Glycemic outcomes and patient satisfaction and self-management improves in transition from standard to virtual multidisciplinary care.

AIMS: With advances in cloud-based technologies, there has been a rise in remote T1D care. We hypothesized that transitioning T1DM care to a virtual, multidisciplinary clinic could improve measures beyond HbA1c. METHODS: To assess the impact of transitioning from standard to virtual T1DM care, we evaluated glycemic measures and patient reported outcomes. RESULTS: Sixty-one adults with T1DM were included, with mean age 40.2 ± 13.5 years and diabetes duration 16.9 ± 9.0 years. Most patients were treated with insulin pumps and CGM. The number of annual diabetes care encounters rose from 2.1 ± 4.2 to 12.8 ± 5.5. Baseline HbA1c was 7.9 ± 1.6 %(63 ± 16.9 mmol/mol), declining to 7.3 ± 1.1 %(56 ± 8.5 mmol/mol) and 7.1 ± 1.0 %(54 ± 7.7 mmol/mol) at 6 and 12 months respectively (p < 0.001 for both). In parallel, TIR improved from 63.1 ± 19.3 % to 69.2 ± 13.8 % (p < 0.001) and 67.5 ± 19.4 % (p = 0.03) at 6 and 12 months respectively, while TBR declined. Scores from validated diabetes treatment and self-management questionnaires rose significantly and these rises were associated with a reduction in HbA1c, the latter score was also associated with increased TIR. There was a trend toward a correlation between encounter frequency and improvement in HbA1c and TIR. CONCLUSIONS: Transitioning from standard to virtual, coordinated, multidisciplinary T1DM care is associated with increased visit frequency, improving glycemic control, treatment satisfaction and self-care behaviors.

Effect of Lumenato a Tomato derived oral supplement on improving skin barrier strength.

INTRODUCTION: Improvement of skin barrier strength could lead to healthy and youthful appearance. "Beauty inside-out" approach using nutraceuticals such as tomato derived carotenoids to support skin barrier strength could be of benefit to the ageing population. METHOD: A panel of 60 female subjects were provided with the Lumenato capsules (containing carotenoids) or placebo capsules as nutritional supplements for 3 months. Skin health and barrier function were observed using evaporimeter which measures trans epidermal water loss (TEWL). Barrier strength was determined by study of the number of strippings required to disrupt skin barrier and barrier repair was observed in terms of TEWL a few hours after barrier disruption. Cutometer was used to observe skin firmness and elasticity. Measurements were obtained before treatment and after 4 and 12 weeks of use. RESULTS: Results indicated a statistically significant improvement (p < 0.05) in skin barrier strength; a higher number of strippings were required to disrupt skin barrier after 12 weeks of supplement use. There was also a significant improvement in skin firmness and elasticity as observed with a cutometer. CONCLUSION: Based on the confines and conditions of this study, oral supplementation with Lumenato resulted in significant improvement in skin barrier as well as skin firmness and elasticity.

Beauty from within: Improvement of skin health and appearance with Lycomato a tomato-derived oral supplement.

BACKROUND: Healthy and a youthful appearance is a common desire of the aging population. "Beauty from within" involves using nutrition and nutraceuticals to support skin function for reducing and reversing signs of aging such as wrinkles, pigmentary changes, skin laxity, and dullness. Carotenoids possess strong antioxidant and anti-inflammatory activities and are effective in improving skin barrier and could thereby stimulate "beauty from within" by providing endogenous support to reduce the expressions of aging. AIM: This study was designed to determine whether 3-month supplementation with Lycomato would improve skin condition. METHOD: A panel of 50 female subjects used Lycomato capsules as nutritional supplements for 3 months. Skin status was observed via questionnaires for the assessment of skin condition and expert visual grading of facial markers such as wrinkles, tonality, roughness, laxity, and pore size. Skin barrier was assessed using transepidermal water loss (TEWL). Measurements were obtained before treatment and after 4 and 12 weeks of use. RESULTS: Results indicated a statistically significant improvement (p < 0.05) in skin barrier as measured by TEWL after 12 weeks of consuming the supplement. There was also a significant improvement in skin tonality, lines and wrinkles, pore size, and skin firmness as observed by expert evaluation as well as subject self-assessment. CONCLUSION: Based on the confines and conditions of this study, oral supplementation with Lycomato resulted in significant improvement in skin barrier. Visual appearance of lines and wrinkles, skin tonality, pores, smoothness, and firmness were considerably improved, and these improvements were found to be substantially discernible by the subjects.

Effect of Lumenato oral supplementation on plasma carotenoid levels and improvement of visual and experiential skin attributes.

BACKGROUND: Cellular metabolism and exposure to solar irradiation result in generation of free radicals which are destructive and can lead to premature aging. Antioxidants and free radical scavengers such as carotenoids successfully protect from these free radicals by quenching and neutralizing them thereby strengthening skin barrier which leads to improved skin moisturization, desquamation, and a more youthful look. This study was designed to evaluate the consumer-perceived efficacy of an oral supplement (Lumenato™) containing a mix of tomato carotenoids and oil-soluble vitamins in improving skin appearance after 12 weeks of supplement use. MATERIALS AND METHODS: Plasma levels of phytoene, phytofluene, zeta-carotene, and lycopene were quantitated before and after 1-, 2-, 3-, and 4-week administration of Lumenato by 24 healthy volunteers. Part II of the study addressed skin visual attributes as assessed by validated tools (questionnaires). A total of 60 females, aged 35 to 55 years, completed part II of the study. The subjects answered questionnaires pertaining to their assessment of skin appearance before and after 12 weeks of taking the supplement. RESULTS: There was a significant increase (p < 0.001) in plasma levels of phytoene, phytofluene, and zeta-carotene after 1- to 4-week treatment with Lumenato. After 12 weeks of using the supplement, the score of different skin parameters was reported to significantly improve (p < 0.001). Improvement was recorded in skin elasticity, firmness, brightness, skin tone, reduction in dark spots and periorbital dark circles, skin hydration, texture and fine lines and wrinkles. A significant (p < 0.001) improvement in overall skin condition after using the supplement was observed. The subjects noticed statistically significant (p < 0.001) improvement in skin elasticity, firmness, brightness, skin tone, reduction in dark spots and periorbital dark circles, skin hydration, texture and fine lines and wrinkles after 12 weeks of using the supplement. The overall skin condition also exhibited a significant improvement (p < 0.001). Self-assessed improvement of the face was identified at the first time point (4 weeks) and improved significantly (p < 0.001) for the 12 weeks of use. Interestingly, these improvements persisted even after treatment was stopped. CONCLUSION: Based on the confines and conditions of this study, the use of oral supplement containing a mix of tomato carotenoids significantly increased plasma levels of phytoene, phytofluene, and zeta-carotene, and continuous use resulted in improved facial skin attributes which were palpable by the consumers and continued even after treatment was stopped.

Effects of golden tomato extract on skin appearance-outlook into gene expression in cultured dermal fibroblasts and on trans-epidermal water loss and skin barrier in human subjects.

SCOPE: Two experiments were performed to test the effects of rich tomato extract (Golden Tomato Extract, GTE) on human skin. In one experiment, the effects of this extract on gene expression in cultured human dermal fibroblasts were examined. In a second experiment, human subjects consumed the extract and trans-epidermal water loss (TEWL), and aspects of skin appearance were monitored. METHODS AND RESULTS: Primary human dermal fibroblasts in culture were treated with the extract. After six hours, RNA was extracted, and gene expression was examined using Affymetrix Human Clariom D array processing. For the clinical study, 65 human subjects consumed a capsule once a day for 16 weeks, and various skin parameters were assessed at predetermined time intervals. Among the genes upregulated by GTE are genes that augment innate immunity, enhance DNA repair, and the ability to detoxify xenobiotics. GTE significantly reduced TEWL in subjects who had high TEWL at baseline, but it had no effect on TEWL in subjects who had lower TEWL at baseline. CONCLUSIONS: Golden tomato extract may provide benefits to the skin by enhancing innate immunity and other defense mechanisms in the dermis and by providing antioxidants to the skin surface to optimize TEWL and the appearance of the skin.

[PATIENT INVOLVEMENT IN THE DESIGN OF RESEARCH AND PRACTICES IN HEALTHCARE].

INTRODUCTION: The integration and involvement of patients in shaping research, processes and policies in the health care system is a new trend, which is gaining momentum in many countries around the world. Although participatory processes have existed for many years, systematic and organized mechanisms have only begun maturing in recent years. The first expression of this trend is in aspects related to research, including: accessibility to information about experiments; patient participation in research as research subjects; participation in the design and management of research. The second area in which patients are involved is priority setting in research, drug approval processes and policy making. The third subject of patient involvement is the formation of therapeutic practices in healthcare quality improvement, healthcare routine, and the development of assessment tools. In this article, we review participatory processes, which are initiated by the authorities via mandatory standardization or participatory practices embedding, and also by patient organizations and public representatives working alongside, or as part of healthcare organizations. We present the global picture and then present examples from the Israeli context.