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Author Heller, S.; Kozlovski, P.; Kurtzhals, P. url  openurl
  Title Insulin's 85th anniversary--An enduring medical miracle Type Journal Article
  Year 2007 Publication Diabetes Res Clin Pract Abbreviated Journal  
  Volume 78 Issue 2 Pages 149-158  
  Keywords Amino Acid Sequence; Animals; Diabetes Mellitus; Humans; Insulin; Insulin Infusion Systems  
  Abstract In 1922, the discovery of insulin led to a revolution in diabetes management. Since then, many improvements have been made to insulin preparations: early preparations of bovine and porcine insulins were purified and their duration of action prolonged, giving rise to the introduction of Neutral Protamine Hagedorn (NPH) insulin and monocomponent insulins. Then, with the advances in genetic engineering in the 1980s, it became possible to produce recombinant human insulin. Nowadays, modern molecular biology techniques enable the production of insulin analogues, which have several advantages over human insulin preparations including a reduced risk of hypoglycaemia. Insulin delivery is still predominantly via subcutaneous injections, but alternative routes of insulin administration are being investigated. Pulmonary delivery has emerged as the most feasible option thus far but oral delivery is an ultimate goal, although basic problems of insulin stability in the gut and absorption from the gastrointestinal tract still need to be resolved. The availability of a true artificial pancreas by means of a closed-loop system, linking continuous glucose monitoring with insulin-pump technology, would also constitute a significant advance, but major technological problems still need to be overcome.  
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  ISSN 0168-8227 ISBN Medium  
  Area Expedition Conference  
  Notes Approved no  
  Call Number refbase @ user @ Heller2007 Serial 2208  
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Author Knowles, J.; Waller, H.; Eiser, C.; Heller, S.; Roberts, J.; Lewis, M.; Wilson, K.; Hutchinson, T.; Willan, M.; Bavelja, P.; Bennet, G.; Price, K. url  openurl
  Title The development of an innovative education curriculum for 11-16 yr old children with type 1 diabetes mellitus (T1DM) Type Journal Article
  Year 2006 Publication Pediatr Diabetes Abbreviated Journal  
  Volume 7 Issue 6 Pages 322-328  
  Keywords Adolescent; Child; Curriculum; Diabetes Mellitus, Type 1; Food Habits; Humans; Interpersonal Relations; Patient Education as Topic; Teaching  
  Abstract BACKGROUND: Evidence-based, structured education is recommended for all people with diabetes; tailored to meet their personal needs and learning styles. Adult courses exist in the UK but are of limited value for children. The aim of this study was to adapt the adult Dose Adjustment For Normal Eating (DAFNE) course to design a skills training course, for children aged 11-16 yr, focusing on self-management skills within an intensive insulin regime. To ensure that the course format meets the developmental, intellectual and social needs of children and adolescents and is delivered using educationally sound techniques. METHODS: Relevant professionals and potential users of the course were involved in curriculum design and content in the following ways: (i) The views of 95 pediatric diabetes specialist nurses were sought through a postal survey; (ii) Focus group discussions were conducted with children with type 1 diabetes mellitus (T1DM) and their families to contribute to content and design; and (iii) Secondary school teachers worked with experienced pediatric diabetes staff advising on educational content and teaching format. RESULTS: The developed curriculum uses a progressive modular-based structure to improve self-management in a variety of medical and social situations. It has clear learning objectives and is based on the format of UK schools curricula. Additional support is provided through dedicated parent sessions, involvement of friends and the provision of a school resource pack. CONCLUSION: Collaborative working between health professionals, school teachers and families has resulted in an age-appropriate curriculum, which employs validated educational techniques. This will be refined following pilot courses before formal evaluation in a multicentre randomized controlled trial.  
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  ISSN 1399-543x ISBN Medium  
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  Notes Approved no  
  Call Number refbase @ user @ Knowles2006 Serial 2211  
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Author Skinner, T.C.; Carey, M.E.; Cradock, S.; Daly, H.; Davies, M.J.; Doherty, Y.; Heller, S.; Khunti, K.; Oliver, L. url  openurl
  Title Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND): process modelling of pilot study Type Journal Article
  Year 2006 Publication Patient Educ Couns Abbreviated Journal  
  Volume 64 Issue 1-3 Pages 369-377  
  Keywords Activities of Daily Living; Attitude to Health; Choice Behavior; Diabetes Mellitus, Type 2; Female; Follow-Up Studies; Health Behavior; Health Knowledge, Attitudes, Practice; Health Services Needs and Demand; Health Services Research; Humans; Informed Consent; Male; Middle Aged; Models, Educational; Models, Organizational; Models, Psychological; Outcome and Process Assessment (Health Care); Patient Education as Topic; Patient-Centered Care; Pilot Projects; Power (Psychology); Program Evaluation; Quality of Life; Questionnaires; Research Design; Self Care; Social Support  
  Abstract OBJECTIVE: To determine the effects of a structured education program on illness beliefs, quality of life and physical activity in people newly diagnosed with Type 2 diabetes. METHODS: Individuals attending a diabetes education and self-management for ongoing and newly diagnosed (DESMOND) program in 12 Primary Care Trusts completed questionnaire booklets assessing illness beliefs and quality of life at baseline and 3-month follow-up, metabolic control being assessed through assay of HbA1c. RESULTS: Two hundred and thirty-six individuals attended the structured self-management education sessions, with 97% and 64% completing baseline and 3-month follow-up questionnaires. At 3 months, individuals were more likely to: understand their diabetes; agree it is a chronic illness; agree it is a serious condition, and that they can affect its course. Individuals achieving a greater reduction in HbA1c over the first 3 months were more likely to agree they could control their diabetes at 3 months (r=0.24; p=0.05), and less likely to agree that diabetes would have a major impact on their day to day life (r=0.35; p=0.006). CONCLUSION: Pilot data indicate the DESMOND program for individuals newly diagnosed with Type 2 diabetes changes key illness beliefs and that these changes predict quality of life and metabolic control at 3-month follow-up. PRACTICE IMPLICATIONS: Newly diagnosed individuals are open to attending self-management programs and, if the program is theoretically driven, can successfully engage with the true, serious nature of diabetes.  
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  Series Volume Series Issue Edition  
  ISSN 0738-3991 ISBN Medium  
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  Notes Approved no  
  Call Number refbase @ user @ Skinner2006 Serial 2212  
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Author Heller, S.R.; Nicholson, A.N. url  openurl
  Title Aircrew and type 1 diabetes mellitus Type Journal Article
  Year 2006 Publication Aviat Space Environ Med Abbreviated Journal  
  Volume 77 Issue 4 Pages 456-458  
  Keywords Aerospace Medicine; Awareness; Cognition; Diabetes Mellitus, Type 1; Humans; Hypoglycemia; Time Factors; Work Capacity Evaluation  
  Abstract The most stringent clinical criteria cannot guarantee that individuals with Type 1 diabetes mellitus (DM) will preserve awareness of an impending hypoglycemic episode or that a hypoglycemic episode can be prevented. Further, cognition may be impaired for a considerable period of time beyond the correction of any episode. These observations and their implications to operational aircrew with Type 1 DM are discussed.  
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  Series Editor Series Title Abbreviated Series Title  
  Series Volume Series Issue Edition  
  ISSN 0095-6562 ISBN Medium  
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  Notes Approved no  
  Call Number refbase @ user @ Heller2006 Serial 2213  
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Author Pedersen-Bjergaard, U.; Pramming, S.; Heller, S.R.; Wallace, T.M.; Rasmussen, A.K.; Jørgensen, H.V.; Matthews, D.R.; Hougaard, P.; Thorsteinsson, B. url  openurl
  Title Severe hypoglycaemia in 1076 adult patients with type 1 diabetes: influence of risk markers and selection Type Journal Article
  Year 2004 Publication Diabetes Metab Res Rev Abbreviated Journal  
  Volume 20 Issue 6 Pages 479-486  
  Keywords Adult; Aged; Aged, 80 and over; Awareness; Biological Markers; Cross-Sectional Studies; Diabetes Mellitus, Type 1; Diabetic Neuropathies; Female; Humans; Hypoglycemia; Incidence; Male; Middle Aged; Multivariate Analysis; Patient Selection; Peripheral Nervous System Diseases; Questionnaires; Risk Factors; Severity of Illness Index; Smoking  
  Abstract BACKGROUND: Differences between studies in rates of severe hypoglycaemia in type 1 diabetic cohorts are common and poorly understood. The purpose of this study was to assess the frequency of severe hypoglycaemia in unselected patients treated in different secondary care centres and to evaluate the influence of risk markers, clinical setting and selection. METHODS: Cross-sectional Danish-British multicentre survey of 1076 consecutive adult patients with clinical type 1 diabetes who completed a detailed questionnaire on hypoglycaemia and related issues. Key variable was the self-reported rate of severe hypoglycaemia during the preceding year. RESULTS: The overall rate of severe hypoglycaemia in the preceding year was 1.3 episodes/patient-year and episodes were reported by 36.7% of subjects. The distribution was highly skewed with 5% of subjects accounting for 54% of all episodes. There were no significant differences between countries or centres. Reduced hypoglycaemia awareness, peripheral neuropathy and smoking were the only significant risk markers of severe hypoglycaemia in a stepwise multivariate analysis. In a subgroup selected to be similar to the Diabetes Control and Complications Trial (DCCT) cohort, the rate of severe hypoglycaemia was 0.35 episodes/patient-year and only retinopathy was a significant risk marker together with state of awareness. CONCLUSION: Severe hypoglycaemia remains a significant clinical problem in type 1 diabetes. The rate of severe hypoglycaemia and the influence of risk markers are very sensitive to selection and differences in rates between centres or studies seem to disappear after correction for differences in clinical characteristics. Smoking is a novel overall risk marker of severe hypoglycaemia.  
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  Series Volume Series Issue Edition  
  ISSN 1520-7552 ISBN Medium  
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  Notes Approved no  
  Call Number refbase @ user @ Pedersen-Bjergaard2004 Serial 2214  
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