Markku Peltonen

Quality Indicators for the Prevention of Type 2 Diabetes in Europe – IMAGE

BACKGROUND The marked increase of type 2 diabetes necessitates active development and implementation of efficient prevention programs. A European level action has been taken by launching the IMAGE project to unify and improve the various prevention management concepts, which currently exist within the EU. This report describes the background and the methods used in the development of the IMAGE project quality indicators for diabetes primary prevention programs. It is targeted to the persons responsible for diabetes prevention at different levels of the health care systems. METHODS Development of the quality indicators was conducted by a group of specialists representing different professional groups from several European countries. Indicators and measurement recommendations were produced by the expert group in consensus meetings and further developed by combining evidence and expert opinion. RESULTS The quality indicators were developed for different prevention strategies: population level prevention strategy, screening for high risk, and high risk prevention strategy. Totally, 22 quality indicators were generated. They constitute the minimum level of quality assurance recommended for diabetes prevention programs. In addition, 20 scientific evaluation indicators with measurement standards were produced. These micro level indicators describe measurements, which should be used if evaluation, reporting, and scientific analysis are planned. CONCLUSIONS We hope that these quality tools together with the IMAGE guidelines will provide a useful tool for improving the quality of diabetes prevention in Europe and make different prevention approaches comparable.

Evaluation of Current Eligibility Criteria for Bariatric Surgery Diabetes prevention and risk factor changes in the Swedish Obese Subjects (SOS) study

OBJECTIVE Patients with a BMI <35 kg/m2 and patients with a BMI between 35 and 40 kg/m2 without comorbidities are noneligible by current eligibility criteria for bariatric surgery. We used Swedish obese subjects (SOS) to explore long-term outcomes in noneligible versus eligible patients. RESEARCH DESIGN AND METHODS The SOS study involved 2,010 obese patients who underwent bariatric surgery (68% vertical-banded gastroplasty, 19% banding, and 13% gastric bypass) and 2,037 contemporaneously matched obese controls receiving usual care. At inclusion, the participant age was 37–60 years and BMI was ≥34 kg/m2 in men and ≥38 kg/m2 in women. The effect of surgery was assessed in patients that do (n = 3,814) and do not (n = 233) meet current eligibility criteria. The date of analysis was 1 January 2012. The follow-up time was up to 20 years, with a median of 10 years. RESULTS Cardiovascular risk factors were significantly improved both in noneligible and eligible individuals after 10 years of follow-up. Surgery reduced the diabetes incidence in both the noneligible (adjusted hazard ratio 0.33 [95% CI 0.13–0.82], P = 0.017) and eligible (0.27 [0.22–0.33], P < 0.001) groups. We could not detect a difference in the effect of surgery between the groups (adjusted interaction P value = 0.713). CONCLUSIONS Bariatric surgery drastically reduced the incidence of type 2 diabetes both in noneligible and eligible patients and improved cardiovascular risk factors in both groups. Our results show that strict BMI cutoffs are of limited use for bariatric surgery prioritization if the aim is to prevent diabetes and improve cardiovascular risk factors.

Politics and science: Francis Bacon and the true greatness of states

The main aim of the article is to question the widely held view that Francis Bacons different writings form a single great project. His numerous writings on the greatness of states were not part of his scientific programme. Since Bacons scientific writings do not provide us with the context in which we should place his texts on the greatness of states, the attempt is made to place them in their contemporary political context. These texts, it is argued, addressed the issue of the union of England and Scotland as well as the question concerning Englands possible intervention in the European war in early 1620s. Several scholars have also claimed that, in accordance with Bacons scientific project, his idea of the greatness of states was an essentially modern programme. Nevertheless, the article attempts to show that as far as his writings on civic greatness are concerned Bacons moral and economic ideas could be classified as classical republican. James Harringtons analysis of Bacon offers a historical point of departure for reading of his writings on the true greatness of states.

POLITENESS AND WHIGGISM, 1688–1732

This article re-examines the role of civility and politeness in the writings of whig authors from 1688 to 1732. It argues that politeness was not an exclusively whig concept. Nor was there any unanimity amongst the whigs about its meaning. Politeness was a hotly debated topic in the late seventeenth and early eighteenth centuries, but differences in its interpretations did not follow party lines. The notions of politeness formulated by whig authors after 1688 differed from each other as much as they differed from those framed by non-whigs. The article also reconsiders the account that the whig theorists used their analysis of politeness to defend the commercial values of post-1688 England and Britain. Again, there was no agreement on this amongst the whigs. Some of them explicitly denied the putative link between commerce and politeness, some of them were not interested in it, and even those who argued for it still interpreted politeness in its traditional courtly terms rather than in post-courtly urban terms.

Francis Bacon, the Earl of Northampton, and the Jacobean anti-duelling campaign.

The article examines the intellectual and ideological debate about the notions of duelling, courtesy, and honour in the Jacobean anti-duelling campaign. Particular attention is paid to the two most important contributions to this campaign – Francis Bacons The charge touching duells (1614) and A pvblication of his ma ties edict, and severe censvre against priuate combats and combatants (1614), written by Henry Howard, the earl of Northampton. By placing these two treatises into their intellectual context of courtesy and duelling manuals, the article seeks to demonstrate their sharply contrasting responses to the problem of duelling. Northampton accepted the notions of courtesy, honour, and insult underlying the duelling theory, but still wanted to abolish duelling. His solution was therefore a court of honour which would solve all the disputes of honour between noblemen and gentlemen. Bacon, on the other hand, argued that the only efficient way of getting rid of duelling was to question the entire intellectual framework on which duelling rested. To accept the notions of honour, courtesy, and insult inherent in the duelling theory and to set up a court of honour, he insisted, was tantamount to encouraging duelling itself. In The charge touching duells Bacon was thus arguing as much against Northamptons plans to suppress duelling as against the theory of duelling itself.

Lifestyle Intervention in Prevention of Type 2 Diabetes in Women With a History of Gestational Diabetes Mellitus: One-Year Results of the FIN-D2D Project

BACKGROUND Lifestyle interventions are effective in preventing type 2 diabetes (T2D). Women with history of gestational diabetes mellitus (GDM) may have barriers to lifestyle changes, and the previous results of lifestyle interventions are contradictory reporting either favorable outcomes or no significant beneficial effects. Our aim was to compare cardio-metabolic risk profile and responses to a 1-year lifestyle intervention program in women with and without history of GDM. METHODS The Implementation Project of the Program for Prevention of Type 2 Diabetes (FIN-D2D) was conducted in Finland in five hospital districts. Altogether 1,661 women aged ≤45 years participated in the program. One-year follow-up was available for 393 women who did not have screen-detected T2D at baseline, and 265 of them had at least one intervention visit [115 (43.4%) women with history of GDM and 150 (56.6%) without history of GDM]. RESULTS At baseline, women with GDM had similar baseline glucose tolerance but better anthropometric characteristics, blood pressure, and lipid profile than women without GDM after adjustment for age. Beneficial changes in cardiovascular risk profile existed among women with and without GDM during follow-up and the effect of lifestyle intervention was similar between the groups, except that low-density lipoprotein cholesterol improved only in women with GDM. Altogether, 4.0% of those with GDM and 5.0% of those without GDM developed T2D (p=0.959 adjustment for age). CONCLUSIONS The effect of a 1-year lifestyle intervention in primary healthcare setting was similar regardless of history of GDM, both women with and without GDM benefitted from participation in the lifestyle intervention.Abstract Background: Lifestyle interventions are effective in preventing type 2 diabetes (T2D). Women with history of gestational diabetes mellitus (GDM) may have barriers to lifestyle changes, and the previous results of lifestyle interventions are contradictory reporting either favorable outcomes or no significant beneficial effects. Our aim was to compare cardio-metabolic risk profile and responses to a 1-year lifestyle intervention program in women with and without history of GDM. Methods: The Implementation Project of the Program for Prevention of Type 2 Diabetes (FIN-D2D) was conducted in Finland in five hospital districts. Altogether 1,661 women aged ≤45 years participated in the program. One-year follow-up was available for 393 women who did not have screen-detected T2D at baseline, and 265 of them had at least one intervention visit [115 (43.4%) women with history of GDM and 150 (56.6%) without history of GDM]. Results: At baseline, women with GDM had similar baseline glucose tolerance but better...