This project evaluated the outcomes of acceptance and commitment therapy (ACT)-informed interventions for individuals with Type 1 or Type 2 diabetes mellitus experiencing mental health distress related to their condition or self-management burden. A within-subjects design evaluated the effectiveness of ACT-informed interventions using pre- and post-psychological wellbeing and diabetes specific outcome measures and HbA1C data. The interventions were part of the Croydon Community Diabetes service which began in October 2020. Fifty-six service users completed psychological wellbeing outcome measures (PHQ-9, GAD-7 and CORE-10) and 38 of these service users fully completed the diabetes specific measure (either DDS or the PAID). Thirty-nine service users had HbA1C data before the start of treatment and following the end of treatment. Wilcoxon’s signed rank test was used to analyse psychological outcomes and HbA1c data. Descriptive statistics were used for diabetes specific measures due to small sample sizes. Statistically significant reductions in levels of depression, generalised anxiety, and general psychological distress were found following ACT-informed interventions. Statistically significant reductions were also observed for HbA1c readings. Although inferential statistics were not used, the data highlighted that n=21 and n=14 reported reduction in scores on the DDS and PAID, respectively. Preliminary evidence suggests that ACT-informed interventions in an NHS community diabetes clinic for a sample of people living with Type 1 or Type 2 diabetes are associated with improved psychological wellbeing and diabetes distress.

Key learning aims

1. (1) To learn about the current evidence base and missing gaps in research on the use of acceptance and commitment therapy (ACT) for people living with Type 1 or Type 2 diabetes mellitus.

2. (2) To provide clinicians with an example of brief individualised ACT informed psychological interventions based on a sample of people living with diabetes in South London.

3. (3) To learn about the implementation of ACT informed psychological interventions in a naturalistic evaluation of a community Diabetes NHS service that reflects realistic treatment delivery.

4. (4) Through the limitations discussed in this paper, we provide future suggestions for psychologists working in diabetes care for evaluating their service in a naturalistic setting. This includes the collection of data through various sources such as the use of physical health measures and therapy process measures.

To determine the prevalence of FA in individuals with type 2 diabetes and to assess the association between FA and type 2 diabetes. MEDLINE, EMBASE, Web of Sciences, Latin American and Caribbean Literature in Health Sciences, ScienceDirect, Scopus, and PsycINFO were searched until November 2024. This study was registered with PROSPERO (CRD42023465903). Cross-sectional studies, case-control, cohorts, and clinical trials that were carried out with individuals with type 2 diabetes, regardless of age and sex, were included. The complete data extracted included the prevalence, odds ratio, and/or risk ratio of FA, the number of individuals evaluated, age, sex, weight, presence of comorbidities, age of participants, and FA symptoms. A pooled prevalence of FA of 30% (95% CI [18; 44] with estimated predictive interval [0; 85]; I2 = 99.51; 12 studies; 15947 participants) was identified. For the associations between FA and type 2 diabetes, we found a grouped crude odds ratio value of 2.35 (95%CI [1.71; 2.98]). The pooled odds ratio adjusted for age and sex was 2.60 (95% CI [1.77; 3.42]). Finally, the odds ratio adjusted for age, sex, and body mass index (BMI) was 2.01 (95%CI [1.39; 2.64]). The results of the meta-analyses showed a high prevalence of FA in individuals with type 2 diabetes and that the associations between these two conditions remained even after adjustment for age, sex, and BMI, although with a high heterogeneity among individual estimates.

Understanding beliefs, values, and preferences of patients is a tenet of contemporary health sciences. This application was motivated by the analysis of multiple partially ordered set (poset) responses from an inventory on layman beliefs about diabetes. The partially ordered set arises because of two features in the data—first, the response options contain a Don’t Know (DK) option, and second, there were two consecutive occasions of measurement. As predicted by the common sense model of illness, beliefs about diabetes were not necessarily stable across the two measurement occasions. Instead of analyzing the two occasions separately, we studied the joint responses across the occasions as a poset response. Few analytic methods exist for data structures other than ordered or nominal categories. Poset responses are routinely collapsed and then analyzed as either rank ordered or nominal data, leading to the loss of nuanced information that might be present within poset categories. In this paper we developed a general class of item response models for analyzing the poset data collected from the Common Sense Model of Diabetes Inventory. The inferential object of interest is the latent trait that indicates congruence of belief with the biomedical model. To apply an item response model to the poset diabetes inventory, we proved that a simple coding algorithm circumvents the requirement of writing new codes such that standard IRT software could be directly used for the purpose of item estimation and individual scoring. Simulation experiments were used to examine parameter recovery for the proposed poset model.

Objectives: Low- and middle-income countries face increasing burden of noncommunicable chronic diseases due to rapid population aging. The Objectives of this study is to estimate the association of co-occurring depression and diabetes with healthcare services utilization in the Brazilian population aged 50 years andolder.

Methods: This is an analysis using baseline data of the ELSI-Brazil study. Measurements used were self-reported previous diagnosis for diabetes and a cut-off point of 4 on the CES-D-8 score for depression. Any medical consultations, specialist consultations and hospitalizations in the previous 12 months were assessed for measuring health services use. Logistic regression was used to estimate the association of having depression, diabetes, or both, compared to having none of the conditions with healthcare services utilization.

Results: In a final sample of 8303 participants, the adjusted odds ratios (95%CI) in the depression only group (27.9%), in the diabetes only group (9.7%), and in the depression and diabetes group (5.8%), for any medical consultations were 1.2 (1.01-1.42), 3.39 (2.4-4.79) and 3.12 (1.82-5.35); for specialist consultations, 1.05 (0.91-1.21), 1.34 (1.07-1.68) and 1.13 (0.86-1.49); and for hospitalizations, 1.42 (1.1-1.84), 1.42 (1.02-1.96) and 3.1 (2.12-4.54), respectively. All models were adjusted for sex, age, education, marital status, insufficient physical activity, current drinking and smoking, obesity and number of other diseases and conditions.

Conclusions: Those with diabetes seemed more likely to have any or specialized medical consultations. However, those with the depression and diabetes comorbidity were more likely than any other group to have been admitted to a hospital in the last year, which is distressing and costly. Screening for depression could be incorporated into diabetes usual care to reduce related complications and hospitalizations.

Funding: This study did not receive any funding. Authors: Ferri and Lima-Costa are recipient of CNPq research productive fellowship.

Epidemiological and clinical trial evidence indicates that n-6 polyunsaturated fatty acid (PUFA) intake is cardioprotective. Nevertheless, claims that n-6 PUFA intake promotes inflammation and oxidative stress prevail. This narrative review aims to provide health professionals with an up-to-date evidence overview to provide the requisite background to address patient/client concerns about oils containing predominantly unsaturated fatty acids (UFA), including MUFA and PUFA. Edible plant oils, commonly termed vegetable oils, are derived from vegetables, nuts, seeds, fruits and cereal grains. Substantial variation exists in the fatty acid composition of these oils; however, all are high in UFA, while being relatively low in saturated fatty acids (SFA), except for tropical oils. Epidemiological evidence indicates that higher PUFA intake is associated with lower risk of incident CVD and type 2 diabetes mellitus (T2DM). Additionally, replacement of SFA with PUFA is associated with reduced risk of CVD and T2DM. Clinical trials show higher intake of UFA from plant sources improves major CVD risk factors, including reducing levels of atherogenic lipids and lipoproteins. Importantly, clinical trials show that increased n-6 PUFA (linoleic acid) intake does not increase markers of inflammation or oxidative stress. Evidence-based guidelines from authoritative health and scientific organisations recommend intake of non-tropical vegetable oils, which contain MUFA and n-6 PUFA, as part of healthful dietary patterns. Specifically, vegetable oils rich in UFA should be consumed instead of rich sources of SFA, including butter, tallow, lard, palm and coconut oils.

Patients with type 2 diabetes have increased risks for dyslipidaemia and subsequently for developing vascular complications. A recent meta-analysis found that cetoleic acid (C22:1n-11) rich fish oils resulted in lower cholesterol concentration in rodents. The aim was to investigate the effect of consuming fish oils with or without cetoleic acid on serum cholesterol concentration in diabetic rats and to elucidate any effects on cholesterol metabolism. Eighteen male Zucker Diabetic Sprague Dawley rats were fed diets containing herring oil (HERO) or anchovy oil (ANCO) or a control diet with soyabean oil for 5 weeks. The HERO diet contained 0·70 % cetoleic acid, with no cetoleic acid in the ANCO diet. The HERO and ANCO diets contained 0·35 and 0·37 wt% EPA + DHA, respectively. Data were analysed using one-way ANOVA. The serum total cholesterol concentration was 14 % lower in the HERO group compared with ANCO and Control groups (P = 0·023). The HERO group had a higher faecal excretion of bile acids (P = 0·0036), but the cholesterol production in the liver, the hepatic secretion of VLDL and the liver’s capacity to take up cholesterol were similar to controls. The ANCO diet did not affect the serum cholesterol concentration, but the hepatic cholesterol biosynthesis, the clearance of lipoprotein cholesterol and the excretion of bile acids in faeces were higher than in the Control group. To conclude, consumption of herring oil, but not of anchovy oil, led to a lower cholesterol concentration in a type 2 diabetes rat model.

Adenylate kinases (AKs) are important enzymes involved in cellular energy metabolism. Among AKs, AK5 (adenylate kinase 5), a cytosolic protein, is emerging as a significant contributor to various diseases and cellular processes. This comprehensive review integrates findings from various research groups on AK5 since its discovery, shedding light on its multifaceted roles in nucleotide metabolism, energy regulation, and cellular differentiation. We investigate its implications in a spectrum of diseases, including autoimmune encephalitis, epilepsy, neurodegenerative disorders such as Alzheimer’s and Parkinson’s, diabetes, lower extremity arterial disease, celiac disease, and various cancers. Notably, AK5’s expression levels and methylation status have been associated with cancer progression and patient outcomes, indicating its potential as a prognostic indicator. Furthermore, AK5 is implicated in regulating cellular processes in breast cancer, gastric cancer, colorectal carcinoma, prostate cancer, and colon adenocarcinoma, suggesting its relevance across different cancer types. However, a limitation lies in the need for more robust clinical validation and a deeper understanding of AK5’s precise mechanisms in disease pathogenesis, despite its association with various pathophysiological conditions. Nonetheless, AK5 holds promise as a therapeutic target, with emerging evidence suggesting its potential in therapy development.

In underserved communities across New York City, uninsured adults encounter a greater risk of cardiovascular disease (CVD) and diabetes. The Heart-to-Heart Community Outreach Program (H2H) addresses these disparities by screening for CVD risk factors, identifying healthcare access barriers, and fostering community engagement in translational research at the Weill Cornell Medicine Clinical and Translational Science Award (CTSA) hub. Screening events are hosted in partnership with faith-based institutions. Participants provide a medical history, complete a survey, and receive counseling by clinicians with referrals for follow-up care. This study aims to quantify H2H screening participant health status; identify socioeconomic, health access, and health-related barriers disproportionately promoting the onset of CVD and diabetes; and develop long-term community partnerships to enable underserved communities to influence activities across the translational research spectrum at our CTSA hub. The population served is disproportionately non-white, and uninsured, with many low-income and underserved individuals. The program was developed in partnership with our Community Advisory Board to empower this cohort to make beneficial lifestyle changes. Leveraging partnerships with faith-based institutions and community centers in at-risk New York City neighborhoods, H2H addresses the increasing burden of diabetes and CVD risk factors in vulnerable individuals while promoting community involvement in CTSA activities, serving as a model for similar initiatives.

Pulmonary tuberculosis (PTB) elimination efforts must consider the global growth of the ageing population. Here we used TB surveillance data from Texas, United States (2008–2020; total n = 10656) to identify unique characteristics and outcomes in older adults (OA, ≥65 years) with PTB, compared to young adults (YA, 18–39 years) or middle-aged adults (40–64 years). We found that the proportion of OA with PTB increased from 15% in 2008 to 24% in 2020 (trend p < 0.05). Diabetes was highly prevalent in OA (32%) but not associated with adverse outcomes. Death was 13-fold higher in OA compared to YA and was 7% at the time of diagnosis which suggests diagnostic delays. However, once TB was suspected, we found no differences in culture, smear, or nucleic acid detection of mycobacteria (although less lung cavitations) in OA. During treatment, OA had less drug-resistant TB, few adverse reactions and adhered with TB treatment. We recommend training healthcare workers to ‘think TB’ in OA, for prompt treatment initiation to diminish deaths. Furthermore, OA should be added as a priority group to the latent TB treatment guidelines by the World Health Organization, to prevent TB disease in this highly vulnerable group.

Methods to reduce obesity and type 2 diabetes in Aotearoa New Zealand are desperately needed, with obesity one of the greatest predisposing factors for type 2 diabetes as well as heart disease, and certain cancers.1 A recent New Zealand report2 identified several interventions that might benefit people with established diabetes, the most promising being a period of rapid weight loss, followed by supported weight-loss maintenance. Such weight loss has shown to achieve what was previously thought impossible, diabetes remission,3 as well as appreciably reduce the risk of cardiovascular disease and prevent diabetes-related chronic kidney disease, retinopathy, nephropathy, and lower limb amputation.2 While the findings from the studies of low energy total meal replacement diets have stimulated great interest, their use in Aotearoa New Zealand has not been considered. The purpose of this primary-care led intervention therefore was to consider the acceptability and efficacy of such a weight loss programme, DiRECT, in Aotearoa New Zealand. Te Kāika DiRECT is a 12-month study conducted within a Māori primary healthcare provider in O¯tepoti Dunedin. The DiRECT protocol is three months of total meal replacement for rapid weight loss followed by food reintroduction and a longer period of supported weight loss maintenance. Participants were adults with prediabetes or T2 diabetes and obesity wanting to lose weight. Twenty participants (70% female, age 46 (SD 10), BMI 41 (9), HbA1c 51 (11)) were randomised to receive the DiRECT protocol, twenty more (70% female, age 50 (SD 8), BMI 40 (7), HbA1c 54 (14)) were randomised to receive best practice weight loss support (usual care). All participants had the same number of visits with the in-house Dietitian and free access to the onsite gym. Participants in the control group also received regular grocery vouchers to purchase the foods encouraged by healthy eating guidelines. Recruitment began in February, 2022. After the initial three month study period, DiRECT participants reported consuming 3.0MJ (95% CI 1.2 to 4.8MJ) less energy per day than those in usual care. Mean weight loss was 6kg (2.3-9.6kg) greater for DiRECT participants than usual care participants, while medication use and systolic blood pressure (12mmHg (0-24mmHg)) were lower. Continuous glucose monitoring identified that at baseline, participants on average only spent 10% of the day with a blood glucose reading under 8mmol/L (normoglycaemia). After three months, the usual care group spent on average 48% of the day within the normoglycaemic range, while DiRECT participants spent 78% of the day within the normoglycaemic range. Results at 12 months will enable comment on longer term markers of blood glucose control (HbA1c) and diabetes remission rates, as well as indicate if the body weight, medication, and blood pressure improvements observed at three months are sustained.