The consequences of delaying insulin initiation in UK type 2 diabetes patients failing oral hyperglycaemic agents: a modelling study

<p>Abstract</p> <p>Background</p> <p>Recent data have shown that type 2 diabetes patients in the UK delay initiating insulin on average for over 11 years after first being prescribed an oral medication. Using a published computer simulation model of diabetes we used UK-specific data to estimate the clinical consequences of immediately initiating insulin versus delaying initiation for periods in line with published estimates.</p> <p>Methods</p> <p>In the base case scenario simulated patients, with characteristics based on published UK data, were modelled as either initiating insulin immediately or delaying for 8 years. Clinical outcomes in terms of both life expectancy and quality-adjusted life expectancy and also diabetes-related complications (cumulative incidence and time to onset) were projected over a 35 year time horizon. Treatment effects associated with insulin use were taken from published studies and sensitivity analyses were performed around time to initiation of insulin, insulin efficacies and hypoglycaemia utilities.</p> <p>Results</p> <p>For patients immediately initiating insulin there were increases in (undiscounted) life expectancy of 0.61 years and quality-adjusted life expectancy of 0.34 quality-adjusted life years versus delaying initiation for 8 years. There were also substantial reductions in cumulative incidence and time to onset of all diabetes-related complications with immediate versus delayed insulin initiation. Sensitivity analyses showed that a reduced delay in insulin initiation or change in insulin efficacy still demonstrated clinical benefits for immediate versus delayed initiation.</p> <p>Conclusion</p> <p>UK type 2 diabetes patients are at increased risk of a large number of diabetes-related complications due to an unnecessary delay in insulin initiation. Despite clear guidelines recommending tight glycaemic control this failure to begin insulin therapy promptly is likely to result in needlessly reduced life expectancy and compromised quality of life.</p

Two-Erasure Codes from 3-Plexes

Part 7: Memory and File SystemInternational audienceWe present a family of parity array codes called 3-PLEX for tolerating two disk failures in storage systems. It only uses exclusive-or operations to compute parity symbols. We give two data/parity layouts for 3-PLEX: (a) When the number of disks in array is at most 6, we use a horizontal layout which is similar to EVENODD codes, (b) otherwise we choose hybrid layout like HoVer codes. The major advantage of 3-PLEX is that it has optimal encoding/decoding/updating complexity in theory and the number of disks in a 3-PLEX disk array is less constrained than other array codes, which enables greater parameter flexibility for trade-offs in storage efficiency and performances

Covering radius in the Hamming permutation space

© 2019 Elsevier LtdLet Sn denote the set of permutations of {1,2,…,n}. The function f(n,s) is defined to be the minimum size of a subset S⊆Sn with the property that for any ρ∈Sn there exists some σ∈S such that the Hamming distance between ρ and σ is at most n−s. The value of f(n,2) is the subject of a conjecture by Kézdy and Snevily, which implies several famous conjectures about Latin squares. We prove that the odd n case of the Kézdy–Snevily Conjecture implies the whole conjecture. We also show that f(n,2)>3n∕4 for all n, that s! [Formula presented] [Formula presented] if s⩾311Nsciescopu

Transversals in Latin Arrays with Many Distinct Symbols

Abstract An array is row‐Latin if no symbol is repeated within any row. An array is Latin if it and its transpose are both row‐Latin. A transversal in an array is a selection of n different symbols from different rows and different columns. We prove that every Latin array containing at least distinct symbols has a transversal. Also, every row‐Latin array containing at least distinct symbols has a transversal. Finally, we show by computation that every Latin array of order 7 has a transversal, and we describe all smaller Latin arrays that have no transversal