trends in hospital mortality for patients with myocardial infarction (MI) according to diabetes mellitus (DM) status from 1994-2006. It analyzed data from the U.S. National Registry of Myocardial Infarction, representing a fourth of all U.S. acute care hospitals. It finds that the hospital mortality gap between MI patients with and without DM narrowed significantly within the period, with the greatest improvement seen in women with DM.

This was a nested sub-study of a randomised placebo-controlled trial of the effect of 6 months of treatment with rosiglitazone added to existing therapy on myocardial triglyceride (mTG) content in patients with type 2 diabetes (T2D) and prevalent cardiovascular disease (CVD) or at least one additional risk factor. The primary endpoint, mTG content, was measured with cardiac 1H-magnetic resonance spectroscopy. Of the 99 randomised participants selected for the imaging sub-study, 49 (48%) had complete and interpretable spectroscopy data (age = 58 years, duration of T2D = 9.5 years; 57% women and 69% non-white). There was no significant change in mTG in either group (−0.1 ± 0.6% and −0.05 ± 0.8% respectively) and the changes in mTG were not associated with changes in left ventricular structure or function. Compared with placebo, treatment with rosiglitazone for 6 months had no discernible effect on mTG or left ventricular function in this population with long-standing diabetes and CVD. [ABSTRACT FROM PUBLISHER]

Aims: Plasma levels of the adipokine adiponectin are accepted as excellent correlates to metabolic health. Here, we aim to characterise associations between circulating plasma adiponectin complexes and baseline parameters in a population of patients with type 2 diabetes mellitus (DM) with increased risk of cardiovascular disease.Methods: We measured levels of high molecular weight (HMW), low molecular weight (LMW) and trimeric adiponectin.Results: The study population comprised 53 subjects, mean age 57 years, 36% non-white and 44% women, with an average body mass index (BMI) of 34 and duration of DM of 8.5 years. There was an established history of cardiovascular disease in 36% of the patients. BMI was inversely associated with the proportion of HMW adiponectin compared with LMW and trimeric adiponectin. Longer duration of DM correlated with an increased proportion of trimeric adiponectin.Conclusions: Patients with elevated BMI, longer history of diabetes and cardiovascular disease have lower levels of the higher order adiponectin complex. In addition, we have measured for the first time levels of trimeric adiponectin in a diabetic population using high resolution fast protein liquid chromatography (FPLC) analysis and identified trimeric adiponectin as a promising new biomarker for cardiovascular disease with a stronger correlative relationship to cardiovascular disease than HMW adiponectin. [ABSTRACT FROM PUBLISHER]