The conditional use of actin during clathrin-mediated endocytosis in mammalian cells suggests that the cell controls whether and how actin is used. Using a combination of biochemical reconstitution ...and mammalian cell culture, we elucidate a mechanism by which the coincidence of PI(4,5)P
and PI(3)P in a curved vesicle triggers actin polymerization. At clathrin-coated pits, PI(3)P is produced by the INPP4A hydrolysis of PI(3,4)P
, and this is necessary for actin-driven endocytosis. Both Cdc42⋅guanosine triphosphate and SNX9 activate N-WASP-WIP- and Arp2/3-mediated actin nucleation. Membrane curvature, PI(4,5)P
, and PI(3)P signals are needed for SNX9 assembly via its PX-BAR domain, whereas signaling through Cdc42 is activated by PI(4,5)P
alone. INPP4A activity is stimulated by high membrane curvature and synergizes with SNX9 BAR domain binding in a process we call curvature cascade amplification. We show that the SNX9-driven actin comets that arise on human disease-associated oculocerebrorenal syndrome of Lowe (OCRL) deficiencies are reduced by inhibiting PI(3)P production, suggesting PI(3)P kinase inhibitors as a therapeutic strategy in Lowe syndrome.
AIM: To investigate the level of Percutaneous Endoscopic Gastrostomy (PEG) feeding in elderly people with diabetes resident in Nursing homes in one area of the UK, to describe their degree of ...disability, comorbidities and to estimate medication costs of these residents. METHODS: The data was collected from a retrospective case notes review of the 75 people with known diabetes who were resident in the 11 Nursing homes in the Coventry Teaching PCT in early 2010. RESULTS: 14 residents (19% of the total sample) had PEG feeds in situ and one (1.3%) had a nasogastric feeding tube in situ. The 14 residents were taking a total of 80 daily medications, a mean of 5.7 daily medications per resident (range 3–10). The total medication costs for the regular medications for these 14 residents was 2410 euros per month giving a mean of 172 euros/month (range 14–935 euros per month). All of the 14 were recorded as being bedbound, having no speech and being doubly incontinent. CONCLUSION: All 14 residents being PEG fed have severe levels of disability. Cerebro Vascular Accident and Dementia are the main recorded co-morbidities. The most expensive monthly medication costs were for special order liquid medications, many for cardio vascular disease prevention, which may be considered as inappropriate in such severely disabled residents.
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EMUNI, GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UILJ, UL, UM, UPCLJ, UPUK, VSZLJ, ZAGLJ, ZRSKP
In residential care homes and aged‐care facilities globally, between one in three and one in four residents may have diabetes, an often complex highly co‐morbid illness that leads to frailty, ...dependency, disability and reduced life expectancy. Residents with diabetes also have a high risk of hypoglycaemia, avoidable hospital admissions, and represent one of the most difficult challenges to health professionals and care staff in optimizing their diabetes and medical care. This detailed review examines the literature relating to care home diabetes over the last 25 years to assess what has been achieved in characterizing residents with diabetes, and what we know about the various but limited intervention studies that have been carried out internationally. The guidance and guidelines that have been published to assist clinicians in planning effective and safe care for this rather vulnerable group of people with diabetes are also reviewed. The review presents the first diagrammatic representation of a likely physiological cascade depicting the mainly irreversible functional decline a resident with diabetes might experience, provides modern principles of care for each resident with diabetes, and identifies what priority recommendations are required to be implemented if diabetes care is to improve. The review concludes that action is required since diabetes care still remains fragmented, sub‐optimal, and in need of investment, otherwise care home residents with diabetes will continue to have their needs unfulfilled.
What's new?
This review is the first major comprehensive account of the state of diabetes care globally in care homes and aged‐care facilities.
This review provides the first schematic representation of functional decline (leading to sarcopenia, frailty and dependency) that occurs following admission to a care home of a resident with diabetes.
A modern appraisal of the key priorities in diabetes care in care homes and how they can be implemented in routine clinical practice is included.
This is the first international call to action requiring all stakeholders to play a part in meeting the needs of disadvantaged vulnerable people with diabetes in care homes whose quality of life has already been severely compromised.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Aim
To use general practice‐level data for England, available through the National Diabetes Audit, and primary care prescribing data to identify prescription treatment factors associated with ...variations in achieved glucose control (HbA1c).
Methods
General practice‐level National Diabetes Audit data on Type 1 diabetes, including details of population characteristics, services, proportion of people achieving target glycaemic control HbA1c ≤58 mmol/mol (7.5%) and proportion of people at high glycaemic risk HbA1c >86 mmol/ml (10%), were linked to 2013–2016 primary care diabetes prescribing data on insulin types and blood glucose monitoring for all people with diabetes.
Results
A wide variation was found between the 10th percentile and the 90th percentile of general practices in both target glycaemic control (15.6% to 44.8%, respectively) and high glycaemic risk (4.8% to 28.6%, respectively). Our analysis suggests that, given the extrapolated total of 280 000 people with Type 1 diabetes in the UK, there may be the potential to increase the number of those within target glycaemic control from 80 000 to 101 000; 53% of this increase (11 000 people) would result from service improvements and 47% (10 000 people) from medication and technology changes. The same improvements would also provide the opportunity to reduce the number of people at high glycaemic risk from 42 000 to 26 500. A key factor associated with practice‐level target HbA1c achievement would be greater use of insulin pumps for up to an additional 56 000 people.
Conclusion
If the HbA1c achievement rates in service provision, medication and use of technology currently seen in practices in the 90th percentile were to be matched with regard to HbA1c achievement rates in all general practices, glycaemic control might be improved for 36 500 people, with all the attendant health benefits.
What's new?
Using publically available general practice‐level National Diabetes Audit and prescribing data for England, we examined achieved glycaemic control and prescribing patterns in Type 1 diabetes.
A wide variation was found between the 10th percentile and 90th percentile of general practices in both proportion of people achieving target glycaemic control (15.6% to 44.8% of people) and those at high glycaemic risk (4.8% to 28.6% of people).
Our model indicates that if all practices in the UK performed as well as the top decile in England, then, of the extrapolated 280 000 people with Type 1 diabetes, 21 000 would achieve target glycaemic control HbA1c ≤58 mmol/mol (7.5%) and 15 500 fewer people would be at high glycaemic risk HbA1c >86 mmol/mol (10%).
If all practices currently achieving the average of 16% of people on insulin pumps, moved to the 90th percentile level of 36% of people on pumps, an additional 56 000 people with Type 1 diabetes would be using insulin pumps, which may be associated with 4000 additional people achieving significant improvements in glycaemic control.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
ABSTRACT
Background: Evidence for a link between periodontal disease and several systemic diseases is growing rapidly. The infectious and inflammatory burden of chronic periodontitis is thought to ...have an important systemic impact. Current evidence suggests that periodontitis is associated with an increased likelihood of coronary heart disease and may influence the severity of diabetes.
Scope: This paper represents a UK and Ireland cross-specialty consensus review, undertaken by a group of physicians and dentists. The consensus group reviewed published evidence (PubMed search for review and original articles), focusing on the past 5 years, on the contributory role of periodontal disease to overall health. In particular, evidence relating to a role for periodontal disease in cardiovascular disease and in diabetes was considered.
Findings: Initial studies of large epidemiological data sets have sought to find links between periodontitis and systemic disease outcomes, but a causal relationship still needs to be demonstrated between periodontal disease, cardiovascular disease and diabetes through prospective studies. There is a need for prospective studies assessing the association between periodontal disease and patients at particular risk of cardiovascular events which will allow assessment of both cardiovascular disease clinical endpoints and surrogate markers of cardiovascular risk. Of note, periodontal disease is also often more severe in subjects with diabetes mellitus, a group at already increased risk for cardiovascular events.
Conclusions: While further research is needed to define the population-attributable risk of periodontal disease to both cardiovascular diseases and to diabetes control and progression, health education to encourage better oral health should be considered as part of current healthy lifestyle messages designed to reduce the increasing health burden of obesity, cardiovascular disease and diabetes.
The NDA for 2010?2011 shows increasing participation by practices and specialist services and increasing prevalence of diabetes. Levels of completion of the nine care processes continue to increase, ...whilst achievements of NICE treatment targets for HbA1c, cholesterol levels and blood pressure show small improvements. The complications report highlights the continuing rise in ketoacidosis admissions and the impact of heart failure. The excess mortality associated with diabetes is calculated to be 24,000 lives lost in England and Wales. At every level and for every measure there are significant variations which persist even after influences such as age and social deprivation are taken into account. We believe that variation of this magnitude is unwarranted in a national health service and that it should trigger healthcare professionals to review and lead the improvement of services everywhere. Conclusion 4 references
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Diabet. Med. 29, 136–139 (2012)
Aims To describe the numbers and costs of medications prescribed to people living with diabetes resident in nursing homes in one primary care trust in the UK.
Methods ... A retrospective case notes review of 75 people with known diabetes who were resident in the 11 nursing homes in the Coventry teaching primary care trust.
Results Sixty‐three residents (84%) were being prescribed four or more medications. Forty‐four residents (59%) were prescribed anti‐platelet drugs for prevention of cardiovascular disease, including aspirin, clopidogrel and dipyridamole, and 31 residents (41%) were on statin therapy. Eighteen (24%) residents had a monthly medication cost that was above £101 per month. On detailed review, these were largely residents who were being prescribed special order liquid preparations, usually for secondary cardiovascular disease prevention.
Conclusion Polypharmacy, defined as taking four or more drugs per day per resident, is highly prevalent within this population of care home residents with diabetes. A high proportion of residents are prescribed drugs for cardiovascular disease prevention, which may be entirely inappropriate in this population with limited life expectancy. Regular medication review of care home residents with diabetes should be undertaken as it has the potential to reduce costs, minimize adverse drug reactions and increase health gain.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Diabet. Med. 28, 778–780 (2011)
Aims To describe the degree of disability and nursing need of people living with diabetes resident in nursing homes in one Primary Care Trust in the UK.
Methods A ...retrospective case notes review of 75 people with known diabetes who were resident in the 11 nursing homes in Coventry Teaching Primary Care Trust.
Results Very significant levels of disability and nursing need were documented in areas of continence, feeding, mobility and communication. Each individual had a mean of four co‐morbidities (range 1–8), excluding diabetes. Using the definition of terminal illness based on a negative answer to the question ‘would I be surprised if my patient were to die in the next 12 months’ it is likely that the majority of individuals described in this study would be classified as being terminally ill.
Conclusion Using four practical clinical measures, this study has shown very significant levels of disability and nursing care need in this population of mainly elderly people resident in nursing homes in Coventry. In addition, it has demonstrated that a large proportion of nursing home residents with diabetes can be considered to be in the terminal phase of life, a period where many other factors interplay in how care should be delivered and what outcomes are appropriate. In fact, residents in this category may well be candidates for a considered withdrawal of treatments, but not of care.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
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