MSc in Diabetes
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Item An investigation in the reduction of wound volume in diabetic foot ulcers (DFUs) comparing NPWT VAC® device to a standard dressing - a single blinded randomized controlled trial (RCT).(2018)Diabetic foot ulcers (DFUs) are relatively common in the UK; 5–7% of people with Diabetes Mellitus currently have or have had a diabetic foot ulcer. Successful diagnosis and treatment of patients with DFUs involves wound healing using optimal wound dressings. Negative Pressure Wound Therapy (NPWT) has a significant role in healing of DFUs. There is very limited data available on the role of NPWT in healing of DFUs. RCTs with larger samples and adequate randomization are required to reinforce the role of NPWT in the management of DFUs. Therefore, this study is put forward to evaluate the role of negative pressure wound therapy in reducing wound volume of DFUs using a vacuum-assisted closure (VAC®) device. The aim of this study is to investigate the reduction of wound volume in diabetic foot ulcers (DFUs) comparing NPWT VAC® device to a standard dressing Mepitel® - a single blinded randomized controlled trial (RCT). A sample group of 80 participants will be used for this study with an equal number of participants assigned to the intervention group (NPWT via VAC® device) and to the control group (Mepitel® dressings). Reduction of DFU volume will be calculated using the Student t-test for percentage change in wound volume from the DFU’s baseline size (1st week) to the cut-off point of treatment (12th week). Quantitative data will be analysed using an inferential statistical test and results will be presented in graphs and will be rounded off to the nearest percentage.Item THE ROLE OF A STRUCUTURED EDUCATION PROGRAMME IN THE MANAGEMENT OF PATIENTS WITH TYPE 2 DIABETES.(2018)Background Type 2 diabetes is a chronic disease associated with significant morbidity and mortality. Early treatment intervention and prevention of complications is key to management. It is well recognised that improving glycaemic control reduces the risk of long term complications in addition to managing the acute symptoms at the time of presentation, in patients with type 2 diabetes. Conventionally treatment has centred on pharmacological agents to improve glycaemic control and manage cardiovascular risk. In recent years programmes to educate patients to self-manage have become the focus of interest among health care professionals in the management of type 2 diabetes and are recommended by both SIGN and NICE for newly diagnosed patients with type 2 diabetes. Evidence from these structured education programmes reports improvement in glycaemic control, weight reduction and improvement in illness beliefs in the first year of management. However few self-management programmes have reported longer term effects of the intervention. Nonetheless it has been suggested that education on self-management may play a key role in tackling beliefs about health with a resultant impact on metabolic control, concordance with medication, quality of life and long-term complications. Aims The aim of this study was to evaluate whether the attendance at a structured education programme in our rural setting (DESMOND Diabetes Education and Structured Management for Ongoing and Newly diagnosed Diabetes) could achieve improvement in glycaemic control (HbA1c) and other cardiovascular risk markers (cholesterol, BP and BMI) one year after attending, in line with studies in urban setting. Methods Data included in this study was collected over a three year period in order to have an adequate sample size with which to compare findings. Demographic data including age, sex, weight, age at diagnosis and duration of diabetes was recorded at baseline and 12 months post programme. The cardiovascular risk factors to be analysed included Glycosylated haemoglobin (HbA1c) and random total cholesterol. HbA1C was measured using high performance liquid chromatography (HPLC), (TOSOH G8 Analyse). The cation exchange column separates haemoglobin components by different ionic charge. Cholesterol was measured using an enzymatic method (Abbott architect C800). Blood pressure (BP) was recorded using an electronic sphygmomanometer. BP was measured in the sitting position after 2 mins and 5 min and the average of these reading recorded. Target blood pressure ≤ 140/80 mmHg. BMI was calculated using the following formula: BMI= Weight (kg)/Height (m²). Dependent variables include: HbA1c, blood pressure, BMI and cholesterol. Independent variables include: Age, gender and duration of diabetes. The inclusion criteria included males and females who had a diagnosis of type 2 diabetes within and up to a 12 month period. There was no upper age limit however the lower age limit was 18 years. Only patients who had had their cardiovascular risk markers and BMI measured prior to and 12 months after attending structured education were included. The exclusion criteria included participants who had not had all of their cardiovascular risk factors and BMI recorded at base line and or at the twelve month review date. Also patients who did not complete the 6 hour DESMOND education programme. Ethical approval was sought and approved prior to recruitment for this study from the local health board via International Research Application System (IRAS) as this is currently the system they use. Informed consent from participants was not required as participants opted into the programme following referral by their GP or practice nurse and data collected for the purposes of the study was anonymised and entered into an electronic data base which was password protected. Access to the information on this data base is only available to the health professional that carried out the research. Queen Margaret University ethical approval forms have been completed and attached. Participants in this study were recruited at point of entry into the programme following referral by their G.P or practice nurse and subsequent acceptance and agreement to attend. Currently only those with newly diagnosed diabetes enter this programme. All patients were required and agreed to attend a six hour education programme (DESMOND) either in a full day format or after attending to half days. Results Over the period of the study 397 patients out of 453 invited attended and complete the DESMOND programme. The primary outcome of this intervention was a reduction in HbA1c. The median HbA1c at entry was 55mmols/mol compared to 49mmols/mol at completion (p<0.005). There was an improvement in both Systolic blood pressure (134mmHg vs 132mmHg after 12 months, p=0.021) and Diastolic blood pressure (80mmHg vs 76mmHg after 12 months, p<0.005). There was an improvement in total cholesterol (5mmol/l vs 4mmol/l after 12 months, p=0.001). BMI was also reduced (32kg/m2 vs 31kg/m2 after 12 months, p<0.005). Conclusion. At the end of one year (data collected over a three year period) has demonstrated that our structured programme has an improvement in HbA1c, Cholesterol and BMI as demonstrated in other studies. Therefore this structured education programme in a rural setting can achieve at one year, similar improvements in cardiovascular risk markers demonstrated in urban studies. While there is evidence to suggest improvements these cardiovascular risk markers reduce cardiovascular risk it remains to be demonstrated whether these can be sustained over time and what level of ongoing intervention would be required to achieve these benefits. Further evaluation at 3 years would be recommended.Item AN EXTENDED LITERATURE REVIEW WITH RESEARCH PROPOSAL TO EXAMINE THE EFFECTS OF AN INTERMITTENT PNEUMATIC COMPRESSION SYSTEM (FLOWTRON HYDROVEN 12) ON THE HEALING RATE OF DIABETIC FOOT ULCERS(2018)Introduction To date there are very few studies available that examine the effect of pneumatic compression on the healing rate of diabetic foot ulcers. This in part, is due to the reluctance to alter an already volatile vascular status with external devices. The use of compression therapy in this compromised group is a contentious issue given that patients with diabetes have a 2-5 times increase in developing peripheral arterial disease (PAD) than that of the non-diabetic population. One study has shown that patients with diabetic foot ulcers and peripheral oedema had a poorer prognosis and was also more common in patients who required amputation than those with primary healing. Aim The aim of this study is to determine whether the use of intermittent pneumatic compression (IPC) therapy in patients who present with an active diabetic foot ulcer is beneficial. The hypothesis is that those in the intervention group will show a reduced healing time that those in the control group. Methods This single-blinded randomised controlled trial will collate data from 40 patients who have presented with a diabetic foot ulcer within the prior 4 weeks. The patients in the intervention group will receive IPC therapy in addition to standard diabetic foot ulcer treatment. They will receive weekly 1-hour sessions of IPC for a period of 12 weeks and measurements of wound size recorded at each visit. The study outcome will be wound size measurement. Results All data will be entered into SPSS version II for statistical analysis. The data will then be analysed and if proven to be beneficial, used to propose an alternative treatment plan for patients with diabetic foot ulcers.Item The impact of Mediterranean diet and vitamin D supplementation on adults at high risk of developing type 2 diabetes: a randomised parallel study(Queen Margaret University, 2015)Diabetes mellitus is the most prevalent chronic medical condition and a critical public health concern for all nations. Only in 2012, in the United Kingdom 2.9 million people were diagnosed with diabetes, and this number is expect to rise to 5 million by the year 2025. Despite the fact that some diabetes-related risk factors are non-modifiable, it was estimated that 89% of people diagnosed with type 2 diabetes had at least one risk factor which could have been modified by diet or physical activity. These lifestyle modifications might help those patients at high risk to reduce their likelihood of developing type 2 diabetes by 28% to 59%. There is a growing body of research indicating that Mediterranean diet, as well as Vitamin D, might help to prevent from developing type 2 diabetes. Despite this, no research has been conducted to investigate the combined effect of Mediterranean diet and vitamin D supplementation in adults at high risk of developing type 2 diabetes. This study will be carried out as a randomised controlled parallel study with factorial design with 4 groups and 48 weeks of follow-up. The research will take place at the Western General Hospital, in Edinburgh, Scotland, for a duration of 27 months. The research will evaluate the effectiveness of Mediterranean diet and vitamin D3, both alone and together, on diabetes-related risk factors such as BMI, blood pressure, cholesterol levels, insulin sensitivity, and fasting plasma glucose, in a population at high risk of developing type 2 diabetes. The results will be analysed and interpreted statistically every 12 weeks and at the end of the trial to investigate the differences between and within groups. To our knowledge this is the first attempt at studying the potential reduction of diabetes risk factors as a result of a combination of MedDiet and VitD3 supplementation. The results of our study could be compared to existing research on dietary or VitD approaches for diabetes prevention, in order to suggest and implement a new way for effective type 2 diabetes preventionItem An investigation of the clinical effectiveness of negative pressure wound therapy (NPWT) using a VAC® device in comparison to a conventional dressing (Activheal®) on diabetic foot ulcers (DFUs) - a single blinded randomized controlled trial (RCT) with a qualitative element.(Queen Margaret University, 2017)Abstract / Lay summary Diabetic foot ulcers (DFUs) are relatively common in the UK; 5-7% of people with diabetes currently have or have had a diabetic foot ulcer (Wounds International 2013). Once a foot ulcer is present and there is poor arterial supply, a foot ulcer becomes more difficult to heal if the blood sugar levels are not controlled adequately and the risk of amputation occurring significantly increases (Sen et al. 2016). Successful diagnosis and treatment of patients with DFUs involves wound healing using optimal wound dressings. Nain et al. (2011) indicate that Negative Pressure Wound Therapy (NPWT) has a significant role in healing of DFUs. However, there is a gap in the literature for prospective single blinded RCTs in order to fully evaluate the effect of NPWT in the healing of DFUs (Vig et al. 2011; Meloni et al. 2015). The aim of this study is to determine the clinical effectiveness of NPWT using a VAC® (vacuum-assisted closure) device in comparison to a conventional dressing (Activheal®) on DFUs by conducting a single blinded RCT with a qualitative element. A sample group of 40 participants will be used for this study and there will be equal numbers of patients who are treated with the VAC® device and Activheal®. The quantitative results will be analysed using descriptive and inferential statistics and the qualitative results will be assessed using thematic analysis. Data will be analysed using computer package SPSS version 19 and data will be illustrated using graphs.Item Non-diabetics Perception and Knowledge of Type 2 Diabetes: A Qualitative Study.(Queen Margaret University, 2016)Research Focus: This research focuses on Identifying what the general public's knowledge is surrounding diabetes and how they think its complications affect the individual's body. Research methods: This research met the research aim by an extensive study of the relevant literature and the implementation of practical research. The latter was carried out through interviews at a Physiotherapy and Foot Clinic in County Armagh, Northern Ireland. Findings: This research produced a number of findings, all participants had the knowledge that there are two types of diabetes, most of the participants had a relative who has been diagnosed with diabetes or know someone who has been diagnosed with diabetes (77%). Most of the participants understood that eating a healthy diet (88.89%) would help to decrease a person's risk of developing diabetes, and 66.67% of participants knew that a poor diet could increase a person's risk in developing diabetes. Overall, knowledge was good, particularly surrounding diet and healthy lifestyle. However, no participants mentioned that ethnic origin would increase a person's risk of developing Diabetes. All participants said they had 'no idea' how much money was spent on Diabetes by the NHS every year. Conclusion: The main conclusion drawn from this research, is that non-diabetic individual's perception of what diabetes is, is lacking in knowledge and detail. Most of the participants knew bits of information but were also lacking in detail, many of them being overwhelmed when told how much money is spent each year from the NHS in treating the complications of Type 2 diabetes. Many of the general public showed key elements of knowledge as to why diabetes is increasing and becoming a big problem in the western world. Recommendations: This research study has suggested that there is a lack of knowledge of nondiabetic individual's as to what diabetes is and how it can affect a persons life, they have knowledge regarding some areas but not in great detail. A wider study could be beneficial to the researcher to indicate whether or not it is appropriate to initiate an educational programme.Item An in-vitro Assessment of Arterial Tone in Response to Altered Concentrations of Extracellular Magnesium(Queen Margaret University, 2015)Background: The presence of Magnesium in the human body is vital as it plays a role in more than 300 enzyme functions. However, in the present day it is being noted how its depletion associates with the presence of many disease states. Diabetes and hypertension are both two conditions which have been highlighted as patients commonly suffer from low levels of Mg. This indicates the need for the emphasis in increasing magnesium intake. Because of this, research has been conducted that looks at the possible effects varying concentrations of Mg can have. Aim: Due to the high association between low levels of Mg and Diabetes, and then the increased risk of developing hypertension, an investigation was conducted that looked to assess the effects low and high levels of magnesium can have in the contraction of an arterial vessel. Methods: Using an in-vitro technique, arteries were mounted in a wire myograph machine where the concentration had been varied. Magnesium was either present in normal physiological values, completely absent or present in high concentrations. An anti-hypertensive drug was also used as a positive control to compare with the possible beneficial effects on arterial tone seen when magnesium concentration was high. Results: There was no significant difference when observing mechanical properties of the vessel when magnesium concentrations were varied. Conclusion: The study did highlight certain trends in the data that were in agreement with published literature, that when there is no magnesium present, the arterial vessels are more sensitive to contraction. And when they are present in high concentrations, it is more difficult to get a powerful contraction. However, there is further research required to corroborate the suggestions made throughout this investigation.Item The Association of Ethnic Pre-Disposition and Type 2 Diabetes in the Black and Minority Ethnic Population in the United Kingdom. An Extended Research Proposal(Queen Margaret University, 2015)It has been noted that people belonging to certain ethnic minority groups and live in the western countries have higher chances of diagnosed with diabetes type 2 (T2D) than Caucasian population. According to studies people belongs to Asian, Chinese, Caribbean or African [also called Black and Minority Ethnic or BME] fall in this category. This exercise is looking to explore the phenomenon mentioned above and review current studies on this subject. A thorough literature search was conducted in the database that includes MedLine, Science Direct, CINAHL, PubMed and Digital library resources of Queen Margaret University. The section 3 explains how the search was conducted and the criteria used for the selection. Section 6 summarise the outcomes of various studies and also explored the strength and weakness of each study (critical assessment). The main findings of the studies are people of BME origin have high chance of diabetes T2D due to their genetic makeup. Along with high calorie diet, sedentary life style, and not following advice of diabetic professionals put them at even more risk for this condition. The critical assessment session closely examines the association of ethnic origin with the two common risk factors of T2D namely lack of exercise and obesity. This literature search and review revealed that there is a lack of major studies within the BME population, where studies conducted did not represent sufficient number of people from these high risk populations. The review concluded that there is a need for more studies with minority ethnic population. It proposes a further study to explore the higher occurrence of type 2 diabetes among BME populations. Part II of this assignment is the proposal for an extended research with a definite research question. The research question is emerged from the literature review as it reflects the current knowledge about T2D and ethnic populations in the UK. The 'methodology' session in part II explains the ways and means for data collection and analysis. The duration for the study is one year and it is expected to meet all ethical obligation of an epidemiological research.