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David Simmons

Publications and source records attributed to David Simmons.

At least 19 recordsLinked to original sources
PubMed2026

Vitamin D Deficiency During Pregnancy Is Associated With Greater LDL-C Increase, Elevated β-Hydroxybutyrate and Altered Neonatal Metabolic Markers-A Secondary, Pooled Analysis of the Randomized, Controlled Vitamin D and Lifestyle for Gestational Diabetes Prevention Trial (DALI).

INTRODUCTION: Vitamin D (vitD) plays a role in metabolic regulation, including lipid metabolism and insulin sensitivity. During pregnancy, profound physiological changes in lipid handling and ketogenesis occur to support fetal development. However, the extent to which maternal vitamin D status influences these metabolic adaptations and fetal metabolic markers remains unclear. METHODS: In this secondary analysis, we examined lipid distribution throughout pregnancy-from before 20&#x2009;weeks' gestation to delivery-in women with overweight or obesity, stratified by vitamin D status (deficiency, insufficiency, or sufficiency), assessing both maternal and cord blood. Main inclusion criteria were: age&#x2009;>&#x2009;=18&#x2009;years, singleton pregnancy, <&#x2009;20&#x2009;weeks' gestation, BMI &#x2265;&#x2009;29&#x2009;kg/m2. Women with GDM <&#x2009;20&#x2009;weeks' gestation were excluded. In total, 962 pregnant women were divided into vitD deficient (<&#x2009;30&#x2009;nmol/L, n&#x2009;=&#x2009;102), insufficient (30-50&#x2009;nmol/L, n&#x2009;=&#x2009;222) and sufficient (>&#x2009;50&#x2009;nmol/L, n&#x2009;=&#x2009;638) groups. VitD levels and lipid concentrations were assessed at <&#x2009;20, 24-28 and 35-37&#x2009;weeks' gestation and in cord blood. RESULTS: Compared with vitD sufficient women, women with vitD deficiency had significantly larger increases in LDL-C throughout pregnancy and &#xdf;-OH-butyrate at 24-28&#x2009;weeks' gestation, in adjusted analysis. VitD in cord blood was highest in offspring of mothers with vitD sufficiency. In cord blood, significantly higher &#xdf;-OH-butyrate was observed with vitD deficiency; lipid concentrations were similar between groups. CONCLUSIONS: Early vitamin D deficiency before 20&#x2009;weeks of gestation was associated with altered metabolic trajectories during pregnancy, including greater increases in LDL cholesterol and ketone body concentrations in women with overweight or obesity, as well as higher cord blood ketone levels in their offspring. These findings suggest that early maternal vitamin D status may influence maternal and fetal metabolic adaptations, although causal relationships and clinical implications require further investigation. TRIAL REGISTRATION: Trial registered at ISRCTN registry (https://doi.org/10.1186/ISRCTN70595832) trial number ISRCTN70595832. Registration date 02/12/2011.

Humans↗
PubMed2006

Investigating the accuracy of ethnicity data in New Zealand hospital records: still room for improvement.

BACKGROUND: The accuracy of ethnicity information in the New Zealand hospital data was reported on in 1994. Data collected in the Barriers to Diabetes Care in the Waikato Study enables further evaluation of the accuracy of ethnicity information in hospital records. AIMS: One aim of public health policy is addressing health disparities between ethnic groups. Monitoring disparities depends on accurate outcome data, such as that from hospitals. It would be expected that this data would improve over time. This paper reports on the contemporary accuracy of ethnicity data in hospital records in the Waikato district. METHODS: Self-identified ethnicity data were gathered as part of the Barriers to Diabetes Care in the Waikato mail survey. Hospital record data were collected for those participants who had consented for access to their hospital records. RESULTS: Complete data was available for 3500 people with diabetes. Ethnicity in the hospital record was correct for one of the sometimes multiple, self-identified ethnicities for 97.7 (95CI 96.8-98.3)% of respondents. Ethnicity data were concordant for 71 (67-75)% of Maori and 99 (99-100)% of non-Maori. The non-Maori ethnic group was disaggregated into component groups: the hospital record agreed with self identified ethnicity for 89 (87-91)% of Europeans, 67 (55-78)% of Pacific groups, 70 (57-81)% of South Asian groups, 64 (48-77)% of Asian groups, and 41 (27-57)% of 'Other' ethnic groups. CONCLUSIONS: Hospital records continue to mis-record ethnicity when compared to a self-identified ethnicity. Mis-recording occurs for all ethnic groups, and is more pronounced at more specific levels of ethnic group. Researchers, clinicians, and policy makers must be cognisant of these continuing discrepancies when using hospital record data to describe ethnic variations in health status, service utilisation, or for policy planning activities.

Ethnicity↗
PubMed2006

Ethnic differences in Type 2 diabetes care and outcomes in Auckland: a multiethnic community in New Zealand.

INTRODUCTION: In New Zealand, Maori and Pacific (mostly of Samoan, Tongan, Niuean, or Cook Islands origin) people with Type 2 diabetes are more likely to suffer poor outcomes than other New Zealanders. Responsibility for addressing this outcome differential is falling on primary care and general practice in particular. This paper compares the general practice care provided to people with Type 2 diabetes in South and West Auckland, according to ethnicity. METHOD: An external audit of general practice diabetes care is carried out in South and West Auckland by the Diabetes Care Support Service. The results of 5917 routine patient audits carried out in 2003 are included in this study. Number of visits, recording of important information, risk factors, and treatments are compared between different ethnic groups. RESULTS: Maori and Pacific people with diabetes who attend a regular GP had a higher average number of consultations than Europeans (5.7, 5.4, and 4.8 visits per year respectively). They were as likely as Europeans to have undergone important regular examinations and investigations. Maori were more likely than Europeans to be on some treatments. However, Maori and Pacific people were more likely to have a range of adverse risk factors for diabetes complications than Europeans. These include being a smoker (35, 18, and 13% respectively), having an HbA1c greater than 8% (50, 56, 23%), and having microalbuminuria (55, 50, 27%). DISCUSSION: Although there were no large differences in the process measures of general practice diabetes care provided to different ethnic groups in South and West Auckland, Maori and Pacific people were not achieving the same outcomes of care in terms of risk factors for diabetes complications. Many of these risk factors are influenced by other factors in the wider community; however the New Zealand health system needs to consider how it can better address these differences.

Aged↗
PubMed2006

Epidemiology of diabetes in New Zealand: revisit to a changing landscape.

AIM: The aim of this review is to describe the evolution of the burden of diabetes, its risk factors and complications in New Zealand, and the current national strategies underway to tackle a condition likely to impact on the national ability to afford other health services. METHODS: The MEDLINE database from 1990 was searched for New Zealand-specific diabetes studies. The Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) Reports from 1990-2004 and Ministry of Health (MoH) publications and reports were also reviewed. Key contact people working in the field of diabetes care in every district health board (DHB) were contacted, and information on current initiatives for diabetes control and prevention were collected. RESULTS: The prevalence of diabetes (known and undiagnosed), impaired glucose tolerance (IGT)/impaired fasting glucose (IFG) and gestational diabetes are tabulated by ethnic group. The latest New Zealand Health Survey (NZHS) result of known diabetes: European 2.9%, Maori 8%, Pacific 10.1%, Asian 8.4%. Diabetes risk factors have been examined and the reported rates have been compiled. Maori and Pacific people have a particularly high prevalence of diabetes risk factors (e.g. obesity, physical inactivity, insulin resistance, metabolic syndrome) compared with Europeans. The profile of diabetic patients in New Zealand has been summarised using publications on their clinical characteristics. The latest available data on ethnic specific clinical characteristics are a decade old. With the suboptimal participation in the Get Checked program: 63% Europeans/Others, 27% Maori, 92% Pacific (possibly overestimated) people in 2004, the results may not be representative. The burden of diabetes complications and diabetes related mortality has been reviewed. A high proportion of Maori and Pacific dialysis patients and new renal disease patients from the ANZDATA registry have diabetes comorbidity. The inadequacy of official statistics in New Zealand and the scarcity of indepth studies across the country, including ethnic perspectives, has been clearly demonstrated. CONCLUSIONS: While the diabetes epidemic has continued to impact increasingly on New Zealanders and its health services over the past 5 years, a growing number of Government and DHB-funded initiatives are in place to prevent diabetes and its complications. A nationally agreed strategic plan is now urgently needed on how best to monitor and control the increasing incidence and prevalence of diabetes in the New Zealand population as well as the proportion with undiagnosed diabetes, impaired glucose tolerance, and impaired fasting glucose.

Adult↗
PubMed2006

Diabetes information systems: a rapidly emerging support for diabetes surveillance and care.

BACKGROUND: With the rapid advances in information technology in the last decade, various diabetes information systems have evolved in different parts of the world. Availability of new technologies and information systems for monitoring and treating diabetes is critical to achieving recommended metabolic control, including glycosylated hemoglobin levels. The first step is to develop a registry, including a patient identifier that can link multiple data sources, which can then serve as a springboard to electronic mechanisms for practitioners to gain information on performance and results. OBJECTIVE: The aim is to review the provisions for diabetes surveillance in different parts of the world. This is a systematic review of national and regional information systems for diabetes surveillance. LITERATURE REVIEW: A comprehensive review was undertaken using Medline literature review, internet search using the Google search engine, and e-mail consultation with opinion leaders. TOPICS REVIEW: National/regional-level diabetes surveillance systems in Europe, the United States, Australia/New Zealand, and Asia have been reviewed. State-of-the-art diabetes information systems linking multiple data sources, with extensive audit and feedback capabilities, have also been looked at. RESULTS: National/regional-level audit databases have been tabulated. Diabetes information systems linking multiple data sources have been described. Most of the developed countries have now implemented systems such as diabetes registers and audits for diabetes surveillance in at least some regions, if not nationally. Developing nations are beginning to recognize the need for chronic disease management. CONCLUSIONS: With the advancements in information technology, the diabetes registers have the potential to rise beyond their traditional functions with dynamic data integration, decision support, and data access, as demonstrated by some diabetes information systems. With the rapid pace of development in electronic health records and health information systems, countries that are beginning to build their health information technology infrastructure could benefit from planning and funding along these lines.

Diabetes Mellitus↗
PubMed2006

Translating the chronic care model into the community: results from a randomized controlled trial of a multifaceted diabetes care intervention.

OBJECTIVE: To determine whether using the chronic care model (CCM) in an underserved community leads to improved clinical and behavioral outcomes for people with diabetes. RESEARCH DESIGN AND METHODS: This multilevel, cluster-design, randomized controlled trial examined the effectiveness of a CCM-based intervention in an underserved urban community. Eleven primary care practices, along with their patients, were randomized to three groups: CCM intervention (n = 30 patients), provider education only (PROV group) (n = 38), and usual care (UC group) (n = 51). RESULTS: A marked decline in HbA(1c) was observed in the CCM group (-0.6%, P = 0.008) but not in the other groups. The magnitude of the association remained strong after adjustment for clustering (P = 0.01). The same pattern was observed for a decline in non-HDL cholesterol and for the proportion of participants who self-monitor blood glucose in the CCM group (non-HDL cholesterol: -10.4 mg/dl, P = 0.24; self-monitor blood glucose: +22.2%, P < 0.0001), with statistically significant between-group differences in improvement (non-HDL cholesterol: P = 0.05; self-monitor blood glucose: P = 0.03) after adjustment. The CCM group also showed improvement in HDL cholesterol (+5.5 mg/dl, P = 0.0004), diabetes knowledge test scores (+6.7%, P = 0.07), and empowerment scores (+2, P = 0.02). CONCLUSIONS: These results suggest that implementing the CCM in the community is effective in improving clinical and behavioral outcomes in patients with diabetes.

Aged↗
PubMed2006

Are energy drinks contributing to the obesity epidemic?

The consumption of energy drinks containing sucrose and caffeine is increasing worldwide. Ten healthy women aged 18 to 22 years and fasted overnight were randomly allocated to a standardised dose of sucrose either as an "energy" drink (containing sucrose and caffeine) or lemonade on the first day and then crossed over to the alternative drink on a second day. For thirty minutes before and thirty minutes after drinking oxygen consumption and carbon dioxide production were measured in the resting subject breath-by-breath by indirect calorimetry and the rates of carbohydrate and fat oxidation calculated. Energy drink consumption apparently caused increased carbohydrate oxidation (P = 0.004) and reduced lipid oxidation (P = 0.004) compared to lemonade. The longer term effects of combined caffeine and sucrose intake, particularly in sedentary individuals, on metabolism and body fatness needs further examination.

Adolescent↗
PubMed2005

Influence of physical and chemical heterogeneity shape on thin film rupture.

It is known that the breakup times for thin liquid films on solid surfaces can be substantially smaller if the surface is heterogeneous, either chemically or physically. In this paper we explore issues related to the effect of the shape of the physical and chemical heterogeneities on the breakup time and the thinning behavior. We consider two shapes, sinusoidal and exponential, for both physical and chemical gradients and compare the breakup times for these two different forms of gradients. Furthermore, the wavelength of the sinusoidal gradients and the length scale of the exponential gradients are varied and the effects of these on the breakup times and the film evolution are determined. For the sinusoidal gradients, we also obtain analytical results for shape evolution that are valid at short times and for small amplitude perturbation of the physical/chemical heterogeneities. The fastest growing modes are determined for spinodal breakup and also for both shapes (sinusoidal and exponential) of physical and chemical heterogeneities. The breakup times for the fastest growing modes from the linear and the nonlinear studies are compared for spinodal breakup and these results are also compared with those for both chemical and physical heterogeneities, of both sinusoidal and exponential shapes. Results show that the presence of heterogeneities, in general, accelerates the breakup of the film. In the linear regime, the growth rates are the same for the chemical and physical heterogeneities and spinodal breakup, and the effect of the heterogeneities is manifested as increased amplitude of initial perturbation. The effect of the chemical and physical heterogeneities dominate the film dynamics at early times, becoming less important at later times. The growth rates and equivalently the breakup times for the films on heterogeneous surfaces depend on the length scale over which physical/chemical gradients occur, and as the length scale approaches zero, which implies that the gradients become very steep, the effect of the heterogeneities on the breakup times becomes small.

Chemical Phenomena↗
PubMed2005

The Australasian Diabetes in Pregnancy Society consensus guidelines for the management of type 1 and type 2 diabetes in relation to pregnancy.

Strict control of blood glucose levels should be pursued before conception and maintained throughout the pregnancy (glycohaemoglobin [HbA(1c)] level as close as possible to the reference range). Before conception: high-dose (5 mg daily) folate supplementation should be commenced; oral hypoglycaemic agents should be ceased; and diabetes complications screening should take place. Management should be by a multidisciplinary team experienced in the management of diabetes in pregnancy. Blood glucose monitoring is mandatory during pregnancy, and targets are: fasting 4.0-5.5 mmol/L; postprandial < 8.0 mmol/L at 1 hour; < 7 mmol/L at 2 hours. A first trimester nuchal translucency (possibly with first trimester biochemical screening with pregnancy-associated plasma protein A and beta-human chorionic gonadotropin) should be offered. Ultrasound should be performed for fetal morphology at 18-20 weeks, if required, for cardiac views at 24 weeks and for fetal growth at 28-30 and 34-36 weeks. Induction of labour or operative delivery should be based on obstetric and/or fetal indications. Level 3 neonatal nursing facilities may be required and should be anticipated when birth occurs before 36 weeks, or if there has been poor glycaemic control. Insulin requirements fall rapidly during labour and in the puerperium. At this time, close monitoring and adjustment of insulin therapy is necessary.

Antihypertensive Agents↗
PubMed2005

Prevalence of diabetes in rural Victoria.

AIMS: To compare the prevalence of diabetes in adults in small and medium sized towns in a part of rural Victoria MATERIALS AND METHODS: Participants were usual residents, aged >or=25 years, from randomly selected households in the crossroads undiagnosed disease study (CUDS: six small rural towns and their regional center in rural Victoria). Response rates to an initial census at the household and attendance at a subsequent biomedical examination involved were 70% and 61% (1454), respectively. All non-diabetic participants had an oral glucose tolerance test. RESULTS: Prevalence of diabetes, IGT, IFG were 7.3 (5.5-9.5)%, 6.9 (5.1-9.9)% and 3.2 (2.0-4.7)% respectively in the regional center and 8.9 (6.9-11.1)%, 4.9 (3.5-6.7)%, 3.0 (1.9-4.5)% in the Shire Capitals. Overall, 31/118 (26.3%) of those with diabetes were previously undiagnosed. Most (83.9%) of those with undiagnosed diabetes remembered having been screened for diabetes in the previous 2 years. Overall screening rates for diabetes were higher than across Victoria as a whole. CONCLUSIONS: The prevalence of diabetes has probably doubled over the last 15 years in this area. Undiagnosed diabetes is less common than expected, possibly as a result of a more vigorous approach to screening in general practice and in spite of the lower numbers of GPs in the area.

Adult↗
PubMed2005

Obstetric outcomes among rural Aboriginal Victorians.

Twenty-eight Aboriginal women and 112 age-matched controls were identified from a retrospective chart review of deliveries over a 1-year period in northern Victoria. Significantly more Aboriginal women were screened for gestational diabetes and met criteria for the diagnosis of gestational diabetes. Overall mode of delivery was similar amongst the two groups. Babies born to Aboriginal mothers were significantly smaller and less likely to be breast fed than those from the non-Aboriginal group.

Adult↗
PubMed2004

Body size, body composition, and fat distribution: a comparison of young New Zealand men of European, Pacific Island, and Asian Indian ethnicities.

AIMS: To investigate body size and body fat relationships and fat distribution in young healthy men drawn from New Zealand European, Pacific Island, and Asian Indian populations. METHOD: A total of 114 healthy men (64 European, 31 Pacific Island, 19 Asian Indian) aged 17-30 years underwent measurements of height, weight, and body composition by total body dual-energy X-ray absorptiometry (DXA). Body mass index (BMI) was then calculated. Percent body fat (%BF), fat-free mass, bone mineral content, bone mineral density, abdominal fat, thigh fat, and appendicular skeletal muscle mass (ASMM) were obtained from the DXA scans. RESULTS: For the same BMI, %BF for Pacific Island men was 4% points lower and for Asian Indian men was 7-8% points higher compared to Europeans. Compared to European men for the same %BF, BMI was 2-3 units higher for Pacific Island, and 3-6 units lower for Asian Indian. The ratio of abdominal fat to thigh fat, adjusted for height, weight, and %BF, was significantly higher for Asian Indian men than European (p=0.022) and Pacific Island (p=0.002) men. ASMM, adjusted for height and weight, was highest in Pacific Island and lowest in Asian Indian men. CONCLUSIONS: The relationship between %BF and BMI is different for European, Pacific Island, and Asian Indian men which may, at least in part, be due to differences in muscularity. Asian Indians have more abdominal fat deposition than their European and Pacific Island counterparts. Use of universal BMI cut-off points are not appropriate for comparison of obesity prevalence between these ethnic groups.

Adolescent↗
PubMed2004

Metformin therapy and diabetes in pregnancy.

No adverse pregnancy outcomes with metformin use have been reported, except in one unmatched study. Otherwise, the studies are small and non-randomised, with the exception of one prospective, randomised controlled trial, currently under way, comparing metformin with insulin in women with gestational diabetes mellitus (the MiG trial). No long-term follow-up data for offspring of mothers receiving metformin have been published. Any woman with diabetes should be as close to euglycaemia as possible before pregnancy. In some circumstances (eg, severe insulin resistance), metformin therapy during pregnancy may be warranted. When metformin treatment is being considered, the individual risks and benefits need to be discussed with the patient so that an appropriate decision can be reached.

Diabetes Mellitus, Type 2↗
PubMed2004

Diabetes care: practice nurse roles, attitudes and concerns.

BACKGROUND: Practice nurses (PNs) are the largest group of nurses providing primary care for patients with diabetes in New Zealand, and changes in the health system are likely to have a substantial effect on their roles. To inform the development of a new primary health care nursing structure and evaluate the new role associated with this, it will be important to have data on current practice nurse roles. AIMS: The aim of this paper is to report a study to compare the diabetes-related work roles, training and attitudes of practice nurses in New Zealand surveyed in 1990 and 1999, to consider whether barriers to practice nurse diabetes care changed through that decade, and whether ongoing barriers will be addressed by current changes in primary care. METHODS: Questionnaires were mailed to all 146 PNs in South Auckland in 1990 and to all 180 in 1999, asking about personal and practice descriptions, practice organization, time spent with patients with diabetes, screening practices, components of care undertaken by practice nurses, difficulties and barriers to good practice, training in diabetes and need for further education. The 1999 questionnaire also asked about nurse prescribing and influence on patient quality of life. RESULTS: More nurses surveyed in 1999 had postregistration diabetes training than those in 1990, although most of those surveyed in both years wanted further training. In 1999, nurses looked after more patients with diabetes, without spending more time on diabetes care than nurses in 1990. Nevertheless, they reported increased involvement in the more complex areas of diabetes care. Respondents in 1999 were no more likely than those in 1990 to adjust treatment, and gave a full range of opinion for and against proposals to allow nurse prescribing. The relatively low response rate to the 1990 survey may lead to an underestimate of changes between 1990 and 1999. CONCLUSIONS: Developments in New Zealand primary care are likely to increase the role of primary health care nurses in diabetes. Research and evaluation is required to ascertain whether this increasing role translates into improved outcomes for patients.

Attitude of Health Personnel↗