BC HEALTH
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1/Part 2 on #diabetes #prevention based on the @TheLancet diabetes commission report.

Individual level prevention of type 2 diabetes (T2D) gets a lot of attention. Part 2 reflect this - but don’t worry, there will be more on the other levels in part 3..

Let’s get going..

 2/Several large randomized controlled trials (RCT) have shown that lifestyle interventions (diet, exercise, metformin) can prevent/delay onset of T2D as well as prevent later complications like cardiovascular disease and eye disease.
3/This has led to the implementation of diabetes prevention programmes for people at high risk of T2D in some high-income countries (HIC) like Germany, Finland, USA, UK, Poland and Singapore.
4/Evaluation of such real-world interventions is important as they may not provide similar benefits as in the RCTs that included volunteers that were very closely supervised. Evaluation of the US DPP has observed favorable weight loss at 1 year. Similar efforts are underway in UK
5/Although the individual level interventions overall work when there is adherence, it is often only a small proportion of the population that can adhere over time. Hence...
6/Understanding barriers like economic constraints, insufficient resources, cultural taboos and inadequate knowledge and skills is essential and needs more research
7/Those with the highest risk of T2D are also likely to be those who benefit the most from individual level prevention efforts. Identifying these high-risk individuals is thus important. There are many diabetes risk scores in the literature
8/It’s important to know that their performance (diabetes risk scores) to some degree is context dependent - some may be more relevant in high- than low-income countries. Understanding who will benefit the most from lifestyle interventions requires further research, though.
9/The cost-effectiveness of diabetes prevention programmes has been shown in HIC. Group-based interventions in high-risk individuals particularly lower the cost.
10/Another opportunity to lower the cost and make individual level diabetes prevention more easily available is through mobile health programmes (e.g. mHealth, eHeath, telemedicine)
11/The use of tech, such as smartphones, has become more wide-spread in low- and middle-income countries. This offers great opportunities.
12/One good example was from an intervention in India where participants received health behavior messages on their mobile phones via text. https://t.co/xQd9z4o6sL
13/The relative risk reduction was 36% after 2 years compared with the control group. However, there is a lack of evidence from RCTs with long-term outcomes on this topic.
14/And even though technology offers advantages, it often work best when supported by health-care workers. The degree of behavioral support seems to be a key component in the success of the intervention.
https://t.co/yGEYwJZrSj
15/And what about screening of diabetes? Well, evidence from the ADDITION-Europe trial has shown that screening following by management reduced the risk of cardiovascular disease by 4.9% (absolute) at 6 years
16/An economic analysis from Denmark also indicated lower health care costs in the screened intervention group.
17/However, screening should only be put into place within a health care system that has the capacity to manage the detected cases. When screening is implemented a lot more cases are likely to be detected.
18/A good example is from Brazil. In a nationwide screening programme, 10% of those screened (346,168 of 22,069,905) were confirmed with detected type 2 diabetes.
19/A lot on individual level prevention here. However, there is also evidence that highlights the importance on population health in prevention:

👩‍👦Mother and child health
📚Basic education
🌳Design of environment
⚕️Health policies
20/But can we design large RCTs to evaluate interventions of these? For some, maybe, but not for all.. What to do then? More on this in part 3…

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1/16
Why do B12 and folate deficiencies lead to HUGE red blood cells?

And, if the issue is DNA synthesis, why are red blood cells (which don't have DNA) the key cell line affected?

For answers, we'll have to go back a few billion years.


2/
RNA came first. Then, ~3-4 billion years ago, DNA emerged.

Among their differences:
🔹RNA contains uracil
🔹DNA contains thymine

But why does DNA contains thymine (T) instead of uracil (U)?

https://t.co/XlxT6cLLXg


3/
🔑Cytosine (C) can undergo spontaneous deamination to uracil (U).

In the RNA world, this meant that U could appear intensionally or unintentionally. This is clearly problematic. How can you repair RNA when you can't tell if something is an error?

https://t.co/bIZGviHBUc


4/
DNA's use of T instead of U means that spontaneous C → U deamination can be corrected without worry that an intentional U is being removed.

DNA requires greater stability than RNA so the transition to a thymine-based structure was beneficial.

https://t.co/bIZGviHBUc


5/
Let's return to megaloblastic anemia secondary to B12 or folate deficiency.

When either is severely deficient deoxythymidine monophosphate (dTMP*) production is hindered. With less dTMP, DNA synthesis is abnormal.

[*Note: thymine is the base in dTMP]

https://t.co/AnDUtKkbZh
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@br0oklynzo0 @KatyMontgomerie @ElPolloDiabloX @AbigailShrier @chadfelixg Okay, so you haven't read the study in the British Journal of Sports Medicine, you've read a Guardian story about it.

I have now read the study, and I teach critical appraisal as part of my job, so let's dive into it a bit.

@KatyMontgomerie @ElPolloDiabloX @AbigailShrier @chadfelixg First things first, the sample size in this study is tiny. 46 people. Plus, the point of comparison was "all women and men under the age of 30 in the Air Force between 2004 and 2014" rather than a longitudinal group.

@KatyMontgomerie @ElPolloDiabloX @AbigailShrier @chadfelixg So no matching for age, background, or physical condition. The result of these is that you're going to get a lot of statistical artefacts.

@KatyMontgomerie @ElPolloDiabloX @AbigailShrier @chadfelixg Second of all, there were three points of comparison here and you're ignoring two of them. The researchers measured for push-ups and sit-ups as well, both of which showed physical advantage removed entirely by hormones. Which means you're cherrypicking.

@KatyMontgomerie @ElPolloDiabloX @AbigailShrier @chadfelixg So what do you get when you have a tiny sample size and cherrypicked results? That's right, you get noise in the data. Take a look at the results graph from this paper you haven't read.
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During a normal pregnancy, oxidative stress enhances antioxidant mechanisms that are capable of reacting by way of enzyme activity and non-enzyme free radical deactivators. However, pregnancy is also a state in which this adaptation and balance may be easily disrupted.

There is strong evidence that a chronicin flammatory reaction combined with the presence of a local oxidizing environment may play a vital role in the etiology and development of complications during pregnancy.

In late pregnancy, damage to DNA (especially when it is caused by oxidative stress) is associated with pre-eclampsia(PE), intrauterine growth restriction (IUGR), and the death of mothers in developing countries; it largely determines pregnancy – related susceptibility to diseases

The referential values of ROS and NOS and their minimal and safe concentrations or physiologically beneficial concentrations are yet to be determined.

The measurement of oxidative stress in vivo is perceived as controversial,

as the sen-sitivity and specificity of various oxidative stress markers is unknown.. .
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I do want to talk a bit about connections, conflicts and information during a pandemic. Since @fordnation insinuated I have COI which I don't, let's take a look at a single instance where @fordnation and Hospital for Sick Children are both making interesting decisions.

Both share a powerful supporter in Peter Gilgan, who has been a great supporter of Sickkids

But his company, Mattamy Homes, has also substantially bankrolled Ontario Proud, which I have reason to believe pushed the Postmedia hit on my reputation.


Sickkids and Mattamy have very close ties. Here is Mary Federau, a longtime Sickkids exec who has moved to Mattamy but remains involved with the Sickkids foundation:


Mary's bio is too modest. It looks as though it has been scrubbed a bit over the last 72 hours. Here's the google cache from Jan 25:
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Deputy Dawgly
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1) Anyone injecting people with EXPERIMENTAL mRNA 'gene-therapy', FRAUDULENTLY labelled ‘vaccines’, WITHOUT informing them they're taking part in an EXPERIMENT with potentially very serious health risks, including death, IS BREAKING THE LAW. Nuremberg Code https://t.co/OY1Q3L3DwA
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1. “Who Are Ireland’s Members Of The World Economic Forum Implementing The Great Reset In 2021 ? 🧵1/28

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2. In previous threads I have looked at 🇮🇪 key players in the Trilateral Commission as well as 🇮🇪 people who have attended the Bilderberger meetings. I also looked at the 🇮🇪 in the Young Global Leaders which is a site run by the WEF. You will see a lot of crossover between them.

3. The purpose of this thread is to compile all the Irish members into one thread for ease of access and reading rather than having to dive through the WEF site. This is by no means definitive and I will be adding more over time when they pop out of the woodwork.

4. Ireland’s WEF members are drawn from all walks of life but can be split into 2 separate areas. The WEF calls the first category “people” and the 2nd one “agenda contributors”. In total Ireland has a minimum of 61 members. Some of the names will be familiar and others will not

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