Aim
To assess the health‐related outcomes of hypoglycaemia for people with diabetes admitted to hospital; specifically, hospital length of stay and mortality.
Methods
We conducted a systematic review ...and meta‐analysis of studies relating to hypoglycaemia (< 4 mmol/l) for hospitalized adults (≥ 16 years) with diabetes reporting the primary outcomes of interest, hospital length of stay or mortality. Final papers for inclusion were reviewed in duplicate and the adjusted results of each were pooled, using a random effects model then undergoing further prespecified subgroup analysis.
Results
In total, 15 studies were included in the meta‐analysis. The pooled mean difference in length of stay for ward‐based inpatients exposed to hypoglycaemia was 4.1 days longer 95% confidence interval (CI) 2.36 to 5.79; I² = 99% compared with those without hypoglycaemia. This association remained robust across the pre‐specified subgroup analyses. The pooled relative risk (RR) of in‐hospital mortality was greater for those exposed to hypoglycaemia (RR 2.09, 95% CI 1.64 to 2.67; I² = 94%, n = 7 studies) but not in intensive care unit mortality (RR 0.75, 95% CI 0.49 to 1.16; I² =0%, n = 2 studies).
Conclusion
There is an association between inpatient hypoglycaemia and longer length of stay and greater in‐hospital mortality. Studies examining this association were heterogenous in terms of both clinical populations and effect size, but the overall direction of the association was consistent. Therefore, glucose concentration should be considered a potential tool to aid the identification of inpatients at risk of poor health‐related outcomes.
What's new?
Heterogeneity of inpatient populations and definitions of hypoglycaemia are a significant challenge in synthesizing evidence from previously published studies.
Hypoglycaemia events, including those considered non‐serious, are associated with an increased length of hospital stay and increased risk of inpatient mortality.
Inpatient hypoglycaemia is a marker for clinical deterioration and potential increased risk for adverse outcomes.
Glucose measurements could aid the identification of those at risk of poor health‐related outcomes.
Aims
To explore the experiences of pregnant women with Type 1 diabetes, and the relationships between perceptions of glucose control, attitudes to technology and glycaemic responses with regard to ...closed‐loop insulin delivery.
Methods
We recruited 16 pregnant women with Type 1 diabetes mean ± sd age 34.1 ± 4.6 years, duration of diabetes 23.6 ± 7.2 years, baseline HbA1c 51±5 mmol/mol (6.8 ± 0.6%) to a randomized crossover trial of sensor‐augmented pump therapy vs automated closed‐loop therapy. Questionnaires (Diabetes Technology Questionnaire, Hypoglycaemia Fear Survey) were completed before and after each intervention, with qualitative interviews at baseline and follow‐up.
Results
Women described the benefits and burdens of closed‐loop systems during pregnancy. Feelings of improved glucose control, excitement and empowerment were counterbalanced by concerns about device visibility, obsessive data checking and diminished attentiveness to hyper‐ and hypoglycaemia symptoms. Responding to questionnaires, eight participants felt less worry about overnight hypoglycaemia and that diabetes ‘did not run their lives’; however, five reported that closed‐loop increased time thinking about diabetes, and three felt it made sleep and preventing hyperglycaemia more problematic. Women slightly overestimated their glycaemic response to closed‐loop therapy. Most became more positive in their technology attitudes throughout pregnancy. Women with more positive technology attitudes had higher degrees of overestimation, and poorer levels of glycaemic control.
Conclusions
Women displayed complex psychosocial responses to closed‐loop therapy in pregnancy. Perceptions of glycaemic response may diverge from biomedical data.
What's new?
This is the first study to examine the psychosocial experiences of pregnant women with Type 1 diabetes who were using automated overnight closed‐loop systems, and the first to use mixed methods to compare women's perceptions with objective glucose control data.
Our findings highlight the complexities of experience surrounding automated closed‐loop systems in pregnancy. Women described a mix of benefits and burdens, and varied in the accuracy of their perceptions of glucose control. Women with more positive technology attitudes had higher degrees of overestimation and poorer glycaemic control.
To ensure appropriate and safe use of closed‐loop systems in pregnancy, clinicians should account for varying user perceptions and seek to manage expectations.
Understanding habitat requirements for species at risk is crucial for effective conservation management, even though the location and extent of vital habitats may be unknown for rare or elusive ...species.
In the case of marine species, determining important habitat often relies on limited occurrence data or extrapolation from species distribution models (SDMs). SDMs predict habitat by associating species records with environmental variables, assuming a functional ecological relationship.
This study focuses on northern bottlenose whales (NBW; Hyperoodon ampullatus) and Sowerby's beaked whales (SBW; Mesoplodon bidens) in the western North Atlantic. As both NBW and SBW are at risk in Canada, the objective was to identify the extent and function of important habitats to guide conservation efforts.
The analysis mapped all available geographic occurrence data and used passive acoustic monitoring (PAM) data to inform the development of ensemble SDMs to predict potential habitat and assess the persistence of realized habitat use.
Important habitats for NBW and SBW were found primarily concentrated along the continental shelf edges, at an average depth of 1200 m ± 460 SD. All habitat areas support foraging and movement and critical life history functions for both species.
The Gully and other submarine canyons off eastern Nova Scotia emerged as important areas for both species, validating the existing Critical Habitat for NBW. However, spatial–temporal patterns diverged on either side of this region. North‐eastern Newfoundland was identified as the next closest area of near‐year‐round presence for NBW, whereas the south‐western Scotian Shelf region, Georges Bank and the Fundian Channel supported persistent foraging by SBW.
By integrating multiple data sources (sightings, acoustic detections and SDMs) and demonstrating the temporal persistence of habitat use by NBW and SBW, this study provides valuable insights for identifying, protecting and managing important habitat for beaked whales.
Understanding the basis of brain function requires knowledge of cortical operations over wide-spatial scales, but also within the context of single neurons. In vivo, wide-field GCaMP imaging and ...sub-cortical/cortical cellular electrophysiology were used in mice to investigate relationships between spontaneous single neuron spiking and mesoscopic cortical activity. We make use of a rich set of cortical activity motifs that are present in spontaneous activity in anesthetized and awake animals. A mesoscale spike-triggered averaging procedure allowed the identification of motifs that are preferentially linked to individual spiking neurons by employing genetically targeted indicators of neuronal activity. Thalamic neurons predicted and reported specific cycles of wide-scale cortical inhibition/excitation. In contrast, spike-triggered maps derived from single cortical neurons yielded spatio-temporal maps expected for regional cortical consensus function. This approach can define network relationships between any point source of neuronal spiking and mesoscale cortical maps.
Most adolescent girls fail to meet current physical activity guidelines. Physical activity behaviours track from childhood into adulthood and providing adolescent girls with opportunities to be ...physically active may have health benefits beyond childhood. The effects of walking interventions on adult cardiometabolic health are known, however less is understood about the potential of walking to promote physical activity in adolescents. Following the Walking In ScHools (WISH) feasibility study, this definitive trial aimed to evaluate the effectiveness of a novel, low-cost, school-based walking intervention at increasing physical activity levels of adolescent girls (aged 12-14 years).
Female pupils were recruited from eighteen schools across the border region of Ireland and in Northern Ireland. In intervention schools (n = 9), girls aged 15-18 years, were trained as walk leaders, and led the younger pupils in 10-15 min walks before school, at break and lunch recess. All walks took place in school grounds and pupils were encouraged to participate in as many walks as possible each week. The primary outcome measure was accelerometer determined total physical activity (counts per minutes, cpm).
In total, 589 pupils were recruited to the study. At baseline, pupils engaged in a median (interquartile range (IQR)) 35.7 (21.2) mins moderate-vigorous physical activity (MVPA) per day and only 12% (n = 66) of participants met physical activity guidelines (60 min MVPA per day). The intervention was delivered for a mean (standard deviation (SD)) 19.9 ± 0.97 weeks. The mean post-intervention total physical activity for the intervention group was 676 cpm and 710 cpm in the control group. Post-intervention total physical activity did not statistically differ between groups when adjusted for age, body mass index z-scores and baseline physical activity (mean difference, -33.5, 95% CI = -21.2 to 88.1; p = 0.213).
'Scaling-up' physical activity interventions is challenging and despite a promising feasibility study, the results of this fully powered trial suggest that in this context, the WISH intervention did not increase device measured physical activity. Since the COVID-19 pandemic, school environments have changed and although pupils enjoyed the programme, attendance at walks was low, indicating that there is a need to better understand how to implement interventions within schools.
ISRCTN; ISRCTN12847782; Registered 2nd July 2019.
Aim
To evaluate the diagnostic and prognostic performance of alternative diagnostic strategies to oral glucose tolerance tests, including random plasma glucose, fasting plasma glucose and HbA1c, ...during the COVID‐19 pandemic.
Methods
Retrospective service data (Cambridge, UK; 17 736 consecutive singleton pregnancies, 2004–2008; 826 consecutive gestational diabetes pregnancies, 2014–2019) and 361 women with ≥1 gestational diabetes risk factor (OPHELIA prospective observational study, UK) were included. Pregnancy outcomes included gestational diabetes (National Institute of Health and Clinical Excellence or International Association of Diabetes and Pregnancy Study Groups criteria), diabetes in pregnancy (WHO criteria), Caesarean section, large‐for‐gestational age infant, neonatal hypoglycaemia and neonatal intensive care unit admission. Receiver‐operating characteristic curves and unadjusted logistic regression were used to compare random plasma glucose, fasting plasma glucose and HbA1c performance.
Results
Gestational diabetes diagnosis was significantly associated with random plasma glucose at 12 weeks area under the receiver‐operating characteristic curve for both criteria 0.81 (95% CI 0.79–0.83), fasting plasma glucose National Institute of Health and Clinical Excellence: area under the receiver‐operating characteristic curve 0.75 (95% CI 0.65–0.85); International Association of Diabetes and Pregnancy Study Groups: area under the receiver‐operating characteristic curve 0.92 (95% CI 0.85–0.98) and HbA1c at 28 weeks' gestation National Institute of Health and Clinical Excellence: 0.83 (95% CI 0.75–0.90); International Association of Diabetes and Pregnancy Study Groups: 0.84 (95% CI 0.77–0.91). Each measure predicts some, but not all, pregnancy outcomes studied. At 12 weeks, ~5% of women would be identified using random plasma glucose ≥8.5 mmol/l (sensitivity 42%; specificity 96%) and at 28 weeks using HbA1c ≥39 mmol/mol (sensitivity 26%; specificity 96%) or fasting plasma glucose ≥5.2–5.4 mmol/l (sensitivity 18–41%; specificity 97–98%).
Conclusions
Random plasma glucose at 12 weeks, and fasting plasma glucose or HbA1c at 28 weeks identify women with hyperglycaemia at risk of suboptimal pregnancy outcomes. These opportunistic laboratory tests perform adequately for risk stratification when oral glucose tolerance testing is not available.
Vasodilatory prostaglandins play a key role in neurovascular coupling (NVC), the tight link between neuronal activity and local cerebral blood flow, but their precise identity, cellular origin and ...the receptors involved remain unclear. Here we show in rats that NMDA-induced vasodilation and hemodynamic responses evoked by whisker stimulation involve cyclooxygenase-2 (COX-2) activity and activation of the prostaglandin E2 (PgE2) receptors EP2 and EP4. Using liquid chromatography-electrospray ionization-tandem mass spectrometry, we demonstrate that PgE2 is released by NMDA in cortical slices. The characterization of PgE2 producing cells by immunohistochemistry and single-cell reverse transcriptase-PCR revealed that pyramidal cells and not astrocytes are the main cell type equipped for PgE2 synthesis, one third expressing COX-2 systematically associated with a PgE2 synthase. Consistent with their central role in NVC, in vivo optogenetic stimulation of pyramidal cells evoked COX-2-dependent hyperemic responses in mice. These observations identify PgE2 as the main prostaglandin mediating sensory-evoked NVC, pyramidal cells as their principal source and vasodilatory EP2 and EP4 receptors as their targets.
Brain function critically depends on a permanent spatiotemporal match between neuronal activity and blood supply, known as NVC. In the cerebral cortex, prostaglandins are major contributors to NVC. However, their biochemical identity remains elusive and their cellular origins are still under debate. Although astrocytes can induce vasodilations through the release of prostaglandins, the recruitment of this pathway during sensory stimulation is questioned. Using multidisciplinary approaches from single-cell reverse transcriptase-PCR, mass spectrometry, to ex vivo and in vivo pharmacology and optogenetics, we provide compelling evidence identifying PgE2 as the main prostaglandin in NVC, pyramidal neurons as their main cellular source and the vasodilatory EP2 and EP4 receptors as their main targets. These original findings will certainly change the current view of NVC.
Traditionally, mapping the motor cortex requires electrodes to stimulate the brain and define motor output pathways. Although effective, electrode-based methods are labor-intensive, potentially ...damaging to the cortex and can have off-target effects. As an alternative method of motor mapping, we photostimulated transgenic mice expressing the light-sensitive ion channel channelrhodopsin-2 in predominantly layer-5 output cortical neurons. We report that optical stimulation of these neurons in vivo using a stage scanning laser system resulted in muscle excitation within 10-20 ms, which can be recorded using implanted electromyogram electrodes or by a noninvasive motion sensor. This approach allowed us to make highly reproducible automated maps of the mouse forelimb and hindlimb motor cortex much faster than with previous methods. We anticipate that the approach will facilitate the study of changes in the location and properties of motor maps after skilled training or damage to the nervous system.
Aims
To determine whether the neonatal and delivery outcomes of gestational diabetes vary seasonally in the context of a relatively cool temperate climate.
Methods
A retrospect cohort of 23 735 women ...consecutively delivering singleton, live‐born term infants in a single tertiary obstetrics centre in the UK (2004–2008) was identified. A total of 985 (4.1%) met the diagnostic criteria for gestational diabetes. Additive dynamic regression models, adjusted for maternal age, BMI, parity and ethnicity, were used to compare gestational diabetes incidence and outcomes over annual cycles. Outcomes included: random plasma glucose at booking; gestational diabetes diagnosis; birth weight centile; and delivery mode.
Results
The incidence of gestational diabetes varied by 30% from peak incidence (October births) to lowest incidence (March births; P=0.031). Ambient temperature at time of testing (28 weeks) was strongly positively associated with diagnosis (P<0.001). Significant seasonal variation was evident in birth weight in gestational diabetes‐affected pregnancies (average 54th centile June to September; average 60th centile December to March; P=0.027). Emergency Caesarean rates also showed significant seasonal variation of up to 50% (P=0.038), which was closely temporally correlated with increased birth weights.
Conclusions
There is substantial seasonal variation in gestational diabetes incidence and maternal–fetal outcomes, even in a relatively cool temperate climate. The highest average birth weight and greatest risk of emergency Caesarean delivery occurs in women delivering during the spring months. Recognizing seasonal variation in neonatal and delivery outcomes provides new opportunity for individualizing approaches to managing gestational diabetes.
What's new?
Gestational diabetes (GDM) shows seasonal variation in hot climates, but there is no consensus on whether this impacts on neonatal or delivery outcomes.
Birth weights and emergency Caesarean section rates vary seasonally in GDM‐affected pregnancies. The highest average birth weight and greatest risk of emergency Caesarean delivery occur when fewest births are complicated by GDM (March births).
There are seasonal differences in GDM outcomes, and consideration should be given to the differing environmental, dietary and lifestyle factors faced by women with GDM throughout the year.
Background
Young people have the right to be informed and consulted about decisions affecting their lives. Patient and public involvement (PPI) ensures that research is carried out ‘with’ or ‘by’ ...young people rather than ‘to’, ‘about’ or ‘for’ them. The aim of this paper is to outline how youth PPI can be embedded within a physical activity intervention, reflect on the impact of PPI and provide recommendations for future PPI in a similar context.
Methods
A Youth Advisory Group (YAG) was set up within the Walking In ScHools (WISH) Study to involve adolescent girls in the delivery, implementation and dissemination of a physical activity intervention targeted at adolescents. Schools invited pupils aged 12–14 years and 15–18 years to YAG meetings (n3, from 2019 to 2023). Participative methods were used to inform recruitment strategies and data collection methods for the WISH Study.
Results
Across the three YAG meetings, n51 pupils from n8 schools were involved. Pupils enjoyed the YAG meetings, felt that their feedback was valued and considered the meetings a good way to get young people involved in research. The YAG advised on specific issues and although measuring impact was not the primary aim of the YAG meetings, over the course of the study there were many examples of the impact of PPI. Recruitment targets for the WISH Study were exceeded, the attrition rate was low and pupils were engaged in data collection.
Conclusion
Youth PPI is a developing field and there are few physical activity studies that report the PPI work undertaken. Within the WISH Study, three YAG meetings were held successfully, and the views of adolescent girls were central to the development of the study. Considering the specific issues that the YAG advised on (study recruitment, attrition and data collection), there was evidence of a positive impact of PPI.
Patient or Public Contribution
Pupils from post‐primary schools interested/participating in the WISH Study were invited to attend YAG meetings. YAG meetings were set up to consult adolescent girls on the delivery, implementation and dissemination of the WISH intervention.
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