XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

Sustainable Development Goals

The genetic architecture of common traits, including the number, frequency, and effect sizes of inherited variants that contribute to individual risk, has been long debated. Genome-wide association studies have identified scores of common variants associated with type 2 diabetes, but in aggregate, these explain only a fraction of the heritability of this disease. Here, to test the hypothesis that lower-frequency variants explain much of the remainder, the GoT2D and T2D-GENES consortia performed whole-genome sequencing in 2,657 European individuals with and without diabetes, and exome sequencing in 12,940 individuals from five ancestry groups. To increase statistical power, we expanded the sample size via genotyping and imputation in a further 111,548 subjects. Variants associated with type 2 diabetes after sequencing were overwhelmingly common and most fell within regions previously identified by genome-wide association studies. Comprehensive enumeration of sequence variation is necessary to identify functional alleles that provide important clues to disease pathophysiology, but large-scale sequencing does not support the idea that lower-frequency variants have a major role in predisposition to type 2 diabetes.

The genetic architecture of type 2 diabetes

OBJECTIVE
The authors examined the prospective relationship between physical activity and incident depression and explored potential moderators.


METHOD
Prospective cohort studies evaluating incident depression were searched from database inception through Oct. 18, 2017, on PubMed, PsycINFO, Embase, and SPORTDiscus. Demographic and clinical data, data on physical activity and depression assessments, and odds ratios, relative risks, and hazard ratios with 95% confidence intervals were extracted. Random-effects meta-analyses were conducted, and the potential sources of heterogeneity were explored. Methodological quality was assessed using the Newcastle-Ottawa Scale.


RESULTS
A total of 49 unique prospective studies (N=266,939; median proportion of males across studies, 47%) were followed up for 1,837,794 person-years. Compared with people with low levels of physical activity, those with high levels had lower odds of developing depression (adjusted odds ratio=0.83, 95% CI=0.79, 0.88; I2=0.00). Furthermore, physical activity had a protective effect against the emergence of depression in youths (adjusted odds ratio=0.90, 95% CI=0.83, 0.98), in adults (adjusted odds ratio=0.78, 95% CI=0.70, 0.87), and in elderly persons (adjusted odds ratio=0.79, 95% CI=0.72, 0.86). Protective effects against depression were found across geographical regions, with adjusted odds ratios ranging from 0.65 to 0.84 in Asia, Europe, North America, and Oceania, and against increased incidence of positive screen for depressive symptoms (adjusted odds ratio=0.84, 95% CI=0.79, 0.89) or major depression diagnosis (adjusted odds ratio=0.86, 95% CI=0.75, 0.98). No moderators were identified. Results were consistent for unadjusted odds ratios and for adjusted and unadjusted relative risks/hazard ratios. Overall study quality was moderate to high (Newcastle-Ottawa Scale score, 6.3). Although significant publication bias was found, adjusting for this did not change the magnitude of the associations.


CONCLUSIONS
Available evidence supports the notion that physical activity can confer protection against the emergence of depression regardless of age and geographical region.

Physical activity and incident depression: a meta-analysis of prospective cohort studies

That prenatal events can have life-long consequences is now well established. Nevertheless, research on the Fetal Origins Hypothesis is flourishing and has expanded to include the early childhood (postnatal) environment. Why does this literature have a “second act?” We summarize the major themes and contributions driving the empirical literature since our 2011 reviews, and try to interpret the literature in light of an overarching conceptual framework about how human capital is produced early in life. One major finding is that relatively mild shocks in early life can have substantial negative impacts, but that the effects are often heterogeneous reflecting differences in child endowments, budget constraints, and production technologies. Moreover, shocks, investments, and interventions can interact in complex ways that are only beginning to be understood. Many advances in our knowledge are due to increasing accessibility of comprehensive administrative data that allow events in early life to be linked to long-term outcomes. Yet, we still know relatively little about the interval between, and thus about whether it would be feasible to identify and intervene with affected individuals at some point between early life and adulthood. We do know enough, however, to be able to identify some interventions that hold promise for improving child outcomes in early life and throughout the life course.Institutional subscribers to the NBER working paper series, and residents of developing countries may download this paper without additional charge at www.nber.org.

Childhood Circumstances and Adult Outcomes: Act Ii

/pdf/transforming-the-future-of-ageing-21sdvn1s4g.pdf

Transforming the future of ageing

This contribution aims to discuss an original survey methodology, conceived in lockdown conditions, when face to face interviewing was prohibited and economic and sociological research faced obstacles in obtaining empirical data. An original pseudo-longitudinal Covid-CAWI is conducted in two fully harmonized waves. The basic methodological principles are elucidated along with limitations and advantages within the context of anti-epidemic measures and lockdowns in Bulgaria. The article elaborates the steps of data cleaning, conducted as an essential pre-processing step to high level of data quality. Special focus is devoted to posterior data optimization, using post-stratification adjustments. A comparison between weighted and unweighted data on economic effects is analysed. The paper contributes to the scientific debate on methodology insofar as online surveys become the one and only research opportunity for quantitative research in a crisis situation. The presented analysis of subsequent optimization procedures in Internet studies aims to open a discussion, especially in the context of socioeconomic research in a crisis situation where there are physical distance constraints. The data from the Covid-CAWI survey will be available for open access, so all interested in research may analyse the effects of the pandemic on social and economic life and debate on survey methodology.

Online Survey Data on Economic Effects of Lockdowns and Post-Stratification Data Adjustment: Evidence from Bulgaria

The main focus of this article is to shed light on the challenges to the work-life balance (WLB) caused by school closures due to lockdowns in Bulgaria. Both paid and unpaid jobs occur intensively in the family environment due to anti-epidemic measures of physical distancing. School closures introduce a novel element of unpaid work: intensive parental participation in the educational process during distance schooling, which requires additional competencies, time and effort, as well as the need to reconcile work with these new obligations. The analysis is based on original CAWI pseudo-longitudinal surveys, conducted during the first (April-May 2020) and second lockdowns (November-December 2020) in Bulgaria, as well as data on changes in personal contacts with family and friends, help given and received, personal care given and received from SHARE Survey, Wave 8 COVID-19 Survey 1 (July-August 2020). Terminological distinction is made between online and distance learning, because the pressures on parents vary. A push-pull model is elaborated, which could influence coping patterns when children are in home schooling due to lockdowns. The main coping pattern observed is that families were better prepared for the second lockdown, because by this time they had grandparents living in the same household. 

https://www.tandfonline.com/doi/pdf/10.1080/25739638.2023.2216499?needAccess=true&role=button

Ekaterina L. Markova

Papers

Transforming the future of ageing

Online Survey Data on Economic Effects of Lockdowns and Post-Stratification Data Adjustment: Evidence from Bulgaria

Work-life balance and parental coping patterns during home schooling as a result of Covid-19 lockdowns: empirical evidence from Bulgaria