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Diabetes is a complex chronic condition that requires ongoing self-management. People with diabetes (PWD) and their caregivers (ie, parent) spend less than 1% of their time in a year visiting with their diabetes health care provider (HCP). 1,2 As a result, PWD and their caregivers troubleshoot day-today activities on their own. It is estimated PWD spend 8000 hours per year self-managing their diabetes outside of the medical setting. 1 The Diabetes, Attitudes, Wishes and Needs Second Study (DAWN2) suggests PWD feel that their HCPs aren't always available to provide patient-centered care related to their diabetes. 3 This lack of support, intensity of diabetes management, and social stigma can be associated with burnout, diabetes distress, 4 higher hemoglobin A1C (A1C) and body mass index. 5 In 831042D STXXX10.

Summary Vascular endothelial growth factor (VEGF) expression and mutations of cancer-related genes increase with cancer progression. This correlation suggests the hypothesis that oncogenes and tumour suppressors regulate VEGF, and a significant correlation between p53 alteration and increased VEGF expression in human lung cancer was reported recently. To further examine this hypothesis, we analysed VEGF protein expression and mutations in p53 and K-ras in 27 non-small-cell lung cancers (NSCLC): 16 squamous cell, six adenocarcinomas, one large cell, two carcinoids and two undifferentiated tumours. VEGF was expressed in 50% of the squamous cell carcinomas (SCC) and carcinoids but none of the others. p53 mutations occurred in 14 tumours (52%), and K-ras mutations were found in two adenocarcinomas and one SCC; there was no correlation between the mutations and VEGF expression. As nitric oxide also regulates angiogenesis, we examined NOS expression in NSCLC. The Ca2+-dependent NOS activity, which indicates NOS1 and NOS3 expression, was significantly reduced in lung carcinomas compared with adjacent non-tumour tissue (P < 0.004). Although the Ca2+-independent NOS activity, which indicates NOS2 expression, was low or undetectable in non-tumour tissues and most carcinomas, significant activity occurred in three SCC. In summary, our data do not show a direct regulation of VEGF by p53 in NSCLC. Finally, we did not find the up-regulation of NOS isoforms during NSCLC progression that has been suggested for gynaecological and breast cancers.

BackgroundWith rising incidence of type 1 diabetes (T1D) diagnoses among children and the high levels of distress experienced by the caregivers of these children, caregiver support is becoming increasingly important. Historically, relatively few support resources have existed. Increasing use of the Internet, and blogs in particular, has seen a growth of peer support between caregivers of children with T1D. However, little is known about the type and quality of information shared on T1D caregiver blogs. At the same time, the information on such blogs offers a new window into what challenges and successes caregivers experience in helping to manage their children’s T1D.ObjectiveThe purpose of this study was to (1) analyze blogs of caregivers to children with T1D to better understand the challenges and successes they face in raising a child with T1D, and (2) assess the blogs for the presence of unsafe or inaccurate clinical information or advice.MethodsAn inductive thematic qualitative study was conducted of three blogs authored by caregivers of children living with T1D, which included 140 unique blog posts and 663 associated comments. Two physician investigators evaluated the blogs for presence of clinical or medical misinformation.ResultsFive major themes emerged: (1) the impact of the child’s diagnosis, (2) the burden of intense self-management experienced in caring for a child with T1D, (3) caregivers’ use of technology to ease their fear of hypoglycemia and impacts that device alarms associated with this technology have on caregiver burden, (4) caregivers’ perceptions of frequently missed or delayed diagnosis of T1D and the frustration this causes, and (5) the resilience that caregivers develop despite the burdens they experience. Misinformation was exceedingly rare and benign when it did occur.ConclusionsBlog analysis represents a novel approach to understand the T1D caregiver’s experience. This qualitative study found many challenges that caregivers face in raising a child with T1D. Despite the many barriers caregivers face in managing their children’s T1D, they find support through advocacy efforts and peer-to-peer blogging. Blogs provide a unique avenue for support, with only rare and benign findings of medical misinformation, and may be a resource that diabetes care providers can consider offering to families for support.

The significant and growing global prevalence of diabetes continues to challenge people with diabetes (PwD), healthcare providers and payers. While maintaining near-normal glucose levels has been shown to prevent or delay the progression of the long-term complications of diabetes, a significant proportion of PwD are not attaining their glycemic goals. During the past six years, we have seen tremendous advances in automated insulin delivery (AID) technologies. Numerous randomized controlled trials and real-world studies have shown that the use of AID systems is safe and effective in helping PwD achieve their long-term glycemic goals while reducing hypoglycemia risk. Thus, AID systems have recently become an integral part of diabetes management. However, recommendations for using AID systems in clinical settings have been lacking. Such guided recommendations are critical for AID success and acceptance. All clinicians working with PwD need to become familiar with the available systems in order to eliminate disparities in diabetes quality of care. This report provides much-needed guidance for clinicians who are interested in utilizing AIDs and presents a comprehensive listing of the evidence payers should consider when determining eligibility criteria for AID insurance coverage.

The purpose of this study was to evaluate feasibility of initiating continuous glucose monitoring (CGM) through telehealth as a means of expanding access. Adults with type 1 diabetes (N=27) or type 2 diabetes using insulin (N=7) and interest in starting CGM selected a CGM system (Dexcom G6 or Abbott FreeStyle Libre), which they received by mail. CGM was initiated with a certified diabetes care and education specialist providing instruction via videoconference or phone. The primary outcome was days per week of CGM use during the last four weeks. HbA1c was measured at baseline and 12 weeks. Participant self-reported outcome measures were also evaluated. All 34 participants (mean age 46 ± 18 years; 53% female, 85% white) were using CGM at 12 weeks, with 94% using CGM at least six days/week in weeks 9-12. Mean HbA1c decreased from 8.3 ± 1.6 at baseline to 7.2 ± 1.3 at 12 weeks (P&lt;0.001) and mean time in range (70-180 mg/dL, 3.9-10.0 mmol/L) increased from an estimated 48% ± 18% to 59% ± 20% (P&lt;0.001), an increase of ~2.7 hours/day. Substantial benefits of CGM to quality of life were observed, with reduced diabetes distress, increased satisfaction with glucose monitoring and fewer perceived technology barriers to management. Remote CGM initiation was successful in achieving sustained use and improving glycemic control after 12 weeks as well as improving quality of life indicators. If widely implemented, this telehealth approach could substantially increase the adoption of CGM and potentially improve glycemic control for people with diabetes using insulin.

Background Of the estimated 23.1 million individuals diagnosed with diabetes, approximately 5% have type 1 diabetes (T1D). It has been proposed that this number will triple by 2050. With increases in technology use and resources available, many individuals are using insulin pumps and continuous glucose monitors (CGMs) to help manage their T1D. They are also using online resources such as social media to find more information and advice based on real-life experiences from peers. Blogs are a particular social media modality often used by people with T1D but have not been widely investigated. Objective The purpose of this study was to assess glycated hemoglobin (HbA 1c ) differences between blog readers and blog nonusers in a population of adults with T1D. This study also looked at differences in technology use in these two groups, as well as HbA 1c differences in blog use and technology subgroups. Methods Participants were recruited both by mail and by online T1D-themed blog postings. Respondents completed a secure online eligibility assessment and were asked questions related to their T1D, blog and internet use, and insulin pump and CGM use. Demographics were also collected. Differences between blog readers and blog nonusers were tested via chi-square and t tests. Mann-Whitney U tests, Fisher exact tests, and analyses of variance (ANOVA) were used to test for differences in self-reported HbA 1c between groups and subgroups. Results A total of 282 eligible participants completed the survey (214 blog readers, 68 blog nonusers). Average duration of diabetes was 21.2 years, 77.7% (219/282) were female, 81.2% (229/282) used an insulin pump, 66.3% (187/282) used a CGM, and 95.7% (270/282) were white. HbA 1c was lower for blog readers (7.0%) than blog nonusers (7.5%), P =.006; for insulin pump users (7.0%) than multiple daily injections (7.7%), P =.001; and for CGM users (7.0%) than CGM nonusers (7.5%), P =.001. After adjusting for significant covariates, the association between blog use and HbA 1c remained significant ( P =.04). ANOVA modeling also demonstrated significant differences in HbA 1c between blog users and nonusers among subgroups by pump use and CGM use ( P <.001). Conclusions These results suggest that reading blogs is associated with lower HbA 1c values. While association does not prove causation, blog readers have the benefit of learning information from peers and having 24/7 access to a community of individuals with similar daily life struggles, where they are able to ask questions and seek advice.

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