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"Holmes, Deborah"
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Effect of metformin on insulin resistance in adults with type 1 diabetes: a 26-week randomized double-blind clinical trial
Insulin resistance is an underrecognized cardiovascular risk factor in type 1 diabetes. The effect of metformin on insulin resistance in adults with type 1 diabetes is unknown. Forty adults with type 1 diabetes, and twenty adults without diabetes were studied in a baseline only cross-sectional study assessing insulin resistance using the two-step hyperinsulinemic-euglycemic clamp. Participants with type 1 diabetes exhibited hepatic (EGP 64% higher), muscle (glucose infusion rate [GIR] 29% lower) and adipose (higher non-esterified fatty acids [NEFA]) insulin resistance. We then conducted a parallel group randomized, placebo-controlled trial to assess the efficacy of metformin 1500 mg (
n
= 20) versus placebo (
n
= 20) in reducing insulin resistance in adults with type 1 diabetes over 26 weeks. The primary outcome was change in endogenous glucose production (EGP) during the low-dose phase of the clamp. Thirty seven of 40 adults with type 1 diabetes completed the study. At 26 weeks, there was no difference in change in EGP between metformin and placebo groups (mean difference 0.2 µmol/kg fat-free mass [FFM]/min [95%CI, −0.4 to 0.8 µmol/kgFFM/min];
p
= 0.53). There was no increase in hypoglycemia or episodes of ketoacidosis in either group. These results do not support prescribing metformin to reduce hepatic insulin resistance in adults with type 1 diabetes. Australian New Zealand Clinical Trials Registry identifier, ACTRN12619001440112.
The INTIMET study is a randomized 26-week double-blind clinical trial to assess whether metformin can reduce insulin resistance in adults with type 1 diabetes. Metformin did not reduce insulin resistance in type 1 diabetes, but lowered insulin dose versus placebo – a secondary outcome.
Journal Article
Attitudes towards mental health, mental health research and digital interventions by young adults with type 1 diabetes: A qualitative analysis
Background Young people with type 1 diabetes are at increased risk of mental disorders. Whereas treatment need is high, difficulty recruiting young people with type 1 diabetes into psychosocial studies complicates development, testing and dissemination of these interventions. Objective Interviews with young adults with type 1 diabetes were conducted to examine attitudes towards mental health and mental health research, including barriers and motivators to participation in mental health studies and preferred sources of mental health support. The interviews were audio‐taped, transcribed and evaluated via thematic analysis. Setting and participants Young adults with type 1 diabetes were recruited via social media channels of 3 advocacy organizations. A total of 31 young adults (26 females and 5 males) with an average age of 22 years were interviewed between October 2015 and January 2016. Results Participants were largely unaware of their increased vulnerability to common mental health problems and knew little about mental health research. Major barriers to participation included perceived stigma and lifestyle issues and low levels of trust in researchers. Opportunities to connect with peers and help others were described as key motivators. Psychological distress was considered normal within the context of diabetes. A need for some level of human contact in receiving psychosocial support was expressed. Discussion and conclusion Findings provide valuable insights into the complex dynamics of engaging young adults with type 1 diabetes in mental health studies. Interviewees provided practical suggestions to assist investigation and delivery of psychosocial interventions for this vulnerable group.
Journal Article
‘Hat doch jeder seinen Schiller’: The Individual and the Masses at the Social Democrat Schiller-Feier of 1905 in Vienna
The centenary of Friedrich Schiller's death was marked with particular fervour by the Social Democratic Party in Vienna. Numerous articles in the party press were complemented by a mass commemoration in the form of a classical concert with a speech given by Engelbert Pernerstorfer. The centenary's proximity in time to the fifteenth celebration of May Day as an international socialist event provides a revealing case study of nascent Social Democrat Festkultur and its fundamental tensions — between the individual and the masses, ‘high’ cultural traditions and a new popular culture, German nationalism and socialist internationalism.
Journal Article
Theodor Herzl and the Utopia of the Salon in Fin-de-Siècle Vienna
Theodor Herzl published his utopian novel Altneuland
in 1902, six years after the Zionist manifesto Der Judenstaat
(1896). As well as giving a multifaceted literary account of the Zionist programme, the novel is also highly revealing of Political Zionism's social imagination at the turn of the century. Its methods of fictionalisation show how deeply Herzl's text is implicated in the liberal discourse of progress. The article investigates how the salon functions as a medium in this discourse, as a space, a social practice and a narrative form. On the one hand it mediates between colonial space and the utopia of progress, on the other, it serves as a testing ground for the social and gender figurations of day-to-day life in utopia.
Journal Article