Dietary strategies for remission of type 2 diabetes: A narrative review.

Type 2 diabetes (T2DM) is a growing health issue globally, which, until recently, was considered to be both chronic and progressive. Although having lifestyle and dietary changes as core components, treatments have focused on optimising glycaemic control using pharmaceutical agents. With data from bariatric surgery and, more recently, total diet replacement (TDR) studies that have set out to achieve remission, remission of T2DM has emerged as a treatment goal. A group of specialist dietitians and medical practitioners was convened, supported by the British Dietetic Association and Diabetes UK, to discuss dietary approaches to T2DM and consequently undertook a review of the available clinical trial and practice audit data regarding dietary approaches to remission of T2DM. Current available evidence suggests that a range of dietary approaches, including low energy diets (mostly using TDR) and low carbohydrate diets, can be used to support the achievement of euglycaemia and potentially remission. The most significant predictor of remission is weight loss and, although euglycaemia may occur on a low carbohydrate diet without weight loss, which does not meet some definitions of remission, it may rather constitute a 'state of mitigation' of T2DM. This technical point may not be considered as important for people living with T2DM, aside from that it may only last as long as the carbohydrate restriction is maintained. The possibility of actively treating T2DM along with the possibility of achieving remission should be discussed by healthcare professionals with people living with T2DM, along with a range of different dietary approaches that can help to achieve this.

Investigation of maternal effects, maternal-fetal interactions and parent-of-origin effects (imprinting), using mothers and their offspring.

Many complex genetic effects, including epigenetic effects, may be expected to operate via mechanisms in the inter-uterine environment. A popular design for the investigation of such effects, including effects of parent-of-origin (imprinting), maternal genotype, and maternal-fetal genotype interactions, is to collect DNA from affected offspring and their mothers (case/mother duos) and to compare with an appropriate control sample. An alternative design uses data from cases and both parents (case/parent trios) but does not require controls. In this study, we describe a novel implementation of a multinomial modeling approach that allows the estimation of such genetic effects using either case/mother duos or case/parent trios. We investigate the performance of our approach using computer simulations and explore the sample sizes and data structures required to provide high power for detection of effects and accurate estimation of the relative risks conferred. Through the incorporation of additional assumptions (such as Hardy-Weinberg equilibrium, random mating and known allele frequencies) and/or the incorporation of additional types of control sample (such as unrelated controls, controls and their mothers, or both parents of controls), we show that the (relative risk) parameters of interest are identifiable and well estimated. Nevertheless, parameter interpretation can be complex, as we illustrate by demonstrating the mathematical equivalence between various different parameterizations. Our approach scales up easily to allow the analysis of large-scale genome-wide association data, provided both mothers and affected offspring have been genotyped at all variants of interest.

A prospective study of positive adjustment to lower limb amputation.

OBJECTIVE: To examine prospectively the influence of demographic, amputation and psychosocial variables on positive psychological adjustment outcomes for lower limb amputees. DESIGN: A quantitative questionnaire study with two time points: at the beginning of rehabilitation and at six-month follow-up. Multiple regression analyses were used to determine the contribution of demographic/amputation factors versus psychosocial factors to adjustment outcomes. SETTING: A regional outpatient specialist mobility and rehabilitation centre in the UK. SUBJECTS: Participants were recruited as a consecutive sample of new referrals with lower limb amputation. MAIN MEASURES: Age, gender, level and cause of amputation were recorded. The following measures were used: Hope Scale, Multidimensional Scale of Perceived Social Support (MSPSS), Trinity Amputation and Prosthetic Experiences Scale (TAPES) pain subscale initially and the Positive and Negative Affect Scale (PANAS) and full TAPES at six-month follow up. The measures were administered by two specialist nurses. RESULTS: Ninety-nine patients provided data at both time points. Hope at the beginning of rehabilitation was related to positive mood (P<0.001) and hope and social support were related to general adjustment (P<0.01, P<0.001) at follow-up. Demographic and amputation factors were not related to psychological adjustment outcomes in this study. CONCLUSIONS: The findings demonstrate prospectively the importance of psychosocial variables in the prediction of positive adjustment to lower limb amputation.

A comparison of the views of patients and medical staff in relation to the process of informed consent.

INTRODUCTION: The quality and quantity of information required in the consent process is well documented, but there is little extant literature regarding timing of either information about the proposed procedure or the act of consent itself. With the recent introduction of a new NHS-wide consent form, we wished to determine the preferences of both patients and staff to ascertain whether any concordance of views existed. PATIENTS AND METHODS: A 10-point questionnaire, developed in conjunction with the department of clinical psychology was completed by 242 patients selected for surgery over a 4-month period. Identical questionnaires were completed by local staff (n = 50) and national consultant plastic surgeons (n = 56). RESULTS: The cumulative majority (61.8%) preferred information at the specialist out-patient appointment (OPA). There was a significant difference (P < 0.001) between patients and staff as to information provision by the specialist as compared to non-specialists; staff indicating it much more strongly. As to the timing of consent form signature, 40.2% preferred signature on admission with no statistically significant difference between subgroups. An additional pre-operative clinic, for consent form signing, was selected by 27.3%. Staff expressed this view more often than patients (P < 0.001). CONCLUSIONS: Patients prefer information about a planned surgical procedure at their specialist OPA and final consent for surgery when admitted to the ward. Staff had quite definite views and felt an additional pre-operative out-patient appointment to be beneficial, more so than the patients themselves.

A case series to pilot cognitive behaviour therapy for women with urinary incontinence.

OBJECTIVE: Psychological factors have been identified with respect to female urinary incontinence. However, there is limited research regarding psychological interventions. The effectiveness of cognitive behaviour therapy (CBT) as a treatment for women with urinary incontinence was investigated. DESIGN: The study adopted an AB case series design with a follow-up phase. METHODS: Ten women with urinary incontinence each attended individual sessions. The Hospital anxiety and depression scale (HADS) and Incontinence Quality of Life (I-QOL) were administered pre-treatment, post-treatment, and 3-months post-treatment. Participants kept weekly records of bladder functioning. An unstandardized client satisfaction questionnaire was administered at 3-months post-treatment. RESULTS: Anxiety and depression, as measured by the HADS did not show any significant changes. Improvements in incontinence-related quality of life reached statistical significance at the post-treatment administration and were maintained at the 3-months post-treatment follow-up. Significant changes in bladder functioning were not apparent until the 3-month post-treatment follow-up. The satisfaction questionnaires suggest that the participants found the intervention of value. CONCLUSIONS: The findings of this study tentatively suggest that incontinence-related quality of life might be improved by involvement in a CBT intervention. Some modest improvements occurred in bladder functioning. Further research is required to confirm these findings.