A touch of sugar : a multimedia case study to facilitate student dietitians learning about the clinical management of diabetes

This paper describes the development, implementation and evaluation of a multimedia case study on dietetic case management of diabetes. A multimedia web-based program was developed to use the interactive capacity of the web-based environment to enable student dietitians to develop the skills of clinical reasoning and to trigger their learning about the nutritional management of diabetes. A case study of a person with diabetes was developed using a simulated medical history, video clips and sound clips. The students were asked to manage the patient online by responding to the patient's questions, attending a team meeting and outpatient clinic, attending to food service tasks and responding to visual cues. Tutors were able to access the student's responses to submissions online. Evaluation of the program was by questionnaire, which gathered quantitative and qualitative data on the student's perceptions of their experiences in using the web-based case. The students rated the content and the interactive parts of the case highly but experienced technical difficulties and found the case took too much time to complete.

Consumer issues in navigating health care services for type I diabetes

• Despite increasing interest in consumer awareness and participation in health care service delivery, there has been little exploration of consumer views in relation to services for people with type I diabetes. • The purpose of this qualitative exploratory study was to identify strategies people with type I diabetes used to access health services and the barriers they perceived in accessing the services they needed. • Data gathered in semi-structured interviews revealed that consumers experience significant barriers when navigating the health care system. • Three dominant themes were identified. They relate to access to specialist medical skill, to the transition from teenager to young adult and to pre-pregnancy and obstetric care. • Directions for change in service delivery and policy development are discussed.

Tanis: a link between type 2 diabetes and inflammation?

Here we describe a novel protein, which we have named Tanis, that is implicated in type 2 diabetes and inflammation. In Psammomys obesus, a unique polygenic animal model of type 2 diabetes and the metabolic syndrome, Tanis is expressed in the liver in inverse proportion to circulating glucose (P = 0.010) and insulin levels (P = 0.004) and in direct proportion with plasma triglyceride concentrations (P = 0.007). Hepatic Tanis gene expression was markedly increased (3.1-fold) after a 24-h fast in diabetic but not in nondiabetic P. obesus. In addition, glucose inhibited Tanis gene expression in cultured hepatocytes (P = 0.006) as well as in several other cell types (P = 0.001–0.011). Thus, Tanis seems to be regulated by glucose and is dysregulated in the diabetic state. Yeast-2 hybrid screening identified serum amyloid A (SAA), an acute-phase inflammatory response protein, as an interacting protein of Tanis, and this was confirmed by Biacore experiments. SAA and other acute-phase proteins have been the focus of recent attention as risk factors for cardiovascular disease, and we contend that Tanis and its interaction with SAA may provide a mechanistic link among type 2 diabetes, inflammation, and cardiovascular disease.