Why Are We Stuck? Therapeutic Inertia in Diabetes Education.

Diabetes educators can be challenged by therapeutic inertia, as has been documented with other health care providers. There are many contributing factors related to the educators themselves, their patients, and the health care system in which they operate. To address this potentially significant barrier to quality patient care, diabetes educators can adopt numerous strategies to maximize their impact and address the factors contributing to therapeutic inertia in their practices.

Role of Physical Activity for Weight Loss and Weight Maintenance.

IN BRIEF This article reviews the impact of exercise on weight loss and weight maintenance and the possible reasons that weight loss outcomes resulting from exercise are not consistently realized.

Impact of Diabetes Self-Management Education/Support on Self-Reported Quality of Life in Youth With Type 1 or Type 2 Diabetes.

PURPOSE: The persistent requirement of self-management for diabetes impacts quality of life (QoL), yet the literature for impact of diabetes self-management education and support (DSMES) on QoL in youth has not been synthesized and reported. The purpose of this review was to systematically identify and describe the state of the science exploring the impact of DSMES on self-reported QoL in youth with type 1 diabetes (T1DM) or type 2 diabetes (T2DM). METHODS: A modified Cochrane review was conducted. Retained studies were published in the English language between January 1, 2007, and March 31, 2020. Included studies specified that the intervention had diabetes education addressing at least 1 or more of The Association of Diabetes Care & Education Specialists' ADCES7 Self-Care BehaviorsTM (ADCES7™) and used an established self-reported QoL measure. Retained studies were assessed for risk of bias. RESULTS: Eleven studies reported in 12 articles were retained. The interventions were primarily delivered to youth with T1DM or T2DM and included caregivers/families in some studies. The ADCES7™ were addressed across the retained studies. Five of the 11 studies assessed QoL as the primary outcome and 6 studies as a secondary outcome. CONCLUSION: To enhance the QoL outcomes and to provide insight into how to positively impact self-perceptions of QoL, ongoing generic and diabetes-specific QoL assessments are warranted for youth with T1DM or T2DM. Further research is needed in structured DSMES programs to help reduce variability in research designs, methods, measures, and outcomes to generate evidence for best practices that can be translated and disseminated into real-world settings.

A Quality Improvement Initiative to Reduce Unnecessary Rapid Responses Using Early Warning Scores.

OBJECTIVES: The Pediatric Early Warning Score (PEWS) is an evidence-based tool that allows early collaborative assessment and intervention for a rapid response team (RRT) activation. The goal of our quality improvement initiative was to reduce the percentage of unnecessary RRT activations by 50% over 2 years without increasing PICU transfers or compromising patient safety and timely evaluation. METHODS: A PEWS system replaced preexisting vital signs-based pediatric RRT criteria and was modified through plan-do-study-act cycles. Unnecessary RRT activations, total RRT activation rate, transfers to the PICU, total clinical interventions performed per RRT, and missed RRT activation rate were compared between intervention periods. Likert scale surveys were administered to measure satisfaction with each modification. RESULTS: There was a significant decrease in the percentage of unnecessary RRT activations from 33% to 3.5% after the implementation of the PEWS and modified-PEWS systems (P < .05). The RRT activation rate decreased from 22.6 to 13.3 RRT activations per 1000 patient care days after implementation of the PEWS and modified-PEWS systems (P < .05), without changes in PICU transfer rates. Physicians reported that the PEWS system improved nursing communication and accuracy of RRT criteria (P < .05). Nursing reported that the PEWS system improved patient management and clinical autonomy (P < .05). CONCLUSIONS: The PEWS systems have been an effective means of identifying deteriorating pediatric patients and reducing unnecessary RRT activations. The new system fosters collaboration and communication at the bedside to prevent acute deterioration, perform timely interventions, and ultimately improve patient safety and outcomes.

Technology Integration: The Role of the Diabetes Care and Education Specialist in Practice.

PURPOSE: Technology is rapidly evolving and has become an integral component of diabetes care. People with diabetes and clinicians are harnessing a variety of technologies, including connected blood glucose meters, continuous glucose monitors, insulin pumps, automated insulin delivery systems, data-sharing platforms, telehealth, remote monitoring, and smartphone mobile applications to improve clinical outcomes and quality of life. Although diabetes technology use is associated with improved outcomes, this is enhanced when the person using it is knowledgeable and actively engaged; simply wearing the device or downloading an app may not automatically translate into health benefits. The diabetes care and education specialist (DCES) has a central role in defining and establishing a technology-enabled practice setting that is efficient and sustainable. The purpose of this article is to describe the role of the DCES in technology implementation and to demonstrate the value of diabetes technology in both the care of the individual and as a tool to support population-level health improvements. CONCLUSION: By following the recommendations in this article, DCESs can serve as technology champions in their respective practices and work to reduce therapeutic inertia while improving health outcomes and providing patient-centered care for the populations they serve.

The 2017 Diabetes Educator and the Diabetes Self-Management Education National Practice Survey.

Purpose The American Association of Diabetes Educators conducts the National Practice Survey (NPS) biennially to document current practice in diabetes education in the United States. The purpose of the study is to obtain insight about factors influencing the work of the diabetes educator. Method The 2017 NPS was comprised of 100 questions covering diabetes educator demographics, profile populations of people with diabetes, practice information, program accreditation, program curriculum, staffing, education delivery methods, data collection, and reporting. The basic survey consisted of 22 questions using branch logic, from which respondents were then directed to questions tailored to their particular practice setting, enabling them to answer only a relevant subset of the remaining questions. The web-based survey was sent to approximately 32 000 individuals who were either members of the American Association of Diabetes Educators (AADE) or Certified Diabetes Educators (CDE) with the National Certification Board for Diabetes Educators (NCBDE) but not AADE members. Weekly reminder e-mails were sent to recipients who had not yet responded. The outreach efforts resulted in the survey being completed by 4696 individuals, a 17% response rate yielding 95% confidence that these responses are within ±5% accuracy. Results Diabetes Self-Management Education and Support (DSMES) continues to be a field dominated by women (95%). Diabetes educators represent a diverse health care profession, with educators indicating most commonly that their primary discipline is nursing (48%), nutrition (38%), and pharmacy (7%). When asked about credentials, 82.6% indicated that they held a CDE, 3.8% held the Board Certified-Advanced Diabetes Management (BC-ADM) credential, and 16.5% held neither the CDE nor the BC-ADM. Nearly 75% characterized their role as a diabetes educator as providing direct patient care. DSMES continued to be provided in a varied array of settings to educationally, socioeconomically, and racially diverse patient populations. DSMES was delivered using a number of different educational strategies. Diabetes educators have direct influence in care and services that people with diabetes receive. Conclusions The results of the 2017 NPS demonstrate that diabetes educators are meeting the needs of varied populations in various practice settings. They are working with individuals with type 1 and type 2 diabetes, those at risk for diabetes, and women with gestational diabetes and are involved in recommending, implementing, and providing key referrals and recommendations for diabetes care, including insulin initiation, titration, medication adjustments, recommendations on devices, and technology. Identified areas for improvement include needs for increased racial and ethnic diversity in the workforce, recruiting young professionals, drawing practice approaches from related disciplines (eg, mental health and disability rehabilitation), and encouraging tracking of more areas of outcomes data. Diabetes educators are playing an increasingly central role within multidisciplinary care teams with people at risk for diabetes, those who have diabetes, and those with other chronic conditions.

Hydration status and water turnover of dogsled drivers during an endurance sled dog event in the arctic.

OBJECTIVES: To determine changes in common urinary markers of hydration maintained by the drivers (mushers) during a wilderness endurance event in the arctic and to determine water turnover in this select group of individuals. STUDY DESIGN: During this descriptive study, data was systematically collected on hydration, water turnover, changes in resting and exercise heart rate, fatigue and rating of perceived exertion during an arduous dogsled race in the arctic. METHODS: Sixteen mushers were recruited for the study, 13 of whom completed the entire race. At five different checkpoints along the 1049-mile trail (symbolic distance), urine was collected. Urine osmolality (U(osm)) was determined using freezing point depression. Urine specific gravity (U(sg)) was determined using a hand-held refractometer. Water turnover was measured in 5 mushers from rates of deuterium (2H2O) elimination (rH2O). Prior to the start of the race, and at five checkpoints along the trail, a resting heart rate, fatigue rating scale and a rating of perceived exertion (RPE), were collected. RESULTS: Out of the 13 subjects that completed the event, four of the mushers had a U(sg) > or = 1.030 (mean 1.023 +/- 0.007) at some point during the event. Ten had a urine osmolality > or = 900 mOsm L(-1) at some point during the event, with an average U(osm) of 868 +/- 277 mOsm L(-1) over the duration of the event. Water turnover demonstrated that rH2O averaged 2.85 +/- 1.18 ml kg(-1) day(-1) (range 2.03 -4.60) over the duration of the event. Resting heart rate increased significantly over the course of the race. The RPE was related to the overall fatigue rating scale. CONCLUSIONS: These data demonstrate that the majority of mushers studied showed signs of dehydration based on common urinary markers during the long-distance dogsled race. The dehydration appears to have had an influence on the resting heart rate, overall fatigue and the rating of perceived exertion during the race.

Alzheimer's Research UK 2016 Conference report.

The annual Alzheimer's Research UK (ARUK) Conference was hosted by the Manchester and North West Network Centre on March 8-9, 2016. In this report, we provide a summary of the research presented.

Report from the Alzheimer's Research UK Conference 2015.

On 10-11 March 2015 University College London hosted the annual Alzheimer's Research UK Conference. This report provides an overview of the presentations and discussions that took place.

Dietary (-)-epicatechin as a potent inhibitor of ßγ-secretase amyloid precursor protein processing.

Flavonoids, a group of dietary polyphenols have been shown to possess cognitive health benefits. Epidemiologic evidence suggests that they could play a role in risk reduction in dementia. Amyloid precursor protein processing and the subsequent generation of amyloid beta (Aß) are central to the pathogenesis of Alzheimer's disease, as soluble, oligomeric Aß is thought to be the toxic species driving disease progression. We undertook an in vitro screen to identify flavonoids with bioactivity at ßγ-mediated amyloid precursor protein processing, which lead to identification of a number of flavonoids bioactive at 100 nM. Because of known bioavailability, we investigated the catechin family further and identified epigallocatechin and (-)-epicatechin as potent (nanomolar) inhibitors of amyloidogenic processing. Supporting this finding, we have shown reduced Aß pathology and Aß levels following short term, a 21-day oral delivery of (-)-epicatechin in 7-month-old TASTPM mice. Further, in vitro mechanistic studies suggest this is likely because of indirect BACE1 inhibition. Taken together, our results suggest that orally delivered (-)-epicatechin may be a potential prophylactic for Alzheimer's disease.

AMPA receptor activation promotes non-amyloidogenic amyloid precursor protein processing and suppresses neuronal amyloid-ß production.

Soluble oligomeric amyloid ß peptide (Aß) generated from processing of the amyloid precursor protein (APP) plays a central role in the pathogenesis of Alzheimer's Disease (AD) and through actions at glutamatergic synapses affects excitability and plasticity. The physiological control of APP processing is not fully understood but stimulation of synaptic NMDA receptors (NMDAR) can suppress Aß levels through an ERK-dependent increase in α-secretase activity. AMPA-type glutamate receptors (AMPAR) couple to ERK phosphorylation independently of NMDAR activation raising the possibility that stimulation of AMPAR might similarly promote non-amyloidogenic APP processing. We have tested this hypothesis by investigating whether AMPAR directly regulate APP processing in cultured mouse cortical neurons, by analyzing APP C-terminal fragments (CTFs), soluble APP (sAPP), Aß levels, and cleavage of an APP-GAL4 reporter protein. We report that direct stimulation of AMPAR increases non-amyloidogenic α-secretase-mediated APP processing and inhibits Aß production. Processing was blocked by the matrix metalloproteinase inhibitor TAPI-1 but was only partially dependent on Ca(2+) influx and ERK activity. AMPAR can therefore, be added to the repertoire of receptors that couple to non-amyloidogenic APP processing at glutamatergic synapses and thus pharmacological targeting of AMPAR could potentially influence the development and progression of Aß pathology in AD.

Case study of training, fitness, and nourishment of a dog driver during the Iditarod 1049-mile dogsled race.

The purpose of the present case study was threefold: (a) to estimate intake and expenditure of a dog driver (musher) while participating in the Iditarod, (b) to determine the hydration status of the musher at the completion of the event, and (c) to evaluate training related changes in aerobic capacity and body composition of a long-distance dog sled driver in preparation for and following completion of a 1049-mile (1692-km) sled dog race. Actual energy intake during the Iditarod Sled Dog Race was estimated at 8,921 kilojoules (kJ) per day. Nutrient intake expressed as percentage kJ of total energy (14%, 44% and 42% for protein, carbohydrates, and fat, respectively). Weight loss of .72 kg of body weight indicated an energy deficit of 1819 kJ per day during the race. Total energy needs per day were calculated to be 10,740 kJ/day. An increase in hematocrit and hemoglobin during the race may indicate dehydration during the event. There was an improvement in aerobic fitness during on-snow training as determined by ventilatory threshold and VO2peak data. Fat-free mass was maintained during training (46.4 kg), with a concomitant decrease in fat (2.4 kg). Fat-free mass was also maintained during the 12-day race.