Simple Advice Research Articles

Can One Test Fit All? Responses to the Article “Striving for Simple but Effective Advice for Comparing the Central Tendency of Two Populations” (Ruxton & Neuhäuser, 2018)

Responses to suggestions made by Ruxton & Neuhäuser (2018) regarding Nguyen et al. (2016) are given.

Striving for Simple but Effective Advice for Comparing the Central Tendency of Two Populations

Nguyen et al. (2016) offered advice to researchers in the commonly-encountered situation where they are interested in testing for a difference in central tendency between two populations. Their data and the available literature support very simple advice that strikes the best balance between ease of implementation, power and reliability. Specifically, apply Satterthwaite’s test, with preliminary ranking of the data if a strong deviation from normality is expected, or is suggested by visual inspection of the data. This simple guideline will serve well except when dealing with small samples of discrete data, when more sophisticated treatment may be required.

Combined education and patient-led goal setting intervention reduced chronic low back pain disability and intensity at 12 months: a randomised controlled trial

BackgroundOne model of care that has not been tested for chronic low back pain (LBP) is patient-led goal setting. We aimed to compare the clinical effectiveness and healthcare use of...

A Strategy-Proof Mechanism Should Be Announced to Be Strategy-Proof: An Experiment for the Vickrey Auction

We conduct laboratory experiments for the multi-unit Vickrey auction with and without providing advice to subjects on strategy-proofness. Although the rate of truth-telling among the subjects stays at 20% without advice, the rate increases to 47% with advice. By conducting similar experiments for the pay-your-bid auction, which is not strategy-proof, we confirm that our results are not due to so-called experimenter demand effects. Moreover, advice improves efficiency in the Vickrey auction, particularly in early periods in which subjects are less experienced. It is well known that subjects tend to overbid in several Vickrey auction experiments. Our results indicate the possibility that simple advice decreases such overbidding by promoting better understanding of the strategy-proofness property in the Vickrey auction. Strategy-proof mechanisms are sometimes criticized because players often fail to find the benefit of truth-telling, but our observations show that introducing advice on the property of strategy-proofness helps them to behave “correctly.”

Simple diet advice for complete denture patients.

Simple diet advice for complete denture patients.

Changes in the nutritional statuses of edentulous elderly patients after new denture fabrication with and without providing simple dietary advice

PurposeProviding appropriate dental prostheses and dietary interventions may improve food and nutrient intake in elderly edentulous patients, but evidence to support their use is scarce. In this trial, we aimed to clarify the combined effect, on the nutritional statuses of edentulous elderly patients, of dentists providing complete dentures with dietary advice. MethodsA randomized-controlled trial was performed on a healthy elderly population who required new complete dentures. All participants had new complete dentures fabricated and were randomly divided into an intervention or a control group. The intervention group received simple dietary advice through standardized patient information leaflets and the control group received advice on denture care only. Nutritional status was assessed using the Mini Nutritional Assessment short-form (MNA-SF) before and at 3 and 6months after treatment. At each assessment point, the MNA-SF scores were compared using the Mann–Whitney U test. The within-group differences in the MNA-SF scores were analyzed using the Wilcoxon signed-rank test with Bonferroni correction. ResultsIn total, 59 participants completed all trial steps. At 6months after treatment, the MNA-SF score in the intervention group was significantly higher than that in the control group (p=0.01). Comparing the within-group changes in the MNA-SF score revealed that the score increased significantly from 3 to 6months in the intervention group (p=0.001, Bonferroni correction). ConclusionsNutritional statuses of healthy edentulous elderly population might be improved by fabricating new complete dentures and providing simple dietary advice.

Estimating resource utilization demands in implementing statewide screening, brief intervention, and referral to treatment for alcohol-impaired drivers

Objectives: The Alcohol Use Disorders Identification Test (AUDIT) is used to assess the level of alcohol use/misuse and to inform the intensity of intervention delivered within screening, brief intervention, and referral to treatment (SBIRT) programs. Policy initiatives are recommending delivery of SBIRT within health care settings to reduce alcohol misuse and prevent alcohol-impaired driving. Recent reports are considering extending delivery of SBIRT to criminal justice settings. One consideration in implementing SBIRT delivery is the question of resource utilization; the amount of effort required in delivering the 4 different intensities of intervention in SBIRT: Alcohol education, simple advice, brief counseling and continued monitoring, and brief counseling and referral to specialist (from least to most intense in terms of delivery time, the skill level of the provider, and personnel resources).Methods: In order to inform expectations about intervention intensity, this article describes the AUDIT scores from 982 adults recently arrested for alcohol-impaired driving. The distribution of scores is extrapolated to state rates for individuals arrested for alcohol-impaired driving by intervention level.Results: Though alcohol education was the most common intervention category, about one quarter of the sample scored in a range corresponding with the more intensive interventions using the brief counseling, continued monitoring for ongoing alcohol use, and/or referral to specialist for diagnostic evaluation and treatment.Conclusions: This article provides local distribution of AUDIT scores and state estimates for the number of individuals scoring in each level of risk (AUDIT risk zone) and corresponding intervention type. Routine criminal justice practice is well positioned to deliver alcohol screening, education, simple advice, and continued alcohol monitoring, making delivery of SBIRT feasible for the majority of alcohol-impaired drivers. Challenges to implementing the full range of SBIRT services include resource demands of brief counseling, identifying the appropriate providers within a criminal justice context, and availability of community providers for referral to diagnostic and specialty care. Solutions may vary by state due to differences in population density and incidence rates of alcohol-impaired driving.

Strengthening nutrition services within integrated community case management (iCCM) of childhood illnesses in the Democratic Republic of Congo: Evidence to guide implementation

In the Democratic Republic of Congo, 43% of children under 5 years of age suffer from stunting, and the majority (60%) of children, 6–59 months of age, are anaemic. Malaria, acute respiratory infections, and diarrheal diseases are common among children less than 5 years of age, with 31% of children 6–59 months affected by malaria. This qualitative implementation science study aimed to identify gaps and opportunities available to strengthen service delivery of nutrition within integrated community case management (iCCM) at the health facility and community level in Tshopo Province, Democratic Republic of Congo, through the following objectives: (a) examine cultural beliefs and perceptions of infant and young child feeding (IYCF) and child illness, (b) explore the perspectives and knowledge of facility‐based and community‐based health providers on nutrition and iCCM, and (c) gain an understanding of the influence of key family and community members on IYCF and care‐seeking practices. This study involved in‐depth interviews with mothers of children under 5 years of age (n = 48), grandmothers (n = 20), fathers (n = 21), facility‐based providers (n = 18), and traditional healers (n = 20) and eight focus group discussions with community health workers. Study findings reveal most mothers reported diminished quantity and quality of breastmilk linked to child/maternal illness, inadequate maternal diet, and feedings spaced too far apart. Mothers' return to work in the field led to early introduction of foods prior to 6 months of age, impeding exclusive breastfeeding. Moreover, children's diets are largely limited in frequency and diversity with small quantities of foods fed. Most families seek modern and traditional medicine to remedy child illness, dependent on type of disease, its severity, and cost. Traditional healers are the preferred source of information for families on certain child illnesses and breastmilk insufficiency. Community health workers often refer and accompany families to the health centre, yet are underutilized for nutrition counselling, which is infrequently given. Programme recommendations are to strengthen health provider capacity to counsel on IYCF and iCCM while equipping health workers with updated social and behavior change communication (SBCC) materials and continued supportive supervision. In addition, targeting key influencers to encourage optimal IYCF practices is needed through community and mother support groups. Finally, exploring innovative ways to work with traditional healers, to facilitate referrals for sick/malnourished children and provide simple nutrition advice for certain practices (i.e., breastfeeding), would aid in strengthening nutrition within iCCM.

Delivering self-management for LBP via a digital solution in primary care - a sustainable solution for a growing problem

Purpose: Most back pain does not need specific or specialist treatment and will often resolve if people follow simple evidence-based advice. Access to this advice is inconsistent with people often self-managing via unvalidated resources online. Using digital technology to provide immediate day-by-day support whilst connecting patients to their local MSK pathway and support services, has the potential to deliver this advice in a consistent and standardised way.

Breakfast: Shaping Guidelines for Food and Nutrient Patterns.

Whilst there is extensive literature on the health benefits of a regular breakfast, there are few guidelines to help policy makers to issue specific targets on optimal nutrient intake at breakfast or the selection of foods to attain these targets. The food and nutritional advice on breakfast offered by most governments is confined to simple advice on food servings. The USA and Mexico typify the few countries that have attempted to issue specific nutrient targets for breakfast. However, these simply reflect general nutrient guidelines for adults, adjusted to suit lower energy needs of toddlers and school children. Little guidance is issued on micronutrient intake, and the advice on food choice does not appear to be linked to patterns of nutrient intake. The application of cluster and principal component analysis, which is used to determine the patterns of daily or breakfast food consumption and also link them to nutrient intake, greatly improved our understanding of optimal breakfast choices. Using 6 national nutrition surveys (Canada, Denmark, France, Spain, the UK, and the USA), the International Breakfast Research Initiative has opted to score each individual with a measure of overall daily nutritional quality (based on the nutrient-rich food index). It is hoped that options for the derivation in breakfast nutrient targets and associated food-based guidelines will arise from an analysis of tertiles of this score. Ultimately, meal-based advice will become the basic building block for digitally based personalized dietary analysis and guidelines.

Knowledge Gaps Around Smoking and Nicotine Among U.S. Military Veterans Who Smoke and Implications for Practice

The present study describes knowledge about smoking and nicotine among a sample of Iraq-/Afghanistan-era veterans who smoke (N = 117). A majority of participants had knowledge regarding general risks of smoking and benefits of nicotine replacement therapy. However, many participants underestimated their personal cardiovascular (50%) and cancer risk (41%) as a smoker. Many participants also inaccurately believed that nicotine causes cancer (44%) and that nicotine medications work by making one physically sick if used while smoking (56%). These beliefs could lead to reluctance to use nicotine replacement therapy. Discussion of findings offers potential solutions in the form of patient education as well as emphasis on training healthcare providers training on best practices for patient education (beyond simple advice to quit). More nuance and detail in patient education may facilitate increased knowledge about smoking and nicotine among U.S. military veterans with the ultimate goal of increasing cessation rates.

Nutritional interventions in elderly gastrointestinal cancer patients: the evidence from randomized controlled trials.

Literature concerning nutritional interventions in elderly patients with gastrointestinal cancer, with special reference to randomized clinical trials, has been critically reviewed. This segment of oncologic population was found to be penalized by a high prevalence of malnutrition and sarcopenia which translated in an increased rate of toxicity from chemotherapy, poor compliance with oncologic treatments, and, finally, with a poor prognosis. Attempts to reverse this condition included a potentiation of nutrients intake which should sequentially proceed through the use of dietary counseling and administration of standard or ω-3 fatty acid-enriched oral supplements to finally come to enteral or parenteral nutrition. Randomized clinical trials investigating the effects of simple dietary advice and use of standard oral supplements were disappointing as regards long-term compliance and results. Nutritional and clinical benefits were reported with the use of ω-3 fatty acid-enriched oral supplements and especially with long-term supplemental parenteral nutrition. Despite the general recommendation of the scientific community that emphasizes the use of the enteral route, whenever possible, for delivering the nutritional support, it appears from the literature that more consistent benefits can be achieved, especially in the long-term nutritional support, when an insufficient oral nutrition is partnered with intravenous nutrition.

A Permanent Cure for Vitiligo: Immigration of Healthy Skin Cells to Unhealthy Sides of the Skin in Vitiligo Through a New Treatment

This article is about a skin disorder which manifests itself as white patches (pigment destruction) in different locations of the body. There are many classifications for this disorder such as segmented, focal, generalized and universal vitiligo. In my article, I have mentioned some of the current methods used in the treatment such as UV rooms. However, there are many risks and long term side effects to this treatment. Besides at the end of the treatment, the patient leaves the clinic in disappointment and without being treated. I was suffering from the same disorder for 14 years, so I can feel how deep is the depression and suffering of those vitiligo patients. My motivation behind the discovery of this treatment was me myself. I was suffering from the same disorder. It was so painful to be out in the society where everybody gazed at you and some were even afraid to talk to you. Because of my economic issues, I did not have access to labs and research centesrs. So I studied a lot and broadened my understanding and knowledge abut human body and biology. After I dicovered the treatment, I cured myself in 5months and then many more patients from England, Iran, Turkey and Azerbaijan. In my article, I have written about some blood tests the patients have to take. I have also mentioned the vitamins, pills and the creams they should use (different for kids and adults). My only intention for writing this article is to let all my colleague dermatologists know about the new treatment. Moreover, the whole treatment takes 5 months or so and is affordable by everybody. If the patients follow the simple advice mentioned in the article, the disorder will not come back. I would kindly ask you to go through my article and read it deep. I have treated myself and many others, so I can replicate the treatment on the cases given by you. The treatment and progress is visiblr from the first month.

Combined effects of new complete denture fabrication and simplified dietary advice on nutrient intake in edentulous elderly patients for 6 months.

The aim was to evaluate the combined effects of a new complete denture fabrication and simple dietary advice (using unique pamphlets) by dentists on nutrient intake in edentulous elderly patients. A randomized controlled trial was performed on edentulous elderly patients who were randomly allocated to either an intervention or a control group. The intervention group received a new complete denture and simple dietary advice, whereas the control group received a new complete denture and denture care advice. The outcomes of this trial (nutrient intakes) were calculated using a brief-type self-administered diet history questionnaire (BDHQ) and assessed at three time points (pretreatment and 3 and 6months post-treatment). At 3months post-treatment, the intake of several nutrients such as proteins (p = 0.004), magnesium (p < 0.001), and vitamin B1 (p = 0.014) was significantly higher in the intervention group than the control group, whereas at 6months post-treatment, plant protein (p = 0.028) intake was significantly higher in the intervention group than the control group. On the contrary, animal protein (p = 0.049) and vitamin B12 (p = 0.028) intakes were significantly higher in the control group. New complete denture fabrication with simple dietary advice might improve nutrient intake in elderly edentulous patients; however, the effect is probably short term. New complete denture fabrication along with simple dietary advice by dentists might improve nutrient intake in edentulous elderly patients. Therefore, regular use of these interventions in the dental setting might have long-term effects on nutrient intake in elderly edentulous patients. UMIN-CTR Clinical Trial, unique trial number: UMIN000017879.

Simple dietary advice reduces 24-hour urinary sodium excretion, blood pressure, and drug consumption in hypertensive patients

Sodium intake should be restricted to 100 mEq, that is, about 2.3 grams per day. Strict diets, however, are often cumbersome and seldom matched by rigorous compliance. We studied 291 patients on antihypertensive treatment, 240 of whom were instructed to avoid salty foods, such as cheese and cured meats, and to switch from regular bread to salt-free bread. The remaining 51 matched patients constituted a control group and received only generic dietary advice. Na[U]/24h, K[U]/24h, and office BP (automated repeated measurements) were recorded before dieting started and after 9 ± 1 weeks of dieting. Our intervention group showed a significant decrease in body weight (71.75 ± 14.0 to 70.54 ± 13.33 kg, P < .0001), sodium excretion (153.1 ± 44.61 to 133.5 ± 37.1 mEq/24h, P < .05), systolic and diastolic BP (134.16 ± 16.0 to 126.5 ± 10.53 mm Hg, P = .014 and 80.59 ± 11.47 to 75.9 ± 8.72 mm Hg, P = .026, respectively), and drug consumption (1.71 ± 0.91 to 1.49 ± 0.84 DDD, P < .05). The rate of responders to antihypertensive therapy increased (51.4% to 79.5%). In the control group neither significant nor substantial changes were seen. Our data suggest that even a minimal reduction in the apparent sodium intake (∼0.5 grams per day) can improve both BP values and responder rates in treated hypertensive patients, while reducing the consumption of antihypertensive drugs.

The associations between employees\u2019 risky drinking and sociodemographics, and implications for intervention needs

BackgroundHarmful alcohol consumption is a major risk factor for ill-health on an individual level, a global public health challenge, and associated with workplace productivity loss. This study aimed to explore the proportion of risky drinkers in a sample of employees, investigate sociodemographic associations with risky drinking, and examine implications for intervention needs, according to recommendations from the World Health Organization (WHO).MethodsIn a cross-sectional design, sociodemographic data were collected from Norwegian employees in 14 companies (n = 3571) across sectors and branches. Risky drinking was measured with the Alcohol Use Disorders Identification Test (AUDIT). The threshold for risky drinking was set at ≥8 scores on the AUDIT. Based on WHO guidelines, risky drinkers were divided into three risk categories (moderate risk: scores 8–15, high risk: scores 16–19, and dependence likely risk: scores 20–40). The association between sociodemographic variables and risky drinking were explored with chi square tests for independence and adjusted logistic regression. The risk groups were then examined according to the WHO intervention recommendations.Results11.0% of the total sample reported risky drinking. Risky drinking was associated with male gender (OR = 2.97, p < .001), younger age (OR = 1.03, p < .001), low education (OR = 1.17, p < .05), being unmarried (OR = 1.38, p < .05) and not having children (OR = 1.62, p < .05). Risky drinking was most common among males without children (33.5%), males living alone (31.4%) and males aged ≤39 (26.5%). 94.6% of risky drinkers scored within the lowest risk category. Based on WHO guidelines, approximately one out of ten employees need simple advice, targeting risky drinking. In high-risk groups, one out of three employees need interventions.ConclusionsA considerable amount of employees (one to three out of ten), particularly young, unmarried males without children and higher education, may be characterised as risky drinkers. This group may benefit from low-cost interventions, based on recommendations from the WHO guidelines.

Supplementation of Vitamin D Deficiency in Patients with Neuroendocrine Tumors Using Over-the-Counter Vitamin D3 Preparations

ABSTRACTVitamin D (vit-D) deficiency is highly prevalent in patients with gastro-entero-pancreatic neuroendocrine tumors (GEP-NET) and has been linked to reduced overall survival. We here assessed the vit-D status in 183 patients with GEP-NET at the time of their first presentation in the ARDEN NET Centre. We further examined the effect of simple advice to increase vit-D intake using over-the-counter vit-D preparations [colecalciferol (Vit-D3), 1,000–2,000 units/day], over a prospective observation period of 24 mo. At baseline, only 33.3% of patients showed vit-D sufficiency (25-OH-vit-D; >50 nmol/L), the remainder was insufficient (31.3%; 25-OH-vit-D; 25–50 nmol/L) or deficient (35.5%; 25-OH-vit-D; <25 nmol/L). Repeated advice to increase vit-D intake at routine 6-monthly follow-up appointments was associated with increased 25-OH-vit-D from 37.8 ± 3.5 nmol/L at baseline to 60.4 ± 5.6 nmol/L (P < 0.0001) and 56.8 ± 7.0 nmol/L (P = 0.039) after 12 and 24 mo. Percentage of vit-D insufficiency decreased from 66.6% at baseline to 44.9% and 46.2% after 12 and 24 months, respectively. Previous abdominal surgery, but not treatment with somatostatin analogues predicted 25-OH-vit-D levels in bootstrapped linear regression analyses (P = 0.037). In summary, simple advice to increase vit-D intake using over-the-counter preparations was associated with significant improvement of vit-D deficiency/insufficiency, although, 15% of GEP-NET patients remained deficient and may benefit from additional measures of vit-D replacement.

Early management of patients with medication-overuse headache: results from a multicentre clinical study.

Educational intervention has proved to be effective in reducing drug abuse in uncomplicated medication-overuse headache (MOH). This ancillary of the SAMOHA multicentre study aimed to assess any differences in phenotypic characteristics, type and amount of drugs overused, and comorbidities between patients with MOH who responded to simple advice and those who did not. Demographic and clinical headache data of the last 3months before enrollment of patients were collected and patients were then asked to fill out a daily headache diary for 4weeks. Patients were then divided into two subgroups, i.e. those with confirmed MOH continued in the study [randomized (R) group], whereas those who did not still show any features of MOH dropped out of the study. A total of 88 (67.7%) patients still met the inclusion criteria after the baseline 4weeks (R group). Conversely, 42 (32.3%) patients dropped out of the study. A detailed analysis of those who dropped out revealed that only 34 were not randomized at visit 2 because they no longer satisfied the inclusion criteria for MOH [screening failures (SF) group]. The SF group was significantly younger and had fewer years of migraine history than the R group. Moreover, the SF group had a significantly shorter history of chronicity compared with the R group. Our findings suggest that in MOH trials, after an educational session, an observational period is needed in order to confirm the diagnosis of MOH and to avoid overestimation of the effect of other treatments used to manage MOH. Future research should focus mainly on those patients with MOH who do not respond to simple advice and with unsuccessful withdrawal.

Physical, emotional, and informational challenges of patients living with neuroendocrine tumors in the United States: Understanding their unmet needs.

299 Background: Surveys of neuroendocrine tumor (NET) burden on daily living rarely explore the impact that patient information sources can have on optimizing care. This subset of a large US survey focused on identifying the unmet needs, and available information sources and support that address the physical, emotional and informational challenges that patients with NETs experience. Methods: The Carcinoid Cancer Foundation is a US, non-profit organization that encourages and supports research and education on carcinoid and related NETs. A Carcinoid Cancer Foundation-approved survey was shared with patients with NETs via the Carcinoid Cancer Foundation website, e-newsletters and social media; some patients were emailed direct links to the online survey. Results: US, online surveys (N=428; 13 questions) were completed over 6 weeks in 2015. Patients had mostly small intestinal (40%), lung (13%) or pancreatic (11%) primary tumors; 66% of patients were diagnosed in the previous 5 years. Patients experienced multiple symptoms, most commonly diarrhea (47%), flushing (45%), changes in bowel/bladder habits (37%) and persistent pain (30%). Common emotions upon diagnosis were fear (58%), anxiety (53%), feeling overwhelmed (50%), confusion (39%) and sadness (34%). Greatest physical challenges were fatigue (66%), diarrhea (48%), pain/discomfort (40%) &amp; sleep disturbance (35%). “Very useful” information sources were (1) NET/carcinoid disease awareness website, (2) carcinoid/NET support group, (3) Google, (4) discussion forums and (5) governmental/health-authority websites. Favored information formats included “patients-like-me” case studies (67%), email (59%), e-newsletters (56%), FAQs (50%), short interactive tutorials (32%) and “top tips” (31%). Information sought, but not found, included simple advice on diet, holistic treatment, complementary therapies, where to find the best treatment, pain management &amp; prognosis. Conclusions: In the US, patients with NETs face negative emotions and multiple physical challenges that require psychological support/coping strategies, and they seek reliable, personally relevant, easily understood information, including that from interaction with other patients.

Comparison of Two Calorie-Reduced Diets of Different Carbohydrate and Fiber Contents and a Simple Dietary Advice Aimed to Modify Carbohydrate Intake on Glycemic Control and Inflammatory Markers in Type 2 Diabetes: A Randomized Trial.

ObjectivesThe aim of this study was to compare the effect of a simple dietary advice with two energy-restricted diets with different carbohydrate and fiber contents on anthropometric, biochemical, and inflammatory markers over an 8-wk intervention period in individuals with diabetes.MethodsForty-seven patients with type 2 diabetes (31 women and 16 men; age: 52.9 ± 8.0 years, body mass index: 29.5 ± 4.9 kg.m-2) completed an 8-wk randomized intervention trial that compared a simple dietary advice aimed to modulate carbohydrate intake (n = 13) with the two calorie-restricted (CR) diets (25% caloric restriction from total energy requirements) differing with regard to carbohydrate and fiber content, one with higher fiber (CRHF) containing 55% energy from carbohydrate plus a tablespoon of psyllium powder (n = 18) and the other with lower carbohydrate (CRLC) containing 40% energy from carbohydrate plus placebo powder (n = 16). Weight, plasma concentrations of glucose, insulin, lipids, interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α) were determined at baseline and after 8 weeks.ResultsThe mean change of body weight and plasma lipids were not different between the groups. Fasting plasma insulin and the homeostasis model assessment of insulin resistance (HOMA-IR) were significantly lower in the CRHF group (changes from baseline values in simple advice, CRHF, and CRLC were 1.3 ± 1.9, -1.0 ± 1.2, and 0.3 ± 3.1 µIL/mL for insulin and 0.5 ± 0.7, -0.3 ± 0.6, and 0.2 ± 0.9 for HOMA-IR, respectively). The levels of IL-6 significantly decreased in the CRHF and CRLC groups (changes from baseline values in simple advice, CRHF, and CRLC were 7.5 ± 6.8, -1.2 ± 4.7, and -4.2 ± 5.6 pg/mL, respectively). TNF-α levels were significantly lower only in the CRHF compared to the advice group (P < 0.05).ConclusionsOur results suggest that in comparison with simple advice to modify carbohydrate intake, a calorie-restricted, moderate carbohydrate diet supplemented with psyllium has better effects on plasma insulin and pro-inflammatory cytokines in patients with type 2 diabetes.