Search

Diabetic ketoacidosis (DKA) accounts for up to a third of all new presentations of Type 1 Diabetes Mellitus (T1DM) in children and adolescents. While most cases are relatively uncomplicated new onset presentations, if DKA is compounded with an additional underlying severe illness, such as appendicitis or severe infection, diagnostic delays may be experienced, and treatment response and outcomes may be compromised. We report an atypical case of new onset diabetes with severe DKA and underlying severe sepsis, which responded poorly to traditional therapy resulting in maximal intensive care management including mechanical ventilation, inotropes, extracorporeal membrane oxygenation (ECMO) for cardiorespiratory support, and kidney replacement therapy.

The progressive nature of type 2 diabetes (T2D) often results in the need for initiation and subsequent intensification of insulin treatment to achieve glycemic control. The aim of this review is to examine published clinical evidence that has directly compared two recommended treatment approaches in patients with T2D: (1) a ‘basal plus’ regimen, whereby 1–2 injections of prandial insulin are added to basal insulin; or (2) the use of once- or twice-daily premix insulin analogs, which contain both basal and prandial insulin in a single injection. Broadly, the available evidence suggests that both basal plus and premix regimens are comparable in terms of efficacy and safety when used for insulin initiation in insulin-naive patients and intensification in patients who have failed on basal insulin; instances of greater glycemic control are observed with premix insulin; however, these are often accompanied by increases in hypoglycemia and/or weight relative to basal plus treatment, and results should be interpreted within the context of total insulin doses used. Relatively low numbers of patients achieved glycemic control when both regimens were used for insulin intensification following failure of basal insulin, suggesting that a full basal–bolus regimen and/or the use of different treatments is clinically indicated in certain patients. In summary, the current review argues that both basal plus and premix insulin regimens are relatively efficacious and safe options for patients with T2D during both insulin initiation in insulin-naive patients and intensification in patients who have failed on basal insulin. This emphasizes the important role of patient-centered factors in clinical decision-making. Funding: Novo Nordisk.

Many governments and insurers are driving down the cost of medical devices, including glucose meters, by the central management of purchasing decisions. We report patients' responses to an "enforced" change in brand of glucose meter, one year after the introduction of a national sole supplier arrangement for funded glucose meters and strips.Specialist diabetes clinic attendees from two geographical locations completed a questionnaire one year after the final meter changeover date. In the first location, consecutive patients were asked to complete a glucose meter satisfaction questionnaire during their clinic visit. In the second location, this questionnaire was mailed to clinic attendees. Responses to open questions were analyzed thematically.Response rates were 85% and 31% from the first and second locations, respectively and 378 questionnaires were suitable for analysis, 309 from the first and 69 from the second location. Insulin users composed 90% of participants. Results from the two locations were broadly similar. Most participants adapted well to the changeover, however 36% reported ongoing dissatisfaction with their "new" meter. The commonest concern, expressed by 23% of participants, related to meter accuracy and precision.One year after glucose meter changeover, a third of participants expressed dissatisfaction with their meter, with many participants describing a failure to adapt to the sole supplier arrangement. Providing a choice of meters and strips, ideally from two or more brands that have demonstrable differences in technical and ergonomic features, is likely to produce higher overall patient satisfaction than is a sole supplier arrangement.

The objective was to determine the effect of a single dose of espresso caffeinated coffee, decaffeinated coffee, or water on glucose tolerance and insulin sensitivity in people with type 2 diabetes mellitus. Eighteen participants who were habitual coffee drinkers, were studied using a random-order cross-over design. After a fasting blood sample participants consumed either a double-shot black espresso coffee, decaffeinated coffee, or hot water. The main outcomes were area under the curve (AUC) glucose and insulin, and insulin sensitivity (Matsuda index) during a 75 g oral glucose tolerance test (OGTT) performed one hour later. Other outcomes were change in glucose and insulin and also the insulinogenic index (IGI) and disposition index (DI). AUC glucose was marginally different between beverages ( P =.06) being greater following caffeinated coffee than water, mean difference 104 mmol/L/180 min (95% CI 0.1 to 198.1, P =.031), or decaffeinated coffee, mean difference 92.1 mmol/L/180 min (95% CI −1.9 to 186.1, P =.055). There was no difference in AUC insulin ( P =.87) or insulin sensitivity ( P =.47), nor in change in glucose or insulin over the hour following beverage consumption. There was a marginal difference in IGI between beverages ( P =.097) with coffee having a lower incremental increase in insulin/glucose than water ( P =.037) though no difference between coffee and decaffeinated coffee ( P =.54) and no difference in DI ( P =.23). Black espresso coffee in people with type 2 diabetes mellitus results in a marginally greater excursion of glucose during a following OGTT compared with water or decaffeinated coffee. This effect does not appear to be mediated by changes in insulin sensitivity.

The present study considers how the athletic performance of minority groups relates to national subjective well-being (SWB) and life expectancy. Based on the argument that sports represent a microcosm of society and the reliable finding that national inequality is associated with reduced SWB, we hypothesized that greater opportunities for typically disadvantaged groups within sports should be positively related to national indicators of well-being. Study 1 compared the relation of success in the Paralympics versus the Olympics to national subjective well-being and life expectancy. The results supported our hypothesis. In Study 2 we conceptually replicated these results using the standings of national men’s and women’s soccer teams. Overall, it appears that the opportunities to compete in sports that nations afford to members of disadvantaged groups reflect on the health and well-being of the entire society.

The present paper explored the relation of wealth and support for self-determination to national subjective well-being (SWB). Support for self-determination was considered from both a political and cultural values standpoint. The results confirmed associations between wealth, support for self-determination, and well-being in a large sample of countries. Importantly, political and cultural value supports for self-determination remained significantly associated with national well-being (as measured by happiness reports and life expectancy) even after controlling for national differences in wealth.

The authors examined whether independent or interdependent self-construals were associated with the way in which individuals pursued personal goals. Individuals with an independent self-construal orient toward personal-goal pursuit, whereas individuals with interdependent self-construal prioritize in-group goals above personal ones. The authors used a 1-week, prospective goal-setting paradigm. The present results revealed that interdependent self-construals were significantly associated with introjected reasons for pursuing goals, experiencing conflict among goals, and achieving less goal progress. Independent self-construals were significantly associated with intrinsic and identified reasons for goal pursuit and greater goal progress. There was some evidence that the relation of interdependent and independent self-construals to goal progress was mediated by goal conflict and goal intrinsic motivation, respectively. The present results also replicated previous research indicating the goal-setting benefits of intrinsic motivation, implementation intentions, and goal harmony.

The cultural internalization and competence of a diverse sample of tricultural university students was assessed. Based on recent research on the internalization of cultural norms, it was predicted that (a) having a heritage culture that embraced egalitarian values would be conducive to autonomous internalization and cultural competence, (b) competence and internalization would be associated with positive affect in heritage cultural contexts, and (c) the same positive relations between competence, internalization, and affect would be evident in English Canadian and French Canadian contexts. The study included 113 participants representing more than 35 distinct ethnicities. Results supported the hypothesized relations among egalitarianism, autonomous internalization, competence, and affect. Furthermore, the results indicated that individuals’ cultural adaptation in both heritage and English Canadian cultures, combined with the extent to which they had integrated their cultural identities in their self, predicted psychological wellbeing.

The authors used an event-contingent daily recording strategy, the Rochester Interaction Record (RIR), to examine the motivational dynamics of interpersonal relations. Using hierarchical linear modeling, the authors demonstrated that social interactions were more pleasant when participants felt autonomous, competent, and related. Autonomy, competence, and relatedness consistently predicted interaction quality, regardless of (a) the length of the interaction; (b) whether it was dyadic or in a group; and (c) whether it was an interaction with family, friends, or acquaintances. However, participants were more likely to report feeling autonomous and related when they were interacting either with family members and friends or in a dyadic situation. These results suggest that experiences of autonomy, competence, and relatedness may make a good day partly because they produce satisfying interpersonal experiences.

Previous research has demonstrated that autonomy support is one particularly effective means of promoting internalization and fostering well-being. The present study sought to determine if this would also be the case with regards to culture by testing the relation of perceived parental autonomy support to the cultural internalization and well-being of multicultural students. In Study 1, 105 multicultural participants living in Canada were more likely to have fully internalized their host and heritage cultures and to have higher self-reported well-being when they reported that their parents were autonomy supportive. In Study 2, 125 Chinese-Malaysians sojourners were also more likely to have fully internalized their heritage culture and indicated higher well-being when they perceived their parents as autonomy supportive. In both studies, heritage cultural internalization was also associated with higher well-being.

In the present study the authors used an event-contingent daily recording strategy, the Rochester Interaction Record, to examine the relation of perceived evaluations of a multicultural person's heritage group to the nature and quality of his or her social interactions. Hierarchical linear modeling showed that having an interaction partner who positively evaluated one's heritage culture was associated with significantly enhanced interaction intimacy, disclosure, and quality, as well as with feelings of personal acceptance. Moderator analyses revealed that individuals who possessed a chameleon-like cultural identity and those who had low public collective self-esteem were particularly reactive to how their heritage group was being evaluated.

We have found these assessment tools to be both trainee centred and training centred. The trainee initiates assessment with a choice of both patient and assessor. The use of a variety of clinical skills, patients, and pathologies on multiple occasions allows for broad based, fair assessment. In particular, the case based discussion focuses on a trainee's understanding and thought process. This allows an opportunity to discuss and analyse a trainee's clinical thinking and decision making. It provides …

Introduction Premix insulin analogs are a well-established treatment for type 2 diabetes (T2D). However, there is a lack of simple, clear guidance on some aspects of their use. These include choosing a regimen for insulin initiation, recognizing when patients need intensification of therapy, and switching from basal–bolus to a premix insulin analog when appropriate. Methods An independent expert panel formulated recommendations on the use in T2D of the premix insulin analog formulations widely available in Australasia, based on the available evidence and their own experience. Results Results from trials in both initiation and intensification of insulin show that no single insulin or regimen is best on all endpoints, and that improved glycemic control can be expected regardless of which regimen is used. Thus, individual patient factors and preferences become more important. Guidance is presented to help the clinician choose between a premix insulin analog or basal analog for insulin initiation, and to intensify insulin therapy using premix insulin analogs. Recommendations are made on dosing, titration, the concomitant use of non-insulin glucose-lowering drugs, and other practical issues, and on the special case of switching from basal–bolus to premix insulin analog therapy. Conclusion This guidance is intended to help both general and specialist practitioners make informed choices and provide optimal care for patients with T2D. It emphasizes the importance of taking into account individual patient factors and preferences so that the choice of insulin regimen is individualized to the patient in the same way that glycemic targets are now individualized. Funding Novo Nordisk Region IO A/S. Electronic supplementary material The online version of this article (doi:10.1007/s13300-015-0116-0) contains supplementary material, which is available to authorized users.