The effect of basal-bolus therapy varies with baseline 1,5-anhydroglucitol level in people with Type 2 diabetes: a post hoc analysis.

AIMS: To investigate the impact of baseline 1,5-anhydroglucitol on the treatment effect of basal-bolus therapy in people with Type 2 diabetes. METHODS: Post hoc analysis of onset 3, an 18-week, randomized, phase 3 trial evaluating the efficacy and safety of fast-acting insulin aspart in basal-bolus therapy (n = 116) vs. basal insulin-only therapy (n = 120) in people with Type 2 diabetes. The estimated treatment difference in change from baseline in HbA1c was investigated for different cut-off values of baseline 1,5-anhydroglucitol (2, 3, 4, 5 and 6 µg/ml). RESULTS: The estimated treatment difference in change from baseline in HbA1c between basal-bolus therapy and basal insulin-only therapy was statistically significantly greater in participants with baseline 1,5-anhydroglucitol ≤3 µg/ml (n = 34) vs. >3 µg/ml (n = 198) [estimated treatment difference (95% CI): -1.53% (-2.12; -0.94) vs. -0.82% (-1.07; -0.57); P-value for interaction = 0.03]. The estimated treatment difference became more pronounced when comparing participants with 1,5-anhydroglucitol ≤2 µg/ml (n = 15) vs. >2 µg/ml (n = 217) [estimated treatment difference (95% CI): -2.26% (-3.15; -1.36) vs. -0.85% (-1.08; -0.62); P-value for interaction = 0.003]. For cut-off values ≥4 µg/ml, estimated treatment differences were numerically greater below the cut-off compared with above, although the interaction terms were not statistically significant. CONCLUSION: This analysis indicates that people with Type 2 diabetes with low 1,5-anhydroglucitol have an added treatment benefit with basal-bolus therapy compared with people with higher 1,5-anhydroglucitol. Further research is needed to clarify any clinical utility of these findings. Clinical Trials Registry No: NCT01850615.

Resource utilisation and quality of life following initiation of insulin detemir in patients with type 2 diabetes mellitus.

OBJECTIVE: Barriers to insulin initiation in type 2 diabetes mellitus (T2DM) include fear of treatment complexity and perceived lack of time and resources by primary care physicians. The SOLVE study investigated the effect of insulin initiation on resource utilisation and patient quality of life. METHODS: SOLVE was a 24-week cohort study in 10 countries evaluating the safety and effectiveness of initiating once-daily insulin detemir in patients with T2DM. Patient quality of life was assessed using the Insulin Treatment Appraisal Scale (ITAS). RESULTS: A total of 14,611 (84%) patients completed the 24-week study. During the study, HbA1c improved by 1.3 ± 1.5%. The corresponding insulin dose increased from 13 ± 6 IU (0.16 ± 0.09 IU/kg) at baseline, to 22 ± 16 IU (0.27 ± 0.17 IU/kg) at final visit. FlexPen was the preferred device (63%) for insulin administration. The time taken to teach patients to self-inject and perform dose self-adjustment was 15 ± 13 min and 11 ± 11 min, respectively. The quality of life analysis included 6875 patients. The addition of insulin was associated with an improvement in mean ITAS score [-3.5 (95% CI -3.8, -3.3), p < 0.001]. Physicians reported the use or self-adjustment of insulin detemir as easy or very easy in 79% of participants; and satisfaction with the level of glycaemic control was reported for 74% of patients. CONCLUSIONS: Initiating basal insulin therapy resulted in a substantial decrease in HbA1c and improved patients' perceptions of insulin treatment.

Environmental and ichthyofaunistic characteristics of Amazonian streams with and without fish farm.

The environmental impacts caused by fish farming can lead to changes in aquatic ecosystems, especially in fish communities. In this study, we investigated possible changes in water quality, in the number of species and individuals of the same species caused by the construction of fish nurseries in dammed Amazonian streams. For this purpose, four streams located in the municipalities of Novo Airão and Presidente Figueiredo were selected. Samples were collected in streams without fish farming and in streams with stretches used for fish farming, where collections took place both downstream and upstream. The fish were captured, identified, quantified and the water was collected for physical and chemical analyses, in addition to the environmental characterization that was carried out. Comparisons were made using fish richness and abundance indices between the sampled points and correspondence analysis of the species identified at the collection sites, using the Mantel test and principal component analysis (PCA) for the environmental characteristics of the water and variables physical and chemical, and permutational multivariate analysis of variance (PERMANOVA) to verify the possible effects of species composition on the sampled conditions and on the analyzed environmental variables. In total, 2,302 fish belonging to 53 species, 15 families and six orders were found. We conclude that the Amazonian streams dammed for fish farming, under the analyzed conditions, can be characterized as environments with different and specific levels of richness and abundance, however, the data set analyzed in this study did not show that these characteristics are directly related to productive activity. We recommend that further studies be carried out following the current research.

The safety and efficacy of adding once-daily insulin detemir to oral hypoglycaemic agents in patients with type 2 diabetes in a clinical practice setting in 10 countries.

AIMS: Evaluate the safety and efficacy of once-daily insulin detemir initiated in routine clinical practice in patients with type 2 diabetes mellitus inadequately controlled with oral hypoglycaemic agents (OHAs). METHODS: This large observational study was conducted in 10 countries. Adverse event data (including hypoglycaemia) and glycaemic control were recorded before and 24 weeks following insulin initiation while patients continued routine clinical management. RESULTS: In this study, 17 374 patients (53% male) were included. Mean pre-insulin values (±s.d.) were: age 62 ± 12 years; body mass index (BMI) 29.3 ± 5.4 kg/m(2); diabetes duration 10 ± 7 years; haemoglobin A1c (HbA1c) 8.9 ± 1.6%. During the study, 27 patients experienced serious adverse drug reaction, severe hypoglycaemic events or both; and there were 31 episodes of severe hypoglycaemia in 21 patients. After 24 weeks, HbA1c was 7.5 ± 1.2% (change of -1.3%; p < 0.001) and mean weight change was -0.6 kg (confidence interval -0.7, -0.5 kg, p < 0.001). Daily insulin dose increased from 13 ± 6 U (0.16 ± 0.09 U/kg) to 22 ± 16 U (0.27 ± 0.17U/kg) by 24 weeks. Multivariate regression analysis identified several independent demographic and treatment predictors of end of study HbA1c. CONCLUSIONS: Addition of once-daily insulin detemir to patients with type 2 diabetes mellitus on OHA therapy resulted in few adverse events, significant improvements in glycaemic control, small reductions in weight and low rates of hypoglycaemia. On the basis of this study, concerns about hypoglycaemia or weight gain should not preclude initiation of basal insulin analogues in patients with poor glycaemic control on OHAs.

[Once daily insulin detemir in patients with type 2 diabetes: results of German centers in a 6-month international observational study (SOLVE)]. / Einmal täglich Insulin detemir bei Patienten mitTyp-2-Diabetes. Ergebnisse deutscher Zentren aus einer 6-monatigen internationalen Beobachtungsstudie (SOLVE).

BACKGROUND: Hypoglycemic risk and improved glycemic control have to be weightened when a decision on intensification of treatment of type 2 diabetes mellitus with basal insulin is made. Findings from randomized studies are available in this respect, and should be complemented by data from routine treatment. METHODS: The international, prospective, open-label, observational study SOLVE (Study of Once-Daily Levemir) investigated add-on treatment with basal insulin in type 2 diabetes mellitus using once daily insulin detemir in patients currently receiving oral antidiabetic drugs (OAD). Data were collected between initiation of insulin treatment and the final visit after approximately 24 weeks. The primary objective of the study was to evaluate the incidence of serious adverse drug reactions (SADR), including major hypoglycemic events. RESULTS: In Germany, 2,090 patients were eligible for the full analysis set and 1,671 patients for the effectiveness analysis set. The mean age was 64.9 years, mean duration of diabetes 9.36 years, and mean duration of OAD treatment 7.29 years. Three patients (0.14%) experienced a SADR (1 fall resulting in death, 2 major hypoglycemic events). At the final visit, there was a significant reduction in major hypoglycemic events if compared with the period before starting insulin treatment (0.002 versus 0.120 events per patient year, p < 0.001), as were minor hypoglycemic events (0.880 versus 1.588 events per patient year, p = 0.006). The mean body weight and BMI decreased by -0.9 kg (p < 0.001) and-0.35 kg/m2 (p < 0.001) respectively and the mean HbA(1c) level improved from 8.45 +/- 1.19% to 7.30 +/- 0.92% (-1.15 +/- 1.08%; p < 0.001). The mean fasting plasma glucose level and plasma glucose variability were significantly reduced. CONCLUSION: Baseline data of the study underline the need for earlier intensification of antidiabetic therapy in type 2 diabetes in Germany. Study results show that within the German diabetes care system, initiation of basal insulin therapy with insulin detemir is able to result in significant HbA(1c) improvements without increased risk of hypoglycemia and/or weight gain.

Hematological parameters of three species of the peacock bass (Cichla spp.) from Balbina lake, Presidente Figueiredo, Amazonas, Brazil.

The objective of this study was to characterize and compare the hematological variables (erythrogram, thrombogram, leukogram and plasma metabolites) of three cichlid species: Cichla monoculus, Cichla temensis and Cichla vazzoleri. A total of 45 specimens were captured in Balbina lake, Presidente Figueiredo, Amazonas, Brazil, with the aid of a rod and reel or hand line, with natural or artificial bait: 15 C. monoculus, 15 C. temensis and 15 C. vazzoleri. Their blood was removed by means of caudal puncture of the dorsal aorta, and hematological data were determined in accordance with methodology previously described in the literature. The erythrogram showed similarities between the species, while the thrombogram showed differences between C. vazzoleri and the other species studied (C. monoculus and C. temensis). The total leukocyte counts for C. temensis and C. vazzoleri were higher than those of C. monoculus. The predominant leukocyte in C. temensis and C. vazzoleri was lymphocytes, whereas it was monocytes in C. monoculus. The plasma metabolites showed differences between the three cichlid species, regarding their glucose, cholesterol, urea and potassium levels. It is concluded that these three species present hematological differentiation, thus indicating that they have differentiated blood-cell immune responses and plasma metabolite physiology.

Growth and hematological responses of tambaqui, Colossoma macropomum fed different levels of rice, Oryza spp.

The tambaqui (Colossoma macropomum) is a fish of primary importance in South American aquaculture, principally in the Amazon region and has a particularly unique diet in the wild. Oryza spp, or Wild rice as it is commonly known, is native to the floodplains of muddy rivers in the Amazon region. The aim of this study was to analyze the physical performance and the effects of dietary levels of Oryza spp. via the hematological parameters, total food intake, conversion efficiency, growth ratio and swimming performance of this fish. Diets containing 45% Oryza spp. induced the best performance in tambaqui. Diets containing 15% and 30% did not affect these indices, thus indicating that this amount of Oryza can be used as an alternative energy source for this important species within Brazilian aquaculture.

Mid- and high-ratio premix insulin analogues: potential treatment options for patients with type 2 diabetes in need of greater postprandial blood glucose control.

Some patients with type 2 diabetes continue to have high postprandial blood glucose levels on twice-daily regimens of 'low-ratio' premix insulin formulations (up to 30% rapid-acting, with 70% protracted insulin). These patients require intensified insulin therapy, which can be provided by a twice- or thrice-daily regimen of mid-ratio (50% rapid-acting and 50% protaminated intermediate-acting insulin - human or analogue) or high-ratio (70% rapid-acting and 30% protaminated insulin - analogue only) premix insulin. Alternatively, a third daily injection of low-ratio premix insulin can be added to the regimen, with the option of incorporating one or more injections of mid- or high-ratio premix as required, and as an alternative to basal-bolus therapy. How these mid- and high-ratio formulations differ from the low-ratio premix insulins is reviewed here, with the aim of identifying the role of these formulations in diabetes management. Glucose clamp studies have shown that premix analogues give serum insulin levels proportional to their percentage of rapid-acting uncomplexed insulin: the higher the proportion, the greater the maximum level reached. Other pharmacokinetic parameters were not always significantly different between the mid- and high-ratio formulations. In clinical trials, postprandial plasma glucose and glycated haemoglobin A1c (HbA(1c)) levels were significantly reduced with thrice-daily mid- /high-ratio premix analogue when compared with twice-daily low-ratio biphasic human insulin (BHI) 30/70 or once-daily insulin glargine. Moreover, glycaemic control with mid-/high-ratio premix analogue was found to be similar to that with a basal-bolus therapy. Mid- and high-ratio premix regimens are generally well tolerated. The frequency of minor hypoglycaemia was reportedly higher with mid- /high-ratio premix analogues than with BHI 30, but nocturnal hypoglycaemia was less frequent. Although there is little evidence that clinical outcomes with mid-ratio premix analogues are different from those with high-ratio, they are useful additions to the low-ratio formulations for the management of diabetes, and addressing postprandial hyperglycaemia in particular.

Comparison of insulin analogue regimens in people with type 2 diabetes mellitus in the PREFER Study: a randomized controlled trial.

AIMS: Insulin analogues are widely used but few data exist comparing different analogue regimens. We compared two such regimens in type 2 diabetes mellitus (T2DM) uncontrolled by oral antidiabetic agents (OADs) with or without basal insulin. METHODS: In a 26-week multinational, multicentre, randomized treat-to-target trial, OADs were discontinued and subjects randomized to analogue basal-bolus therapy (insulin detemir once daily and insulin aspart mealtimes) or biphasic insulin aspart 30 (30% rapid-acting insulin aspart), twice daily. Insulin was titrated to targets for fasting, predinner and postprandial plasma glucose (PG), as appropriate. RESULTS: Of 719 subjects, 92% completed the study; 58% achieved haemoglobin fraction A(1c) (HbA(1c)) < or =7.0%, with reductions of 1.56% (to 6.96%) with basal-bolus therapy and 1.23% (to 7.17%) with biphasic insulin aspart. Reduction with basal-bolus therapy was superior in the overall population by 0.23% (p = 0.0052), with no difference between regimens in insulin-naive patients. Major hypoglycaemia occurred in five basal-bolus patients (0.9%) and in no patients with biphasic insulin aspart. Incidence of minor hypoglycaemia was similar in both groups. All insulin doses increased during titration, with increase in lunchtime insulin aspart dose and equal distribution of breakfast and dinner biphasic insulin aspart doses. Insulin detemir remained once daily in 87% of patients. CONCLUSIONS: Modern insulin analogue regimens, adjusted to PG targets, enable a majority of people with T2DM to reach HbA(1c)< or =7.0% after failure of OADs and OAD-basal insulin therapy. Insulin-treated patients may benefit more from transfer to analogue basal-bolus therapy, while insulin-naive individuals benefit equally well from the more convenient biphasic analogue regimen.

Three different premixed combinations of biphasic insulin aspart - comparison of the efficacy and safety in a randomized controlled clinical trial in subjects with type 2 diabetes.

AIM: To evaluate clinical efficacy and safety of biphasic insulin aspart (BIAsp) 30 twice daily (b.i.d.) vs. BIAsp 50 or BIAsp 70 (high-mix regimens) thrice daily (t.i.d.) all in combination with metformin in a 36-week clinical trial in subjects with type 2 diabetes. METHODS: Efficacy measurements included haemoglobin A(1c) (HbA(1c)) and eight-point plasma glucose (PG); safety included adverse events (AEs) and hypoglycaemic episodes. The three treatment groups (approximately 200 subjects in each group) were well matched regarding sex ratio, ethnicity, age and body mass index. RESULTS: After 12 weeks, 43% and 54% in the BIAsp 50 and 70 groups, respectively, switched their dinner insulin to BIAsp 30. Both high-mix regimens were non-inferior to BIAsp 30 b.i.d., as measured by change in HbA(1c), and the BIAsp %50 regimen was superior. The odds for meeting the American Diabetes Association and The American Association of Clinícal Endocrinologist HbA(1c) targets of <7% and < or =6.5%, respectively, were significantly higher with the BIAsp 50 regimen than with BIAsp 30. A significantly lower PG level was achieved from lunch until 02:00 hours with both high-mix regimens compared with BIAsp 30 b.i.d. AEs were mild or moderate with all three regimens. Frequency of hypoglycaemic episodes was comparable for the BIAsp 50 and the BIAsp 30 b.i.d. regimens but was significantly higher with BIAsp 70 t.i.d. CONCLUSIONS: Glycaemic control improved with BIAsp 50 t.i.d. without higher incidence of hypoglycaemia compared with BIAsp 30 b.i.d.; with BIAsp 70 t.i.d. lower PG levels from lunch to 02.00 hours, but more hypoglycaemic episodes were obtained compared with BIAsp 30 b.i.d.

A reduction in severe hypoglycaemia in type 1 diabetes in a randomized crossover study of continuous intraperitoneal compared with subcutaneous insulin infusion.

AIM: Continuous intraperitoneal insulin infusion (CIPII) with the DiaPort system using regular insulin was compared to continuous subcutaneous insulin infusion (CSII) using insulin Lispro, to investigate the frequency of hypoglycemia, blood glucose control, quality of life, and safety. METHODS: In this open, randomized, controlled, cross-over, multinational, 12-month study, 60 type 1 diabetic patients with frequent hypoglycemia and/or HbA1c > 7.0% with CSII were randomized to CIPII or CSII. The aim was to obtain the best possible blood glucose while avoiding hypoglycemia. RESULTS: The frequency of any hypoglycemia was similar (CIPII 118.2 (SD 82.6) events / patient year, CSII 115.8 (SD 75.7) p = 0.910). The incidence of severe hypoglycemia with CSII was more than twice the one with CIPII (CIPII 34.8 events / 100 patient years, CSII 86.1, p = 0.013). HbA1c, mean blood glucose, and glucose fluctuations were not statistically different. Treatment-related severe complications occurred mainly during CIPII: port infections (0.47 events / patient year), abdominal pain (0.21 events / patient year), insulin underdelivery (0.14 events / patient year). Weight gain was greater with CSII (+ 1.5 kg vs. - 0.1 kg, p = 0.013), quality of life better with CIPII. CONCLUSIONS: In type 1 diabetes CIPII with DiaPort reduces the number of severe episodes of hypoglycemia and improves quality of life with no weight gain. Because of complications, indications for CIPII must be strictly controlled. CIPII with DiaPort is an alternative therapy when CSII is not fully successful and provides an easy method of intraperitoneal therapy.

Insulin intensification--the rationale and the target.

AIMS: To review the key evidence supporting targets for glycaemic control in people with type 2 diabetes and the implications for management in primary care. METHOD: Literature review. RESULTS: Achieving early glycaemic control may reduce long-term risk by minimising the 'metabolic memory' effect of hyperglycaemia. Several large studies have failed to confirm expectations that intensive treatment would offer greater reductions in risk. This may reflect the failure to achieve control blood glucose early in the course of diabetes. Management guidelines emphasise the importance of targets for glycaemic control, but differ in the strategies they recommend for dose intensification. All, however, acknowledge the importance of individualising treatment. CONCLUSION: Early achievement of targets for glycaemic control may be important to reduce long-term risk in people with diabetes, but treatment should be tailored to individual need.

Biphasic insulin aspart given thrice daily is as efficacious as a basal-bolus insulin regimen with four daily injections: a randomised open-label parallel group four months comparison in patients with type 2 diabetes.

AIMS: To show that a thrice daily meal-time biphasic insulin aspart (BIAsp) treatment regimen is as efficacious as a 4 times daily basal-bolus regimen with human isophane insulin (NPH) and insulin aspart (IAsp). METHODS: A multinational, randomised, open-label parallel-group trial in 394 patients with type 2 diabetes on a once or twice daily insulin regimen. Patients were randomised 1:1 to BIAsp or IAsp+NPH for 16 weeks. The BIAsp group was treated according to individual needs using BMI as a surrogate index of insulin resistance. Subjects administered BIAsp 70 (BMI< or =30 kg/m (2)) or BIAsp 50 (BMI>30 kg/m (2)) with breakfast and lunch and BIAsp 30 with dinner. The IAsp+NPH group injected IAsp at meals and NPH at bedtime as basal insulin. HbAlc levels after 16 weeks were compared between treatments using a predefined non-inferiority criterion of 0.4%. The incidence of hypoglycaemic episodes and adverse events was evaluated. RESULTS: Mean HbAlc (+/-SD) decreased from 9.1+/-0.7% to 7.8+/-1.0% with both treatments. Glycaemic control provided by BIAsp was non-inferior to that obtained by the IAsp+NPH (intention to treat ITT) population: diff, HbAlc -0.05%; 95% CI (-0.24; 0.14); per protocol (PP) population: diff, HbAlc -0.03%; 95% CI (-0.23; 0.16). Similar improvements in glycaemic control in both groups were confirmed by self-measured 8-point plasma glucose (PG) profiles, average and fasting PG concentrations, and average prandial PG increments. The incidence of adverse events and hypoglycaemic episodes was similar in the two treatment groups. CONCLUSIONS: A thrice daily meal-time BIAsp regimen is a suitable alternative to an intensified insulin regimen in people with inadequately controlled type 2 diabetes mellitus, and requires fewer daily injections than a basal-bolus therapy without compromising efficacy and safety.

Manipulating carer number versus brood size: complementary but not equivalent ways of quantifying carer effects on offspring.

Experiments designed to quantify the effects of increasing numbers of carers on levels of offspring care are rare in cooperative breeding systems, where offspring are reared by individuals additional to the breeding pair. This paucity might stem from disagreement over the most appropriate manipulations necessary to elucidate these effects. Here, we perform both carer removal and brood enhancement experiments to test the effects of numbers of carers and carer:offspring ratios on provisioning rates in the cooperatively breeding chestnut-crowned babbler (Pomatostomus ruficeps). Removing carers caused linear reductions in overall brood provisioning rates. Further analyses failed to provide evidence that this effect was influenced by territory quality or disruption of group dynamics stemming from the removals. Likewise, adding nestlings to broods caused linear increases in brood provisioning rates, suggesting carers are responsive to increasing offspring demand. However, the 2 experiments did not generate quantitatively equivalent results: Each nestling received more food following brood size manipulation than carer removal, despite comparable carer:offspring ratios in each. Following an at-hatching split-design cross-fostering manipulation to break any links between prehatching maternal effects and posthatching begging patterns, we found that begging intensity increased in larger broods after controlling for metrics of hunger. These findings suggest that manipulation of brood size can, in itself, influence nestling provisioning rates when begging intensity is affected by scramble competition. We highlight that carer number and brood size manipulations are complimentary but not equivalent; adopting both can yield greater overall insight into carer effects in cooperative breeding systems.

Hematological parameters of three species of the peacock bass (Cichla spp. ) from Balbina lake, Presidente Figueiredo, Amazonas, Brazil / Parâmetros hematológicos de três espécies de tucunarés (Cichla spp. ) do lago de Balbina, Presidente Figueiredo, Amazonas, Brasil

Abstract The objective of this study was to characterize and compare the hematological variables (erythrogram, thrombogram, leukogram and plasma metabolites) of three cichlid species: Cichla monoculus, Cichla temensis and Cichla vazzoleri. A total of 45 specimens were captured in Balbina lake, Presidente Figueiredo, Amazonas, Brazil, with the aid of a rod and reel or hand line, with natural or artificial bait: 15 C. monoculus, 15 C. temensis and 15 C. vazzoleri. Their blood was removed by means of caudal puncture of the dorsal aorta, and hematological data were determined in accordance with methodology previously described in the literature. The erythrogram showed similarities between the species, while the thrombogram showed differences between C. vazzoleri and the other species studied (C. monoculus and C. temensis). The total leukocyte counts for C. temensis and C. vazzoleri were higher than those of C. monoculus. The predominant leukocyte in C. temensis and C. vazzoleri was lymphocytes, whereas it was monocytes in C. monoculus. The plasma metabolites showed differences between the three cichlid species, regarding their glucose, cholesterol, urea and potassium levels. It is concluded that these three species present hematological differentiation, thus indicating that they have differentiated blood-cell immune responses and plasma metabolite physiology.

Resumo O presente trabalho teve por objetivo caracterizar e comparar as variáveis hematológicas (eritrograma, trombograma, leucograma e metabólitos plasmáticos) de três espécies de tucunarés Cichla monoculus, Cichla temensis e Cichla vazzoleri. Um total de 45 animais foi capturado no lago de Balbina, Presidente Figueiredo, Amazonas, com auxílio de vara e carretilha, linha de mão com isca natural e artificial, sendo 15 C. monoculos, 15 C. temensis e 15 C. vazzoleri. O sangue foi retirado por punção caudal da aorta dorsal e os dados hematológicos foram determinados de acordo com metodologia previamente descrita na literatura. No eritrograma foram observadas similaridades entre as espécies, o trombograma demonstrou diferenças entre o C. vazzoleri e as demais espécies estudadas (C. monoculus e C. temensis), a contagem total de leucócitos demonstrou que em C. temensis e C. vazzoleri os valores são superiores ao C. monoculus. Foi demonstrado que os linfócitos foram às células predominantes em C. temensis e C. vazzoleri, diferentemente do C. monoculos que apresentou como leucócito predominante os monócitos. Nos metabólitos plasmáticos, foi possível observar diferenças entre as três espécies de tucunarés nos níveis de glicose, colesterol, uréia e potássio. Conclui-se que as três espécies de tucunarés apresentam diferenciação hematológica, indicando que as mesmas possuem respostas diferenciadas, na resposta imunológica de suas células do sangue e na fisiologia dos metabólitos plasmáticos.

Growth and hematological responses of tambaqui, Colossoma macropomum fed different levels of rice, Oryza spp / Crescimento e resposta hematológica do tambaqui, Colossoma macropomum alimentados com diferentes níveis de arroz, Oryza spp

Abstract The tambaqui (Colossoma macropomum) is a fish of primary importance in South American aquaculture, principally in the Amazon region and has a particularly unique diet in the wild. Oryza spp, or Wild rice as it is commonly known, is native to the floodplains of muddy rivers in the Amazon region. The aim of this study was to analyze the physical performance and the effects of dietary levels of Oryza spp. via the hematological parameters, total food intake, conversion efficiency, growth ratio and swimming performance of this fish. Diets containing 45% Oryza spp. induced the best performance in tambaqui. Diets containing 15% and 30% did not affect these indices, thus indicating that this amount of Oryza can be used as an alternative energy source for this important species within Brazilian aquaculture.

Resumo O tambaqui Colossoma macropomum é um peixe de importância na aquicultura brasileira, especialmente na região amazônica. O arroz silvestre é comum nas planícies inundadas dos rios de aguas barrentas da Amazônia. O objetivo deste trabalho foi analisar os efeitos combinados do treinamento físico e dos níveis dietéticos de Oryza spp. nos parâmetros hematológicos, consumo de alimentos, eficiência de conversão, taxa de crescimento e desempenho de natação deste peixe. Dietas contendo 45% de arroz apresentaram o melhor desempenho para tambaquis. As dietas contendo 15% e 30% não afetaram esses índices, indicando que alguma quantidade de arroz pode ser usada como fonte de energia alternativa para esta importante espécie dentro da aquicultura.

Evaluation of risk factors for development of complications in Type II diabetes in Europe.

AIMS/HYPOTHESIS: The Cost of Diabetes in Europe-Type II study is the first large coordinated attempt to measure the current standard of care and determine the costs of managing patients with Type II (non-insulin-dependent) diabetes mellitus. METHODS: The study evaluated glycaemic control, blood lipid levels and blood pressure, all of which are risk factors for complications. Records of these clinical characteristics were collected from over 7000 patients during the 6-month study period. RESULTS: The mean HbAlc value for the entire study population was 7.5%, ranging from 7.0% in Sweden to 7.8% in the United Kingdom. Only 31% of individuals achieved good glycaemic control (HbAlc≤=6.5%) according to current European guidelines. Only 64% of the total study population were tested for HbAlc values at least once within the 6-month study period (ranging from 49% in Spain to 71% in the UK), although HbAlc testing every 3 months is recommended for all patients, by European Diabetes Policy Group guidelines. The majority of patients had borderline total cholesterol values, with a mean value of 5.7 mmol/1. Overall, 21% of patients were classified as having low risk cholesterol levels (<4.8 mmol/1). Good triglyceride levels (<1.7 mmol/1) were achieved by 47% of the total study population. During the study period, 81 % of patients had their blood pressure measured, with 35% and 53.3% of the patients reaching the recommended targets for systolic and diastolic blood pressure, respectively. CONCLUSION/INTERPRETATION: This study showed that a high proportion of patients with risk factors for diabetes-related complications are not adequately controlled. Improvements in disease management and monitoring are therefore required to ensure that guideline targets are met, thus reducing the long-term complications of Type II diabetes.

Complications, co-morbidity, and blood glucose control in type 2 diabetes mellitus patients in Germany--results from the CODE-2 study.

In this study, prevalence and incidence of complications as well as co-morbidity in type 2 diabetes patients in Germany were evaluated as part of a cost-of-illness study (CODE-2(TM), Costs of Diabetes in Europe - Type 2)In a pre-study, 197 general practitioners and diabetes specialists all over Germany provided data on the complication status of 2701 randomly selected patients with type 2 diabetes. The patients were grouped into five mutually exclusive strata. This pre-study was performed to generate a general overview on complication status to select proper patients for the main study. The main study was performed on stratified samples derived from the pre-study. Irrespective of the real prevalence of the five strata, an equal number of 160 were randomly selected from each stratum. Thus, rare complications were also covered in the study. Data from 809 patients were collected retrospectively on the basis of medical files during interviews with the physician. To achieve representative estimates of absolute prevalence and incidence of diabetes-related complications in Germany, results were weighted using frequencies of the strata. Severe complications were diagnosed in 50% of these patients. Prevalences were: 10.56% myocardial infarction, 6.66% stroke, 3.97% foot ulcer, 2.30% amputations and 1.34% blindness. Overall incidences in the diabetes population were estimated at 0.78% myocardial infarction, 1.28% stroke and 0.80% amputations. 23% of the diabetes patients suffered from 2 or more complications. The complication status became considerably worse with increasing time since the diagnosis of diabetes. The mean HbA1c level was 7.51% (i.e. 122% of the upper limit of the respective normal ranges). The presence of complications and co-morbidity in type 2 diabetes patients was a frequent finding. This underlines the importance of complications in diabetes patients and the necessity to increase any means of prevention in order to relieve the personal and economic burden of type 2 diabetes.

Health economics analysis of insulin aspart vs. regular human insulin in type 2 diabetes patients, based on observational real life evidence from general practices in Germany.

BACKGROUND: A retrospective analysis of German general practice data demonstrated that insulin aspart (IA) was associated with a significantly reduced incidence of macrovascular events (MVE: stroke, myocardial infarction, peripheral vascular disease or coronary heart disease) vs. regular human insulin (RHI) in type 2 diabetes patients. Economic implications, balanced against potential improvements in quality-adjusted life years (QALYs) resulting from lower risks of complications with IA in this setting have not yet been explored. METHODS: A decision analysis model was developed utilizing 3-year initial MVE rates for each comparator, combined with published German-specific insulin and MVE costs and health utilities to calculate number needed to treat (NNT) to avoid any MVE, incremental costs and QALYs gained/ person for IA vs. RHI. A 3-year time horizon and German 3(rd)-party payer perspective were used. Probabilistic sensitivity analysis was performed, sampling from distributions of key parameters. Additional sensitivity analyses were performed. RESULTS: NNT over a 3 year period to avoid any MVE was 8 patients for IA vs. RHI. Due to lower MVE rates, IA dominated RHI with 0.020 QALYs gained (95% confidence interval: 0.014-0.025) and cost savings of EUR 1 556 (1 062-2 076)/person for IA vs. RHI over the 3-year time horizon. Sensitivity analysis revealed that IA would still be overall cost saving even if the cost of IA was double the cost/unit of RHI. CONCLUSIONS: From a health economics perspective, IA was the superior alternative for the insulin treatment of type 2 diabetes, with lower incidence of MVE events translating to improved QALYs and lower costs vs. RHI within a 3-year time horizon.

Hematological parameters of three species of the peacock bass (Cichla spp.) from Balbina lake, Presidente Figueiredo, Amazonas, Brazil

Abstract The objective of this study was to characterize and compare the hematological variables (erythrogram, thrombogram, leukogram and plasma metabolites) of three cichlid species: Cichla monoculus, Cichla temensis and Cichla vazzoleri. A total of 45 specimens were captured in Balbina lake, Presidente Figueiredo, Amazonas, Brazil, with the aid of a rod and reel or hand line, with natural or artificial bait: 15 C. monoculus, 15 C. temensis and 15 C. vazzoleri. Their blood was removed by means of caudal puncture of the dorsal aorta, and hematological data were determined in accordance with methodology previously described in the literature. The erythrogram showed similarities between the species, while the thrombogram showed differences between C. vazzoleri and the other species studied (C. monoculus and C. temensis). The total leukocyte counts for C. temensis and C. vazzoleri were higher than those of C. monoculus. The predominant leukocyte in C. temensis and C. vazzoleri was lymphocytes, whereas it was monocytes in C. monoculus. The plasma metabolites showed differences between the three cichlid species, regarding their glucose, cholesterol, urea and potassium levels. It is concluded that these three species present hematological differentiation, thus indicating that they have differentiated blood-cell immune responses and plasma metabolite physiology.

Resumo O presente trabalho teve por objetivo caracterizar e comparar as variáveis hematológicas (eritrograma, trombograma, leucograma e metabólitos plasmáticos) de três espécies de tucunarés Cichla monoculus, Cichla temensis e Cichla vazzoleri. Um total de 45 animais foi capturado no lago de Balbina, Presidente Figueiredo, Amazonas, com auxílio de vara e carretilha, linha de mão com isca natural e artificial, sendo 15 C. monoculos, 15 C. temensis e 15 C. vazzoleri. O sangue foi retirado por punção caudal da aorta dorsal e os dados hematológicos foram determinados de acordo com metodologia previamente descrita na literatura. No eritrograma foram observadas similaridades entre as espécies, o trombograma demonstrou diferenças entre o C. vazzoleri e as demais espécies estudadas (C. monoculus e C. temensis), a contagem total de leucócitos demonstrou que em C. temensis e C. vazzoleri os valores são superiores ao C. monoculus. Foi demonstrado que os linfócitos foram às células predominantes em C. temensis e C. vazzoleri, diferentemente do C. monoculos que apresentou como leucócito predominante os monócitos. Nos metabólitos plasmáticos, foi possível observar diferenças entre as três espécies de tucunarés nos níveis de glicose, colesterol, uréia e potássio. Conclui-se que as três espécies de tucunarés apresentam diferenciação hematológica, indicando que as mesmas possuem respostas diferenciadas, na resposta imunológica de suas células do sangue e na fisiologia dos metabólitos plasmáticos.