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"Ang, Lynn"
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Glucose Control and Diabetic Neuropathy: Lessons from Recent Large Clinical Trials
Diabetic peripheral and autonomic neuropathies are common complications of diabetes with broad spectrums of clinical manifestations and high morbidity. Studies using various agents to target the pathways implicated in the development and progression of diabetic neuropathy were promising in animal models. In humans, however, randomized controlled studies have failed to show efficacy on objective measures of neuropathy. The complex anatomy of the peripheral and autonomic nervous systems, the multitude of pathogenic mechanisms involved, and the lack of uniformity of neuropathy measures have likely contributed to these failures. To date, tight glycemic control is the only strategy convincingly shown to prevent or delay the development of neuropathy in patients with type 1 diabetes and to slow the progression of neuropathy in some patients with type 2 diabetes. Lessons learned about the role of glycemic control on distal symmetrical polyneuropathy and cardiovascular autonomic neuropathy are discussed in this review.
Journal Article
Mulan : the legend of the woman warrior
\"Mulan, the legendary woman warrior, comes to life in this empowering retelling of The Ballad of Mulan with stunning full-color illustrations by New York Times bestseller Joy Ang. Mulan loves nothing more than her family. She will do anything for them--even if it means joining the army in her ageing father's place. Since girls are not allowed in the army, Mulan cleverly disguises herself as a man. But she must look deep within herself to find her might and her courage. Faye-Lynn Wu and Joy Ang turn this ancient Chinese ballad into an uplifting, empowering ode to young girls everywhere, showing that true strength comes from within, regardless of appearance, inspiring a new generation of women warriors. The book also includes the original ballad.\"--Provided by publisher.
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Urinary epidermal growth factor levels correlate with cardiovascular autonomic neuropathy indices in adults with type 1 diabetes
The relationship between urinary endothelial growth factor (uEGF) and cardiovascular autonomic neuropathy (CAN) in adults with type 1 diabetes was evaluated. uEGF levels at baseline and standardized CAN measures were collected at baseline and annually for 3 years for type 1 diabetes adults. Linear regression analysis and linear mixed effects model were used for analysis. In this cohort (n = 44, 59% women, mean ± standard deviation age 34 ± 13 years and diabetes duration 14 ± 6 years), lower baseline uEGF levels correlated with lower baseline expiration : inspiration ratios (P = 0.03) and greater annual declines in Valsalva ratios (P = 0.02) in the unadjusted model, and correlated with lower low‐frequency power : high‐frequency power ratios (P = 0.01) and greater annual changes in low‐frequency power : high‐frequency power ratios (P = 0.01) after adjustment for age, sex, body mass index, and hemoglobin A1C. In conclusion, baseline uEGF levels correlate to baseline and longitudinal changes in CAN indices. A large‐scale, long‐term study is needed to validate uEGF as a reliable CAN biomarker.
Relationships between baseline urinary endothelial growth factor and baseline and longitudinal changes in cardiovascular autonomic neuropathy indices were observed. A large‐scale, long‐term study is needed to evaluate if urinary endothelial growth factor can serve as a reliable non‐invasive biomarker of cardiovascular autonomic neuropathy.
Journal Article
Is there an association between non-dipping blood pressure and measures of glucose variability in type 1 diabetes?
To assess the relationship between glucose variability (GV) and non-dipping of blood pressure (BP) as a marker of cardiovascular autonomic neuropathy (CAN) among patients with type 1 diabetes (T1D).
Forty-one subjects with T1D (age 34 ± 13 years, duration 13 ± 6 years, HbA1c 8 ± 1.2%) without cardiovascular disease, dyslipidemia, or hypertension at baseline were enrolled in a 3-year observational cohort study. Subjects were phenotyped for CAN with heart rate variability, cardiovascular autonomic reflex tests, and 24-h BP profiles at baseline and during follow-up. Non-dipping was defined as nocturnal systolic and diastolic BP fall of ≤10%. Reverse dipping BP was defined as a <0% change in the day to night for systolic and diastolic BP. Indices of GV were derived from 5-day continuous glucose monitoring obtained at 3-month intervals, and serum inflammatory biomarkers in all subjects.
At baseline 10% of the T1D subjects were non-dippers. The dippers and non-dippers were similar in age, diabetes duration, glucose control, traditional cardiovascular risk factors, GV and inflammatory markers. No significant correlations were found at baseline between non-dipping nocturnal blood pressure and measures of GV. At 3 years there were no differences in risk factor profile of subjects who were non-dippers over time (progressors) and those who were dippers (non-progressors).
In a cohort of contemporary patients with T1D following the current standard of care in diabetes, the prevalence of non-dipping is relatively low. There were no clear phenotypes that explained the difference in the risk for non-dipping, including GV. Ambulatory blood pressure monitoring could be used as a tool for improved CVD risk stratification and development of therapeutic interventions in these patients.
Journal Article
Measurement of cognition and profiling early learning environments in India, Indonesia and Senegal: a UKRI GCRF Action Against Stunting Hub protocol paper
IntroductionChildhood stunting is associated with poorer child health, growth and development including diminished cognitive abilities. Mapping out the links between child stunting and Early Childhood Education and Development is critical to increasing understanding of the causes and effects of childhood stunting, and for programme and policy development. The aim of this study is to investigate and compare the development and educational environments across India, Indonesia and Senegal, and to identify the multifactorial drivers and impacts of childhood stunting to inform a new typology.Methods and analysisThis current study is part of an interdisciplinary observational research study, where women are recruited during pregnancy and mother–infant pairs followed prospectively, up to 24 months after birth. Eight measures will be used to profile children’s early development and learning environments in two sample cohorts: (A) children aged 12 and 24 months born to the women recruited during pregnancy (ie, 500 pregnant mothers per country) and (B) a preschool case–control cohort of siblings from the main cohort aged between 3:6 and 5:6 years of age where anthropomorphic measures will be collected to assess degrees of stunting. Profiling of the development and learning environments in the countries will include both parent/caregiver self-reported and local staff (enumerators) direct assessments of children and settings.Ethics and disseminationThis study was approved by the institutional ethics committees of all partner institutions. In India, Indian Council of Medical Research-National Institute of Nutrition, Hyderabad; In Indonesia, Ethics Committee of the Faculty of Medicine, University of Indonesia; and in Senegal, National Ethics Committee for Scientific Research in Senegal.The findings of the study will be disseminated in national and international meetings, seminars, conferences and peer-reviewed journals.
Journal Article
Transdisciplinary working to shape systematic reviews and interpret the findings: commentary
Important policy questions tend to span a range of academic disciplines, and the relevant research is often carried out in a variety of social, economic and geographic contexts. In efforts to synthesise research to help inform decisions arising from the policy questions, systematic reviews need conceptual frameworks and ways of thinking that combine knowledge drawn from different academic traditions and contexts; in other words, transdisciplinary research. This paper considers how transdisciplinary working can be achieved with: conceptual frameworks that span traditional academic boundaries; methods for shaping review questions and conceptual frameworks; and methods for interpreting the relevance of findings to different contexts. It also discusses the practical challenges and ultimate benefits of transdisciplinary working for systematic reviews.
Journal Article
Urologic complications in diabetes
Urologic complications such as bladder and sexual dysfunction among men and women with diabetes have received relatively little attention. This is despite emerging evidence that demonstrates that urologic complications increase with age in the general population and are more common in individuals with diabetes compared to those without diabetes. Here we summarize the latest information about the epidemiology of urologic complications in the setting of diabetes and the most recent findings regarding pathophysiology. In addition, we identify knowledge gaps and need for future funding to address these gaps that will reduce the burden of urologic complications in diabetes and optimize quality of life for all individuals affected by it.
•Several studies have shown the association of lower urinary tract symptoms and erectile dysfunction in men with diabetes•Further studies are needed to better understand the mechanisms of how diabetes exerts its effects on ED and LUTS•In diabetic women, studies have shown the association of LUTS, namely urinary incontinence, and female sexual dysfunction•Further longitudinal studies are needed to understand LUTS and FSD in women with type 2 diabetes•Urological complications have an impact on quality of life and diabetic patients should be monitored for these conditions
Journal Article
A participatory approach to embedding evidence in practice to support early language and communication in a London nursery school
IOE (Institute of Education), UCL’s Faculty of Education and Society (University College London, UK) has a long tradition of engagement with schools to support young children’s learning and co-produce knowledge through research–practice partnerships. From the first demonstration schools in the early 1900s to engagement with contemporary research schools, the vital importance of linking theory and practice in education through schools has been an integral part of the IOE’s values and ethos. One way to link theory to practice is to utilise participatory research methodologies to embed evidence in practice. This article discusses the research project Manor Park Talks, undertaken in collaboration with IOE and a leading partner, a head teacher and IOE alumnus of the East London Teaching and Research School. The aim of the project was to support early language and communication in a cluster of early years settings in Newham, London, and it involved a process of co-production in the design of a systematic review to assess the evidence-based pedagogical strategies that can be used to inform teaching practices to enhance the professional development of early years education practitioners (to include teachers, classroom assistants, childcare workers and other ancillary staff). The research aimed to evaluate a community of practice for early years practitioners to support young children’s early language development and communication, and to inform an evidence-based practice tool to guide teaching practices in early years settings. A commentary on the review findings and methodological innovation of the study in using a participatory approach to review the evidence is provided in this article.
Journal Article
Conceptualising Home-Based Child Care: A Study of Home-Based Settings and Practices in Japan and England
Home-based child care or childminding as it is commonly known in the United Kingdom (UK) is a service often used by parents and families in many countries. However, despite its prevalence, there is a paucity of research on the subject. Addressing this gap, this study presents new empirical data to better understand this type of provision in supporting children’s learning and development. The paper presents the findings of a qualitative study of home-based child care undertaken in five settings in Japan and England. The study examined caregivers’ activities and their interactions with the children aged 4 months to 4 years. The methods included practitioner interviews, narrative observations, document analysis of activity records, and documentations of the structural and process features of the settings. The study is significant for advancing the international knowledge base of home-based child care in highlighting the service as a form of distinct, specialised care and pedagogy, as well as family support.
Journal Article