Shi, Hao-Jun; Jin, Chen; Fu, De-Liang
To evaluate the impact of glycemic control and nutritional status after total pancreatectomy (TP) on complications, tumor recurrence and overall survival. Retrospective records of 52 patients with pancreatic tumors who underwent TP were collected from 2007 to 2015. A series of clinical parameters collected before and after surgery, and during the follow-up were evaluated. The associations of glycemic control and nutritional status with complications, tumor recurrence and long-term survival were determined. Risk factors for postoperative glycemic control and nutritional status were identified. High early postoperative fasting blood glucose (FBG) levels (OR = 4.074, 95%CI: 1.188-13.965, P = 0.025) and low early postoperative prealbumin levels (OR = 3.816, 95%CI: 1.110-13.122, P = 0.034) were significantly associated with complications after TP. Postoperative HbA1c levels over 7% (HR = 2.655, 95%CI: 1.299-5.425, P = 0.007) were identified as one of the independent risk factors for tumor recurrence. Patients with postoperative HbA1c levels over 7% had much poorer overall survival than those with HbA1c levels less than 7% (9.3 mo vs 27.6 mo, HR = 3.212, 95%CI: 1.147-8.999, P = 0.026). Patients with long-term diabetes mellitus (HR = 15.019, 95%CI: 1.278-176.211, P = 0.031) and alcohol history (B = 1.985, SE = 0.860, P = 0.025) tended to have poor glycemic control and lower body mass index levels after TP, respectively. At least 3 mo are required after TP to adapt to diabetes and recover nutritional status. Glycemic control appears to have more influence over nutritional status on long-term outcomes after TP. Improvement in glycemic control and nutritional status after TP is important to prevent early complications and tumor recurrence, and improve survival.
Guillén-Sacoto, María Augusta; Barquiel, Beatriz; Hillman, Natalia; Burgos, María Ángeles; Herranz, Lucrecia
To assess the impact of glycemic control in gestational on neonatal weight and metabolic complications of twin and singleton pregnancies. An observational, retrospective study to monitor 120 twin and 240 singleton pregnancies in women with GDM. Maternal glycemic parameters during pregnancy (oral glucose tolerance test results, treatment, insulinization rate, mean HbA1c in the third trimester), and neonatal complications and weight were recorded. A higher infant birth weight ratio (IBWR 1.02±0.12 vs. 0.88±0.12, P<.001) and a lower rate of newborns small for gestational age (severe SGA 2.5% vs. 8.3%, P=.012) were seen after singleton pregnancies as compared to twin pregnancies. The rates of newborns large for gestational age (LGA 12.6% vs. 12.5%, P=.989); macrosomic (6.7% vs. 7.5%, P=.777); or small for gestational age (SGA 6.7% vs. 10.8%, P=.175) were similar in both groups. Neonates from twin pregnancies had a higher risk of hypoglycemia (adjusted OR 4.71; 1.38-16.07, P=.013) and polycythemia (adjusted OR 10.05; 1.82-55.42, P=0.008). A linear relationship was seen between third trimester HbA1c levels and IBWR in singleton (r=.199, P=.003), but not in twin pregnancies (r=0.049, P=0.610). Risk of severe SGA, hypoglycemia, and polycythemia was significantly higher in twin pregnancies of women with GDM. Neonatal weight outcomes and metabolic complications in twin pregnancies of women with GDM were not related to glycemic control. Moreover, in our study population, fasting glucose at diagnosis and mean HbA1c in the third trimester showed a linear relationship with higher birth weights in singleton, but not in twin pregnancies. Copyright © 2018 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.
Objectives: To compare the outcome of tight versus standard glycemic control and its impact on post operative morbidity and short term mortality in patients undergoing Coronary Artery Bypass Grafting (CA-BG). Patients and Methods: A prospective surveillance of 124 patients undergoing isolated CABG surgery (on pump) was included in the study, 62 patients in each group were randomly assigned to tight and standard glucose control group. The main exposure was insulin in respect to level of blood glucose and the primary outcome measures were Sternotomy wound infection, Leg wound infection and new Myocardial Infarction. Surgical Site infection was assessed on a daily basis during the patient's stay in the Department of Cardio-thoracic Surgery, Sheikh Zayed Hospital, Lahore or within 30 days of operation prompting the patient to return to the hospital. Chi-square test or test was used to identify the significance of various short term morbidities and mortality. Results: In this study, 12 patients in the standard group and 4 patients in the tightly controlled group developed Sternal wound infection (p value 0.046). Similarly, 9 versus 2 patients in the standard and tight group respectively developed Leg wound infection (p-value 0.035). Test of proportion was applied and it was found that there was significant difference in the pro-portion of infection in the two groups (p value 0.05). However, there were no significant differences in other morbidities and the short term mortality. Conclusion: Study confirmed that tight glucose con-trol post operatively in CABG patient's results in reduced sternal and leg wound infection rates; however, there was no effect on other morbidities and short term mortality. (author)
Rhee, Jinnie J; Zheng, Yuanchao; Montez-Rath, Maria E; Chang, Tara I; Winkelmayer, Wolfgang C
There is a lack of data on the relationship between glycemic control and cardiovascular end points in hemodialysis patients with diabetes mellitus. We included adult Medicare-insured patients with diabetes mellitus who initiated in-center hemodialysis treatment from 2006 to 2008 and survived for >90 days. Quarterly mean time-averaged glycated hemoglobin (HbA 1c ) values were categorized into diabetes mellitus. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
Diabetes mellitus is a chronic disease associated with development of microvascular and macrovascular complications. Optimal glycemic control, usually measured by HbA1c is the cornerstone for prevention of complications. In this thesis glycemic variability (which resembles actual glucose levels,
Miremberg, Hadas; Ben-Ari, Tal; Betzer, Tal; Raphaeli, Hagit; Gasnier, Rose; Barda, Giulia; Bar, Jacob; Weiner, Eran
Patient compliance and tight glycemic control have been demonstrated to improve outcome in pregnancies complicated by gestational diabetes mellitus. The use of advanced technological tools, including smartphone-based platforms, to improve medical care and outcomes has been demonstrated in various fields of medicine, but only a few small studies were performed with gestational diabetes mellitus patients. We aimed to study the impact of introducing a smartphone-based daily feedback and communication platform between gestational diabetes mellitus patients and their physicians, on patient compliance, glycemic control, pregnancy outcome, and patient satisfaction. This is a prospective, single-center, randomized controlled trial. Newly diagnosed gestational diabetes mellitus patients presenting to our multidisciplinary diabetes-in-pregnancy clinic were randomized to: (1) routine biweekly prenatal clinic care (control group); or (2) additional daily detailed feedback on their compliance and glycemic control from the clinic team via an application installed on their smartphone (smartphone group). The primary outcome was patient compliance defined as the actual blood glucose measurements/instructed measurements ×100. The secondary outcomes included diabetes-control parameters, pregnancy, and neonatal outcomes. The study was adequately powered to detect a 20% difference in patient compliance, based on a preliminary phase that demonstrated 70% baseline compliance to glucose measurements. A total of 120 newly diagnosed gestational diabetes mellitus patients were analyzed. The 2 groups did not differ in terms of age, parity, education, body mass index, family history, maternal comorbidities, oral glucose tolerance test values, and hemoglobin A1C at randomization. The smartphone group demonstrated higher level of compliance (84 ± 0.16% vs 66 ± 0.28%, P diabetes mellitus patients and the multidisciplinary diabetes-in-pregnancy clinic team improved patient compliance and
Sadhwani, Anjali; Asaro, Lisa A.; Goldberg, Caren; Ware, Janice; Butcher, Jennifer; Gaies, Michael; Smith, Cynthia; Alexander, Jamin L.; Wypij, David; Agus, Michael S. D.
Objective To assess the association of postoperative tight glycemic control and hypoglycemia in children undergoing cardiac surgery with neurodevelopmental outcomes at 1 year of age. Study design A 2-center, prospective, randomized trial of postoperative tight glycemic control vs standard care was conducted in 980 children undergoing cardiac surgery. Neurodevelopmental outcomes were assessed at nine to 18 months using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III), the Adaptive Behavior Assessment System, Second Edition, the Ages and Stages Questionnaire, Third Edition, and the Brief Infant Toddler Social-Emotional Assessment. Results Neurodevelopmental follow-up was performed on 237 patients with a mean age of 13 months. No significant treatment group differences were found in the Bayley-III and Adaptive Behavior Assessment System, Second Edition composite scores or percentage at risk based on the Ages and Stages Questionnaire, Third Edition and the Brief Infant Toddler Social-Emotional Assessment. Patients who experienced moderate to severe hypoglycemia (n = 8) had lower Bayley-III composite scores compared with patients with no to mild hypoglycemia, even after controlling for factors known to be associated with poorer neurodevelopmental outcomes. Conclusion For infants undergoing cardiac surgery, tight glycemic control did not impact neurodevelopmental outcomes compared with standard care. These data suggest a possible association between moderate to severe hypoglycemia and poorer neurodevelopmental outcomes at 1 year of age. PMID:27112038
Shaun W. H. Lee
Full Text Available Importance: Telemedicine has been shown to be an efficient and effective means of providing care to patients with chronic disease especially in remote and undeserved regions, by improving access to care and reduce healthcare cost. However, the evidence surrounding its applicability in type 1 diabetes remains scarce and conflicting.Objective: To synthesize evidence and quantify the effectiveness of telemedicine interventions for the management of glycemic and clinical outcomes in type 1 diabetes patients, relative to comparator conditions.Data Sources: MEDLINE, EMBASE, Cochrane Library, Web of Science, PsycINFO, and CINAHL were searched for published articles since inception until December 2016.Study Selection: Original articles reporting the results of randomized controlled studies on the effectiveness of telemedicine in people with type 1 diabetes were included.Data Extraction and Synthesis: Two reviewers independently extracted data, assessed quality, and strength of evidence. Interventions were categorized based upon the telemedicine focus (monitoring, education, consultation, case-management, and peer mentoring.Main Outcome and Measure: Absolute change in glycosylated hemoglobin A1c (HbA1c from baseline to follow-up assessment.Results: A total of 38 studies described in 41 articles were identified. Positive effects on glycemic control were noted with studies examining telemedicine, with a mean reduction of 0.18% at the end of intervention. Studies with longer duration (>6 months who had recruited patients with a higher baseline HbA1c (≥9% were associated with larger effects. Telemedicine interventions that involve individualized assessments, audit with feedback and skill building were also more effective in improving glycemic control. However, no benefits were observed on blood pressure, lipids, weight, quality of life, and adverse events.Conclusions and Relevance: There is insufficient evidence to support telemedicine use for glycemic
Minze, Molly G; Will, Kayley; Terrell, Brian T; Black, Robin L; Irons, Brian K
Sodium-glucose co-transporter 2 (SGLT2) inhibitors are a new pharmacotherapeutic class for the treatment of type 2 diabetes mellitus (T2DM). To evaluate beneficial effects of the SGLT2 inhibitors on metabolic, cardiovascular, and renal outcomes. A Pub-Med search (1966 to July 2017) was performed of published English articles using keywords sodium-glucose co-transporter 2 inhibitors, canagliflozin, dapagliflozin, and empagliflozin. A review of literature citations provided further references. The search identified 17clinical trials and 2 meta-analysis with outcomes of weight loss and blood pressure reduction with dapagliflozin, canagliflozin, or empagliflozin. Three randomized trials focused on either empagliflozin or canagliflozin and reduction of cardiovascular disease and progression of renal disease. SGLT2 inhibitors have a beneficial profile in the treatment of T2DM. They have evidence of reducing weight between 2.9 kilograms when used as monotherapy to 4.7 kilograms when used in combination with metformin, and reduce systolic blood pressure between 3 to 5 mmHg and reduce diastolic blood pressure approximately 2 mmHg. To date, reduction of cardiovascular events was seen specifically with empagliflozin in patients with T2DM and a history of cardiovascular disease. In the same population, empagliflozin was associated with slowing the progression of kidney disease. Moreover, patients with increased risk of cardiovascular disease treated with canagliflozin has decreased risk of death from cardiovascular causes, nonfatal MI, or nonfatal stroke. Data regarding these outcomes with dapagliflozin are underway. SGLT2 inhibitors demonstrate some positive metabolic effects. In addition, empagliflozin specifically has demonstrated reduction in cardiovascular events and delay in the progression of kidney disease in patients with T2DM and a history of cardiovascular disease. Further data is needed to assess if this is a class effect. Copyright© Bentham Science Publishers
Crispín-Trebejo, Brenda; Robles-Cuadros, María Cristina; Bernabé-Ortiz, Antonio
There is limited and controversial information regarding the potential impact of depression on glycemic control. This study aims to evaluate the association between depression and poor glycemic control. In addition, the prevalence of depression and rates of poor glycemic control were determined. Cross-sectional study performed in the endocrinology unit of two hospitals of ESSALUD in Peru. The outcome of interest was poor glycemic control, evaluated by glycated hemoglobin (HbA1c: diabetes patients. Our results suggest that early detection of depression might be important to facilitate appropriate glycemic control and avoid further metabolic complications. © 2015 Wiley Publishing Asia Pty Ltd.
Brown, Aparna; Reynolds, L Raymond; Bruemmer, Dennis
Cardiovascular complications constitute the major cause of morbidity and mortality in patients with diabetes. The Diabetes Control and Complications Trial (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS) provided consistent evidence that intensive glycemic control prevents the development and progression of microvascular complications in patients with type 1 or type 2 diabetes. However, whether intensive glucose lowering also prevents macrovascular disease and major cardiovascular events remains unclear. Extended follow-up of participants in these studies demonstrated that intensive glycemic control reduced the long-term incidence of myocardial infarction and death from cardiovascular disease. By contrast, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial, and Veterans Affairs Diabetes Trial (VADT) results suggested that intensive glycemic control to near normoglycemia had either no, or potentially even a detrimental, effect on cardiovascular outcomes. This article discusses the effects of intensive glycemic control on cardiovascular disease, and examines key differences in the design of these trials that might have contributed to their disparate findings. Recommendations from the current joint ADA, AHA, and ACCF position statement on intensive glycemic control and prevention of cardiovascular disease are highlighted.
Jørgensen, Lone G M; Petersen, Per Hyltoft; Heickendorff, Lene; Møller, Holger Jon; Hendel, Jørn; Christensen, Cramer; Schmitz, Anita; Reinholdt, Birgitte; Lund, Erik D; Christensen, Niels J; Hansen, Erik Kjaersgaard; Hastrup, Jens; Skjødt, Hanne; Eriksen, Ebbe Wendel; Brandslund, Ivan
Hemoglobin A1c (HbA1c) is a proxy measure for glycemic control in diabetes. We investigated the trend for glycemic control in patients from three Danish counties using HbA1c measurements. We studied 2454 patients from a population of 807,000 inhabitants for whom routine monitoring of diabetes using HbA1c-DCCT aligned was initiated in 2001. We estimated the incidence of monitored patients in the population. The progress in patients with originally diabetic HbA1c levels was investigated by cumulative probability plots, and the individual trend in clinical outcome was investigated by a modified difference plot. The age-standardized incidence of monitored patients was or=6.62% HbA1c) showed on average 15% improved glycemic control in the first year. Further improvement was limited. The overall percentage above the treatment target (>or=6.62% HbA1c) was 51% in 2003 compared to 59% in 2001, and the percentage with poor glycemic control (>or=10.0% HbA1c) was reduced from 19% to 4%. Of patients with originally diabetic HbA1c levels, 15% showed progress in glycemic control, and 28% reached treatment targets. In patients with originally normal HbA1c, 75% showed an upward trend in HbA1c levels, which reached diabetic concentrations in 17%. Patients with diabetic first HbA1c concentrations (>or=6.62% HbA1c) showed on average 15% improved glycemic control in the first year. Further improvement was limited. In individual patients, 75% with originally diabetic HbA1c levels showed improved glycemic control after 3 years, while 78% with originally normal concentrations showed an upward trend in HbA1c levels.
Ahmed, W.; Arshad, A.R.
To determine whether good glycemic control has an effect on lipid profile in diabetics After taking relevant history and physical examination, serum urea, creatinine, thyroid stimulating hormone, bilirubin, alanine transaminase and HbA1c were measured. Blood samples for determination of fasting plasma glucose, serum total cholesterol, triglycerides, HDL and LDL levels were collected in a fasting state. Patients were divided into two groups based on HbA1c levels. They were compared using SPSS 13. 42 patients had good glycemic control and 58 had poor control. The two groups were age and weight matched. 43 patients had abnormal lipid profiles. Serum total cholesterol and triglycerides were lower and HDL levels higher in the good control group but serum LDL levels were equal. Conclusion: Good glycemic control improves lipid profile in patients with type 2 diabetes mellitus. (author)
Ahmed, W [Military Hospital Rawalpindi, Rawalpindi (Pakistan); Arshad, A R [Combined Military Hospital, Lahore (Pakistan)
To determine whether good glycemic control has an effect on lipid profile in diabetics After taking relevant history and physical examination, serum urea, creatinine, thyroid stimulating hormone, bilirubin, alanine transaminase and HbA1c were measured. Blood samples for determination of fasting plasma glucose, serum total cholesterol, triglycerides, HDL and LDL levels were collected in a fasting state. Patients were divided into two groups based on HbA1c levels. They were compared using SPSS 13. 42 patients had good glycemic control and 58 had poor control. The two groups were age and weight matched. 43 patients had abnormal lipid profiles. Serum total cholesterol and triglycerides were lower and HDL levels higher in the good control group but serum LDL levels were equal. Conclusion: Good glycemic control improves lipid profile in patients with type 2 diabetes mellitus. (author)
Maldonado-Rodríguez, Miguel; Pérez-López, Shirley; Torres-Torres, Nancy; Torres-Semprit, Erick; Millán-Aponte, Ismenio
Diabetes mellitus is one of the most prevalent medical conditions among the Hispanic population. Although studies with patients in intensive care units have shown poor outcomes among those with uncontrolled glucose, more recent data have shown increased mortality associated with a tighter inpatient glucose control. In view of the lack of information regarding geriatric Hispanic patients with diabetes this study evaluated the effect of glucose control in the outcomes of this population in a community hospital in Puerto Rico. Through analysis of data from a previous study we evaluated 502 admissions of Hispanic geriatric patients with diabetes as comorbidity, for glucose control, management of diabetes and outcome. Data was stratified by age groups (65-74 years, 75-84 years and > or = 85 years) and outcomes were compared between the groups using chi-square and odds ratio. The most common admission diagnosis was pneumonia. Hypoglycemia was the most common complication and was associated with tighter glucose control in the age group of 75-84 years. An increased risk of having an acute coronary syndrome/acute myocardial infarction among uncontrolled patients was observed in the 75-84 year old group. Finally, although we found a high prevalence of uncontrolled blood glucose, only 54% of the patients received interventions for their glucose control. Poor glucose control seems to be associated with a tendency for decreased risk of hypoglycemia and higher risk of acute coronary syndrome/acute myocardial infarction as complications among geriatric patients with diabetes admitted to a general ward.
Torres-Torres, Nancy; Maldonado-Rodríguez, Miguel A; Pérez-López, Shirley; Sierra-Martínez, Kassandra; García, Astrid J
Uncontrolled glucose, present in 40% of diabetic patients admitted to United States hospitals, has been associated with prolonged length of stay and poorer general outcomes in critically ill and surgical patients. However, past studies of general ward patients have shown there to be no consistent benefits of strict glucose control, and the Hispanic population has been underrepresented in such studies. This work evaluated the association between glycemic control and the outcomes of hospitalized Hispanics with diabetes and to describe physicians' interventions in the treatment of diabetes. This is a retrospective chart review of all patients with diabetes admitted over a period of six months in the general ward of a community hospital in Puerto Rico. We evaluated glucose levels during the first 72 hours, length of stay, and reported complications during admission. Outcomes were evaluated with crude odds ratios and multivariate logistic regression. Uncontrolled blood glucose was observed in 59.1% of the 875 patients whose records were revised; of that 59.1%, treatment modification was not prescribed for 43.2%. Patients with poorly controlled glucose were more likely to develop acute coronary syndrome (corrected OR: 11.46; 95% CI = 1.48-88.50) as a complication and less likely to develop hypoglycemia (corrected OR: 0.57; 95% = CI 0.37-0.88). Our results suggest that hospitalized but non-critically ill Hispanic patients with diabetes are prone to poor outcomes secondary to uncontrolled glucose levels; in addition, those results support the creation of standardized protocols for the management of diabetes in this population.
Moxley, Elizabeth W; Smith, Donald; Quinn, Lauretta; Park, Chang
Diabetes is a serious health problem affecting approximately 29.1 million individuals in the United States. Another 86 million have prediabetes. The development and implementation of lifestyle modifications such as physical activity for these persons are among the most effective methods for prevention and treatment. The aim of this study was to examine relationships between glycemic control (HbA1c) and cardiovascular fitness (peak maximal oxygen uptake [VO 2 peak] and ventilatory threshold [VT]) in overweight/obese subjects with and without type 2 diabetes (T2DM). In addition, the influences of body mass index (BMI) and insulin sensitivity (homeostasis model assessment [HOMA %S]) on the relationship between glycemic control and cardiovascular fitness were explored. Data were abstracted from a completed study that included 51 overweight or obese subjects with T2DM ( n = 18), impaired glucose tolerance ( n = 8), or normal glucose tolerance ( n = 25). Relationships between glycemic control (HbA1c) and cardiovascular fitness (VO 2 peak and VT) were determined using correlational analysis and multiple linear regression analyses. A statistically significant relationship was observed between HbA1c and cardiovascular fitness. However, BMI and HOMA %S did not influence the relationship between glycemic control and cardiovascular fitness. HbA1c contributes to VO 2 peak and VT in obese and overweight subjects across glucose tolerance categories. Significant results were achieved despite the fact that there was a limited range of HbA1c based on the study inclusion criteria. This finding suggests that even a mild decrease in glycemic control can negatively influence cardiovascular fitness.
Ehab A. Wahby
Conclusion: Tight glycemic control improved perioperative outcome in diabetic CABG patients. Maintaining perioperative blood glucose level between 110 and 149 mg/dl is safe and should be recommended as a routine practice in diabetic patients undergoing CABG surgery.
Wang, Rui; Lefevre, Roger; Hacker, Michele R.; Golen, Toni H.
OBJECTIVES To estimate the association between urinary incontinence and glycemic control in women ages 20 to 85. METHODS We included 7,270 women from the 2005–2010 National Health and Nutrition Examination Survey, stratified into three groups of glycemic control defined by hemoglobin A1c (HbA1c): i) those below the diagnostic threshold (HbA1c8.5%) to allow for a different relationship between glycemic control and urinary incontinence within each group. The primary outcomes were the presence of any, only stress, only urgency, and mixed urinary incontinence. We calculated adjusted risk ratios using Poisson regressions with robust variance estimates. RESULTS The survey-weighted prevalence was 52.9% for any, 27.2% for only stress, 9.9% for only urgency, and 15.8% for mixed urinary incontinence. Among women with relatively controlled diabetes, each one-unit increase in HbA1c was associated with a 13% (95% CI: 1.03–1.25) increase for any urinary incontinence and a 34% (95% CI 1.06–1.69) increase in risk for only stress incontinence but was not significantly associated with only urgency and mixed incontinence. Other risk factors included body mass index, hormone replacement therapy, smoking, and physical activity. CONCLUSIONS Worsening glycemic control is associated with an increased risk for stress incontinence for women with relatively controlled diabetes. For those either below the diagnostic threshold or with poorly controlled diabetes, the risk may be driven by other factors. Further prospective investigation of HbA1c as a modifiable risk factor may motivate measures to improve continence in women with diabetes. PMID:26313496
Fiseha, Temesgen; Alemayehu, Ermiyas; Kassahun, Wongelawit; Adamu, Aderaw; Gebreweld, Angesom
The aim of this study was to determine the status of glycemic control and identify factors associated with poor glycemic control among diabetic out-patients. A hospital based cross-sectional study was conducted among randomly selected 384 (126 type 1 and 258 type 2) diabetic adults attending a hospital in Northeast Ethiopia from January 1 to April 30, 2017. Of the total participants, 70.8% had poor status of glycemic control (defined as mean fasting blood glucose level above 130 mg/dl). In the multivariate analysis, rural residence (AOR = 2.61, 95% CI 1.37-4.96), low educational level (AOR = 7.10, 95% CI 2.94-17.17) and longer duration of diabetes (AOR = 2.20, 95% CI 1.18-4.08) were significantly associated with increased odds of poor glycemic control. Moreover, merchants (AOR = 3.39, 95% CI 1.16-9.96) were significantly more likely to have poor glycemic control compared to government employee. Diabetic patients receiving oral anti-diabetics (AOR = 5.12, 95% CI 2.10-12.52) or insulin (AOR = 3.26, 95% CI 1.26-8.48) were more likely to be poorly controlled. These results highlight the needed for appropriate management of patients focusing on associated factors identified for poor glycemic control to maintain good glycemic control and improve adverse outcomes of the disease in this study setting.
Full Text Available LeChauncy D Woodard, Cassie R Landrum, Amber B Amspoker, David Ramsey, Aanand D Naik Veterans Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veterans Affairs Medical Center, and Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA Background: Functional health literacy (FHL and patient activation can impact diabetes control through enhanced diabetes self-management. Less is known about the combined effect of these characteristics on diabetes outcomes. Using brief, validated measures, we examined the interaction between FHL and patient activation in predicting glycosylated hemoglobin (HbA1c control among a cohort of multimorbid diabetic patients.Methods: We administered a survey via mail to 387 diabetic patients with coexisting hypertension and ischemic heart disease who received outpatient care at one regional VA medical center between November 2010 and December 2010. We identified patients with the study conditions using the International Classification of Diseases-Ninth Revision-Clinical Modification (ICD-9-CM diagnoses codes and Current Procedure Terminology (CPT procedures codes. Surveys were returned by 195 (50.4% patients. We determined patient activation levels based on participant responses to the 13-item Patient Activation Measure and FHL levels using the single-item screening question, “How confident are you filling out medical forms by yourself?” We reviewed patient medical records to assess glycemic control. We used multiple logistic regression to examine whether activation and FHL were individually or jointly related to HbA1c control.Results: Neither patient activation nor FHL was independently related to glycemic control in the unadjusted main effects model; however, the interaction between the two was significantly associated with glycemic control (odds ratio 1.05 [95% confidence
Stewart, S M; Lee, P W; Low, L C; Cheng, A; Yeung, W; Huen, K F; O'Donnell, D
To examine factors that influence emotional adjustment, adherence to diabetic care, and glycemic control in Hong Kong youths with insulin-dependent diabetes mellitus (IDDM). Seventy youths, their mothers, and matched controls provided information on health beliefs, authoritarian parenting style, parent-child conflict, emotional adjustment, and adherence to medical regimen. Glycosylated hemoglobin levels were obtained to measure glycemic control. Predictors explained 34% of the variance in emotional adjustment and 39% of the variance in glycemic control. The data supported a pathway from emotional adjustment to self-efficacy to adherence behaviors to glycemic control. In contrast to Western culture and consistent with prediction, parenting style did not associate with negative outcomes, and even relatively low levels of parent-child conflict correlated negatively with emotional adjustment in this culture. Management of conflict and self-efficacy enhancing interactions are suggested interventions to enhance adherence to diabetic care in Hong Kong youths with IDDM.
Pereira, Elisângela Vitoriano; Costa, Jorge de Assis; Alfenas, Rita de Cássia Gonçalves
Evaluate the effect of glycemic index (GI) on biochemical parameters, food intake, energy metabolism, anthropometric measures and body composition in overweight subjects. Simple blind study, in which nineteen subjects were randomly assigned to consume in the laboratory two daily low GI (n = 10) or high GI (n = 9) meals, for forty-five consecutive days. Habitual food intake was assessed at baseline. Food intake, anthropometric measures and body composition were assessed at each 15 days. Energy metabolism and biochemical parameters were evaluated at baseline and the end of the study. Low GI meals increased fat oxidation, and reduced waist circumference and HOMA-IR, while high GI meals increased daily dietary fiber and energy intake compared to baseline. There was a higher reduction on waist circumference and body fat, and a higher increase on postprandial fat oxidation in response to the LGI meals than after high GI meals. High GI meals increased fasting respiratory coefficient compared to baseline and low GI meals. The results of the present study showed that the consumption of two daily low GI meals for forty-five consecutive days has a positive effect on obesity control, whereas, the consumption of high GI meals result has the opposite effect.
Ross, Stuart A
Approximately half of patients with type 2 diabetes (T2D) do not achieve globally recognized blood glucose targets, despite the availability of a wide range of effective glucose-lowering therapies. Failure to maintain good glycemic control increases the risk of diabetes-related complications and long-term health care costs. Patients must be brought under glycemic control to improve treatment outcomes, but existing barriers to optimizing glycemic control must first be overcome, including patient nonadherence to treatment, the failure of physicians to intensify therapy in a timely manner, and inadequacies in the health care system itself. The reasons for such barriers include treatment side effects, complex treatment regimens, needle anxiety, poor patient education, and the absence of an adequate patient care plan; however, newer therapies and devices, combined with comprehensive care plans involving adequate patient education, can help to minimize barriers and improve treatment outcomes. Copyright © 2013 Elsevier Inc. All rights reserved.
Li, Di; Zhang, Peiwen; Guo, Honghui; Ling, Wenhua
Dietary therapy is the mainstay of treatment for diabetes. This study examined the effect of a low glycemic index (GI) multi-nutrient supplement, consumed in place of breakfast, on glycemic control in patients with type 2 diabetes mellitus (T2DM). A total of 71 participants were randomized at a 2:1 ratio into either a breakfast replacement group or a normal breakfast group for a 12-week interventional study. The primary outcome measure was change in hemoglobin A1c (HbA1c). Nutrition status and somatometry were studied as secondary outcomes. The breakfast replacement group displayed a -0.2% absolute reduction in HbA1c (95% CI (confidence interval), -0.38% to -0.07%, p = 0.004), while the HbA1c of the control group increased 0.3% (95% CI, 0.1% to 0.5%, p = 0.005). The baseline Mini Nutritional Assessment score for both groups was 26.0 and no significant changes occurred following intervention. However, there was a statistically significant difference in body mass index between the treatment and control groups (p = 0.032) due to the weight gain in the control group (increased 0.5 kg, 95% CI was 0.2 to 0.9, p = 0.007). These data suggest that breakfast replacement with a low GI multi-nutrient supplement can improve glycemic and weight control in T2DM.
Full Text Available Abstract Background Epilepsy is the most common neurological disorder after stroke, affecting more than 50 million persons worldwide. Metabolic disturbances are often associated with epileptic seizures, but the pathogenesis of this relationship is poorly understood. It is known that seizures result in altered glucose metabolism, the reduction of intracellular energy metabolites such as ATP, ADP and phosphocreatine and the accumulation of metabolic intermediates, such as lactate and adenosine. In particular, it has been suggested that the duration and extent of glucose dysregulation may be a predictor of the pathological outcome of status. However, little is known about neither the effects of glycemic control on brain metabolism nor the effects of managing systemic glucose concentrations in epilepsy. Results In this study, we examined glycemic modulation of kainate-induced seizure sensitivity and its neuropathological consequences. To investigate the relationship between glycemic modulation, seizure susceptibility and its neuropathological consequences, C57BL/6 mice (excitotoxin cell death resistant were subjected to hypoglycemia or hyperglycemia, followed by systemic administration of kainic acid to induce seizures. Glycemic modulation resulted in minimal consequences with regard to seizure severity but increased hippocampal pathology, irrespective of whether mice were hypoglycemic or hyperglycemic prior to kainate administration. Moreover, we found that exogenous administration of glucose following kainic acid seizures significantly reduced the extent of hippocampal pathology in FVB/N mice (excitotoxin cell death susceptible following systemic administration of kainic acid. Conclusion These findings demonstrate that modulation of the glycemic index can modify the outcome of brain injury in the kainate model of seizure induction. Moreover, modulation of the glycemic index through glucose rescue greatly diminishes the extent of seizure
Kawachi, Ichiro; Kondo, Katsunori; Kondo, Naoki; Nagamine, Yuiko; Tani, Yukako; Shirai, Kokoro; Tazuma, Susumu
Aim The present study examined whether social support, informal socializing and social participation are associated with glycemic control in older people. Methods Data for this population-based cross-sectional study was obtained from the Japan Gerontological Evaluation Study (JAGES) 2010 linked to the annual health check-up data in Japan. We analyzed 9,554 individuals aged ≥65 years without the certification of needed long-term care. Multivariate logistic regression models were used to assess the effect of social support, informal socializing and social participations on glycemic control. The outcome measure was HbA1c ≥8.4%. Results 1.3% of the participants had a level of HbA1c over 8.4%. Better glycemic control was significantly associated with meeting with friends one to four times per month (odds ratio [OR] 0.51, 95% confidence interval [CI]0.30–0.89, compared to meeting with friends a few times per year or less) and participation in sports groups (OR 0.50, 95% CI 0.26–0.97) even after adjusting for other variables. Meeting with friends more than twice per week, receiving social support, and being married were not associated with better control of diabetes. Conclusions Meeting with friends occasionally is associated with better glycemic control among older people. PMID:28060887
Yokobayashi, Kenichi; Kawachi, Ichiro; Kondo, Katsunori; Kondo, Naoki; Nagamine, Yuiko; Tani, Yukako; Shirai, Kokoro; Tazuma, Susumu
The present study examined whether social support, informal socializing and social participation are associated with glycemic control in older people. Data for this population-based cross-sectional study was obtained from the Japan Gerontological Evaluation Study (JAGES) 2010 linked to the annual health check-up data in Japan. We analyzed 9,554 individuals aged ≥65 years without the certification of needed long-term care. Multivariate logistic regression models were used to assess the effect of social support, informal socializing and social participations on glycemic control. The outcome measure was HbA1c ≥8.4%. 1.3% of the participants had a level of HbA1c over 8.4%. Better glycemic control was significantly associated with meeting with friends one to four times per month (odds ratio [OR] 0.51, 95% confidence interval [CI]0.30-0.89, compared to meeting with friends a few times per year or less) and participation in sports groups (OR 0.50, 95% CI 0.26-0.97) even after adjusting for other variables. Meeting with friends more than twice per week, receiving social support, and being married were not associated with better control of diabetes. Meeting with friends occasionally is associated with better glycemic control among older people.
Chavez, E M; Taylor, G W; Borrell, L N; Ship, J A
There is no consensus on the possible association between diabetes and salivary dysfunction in older persons with diabetes. This study's purpose was to investigate the effect of diabetes and glycemic control on salivary function in an older population. Twenty nine persons with type 2 diabetes and 23 nondiabetic control subjects participated (age range, 54-90 years). Diabetic status was determined by a glycosylated hemoglobin (HbA(1c)) test and a 2-hour glucose tolerance test. Poor glycemic control was defined as HbA(1c) >9%. Unstimulated whole saliva, unstimulated parotid, and stimulated parotid flow rates were measured, and subjects completed a standardized xerostomia questionnaire. Persons with poorly controlled diabetes had lower (P =.01) stimulated parotid flow rates than persons with well-controlled diabetes and nondiabetic control subjects. There were no significant differences in xerostomic complaints based on diabetic or glycemic control status or salivary flow rates. These results provide some evidence that poorly controlled diabetes may be associated with salivary dysfunction in older adults who have no concomitant complaints of xerostomia.
Kohnert, Klaus-Dieter; Heinke, Peter; Vogt, Lutz; Salzsieder, Eckhard
The benchmark for assessing quality of long-term glycemic control and adjustment of therapy is currently glycated hemoglobin (HbA1c). Despite its importance as an indicator for the development of diabetic complications, recent studies have revealed that this metric has some limitations; it conveys a rather complex message, which has to be taken into consideration for diabetes screening and treatment. On the basis of recent clinical trials, the relationship between HbA1c and cardiovascular outcomes in long-standing diabetes has been called into question. It becomes obvious that other surrogate and biomarkers are needed to better predict cardiovascular diabetes complications and assess efficiency of therapy. Glycated albumin, fructosamin, and 1,5-anhydroglucitol have received growing interest as alternative markers of glycemic control. In addition to measures of hyperglycemia, advanced glucose monitoring methods became available. An indispensible adjunct to HbA1c in routine diabetes care is self-monitoring of blood glucose. This monitoring method is now widely used, as it provides immediate feedback to patients on short-term changes, involving fasting, preprandial, and postprandial glucose levels. Beyond the traditional metrics, glycemic variability has been identified as a predictor of hypoglycemia, and it might also be implicated in the pathogenesis of vascular diabetes complications. Assessment of glycemic variability is thus important, but exact quantification requires frequently sampled glucose measurements. In order to optimize diabetes treatment, there is a need for both key metrics of glycemic control on a day-to-day basis and for more advanced, user-friendly monitoring methods. In addition to traditional discontinuous glucose testing, continuous glucose sensing has become a useful tool to reveal insufficient glycemic management. This new technology is particularly effective in patients with complicated diabetes and provides the opportunity to characterize
Werzowa, Johannes; Pacini, Giovanni; Hecking, Manfred; Fidler, Catharina; Haidinger, Michael; Brath, Helmut; Thomas, Andreas; Säemann, Marcus D; Tura, Andrea
Posttransplantation diabetes mellitus (PTDM) is a common complication after renal transplantation leading to increased cardiovascular morbidity and mortality. In subjects with type 2 diabetes (T2DM) increased glycemic variability and poor glycemic control have been associated with cardiovascular complications. We therefore aimed at determining glycemic variability and glycemic control in subjects with PTDM in comparison to T2DM subjects. In this observational study we analyzed 10 transplanted subjects without diabetes (Control), 10 transplanted subjects with PTDM, and 8 non-transplanted T2DM subjects using Continuous Glucose Monitoring (CGM). Several indices of glycemic control quality and variability were computed. Many indices of both glycemic control quality and variability were different between control and PTDM subjects, with worse values in PTDM. The indices of glycemic control, such as glucose mean, GRADE and M-value, were similar in PTDM and T2DM, but some indices of glycemic variability, that is CONGA, lability index and shape index, showed a markedly higher (i.e., worse) value in T2DM than in PTDM (P value range: 0.001-0.035). Although PTDM and T2DM subjects showed similar glycemic control quality, glycemic variability was significantly higher in T2DM. These data underscore potential important pathophysiological differences between T2DM and PTDM indicating that increased glycemic variability may not be a key factor for the excess cardiovascular mortality in patients with PTDM. Copyright © 2015 Elsevier Inc. All rights reserved.
Full Text Available We report the case of a 67-year-old Japanese woman with type 1 diabetes mellitus. At 47 years of age, her hemoglobin A1c (HbA1c was 10.0%, and she had overt nephropathy. The first renal biopsy yielded a diagnosis of diabetic nephropathy. Intensive glycemic control was initiated and her HbA1c improved to 6.0%. Renal dysfunction showed no progression for 15 years. At 62 years of age, a second renal biopsy was performed. Glomerular lesions did not show progression but tubulointerstitial fibrosis and vascular lesions showed progression compared with the first biopsy. Intensive glycemic control can prevent the progression of glomerular lesions, but might not be effective for interstitial and vascular lesions.
Brice Reynolds, D.; Walker, Rebekah J.; Campbell, Jennifer A.; Egede, Leonard E.
Background: Discrimination has been linked to negative health outcomes, but little research has investigated different types of discrimination to determine if some have a greater impact on outcomes. We examined the differential effect of discrimination based on race, level of education, gender, and language on glycemic control in adults with type 2 diabetes.
Karon, Brad S; Meeusen, Jeffrey W; Bryant, Sandra C
We retrospectively studied the impact of glucose meter error on the efficacy of glycemic control after cardiovascular surgery. Adult patients undergoing intravenous insulin glycemic control therapy after cardiovascular surgery, with 12-24 consecutive glucose meter measurements used to make insulin dosing decisions, had glucose values analyzed to determine glycemic variability by both standard deviation (SD) and continuous overall net glycemic action (CONGA), and percentage glucose values in target glucose range (110-150 mg/dL). Information was recorded for 70 patients during each of 2 periods, with different glucose meters used to measure glucose and dose insulin during each period but no other changes to the glycemic control protocol. Accuracy and precision of each meter were also compared using whole blood specimens from ICU patients. Glucose meter 1 (GM1) had median bias of 11 mg/dL compared to a laboratory reference method, while glucose meter 2 (GM2) had a median bias of 1 mg/dL. GM1 and GM2 differed little in precision (CV = 2.0% and 2.7%, respectively). Compared to the period when GM1 was used to make insulin dosing decisions, patients whose insulin dose was managed by GM2 demonstrated reduced glycemic variability as measured by both SD (13.7 vs 21.6 mg/dL, P meter error (bias) was associated with decreased glycemic variability and increased percentage of values in target glucose range for patients placed on intravenous insulin therapy following cardiovascular surgery. © 2015 Diabetes Technology Society.
Krystal K. Haase
Full Text Available Purpose. Patients treated with therapeutic hypothermia (TH and continuous insulin may be at increased risk of hyperglycemia or hypoglycemia, particularly during temperature transitions. This study aimed to evaluate frequency of glucose excursions during each phase of TH and to characterize glycemic control patterns in relation to survival. Methods. Patients admitted to a tertiary care hospital for circulatory arrest and treated with both therapeutic hypothermia and protocol-based continuous insulin between January 2010 and June 2013 were included. Glucose measures, insulin, and temperatures were collected through 24 hours after rewarming. Results. 24 of 26 patients experienced glycemic excursions. Hyperglycemic excursions were more frequent during initiation versus remaining phases (36.3%, 4.3%, 2.5%, and 4.0%, p=0.002. Hypoglycemia occurred most often during rewarming (0%, 7.7%, 23.1%, and 3.8%, p=0.02. Patients who experienced hypoglycemia had higher insulin doses prior to rewarming (16.2 versus 2.1 units/hr, p=0.03. Glucose variation was highest during hypothermia and trended higher in nonsurvivors compared to survivors (13.38 versus 9.16, p=0.09. Frequency of excursions was also higher in nonsurvivors (32.3% versus 19.8%, p=0.045. Conclusions. Glycemic excursions are common and occur more often in nonsurvivors. Excursions differ by phase but risk of hypoglycemia is increased during rewarming.
Steil, Garry M; Agus, Michael S D
Tight glycemic control in the ICU has been shown to reduce mortality in some but not all prospective randomized control trials. Confounding the interpretation of these studies are differences in how the control was achieved and underlying incidence of hypoglycemia, which can be expected to be affected by the introduction of continuous glucose monitoring (CGM). In this issue of Critical Care, a consensus panel provides a list of the research priorities they believe are needed for CGM to become routine practice in the ICU. We reflect on these recommendations and consider the implications for using CGM today.
Anna eChapman; Anna eChapman; Shuo eLiu; Stephanie eMerkouris; Stephanie eMerkouris; Joanne C Enticott; Joanne C Enticott; Hui eYang; Colette Joy Browning; Colette Joy Browning; Shane Andrew Thomas
IntroductionChina has the largest number of type 2 diabetes mellitus (T2DM) cases globally and T2DM management has become a critical public health issue in China. Individuals with T2DM have an increased risk of developing mental health disorders, psychological disturbances and functional problems associated with living with their condition. Previous systematic reviews have demonstrated that, generally, psychological interventions are effective in the management of T2DM related outcomes; howev...
Full Text Available Abstract Background Diabetes is the sixth leading cause of death and results in significant morbidity. The purpose of this study is to determine what demographic, health status, treatment, access/quality of care, and behavioral factors are associated with poor glycemic control in a Type 2 diabetic, low-income, minority, San Diego population. Methods Longitudinal observational data was collected on patients with Type 2 diabetes from Project Dulce, a program in San Diego County designed to care for an underserved diabetic population. The study sample included 573 patients with a racial/ethnic mix of 53% Hispanic, 7% black, 18% Asian, 20% white, and 2% other. We utilized mixed effects models to determine the factors associated with poor glycemic control using hemoglobin A1C (A1C as the outcome of interest. A multi-step model building process was used resulting in a final parsimonious model with main effects and interaction terms. Results Patients had a mean age of 55 years, 69% were female, the mean duration of diabetes was 7.1 years, 31% were treated with insulin, and 57% were obese. American Diabetes Association (ADA recommendations for blood pressure and total cholesterol were met by 71% and 68%, respectively. Results of the mixed effects model showed that patients who were uninsured, had diabetes for a longer period of time, used insulin or multiple oral agents, or had high cholesterol had higher A1C values over time indicating poorer glycemic control. The younger subjects also had poorer control. Conclusion This study provides factors that predict glycemic control in a specific low-income, multiethnic, Type 2 diabetic population. With this information, subgroups with high risk of disease morbidity were identified. Barriers that prevent these patients from meeting their goals must be explored to improve health outcomes.
Castela, Angela; Gomes, Pedro; Silvestre, Ricardo; Guardão, Luísa; Leite, Liliana; Chilro, Rui; Rodrigues, Ilda; Vendeira, Pedro; Virag, Ronald; Costa, Carla
Erectile dysfunction (ED) is a complication of diabetes, condition responsible for causing endothelial dysfunction (EDys) and hampering repair mechanisms. However, scarce information is available linking vasculogenesis mediated by Endothelial Progenitor Cells (EPCs) and diabetes-associated ED. Furthermore, it remains to be elucidated if glycemic control plays a role on EPCs functions, EPCs modulators, and penile vascular health. We evaluated the effects of diabetes and insulin therapy on bone marrow (BM) and circulating EPCs, testosterone, and systemic/penile Stromal Derived Factor-1 alpha (SDF-1α) expression. Male Wistar rats were divided into groups: age-matched controls, 8-weeks streptozotocin-induced type 1 diabetics, and insulin-treated 8-weeks diabetics. EPCs were identified by flow cytometry for CD34/CD133/VEGFR2/CXCR4 antigens. Systemic SDF-1α and testosterone levels were evaluated by ELISA. Penile SDF-1α protein expression was assessed, in experimental and human diabetic cavernosal samples, by immunohistochemical techniques. Diabetic animals presented a reduction of BM-derived EPCs and an increase in putative circulating endothelial cells (CECs) sloughed from vessels wall. These alterations were rescued by insulin therapy. In addition, glycemic control promoted an increase in systemic testosterone and SDF-1α levels, which were significantly decreased in animals with diabetes. SDF-1α protein expression was reduced in experimental and human cavernosal diabetic samples, an effect prevented by insulin in treated animals. Insulin administration rescued the effects of diabetes on BM function, CECs levels, testosterone, and plasmatic/penile SDF-1α protein expression. This emphasizes the importance of glycemic control in the prevention of diabetes-induced systemic and penile EDys, by the amelioration of endothelial damage, and increase in protective pathways. J. Cell. Biochem. 118: 82-91, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.
Full Text Available Objectives: As the most part of geriatric (65 years and older diabetic care is given at home, family support has an important role in their blood sugar level control care. This study aimed to assess the relationship between family support and blood sugar level control in such elderly suffering type-2 diabetes. Methods & Materials: Via descriptive-correlative study, one hundred fifty geriatric patients with type-2 diabetes, who referred to Institute of Endocrinology and Metabolism in Iran University of Medical Sciences were selected. Samplings based on nonrandomized and convenience. The questionnaire consisted of three sections: demographic data glucose-labeled hemoglobin (HbA1C and received-perceived family support by applying the standard questionnaire of "Diabetes Social Support-Family Version" format. Data were analyzed by SPSS version 15 by using Chi-square and Pierson Tests. Results: Results showed a significant relationship between family support and glycemic control (r=-0.56, P<0.0001. Also there were significant relationships between family support, gender and marital status (P<0.0001. There were also significant relationships between glycemic control and marital status (P=0.02, financial status (P=0.04 and educational level (P=0.05. Conclusion: Findings of this research added further evidence about the impact of family support on the health of older adults with diabetes. These findings suggest using family centered nursing interventions and collaboration of family members in care of the elderly with type-2 diabetes.
Butler, Ashley M; Weller, Bridget E; Yi-Frazier, Joyce P; Fegan-Bohm, Kelly; Anderson, Barbara; Pihoker, Catherine; Hilliard, Marisa E
This study examines whether race/ethnicity moderates relationships of (a) diabetes stress and general life stressors with (b) diabetes outcomes of glycemic control and diabetic ketoacidosis (DKA) among emerging adults (aged 18-25 years) with type 1 diabetes (T1D). Using a T1D Exchange Registry sample of non-Hispanic White, African American, and Hispanic emerging adults (N = 3,440), multiple group analyses were used to determine whether race/ethnicity moderates the relationships between stress and diabetes outcomes. The relationships between the two stress types and glycemic control did not differ between African American and non-Hispanic Whites. However, as compared with non-Hispanic Whites, the association between higher diabetes-specific stress and poorer glycemic control was significantly stronger for Hispanics, and Hispanics had poorer glycemic control when they experienced a relatively fewer number of general life stressors than non-Hispanic Whites. The relationships between the type of stress (diabetes-specific and general stress) and DKA did not differ across racial/ethnic groups. Future research should evaluate possible mechanisms that contribute to the different relationships of stress with glycemic control among Hispanics compared with non-Hispanic Whites. © The Author 2017. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: email@example.com
Arunpreet Singh Kahlon
Full Text Available Aim : Till now estimation of blood glucose is the highly effective method for diagnosing diabetes mellitus but it provides a short-term picture of control. More evidence is required to prove that plasma glucose and glycosylated hemoglobin levels together gives a better estimate of glycemic control and compliance with treatment. Indian diabetes risk score (IDRS is a simplified screening tool for identifying undiagnosed diabetic subjects, requires minimum time, and effort and can help to considerably reduce the costs of screening. Objective : To study patterns of glycemic control using glycosylated hemoglobin in diabetic patients. To find out correlation between levels of plasma glucose and glycosylated hemoglobin in diabetics and to calculate IDRS of the study population. Materials and Methods : A cross sectional study was conducted among 300 known diabetic patients attending outpatient department of a rural medical college in Haryana, India. Following standard procedures and protocols FPG and glycosylated hemoglobin were measured to find out a pattern of glycemic control in them after taking their written and informed consent. A correlation between the levels of glycosylated hemoglobin and fasting blood glucose was also calculated. These patients were made to fill a performa and their demographic and clinical risk factors were noted and based on this, their IDRS was calculated. This was done to validate the IDRS in Indian rural population. Results : Fifty-two percent of the population had fasting plasma glucose level between 125-150 mg/dl, 21% had this level between 151-175 mg/dl. Thirteen percent of the study subjects had HbA1C between 6.5-7.5, more than half (57.3% had this value between 7.5-8.5, 12% and 18% had values between 8.5-9.5 and 9.5-10.5, respectively. Twelve percent of the participants had HbA1C level higher than 10.5. Correlation of fasting plasma glucose level and HbA1C was also studied and found that correlation coefficient came
Kahlon, Arunpreet Singh; Pathak, Rambha
Till now estimation of blood glucose is the highly effective method for diagnosing diabetes mellitus but it provides a short-term picture of control. More evidence is required to prove that plasma glucose and glycosylated hemoglobin levels together gives a better estimate of glycemic control and compliance with treatment. Indian diabetes risk score (IDRS) is a simplified screening tool for identifying undiagnosed diabetic subjects, requires minimum time, and effort and can help to considerably reduce the costs of screening. To study patterns of glycemic control using glycosylated hemoglobin in diabetic patients. To find out correlation between levels of plasma glucose and glycosylated hemoglobin in diabetics and to calculate IDRS of the study population. A cross sectional study was conducted among 300 known diabetic patients attending outpatient department of a rural medical college in Haryana, India. Following standard procedures and protocols FPG and glycosylated hemoglobin were measured to find out a pattern of glycemic control in them after taking their written and informed consent. A correlation between the levels of glycosylated hemoglobin and fasting blood glucose was also calculated. These patients were made to fill a performa and their demographic and clinical risk factors were noted and based on this, their IDRS was calculated. This was done to validate the IDRS in Indian rural population. Fifty-two percent of the population had fasting plasma glucose level between 125-150 mg/dl, 21% had this level between 151-175 mg/dl. Thirteen percent of the study subjects had HbA1C between 6.5-7.5, more than half (57.3%) had this value between 7.5-8.5, 12% and 18% had values between 8.5-9.5 and 9.5-10.5, respectively. Twelve percent of the participants had HbA1C level higher than 10.5. Correlation of fasting plasma glucose level and HbA1C was also studied and found that correlation coefficient came out to be .311. This correlation was found to be statistically
Rodrigo Fonseca Lima
Full Text Available Abstract OBJECTIVE Identifying factors associated with glycemic control in people with type 2 Diabetes Mellitus (DM registered in the Family Health Strategy (FHS in Pernambuco, Brazil. METHOD Associations between glycemic control (glycosylated hemoglobin A lower or equal to 7% presented by people with DM and variables related to sociodemographic conditions, lifestyle, characteristics of diabetes, treatment and follow-up of patients by health services were investigated by multiple regression. RESULTS More than 65% of the participants presented inadequate glycemic control, especially those with lower age, longer illness duration, more annual contacts with FHS and complex therapeutic regimen. People with DM without referrals to specialists presented greater glycemic control. Associations with education level and obesity did not remain significant in the multivariate model. CONCLUSION The evolution of diabetes hinders adequate control, however, attention to younger people with DM and referrals to specialists are factors that can improve glycemic control.
The report of Williams et al. gives rise to at least two important questions regarding diabetic patients on maintenance hemodialysis: (1) Does glycemic control play a significant role? (2) Is HbA1c a reliable measure of glycemic control? These questions are discussed. It is recommended that you t...
The deleterious effects of hyperglycemia have been documented from the biochemical to the pathophysiologic level. Given the research findings and the guidelines for glycemic control established by ADA and ACE, ASHP supports and encourages strict glycemic control in all appropriate patients with diabetes mellitus to reduce the progression of chronic complications.
Chiang, Chen Yuan; Bai, Kuan Jen; Lin, Hsien Ho; Chien, Shun Tien; Lee, Jen Jyh; Enarson, Donald A.; Lee, Ting-I; Yu, Ming-Chih
Background To assess the influence of diabetes mellitus (DM), glycemic control, and diabetes-related comorbidities on manifestations and outcome of treatment of pulmonary tuberculosis (TB). Methodology/Principal Findings Culture positive pulmonary TB patients notified to health authorities in three hospitals in Taiwan from 2005–2010 were investigated. Glycemic control was assessed by glycated haemoglobin A1C (HbA1C) and diabetic patients were categorized into 3 groups: HbA1C9%. 1,473 (705 with DM and 768 without DM) patients were enrolled. Of the 705 diabetic patients, 82 (11.6%) had pretreatment HbA1C9%, and 195 (27.7%) had no information of HbA1C. The proportions of patients with any symptom, cough, hemoptysis, tiredness and weight loss were all highest in diabetic patients with HbA1C>9%. In multivariate analysis adjusted for age, sex, smoking, and drug resistance, diabetic patients with HbA1C>9% (adjOR 3.55, 95% CI 2.40–5.25) and HbA1C 7–9% (adjOR 1.62, 95% CI 1.07–2.44) were significantly more likely to be smear positive as compared with non-diabetic patients, but not those with HbA1C<7% (adjOR 1.16, 95% CI 0.70–1.92). The influence of DM on outcome of TB treatment was not proportionately related to HbA1C, but mainly mediated through diabetes-related comorbidities. Patients with diabetes-related comorbidities had an increased risk of unfavorable outcome (adjOR 3.38, 95% CI 2.19–5.22, p<0.001) and one year mortality (adjOR 2.80, 95% CI 1.89–4.16). However, diabetes was not associated with amplification of resistance to isoniazid (p = 0.363) or to rifampicin (p = 0.344). Conclusions/Significance Poor glycemic control is associated with poor TB treatment outcome and improved glycemic control may reduce the influence of diabetes on TB. PMID:25822974
Valsesia, Armand; Saris, Wim Hm; Astrup, Arne
BACKGROUND: An aim of weight loss is to reduce the risk of type 2 diabetes (T2D) in obese subjects. However, the relation with long-term glycemic improvement remains unknown. OBJECTIVE: We evaluated the changes in lipid composition during weight loss and their association with long-term glycemic...... improvement. DESIGN: We investigated the plasma lipidome of 383 obese, nondiabetic patients within a randomized, controlled dietary intervention in 8 European countries at baseline, after an 8-wk low-caloric diet (LCD) (800-1000 kcal/d), and after 6 mo of weight maintenance. RESULTS: After weight loss......: In this study, we report a lipid signature of LCD success (for weight and glycemic outcome) in obese, nondiabetic patients. Lipid changes during an 8-wk LCD allowed us to predict insulin-resistant patients after 6 mo of weight maintenance. The determination of the lipid composition during an LCD enables...
Markovic, Tania P; Muirhead, Ros; Overs, Shannon; Ross, Glynis P; Louie, Jimmy Chun Yu; Kizirian, Nathalie; Denyer, Gareth; Petocz, Peter; Hyett, Jon; Brand-Miller, Jennie C
Dietary interventions can improve pregnancy outcomes in women with gestational diabetes mellitus (GDM). We compared the effect of a low-glycemic index (GI) versus a conventional high-fiber (HF) diet on pregnancy outcomes, birth weight z score, and maternal metabolic profile in women at high risk of GDM. One hundred thirty-nine women [mean (SD) age 34.7 (0.4) years and prepregnancy BMI 25.2 (0.5) kg/m(2)] were randomly assigned to a low-GI (LGI) diet (n = 72; target GI ∼50) or a high-fiber, moderate-GI (HF) diet (n = 67; target GI ∼60) at 14-20 weeks' gestation. Diet was assessed by 3-day food records and infant body composition by air-displacement plethysmography, and pregnancy outcomes were assessed from medical records. The LGI group achieved a lower GI than the HF group [mean (SD) 50 (5) vs. 58 (5); P diet and a healthy diet produce similar pregnancy outcomes. © 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.
Zocchi, Elena; Hontecillas, Raquel; Leber, Andrew; Einerhand, Alexandra; Carbo, Adria; Bruzzone, Santina; Tubau-Juni, Nuria; Philipson, Noah; Zoccoli-Rodriguez, Victoria; Sturla, Laura; Bassaganya-Riera, Josep
Abscisic acid is naturally present in fruits and vegetables, and it plays an important role in managing glucose homeostasis in humans. According to the latest U.S. dietary survey, about 92% of the population might have a deficient intake of ABA due to their deficient intake of fruits and vegetables. This review summarizes the in vitro, preclinical, mechanistic, and human translational findings obtained over the past 15 years in the study of the role of ABA in glycemic control. In 2007, dietary ABA was first reported to ameliorate glucose tolerance and obesity-related inflammation in mice. The most recent findings regarding the topic of ABA and its proposed receptor lanthionine synthetase C-like 2 in glycemic control and their interplay with insulin and glucagon-like peptide-1 suggest a major role for ABA in the physiological response to a glucose load in humans. Moreover, emerging evidence suggests that the ABA response might be dysfunctional in diabetic subjects. Follow on intervention studies in healthy individuals show that low-dose dietary ABA administration exerts a beneficial effect on the glycemia and insulinemia profiles after oral glucose load. These recent findings showing benefits in humans, together with extensive efficacy data in mouse models of diabetes and inflammatory disease, suggest the need for reference ABA values and its possible exploitation of the glycemia-lowering effects of ABA for preventative purposes. Larger clinical studies on healthy, prediabetic, and diabetic subjects are needed to determine whether addressing the widespread dietary ABA deficiency improves glucose control in humans. PMID:28660193
Pinto, Camila Lemos; Botelho, Patrícia Borges; Pimentel, Gustavo Duarte; Campos-Ferraz, Patrícia Lopes; Mota, João Felipe
The focus of this review is the effects of creatine supplementation with or without exercise on glucose metabolism. A comprehensive examination of the past 16 years of study within the field provided a distillation of key data. Both in animal and human studies, creatine supplementation together with exercise training demonstrated greater beneficial effects on glucose metabolism; creatine supplementation itself demonstrated positive results in only a few of the studies. In the animal studies, the effects of creatine supplementation on glucose metabolism were even more distinct, and caution is needed in extrapolating these data to different species, especially to humans. Regarding human studies, considering the samples characteristics, the findings cannot be extrapolated to patients who have poorer glycemic control, are older, are on a different pharmacological treatment (e.g., exogenous insulin therapy) or are physically inactive. Thus, creatine supplementation is a possible nutritional therapy adjuvant with hypoglycemic effects, particularly when used in conjunction with exercise.
Timmermann, Clara Amalie G.; Rossing, Laura I.; Grontved, Anders
, waist circumference, leptin, adiponectin, insulin, glucose, and triglyceride concentrations were assessed in 8- to 10-year-old children in 1997 in a subset of the European Youth Heart Study, Danish component. Plasma PFC concentrations were available from 499 children. Linear regression models were......Objective: Our objective was to explore whether childhood exposure to perfluorinated and polyfluorinated compounds (PFCs), widely used stain- and grease-repellent chemicals, is associated with adiposity and markers of glycemic control. Materials and Methods: Body mass index, skinfold thickness...... perfluorooctane sulfonic acid/mL plasma was associated with 16.2% (95% confidence interval [CI], 5.2%-28.3%) higher insulin concentration, 12.0% (95% CI, 2.4%-22.4%) higher β-cell activity, 17.6% (95% CI, 5.8%-30.8%) higher insulin resistance, and 8.6% (95% CI, 1.2%-16.5%) higher triglyceride concentrations...
Armenise, Claudia; Lefebvre, Gregory C; Carayol, Jérôme
and glycemic outcomes both at LCD termination and 6 mo after the LCD.Design: Using RNA sequencing (RNAseq), we analyzed transcriptome changes in AT from 191 obese, nondiabetic patients within a multicenter, controlled dietary intervention. Expression changes were associated with outcomes after an 8-wk LCD (800......-1000 kcal/d) and 6 mo after the LCD. Results were validated by using quantitative reverse transcriptase-polymerase chain reaction in 350 subjects from the same cohort. Statistical models were constructed to classify weight maintainers or glycemic improvers.Results: With RNAseq analyses, we identified 1173...... expression combined with clinical variables enabled us to distinguish weight and glycemic responders from nonresponders. These potential biomarkers may help clinicians understand intersubject variability and better predict the success of dietary interventions. This trial was registered at clinicaltrials...
Kaselitz, Elizabeth; Shah, Megha; Choi, Hwajung; Heisler, Michele
Objective In a secondary analysis of a randomized controlled trial of diabetes reciprocal peer support, we examined characteristics of peers associated with improvements in their partner's glycemic control. Methods A total of 102 adults with diabetes were randomized to the reciprocal peer support arm (vs. a nurse care management arm). The primary outcome was change in A1c over six months. Intermediate outcomes were insulin initiation and peer engagement. A number of baseline characteristics of peers were hypothesized to influence outcomes for their peer, and concordant characteristics of peer dyads were hypothesized that would influence outcomes for both peer partners. Results Improvement in A1c was associated with having a peer older than oneself ( P peers who reported poorer health at baseline had worse glycemic control at follow-up ( P peers had a more controlled self-regulation style were more likely to initiate insulin ( P peers whose partners were older and reported more diabetes distress at baseline supports the need for further research into the peer characteristics that lead to improved outcomes. This could allow for better matching and more effective partnerships.
Rian Adi Pamungkas
Full Text Available Background: Type 2 Diabetes mellitus becomes the public health problem in the wide world. Reasons for poor glycemic control in Type 2 diabetes are complex. Objective: To determine factors contributed to poor glycemic control among Indonesian patients with Type 2 Diabetes Methods: This was a cross sectional regression study. There were 70 respondents selected using purposive sampling. Pre-structured questionnaires were used to measure socio demographic, clinical characteristics, self-care management behaviors, medication adherence, barriers to adherence, and family support. Data were analyzed using chi-square and binary logistic regression. Results: Poor glycemic control was defined as HbA1c ≥7% or FBG ≥200 mg/dl. Findings of this study reported that 83% patients had or FBG ≥200 mg/dl, which confirmed as poor glycemic control. Logistic regression showed that increasing duration of diabetes (> 5 years, non-adherence to dietary behaviors recommendation through selecting healthy diet, arranging a meal plan, recognizing the amount calorie needs, managing dietary behaviors challenges, medication adherence, and family support were significantly influence poor glycemic control with increased odds ratio scores. Conclusion: The proportion of patients with poor glycemic control was raised. Increasing duration of diabetes, non- adherence to medication and dietary behaviors management, and lack of family support were associated with poor glycemic control. Thus, integration of diabetes self-management program with social support is needed to deal with patients’ need to achieve the great benefits in diabetes care.
Walker, Rebekah J; Gebregziabher, Mulugeta; Martin-Harris, Bonnie; Egede, Leonard E
The aim of this study was to investigate if self-care is the pathway through which social determinants of health impact diabetes outcomes by analyzing the direct and indirect effects of socioeconomic and psychosocial factors on self-care and glycemic control. Six hundred fifteen adults were recruited from two primary care clinics in the southeastern United States. A series of confirmatory factor analyses identified the latent factors underlying social status, psychosocial determinants (psychological distress, self-efficacy, and social support), and self-care (diet, exercise, foot care, glucose testing, and medication adherence). Structured equation modeling investigated the relationship among social determinants, self-care and glycemic control. Latent variables were created for diabetes self-care, psychological distress, self-efficacy, social support, and social status. The final model [χ(2)(275)=450.07, Psocial support (r=0.14, P=0.01), and higher self-efficacy (r=0.47, Psocial support (r=0.10, P=0.02), and higher self-efficacy (r=-0.37, Psocial determinants of health variables were included in the model, self-care was no longer significantly associated with glycemic control (r=0.01, P=0.83). This study suggests a direct relationship between psychosocial determinants of health and glycemic control. Although associated with self-care, the relationship between social determinants of health and glycemic control is not mediated by self-care. Development of interventions should take psychosocial factors into account as independent influences on diabetes outcomes, rather than as indirect influences via self-care behavior.
Reynolds, D Brice; Walker, Rebekah J; Campbell, Jennifer A; Egede, Leonard E
Discrimination has been linked to negative health outcomes, but little research has investigated different types of discrimination to determine if some have a greater impact on outcomes. We examined the differential effect of discrimination based on race, level of education, gender, and language on glycemic control in adults with type 2 diabetes. Six hundred two patients with type 2 diabetes from two adult primary care clinics in the southeastern United States completed validated questionnaires. Questions included perceived discrimination because of race/ethnicity, level of education, sex/gender, or language. A multiple linear regression model assessed the differential effect of each type of perceived discrimination on glycemic control while adjusting for relevant covariates, including race, site, gender, marital status, duration of diabetes, number of years in school, number of hours worked per week, income, and health status. The mean age was 61.5 years, and the mean duration of diabetes was 12.3 years. Of the sample, 61.6% were men, and 64.9% were non-Hispanic black. In adjusted models, education discrimination remained significantly associated with glycemic control (β=0.47; 95% confidence interval, 0.03, 0.92). Race, gender and language discrimination were not significantly associated with poor glycemic control in either unadjusted or adjusted analyses. Discrimination based on education was found to be significantly associated with poor glycemic control. The findings suggest that education discrimination may be an important social determinant to consider when providing care to patients with type 2 diabetes and should be assessed separate from other types of discrimination, such as that based on race.
Shan, Shan; Gu, Liubao; Lou, Qinglin; Ouyang, Xiaojun; Yu, Yun; Wu, Haidi; Bian, Rongwen
This study aimed to evaluate the glycemic levels in Chinese patients with type 2 diabetes mellitus (T2DM) and to explore the factors related to the results of glycemic control. A total of 2454 T2DM patients from 11 communities were examined for glycosylated hemoglobin levels and glycemic control options. Potential factors related to the results of glycemic control were analyzed using logistic regression. Of all the patients, 55.3 % achieved the glycemic control target of HbA1c 1.345, 95 % CI 1.022-1.769; P = 0.034), higher levels of fasting blood glucose (OR 1.954, 95 % CI 1.778-2.147; P 1), and low-density lipoprotein cholesterol (OR 1.181, 95 % CI 1.020-1.367; P = 0.026) were significantly associated with poor glycemic control. The complexity of antidiabetics was also associated with poor glycemic control (P insulin injection was most strongly associated with poor glycemic control (OR 6.210, 95 % CI 4.054-9.514; P 1). Male patients with higher levels of total cholesterol, lower levels of high-density lipoprotein cholesterol, or longer diabetic durations showed poor glycemic control, which was not found in female patients. Glycemic control was not satisfactory in T2DM patients of Nanjing communities. Various factors are associated with poor results of glycemic control.
Rauch, Thomas; Graefe-Mody, Ulrike; Deacon, Carolyn F
Linagliptin is a xanthine-based dipeptidyl peptidase (DPP)-4 inhibitor that is now available in numerous countries worldwide for the treatment of type 2 diabetes mellitus (T2DM). The aim of this study was to evaluate further the mechanisms underlying the improvements in glycemic control observed...... with linagliptin. The effects of linagliptin on DPP-4, pharmacodynamic parameters, and glycemic control versus placebo were assessed in patients with inadequately controlled T2DM....
Sadiq, J.; Khan, R.
Background: Depression among type 2 diabetes mellitus patient results in negative health outcomes. Objectives: To determine the association between depression and glycemic control in patients suffering from type 2 diabetes mellitus. Study design, settings and duration: This comparative cross-sectional study was conducted in the diabetic patients attending diabetic clinic of Capital Hospital, Islamabad which is a tertiary care hospital from 1st September 2015 to 30th November 2015. Patients and Methods: The serum glycosylated hemoglobin levels (HbA1c) were recorded from the medical records of patients while Patient Health Questionnaire (PHQ-9) was used to assess depression in these patients. Poor glycemic control was taken as value of HbA1c = 7 percent. Equal number of depressive and non-depressive type 2 diabetics were recruited. The data was analyzed using SPSS 20.0 and Chi-square was used to find out association between depression and glycemic control among type 2 diabetes mellitus patients. Results: A total of 250 type 2 diabetes patients were enrolled in the study. Their mean HbA1c level was 8.5% (S.D +- 2.15) and the PHQ-9 score was 9.0 (S.D +- 4.11). Almost 83.2 percent patients had poor glycemic control and were depressed while 57.6 percent had poor glycemic control but were non-depressed. Depression was strongly associated with poor glycemic control in type 2 diabetes mellitus. Conclusion: Depression among type 2 diabetes patients was significantly associated with poor glycemic control. Policy message: Type 2 diabetic patients should be regularly monitored for their glycemic control and assessed for depression and treated accordingly.(author)
Parikh, Laura I; Jelin, Angie C; Iqbal, Sara N; Belna, Sarah L; Fries, Melissa H; Patel, Misbah; Desale, Sameer; Ramsey, Patrick S
To determine if diabetic gravidas enrolled in Centering® group care have improved glycemic control compared to those attending standard prenatal care. To compare compliance and patient satisfaction between the groups. We conducted a prospective cohort study of diabetics enrolled in centering group care from October 2013 to December 2015. Glycemic control, compliance and patient satisfaction (five-point Likert scale) were evaluated. Student's t-test, Chi-Square and mixed effects model were used to compare outcomes. We compared 20 patients in centering to 28 standard prenatal care controls. Mean fasting blood sugar was lower with centering group care (91.0 versus 105.5 mg/dL, p =0.017). There was no difference in change in fasting blood sugar over time between the two groups (p = 0.458). The percentage of time patients brought their blood glucose logs did not differ between the centering group and standard prenatal care (70.7 versus 73.9%, p = 0.973). Women in centering group care had better patient satisfaction scores for "ability to be seen by a physician" (5 versus 4, p = 0.041) and "time in waiting room" (5 versus 4, p =0.001). Fasting blood sugar was lower for patients in centering group care. Change in blood sugar over time did not differ between groups. Diabetic gravidas enrolled in centering group care report improved patient satisfaction.
Stoecklin, Patricia; Delodder, Frederik; Pantet, Olivier; Berger, Mette M
Hyperglycemia is a metabolic alteration in major burn patients associated with complications. The study aimed at evaluating the safety of general ICU glucose control protocols applied in major burns receiving prolonged ICU treatment. 15 year retrospective analysis of consecutive, adult burn patients admitted to a single specialized centre. death or length of stay burned surface (TBSA), severity scores, infections, ICU stay, outcome. Metabolic variables: total energy, carbohydrate and insulin delivery/24h, arterial blood glucose and CRP values. Analysis of 4 periods: 1, before protocol; 2, tight doctor driven; 3, tight nurse driven; 4, moderate nurse driven. 229 patients, aged 45 ± 20 years (mean ± SD), burned 32 ± 20% TBSA were analyzed. SAPSII was 35 ± 13. TBSA, Ryan and ABSI remained stable. Inhalation injury increased. A total of 28,690 blood glucose samples were analyzed: the median value remained unchanged with a narrower distribution over time. After the protocol initiation, the normoglycemic values increased from 34.7% to 65.9%, with a reduction of hypoglycaemic events (no extreme hypoglycemia in period 4). Severe hyperglycemia persisted throughout with a decrease in period 4 (9.25% in period 4). Energy and glucose deliveries decreased in periods 3 and 4 (pprotocol improved the glycemic control in adult burn patients, reducing glucose variability. Moderate glycemic control in burns was safe specifically related to hypoglycemia, reducing the incidence of hypoglycaemic events compared to the period before. Hyperglycemia persisted at a lower level. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.
Sarah Y. Nowlin
Full Text Available Type 2 diabetes (T2D is a growing national health problem affecting 35% of adults ≥20 years of age in the United States. Recently, diabetes has been categorized as an inflammatory disease, sharing many of the adverse outcomes as those reported from cardiovascular disease. Medical nutrition therapy is recommended for the treatment of diabetes; however, these recommendations have not been updated to target the inflammatory component, which can be affected by diet and lifestyle. To assess the current state of evidence for which dietary programs contain the most anti-inflammatory and glycemic control properties for patients with T2D, we conducted an integrative review of the literature. A comprehensive search of the PubMed, CINAHL, Scopus, and Web of Science databases from January 2000 to May 2012 yielded 786 articles. The final 16 studies met the selection criteria including randomized control trials, quasiexperimental, or cross-sectional studies that compared varying diets and measured inflammatory markers. The Mediterranean and DASH diets along with several low-fat diets were associated with lower inflammatory markers. The Mediterranean diet demonstrated the most clinically significant reduction in glycosylated hemoglobin (HbA1c. Information on best dietary guidelines for inflammation and glycemic control in individuals with T2D is lacking. Continued research is warranted.
Trepanowski, John F; Varady, Krista A
The American Diabetes Association (ADA) and the National Cholesterol Education Program (NCEP) have each outlined a set of dietary recommendations aimed at improving glycemic control and blood lipids, respectively. However, traditional vegan diets (low-fat diets that proscribe animal product consumption) are also effective at improving glycemic control, and dietary portfolios (vegan diets that contain prescribed amounts of plant sterols, viscous fibers, soy protein, and nuts) are also effective at improving blood lipids. The purpose of this review was to compare the effects of traditional vegan diets and dietary portfolios with ADA and NCEP diets on body weight, blood lipids, blood pressure, and glycemic control. The main findings are that traditional vegan diets appear to improve glycemic control better than ADA diets in individuals with type 2 diabetes mellitus (T2DM), while dietary portfolios have been consistently shown to improve blood lipids better than NCEP diets in hypercholesterolemic individuals.
Khan, A.U.; Fakhr, A.; Khan, Z.A.; Nadeem, M.; Bangash, R.Y.
Objective: To determine the status of glycemic control in patients of type 2 diabetes mellitus. Design: Cross sectional descriptive study. Place and Duration of Study: Medical out-patient/ in -patient departments at Military Hospital Rawalpindi from January 2011 to December 2012. Methods: Six hundred and fifty patients of type 2 DM fulfilling the required criteria were included in the study. Glycemic control of these patients was determined by estimation of blood glucose (fasting and random) and glycosylated haemoglobin (HbA1c). The patients were grouped in three categories good, fair and poor diabetic control having their HbA1c values of being 6-7%, 7.1-8% and more than 8.1% respectively. Statistical package for social sciences (SPSS) version 15 was used for analysis. Results: Out of 650 patients 377 (58%) had poor glycemic control with mean HbA1c of 9.5% +- 0.95, 78 (12%) patients had fair control of glycemic control with mean HbA1c of 7.8 +- 0.25, and 195 (30%) patients had good glycemic control with mean HbA1c of 6.4 +- 0.17. Conclusion: Majority of patients had poor control of their glycemic status which is an important indicator and predictor of both micro and macrovascular complications. (author)
Rodríguez-Gutiérrez, René; Montori, Victor M
We sought to determine the concordance between the accumulating evidence about the impact of tight versus less tight glycemic control in patients with type 2 diabetes mellitus since the publication of UKPDS (UK Prospective Diabetes Study) in 1998 until 2015 with the views about that evidence published in journal articles and practice guidelines. We searched in top general medicine and specialty journals for articles referring to glycemic control appearing between 2006 and 2015 and identified the latest practice guidelines. To summarize the evidence, we included all published systematic reviews and meta-analyses of contemporary randomized trials of glycemic control measuring patient-important microvascular and macrovascular outcomes, and completed a meta-analysis of their follow-up extensions. We identified 16 guidelines and 328 statements. The body of evidence produced estimates warranting moderate confidence. This evidence reported no significant impact of tight glycemic control on the risk of dialysis/transplantation/renal death, blindness, or neuropathy. In the past decade, however, most published statements (77%-100%) and guidelines (95%) unequivocally endorsed benefit. There is also no significant effect on all-cause mortality, cardiovascular mortality, or stroke; however, there is a consistent 15% relative-risk reduction of nonfatal myocardial infarction. Between 2006 and 2008, most statements (47%-83%) endorsed the benefit; after 2008 (ACCORD), only a minority (21%-36%) did. Discordance exists between the research evidence and academic and clinical policy statements about the value of tight glycemic control to reduce micro- and macrovascular complications. This discordance may distort priorities in the research and practice agendas designed to improve the lives of patients with type 2 diabetes mellitus. © 2016 American Heart Association, Inc.
Tseng, Hsu-Min; Liao, Shu-Fen; Wen, Yu-Ping; Chuang, Yuh-Jue
Health literacy has been recognized as a key construct associated with clinical outcomes; however, few studies have explored the mechanism underlying the association. The transtheoretical model (TTM) has long been considered a useful conceptualization in the process of intentional behavior change. Stages of change lies at the heart of the TTM as studies of change have found that people move through a series of stages when modifying behavior. This study focuses on the role of knowledge and stages of change (SOC) as serial mediators linking health literacy to glycemic control. In this cross-sectional survey, a total of 232 patients with type 2 diabetes participated in this study. Participants completed questionnaires for assessing health literacy, readiness to consume healthy foods, and a dietary knowledge test specific to diabetes. Low health literacy was significantly associated with worse glycemic control. Statistical evaluation supported the serial mediation model, in which knowledge and SOC formed a serial mediation chain that accounted for the indirect effect of health literacy on glycemic control. In other words, dietary knowledge significantly motivated participants to move into the later stages of behavior change, which in turn improved the outcome of glycemic control. The results indicate that the ordering of mediators in the pathway between health literacy and health outcome may be complex, help explain the conflicting results of the past, and form a basis for the development of interventions promoting self-management of diabetes through glycemic control. Copyright © 2016. Published by Elsevier Ltd.
approach to diabetes management should be changed to actions that include patients’ psychosocial aspects aiming to reduce the stress of living with diabetes, improving glycemic control, and avoiding adverse outcomes. Keywords: type 1 diabetes, diabetes knowledge, diabetes education, glycemic control, diabetes complications
Kerimi, Asimina; Nyambe-Silavwe, Hilda; Gauer, Julia S; Tomás-Barberán, Francisco A; Williamson, Gary
Background: Low-glycemic index diets have demonstrated health benefits associated with a reduced risk of developing type 2 diabetes. Objectives: We tested whether pomegranate polyphenols could lower the glycemic response of a high-glycemic index food when consumed together and the mechanism by which this might occur. Design: We compared the acute effect of a pomegranate juice and a polyphenol-rich extract from pomegranate (supplement) on the bread-derived postprandial blood glucose concentration in 2 randomized, crossover, controlled studies (double-blinded for the supplements), each on 16 healthy volunteers. An additional randomized, crossover, controlled study on 16 volunteers consuming constituent fruit acids in a pH-balanced solution (same pH as pomegranate) and bread was conducted to determine any contributions to postprandial responses caused by acidic beverages. Results: As primary outcome, the incremental area under the curve for bread-derived blood glucose (-33.1% ± 18.1%, P = 0.000005) and peak blood glucose (25.4% ± 19.3%, P = 0.0004) were attenuated by pomegranate juice, compared with a control solution containing the equivalent amount of sugars. In contrast, the pomegranate supplement, or a solution containing the malic and citric acid components of the juice, was ineffective. The pomegranate polyphenol punicalagin was a very effective inhibitor of human α-amylase in vitro, comparable to the drug acarbose. Neither the pomegranate extract nor the individual component polyphenols inhibited 14 C-D-glucose transport across differentiated Caco-2/TC7 cell monolayers, but they inhibited uptake of 14 C-glucose into Xenopus oocytes expressing the human glucose transporter type 2. Further, some of the predicted pomegranate gut microbiota metabolites modulated 14 C-D-glucose and 14 C-deoxy-D-glucose uptake into hepatic HepG2 cells. Conclusions: These data indicate that pomegranate polyphenols, when present in a beverage but not in a supplement, can reduce the
Full Text Available Objective: Glycemic control in the critically ill intensive care unit (ICU patient has been shown to improve morbidity and mortality. We sought to investigate the effect of early glycemic control in critically ill emergency department (ED patients in a small pilot trial.Methods: Adult non-trauma, non-pregnant ED patients presenting to a university tertiary referral center and identified as critically ill were eligible for enrollment on a convenience basis. Critical illness was determined upon assignment for ICU admission. Patients were randomized to either ED standard care or glycemic control. Glycemic control involved use of an insulin drip to maintain blood glucose levels between 80-140 mg/dL. Glycemic control continued until ED discharge. Standard patients were managed at ED attending physician discretion. We assessed severity of illness by calculation of APACHE II score. The primary endpoint was in-hospital mortality. Secondary endpoints included vasopressor requirement, hospital length of stay, and mechanical ventilation requirement.Results: Fifty patients were randomized, 24 to the glycemic group and 26 to the standard care cohort. Four of the 24 patients (17% in the treatment arm did not receive insulin despite protocol requirements. While receiving insulin, three of 24 patients (13% had an episode of hypoglycemia. By chance, the patients in the treatment group had a trend toward higher acuity by APACHE II scores. Patient mortality and morbidity were similar despite the acuity difference.Conclusion: There was no difference in morbidity and mortality between the two groups. The benefit of glycemic control may be subject to source of illness and to degree of glycemic control, or have no effect. Such questions bear future investigation. [West J Emerg Med. 2010; 11(1:20-23].
Cosansu, Gulhan; Erdogan, Semra
The main purpose of this study was to investigate the direct and indirect effects of psychosocial factors on self-care behavior and glycemic control in Turkish patients with type 2 diabetes mellitus. The study used a cross-sectional questionnaire survey design (N = 350). Data were collected using the Summary of Diabetes Self-Care Activities Scale and the Multidimensional Diabetes Questionnaire. The relationship between the study variables was analyzed using Pearson's correlation coefficient and structural equation modeling. Self-efficacy was associated with social support, outcome expectancies, perceived interference, educational level, and self-care and A1C. According to the structural equation model, self-efficacy was the predictor variable that influenced both self-care and glycemic control. Self-efficacy in achieving desired health outcomes was found to play a central role in Turkish patients. Although interventions are planned and implemented to achieve and maintain self-management in individuals with diabetes, strengthening psychosocial factors, particularly self-efficacy, may contribute to adjustment to disease and good glycemic control in the long term.
Standl, Eberhard; Erbach, Michael; Schnell, Oliver
Some 30% of contemporary cardiology patients have coexisting known diabetes, and another 40% have either undiagnosed diabetes or prediabetes. There is still no final conclusive evidence of cardiovascular benefit by good glycemic control in type 2 diabetes, although studies like the United Kingdom Prospective Diabetes Study (UKPDS) and the Prospective Pioglitazone Clinical Trial in Macrovascular Events, and meta-analyses based on these and other randomized controlled trials of blood glucose-lowering therapies have been encouraging. On the other hand, microvascular disease is clearly reduced by good glycemic control. Structured education has remained a mandatory prerequisite of any successful treatment. Not only is appropriate weight management by diet and exercise able to revert new onset diabetes to normal, but it is also the foundation of any successful pharmacotherapy of diabetes. Aiming at normal fasting plasma glucose concentrations of 5.3 mmol/L or 95 mg/dL appears to be safe since publication of the long-term outcome results of the Outcome Reduction with an Initial Glargine INtervention trial. Individualized target glycosylated hemoglobin levels as near to normal as safely possible (i.e., type 2 diabetes, also in terms of preventing cardiovascular complications. An alternate first-line option in some parts of the world, especially Asian countries, is the class of alpha-glucosidase inhibitors. In most patients, combination therapies with two or three classes of drugs are warranted. Early combination are the golden strategy as type 2 diabetes is a multi-causal disease; the various classes of drugs have distinct and synergistic modes of action, and the blood glucose-lowering efficacy of these drugs is more or less fully maintained in combination. The recent joint American Diabetes Association/European Association for the Study of Diabetes position statement mentions five options as step two of the treatment algorithm for combination with metformin
Full Text Available Hasniza Zaman Huri,1,2 Lay Peng Lim,1 Soo Kun Lim3 1Department of Pharmacy, Faculty of Medicine, University of Malaya, 2Clinical Investigation Centre, University Malaya Medical Centre, 3Renal Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia Background: Good glycemic control can delay the progression of kidney diseases in type 2 diabetes mellitus (T2DM patients with renal complications. To date, the association between antidiabetic agents and glycemic control in this specific patient population is not well established.Purpose: This study aimed to identify antidiabetic regimens as well as other factors that associated with glycemic control in T2DM patients with different stages of chronic kidney disease (CKD.Patients and methods: This retrospective, cross-sectional study involved 242 T2DM inpatients and outpatients with renal complications from January 2009 to March 2014 and was conducted in a tertiary teaching hospital in Malaysia. Glycated hemoglobin (A1C was used as main parameter to assess patients’ glycemic status. Patients were classified to have good (A1C <7% or poor glycemic control (A1C ≥7% based on the recommendations of the American Diabetes Association.Results: Majority of the patients presented with CKD stage 4 (43.4%. Approximately 55.4% of patients were categorized to have poor glycemic control. Insulin (57.9% was the most commonly prescribed antidiabetic medication, followed by sulfonylureas (43%. Of all antidiabetic regimens, sulfonylureas monotherapy (P<0.001, insulin therapy (P=0.005, and combination of biguanides with insulin (P=0.038 were found to be significantly associated with glycemic control. Other factors including duration of T2DM (P=0.004, comorbidities such as anemia (P=0.024 and retinopathy (P=0.033, concurrent medications such as erythropoietin therapy (P=0.047, a-blockers (P=0.033, and antigouts (P=0.003 were also correlated with A1C.Conclusion: Identification of
Full Text Available Davis Kibirige,1 George Patrick Akabwai,2 Leaticia Kampiire,3 Daniel Ssekikubo Kiggundu,4 William Lumu5 1Department of Medicine/Diabetic and Hypertension Clinics, Our Lady of Consolota Hospital, Kisubi, 2Baylor College of Medicine, Children’s Foundation, 3Infectious Diseases Research Collaboration, Kampala, 4Nephrology Unit, Mulago National Referral and Teaching Hospital, Kampala, 5Department of Medicine and Diabetes/Endocrine Unit, Mengo Hospital, Mengo, Uganda Background: Persistent suboptimal glycemic control is invariably associated with onset and progression of acute and chronic diabetic complications in diabetic patients. In Uganda, studies documenting the magnitude and predictors of suboptimal glycemic control in adult ambulatory diabetic patients are limited. This study aimed at determining the frequency and predictors of suboptimal glycemic control in adult diabetic patients attending three urban outpatient diabetic clinics in Uganda. Methods: In this hospital-based cross-sectional study, eligible ambulatory adult diabetic patients attending outpatient diabetic clinics of three urban hospitals were consecutively enrolled over 11 months. Suboptimal glycemic control was defined as glycated hemoglobin (HbA1c level ≥7%. Multivariable analysis was applied to determine the predictors. Results: The mean age of the study participants was 52.2±14.4 years, and the majority of them were females (283, 66.9%. The median (interquartile range HbA1c level was 9% (6.8%–12.4%. Suboptimal glycemic control was noted in 311 study participants, accounting for 73.52% of the participants. HbA1c levels of 7%–8%, 8.1%–9.9%, and ≥10% were noted in 56 (13.24%, 76 (17.97%, and 179 (42.32% study participants, respectively. The documented predictors of suboptimal glycemic control were metformin monotherapy (odds ratio: 0.36, 95% confidence interval: 0.21–0.63, p<0.005 and insulin therapy (odds ratio: 2.41, 95% confidence interval: 1.41–4.12, p=0
Kyoung Jin Kim
Full Text Available BackgroundLong-term durable glycemic control is a difficult goal in the management of type 2 diabetes mellitus (T2DM. We evaluated the factors associated with durable glycemic control in a real clinical setting.MethodsWe retrospectively reviewed the medical records of 194 new-onset, drug-naïve patients with T2DM who were diagnosed between January 2011 and March 2013, and were followed up for >2 years. Glycemic durability was defined as the maintenance of optimal glycemic control (glycosylated hemoglobin [HbA1c] <7.0% for 2 years without substitution or adding other glucose-lowering agents. Clinical factors and glycemic markers associated with glycemic durability were compared between two groups: a durability group and a non-durability group.ResultsPatients in the durability group had a higher baseline body mass index (26.1 kg/m2 vs. 24.9 kg/m2 and lower HbA1c (8.6% vs. 9.7% than the non-durability group. The initial choice of glucose-lowering agents was similar in both groups, except for insulin and sulfonylureas, which were more frequently prescribed in the non-durability group. In multiple logistic regression analyses, higher levels of education, physical activity, and homeostasis model assessment of β-cell function (HOMA-β were associated with glycemic durability. Notably, lower HbA1c (<7.0% at baseline and first follow-up were significantly associated with glycemic durability (adjusted odds ratio [OR], 7.48; 95% confidence interval [CI], 2.51 to 22.3 (adjusted OR, 9.27; 95% CI, 1.62 to 53.1, respectively, after adjusting for confounding variables including the types of glucose-lowering agents.ConclusionEarly achievement of HbA1c level within the glycemic target was a determinant of long-term glycemic durability in new-onset T2DM, as were higher levels of education, physical activity, and HOMA-β.
Ishii, K; Tanabe, S; Mitsuhashi, T; Saigenji, K
To investigate the effect on glycemic control of improving diabetic gastroparesis, we evaluated symptoms (scored), gastric motor functions (solid and liquid gastric emptying studies and electrogastrography), and glycemic control in 11 patients with diabetic gastroparesis (5 men, 6 women, 50.4 +/- 4.5 years old) before and after treatment with cisapride (15 mg/day p.o., 12 weeks). None of the patients had organic abnormalities on gastrointestinal endoscopy. The dysmotility symptom score (maximum: 18) on cisapride significantly improved from 13.1 to 4.0 (p instant noodles labeled with 37 MBq (1 mCi) technetium-99m (both p < 0.05). Liquid gastric emptying, evaluated using a sulfamethizole technique, also improved but not significantly. Electrogastrography revealed no significant changes after treatment, but the postprandial rate of normal frequency waves tended to increase. Glycemic control was assessed based on HbA1C, fructosamine and M value. There were no significant changes in glycemic control after treatment with cisapride. We conclude that long-term administration of cisapride reduced dysmotility symptoms and improved solid and liquid gastric emptying without adversely affecting glycemic control.
Gungunes, Askin; Sahin, Mustafa; Demirci, Taner; Ucan, Bekir; Cakir, Evrim; Arslan, Muyesser Sayki; Unsal, Ilknur Ozturk; Karbek, Basak; Calıskan, Mustafa; Ozbek, Mustafa; Cakal, Erman; Delibasi, Tuncay
Cushing's syndrome may be more frequent in some specific patient groups such as type 2 diabetes and obesity. The aim of this study was to investigate the prevalence of Cushing's syndrome in outpatients with type 2 diabetes with poor glycemic control despite at least 3-months insulin therapy. Outpatients with type 2 diabetes whose glycemic control is poor (Hb Alc value >7 %) despite receiving at least 3-months long insulin treatment (insulin alone or insulin with oral antidiabetics) were included. Patients with classic features of Cushing's syndrome were excluded. Overnight 1 mg dexamethasone suppression test (DST) was performed as a screening test. A total of 277 patients with type 2 diabetes whose glycemic control is poor (Hb Alc value >7 %) despite insulin therapy were included. Two of the 277 patients with type 2 diabetes were diagnosed with Cushing's syndrome (0.72 %). Hypertension was statistically more frequent in the patients with cortisol levels ≥1.8 μg/dL than the patients with cortisol levels Cushing's syndrome among patients with type 2 diabetes with poor glycemic control despite insulin therapy is much higher than in the general population. The patients with type 2 diabetes with poor glycemic control despite at least three months of insulin therapy should be additionally tested for Cushing's syndrome if they have high dose insülin requirements.
Hanaa A Mohammad
Full Text Available Background : Type 1 diabetes mellitus (T1DM may lead to severe long-term health consequences, such as renal failure, blindness, as well as heart and cerebrovascular disease. Although a direct relationship between blood glucose control and diabetes complications remains to be established beyond doubt, most diabetologists aim to achieve the best possible glucose control in their patients with T1DM. The aim of this study was to detect the predictors of glycemic control among children with T1DM in Assiut Governorate-Egypt. Materials and Methods : We enrolled 415 children aged 2 to 18 years with type 1 diabetes of >1-year duration. They were subjected to full history including demographic factors and disease-related factors. Examination was done with determination of the body mass index, and assessment of stage of maturity. Investigations included hemoglobin A1c (HbA1c and lipid profile. Patients with HbA1c above the recommended values for age by the American Diabetes Association were considered as poor glycemic control group. Results : Of the studied cases, 190 cases (45.8% were of poor glycemic control. Patients with poor control had significantly higher mean age (16.83 ± 3.3 vs 9.77 ± 3.7, P<0.000. Girls aged 15 years or more had significantly higher prevalence of poor glycemic control than males of the same age group. As regard the disease-related factors, patients with poor control had significantly longer duration of disease (7.94 ± 2.6 vs 2.40 ± 2.0, P<0.000 and were older in age at onset of disease. Insulin regimen which consists of basal bolus insulin plus three injections of regular insulin was associated with more frequency of good glycemic control than other regimens. Patients with poor control had significantly higher mean of cholesterol, triglyceride (TG, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol than patients with good control. Adjusting for other variables, age of the patients, duration of
Hilliard, Marisa E.; Guilfoyle, Shanna M.; Dolan, Lawrence M.; Hood, Korey K.
Objective To test adherence to blood glucose monitoring (BGM) as a mediator between diabetes-specific family conflict and glycemic control (hemoglobin A1c [HbA1c] levels) for 1 year. Design Three waves of prospective data spanning 1 year. Setting Diabetes clinic in a large tertiary care children’s hospital in the Midwestern United States. Participants One hundred forty-five dyads composed of an adolescent (aged 13–18 years) with type 1 diabetes mellitus and a parent. Main Exposures Adolescent- and parent-rated diabetes-specific family conflict and mean daily BGM frequency obtained through meter downloads. Main Outcome Measure Levels of HbA1c, abstracted from the medical record. Results In separate general linear models, higher adolescent-rated family conflict scores at baseline predicted less frequent BGM at 6 months (β=−0.08 [P=.01]) and higher HbA1c levels at 12 months (β=0.08 [P=.02]). In the multivariate model including baseline conflict and BGM as predictors of HbA1c levels, BGM was a significant predictor (β=−0.24 [P=.007]) and conflict was no longer significant (β=0.05 [P=.11]), supporting the mediation hypothesis. Post hoc probing showed that BGM explained 24% of the variance in the conflict-HbA1c link. The mediation between parent-reported conflict andHbA1c levels via BGM adherence was partially supported (conflict predicting HbA1c in the zero-order equation, β=−0.24 [P=.004]; multivariate equation, β=0.06 [P=.02]), and BGM frequency explained 16% of the conflict-HbA1c link. Conclusions Diabetes-specific family conflict in adolescence predicts deteriorations in BGM and subsequent glycemic control for at least 1 year. Results support ongoing intervention research designed to reduce family conflict and thus prevent a trajectory of declining adherence and glycemic control across adolescence. PMID:21727273
Schnell, Oliver; Klausmann, Gerd; Gutschek, Bettina; Garcia-Verdugo, Rosa Maria; Hummel, Michael
Self-monitoring of blood glucose (SMBG) is a key pillar of personal diabetes management. The objective of this observational study was to analyze diabetes self-management (DSM) and glycemic outcomes before and during system implementation in real-life settings of a blood glucose meter system with a color-coded display of glucose levels, which helps identify out-of-range levels. A total of 193 insulin-treated diabetes patients (11% T1DM; 55% male, age 60 ± 4 years, mean diabetes duration 14 ± 9 years, HbA1c 8.68 ± 1.2%) were enrolled into the study. Both the Diabetes Self-Management Questionnaire (DSMQ) and glycemic control were analyzed at baseline and 3 and 6 months after study initiation. DSMQ general perception improved significantly by the end of the study period ("Sum Scale," P meter resulted in improved glycemic control, as shown by mean HbA1c levels, which decreased from 8.68 ± 1.2% at baseline to 8.13 ± 1.02% after 3 months ( P meter not only leads to an improvement in metabolic control, but also is associated with a significant improvement in diabetes management.
Mavropoulos John C
Full Text Available Abstract Objective Dietary carbohydrate is the major determinant of postprandial glucose levels, and several clinical studies have shown that low-carbohydrate diets improve glycemic control. In this study, we tested the hypothesis that a diet lower in carbohydrate would lead to greater improvement in glycemic control over a 24-week period in patients with obesity and type 2 diabetes mellitus. Research design and methods Eighty-four community volunteers with obesity and type 2 diabetes were randomized to either a low-carbohydrate, ketogenic diet (1c. Results Forty-nine (58.3% participants completed the study. Both interventions led to improvements in hemoglobin A1c, fasting glucose, fasting insulin, and weight loss. The LCKD group had greater improvements in hemoglobin A1c (-1.5% vs. -0.5%, p = 0.03, body weight (-11.1 kg vs. -6.9 kg, p = 0.008, and high density lipoprotein cholesterol (+5.6 mg/dL vs. 0 mg/dL, p Conclusion Dietary modification led to improvements in glycemic control and medication reduction/elimination in motivated volunteers with type 2 diabetes. The diet lower in carbohydrate led to greater improvements in glycemic control, and more frequent medication reduction/elimination than the low glycemic index diet. Lifestyle modification using low carbohydrate interventions is effective for improving and reversing type 2 diabetes.
Hanazaki, Kazuhiro; Munekage, Masaya; Kitagawa, Hiroyuki; Yatabe, Tomoaki; Munekage, Eri; Shiga, Mai; Maeda, Hiromichi; Namikawa, Tsutomu
The incidence of diabetes is increasing at an unprecedented pace and has become a serious health concern worldwide during the last two decades. Despite this, adequate glycemic control using an artificial pancreas has not been established, although the 21st century has seen rapid developments in this area. Herein, we review current topics in glycemic control for both the wearable artificial pancreas for type 1 and type 2 diabetic patients and the bedside artificial pancreas for surgical diabetic patients. In type 1 diabetic patients, nocturnal hypoglycemia associated with insulin therapy remains a serious problem that could be addressed by the recent development of a wearable artificial pancreas. This smart phone-like device, comprising a real-time, continuous glucose monitoring system and insulin pump system, could potentially significantly reduce nocturnal hypoglycemia compared with conventional glycemic control. Of particular interest in this space are the recent inventions of a low-glucose suspend feature in the portable systems that automatically stops insulin delivery 2 h following a glucose sensor value <70 mg/dL and a bio-hormonal pump system consisting of insulin and glucagon pumps. Perioperative tight glycemic control using a bedside artificial pancreas with the closed-loop system has also proved safe and effective for not only avoiding hypoglycemia, but also for reducing blood glucose level variability resulting in good surgical outcomes. We hope that a more sophisticated artificial pancreas with closed-loop system will now be taken up for routine use worldwide, providing enormous relief for patients suffering from uncontrolled hyperglycemia, hypoglycemia, and/or variability in blood glucose concentrations.
Parker, Lewan; Shaw, Christopher S.; Stepto, Nigel K.; Levinger, Itamar
Physical inactivity, excess energy consumption, and obesity are associated with elevated systemic oxidative stress and the sustained activation of redox-sensitive stress-activated protein kinase (SAPK) and mitogen-activated protein kinase signaling pathways. Sustained SAPK activation leads to aberrant insulin signaling, impaired glycemic control, and the development and progression of cardiometabolic disease. Paradoxically, acute exercise transiently increases oxidative stress and SAPK signaling, yet postexercise glycemic control and skeletal muscle function are enhanced. Furthermore, regular exercise leads to the upregulation of antioxidant defense, which likely assists in the mitigation of chronic oxidative stress-associated disease. In this review, we explore the complex spatiotemporal interplay between exercise, oxidative stress, and glycemic control, and highlight exercise-induced reactive oxygen species and redox-sensitive protein signaling as important regulators of glucose homeostasis. PMID:28529499
Full Text Available BACKGROUND: Diabetes mellitus (DM is a very well-known risk factor for development of atherosclerosis, and it has been hypothesized that poor glycemic control and hyperglycemia plays a major role in this process. In the current study, we aimed to evaluate the associates of poor glycemic control in Iranian patients who have already undergone coronary artery bypass grafting (CABG, with especial focus on the inhabitation of infectious agents within the coronary arterial wall. METHODS: In January 2010, 52 consecutive patients with type 2 DM who undergone CABG at the Department of Cardiovascular Surgery of Baqiyatallah University of Medical Sciences (Tehran, Iran were included into this cross-sectional study and biopsy specimens from their coronary plaques were taken and analyzed by polymerase chain reaction (PCR methods for detecting Helicobacter species, cytomegalovirus (CMV and Chlamydia pneumoniae, and their potential relation to the glycemic control status in these patients. RESULTS: Compared to that in diabetic patients with mean fasting blood sugar (FBS levels FBS < 126, atherosclerotic lesions in type 2 diabetic patients with poor glycemic control (FBS > 126 were significantly more likely to be positive for CMV PCR test (41% vs. 9%, respectively; P = 0.05. In laboratorial test results, mean triglyceride level was significantly higher among patients of poor glycemic control (168 ± 89 vs. 222 ± 125 mg/dl, respectively; P = 0.033. Hypertension was also significantly more prevalent in this population (73% vs. 36%, respectively; P = 0.034. CONCLUSION: Type 2 diabetic patients with poor glycemic control can be at higher risk for developing CMV infection in their coronary arterial wall, which can promote atherosclerosis formation process in this patient population. According to the findings of this study, we recommend better control of serum glucose levels in type 2 diabetic patients to prevent formation/progression of atherosclerosis. Keywords
Bawadi, Hiba Ahmad; Ammari, Fawaz; Abu-Jamous, Dima; Khader, Yousef Saleh; Bataineh, Safa'a; Tayyem, Reema Fayez
Poor glycemic control has been shown to play a major role in the development and progression of diabetes complications. This cross-sectional study tested the hypothesis that food insecurity may deteriorate glycemic control in patients with type 2 diabetes. The objectives of this study were to assess the prevalence of food insecurity among type 2 diabetics in a major hospital that serves the area of northern Jordan, and to investigate its relation to glycemic control. A sample of 843 patients diagnosed with type 2 diabetes participated in the study. Socioeconomic and health data were collected by interview-based questionnaire. Weight and height were measured by a trained nutritionist. Dietary assessment was done using food frequency questionnaire. Dietary data were processed using food processor software. Food insecurity was assessed by the short form of the U.S. food security survey module. Glycemic control was assessed by measuring glycosyated hemoglobin (HbA1c). Statistical procedures used to analyze the data were chi-square, and post-hoc analysis of variance. About 22% of the tested sample were food secure (FS); 51% were moderately food insecure (MFIS); and 27% were severely food insecure (SFIS). Higher BMI was associated with SFIS patients. After adjusting for age, gender, income, education, and duration of diabetes, body mass index, and caloric consumption; moderate and severe food insecurity were associated with poor glycemic control (p = 0.04). food insecurity may be associated with glycemic control deterioration in patients with type 2 diabetes. Copyright © 2011 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
Full Text Available Abstract Background The major metabolic complications of obesity and type 2 diabetes may be prevented and managed with dietary modification. The use of sweeteners that provide little or no calories may help to achieve this objective. Methods We did a systematic review and network meta-analysis of the comparative effectiveness of sweetener additives using Bayesian techniques. MEDLINE, EMBASE, CENTRAL and CAB Global were searched to January 2011. Randomized trials comparing sweeteners in obese, diabetic, and healthy populations were selected. Outcomes of interest included weight change, energy intake, lipids, glycated hemoglobin, markers of insulin resistance and glycemic response. Evidence-based items potentially indicating risk of bias were assessed. Results Of 3,666 citations, we identified 53 eligible randomized controlled trials with 1,126 participants. In diabetic participants, fructose reduced 2-hour blood glucose concentrations by 4.81 mmol/L (95% CI 3.29, 6.34 compared to glucose. Two-hour blood glucose concentration data comparing hypocaloric sweeteners to sucrose or high fructose corn syrup were inconclusive. Based on two ≤10-week trials, we found that non-caloric sweeteners reduced energy intake compared to the sucrose groups by approximately 250-500 kcal/day (95% CI 153, 806. One trial found that participants in the non-caloric sweetener group had a decrease in body mass index compared to an increase in body mass index in the sucrose group (-0.40 vs 0.50 kg/m2, and -1.00 vs 1.60 kg/m2, respectively. No randomized controlled trials showed that high fructose corn syrup or fructose increased levels of cholesterol relative to other sweeteners. Conclusions Considering the public health importance of obesity and its consequences; the clearly relevant role of diet in the pathogenesis and maintenance of obesity; and the billions of dollars spent on non-caloric sweeteners, little high-quality clinical research has been done. Studies are
Full Text Available Abstract Background Diabetes is a common disease with self-management a key aspect of care. Large prospective trials have shown that maintaining glycated hemoglobin less than 7% greatly reduces complications but translating this level of control into everyday clinical practice can be difficult. Intensive improvement programs are successful in attaining control in patients with type 2 diabetes, however, many patients experience glycemic relapse once returned to routine care. This early relapse is, in part, due to decreased adherence in self-management behaviors. Objective This paper describes the design of the Glycemic Relapse Prevention study. The purpose of this study is to determine the optimal frequency of maintenance intervention needed to prevent glycemic relapse. The primary endpoint is glycemic relapse, which is defined as glycated hemoglobin greater than 8% and an increase of 1% from baseline. Methods The intervention consists of telephonic contact by a nurse practitioner with a referral to a dietitian if indicated. This intervention was designed to provide early identification of self-care problems, understanding the rationale behind the self-care lapse and problem solve to find a negotiated solution. A total of 164 patients were randomized to routine care (least intensive, routine care with phone contact every three months (moderate intensity or routine care with phone contact every month (most intensive. Conclusion The baseline patient characteristics are similar across the treatment arms. Intervention fidelity analysis showed excellent reproducibility. This study will provide insight into the important but poorly understood area of glycemic relapse prevention.
Solomon, Thomas P. J.; Malin, Steven K.; Karstoft, Kristian
OBJECTIVE: Cardiorespiratory fitness (VO2max) is associated with glycemic control, yet the relationship between VO2max and the underlying determinants of glycemic control is less clear. Our aim was to determine whether VO2max is associated with insulin sensitivity, insulin secretion, and the disp...... fitness and compromised pancreatic β-cell compensation across the entire glucose tolerance continuum provides additional evidence highlighting the importance of fitness in protection against the onset of a fundamental pathophysiological event that leads to type 2 diabetes....
Choi, Tammie S T; Davidson, Zoe E; Walker, Karen Z; Lee, Jia Hwa; Palermo, Claire
The purpose of this study is to systematically review evidence in English and Chinese publications to determine the size of glycemic effect of different diabetes education approaches for Chinese patients. CINAHL Plus, Embase, Ovid Medline, Scopus and the China National Knowledge Infrastructure database were searched. Studies were included if they were randomised controlled trials with a detailed description of education approach, with more than 50 Chinese-adult participants, reporting actual glycemic outcome and with at least 3-month follow-up. Data was systematically extracted and cross-checked by the authors. Methodological quality was assessed. Fifty-three studies, including five English and 48 Chinese publications, were included. The overall weighted mean difference (WMD) in glycated haemoglobin (HbA1c) was -1.19% (-13mmol/mol). Ongoing regular education was most-commonly employed, with a reported WMD of -2.02% (-22mmol/mol). Glycemic control was further enhanced in studies using information reinforcement strategies. Diabetes education in any format generates glycemic improvement for Chinese patients, but is particularly effective when an ongoing regular education is employed. Innovative strategies aligned with cultural concepts, such as employing patient examination to reinforce diabetes management knowledge and/or involving family in patient care deserve further trial to determine whether they enhance glycemic control in this group. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Rotberg, Britt; Junqueira, Yasmine; Gosdin, Lucas; Mejia, Roberto; Umpierrez, Guillermo E.
Background: The U.S. Latino population exhibits poorer glycemic control than the white population, leading to more frequent health complications and greater disease severity. Social support has been shown a significant factor in health and well-being. Purpose: To determine the association between glycemic control and social support in patients…
Schoenaker, D.A.J.M.; Simon, D.; Chaturvedi, N.; Fuller, J.H.; Soedamah-Muthu, S.S.
Context: Glycemic targets and the benefit of intensive glucose control are currently under debate because intensive glycemic control has been suggested to have negative effects on mortality risk in type 2 diabetes patients. Objective: We examined the association between glycated hemoglobin (HbA1c)
Tsiouli, Elina; Alexopoulos, Evangelos C; Stefanaki, Charikleia; Darviri, Christina; Chrousos, George P
To investigate the way that family stress influences glycemic control among patients with diabetes who are younger than 18 years of age. PubMed and Scopus were searched for relevant studies published since 1990 using the following key words: diabetes type 1, glycemic control, family stress, family conflict, and family function. In total, 1478 papers were identified in the initial search. The final review included 6 cohort studies, 3 cross-sectional studies, and 1 qualitative review in which family stress was assessed using specific diabetes-related conflict measurement instruments, and glycemic control was evaluated by glycosylated hemoglobin measurement. In most studies family stress was negatively correlated with patients' glycemic control. Family function was strongly related to patients' glycemic control, while family conflict was adversely associated with glycemic control. Families of low socioeconomic status, those of adolescents with diabetes, and those of single parents were more prone to diabetes-related stress and thus more susceptible to worse glycemic control. Therapeutic psychological interventions and educational programs can help alleviate family diabetes-related stress and will likely improve glycemic control.
Lemkes, B. A.; Bahler, L.; Kamphuisen, P. W.; Stroobants, A. K.; van den Dool, E. J.; Hoekstra, J. B.; Nieuwland, R.; Gerdes, V. E.; Holleman, F.
Background: Low-dose aspirin seems to offer no benefit in the primary prevention of cardiovascular disease in type 2 diabetes mellitus (DM2). The anti-platelet effect may be diminished by poor glycemic control or inadequate dosing of aspirin. Objectives: To study the effects of both glycemic control
Farsaei, Shadi; Karimzadeh, Iman; Elyasi, Sepideh; Hatamkhani, Shima; Khalili, Hossein
Hyperglycemia is one of the most frequent metabolic complications in hospitalized patients. Increased risk of infection following hyperglycemia has been reported in hospitalized patients and infections may also cause insulin resistance which complicates the control of blood glucose level. In this study the impact of the clinical pharmacist interventions on the glycemic control in patients admitted to infectious diseases ward has been evaluated. We conducted a prospective, pre-post interventional study among patients with hyperglycemia. The clinical pharmacist-led multidisciplinary team managed the glycemic profile of patients according to an established insulin protocol commonly used in internal wards. Clinical pharmacists reviewed patients' medical charts for proper insulin administration, evaluated nurses' technique for insulin injection and blood glucose measurement, and educated patients about symptoms of hypoglycemia and the importance of adherence to different aspects of their glycemic management. The percentage of controlled random blood sugar increased from 13.8% in the pre-intervention to 22.3% in the post-intervention group (p value percentage of controlled fasting blood sugars in the post-intervention group was non-significantly higher than in the pre-intervention group. Pharmacists and additional health care providers from other departments such as nursing and dietary departments need to be devoted to glycemic control service. Collaborative practice agreement between physicians is necessary to promote this service and help to increase the use of such services in different settings for diabetes control.
Marques, Rosana de Morais Borges; Fornés, Nélida Schmid; Stringhini, Maria Luiza Ferreira
To identify the association of socioeconomic, demographic, nutritional and of physical activity factors in the glycemic control of adolescents with T1DM. Sectional study of 71 adolescents with type 1 diabetes. Socioeconomic, demographic and anthropometric data were obtained. The glycemic control was classified by the index of glycated hemoglobin (A1C). Four 24-hours recalls of food consumption and physical activity were applied. The A1C was inadequate for the majority of the adolescents. The low educational level of the caregivers influenced the inadequate glycemic control. Patients with lower insulin dose presented better glycemic control. The food consumption was high of fat and poor of carbohydrate. Most of the patients were sedentary. Factors related to education, insulin and food consumption influenced the glycemic control.
Kwon, Steve; Thompson, Rachel; Dellinger, Patchen; Yanez, David; Farrohki, Ellen; Flum, David
Objective To determine the relationship of perioperative hyperglycemia and insulin administration on outcomes in elective colon/rectal and bariatric operations. Background There is limited evidence to characterize the impact of perioperative hyperglycemia and insulin on adverse outcomes in patients, with and without diabetes, undergoing general surgical procedures. Methods The Surgical Care and Outcomes Assessment Program is a Washington State quality improvement benchmarking-based initiative. We evaluated the relationship of perioperative hyperglycemia (>180 mg/dL) and insulin administration on mortality, reoperative interventions, and infections for patients undergoing elective colorectal and bariatric surgery at 47 participating hospitals between fourth quarter of 2005 and fourth quarter of 2010. Results Of the 11,633 patients (55.4 ± 15.3 years; 65.7% women) with a serum glucose determination on the day of surgery, postoperative day 1, or postoperative day 2, 29.1% of patients were hyperglycemic. After controlling for clinical factors, those with hyperglycemia had a significantly increased risk of infection [odds ratio (OR) 2.0; 95% confidence interval (CI), 1.63–2.44], reoperative interventions (OR, 1.8; 95% CI, 1.41–2.3), and death (OR, 2.71; 95% CI, 1.72–4.28). Increased risk of poor outcomes was observed both for patients with and without diabetes. Those with hyperglycemia on the day of surgery who received insulin had no significant increase in infections (OR, 1.01; 95% CI, 0.72–1.42), reoperative interventions (OR, 1.29; 95% CI, 0.89–1.89), or deaths (OR, 1.21; 95% CI, 0.61–2.42). A dose-effect relationship was found between the effectiveness of insulin-related glucose control (worst 180–250 mg/dL, best adverse outcomes. Conclusions Perioperative hyperglycemia was associated with adverse outcomes in general surgery patients with and without diabetes. However, patients with hyperglycemia who received insulin were at no greater risk than
van Dijk, Jan-Willem; Eijsvogels, Thijs M; Nyakayiru, Jean; Schreuder, Tim H A; Hopman, Maria T; Thijssen, Dick H; van Loon, Luc J C
Despite its general benefits for health, exercise complicates the maintenance of stable blood glucose concentrations in individuals with type 1 diabetes. The aim of the current study was to examine changes in food intake, insulin administration, and 24-h glycemic control in response to consecutive days with prolonged walking exercise (∼8h daily) in individuals with type 1 diabetes. Ten individuals with type 1 diabetes participating in the worlds' largest walking event were recruited for this observational study. Simultaneous measurements of 24-h glycemic control (continuous glucose monitoring), insulin administration and food intake were performed during a non-walking day (control) and during three subsequent days with prolonged walking exercise (daily distance 40 or 50km). Despite an increase in daily energy (31±18%; p10 mmol/L) and hypoglycemia (blood glucose 0.05 for all variables). The prolonged walking exercise was associated with a modest increase in glycemic variability compared with the control day (pexercise allows for profound reductions in daily insulin administration in persons with type 1 diabetes, despite large increments in energy and carbohydrate intake. When taking such adjustments into account, prolonged moderate-intensity exercise does not necessarily impair 24-h glycemic control. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Le, Hung; Wong, Sophia; Iftikar, Tracy; Keenan, Hillary; King, George L.; Hsu, William C.
Purpose The purpose of this study is to examine the effectiveness of a culturally specific pilot clinic for Asian Americans (AA) in reaching glycemic target and to characterize factors affecting the attainment of glycemic control in comparison with white counterparts. Methods This electronic health record review included all new AA patients with type 2 diabetes (n = 109) in a culturally specific program and a randomly selected sample of new white patients with type 2 diabetes (n = 218) in the adult clinic within the same time period and diabetes center. Results AA and whites had a comparable proportion of patients with A1C ≤7% (32.1%, 34.9%; P = .621) at baseline and after 12 months of care (48.6%, 56.0%; P = .210), with a similar A1C decline (−0.9% ± 1.6%, −0.8% ± 1.7%, P = .710) by 12 months. Factors associated with the lack of success in reaching target in AA but not in whites included older age, lower educational attainment, less likelihood of having health insurance, and a need for more educational visits. The percentage of AA reaching A1C ≤7%, as compared to whites, worsened among those with highest initial A1C when stratified by ascending quartiles (96.7% vs 85.2%, P = .101; 61.9% vs 58.9%, P = .813; 24.0% vs 37.7%, P = .230; 15.2% vs 35.4%, P = .044). Conclusion While a culturally specific diabetes program in a specialty setting achieved a similar glycemic outcome for AA compared with whites, reasons for not reaching glycemic target differed. The findings suggest that the elimination of diabetes disparities requires not only culturally and linguistically specific programs, but must also identify and address the socio-environmental differences unique to each population. PMID:23771841
Full Text Available Background and aims. Thyroid disorders are more frequently met in patients with diabetes mellitus than in general population. Thyroid hormones increase glycemia by several mechanisms, but the effect of antithyroid treatment on glucose control in type 1 diabetes mellitus (T1DM cases is not well studied. The aim of our work was to analyze the evolution of glycemic control of T1DM patients submitted to specific therapy when hyperthyroidism was diagnosed. Material and method. The study group comprised by 37 patients, 35 women (94.6% and 2 men (5.4%, known as having T1DM and diagnosed with hyperthyroidism during a 10-years interval. They were treated with antithyroid medication and reassessed after 6 months regarding thyroid function and glycemic control. Results. In the whole group, there was a significant decrease in mean HbA1c level (with 0.41% and a significant increase in the percentage of patients being in the glycemic target (from 10.8% to 35.1%. The better glycemic control was obtained with a lower mean insulin dose. Patients who became euthyroid had a better evolution regarding glucose control in comparison to those who remained hyperthyroid. Changes in other cardiovascular risk factors were noted: systolic blood pressure decreased; diastolic blood pressure, HDL cholesterol, LDL cholesterol, non-HDL cholesterol, triglycerides and body weight increased. TSH and HbA1c values were inversely correlated. Conclusions. The therapeutic control of excessive thyroid function significantly contributes to the improvement of glycemic control in patients with T1DM and induces changes in the cardiovascular risk factors profile.
Natarajan, Sundar; Clyburn, Ernest B.; Brown, Ronald T.
Investigated the distribution of diabetic patients' stages of change to follow an exercise regimen, examining whether later stages of change were associated with better glycemic control. Data on participants from a primary care clinic (who were predominantly black, female, and indigent) indicated that over half of were in pre-contemplation,…
van Dijk, J.W.; Manders, R.J.F.; Canfora, E.E.; van Mechelen, W.; Hartgens, F.; Stehouwer, C.D.A.; van Loon, L.J.C.
Purpose: We assessed the effect of a single bout of moderate-intensity exercise on subsequent 24-h glycemic control in 60 type 2 diabetes patients. Moreover, we examined whether individual responses to exercise were related to subjects' baseline characteristics, including age, body mass index,
Katsuhiro, Miyajima; Hui Teoh, Soon; Yamashiro, Hideaki; Shinohara, Masami; Fatchiyah, Fatchiyah; Ohta, Takeshi; Yamada, Takahisa
Impaired diabetic wound healing is an important issue in diabetic complications. The present study aims to evaluate the protective effect on glycemic control against impaired diabetic wound healing using a diabetic rat model. We investigated the wound healing process and effect on the impaired wound repair by glycemic control in the Spontaneously Diabetic Torii (SDT) fatty rat, which is a new animal model of obese type 2 diabetes and may be a good model for study impaired wound healing. Male SDT fatty rats at 15 weeks of age were administered orally with sodium glucose co-transporter (SGLT) 2 inhibitor for 3 weeks. Wounds were induced at 2 weeks after SGLT 2 inhibitor treatment, and the wound areas were periodically examined in morphological and histological analyses. The SDT fatty rats showed a delayed wound healing as compared with the normal rats, but a glycemic control improved the impaired wound healing. In histological analysis in the skin of SDT fatty rats showed severe infiltration of inflammatory cell, hemorrhage and many bacterial masses in the remaining and slight fibrosis of crust on skin tissue . Thought that this results skin performance to be a delay of crust formation and regeneration of epithelium; however, these findings were ameliorated in the SGLT 2 inhibitor treated group. Glycemic control is effective for treatment in diabetic wounds and the SDT fatty rat may be useful to investigate pathophysiological changes in impaired diabetic wound healing.
Erwin P. Soenggono
Conclusion Glycemic control in T1DM children and adolescents was significantly improved 3 months after attending diabetic camp compared to that before attending camp. According to subjects’ self-assessment by PedsQL questionnaire, no subjects indicated a poor quality of life for the duration of their illness. [Paediatr Indones. 2011;51:294-7].
BeLue, Rhonda; Ndiaye, Khadidiatou; NDao, Fatou; Ba, Fatou Niass Niang; Diaw, Mor
Background: Sub-Saharan Africa (SSA) including Senegal is faced with a significant and increasing burden of type 2 diabetes. However, little information is available about diabetes management among Senegalese diabetics. Purpose: The current study aims to describe the level of glycemic control among a convenience sample of diabetics who receive…
Dijk, J.W.; Eijsvogels, T.M.H.; Nyakayiru, J.D.O.A.; Schreuder, T.H.A.; Hopman, M.T.E.; Thijssen, D.H.J.; Loon, L.J. van
AIMS: Despite its general benefits for health, exercise complicates the maintenance of stable blood glucose concentrations in individuals with type 1 diabetes. The aim of the current study was to examine changes in food intake, insulin administration, and 24-h glycemic control in response to
Janket, S-J; Wightman, A; Baird, A E; Van Dyke, T E; Jones, J A
Previous analyses regarding effects of periodontal treatment on glycemic control included studies where causal association might not be assumed, or the results were reported non-quantitatively. We initiated this meta-analysis of 10 intervention studies to quantify the effects of periodontal treatment on HbA1c level among diabetic patients, to explore possible causes for the discrepant reports, and to make recommendations for future studies. Data sources were MEDLINE (January, 1980, to January, 2005), the EBMR, Cochrane Register, and bibliographies of the published articles. Three investigators extracted data regarding intervention, outcomes, and effect size. A total of 456 patients was included in this analysis, with periodontal treatment as predictor and the actual change in hemoglobin A1c level as the outcome. The weighted average decrease in actual HbA1c level was 0.38% for all studies, 0.66% when restricted to type 2 diabetic patients, and 0.71% if antibiotics were given to them. However, none was statistically significant.
Luís B. Sardinha
Full Text Available Background: Sedentary behavior has been considered an independent risk factor for type-2 diabetes (T2D, with a negative impact on several physiological outcomes, whereas breaks in sedentary time (BST have been proposed as a viable solution to mitigate some of these effects. However, little is known about the independent associations of sedentary pursuits, physical activity, and cardiorespiratory fitness (CRF variables with glycemic control. We investigated the independent associations of total sedentary time, BST, moderate-to-vigorous physical activity (MVPA, and CRF with glycemic outcomes in patients with T2D.Methods: Total sedentary time, BST, and MVPA were assessed in 66 participants (29 women with T2D, using accelerometry. Glucose and insulin were measured during a mixed meal tolerance test, with the respective calculations of HOMA-IR and Matsuda index. Glycated hemoglobin (HbA1c was also analyzed. CRF was measured in a maximal treadmill test with breath-by-breath gases analysis. Multiple regressions were used for data analysis.Results: Regardless of CRF, total sedentary time was positively associated with HbA1c (β = 0.25, p = 0.044. Adjusting for MVPA, total sedentary time was related to fasting glucose (β = 0.32, p = 0.037. No associations between total sedentary time and the remaining glycemic outcomes, after adjusting for MVPA. BST had favorable associations with HOMA-IR (β = −0.28, p = 0.047 and fasting glucose (β = −0.25, p = 0.046, when adjusted for MVPA, and with HOMA-IR (β = −0.25, p = 0.036, Matsuda index (β = 0.26, p = 0.036, and fasting glucose (β = −0.22, p = 0.038, following adjustment for CRF. When adjusting for total sedentary time, only CRF yielded favorable associations with HOMA-IR (β = −0.29, p = 0.039, fasting glucose (β = −0.32, p = 0.012, and glucose at 120-min (β = −0.26, p = 0.035, and no associations were found for MVPA with none of the metabolic outcomes.Conclusion: The results from this
Desimone, Marisa E; Blank, Gary E; Virji, Mohamed; Donihi, Amy; DiNardo, Monica; Simak, Deborah M; Buranosky, Raquel; Korytkowski, Mary T
To investigate the effectiveness of an Inpatient Diabetes Management Program (IDMP) on physician knowledge and inpatient glycemic control. Residents assigned to General Internal Medicine inpatient services were randomized to receive the IDMP (IDMP group) or usual education only (non-IDMP group). Both groups received an overview of inpatient diabetes management in conjunction with reminders of existing order sets on the hospital Web site. The IDMP group received print copies of the program and access to an electronic version for a personal digital assistant (PDA). A Diabetes Knowledge Test (DKT) was administered at baseline and at the end of the 1-month rotation. The frequency of hyperglycemia among patients under surveillance by each group was compared by using capillary blood glucose values and a dispersion index of glycemic variability. IDMP users completed a questionnaire related to the program. Twenty-two residents participated (11 in the IDMP group and 11 in the non-IDMP group). Overall Diabetes Knowledge Test scores improved in both groups (IDMP: 69% ± 1.7% versus 83% ± 2.1%, P = .003; non-IDMP: 76% ± 1.2% versus 84% ± 1.4%, P = .02). The percentage of correct responses for management of corticosteroid-associated hyperglycemia (P = .004) and preoperative glycemic management (P = .006) improved in only the IDMP group. The frequency of hyperglycemia (blood glucose level >180 mg/dL) and the dispersion index (5.3 ± 7.6 versus 3.7 ± 5.6; P = .2) were similar between the 2 groups. An IDMP was effective at improving physician knowledge for managing hyperglycemia in hospitalized patients treated with corticosteroids or in preparation for surgical procedures. Educational programs directed at improving overall health care provider knowledge for inpatient glycemic management may be beneficial; however, improvements in knowledge do not necessarily result in improved glycemic outcomes.
Taylor, G W; Burt, B A; Becker, M P; Genco, R J; Shlossman, M
This study tested the hypothesis that the risk for alveolar bone loss is greater, and bone loss progression more severe, for subjects with poorly controlled (PC) type 2 diabetes mellitus (type 2 DM) compared to those without type 2 DM or with better controlled (BC) type 2 DM. The PC group had glycosylated hemoglobin (HbA1) > or = 9%; the BC group had HbA1 or = 75% were used to identify the worst bone score (WBS) in the dentition. Change in worst bone score at follow-up, the outcome, was specified on a 4-category ordinal scale as no change, or a 1-, 2-, 3-, or 4-category increase over baseline WBS (WBS1). Poorly controlled diabetes, age, calculus, time to follow-up examination, and WBS1 were statistically significant explanatory variables in ordinal logistic regression models. Poorly controlled type 2 DM was positively associated with greater risk for a change in bone score (compared to subjects without type 2 DM) when the covariates were included in the model. The cumulative odds ratio (COR) at each threshold of the ordered response was 11.4 (95% CI = 2.5, 53.3). When contrasted with subjects with BC type 2 DM, the COR for those in the PC group was 5.3 (95% CI = 0.8, 53.3). The COR for subjects with BC type 2 DM was 2.2 (95% CI = 0.7, 6.5), when contrasted to those without type 2 DM. These results suggest that poorer glycemic control leads to both an increased risk for alveolar bone loss and more severe progression over those without type 2 DM, and that there may be a gradient, with the risk for bone loss progression for those with better controlled type 2 DM intermediate to the other 2 groups.
Madsen, Helen Nordahl; Ekelund, Charlotte K; Tørring, Niels
Objective. To determine the influence of type 1 diabetes mellitus (T1DM) on the first trimester serum markers of fetal aneuploidy; pregnancy-associated plasma protein-A (PAPP-A) and free beta subunit of human chorionic gonadotropin (free β-hCG) and to evaluate the influence of glycemic control...... on these parameters in the pregnant diabetic women. Design. Retrospective study. Setting. Data were extracted from electronic obstetric and laboratory databases at two Danish University Hospitals. Population. Based on 36 415 pregnancies without T1DM (non-T1DM) and 331 pregnancies with T1DM; β-hCG and PAPP-A were...... across the T1DM and non-T1DM groups, respectively. Additionally, the relationship between PAPP-A MoM and HgbA1C was examined in 348 T1DM pregnancies by Spearman's rank correlation. Main outcome measures. Difference in biochemical marker levels between T1DM and non-T1DM. Results. PAPP-A was 0.86 MoM in T1...
Madsen, Helen Nordahl; Ekelund, Charlotte Kvist; Tørring, Niels
Objective: To determine the influence of type 1 diabetes mellitus (T1DM) on the first trimester serum markers of fetal aneuploidy; pregnancy-associated plasma protein-A (PAPP-A) and free beta subunit of human chorionic gonadotropin (free β-hCG) and to evaluate the influence of glycemic control...... on these parameters in the pregnant diabetic women. Design: Retrospective study. Setting: Data were extracted from electronic obstetric and laboratory databases at two Danish University Hospitals. Population: Based on 36,415 pregnancies without T1DM (non-T1DM) and 331 pregnancies with T1DM; β-hCG and PAPP-A were...... across the T1DM and non-T1DM groups, respectively. Additionally, the relation between PAPP-A MoM and HgbA1C was examined in 348 T1DM pregnancies by Spearman’s rank correlation. Main outcome measure: Difference in biochemical marker levels between T1DM and non-T1DM. Results: PAPP-A was 0.86 MoM in T1DM...
Standl, Eberhard; Erbach, Michael; Schnell, Oliver
Some 30% of contemporary cardiology patients have coexisting known diabetes, and another 40% have either undiagnosed diabetes or prediabetes. There is still no final conclusive evidence of cardiovascular benefit by good glycemic control in type 2 diabetes, although studies like the United Kingdom Prospective Diabetes Study (UKPDS) and the Prospective Pioglitazone Clinical Trial in Macrovascular Events, and meta-analyses based on these and other randomized controlled trials of blood glucose-lo...
Cynthia Susan Mathew
Full Text Available Context: Type 2 diabetes mellitus doubles the odds of suffering from depressive illness. Co-morbid depression is associated with poorer outcomes in diabetes mellitus in terms of glycemic control, medication adherence, quality of life, physical activity, and blood pressure control. Aim: The present study aims to estimate the prevalence of depression among a consecutive group of patients with type 2 diabetes and assess its impact on glycemic and blood pressure control. Setting: Outpatient department of the endocrinology department of a university affiliated teaching hospital in north India. Subjects: Consecutive adult patients (18-65 years with type 2 diabetes mellitus of over 5-year duration with no prior history of psychiatric illnesses or intake of anti-depressants. Materials and Methods: A semi-structured questionnaire was used for demographic data, HbA1c was obtained to assess glycemic control, and blood pressure was recorded twice during patient interview to assess blood pressure control. Depression was assessed with the Major Depression Inventory and scores obtained were classified as consistent with mild, moderate and severe depression. Data was analyzed with SPSS v16, and multiple logistical regression test was done to compare the effect of depression on glycemic control after adjusting for age and sex. Results: Of the 80 patients interviewed, 31 (38.8% had depressive symptoms. Among them 20 (25% had mild depression, 10 (12.5% had moderate depression, and 1 (1.3% had severe depression. Conclusions: Over one third of patients with type 2 diabetes mellitus of over 5-year duration had depressive symptoms. The presence of depressive symptoms was associated with a significant worsening of glycemic control.
Al Khalifa, Khalid; Al Ansari, Ahmed; Showaiter, May
Obesity and its associated metabolic disorders are strongly linked to both morbidity and mortality. Sleeve gastrectomy (SG) has been established as an effective means of weight loss for obese patients as well as a treatment for type 2 diabetes mellitus (T2DM). This study was designed to examine the short- and midterm outcomes of patients who underwent SG in a Middle Eastern Center of Excellence, a military training teaching hospital. The clinical outcomes of 59 patients with impaired glucose tolerance and T2DM who underwent SG between 2011 and 2014 with at least one and up to four years of follow-up were studied. Data were collected and compared, including the pre- and post-surgery measures of weight, body mass index, glycosylated hemoglobin (HbA1c), and fasting blood glucose. Complete remission was defined as a fasting blood glucose level ≤100 mg/dL, an HbA1c ≤6 mg/dL, without use of antidiabetic medications. All patients showed significant reduction in body mass index following SG. Tight glycemic control was achieved among both diabetic and prediabetic patients. In this study, 88.14 per cent of all patients (diabetic and prediabetic) achieved complete resolution from their impaired glucose tolerance and T2DM and maintained normal blood glucose and HbA1C levels from one to four years postoperatively. SG is beneficial both in terms of short- and midterm weight loss and glucose control in both diabetic and prediabetic obese patients.
Eray, Şafak; Uçar, Halit Necmi; Çetinkaya, Fatma; Eren, Erdal; Vural, Pınar
Type 1 diabetes mellitus (T1DM) is a chronic disease which ranks third in children under age 16 years. Expressed emotion (EE) is a term that indicates a specific family climate including lack of emotional support (LES), irritability, and emotional over-involvement. It is known that the family environment is highly important for glycemic control in diabetic adolescents. In this study, the relationship between perceived EE and glycemic control in adolescents diagnosed with T1DM not accompanied by psychopathology were investigated. The study included 49 adolescents with T1DM and 50 adolescents as a control group. Adolescents with psychopathology and intellectual disability were excluded from the study. Perceived EE was measured by the Shortened Level of Expressed Emotion Scale (SLEES) and blood sugar regulation was assessed by HbA1c levels. The adolescents with T1DM showed a significant difference in perceived EE (p=0.020) and LES (p=0.014) when compared with the control group. When diabetic adolescents were compared among themselves, the diabetic adolescents with poor glycemic control perceived greater EE (p=0.033) and less emotional support (p=0.049). In regression analyses, the predictive power of mother's educational level, the employment status of mothers and the subscale "LES" of SLEES combined to explain HbA1c level was determined to be 37.8%. The strong relationship between perceived EE and glycemic control showed us that perceived EE can hinder treatment compliance without causing psychopathology. For this reason, it is recommended that not only patients with psychopathology, but all diabetic adolescents receive psychosocial support and family interventions.
Full Text Available INTRODUCTION: Oxidative stress due to enhanced free - radical generation and/or a decrease in antioxidant defense mechanisms has been implicated in the pathogenesis of diabetic neuropathy. This study was conducted to study the impact of glycemic control on oxidative stress and antioxidant balance in diab etic neuropathy. METHOD S : fifty patients with diabetic neuropathy and fifty age matched healthy controls were included in the study. Glycosylated hemoglobin (HbA1c was estimated to assess the severity of diabetes and the glycemic control. Serum malondiaal dehyde (MDA levels were assessed as a marker of lipid peroxidation and hence oxidative stress. Superoxide Dismutase (SOD levels were assessed for antioxidant status. RESULTS: Significant positive correlation was found between serum MDA levels and hba1c ( r = 0.276, p < 0.0001 in patients with diabetic neuropathy. There was statistically significant reduction in the Glutathione peroxidase levels. Further, SOD levels were inversely correlated with HbA1c (r= - 0.603, p<0.0001 levels. CONCLUSION AND SUMMARY: oxidative stress is greatly increased in patients suffering from diabetic neuropathy and is inversely related to glycemic control. This may be due to depressed antioxidant enzyme levels and may also be responsible for further depletion of antioxidant enzym e GPx. This worsens the oxidative stress and creates a vicious cycle of imbalance of free radical generation and deficit of antioxidant status in these patients which may lead to nervous system damage causing diabetic neuropathy. A good glycemic control is essential for prevention of diabetic neuropathy.
Bihan, Hélène; Laurent, Silvana; Sass, Catherine; Nguyen, Gérard; Huot, Caroline; Moulin, Jean Jacques; Guegen, René; Le Toumelin, Philippe; Le Clésiau, Hervé; La Rosa, Emilio; Reach, Gérard; Cohen, Régis
Previous studies have related poor glycemic control and/or some diabetes complications to low socioeconomic status. Some aspects of socioeconomic status have not been assessed in these studies. In the present study, we used an individual index of deprivation, the Evaluation de la Précarité et des Inégalités de santé dans les Centres d'Examens de Santé (Evaluation of Precarity and Inequalities in Health Examination Centers [EPICES]) score, to determine the relationship among glycemic control, diabetes complications, and individual conditions of deprivation. We conducted a cross-sectional prevalence study in 135 consecutive diabetic patients (age 59.41 +/- 13.2 years [mean +/- SD]) admitted in the hospitalization unit of a French endocrine department. Individual deprivation was assessed by the EPICES score, calculated from 11 socioeconomic questions. Glycemic control, lipid levels, blood pressure, retinopathy, neuropathy, and nephropathy were assessed. HbA(1c) level was significantly correlated with the EPICES score (r = 0.366, P < 0.001). The more deprived patients were more likely than the less deprived patients to have poor glycemic control (beta = 1.984 [SE 0.477], P < 0.001), neuropathy (odds ratio 2.39 [95% CI 1.05-5.43], P = 0.037), retinopathy (3.66 [1.39-9.64], P = 0.009), and being less often admitted for 1-day hospitalization (0.32 [0.14-0.74], P = 0.008). No significant relationship was observed with either nephropathy or cardiovascular risk factors. Deprivation status is associated with poor metabolic control and more frequent microvascular complications, i.e., retinopathy and neuropathy. The medical and economic burden of deprived patients is high.
Santos, Fábio R M; Sigulem, Daniel; Areco, Kelsy C N; Gabbay, Monica A L; Dib, Sergio A; Bernardo, Viviane
This study investigated the association of hope and its factors with depression and glycemic control in adolescents and young adults with type 1 diabetes. A total of 113 patients were invited to participate. Significant negative correlations were found between hope and HbA1c and also between hope and depression. Hope showed a significant association with HbA1c and depression in the stepwise regression model. Among the hope factors, "inner positive expectancy" was significantly associated with HbA1c and depression. This study supports that hope matters to glycemic control and depression. Intervention strategies focusing on hope should be further explored. © The Author(s) 2015.
Full Text Available Type 1 diabetes mellitus (T1DM a chronic characterized by an absolute insulin deficiency requires conscientious patient self-management to maintain glucose control within a normal range. Family cohesion and adaptability, positive coping strategies, social support and adequate self-regulatory behavior are found to favorably influence glycemic control. Our hypothesis was that the responsible care of a companion animal is associated with these positive attributes and correlated with the successful management of a chronic illness such as type 1 diabetes. We recruited 223 youths between 9 and 19 years of age from the Pediatric Diabetes clinic at the University of Massachusetts Medical School, reviewed the status of their glycemic control (using three consecutive A1c values and asked them questions about the presence of a pet at home, and their level of involvement with its care. Multivariate analyses show that children who care actively for one or more pets at home are 2.5 times more likely to have control over their glycemic levels than children who do not care for a pet, adjusting for duration of disease, socio-economic status, age and self-management [1.1 to 5.8], pWald = 0.032. A separate model involving the care of a petdog only yielded comparable results (ORa = 2.6 [1.1 to 5.9], pWald = 0.023.
Su, J; Qin, Y; Shen, C; Gao, Y; Pan, E C; Pan, X Q; Tao, R; Zhang, Y Q; Wu, M
Objective: To explore the association of smoking and smoking cessation with glycemic control in male patients with type 2 diabetes. Methods: From December 2013 to January 2014, a total of 7 763 male patients with type 2 diabetes, who received national basic public health service in Changshu county of Suzhou city, Huai'an and Qinghe districts of Huai'an city, Jiangsu province, were recruited by cluster sampling. Questionnaire survey and anthropometric measurements were conducted, and fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) levels were measured. Multiple linear regression model was used to evaluate the association of smoking and smoking cessation with glycemic control. Results: The prevalence of current smoking was 45.5% in male patients with type 2 diabetes. The levels of FPG and HbA1c increased with number of cigarettes smoked per day compared with non-smokers ( P smoking duration ≥30 years and smoking index ≥40 pack-years were 0.27% (95 %CI : 0.05%-0.49%) and 0.38% (95 %CI : 0.23%-0.53%), respectively. FPG and HbA1c level decreased obviously with smoking cessation years among former smokers ( P smoking duration, smoking cessation years and levels of FPG and HbA1c. Conclusion: Cigarette smoking was negatively related with glycemic control in male type 2 diabetes patients, especially in patients with drug treatment. Smoking cessation may be beneficial for glycemic control. Smoking cessation should be encouraged for diabetes patients as early as possible.
Ensor, Mark; Banfield, Amy B.; Smith, Rebecca R.; Williams, Jarrod; Lodder, Robert A.
The primary objectives of this study were to evaluate the treatment effect of D-tagatose on glycemic control, determined by a statistically significant decrease in hemoglobin A1c (HbA1c), and safety profile of D-tagatose compared to placebo. The secondary objectives were to evaluate the treatment effects on fasting blood glucose, insulin, lipid profiles, changes in BMI, and the proportion of subjects achieving HbA1c targets of
1) Adolescent female patients with type 1 diabetes mellitus have better glycemic control and higher levels of diabetes distress than male patients. 2) Parents of adolescents using insulin pumps experience higher diabetes distress than parents of adolescents using multiple daily injections. 3) No differences in diabetes-related factors, emotional state, diabetes-related distress (in adolescent patients and in their primary care-givers) and social factors in groups of adolescent patients ...
Ryu, Ohk-Hyun; Lee, Sungwha; Yoo, Hyung Joon; Choi, Moon-Gi
Seasonal variations in lifestyle, such as food intake and physical activity, have been reported. Glycemic control in type 2 diabetes mellitus (T2DM) may be affected by such changes. We investigated seasonal variations in glycemic control, food intake, and physical activity in type 2 diabetic patients. This prospective observational study included 37 Korean female patients who had food intake (kcal/day), HbA1c, and anthropometry every 3 months (August, November, February, May, and August in the Northern Hemisphere) over 1 year. When anti-diabetic drugs were changed, we analyzed the data just before the changes. The mean HbA1c levels (%) of August and November in 2008, and February, May, and August in 2009 were 7.0 ± 0.1, 6.9 ± 0.1, 7.2 ± 0.2, 7.4 ± 0.2, and 7.2 ± 0.2, respectively (P = 0.018). The change of HbA1c was nearly 0.5 % for the 1-year period. From August to May of the following year, there were also seasonal variations in food intake (1,872 ± 143, 1,739 ± 97, 1,673 ± 86, 1,561 ± 132, respectively; P = 0.013), and total physical activity [7.7 (3.7-14.6), 6.3 (2.8-10.4), 5.1 (2.7-12.6), and 11.2 (4.7-20.5), respectively; P = 0.048]. However, the seasonal variations of HbA1c and total physical activity became non-significant when farmers were excluded. These data suggested that glycemic control, total physical activity, and food intake varied seasonally in Korean T2DM patients. These seasonal variations should be considered in education for glycemic control.
Karstoft, Kristian; Christensen, Camilla S; Pedersen, Bente K
Context: Glycemic control improves with physical activity, but the optimal exercise mode is unknown. Objective: To determine whether interval-based exercise improves postprandial glucose tolerance and free-living glycemia more than oxygen-consumption and time-duration matched continuous exercise....... Design: Cross-over, controlled with trials performed in randomized order. Setting: Hospitalized and ambulatory care. Patients: Diagnosed with type 2 diabetes (T2DM; n=10, no withdrawels). Interventions: Subjects performed three 1-hour interventions: 1) interval-walking (IW; repeated cycles of 3 minutes...... of slow and fast walking); 2) continuous-walking (CW); 3) Control (CON). Oxygen consumption (VO2) was measured continuously to match mean VO2 between exercise sessions (∼75% VO2peak). Main Outcome Measures: A mixed meal tolerance test (MMTT; 450 kcal, 55% carbohydrate) with stable glucose isotopic tracers...
Cheng, Alice Y Y
Achieving and maintaining glycemic control in patients with diabetes admitted to hospital is challenging because of the many competing factors of nutrition, pharmacotherapy and other patient-related and systemic factors. For patients receiving enteral or parenteral feeding, eating irregularly or receiving glucocorticoid therapy, the challenges are even greater. The basic principles to follow when managing glycemia in these populations are as follows: 1) Recognition of those at risk for hyperglycemia; 2) frequent bedside glucose monitoring; 3) a proactive approach with routine insulin administration based on the predicted glucose patterns; 4) constant reassessment of the glycemic status and titration of the routine insulin accordingly. Copyright © 2014 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.
Full Text Available Abstract INTRODUCTION: Diabetes control is one of the main conflict issues in diabetes management. Scientists, recently, recommend [increasing low glycemic index (LGI foods in dietary regimen. The effects of cooked lentil as a low glycemic index food on serum blood glucose and lipid profile among type 2 diabetic patients has been investigated in this study. METHODS: In a randomized cross-over clinical trial which was performed on 30 patients with type II diabetes mellitus, subjects were randomly divided into 2 groups. Group A followed the normal diet and Group B followed normal diet with 50gm cooked lentil and 6gm canula oil substitute of 30gm bread and 20gm cheese. After 6 weeks, groups stopped their diets and put on wash out period for 3 weeks and later the diets where switched between the them. Diet continued for another 6 weeks. Anthropometric measurements, dietary intakes, serum lipids and glucose levels were determined at the beginning and the end of each test period. Data were analyzed by Food Processor II and SPSS-13. RESULTS: BMI, LDL_C, HDL_C, TG and serum Fructozamine were not significantly affected by dietary regimens. But Total cholesterol and fasting blood glucose decreased significantly in regimen containing lentil (P<0.05. CONCLUSION: Consumption of cooked lentil as a LGI food in breakfast led to reduction of FBS and TC and improvement of glycemic control in type 2 diabetic patients. Keywords: Diabetes Mellitus, Lentil, Lipid profiles, Blood glucose, Glycemic index, Clinical Trial.
Bandeira, Verônica da Silva; Pires, Liliane Viana; Hashimoto, Leila Leiko; Alencar, Luciane Luca de; Almondes, Kaluce Gonçalves Sousa; Lottenberg, Simão Augusto; Cozzolino, Silvia Maria Franciscato
This study evaluated the relationship between the zinc-related nutritional status and glycemic and insulinemic markers in individuals with type 2 diabetes mellitus (T2DM). A total of 82 individuals with T2DM aged between 29 and 59 years were evaluated. The concentration of zinc in the plasma, erythrocytes, and urine was determined by the flame atomic absorption spectrometry method. Dietary intake was assessed using a 3-day 24-h recall. In addition, concentrations of serum glucose, glycated hemoglobin percentage, total cholesterol and fractions, triglycerides, and serum insulin were determined. The insulin resistance index (HOMA-IR) and β-cell function (HOMA- β) were calculated. The markers of zinc status (plasma: 83.3±11.9μg/dL, erythrocytes: 30.1±4.6μg/g Hb, urine: 899.1±622.4μg Zn/24h, and dietary: 9.9±0.8mg/day) were classified in tertiles and compared to insulinemic and glycemic markers. The results showed that lower zinc concentrations in plasma and erythrocytes, as well as its high urinary excretion, were associated with higher percentages of glycated hemoglobin, reflecting a worse glycemic control in individuals with T2DM (pzinc levels and glycated hemoglobin percentage (r=-0.325, p=0.003), and a positive correlation between urinary zinc excretion and glycemia (r=0.269, p=0.016), glycated hemoglobin percentage (r=0.318, p=0.004) and HOMA-IR (r=0.289, p=0.009). According to our study results, conclude that T2DM individuals with reduced zinc status exhibited poor glycemic control. Copyright © 2017 Elsevier GmbH. All rights reserved.
Shen, Ying; Wang, Fengbin; Zhang, Xing; Zhu, Xiaorou; Sun, Qiudan; Fisher, Edwin
Background The popularity of internet as an area of research has grown manifold over the years. Given its rapid development and increasing coverage worldwide, internet-based interventions seem to offer a promising option to ameliorate huge burdens brought by type 2 diabetes mellitus. However, studies conducted by different researchers have provided contradictory results on the effect of internet-based interventions in glycemic control. Objective This meta-analysis aims to summarize currently available evidence and evaluate the overall impact of internet-based interventions on glycemic management of type 2 diabetic patients. Methods A systematic literature search was performed in PubMed, ScienceDirect, and Web of Science. Randomized controlled trials that used glycosylated hemoglobin values as the outcome measure of glycemic control were considered. Risk of bias and publication bias were evaluated. Results Of the 492 studies, 35 were included in meta-analysis, and results indicated that the weighted mean difference (WMD) between usual care and internet-based interventions at endpoint was –0.426% (95% CI –0.540 to –0.312; P<.001). Subgroup analyses revealed that intervention duration ≤3 months yielded optimal performance (WMD –0.51%; 95% CI –0.71 to –0.31; P<.001). Combined mobile and website interventions were substantially superior to solely Web-based and mobile-based interventions in glycemic control (combined WMD –0.77%, 95% CI –1.07 to –0.47; P<.001; Web only: WMD –0.48%; 95% CI –0.71 to –0.24, P<.001; mobile only WMD –0.31%, 95% CI –0.49 to –0.14; P<.001). Furthermore, the effect of interventions with automated feedbacks was similar to those with manual feedbacks, and studies with internet-based educational contents were more effective in glycemic control. The assessment revealed a low risk of bias. Conclusions In conclusion, utilization of internet-based intervention is beneficial for patients with type 2 diabetes mellitus, and
Shen, Ying; Wang, Fengbin; Zhang, Xing; Zhu, Xiaorou; Sun, Qiudan; Fisher, Edwin; Sun, Xinying
The popularity of internet as an area of research has grown manifold over the years. Given its rapid development and increasing coverage worldwide, internet-based interventions seem to offer a promising option to ameliorate huge burdens brought by type 2 diabetes mellitus. However, studies conducted by different researchers have provided contradictory results on the effect of internet-based interventions in glycemic control. This meta-analysis aims to summarize currently available evidence and evaluate the overall impact of internet-based interventions on glycemic management of type 2 diabetic patients. A systematic literature search was performed in PubMed, ScienceDirect, and Web of Science. Randomized controlled trials that used glycosylated hemoglobin values as the outcome measure of glycemic control were considered. Risk of bias and publication bias were evaluated. Of the 492 studies, 35 were included in meta-analysis, and results indicated that the weighted mean difference (WMD) between usual care and internet-based interventions at endpoint was -0.426% (95% CI -0.540 to -0.312; P<.001). Subgroup analyses revealed that intervention duration ≤3 months yielded optimal performance (WMD -0.51%; 95% CI -0.71 to -0.31; P<.001). Combined mobile and website interventions were substantially superior to solely Web-based and mobile-based interventions in glycemic control (combined WMD -0.77%, 95% CI -1.07 to -0.47; P<.001; Web only: WMD -0.48%; 95% CI -0.71 to -0.24, P<.001; mobile only WMD -0.31%, 95% CI -0.49 to -0.14; P<.001). Furthermore, the effect of interventions with automated feedbacks was similar to those with manual feedbacks, and studies with internet-based educational contents were more effective in glycemic control. The assessment revealed a low risk of bias. In conclusion, utilization of internet-based intervention is beneficial for patients with type 2 diabetes mellitus, and taking full advantage of this type of intervention may substantially reduce the
Schmidt, Julie Berg; Pedersen, Susie Dawn; Gregersen, Nikolaj Ture
the effect of RYGB on glycaemic control per se. Here, we investigated the effect of RYGB on EE, appetite, glycaemic control, and specific signalling molecules compared to a control group in comparable negative energy balance. Subjects/Methods:Obese normal glucose tolerant participants were randomized...... to receive RYGB after 8 (n=14) or 12 weeks (n=14). The protocol included a visit at week 0 and three visits (week 7, 11 and 78) where 24 h EE, appetite and blood parameters were assessed. Participants followed a low-calorie diet from week 0-11, with those operated at week 12 serving as a control group...... response of GLP-1, PYY, ghrelin, CCK, FGF-19 and bile acids (all Pappetite. None of HOMA-IR, Matsuda Index, the Insulinogenic Index, the Disposition Index and fasting hepatic insulin clearance were...
Di Pierro, Francesco; Villanova,Nicola; Agostini,Federica; Soverini,Valentina; Marchesini,Giulio; Marzocchi,Rebecca
Francesco Di Pierro,1 Nicola Villanova,2 Federica Agostini,2 Rebecca Marzocchi,2 Valentina Soverini,2 Giulio Marchesini21Scientific Department, Velleja Research, Milano, 2Diseases of Metabolism, S Orsola Malpighi Hospital, Bologna, ItalyBackground: Suboptimal glycemic control is a common situation in diabetes, regardless of the wide range of drugs available to reach glycemic targets. Basic research in diabetes is endeavoring to identify new actives working as insulin savers, use of which coul...
Full Text Available Introduction: Diabetes mellitus (DM is a chronic, noncommunicable disease with concomitant oral manifestations that impact on dental care. Aim: To determine the correlation between glycemic control and periodontitis among 35-45 years aged patients with DM type 2 (DM2. Materials and Methods: A convenient sample of 40 subjects aged 35-45 years with DM2 on oral medication were recruited for the study. Glycosylated, hemoglobin(HbA1c, probing pocket depth (PPD, gingival index (GI, plaque index (PI, and the relevant drug history were recorded. The data were analyzed using unpaired student t-test to compare the means of PPD, GI, PI between different HbA1c levels, gender, and duration of drug, and the Pearson correlation was used to find correlation between HbA1c and PPD, GI, PI, duration of drug. Results: With the increase in HbA1c values there was a significant rise in PPD, PI scores, and GI scores (P < 0.001. Diabetic males had a higher PPD, PI, and GI score as compared to females. With the increase in duration of the drug, there was an increase in PPD, which was found to be statistically nonsignificant. Conclusion: Patients are having poor glycemic level had more severe periodontitis as compared to patients having a fair glycemic level.
Chiu, Yi-Wen; Chang, Jer-Ming; Lin, Li-Ing; Chang, Pi-Yu; Lo, Wan-Ching; Wu, Ling-Chu; Chen, Tun-Chieh; Hwang, Shang-Jyh
Tight control of blood sugar improves the outcomes for diabetic patients, but it can only be achieved by adhering to a well-organized care plan. To evaluate the effect of a diabetes care plan with reinforcement of glycemic control in diabetic patients, 98 ambulatory patients with type 2 diabetes who visited our diabetes clinic every 3-4 months and who completed four education courses given by certified diabetes educators within 3 months after the first visit, were defined as the Intervention group. A total of 82 patients fulfilling the inclusion criteria for the Intervention group but who missed at least half of the diabetes education sessions were selected as controls. Both groups had comparable mean hemoglobin A1c (HbA1c) levels at baseline, which decreased significantly at 3 months and were maintained at approximately constant levels at intervals for up to 1 year. The HbA1c decrement in the Intervention group was significantly greater than that in the Control group over the 1-year follow-up period (HbA1c change: -2.5 +/- 1.8% vs. -1.1 +/- 1.7%, p decrement occurred during the first 3 months, and accounted for 95.6% and 94.6% of the total HbA1c decrements in the Intervention and Control groups, respectively. In the multiple regression model, after adjustment for age, body mass index, and duration of diabetes, the Intervention group may still have a 12.6% improvement in HbA1c from their original value to the end of 1 year treatment compared with the Control group (p < 0.05). Diabetes care, with reinforcement from certified diabetes educators, significantly improved and maintained the effects on glycemic control in ambulatory patients with type 2 diabetes.
Full Text Available Tight control of blood sugar improves the outcomes for diabetic patients, but it can only be achieved by adhering to a well-organized care plan. To evaluate the effect of a diabetes care plan with reinforcement of glycemic control in diabetic patients, 98 ambulatory patients with type 2 diabetes who visited our diabetes clinic every 3–4 months and who completed four education courses given by certified diabetes educators within 3 months after the first visit, were defined as the Intervention group. A total of 82 patients fulfilling the inclusion criteria for the Intervention group but who missed at least half of the diabetes education sessions were selected as controls. Both groups had comparable mean hemoglobin A1c (HbA1c levels at baseline, which decreased significantly at 3 months and were maintained at approximately constant levels at intervals for up to 1 year. The HbA1c decrement in the Intervention group was significantly greater than that in the Control group over the 1-year follow-up period (HbA1c change: −2.5 ± 1.8% vs. −1.1 ± 1.7%, p < 0.01. The maximal HbA1c decrement occurred during the first 3 months, and accounted for 95.6% and 94.6% of the total HbA1c decrements in the Intervention and Control groups, respectively. In the multiple regression model, after adjustment for age, body mass index, and duration of diabetes, the Intervention group may still have a 12.6% improvement in HbA1c from their original value to the end of 1 year treatment compared with the Control group (p < 0.05. Diabetes care, with reinforcement from certified diabetes educators, significantly improved and maintained the effects on glycemic control in ambulatory patients with type 2 diabetes.
Domingos, Caroline Maria Herrero; Iida, Luciana Inaba Senyer; Poveda, Vanessa de Brito
To analyze the evidence available in the scientific literature regarding the relationship between the glycemic control strategies used and the occurrence of surgical site infection in adult patients undergoing surgery. This is a systematic review performed through search on the databases of CINAHL, MEDLINE, LILACS, Cochrane Database of Systematic Reviews and EMBASE. Eight randomized controlled trials were selected. Despite the diversity of tested interventions, studies agree that glycemic control is essential to reduce rates of surgical site infection, and should be maintained between 80 and 120 mg/dL during the perioperative period. Compared to other strategies, insulin continuous infusion during surgery was the most tested and seems to get better results in reducing rates of surgical site infection and achieving success in glycemic control. Tight glycemic control during the perioperative period benefits the recovery of surgical patients, and the role of the nursing team is key for the successful implementation of the measure. Analisar as evidências disponíveis na literatura científica sobre a relação entre as estratégias de controle glicêmico efetuadas e a ocorrência de infecção do sítio cirúrgico em pacientes adultos submetidos à cirurgia. Trata-se de revisão sistemática, por meio das bases de dados CINAHL, MEDLINE, LILACS, Cochrane Database of Systematic Reviews e EMBASE. Foram selecionados oito ensaios clínicos randomizados. Apesar da diversidade de intervenções testadas, os estudos concordam que o controle glicêmico é essencial para a redução das taxas de infecção do sítio cirúrgico e deve ser mantido entre 80 e 120 mg/dL durante o perioperatório. A infusão contínua de insulina no transoperatório foi a mais testada e parece obter melhores resultados na redução das taxas de infecção do sítio cirúrgico e sucesso no controle glicêmico comparada às demais estratégias. O controle glicêmico rigoroso durante o perioperat
A. Armani Kian
Full Text Available Objective. The aim of the study was to determine the effect of mindfulness-based stress reduction (MBSR intervention on emotion regulation and glycemic control of patients with type 2 diabetes. Materials and Methods. Sixty patients with type 2 diabetes were recruited for this randomized controlled trial from an outpatient clinic at Imam Hospital in Iran. The intervention group participated in 8 sessions of MBSR, and the control group continued the treatment as usual. Fasting blood sugar and HbA1c were measured as two indices of glycemic control. Overall mental health, depression, and anxiety were measured using the General Health Questionnaire (GHQ-28, Hamilton Depression Rating Scale (HDRS, and Hamilton Anxiety Rating Scale (HARS, respectively. All the assessments were performed at baseline and after 8 weeks and 3 months as follow-up. Results. In comparison with the control group, the MBSR intervention group showed a significant reduction on all outcome measures including FBS, HbA1C, HARS, and HDRS scores (p<0/05. Conclusion. MBSR had a remarkable improvement on emotional wellbeing and glycemic control of patients with type 2 diabetes.
Considerable epidemiologic evidence links consuming lower glycemic index (GI) diets with good health, particularly upon aging. The GI is a kinetic parameter that reflects the ability of carbohydrate (CHO) contained in consumed foods to raise blood glucose in vivo. Newer nutritional, clinical, and ex...
Mathiesen, Elisabeth R; Kinsley, Brendan; Amiel, Stephanie A
OBJECTIVE: To assess the safety and efficacy of insulin aspart (IAsp) versus regular human insulin (HI) in basal-bolus therapy with NPH insulin in pregnant women with type 1 diabetes. RESEARCH DESIGN AND METHODS: Subjects (n = 322) who were pregnant or planning pregnancy were randomized to IAsp...... in basal-bolus therapy with NPH insulin in pregnant women with type 1 diabetes and may potentially offer some benefits in terms of postprandial glucose control and preventing severe hypoglycemia....... or HI as meal-time insulin in an open-label, parallel-group, multicenter study. Subjects had A1C pregnancy. Insulin doses were titrated toward predefined glucose targets and A1C 1C, plasma glucose...
Engle, Martha; Ferguson, Allison; Fields, Willa
The purpose of this quality improvement project was to redesign a hospital meal delivery process in order to shorten the time between blood glucose monitoring and corresponding insulin administration and improve glycemic control. This process change redesigned the workflow of the dietary and nursing departments. Modifications included nursing, rather than dietary, delivering meal trays to patients receiving insulin. Dietary marked the appropriate meal trays and phoned each unit prior to arrival on the unit. The process change was trialed on 2 acute care units prior to implementation hospital wide. Elapsed time between blood glucose monitoring and insulin administration was analyzed before and after process change as well as evaluation of glucometrics: percentage of patients with blood glucose between 70 and 180 mg/dL (percent perfect), blood glucose greater than 300 mg/dL (extreme hyperglycemia), and blood glucose less than 70 mg/dL (hypoglycemia). Percent perfect glucose results improved from 45% to 53%, extreme hyperglycemia (blood glucose >300 mg/dL) fell from 11.7% to 5%. Hypoglycemia demonstrated a downward trend line, demonstrating that with improving glycemic control hypoglycemia rates did not increase. Percentage of patients receiving meal insulin within 30 minutes of blood glucose check increased from 35% to 73%. In the hospital, numerous obstacles were present that interfered with on-time meal insulin delivery. Establishing a meal delivery process with the nurse performing the premeal blood glucose check, delivering the meal, and administering the insulin improves overall blood glucose control. Nurse-led process improvement of blood glucose monitoring, meal tray delivery, and insulin administration does lead to improved glycemic control for the inpatient population.
Reutrakul, Sirimon; Hood, Megan M; Crowley, Stephanie J; Morgan, Mary K; Teodori, Marsha; Knutson, Kristen L
Breakfast skipping is associated with obesity and an increased risk of type 2 diabetes. Later chronotypes, individuals who have a preference for later bed and wake times, often skip breakfast. The aim of the study was to explore the relationships among breakfast skipping, chronotype, and glycemic control in type 2 diabetes patients. We collected sleep timing and 24-h dietary recall from 194 non-shift-working type 2 diabetes patients who were being followed in outpatient clinics. Mid-sleep time on free days (MSF) was used as an indicator of chronotype. Hemoglobin A1C (HbA1C) values were obtained from medical records. Hierarchical linear regression analyses controlling for demographic, sleep, and dietary variables were computed to determine whether breakfast skipping was associated with HbA1C. Additional regression analyses were performed to test if this association was mediated by chronotype. There were 22 participants (11.3%) who self-reported missing breakfast. Breakfast skippers had significantly higher HbA1C levels, higher body mass indices (BMI), and later MSF than breakfast eaters. Breakfast skipping was significantly associated with higher HbA1C values (B = 0.108, p = 0.01), even after adjusting for age, sex, race, BMI, number of diabetes complications, insulin use, depressive symptoms, perceived sleep debt, and percentage of daily caloric intake at dinner. The relationship between breakfast skipping and HbA1C was partially mediated by chronotype. In summary, breakfast skipping is associated with a later chronotype. Later chronotype and breakfast skipping both contribute to poorer glycemic control, as indicated by higher HbA1C levels. Future studies are needed to confirm these findings and determine whether behavioral interventions targeting breakfast eating or sleep timing may improve glycemic control in patients with type 2 diabetes.
Full Text Available Background Type 2 diabetes is a metabolic disease in which hyperglycemia is a major symptom, and is associated with numerous vascular and non-vascular complications. People with diabetes use medicinal treatment to exert glycemic control, as well as exercise training and herbal remedies, such as urtica dioica (UD. Objectives This study aimed to compare the effects of 8 weeks of aerobic training and UD supplementation alone, and in combination, on glycemic control in men with type 2 diabetes mellitus (T2DM. Patients and Methods This semi-experimental study was conducted in 2014, in the city of Dezful, Iran. A total of 40 males (aged 30 - 50 years with T2DM were selected and randomly divided into one of four groups in equal numbers (n = 10: 1 - aerobic training (Ae, 2 - UD supplements (UD, 3 - a combination of aerobic training and UD supplements (Ae + UD, and 4 - a control group. Blood samples were taken 24 hours before and 48 hours after the intervention period, following 10 - 12 hours of fasting. A t-test and analysis of variance was used to analyze the changes in the measured parameters, and P ≤ 0.05 was considered statistically significant. Results A significant decrease in fasting blood sugar (FBS was observed in the Ae group (-9.50 ± 6.96 mg/dl; P = 0.002, the UD group (-7.60 ± 6.04 mg/dL; P = 0.001, and the Ae + UD group (-18.30 ± 6.63 mg/dL; P < 0.001 after 8 weeks. There was a significant difference in FBS between the three intervention groups and the control group. In addition, a significant difference in FBS (P < 0.05 was shown between the UD and Ae + UD groups. Conclusions The findings confirmed the positive influence of UD supplements and aerobic training on glycemic control in males with T2DM. When aerobic training was combined with a UD supplement, a greater degree of glycemic control was observed.
Dwyer, Johanna T.; Bailey, Regan L.
Some adults with type 2 diabetes mellitus (T2DM) believe that chromium-containing supplements will help control their disease, but the evidence is mixed. This narrative review examines the efficacy of chromium supplements for improving glycemic control as measured by decreases in fasting plasma glucose (FPG) or hemoglobin A1c (HbA1c). Using systematic search criteria, 20 randomized controlled trials of chromium supplementation in T2DM patients were identified. Clinically meaningful treatment goals were defined as an FPG of ≤7.2 mmol/dL, a decline in HbA1c to ≤7%, or a decrease of ≥0.5% in HbA1c. In only a few randomized controlled trials did FPG (5 of 20), HbA1c (3 of 14), or both (1 of 14) reach the treatment goals with chromium supplementation. HbA1c declined by ≥0.5% in 5 of 14 studies. On the basis of the low strength of existing evidence, chromium supplements have limited effectiveness, and there is little rationale to recommend their use for glycemic control in patients with existing T2DM. Future meta-analyses should include only high-quality studies with similar forms of chromium and comparable inclusion/exclusion criteria to provide scientifically sound recommendations for clinicians. PMID:27261273
Rushakoff, Robert J; Sullivan, Mary M; Seley, Jane Jeffrie; Sadhu, Archana; O'Malley, Cheryl W; Manchester, Carol; Peterson, Eric; Rogers, Kendall M
establishing an inpatient glycemic control program is challenging, requires years of work, significant education and coordination of medical, nursing, dietary, and pharmacy staff, and support from administration and Performance Improvement departments. We undertook a 2 year quality improvement project assisting 10 medical centers (academic and community) across the US to implement inpatient glycemic control programs. the project was comprised of 3 interventions. (1) One day site visit with a faculty team (MD and CDE) to meet with key personnel, identify deficiencies and barriers to change, set site specific goals and develop strategies and timelines for performance improvement. (2) Three webinar follow-up sessions. (3) Web site for educational resources. Updates, challenges, and accomplishments for each site were reviewed at the time of each webinar and progress measured at the completion of the project with an evaluation questionnaire. as a result of our intervention, institutions revised and simplified formularies and insulin order sets (with CHO counting options); implemented glucometrics and CDE monitoring of inpatient glucoses (assisting providers with orders); added new protocols for DKA and perinatal treatment; and implemented nursing, physician and patient education initiatives. Changes were institution specific, fitting the local needs and cultures. As to the extent to which Institution׳s goals were satisfied: 2 reported "completely", 4 "mostly," 3 "partially," and 1 "marginally". Institutions continue to move toward fulfilling their goals. an individualized, structured, performance improvement approach with expert faculty mentors can help facilitate change in an institution dedicated to implementing an inpatient glycemic control program. Copyright © 2014 Elsevier Inc. All rights reserved.
Prescott, Eva; Hjardem-Hansen, Rasmus; Dela, Flemming
markers of glycemic control (glucose, insulin, glycerol, free fatty acids, HbA1c), inflammation and endothelial function (hsCRP, orosomucoid, interleukin 6, TNF-alpha, urine-orosomucoid and -albumin/creatinin), lipid metabolism, NT-proBNP or other regulatory hormones (cortisol, epinephrine and IGF-1......). There were no changes in quality of life. Conclusions. The effect of exercise training in these older CHF-patients was not as impressive as reported in younger and more selected patients. More studies on the efficiency of exercise training that reflect the age- and co-morbidity of the majority of CHF...
Maynard, Gregory A; Holdych, Janet; Kendall, Heather; Harrison, Karen; Montgomery, Patricia A; Kulasa, Kristen
Safely improve glycemic control in the critical care units of nine hospitals. Critical care adult inpatients from nine hospitals with ≥4 point-of-care blood glucose (BG) readings over ≥2 days were targeted by collaborative improvement efforts to reduce hyper- and hypoglycemia. Balanced glucometric goals for each hospital were set targeting improvement from baseline or goals deemed desirable from Society of Hospital Medicine (SHM) benchmarking data. Collaborative interventions included standardized insulin infusion protocols, hypoglycemia prevention bundles, audit and feedback, education, and measure-vention (coupling measurement of patients "off protocol" with concurrent interventions to correct suboptimal care). All sites improved glycemic control. Six reached prespecified levels of improvement of the day-weighted mean BG. The day-weighted mean BG for the cohort decreased by 7.7 mg/dL (95% confidence interval [CI], 7.0 mg/dL to 8.4 mg/dL) to 151.3 mg/dL. Six of nine sites showed improvement in the percent intensive care unit (ICU) days with severe hyperglycemia (any BG >299 mg/dL). ICU severe hyperglycemic days declined from 8.6 to 7.2% for the cohort (relative risk, 0.84; 95% CI, 0.80 to 0.88). Patient days with any BG <70 mg/dL were reduced by 0.4% (95% CI, 0.06% to 0.6%), from 4.5 to 4.1%, for a small but statistically significant reduction in hypoglycemia. Seven of nine sites showed improvement. Multihospital improvements in ICU glycemic control, severe hyperglycemia, and hypoglycemia are feasible. Balanced goals for glycemic control and hypoglycemia in the ICU using SHM benchmarks and metrics enhanced successful improvement efforts with good staff acceptance and sustainability. BG = blood glucose CMI = case-mix index CY = calendar year DKA = diabetic ketoacidosis EMR = electronic medical record GBMF = Gordon and Betty Moore Foundation ICU = intensive care unit IIP = insulin infusion protocol SHM = Society of z Hospital Medicine.
Shang, Quan; Liu, Matthew K; Saumoy, Monica
. In the present study, we tested whether adding sitagliptin (Januvia) (SIT), which prolongs bioactive GLP-1 half life, to COL would further enhance glycemic control. Male Zucker diabetic fatty (ZDF) rats were assigned to four groups: diabetic model without treatment (the model), the model treated with 2% COL or 0...... to levels similar to the model. Histological examination of the pancreatic ß-cell islets showed that islet sizes were larger, proliferation enhanced, and cell apoptosis reduced in the COL+SIT but not the SIT alone group compared with the model. We hypothesize that the combination of COL with SIT extends...
Guilfoyle, Shanna M; Crimmins, Nancy A; Hood, Korey K
Reported frequencies of blood glucose monitoring (BGM) by both adolescents and their caregivers serve as adherence proxies when meter downloads are not available. Yet, correlates of reported BGM frequencies and their predictive utility are understudied. To identify sociodemographic, psychological, and disease-specific correlates of reported BGM frequencies in adolescents with type 1 diabetes and to explore the predictive utility of BGM indices on glycemic control. Study participants included caregivers and adolescents with type 1 diabetes (N=143, 13-18 yr) receiving diabetes treatment at a tertiary care setting. At the initial visit, adolescents and caregivers reported on daily BGM frequencies. A sub-sample provided meter downloads. Adolescents also completed a depression inventory. Three months later, adolescents provided blood sampling for A1c assessment. Multivariate general linear modeling identified that older adolescent age and more depressive symptoms were associated with reports of less frequent BGM. Two stepwise multivariate regression models examined the predictive utility of BGM indices (i.e., adolescent-reported BGM, caregiver-reported BGM, meter download) on glycemic control. Caregiver-reported BGM frequency predicted glycemic control in the absence of meter download data (pmeter download data were the most robust predictor of glycemic control (pMeter downloads have the most robust association with glycemic control when contextual variables are considered. Caregiver-reported BGM frequencies can serve as reliable substitutes in the absence of meter download, but they may not be as reliable in adolescents with depressive symptoms. © 2011 John Wiley & Sons A/S.
Full Text Available Riyadh A Alzaheb,1 Abdullah H Altemani2 1Department of Clinical Nutrition, Faculty of Applied Medical Sciences, 2Department of Family and Community Medicine, Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia Background: Although the prevalence of type 2 diabetes mellitus (T2DM is rising sharply in Saudi Arabia, data on glycemic control, crucial to reducing diabetes mellitus complications, remain scarce. This study therefore investigated glycemic control status and the factors influencing poor glycemic control among adult T2DM patients in Saudi Arabia.Methods: This cross-sectional study examined 423 T2DM patients at a diabetic center in Tabuk, Saudi Arabia between September 2016 and July 2017. Glycemic levels were measured via fasting blood glucose (FBG levels, and “poor glycemic control” was defined as FBG >130 mg/dL. Poor glycemic control’s risk factors were identified using a logistic regression.Results: In the sample, 74.9% of the patients had poor blood glycemic control. Logistic regression revealed that T2DM patients had an increased chance of poorly controlled diabetes if they had family histories of diabetes (adjusted odds ratio [AOR] =7.38, 95% CI 4.09–13.31, longer diabetic durations (AOR =2.33, 95% CI 1.14–4.78 for 5–10 years and AOR =5.19, 95% CI 2.50–10.69 for >10 years, insufficient physical exercise (AOR =19.02, 95% CI 6.23–58.06, or were overweight (AOR =3.79, 95% CI 2.00–7.18, or obese (AOR =5.35, 95% CI 2.72–12.59.Conclusion: A high proportion of the sampled patients had poor glycemic control, therefore, health care professionals should manage the associated risk factors to limit disease complications and improve the health of patients with diabetes. Keywords: type 2 diabetes, glycemic control, Saudi Arabia
Balas-Nakash, Margie; Rodríguez-Cano, Ameyalli; Muñoz-Manrique, Cinthya; Vásquez-Peña, Paulina; Perichart-Perera, Otilia
The measurement of adherence to nutrition therapy is essential to evaluate if the outcomes are related to given recommendations. The aim of this study was to describe adherence to a Medical Nutrition Therapy Program in Mexican pregnant women with diabetes, using three different methods; and evaluate its association with glycemic control. Adherence was measured with a questionnaire (0-100%), women's self-perception (0-100%) and energy intake adequacy by multiple pass 24 hour recall (85-115% of recommendation). Women were randomly assigned to two different dietary strategies. Glycemic control was determined by capillary glucose self-monitoring. Women analyzed in this study (n=69) had an age range of 22-42 years; 47.8% had type 2 diabetes (DM2) and 52.2% had gestational diabetes (GDM). Energy intake adequacy was higher in women with GDM (41.9% vs. 37.7%, p = 0.001). Average adherence measured with the questionnaire was 55%; no differences were found by type of diabetes. Self-perception was higher in women with DM2 (84%) when compared to women with GDM (70%) (p = 0.039). No differences were found in the three methods by study group. Optimal glycemic control was observed in 50% of women; no association was found with adherence measured with any of the three methods studied. The observed differences in adherences suggest that it may be recommendable to combine different measurement methods and include social and psychological factors that affect behavioral change.
Norouzy, A; Mohajeri, S M R; Shakeri, S; Yari, F; Sabery, M; Philippou, E; Varasteh, A-R; Nematy, M
Although Muslim patients with Type 2 diabetes may be exempt from fasting during Ramadan for medical reasons, a high proportion of them fast. To investigate the association between Ramadan fasting and glycemic control in patients with Type 2 diabetes. A prospective cohort clinical trial was designed. Eighty-eight patients with Type 2 diabetes (45 male, 43 female, age 51±10 yr) who opted to fast for at least 10 days during the month of Ramadan were recruited. Fasting blood samples were taken at the beginning and end of Ramadan, and 1 month after Ramadan, to assess fasting blood glucose (FBG), fasting insulin, full blood count, glycated hemoglobin (HbA(1c)) and fasting lipid profile. Insulin resistance was estimated using the homeostatic model assessment. Anthropometrics and blood pressure were also measured. There was a significant deterioration in FBG and HbA(1c) (p=0.002 and p≤0.001, respectively) and significant improvements in HDL and LDL cholesterol and body mass index after Ramadan (pRamadan (9.4±2% at the end of Ramadan vs 8.4±2.5% 1 month after Ramadan; pRamadan deteriorated the glycemic control in Type 2 diabetes patients. This was more evident in patients using oral hypoglycemic medication than diet- controlled patients. However, Ramadan fasting had small positive effects on lipid profile and body weight.
Amelia, R.; Yunanda, Y.
Depression is a mental problem whichifnot handled properly will cause uncontrolled diabetes that affects the quality of life and increase the risk of complications. This study aimed to determine the relationship between depressionwith glycemic control among patients with type 2 Diabetes in Amplas Primary Health Care (PHC) Medan. The study design was a cross-sectional analytic approach. The study population was patients with Type 2 diabetes that is in the region Amplas PHC with a sample of 100 people with consecutive sampling method. We collected data by interviewing and blood analysis. Adapted CES-D questionnaire assessed the depression status. AFull Automatic Spectrophotometer Colorimeter method measured the Blood Sugar Level (BSL),and a Modified HPLC with Doronad affinity measured the HbA1c in avenous blood sample. We used Chi-square test and SPP to analyze and process the data. The results showed 57 (57%) subjects had depression, based on BSL as many as 69 subjects (69%) were not well-controlled diabetes, HbA1c levels showed that 79 subjects (79%) were uncontrolled diabetes. Chi-Square test found a significant relationship between the incidence of depression with glycemic control in diabetic patients in the Amplas PHC (p <0.05).
Annor, Francis B; Roblin, Douglas W; Okosun, Ike S; Goodman, Michael
To examine the association between glycosylated hemoglobin (HbA1c) and four subscales of work-related psychosocial stress at study baseline and over time. We used survey data from a major HMO located in the Southeastern part of the US on health and healthy behaviors linked with patients' clinical, pharmacy and laboratory records for the period between 2005 and 2009. Study participants (n=537) consisted of working adults aged 25-59 years, diagnosed with diabetes mellitus (DM) but without advanced micro or macrovascular complications at the time of the survey. We estimated the baseline (2005) association between HbA1c and work-related psychosocial stress and their interactions using linear regression analysis. Using individual growth model approach, we estimated the association between HbA1c over time and work-related psychosocial stress. Each of the models controlled for socio-demographic variables, diet and physical activity factor, laboratory factor, physical examinations variables and medication use in a hierarchical fashion. After adjusting for all study covariates, we did not find a significant association between work-related psychosocial stress and glycemic control either at baseline or over time. Among fairly healthy middle aged working adults with DM, work-related psychosocial stress was not directly associated with glycemic control. Copyright © 2015 Diabetes India. Published by Elsevier Ltd. All rights reserved.
Bukar, J; Mezitis, N H; Saitas, V; Pi-Sunyer, F X
Fructose is known to elicit a lower glycemic response than sucrose, and high-fructose desserts have been recommended for a diabetic diet. We compared a cholesterol-free tofu-based frozen dessert (TFD) containing high-fructose corn syrups with a dairy-based sucrose-sweetened ice cream (IC). Six male and six female non-insulin-dependent diabetic patients (mean age 51 yr, mean ideal body weight 143%, fasting blood glucose less than 160 mg/dl) with well-controlled diabetes and managed on oral hypoglycemic agents were studied. Subjects underwent three trials. In the first trial they ingested 50 g glucose, and in the next two trials they ingested 50-g carbohydrate equivalents of either TFD or IC in random sequence. Venous blood was drawn at intervals during the 3-h trials for glucose and insulin determinations. Fasting plasma glucose was not statistically different between IC and TFD trials (130 vs. 121 mg/dl). Peak glucose responses were at 120 min in both trials (190 mg/dl for IC and 222 mg/dl for TFD), with those for TFD being significantly higher (P less than 0.01). Mean glucose area and glycemic index for TFD were significantly greater than for IC (P less than 0.01 and P less than 0.03, respectively). There was no significant difference between mean insulin areas. In summary, the TFD, which contains soybean curd and high-fructose corn syrup, might have been expected to produce more satisfactory postprandial blood glucose levels than IC, which contains sucrose, yet a higher glycemic response was elicited. This is related to the substantial amount of total glucose in this "fructose" dessert.(ABSTRACT TRUNCATED AT 250 WORDS)
Jensen, Majken K; Koh-Banerjee, Pauline; Franz, Mary
BACKGROUND: Intake of whole grains is inversely associated with risk of diabetes and ischemic heart disease in observational studies. The lower risk associated with high whole-grain intakes may be mediated through improvements in glycemic control, lipid profiles, or reduced inflammation. OBJECTIV...... in this population. CONCLUSION: The results suggest a lower risk of diabetes and heart disease in persons who consume diets high in whole grains.......BACKGROUND: Intake of whole grains is inversely associated with risk of diabetes and ischemic heart disease in observational studies. The lower risk associated with high whole-grain intakes may be mediated through improvements in glycemic control, lipid profiles, or reduced inflammation. OBJECTIVE......-reactive protein, fibrinogen, and interleukin 6). DESIGN: This was a cross-sectional study of the relations of whole grains, bran, and germ intakes with homocysteine and markers of glycemic control, lipids, and inflammation in 938 healthy men and women. RESULTS: Whole-grain intake was inversely associated...
Sood, Erica D; Pendley, Jennifer Shroff; Delamater, Alan M; Rohan, Jennifer M; Pulgaron, Elizabeth R; Drotar, Dennis
To examine the relationship of mother-father informant discrepancies regarding diabetes management to diabetes-specific family conflict and glycemic control. One hundred thirty-six mothers and fathers of youth with Type 1 diabetes reported on the youth's diabetes management, diabetes-specific family conflict, and amount of paternal involvement in diabetes care. Glycosylated hemoglobin A1c (HbA1c) was used to measure glycemic control. As hypothesized, mother-father discrepancies regarding diabetes management were positively associated with frequency of diabetes-specific family conflict. Contrary to hypotheses, mother-father discrepancies regarding diabetes management predicted poorer glycemic control for youth with less involved fathers only. Results highlight the importance of caregivers being consistent about pediatric illness management and support the idea that informant discrepancies represent an important window into the functioning of the family system. PsycINFO Database Record (c) 2012 APA, all rights reserved.
Oleg Gennad'evich Motovilin
Full Text Available Aim. To elucidate the relationship between glycemic control (assessed by the level of HbA1c and psychological status of the patients. Materials and methods. The study included 115 patients with type 1 diabetes aged 13-27 years. The following tests were used to assess the psychological statusof the patients status (emotional state, social relations, attitude toward disease: State-trait-anxiety Inventory (Spielberger C.D., Hanin Y.L, Center for EpidemiologicStudies Depression Scale (CES-D, Social ajustment scale by A.K. Osnizkiy based on Q-Sort Adjustment Scale developed by R. Dymond andC.R. Rogers (1954, Lusher colour test , Colour attitudes test, A.M. Etkind original technique, method for the assessment of attitude toward disease developedin V.M. Bekhterev Research Psychoneurologic Institute, Sankt-Peterburg. The patients were allocated to 3 groups differing in terms of 33.3% percentile ofHbA1c levels. Results. Patients with good glycemic control (mean HbA1c level 7.4% show the lowest level of social adaptation and emotional well-being. The reason for thisphenomenon is the excessive focus of patient on the disease and narrow scope of interests, which suggest psychological dependence on diabetes. Patients withpoor glycemic control (mean HbA1c level 13.1% also experience emotional discomfort due to increased anxiety. Despite the fact they exhibit a higher degreeof social adaptation than the patients of the above group, the main concern is the low level of communicative autonomy and the feeling of being unable to copewith the disease. Such personal characteristics also create a psychological dependence on diabetes, although of a different type than in the first group of patients.Patients with average glycemic control (mean HbA1c level 9.5% in the sample have the most favorable psychological state in comparison with the other twogroups. Their emotional state and social adaptation are significantly better than in the other two groups. These patients
Liu, Winnie; Saxon, David R; McNair, Bryan; Sanagorski, Rebecca; Rasouli, Neda
Rates of diabetes for veterans who receive health care through the Veterans Health Administration are higher than rates in the general population. Furthermore, many veterans live in rural locations, far from Veterans Affairs (VA) hospitals, thus limiting their ability to readily seek face-to-face endocrinology care for diabetes. Telehealth (TH) technologies present an opportunity to improve access to specialty diabetes care for such patients; however, there is a lack of evidence regarding the ability of TH to improve glycemic control in comparison to traditional face-to-face consultations. This was a retrospective cohort study of all new endocrinology diabetes consultations at the Denver VA Medical Center over a 1-year period. A total of 189 patients were included in the analysis. In all, 85 patients had received face-to-face (FTF) endocrinology consultation for diabetes and 104 patients had received TH consultation. Subjects were mostly males (94.7%) and the mean age was 62.8 ± 10.1 years old. HbA1c improved from 9.76% (9.40% to 10.11%) to 8.55% (8.20% to 8.91%) (P Endocrinology TH consultations improved short-term glycemic control as effectively as traditional FTF visits in a veteran population with diabetes. © 2016 Diabetes Technology Society.
Full Text Available Hot spring water and natural mineral water have been therapeutically used to prevent or improve various diseases. Specifically, consumption of bicarbonate-rich mineral water (BMW has been reported to prevent or improve type 2 diabetes (T2D in humans. However, the molecular mechanisms of the beneficial effects behind mineral water consumption remain unclear. To elucidate the molecular level effects of BMW consumption on glycemic control, blood metabolome analysis and fecal microbiome analysis were applied to the BMW consumption test. During the study, 19 healthy volunteers drank 500 mL of commercially available tap water (TW or BMW daily. TW consumption periods and BMW consumption periods lasted for a week each and this cycle was repeated twice. Biochemical tests indicated that serum glycoalbumin levels, one of the indexes of glycemic controls, decreased significantly after BMW consumption. Metabolome analysis of blood samples revealed that 19 metabolites including glycolysis-related metabolites and 3 amino acids were significantly different between TW and BMW consumption periods. Additionally, microbiome analysis demonstrated that composition of lean-inducible bacteria was increased after BMW consumption. Our results suggested that consumption of BMW has the possible potential to prevent and/or improve T2D through the alterations of host metabolism and gut microbiota composition.
Lipska, Kasia J; Yao, Xiaoxi; Herrin, Jeph; McCoy, Rozalina G; Ross, Joseph S; Steinman, Michael A; Inzucchi, Silvio E; Gill, Thomas M; Krumholz, Harlan M; Shah, Nilay D
To examine temporal trends in utilization of glucose-lowering medications, glycemic control, and rate of severe hypoglycemia among patients with type 2 diabetes (T2DM). Using claims data from 1.66 million privately insured and Medicare Advantage patients with T2DM from 2006 to 2013, we estimated the annual 1 ) age- and sex-standardized proportion of patients who filled each class of agents; 2 ) age-, sex-, race-, and region-standardized proportion with hemoglobin A 1c (HbA 1c ) use increased for metformin (from 47.6 to 53.5%), dipeptidyl peptidase 4 inhibitors (0.5 to 14.9%), and insulin (17.1 to 23.0%) but declined for sulfonylureas (38.8 to 30.8%) and thiazolidinediones (28.5 to 5.6%; all P use of glucose-lowering drugs has changed dramatically among patients with T2DM. Overall glycemic control has not improved and remains poor among nearly a quarter of the youngest patients. The overall rate of severe hypoglycemia remains largely unchanged. © 2017 by the American Diabetes Association.
Full Text Available Background: A low-glycemic index diet is effective in blood glucose control of diabetic subjects, reduces insulin requirement in women with gestation diabetes mellitus (GDM and improves pregnancy outcomes when used from beginning of the second trimester. However there are limited reports to examine the effect of low glycemic load (LGL diet and fiber on blood glucose control and insulin requirement of women with GDM. Therefore, the aim of this study was to examine the effect of low glycemic load diet with and without fiber on reducing the number of women with GDM requiring insulin. Materials and Methods: All GDM women (n = 31 were randomly allocated to consume either a LGL diet with Fiber or LGL diet. Results: We found that 7 (38.9% of 18 women with GDM in Fiber group and 10 (76.9% in "Without Fiber" group required insulin treatment. Conclusion: The LGL diet with added fiber for women with GDM dramatically reduced the number needing for insulin treatment.
Tan, S L; Juliana, S; Sakinah, H
Compliance with medical nutrition therapy is important to improve patient outcomes. The purpose of this study was to determine dietary compliance and its association with glycemic control among outpatients with poorly controlled type 2 diabetes mellitus (T2DM) in Hospital Universiti Sains Malaysia (HUSM). In this cross-sectional study, patients who had a glycosylated hemoglobin (HbA1c) level of at least 6.5%, after attending a diet counseling session at the Outpatient Dietetic Clinic, HUSM, were enrolled. Out of 150 diabetic patients reviewed between 2006 and 2008, 61 adults (32 men and 29 women) agreed to participate in this study. A questionnaire-based interview was used to collect socio-demographic, clinical and diabetes self-care data. The patient's dietary compliance rate was determined by the Summary of Diabetes Self-Care Activities (SDSCA) measure. Anthropometric and biological measurements were also taken. Only 16.4% of the respondents adhered to the dietary regimen provided by dietitians. Among the 7 dietary self-care behaviours, item number 6 (eat lots of food high in dietary fibre such as vegetable or oats) had the highest compliant rate (54.1%); whereas item number 3 (eat five or more servings of fruits and vegetables per day) had the lowest compliant rate (23.0%). There was a significant association between gender (p = 0.037) and fasting blood sugar (FBS) (p = 0.007) with the compliance status. Dietary non-compliance is still common among T2DM patients. Dietitians need to improve their skills and use more effective intervention approaches in providing dietary counseling to patients.
Costello, Rebecca B.; Dwyer, Johanna T.; Saldanha, Leila; Bailey, Regan L.; Merkel, Joyce; Wambogo, Edwina
Cinnamon (Cinnamomum sp.) has been suggested to help patients with type 2 diabetes mellitus (T2DM) achieve better glycemic control although conclusions from meta-analyses are mixed. To evaluate whether the use of cinnamon dietary supplements by adults with T2DM had clinically meaningful effects on glycemic control, as measured by changes in fasting plasma glucose (FPG) or hemoglobin A1c (HbA1c), a comprehensive PubMed literature search was performed. Eleven RCTs were identified meeting our in...
Beck, Roy W; Connor, Crystal G; Mullen, Deborah M; Wesley, David M; Bergenstal, Richard M
HbA 1c is a v aluable metric for comparing treatment groups in a randomized trial, for assessing glycemic trends in a population over time, or for cross-sectional comparisons of glycemic control in different populations. However, what is not widely appreciated is that HbA 1c may not be a good indicator of an individual patient's glycemic control because of the wide range of mean glucose concentrations and glucose profiles that can be associated with a given HbA 1c level. To illustrate this point, we plotted mean glucose measured with continuous glucose monitoring (CGM) versus central laboratory-measured HbA 1c in 387 participants in three randomized trials, showing that not infrequently HbA 1c may underestimate or overestimate mean glucose, sometimes substantially. Thus, if HbA 1c is to be used to assess glycemic control, it is imperative to know the patient's actual mean glucose to understand how well HbA 1c is an indicator of the patient's glycemic control. With knowledge of the mean glucose, an estimated HbA 1c (eA1C) can be calculated with the formula provided in this article to compare with the measured HbA 1c . Estimating glycemic control from HbA 1c alone is in essence applying a population average to an individual, which can be misleading. Thus, a patient's CGM glucose profile has considerable value for optimizing his or her diabetes management. In this era of personalized, precision medicine, there are few better examples with respect to the fallacy of applying a population average to a specific patient rather than using specific information about the patient to determine the optimal approach to treatment. © 2017 by the American Diabetes Association.
Hansen, Morten; Sonne, David P; Mikkelsen, Kristian H
AIM: To evaluate the effects of bile acid sequestrants (BASs) versus placebo, no intervention or active comparators on glycemic control in type 2 diabetes. METHODS: Data were retrieved and a systematic review with meta-analyses was performed. We evaluated bias control and subgroup and sensitivity...... analyses were performed to evaluate heterogeneity and bias. RESULTS: We included 17 trials with a total of 2950 patients randomized to BASs (colesevelam or colestimide) versus placebo, no intervention, statins or sitagliptin. Random-effects meta-analysis showed that patients randomized to BASs had a lower...... hemoglobin A1c at the end of treatment compared with the control group (mean difference-0.55%; 95% confidence interval-0.64 to -0.46). Analysis of trials with low risk of bias in all domains confirmed the findings. Data on adverse events were limited. There were no differences between trials stratified...
Kahlhöfer, J; Lagerpusch, M; Enderle, J; Eggeling, B; Braun, W; Pape, D; Müller, M J; Bosy-Westphal, A
Because both, glycemic index (GI) and carbohydrate content of the diet increase insulin levels and could thus impair fat oxidation, we hypothesized that refeeding a low GI, moderate-carbohydrate diet facilitates weight maintenance. Healthy men (n=32, age 26.0±3.9 years; BMI 23.4±2.0 kg/m(2)) followed 1 week of controlled overfeeding, 3 weeks of caloric restriction and 2 weeks of hypercaloric refeeding (+50, -50 and +50% energy requirement) with low vs high GI (41 vs 74) and moderate vs high CHO intake (50% vs 65% energy). We measured adaptation of fasting macronutrient oxidation and the capacity to supress fat oxidation during an oral glucose tolerance test. Changes in fat mass were measured by quantitative magnetic resonance. During overfeeding, participants gained 1.9±1.2 kg body weight, followed by a weight loss of -6.3±0.6 kg and weight regain of 2.8±1.0 kg. Subjects with 65% CHO gained more body weight compared with 50% CHO diet (Pfat oxidation when compared with a low-GI diet (Pfat oxidation was associated with regain in fat mass (r=0.43, Pcarbohydrate content affect substrate oxidation and thus the regain in body weight in healthy men. These results argue in favor of a lower glycemic load diet for weight maintenance after weight loss.
Full Text Available Background: Vitamin D deficiency may play a key role in the development of impaired glucose tolerance, type 2 diabetes mellitus (T2DM, and metabolic syndrome. Several studies have shown that Vitamin D has an antioxidant property. We aimed to investigate 25-hydroxy Vitamin D (25[OH]D levels in patients with T2DM and in nondiabetic healthy controls and to ascertain the impact of 25(OHD levels on glycemic control and oxidative stress in T2DM patients. Materials and Methods: Thirty male patients with T2DM and twenty age- and socioeconomic status-matched male healthy controls were included in the study. Fasting and postprandial blood sugar and glycated hemoglobin (HbA1c were measured. Enzyme activity of superoxide dismutase (SOD and glutathione peroxidase (GPx was determined by spectrophotometric assay, and serum levels of 25(OHD were measured using radioimmunoassay. Results: Serum Vitamin D levels were significantly lower in patients with T2DM than healthy controls (P = 0.015. There was a significantly lower GPx activity in patients with T2DM than controls (P = 0.048, but the difference in SOD activity did not reach statistical significance. There was a significant negative correlation between serum Vitamin D levels and HbA1c (P = 0.016, but no statistical correlation was shown between serum Vitamin D levels and GPx and SOD. Conclusion: We conclude that low level of Vitamin D might play a significant role in T2DM pathogenesis. Hence, Vitamin D supplementation may improve glycemic control and oxidative stress in T2DM.
Casey, Dympna; O'Hara, Mary Clare; Meehan, Ben; Byrne, Molly; Dinneen, Sean F.; Murphy, Kathy
Aim: To explain the factors affecting glycemic control (measured by HbA1c) following the Dose Adjustment for Normal Eating (DAFNE) program. Background: DAFNE is a structured education program designed to assist persons with type 1 diabetes mellitus achieve optimal glycemic control. However, not all participants reach this goal. Few studies…
Full Text Available Rania M Fahmy,1,2 Ramesa S Bhat,3 Manar Al-Mutairi,4 Feda S Aljaser,5 Afaf El-Ansary4 1Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia; 2Department of Ophthalmology, Faculty of Medicine, Cairo University, Giza, Egypt; 3Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia; 4Central Laboratory, Female Center for Medical Studies and Scientific Section, King Saud University, Riyadh, Saudi Arabia; 5Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia Objective: To evaluate the effect of diabetes mellitus (DM, diabetic retinopathy, and degree of glycemic control (glycosylated hemoglobin [HbA1c] on peripapillary retinal nerve fiber layer thickness (RNFLT using optical coherence tomography.Methods: The study included 126 eyes of healthy controls (n=32 and diabetics patients (n=31, whose ages ranged from 40 to 70 years. The diabetic group was divided into: Subgroup 1: with HbA1c <7% and Subgroup 2: with HbA1c ≥7%. All patients underwent full ophthalmic examination. HbA1c level was obtained with the A1cNow+ system and the peripapillary RNFLT was measured using 3D-OCT 2000 Topcon (360-degree circular scan with 3.4 mm diameter centered on optic disc.Results: The obtained data demonstrates significant decrease in peripapillary RNFLT in superior and inferior quadrants of the right eye (p=0.000 and p=0.039, respectively, and in superior quadrant of the left eye (p=0.002 with impairment of glycemic control. Pearson’s correlation test showed significant negative correlation of RNFLT with HbA1c in the superior quadrant in both eyes.Conclusion: Impairment of glycemic control affects the peripapillary RNFLT mainly in the superior quadrant. This thickness also tends to decrease with long-standing DM, use of DM medications, and development of diabetic retinopathy. The measurement of peripapillary RNFLT
Degli Esposti L
Full Text Available Luca Degli Esposti,1 Stefania Saragoni,1 Stefano Buda,1 Alessandra Sturani,2 Ezio Degli Esposti11CliCon Srl, Health, Economics and Outcomes Research, Ravenna, Italy; 2Nephrology and Dialysis Unit, Santa Maria delle Croci Hospital, Ravenna, ItalyBackground: Diabetes is one of the most prevalent chronic diseases, and its prevalence is predicted to increase in the next two decades. Diabetes imposes a staggering financial burden on the health care system, so information about the costs and experiences of collecting and reporting quality measures of data is vital for practices deciding whether to adopt quality improvements or monitor existing initiatives. The aim of this study was to quantify the association between health care costs and level of glycemic control in patients with type 2 diabetes using clinical and administrative databases.Methods: A retrospective analysis using a large administrative database and a clinical registry containing laboratory results was performed. Patients were subdivided according to their glycated hemoglobin level. Multivariate analyses were used to control for differences in potential confounding factors, including age, gender, Charlson comorbidity index, presence of dyslipidemia, hypertension, or cardiovascular disease, and degree of adherence with antidiabetic drugs among the study groups.Results: Of the total population of 700,000 subjects, 31,022 were identified as being diabetic (4.4% of the entire population. Of these, 21,586 met the study inclusion criteria. In total, 31.5% of patients had very poor glycemic control and 25.7% had excellent control. Over 2 years, the mean diabetes-related cost per person was: €1291.56 in patients with excellent control; €1545.99 in those with good control; €1584.07 in those with fair control; €1839.42 in those with poor control; and €1894.80 in those with very poor control. After adjustment, compared with the group having excellent control, the estimated excess cost
Full Text Available Evidence to support dietary modifications to improve glycemia during pregnancy is limited, and the benefits of diet beyond limiting gestational weight gain is unclear. Therefore, a systematic review and network meta-analysis of randomized trials was conducted to compare the effects of various common diets, stratified by the addition of gestational weight gain advice, on fasting glucose and insulin, hemoglobin A1c (HbA1c, and homeostatic model assessment for insulin resistance (HOMA-IR in pregnant women.MEDLINE, EMBASE, Cochrane database, and reference lists of published studies were searched through April 2017. Randomized trials directly comparing two or more diets for ≥2-weeks were eligible. Bayesian network meta-analysis was performed for fasting glucose. Owing to a lack of similar dietary comparisons, a standard pairwise meta-analysis for the other glycemic outcomes was performed. The certainty of the pooled effect estimates was assessed using the GRADE tool.Twenty-one trials (1,865 participants were included. In general, when given alongside gestational weight gain advice, fasting glucose improved in most diets compared to diets that gave gestational weight gain advice only. However, fasting glucose increased in high unsaturated or monounsaturated fatty acids diets. In the absence of gestational weight gain advice, fasting glucose improved in DASH-style diets compared to standard of care. Although most were non-significant, similar trends were observed for these same diets for the other glycemic outcomes. Dietary comparisons ranged from moderate to very low in quality of evidence.Alongside with gestational weight gain advice, most diets, with the exception of a high unsaturated or a high monounsaturated fatty acid diet, demonstrated a fasting glucose improvement compared with gestational weight gain advice only. When gestational weight gain advice was not given, the DASH-style diet appeared optimal on fasting glucose. However, a small
Ha, Vanessa; Bonner, Ashley J.; Jadoo, Jaynendr K.; Beyene, Joseph; Anand, Sonia S.
Aims Evidence to support dietary modifications to improve glycemia during pregnancy is limited, and the benefits of diet beyond limiting gestational weight gain is unclear. Therefore, a systematic review and network meta-analysis of randomized trials was conducted to compare the effects of various common diets, stratified by the addition of gestational weight gain advice, on fasting glucose and insulin, hemoglobin A1c (HbA1c), and homeostatic model assessment for insulin resistance (HOMA-IR) in pregnant women. Methods MEDLINE, EMBASE, Cochrane database, and reference lists of published studies were searched through April 2017. Randomized trials directly comparing two or more diets for ≥2-weeks were eligible. Bayesian network meta-analysis was performed for fasting glucose. Owing to a lack of similar dietary comparisons, a standard pairwise meta-analysis for the other glycemic outcomes was performed. The certainty of the pooled effect estimates was assessed using the GRADE tool. Results Twenty-one trials (1,865 participants) were included. In general, when given alongside gestational weight gain advice, fasting glucose improved in most diets compared to diets that gave gestational weight gain advice only. However, fasting glucose increased in high unsaturated or monounsaturated fatty acids diets. In the absence of gestational weight gain advice, fasting glucose improved in DASH-style diets compared to standard of care. Although most were non-significant, similar trends were observed for these same diets for the other glycemic outcomes. Dietary comparisons ranged from moderate to very low in quality of evidence. Conclusion/Interpretation Alongside with gestational weight gain advice, most diets, with the exception of a high unsaturated or a high monounsaturated fatty acid diet, demonstrated a fasting glucose improvement compared with gestational weight gain advice only. When gestational weight gain advice was not given, the DASH-style diet appeared optimal on
Full Text Available Context: Depression is common in people with diabetes and is associated with poor glycemic control. Evidence suggests that certain antidepressants (AD increase the risk of poor control. Few population-based studies have examined the impact of individual ADs on glycemic control. This study's objective is to measure the impact of Citalopram, Amitriptyline, Venlafaxine, Trazodone and Escitalopram on glycated hemoglobin (HbA1c in Canadian primary care patients with diabetes.Methods: A retrospective study of electronic medical records (EMR from 115 primary care practices across Canada was undertaken. Data were obtained from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN. The sample population comprised 1,084 diabetic patients with 1,127 prescriptions of one of the five selected ADs and with baseline and post-exposure HbA1c measurements. Generalized linear mixed models were computed to estimate the effect of the ADs on HbA1c.Results: Mean HbA1c ratios for Amitriptyline, Venlafaxine, Trazodone and Escitalopram were all numerically lower than Citalopram. The confidence intervals included the minimum detectable effect, however the differences were not statistically significant. The lowest clinically relevant HbA1c ratios, relative to Citalopram, were found in patients prescribed Trazodone and Escitalopram. Accounting for the prescription of Trazodone for indications other than depression, this research suggests that Escitalopram may be safer than Citalopram for people with diabetes and depression, in terms of its effect on blood glucose.Conclusion: This study can inform future research examining the relationship between ADs and blood glucose and provides insight into the limitations pertaining to the use of health data in health research. Future research should seek to control for, across multiple time points: depression symptoms, depression severity, depression duration, weight, diabetes medication, tobacco and alcohol consumption and
Lee, Shu-Li; Lo, Fu-Sung; Lee, Yann-Jinn; Chen, Bai-Hsiun; Wang, Ruey-Hsia
Understanding the predictors of glycemic control in adolescents of various age groups with type 1 diabetes (T1D) is crucial for nurses to cultivate developmental-specific interventions to improve glycemic control in this age group. However, research has rarely addressed this issue, particularly in the context of Asian populations. We explored the predictive influence of demographic characteristics, self-care behaviors, family conflict, and parental involvement on glycosylated hemoglobin (HbA1C) levels 6 months after the baseline measurement in adolescents of various age groups with T1D in Taiwan. A prospective survey design was applied. At baseline, adolescents with T1D completed a self-care behavior scale. Parents or guardians finished scales of parental involvement and family conflict. The HbA1C levels 6 months after baseline measurement were collected from medical records. Two hundred ten adolescent-parent/guardian pairs were enrolled as participants. Multiple stepwise regressions examined the significant predictors of HbA1C levels 6 months after the baseline measurement in the three adolescent age groups: 10-12, 13-15, and 16-18 years. Family conflict was a significant predictor of HbA1C level within the 10-12 years of age group 6 months after the baseline measurement. Self-care behaviors were a significant predictor of HbA1C level within the 13-15 years of age group 6 months after the baseline measurement. Being female and self-care behaviors were each significant predictors of HbA1C level in the 16-18 years of age group 6 months after the baseline measurement. Nurses should design specific interventions to improve glycemic control in adolescents of various age groups with T1D that are tailored to their developmental needs. For adolescents with T1D aged 10-12 years, nurses should actively assess family conflict and provide necessary interventions. For adolescents with T1D aged 13-18 years, nurses should exert special efforts to improve their self
Gluschenko, N; Vasylyshyn, Kh; Roschupkin, A; Lekishvili, S; Gladchenko, O
The aim of this paper is to investigate the content of chromium, cobalt and nickel in serum and erythrocytes in children with type 1 diabetes mellitus, depending on the level of glycemic control. The study was conducted on 68 children with type 1 diabetes mellitus. The patients were divided into four groups based on glycemic control. Group I was composed of 9 children with optimal level of glycemic control. Group II - 25 children with suboptimal level of glycemic control. Group III - 34 children with a high risk to life level of glycemic control. Group IV (control group) consisted of 30 healthy children. Compensation state of type 1 diabetes was evaluated according to ISPAD (Consensus for the Management of Type 1 Diabetes Mellitus in Children and Adolescens 2000). The content of trace elements in biological agents was determined by atomic absorbtion spectrophotometry method with C-115M1 mass-spectrophotometer, manufactured by «Selmi» enterprise (Ukraine). It is found that there is a decrease in serum concentrations of chromium and erythrocyte content of cobalt in patients with optimal level of glycemic control. The deficiency of chromium is accompanied by the deficiency of cobalt in patients with suboptimal level of glycemic control. The lower levels of cobalt and nickel are recorded simultaneously, but there is theexcess of chromium in the erythrocytes of these patients. Patients, who suffer from 1 type diabetes mellitus and high risk for life level of glycemic control have considerable polideficiency of cobalt, nickel and chromium in serum.The increasing level of chromium was recorded only in the erythrocytes. The level of glycemic control and the duration of 1 type diabetes mellitus are important in the forecasting of the development of chronic diabetic complications. It is found that the duration of 1 type diabetes mellitus influences the levels of cobalt and nickel in serum mostly, while the level of glycemic control influences the chromium content.
Paz, Rachael; Rouhanian, Minoo; Vogt, Karen
Disparities in glycemic control are reported in children with type 1 diabetes related to differences in access to health care and socioeconomic status. In the US military, rank is an indicator of socioeconomic status, but all have complete health care access without cost. We sought to determine if glycemic control in children with type 1 diabetes differs if their sponsor (parent) is an officer vs. enlisted military service member. We performed a cross-sectional retrospective chart review of children with type 1 diabetes >1 yr duration whose parent is a military service member. A total of 281 subjects met study criteria, 136 (48.4%) having an enlisted and 145 (51.6%) having an officer sponsor. The groups differed by race with 38.2% black in the enlisted and 9% black in the officer group (p 1). The median enlisted average hemoglobin A1c (HbA1c) over the most recent year of available data was significantly higher than the officer group (9.2 vs. 8.4%, p 1). The difference remained significant when controlled for age and race. Diabetes-related hospitalizations were greater in the enlisted group (39.0 vs. 19.3%, p 1). More subjects in the officer group were on insulin pumps (54.5 vs. 28.7%, p 1). Dependent children of enlisted service members with type 1 diabetes have higher HbA1c levels, more diabetes-related hospitalizations, and are less likely to use insulin pumps than children of officers. These differences are likely linked to socioeconomic status and education levels given the universal access to health care within the military system. Published 2015. This article is a U.S. Government work and is in the public domain in the USA.
Perez, Alvaro; Rojas, Pamela; Carrasco, Fernando; Basfi-Fer, Karen; Perez-Bravo, Francisco; Codoceo, Juana; Inostroza, Jorge; Galgani, Jose E; Gilmore, L Anne; Ruz, Manuel
Interest in healthy properties of food and nutrients as co-adjuvant in type-2 diabetes therapy has increased in recent years. Zinc supplementation trials have shown improvements in glycemic control in these patients, although it seems dependent on zinc status of the individuals. The objective of this study was to evaluate the relationship between zinc nutritional status and glucose homeostasis in patients with type-2 diabetes. Eighty patients with well controlled type-2 diabetes were recruited and clinical, anthropometric and dietary evaluations were performed. One week after, insulin sensitivity and beta cell function were assessed by a modified Frequently Sampled Intravenous Glucose Tolerance Test. Zinc status was assessed by plasma zinc and the size of rapidly Exchangeable Zinc Pool (EZP); zinc intake was also determined. Glucagon concentration was evaluated in a subsample of 36 patients. Patients presented a normal zinc status although zinc intake was lower than recommended. Overall, no associations were observed between zinc status and glycemic control markers. Nevertheless, positive correlations were observed between EZP and fasting insulin concentration (ρ = 0.393, p = 0.021) and HOMA-IR (ρ = 0.386, p = 0.024) in women, and between plasma zinc concentration and HbA1c (ρ = 0.342, p = 0.020) in men. No significant associations were found between zinc status and glycemic control parameters in patients with well-controlled type 2 diabetes and normal zinc status, although low-degree gender-dependent associations were observed. Further research is required to assess the role of zinc status in zinc deficient patients. Copyright © 2018 Elsevier GmbH. All rights reserved.
Due, Pernille; de Beaufort, Carine; Damsgaard, Mogens Trab
. The frequency of intake of fruit, vegetables, sweets, sugary soft drinks, and daily breakfast was compared between the two groups. The glycemic control of the adolescents in the HSG cohort was determined by measuring glycated hemoglobin (HbA1c). RESULTS: Across countries in the HSBC survey...
Caccavale, Laura J; Weaver, Patrick; Chen, Rusan; Streisand, Randi; Holmes, Clarissa S
Youth with Type 1 diabetes (T1D) from single-parent families have poorer glycemic control; a finding confounded with socioeconomic status (SES). Family density (FD), or youth:adult ratio, may better characterize family risk status. Structural equation modeling assessed the relation of single-parent status, SES, and FD to parenting stress, diabetes-related conflict, parental monitoring, adherence, and glycemic control using cross-sectional parent and youth data (n = 257). Single-parent status exhibited similar relations as SES and was removed. Lower FD was associated with better glycemic control (β = -.29, p = .014) via less conflict (β = .17, p = .038) and greater adherence (β = -.54, p single-parent status were indistinguishable from those of SES. FD provides distinct information related to adolescent glycemic control. © The Author 2015. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
D’Souza, Melba Sheila; Karkada, Subrahmanya Nairy; Hanrahan, Nancy P.; Venkatesaperumal, Ramesh; Amirtharaj, Anandhi
Background: The Arab adult with T2DM is understudied with less known facts about the perception of empowerment and its relationship with self-care and glycemic control. Purpose: The purpose of this study was to determine the extent to which perception of empowerment by Arab adults living with Type 2 Diabetes Mellitus (T2DM) was associated with better glycemic control and self-care management. Methods: A cross-sectional descriptive study was led among 300 Arab adults living in Oman with T2DM in an outpatient diabetes clinic. The Diabetes Empowerment Scale (DES), glycosylated haemaglobin (HbA1c) and Body mass index was assessed. The DES was found to be valid and reliable for the population. ANOVA, Regression analysis, and Structural equation modeling was used for analysis. Results: The composite score and three subscales of DES were a significant and strong predictor of good glycemic control among Omani adults with T2DM (pempowerment and tailor interventions to increase empowerment for better glycemic control. Patient empowerment plays an essential role in maintaining self-care behaviours and HbA1c. PMID:26156908
Hirata, Takumi; Higashiyama, Aya; Kubota, Yoshimi; Nishimura, Kunihiro; Sugiyama, Daisuke; Kadota, Aya; Nishida, Yoko; Imano, Hironori; Nishikawa, Tomofumi; Miyamatsu, Naomi; Miyamoto, Yoshihiro; Okamura, Tomonori
Several studies have reported that insulin resistance was a major risk factor for the onset of type 2 diabetes mellitus in individuals without diabetes or obesity. We aimed to clarify the association between insulin resistance and glycemic control in Japanese subjects without diabetes or obesity. We conducted a community-based cross-sectional study including 1083 healthy subjects (323 men and 760 women) in an urban area. We performed multivariate regression analyses to estimate the association between the homeostasis model assessment of insulin resistance (HOMA-IR) values and markers of glycemic control, including glycated haemoglobin (HbA1c), 1,5-anhydroglucitol (1,5-AG), and fasting plasma glucose (FPG) levels, after adjustment for potential confounders. Compared with the lowest tertile of HOMA-IR values, the highest tertile was significantly associated with HbA1c and FPG levels after adjustment for potential confounders, both in men (HbA1c: β = 1.83, P = 0.001; FPG: β = 0.49, P HOMA-IR values was inversely associated with 1,5-AG levels compared with the lowest tertile (β = -18.42, P = 0.009) only in men. HOMA-IR values were associated with markers of glycemic control in Japanese subjects without diabetes or obesity. Insulin resistance may influence glycemic control even in a lean, non-diabetic Asian population.
Mor, Anil; Dekkers, Olaf M; Nielsen, Jens S
Infections are a major clinical challenge for type 2 diabetes patients, but little is known about the impact of glycemic control. We used Cox regression analyses to examine the association between baseline and time-varying HbA1c values and development of community antiinfective-treated and hospital.......51, 1.79) for the latest updated HbA1c. Our findings provide evidence for an association of current hyperglycemia with infection risk in type 2 diabetes patients.......-treated infections in 69,318 patients with type 2 diabetes diagnosed between 2000 and 2012 in Northern Denmark. Incidence rates were 394/1,000 patient-years for community-treated infections and 63/1,000 patient-years for hospital-treated infections. The adjusted hazard ratios for community-treated infection at an Hb...
Campbell, R Keith; Miller, Sara
More than 24 million adults and children in the United States are living with diabetes, and the vast majority of those individuals have type 2 diabetes. The clinical benefits of good glycemic control have been well established. Most patients eventually require the use of multiple hyperglycemic drugs in combination to approach or achieve the American Diabetes Association's recommended target A1C value of 7%. The role of incretin-based therapies for both glycemic control and beta-cell protection has become an area of intense interest and development. Although current practice guidelines do not include specific recommendations about when and how to incorporate incretin-based agents, a consensus statement published by the American Diabetes Association/European Association for the Study of Diabetes suggests the addition of a glucagon-like peptide-1 (GLP-1) agonist for patients not at goal A1C with metformin and lifestyle changes. The goal of this article is to review this class of agents, discuss their role in the treatment of type 2 diabetes, and address the practical aspects of integrating incretin-based agents into the management of patients with diabetes. Currently, 3 incretin-based therapies are available and widely used in clinical practice. Several more agents are either under review by the Food and Drug Administration (FDA) or are in the very late stages of development. For diabetes educators trying to help their patients understand the differences among their antidiabetic medications, a comprehensive understanding of these agents and their role in therapy is imperative.
Full Text Available Background: The prevalence of type 2 diabetes is increasing in Malaysia, with most patients poorly controlled. Hence, this study aimed to determine nutritional and metabolic status as well as blood pressure of Malaysian patients with type 2 diabetes mellitus and identify associated risk factors for poor glycemic control. Materials and Methods: A total of 104 type 2 diabetic patients were recruited and completed a questionnaire covering socio-demographic status, 3-day diet records, and physical activity. Anthropometry and glycemic control parameters, lipid profile and blood pressure were also measured. Results: Subjects were on average 56.7±9.9 years old with a mean duration of diabetes of 6.5 ± 5.0 years. The mean hemoglobin A1c of the subjects was 7.6% ± 1.4%, with only 20.2% achieving the target goal of <6.5% with no significant differences between genders. The mean body mass index was 26.9 ± 4.7 kg/m 2 , with 86.5% either were overweight or obese. Only 10.6% of the subjects exercised daily. The proportions of macronutrients relative to total energy intake were consistent with the recommendations of most diabetes associations. The adjusted odds of having poor glycemic control were 3.235 (1.043-10.397 (P < 0.05 higher among those who had high density lipoprotein cholesterol levels below the normal range. Those taking one or two types of oral anti-diabetic drugs had 19.9 (2.959-87.391 (P < 0.01 and 14.3 (2.647-77.500 (P < 0.01 higher odds of poor glycemic control respectively compared to those who were being treated by diet alone. Conclusion: Poor glycemic control was prevalent among Malaysian diabetic patients, and this could be associated with low levels of HDL and being treated with oral anti-diabetes agents.
Firouzi, Somayyeh; Barakatun-Nisak, Mohd Yusof; Azmi, Kamaruddin Nor
The prevalence of type 2 diabetes is increasing in Malaysia, with most patients poorly controlled. Hence, this study aimed to determine nutritional and metabolic status as well as blood pressure of Malaysian patients with type 2 diabetes mellitus and identify associated risk factors for poor glycemic control. A total of 104 type 2 diabetic patients were recruited and completed a questionnaire covering socio-demographic status, 3-day diet records, and physical activity. Anthropometry and glycemic control parameters, lipid profile and blood pressure were also measured. Subjects were on average 56.7±9.9 years old with a mean duration of diabetes of 6.5 ± 5.0 years. The mean hemoglobin A1c of the subjects was 7.6% ± 1.4%, with only 20.2% achieving the target goal of 10.6% of the subjects exercised daily. The proportions of macronutrients relative to total energy intake were consistent with the recommendations of most diabetes associations. The adjusted odds of having poor glycemic control were 3.235 (1.043-10.397) (P types of oral anti-diabetic drugs had 19.9 (2.959-87.391) (P 1) and 14.3 (2.647-77.500) (P 1) higher odds of poor glycemic control respectively compared to those who were being treated by diet alone. Poor glycemic control was prevalent among Malaysian diabetic patients, and this could be associated with low levels of HDL and being treated with oral anti-diabetes agents.
Firouzi, Somayyeh; Barakatun-Nisak, Mohd Yusof; Azmi, Kamaruddin Nor
Background: The prevalence of type 2 diabetes is increasing in Malaysia, with most patients poorly controlled. Hence, this study aimed to determine nutritional and metabolic status as well as blood pressure of Malaysian patients with type 2 diabetes mellitus and identify associated risk factors for poor glycemic control. Materials and Methods: A total of 104 type 2 diabetic patients were recruited and completed a questionnaire covering socio-demographic status, 3-day diet records, and physical activity. Anthropometry and glycemic control parameters, lipid profile and blood pressure were also measured. Results: Subjects were on average 56.7±9.9 years old with a mean duration of diabetes of 6.5 ± 5.0 years. The mean hemoglobin A1c of the subjects was 7.6% ± 1.4%, with only 20.2% achieving the target goal of exercised daily. The proportions of macronutrients relative to total energy intake were consistent with the recommendations of most diabetes associations. The adjusted odds of having poor glycemic control were 3.235 (1.043-10.397) (P < 0.05) higher among those who had high density lipoprotein cholesterol levels below the normal range. Those taking one or two types of oral anti-diabetic drugs had 19.9 (2.959-87.391) (P < 0.01) and 14.3 (2.647-77.500) (P < 0.01) higher odds of poor glycemic control respectively compared to those who were being treated by diet alone. Conclusion: Poor glycemic control was prevalent among Malaysian diabetic patients, and this could be associated with low levels of HDL and being treated with oral anti-diabetes agents. PMID:25767521
Full Text Available Harold E Bays,1 Eliot A Brinton,2 Joseph Triscari,3 Erluo Chen,3 Darbie Maccubbin,3 Alexandra A MacLean,3 Kendra L Gibson,3 Rae Ann Ruck,3 Amy O Johnson-Levonas,3 Edward A O’Neill,3 Yale B Mitchel3 1Louisville Metabolic & Atherosclerosis Research Center (L-MARC, Louisville, KY, USA; 2Utah Foundation for Biomedical Research, Salt Lake City, UT, USA; 3Merck & Co, Inc., Whitehouse Station, NJ, USA Background: The degree of glycemic control in patients with type 2 diabetes mellitus (T2DM may alter lipid levels and may alter the efficacy of lipid-modifying agents. Objective: Evaluate the lipid-modifying efficacy of extended-release niacin/laropiprant (ERN/LRPT in subgroups of patients with T2DM with better or poorer glycemic control. Methods: Post hoc analysis of clinical trial data from patients with T2DM who were randomized 4:3 to double-blind ERN/LRPT or placebo (n=796, examining the lipid-modifying effects of ERN/LRPT in patients with glycosylated hemoglobin or fasting plasma glucose levels above and below median baseline levels. Results: At Week 12 of treatment, ERN/LRPT significantly improved low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C, non-high-density lipoprotein cholesterol, triglycerides, and lipoprotein (a, compared with placebo, with equal efficacy in patients above or below median baseline glycemic control. Compared with placebo, over 36 weeks of treatment more patients treated with ERN/LRPT had worsening of their diabetes and required intensification of antihyperglycemic medication, irrespective of baseline glycemic control. Incidences of other adverse experiences were generally low in all treatment groups. Conclusion: The lipid-modifying effects of ERN/LRPT are independent of the degree of baseline glycemic control in patients with T2DM (NCT00485758. Keywords: lipid-modifying agents, hyperglycemia, LDL, HDL, triglycerides
Tai, Huai-Ching; Tai, Tong-Yuan; Yang, Wei-Shiung; Wang, Shin-Wei; Yu, Hong-Jeng
Patients with diabetes are predisposed to develop a variety of complications, including lower urinary tract (LUT) dysfunction. We aimed to examine the associations between glycemic control and LUT dysfunction in women with type 2 diabetes (T2D). We included 400 women with T2D (age range, 48-75 years) in this cross-sectional analysis. The participants were divided into tertiles according to glycosylated hemoglobin (HbA1c) measurements. The mean HbA1c levels for tertiles 1, 2, and 3 were 6.2% (N=132), 7.1% (N=132), and 8.4% (N=136), respectively. We evaluated LUT dysfunction with the American Urological Association Symptom Index (AUA-SI) questionnaire, uroflowmetry (UFM), and post-void residual (PVR). No significant differences were found among HbA1c tertiles regarding storage, voiding and total AUA-SI scores, and prevalence of LUT symptoms. However, women in tertile 3 had higher prevalences of severe LUT symptoms (AUA-SI≥20) and clinically significant PVR (≥100mL) compared to women in the other tertiles. Multivariate analysis revealed that diabetic neuropathy, but not HbA1c, significantly predicted LUT symptoms in women with T2D after adjustment for age, body mass index (BMI) and hypertension. However, HbA1c was associated with an increased risk of developing clinically significant PVR. Our findings do not support significant associations between glycemic control and LUT symptoms in women with T2D. However, women with poor glycemic control are more likely to develop urinary retention than women with proper glycemic control. Clinicians should, therefore, be aware of and educate patients about the association between urinary retention and glycemic control. Copyright © 2016 Elsevier Inc. All rights reserved.
Li, Sing-Chung; Liu, Yen-Hua; Liu, Jen-Fang; Chang, Wen-Hsin; Chen, Chiao-Ming; Chen, C-Y Oliver
Almond consumption is associated with ameliorations in obesity, hyperlipidemia, hypertension, and hyperglycemia. The hypothesis of this 12-week randomized crossover clinical trial was that almond consumption would improve glycemic control and decrease the risk for cardiovascular disease in 20 Chinese patients with type 2 diabetes mellitus (T2DM) (9 male, 11 female; 58 years old; body mass index, 26 kg/m²) with mild hyperlipidemia. After a 2-week run-in period, patients were assigned to either a control National Cholesterol Education Program step II diet (control diet) or an almond diet for 4 weeks, with a 2-week washout period between alternative diets. Almonds were added to the control diet to replace 20% of total daily calorie intake. Addition of approximately 60 g almonds per day increased dietary intakes of fiber, magnesium, polyunsaturated fatty acid, monounsaturated fatty acid, and vitamin E. Body fat determined with bioelectrical impedance analysis was significantly lower in patients consuming almonds (almonds vs control: 29.6% vs 30.4%). The almond diet enhanced plasma α-tocopherol level by a median 26.8% (95% confidence intervals, 15.1-36.6) compared with control diet. Furthermore, almond intake decreased total cholesterol, low-density lipoprotein cholesterol, and the ratio of low-density lipoprotein cholesterol to high-density lipoprotein cholesterol by 6.0% (1.6-9.4), 11.6% (2.8-19.1), and 9.7% (0.3-20.9), respectively. Plasma apolipoprotein (apo) B levels, apo B/apo A-1 ratio, and nonesterified fatty acid also decreased significantly by 15.6% (5.1-25.4), 17.4% (2.8-19.9), and 5.5% (3.0-14.4), respectively. Compared with subjects in the control diet, those in the almond diet had 4.1% (0.9-12.5), 0.8% (0.4-6.3), and 9.2% (4.4-13.2) lower levels of fasting insulin, fasting glucose, and homeostasis model assessment of insulin resistance index, respectively. Our results suggested that incorporation of almonds into a healthy diet has beneficial effects on
Johansen, Mette Yun; MacDonald, Christopher Scott; Hansen, Katrine Bagge; Karstoft, Kristian; Christensen, Robin; Pedersen, Maria; Hansen, Louise Seier; Zacho, Morten; Wedell-Neergaard, Anne-Sophie; Nielsen, Signe Tellerup; Iepsen, Ulrik Wining; Langberg, Henning; Vaag, Allan Arthur; Pedersen, Bente Klarlund; Ried-Larsen, Mathias
It is unclear whether a lifestyle intervention can maintain glycemic control in patients with type 2 diabetes. To test whether an intensive lifestyle intervention results in equivalent glycemic control compared with standard care and, secondarily, leads to a reduction in glucose-lowering medication in participants with type 2 diabetes. Randomized, assessor-blinded, single-center study within Region Zealand and the Capital Region of Denmark (April 2015-August 2016). Ninety-eight adult participants with non-insulin-dependent type 2 diabetes who were diagnosed for less than 10 years were included. Participants were randomly assigned (2:1; stratified by sex) to the lifestyle group (n = 64) or the standard care group (n = 34). All participants received standard care with individual counseling and standardized, blinded, target-driven medical therapy. Additionally, the lifestyle intervention included 5 to 6 weekly aerobic training sessions (duration 30-60 minutes), of which 2 to 3 sessions were combined with resistance training. The lifestyle participants received dietary plans aiming for a body mass index of 25 or less. Participants were followed up for 12 months. Primary outcome was change in hemoglobin A1c (HbA1c) from baseline to 12-month follow-up, and equivalence was prespecified by a CI margin of ±0.4% based on the intention-to-treat population. Superiority analysis was performed on the secondary outcome reductions in glucose-lowering medication. Among 98 randomized participants (mean age, 54.6 years [SD, 8.9]; women, 47 [48%]; mean baseline HbA1c, 6.7%), 93 participants completed the trial. From baseline to 12-month follow-up, the mean HbA1c level changed from 6.65% to 6.34% in the lifestyle group and from 6.74% to 6.66% in the standard care group (mean between-group difference in change of -0.26% [95% CI, -0.52% to -0.01%]), not meeting the criteria for equivalence (P = .15). Reduction in glucose-lowering medications occurred in 47 participants (73
Borgquist, Ola; Wise, Matt P; Nielsen, Niklas
OBJECTIVES: Dysglycemia and glycemic variability are associated with poor outcomes in critically ill patients. Targeted temperature management alters blood glucose homeostasis. We investigated the association between blood glucose concentrations and glycemic variability and the neurologic outcomes...... of patients randomized to targeted temperature management at 33°C or 36°C after cardiac arrest. DESIGN: Post hoc analysis of the multicenter TTM-trial. Primary outcome of this analysis was neurologic outcome after 6 months, referred to as "Cerebral Performance Category." SETTING: Thirty-six sites in Europe...... and Australia. PATIENTS: All 939 patients with out-of-hospital cardiac arrest of presumed cardiac cause that had been included in the TTM-trial. INTERVENTIONS: Targeted temperature management at 33°C or 36°C. MEASUREMENTS AND MAIN RESULTS: Nonparametric tests as well as multiple logistic regression and mixed...
Full Text Available Ample evidence suggests that social support, self-efficacy, and adherence significantly, independently, and together affect glycemic control in patients with type 2 diabetes mellitus (T2DM, but the pathway from social support to glycemic control remains unclear. This study hypothesized that the effect of social support on glycemic control was mediated sequentially by self-efficacy and adherence. Patients with T2DM were recruited from two hospitals in Guangzhou, China, from January 1 to July 31, 2014, and their sociodemographic clinical data and their assessments on social support, self-efficacy, and adherence were obtained from medical records and self-completed questionnaires. Of the 532 patients who participated, 35% achieved glycemic control (i.e., HbA1c < 7%. Social support, self-efficacy, and adherence had significant correlations with each other and with glycemic control (P<0.05. Regression analyses and structural equation modeling showed that better social support was associated to better patient self-efficacy, which, in turn, was associated with better medical adherence, which was associated with improved glycemic control, and the relationship between social support and glycemic control was sequentially and completely mediated by self-efficacy and adherence. The five goodness-of-fit indices confirmed that our data fitted the hypothesized pathway model strongly.
Di Pierro F
Full Text Available Francesco Di Pierro,1 Nicola Villanova,2 Federica Agostini,2 Rebecca Marzocchi,2 Valentina Soverini,2 Giulio Marchesini21Scientific Department, Velleja Research, Milano, 2Diseases of Metabolism, S Orsola Malpighi Hospital, Bologna, ItalyBackground: Suboptimal glycemic control is a common situation in diabetes, regardless of the wide range of drugs available to reach glycemic targets. Basic research in diabetes is endeavoring to identify new actives working as insulin savers, use of which could delay the introduction of injectable insulin or reduce the insulin dose needed. Commonly available as a nutraceutical, berberine is a potential candidate.Methods and results: Because its low oral bioavailability can be overcome by P-glycoprotein inhibitors like herbal polyphenols, we have tested the nutraceutical combination of Berberis aristata extract and Silybum marianum extract (Berberol® in type 2 diabetes in terms of its additive effect when combined with a conventional oral regimen for patients with suboptimal glycemic control. After 90 days of treatment, the nutraceutical association had a positive effect on glycemic and lipid parameters, significantly reducing glycosylated hemoglobin, basal insulin, homeostatic model assessment of insulin resistance, total and low-density lipoprotein cholesterol, and triglycerides. A relevant effect was also observed in terms of liver function by measuring aspartate transaminase and alanine transaminase. The product had a good safety profile, with distinctive gastrointestinal side effects likely due to its acarbose-like action.Conclusion: Although further studies should be carried out to confirm our data, Berberol could be considered a good candidate as an adjunctive treatment option in diabetes, especially in patients with suboptimal glycemic control.Keywords: berberine, silymarin, glycosylated hemoglobin, diabetes
Gohel, Mukesh G; Chacko, Anusha N
Diabetes is undoubtedly one of the most challenging health problems in 21st century. Understanding the pathogenesis and preventing long term complications have been major goals of research in diabetes mellitus (DM). Research in the past few years has linked oxidative stress and inflammation to beta cell dysfunction. Aim of this study is to evaluate serum gamma-glutamyl transferase (GGT) activity (marker of oxidative stress) and high sensitivity C reactive protein (hsCRP) level (an inflammatory marker) in type 2 DM subjects with good and poor glycemic control. Further, we investigated correlation between serum GGT and hsCRP level with glycemic control (FBS, PP2BS, HbA1c) in subjects. A cross sectional study consists of 150 patients out of them 50 patients having type 2 DM with good control (Group II), 50 patients with type 2 DM with poor control (Group III) and 50 normal healthy control (Group I) were selected. Serum GGT, serum hsCRP, FBS, PP2BS, HbA1c, and other biochemical investigations include serum liver enzymes and lipids were measured. Mean serum GGT and hsCRP concentration were statistically significantly higher in group III patients compared to group I and group II subjects as well as increased in group II compared to group I (p stress and inflammation appears to be a key component and also associated with poor glycemic control and further pathogenesis of diabetes and its complications. All our finding suggesting a link between oxidative stress, inflammation and glycemic control in patient with type 2 diabetes mellitus.
Full Text Available Diabetes, in addition to adverse physical effects, is associated with many psychological problems. The correlation between physical health and emotional intelligence are acceptable. The aim of this study was to determine the effect of emotional intelligence training in glycemic control in patients with type II diabetes. The present study was a quasi-experimental research, which was conducted in Mashhad city, Iran. The participants included 20 patients referring to the diabetic centers. They were selected through convenience sampling and randomly divided into two groups of experiment (n=10 and control (n=10. To measure blood glucose, the level of HbA1c in patients was measured before and after training. The experimental group attended in a period of emotional intelligence training. The training sessions were held as group discussion during 8 weeks, one session of 120-min per week. The findings suggest that emotional intelligence training significantly reduced the level of blood glucose (HbA1c in the test group compared to the control group. Based on the results, emotional intelligence training, as a psychological intervention, by affecting understanding, interpretation, regulation and efficient use of excitement, is effective along with medication therapy in controlling blood glucose in type II diabetic patients.
Lubart, Emily; Segal, Refael; Wainstein, Julio; Marinov, Galina; Yarovoy, Alexandra; Leibovitz, Arthur
Increasing numbers of nursing home elderly patients suffer from diabetes requiring individually optimized glycemic control. This is a complicated challenge because of their high comorbidity level, and heterogeneous and changing eating status varying from independent to dysphagia and enteral feeding. In order to cope with these complex needs, we developed and implemented a diabetes disease management program. The purpose of the present study was to evaluate this program. We used the point prevalence approach by checking for fasting blood glucose, glycated hemoglobin and other routine biochemical tests. Eating status was evaluated by the Functional Outcome Swallowing Scale. Details about the diabetes disease management program are given in the text. A total of 86 (36%) of the 234 patients on the study day were diabetics. Of these, 80 were eligible for the study. Their mean fasting blood glucose was 143.1 ± 60.6 mg/dL. The mean glycated hemoglobin level was 7.23 ± 1.39%. No case of hypoglycemia was detected on the examination day, or during the preceding 3 weeks. No significant difference was found among the different Functional Outcome Swallowing Scale categories. These results are within satisfactory range for this category of patients suggesting that our diabetes disease management program contributes to a better glycemic control. © 2013 Japan Geriatrics Society.
Egi, Moritoki; Krinsley, James S; Maurer, Paula; Amin, Devendra N; Kanazawa, Tomoyuki; Ghandi, Shruti; Morita, Kiyoshi; Bailey, Michael; Bellomo, Rinaldo
To study the impact of pre-morbid glycemic control on the association between acute hypoglycemia in intensive care unit (ICU) patients and subsequent hospital mortality in critically ill patients. We performed a multicenter, multinational, retrospective observational study of patients with available HbA1c levels within the 3-month period preceding ICU admission. We separated patients into three cohorts according to pre-admission HbA1c levels (<6.5, 6.5-7.9, ≥8.0%, respectively). Based on published data, we defined a glucose concentration of 40-69 mg/dL (2.2-3.8 mmol/L) as moderate hypoglycemia and <40 mg/dL (<2.2 mmol/L) as severe hypoglycemia. We applied logistic regression analysis to study the impact of pre-morbid glycemic control on the relationship between acute hypoglycemia and mortality. A total of 3084 critically ill patients were enrolled in the study. Among these patients, with increasing HbA1c levels from <6.5, to 6.5-7.9, and to ≥8.0%, the incidence of both moderate (3.8, 11.1, and 16.4%, respectively; p < 0.001) and severe (0.9, 2.5, and 4.3%, respectively; p < 0.001) hypoglycemia progressively and significantly increased. The relationship between the occurrence of hypoglycemic episodes in the ICU and in-hospital mortality was independently and significantly affected by pre-morbid glucose control, as assessed by adjusted odds ratio (OR) and 95 % confidence interval (CI) for hospital mortality: (1) moderate hypoglycemia: in patients with <6.5, 6.5-7.9, and ≥8.0 % of HbA1c level-OR 0.54, 95% CI 0.25-1.16; OR 0.82, 95 % CI 0.33-2.05; OR 3.42, 95 % CI 1.29-9.06, respectively; (2) severe hypoglycemia: OR 1.50, 95% CI 0.42-5.33; OR 1.59, 95% CI 0.36-7.10; OR 23.46, 95% CI 5.13-107.28, respectively (interaction with pre-morbid glucose control, p = 0.009). We found that the higher the glucose level before admission to the ICU, the higher the mortality risk when patients experienced hypoglycemia. In critically ill patients, chronic pre
Egede, Leonard E; Osborn, Chandra Y
The mechanism by which depression influences health outcomes in persons with diabetes is uncertain. The purpose of this study was to test whether depression is related to self-care behavior via social motivation and indirectly related to glycemic control via self-care behavior. Patients with diabetes were recruited from an outpatient clinic. Information gathered pertained to demographics, depression, and diabetes knowledge (information); diabetes fatalism (personal motivation); social support (social motivation); and diabetes self-care (behavior). Hemoglobin A1C values were extracted from the patient medical record. Structural equation models tested the predicted pathways. Higher levels of depressive symptoms were significantly related to having less social support and decreased performance of diabetes self-care behavior. In addition, when depressive symptoms were included in the model, fatalistic attitudes were no longer associated with behavioral performance. Among adults with diabetes, depression impedes the adoption of effective self-management behaviors (including physical activity, appropriate dietary behavior, foot care, and appropriate self-monitoring of blood glucose behavior) through a decrease in social motivation.
Full Text Available Aim: The aim of the study was to evaluate the relationship between the diabetic status and severity of the periodontal involvement, and also of the non-surgical periodontal therapy on the periodontal status of patients with diabetes mellitus. Materials and method: The study was conducted on 21 patients with type 1 diabetes mellitus (study group and 10 systemically healthy subjects (control group. We examined: the degree of glycemic control (by measuring the glycated hemoglobin, the periodontal and oral hygiene parameters at the baseline and 4 weeks, 6 months and 12 months after the periodontal treatment (scaling and root planning. Results and discussion: Subjects with a poor glycemic control presented a higher percentage of sites with attachment loss, significantly higher amounts of bacterial plaque, sub-gingival calculus and gingival bleeding - when compared with the control group or with subjects with good or moderated glycemic control. In the same group, a rapid recurrence of the deep periodontal pockets was observed after 12 months. Conclusions: A prolonged poor control of glycemia and the time elapsed from the debut of diabetes were closely related with its complications. The comparison between the diabetes and the control groups demonstrated that diabetes mellitus is a risk factor for the periodontal disease.
Vyas, Chintan; Dalal, Lopa; Talaviya, Praful; Saboo, Banshi
The aim of present study was to assess the outcomes of multiple educational programs on glycemic control, quality of life and impact of diabetes in poorly controlled Type 1 Diabetic patients. A 12 months diabetes education programs were conducted every week for first one month then followed by every 3 months with follow up on improvement of HbA1c and QOL in T1D patients (n=54). Clinical characteristics were recorded at baseline visit. The QOL was evaluated by 15 set DQOL questionnaires in 40 consecutive patients at baseline, 3, 6 and 12 months after education programs. The HbA1c level (%) was evaluated at same time point. Decrease in DQOL score was reported as improvement in QOL. The rate of patients response to educational programs was noted 74.07% (n=40) at end of the study (12 months). The prevalence of T1D was reported higher in men than in women. The overall DQOL score and HbA1c% level was significantly (Peducational programs. Patients exhibited greater satisfaction and diminished impact of diabetes after educational programs was observed after 3 months and it was continue up to end of study. The frequencies of self-monitoring of blood glucose were increased. Numbers of hypoglycemic and DKA events were decreased after educational programs when compared to baseline. Results of study revealed that the appropriate education and counseling diminish impact of diabetes, improve QOL and help to achieve desired glycemic (HbA1c) level in poorly control T1D patients. Copyright © 2017. Published by Elsevier Ltd.
Full Text Available To evaluate the impact of glycemic control of diabetes mellitus (DM on prostate cancer detection in a biopsy population.We retrospectively reviewed the records of 1,368 men who underwent prostate biopsy at our institution. We divided our biopsy population into three groups according to their history of DM, and their Hemoglobin A1c (HbA1c level: a no-DM (DM- group; a good glycemic control (DM+GC group (HbA1c <6.5%; and a poor glycemic control (DM+PC group (HbA1c ≥6.5%. For sub-analyses, the DM+PC group was divided into a moderately poor glycemic control (DM+mPC group (6.5≤ HbA1c <7.5% and a severely poor glycemic control (DM+sPC group (HbA1c ≥7.5%.Among 1,368 men, 338 (24.7% had a history of DM, and 393 (28.7% had a positive biopsy. There was a significant difference in prostatic specific antigen density (PSAD (P = 0.037 and the frequency of abnormal DRE findings (P = 0.031 among three groups. The occurrence rate of overall prostate cancer (P<0.001 and high-grade prostate cancer (P = 0.016 also presented with a significantly difference. In the multivariate analysis, the DM+PC group was significantly associated with a higher rate of overall prostate cancer detection in biopsy subjects compared to the DM- group (OR = 2.313, P = 0.001 but the DM+PC group was not associated with a higher rate of high-grade (Gleason score ≥7 diseases detected during the biopsy (OR = 1.297, P = 0.376. However, in subgroup analysis, DM+sPC group was significantly related to a higher risk of high-grade diseases compared to the DM- group (OR = 2.446, P = 0.048.Poor glycemic control of DM was associated with a higher risk of prostate cancer detection, including high-grade disease, in the biopsy population.
A randomized controlled study to evaluate the effect of pharmacist-led educational intervention on glycemic control, self-care activities and disease knowledge among type 2 diabetes patients: A consort compliant study protocol.
Bukhsh, Allah; Nawaz, Muhammad Sarfraz; Ahmed, Hafiz Sajjad; Khan, Tahir Mehmood
Diabetes self-care activities, like, healthy diet, regular exercise, self-monitoring of blood glucose, and rational use of medicines are considered to play a vital role in establishing euglycemia. Health literacy among type 2 diabetes mellitus (T2DM) patients in Pakistan is very low, which is the most likely cause for poor clinical outcomes. This study is designed to investigate the impact of pharmacist-led educational intervention on glycemic control, self-care activities and disease knowledge among T2DM patients in Pakistan. In this randomized controlled trail, effectiveness of a 6-month pharmacist-led educational intervention will be examined on glycemic control, diabetes self-care activities and disease knowledge of 80 adult T2DM patients (age >30 years) with poorly controlled T2DM (HbA1c> 7%), after randomizing them into intervention and control groups, at diabetes care clinic of Capital Hospital Islamabad, Pakistan. The primary outcome is change in patients' HbA1c, whereas, changes in self-care activities and patients' disease knowledge are the secondary outcomes. After baseline assessment of their self-care activities and disease knowledge by using validated Urdu versions of Diabetes Self-management Questionnaire (DSMQ) and Diabetes Knowledge Questionnaire (DKQ), respectively, interventional group patients will be supplemented with a face-to-face pharmacist-led educational intervention, whereas, the control group will receive usual care. Intervention arm patients will be educated successively at their first follow-up visit (12th week) and telephonically after every 4 weeks. All assessments will be made at baseline and end of trail for both intervention and control groups. Multivariate general linear model will be applied to analyze the effects of the intervention. Glycemic control in T2DM patients requires optimum self-care activities. This study is an attempt to improve self-care behaviors among poorly controlled T2DM patients who are at higher risk of
Kim, HeeSook; Kim, Sue
The purpose of the study was to investigate the effects of an integrated self-management program on self-management, glycemic control, and maternal identity in women with gestational diabetes mellitus (GDM). A non-equivalent control group non-synchronized quasi-experimental design was used. A total of 55 women with GDM were recruited from Cheil General Hospital, Seoul, Korea and were assigned to an experimental (n=28) or control group (n=27). The participants were 24-30 weeks pregnant women who had been diagnosed with GDM as of July 30, 2010. The program was conducted as a 1 hour small group meeting 3 out of 5 times and by telephone-counseling 2 out of 5 times. The integrated self-management program was verified by an expert panel. Although there was no significant reduction in HbA1c (U= -1.17, p=.238), there were statistically significant increases in self-management (U= -3.80, pidentity (U= -4.48, pmanagement program for women with GDM improves self-management, maternal identity, and glycemic control. Further studies are needed to identify the effects of an integrated self-management program on pregnancy and neonatal outcomes.
Full Text Available Abstract Background Leucine may function as a signaling molecule to regulate metabolism. We have previously shown that dietary leucine supplementation significantly improves glucose and energy metabolism in diet-induced obese mice, suggesting that leucine supplementation could potentially be a useful adjuvant therapy for obesity and type 2 diabetes. Since the underlying cause for obesity and type 2 diabetes is multifold, we further investigated metabolic effects of leucine supplementation in obese/diabetes mouse models with different etiologies, and explored the underlying molecular mechanisms. Methods Leucine supplementation was carried out in NONcNZO10/LtJ (RCS10 - a polygenic model predisposed to beta cell failure and type 2 diabetes, and in B6.Cg-Ay/J (Ay - a monogenic model for impaired central melanocortin receptor signaling, obesity, and severe insulin resistance. Mice in the treatment group received the drinking water containing 1.5% leucine for up to 8 months; control mice received the tap water. Body weight, body composition, blood HbA1c levels, and plasma glucose and insulin levels were monitored throughout and/or at the end of the study period. Indirect calorimetry, skeletal muscle gene expression, and adipose tissue inflammation were also assessed in Ay mice. Results Leucine supplementation significantly reduced HbA1c levels throughout the study period in both RCS10 and Ay mice. However, the treatment had no long term effect on body weight or adiposity. The improvement in glycemic control was associated with an increased insulin response to food challenge in RCS10 mice and decreased plasma insulin levels in Ay mice. In leucine-treated Ay mice, energy expenditure was increased by ~10% (p y mice whereas the expression levels of MCP-1 and TNF-alpha and macrophage infiltration in adipose tissue were significantly reduced. Conclusions Chronic leucine supplementation significantly improves glycemic control in multiple mouse models of
Mohamed Ghada A
Full Text Available Type 1 diabetes (T1D is a tissue-specific autoimmune disease and often associated with other autoimmune diseases; so our study aimed to define the occurrence of thyroid peroxidase antibody (TPOAb and thyroglobulin antibody (TGAb in autoimmune thyroid disease (AIT, tissue transglutaminase antibody (TTGAb in celiac disease, And to evaluate the relationship between the presence of these antibodies and glycemic control. Our retrospective study included 60 Kuwaiti patients with T1D who attended and follow in Diabetes outpatient clinics of Kuwait primary health care centers during the period of 2014-2015. For them, recorded data for age, sex, duration of diabetes, Body Mass Index (BMI, HbA1c was reviewed. Patients were screened for the presence of Specific antibodies to islet antigens (ICAb, glutamic acid decarboxylase autoantibodies (GADAb, insulin autoantibodies (IAA, TPOAb, TGAb, TTGAb and also thyroid stimulating hormone (TSH were measured by ELISA. Of the total 60 patients (20 men, 40women, mean age was17.95 ± (5.44 y; the mean duration of diabetes was 6.63 ± (4.27 y; mean HbA1c was 10.41± (1.96 %. Only 58 (96.7% wer e positive for GADAb, 32 (53.3% were positive for ICAb, and 48 (80% were positive for IAA, 14 (23.3% patients were positive for TPOAb, 11 (18.3% were positive for TGAb, 10 (16.7 % were positive for both TPOAb and TGAb; furthermore 8 (13.3% patients were positive for TTGAb. Neither organ-specific autoimmune disease (AIT and celiac disease nor pancreatic β cells autoantibodies had a significant association with the glycemic control. In our study, we confirmed the high prevalence of a second organ-specific autoimmune disease in individuals with type 1 diabetes. Also Subclinical forms of these disorders have no influence on diabetes control. Further research will be necessary to test these relationships in a prospective follow-up study
Patton, Susana R; Williams, Laura B; Dolan, Lawrence M; Chen, Ming; Powers, Scott W
Previous research demonstrated high rates of perceived mealtime behavior problems in families of young children with type 1 diabetes who were managed with conventional therapy. Because of new insulin regimens that offer greater flexibility, reexamination of mealtime behaviors is required. We assessed parent-reported mealtime behaviors in a sample of young children using an insulin pump. An additional aim was to evaluate the associations of two measures of parental feeding behavior with children's glycemic control. Primary caregivers of 31 young children (mean age = 5.0 +/- 1.3 yr) completed the Child Feeding Questionnaire (CFQ) and the Behavioral Pediatric Feeding Assessment Scale (BPFAS). Hemoglobin A1c (HbA1c) was used as a surrogate marker for children's glycemic control. Children had a mean HbA1c of 7.8 +/- 0.64%. Mean CFQ - Restriction and Pressure to Eat scores were 3.1 +/- 0.94 and 2.0 +/- 0.88, respectively (range = 1-5). Mean BPFAS - Parent and Child scores were 16.0 +/- 4.3 (range = 10-50) and 44.9 +/- 9.3 (range = 25-125), respectively. Positive correlations were found between children's HbA1c levels and caregivers' reporting of frequency of child mealtime behavior problems. Caregivers of young children on pump therapy report relatively low rates of mealtime behavior problems. However, correlations with children's HbA1c suggest that parent-child mealtime behaviors continue to relate to children's health outcomes. Research is needed to determine if changing mealtime interactions can improve children's glycemic control; items from the BPFAS and CFQ can offer targets to guide interventions.
Full Text Available Both glycemic control and handgrip strength affect microvascular function. Multiscale entropy (MSE of photoplethysmographic (PPG pulse amplitudes may differ by diabetes status and hand activity. Of a middle-to-old aged and right-handed cohort without clinical cardiovascular disease, we controlled age, sex, and weight to select the unaffected (no type 2 diabetes, n=36, the well-controlled diabetes (HbA1c < 8%, n=22, and the poorly controlled diabetes (HbA1c ≥ 8%, n=22 groups. MSEs were calculated from consecutive 1,500 PPG pulse amplitudes of bilateral index fingertips. The small-, medium-, and large-scale MSEs were defined as the average of scale 1 (MSE1, scales 2–4 (MSE2–4, and scales 5–10 (MSE5–10, respectively. Intra- and intergroups were compared by one- and two-sample t-tests, respectively. The dominant hand MSE5–10 was lower in the poorly controlled diabetes group than the well-controlled diabetes and the unaffected (1.28 versus 1.52 and 1.56, p=0.019 and 0.001, resp. groups, whereas the nondominant hand MSE5–10 was lower in the well- and poorly controlled diabetes groups than the unaffected group (1.35 and 1.29 versus 1.58, p=0.008 and 0.005, resp.. The MSE1 of dominant hand was higher than that of nondominant hand in the well-controlled diabetes (1.35 versus 1.10, p=0.048. In conclusion, diabetes status and hand dominance may affect the MSE of PPG pulse amplitudes.
Helmle, Karmon E; Chacko, Sunita; Chan, Trevor; Drake, Alison; Edwards, Alun L; Moore, Glenda E; Philp, Leta C; Popeski, Naomi; Roedler, Rhonda L; Rogers, Edwin J R; Zimmermann, Gabrielle L; McKeen, Julie
To develop and evaluate a Basal Bolus Insulin Therapy (BBIT) Knowledge Translation toolkit to address barriers to adoption of established best practice with BBIT in the care of adult inpatients. This study was conducted in 2 phases and focused on the hospitalist provider group across 4 acute care facilities in Calgary. Phase 1 involved a qualitative evaluation of provider and site specific barriers and facilitators, which were mapped to validated interventions using behaviour change theory. This informed the co-development and optimization of the BBIT Knowledge Translation toolkit, with each tool targeting a specific barrier to improved diabetes care practice, including BBIT ordering. In Phase 2, the BBIT Knowledge Translation toolkit was implemented and evaluated, focusing on BBIT ordering frequency, as well as secondary outcomes of hyperglycemia (patient-days with BG >14.0 mmol/L), hypoglycemia (patient-days with BG Knowledge Translation toolkit resulted in a significant 13% absolute increase in BBIT ordering. Hyperglycemic patient-days were significantly reduced, with no increase in hypoglycemia. There was a significant, absolute 14% reduction in length of stay. The implementation of an evidence-informed, multifaceted BBIT Knowledge Translation toolkit effectively reduced a deeply entrenched in-patient diabetes care gap. The resulting sustained practice change improved patient clinical and system resource utilization outcomes. This systemic approach to implementation will guide further scale and spread of glycemic optimization initiatives. Copyright © 2018 Diabetes Canada. Published by Elsevier Inc. All rights reserved.
Al Balushi, Khalid A; Al-Haddabi, Mahmod; Al-Zakwani, Ibrahim; Al Za'abi, Mohammed
To determine the status of blood sugar control by using fasting blood sugar (FBS) of ≤6.1 mmol/l and glycosyted hemoglobin A1c (HbAc1) of Oman. The overall mean age of the cohort was 53±12 years (range: 24-91) with females representing 60% (n=106) of the study sample. The study found that only 9.6% (n=17) and 35% (n=62) of the patients attained optimal FBS and HbAc1 levels, respectively. Higher HbA1c was significantly associated with higher diastolic BP (84 versus 80 mm Hg; p=0.006), higher total cholesterol (5.2 versus 4.7 mmol/l; p=0.002) and higher low-density lipoprotein cholesterol (3.8 versus 3.0 mmol/l; p=0.034). The results demonstrated poor glycemic control in Oman type 2 diabetic patients comparable to local and global studies especially in those hypertensive and dyslipidemic patients. Implementation of early and aggressive management of diabetes mellitus at the primary care setting is warranted. Copyright © 2014 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.
Abdelhamid, Amir Mohamed; Abdelaziz, Rania Ramadan; Salem, Hatem Abdelrahman Ali
Type I diabetes (TID) is generally assumed to be caused by an immune associated, if not directly immune-mediated, destruction of pancreatic β-cells. In patients with long-term diabetes, the pancreas lacks insulin-producing cells and the residual β-cells are unable to regenerate. Patients with TID are subjected to a lifelong insulin therapy which shows risks of hypoglycemia, suboptimal control and ketosis. In this study, we investigated the potential role of vildagliptin (Vilda) alone or in combination with pioglitazone (Pio), as treatment regimens for TID using streptozotocin (STZ)-induced TID model in rats. Daily oral administration of Vilda (5 mg/kg) alone or in combination with Pio (20 mg/kg) for 7 weeks significantly reduced blood glucose levels and HbA 1c . It increased serum insulin levels and decreased serum glucagon. It also showed a strong antioxidant activity. Immunohistochemical analysis showed a marked improvement in β-cells in treated groups when compared with the diabetic group, which appeared in the normal cellular and architecture restoration of β-cells in the islets of Langerhans. Vilda alone or in combination with Pio has the ability to improve the overall glycemic control in type I diabetic rats and may be considered a hopeful and effective remedy for TID.
Yuliya Andreevna Shishkova
Full Text Available Aim. To identify psychological characteristics associated with better glycemic control and higher quality of life (QoL in patients with type 1 diabetes mellitus (T1DM. Materials and Methods. The study included 140 T1DM patients (47 males aged 18 to 28 years. Assessment of the QoL and associated emotional state (ES was performed by validated localized questionnaires, supplemented with the inventories for evaluation of psychological characteristics. Based on the acquired data we performed a trilateral analysis of glycemic control, QoL and ES, followed by testing of these parameters for correlation with certain psychological characteristics, including disease attitude, mindfulness, self-attitude and self-assessment, coping strategies, autoregulation parameters and the locus of control. Results. In the studied sample, better glycemic control was associated with higher QoL and more favourable ES. We also identified several psychological characteristics associated with an improvement in all three primary parameters, namely: higher level of mindfulness, internal locus of control and ergopathic attitude. Conclusion. The diagnostic inventory for QoL and ES evaluation used in the present study may be helpful for psychological testing in patients with T1DM.
Melina Bezerra Loureiro
Full Text Available ABSTRACT The aim of the present study was to investigate the bone mineral density (BMD of patients with type 1 Diabetes mellitus (T1DM. We also assessed the association between osteoprotegerin (OPG genetic polymorphisms and BMD. Genotyping was performed for 1181G>C and 163A>G OPG polymorphisms by allelic discrimination in 119 patients with T1DM and 161 normoglycemic (NG individuals, aged 6 to 20 years old. Glycemic control, serum parameters of bone metabolism and BMD were evaluated. T1DM patients showed low BMD, poor glycemic control and decreased total calcium values when compared to controls (p < 0.05. For all the polymorphisms studied, the genotype and allele frequencies in patients with T1DM were not significantly different from the controls. In patients with T1DM, carriers of OPG 1181CC showed higher concentrations of ionized calcium compared to patients with GG+GC genotypes. These results suggest that low BMD is associated with poor glycemic control in T1DM. Despite the lack of a detected association between OPG polymorphisms and BMD in these patients, the increased ionized calcium in those carrying OPG 1181CC suggests a possible increase in osteoclastogenesis, a conclusion that may be supported by the lower BMD observed in these subjects.
Yuliya Andreevna Shishkova
Full Text Available Aim. To identify psychological characteristics associated with better glycemic control and higher quality of life (QoL in patients with type 1 diabetes mellitus (T1DM.Materials and Methods. The study included 140 T1DM patients (47 males aged 18 to 28 years. Assessment of the QoL and associated emotional state (ES was performed by validated localized questionnaires, supplemented with the inventories for evaluation of psychological characteristics. Based on the acquired data we performed a trilateral analysis of glycemic control, QoL and ES, followed by testing of these parameters for correlation with certain psychological characteristics, including disease attitude, mindfulness, self-attitude and self-assessment, coping strategies, autoregulation parameters and the locus of control.Results. In the studied sample, better glycemic control was associated with higher QoL and more favourable ES. We also identified several psychological characteristics associated with an improvement in all three primary parameters, namely: higher level of mindfulness, internal locus of control and ergopathic attitude.Conclusion. The diagnostic inventory for QoL and ES evaluation used in the present study may be helpful for psychological testing in patients with T1DM.
Glycemic control paradox: Poor glycemic control associated with higher one-year and eight-year risks of all-cause hospitalization but lower one-year risk of hypoglycemia in patients with type 2 diabetes.
Li, Tsai-Chung; Kardia, Sharon L R; Li, Chia-Ing; Chen, Ching-Chu; Liu, Chiu-Shong; Yang, Sing-Yu; Muo, Chin-Shin; Peyser, Patricia A; Lin, Cheng-Chieh
The relationship between glycemic control and adverse outcomes found in a population with diabetes has seldom been evaluated in patients with type 2 diabetes. We explored the association between hemoglobin A1c (HbA1c) and hospitalization risks within one-year and eight-year follow-up periods. We conducted a retrospective cohort study on 57,061 patients with type 2 diabetes from National Diabetes Case Management Program during 2002-2004 in Taiwan. HbA1c at baseline and in-hospital mortality, all-cause and cause-specific hospitalization over one year and eight years were analyzed. After multivariate adjustment, one-year risk was higher for cases with HbA1c level risk of hypoglycemia hospitalization (0.81, 95% CI: 0.74-0.88). For eight-year risk, subjects with HbA1c level risks of all-cause and diabetes-related hospitalization (1.04, 1.03-1.05, and 1.15, 1.14-1.17, respectively). Higher HbA1c level correlated with lower one-year risk due to hypoglycemia hospitalization but increased one-year and eight-year risks due to all-cause and diabetes-specific hospitalization among Chinese people with type 2 diabetes in Taiwan. Future study must ascertain how to meet HbA1c targets and improve outcome without risk to this population. Copyright © 2015 Elsevier Inc. All rights reserved.
Deerochanawong, Chaicharn; Bajpai, Shailendra; Dwipayana, I Made Pande; Hussein, Zanariah; Mabunay, Maria Aileen; Rosales, Reynaldo; Tsai, Shih-Tzer; Tsang, Man Wo
Various data have demonstrated inadequate glycemic control amongst Asians with type 2 diabetes mellitus (T2DM), possibly on account of suboptimal titration of basal insulin-an issue which needs to be further examined. Here we review the available global and Asia-specific data on titration of basal insulin, with a focus on the use of insulin glargine 100 U/mL (Gla-100). We also discuss clinical evidence on the efficacy and safety of titrating Gla-100, different approaches to titration, including some of the latest technological advancements, and guidance on the titration of basal insulin from international and local Asian guidelines. The authors also provide their recommendations for the initiation and titration of basal insulin for Asian populations. Discussion of the data included in this review and in relation to the authors' clinical experience with treating T2DM in Asian patients is also included. Briefly, clinical studies demonstrate the achievement of adequate glycemic control in adults with T2DM through titration of Gla-100. However, studies investigating approaches to titration, specifically in Asian populations, are lacking and need to be conducted. Given that the management of insulin therapy is a multidisciplinary team effort involving endocrinologists, primary care physicians, nurse educators, and patients, greater resources and education targeted at these groups are needed regarding the optimal titration of basal insulin. Technological advancements in the form of mobile or web-based applications for automated dose adjustment can aid different stakeholders in optimizing the dose of basal insulin, enabling a larger number of patients in Asia to reach their target glycemic goals with improved outcomes.
Yeh, Gloria Y; Eisenberg, David M; Kaptchuk, Ted J; Phillips, Russell S
To conduct a systematic review of the published literature on the efficacy and safety of herbal therapies and vitamin/mineral supplements for glucose control in patients with diabetes. We conducted an electronic literature search of MEDLINE, OLDMEDLINE, Cochrane Library Database, and HealthSTAR, from database inception to May 2002, in addition to performing hand searches and consulting with experts in the field. Available clinical studies published in the English language that used human participants and examined glycemic control were included. Data were extracted in a standardized manner, and two independent investigators assessed methodological quality of randomized controlled trials using the Jadad scale. A total of 108 trials examining 36 herbs (single or in combination) and 9 vitamin/mineral supplements, involving 4,565 patients with diabetes or impaired glucose tolerance, met the inclusion criteria and were analyzed. There were 58 controlled clinical trials involving individuals with diabetes or impaired glucose tolerance (42 randomized and 16 nonrandomized trials). Most studies involved patients with type 2 diabetes. Heterogeneity and the small number of studies per supplement precluded formal meta-analyses. Of these 58 trials, the direction of the evidence for improved glucose control was positive in 76% (44 of 58). Very few adverse effects were reported. There is still insufficient evidence to draw definitive conclusions about the efficacy of individual herbs and supplements for diabetes; however, they appear to be generally safe. The available data suggest that several supplements may warrant further study. The best evidence for efficacy from adequately designed randomized controlled trials (RCTs) is available for Coccinia indica and American ginseng. Chromium has been the most widely studied supplement. Other supplements with positive preliminary results include Gymnema sylvestre, Aloe vera, vanadium, Momordica charantia, and nopal.
Atalay, Hasan Anıl; Akarsu, Murat; Canat, Lutfi; Ülker, Volkan; Alkan, İlter; Ozkuvancı, Unsal
To evaluate the impact of poor glycemic control of type 2 diabetes mellitus (T2DM) on serum prostate-specific antigen (PSA) concentrations in men. We performed a prospective analysis of 215 consecutive patients affected by erectile dysfunction (ED). ED was evaluated using the IIEF-5 questionnaire and the poor glycemic control (PGC) of T2DM was assessed according to the HbA1c criteria (International Diabetes Federation). Patients were divided into PGC group (HbA1c ≥ 7%) and control group (CG) (HbA1c men ranging from 44 to 81 years of age, lower PSA concentrations were observed in men with PGC (PGC mean PSA: 0.9 ng/dl, CG mean PSA: 2.1 ng/dl, p men with PGC compared with men with CG (PGC mean prostate volume: 26 ml, CG prostate volume: 43 ml, p strong negative correlation was found between serum HbA1c levels and serum PSA (p men with PGC. We also found at the multivariate logistic regression model that PSA, prostate volume and peak systolic velocity were independent predictors of PGC. Our results suggest that there is significant impact of PGC on serum PSA levels in T2DM. Poor glycemic control of type 2 diabetes was associated with lower serum PSA levels and smaller prostate volumes.
regular insulin has significantly increased in recent years. These patients are severely insulin resistant requiring high doses of insulin to achieve...on U-500 Insulin Admitted to the Hospital presented at SURF Conference, San Antonio, TX 20 May 201 6 with MDWI 41-108, and has been assigned local...59th CSPG/SGVU) C.201 4 . I 52d PROTOCOL TITLE Evaluation of Total Dai ly Dose and Glycemic Control for Patients on U-500 Insulin Admitted to the
Jessie Nallely Zurita-Cruz
Full Text Available Abstract Objectives: In prepubertal type 1 diabetic patients (DM1, the availability of an informal primary caregiver (ICP is critical to making management decisions; in this study, the ICP-related risk factors associated with glycemic control were identified. Patients, materials, and methods: A comparative cross-sectional study was performed. Fifty-five patients with DM1 under the age of 11 years were included. The patient-related factors associated with glycemic control evaluated were physical activity, DM1 time of evolution, and adherence to medical indications. The ICP-related factors evaluated were education, employment aspects, depressive traits (Beck questionnaire, family functionality (family APGAR, support of another person in patient care, stress (Perceived Stress Scale, and socioeconomic status (Bronfman questionnaire. Multivariate logistic and linear regression analyses were performed. Results: The patients' median age was 8 years; 29 patients had good glycemic control, and 26 were uncontrolled. The main risk factor associated with glycemic dyscontrol was stress in the ICP (OR 24.8; 95% CI 4.06-151.9, p = 0.001. While, according to the linear regression analysis it was found that lower level of education (β 0.991, 95% CI 0.238-1.743, p = 0.011 and stress (β 1.918, 95% CI 1.10-2.736, p = 0.001 in the ICP, as well as family dysfunction (β 1.256, 95% CI 0.336-2.177, p = 0.008 were associated with higher levels of glycated hemoglobin. Conclusions: Level of education and stress in the ICP, as well as family dysfunction, are factors that influence the lack of controlled blood glucose levels among prepubertal DM1 patients.
Chang, Chun-Jen; Pei, Dee; Wu, Chien-Chih; Palmer, Mary H; Su, Ching-Chieh; Kuo, Shu-Fen; Liao, Yuan-Mei
To explore correlates of nocturia, compare sleep quality and glycemic control for women with and without nocturia, and examine relationships of nocturia with sleep quality and glycemic control in women with diabetes. This study was a cross-sectional, correlational study with data collected from 275 women with type 2 diabetes. Data were collected using a structured questionnaire. Multivariate logistic regression analyses were used to identify correlates. Chi-squared tests were used to identify candidate variables for the first logistic regression model. A one-way analysis of variance was used to compare sleep quality and glycemic control for women with and those without nocturia. Pearson correlations were used to examine the relationships of nocturia with sleep quality and glycemic control. Of the 275 participants, 124 (45.1%) had experienced nocturia (at least two voids per night). Waist circumference, parity, time since diagnosis of diabetes, sleep quality, and increased daytime urinary frequency were correlated with nocturia after adjusting for age. Compared to women without nocturia, women who had nocturia reported poorer sleep quality. A significant correlation was found between the number of nocturnal episodes and sleep quality. Nocturia and poor sleep are common among women with diabetes. The multifactorial nature of nocturia supports the delivered management and treatments being targeted to underlying etiologies in order to optimize women's symptom management. Interventions aimed at modifiable correlates may include maintaining a normal body weight and regular physical exercise for maintaining a normal waist circumference, and decreasing caffeine consumption, implementing feasible modifications in sleeping environments and maintaining sleep hygiene to improve sleep quality. Healthcare professionals should screen for nocturia and poor sleep and offer appropriate nonpharmacological lifestyle management, behavioral interventions, or pharmacotherapy for women
Sheikh, S.A.; Baig, J.A.; Iqbal, T.; Kazmi, T.; Baig, M.; Husain, S.S.
Diabetes is one of the most common endocrine disorders characterized by hyperglycaemia. Diabetic nephropathy is a consequence of long standing diabetes. The prevalence of microalbuminuria predicts progression to diabetic nephropathy. The present study was conducted to determine the prevalence of microalbuminuria in relation to duration of diabetes, BMI, Serum Creatinine and HbA1c in an ethnic group of Type 2 diabetes mellitus residing in Karachi. Methods: This cross-sectional descriptive study was carried out in a community diabetic centre, located at Garden East Karachi from July to December 2007. One hundred known Type 2 diabetic patients with age 30 - 70 years were included in the study. Informed consent and a structured questionnaire of each patient were recorded. Fasting venous blood and morning urine sample was collected for analysis of creatinine, HbA1c and microalbuminuria respectively. Statistical analysis was done using SPSS version 13.0. Pearson correlation was applied to observe association of microalbuminuria with different parameters. All p-values 7%) or heredity factors. Screening for microalbuminuria and HbA1c test should be done in both newly and already diagnosed Type 2 diabetic patients as an early marker of renal dysfunction and glycemic control. (author)
Ensor, Mark; Banfield, Amy B; Smith, Rebecca R; Williams, Jarrod; Lodder, Robert A
The primary objectives of this study were to evaluate the treatment effect of D-tagatose on glycemic control, determined by a statistically significant decrease in hemoglobin A1c (HbA1c), and safety profile of D-tagatose compared to placebo. The secondary objectives were to evaluate the treatment effects on fasting blood glucose, insulin, lipid profiles, changes in BMI, and the proportion of subjects achieving HbA1c targets of tagatose dissolved in 125-250 ml of water three times a day or placebo with meals. Reduction in HbA1c was statistically significant compared to placebo at all post-baseline time points in the ITT population. Additionally, secondary endpoints were achieved in the ITT population with regard to LDL, total cholesterol, fasting blood glucose, and proportion of subjects achieving HbA1c targets of tagatose was unable to lower triglycerides or raise HDL compared to placebo. A subgroup LOCF analysis on the ITT US population showed a greater and statistically significant LS mean reduction in HbA1c in the D-tagatose group at all post-baseline visits. Based on these results it is concluded that in the ITT population D-tagatose is an effective single agent at treating many of the therapy targets of type 2 diabetes including lowering fasting blood glucose and HbA1c, and lowering of LDL and total cholesterol.
M C Deepaklal
Full Text Available Aim: To assess the safety and efficacy of insulin lispro in improving glycemic control in patients with gestational diabetes. Materials and Methods: A retrospective observational study was conducted at a single center on 201 gestational women with diabetes. Subjects who received insulin lispro performed blood glucose self-monitoring and recorded the readings in the fasting state and 1 h after each meal. At each contact (in person or telephonic contact, the insulin dose was adjusted based on the readings measured. A total of 53 subjects also recorded glucose levels post-partum. Pregnancy and post-delivery glucose level and insulin requirements of these 53 patients were compared. Results: Analysis of glucose levels both fasting and post-prandial glucose levels revealed that after using insulin lispro, the number of episodes of post-prandial hyperglycemia (1 h plasma glucose >120 mg/dL was minimal and so was the incidence of hypoglycemia. Hypoglycemia was defined as a blood sugar value of. There was neither any congenital abnormality except for a poorly formed pinna in the right ear of one baby nor any post-partum complications of note. Conclusion: Insulin lispro is an effective and safe treatment option in gestational diabetes.
Full Text Available Diabetes mellitus (DM and osteoporosis (OP are common disorders with a significant health burden, and an increase in fracture risk has been described both in type 1 (T1DM and in type 2 (T2DM diabetes. The pathogenic mechanisms of impaired skeletal strength in diabetes remain to be clarified in details and they are only in part reflected by a variation in bone mineral density (BMD. In T2DM, the occurrence of low bone turnover together with a decreased osteoblast activity and compromised bone quality has been shown. Of note, some antidiabetic drugs (e.g. tiazolidinediones, insulin may deeply affect bone metabolism. In addition, the recently introduced class of incretin-based drugs (i.e. GLP-1 receptor agonists and DPP-4 inhibitors is expected to exert potentially beneficial effects on bone health, possibly due to a bone anabolic activity of GLP-1, that can be either direct or indirect through the involvement of thyroid C cells.Here we will review the established as well as the putative effects of incretin hormones and of incretin-based drugs on bone metabolism, both in preclinical models and in man, taking into account that such therapeutic strategy may be effective not only to achieve a good glycemic control, but also to improve bone health in diabetic patients.
Cockcroft, Emma J; Moudiotis, Christopher; Kitchen, Julie; Bond, Bert; Williams, Craig A; Barker, Alan R
Current physical activity guidelines for youth with type 1 diabetes (T1D) are poorly supported by empirical evidence and the optimal dose of physical activity to improve glycemic control is unknown. This case report documents the effect of acute high-intensity interval exercise (HIIE) and moderate-intensity exercise (MIE) on 24-h glycemic control in three adolescents with T1D using continuous glucose monitoring. Results highlight varied individual response to exercise across the participants. In two participants both MIE and HIIE resulted in a drop in blood glucose during exercise (-38 to -42% for MIE and -21-46% in HIIE) and in one participant both MIE and HIIE resulted in increased blood glucose (+19% and + 36%, respectively). Over the 24-h period average blood glucose was lower for all participants in the HIIE condition, and for two for the MIE condition, compared to no exercise. All three participants reported HIIE to be more enjoyable than MIE These data show both HIIE and MIE have the potential to improve short-term glycemic control in youth with T1D but HIIE was more enjoyable. Future work with a larger sample size is required to explore the potential for HIIE to improve health markers in youth with T1D. © 2017 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society.
Gauthier, Lyne; Ferguson, Jessica; Dubé, Anne-Isabelle; Nguyen, Patrick Viet-Quoc; Beauchesne, Marie-France; Boutin, Jean-Marie
To describe the quality of glycemic control in patients in intensive care units (ICUs) treated with an intravenous (IV) insulin infusion at a teaching hospital. This retrospective study included patients admitted to the ICU and treated with an IV insulin infusion for at least 12 h between August 1 and November 30, 2011. Medical charts were reviewed. The primary quality indicator for glycemic control was the mean percent of blood glucose values per patient in the 6.1 to 8 mmol/L target range. A total of 351 patients were included; 61.5% of subjects had no known diabetes. Admissions were mainly for surgery (61.3%). The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 16.8±7.3. The mean percent of blood glucose values per patient in the 6.1 to 8 mmol/L range was 35% for all subjects and 26.2% for patients with diabetes. If a target of 6.1 to 10 mmol/L was considered, those values became 63% and 54.6%. At least 1 episode of hyperglycemia (>10 mmol/L), hypoglycemia (quality of glycemic control in patients in the ICU at our hospital needs to be improved. A new computerized IV insulin protocol is currently being tested. Copyright © 2014 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.
Gildea, Chris M; Lantaff, Wendy M; Olenik, Nicole L
The objective of this study was to identify patient-perceived barriers to achieving A1C targets after receiving instruction in an accredited diabetes education program. Qualitative research using semistructured interviews and thematic analyses. One pharmacist-run diabetes center located within an independent community pharmacy in a suburban region of southern Indiana. A total of 17 participants between the ages of 41-78 were interviewed in March and April 2016. Not applicable. Patient-perceived barriers to attaining glycemic control after completion of a pharmacist-taught diabetes self-management education (DSME) program accredited by the American Association of Diabetes Educators. Participants reported a variety of perceived barriers to glycemic control subsequent to the receipt of structured education. Seven major themes emerged: 1) health care provider factors; 2) self-identified indiscretions; 3) psychological barriers and poor social support; 4) knowledge deficits; 5) personal injury or adverse drug events; 6) time constraints and competing life demands; and 7) financial constraints. Participants reported a variety of perceived barriers to achieving A1C targets after completing DSME. Incorporation of solutions and coping mechanisms to these barriers into diabetes education programs may help patients attain glycemic control. Other factors may require individualized attention outside of DSME in follow-up episodes of diabetes care. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.
Wong, Charlene A; Miller, Victoria A; Murphy, Kathryn; Small, Dylan; Ford, Carol A; Willi, Steven M; Feingold, Jordyn; Morris, Alexander; Ha, Yoonhee P; Zhu, Jingsan; Wang, Wenli; Patel, Mitesh S
Glycemic control often deteriorates during adolescence and the transition to young adulthood for patients with type 1 diabetes. The inability to manage type 1 diabetes effectively during these years is associated with poor glycemic control and complications from diabetes in adult life. To determine the effect of daily financial incentives on glucose monitoring adherence and glycemic control in adolescents and young adults with type 1 diabetes. The Behavioral Economic Incentives to Improve Glycemic Control Among Adolescents and Young Adults With Type 1 Diabetes (BE IN CONTROL) study was an investigator-blinded, 6-month, 2-arm randomized clinical trial conducted between January 22 and November 2, 2016, with 3-month intervention and follow-up periods. Ninety participants (aged 14-20) with suboptimally controlled type 1 diabetes (hemoglobin A1c [HbA1c] >8.0%) were recruited from the Diabetes Center for Children at the Children's Hospital of Philadelphia. All participants were given daily blood glucose monitoring goals of 4 or more checks per day with 1 or more level within the goal range (70-180 mg/dL) collected with a wireless glucometer. The 3-month intervention consisted of a $60 monthly incentive in a virtual account, from which $2 was subtracted for every day of nonadherence to the monitoring goals. During a 3-month follow-up period, the intervention was discontinued. The primary outcome was change in HbA1c levels at 3 months. Secondary outcomes included adherence to glucose monitoring and change in HbA1c levels at 6 months. All analyses were by intention to treat. Of the 181 participants screened, 90 (52 [57.8%] girls) were randomized to the intervention (n = 45) or control (n = 45) arms. The mean (SD) age was 16.3 (1.9) years. The intervention group had significantly greater adherence to glucose monitoring goals in the incentive period (50.0% vs 18.9%; adjusted difference, 27.2%; 95% CI, 9.5% to 45.0%; P = .003) but not in the follow-up period (15
Karstoft, Kristian; Winding, Kamilla; Knudsen, Sine H; Nielsen, Jens S; Thomsen, Carsten; Pedersen, Bente K; Solomon, Thomas P J
To evaluate the feasibility of free-living walking training in type 2 diabetic patients and to investigate the effects of interval-walking training versus continuous-walking training upon physical fitness, body composition, and glycemic control. Subjects with type 2 diabetes were randomized to a control (n = 8), continuous-walking (n = 12), or interval-walking group (n = 12). Training groups were prescribed five sessions per week (60 min/session) and were controlled with an accelerometer and a heart-rate monitor. Continuous walkers performed all training at moderate intensity, whereas interval walkers alternated 3-min repetitions at low and high intensity. Before and after the 4-month intervention, the following variables were measured: VO(2)max, body composition, and glycemic control (fasting glucose, HbA(1c), oral glucose tolerance test, and continuous glucose monitoring [CGM]). Training adherence was high (89 ± 4%), and training energy expenditure and mean intensity were comparable. VO(2)max increased 16.1 ± 3.7% in the interval-walking group (P Body mass and adiposity (fat mass and visceral fat) decreased in the interval-walking group only (P interval-walking group. The continuous walkers showed no changes in glycemic control. Free-living walking training is feasible in type 2 diabetic patients. Continuous walking offsets the deterioration in glycemia seen in the control group, and interval walking is superior to energy expenditure-matched continuous walking for improving physical fitness, body composition, and glycemic control.
Kang, Hye Mi; Kim, Dong-Jun
Major macronutrients for energy intake vary among countries and cultures. Carbohydrates, including rice, are the major component of daily energy intake in Korea. The aim of this study was to examine the association of daily energy intake or each proportion of macronutrients, especially carbohydrates, with glycemic control in diabetic Koreans. A total of 334 individuals with diabetes (175 men, age 57.4±0.8 years; 159 women, age 60.9±0.9 years) who participated in the 2005 Korean National Health and Nutrition Examination Survey were examined. Glycemic control was categorized based on concentration of glycated hemoglobin (HbA1c; HbA1c ≤6.5%; 6.6% to 8.0%; ≥8.1%). Dietary intake was assessed by using a 24-recall item questionnaire. High total energy intake was associated with poor glycemic control (HbA1c ≤6.5%, 1,824±75 kcal; 6.6% to 8.0%, 1,990±57 kcal; ≥8.1%, 2,144±73 kcal; P value for trend=0.002). Each proportion of protein, fat, or carbohydrate was not associated with glycemic control. Even after adjusting for several parameters, the association of daily energy intake with glycemic control still persisted. Total energy intake may be more closely related to glycemic control than each proportionof macronutrients in Korean diabetics.
Hye Mi Kang
Full Text Available BackgroundMajor macronutrients for energy intake vary among countries and cultures. Carbohydrates, including rice, are the major component of daily energy intake in Korea. The aim of this study was to examine the association of daily energy intake or each proportion of macronutrients, especially carbohydrates, with glycemic control in diabetic Koreans.MethodsA total of 334 individuals with diabetes (175 men, age 57.4±0.8 years; 159 women, age 60.9±0.9 years who participated in the 2005 Korean National Health and Nutrition Examination Survey were examined. Glycemic control was categorized based on concentration of glycated hemoglobin (HbA1c; HbA1c ≤6.5%; 6.6% to 8.0%; ≥8.1%. Dietary intake was assessed by using a 24-recall item questionnaire.ResultsHigh total energy intake was associated with poor glycemic control (HbA1c ≤6.5%, 1,824±75 kcal; 6.6% to 8.0%, 1,990±57 kcal; ≥8.1%, 2,144±73 kcal; P value for trend=0.002. Each proportion of protein, fat, or carbohydrate was not associated with glycemic control. Even after adjusting for several parameters, the association of daily energy intake with glycemic control still persisted.ConclusionTotal energy intake may be more closely related to glycemic control than each proportionof macronutrients in Korean diabetics.
Tang, Yunzhao; Meng, Lingling; Li, Daiqing; Yang, Min; Zhu, Yanjuan; Li, Chenguang; Jiang, Zhenhuan; Yu, Ping; Li, Zhu; Song, Hongna; Ni, Changlin
Copious evidence from epidemiological and laboratory studies has revealed that sleep status is associated with glucose intolerance, insulin resistance, thus increasing the risk of developing type 2 diabetes. The aim of this study was to reveal the interaction of sleep quality and sleep quantity on glycemic control in patients with type 2 diabetes mellitus. From May 2013 to May 2014, a total of 551 type 2 diabetes patients in Tianjin Metabolic Diseases Hospital were enrolled. Blood samples were taken to measure glycosylated hemoglobin (HbA1c), and all the patients completed the Chinese version of the Pittsburgh Sleep Quality Index (PSQI) questionnaire to evaluate their sleep status. "Good sleep quality" was defined as PQSI quality" was defined as PQSI 6-8, and "poor sleep quality" was defined as PQSI >8. Poor glycemic control was defined as HbA1c ≥7%. Sleep quantity was categorized as 8 hours/night. Short sleep time was defined as sleep duration quality in poor glycemic control group was much greater than that in the average control group (χ(2) = 9.79, P = 0.007). After adjusted by gender, age, body mass index, and disease duration, the adjusted PSQI score's OR was 1.048 (95% CI 1.007-1.092, P = 0.023) for HbA1c level. The sleep duration's OR was 0.464 (95% CI 0.236-0.912, P = 0.026) for HbA1c level. One-way analysis of variance showed that the poor sleep quality group had the highest homeostasis model assessment-insulin resistance (P quality and quantity, should be regarded as a plausible risk factor for glycemic control in type 2 diabetes. Poor sleep might bring much more serious insulin resistance and could be the reason for bad glycemic control. A good night's sleep should be seen as a critical health component tool in the prevention and treatment of type 2 diabetes. It is important for clinicians to target the root causes of short sleep duration and/or poor sleep quality.
Ogawa, Susumu; Abe, Takaaki; Nako, Kazuhiro; Okamura, Masashi; Senda, Miho; Sakamoto, Takuya; Ito, Sadayoshi
Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are ω3-polyunsaturated fatty acids mainly contained in the blue-backed fish oil, and are effective in decreasing the lipids disorder and the cardiovascular incidence among diabetic patients. Moreover, it has been suggested that EPA and DHA may improve the insulin resistance and glucose metabolism. However, the clinical effects of EPA and DHA on glucose metabolism remain unclear. We aimed to clarify the effects of EPA/DHA treatment on glycemic control in type 2 diabetes mellitus. This study was a multicenter prospective randomized controlled trial involving 30 elderly type 2 diabetic patients on a liquid diet. Their exercises were almost zero and the content of their meals was strictly managed and understood well. Therefore, the difference by the individual's life was a minimum. The subjects were divided into two groups: those receiving EPA/DHA-rich liquid diet [EPA/DHA (+)] or liquid diet lacking EPA/DHA [EPA/DHA (-)]. Changes in factors related to glucose and lipid metabolism were assessed after the three-month study. Serum concentrations of EPA rose in EPA/DHA (+), although the levels of DHA and fasting C-peptide remained unchanged in EPA/DHA (+). In addition, there was a significant decline in the fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), fasting remnant-like particles and apolipoprotein (apo) B in EPA/DHA (+), compared with the values in EPA/DHA (-). EPA/DHA-rich diet might improve glucose metabolism in elderly type 2 diabetic patients on a liquid diet. This phenomenon may be due to the improved insulin resistance mediated by the rise in serum EPA concentrations.
Bralić Lang, Valerija; Bergman Marković, Biserka; Kranjčević, Ksenija
Many patients with diabetes do not achieve target values. One of the reasons for this is clinical inertia. The correct explanation of clinical inertia requires a conjunction of patient with physician and health care system factors. Our aim was to determine the rate of clinical inertia in treating diabetes in primary care and association of patient, physician, and health care setting factors with clinical inertia. This was a national, multicenter, observational, cross-sectional study in primary care in Croatia. Each family physician (FP) provided professional data and collected clinical data on 15-25 type 2 diabetes (T2DM) patients. Clinical inertia was defined as a consultation in which treatment change based on glycated hemoglobin (HbA1c) levels was indicated but did not occur. A total of 449 FPs (response rate 89.8%) collected data on 10275 patients. Mean clinical inertia per FP was 55.6% (SD ±26.17) of consultations. All of the FPs were clinically inert with some patients, and 9% of the FPs were clinically inert with all patients. The main factors associated with clinical inertia were: higher percentage of HbA1c, oral anti-diabetic drug initiated by diabetologist, increased postprandial glycemia and total cholesterol, physical inactivity of patient, and administration of drugs other than oral antidiabetics. Clinical inertia in treating patients with T2DM is a serious problem. Patients with worse glycemic control and those whose therapy was initiated by a diabetologist experience more clinical inertia. More research on causes of clinical inertia in treating patients with T2DM should be conducted to help achieve more effective diabetes control.
Mohammad Hossein Gozashti
Full Text Available Sleep disturbances have been shown to be associated with diabetes control, but the relation between planned wakings or napping with glycemic indices has not been evaluated yet. This study evaluated the relation between sleep quality, duration, and pattern, including daytime napping of people with diabetes and their glycemic control. A cross-sectional correlation research design was used for this study. We enrolled 118 people with type 2 diabetes receiving oral agents without major complications at the Shahid Bahonar Center, Kerman. The age, weight, height, serum HbA1c, as well as other glycemic indices and lipid profile were measured. BMI was also calculated. All participants were requested to fill in the Pittsburgh Sleep Quality Index (PSQI questionnaire to evaluate their sleep quality. In addition, they were inquired about their sleep schedule during day and night. Pearson correlation and multiple regression analyses were conducted to examine the correlation between HbA1c and sleep pattern variables. The variables were also compared between participants with or without napping using t-test. All analyses were performed with the SPSS version 19 (SPSS, Chicago, IL, USA. The mean age was 58±11 years and mean HbA1c (% was 7.8±11 (62±13 mmol/mol. Sleep duration and the number of sleep segments significantly predicted HbA1c (F (2,114=5.232, P=0.007, R2=0.084. A one-hour increment in sleep duration was associated with a 0.174% (1.4 mmol/mol decrement in HbA1c. PSQI score did not contribute to the regression model. Moreover, participants who napped (66% had a lower HbA1c (7.6±1 compared to others (8.1±1.3 (P=0.04. We concluded that napping and segmented sleep are associated with a better glycemic control in type 2 diabetes and there is a linear correlation between sleep duration and better glycemic control.
Gozashti, Mohammad Hossein; Eslami, Nazanin; Radfar, Mohammad Hadi; Pakmanesh, Hamid
Sleep disturbances have been shown to be associated with diabetes control, but the relation between planned wakings or napping with glycemic indices has not been evaluated yet. This study evaluated the relation between sleep quality, duration, and pattern, including daytime napping of people with diabetes and their glycemic control. A cross-sectional correlation research design was used for this study. We enrolled 118 people with type 2 diabetes receiving oral agents without major complications at the Shahid Bahonar Center, Kerman. The age, weight, height, serum HbA1c, as well as other glycemic indices and lipid profile were measured. BMI was also calculated. All participants were requested to fill in the Pittsburgh Sleep Quality Index (PSQI) questionnaire to evaluate their sleep quality. In addition, they were inquired about their sleep schedule during day and night. Pearson correlation and multiple regression analyses were conducted to examine the correlation between HbA1c and sleep pattern variables. The variables were also compared between participants with or without napping using t-test. All analyses were performed with the SPSS version 19 (SPSS, Chicago, IL, USA). The mean age was 58±11 years and mean HbA1c (%) was 7.8±11 (62±13 mmol/mol). Sleep duration and the number of sleep segments significantly predicted HbA1c (F (2,114)=5.232, P=0.007, R2=0.084). A one-hour increment in sleep duration was associated with a 0.174% (1.4 mmol/mol) decrement in HbA1c. PSQI score did not contribute to the regression model. Moreover, participants who napped (66%) had a lower HbA1c (7.6±1) compared to others (8.1±1.3) (P=0.04). We concluded that napping and segmented sleep are associated with a better glycemic control in type 2 diabetes and there is a linear correlation between sleep duration and better glycemic control.
Li, Ling-Jun; Lamoureux, Ecosse; Wong, Tien Yin; Lek, Ngee
Poor glycemic control in Type 1 Diabetes (T1D) patients is strongly associated with an increased risk of diabetes-related microvascular complications later in life, but it is unclear whether short period of poor glycemic control in children with T1D can cause evident microvascular morphological changes long before any pathological manifestation. Our study aimed to investigate the longitudinal association between poor glycemic control and subsequent changes in retinal microvasculature, in a pilot study of 55 pediatric T1D patients from Singapore after a one-year follow-up. This is a hospital-based, exposure-matched and retrospective longitudinal study. A total of 55 T1D patients were included from Singapore KK Women's and Children Hospital, 28 of whom had poor glycemic control (average glycated hemoglobin [HbA1c] ≥8% during the year) while the other 27 age- and gender-matched subjects had good glycemic control (HbA1c Singapore I Vessel Assessment [SIVA], version 4.0, Singapore Eye Research Institute, Singapore) and a spectrum of retinal vascular parameters (e.g. caliber, tortuosity, branching angle and fractal dimension) were measured quantitatively from 0.5 to 2.0 disc diameters. There was no significant difference in ethnicity, duration of T1D, blood pressure, body mass index (BMI) and low-density cholesterol lipoprotein (LDL) between the two groups. Retinal imaging was obtained at the end of 1 year of glycemic control assessment. In multiple linear regression adjusting for ethnicity, BMI, LDL and duration of T1D, patients with poor glycemic control tended to have marginally wider retinal arteriolar caliber (6.0 μm, 95% CI: -0.9, 12.8) and had significantly larger retinal arteriolar branching angle (10.1 degrees, 95% CI: 1.4, 18.9) compared with their age- and gender- matched counterparts with good glycemic control. Our findings showed that abnormal retinal microvascular morphology was evident in pediatric patients with T1D after one-year's poor glycemic
Ward, Logan; Steel, James; Le Compte, Aaron; Evans, Alicia; Tan, Chia-Siong; Penning, Sophie; Shaw, Geoffrey M; Desaive, Thomas; Chase, J Geoffrey
Tight glycemic control (TGC) has shown benefits but has been difficult to implement. Model-based methods and computerized protocols offer the opportunity to improve TGC quality and compliance. This research presents an interface design to maximize compliance, minimize real and perceived clinical effort, and minimize error based on simple human factors and end user input. The graphical user interface (GUI) design is presented by construction based on a series of simple, short design criteria based on fundamental human factors engineering and includes the use of user feedback and focus groups comprising nursing staff at Christchurch Hospital. The overall design maximizes ease of use and minimizes (unnecessary) interaction and use. It is coupled to a protocol that allows nurse staff to select measurement intervals and thus self-manage workload. The overall GUI design is presented and requires only one data entry point per intervention cycle. The design and main interface are heavily focused on the nurse end users who are the predominant users, while additional detailed and longitudinal data, which are of interest to doctors guiding overall patient care, are available via tabs. This dichotomy of needs and interests based on the end user's immediate focus and goals shows how interfaces must adapt to offer different information to multiple types of users. The interface is designed to minimize real and perceived clinical effort, and ongoing pilot trials have reported high levels of acceptance. The overall design principles, approach, and testing methods are based on fundamental human factors principles designed to reduce user effort and error and are readily generalizable. © 2012 Diabetes Technology Society.
Lin, Wei-Sheng; Lo, Jung-Hsin; Yang, Jo-Hsuan; Wang, Hao-Wei; Fan, Shou-Zen; Yen, Jui-Hung; Wang, Pei-Yu
Ludwigia octovalvis (Jacq.) P.H. Raven (Onagraceae) extracts have historically been consumed as a healthful drink for treating various conditions, including edema, nephritis, hypotension and diabetes. We have previously shown that Ludwigia octovalvis extract (LOE) can significantly extend lifespan and improve age-related memory deficits in Drosophila melanogaster through activating AMP-activated protein kinase (AMPK). Since AMPK has become a critical target for treating diabetes, we herein investigate the anti-hyperglycemic potential of LOE. Differentiated C2C12 muscle cells, HepG2 hepatocellular cells, streptozotocin (STZ)-induced diabetic mice and high fat diet (HFD)-induced diabetic mice were used to investigate the anti-hyperglycemic potential of LOE. The open field test and novel object recognition test were used to evaluate spontaneous motor activity and memory performance of HFD-induced diabetic mice. In differentiated C2C12 muscle cells and HepG2 hepatocellular cells, treatments with LOE and its active component (β-sitosterol) induced significant AMPK phosphorylation. LOE also enhanced uptake of a fluorescent glucose derivative (2-NBDG) and inhibited glucose production in these cells. The beneficial effects of LOE were completely abolished when an AMPK inhibitor, dorsomorphin, was added to the culture system, suggesting that LOE requires AMPK activation for its action in vitro. In streptozotocin (STZ)-induced diabetic mice, we found that both LOE and β-sitosterol induced an anti-hyperglycemic effect comparable to that of metformin, a drug that is commonly prescribed to treat diabetes. Moreover, LOE also improved glycemic control and memory performance of mice fed a HFD. These results indicate that LOE is a potent anti-diabetic intervention that may have potential for future clinical applications. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.
Kumah-Crystal, Yaa A; Hood, Korey K; Ho, Yu-Xian; Lybarger, Cindy K; O'Connor, Brendan H; Rothman, Russell L; Mulvaney, Shelagh A
This study examines technology use for problem solving in diabetes and its relationship to hemoglobin A1C (A1C). A sample of 112 adolescents with type 1 diabetes completed measures assessing use of technologies for diabetes problem solving, including mobile applications, social technologies, and glucose software. Hierarchical regression was performed to identify the contribution of a new nine-item Technology Use for Problem Solving in Type 1 Diabetes (TUPS) scale to A1C, considering known clinical contributors to A1C. Mean age for the sample was 14.5 (SD 1.7) years, mean A1C was 8.9% (SD 1.8%), 50% were female, and diabetes duration was 5.5 (SD 3.5) years. Cronbach's α reliability for TUPS was 0.78. In regression analyses, variables significantly associated with A1C were the socioeconomic status (β = -0.26, P Problem Solving Questionnaire (β = -0.26, P = 0.01), and TUPS (β = 0.26, P = 0.01). Aside from the Diabetes Self-Care Inventory--Revised, each block added significantly to the model R(2). The final model R(2) was 0.22 for modeling A1C (P problem solving and higher A1C. Adolescents with poorer glycemic control may use technology in a reactive, as opposed to preventive, manner. Better understanding of the nature of technology use for self-management over time is needed to guide the development of technology-mediated problem solving tools for youth with type 1 diabetes.
Ronald B Goldberg
Full Text Available Ronald B GoldbergDivision of Endocrinology, Diabetes and Metabolism, Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, USAAbstract: Bile sequestrants have been used for almost 50 years to lower low density lipoprotein cholesterol (LDL-C. The advent of colesevelam in 2000 provided a more tolerable add-on LDL-C-lowering agent with an excellent safety record and with likely benefit for coronary heart disease events. Colesevelam lowers LDL-C approximately 15%, and has an additive effect when combined with statin or non-statin lipid-modifying agents. It also tends to increase triglyceride levels. The discovery that bile sequestrants also lower glucose levels led to definitive large-scale clinical trials testing the effect of colesevelam as a dual antihyperglycemic agent with LDL-C-lowering properties in type 2 diabetic subjects on metformin-, sulfonylurea- or insulin-based therapy with inadequate glycemic control. Colesevelam was found to lower hemoglobin A1c (HbA1c by approximately 0.5% compared to placebo over the 16- to 26-week period, and had similar effects on the lipid profile in these diabetic subjects, as had previously been demonstrated in non-diabetic individuals. Colesevelam was well tolerated, with constipation being the most common adverse effect, and did not cause weight gain or excessive hypoglycemia. Colesevelam thus combines antihyperglycemic action with LDL-C-lowering properties, and should be useful in the management of type 2 diabetes.Keywords: colesevelam, treatment, hyperglycemia, LDL-cholesterol
Full Text Available Objective. The purpose of the study was to examine the acute effects of the timing of exercise on the glycemic control during and after exercise in T2D. Methods. This study included 26 T2D patients (14 women and 12 men who were treated with metformin. All patients were tested on four occasions: metformin administration alone (Metf, high-intensity interval training (HIIT performed at 30 minutes (EX30, 60 minutes (EX60, and 90 minutes (EX90 postbreakfast, respectively. Glucose, insulin, and superoxide dismutase (SOD activity were examined. Results. Glucose decreased significantly after the exercise in EX30, EX60, and EX90. Compared with Metf, the decline in glucose immediately after the exercise was larger in EX30 (−2.58 mmol/L; 95% CI, −3.36 to −1.79 mmol/L; p<0.001, EX60 (−2.13 mmol/L; 95% CI, −2.91 to −1.34 mmol/L; p<0.001, and EX90 (−1.87 mmol/L; 95% CI, −2.65 to −1.08 mmol/L; p<0.001, respectively. Compared with Metf, the decrease in insulin was larger in EX30 and EX60 (both p<0.001. Conclusions. Timing of exercise is a factor to consider when prescribing exercise for T2D patients treated with metformin. This trial is registered with ChiCTR-IOR-16008469 on 13 May 2016.
Wagner, E H; Sandhu, N; Newton, K M; McCulloch, D K; Ramsey, S D; Grothaus, L C
Because of the additional costs associated with improving diabetes management, there is interest in whether improved glycemic control leads to reductions in health care costs, and, if so, when such cost savings occur. To determine whether sustained improvements in hemoglobin A(1c) (HbA(1c)) levels among diabetic patients are followed by reductions in health care utilization and costs. Historical cohort study conducted in 1992-1997 in a staff-model health maintenance organization (HMO) in western Washington State. All diabetic patients aged 18 years or older who were continuously enrolled between January 1992 and March 1996 and had HbA(1c) measured at least once per year in 1992-1994 (n = 4744). Patients whose HbA(1c) decreased 1% or more between 1992 and 1993 and sustained the decline through 1994 were considered to be improved (n = 732). All others were classified as unimproved (n = 4012). Total health care costs, percentage hospitalized, and number of primary care and specialty visits among the improved vs unimproved cohorts in 1992-1997. Diabetic patients whose HbA(1c) measurements improved were similar demographically to those whose levels did not improve but had higher baseline HbA(1c) measurements (10.0% vs 7.7%; Pcosts were $685 to $950 less each year in the improved cohort for 1994 (P =.09), 1995 (P =.003), 1996 (P =.002), and 1997 (P =.01). Cost savings in the improved cohort were statistically significant only among those with the highest baseline HbA(1c) levels (>/=10%) for these years but appeared to be unaffected by presence of complications at baseline. Beginning in the year following improvement (1994), utilization was consistently lower in the improved cohort, reaching statistical significance for primary care visits in 1994 (P =.001), 1995 (Pcost savings within 1 to 2 years of improvement.
Asbjörnsdóttir, Björg; Akueson, Cecelia E.; Ronneby, Helle
, as a part of routine care. The total daily carbohydrate consumption from the major sources (e.g. bread, potatoes, rice, pasta, dairy products, fruits, candy) was calculated. A dietician estimated the overall glycemic index score (scale 0–7). Results At least two days of diet recording were available in 75...
van Hooijdonk, Roosmarijn T. M.; Binnekade, Jan M.; Bos, Lieuwe D. J.; Horn, Janneke; Juffermans, Nicole P.; Abu-Hanna, Ameen; Schultz, Marcus J.
We retrospectively studied associations between bolus infusion of hydrocortisone and variability of the blood glucose level and changes in insulin rates in intensive care unit (ICU) patients. 'Glycemic variability' and 'insulin infusion rate variability' were calculated from and expressed as the
Dmitry N. Laptev
Full Text Available Rationale: Healthcare access plays a significant role in the improvement and maintaining of glycemic control and quality of life in type 1 diabetes mellitus (T1DM patients on continuous subcutaneous insulin infusion (CSII. Aims: The aim of the study was to evaluate the feasibility of remote support in children and adolescents with type 1 diabetes mellitus (T1DM and its effect on glycemic control and quality of life. Materials and methods: In 40 children and adolescents (13±2,7 years, 18/22 m/f on CSII with inadequately controlled T1DM (HbA1c≥7,5% we evaluated the effectiveness of telemedical support (TS, as compared with conventional support (CS. Parameters of glycemic control (HbA1c, average glycemia, SD, etc. and quality of a life were obtained on follow-up visits. Patients and their parents in ТМ group twice a month sent their insulin pump data using to CSII center and diabetologists sent back their advice via e-mail, phone or Skype. The primary end point was the change from the baseline HbA1c level and the proportion of patients achieving HbA1c of less than 7.5%. Results: At 24 weeks, the baseline mean HbA1c (8.7% in the two study groups had decreased to 7.7% in the TS group, as compared with 8.4% in the CS group (P0,05. Conclusion: In children with inadequately controlled T1DM, telemedical support proved to be feasible and resulted in significant improvement in glucose control (HbA1c, glucose variability and quality of life without the increase in the incidence of DKA and severe glycemia.
Albrecht, Sandra S; Mayer-Davis, Elizabeth; Popkin, Barry M
For the same body mass index (BMI) level, waist circumference (WC) is higher in more recent years. How this impacts diabetes and prediabetes prevalence in the United States and for different race/ethnic groups is unknown. We examined prevalence differences in diabetes and prediabetes by BMI over time, investigated whether estimates were attenuated after adjusting for waist circumference, and evaluated implications of these patterns on race/ethnic disparities in glycemic outcomes. Data came from 12 614 participants aged 20 to 74 years from the National Health and Nutrition Examination Surveys (1988-1994 and 2007-2012). We estimated prevalence differences in diabetes and prediabetes by BMI over time in multivariable models. Relevant interactions evaluated race/ethnic differences. Among normal, overweight, and class I obese individuals, there were no significant differences in diabetes prevalence over time. However, among individuals with class II/III obesity, diabetes prevalence rose 7.6 percentage points in 2007-2012 vs 1988-1994. This estimate was partly attenuated after adjustment for mean waist circumference but not mean BMI. For prediabetes, prevalence was 10 to 13 percentage points higher over time at lower BMI values, with minimal attenuation after adjustment for WC. All patterns held within race/ethnic groups. Diabetes disparities among blacks and Mexican Americans relative to whites remained in both periods, regardless of BMI, and persisted after adjustment for WC. Diabetes prevalence rose over time among individuals with class II/III obesity and may be partly due to increasing waist circumference. Anthropometric measures did not appear to account for temporal increases in prediabetes, nor did they attenuate race/ethnic disparities in diabetes. Reasons underlying these trends require further investigation. Copyright © 2017 John Wiley & Sons, Ltd.
Mazarello Paes, Veena; Charalampopoulos, Dimitrios; Edge, Julie; Taylor-Robinson, David; Stephenson, Terence; Amin, Rakesh
Early glycemic control is associated with reduced future vascular complications risk in type 1 diabetes (T1D). The aim of this study was to systematically review evidence on the predictors of glycemic control within 12 months of diagnosis of childhood onset T1D. Inclusion criteria for the electronic search were: interventional and observational studies that assessed and quantified an association between the predictor and glycemic control within 12 months of diagnosis of childhood onset T1D. A total of 17 915 articles were identified from 6 databases and 20 studies were finally included in the analysis. Harvest plots and narrative synthesis were used to summarize data from intervention (n = 0), prospective/retrospective cohort (n = 15), and cross-sectional (n = 5) studies. Significant predictors of poorer glycemic control 0 to 3 months after diagnosis were older age and female gender. Non-white ethnicity, diabetes autoantibody positivity, measures of deprivation, and non-private health insurance were potential predictors. Predictors of poorer glycemic control 4 to 12 months after diagnosis were: older age, non-white ethnicity, a single parent family, high hemoglobin A1c (HbA1c) levels at diagnosis, longer T1D duration, and non-intensive insulin therapy. Potential predictors included: family with health issues, clinical factors, and comorbidities at diagnosis. Most significant predictors of poor glycemic control within 12 months of diagnosis of childhood onset T1D are non-modifiable. These factors need to be recognized and addressed through individualized and multidisciplinary diabetes care. Further research is required to confirm the association of potential predictors with early glycemic control. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Full Text Available The present study aimed to investigate the effectiveness of group cognitive behavioral therapy in reducing anxiety and depression and glycemic control in children with type I diabetes. The study was quasi- experimental with a pre-test, post-test design with control group. For this purpose, 30 children with diabetes were selected from Imam Reza Hospital in Mashhad. The children were randomly assigned into two experimental group (15 and control group (15. The experimental group was undergone eight 2-hour sessions of cognitive-behavioral training. Before and after the intervention, the Multidimensional Anxiety Scale for Children, which included four components of social anxiety, physical symptoms, harm avoidance, and separation anxiety, and Children Depression Inventory was administrated in both groups. The findings from the covariance analysis test revealed that depression and anxiety and glycemic control in experimental group was controlled at post-test and depression score in experimental group compared to the control group at post-test was decreased. The findings from the multivariate covariance analysis test between components of, physical symptoms, harm avoidance, separation anxiety, and social anxiety revealed meaningful differences between the two groups in social anxiety post-test score. Thus, cognitive behavior therapy can be effective for depression, anxiety, and blood sugar control in children.
Aman, J; Skinner, T C; de Beaufort, C E
A1c) levels were assayed in one central laboratory. All individuals with diabetes aged 11-18 yr (49.4% female), with duration of diabetes of at least 1 yr, were invited to participate. Individuals completed a self-reported measure of quality of life (Diabetes Quality of Life - Short Form [DQOL...... whether differences in physical activity or sedentary behavior could explain the variation in metabolic outcomes between centers. METHODS: An observational cross-sectional international study in 21 centers, with demographic and clinical data obtained by questionnaire from participants. Hemoglobin A1c (Hb.......001) but not with glycemic control, body mass index, frequency of hypoglycemia, or diabetic ketoacidosis. The more time spent on the computer (r = 0.06; p
Dias Viviane M
Full Text Available Abstract Background The importance of achieving and maintaining an appropriate metabolic control in patients with type 1 diabetes mellitus (DM1 has been established in many studies aiming to prevent the development of chronic complications. The carbohydrate counting method can be recommended as an additional tool in the nutritional treatment of diabetes, allowing patients with DM1 to have more flexible food choices. This study aimed to evaluate the influence of nutrition intervention and the use of multiple short-acting insulin according to the carbohydrate counting method on clinical and metabolic control in patients with DM1. Methods Our sample consisted of 51 patients with DM1, 32 females, aged 25.3 ± 1.55 years. A protocol of nutritional status evaluation was applied and laboratory analysis was performed at baseline and after a three-month intervention. After the analysis of the food records, a balanced diet was prescribed using the carbohydrate counting method, and short-acting insulin was prescribed based on the total amount of carbohydrate per meal (1 unit per 15 g of carbohydrate. Results A significant decrease in A1c levels was observed from baseline to the three-month evaluation after the intervention (10.40 ± 0.33% and 9.52 ± 0.32%, respectively, p = 0.000. It was observed an increase in daily insulin dose after the intervention (0.99 ± 0.65 IU/Kg and 1.05 ± 0.05 IU/Kg, respectively, p = 0.003. No significant differences were found regarding anthropometric evaluation (BMI, waist, hip or abdominal circumferences and waist to hip ratio after the intervention period. Conclusions The use of short-acting insulin based on the carbohydrate counting method after a short period of time resulted in a significant improvement of the glycemic control in patients with DM1 with no changes in body weight despite increases in the total daily insulin doses.
Lee, Aaron A; Piette, John D; Heisler, Michele; Rosland, Ann-Marie
To examine whether autonomy support (defined as social support for an individual's personal agency) for diabetes management from informal health supporters (family/friends) reduces the detrimental effects of diabetes distress on glycemic control. Three hundred eight veterans with type 2 diabetes and one or more risk factors for diabetes complications completed a survey that included measures of diabetes distress and perceived autonomy support from their main informal health supporter. Hemoglobin A 1c (HbA 1c ) data from 12 months before and after the survey were extracted from electronic medical records. Linear mixed modeling examined the main effects and interaction of autonomy support and diabetes distress on repeated measures of HbA 1c over the 12 months after the survey, controlling for mean prior 12-month HbA 1c , time, insulin use, age, and race/ethnicity. Diabetes distress ( B = 0.12 [SE 0.05]; P = 0.023) was associated with higher and autonomy support ( B = -0.16 [SE 0.07]; P = 0.032) with lower subsequent HbA 1c levels. Autonomy support moderated the relationship between diabetes distress and HbA 1c ( B = -0.13 [SE 0.06]; P = 0.027). Greater diabetes distress was associated with higher HbA 1c at low ( B = 0.21 [SE 07]; P = 0.002) but not high ( B = 0.01 [SE 0.07]; P = 0.890) levels of autonomy support. Autonomy support from main health supporters may contribute to better glycemic control by ameliorating the effects of diabetes distress. Interventions that reduce diabetes distress and enhance the autonomy supportiveness of informal supporters may be effective approaches to improving glycemic control. © 2018 by the American Diabetes Association.
Charleer, Sara; Mathieu, Chantal; Nobels, Frank; De Block, Christophe; Radermecker, Regis P; Hermans, Michel P; Taes, Youri; Vercammen, Chris; T'Sjoen, Guy; Crenier, Laurent; Fieuws, Steffen; Keymeulen, Bart; Gillard, Pieter
Randomized controlled trials evaluating real-time continuous glucose monitoring (RT-CGM) patients with type 1 diabetes (T1D) show improved glycemic control, but limited data are available on real-world use. To assess impact of RT-CGM in real-world settings on glycemic control, hospital admissions, work absenteeism, and quality of life (QOL). Prospective, observational, multicenter, cohort study. A total of 515 adults with T1D on continuous subcutaneous insulin infusion (CSII) therapy starting in the Belgian RT-CGM reimbursement program. Initiation of RT-CGM reimbursement. Hemoglobin A1c (HbA1c) evolution from baseline to 12 months. Between September 1, 2014, and December 31, 2016, 515 adults entered the reimbursement system. Over this period, 417 (81%) patients used RT-CGM for at least 12 months. Baseline HbA1c was 7.7 ± 0.9% (61 ± 9.8 mmol/mol) and decreased to 7.4 ± 0.8% (57 ± 8.7 mmol/mol) at 12 months (P < 0.0001). Subjects who started RT-CGM because of insufficient glycemic control showed stronger decrease in HbA1c at 4, 8, and 12 months compared with patients who started because of hypoglycemia or pregnancy. In the year preceding reimbursement, 16% of patients were hospitalized for severe hypoglycemia or ketoacidosis in contrast to 4% (P < 0.0005) the following year, with decrease in admission days from 54 to 18 per 100 patient years (P < 0.0005). In the same period, work absenteeism decreased and QOL improved significantly, with strong decline in fear of hypoglycemia. Sensor-augmented pump therapy in patients with T1D followed in specialized centers improves HbA1c, fear of hypoglycemia, and QOL, whereas work absenteeism and admissions for acute diabetes complications decreased.
Lenherr, Sara M; Clemens, J Quentin; Braffett, Barbara H; Cleary, Patricia A; Dunn, Rodney L; Hotaling, James M; Jacobson, Alan M; Kim, Catherine; Herman, William; Brown, Jeanette S; Wessells, Hunter; Sarma, Aruna V
We examined the relationship between glycemic control and urinary tract infections in women with type 1 diabetes mellitus. Women enrolled in the Epidemiology of Diabetes Interventions and Complications study, the observational followup of the Diabetes Control and Complications Trial, were surveyed to assess the rate of physician diagnosed urinary tract infections in the preceding 12 months. The relationship between glycated hemoglobin levels and number of urinary tract infections in the previous 12 months was assessed using a multivariable Poisson regression model. A total of 572 women were evaluated at year 17. Mean age was 50.7 ± 7.2 years, mean body mass index was 28.6 ± 5.9 kg/m(2), mean type 1 diabetes duration was 29.8 ± 5.0 years and mean glycated hemoglobin was 8.0% ± 0.9%. Of these women 86 (15.0%) reported at least 1 physician diagnosed urinary tract infection during the last 12 months. Higher glycated hemoglobin levels were significantly associated with number of urinary tract infections such that for every unit increase (1%) in recent glycated hemoglobin level, there was a 21% (p=0.02) increase in urinary tract infection frequency in the previous 12 months after adjusting for race, hysterectomy status, urinary incontinence, sexual activity in the last 12 months, peripheral and autonomic neuropathy, and nephropathy. The frequency of urinary tract infections increases with poor glycemic control in women with type 1 diabetes. This relationship is independent of other well described predictors of urinary tract infections and suggests that factors directly related to glycemic control may influence the risk of lower urinary tract infections. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Robert G Moses
Full Text Available Robert G MosesClinical Trials and Research Unit, South East Sydney and Illawarra Area Health Service, New South Wales, AustraliaAbstract: Type 2 diabetes is a progressive disease associated with high levels of morbidity and mortality and for which there is both a large and growing prevalence worldwide. Lifestyle advice plus metformin is commonly recommended initially to manage hyperglycemia and to minimize the risk of vascular complications. However, additional agents are required when glycemic targets cannot be achieved or maintained due to the progressive nature of the disease. Repaglinide/metformin fixed-dose combination (FDC therapy (PrandiMet®; Novo Nordisk, Bagsværd, Denmark has been approved for use in the USA. This FDC is a rational second-line therapy given the complementary mechanisms of action of the components. Repaglinide is a rapidly absorbed, short-acting insulin secretagogue targeting postprandial glucose excursions; metformin is an insulin sensitizer with a longer duration of action that principally regulates basal glucose levels. A pivotal, 26-week, randomized study with repaglinide/metformin FDC therapy has been conducted in patients experiencing suboptimal control with previous oral antidiabetes therapy. Repaglinide/metformin FDC improved glycemic control and weight neutrality without adverse effects on lipid profiles. There were no major hypoglycemic episodes and patients expressed greater satisfaction with repaglinide/metformin FDC than previous treatments. Repaglinide/metformin FDC is expected to be more convenient than individual tablets for patients taking repaglinide and metformin in loose combination, and it is expected to improve glycemic control in patients for whom meglitinide or metformin monotherapies provide inadequate control.Keywords: type 2 diabetes, metformin, repaglinide, PrandiMet®, fixed-dose combination
Full Text Available Mostafa A Abolfotouh1,*, Mofida M Kamal2,*, Mohamed D El-Bourgy2,*, Sherine G Mohamed2,*1King Abdullah International Medical Research Center (KAIMRC, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS, Riyadh, Kingdom of Saudi Arabia; 2Department of Health Administration and Behavioral Sciences, High Institute of Public Health, Alexandria University, Alexandria, Egypt; *All authors contributed equally to this workObjective: To assess quality of life (QoL and glycemic control in adolescents with type 1 diabetes and to investigate the impact of an educational program.Methods: A quasiexperimental study with nonrandomized experimental and control groups was conducted in which a total of 503 adolescents with type 1 diabetes completed a questionnaire using the Diabetes Quality of Life Instrument for Youth. Adolescents were then assigned to experimental and control groups. The experimental group was subjected to four 120-minute sessions of an educational program over a period of 4 months. Extracted medical chart data included the duration of diabetes, insulin dosage, and most recent hemoglobin A1c levels. Analysis of covariance was used to detect the impact of intervention.Results: The overall mean QoL score (% was 76.51 ± 9.79, with good QoL in 38% of all adolescents. Poorer QoL was significantly associated with older age (P < 0.001, more hospital admissions in the last 6 months (P = 0.006, higher levels of depression (P < 0.001, poor self-esteem (P < 0.001, and poor self-efficacy (P < 0.001. There was significant deterioration in all domains of QoL in the experimental group after intervention. However, this deterioration was significantly less severe than in the control group. Between-group effects on total knowledge, adherence to exercise, glucose monitoring, treatment, self-efficacy, family contribution to management, glycemic control, and satisfaction with life were significantly in favor of the experimental group
Amiri, Fatemehsadat; Vafa, Mohammadreza; Gonder-Frederick, Linda
This study was designed to test the reliability of a Persian version of 2 questionnaires to assess the level of fear of hypoglycemia (FoH) and self-efficacy in diabetes management and their association with glycated hemoglobin (A1C) and parents' demographic characteristics in a sample of children with type 1 diabetes. We assessed 61 children with type 1 diabetes (35 boys and girls, 6.0 to 12.7 years of age) using the Hypoglycemia Fear Survey-Child version (HFS-C) and Self-Efficacy for Diabetes Scale-Child version (SED-C). Their glycemic control was evaluated by A1C levels. The internal consistency of the Persian version of HFS-C and SED-C were very good. Our results showed that children older than 10 years of age report lower levels of FoH, which are related to higher levels of self-efficacy (r=-.30, p=0.025 and r=-.30, p=0.02, respectively). Of the children, 42.3% of girls and 31.4% of boys reported that low blood sugar is a big problem for them. These findings suggest that FoH is a significant concern for this target group. Only 19.7% of children had controlled diabetes based on A1C levels. There was no significant association between higher A1C levels and other variables, including HFS-C, SED-C and parents' demographic characteristics. The Persian version of HFS-C and SED-C are reliable and valid measures of the fear of hypoglycemia and of self-efficacy in children with type 1 diabetes, and these questionnaires could be used in our country for identifying those children who may need diabetes education and other supports. The association between greater self-efficacy and lower fear of hypoglycemia suggests that addressing self-efficacy in diabetes education courses may be effective in helping to overcome FoH. Copyright © 2015 Canadian Diabetes Association. All rights reserved.
van Hooijdonk, Roosmarijn T. M.; Mesotten, Dieter; Krinsley, James S.; Schultz, Marcus J.
Hyperglycemia, hypoglycemia, and glycemic variability are all independently associated with morbidity and mortality of critically ill patients. A strategy aiming at normoglycemia (so-called tight glycemic control) could improve outcomes of critically ill patients, but results from randomized
Kitamura, Tetsuhiro; Otsuki, Michio; Tamada, Daisuke; Tabuchi, Yukiko; Mukai, Kosuke; Morita, Shinya; Kasayama, Soji; Bando, Yukihiro; Shimomura, Iichiro; Koga, Masafumi
We recently reported that glycated albumin (GA) in patients with Cushing's syndrome is low. In the present study, we examined whether serum albumin (SA)-adjusted GA (SAaGA) is an adequate indicator of glycemic control in patients with Cushing's syndrome. We studied 26 patients with Cushing's syndrome (13 patients without diabetes and 13 patients with diabetes). Twenty six non-diabetic subjects and 26 patients with type 2 diabetes mellitus matched for age, sex and BMI were used as the controls. SAaGA was calculated using the regression formula between SA and GA in non-diabetic patients with Cushing's syndrome and non-diabetic subjects. SA showed a significant correlation with GA in non-diabetic patients with Cushing's syndrome and non-diabetic subjects. GA, but not SAaGA, in non-diabetic patients with Cushing's syndrome was significantly lower than that in the non-diabetic controls. Furthermore, the GA/HbA1c ratio, but not the SAaGA/HbA1c ratio, in diabetic patients with Cushing's syndrome was significantly lower than that in the diabetic controls. The measured GA in the patients with Cushing's syndrome was significantly lower than the estimated GA, but there was no difference between SAaGA and the estimated GA. The present findings suggest that SAaGA is an adequate indicator of the glycemic control in patients with Cushing's syndrome. Copyright © 2014 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.
Full Text Available Poor sleep quality is an independent predictor of cardiovascular events. However, little is known about the association between glycemic control and objective sleep architecture and its influence on arteriosclerosis in patients with type-2 diabetes mellitus (DM. The present study examined the association of objective sleep architecture with both glycemic control and arteriosclerosis in type-2 DM patients.Cross-sectional study in vascular laboratory.The subjects were 63 type-2 DM inpatients (M/F, 32/31; age, 57.5±13.1 without taking any sleeping promoting drug and chronic kidney disease. We examined objective sleep architecture by single-channel electroencephalography and arteriosclerosis by carotid-artery intima-media thickness (CA-IMT.HbA1c was associated significantly in a negative manner with REM sleep latency (interval between sleep-onset and the first REM period (β=-0.280, p=0.033, but not with other measurements of sleep quality. REM sleep latency associated significantly in a positive manner with log delta power (the marker of deep sleep during that period (β=0.544, p=0.001. In the model including variables univariately correlated with CA-IMT (REM sleep latency, age, DM duration, systolic blood pressure, and HbA1c as independent variables, REM sleep latency (β=-0.232, p=0.038, but not HbA1c were significantly associated with CA-IMT. When log delta power was included in place of REM sleep latency, log delta power (β=-0.257, p=0.023 emerged as a significant factor associated with CA-IMT.In type-2 DM patients, poor glycemic control was independently associated with poor quality of sleep as represented by decrease of REM sleep latency which might be responsible for increased CA-IMT, a relevant marker for arterial wall thickening.
Raffield, Laura M; Cox, Amanda J; Freedman, Barry I; Hugenschmidt, Christina E; Hsu, Fang-Chi; Wagner, Benjamin C; Xu, Jianzhao; Maldjian, Joseph A; Bowden, Donald W
To examine the relationships between type 2 diabetes (T2D) status, glycemic control, and T2D duration with magnetic resonance imaging (MRI)-derived neuroimaging measures in European Americans from the Diabetes Heart Study (DHS) Mind cohort. Relationships were examined using marginal models with generalized estimating equations in 784 participants from 514 DHS Mind families. Fasting plasma glucose, glycated hemoglobin, and diabetes duration were analyzed in 682 participants with T2D. Models were adjusted for potential confounders, including age, sex, history of cardiovascular disease, smoking, educational attainment, and use of statins or blood pressure medications. Association was tested with gray and white matter volume, white matter lesion volume, gray matter cerebral blood flow, and white and gray matter fractional anisotropy and mean diffusivity. Adjusting for multiple comparisons, T2D status was associated with reduced white matter volume (p = 2.48 × 10(-6)) and reduced gray and white matter fractional anisotropy (p ≤ 0.001) in fully adjusted models, with a trend toward increased white matter lesion volume (p = 0.008) and increased gray and white matter mean diffusivity (p ≤ 0.031). Among T2D-affected participants, neither fasting glucose, glycated hemoglobin, nor diabetes duration were associated with the neuroimaging measures assessed (p > 0.05). While T2D was significantly associated with MRI-derived neuroimaging measures, differences in glycemic control in T2D-affected individuals in the DHS Mind study do not appear to significantly contribute to variation in these measures. This supports the idea that the presence or absence of T2D, not fine gradations of glycemic control, may be more significantly associated with age-related changes in the brain.
Nishimura, Akiko; Harashima, Shin-ichi; Honda, Ikumi; Shimizu, Yoshiyuki; Harada, Norio; Nagashima, Kazuaki; Hamasaki, Akihiro; Hosoda, Kiminori; Inagaki, Nobuya
Color affects emotions, feelings, and behaviors. We hypothesized that color used in self-monitoring of blood glucose (SMBG) is helpful for patients to recognize and act on their glucose levels to improve glycemic control. Here, two color-indication methods, color record (CR) and color display (CD), were independently compared for their effects on glycemic control in less frequently insulin-treated type 2 diabetes. One hundred twenty outpatients were randomly allocated to four groups with 2×2 factorial design: CR or non-CR and CD or non-CD. Blood glucose levels were recorded in red or blue pencil in the CR arm, and a red or blue indicator light on the SMBG meter was lit in the CD arm, under hyperglycemia or hypoglycemia, respectively. The primary end point was difference in glycated hemoglobin (HbA1c) reduction in 24 weeks. Secondary end points were self-management performance change and psychological state change. HbA1c levels at 24 weeks were significantly decreased in the CR arm by -0.28% but were increased by 0.03% in the non-CR arm (P=0.044). In addition, diet and exercise scores were significantly improved in the CR arm compared with the non-CR arm. The exercise score showed significant improvement in the CD arm compared with the non-CD arm but without a significant difference in HbA1c reduction. Changes in psychological states were not altered between the arms. CR has a favorable effect on self-management performance without any influence on psychological stress, resulting in improved glycemic control in type 2 diabetes patients using less frequent insulin injection. Thus, active but not passive usage of color-indication methods by patients is important in successful SMBG.
McMurphy, Travis B; Huang, Wei; Xiao, Run; Liu, Xianglan; Dhurandhar, Nikhil V; Cao, Lei
Considering that impaired proximal insulin signaling is linked with diabetes, approaches that enhance glucose disposal independent of insulin signaling are attractive. In vitro data indicate that the E4ORF1 peptide derived from human adenovirus 36 (Ad36) interacts with cells from adipose tissue, skeletal muscle, and liver to enhance glucose disposal, independent of proximal insulin signaling. Adipocyte-specific expression of Ad36E4ORF1 improves hyperglycemia in mice. To determine the hepatic interaction of Ad36E4ORF1 in enhancing glycemic control, we expressed E4ORF1 of Ad36 or Ad5 or fluorescent tag alone by using recombinant adeno-associated viral vector in the liver of three mouse models. In db/db or diet-induced obesity (DIO) mice, hepatic expression of Ad36E4ORF1 but not Ad5E4ORF1 robustly improved glycemic control. In normoglycemic wild-type mice, hepatic expression of Ad36E4ORF1 lowered nonfasting blood glucose at a high dose of expression. Of note, Ad36E4ORF1 significantly reduced insulin levels in db/db and DIO mice. The improvement in glycemic control was observed without stimulation of the proximal insulin signaling pathway. Collectively, these data indicate that Ad36E4ORF1 is not a typical sensitizer, mimetic, or secretagogue of insulin. Instead, it may have insulin-sparing action, which seems to reduce the need for insulin and, hence, to reduce insulin levels. © 2017 by the American Diabetes Association.
Roese, Neal J.; Olson, James M.
Examined impact of outcome controllability on counterfactual thoughts (thoughts of what could have been). Two studies showed that outcome controllability affected counterfactual direction: thoughts on how things could have been better were more frequent following controllable outcomes, and thoughts on how things could have been worse followed…
Chien, Ming-Nan; Chen, Yen-Ling; Hung, Yi-Jen; Wang, Shu-Yi; Lu, Wen-Tsung; Chen, Chih-Hung; Lin, Ching-Ling; Huang, Tze-Pao; Tsai, Ming-Han; Tseng, Wei-Kung; Wu, Ta-Jen; Ho, Cheng; Lin, Wen-Yu; Chen, Bill; Chuang, Lee-Ming
The aim of the present study was to assess the glycemic control, adherence and treatment satisfaction in a real-world setting with basal insulin therapy in type 2 diabetes patients in Taiwan. This was a multicenter, prospective, observational registry. A total of 836 patients with type 2 diabetes taking oral antidiabetic drugs with glycated hemoglobin (HbA1c) >7% entered the study. Basal insulin was given for 24 weeks. All treatment choices and medical instructions were at the physician's discretion to reflect real-life practice. After 24-week treatment, 11.7% of patients reached set HbA1c goals without severe hypoglycemia (primary effectiveness end-point). HbA1c and fasting blood glucose were significantly decreased from (mean ± SD) 10.1 ± 1.9% to 8.7 ± 1.7% (-1.4 ± 2.1%, P 1) and from 230.6 ± 68.8 mg/dL to 159.1 ± 55.6 mg/dL (-67.4 ± 72.3 mg/dL, P 1), respectively. Patients received insulin therapy at a frequency of nearly one shot per day on average, whereas self-monitoring of blood glucose was carried out approximately four times a week. Hypoglycemia was reported by 11.4% of patients, and only 0.7% of patients experienced severe hypoglycemia. Slight changes in weight (0.7 ± 2.4 kg) and a low incidence of adverse drug reactions (0.4%) were also noted. The score of 7-point treatment satisfaction rated by patients was significantly improved by 1.9 ± 1.7 (P 1). Basal insulin therapy was associated with a decrease in HbA1c and fasting blood glucose, and an improved treatment satisfaction. Most patients complied with physicians' instructions. The treatment was generally well tolerated by patients with type 2 diabetes, but findings pointed out the need to reinforce the early and appropriate uptitration to achieve treatment targets. © 2016 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.
Sinorita, Hemi; Saádah; Jazakillah, Setyowati
to recognize the effect of education and diet on glycemic control in patients with type 2 diabetes mellitus at Dr. Sardjito Central General Hospital, Jogjakarta. a cross-sectional study was conducted in 88 patients with type 2 DM who had routine visit to the outpatient clinic in Endocrinology Division of Dr. Sardjito Central General Hospital, Jogjakarta. As inclusion criteria, patients who had routine visit in 3 month continuously with fasting plasma glucose (GDN) 126 mg/dl as poor glycemic control group. Data were recorded which included age, sex, period of DM, daily diet pattern, and education received. we found that glycemic control was not affected by sex (p=0.52) and age (p=0.38), but it was affected by period of DM (p=0.02). Glycemic control in the present study was affected by dietary pattern (p=0.01), but not by education (p=1.00). the present study has found significant correlation between regulation of dietary pattern and glycemic control (p=0.01).
Dodds, M W; Dodds, A P
The objective of this study was to determine whether improvements in the level of diabetic control in a group of subjects with poorly controlled non-insulin-dependent diabetes mellitus influence salivary output and composition. Repeated whole unstimulated and stimulated parotid saliva samples were collected from diabetic patients attending an outpatient diabetes education program and a matched nondiabetic control group. Saliva was analyzed for flow rates, parotid protein concentration and composition, and amylase activity. Subjective responses to questions about salivary hypofunction were tested. There were no significant differences in whole unstimulated and stimulated parotid flow rates or stimulated parotid protein concentration and composition between diabetics and the control group. Amylase activity was higher in diabetics and decreased with improved glycemic control. Subjects reporting taste alterations had higher mean blood glucose levels than subjects with normal taste sensation. Poorly controlled non-insulin-dependent diabetes mellitus has no influence on saliva output, although amylase activity may be elevated, and there may be taste alterations.
José Raimundo Araújo de Azevedo
Full Text Available OBJECTIVE: To compare the renal outcome in patients submitted to two different regimens of glycemic control, using the RIFLE criteria to define acute kidney injury. INTRODUCTION: The impact of intensive insulin therapy on renal function outcome is controversial. The lack of a criterion for AKI definition may play a role on that. METHODS: Included as the subjects were 228 randomly selected, critically ill patients engaged in intensive insulin therapyor in a carbohydrate-restrictive strategy. Renal outcome was evaluated through the comparison of the last RIFLE score obtained during the ICU stay and the RIFLE score at admission; the outcome was classified as favorable, stable or unfavorable. RESULTS: The two groups were comparable regarding demographic data. AKI developed in 52% of the patients and was associated with a higher mortality (39.4% compared with those who did not have AKI (8.2% (p60, acute kidney injury and hypoglycemia were risk factors for mortality. CONCLUSION: Intensive insulin therapy and a carbohydrate-restrictive strategy were comparable regarding the incidence of acute kidney injury evaluated using RIFLE criteria.
Poolsup, Nalinee; Suksomboon, Naeti; Paw, Naw Juna
The purpose of this study was to systematically determine the effect of dragon fruit on glycemic control in prediabetes and type 2 diabetes. Electronic databases including MEDLINE, CENTRAL, CINAHL, Scopus, ScienceDirect®, Proquest, Web of Science®, LILACS, NAPRALERT, SciFinder, Clinicalkey, Herbmed, NCCIH and Google Scholar were searched from their earliest inception up to March 2017 for relevant randomized controlled trials (RCTs) which compared dragon fruit with placebo or no treatment in prediabetes or type 2 diabetes. Clinicaltrials.gov, clinicaltrialresults.org, and ISRCTN registry were also searched. Personal contact with experts and historical search of related articles was undertaken. Outcome of interest were fasting plasma glucose (FPG) and 2 hours post-prandial glucose (2HPP). Study selection, data extraction and study quality assessment were performed independently by two investigators. Disagreements were resolved by a third reviewer. Treatment effect was estimated with mean difference (MD). Effect estimates were pooled using inverse-variance weighted method. Heterogeneity was assessed with the Q statistic and quantified with the I2 statistic. DerSimonian and Laird random-effects model was used when the Q-statistic was significant at the level of 0.1, otherwise a fixed-effects model was used. Among 401 studies identified from literature search, 4 RCTs involving 36 prediabetes subjects and 109 type 2 diabetes patients were included in the analysis. In prediabetes, FPG reduction was significant with MD of -15.1 mg/dL (95% CI: -23.8 to -6.5 mg/dL, P-value = 0.0006). Meta-analysis in type 2 diabetes showed no effect of dragon fruit on FPG (MD -26.5 mg/dL, 95% CI: -72.6 mg/dL to 19.6 mg/dL) and in 2HPP (MD -30.5 mg/dL, 95% CI: -80.9 mg/dL to 19.9 mg/dL). The available evidence in prediabetes is interesting. This will shed some light on diabetes prevention. The effect in T2DM was not significant. However, a trend towards greater blood glucose reduction with
Christensen, Allan S; Viggers, Lone; Hasselström, Kjeld; Gregersen, Søren
Medical nutrition therapy is recognized as an important treatment option in type 2 diabetes. Most guidelines recommend eating a diet with a high intake of fiber-rich food including fruit. This is based on the many positive effects of fruit on human health. However some health professionals have concerns that fruit intake has a negative impact on glycemic control and therefore recommend restricting the fruit intake. We found no studies addressing this important clinical question. The objective was to investigate whether an advice to reduce the intake of fruit to patients with type 2 diabetes affects HbA1c, bodyweight, waist circumference and fruit intake. This was an open randomized controlled trial with two parallel groups. The primary outcome was a change in HbA1c during 12 weeks of intervention. Participants were randomized to one of two interventions; medical nutrition therapy + advice to consume at least two pieces of fruit a day (high-fruit) or medical nutrition therapy + advice to consume no more than two pieces of fruit a day (low-fruit). All participants had two consultations with a registered dietitian. Fruit intake was self-reported using 3-day fruit records and dietary recalls. All assessments were made by the "intention to treat" principle. The study population consisted of 63 men and women with newly diagnosed type 2 diabetes. All patients completed the trial. The high-fruit group increased fruit intake with 125 grams (CI 95%; 78 to 172) and the low-fruit group reduced intake with 51 grams (CI 95%; -18 to -83). HbA1c decreased in both groups with no difference between the groups (diff.: 0.19%, CI 95%; -0.23 to 0.62). Both groups reduced body weight and waist circumference, however there was no difference between the groups. A recommendation to reduce fruit intake as part of standard medical nutrition therapy in overweight patients with newly diagnosed type 2 diabetes resulted in eating less fruit. It had however no effect on HbA1c, weight loss or waist
Full Text Available Tree nut consumption has been associated with reduced diabetes risk, however, results from randomized trials on glycemic control have been inconsistent.To provide better evidence for diabetes guidelines development, we conducted a systematic review and meta-analysis of randomized controlled trials to assess the effects of tree nuts on markers of glycemic control in individuals with diabetes.MEDLINE, EMBASE, CINAHL, and Cochrane databases through 6 April 2014.Randomized controlled trials ≥3 weeks conducted in individuals with diabetes that compare the effect of diets emphasizing tree nuts to isocaloric diets without tree nuts on HbA1c, fasting glucose, fasting insulin, and HOMA-IR.Two independent reviewer's extracted relevant data and assessed study quality and risk of bias. Data were pooled by the generic inverse variance method and expressed as mean differences (MD with 95% CI's. Heterogeneity was assessed (Cochran Q-statistic and quantified (I2.Twelve trials (n = 450 were included. Diets emphasizing tree nuts at a median dose of 56 g/d significantly lowered HbA1c (MD = -0.07% [95% CI:-0.10, -0.03%]; P = 0.0003 and fasting glucose (MD = -0.15 mmol/L [95% CI: -0.27, -0.02 mmol/L]; P = 0.03 compared with control diets. No significant treatment effects were observed for fasting insulin and HOMA-IR, however the direction of effect favoured tree nuts.Majority of trials were of short duration and poor quality.Pooled analyses show that tree nuts improve glycemic control in individuals with type 2 diabetes, supporting their inclusion in a healthy diet. Owing to the uncertainties in our analyses there is a need for longer, higher quality trials with a focus on using nuts to displace high-glycemic index carbohydrates.ClinicalTrials.gov NCT01630980.
Takebayashi, Kohzo; Sakurai, Shintaro; Suzuki, Tatsuhiko; Hori, Kenichiro; Terasawa, Tomoko; Naruse, Rika; Hara, Kenji; Suetsugu, Mariko; Tsuchiya, Takafumi; Aoki, Hiromi; Hamasaki, Takashi; Shuutou, Hiroshi; Inukai, Toshihiko
The main purpose of the current study was to investigate the effect of a combination of alogliptin [a dipeptydil peptidase (DPP)-4 inhibitor] and lansoprazole [a proton pump inhibitor (PPI)] compared with alogliptin mono-therapy on glycemic control in patients with type 2 diabetes. This study was a multicenter randomized open-label study. One hundred type 2 diabetic patients were randomly assigned to either the alogliptin with lansoprazole group or the alogliptin mono-therapy group. After 3 months of treatment, the changes in hemoglobin (Hb)A1c, fasting plasma glucose (FPG), serum gastrin, homeostasis model assessment (HOMA)-β, and HOMA-insulin resistance (IR) were evaluated. A significant decrease in HbA1c and FPG, and a significant increase in HOMA-β were observed in both groups (all with P lansoprazole more effectively elevated serum gastrin levels compared with alogliptin mono-therapy, the effect of the combination therapy on glycemic control was equal to that of alogliptin mono-therapy during a 3-month study period.
Full Text Available Sodium-glucose cotransporter 2 inhibitor tofogliflozin is a new type of antidiabetic drug for individuals with type 2 diabetes mellitus (T2DM. The aim of this study was to examine in which type of individuals and/or under which conditions tofogliflozin could exert more beneficial effects on body composition and/or glycemic control in Japanese individuals with T2DM. We retrospectively evaluated the effects of tofogliflozin on body composition and/or glycemic control in individuals with T2DM who newly started taking tofogliflozin. After tofogliflozin treatment, body weight was significantly reduced and HbA1c levels were significantly decreased. Body fat mass, skeletal muscle mass, and skeletal muscle index, a marker for sarcopenia, were also reduced after the treatment. In univariate analyses, there was a statistically significant association between the decrease of HbA1c level after tofogliflozin treatment (Δ HbA1c and the following parameters such as HbA1c levels at baseline, visceral fat area (VFA at baseline, and reduction of VFA after the treatment (Δ VFA. Furthermore, in multivariate analyses, HbA1c levels at baseline and duration of diabetes were independently associated with Δ HbA1c. These results suggest that tofogliflozin would be more suitable for relatively obese individuals whose duration of diabetes is relatively short.
Yazdanpanah, Sara; Rabiee, Mohammad; Tahriri, Mohammadreza; Abdolrahim, Mojgan; Rajab, Asadollah; Jazayeri, Hossein E; Tayebi, Lobat
Diabetes Mellitus (DM) is a group of metabolic diseases characterized by chronic high blood glucose concentrations (hyperglycemia). When it is left untreated or improperly managed, it can lead to acute complications including diabetic ketoacidosis and non-ketotic hyperosmolar coma. In addition, possible long-term complications include impotence, nerve damage, stroke, chronic kidney failure, cardiovascular disease, foot ulcers, and retinopathy. Historically, universal methods to measure glycemic control for the diagnosis of diabetes included fasting plasma glucose level (FPG), 2-h plasma glucose (2HP), and random plasma glucose. However, these measurements did not provide information about glycemic control over a long period of time. To address this problem, there has been a switch in the past decade to diagnosing diabetes and its severity through measurement of blood glycated proteins such as Hemoglobin A1c (HbA1c) and glycated albumin (GA). Diagnosis and evaluation of diabetes using glycated proteins has many advantages including high accuracy of glycemic control over a period of time. Currently, common laboratory methods used to measure glycated proteins are high-performance liquid chromatography (HPLC), immunoassay, and electrophoresis. HbA1c is one of the most important diagnostic factors for diabetes. However, some reports indicate that HbA1c is not a suitable marker to determine glycemic control in all diabetic patients. GA, which is not influenced by changes in the lifespan of erythrocytes, is thought to be a good alternative indicator of glycemic control in diabetic patients. Here, we review the literature that has investigated the suitability of HbA1c, GA and GA:HbA1c as indicators of long-term glycemic control and demonstrate the importance of selecting the appropriate glycated protein based on the patient's health status in order to provide useful and modern point-of-care monitoring and treatment.
Hunt, B; Mocarski, M; Valentine, W J; Langer, J
IDegLira, a fixed ratio combination of insulin degludec and glucagon-like peptide-1 receptor agonist liraglutide, utilizes the complementary mechanisms of action of these two agents to improve glycemic control with low risk of hypoglycemia and avoidance of weight gain. The aim of the present analysis was to assess the long-term cost-effectiveness of IDegLira vs liraglutide added to basal insulin, for patients with type 2 diabetes not achieving glycemic control on basal insulin in the US setting. Projections of lifetime costs and clinical outcomes were made using the IMS CORE Diabetes Model. Treatment effect data for patients receiving IDegLira and liraglutide added to basal insulin were modeled based on the outcomes of a published indirect comparison, as no head-to-head clinical trial data is currently available. Costs were accounted in 2015 US dollars ($) from a healthcare payer perspective. IDegLira was associated with small improvements in quality-adjusted life expectancy compared with liraglutide added to basal insulin (8.94 vs 8.91 discounted quality-adjusted life years [QALYs]). The key driver of improved clinical outcomes was the greater reduction in glycated hemoglobin associated with IDegLira. IDegLira was associated with mean costs savings of $17,687 over patient lifetimes vs liraglutide added to basal insulin, resulting from lower treatment costs and cost savings as a result of complications avoided. The present long-term modeling analysis found that IDegLira was dominant vs liraglutide added to basal insulin for patients with type 2 diabetes failing to achieve glycemic control on basal insulin in the US, improving clinical outcomes and reducing direct costs.
Reutrakul, Sirimon; Thakkinstian, Ammarin; Anothaisintawee, Thunyarat; Chontong, Sasipas; Borel, Anne-Laure; Perfect, Michelle M; Janovsky, Carolina Castro Porto Silva; Kessler, Romain; Schultes, Bernd; Harsch, Igor Alexander; van Dijk, Marieke; Bouhassira, Didier; Matejko, Bartlomiej; Lipton, Rebecca B; Suwannalai, Parawee; Chirakalwasan, Naricha; Schober, Anne-Katrin; Knutson, Kristen L
The association between inadequate sleep and type 2 diabetes has garnered much attention, but little is known about sleep and type 1 diabetes (T1D). Our objectives were to conduct a systematic review and meta-analysis comparing sleep in persons with and without T1D, and to explore relationships between sleep and glycemic control in T1D. Studies were identified from Medline and Scopus. Studies reporting measures of sleep in T1D patients and controls, and/or associations between sleep and glycemic control, were selected. A total of 22 studies were eligible for the meta-analysis. Children with T1D had shorter sleep duration (mean difference [MD] = -26.4 minutes; 95% confidence interval [CI] = -35.4, -17.7) than controls. Adults with T1D reported poorer sleep quality (MD in standardized sleep quality score = 0.51; 95% CI = 0.33, 0.70), with higher scores reflecting worse sleep quality) than controls, but there was no difference in self-reported sleep duration. Adults with TID who reported sleeping >6 hours had lower hemoglobin A1c (HbA1c) levels than those sleeping ≤6 hours (MD = -0.24%; 95% CI = -0.47, -0.02), and participants reporting good sleep quality had lower HbA1c than those with poor sleep quality (MD = -0.19%; 95% CI = -0.30, -0.08). The estimated prevalence of obstructive sleep apnea (OSA) in adults with TID was 51.9% (95% CI = 31.2, 72.6). Patients with moderate-to-severe OSA had a trend toward higher HbA1c (MD = 0.39%, 95% CI = -0.08, 0.87). T1D was associated with poorer sleep and high prevalence of OSA. Poor sleep quality, shorter sleep duration, and OSA were associated with suboptimal glycemic control in T1D patients. Copyright © 2016 The Author(s). Published by Elsevier B.V. All rights reserved.
C.-Y. Oliver Chen
Full Text Available Orange pomace (OP, a fiber-rich byproduct of juice production, has the potential for being formulated into a variety of food products. We hypothesized that OP would diminish postprandial glycemic responses to a high carbohydrate/fat breakfast and lunch. We conducted an acute, randomized, placebo-controlled, double blind, crossover trial with 34 overweight men who consumed either a 255 g placebo (PLA, a low (35% OP (LOP, or a high (77% (HOP dose OP beverage with breakfast. Blood was collected at 0, 10, 20, 30, and 45 min and at 1, 1.5, 2, 3, 4, 5, 5.5, 6, 6.5, 7, and 8 h. Lunch was consumed after the 5.5-h blood draw. OP delayed the time (Tmax1 to the maximum concentration (Cmax1 of serum glucose during the 2-h period post breakfast by ≥36% from 33 (PLA to 45 (HOP and 47 (LOP min (p = 0.055 and 0.013, respectively. OP decreased post-breakfast insulin Cmax1 by ≥10% and LOP delayed the Tmax1 by 14 min, compared to PLA at 46 min (p ≤ 0.05. HOP reduced the first 2-h insulin area under concentration time curve (AUC by 23% compared to PLA. Thus, OP diminishes postprandial glycemic responses to a high carbohydrate/fat breakfast and the second meal in overweight men.
Full Text Available Background: Type 2 diabetes mellitus (type 2 DM and chronic periodontitis are common chronic diseases in adults in the world population. Once periodontal disease is established, the chronic nature of this infection may contribute to worsening of diabetic status leading to more severe diabetes-related complications. It has been proposed that the relation of periodontitis and diabetes is bidirectional. Objectives: The objective was to compare the clinical response and glycemic control in type 2 DM patients with periodontitis, before and after the nonsurgical periodontal treatment with controls. Materials and Methods: A total 70 type 2 DM patients with chronic generalized moderate periodontitis was divided into 2 groups. Treatment group (35 received one stage full mouth scaling and root planning plus oral hygiene instructions; the control group (35 received only oral hygiene instructions. At baseline, 1 st month and 3 rd month, the clinical periodontal parameters (plaque index [PI], gingival index [GI], pocket depth [PD], clinical attachment loss [CAL], gingival recession [GR], and bleeding on probing [BOP] and glycemic parameters (fasting blood sugar [FBS], and postprandial blood sugar [PPBS] were recorded, whereas the glycated hemoglobin (HbA1c was recorded only at baseline and 3rd month. The collected data were subjected to statistical analysis. Results: When comparing the mean scores of clinical parameters for both the groups, there was a significant difference in all clinical parameters, that is, mean PI, GI, BOP, PD, CAL scores except mean GR, whereas for the glycemic parameters, there was a significant difference in mean FBS; PPBS values and no significant difference in mean percentage of HbA1c for treatment group at 3 rd month follow-up. Conclusion: Findings of the present study showed that nonsurgical periodontal treatment resulted in lower glycemic levels and the reduction of clinical parameters of periodontal infection, confirming the
Hopkins, Laura; Brown-Broderick, Jennifer; Hearn, James; Malcolm, Janine; Chan, James; Hicks-Boucher, Wendy; De Sousa, Filomena; Walker, Mark C; Gagné, Sylvain
To evaluate the frequency of surgical site infections before and after implementation of a comprehensive, multidisciplinary perioperative glycemic control initiative. As part of a CUSP (Comprehensive Unit-based Safety Program) initiative, between January 5 and December 18, 2015, we implemented comprehensive, multidisciplinary glycemic control initiative to reduce SSI rates in patients undergoing major pelvic surgery for a gynecologic malignancy ('Group II'). Key components of this quality of care initiative included pre-operative HbA1c measurement with special triage for patients meeting criteria for diabetes or pre-diabetes, standardization of available intraoperative insulin choices, rigorous pre-op/intra-op/post-op glucose monitoring with control targets set to maintain BG ≤10mmol/L (180mg/dL) and communication/notification with primary care providers. Effectiveness was evaluated against a similar control group of patients ('Group I') undergoing surgery in 2014 prior to implementation of this initiative. We studied a total of 462 patients. Subjects in the screened (Group II) and comparison (Group I) groups were of similar age (avg. 61.0, 60.0years; p=0.422) and BMI (avg. 31.1, 32.3kg/m 2 ; p=0.257). Descriptive statistics served to compare surgical site infection (SSI) rates and other characteristics across groups. Women undergoing surgery prior to implementation of this algorithm (n=165) had an infection rate of 14.6%. Group II (n=297) showed an over 2-fold reduction in SSI compared to Group I [5.7%; p=0.001, adjRR: 0.45, 95% CI: (0.25, 0.81)]. Additionally, approximately 19% of Group II patients were newly diagnosed with either prediabetes (HbA1C 6.0-6.4) or diabetes (HbA1C≥6.5) and were referred to family or internal medicine for appropriate management. Implementation of a comprehensive multidisciplinary glycemic control initiative can lead to a significant reduction in surgical site infections in addition to early identification of an important health
Anzaldo-Campos, María Cecilia; Contreras, Sonia; Vargas-Ojeda, Adriana; Menchaca-Díaz, Rufino; Fortmann, Addie; Philis-Tsimikas, Athena
The global epidemic of diabetes calls for innovative interventions. This study evaluated the effectiveness of the Project Dulce model, with and without wireless technology, on glycemic control and other clinical and self-reported outcomes in patients with poorly controlled type 2 diabetes in Mexico. Adults with type 2 diabetes and a glycated hemoglobin A1c (HbA1c) level of ≥8% were recruited from Family Medical Unit #27 of the Instituto Mexicano del Seguro Social (IMSS) in Tijuana, México, and randomly assigned to one of three groups: Project Dulce-only (PD); Project Dulce technology-enhanced with mobile tools (PD-TE); or IMSS standard of care/control group (CG). Clinical and self-reported outcomes were assessed at baseline, Month 4, and Month 10. Time-by-group interactions and within-group changes were analyzed. HbA1c reductions from baseline to Month 10 were significantly greater in PD-TE (-3.0% [-33 mmol/mol]) and PD (-2.6% [-28.7 mmol/mol]) compared with CG (-1.3% [-14.2 mmol/mol]) (P = 0.009 and 0.001, respectively). PD-TE and PD also exhibited significant improvement in diabetes knowledge when compared with CG (P improvements were observed on other clinical and self-report indicators but did not vary significantly across groups. Project Dulce with and without wireless technology substantially improved glycemic control and diabetes knowledge in high-risk patients with type 2 diabetes in a Mexican family medical unit, suggesting that integrating peer-led education, nurse coordination, and 3G wireless technology is an effective approach for improving diabetes outcomes in high-risk populations.
Rama Kumari Nuthalapati
Full Text Available Objective: Morning blood pressure surge (MBPS is an independent predictor of cardiovascular events. However, little is known about the association between glycemic control and MBPS, and its effect on vascular injury in patients with type 2 diabetes mellitus (T2DM. The current study examined the association between glycemic control and MBPS and the involvement of MBPS in the development of vascular dysfunction in T2DM patients. Materials and Methods: One hundred and twenty-two consecutive T2DM outpatients from the Department of Cardiology and Endocrinology were enrolled in this study. We did MBPS in T2DM patients, 85 (male (69.7% patients and 37 (female patients (30.3%; mean age 60.1 ± 9.39; (n = 122 using 24 h ambulatory blood pressure monitoring and assessed vascular function by brachial artery flow-mediated dilation (FMD and nitroglycerin-mediated dilation (NMD. Results: The correlation between MBPS and various clinical variables were examined by single regression analysis in all subjects. MBPS showed significant and positive correlation with pulse rate (P = 0.01, fasting blood sugar (P = 0.002, and postprandial blood sugar (P = 0.05. To further confirm the association of insulin resistance (IR with MBPS in T2DM patients, we examined the correlation between homeostasis model assessment-IR (HOMA-IR, an established marker of IR and MBPS in diabetic (DM patients who were not taking insulin no significant association with MBPS in T2DM patients (P = 0.41, angiotensin-converting enzyme/angiotensin receptor blocker (P = 0.07. We examined the relationship between MBPS and vascular injury by measuring endothelium-dependent FMD and endothelium-independent NMD in T2DM patients. Among the various traditional risk factors for atherosclerosis such as DM duration (P = 0.04, platelet reactivity (P = 0.04 and morning surge (P = 0.002 emerged as significant factors. HOMA-IR was a negative correlation with FMD. Conclusions: The current study demonstrated that
Full Text Available INTRODUCTION: It is well known that type 2 diabetes mellitus (T2DM produces cardiovascular autonomic neuropathy (CAN, which may affect the cardiac autonomic modulation. However, it is unclear whether the lack of glycemic control in T2DM without CAN could impact negatively on cardiac autonomic modulation. Objective: To evaluate the relationship between glycemic control and cardiac autonomic modulation in individuals with T2DM without CAN. Descriptive, prospective and cross sectional study.METHODS: Forty-nine patients with T2DM (51±7 years were divided into two groups according to glycosylated hemoglobin (HbA1c: G1≤7% and G2>7.0%. Resting heart rate (HR and RR interval (RRi were obtained and calculated by linear (Mean iRR; Mean HR; rMSSD; STD RR; LF; HF; LF/HF, TINN and RR Tri, and non-linear (SD1; SD2; DFα1; DFα2, Shannon entropy; ApEn; SampEn and CD methods of heart rate variability (HRV. Insulin, HOMA-IR, fasting glucose and HbA1c were obtained by blood tests.RESULTS: G2 (HbA1c≤7% showed lower values for the mean of iRR; STD RR; RR Tri, TINN, SD2, CD and higher mean HR when compared with G1 (HbA1c > 7%. Additionally, HbA1c correlated negatively with mean RRi (r=0.28, p=0.044; STD RR (r=0.33, p=0.017; RR Tri (r=-0.35, p=0.013, SD2 (r=-0.39, p=0.004 and positively with mean HR (r=0.28, p=0.045. Finally, fasting glucose correlated negatively with STD RR (r=-0.36, p=0.010; RR Tri (r=-0.36, p=0.010; TINN (r=-0.33, p=0.019 and SD2 (r=-0.42, p=0.002.CONCLUSION: We concluded that poor glycemic control is related to cardiac autonomic modulation indices in individuals with T2DM even if they do not present cardiovascular autonomic neuropathy.
Full Text Available Lotta Walz,1,3 Billie Pettersson,2,3 Ulf Rosenqvist,4 Anna Deleskog,3,5 Gunilla Journath,6 Per Wändell7 1Department of Oncology-Pathology, Karolinska Institutet, Stockholm, 2Center for Medical Technology Assessment, Linköping University, Linköping, 3Merck Sharp and Dohme (Sweden AB, Sollentuna, 4Department of Internal Medicine, Motala Hospital, Motala, 5Department of Molecular Medicine and Surgery, 6Department of Medicine, Karolinska Institutet, Stockholm, 7Department of Neurobiology, Care Sciences and Society, Centre for Family Medicine, Karolinska Institutet, Huddinge, Sweden Background: The purpose of this study was to evaluate the impact of symptomatic hypoglycemia on medication adherence, satisfaction with treatment, and glycemic control in patients with type 2 diabetes based on the treatment goals stated in the Swedish national guidelines. Methods: This cross-sectional, multicenter study was carried out between January and August 2009 in 430 consecutive primary health care patients on stable doses of metformin and sulfonylureas for at least 6 months. The patients completed questionnaires covering their experiences of low blood glucose and adherence, as well as barriers to and satisfaction with drug treatment (using the Treatment Satisfaction Questionnaire for Medication. Physicians collected the data from medical records. Results: Patients who experienced moderate or worse symptoms of hypoglycemia reported poorer adherence to medication (46% versus 67%; P<0.01 and were more likely to perceive barriers such as “bothered by medication side effects” (36% versus 14%; P<0.001 compared with patients with no or mild symptoms. Patients with moderate or worse symptoms of hypoglycemia were less satisfied with their treatment than those with no or mild symptoms as determined by the Treatment Satisfaction Questionnaire for Medication-Global satisfaction (67.0 versus 71.2; P<0.05. Overall, achievement of target glycated hemoglobin
Oliveira, Ariclecio Cunha de; Andreotti, Sandra; Sertie, Rogério António Laurato; Campana, Amanda Baron; de Proença, André Ricardo Gomes; Vasconcelos, Renata Prado; Oliveira, Keciany Alves de; Coelho-de-Souza, Andrelina Noronha; Donato-Junior, José; Lima, Fábio Bessa
Melatonin treatment has been reported to be capable of ameliorating metabolic diabetes-related abnormalities but also to cause hypogonadism in rats. We investigated whether the combined treatment with melatonin and insulin can improve insulin resistance and other metabolic disorders in rats with streptozotocin-induced diabetes during neonatal period and the repercussion of this treatment on the hypothalamic-pituitary-gonadal axis. At the fourth week of age, diabetic animals started an 8-wk treatment with only melatonin (0.2 mg/kg body weight) added to drinking water at night or associated with insulin (NHP, 1.5 U/100 g/day) or only insulin. Animals were then euthanized, and the subcutaneous (SC), epididymal (EP), and retroperitoneal (RP) fat pads were excised, weighed and processed for adipocyte isolation for morphometric analysis as well as for measuring glucose uptake, oxidation, and incorporation of glucose into lipids. Hypothalamus was collected for gene expression and blood samples were collected for biochemical assays. The treatment with melatonin plus insulin (MI) was capable of maintaining glycemic control. In epididymal (EP) and subcutaneous (SC) adipocytes, the melatonin plus insulin (MI) treatment group recovered the insulin responsiveness. In the hypothalamus, melatonin treatment alone promoted a significant reduction in kisspeptin-1, neurokinin B and androgen receptor mRNA levels, in relation to control group. Combined treatment with melatonin and insulin promoted a better glycemic control, improving insulin sensitivity in white adipose tissue (WAT). Indeed, melatonin treatment reduced hypothalamic genes related to reproductive function. Copyright © 2017. Published by Elsevier Inc.
Lauritsen, Tina Vilsbøll; Vora, Jiten; Jarlov, Henrik
BACKGROUND AND OBJECTIVES: The time-course when changes in glycemic control and body weight were first manifest in patients with type 2 diabetes mellitus (T2DM) treated with a combination of insulin degludec and liraglutide (IDegLira) was assessed, comparing IDegLira to its individual components...
Park, Ji-Hye; Lee, Young-Eun
[Purpose] The aim of this study was to investigate the effect of exercise on glycemic control using data from fifth Korea National Health and Nutrition Examination Survey and to provide appropriate exercise guidelines for patients with type 2 diabetes mellitus in Korea. [Subjects and Methods] We selected 1,328 patients from the fifth Korea National Health and Nutrition Examination Survey database who had type 2 diabetes and ranged in age from 30 to 90 years. Statistical analyses included χ(2) tests, multiple linear regression, and logistic regression. [Results] Factors found to be significantly related to glycemic control included income level, physical activity based on intensity of aerobic exercise, use of diabetes medicine, presence of hypertension, duration of diabetes, and waist circumference. In addition, engaging in combined low- and moderate-intensity aerobic exercise when adjusted for resistance exercise was found to lower the risk of glycemic control failure. [Conclusion] Patients with type 2 diabetes mellitus in Korea should engage in combined low- and moderate-intensity aerobic exercise such as walking for 30 minutes or more five times a week. Physical activity is likely to improve glycemic control and thus prevent the acute and chronic complications of diabetes mellitus.
Aman, J.; Skinner, T. C.; de Beaufort, C. E.; Swift, P. G. F.; Aanstoot, H-J; Cameron, F.
angstrom man J, Skinner TC, de Beaufort CE, Swift PGF, Aanstoot H-J, Cameron F, for and on behalf of the Hvidoere Study Group on Childhood Diabetes. Associations between physical activity, sedentary behavior, and glycemic control in a large cohort of adolescents with type 1 diabetes: the Hvidoere
Færch, Louise; Pedersen-Bjergaard, Ulrik; Thorsteinsson, Birger
GH is implicated in the counter-regulatory response to hypoglycemia. We tested whether IGF1 levels are associated with occurrence of severe hypoglycemic events in patients with type 1 diabetes and whether the IGF1 concentration is influenced by glycemic control....
Engelen, Lian; Lund, Søren S; Ferreira, Isabel
Metformin has been reported to reduce a-dicarbonyls, which are known to contribute to diabetic complications. It is unclear whether this is due to direct quenching of a-dicarbonyls or to an improvement in glycemic control. We therefore compared the effects of metformin versus repaglinide...
Luijks, H.; Biermans, M.; Bor, H.; Weel, C. van; Lagro-Janssen, T.; Grauw, W. de; Schermer, T.
Aims: To explore the longitudinal effect of chronic comorbid diseases on glycemic control (HbA1C) and systolic blood pressure (SBP) in type 2 diabetes patients. Methods: In a representative primary care cohort of patients with newly diagnosed type 2 diabetes in The Netherlands (n = 610), we tested
Martinez, Elizabeth A; Chavez-Valdez, Raul; Holt, Natalie F; Grogan, Kelly L; Khalifeh, Katherine W; Slater, Tammy; Winner, Laura E; Moyer, Jennifer; Lehmann, Christoph U
Although the evidence strongly supports perioperative glycemic control among cardiac surgical patients, there is scant literature to describe the practical application of such a protocol in the complex ICU environment. This paper describes the use of the Lean Six Sigma methodology to implement a perioperative insulin protocol in a cardiac surgical intensive care unit (CSICU) in a large academic hospital. A preintervention chart audit revealed that fewer than 10% of patients were admitted to the CSICU with glucose <200 mg/dL, prompting the initiation of the quality improvement project. Following protocol implementation, more than 90% of patients were admitted with a glucose <200 mg/dL. Key elements to success include barrier analysis and intervention, provider education, and broadening the project scope to address the intraoperative period.
Martinez, Elizabeth A.; Chavez-Valdez, Raul; Holt, Natalie F.; Grogan, Kelly L.; Khalifeh, Katherine W.; Slater, Tammy; Winner, Laura E.; Moyer, Jennifer; Lehmann, Christoph U.
Although the evidence strongly supports perioperative glycemic control among cardiac surgical patients, there is scant literature to describe the practical application of such a protocol in the complex ICU environment. This paper describes the use of the Lean Six Sigma methodology to implement a perioperative insulin protocol in a cardiac surgical intensive care unit (CSICU) in a large academic hospital. A preintervention chart audit revealed that fewer than 10% of patients were admitted to the CSICU with glucose <200 mg/dL, prompting the initiation of the quality improvement project. Following protocol implementation, more than 90% of patients were admitted with a glucose <200 mg/dL. Key elements to success include barrier analysis and intervention, provider education, and broadening the project scope to address the intraoperative period. PMID:22091218
Elizabeth A. Martinez
Full Text Available Although the evidence strongly supports perioperative glycemic control among cardiac surgical patients, there is scant literature to describe the practical application of such a protocol in the complex ICU environment. This paper describes the use of the Lean Six Sigma methodology to implement a perioperative insulin protocol in a cardiac surgical intensive care unit (CSICU in a large academic hospital. A preintervention chart audit revealed that fewer than 10% of patients were admitted to the CSICU with glucose <200 mg/dL, prompting the initiation of the quality improvement project. Following protocol implementation, more than 90% of patients were admitted with a glucose <200 mg/dL. Key elements to success include barrier analysis and intervention, provider education, and broadening the project scope to address the intraoperative period.
Blonde, Lawrence; Meneghini, Luigi; Peng, Xuejun Victor; Boss, Anders; Rhee, Kyu; Shaunik, Alka; Kumar, Supriya; Balodi, Sidhartha; Brulle-Wohlhueter, Claire; McCrimmon, Rory J
Basal insulin (BI) plays an important role in treating type 2 diabetes (T2D), especially when oral antidiabetic (OAD) medications are insufficient for glycemic control. We conducted a retrospective, observational study using electronic medical records (EMR) data from the IBM ® Explorys database to evaluate the probability of achieving glycemic control over 24 months after BI initiation in patients with T2D in the USA. A cohort of 6597 patients with T2D who started BI following OAD(s) and had at least one valid glycated hemoglobin (HbA1c) result recorded both within 90 days before and 720 days after BI initiation were selected. We estimated the changes from baseline in HbA1c every 6 months, the quarterly conditional probabilities of reaching HbA1c < 7% if a patient had not achieved glycemic control prior to each quarter (Q), and the cumulative probability of reaching glycemic control over 24 months. Our cohort was representative of patients with T2D who initiated BI from OADs in the USA. The average HbA1c was 9.1% at BI initiation, and decreased robustly (1.5%) in the first 6 months after initiation with no further reductions thereafter. The conditional probability of reaching glycemic control decreased rapidly in the first year (26.6% in Q2; 17.6% in Q3; 8.6% in Q4), and then remained low (≤ 6.1%) for each quarter in the second year. Cumulatively, about 38% of patients reached HbA1c < 7% in the first year; only approximately 8% more did so in the second year. Our study of real-world data from a large US EMR database suggested that among patients with T2D who initiated BI after OADs, the likelihood of reaching glycemic control diminished over time, and remained low from 12 months onwards. Additional treatment options should be considered if patients do not reach glycemic control within 12 months of BI initiation. Sanofi Corporation.
Dalsgaard, Haline; Saunders, Cláudia; Padilha, Patrícia de C; Luescher, Jorge Luiz; Szundy Berardo, Renata; Accioly, Elizabeth
To compare the glycemic control and lipid profile of children and adolescents undergoing two different dietetic treatments for type 1 Diabetes Mellitus assisted at the Children and Adolescent's Diabetes Mellitus Health Center-UFRJ. A retrospective longitudinal study conducted between 2002 and 2006. We evaluated the same subjects in two different periods: after 1 year in TD and subsequently after 1 year in CCHO. The evolution of the nutritional status during the dietary treatments was evaluated using Body Mass Index (BMI) for age. The lipid panel was evaluated according to the 1st Guideline for Prevention of Atherosclerosis in Childhood and Adolescence, used in Brazil, and the glycemic control was evaluated by measuring glycated hemoglobin (HbA1c). We evaluated 93 individuals, 38.7% children and 61.3% adolescents. The mean age at study entry was 11.1 (± 2.66) years and the mean disease duration was 6.1 (± 3.2) years. A significant difference in the percentage of adequacy of HbA1c (p = 0.000) and in the values of total plasma cholesterol (p = 0.043) was found after 1 year of CCHO diet, which did not happen during the observation time of TD. The evolution of anthropometric nutritional status showed no significant difference between the beginning and the end of both dietary treatments. The results of this study suggest that a more flexible food orientation program can contribute to the improvement of blood glucose levels without causing deterioration of the lipid profile when compared to TD. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.
Full Text Available The study explored the utility of four-point preprandial glucose self-monitoring to calculate several indices of glycemic control and variability in a study adding the DPP-4 inhibitor vildagliptin to ongoing insulin therapy. This analysis utilized data from a double-blind, randomized, placebo-controlled crossover study in 29 patients with type 2 diabetes treated with vildagliptin or placebo on top of stable insulin dose. During two 4-week treatment periods, self-monitoring of plasma glucose was undertaken at 4 occasions every day. Glucose values were used to assess several indices of glycemic control quality, such as glucose mean, GRADE, M-VALUE, hypoglycemia and hyperglycemia index, and indices of glycemic variability, such as standard deviation, CONGA, J-INDEX, and MAGE. We found that vildagliptin improved the glycemic condition compared to placebo: mean glycemic levels, and both GRADE and M-VALUE, were reduced by vildagliptin (P<0.01. Indices also showed that vildagliptin reduced glycemia without increasing the risk for hypoglycemia. Almost all indices of glycemic variability showed an improvement of the glycemic condition with vildagliptin (P<0.02, though more marked differences were shown by the more complex indices. In conclusion, the study shows that four-sample preprandial glucose self-monitoring is sufficient to yield information on the vildagliptin effects on glycemic control and variability.
Effect of adding the novel fiber, PGX®, to commonly consumed foods on glycemic response, glycemic index and GRIP: a simple and effective strategy for reducing post prandial blood glucose levels - a randomized, controlled trial
Full Text Available Abstract Background Reductions in postprandial glycemia have been demonstrated previously with the addition of the novel viscous polysaccharide (NVP, PolyGlycopleX® (PGX®, to an OGTT or white bread. This study explores whether these reductions are sustained when NVP is added to a range of commonly consumed foods or incorporated into a breakfast cereal. Methods Ten healthy subjects (4M, 6F; age 37.3 ± 3.6 y; BMI 23.8 ± 1.3 kg/m2, participated in an acute, randomized controlled trial. The glycemic response to cornflakes, rice, yogurt, and a frozen dinner with and without 5 g of NVP sprinkled onto the food was determined. In addition, 3 granolas with different levels of NVP and 3 control white breads and one white bread and milk were also consumed. All meals contained 50 g of available carbohydrate. Capillary blood samples were taken fasting and at 15, 30, 45, 60, 90 and 120 min after the start of the meal. The glycemic index (GI and the glycemic reduction index potential (GRIP were calculated. The blood glucose concentrations at each time and the iAUC values were subjected to repeated-measures analysis of variance (ANOVA examining for the effect of test meal. After demonstration of significant heterogeneity, differences between individual means was assessed using GLM ANOVA with Tukey test to adjust for multiple comparisons. Results Addition of NVP reduced blood glucose response irrespective of food or dose (p Conclusion Sprinkling or incorporation of NVP into a variety of different foods is highly effective in reducing postprandial glycemia and lowering the GI of a food. Clinical Trial registration NCT00935350.
Viguiliouk, Effie; Stewart, Sarah E; Jayalath, Viranda H; Ng, Alena Praneet; Mirrahimi, Arash; de Souza, Russell J; Hanley, Anthony J; Bazinet, Richard P; Blanco Mejia, Sonia; Leiter, Lawrence A; Josse, Robert G; Kendall, Cyril W C; Jenkins, David J A; Sievenpiper, John L
Previous research on the effect of replacing sources of animal protein with plant protein on glycemic control has been inconsistent. We therefore conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess the effect of this replacement on glycemic control in individuals with diabetes. We searched MEDLINE, EMBASE, and Cochrane databases through 26 August 2015. We included RCTs ≥ 3-weeks comparing the effect of replacing animal with plant protein on HbA1c, fasting glucose (FG), and fasting insulin (FI). Two independent reviewers extracted relevant data, assessed study quality and risk of bias. Data were pooled by the generic inverse variance method and expressed as mean differences (MD) with 95% confidence intervals (CIs). Heterogeneity was assessed (Cochran Q-statistic) and quantified (I²-statistic). Thirteen RCTs (n = 280) met the eligibility criteria. Diets emphasizing a replacement of animal with plant protein at a median level of ~35% of total protein per day significantly lowered HbA1c (MD = -0.15%; 95%-CI: -0.26, -0.05%), FG (MD = -0.53 mmol/L; 95%-CI: -0.92, -0.13 mmol/L) and FI (MD = -10.09 pmol/L; 95%-CI: -17.31, -2.86 pmol/L) compared with control arms. Overall, the results indicate that replacing sources of animal with plant protein leads to modest improvements in glycemic control in individuals with diabetes. Owing to uncertainties in our analyses there is a need for larger, longer, higher quality trials. ClinicalTrials.gov registration number: NCT02037321.
Full Text Available Previous research on the effect of replacing sources of animal protein with plant protein on glycemic control has been inconsistent. We therefore conducted a systematic review and meta-analysis of randomized controlled trials (RCTs to assess the effect of this replacement on glycemic control in individuals with diabetes. We searched MEDLINE, EMBASE, and Cochrane databases through 26 August 2015. We included RCTs ≥ 3-weeks comparing the effect of replacing animal with plant protein on HbA1c, fasting glucose (FG, and fasting insulin (FI. Two independent reviewers extracted relevant data, assessed study quality and risk of bias. Data were pooled by the generic inverse variance method and expressed as mean differences (MD with 95% confidence intervals (CIs. Heterogeneity was assessed (Cochran Q-statistic and quantified (I2-statistic. Thirteen RCTs (n = 280 met the eligibility criteria. Diets emphasizing a replacement of animal with plant protein at a median level of ~35% of total protein per day significantly lowered HbA1c (MD = −0.15%; 95%-CI: −0.26, −0.05%, FG (MD = −0.53 mmol/L; 95%-CI: −0.92, −0.13 mmol/L and FI (MD = −10.09 pmol/L; 95%-CI: −17.31, −2.86 pmol/L compared with control arms. Overall, the results indicate that replacing sources of animal with plant protein leads to modest improvements in glycemic control in individuals with diabetes. Owing to uncertainties in our analyses there is a need for larger, longer, higher quality trials. Trial Registration: ClinicalTrials.gov registration number: NCT02037321.
Full Text Available Background: Association between poor control of glycemia and the onset of microvascular complications in type 2 diabetes mellitus (T2DM patients is a hard issue. However, it seems that the impact of pharmacological treatment is important only in early stages of diabetic nephropathy. We sought to examine whether intensive glycemic control is associated with improvement of clinical Chronic Kidney Disease (CKD outcomes compared to standard glycemic control.Methods: Meta-analysis of published and unpublished randomized controlled trials (RCT and post-hoc analysis of RCTs comparing anti-diabetic drugs and/or insulin (intensive control vs. dietary measures (standard control for relevant outcomes related to progression of CKD clinically manifest was undertaken. Summary estimates obtained by random effects model and funnel plots for assessing reporting bias are presented.Results: Our analysis was based on four RCTs representing 27,391 adult T2DM patients with CKD from around the world. The pooled OR for the outcomes of doubling of serum creatinine and need of dialysis were, respectively, of 0.98 with 95% confidence interval (95% CI 0.81–1.19, and 0.84 with 95% CI 0.69–1.02. The pooled OR for the outcome of death from kidney failure was 0.62 with 95% CI 0.39–0.98. Clinical differences between studies were not translated in statistical heterogeneity. Reporting bias may be present.Conclusions: Intensive glycemic control has an effect on death from kidney failure compared to standard glycemic control. Better comprehension of glycemic control effects on both T2DM patients with and without CKD is important for individualization of these two treatment modalities.
Drummond, Elaine; Flynn, Sarah; Whelan, Helena; Nongonierma, Alice B; Holton, Thérèse A; Robinson, Aisling; Egan, Thelma; Cagney, Gerard; Shields, Denis C; Gibney, Eileen R; Newsholme, Philip; Gaudel, Celine; Jacquier, Jean-Christophe; Noronha, Nessa; FitzGerald, Richard J; Brennan, Lorraine
Evidence exists to support the role of dairy derived proteins whey and casein in glycemic management. The objective of the present study was to use a cell screening method to identify a suitable casein hydrolysate and to examine its ability to impact glycemia related parameters in an animal model and in humans. Following screening for the ability to stimulate insulin secretion in pancreatic beta cells, a casein hydrolysate was selected and further studied in the ob/ob mouse model. An acute postprandial study was performed in 62 overweight and obese adults. Acute and long-term supplementation with the casein hydrolysate in in vivo studies in mice revealed a glucose lowering effect and a lipid reducing effect of the hydrolysate (43% reduction in overall liver fat). The postprandial human study revealed a significant increase in insulin secretion ( p = 0.04) concomitant with a reduction in glucose ( p = 0.03). The area under the curve for the change in glucose decreased from 181.84 ± 14.6 to 153.87 ± 13.02 ( p = 0.009). Overall, the data supports further work on the hydrolysate to develop into a functional food product.
Álvarez, C; Ramírez-Campillo, R; Ramírez-Vélez, R; Martínez, C; Castro-Sepúlveda, M; Alonso-Martínez, A; Izquierdo, M
Little evidence exists on which variables of body composition or muscular strength mediates more glucose control improvements taking into account inter-individual metabolic variability to different modes of exercise training. We examined 'mediators' to the effects of 6-weeks of resistance training (RT) or high-intensity interval training (HIT) on glucose control parameters in physically inactive schoolchildren with insulin resistance (IR). Second, we also determined both training-induce changes and the prevalence of responders (R) and non-responders (NR) to decrease the IR level. Fifty-six physically inactive children diagnosed with IR followed a RT or supervised HIT program for 6 weeks. Participants were classified based on ΔHOMA-IR into glycemic control R (decrease in homeostasis model assessment-IR (HOMA-IR) training-induced changes to glucose control parameters; and third the report of R and NR to improve body composition, cardiovascular, metabolic and performance variables. Mediation analysis revealed that improvements (decreases) in abdominal fat by the waist circumference can explain more the effects (decreases) of HOMA-IR in physically inactive schoolchildren under RT or HIT regimes. The same analysis showed that increased one-maximum repetition leg-extension was correlated with the change in HOMA-IR (β=-0.058; P=0.049). Furthermore, a change in the waist circumference fully mediated the dose-response relationship between changes in the leg-extension strength and HOMA-IR (β'=-0.004; P=0.178). RT or HIT were associated with significant improvements in body composition, muscular strength, blood pressure and cardiometabolic parameters irrespective of improvement in glycemic control response. Both glucose control RT-R and HIT-R (respectively), had significant improvements in mean HOMA-IR, mean muscular strength leg-extension and mean measures of adiposity. The improvements in the lower body strength and the decreases in waist circumference can explain more
Afandi, B; Kaplan, W; Al Hassani, N; Hadi, S; Mohamed, A
Even though patients with type 1 diabetes mellitus (T1DM) are exempted from fasting, the vast majority elect to fast against the advice of their healthcare providers. We have previously reported the incidence of wide fluctuations in blood glucose (BG) along with "unrecognized" severe hypoglycemia during Ramadan fasting in adolescents with T1DM. This report compares the continuous glucose monitoring (CGM) data during fasting in adolescents with T1DM according to their Pre-Ramadan diabetes control. Children and adolescents with T1DM who intended to fast the month of Ramadan were asked to wear the CGM during fasting for a minimum of 3 days. Hypoglycemia, hyperglycemia, and severe hyperglycemia were identified as BG 300 mg/dL (16.7 mmol/L) respectively, while normoglycemia was identified as BG 70-200 mg/dL (3.9-11.1 mmol/L). Patients were categorized as well-controlled (Group 1) and poorly controlled (Group 2) if the pre-fasting HbA1C was ≤8% (64 mmol/mol) and >8%, respectively. We compared the mean BG and the percentages of time spent in hypoglycemia, hyperglycemia, and severe hyperglycemia between the two groups using Chi-square (significant difference when P value was fasting. Our data suggest that optimal glycemic control before Ramadan may reduce the potential risks associated with fasting and minimize glucose fluctuation.
Swati H Shah
Full Text Available Background: Pulmonary complications of diabetes mellitus (DM have been poorly characterized. Some authors have reported normal pulmonary functions and even concluded that spirometry is not at all necessary in diabetic patients. Some studies have shown abnormal respiratory parameters in patients of DM. Moreover, the duration of DM and glycemic control have varied impact on the pulmonary functions. Aims and Objectives: The study was undertaken to analyze the pulmonary function parameters in diabetic patients and compare them with age and gender matched healthy subjects. We correlated forced vital capacity (FVC and forced expiratory volume in 1 second (FEV 1 in diabetic patients with duration of the disease and glycosylated hemoglobin (HbA1c. Materials and Methods: Pulmonary function tests (PFTs were recorded in 60 type 2 diabetic male patients and 60 normal healthy male controls aged 40-60 years by using Helios 702 spirometer. The PFTs recorded were - FVC, FEV 1 , FEV 1 /FVC, FEF 25 , FEF 50 , FEF 75 , FEF 25-75 , FEF 0.2-1.2 , and peak expiratory flow rate (PEFR. HbA1c of all the patients was estimated by ion exchange resin method, which is a very standard method of estimation. PFTs of diabetic patients and controls were compared by applying Student′s unpaired t test. Associations between FVC and FEV 1 and HbA1c and duration of illness in diabetic patients were analyzed by applying Pearson′s coefficient. Results: The PFTs were significantly decreased in diabetic patients compared with the healthy controls except FEV 1 /FVC. There was no correlation found between FVC and FEV 1 and duration of illness as well as HbA1c. Conclusion: DM being a systemic disease, which also affects lungs causing restrictive type of ventilatory changes probably because of glycosylation of connective tissues, reduced pulmonary elastic recoil and inflammatory changes in lungs. We found glycemic levels and duration of disease are probably not the major determinants of
Bae, J P; Lage, M J; Mo, D; Nelson, D R; Hoogwerf, B J
Examine the association between obesity and glycemic control among patients with type 1 (T1DM) or type 2 diabetes mellitus (T2DM). Data from US physician electronic health records (Humedica®) from 2009-2011 were utilized. Patients were defined as having above-target glycemic control if they had an HbA1c ≥7% at any time during the study period. Multinomial logistic regressions were conducted separately for T1DM and T2DM patients, and examined associations between BMI categories and probability of having above-target glycemic control (≥7% and <8%, ≥8% and <9%, or ≥9%) while controlling for patient demographics, general health, comorbid conditions, and antihyperglycemic medication use. There were 14,028 T1DM and 248,567 T2DM patients; 47.8% of T1DM and 63.4% of T2DM were obese (BMI ≥30kg/m(2)). For T1DM, being overweight (BMI 25-<30), obese class I (30-<35), II (35-<40), or III (≥40) was associated with a significantly higher probability of having HbA1c≥8% and <9% or ≥9%, while being overweight was associated with a significantly higher probability of having HbA1c ≥7% and <8% compared to normal BMI (BMI≥18.5 and<25). For T2DM patients, being overweight, obese class I, II, or III was associated with a significantly higher probability of having HbA1c ≥7% and <8%, ≥8% and <9%, or ≥9%. For both T1DM and T2DM patients, there were positive and statistically significant associations between being overweight or obese and having suboptimal glycemic control. These findings quantify the associations between obesity and glycemic control, and highlight the potential importance of individual characteristics on glycemic control. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.
Khardori, Romesh; Nguyen, Diep D
Cardiovascular disease accounts for nearly 70% of morbidity and mortality in patients with diabetes mellitus. Strides made in diabetes care have indeed helped prevent or reduce the burden of microvascular complications in both type 1 and type 2 diabetes. However, the same cannot be said about macrovascular disease in diabetes. Several prospective trials so far have failed to provide conclusive evidence of the superiority of glycemic control in reducing macrovascular complications or death rates in people with advanced disease or those with long duration of diabetes. There are trends that suggest that benefits are restricted to those with lesser burden and shorter duration of disease. Furthermore, it is also suggested that benefits might accrue but it would take a longer time to manifest. Clinicians are faced with the challenge to decide how to triage patients for intensified care vs less intense care. This review focuses on evidence and attempts to provide a balanced view of the literature that has radically affected how physicians treat patients with macrovascular disease. It also takes cognizance of the fact that the natural course of the disease may be changing as well, possibly related to better overall awareness and possibly improved access to information about better individual healthcare. The review further takes note of some hard held notions about the pathobiology of the disease that must be interpreted with caution in light of new and emerging data. In light of recent developments ADA and EASD have taken step to provide some guidance to clinicians through a joint position statement. A lot more research would be required to figure out how best to manage macrovascular disease in diabetes mellitus. Glucocentric stance would need to be reconsidered, and attention paid to concurrent multifactorial interventions that seem to be effective in reducing vascular outcomes.
Full Text Available Introduction: Logbooks of self-monitoring of blood glucose (SMBG are useful in the modulation of insulin regimens, which aid in achieving glycemic control in type 1 diabetes mellitus (T1DM. However, discrepancies in SMBG charting may impede its utility. This study aimed to assess the accuracy of log entries and its impact on long-term glycemic control. Methods: SMBG in logbooks was compared with readings in glucometer memory and discrepancies between the two were evaluated in 101 children with T1DM. The relationship between these discrepancies and glycated hemoglobin (HbA1c over 44 months was assessed. Results: Errors in glucose charting were observed in 32.67% children. The most common observed error was omission (42.42%, followed by fabrication (27.27%, erroneous (18.18%, and others (12.12%. Age was not significantly different among children having accurate versus inaccurate SMBG logs. During follow-up of 44 months, children with accurate SMBG logs consistently had lower HbA1c as compared to children having inaccurate logs, which was statistically significant at 4, 16, 20, and 28 months' follow-up. The same was reflected in the proportion of children achieving HbA1c <7% and 7%–9%. Of the 14 children who had omissions, 9 had omission of high values only, 3 patients had omission of low values only, 1 had omission of both high and low values, and 1 had omission of normal values. Among logs with fabrication, parents were responsible in 2 of 9 incidents. In the remaining 7, it was the child himself/herself. Children with fabrication consistently had the highest HbA1c values among the different types of inaccurate blood glucose chartings, which was statistically significant at 32 and 36 months of follow-up. Conclusions: Reliability of SMBG logs is a significant problem among children with T1DM at our center. Children with accurate logs of SMBG readings were more likely to have better glycemic control on long-term follow-up.
Eman Mohamed Mahfouz
Full Text Available Background: This study aimed to examine the relationship between mothers' knowledge related to treatment management of type 1 diabetes (T1D, with perceptions of coping with diabetes-related stress and to examine the relationship between children's metabolic control and maternal coping. A cross-sectional study was done among ninety-two mothers of T1D children. Methods: Data were collected using a structured questionnaire, Ways of coping questionnaire (WCQ, and Diabetes Knowledge questionnaire-24 (DKQ-24. Results: The most important predictors of the total knowledge scores among mothers were father education (P < 0.0001, followed by child age and sex (P < 0.0001, while the most important coping scales affected by total knowledge scores was accepting responsibility (P = 0.01. There were positive correlation between HBA1C and escape-avoidance and positive reappraisal coping scales (r = 0.24, P = 0.02 and r = 0.23, P = 0.02, respectively. Blood glucose level was the most important clinical characteristics affecting the use of seeking social support coping scale among mothers. Conclusions: Parents with more knowledge of diabetes and with better education were able to cope more effective and maintain a better glycemic control of their diabetic children.
Rodríguez-Morán, M; Guerrero-Romero, F
The aim of this study was to establish whether glycemic control results in decrease of C-reactive protein (CRP) in Type 2 diabetic subjects. Newly diagnosed Type 2 diabetic subjects were recruited and followed-up by 6-month intensive medical management. All the participants were carefully interviewed, clinically examined, and laboratory tested to exclude conditions likely to provoke an inflammatory response, which was an exclusion criterium. CRP was measured by automated microparticle enzyme immunoassay (IMx, Abbott Laboratories, USA). Two-hundred and forty-eight patients were included in the analysis of data. At baseline, average CRP levels were of 9.6 +/- 6.2 mg/l. Only 14 (5.7%) patients showed a fasting glucose equal or lower than 6.1 mmo/l (5.6 +/- 0.4 mmo/l); of them, 6 (42.8%) had elevated CRP levels (8.8 +/- 6.7 mg/l). The fasting glucose in the 234 (94.3%) non-controlled subjects was 13.1 +/- 4.8 mmol/l; of them 179 (76.5%) subjects showed elevated CRP levels (10.9 +/- 6.5 mg/I). At the end of the 6-month follow-up, the average fasting glucose and HbA1c in the overall group decreased from 12.5 +/- 5.0 to 9.0 +/- 1.6 mmol/l, p diabetic subjects.
Méndez-Del Villar, Miriam; Puebla-Pérez, Ana M; Sánchez-Peña, María J; González-Ortiz, Luis J; Martínez-Abundis, Esperanza; González-Ortiz, Manuel
To evaluate the effect of Artemisia dracunculus on glycemic control, insulin sensitivity, and insulin secretion in patients with impaired glucose tolerance (IGT). A randomized, double blind, placebo-controlled clinical trial was performed in 24 patients with diagnosis of IGT. Before and after the intervention, glucose and insulin levels were measured every 30 min for 2 h after a 75-g dextrose load, along with glycated hemoglobin A1c (A1C) and lipid profile. Twelve patients received A. dracunculus (1000 mg) before breakfast and dinner for 90 days; the remaining 12 patients received placebo. Area under the curve (AUC) of glucose and insulin, total insulin secretion, first phase of insulin secretion, and insulin sensitivity were calculated. Wilcoxon signed-rank, Mann-Whitney U, and chi-square tests were used for statistical analyses. The institutional ethics committee approved the protocol. After A. dracunculus administration, there were significant decreases in systolic blood pressure (SBP; 120.0 ± 11.3 vs. 113.0 ± 11.2 mmHg, P AUC of insulin (56,136.0 ± 27,426.0 vs. 44,472.0 ± 23,370.0 pmol/L, P AUC of insulin, and total insulin secretion with a significant increase in HDL-C levels.
Jessie Nallely Zurita-Cruz
Full Text Available Objectives: In prepubertal type 1 diabetic patients (DM1, the availability of an informal primary caregiver (ICP is critical to making management decisions; in this study, the ICP-related risk factors associated with glycemic control were identified. Patients, materials, and methods: A comparative cross-sectional study was performed. Fifty-five patients with DM1 under the age of 11 years were included. The patient-related factors associated with glycemic control evaluated were physical activity, DM1 time of evolution, and adherence to medical indications. The ICP-related factors evaluated were education, employment aspects, depressive traits (Beck questionnaire, family functionality (family APGAR, support of another person in patient care, stress (Perceived Stress Scale, and socioeconomic status (Bronfman questionnaire. Multivariate logistic and linear regression analyses were performed. Results: The patients’ median age was 8 years; 29 patients had good glycemic control, and 26 were uncontrolled. The main risk factor associated with glycemic dyscontrol was stress in the ICP (OR 24.8; 95% CI 4.06–151.9, p = 0.001. While, according to the linear regression analysis it was found that lower level of education (β 0.991, 95% CI 0.238–1.743, p = 0.011 and stress (β 1.918, 95% CI 1.10–2.736, p = 0.001 in the ICP, as well as family dysfunction (β 1.256, 95% CI 0.336–2.177, p = 0.008 were associated with higher levels of glycated hemoglobin. Conclusions: Level of education and stress in the ICP, as well as family dysfunction, are factors that influence the lack of controlled blood glucose levels among prepubertal DM1 patients. Resumo: Objetivos: Em pacientes pré-púberes com diabetes tipo 1 (DM1, a disponibilidade de um cuidador familiar principal (CFP é fundamental para tomar decisões de administração; neste estudo, foram identificados os fatores de risco relacionados a CFPs associados ao controle glicêmico. Pacientes
Lind, Marcus; Polonsky, William; Hirsch, Irl B; Heise, Tim; Bolinder, Jan; Dahlqvist, Sofia; Schwarz, Erik; Ólafsdóttir, Arndís Finna; Frid, Anders; Wedel, Hans; Ahlén, Elsa; Nyström, Thomas; Hellman, Jarl
The majority of individuals with type 1 diabetes do not meet recommended glycemic targets. To evaluate the effects of continuous glucose monitoring in adults with type 1 diabetes treated with multiple daily insulin injections. Open-label crossover randomized clinical trial conducted in 15 diabetes outpatient clinics in Sweden between February 24, 2014, and June 1, 2016 that included 161 individuals with type 1 diabetes and hemoglobin A1c (HbA1c) of at least 7.5% (58 mmol/mol) treated with multiple daily insulin injections. Participants were randomized to receive treatment using a continuous glucose monitoring system or conventional treatment for 26 weeks, separated by a washout period of 17 weeks. Difference in HbA1c between weeks 26 and 69 for the 2 treatments. Adverse events including severe hypoglycemia were also studied. Among 161 randomized participants, mean age was 43.7 years, 45.3% were women, and mean HbA1c was 8.6% (70 mmol/mol). A total of 142 participants had follow-up data in both treatment periods. Mean HbA1c was 7.92% (63 mmol/mol) during continuous glucose monitoring use and 8.35% (68 mmol/mol) during conventional treatment (mean difference, -0.43% [95% CI, -0.57% to -0.29%] or -4.7 [-6.3 to -3.1 mmol/mol]; P < .001). Of 19 secondary end points comprising psychosocial and various glycemic measures, 6 met the hierarchical testing criteria of statistical significance, favoring continuous glucose monitoring compared with conventional treatment. Five patients in the conventional treatment group and 1 patient in the continuous glucose monitoring group had severe hypoglycemia. During washout when patients used conventional therapy, 7 patients had severe hypoglycemia. Among patients with inadequately controlled type 1 diabetes treated with multiple daily insulin injections, the use of continuous glucose monitoring compared with conventional treatment for 26 weeks resulted in lower HbA1c. Further research is needed to assess clinical outcomes and longer
Heitkemper, Elizabeth M; Mamykina, Lena; Travers, Jasmine; Smaldone, Arlene
The purpose of this systematic review and meta-analysis was to examine the effect of health information technology (HIT) diabetes self-management education (DSME) interventions on glycemic control in medically underserved patients. Following an a priori protocol, 5 databases were searched. Studies were appraised for quality using the Cochrane Risk of Bias assessment. Studies reporting either hemoglobin A1c pre- and post-intervention or its change at 6 or 12 months were eligible for inclusion in the meta-analysis using random effects models. Thirteen studies met the criteria for the systematic review and 10 for the meta-analysis and represent data from 3257 adults with diabetes (mean age 55 years; 66% female; 74% racial/ethnic minorities). Most studies ( n = 10) reflected an unclear risk of bias. Interventions varied by HIT type: computer software without Internet ( n = 2), cellular/automated telephone ( n = 4), Internet-based ( n = 4), and telemedicine/telehealth ( n = 3). Pooled A1c decreases were found at 6 months (-0.36 (95% CI, -0.53 and -0.19]; I 2 = 35.1%, Q = 5.0), with diminishing effect at 12 months (-0.27 [95% CI, -0.49 and -0.04]; I 2 = 42.4%, Q = 10.4). Findings suggest that medically underserved patients with diabetes achieve glycemic benefit following HIT DSME interventions, with dissipating but significant effects at 12 months. Telemedicine/telehealth interventions were the most successful HIT type because they incorporated interaction with educators similar to in-person DSME. These results are similar to in-person DSME in medically underserved patients, showing that well-designed HIT DSME has the potential to increase access and improve outcomes for this vulnerable group. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: email@example.com
Breum, Leif; Bjerre, U; Bak, J F
differences (mean +/- SD: F, 10.1 +/- 10.0 kg; P, 9.4 +/- 11.5 kg). Fifteen patients from the F group and 14 from the P group completed the 12-month study without weight loss differences. Glycemic regulation improved along with the weight loss, but with a larger decline in plasma C-peptide and fasting glucose......Fluoxetine (F) is a specific serotonin-reuptake inhibitor that has been shown to promote weight loss and improve glycemic control in obese diabetic patients. To study its long-term metabolic effect, 40 obese patients with non-insulin -dependent diabetes mellitus (NIDDM) or impaired glucose...... tolerance (IGT) were included in a 12-month, randomized, placebo controlled study. Patients were assigned to receive either 60 mg F or placebo (P) daily in conjunction with a 5.0-MJ/d diet (> 50% carbohydrate). Both groups showed a significant weight loss, with a nadir after 6 months without group...
Anne M Koponen
Full Text Available This study showed, in line with self-determination theory, that glycemic control among patients with type 2 diabetes ( n = 2866 was strongly associated with perceived self-care competence, which in turn was associated with autonomous motivation and autonomy-supportive health-care climate. These associations remained after adjusting for the effect of important life-context factors. Autonomous motivation partially mediated the effect of health-care climate on perceived competence, which fully mediated the effect of autonomous motivation on glycemic control. The results of the study emphasize health-care personnel’s important role in supporting patients’ autonomous motivation and perceived self-care competence.
Kielgast, Urd; Krarup, Thure; Holst, Jens Juul
OBJECTIVE To investigate the effect of 4 weeks of treatment with liraglutide on insulin dose and glycemic control in type 1 diabetic patients with and without residual ß-cell function. RESEARCH DESIGN AND METHODS Ten type 1 diabetic patients with residual ß-cell function (C-peptide positive) and 19.......1]; P Treatment with liraglutide in type 1 diabetic patients reduces insulin dose with improved or unaltered glycemic control....... activity was performed before (week 0) and during (week 4) treatment. Differences in insulin dose; HbA(1c); time spent with blood glucose 10, and 3.9-9.9 mmol/L; and body weight were evaluated. RESULTS Insulin dose decreased from 0.50 ± 0.06 to 0.31 ± 0.08 units/kg per day (P
Solomon, Thomas; Malin, Steven K; Karstoft, Kristian
glucose-stimulated insulin secretion (GSIS), and disposition index (DI) were measured following 12-16-weeks of aerobic exercise training. Regression analyses were used to identify relationships between variables.ResultsFollowing training, 86% of subjects increased VO2max and lost weight. HbA1c, fasting......ContextUnderstanding inter-subject variability in glycemic control following exercise training will help individualize treatment.ObjectiveTo determine whether this variability is related to training-induced changes in insulin sensitivity or pancreatic beta-cell function.Design, Setting....... Training increased first- and second-phase DI in 83% and 74% of subjects. Training-induced changes in glycemic control were related to changes in GSIS (P...
Lim, Soo; Kang, Seon Mee; Shin, Hayley; Lee, Hak Jong; Won Yoon, Ji; Yu, Sung Hoon; Kim, So-Youn; Yoo, Soo Young; Jung, Hye Seung; Park, Kyong Soo; Ryu, Jun Oh; Jang, Hak C
To improve quality and efficiency of care for elderly patients with type 2 diabetes, we introduced elderly-friendly strategies to the clinical decision support system (CDSS)-based ubiquitous healthcare (u-healthcare) service, which is an individualized health management system using advanced medical information technology. We conducted a 6-month randomized, controlled clinical trial involving 144 patients aged >60 years. Participants were randomly assigned to receive routine care (control, n = 48), to the self-monitored blood glucose (SMBG, n = 47) group, or to the u-healthcare group (n = 49). The primary end point was the proportion of patients achieving A1C healthcare system refers to an individualized medical service in which medical instructions are given through the patient's mobile phone. Patients receive a glucometer with a public switched telephone network-connected cradle that automatically transfers test results to a hospital-based server. Once the data are transferred to the server, an automated system, the CDSS rule engine, generates and sends patient-specific messages by mobile phone. After 6 months of follow-up, the mean A1C level was significantly decreased from 7.8 ± 1.3% to 7.4 ± 1.0% (P healthcare group and from 7.9 ± 1.0% to 7.7 ± 1.0% (P = 0.020) in the SMBG group, compared with 7.9 ± 0.8% to 7.8 ± 1.0% (P = 0.274) in the control group. The proportion of patients with A1C healthcare group, 23.4% in the SMBG group (23.4%), and 14.0% in the control group (P healthcare service achieved better glycemic control with less hypoglycemia than SMBG and routine care and may provide effective and safe diabetes management in the elderly diabetic patients.
Diabetes treatment satisfaction, medication adherence, and glycemic control among ambulatory type 2 diabetic nigerians in a primary care clinic of a tertiary hospital situated in a resource-limited environment of Southeast Nigeria
Iloh Gabriel Uche Pascal
Full Text Available Background: Diabetic treatment satisfaction, medication adherence, and glycemic control are widely recognized as the cornerstones for successful management of diabetes and proxy indicators of quality of care. However, in Nigeria, nothing is known on the role of diabetic treatment satisfaction on medication adherence and blood glucose control. Aim: The study was aimed at determining the role of diabetes treatment satisfaction in medication adherence and glycemic control among ambulatory type 2 diabetic Nigerians in a primary care clinic in Southeast Nigeria. Materials and Methods: This was a descriptive study that was carried out on 120 type 2 diabetic Nigerians who were on treatment for at least 3 months at the primary care clinic of a tertiary hospital in Nigeria. Diabetes treatment satisfaction and medication adherence were assessed in the previous 30 days using pretested, interviewer-administered questionnaire on self-reported satisfaction and adherence to therapy, respectively. Glycemic control was assessed in the previous 1 month. A patient was defined to have goal glycemic control if the fasting blood glucose at the end of the study, visit was between 70 and 130 mg/dL. Results: Diabetic treatment satisfaction, medication adherence, and glycemic control rates were 85.8%, 72.5%, and 61.7%, respectively. Diabetic treatment satisfaction was significantly associated with medication adherence (P = 0.025 and glycemic control (P = 0.04. Conclusion: Diabetic treatment satisfaction was significantly associated with medication adherence and glycemic control. However, treatment satisfaction did not translate marginally to higher medication and glycemic control. Diabetic treatment satisfaction should be integrated into a standard care package for diabetic patients in primary care settings.
Al Hayek, Ayman A.; Robert, Asirvatham A.; Al Dawish, Mohamed A.; Braham, Rim B.; Goudeh, Hanouf S.; Al Sabaan, Fahad S.
Introduction The aim of this study was to explore the impact of insulin pump therapy on diabetes treatment satisfaction and glycemic control among patients with type 1 diabetes mellitus (T1DM) in Saudi Arabia. Methods A 6-month, prospective study was conducted among 47 patients (aged 17?24?years) with T1DM who attended the Insulin Pump Clinic at Prince Sultan Military Medical City, Riyadh, Saudi Arabia, between April 2014 and November 2014. The respondents were purposively and conveniently se...
Sakai, Ryosuke; Hashimoto, Yoshitaka; Ushigome, Emi; Miki, Akane; Okamura, Takuro; Matsugasumi, Masako; Fukuda, Takuya; Majima, Saori; Matsumoto, Shinobu; Senmaru, Takafumi; Hamaguchi, Masahide; Tanaka, Muhei; Asano, Mai; Yamazaki, Masahiro; Oda, Yohei; Fukui, Michiaki
Skipping breakfast or irregular breakfast is associated with poor glycemic control. However, a relationship between the timing of dinner and glycemic control in people with type 2 diabetes remains indefinite. Therefore, we investigated the relationship between late-night-dinner and glycemic control in people with type 2 diabetes. We performed questionnaire survey for lifestyle factors in this cross-sectional study. We defined having dinner later than eight pm as late-night-dinner. We examined the differences in clinical and metabolic parameters between those who have late-night-dinner and those who do not have. We also examined the relationship between late-night-dinner and HbA1c, using multiple regression analysis. Ninety-five people (23.2%) had a late-night-dinner, among 409 people with type 2 diabetes. Metabolic parameters (mean (SD) or median (interquartile range)) of people with late-night-dinner were worse than those of without, including body mass index (BMI) (24.4 (4.0) vs. 23.2 (3.4) kg/m 2 , p = 0.006), triglycerides (1.5 (1.1-2.1) vs. 1.2 (0.8-1.7) mmol/L, p dinner (standardized regression coefficient = 0.13, p = 0.028) was associated with hemoglobin A1c after adjusting for age, BMI, sex, duration of diabetes, smoking, exercise, alcohol, snacking after dinner, nighttime sleep duration, time from dinner to bedtime, skipping breakfast, and medication for diabetes. Late-night-dinner is independently associated with poor glycemic control in people with type 2 diabetes.
Fujii, Hiroki; Iwase, Masanori; Ohkuma, Toshiaki; Ogata-Kaizu, Shinako; Ide, Hitoshi; Kikuchi, Yohei; Idewaki, Yasuhiro; Joudai, Tamaki; Hirakawa, Yoichiro; Uchida, Kazuhiro; Sasaki, Satoshi; Nakamura, Udai; Kitazono, Takanari
Background Dietary fiber is beneficial for the treatment of type 2 diabetes mellitus, although it is consumed differently in ethnic foods around the world. We investigated the association between dietary fiber intake and obesity, glycemic control, cardiovascular risk factors and chronic kidney disease in Japanese type 2 diabetic patients. Methods A total of 4,399 patients were assessed for dietary fiber intake using a brief self-administered diet history questionnaire. The associations betwee...
Mendoza, Jason A; Haaland, Wren; D'Agostino, Ralph B; Martini, Lauren; Pihoker, Catherine; Frongillo, Edward A; Mayer-Davis, Elizabeth J; Liu, Lenna L; Dabelea, Dana; Lawrence, Jean M; Liese, Angela D
Household food insecurity (FI), i.e., limited availability of nutritionally adequate foods, is associated with poor glycemic control among adults with type 2 diabetes. We evaluated the association of FI among youth and young adults (YYA) with type 1 diabetes to inform recent clinical recommendations from the American Diabetes Association for providers to screen all patients with diabetes for FI. Using data from the Washington and South Carolina SEARCH for Diabetes in Youth Study sites, we conducted an observational, cross-sectional evaluation of associations between FI and glycemic control, hospitalizations, and emergency department (ED) visits among YYA with type 1 diabetes. FI was assessed using the Household Food Security Survey Module, which queries conditions and behaviors typical of households unable to meet basic food needs. Participants' HbA 1c were measured from blood drawn at the research visit; socio-demographics and medical history were collected by survey. The prevalence of FI was 19.5%. In adjusted logistic regression analysis, YYAs from food-insecure households had 2.37 higher odds (95% CI: 1.10, 5.09) of high risk glycemic control, i.e., HbA 1c >9.0%, vs. peers from food-secure households. In adjusted binomial regression analysis for ED visits, YYAs from food-insecure households had an adjusted prevalence rate that was 2.95 times (95% CI [1.17, 7.45]) as great as those from food secure households. FI was associated with high risk glycemic control and more ED visits. Targeted efforts should be developed and tested to alleviate FI among YYA with type 1 diabetes. Copyright © 2018 Elsevier B.V. All rights reserved.
Matejko, Bartlomiej; Kiec-Wilk, Beata; Szopa, Magdalena; Trznadel Morawska, Iwona; Malecki, Maciej T; Klupa, Tomasz
Little is known about the impact of sleep duration and late-night snacking on glycemic control in patients with type 1 diabetes using insulin pumps. The aim of the present study was to examine whether late-night eating habits and short sleep duration are associated with glycemic control in continuous subcutaneous insulin infusion-treated type 1 diabetic patients. We included 148 consecutive adult type 1 diabetic subjects using an insulin pump (100 women and 48 men). Participants completed a questionnaire regarding sleep duration (classified as short if ≤6 h) and late-night snacking. Other sources of information included medical records and data from blood glucose meters. Glycemic control was assessed by glycated hemoglobin (HbA1c) levels and mean self-monitoring of blood glucose (SMBG) readings. The mean age of patients was 26 years, mean type 1 diabetes duration was 13.4 years and mean HbA1c level was 7.2%. In a univariate regression analysis, sleep duration was a predictor of both HbA1c (β = 0.51, P = 0.01) and SMBG levels (β = 11.4, P = 0.02). Additionally, an association was found between frequent late-night snacking and higher SMBG readings (often snacking β = 18.1, P = 0.05), but not with increased HbA1c levels. In the multivariate linear regression, independent predictors for HbA1c and SMBG were sleep duration and patient age. In a univariate logistic regression, sleep duration and frequency of late-night snacking were not predictors of whether HbA1c target levels were achieved. Short sleep duration, but not late-night snacking, seems to be associated with poorer glycemic control in type 1 diabetic patients treated with continuous subcutaneous insulin infusion.
Full Text Available Despite the widespread use of ginseng in the management of diabetes, supporting evidence of its anti-hyperglycemic efficacy is limited, necessitating the need for evidence-based recommendations for the potential inclusion of ginseng in diabetes management.To elucidate the effect of ginseng on glycemic control in a systematic review and meta-analysis of randomized controlled trials in people with and without diabetes.MEDLINE, EMBASE, CINAHL and the Cochrane Library (through July 3, 2013.Randomized controlled trials ≥30 days assessing the glycemic effects of ginseng in people with and without diabetes.Relevant data were extracted by 2 independent reviewers. Discrepancies were resolved by consensus. The Heyland Methodological Quality Score and the Cochrane risk of bias tool were used to assess study quality and risk of bias respectively.Sixteen trials were included, in which 16 fasting blood glucose (n = 770, 10 fasting plasma insulin (n = 349, 9 glycated hemoglobin (n = 264, and 7 homeostasis model assessment of insulin resistance (n = 305 comparisons were reported. Ginseng significantly reduced fasting blood glucose compared to control (MD = -0.31 mmol/L [95% CI: -0.59 to -0.03], P = 0.03. Although there was no significant effect on fasting plasma insulin, glycated hemoglobin, or homeostasis model assessment of insulin resistance, a priori subgroup analyses did show significant reductions in glycated hemoglobin in parallel compared to crossover trials (MD = 0.22% [95%CI: 0.06 to 0.37], P = 0.01.Most trials were of short duration (67% trials<12wks, and included participants with a relatively good glycemic control (median HbA1c non-diabetes = 5.4% [2 trials]; median HbA1c diabetes = 7.1% [7 trials].Ginseng modestly yet significantly improved fasting blood glucose in people with and without diabetes. In order to address the uncertainty in our effect estimates and provide better assessments of ginseng's anti
Çelik, Selime; Kayar, Yusuf; Önem Akçakaya, Rabia; Türkyılmaz Uyar, Ece; Kalkan, Kübra; Yazısız, Veli; Aydın, Çiğdem; Yücel, Başak
It is reported that eating disorders and depression are more common in patients with type 2 diabetes mellitus (T2DM). In this study, we aimed to determine the prevalence of binge eating disorder (BED) in T2DM patients and examine the correlation of BED with level of depression and glycemic control. One hundred fifty-two T2DM patients aged between 18 and 75 years (81 females, 71 males) were evaluated via a Structured Clinical Interview for DSM-IV Axis I Disorder, Clinical Version in terms of eating disorders. Disordered eating attitudes were determined using the Eating Attitudes Test (EAT) and level of depression was determined using the Beck Depression Scale. Patients who have BED and patients who do not were compared in terms of age, gender, body mass index, glycosylated hemoglobin (HbA1c) levels, depression and EAT scores. Eight of the patients included in the study (5.26%) were diagnosed with BED. In patients diagnosed with BED, depression and EAT scores were significantly high (PEAT scores and depression scores (r = +0.196, Pdisordered eating attitudes. Psychiatric treatments should be organized for patients diagnosed with BED by taking into consideration comorbid depression. Copyright © 2015 Elsevier Inc. All rights reserved.
Krinsley, James S; Egi, Moritoki; Kiss, Alex; Devendra, Amin N; Schuetz, Philipp; Maurer, Paula M; Schultz, Marcus J; van Hooijdonk, Roosmarijn T M; Kiyoshi, Morita; Mackenzie, Iain M J; Annane, Djillali; Stow, Peter; Nasraway, Stanley A; Holewinski, Sharon; Holzinger, Ulrike; Preiser, Jean-Charles; Vincent, Jean-Louis; Bellomo, Rinaldo
Hyperglycemia, hypoglycemia, and increased glycemic variability have each been independently associated with increased risk of mortality in critically ill patients. The role of diabetic status on modulating the relation of these three domains of glycemic control with mortality remains uncertain. The purpose of this investigation was to determine how diabetic status affects the relation of hyperglycemia, hypoglycemia, and increased glycemic variability with the risk of mortality in critically ill patients. This is a retrospective analysis of prospectively collected data involving 44,964 patients admitted to 23 intensive care units (ICUs) from nine countries, between February 2001 and May 2012. We analyzed mean blood glucose concentration (BG), coefficient of variation (CV), and minimal BG and created multivariable models to analyze their independent association with mortality. Patients were stratified according to the diagnosis of diabetes. Among patients without diabetes, mean BG bands between 80 and 140 mg/dl were independently associated with decreased risk of mortality, and mean BG bands>or=140 mg/dl, with increased risk of mortality. Among patients with diabetes, mean BG from 80 to 110 mg/dl was associated with increased risk of mortality and mean BG from 110 to 180 mg/dl with decreased risk of mortality. An effect of center was noted on the relation between mean BG and mortality. Hypoglycemia, defined as minimum BGor=20%, was independently associated with increased risk of mortality only among patients without diabetes. Derangements of more than one domain of glycemic control had a cumulative association with mortality, especially for patients without diabetes. Although hyperglycemia, hypoglycemia, and increased glycemic variability is each independently associated with mortality in critically ill patients, diabetic status modulates these relations in clinically important ways. Our findings suggest that patients with diabetes may benefit from higher glucose
León-Sanz, Miguel; García-Luna, Pedro P; Sanz-París, Alejandro; Gómez-Candela, Carmen; Casimiro, César; Chamorro, José; Pereira-Cunill, José L; Martin-Palmero, Angeles; Trallero, Roser; Martínez, José; Ordóñez, Francisco Javier; García-Peris, Pilar; Camarero, Emma; Gómez-Enterría, Pilar; Cabrerizo, Lucio; Perez-de-la-Cruz, Antonio; Sánchez, Carmen; García-de-Lorenzo, Abelardo; Rodríguez, Nelly; Usán, Luis
Type 2 diabetic patients may need enteral nutrition support as part of their treatment. The objective was to compare glycemic and lipid control in hospitalized patients with type 2 diabetes requiring feeding via nasogastric tube using enteral feedings with either a highcarbohydrate or a high-monounsaturated-fat content. This trial included type 2 diabetes patients admitted to the hospital for neurologic disorders or head and neck cancer surgery who received either a low-carbohydrate-high-mono-unsaturated-fat (Glucerna) or a high-carbohydrate diet (Precitene Diabet). Glycemic and lipid control was determined weekly. Safety and gastrointestinal tolerance were also assessed. A total of 104 patients were randomized and 63 were evaluable according to preestablished protocol criteria. Median duration of therapy was 13 days in both groups. Mean glucose was significantly increased at 7 days of treatment (p = .006) in the Precitene arm, with no significant variations in the Glucerna arm. Mean weekly blood triglycerides levels in the Precitene arm were increased without reaching statistical significance, whereas patients in the Glucerna arm showed a stable trend. Patients in the Precitene arm showed a significantly higher incidence of diarrhea than patients in Glucerna arm (p = .008), whereas the incidence of nausea was smaller in the Precitene arm than in the Glucerna arm (p = .03). An enteral formula with lower carbohydrate and higher monounsaturated fat (Glucerna) has a neutral effect on glycemic control and lipid metabolism in type 2 diabetic patients compared with a high-carbohydrate and a lower-fat formula (Precitene Diabet).
Kaul, Anne; Gläser, Sven; Hannemann, Anke; Stubbe, Beate; Felix, Stefan B; Nauck, Matthias; Ewert, Ralf; Friedrich, Nele
Vitamin D deficiency is discussed to be associated with lung health. While former studies focused on subjects suffering from pulmonary diseases, we aimed to investigate the association of 25-hydroxy vitamin D [25(OH)D] with lung function in the general population and examined whether mediating effects of inflammation, glycemic control or renal function exist. 1404 participants from the Study of Health in Pomerania with pulmonary function testing assessed by expiratory volume in 1 s (FEV 1 ), forced vital capacity (FVC), total lung capacity and Krogh index were used. Adjusted analysis of variance, linear regression models and mediation analyses were performed. Significant positive associations between 25(OH)D levels and FEV 1 , FVC and Krogh index were found. Mediator analyses revealed no mediating effect of inflammation (fibrinogen), glycemic control (HbA1c) or renal function (eGFR) on associations with FEV 1 or FVC. With respect to Krogh-Index, the association to 25(OH)D was slightly mediated by fibrinogen with a proportion mediated of 9.7%. Significant positive associations of 25(OH)D with lung function were revealed in a general population. The proposed mediating effects of inflammation, glycemic control and renal function on these relations were not confirmed. Further studies examining the causality of the association between 25(OH)D and lung function are necessary. Copyright © 2017 Elsevier Ltd. All rights reserved.
Jetha Mary M
Full Text Available Abstract Background Our purpose was to evaluate the impact of lifestyle behavior modification on glycemic control among children and youth with clinically defined Type 2 Diabetes (T2D. Methods We conducted a systematic review of studies (randomized trials, quasi-experimental studies evaluating lifestyle (diet and/or physical activity modification and glycemic control (HbA1c. Our data sources included bibliographic databases (EMBASE, CINAHL®, Cochrane Library, Medline®, PASCAL, PsycINFO®, and Sociological Abstracts, manual reference search, and contact with study authors. Two reviewers independently selected studies that included any intervention targeting diet and/or physical activity alone or in combination as a means to reduce HbA1c in children and youth under the age of 18 with T2D. Results Our search strategy generated 4,572 citations. The majority of citations were not relevant to the study objective. One study met inclusion criteria. In this retrospective study, morbidly obese youth with T2D were treated with a very low carbohydrate diet. This single study received a quality index score of Conclusions There is no high quality evidence to suggest lifestyle modification improves either short- or long-term glycemic control in children and youth with T2D. Additional research is clearly warranted to define optimal lifestyle behaviour strategies for young people with T2D.
Shikora, Scott A; Toouli, James; Herrera, Miguel F; Kulseng, Bård; Brancatisano, Roy; Kow, Lilian; Pantoja, Juan P; Johnsen, Gjermund; Brancatisano, Anthony; Tweden, Katherine S; Knudson, Mark B; Billington, Charles J; Billingto, Charles J
One-year results of the VBLOC DM2 study found that intermittent vagal blocking (VBLOC therapy) was safe among subjects with obesity and type 2 diabetes mellitus (T2DM) and led to significant weight loss and improvements in glycemic parameters and cardiovascular risk factors. Longer-term data are needed to determine whether the results are sustained. VBLOC DM2 is a prospective, observational study of 28 subjects with T2DM and body mass index (BMI) between 30 and 40 kg/m(2) to assess mid-term safety and weight loss and improvements in glycemic parameters, and other cardiovascular risk factors with VBLOC therapy. Continuous outcome variables are reported using mixed models. At 24 months, the mean percentage of excess weight loss was 22% (95% CI, 15 to 28, p Fasting plasma glucose declined by 15 mg/dL (95% CI, 0 to 29, p = 0.0564) on average from 151 mg/dL at baseline. Among subjects who were hypertensive at baseline, systolic blood pressure declined 10 mmHg (95% CI, 2 to 19, p = 0.02), diastolic blood pressure declined by 6 mmHg (95% CI, 0 to 12, p = 0.0423), and mean arterial pressure declined 7 mmHg (95% CI, 2 to 13, p = 0.014). Waist circumference was significantly reduced by 7 cm (95% CI, 4 to 10, p obesity and glycemic control were largely sustained after 2 years of treatment with VBLOC therapy with a well-tolerated risk profile.
Full Text Available Observational studies have indicated an inverse association between vitamin D levels and the risk of diabetes, yet evidence from population interventions remains inconsistent. PubMed, EMBASE, Cochrane Library and ClinicalTrials.gov were searched up to September 2017. Data from studies regarding serum 25(OHD, fasting blood glucose (FBG, hemoglobin A1c (HbA1c, fasting insulin and homeostasis model assessment of insulin resistance (HOMA-IR were pooled. Twenty studies (n = 2703 were included in the meta-analysis. Vitamin D supplementation resulted in a significant improvement in serum 25(OHD levels (weighted mean difference (WMD = 33.98; 95%CI: 24.60–43.37 and HOMA-IR (standardized mean difference (SMD = −0.57; 95%CI: −1.09~−0.04, but not in other outcomes. However, preferred changes were observed in subgroups as follows: short-term (WMDFBG = −8.44; 95%CI: −12.72~−4.15, high dose (WMDFBG = −8.70; 95%CI: −12.96~−4.44, non-obese (SMDFasting insulin = −1.80; 95%CI: −2.66~−0.95, Middle Easterners (WMDFBG = −10.43; 95%CI: −14.80~−6.06, baseline vitamin D deficient individuals (WMDFBG = −5.77; 95%CI: −10.48~−1.05 and well-controlled HbA1c individuals (WMDFBG = −4.09; 95%CI: −15.44~7.27. Vitamin D supplementation was shown to increase serum 25(OHD and reduce insulin resistance effectively. This effect was especially prominent when vitamin D was given in large doses and for a short period of time, and to patients who were non-obese, Middle Eastern, vitamin D deficient, or with optimal glycemic control at baseline.
Clements, Mark A; Staggs, Vincent S
Many individuals with type 1 diabetes (T1D) upload and review blood glucose data between clinic visits. Mobile phone applications that receive data from a "connected" glucometer and that support pattern management are available and have the capacity to make data upload and review less burdensome. Whether mobile apps can improve diabetes self-management among individuals with type 1 diabetes remains unknown. We analyzed retrospective data on 81 youths with T1D who were trained to use a glucometer-connected mobile app in their self-management. To assess the effect of glucometer synchronization ("sync") rate on hemoglobin A1c (HbA1c), mean blood glucose (mBG), and daily frequency of SMBG, we regressed those clinical outcomes on the frequency of glucometer syncs with the mobile app after controlling for other clinical care variables. Median age was 14.0 (IQR 10.4-15.9) years, median duration of diabetes was 4.9 (2.7, 7.5) years, and median baseline HbA1c was 8.6% (7.9, 9.8). The sample was 49% male and 86% white. Youths with T1D synchronized glucometer data with the mobile app an average of 0.22 times per week (range 0-2.25). The glucometer sync rate did not have a statistically significant association with HbA1c or mean BG; in contrast, data sync frequency was associated with the frequency of self-monitoring of blood glucose (SMBG) such that each additional sync was associated with a 2.3-fold increase in SMBG frequency ( P mobile app may increase an individual's engagement with other aspects of care (eg, SMBG frequency). Whether diabetes device-connected mobile apps can improve glycemic control remains to be determined.
Koga, Masafumi; Inada, Shinya; Nakao, Taisei; Kawamori, Ryuzo; Kasayama, Soji
Glycated albumin (GA) reflects shorter-term glycemic control than HbA1c. We have reported that HbA1c is paradoxically increased in diabetic patients whose glycemic control deteriorated before ameliorating. In this study, we analyzed paradoxical increases of glycemic control indicators after treatment in patients with fulminant type 1 diabetes (FT1D). We also investigated whether the GA/HbA1c ratio may reflect shorter-term glycemic control than GA. Five FT1D patients whose post-treatment HbA1c and GA levels were measured were enrolled. We also used a formula to estimate HbA1c and GA from the fictitious models of changes in plasma glucose in FT1D patients. In this model, the periods during which HbA1c, GA, and the GA/HbA1c ratio were higher than at the first visit were compared. In addition, the half-life for the GA/HbA1c ratio was calculated in accordance with the half-lives for HbA1c and GA (36 and 14 days, respectively). In all FT1D patients, HbA1c levels 2-4 weeks after treatment were increased, with three patients (60%) experiencing an increase of GA levels. In contrast, an increase of the GA/HbA1c ratio was observed in only one patient. In all of the different models of changes in plasma glucose in FT1D patients, the length of time during which the values were higher than at the first visit was in the order of HbA1c > GA > GA/HbA1c ratio. The half-life for the GA/HbA1c ratio was 9 days, shorter than GA. These findings suggest that the GA/HbA1c ratio reflects shorter-term glycemic control than GA. © 2016 Wiley Periodicals, Inc.
Effects of a Multicomponent Life-Style Intervention on Weight, Glycemic Control, Depressive Symptoms, and Renal Function in Low-Income, Minority Patients With Type 2 Diabetes: Results of the Community Approach to Lifestyle Modification for Diabetes Randomized Controlled Trial.
Moncrieft, Ashley E; Llabre, Maria M; McCalla, Judith Rey; Gutt, Miriam; Mendez, Armando J; Gellman, Marc D; Goldberg, Ronald B; Schneiderman, Neil
Few interventions have combined life-style and psychosocial approaches in the context of Type 2 diabetes management. The purpose of this study was to determine the effect of a multicomponent behavioral intervention on weight, glycemic control, renal function, and depressive symptoms in a sample of overweight/obese adults with Type 2 diabetes and marked depressive symptoms. A sample of 111 adults with Type 2 diabetes were randomly assigned to a 1-year intervention (n = 57) or usual care (n = 54) in a parallel groups design. Primary outcomes included weight, glycosylated hemoglobin, and Beck Depression Inventory II score. Estimated glomerular filtration rate served as a secondary outcome. All measures were assessed at baseline and 6 and 12 months after randomization by assessors blind to randomization. Latent growth modeling was used to examine intervention effects on each outcome. The intervention resulted in decreased weight (mean [M] = 0.322 kg, standard error [SE] = 0.124 kg, p = .010) and glycosylated hemoglobin (M = 0.066%, SE = 0.028%, p = .017), and Beck Depression Inventory II scores (M = 1.009, SE = 0.226, p diabetes. This study is registered at Clinicaltrials.gov ID: NCT01739205.
The Impact of Patient Education on Anthropometric, Lipidemic, and Glycemic Parameters Among Patients With Poorly Controlled Type II Diabetes Mellitus: A 3-Month Prospective Single-Center Turkish Study.
Cander, Soner; Gul, Ozen Oz; Gul, Cuma B; Keles, Saadet B; Yavas, Sibel; Ersoy, Canan
This study evaluated the impact of patient education on adherence to a diabetes care plan (e.g., anthropometric, lipidemic, and glycemic parameters) among adults with type II diabetes mellitus without adequate glycemic control. A total of 61 ambulatory adults with type II diabetes mellitus (mean age: 53.6 ± 8.2 years, 70.5% female) were evaluated for anthropometrics, duration of diabetes mellitus, type of anti-diabetic treatment, blood biochemistry, and glycemic parameters in this 3-month prospective observational single-center study. During the course of the study, participants demonstrated a significant decrease in body weight and fat percentage and HbA1c (p diabetes mellitus who received education on adherence to routine self-monitoring of blood glucose, standard diabetic diet, and an exercise program delivered by certified diabetes educators had better glycemic control and significant decrease in body weight and fat percentage over a 3-month monitoring period. Copyright 2014, SLACK Incorporated.
Seligman, Hilary K; Lyles, Courtney; Marshall, Michelle B; Prendergast, Kimberly; Smith, Morgan C; Headings, Amy; Bradshaw, Georgiana; Rosenmoss, Sophie; Waxman, Elaine
Food insecurity--defined as not having adequate quantity and quality of food at all times for all household members to have an active, healthy life--is a risk factor for poor diabetes control, yet few diabetes interventions address this important factor. Food pantries, which receive food from food banks and distribute it to clients in need, may be ideal sites for diabetes self-management support because they can provide free diabetes-appropriate food to people in low-income communities. Between February 2012 and March 2014, we enrolled 687 food pantry clients with diabetes in three states in a six-month pilot intervention that provided them with diabetes-appropriate food, blood sugar monitoring, primary care referral, and self-management support. Improvements were seen in pre-post analyses of glycemic control (hemoglobin A1c decreased from 8.11 percent to 7.96 percent), fruit and vegetable intake (which increased from 2.8 to 3.1 servings per day), self-efficacy, and medication adherence. Among participants with elevated HbA1c (at least 7.5 percent) at baseline, HbA1c improved from 9.52 percent to 9.04 percent. Although food pantries are nontraditional settings for diabetes support, this pilot study suggests a promising health promotion model for vulnerable populations. Policies supporting such interventions may be particularly effective because of food pantries' food access and distribution capacity. Project HOPE—The People-to-People Health Foundation, Inc.
Wang, Li-Li; Wang, Qi; Hong, Yong; Ojo, Omorogieva; Jiang, Qing; Hou, Yun-Ying; Huang, Yu-Hua; Wang, Xiao-Hua
In China, a low-fat diet (LFD) is mainly recommended to help improve blood glucose levels in patients with type 2 diabetes mellitus (T2DM). However, a low-carbohydrate diet (LCD) has been shown to be effective in improving blood glucose levels in America and England. A few studies, primarily randomized controlled trials, have been reported in China as well. Firstly, we designed two 'six-point formula' methods, which met the requirements of LCD and LFD, respectively. Fifty-six T2DM patients were recruited and randomly allocated to the LCD group ( n = 28) and the LFD group ( n = 28). The LCD group received education about LCD's six-point formula, while the LFD group received education about LFD's six-point formula. The follow-up time was three months. The indicators for glycemic control and other metabolic parameters were collected and compared between the two groups. Forty-nine patients completed the study. The proportions of calories from three macronutrients the patients consumed met the requirements of LCD and LFD. Compared to the LFD group, there was a greater decrease in HbA1c level in the LCD group (-0.63% vs. -0.31%, p < 0.05). The dosages of insulin and fasting blood glucoses (FBG) in the third month were lower than those at baseline in both groups. Compared with baseline values, body mass index (BMI) and total cholesterol (TC) in the LCD group were significantly reduced in the third month ( p < 0.05); however, there were no statistically significant differences in the LFD group. LCD can improve blood glucose more than LFD in Chinese patients with T2DM. It can also regulate blood lipid, reduce BMI, and decrease insulin dose in patients with T2DM. In addition, the six-point formula is feasible, easily operable, and a practical educational diet for Chinese patients with T2DM.
Özcan, Behiye; Neggers, Sebastian J C M M; Miller, Anne Reifel; Yang, Hsiu-Chiung; Lucaites, Virginia; Abribat, Thierry; Allas, Soraya; Huisman, Martin; Visser, Jenny A; Themmen, Axel P N; Sijbrands, Eric J G; Delhanty, Patric J D; van der Lely, Aart Jan
The objective of this study was to assess the effects of a continuous overnight infusion of des-acyl ghrelin (DAG) on acylated ghrelin (AG) levels and glucose and insulin responses to a standard breakfast meal (SBM) in eight overweight patients with type 2 diabetes. Furthermore, in the same patients and two additional subjects, the effects of DAG infusion on AG concentrations and insulin sensitivity during a hyperinsulinemic-euglycemic clamp (HEC) were assessed. A double-blind, placebo-controlled cross-over study design was implemented, using overnight continuous infusions of 3 and 10 μg DAG/kg per h and placebo to study the effects on a SBM. During a HEC, we studied the insulin sensitivity. We observed that, compared with placebo, overnight DAG administration significantly decreased postprandial glucose levels, both during continuous glucose monitoring and at peak serum glucose levels. The degree of improvement in glycemia was correlated with baseline plasma AG concentrations. Concurrently, DAG infusion significantly decreased fasting and postprandial AG levels. During the HEC, 2.5 h of DAG infusion markedly decreased AG levels, and the M-index, a measure of insulin sensitivity, was significantly improved in the six subjects in whom we were able to attain steady-state euglycemia. DAG administration was not accompanied by many side effects when compared with placebo. DAG administration improves glycemic control in obese subjects with type 2 diabetes through the suppression of AG levels. DAG is a good candidate for the development of compounds in the treatment of metabolic disorders or other conditions with a disturbed AG:DAG ratio, such as type 2 diabetes mellitus or Prader-Willi syndrome. © 2014 European Society of Endocrinology.
Carneiro, Vera Lúcia; Fraiz, Fabian Calixto; Ferreira, Fernanda de Morais; Pintarelli, Tatiana Pegoretti; Oliveira, Ana Cristina Borges; Boguszewski, Margaret Cristina da Silva
To evaluate the influence of disease control, expressed by the mean values of glycated hemoglobin (HbA1c), in the oral health of children and adolescents with diabetes mellitus type 1 (T1DM). A cross sectional study involving 87 children and adolescents (59 girls), 10 ± 2.6 years old. The participants were divided into three groups: HbA1c ≤ 8%, 8% 10%. The duration of the disease, age and average HbA1c were obtained from their medical records. Oral health was evaluated according to the following indexes: Simplified Oral Hygiene Index (OHI-S); Community Periodontal Index (CPI); Decayed, Missing or Filled Teeth Index (DMFT/dmft) for permanent and deciduous teeth; and the stimulated salivary flow rate (SSFR). The median SSFR was 1.1 mL/min in the group with HbA1c ≤ 8%, 0.7 mL/min in the intermediary group and 0.6 mL/min in the HbA1c > 10% group. A significant decrease in salivary flow was observed with an increase in HbA1c (p = 0.007). The DMFT/dmft and CPI indexes were higher in individuals with higher HbA1c values. More caries-free individuals were found in the group with HbA1c ≤ 8% compared to those with HbA1c > 10%. The group with HbA1c > 10% exhibited more caries and bleeding gums than the other groups. HbA1c values in girls were higher than in boys. Children and adolescents with unsatisfactory glycemic control, represented by higher HbA1c concentrations, exhibited a higher frequency of caries and gingivitis, and a reduction in salivary flow.
Full Text Available Objective. This trial aims to examine the effects of a Probiotic Mixture (VSL#3 on glycemic status and inflammatory markers, in women with GDM. Materials and Methods. Over a period of 8 weeks, 82 women with gestational diabetes were randomly assigned to either an intervention group (n=41 which were given VSL#3 capsule or to a control group which were given placebo capsule (n=41. Fasting plasma glucose, homeostatic model assessment of insulin resistance, glycosylated hemoglobin, high-sensitivity C-reactive protein, tumor necrosis factor-α, interleukin-6, Interferon gamma, and interleukin-10 were measured before and after the intervention. Results. After 8 wk of supplementation FPG, HbA1c, HOMA-IR, and insulin levels remained unchanged in the probiotic and placebo groups. The comparison between the two groups showed no significant differences with FPG and HbA1c, but there were significant differences in insulin levels and HOMA-IR (16.6±5.9; 3.7±1.5, resp.. Unlike the levels of IFN-g (19.21±16.6, there was a significant decrease in levels of IL-6 (3.81±0.7, TNF-α (3.10±1.1, and hs-CRP (4927.4±924.6. No significant increase was observed in IL-10 (3.11±5.7 in the intervention group as compared with the control group. Conclusions. In women with GDM, supplementation with probiotics (VSL#3 may help to modulate some inflammatory markers and may have benefits on glycemic control.
Wagner, Julie; Heapy, Alicia; James, Amy; Abbott, Gina
To investigate the relationships among perceived school experiences, diabetes control, and quality of life (QOL) in children with diabetes. Fifty-eight children with type 1 diabetes and their parents participated. The typical child was 12 years old, had diabetes for 5 years, and attended public, suburban, middle/junior high schools with 300-500 students. Children whose parents reported that school personnel received diabetes training showed significantly better diabetes control than those who reported untrained school personnel. Children who reported their classmates received diabetes training had significantly better QOL than those who reported untrained classmates. Children who reported greater flexibility in performing diabetes care tasks at school had significantly better diabetes control than children who reported less flexibility. Students with diabetes continue to face challenges at school. Training staff and classmates and allowing students the maximum appropriate flexibility in diabetes care appears beneficial for disease control and QOL.
Sun, Ke-xin; Liu, Zhi-ke; Cao, Ya-ying; Juan, Juan; Xiang, Xiao; Yang, Cheng; Huang, Shao-ping; Liu, Xiao-fen; Li, Na; Tang, Xun; Li, Jin; Wu, Tao; Chen, Da-fang; Hu, Yong-hua
To explore the correlation between glycemic control of type 2 diabetes mellitus (T2DM) patients and brachial-ankle pulse velocity (baPWV). A community-based cross-sectional study was conducted in Beijing, China. Every subject underwent physical examinations, glycated hemoglobin (HbA1c), blood lipid and baPWV measurements and completed a standardized questionnaire. T2DM patients were divided into well controlled and poorly controlled groups according to HbA1c levels. The correlation between glycemic control of T2DM patients and baPWV was analyzed. In this study, 1 341 subjects were recruited, including 733 T2DM patients and 608 non-diabetes subjects. Compared with non-diabetes subjects, abnormal baPWV (baPWV≥1 700 cm/s) rate for T2DM patients was higher (40.8% vs. 26.8%, Pcontrol in T2DM patients, the abnormal baPWV rates for non-diabetes subjects, well controlled and poorly controlled T2DM patients were significantly different (non-diabetes vs. HbA1ccontrol status of T2DM patients was associated with abnormal baPWV. Compared with non-diabetes subjects, the ORs for abnormal baPWV in HbA1ccontrol status of T2DM patients from communities is significantly associated with baPWV. Poor glycemic control is a risk factor for abnormal baPWV. Keeping HbA1c under control might lower the risk of cardiovascular diseases in T2DM patients.
Karges, Beate; Schwandt, Anke; Heidtmann, Bettina; Kordonouri, Olga; Binder, Elisabeth; Schierloh, Ulrike; Boettcher, Claudia; Kapellen, Thomas; Rosenbauer, Joachim; Holl, Reinhard W
Insulin pump therapy may improve metabolic control in young patients with type 1 diabetes, but the association with short-term diabetes complications is unclear. To determine whether rates of severe hypoglycemia and diabetic ketoacidosis are lower with insulin pump therapy compared with insulin injection therapy in children, adolescents, and young adults with type 1 diabetes. Population-based cohort study conducted between January 2011 and December 2015 in 446 diabetes centers participating in the Diabetes Prospective Follow-up Initiative in Germany, Austria, and Luxembourg. Patients with type 1 diabetes younger than 20 years and diabetes duration of more than 1 year were identified. Propensity score matching and inverse probability of treatment weighting analyses with age, sex, diabetes duration, migration background (defined as place of birth outside of Germany or Austria), body mass index, and glycated hemoglobin as covariates were used to account for relevant confounders. Type 1 diabetes treated with insulin pump therapy or with multiple (≥4) daily insulin injections. Primary outcomes were rates of severe hypoglycemia and diabetic ketoacidosis during the most recent treatment year. Secondary outcomes included glycated hemoglobin levels, insulin dose, and body mass index. Of 30 579 patients (mean age, 14.1 years [SD, 4.0]; 53% male), 14 119 used pump therapy (median duration, 3.7 years) and 16 460 used insulin injections (median duration, 3.6 years). Patients using pump therapy (n = 9814) were matched with 9814 patients using injection therapy. Pump therapy, compared with injection therapy, was associated with lower rates of severe hypoglycemia (9.55 vs 13.97 per 100 patient-years; difference, -4.42 [95% CI, -6.15 to -2.69]; P young patients with type 1 diabetes, insulin pump therapy, compared with insulin injection therapy, was associated with lower risks of severe hypoglycemia and diabetic ketoacidosis and with better glycemic control during the
Khan, D.A.; Saeed, M.; Khan, F.A.
Glycaemic control is critical for managing diabetes and related complications. Considering high prevalence of Diabetes in Pakistan, our study aimed to assess the status of glycaemic control in Type-II Diabetics by measurement of HbA1c from 2005-2007 at Rawalpindi. We also evaluated changes in its trends in relation with sex and age. It was a retrospective analysis of data from Clinical Pathology Laboratory, Army Medical College, Rawalpindi during 2005-2007. A total of 2875 patients, aged 24-70 years, taking oral hypoglycaemic agents, were included. HbA1c was measured by using Human kit. International Diabetes Federation guidelines, 6.5%, 6.6%-8.4% and 8.5% were used to classify patients into good, fair and poor control categories. The number of patients (n=2875) tested for HbAlc increased from 904,974 to 997 during 2005-2007. The patients had an age of 48+-13 years and comprised of 54% males and 46% females. Improvement in patient's glycaemic control among the three categories during 2005 to 2007 was as follows: good (41% vs. 47%), fair (38% vs. 40%) and poor (21% vs. 13%) respectively. The average HbA1c values improved from 7.25 % in 2005 to 6.69% in 2007 (p<0.05). Overall, males (45%) and youngest age group (53%) patients had good diabetic control. Glycaemic control improved in diabetic patients from 41% to 47% during 2005-2007 at Rawalpindi. Males, especially the youngest patients comprised majority of good control population. For effective disease management and optimal HbA1c values, a combined effort by the patient and physician is required. (author)
Distiller, Larry A; Cranston, Iain; Mazze, Roger
In 2014, an innovative blinded continuous glucose monitoring system was introduced with automated ambulatory glucose profile (AGP) reporting. The clinical use and interpretation of this new technology has not previously been described. Therefore we wanted to understand its use in characterizing key factors related to glycemic control: glucose exposure, variability, and stability, and risk of hypoglycemia in clinical practice. Clinicians representing affiliated diabetes centers throughout South Africa were trained and subsequently were given flash glucose monitoring readers and 2-week glucose sensors to use at their discretion. After patient use, sensor data were collected and uploaded for AGP reporting. Complete data (sensor AGP with corresponding clinical information) were obtained for 50 patients with type 1 (70%) and type 2 diabetes (30%), irrespective of therapy. Aggregated analysis of AGP data comparing patients with type 1 versus type 2 diabetes, revealed that despite similar HbA1c values between both groups (8.4 ± 2 vs 8.6 ± 1.7%, respectively), those with type 2 diabetes had lower mean glucose levels (9.2 ± 3 vs 10.3 mmol/l [166 ± 54 vs 185 mg/dl]) and lower indices of glucose variability (3.0 ± 1.5 vs 5.0 ± 1.9 mmol/l [54 ± 27 vs 90 ± 34.2 mg/dl]). This highlights key areas for future focus. Using AGP, the characteristics of glucose exposure, variability, stability, and hypoglycemia risk and occurrence were obtained within a short time and with minimal provider and patient input. In a survey at the time of the follow-up visit, clinicians indicated that aggregated AGP data analysis provided important new clinical information and insights. © 2016 Diabetes Technology Society.
Full Text Available Hydrogen (H(2 acts as a therapeutic antioxidant. However, there are few reports on H(2 function in other capacities in diabetes mellitus (DM. Therefore, in this study, we investigated the role of H(2 in glucose transport by studying cultured mouse C2C12 cells and human hepatoma Hep-G2 cells in vitro, in addition to three types of diabetic mice [Streptozotocin (STZ-induced type 1 diabetic mice, high-fat diet-induced type 2 diabetic mice, and genetically diabetic db/db mice] in vivo. The results show that H(2 promoted 2-[(14C]-deoxy-d-glucose (2-DG uptake into C2C12 cells via the translocation of glucose transporter Glut4 through activation of phosphatidylinositol-3-OH kinase (PI3K, protein kinase C (PKC, and AMP-activated protein kinase (AMPK, although it did not stimulate the translocation of Glut2 in Hep G2 cells. H(2 significantly increased skeletal muscle membrane Glut4 expression and markedly improved glycemic control in STZ-induced type 1 diabetic mice after chronic intraperitoneal (i.p. and oral (p.o. administration. However, long-term p.o. administration of H(2 had least effect on the obese and non-insulin-dependent type 2 diabetes mouse models. Our study demonstrates that H(2 exerts metabolic effects similar to those of insulin and may be a novel therapeutic alternative to insulin in type 1 diabetes mellitus that can be administered orally.
Full Text Available Background. An active device that downregulates abdominal vagal signalling has resulted in significant weight loss in feasibility studies. Objective. To prospectively evaluate the effect of intermittent vagal blocking (VBLOC on weight loss, glycemic control, and blood pressure (BP in obese subjects with DM2. Methods. Twenty-eight subjects were implanted with a VBLOC device (Maestro Rechargeable System at 5 centers in an open-label study. Effects on weight loss, HbA1c, fasting blood glucose, and BP were evaluated at 1 week to 12 months. Results. 26 subjects (17 females/9 males, 51±2 years, BMI 37±1 kg/m2, mean ± SEM completed 12 months followup. One serious adverse event (pain at implant site was easily resolved. At 1 week and 12 months, mean excess weight loss percentages (% EWL were 9±1% and 25±4% (P<0.0001, and HbA1c declined by 0.3±0.1% and 1.0±0.2% (P=0.02, baseline 7.8±0.2%. In DM2 subjects with elevated BP (n=15, mean arterial pressure reduced by 7±3 mmHg and 8±3 mmHg (P=0.04, baseline 100 ± 2 mmHg at 1 week and 12 months. All subjects MAP decreased by 3 ± 2 mmHg (baseline 95 ± 2 mmHg at 12 months. Conclusions. VBLOC was safe in obese DM2 subjects and associated with meaningful weight loss, early and sustained improvements in HbA1c, and reductions in BP in hypertensive DM2 subjects. This trial is registered with ClinicalTrials.gov NCT00555958.
Orange pomace (OP), a fiber-rich byproduct of juice production, has the potential for being formulated into a variety of food products. We hypothesized that OP would diminish postprandial glycemic responses to a high carbohydrate/fat breakfast and lunch. We conducted an acute, randomized, placebo-co...
Holmes-Walker, Deborah Jane; Gunton, Jenny E; Hawthorne, Wayne; Payk, Marlene; Anderson, Patricia; Donath, Susan; Loudovaris, Tom; Ward, Glenn M; Kay, Thomas Wh; OʼConnell, Philip J
The aim was to compare efficacy of multiple daily injections (MDI), continuous subcutaneous insulin infusion (CSII) and islet transplantation to reduce hypoglycemia and glycemic variability in type 1 diabetes subjects with severe hypoglycemia. This was a within-subject, paired comparison of MDI and CSII and CSII with 12 months postislet transplantation in 10 type 1 diabetes subjects referred with severe hypoglycemia, suitable for islet transplantation. Individuals were assessed with HbA1c, Edmonton Hypoglycemia Score (HYPOscore), continuous glucose monitoring (CGM) and in 8 subjects measurements of glucose variability using standard deviation of glucose (SD glucose) from CGM and continuous overlapping net glycemic action using a 4 hour interval (CONGA4). After changing from MDI to CSII before transplantation, 10 subjects reduced median HYPOscore from 2028 to 1085 (P transplantation, there were significant reductions in all baseline parameters versus CSII, respectively, HbA1c (6.4% cf 8.2%), median HYPOscore (0 cf 1085), mean glucose (7.1 cf 8.6 mmol L), SD glucose (1.7 cf 3.2 mmol/L), and CONGA4 (1.6 cf 3.0). In subjects with severe hypoglycemia suitable for islet transplantation, CSII decreased hypoglycemia frequency and glycemic variability compared with MDI whereas islet transplantation resolved hypoglycemia and further improved glycemic variability regardless of insulin independence.
Full Text Available Interval-type exercise is effective for improving glycemic control, but the optimal approach is unknown. The purpose of this study was to determine the importance of the interval length on changes in postprandial glycemic control following a single exercise bout. Twelve subjects with type 2 diabetes completed a cross-over study with three 1-hour interventions performed in a non-randomized but counter-balanced order: 1 Interval walking consisting of repeated cycles of 3 min slow (aiming for 54% of Peak oxygen consumption rate [VO2peak] and 3 min fast (aiming for 89% of VO2peak walking (IW3; 2 Interval walking consisting of repeated cycles of 1 min slow and 1 min fast walking (IW1 and 3 No walking (CON. The exercise interventions were matched with regards to walking speed, and VO2 and heart rate was assessed throughout all interventions. A 4-hour liquid mixed meal tolerance test commenced 30 min after each intervention, with blood samples taken regularly. IW3 and IW1 resulted in comparable mean VO2 and heart rates. Overall mean postprandial blood glucose levels were lower after IW3 compared to CON (10.3±3.0 vs. 11.1±3.3 mmol/L; P 0.05 for both. Conversely blood glucose levels at specific time points during the MMTT differed significantly following both IW3 and IW1 as compared to CON. Our findings support the previously found blood glucose lowering effect of IW3 and suggest that reducing the interval length, while keeping the walking speed and time spend on fast and slow walking constant, does not result in additional improvements.ClinicalTrials.gov NCT02257190.
Full Text Available Objective: The aim of the study was to evaluate periodontal health status in patients diagnosed with type 1 diabetes mellitus (DM1 and to establish a correlation between metabolic control and periodontal health status. Materials and Methods: Periodontal health parameters namely plaque index (PI, gingival index (GI, probing pocket depth (PPD and clinical attachment loss (CAL were recorded in 28 patients diagnosed with type 1 diabetes mellitus (DM1 and 20 healthy controls. Diabetes history was recorded based on the information provided by the physician and it included date of diagnosis, duration, age of diagnosis, latest values of glycosylated haemoglobin and existing diabetic complications. Statistical analysis was performed to evaluate the relationship between periodontal parameters and degree of metabolic control, the duration of the disease and the appearance of complications. Results: The periodontal health in the diabetic group was compromised and they had greater bleeding index (P < 0.001, probing pocket depth (P < 0.001 and clinical attachment level (P = 0.001. Patients diagnosed for diabetes for shorter duration of time (4-7 years showed bleeding index-disease severity correlation to be 1.760 0.434. Conclusion: Periodontal disease was more evident in type 1 diabetes mellitus patients and periodontal inflammation is greatly increased in subjects with longer disease course, poor metabolic control and diabetic complications.
Short-term effects of a hypocaloric diet with low glycemic index and low glycemic load on body adiposity, metabolic variables, ghrelin, leptin, and pregnancy rate in overweight and obese infertile women: a randomized controlled trial.
Becker, Geórgia F; Passos, Eduardo P; Moulin, Cileide C
Obesity is related to hormonal disorders that affect the reproductive system. Low-glycemic index (LGI) diets seem to exert a positive effect on weight loss and on metabolic changes that result from obesity. We investigated the effects of a hypocaloric diet with an LGI and low glycemic load on anthropometric and metabolic variables, ghrelin and leptin concentrations, and the pregnancy rate in overweight and obese infertile women who were undergoing in vitro fertilization (IVF). The study was a randomized block-design controlled trial in which we analyzed 26 overweight or obese infertile women. Patients were assigned to a hypocaloric LGI-diet group or a control group and followed the protocol for 12 wk. Body weight, body mass index (BMI), percentage of body fat, glucose, insulin, homeostasis model assessment of insulin resistance, serum lipids, reproductive hormones, leptin, acylated ghrelin, number of oocytes retrieved in the IVF cycle, and pregnancy rate were determined. There were greater reductions in body mass, BMI, percentage of body fat, waist:hip ratio, and leptin in the LGI-diet group than in the control group (P diet group had 85.4% more oocytes retrieved than did the control group (7.75 ± 1.44 and 4.18 ± 0.87, respectively; P = 0.039) in the IVF cycle. Three patients (21.4%) in the LGI group experienced a spontaneous pregnancy during the follow-up, which generated 3 live births. The hypocaloric LGI diet promoted a decrease in BMI, percentage of body fat, and leptin concentrations, which improved oocyte development and pregnancy rate. These results support the clinical recommendation to advise overweight and obese women to lose weight through a balanced diet before being submitted for treatment with assisted reproduction technologies. A hypocaloric diet combined with LGI foods seems to be beneficial for these patients, but additional studies are required before this treatment is recommended. This trial was registered at clinicaltrials.gov as NCT02416960
Gadjeva, Veselina Georgieva; Goycheva, Petia; Nikolova, Galina; Zheleva, Antoaneta
The pathology of diabetes is associated with several mechanisms, one of which is oxidative stress (OS). The relationship between OS and diabetic complications has been extensively investigated. OS has been suggested to be involved in the genesis of both macroand microangiopathy. In contrast, the relationship between OS and insulin action is a neglected research area. The aim of this study is to elucidate the effect of glycemic control in type 2 diabetic patients by following the serum levels of some real-time oxidative stress biomarkers. The study group consisted of 53 type 2 diabetic patients (31 with poor glycemic control and 22 with good glycemic control) and 24 healthy control subjects. The oxidative stress biomarkers (ROS, Asc• and •NO) were measured by using electron paramagnetic resonance spectroscopy (EPR) methods and compared with clinical parameters. The statistically significantly higher levels of ROS products and •NO in type 2 diabetic patients in both groups compared to controls mean that the oxidation processes take place at the time the survey is performed. Free radical overproduction persists after the normalization of the glucose levels, and oxidative stress may be involved in the "metabolic memory" effect. This is confirmed by the positive correlation between ROS levels/•NO and average blood glucose levels, triglycerides, and total cholesterol. Furthermore, the low level of the ascorbate radical in both diabetes groups compared to controls confirmed an increase in oxidation processes. Higher levels of real-time biomarkers show that intensive insulin treatment does not lead to the expected decrease in oxidative processes involving ROS and •NO, probably due to "metabolic memory".
Full Text Available BACKGROUND: Diabetes Mellitus (DM refers to a group of common metabolic disorders that share the phenotype of hyperglycemia. It is the leading cause of of end stage renal disease, non-traumatic limb amputation and adult blindness. The studies have shown that complications of DM can be prevented by the proper control of blood glucose, which is dependent on the patient’s adherence to medication, life style modification, frequent monitoring of blood glucose etc. and can be influenced by proper education and counseling of the patient. The patients with DM should receive education about exercise, care of DM during illness and medications to lower plasma glucose1 . This study aims to assess the impact of patients counseling on the medication adherence in type 2DM. METHOD: This is a prospective randomized study that includes 100 patients with type 2 DM in the out-patient department of internal medicine in a tertiary care teaching hospital, north Kerala. After getting informed consent, they were kept in two groups by simple randomization technique and were assessed and followed at 4 weeks interval. Data related to the medication adherence was collected using Morisky Medication Adherence Scale questionnaire (MMAS-8. RESULTS: Out of 100 patients 33% were male and 67% female. Both baseline and 1st follow up showed a low adherence value (<6 both in control and intervention group. In the second follow up most of the patients in intervention group showed a moderate adherence (6-8, whereas control group did not show any improvement. CONCLUSION: It can be concluded that there is a stastically significant improvement in the adherence level after patient counseling and education. Knowledge about the disease and treatment has improved the patient’s adherence to medication.
Full Text Available The paper considers the questions of diagnostics of diabetes mellitus (DM and early violations of carbohydrate metabolism. Venous plasma was underlined to be the only commonly accepted standard for blood glucose determination for prediabetes and diabetes mellitus diagnosis. In the third world countries (including Ukraine peripheral (capillary plasma of blood can be used for self-control and diagnostics of prediabetes and DM as their fasting values correspond to those of venous plasma and do not require revaluation. While using portable glucometers for carbohydrate violations diagnostics postprandial glucose value and after meal should be estimated in conversion. Normoglycemia is glucose concentration in venous plasma from 3.9 mmol/l (ADA criteria to 6.0 mmol/l (WHO criteria.
Jafari, Tina; Faghihimani, Elham; Feizi, Awat; Iraj, Bijan; Javanmard, Shaghayegh Haghjooy; Esmaillzadeh, Ahmad; Fallah, Aziz A; Askari, Gholamreza
Low levels of serum 25-hydroxy vitamin D (25(OH)D) are common in type 2 diabetic patients and cause several complications particularly, in postmenopausal women due to their senile and physiological conditions. This study aimed to assess the effects of vitamin D-fortified low fat yogurt on glycemic status, anthropometric indexes, inflammation, and bone turnover in diabetic postmenopausal women. In a randomized, placebo-controlled, double-blind parallel-group clinical trial, 59 postmenopausal women with type 2 diabetes received fortified yogurt (FY; 2000 IU vitamin D in 100 g/day) or plain yogurt (PY) for 12 weeks. Glycemic markers, anthropometric indexes, inflammatory, and bone turnover markers were assessed at baseline and after 12 weeks. After intervention, in FY group (vs PY group), were observed: significant increase in serum 25(OH)D and decrease of PTH (stable values in PY); significant improvement in serum fasting insulin, HOMA-IR, HOMA-B, QUICKI, and no changes in serum fasting glucose and HbA1c (significant worsening of all indexes in PY); significant improvement in WC, WHR, FM, and no change in weight and BMI (stable values in PY); significant increase of omentin (stable in PY) and decrease of sNTX (significant increase in PY). Final values of glycemic markers (except HbA1c), omentin, and bone turnover markers significantly improved in FY group compared to PY group. Regarding final values of serum 25(OH)D in FY group, subjects were classified in insufficient and sufficient categories. Glycemic status improved more significantly in the insufficient rather than sufficient category; whereas the other parameters had more amelioration in the sufficient category. Daily consumption of 2000 IU vitamin D-fortified yogurt for 12 weeks improved glycemic markers (except HbA1c), anthropometric indexes, inflammation, and bone turnover markers in postmenopausal women with type 2 diabetes. www.irct.ir (IRCT2013110515294N1). Copyright © 2015 Elsevier Ltd and European
Joseph El Youssef
intermittent blood glucose data. In addition, it is important to acknowledge that an “automated” closed loop pancreas cannot approach the complexity of the normal human endocrine pancreas, which takes continuous data from substrates, hormones, paracrine compounds and autonomic neural inputs, and in response, secretes four hormones. Another major issue is the substantial absorption/action delay of insulin given by the subcutaneous route. Because of this delay, some researchers have recently given a portion of the meal-related insulin in an open loop manner before the meal and found this hybrid approach to be superior to closed loop control. Proportional-Integral-Derivative (PID systems adapted from the industrial sector utilize control algorithms that alter output based on proportional (difference between actual and target levels, derivative (rate of change and integral (time-related summative errors in glucose. These algorithms have proven to be very promising in limited clinical trials. Related algorithms include a “fading memory” system that combines the proportional-derivative components of a classic PID system with time-relating decay of input signals that allow greater emphasis on more recent glucose values, a characteristic noted in mammalian beta-cells. Model Predictive Control (MPC systems are highly adaptive methods that utilize mathematical models based on observations of biological behavior patterns using system identification and are now undergoing testing in humans. The application of further mathematical models, such as fuzzy control and artificial neural networks, are also promising, but are largely clinically untested. In summary, the prospects for closed loop control of glycemia in persons with diabetes have improved considerably. Major limitations include the delayed absorption/action of subcutaneous insulin and the imperfect stability of currently-available continuous glucose sensors. The potential for improved glycemic control in persons with
Full Text Available Green tea or green tea extract (GT/GTE has been demonstrated to reduce insulin resistance and improve glycemic control. However, evidence for this health beneficial effect is inconsistent. This systematic review evaluated the effect of GT/GTE on insulin resistance and glycemic control in people with pre-diabetes/type 2 diabetes mellitus (T2DM. Ovid MEDLINE, Embase, AMED, Web of Science, and the Cochrane Library were searched up to April 2017 for randomised controlled trials of participants with pre-diabetes or T2DM, where the intervention was GT/GTE. Meta-analysis was performed to assess the standardised mean difference (SMD in biomarkers of insulin resistance and glycemic control between GT/GTE and placebo groups. Six studies (n=382 were pooled into random-effects meta-analysis. Overall, no differences were found between GT/GTE and the placebo for glycosylated hemoglobin (HbA1c: SMD, −0.32; 95% confidence interval [CI], −0.86 to 0.23, homeostatic model assessment for insulin resistance (HOMA-IR: SMD, 0.10; 95% CI, −0.17 to 0.38, fasting insulin (SMD, −0.25; 95% CI, −0.64 to 0.15, and fasting glucose (SMD, −0.10; 95% CI, −0.50 to 0.30. No evidence support the consumption of GT/GTE could reduce the levels of HbA1c, HOMA-IR, fasting insulin, or fasting glucose in people with pre-diabetes/T2DM. However, the studies included were small and of varying quality.
Full Text Available Background: Type 2 diabetes mellitus, as a noncommunicable disease, is the main public health challenge in the 21st century. The prevalence of di¬abetes mellitus adjusted for the world population in Iran was 8% until the year 2010. Lipid levels are considered as important parameters to be eva¬luated, as high serum lipid levels are often reported as a complication in patients with diabetes mellitus. It is claimed that functional foods may im¬prove complications of diabetes mellitus, so this study was designed to evaluate the effects of high performance inulin on glycemic status and lipid profile of women with type 2 diabetes.Methods: The study was a randomized controlled clinical trial. Forty-nine type 2 diabetic females (fiber intake <30g/d, 25
Contreras, Sonia; Vargas-Ojeda, Adriana; Menchaca-Díaz, Rufino; Fortmann, Addie; Philis-Tsimikas, Athena
Abstract Background: The global epidemic of diabetes calls for innovative interventions. This study evaluated the effectiveness of the Project Dulce model, with and without wireless technology, on glycemic control and other clinical and self-reported outcomes in patients with poorly controlled type 2 diabetes in Mexico. Subjects and Methods: Adults with type 2 diabetes and a glycated hemoglobin A1c (HbA1c) level of ≥8% were recruited from Family Medical Unit #27 of the Instituto Mexicano del Seguro Social (IMSS) in Tijuana, México, and randomly assigned to one of three groups: Project Dulce–only (PD); Project Dulce technology-enhanced with mobile tools (PD-TE); or IMSS standard of care/control group (CG). Clinical and self-reported outcomes were assessed at baseline, Month 4, and Month 10. Time-by-group interactions and within-group changes were analyzed. Results: HbA1c reductions from baseline to Month 10 were significantly greater in PD-TE (−3.0% [−33 mmol/mol]) and PD (−2.6% [−28.7 mmol/mol]) compared with CG (−1.3% [−14.2 mmol/mol]) (P = 0.009 and 0.001, respectively). PD-TE and PD also exhibited significant improvement in diabetes knowledge when compared with CG (P diabetes knowledge in high-risk patients with type 2 diabetes in a Mexican family medical unit, suggesting that integrating peer-led education, nurse coordination, and 3G wireless technology is an effective approach for improving diabetes outcomes in high-risk populations. PMID:26914371
A P Sawant
Full Text Available Aims & Objectives: 1.To study the time course of plasma glucose, in gestational diabetic and normal pregnant women. 2.To compare maternal outcome and fetal outcome in gestational diabetic and normal pregnant women. Materials and Methods: Five hundred pregnant individuals visiting the Antenatal Clinic of Rural Medical College, Loni in either half of the gestation were screened and gestational diabetes mellitus was diagnosed according to the WHO criteria. Results: The scope of diabetes and pregnancy encompasses not only diabetics marching through pregnancy but also, any form of abnormal glucose tolerance developing during gestation, termed as gestational diabetes, abnormal glucose tolerance of any etiology recognized or unrecognized starting before pregnancy or revealed during pregnancy, is associated with a high risk of a poor maternal and fetal outcomes. In our study we found a significantly higher incidence of caesarean section in-patients with GDM when compared with the normal group (67% versus 25%, P <0.001. In GDM cases, we observed fetal macrosomia, high birth weight etc. Naturally these are the factors, which add to the pre-existing unfavourable maternal factors affecting the process of labour adversely. We observed a significant difference in the incidence of preterm labour in between the GDM and non-GDM groups (22% Vs 13%, p<0.05. These individuals underwent a process of preterm labour at a gestational age of 32+3 weeks. Hyperglycemia and polyhydramnios are held responsible for preterm labour. The incidence rate of PIH was more in subjects with GDM as compared to the other group. However this difference failed to prove statistically significant at 5% level of significance. Though we did not get a significant difference in occurrence of PIH in between the GDM and non-GDM groups, we do agree with the comment that hyperglycemia earlier in the pregnancy is associated with greater incidence of PIH as three of the four cases who were diagnosed
insignificant (P=0.069, 0.376, 0.058, respectively. FI decreased by 22%, HOMA-IR by 27.6%, and c-peptide by 1.83%. Total cholesterol, low-density lipoprotein cholesterol, parathyroid hormone, alkaline phosphatase, serum creatinine, and pulse rate significantly decreased (4.3±0.9 vs 4.0±0.9 mmol/L, P=0.036; 2.5±0.8 vs 2.2±0.8 mmol/L, P=0.018; 4.6±2.1 vs 3.5±1.8 pmol/L, P=0.001; 82.1±26.2 vs 66.2±19.5 U/L, P<0.001; 74.6±15.6 vs 70.7±14.7 µmol/L, P=0.047; and 81.6±11.9 vs 77.5±12.0 bpm, P=0.045, respectively. Triglycerides and high-density lipoprotein cholesterol, both systolic and diastolic BP, and BMI did not show significant change.Conclusion: Cholecalciferol helps improve blood glucose control and cholesterol profile in vitamin D3-deficient type 2 diabetic patients. Keywords: vitamin D, type 2 diabetes, HbA1c, cholesterol, creatinine, parathyroid hormone
Azimi, Paria; Ghiasvand, Reza; Feizi, Awat; Hariri, Mitra; Abbasi, Behnoud
Type 2 diabetes (T2D) may be caused by elevated oxidative stress, inflammation, and hyperglycemia. The phytochemicals in several herbal medicines are reported to effectively improve diabetes and to ameliorate diabetic complications. The aim of the present study was to determine the effects of cinnamon, cardamom, saffron, and ginger as supplementary remedies in T2D. This randomized controlled, clinical trial included 204 T2D patients. The participants were randomly assigned to four intervention groups receiving 3 glasses of black tea and either 3 g cardamom, or cinnamon, or ginger, or 1 g saffron and one control group which consumed only 3 tea glasses without any herbal medicine for 8 weeks. Markers of inflammation, oxidative stress, fasting blood sugar, lipid profile, and anthropometric measures were evaluated at baseline and after 8 weeks of intervention. After 8 weeks of intervention, cinnamon, cardamom, ginger, and saffron consumption had significant effects on total cholesterol, LDL, and HDL levels (p < 0.05) compared with controls. However, the herbal products did not have significant effects on measures of glycemic control, anthropometry, inflammation, and oxidative stress. In within-group comparisons only, cinnamon intake significantly decreased fasting blood sugar (FBS). The herbal remedies examined had significantly beneficial effects on cholesterol, but not on measures of glycemic control, oxidative stress, and inflammation. Based on the contradictory results reported in the literature, the effects of herbal medicine in diabetic patients should undergo further detailed investigation.
Yin, Junmei; Yeung, Roseanne; Luk, Andrea; Tutino, Greg; Zhang, Yuying; Kong, Alice; Chung, Harriet; Wong, Rebecca; Ozaki, Risa; Ma, Ronald; Tsang, Chiu-Chi; Tong, Peter; So, Wingyee; Chan, Juliana
Factors associated with persistent poor glycemic control were explored in patients with type 2 diabetes under the Joint Asia Diabetes Evaluation (JADE) program. Chinese adults enrolled in JADE with HbA1c ≥8% at initial comprehensive assessment (CA1) and repeat assessment were analyzed. The improved group was defined as those with a ≥1% absolute reduction in HbA1c, and the unimproved group was those with patients with HbA1c ≥8% at baseline, 1450 underwent repeat CA. After a median interval of 1.7 years (interquartile range[IQR] 1.1-2.2) between CA1 and CA2, the unimproved group (n = 677) had a mean 0.4% (95% confidence interval [CI] 0.3%, 0.5%) increase in HbA1c compared with a mean 2.8% reduction (95% CI -2.9, -2.6%) in the improved group (n = 773). The unimproved group had a female preponderance with lower education level, and was more likely to be insulin treated. Patients in the improved group received more diabetes education between CAs with improved self-care behaviors, whereas the unimproved group had worsening of health-related quality of life at CA2. Apart from female gender, long disease duration, low educational level, obesity, retinopathy, history of hypoglycemia, and insulin use, lack of education from diabetes nurses between CAs had the strongest association for persistent poor glycemic control. These results highlight the multidimensional nature of glycemic control, and the importance of diabetes education and optimizing diabetes care by considering psychosocial factors. © 2015 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.
Kendzor, Darla E; Chen, Minxing; Reininger, Belinda M; Businelle, Michael S; Stewart, Diana W; Fisher-Hoch, Susan P; Rentfro, Anne R; Wetter, David W; McCormick, Joseph B
The prevalence of diabetes is alarmingly high among Mexican American adults residing near the U.S.-Mexico border. Depression is also common among Mexican Americans with diabetes, and may have a negative influence on diabetes management. Thus, the purpose of the current study was to evaluate the associations of depression and anxiety with the behavioral management of diabetes and glycemic control among Mexican American adults living near the border. The characteristics of Mexican Americans with diabetes living in Brownsville, TX (N = 492) were compared by depression/anxiety status. Linear regression models were conducted to evaluate the associations of depression and anxiety with BMI, waist circumference, physical activity, fasting glucose, and glycated hemoglobin (HbA1c). Participants with clinically significant depression and/or anxiety were of greater age, predominantly female, less educated, more likely to have been diagnosed with diabetes, and more likely to be taking diabetes medications than those without depression or anxiety. In addition, anxious participants were more likely than those without anxiety to have been born in Mexico and to prefer study assessments in Spanish rather than English. Greater depression and anxiety were associated with poorer behavioral management of diabetes (i.e., greater BMI and waist circumference; engaging in less physical activity) and poorer glycemic control (i.e., higher fasting glucose, HbA1c). Overall, depression and anxiety appear to be linked with poorer behavioral management of diabetes and glycemic control. Findings highlight the need for comprehensive interventions along the border which target depression and anxiety in conjunction with diabetes management.
Herbozo, Sylvia; Flynn, Patricia M; Stevens, Serena D; Betancourt, Hector
Despite the strong association between obesity and binge eating, limited research has examined the implications of binge eating on dietary adherence and psychological factors in ethnically diverse type 2 diabetes patients. This study investigated the prevalence of binge eating and its association with dietary adherence, glycemic control, and psychological factors among indigenous and non-indigenous type 2 diabetes patients in Chile. Participants were 387 indigenous (Mapuche) and non-indigenous (non-Mapuche) adults with type 2 diabetes. Self-report measures of binge eating, dietary adherence, diet self-efficacy, body image dissatisfaction, and psychological well-being were administered. Participants' weight, height, and glycemic control (HbA(1c)) were also obtained. Approximately 8 % of the type 2 diabetes patients reported binge eating. The prevalence among Mapuche patients was 4.9 %, and among non-Mapuche patients, it was 9.9 %. Compared to non-binge eaters, binge eating diabetes patients had greater body mass index values, consumed more high-fat foods, were less likely to adhere to their eating plan, and reported poorer body image and emotional well-being. Results of this study extend previous research by examining the co-occurrence of binge eating and type 2 diabetes as well as the associated dietary behaviors, glycemic control, and psychological factors among indigenous and non-indigenous patients in Chile. These findings may increase our understanding of the health challenges faced by indigenous populations from other countries and highlight the need for additional research that may inform interventions addressing binge eating in diverse patients with type 2 diabetes.
Degli Esposti, Luca; Saragoni, Stefania; Buda, Stefano; Sturani, Alessandra; Degli Esposti, Ezio
Diabetes is one of the most prevalent chronic diseases, and its prevalence is predicted to increase in the next two decades. Diabetes imposes a staggering financial burden on the health care system, so information about the costs and experiences of collecting and reporting quality measures of data is vital for practices deciding whether to adopt quality improvements or monitor existing initiatives. The aim of this study was to quantify the association between health care costs and level of glycemic control in patients with type 2 diabetes using clinical and administrative databases. A retrospective analysis using a large administrative database and a clinical registry containing laboratory results was performed. Patients were subdivided according to their glycated hemoglobin level. Multivariate analyses were used to control for differences in potential confounding factors, including age, gender, Charlson comorbidity index, presence of dyslipidemia, hypertension, or cardiovascular disease, and degree of adherence with antidiabetic drugs among the study groups. Of the total population of 700,000 subjects, 31,022 were identified as being diabetic (4.4% of the entire population). Of these, 21,586 met the study inclusion criteria. In total, 31.5% of patients had very poor glycemic control and 25.7% had excellent control. Over 2 years, the mean diabetes-related cost per person was: €1291.56 in patients with excellent control; €1545.99 in those with good control; €1584.07 in those with fair control; €1839.42 in those with poor control; and €1894.80 in those with very poor control. After adjustment, compared with the group having excellent control, the estimated excess cost per person associated with the groups with good control, fair control, poor control, and very poor control was €219.28, €264.65, €513.18, and €564.79, respectively. Many patients showed suboptimal glycemic control. Lower levels of glycated hemoglobin were associated with lower diabetes
Brazeau, Anne-Sophie; Nakhla, Meranda; Wright, Michael; Henderson, Mélanie; Panagiotopoulos, Constadina; Pacaud, Daniele; Kearns, Patricia; Rahme, Elham; Da Costa, Deborah; Dasgupta, Kaberi
Qualitative studies in type 1 diabetes indicate that visibility of diabetes supplies, self-care, and hypoglycemia symptoms are associated with stigma and suboptimal management. This may be particularly salient in youth who face concurrent challenges such as establishing autonomy and making vocational choices. The aim of the study was to estimate stigma prevalence in youth (aged 14-24 years) with type 1 diabetes and its associations with glycemic control. Participants, recruited largely through social media, were asked to complete a Web-based survey and to send via mail capillary blood samples for glycated hemoglobin (HbA 1c ) measurement. The primary definition of stigma required endorsement of one or more of 3 stigma-specific items of the Barriers to Diabetes Adherence questionnaire. These addressed avoidance of diabetes management with friends present, difficulty telling others about diabetes diagnosis, and embarrassment in performing diabetes care with others present. Poor glycemic control was defined as HbA 1c >9% (ie, >75 mmol/mol; measured value when available, else self-report) and/or ≥1 severe hypoglycemic episode in the previous year (reported requiring assistance from someone else during the episode). Stigma prevalence was computed (95% CI), and associations with glycemic control were evaluated (multivariate logistic regression models). Among the 380 respondents, stigma prevalence was 65.5% (95% CI 60.7-70.3). Stigma was associated with a 2-fold higher odds of poor glycemic control overall (odds ratio [OR] 2.25, 95% CI 1.33-3.80; adjusted for age, sex, and type of treatment). There were specific associations with both HbA 1c >9% (75 mmol/mol; OR 3.05, 95% CI 1.36-6.86) and severe hypoglycemia in the previous year (OR 1.86, 95% CI 1.05-3.31). There is a high prevalence of stigma in youth with type 1 diabetes that is associated with both elevated HbA 1c levels and severe hypoglycemia. Targeted strategies to address stigma are needed. Clinical
Karstoft, Kristian; Winding, Kamilla; Knudsen, Sine H
at moderate intensity, whereas interval walkers alternated 3-min repetitions at low and high intensity. Before and after the 4-month intervention, the following variables were measured: VO(2)max, body composition, and glycemic control (fasting glucose, HbA(1c), oral glucose tolerance test, and continuous...... glucose monitoring [CGM]).RESULTSTraining adherence was high (89 ± 4%), and training energy expenditure and mean intensity were comparable. VO(2)max increased 16.1 ± 3.7% in the interval-walking group (P
Full Text Available Abstract Background The high glucose levels typically occurring among adults with type 2 diabetes contribute to blood vessel injury and complications such as blindness, kidney failure, heart disease, and stroke. Higher physical activity levels are associated with improved glycemic control, as measured by hemoglobin A1C. A 1% absolute increase in A1C is associated with an 18% increased risk for heart disease or stroke. Among Canadians with type 2 diabetes, we postulate that declines in walking associated with colder temperatures and inclement weather may contribute to annual post-winter increases in A1C levels. Methods During this prospective cohort study being conducted in Montreal, Quebec, Canada, 100 men and 100 women with type 2 diabetes will undergo four assessments (once per season over a one-year period of observation. These assessments include (1 use of a pedometer with a concealed viewing window for a two-week period to measure walking (2 a study centre visit during which venous blood is sampled for A1C, anthropometrics are assessed, and questionnaires are completed for measurement of other factors that may influence walking and/or A1C (e.g. food frequency, depressive symptomology, medications. The relationship between spring-fall A1C difference and winter-summer difference in steps/day will be examined through multivariate linear regression models adjusted for possible confounding. Interpretation of findings by researchers in conjunction with potential knowledge "users" (e.g. health professionals, patient groups will guide knowledge translation efforts. Discussion Although we cannot alter weather patterns to favour active lifestyles, we can design treatment strategies that take seasonal and weather-related variations into account. For example, demonstration of seasonal variation of A1C levels among Canadian men and women with T2D and greater understanding of its determinants could lead to (1 targeting physical activity levels to remain
Psychological impacts from expectation of worsening conditions and obstacles to life planning are affected by glycemic control, self-reported symptoms, and drug therapy in patients with type 2 diabetes mellitus.
Nakao, Motoyuki; Hara, Yoriko; Ishihara, Yoko
It is important to reduce psychological stresses for glycemic control in diabetes. We investigated the factors affecting psychological impact, which was involved in the disease conditions in 378 patients with type 2 diabetes mellitus. Patients' self-assessed symptoms and four subscales of psychological impacts on diabetes - impact from diabetes (S1), anxiety from having a chronic disease (S2), expectation of worsening conditions (S3) and obstacles to life planning (S4) - were analyzed. Significant odds ratios (ORs) were found for sex and age in S1, age and glycemic control in S2, glycemic control in S3, disease duration and glycemic control in S4, and number of symptoms in S1-S4. Scores of S1 and S2 in women were lower than those in men, and decreased age-dependently. Significant ORs for the number of symptoms in S3 and S4 were greater than in S1 and S2. ORs increased markedly for patients under oral hypoglycemic agent therapy in S4 and insulin therapy in S1-S4 when compared with ORs for lifestyle therapy alone. The psychological impact of type 2 diabetes involved a priori factors dependent on sex and aging in the subscales of current anxieties and impact, and a posteriori factors, such as disease duration, glycemic control and treatment methods, in the subscales of expectation of worsening conditions and obstacles to life planning.
Full Text Available Growing evidence from animal studies supports the anti-diabetic properties of some dietary polyphenols, suggesting that dietary polyphenols could be one dietary therapy for the prevention and management of Type 2 diabetes. This review aims to address the potential mechanisms of action of dietary polyphenols in the regulation of glucose homeostasis and insulin sensitivity based on in vitro and in vivo studies, and to provide a comprehensive overview of the anti-diabetic effects of commonly consumed dietary polyphenols including polyphenol-rich mixed diets, tea and coffee, chocolate and cocoa, cinnamon, grape, pomegranate, red wine, berries and olive oil, with a focus on human clinical trials. Dietary polyphenols may inhibit α-amylase and α-glucosidase, inhibit glucose absorption in the intestine by sodium-dependent glucose transporter 1 (SGLT1, stimulate insulin secretion and reduce hepatic glucose output. Polyphenols may also enhance insulin-dependent glucose uptake, activate 5′ adenosine monophosphate-activated protein kinase (AMPK, modify the microbiome and have anti-inflammatory effects. However, human epidemiological and intervention studies have shown inconsistent results. Further intervention studies are essential to clarify the conflicting findings and confirm or refute the anti-diabetic effects of dietary polyphenols.
Full Text Available Type 2 diabetes mellitus (DM accelerates brain aging and cognitive decline. Complex interactions between hyperglycemia, glycemic variability and brain aging remain unresolved. This study investigated the relationship between glycemic variability at multiple time scales, brain volumes and cognition in type 2 DM.Forty-three older adults with and 26 without type 2 DM completed 72-hour continuous glucose monitoring, cognitive tests and anatomical MRI. We described a new analysis of continuous glucose monitoring, termed Multi-Scale glycemic variability (Multi-Scale GV, to examine glycemic variability at multiple time scales. Specifically, Ensemble Empirical Mode Decomposition was used to identify five unique ultradian glycemic variability cycles (GVC1-5 that modulate serum glucose with periods ranging from 0.5-12 hrs.Type 2 DM subjects demonstrated greater variability in GVC3-5 (period 2.0-12 hrs than controls (P<0.0001, during the day as well as during the night. Multi-Scale GV was related to conventional markers of glycemic variability (e.g. standard deviation and mean glycemic excursions, but demonstrated greater sensitivity and specificity to conventional markers, and was associated with worse long-term glycemic control (e.g. fasting glucose and HbA1c. Across all subjects, those with greater glycemic variability within higher frequency cycles (GVC1-3; 0.5-2.0 hrs had less gray matter within the limbic system and temporo-parietal lobes (e.g. cingulum, insular, hippocampus, and exhibited worse cognitive performance. Specifically within those with type 2 DM, greater glycemic variability in GVC2-3 was associated with worse learning and memory scores. Greater variability in GVC5 was associated with longer DM duration and more depression. These relationships were independent of HbA1c and hypoglycemic episodes.Type 2 DM is associated with dysregulation of glycemic variability over multiple scales of time. These time-scale-dependent glycemic fluctuations
Full Text Available Background. Studies showed effects of Moringa oleifera (MO on lowering blood sugar levels in animal and diabetes patients. The aims of this study were to determine the effect of MO leaf capsules on glucose control in therapy-naïve type 2 diabetes mellitus (T2DM and to evaluate its safety. Method. This was a prospective randomized placebo controlled study. Therapy-naïve T2DM was randomly assigned to receive either 8 grams per day of MO leaf capsules (MO leaf group or placebo for 4 weeks. Clinical and laboratory characteristics were recorded at screening and at the end of 4-week study. 9-point plasma glucose was obtained before and every week during the study. Results. Thirty-two T2DM patients were enrolled. The mean age was 55 years and the mean HbA1C was 7.0%. There was no significant difference in FPG and HbA1C between groups. MO leaf group had SBP reduction by 5 mmHg as compared to baseline but this difference had no statistical significance. There were no adverse effects of MO leaf. Conclusions. Moringa oleifera leaf had no effect on glycemic control and no adverse effects in T2DM. Interestingly, this study demonstrated that MO leaf had a tendency on blood pressure reduction in T2DM, and this result needs further investigation.
Piera-Mardemootoo, Carole; Lambert, Philippe; Faillie, Jean-Luc
Metformin is recommended as the first-line treatment of type 2 diabetes mellitus. Despite its common use, few studies have been conducted to precisely measure the efficacy of metformin versus placebo as a first-line treatment. This study aims to assess the precise effects of metformin monotherapy on glycemic control and weight in drug-naive patients with type 2 diabetes mellitus. Medline ® and Cochrane databases were searched until March 19, 2016 to perform a systematic review and meta-analysis of placebo-controlled randomized trials evaluating metformin monotherapy in drug-naive patients with type 2 diabetes mellitus. Assessed outcomes include glycemic control (fasting plasma glucose, glycosated hemoglobin) and weight. Overall, 16 studies (1140 patients) were selected. Compared to placebo, metformin monotherapy was associated with decreased glycosated hemoglobin by 0.95% at 3 months (95% CI: 0.50 to 1.39, I 2 =87%) and 1.32% at 6 months (95% CI: 1.01 to 1.62, I 2 =71%), and decreased fasting plasma glucose by 1.92mmol/L at 1 month (95% CI: 0.11 to 3.74, I 2 =88%), 1.79mmol/L at 3 months (95% CI: 0.92 to 2.66, I 2 =88%) and 2.14mmol/L at 6 months (95% CI: 1.17 to 3.12, I 2 =82%). No significant difference was demonstrated for the comparisons of weight due to relatively small number of studies retrieved from the literature resulting in insufficient statistical power. This study provides the precise effects of metformin monotherapy regarding the decreases in fasting plasma glucose and glycosated hemoglobin that physician can expected in drug-naive patients with type 2 diabetes mellitus. No evidence was found for the effects on weight. Copyright © 2018 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.
Zewen Kelvin Tuong
Full Text Available RORα is a member of the nuclear receptor (NR superfamily and analysis of the (global RORα-deficient mouse model revealed this NR has a role in glycemic control and fat deposition. Therefore, we generated an adipose-specific RORα ‘gain of function’ mouse model under the control of the fatty acid binding protein 4 (FABP4 promoter to elucidate the function of RORα in adipose tissue. The Tg-FABP4-RORα4 mice demonstrated a shift in fat distribution to non-adipose tissues when challenged with a high fat diet (HFD. Specifically, we observed a subcutaneous lipodystrophy, accompanied by hepatomegaly (fatty liver/mild portal fibrosis and splenomegaly; in a background of decreased weight gain and total body fat after HFD. Moreover, we observed significantly higher fasting blood glucose and impaired clearance of glucose in Tg-FABP4-RORα4 mice. Genome wide expression and qPCR profiling analysis identified: (i subcutaneous adipose specific decreases in the expression of genes involved in fatty acid biosynthesis, lipid droplet expansion and glycemic control, and (ii the fibrosis pathway as the most significant pathway [including dysregulation of the collagen/extracellular matrix (ECM pathways] in subcutaneous adipose and liver. The pathology presented in the Tg-FABP4-RORα4 mice is reminiscent of human metabolic disease (associated with aberrant ECM expression highlighting the therapeutic potential of this NR.
Full Text Available Abstract Background The role of dietary factors in the pathophysiology of acne vulgaris is highly controversial. Hence, the aim of this study was to determine the association between dietary factors and acne vulgaris among Malaysian young adults. Methods A case–control study was conducted among 44 acne vulgaris patients and 44 controls aged 18 to 30 years from October 2010 to January 2011. Comprehensive acne severity scale (CASS was used to determine acne severity. A questionnaire comprising items enquiring into the respondent’s family history and dietary patterns was distributed. Subjects were asked to record their food intake on two weekdays and one day on a weekend in a three day food diary. Anthropometric measurements including body weight, height and body fat percentage were taken. Acne severity was assessed by a dermatologist. Results Cases had a significantly higher dietary glycemic load (175 ± 35 compared to controls (122 ± 28 (p 0.05. Conclusions Glycemic load diet and frequencies of milk and ice cream intake were positively associated with acne vulgaris.
Ismail, Noor Hasnani; Manaf, Zahara Abdul; Azizan, Noor Zalmy
The role of dietary factors in the pathophysiology of acne vulgaris is highly controversial. Hence, the aim of this study was to determine the association between dietary factors and acne vulgaris among Malaysian young adults. A case-control study was conducted among 44 acne vulgaris patients and 44 controls aged 18 to 30 years from October 2010 to January 2011. Comprehensive acne severity scale (CASS) was used to determine acne severity. A questionnaire comprising items enquiring into the respondent's family history and dietary patterns was distributed. Subjects were asked to record their food intake on two weekdays and one day on a weekend in a three day food diary. Anthropometric measurements including body weight, height and body fat percentage were taken. Acne severity was assessed by a dermatologist. Cases had a significantly higher dietary glycemic load (175 ± 35) compared to controls (122 ± 28) (p 0.05). Glycemic load diet and frequencies of milk and ice cream intake were positively associated with acne vulgaris.
Saffari, Mohsen; Ghanizadeh, Ghader; Koenig, Harold G
Diabetes type 2 is an increasing problem worldwide that may be managed through education. Text-messaging using a cell phone can assist with self-care. The aim of this study was to systematically review the impact of education through mobile text-messaging on glycemic control. The design was a systematic review with meta-analysis. Five electronic databases were searched to access English studies involving a randomized controlled trial design that used text-messaging educational interventions in patients with type 2 diabetes during an 11-year period (2003-2013). Studies were evaluated using a quality assessment scale adapted from Jadad scale and Cochrane handbook. Extraction of data was carried out by two reviewers. A random-effect model with a standardized mean difference and Hedges's g indices was used for conducting the meta-analysis. Subgroup analyses were conducted and a Funnel plot was used to examine publication bias. Ten studies overall were identified that fulfilled inclusion criteria, involving a total of 960 participants. The mean age of the sample was 52.8 years and majority were females. Data were heterogeneous (I(2)=67.6). Analyses suggested a publication bias based on Egger's regression (Peducating Type 2 diabetics appears to be effective on glycemic control. Further investigations on mobile applications to achieve educational goals involving other diseases are recommended. Copyright © 2014 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.
Gerber, Philipp A; Hochuli, Michel; Benediktsdottir, Bara D; Zuellig, Richard A; Tschopp, Oliver; Glenck, Michael; de Rougemont, Olivier; Oberkofler, Christian; Spinas, Giatgen A; Lehmann, Roger
The aim of this study was to assess safety and efficacy of islet transplantation after initial pancreas transplantation with subsequent organ failure. Patients undergoing islet transplantation at our institution after pancreas organ failure were compared to a control group of patients with pancreas graft failure, but without islet transplantation and to a group receiving pancreas retransplantation. Ten patients underwent islet transplantation after initial pancreas transplantation failed and were followed for a median of 51 months. The primary end point of HbA1c islet transplantation and in all three patients in the pancreas retransplantation group, but by none of the patients in the group without retransplantation (n = 7). Insulin requirement was reduced by 50% after islet transplantation. Kidney function (eGFR) declined with a rate of -1.0 mL ± 1.2 mL/min/1.73 m 2 per year during follow-up after islet transplantation, which tended to be slower than in the group without retransplantation (P = .07). Islet transplantation after deceased donor pancreas transplant failure is a method that can safely improve glycemic control and reduce the incidence of severe hypoglycemia and thus establish similar glycemic control as after initial pancreas transplantation, despite the need of additional exogenous insulin. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Full Text Available The present study was carried out to determine the glycemic index (GI, glycemic load (GL, insulinemic index (InI, appetite ratings and postprandial plasma concentrations of gastrointestinal hormones related to the control of food intake after the ingestion of the five most common breads consumed in Spain with different compositions and manufacturing processes. Twenty-two healthy adults participated in a randomized crossover study. The breads tested were Ordinary, Precooked-Frozen, Candeal-flour, Alfacar whites and Wholemeal. All breads portions were calculated to supply 50 g of available carbohydrates. In addition, 50 g of glucose was used as a reference. A linear mixed-effects model was used to compare data calculated for all breads with glucose load. The GI value varied from 61 for the Wholemeal, to Alfacar 68, Ordinary 76, and 78 and 86 for the Precooked-Frozen and Candeal-flour breads, respectively. Wholemeal and Alfacar had lower GI than glucose. All tested breads had a lower GL (ranged 9 to 18 compared with glucose. Wholemeal GL was similar to Alfacar, but lower than the other white breads. InI were significantly lower for all breads (ranged 68 to 73 compared with glucose, and similar among them. The intake of the Wholemeal bread led to a higher release of gastric inhibitory polypeptide compared with the Ordinary and Precooked breads and to a higher release of pancreatic polypeptide compared with the Precooked-Frozen bread. All breads affected appetite ratings similarly. In conclusion, based on GL, the Wholemeal bread would be expected to exert a favorable glycemic response.
Kianbakht, Saeed; Khalighi-Sigaroodi, Farahnaz; Dabaghian, Fataneh Hashem
Advanced type 2 diabetes mellitus (T2DM) needing insulin therapy is common. Most conventional anti-hyperglycemic drugs have limited efficacies and significant side effects, so that better anti-hyperglycemic agents are needed. Urtica dioica L. (nettle) leaves have insulin secretagogue, PPARgamma agonistic, and alpha-glucosidase inhibitory effects. Moreover, nettle leaves are used in traditional medicine as an anti-hyperglycemic agent to treat diabetes mellitus. Thus, efficacy and safety of nettle in the treatment of patients with advanced type 2 diabetes mellitus needing insulin were studied. In this randomized double-blind placebo-controlled clinical trial, we evaluated the effects of taking nettle leaf extract (one 500 mg capsule every 8 hours for 3 months) combined with the conventional oral anti-hyperglycemic drugs on the blood levels of fasting glucose, postprandial glucose, glycosylated hemoglobin (HbA1c), creatinine and liver enzymes SGOT and SGPT, and systolic and diastolic blood pressures in 46 patients and compared with the placebo group (n = 46). At the endpoint, the extract lowered the blood levels of fasting glucose, 2 hours postprandial glucose, and HbA1c significantly (p 0.05) compared with placebo. Nettle may safely improve glycemic control in type 2 diabetic patients needing insulin therapy.
Full Text Available William B Saunders,1 Hiep Nguyen,2 Iftekhar Kalsekar2 1Department of Public Health Sciences, College of Health and Human Services, The University of North Carolina at Charlotte, Charlotte, NC, 2AstraZeneca, Fort Washington, PA, USA Aim: The glucagon-like peptide-1 receptor agonists exenatide once weekly (QW and liraglutide once daily (QD have demonstrated improvements in glycemic outcomes in patients with type 2 diabetes mellitus in randomized clinical trials. However, little is known about their real-world comparative effectiveness. This retrospective cohort study used the Quintiles Electronic Medical Record database to evaluate the 6-month change in glycated hemoglobin (A1C for patients initiating exenatide QW or liraglutide QD.Methods: Patients with type 2 diabetes mellitus prescribed exenatide QW (n=664 or liraglutide QD (n=3,283 between February 1, 2012 and May 31, 2013 were identified. Baseline A1C measures were from 75 days before to 15 days after initiating exenatide QW or liraglutide QD, with follow-up measures documented at 6 months (±45 days. Adjusted linear regression models compared the difference in mean A1C change. A priori defined sensitivity analysis was performed in the subgroup of patients with baseline A1C ≥7.0% and no prescription for insulin during the 12-month pre-index period.Results: For exenatide QW and liraglutide QD, respectively, mean (SD age of the main study cohort was 58.01 (10.97 and 58.12 (11.05 years, mean (SD baseline A1C was 8.4% (1.6 and 8.4% (1.6, and 48.2% and 54.2% of patients were women. In adjusted models, change in A1C did not differ between exenatide QW and liraglutide QD during 6 months of follow-up. Results were consistent in the subgroup analyses.Conclusion: In a real-world setting, A1C similarly improves in patients initiating exenatide QW or liraglutide QD. Keywords: diabetes, exenatide, outcomes
Rohan, Jennifer M.; Pendley, Jennifer Shroff; Delamater, Alan; Drotar, Dennis
Objective To examine changes in parent–child communication patterns and their relation to glycemic control and treatment adherence using observational data in a 3-year prospective multisite study of youth with type 1 diabetes aged 9–11 years at baseline and their families (n = 217). Methods Adolescents and caregivers participated in a diabetes problem-solving discussion. Families were rated on negative and positive communication and interactions using the Interaction Behavior Code. Results Maternal and paternal negative communication decreased over time, whereas adolescent and maternal positive communication and positive reciprocity increased. Baseline preadolescent youth and maternal positive communication predicted adherence 3 years later. Changes in family communication did not predict changes in glycemic control or adherence. Conclusions During the transition to adolescence, family communication changed in unexpected and positive ways. Additionally, the relationship of baseline family communication to subsequent adherence suggests the need to assess family communication concerning diabetes-related management during preadolescence. PMID:24839292
Michishita, Ryoma; Matsuda, Takuro; Kawakami, Shotaro; Tanaka, Satoshi; Kiyonaga, Akira; Tanaka, Hiroaki; Morito, Natsumi; Higaki, Yasuki
This retrospective study evaluated the influence of the joint impact of habitual exercise and glycemic control on the incidence of chronic kidney disease (CKD) during a 6-year follow-up period in middle-aged and older males. The study population included 303 males without a history of cardiovascular disease, stroke, renal dysfunction, or dialysis treatment. Their lifestyle behaviors regarding exercise and physical activity were evaluated using a standardized self-administered questionnaire. The participants were divided into four categories according to the performance or non-performance of habitual exercise and the presence or absence of hyperglycemia. After 6 years, 32 subjects (10.6%) developed CKD (estimated glomerular filtration rate exercise and hyperglycemic subjects (log-rank test: p exercise (HR = 2.82, 95% confidence of interval (CI) = 1.07-7.36, p = 0.034) and that in hyperglycemic subjects who did not perform habitual exercise (HR = 5.89, 95% CI = 1.87-16.63, p = 0.003) were significantly higher in comparison to the subjects with a NGT who performed habitual exercise. These results suggest that the habitual exercise and good glycemic control and their combination were associated with the incidence of CKD.
Lee, Yau-Jiunn; Shin, Shyi-Jang; Wang, Ruey-Hsia; Lin, Kun-Der; Lee, Yu-Li; Wang, Yi-Hsien
To validate a hypothesized model exploring the influencing pathways of empowerment perceptions, health literacy, self-efficacy, and self-care behaviors to glycosylated hemoglobin (HbA1c) levels in patients with type 2 diabetes (T2DM). Overall, 295 patients with T2DM were recruited from five endocrine clinics in Taiwan through convenience sampling. Data regarding personal characteristics, empowerment perceptions, health literacy, self-efficacy, self-care behaviors, and HbA1c levels were collected. A structural equation modeling was used to validate the hypothesized model. Significant direct pathways were determined from empowerment perceptions to health literacy, from health literacy to self-efficacy, from self-efficacy to self-care behaviors, and from self-care behaviors to HbA1c levels. The empowerment perceptions and health literacy relatively influenced self-efficacy and self-care behaviors. Self-efficacy and self-care behaviors relatively influenced glycemic control in patients with T2DM. Modifying self-care behaviors have been demonstrated to be the most essential for improving glycemic control. To improve self-care behaviors, healthcare providers should target improving self-efficacy, and enhancing health literacy can be considered to be a potential strategy for improving self-efficacy. To enhance health literacy, healthcare providers could use an empowerment approach rather than an authoritative approach that emphasizes patient compliance in managing patients with T2DM. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Iskander, Jeannette M; Rohan, Jennifer M; Pendley, Jennifer Shroff; Delamater, Alan; Drotar, Dennis
To examine changes in parent-child communication patterns and their relation to glycemic control and treatment adherence using observational data in a 3-year prospective multisite study of youth with type 1 diabetes aged 9-11 years at baseline and their families (n = 217). Adolescents and caregivers participated in a diabetes problem-solving discussion. Families were rated on negative and positive communication and interactions using the Interaction Behavior Code. Maternal and paternal negative communication decreased over time, whereas adolescent and maternal positive communication and positive reciprocity increased. Baseline preadolescent youth and maternal positive communication predicted adherence 3 years later. Changes in family communication did not predict changes in glycemic control or adherence. During the transition to adolescence, family communication changed in unexpected and positive ways. Additionally, the relationship of baseline family communication to subsequent adherence suggests the need to assess family communication concerning diabetes-related management during preadolescence. © The Author 2014. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Jakicic, John M.; Egan, Caitlin M.; Fabricatore, Anthony N.; Gaussoin, Sarah A.; Glasser, Stephen P.; Hesson, Louise A.; Knowler, William C.; Lang, Wei; Regensteiner, Judith G.; Ribisl, Paul M.; Ryan, Donna H.
OBJECTIVE To examine an intensive lifestyle intervention (ILI) compared with diabetes support and education (DSE) on 4-year change in fitness and physical activity (PA), and to examine the effect of change in fitness and PA, adjusting for potential confounders, on glycemic control in the Look AHEAD Trial. RESEARCH DESIGN AND METHODS Subjects were overweight/obese adults with type 2 diabetes mellitus (T2DM) with available fitness data at 4 years (n = 3,942).This clinical trial randomized subjects to DSE or ILI. DSE subjects received standard care plus information related to diet, PA, and social support three times per year. ILI subjects received weekly intervention contact for 6 months, which was reduced over the 4-year period, and were prescribed diet and PA. Measures included weight, fitness, PA, and HbA1c. RESULTS The difference in percent fitness change between ILI and DSE at 4 years was significant after adjustment for baseline fitness and change in weight (3.70 vs. 0.94%; P Fitness change at 4 years was inversely related to change in HbA1c after adjustment for clinical site, treatment, baseline HbA1c, prescribed diabetes medication, baseline fitness, and weight change (P fitness and PA in overweight/obese individuals with T2DM. Change in fitness was associated with improvements in glycemic control, which provides support for interventions to improve fitness in adults with T2DM. PMID:23223405
Blüher, Susann; Petroff, David; Wagner, Antje; Warich, Katja; Gausche, Ruth; Klemm, Thorsten; Wagner, Mario; Keller, Alexandra
Regular physical exercise within structured lifestyle programs may improve weight status and minimize metabolic risk factors in childhood obesity. The aim of this study was to evaluate the effect of the one-year combined physical exercise/lifestyle program KLAKS on anthropometric and metabolic parameters and glycemic control in childhood obesity. 142 overweight/obese (BMI>90th percentile) candidates (7-18years) were enrolled, 115 participants completed the program. Anthropometrics and biochemical parameters were obtained at beginning and completion. An oral glucose tolerance test (OGTT) was performed in a subgroup of participants. Course of glucose and insulin levels within OGTT was correlated with several parameters and is reported here for those who completed the program. The mean standard deviation scores (SDS) decreased significantly for BMI, waist circumference, waist-to-height ratio (WHtR) and percentage body fat (all p≤0.01). Improved metabolic risk markers included mean glucose levels within an OGTT at follow-up compared to baseline (pexercise/lifestyle program KLAKS significantly improves markers of obesity and glycemic control. Impaired cardiometabolic risk markers, even subclinical, are also favorably influenced by program participation. Copyright © 2014 Elsevier Inc. All rights reserved.
Full Text Available To synthesize current evidence of the impact of Glucagon-like peptide-1 receptor agonists (GLP-1 RAs on hypoglycemia, treatment discontinuation and glycemic level in patients with type 2 diabetes.Systematic review and network meta-analysis.Literature search (Medline, Embase, the Cochrane library, website of clinical trial, bibliographies of published systematic reviews.Randomized controlled trials with available data comparing GLP-1 RAs with placebo or traditional anti-diabetic drugs in patients with type 2 diabetes.Traditional pairwise meta-analyses within DerSimonian-Laird random effects model and network meta-analysis within a Bayesian framework were performed to calculate odds ratios for the incidence of hypoglycemia, treatment discontinuation, HbA1c<7.0% and HbA1c<6.5%. Ranking probabilities for all treatments were estimated to obtain a treatment hierarchy using the surface under the cumulative ranking curve (SUCRA and mean ranks.78 trials with 13 treatments were included. Overall, all GLP-1 RAs except for albiglutide increased the risk of hypoglycemia when compared to placebo. Reduction in the incidence of hypoglycemia was found for all GLP-1 RAs versus insulin (except for dulaglutide and sulphonylureas. For the incidence of treatment discontinuation, increase was found for exenatide, liraglutide, lixisenatide and taspoglutide versus placebo, insulin and sitagliptin. For glycemic level, decrease was found for all GLP-1 RAs versus placebo. Dulaglutide, exenatide long-acting release (exe_lar, liraglutide and taspoglutide had significant lowering effect when compared with sitagliptin (HbA1c<7.0% and insulin (HbA1c<6.5%. Finally, according to SUCRAs, placebo, thiazolidinediones and albiglutide had the best decrease effect on hypoglycemia; sulphanylureas, sitagliptin and insulin decrease the incidence of treatment discontinuation most; exe_lar and dulaglutide had the highest impact on glycemic level among 13 treatments.Among 13 treatments, GLP
Soliman, Ashraf T; Omar, Magdi; Assem, Hala M; Nasr, Ibrahim S; Rizk, Mohamed M; El Matary, Wael; El Alaily, Rania K
Although obesity is a frequent feature of type 2 diabetes mellitus (DM), many patients with type 1 DM are prone to high body mass index (BMI). We measured serum leptin concentrations in a cohort of children (n = 55) with type 1 diabetes mellitus (DM), as well as their anthropometric parameters including BMI, skin fold thickness at multiple sites, and midarm circumference. Glycemic control was assessed by blood glucose (BG) monitoring before meals, and measurement of glycated hemoglobin (HbA1c) and insulin dose/kg/d was recorded. Dietary evaluation and assessment of caloric intake (kg/d) was performed by an expert dietitian. In the newly diagnosed children (n = 10) before initiation of insulin therapy, circulating leptin concentration was significantly lower (1.1 +/- 0.8 ng/dL) versus 5 days after insulin therapy (1.45 +/- 0.7 ng/dL). The decreased leptin level appears to be related to insulinopenia in these patients. In 45 children with type 1 DM on conventional therapy (2 doses of insulin mixture (NPH and regular) subcutaneous (SC) before breakfast and dinner for more than 2 years), serum leptin concentration was significantly higher (2.15 +/- 1 ng/dL) compared with age-matched normal children (1.3 +/- 1 ng/dL). Diabetic children were further divided into 2 groups according to their HbA1c level: group 1 with HbA1C less than 7.5% (less than 2 SD above the mean for normal population) (n = 29) and group 2 with HbA1c greater than 7.5%. (greater than 2 SD above the mean for normal population) (n = 16). Patients with a higher HbA1c level (group 2) had a higher leptin concentration (2.3 +/- 0.8 ng/dL), higher BMI (17.8 +/- 1.7), and were receiving higher insulin dose/kg (0.92 +/- 0.2 U/kg/d) compared with group 1 (lower HbA1c) (1.78 +/- 0.8 ng/dL, 16.7 +/- 1.5, and 0.59 +/- 0.2 U/kg/d, respectively). Group 2 patients had a higher incidence of late morning hypoglycemia (9/29) versus group 1 patients (2/16). Analysis of dietary intake showed that patients with a higher Hb
... Most snack foods Potatoes White rice Watermelon Meal Planning with the Glycemic Index When planning your meals: ... urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows ...
Osasenaga Macdonald Ighodaro
Full Text Available Glycemic homeostasis refers to glucose balance or control within circulation in living organisms. It is normally and largely compromised in diabetes. The compromise when exacerbated, leads to several complications including retinopathy, nephropathy and neuropathy which are collectively known as diabetic complications and are the principal actors in co-morbidity and eventual mortality often associated with diabetes. The ability of therapeutic compounds including medicinal plants to restore glycemic balance or homeostasis in hyperglycemic condition is an index of their antidiabetic function and relevance. Alloxan and streptozotocin are the most popular diabetogenic agents used for assessing the antidiabetic or hypoglycemic capacity of test compounds. Notably, alloxan is far less expensive and more readily available than streptozotocin. On this ground, one will logically expect a preference for use of alloxan in experimental diabetes studies. Surprisingly, a sub meta-analysis of randomly selected studies conducted within the last one and half decade revealed otherwise. This observation necessitated the review of alloxan as a diabetogenic agent in animal studies. Keywords: Alloxan, Diabetes mellitus, Diabetogenic agent, Streptozotocin, Animals
Full Text Available Background/Aim. Balancing strict glycemic control with setting realistic goals for each individual child and family can optimize growth, ensure normal pubertal development and emotional maturation, and control long term complications in children with type 1 diabetes (T1DM. The aim of this study was to evaluate the efficacy of short-term continuous glucose monitoring system (CGMS application in improvement of glycemic control in pediatric type 1 diabetes mellitus (T1DM patients. Methods. A total of 80 pediatric T1DM patients were randomly assigned into the experimental and the control group. The experimental group wore CGMS sensor for 72 hours at the beginning of the study. Self-monitored blood glucose (SMBG levels and hemoglobin A1c (HbA1c levels were obtained for both groups at baseline, and at 3 and 6 months. Results. There was a significant improvement in HbA1c (p < 0.001, in both the experimental and the control group, without a significant difference between the groups. Nevertheless, after 6 months the improvement of mean glycemia was noticed only in the experimental group. This finding was accompanied with a decrease in the number of hyperglycemic events and no increase in the number of hypoglycemic events in the experimental group. Conclusions. The results suggest that the CGMS can be considered as a valuable tool in treating pediatric T1DM patients, however further research is needed to more accurately estimate to what extent, if any, it outperforms intensive self-monitoring of blood glucose.
Lee, Yu-Mi; Kim, Se-A; Lee, In-Kyu; Kim, Jung-Guk; Park, Keun-Gyu; Jeong, Ji-Yun; Jeon, Jae-Han; Shin, Ji-Yeon; Lee, Duk-Hee
Several intervention studies have suggested that vegetarian or vegan diets have clinical benefits, particularly in terms of glycemic control, in patients with type 2 diabetes (T2D); however, no randomized controlled trial has been conducted in Asians who more commonly depend on plant-based foods, as compared to Western populations. Here, we aimed to compare the effect of a vegan diet and conventional diabetic diet on glycemic control among Korean individuals. Participants diagnosed with T2D were randomly assigned to follow either a vegan diet (excluding animal-based food including fish; n = 46) or a conventional diet recommended by the Korean Diabetes Association 2011 (n = 47) for 12 weeks. HbA1c levels were measured at weeks 0, 4, and 12, and the primary study endpoint was the change in HbA1c levels over 12 weeks. The mean HbA1c levels at weeks 0, 4, and 12 were 7.7%, 7.2%, and 7.1% in the vegan group, and 7.4%, 7.2%, and 7.2% in the conventional group, respectively. Although both groups showed significant reductions in HbA1C levels, the reductions were larger in the vegan group than in the conventional group (-0.5% vs. -0.2%; p-for-interaction = 0.017). When only considering participants with high compliance, the difference in HbA1c level reduction between the groups was found to be larger (-0.9% vs. -0.3%). The beneficial effect of vegan diets was noted even after adjusting for changes in total energy intake or waist circumference over the 12 weeks. Both diets led to reductions in HbA1c levels; however, glycemic control was better with the vegan diet than with the conventional diet. Thus, the dietary guidelines for patients with T2D should include a vegan diet for the better management and treatment. However, further studies are needed to evaluate the long-term effects of a vegan diet, and to identify potential explanations of the underlying mechanisms. CRiS KCT0001771.
Full Text Available Several intervention studies have suggested that vegetarian or vegan diets have clinical benefits, particularly in terms of glycemic control, in patients with type 2 diabetes (T2D; however, no randomized controlled trial has been conducted in Asians who more commonly depend on plant-based foods, as compared to Western populations. Here, we aimed to compare the effect of a vegan diet and conventional diabetic diet on glycemic control among Korean individuals.Participants diagnosed with T2D were randomly assigned to follow either a vegan diet (excluding animal-based food including fish; n = 46 or a conventional diet recommended by the Korean Diabetes Association 2011 (n = 47 for 12 weeks. HbA1c levels were measured at weeks 0, 4, and 12, and the primary study endpoint was the change in HbA1c levels over 12 weeks.The mean HbA1c levels at weeks 0, 4, and 12 were 7.7%, 7.2%, and 7.1% in the vegan group, and 7.4%, 7.2%, and 7.2% in the conventional group, respectively. Although both groups showed significant reductions in HbA1C levels, the reductions were larger in the vegan group than in the conventional group (-0.5% vs. -0.2%; p-for-interaction = 0.017. When only considering participants with high compliance, the difference in HbA1c level reduction between the groups was found to be larger (-0.9% vs. -0.3%. The beneficial effect of vegan diets was noted even after adjusting for changes in total energy intake or waist circumference over the 12 weeks.Both diets led to reductions in HbA1c levels; however, glycemic control was better with the vegan diet than with the conventional diet. Thus, the dietary guidelines for patients with T2D should include a vegan diet for the better management and treatment. However, further studies are needed to evaluate the long-term effects of a vegan diet, and to identify potential explanations of the underlying mechanisms.CRiS KCT0001771.
Egede, Leonard E; Gebregziabher, Mulugeta; Hunt, Kelly J; Axon, Robert N; Echols, Carrae; Gilbert, Gregory E; Mauldin, Patrick D
We performed a retrospective analysis of a national cohort of veterans with diabetes to better understand regional, geographic, and racial/ethnic variation in diabetes control as measured by HbA(1c). A retrospective cohort study was conducted in a national cohort of 690,968 veterans with diabetes receiving prescriptions for insulin or oral hypoglycemic agents in 2002 that were followed over a 5-year period. The main outcome measures were HbA(1c) levels (as continuous and dichotomized at ≥8.0%). Relative to non-Hispanic whites (NHWs), HbA(1c) levels remained 0.25% higher in non-Hispanic blacks (NHBs), 0.31% higher in Hispanics, and 0.14% higher in individuals with other/unknown/missing racial/ethnic group after controlling for demographics, type of medication used, medication adherence, and comorbidities. Small but statistically significant geographic differences were also noted with HbA(1c) being lowest in the South and highest in the Mid-Atlantic. Rural/urban location of residence was not associated with HbA(1c) levels. For the dichotomous outcome poor control, results were similar with race/ethnic group being strongly associated with poor control (i.e., odds ratios of 1.33 [95% CI 1.31-1.35] and 1.57 [1.54-1.61] for NHBs and Hispanics vs. NHWs, respectively), geographic region being weakly associated with poor control, and rural/urban residence being negligibly associated with poor control. In a national longitudinal cohort of veterans with diabetes, we found racial/ethnic disparities in HbA(1c) levels and HbA(1c) control; however, these disparities were largely, but not completely, explained by adjustment for demographic characteristics, medication adherence, type of medication used to treat diabetes, and comorbidities.
Full Text Available Aim To compare the effect of different treatment regimens (oral hypoglycemic agents [OHGs], insulin therapy, and combination of both on glycemic control and other cardiometabolic risk factors in type 2 diabetes mellitus (T2DM patients in Saudi. Subjects and Methods Patients with T2DM, but no serious diabetic complications, were randomly recruited from the diabetes clinics at two large hospitals in Jeddah, Saudi Arabia, during June 2013 to July 2014. Only those without change in treatment modality for the last 18 months were included. Blood pressure and anthropometric measurements were measured. Treatment plan was recorded from the patients' files. Fasting blood sample was obtained to measure glucose, HbA1c, and lipid profile. Results A total of 197 patients were recruited; 41.1% were men and 58.9% were women. The mean (±SD age was 58.5 ± 10.5 years. Most patients (60.7% were on OHGs, 11.5% on insulin therapy, and 27.7% were using a combination of insulin and OHGs. The mean HbA1c was lower in patients using OHGs only, compared with means in those using insulin, or combined therapy in patients with disease duration of #10 years ( P = 0.001 and also in those with a longer duration of the disease ( P < 0.001. A lower mean diastolic and systolic blood pressure was found among patients on insulin alone ( P < 0.01. No significant differences were found in lipid profiles among the groups. Conclusion Insulin therapy, without adequate diabetes education, fails to control hyperglycemia adequately in Saudi T2DM patients. There is a challenge to find out reasons for poor control and the ways as to how to improve glycemic control in T2DM.
Full Text Available Abstract Background Low-carbohydrate diets in the management of obese patients with type 2 diabetes seem intuitively attractive due to their potent antihyperglycemic effect. We previously reported that a 20 % carbohydrate diet was significantly superior to a 55–60 % carbohydrate diet with regard to bodyweight and glycemic control in 2 non-randomised groups of obese diabetes patients observed closely over 6 months. The effect beyond 6 months of reduced carbohydrate has not been previously reported. The objective of the present study, therefore, was to determine to what degree the changes among the 16 patients in the low-carbohydrate diet group at 6-months were preserved or changed 22 months after start, even without close follow-up. In addition, we report that, after the 6 month observation period, two thirds of the patients in the high-carbohydrate changed their diet. This group also showed improvement in bodyweight and glycemic control. Method Retrospective follow-up of previously studied subjects on a low carbohydrate diet. Results The mean bodyweight at the start of the initial study was 100.6 ± 14.7 kg. At six months it was 89.2 ± 14.3 kg. From 6 to 22 months, mean bodyweight had increased by 2.7 ± 4.2 kg to an average of 92.0 ± 14.0 kg. Seven of the 16 patients (44% retained the same bodyweight from 6 to 22 months or reduced it further; all but one had lower weight at 22 months than at the beginning. Initial mean HbA1c was 8.0 ± 1.5 %. After 6 and 12 months it was 6.6 ± 1.0 % and 7.0 ± 1.3 %, respectively. At 22 months, it was still 6.9 ± 1.1 %. Conclusion Advice on a 20 % carbohydrate diet with some caloric restriction to obese patients with type 2 diabetes has lasting effect on bodyweight and glycemic control.
de Araújo, Márcio Flávio Moura; Veras, Vivian Saraiva; de Freitas, Roberto Wagner Júnior Freire; de Paula, Maria do Livramento; de Araújo, Thiago Moura; Uchôa, Lilian Raquel Alexandre; Gaspar, Maria Wendiane Gueiros; Cunha, Maria da Conceição do Santos Oliveira; Serra, Maria Aparecida Alves de Oliveira; Carvalho, Carolina Maria de Lima; Costa, Edmara Chaves; Damasceno, Marta Maria Coelho
The single or combined use of herbal and dietary products with medications has shown benefits in the metabolic modulation of carbohydrates, in the restoring of the function of pancreatic beta cells, and in insulin resistance. To analyze the effect of the use of flour made from the rind of the yellow passion fruit on the glycemic control of people with diabetes mellitus type 2. An open, prospective, randomized clinical trial was undertaken with 54 participants over an eight-week period. The participants from the case group were advised to ingest 12 g of the flour, three times daily; before breakfast, lunch and dinner. After eight weeks of use of the flour made from the rind of the yellow passion fruit, we did not identify significant statistical differences in the values for capillary blood glucose ( p = 0.562), fasting blood glucose ( p = 0.268) or glycated hemoglobin ( p = 0.229) between the study groups. In the case group, we identified an increase (29.6%-37%) of the people with normal HbA1 c ; however, this did not have statistical relevance ( p = 0.274). Based in our findings, we believe it is important to extend the time of exposure to the intervention and increase the rigor in the monitoring of adherence in future studies on this topic. Only in this way will we be able to make confident inferences in relation to the use of flour made from the rind of theyellow passion fruit as a therapeutic tool for glycemic and/or metabolic control in persons with DM 2. In the sample in question, the use of the flour made from the rind of the yellow passion fruit, over an eight-week period, did not improve the glycemic control of people with type 2 diabetes. Trial registration: U1111.1187.3616. Registered 6 September, retrospectively registered, in the Brazilian Clinical Trials Registry.
Şiraz, Ülkü Gül; Doğan, Murat; Hatipoğlu, Nihal; Muhtaroğlu, Sabahattin; Kurtoğlu, Selim
Metabolic impairment in type 1 diabetes mellitus (T1DM) with poor glycemic control causes insulin resistance, non-alcoholic fatty liver disease (NAFLD), atherosclerosis, and increased carotid intima-media thickness (CIMT). Fetuin-A has a protective effect in cardiovascular disorders and is increased in hepatosteatosis. We aimed to investigate the reliability of fetuin-A levels in early detection of diabetic complications in children with T1DM and to identify a cut-off value that may show poor metabolic control. The study included 80 patients who had T1DM for at least 5 years and who had no chronic complications or an auto-immune disorder. Blood samples were drawn to measure hemoglobin A1c (HbA1c), biochemical parameters, and fetuin-A levels. Anthropometric parameters were also measured. Percent body fat was calculated. Hepatosteatosis and CIMT were assessed by sonography. Mean age of the patients was 13.5 years. Grade 1 hepatosteatosis was detected in 10%. Patients were stratified into 2 groups based on presence of NAFLD. Fetuin-A level was increased in patients with NAFLD. We identified a fetuin-A cut-off value (514.28 ng/mL; sensitivity: 47.34; specificity: 96.72) that may predict NAFLD. HbA1c and total cholesterol levels were found to be higher in patients with fetuin-A levels above higher the cut-off value. Fetuin-A is a reliable parameter in the prediction of complications and poor glycemic control in patients with T1DM.
Anirudh Balakrishna Acharya
Full Text Available Aim: Chronic periodontal disease (CPD and type 2 diabetes mellitus (T2DM share common pathogenic pathways involving the cytokine network resulting in increased susceptibility to both diseases, leading to increased inflammatory destruction, insulin resistance, and poor glycemic control. Periodontal treatment may improve glycemic control. The aim of this study was to evaluate the effect of scaling and root planing (SRP of T2DM patients with CPD on hyperglycemia and the levels of serum interleukin-10 (IL-10. Materials and Methods: Forty-five subjects were divided into three groups comprising 15 subjects each as Group 1 (healthy controls, Group 2 (CPD patients, and Group 3 (T2DM patients with CPD. Plaque index, gingival index (GI, probing pocket depths (PPD, clinical attachment loss (AL, bleeding on probing (BoP, random blood sugar, glycosylated hemoglobin (HbA1C, and serum IL-10 were measured at baseline; SRP was performed on Groups 2 and 3 and the selected parameters recorded again at 6 months. Results: Statistically significant (P < 0.05 differences were observed in the variables at baseline and 6 months after SRP between the three groups using one-way ANOVA. The paired samples t-test for PPD and AL in Group 3 was statistically significant. Group 3 revealed positive correlations between PPD and HbA1C, BoP and IL-10, respectively, at 6 months and a predictable association of HbA1C with PPD and GI, and IL-10 levels with BoP, respectively, at 6 months. Conclusion: Scaling and root planing is effective in reducing blood glucose levels in T2DM patient with pocket depths and effective in elevating systemic IL-10 levels in CPD patients and CPD patients with T2DM.
Houdijk Mieke C
Full Text Available Abstract Background To determine physical and psychosocial well-being of adolescents with type 1 diabetes by self-report and parent report and to explore associations with glycemic control and other clinical and socio-demographic characteristics. Methods Demographic, medical and psychosocial data were gathered from 4 participating outpatient pediatric diabetes clinics in the Netherlands. Ninety-one patients completed the Child Health Questionnaire-CF87 (CHQ-CF87, Centre for Epidemiological Studies scale for Depression (CES-D, and the DFCS (Diabetes-specific Family Conflict Scale. Parents completed the CHQ-PF50, CES-D and the DFCS. Results Mean age was 14.9 years (± 1.1, mean HbA1c 8.8% (± 1.7; 6.2–15.0%. Compared to healthy controls, patients scored lower on CHQ subscales role functioning-physical and general health. Parents reported less favorable scores on the behavior subscale than adolescents. Fewer diabetes-specific family conflicts were associated with better psychosocial well-being and less depressive symptoms. Living in a one-parent family, being member of an ethnic minority and reporting lower well-being were all associated with higher HbA1c values. Conclusion Overall, adolescents with type 1 diabetes report optimal well-being and parent report is in accordance with these findings. Poor glycemic control is common, with single-parent families and ethnic minorities particularly at risk. High HbA1c values are related to lower social and family functioning.
Belli, Taisa; de Macedo, Denise V; Scariot, Pedro P M; de Araújo, Gustavo G; Dos Reis, Ivan G M; Lazarim, Fernanda L; Nunes, Lázaro A S; Brenzikofer, René; Gobatto, Claudio A
Ultramarathon races are fairly demanding and impose substantial physiological stress on healthy athletes. These competitions may thus be considerably more challenging for individuals with diabetes. This case study aims to describe glycemic control, muscle damage, inflammation, and renal function in 3 athletes with type 1 diabetes during a successful performance in a relay ultramarathon. The team completed the race in 29 hours and 28 minutes, earning third place. The total distance covered by each athlete was 68.7, 84.5, and 65.1 km. Most blood glucose levels showed that athletes were in a zone where it was safe to exercise (90-250 mg/dL or 5.0-13.9 mmol/L). Creatine kinase, lactate dehydrogenase, and aspartate aminotransferase serum levels increased 1.2- to 50.7-fold prerace to postrace, and were higher than the reference ranges for all the athletes postrace. Blood leukocytes, neutrophils, and serum C-reactive protein (CRP) increased 1.6- to 52-fold prerace to postrace and were higher than the reference ranges for 2 athletes after the race. Serum creatinine increased 1.2-fold prerace to postrace for all the athletes but did not meet the risk criteria for acute kidney injury. In conclusion, our main findings show evidence of satisfactory glycemic control in athletes with type 1 diabetes during a relay ultramarathon. Moreover, elevation of muscle damage and inflammatory biomarkers occurred without affecting renal function and challenging the maintenance of blood glucose among athletes. These findings are novel and provide an initial understanding of the physiological responses in athletes with type 1 diabetes during ultramarathon races. Copyright © 2017 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.
Barnard, Neal D; Cohen, Joshua; Jenkins, David J A; Turner-McGrievy, Gabrielle; Gloede, Lise; Jaster, Brent; Seidl, Kim; Green, Amber A; Talpers, Stanley
We sought to investigate whether a low-fat vegan diet improves glycemic control and cardiovascular risk factors in individuals with type 2 diabetes. Individuals with type 2 diabetes (n = 99) were randomly assigned to a low-fat vegan diet (n = 49) or a diet following the American Diabetes Association (ADA) guidelines (n = 50). Participants were evaluated at baseline and 22 weeks. Forty-three percent (21 of 49) of the vegan group and 26% (13 of 50) of the ADA group participants reduced diabetes medications. Including all participants, HbA(1c) (A1C) decreased 0.96 percentage points in the vegan group and 0.56 points in the ADA group (P = 0.089). Excluding those who changed medications, A1C fell 1.23 points in the vegan group compared with 0.38 points in the ADA group (P = 0.01). Body weight decreased 6.5 kg in the vegan group and 3.1 kg in the ADA group (P vegan group and 10.7% in the ADA group (P = 0.02). After adjustment for baseline values, urinary albumin reductions were greater in the vegan group (15.9 mg/24 h) than in the ADA group (10.9 mg/24 h) (P = 0.013). Both a low-fat vegan diet and a diet based on ADA guidelines improved glycemic and lipid control in type 2 diabetic patients. These improvements were greater with a low-fat vegan diet.
Boonin, Alan; Balinski, Brenda; Sauter, Jerry; Martinez, Joe; Abbott, Scott
The current retrospective chart review compared glycemic control and cost impact of two insulin administration systems, V-Go ® versus usual care with standard of care (SOC) insulin injections, in eight patients residing in a nursing home (NH). A total of 1,937 blood glucose (BG) values were collected over 61 days. Significant improvements were observed for the V-Go versus SOC group in time in range 100 mg/dL to 200 mg/dL (V-Go 59.09% vs. SOC 34.02%; p < 0.001), reduced BG fluctuations as measured by standard deviation (V-Go 61.2 vs. SOC 92.1; p < 0.001), and improved mean daily BG (V-Go 159.38 mg/dL vs. SOC 223.86 mg/dL; p < 0.001). The estimated A1c change, calculated from BG values, decreased from 8.9% to 7.2% in the V-Go group and increased from 9.0% to 9.4% in the SOC group. Compared to SOC, use of V-Go decreased the mean time for insulin administration by nursing staff by 26.3 minutes per patient per day and associated labor costs by $328.75 per patient per month. Insulin administration with V-Go may improve glycemic control and reduce administration costs compared to existing care in the NH setting. [Journal of Gerontological Nursing, 43(1), 10-16.]. Copyright 2017, SLACK Incorporated.
Fujii, Hiroki; Iwase, Masanori; Ohkuma, Toshiaki; Ogata-Kaizu, Shinako; Ide, Hitoshi; Kikuchi, Yohei; Idewaki, Yasuhiro; Joudai, Tamaki; Hirakawa, Yoichiro; Uchida, Kazuhiro; Sasaki, Satoshi; Nakamura, Udai; Kitazono, Takanari
Dietary fiber is beneficial for the treatment of type 2 diabetes mellitus, although it is consumed differently in ethnic foods around the world. We investigated the association between dietary fiber intake and obesity, glycemic control, cardiovascular risk factors and chronic kidney disease in Japanese type 2 diabetic patients. A total of 4,399 patients were assessed for dietary fiber intake using a brief self-administered diet history questionnaire. The associations between dietary fiber intake and various cardiovascular risk factors were investigated cross-sectionally. Body mass index, fasting plasma glucose, HbA1c, triglyceride and high-sensitivity C-reactive protein negatively associated with dietary fiber intake after adjusting for age, sex, duration of diabetes, current smoking, current drinking, total energy intake, fat intake, saturated fatty acid intake, leisure-time physical activity and use of oral hypoglycemic agents or insulin. The homeostasis model assessment insulin sensitivity and HDL cholesterol positively associated with dietary fiber intake. Dietary fiber intake was associated with reduced prevalence of abdominal obesity, hypertension and metabolic syndrome after multivariate adjustments including obesity. Furthermore, dietary fiber intake was associated with lower prevalence of albuminuria, low estimated glomerular filtration rate and chronic kidney disease after multivariate adjustments including protein intake. Additional adjustments for obesity, hypertension or metabolic syndrome did not change these associations. We demonstrated that increased dietary fiber intake was associated with better glycemic control and more favorable cardiovascular disease risk factors including chronic kidney disease in Japanese type 2 diabetic patients. Diabetic patients should be encouraged to consume more dietary fiber in daily life.
Barrett, Marilyn L; Udani, Jay K
Obesity, and resultant health hazards which include diabetes, cardiovascular disease and metabolic syndrome, are worldwide medical problems. Control of diet and exercise are cornerstones of the management of excess weight. Foods with a low glycemic index may reduce the risk of diabetes and heart disease as well as their complications. As an alternative to a low glycemic index diet, there is a growing body of research into products that slow the absorption of carbohydrates through the inhibition of enzymes responsible for their digestion. These products include alpha-amylase and glucosidase inhibitors. The common white bean (Phaseolus vulgaris) produces an alpha-amylase inhibitor, which has been characterized and tested in numerous clinical studies. A specific and proprietary product named Phase 2® Carb Controller (Pharmachem Laboratories, Kearny, NJ) has demonstrated the ability to cause weight loss with doses of 500 to 3000 mg per day, in either a single dose or in divided doses. Clinical studies also show that Phase 2 has the ability to reduce the post-prandial spike in blood glucose levels. Experiments conducted incorporating Phase 2 into food and beverage products have found that it can be integrated into various products without losing activity or altering the appearance, texture or taste of the food. There have been no serious side effects reported following consumption of Phase 2. Gastro-intestinal side effects are rare and diminish upon extended use of the product. In summary, Phase 2 has the potential to induce weight loss and reduce spikes in blood sugar caused by carbohydrates through its alpha-amylase inhibiting activity.
Barrett Marilyn L
Full Text Available Abstract Obesity, and resultant health hazards which include diabetes, cardiovascular disease and metabolic syndrome, are worldwide medical problems. Control of diet and exercise are cornerstones of the management of excess weight. Foods with a low glycemic index may reduce the risk of diabetes and heart disease as well as their complications. As an alternative to a low glycemic index diet, there is a growing body of research into products that slow the absorption of carbohydrates through the inhibition of enzymes responsible for their digestion. These products include alpha-amylase and glucosidase inhibitors. The common white bean (Phaseolus vulgaris produces an alpha-amylase inhibitor, which has been characterized and tested in numerous clinical studies. A specific and proprietary product named Phase 2® Carb Controller (Pharmachem Laboratories, Kearny, NJ has demonstrated the ability to cause weight loss with doses of 500 to 3000 mg per day, in either a single dose or in divided doses. Clinical studies also show that Phase 2 has the ability to reduce the post-prandial spike in blood glucose levels. Experiments conducted incorporating Phase 2 into food and beverage products have found that it can be integrated into various products without losing activity or altering the appearance, texture or taste of the food. There have been no serious side effects reported following consumption of Phase 2. Gastro-intestinal side effects are rare and diminish upon extended use of the product. In summary, Phase 2 has the potential to induce weight loss and reduce spikes in blood sugar caused by carbohydrates through its alpha-amylase inhibiting activity.
Full Text Available Malkanthi Evans,1 William V Judy,2 Dale Wilson,3 John A Rumberger,4 Najla Guthrie,1 1KGK Synergize Inc., London, ON, Canada; 2SIBR Research Inc., Bradenton, FL, USA; 3London Health Sciences Center, University of Western Ontario, London, ON, Canada; 4Princeton Longevity Center, Princeton, NJ, USA Background: This study investigated the efficacy of Diabetinol® in people with diabetes on medication but not meeting the American Association of Clinical Endocrinologists and American Diabetes Association glycemic, blood pressure, and lipid targets. Subjects and methods: Fifty subjects, aged 18–75 years, with fasting blood glucose ≤15.4 mmol/L, hemoglobin A1c levels ≤12%, and a body mass index between 25 and 40 kg/m2, were enrolled in a 24-week, randomized, double-blind, placebo-controlled, parallel study. Diabetinol® or placebo was administered as 2×525 mg capsules/day. Results: In the Diabetinol® group, 14.3% versus 0% in the placebo group, 33.3% versus 15.4% in placebo, 20.0% versus 12.5% in placebo, and 83.3% versus 60% in placebo achieved the American Association of Clinical Endocrinologists and American Diabetes Association targets for hemoglobin A1c, low-density lipoprotein, total cholesterol, and systolic blood pressure, respectively. There was no difference in the maximum concentration (Cmax of serum glucose or area under the curve (AUC0–240 minutes. The time to Cmax was longer for participants on Diabetinol® than placebo group at week 12 (P=0.01. Fasting blood glucose increased from baseline to week 24 in both groups; however, this increase was 14.3 mg/dL lower in the Diabetinol® group versus placebo. The Diabetinol® group showed an increase of 5.53 mg/dL in fasting insulin at week 12 (P=0.09 and 3.2 mg/dL at week 24 (P=0.41 over and above the placebo group. A decrease of 1.5% in total cholesterol, 5.8% in low-density lipoprotein, and a 1.6% increase in high-density lipoprotein concentrations were seen in the Diabetinol® group
Oud, Lavi; Spellman, Craig
In-intensive care unit (ICU) glucose variability (GV) is associated with increased mortality. However, the impact of GV on hospital survivors' morbidity and associated changes in destination at time of hospital discharge are unknown. We studied a retrospective patient cohort in a medical/surgical ICU, requiring insulin infusion, using computer-guided insulin dosing software. Standard deviation (Glu SD ) and coefficient of variation (Glu CV ) were used as GV measures. We examined rates of home discharge (H) in the whole cohort and selected subgroups across GV quartiles, between patients with and without H, determinants of H, and determinants of GV and its association with patients' ICU length of stay (LOS). A total of 351 patients met study criteria. The association of GV and H varied among examined subgroups. H increased with GV quartile (Glu SD ; P = .004). GV was higher in patients with H than non-H (Glu SD 36.1 vs 30.0 mg/dl, respectively; P = .002). Increased GV was not a predictor of reduced H on multivariate analysis. GV was inversely associated with patients' ICU LOS in all examined subgroups. Increased number of hypoglycemic events and time to attain target glycemia were independent predictors of reduced H. GV was not associated with adverse impact on H in the present cohort, and its prognostic impact should be considered in the context of ICU LOS of examined patient populations. Further studies are needed to examine the morbidity effects of GV and other glycemia-related measures among hospital survivors of critical illness across varying ICU populations, glycemic control approaches, and glycemic targets. © 2014 Diabetes Technology Society.
Raccah, Denis; Chou, Engels; Colagiuri, Stephen; Gaàl, Zsolt; Lavalle, Fernando; Mkrtumyan, Ashot; Nikonova, Elena; Tentolouris, Nikolaos; Vidal, Josep; Davies, Melanie
This study used data from different sources to identify the extent of the unmet need for postprandial glycemic control in patients with type 2 diabetes mellitus (T2DM) after the initiation of basal insulin therapy in Europe, Asia Pacific, the United States, and Latin America. Different levels of evidence were used as available for each country/region, with data extracted from seven randomized controlled trials (RCTs), three clinical trial registries (CTRs), and three electronic medical record (EMR) databases. Glycemic status was categorized as "well controlled" (glycated hemoglobin [HbA 1c ] at target [130/140 mg/dL, depending on country-specific recommendations]), or "uncontrolled" (both FPG and HbA 1c above target). Predictor factors were identified from the RCT data set using logistic regression analysis. RCT data showed that 16.9% to 28.0%, 42.7% to 54.4%, and 16.9% to 38.1% of patients with T2DM had well-controlled glycemia, residual hyperglycemia, and uncontrolled hyperglycemia, respectively. In CTRs, respective ranges were 21.8% to 33.6%, 31.5% to 35.6%, and 30.7% to 46.8%, and in EMR databases were 4.4% to 21.0%, 23.9% to 31.8%, and 53.6% to 63.8%. Significant predictor factors of residual hyperglycemia identified from RCT data included high baseline HbA 1c (all countries/regions except Brazil), high baseline FPG (United Kingdom/Japan), longer duration of diabetes (Brazil), and female sex (Europe/Latin America). Irrespective of intrinsic differences between data sources, 24% to 54% of patients with T2DM globally had residual hyperglycemia with HbA 1c not at target, despite achieving FPG control, indicating a significant unmet need for postprandial glycemic control. © 2016 The Authors. Diabetes/Metabolism Research and Reviews published by John Wiley & Sons Ltd.
Kotb Abbass Metwalley
Full Text Available Context: Soluble CD40 ligand (sCD40L is known to be elevated in different clinical situations including hypercholesterolemia, acute coronary syndromes, and type 2 diabetes mellitus (T2DM, Data about the relationship between type 1 diabetes mellitus (T1DM and sCD40L is limited. In addition, the potential role ofsCD40Lin the pathogenesis of vascular complications in children and adolescents with T1DM is to be clarified. Hence, the study aimed at assessment of sCD40L levels in children and adolescents with T1DM and correlation of these levels with glycemic control and microalbuminuria. Settings and Design: Cross-sectional controlled study. Materials and Methods: The study was performed in the Pediatric Endocrinology and Diabetes Unit, Assuit University Children Hospital, Assiut, Egypt. It included 70 children and adolescents with T1DM (mean age 14. 76 ± 2.21 years. Cases were further subdivided into 43 cases with normoalbuminuria and 27 cases with microalbuminuria according to presence or absence or microalbuminuria in fresh urine samples. Twentyfive healthy subjects, age- and sex-matched were included as control group (mean age = 13.62 ± 2.11 years. Studied cases were subjected to medical history, clinical examination, and laboratory assessment of fasting blood glucose (FBG, lipid profile, glycosylated hemoglobin (HbA1c, and sCD40L were performed. Results: Mean HbA1c and sCD40L were significantly higher in diabetic children (n = 70 compared to control (n = 25 (P < 0.001 for each. Mean HbA1c and sCD40L levels were significantly higher in microalbuminuric cases (n = 27 compared to normoalbuminuric cases (n = 43 (P < 0.05 and <0.01, respectively.We also observed a significant positive correlation between sCD40L levels and the age, diabetes duration, HbA1c, and urinary albumin creatinine ratio. Conclusions: The high serum sCD40L levels in children and adolescents with T1DM particularly in those with microalbminuria and its positive correlation with
Effects of Vildagliptin or Pioglitazone on Glycemic Variability and Oxidative Stress in Patients with Type 2 Diabetes Inadequately Controlled with Metformin Monotherapy: A 16-Week, Randomised, Open Label, Pilot Study
Nam Hoon Kim
Full Text Available BackgroundGlycemic variability is associated with the development of diabetic complications through the activation of oxidative stress. This study aimed to evaluate the effects of a dipeptidyl peptidase 4 inhibitor, vildagliptin, or a thiazolidinedione, pioglitazone, on glycemic variability and oxidative stress in patients with type 2 diabetes.MethodsIn this open label, randomised, active-controlled, pilot trial, individuals who were inadequately controlled with metformin monotherapy were assigned to either vildagliptin (50 mg twice daily, n=17 or pioglitazone (15 mg once daily, n=14 treatment groups for 16 weeks. Glycemic variability was assessed by calculating the mean amplitude of glycemic excursions (MAGE, which was obtained from continuous glucose monitoring. Urinary 8-iso prostaglandin F2α, serum oxidised low density lipoprotein, and high-sensitivity C-reactive protein were used as markers of oxidative stress or inflammation.ResultsBoth vildagliptin and pioglitazone significantly reduced glycated hemoglobin and mean plasma glucose levels during the 16-week treatment. Vildagliptin also significantly reduced the MAGE (from 93.8±38.0 to 70.8±19.2 mg/dL, P=0.046, and mean standard deviation of 24 hours glucose (from 38±17.3 to 27.7±6.9, P=0.026; however, pioglitazone did not, although the magnitude of decline was similar in both groups. Markers of oxidative stress or inflammation including urinary 8-iso prostaglandin F2α did not change after treatment in both groups.ConclusionIn this 16-week treatment trial, vildagliptin, but not pioglitazone, reduced glycemic variability in individuals with type 2 diabetes who was inadequately controlled with metformin monotherapy, although a reduction of oxidative stress markers was not observed.
Shakil-Ur-Rehman, Syed; Karimi, Hossein; Gillani, Syed Amir
To determine the effects of supervised structured aerobic exercise training (SSAET) program on fasting blood glucose level (FBGL), plasma insulin level (PIL), glycemic control (GC), and insulin resistance (IR) in type 2 diabetes mellitus (T2DM). Riphah Rehabilitation and Research Centre (RRRC) was the clinical setting for this randomized controlled trial, located at Pakistan Railways General Hospital (PRGH), Rawalpindi, Pakistan. Study duration was 18 months from January 1, 2015 to June 30, 2016. Patients of both genders ranging 40-70 years of age with at least one year of history of T2DM were considered eligible according to WHO criteria, while patients with other chronic diseases, history of smoking, regular exercise and diet plan were excluded. Cohorts of 195 patients were screened out of whom 120 fulfilled the inclusion criteria. Amongst them 102 agreed to participate and were assigned to experimental (n=51) and control (n=51) groups. Experimental group underwent SSAET program, routine medication and dietary plan, whereas the control group received routine medication and dietary plan, while both group received treatment for 25 weeks. The blood samples were taken at baseline and on the completion of 25 weeks. The investigation of fasting blood glucose level, plasma insulin level, and glycemic control was conducted to calculate IR. Patients with T2DM in experimental group (n=51) treated with SSAET program, routine medication and dietary plan significantly improved FBGL (pre-mean= 276.41±25.31, post-mean=250.07±28.23), PIL (pre-mean=13.66±5.31, post-mean=8.91±3.83), GC (pre-mean=8.31±1.79, post-mean 7.28±1.43), and IR (pre-mean=64.95±27.26, post-mean 37.97±15.58), as compared with patients in control group treated with routine medication and dietary plan in whom deteriorations were noted in FBGL (pre-mean=268.19±22.48, post-mean=281.41±31.30), PIL(pre-mean=14.14±5.48, post-mean=14.85±5.27) GC (pre-mean=8.15±1.74, post-mean=8.20±1.44, and IR (pre
Full Text Available Background: Tocotrienols have been shown to improve glycemic control and redox balance in an animal study, but their effects on patients with diabetes are unknown. The study aimed to investigate whether tocotrienols improves glycemic control, insulin sensitivity, and oxidative stress in individuals with type 2 diabetes mellitus (T2DM. Materials and Methods: This study was a double-blinded, placebo-controlled, randomized trial. A total of 50 patients, aged 35-60 years, with T2DM treated by noninsulin hypoglycemic drugs were randomly assigned to receive either 15 mL/day tocotrienols (200 mg enriched canola oil (n = 25 or pure canola oil (n = 25 for 8 weeks. Fasting blood sugar (FBS, fasting insulin, total antioxidant capacity (TAC, malondialdehyde (MDA, and homeostatic model assessment for insulin resistance (HOMA-IR were determined before and after the intervention. The data were compared between and within groups, before and after the intervention. Results: Baseline characteristics of participants including age, sex, physical activity, disease duration, and type of drug consumption were not significantly different between the two groups. In tocotrienol enriched canola oil, FBS (mean percent change: -15.4% vs. 3.9%; P = 0.006 and MDA (median percent change: -35.6% vs. 16.3%; P = 0.003 were significantly reduced while TAC was significantly increased (median percent change: 21.4% vs. 2.3%; P = 0.001 compared to pure canola oil. At the end of the study, patients who treated with tocotrienols had lower FBS (P = 0.023 and MDA (P = 0.044 compared to the pure canola oil group. However, tocotrienols had no effect on insulin concentrations and HOMA-IR. Conclusion: Tocotrienols can improve FBS concentrations and modifies redox balance in T2DM patients with poor glycemic control and can be considered in combination with hypoglycemic drugs to better control of T2DM.
Effectiveness of behavioral change techniques employed in eHealth interventions designed to improve glycemic control in persons with poorly controlled type 2 diabetes: a systematic review and meta-analysis protocol
Full Text Available Abstract Background The incorporation of Behavioral Change Techniques (BCTs in eHealth interventions for the management of non-communicable diseases (NCDs, such as type 2 diabetes mellitus (T2DM, might be a promising approach to improve clinical and behavioral outcomes of NCDs in the long run. This 3paper reports a protocol for a systematic review that aims to (a identify the effects of individual BCTs in eHealth interventions for lowering glycated hemoglobin levels (HbA1c and (b investigate which additional intervention features (duration of intervention, tailoring, theory-base, and mode of delivery affect levels of HbA1c in this population. The protocol follows the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P 2015 guideline. Methods/design To identify eligible studies, an extensive systematic database search (PubMed, Web of Science, and PsycINFO using keywords will be conducted. This review will include randomized controlled trials examining the effects of eHealth interventions on HbA1c in persons with poorly controlled T2DM over a minimum follow-up period of 3 months. Relevant data will be extracted from the included studies using Microsoft Excel. The content of the interventions will be extracted from the description of interventions and will be classified according to the BCT taxonomy v1 tool. The quality of studies will be independently assessed by two reviewers using the Cochrane risk of bias tool. If the studies have adequate homogeneity, meta-analysis will be considered. The effect sizes of each BCT will be calculated using the random effect model. The quality of the synthesized evidence will be evaluated employing the Grading of the Recommendations Assessment, Development and Evaluation (GRADE criteria. Discussion This systematic review is one of the firsts to appraise the effectiveness of eHealth interventions employing BCTs which aimed at improving glycemic control in persons with poorly
Pai, Lee-Wen; Li, Tsai-Chung; Hwu, Yueh-Juen; Chang, Shu-Chuan; Chen, Li-Li; Chang, Pi-Ying
The objective of this study was to systematically review the effectiveness of different types of regular leisure-time physical activities and pooled the effect sizes of those activities on long-term glycemic control in people with type 2 diabetes compared with routine care. This review included randomized controlled trials from 1960 to May 2014. A total of 10 Chinese and English databases were searched, following selection and critical appraisal, 18 randomized controlled trials with 915 participants were included. The standardized mean difference was reported as the summary statistic for the overall effect size in a random effects model. The results indicated yoga was the most effective in lowering glycated haemoglobin A1c (HbA1c) levels. Meta-analysis also revealed that the decrease in HbA1c levels of the subjects who took part in regular leisure-time physical activities was 0.60% more than that of control group participants. A higher frequency of regular leisure-time physical activities was found to be more effective in reducing HbA1c levels. The results of this review provide evidence of the benefits associated with regular leisure-time physical activities compared with routine care for lowering HbA1c levels in people with type 2 diabetes. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.
Sheu, Wayne H-H; Park, Sung Woo; Gong, Yan; Pinnetti, Sabine; Bhattacharya, Sudipta; Patel, Sanjay; Seck, Thomas; Woerle, Hans-Juergen
To evaluate the efficacy and long-term safety of linagliptin added to basal insulin in Asian patients with type 2 diabetes mellitus (T2DM) inadequately controlled by basal insulin with/without oral agents. This was a post hoc analysis of Asian patients from a global ≥52 week study in which patients on basal insulin were randomized (1:1) to double-blind treatment with linagliptin 5 mg once daily or placebo (NCT00954447). Basal insulin dose remained stable for 24 weeks, after which adjustments could be made according to the investigator's discretion to improve glycemic control. The primary endpoint was the mean change in glycated hemoglobin (HbA1c) from baseline to 24 weeks. Data were available for 154 Asian patients (80 linagliptin, 74 placebo). Baseline HbA1c (standard deviation [SD]) was 8.6 (0.9)% (70  mmol/mol). The placebo-corrected mean change (standard error [SE]) in HbA1c from baseline was -0.9 (0.1)% (-10  mmol/mol) (95% confidence interval [CI]: -1.2, -0.7; p1) at Week 24 and -0.9 (0.1)% (-10  mmol/mol) (95% CI: -1.1, -0.6; p1) at Week 52. The frequency of adverse events (linagliptin 81.3%, placebo 91.9%) and hypoglycemia (Week 24: linagliptin 25.0%, placebo 25.7%; treatment end: linagliptin 28.8%, placebo 35.1%) was similar between groups. By Week 52, changes (SE) in mean body weight were similar in both groups (linagliptin -0.67 [0.26] kg, placebo -0.38 [0.25] kg). This study was limited by the post hoc nature of the analysis and the small number of patients in the subgroup. However, the results suggest that linagliptin significantly improves glycemic control in Asian patients with T2DM inadequately controlled by basal insulin, without increasing the risk for hypoglycemia or weight gain. ClinicalTrials identifier: NCT00954447.
Buse, John B; Garber, Alan; Rosenstock, Julio
the impact on glycemic control and safety, and to compare it with exenatide, an agent in the same class. Design: Antibody data were collected during six Liraglutide Effect and Action in Diabetes (LEAD) trials (26–104 wk duration). Setting: Samples for determination of antibody formation were collected...... at LEAD trial sites and analyzed at central laboratories. Participants: Antibodies were measured in LEAD trial participants with type 2 diabetes. Interventions: Interventions included once-daily liraglutide (1.2 or 1.8 mg) or twice-daily exenatide (10 µg). Main Outcome Measures: The main outcome measures...... not impact glycemic efficacy or safety....
Full Text Available Cardiovascular disease accounts for nearly 70 % of morbidity and mortality in patients with diabetes mellitus. Strides made in diabetes care have indeed helped prevent or reduce the burden of microvascular complications in both type-1 and type-2 diabetes. However, the same can’t be said about macrovascular disease in diabetes. Several prospective trials so far have failed to provide conclusive evidence of glycemic control superiority in reducing macrovascular complications or death rate in people with advanced disease or those with long duration of diabetes. There are trends that suggest that benefits are restricted to those with lesser burden and shorter duration of disease. Furthermore, it is also suggested that benefits might accrue but it would take longer time to manifest. Clinicians are fraught with challenge to decide how to triage patients for intensified care versus less intense care. This review focusses on evidence and attempts to provide a balanced view of literature that has radically affected how physicians treat patients with macrovascular disease. It also takes cognizance of the fact that natural course of disease may be changing as well possibly related to better overall awareness and possibly improved access to information about better individual healthcare. The review further takes note of some hard held notions about pathobiology of disease that must be interpreted with caution in light of new emerging data. In light of recent developments ADA and EASD have taken step to provide some guidance to clinicians through a joint position statement. A lot more research would be required to figure out how best to manage macrovascular disease in diabetes mellitus. Glucocentric stance would have to yield to evidence based, and possibly, concurrent multifactorial intervention to enhance quality of care that is safe and effective.
Marker, Arwen M; Noser, Amy E; Clements, Mark A; Patton, Susana R
We examined how parent and youth responsibility for type 1 diabetes (T1D) care is related to adherence and glycemic outcomes, namely, glycemic variability and risk of glycemic excursions. One hundred thirty-five parent-youth dyads (10-16 years old; diagnosed with T1D for at least 6 months) participated in this study. Percent responsibility of T1D care attributed to the youth, parent, or shared was measured using the Diabetes Family Responsibility Questionnaire. We collected youth's hemoglobin A1c (HbA1c) and glucometer downloads to examine relationships between responsibility and HbA1c, frequency of blood glucose monitoring (self-monitoring blood glucose, SMBG), risk of glycemic excursions, and actual glycemic variability using bivariate correlations and path analysis. Participants reported shared responsibility for almost half of T1D self-care tasks. Bivariate correlations showed shared responsibility was associated with less variability, whereas parent responsibility was associated with greater glycemic variability and risk for glycemic excursions. Youth responsibility was associated with lower frequency of SMBG. The path analyses confirmed our correlational findings (pshypothesis that shared T1D responsibility is associated with better diabetes outcomes in youth. © The Author 2017. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: email@example.com
Schwingshackl, Lukas; Chaimani, Anna; Hoffmann, Georg; Schwedhelm, Carolina; Boeing, Heiner
Background Dietary advice is one of the cornerstones in the management of type 2 diabetes mellitus. The American Diabetes Association recommended a hypocaloric diet for overweight or obese adults with type 2 diabetes in order to induce weight loss. However, there is limited evidence on the optimal approaches to control hyperglycemia in type 2 diabetes patients. The aim of the present study is to assess the comparative efficacy of different dietary approaches on glycemic control and blood lipi...
Full Text Available We used tele-monitoring to attempt to improve exercise adherence (number of hours of exercise completed, peak VO2, HbA1c% and quality of life in an unsupervised, home based exercise program in people with type II diabetes, a cost analysis was also conducted. Thirty-nine patients with type II diabetes were randomized to tele-monitoring (TELE or control (CON groups. All patients were asked to complete 6 months exercise training and complete an exercise activity diary. The TELE group was instructed to record their exercise heart rates using a monitor and received weekly telephone calls from an exercise physiologist. Six TELE patients and seven CON patients did not complete the 6 month testing. TELE patients completed a mean weekly volume of 138 minutes, moderate intensity exercise, while CON patients completed 58 minutes weekly (p < 0.02. Neither group achieved the American Heart Association statement guideline for weekly exercise volume of 150 minutes. TELE patients improved peak VO2 (5.5 %, but neither group improved HbA1c% or quality of life. The CON group showed a 4.9% reduction in peak VO2. While tele-monitored patients completed more hours of exercise and demonstrated improved peak VO2 compared to controls, the exercise volume completed was insufficient to improve glycemic control. There is the potential via tele-monitoring to enable people with diabetes to meet exercise training guidelines.
Raquel Pei Chen Chan
Full Text Available BACKGROUND: The objective of this study was to investigate the relationship between different target levels of glucose and the clinical outcomes of patients undergoing cardiac surgery with cardiopulmonary bypass. METHODS: We designed a prospective study in a university hospital where 109 consecutive patients were enrolled during a six-month period. All patients were scheduled for open-heart surgery requiring cardiopulmonary bypass. Patients were randomly allocated into two groups. One group consisted of 55 patients and had a target glucose level of 80-130 mg/dl, while the other contained 54 patients and had a target glucose level of 160-200 mg/dl. These parameters were controlled during surgery and for 36 hours after surgery in the intensive care unit. Primary outcomes were clinical outcomes, including time of mechanical ventilation, length of stay in the intensive care unit, infection, hypoglycemia, renal or neurological dysfunction, blood transfusion and length of stay in the hospital. The secondary outcome was a combined end-point (mortality at 30 days, infection or length of stay in the intensive care unit of more than 3 days. A p-value of 0.05. CONCLUSIONS: In 109 patients undergoing cardiac surgery with cardiopulmonary bypass, both protocols of glycemic control in an intraoperative setting and in the intensive care unit were found to be safe, easily achieved and not to differentially affect clinical outcomes.
Ensor, Mark; Williams, Jarrod; Smith, Rebecca; Banfield, Amy; Lodder, Robert A.
The primary objective of this study was to evaluate the safety and the effect of D-tagatose on the glycemic control of subjects with type 2 diabetes as determined by HbA1c levels at the end of 6 months of therapy using the subject’s own baseline HbA1c level as a comparator. The determination of the minimal dose required to cause a statistically significant reduction in HbA1c was of particular interest. Eight weeks after screening, the qualifying subjects were randomized to receive one of thre...
Full Text Available Objective: Addition of vildagliptin to ongoing insulin therapy may help in terms of overall glycemic control as well as reduction in dose of insulin and weight. This study sought to evaluate the effect of vildagliptin and fixed dose combination (FDC of vildagliptin and metformin in patients in ongoing insulin therapy for Type 2 diabetes mellitus. Materials and Methods: This was an open label, prospective, non-randomised, multicentric observational study. In this study 400 patients with T2DM on insulin were enrolled and allocated with the treatment of vildagliptin 50 mg in monotherapy and FDC of vildagliptin 50 mg and metformin strengths as 500/ 850 / 1000 mg. Baseline investigations included fasting blood glucose (FBG and post prandial plasma glucose (PPPG Estimation and glycosylated haemoglobin (HbA1c. Results: The combined analysis was carried out on 300 completed patients in this study, who were treated with vildagliptin or FDC of vildagliptin and metformin. The difference in mean value of insulin dose (MID showed a highly significant decrease (P <0.0001 from baseline to end of the treatment i.e. from 36.26 ± 18.21 to 26.87 ± 16.49 IU. A highly significant decrease (P <0.0001 in FBG from 194.94 ± 56.19 to 124.93 ± 30.11 mg/dl was observed. Similarly PPPG showed a highly significant (P <0.0001 decrease from baseline to end of the treatment i.e. from 287.60 mg/dl to 172.05 mg/dl and there was highly significant (P <0.0001 decrease in HbA1c i.e. from 9.01% to 7.65% respectively. At the same time, highly significant decrease (P <0.0001 in mean weight also observed from baseline to end of the treatment i.e. from 71.23 ± 11.06 kg to 70.06 ± 10.62 Kg. Conclusion: Addition of vildagliptin and FDC of vildagliptin and metformin is an effective strategy in glycemic control, reduction in dose of insulin and weight of patients suffering with T2DM.
Full Text Available Differences exist between treatment recommendations regarding the choice of metformin as first-line therapy for type 2 diabetes patients according to body mass index (BMI. This study compared the efficacy of metformin monotherapy among normal-weight, overweight, and obese patients with newly diagnosed type 2 diabetes.In this prospective, multicenter, open-label study in China, patients aged 23-77 years were enrolled 1∶1:1 according to baseline BMI: normal-weight (BMI 18.5-23.9 kg/m(2; n = 125; overweight (BMI 24.0-27.9 kg/m(2; n = 122 or obese (BMI ≥28 kg/m(2; n = 124. Extended-release metformin was administered for 16 weeks (500 mg/day, up-titrated weekly to a maximum 2,000 mg/day. The primary efficacy endpoint was the effect of baseline BMI on glycemic control with metformin monotherapy, measured as the change from baseline in glycosylated hemoglobin (HbA1c at week 16 compared among BMI groups using ANCOVA. Other endpoints included comparisons of metformin's effects on fasting plasma glucose (FPG, lipid levels and body weight.Mean HbA1c decreases at week 16, adjusted for baseline values, were -1.84%, -1.78% and -1.78% in normal-weight, overweight and obese patients, (P = 0.664; body weight decreased by 2.4%, 3.9% and 3.5%, respectively. FPG levels decreased similarly over time in all BMI groups (P = 0.461 and changes from baseline in high-density lipoprotein cholesterol (HDL-C and low-density lipoprotein cholesterol (LDL-C did not differ significantly among BMI groups at week 16 (P = 0.143 and 0.451, respectively.Baseline BMI had no impact on glycemic control, weight change or other efficacy measures with metformin monotherapy. These data suggest that normal-weight type 2 diabetes patients would derive the same benefits from first-line treatment with metformin as overweight and obese patients, and are not at increased risk of excess weight loss.ClinicalTrials.gov NCT00778622.
Tomas-Carus, Pablo; Ortega-Alonso, Alfredo; Pietilainen, Kirsi H; Santos, Vitoria; Goncalves, Helena; Ramos, Jorge; Raimundo, Armando
The aim of this paper was to evaluate the effects of a 12-weeks combined aerobic-resistance exercise therapy on fatigue and isokinetic muscle strength, glycemic control and health-related quality of life (HRQoL) in moderately affected type 2 diabetes (T2DM) patients. A randomized controlled trial design was employed. Forty-three T2DM patients were assigned to an exercise group (N.=22), performing 3 weekly sessions of 60 minutes of combined aerobic-resistance exercise for 12-weeks; or a no exercise control group (N.=21). Both groups were evaluated at a baseline and after 12-weeks of exercise therapy for: 1) muscle strength and fatigue by isokinetic dynamometry; 2) plasma glycated hemoglobin A1C (HbA1C); and 3) HRQoL utilizing the SF-36 questionnaire. The exercise therapy led to improvements in muscle fatigue in knee extensors (-55%) and increased muscle strength in knee flexors and extensors (+15 to +30%), while HbA1C decreased (-18%). In addition, the exercising patients showed sizeable improvements in HRQoL: physical function (+53%), vitality (+21%) and mental health (+40%). Twelve-weeks of combined aerobic-resistance exercise was highly effective to improve muscle strength and fatigue, glycemic control and several aspects of HRQoL in T2DM patients. These data encourage the use of aerobic and resistance exercise in the good clinical care of T2DM.
Blonde, Lawrence; Patel, Charmi; Bookhart, Brahim; Pfeifer, Michael; Chen, Yen-Wen; Wu, Bingcao
This US retrospective cohort study compared the real-world effectiveness of canagliflozin 300 mg versus dapagliflozin 10 mg on HbA1c reduction in patients with type 2 diabetes mellitus (T2DM). Patients initiated on canagliflozin 300 mg or dapagliflozin 10 mg were identified from de-identified claims data in the Optum Clinformatics database (1 January 2014-30 September 2016). Propensity score matching was used to create balanced cohorts. The primary outcome was the proportion of patients with HbA1c 9.0% (HEDIS poor control), absolute change in HbA1c, and treatment patterns. At 6 months post-index (intent-to-treat population), a significantly higher proportion of patients in the canagliflozin 300 mg versus dapagliflozin 10 mg cohort achieved HbA1c 9.0%. Mean HbA1c reduction was -1.17% with canagliflozin 300 mg and -0.91% with dapagliflozin 10 mg (difference of -0.26%; p = .0049). HbA1c results from a sensitivity analysis in the on-treatment population were consistent with the primary analysis. Patients in the canagliflozin 300 mg versus dapagliflozin 10 mg cohort were less likely to discontinue treatment (OR [95% CI]: 0.75 [0.57, 0.99]; p = .0400) or switch medication (OR [95% CI]: 0.72 [0.54, 0.96]; p = .0229). In this real-world study, patients with T2DM initiated on canagliflozin 300 mg had better HbA1c goal attainment and larger HbA1c reduction than patients initiated on dapagliflozin 10 mg.
Sanz-Paris, Alejandro; Boj-Carceller, Diana; Lardies-Sanchez, Beatriz; Perez-Fernandez, Leticia; Cruz-Jentoft, Alfonso J
Diabetes-specific formulas are an effective alternative for providing nutrients and maintaining glycemic control. This study assesses the effect of treatment with an oral enteral nutrition with a hypercaloric diabetes-specific formula (HDSF) for one year, on health-care resources use, health-care costs, glucose control and nutritional status, in 93 type-2 diabetes mellitus (T2DM) malnourished patients. Changes in health-care resources use and health-care costs were collected the year before and during the year of intervention. Glucose status and nutritional laboratory parameters were analyzed at baseline and one-year after the administration of HDSF. The administration of HDSF was significantly associated with a reduced use of health-care resources, fewer hospital admissions (54.7%; p Health-care costs were reduced by 65.6% (p nutritional parameters were improved at one year (albumin: +10.6%, p nutritional parameters. The use of health-care resources and costs were significantly reduced during the nutritional intervention.
Full Text Available Background: The present study designed to assess the effect of Mg+Zn, vitamin C+E, and combination of these micronutrients on glycemic control and insulin resistance in type 2 diabetic patients Methods: In a randomized, double-blind, placebo controlled clinical trial, 69 type 2 diabetic patients were randomly divided into four groups, each group receiving one of the following daily supplement for 3 months; group M: 200 mg and 30 mg Zn (n=16, group V: 200 mg vitamin C and 150 mg vitamin E (n=18, group MV: minerals plus vitamins (n=17, group P: placebo (n=18.Fasting blood glucose, fructosamine, HbA1c and serum insulin were measured at the beginning and at the end of 3 months supplementation. Insulin resistance was calculated by HOMA score. Treatment effects were analyzed by general linear modeling. Results: After 3 months of supplementation fasting blood glucose decreased in MV group (165±46 vs 177±41 mg/dl, p=0.035. There was no significant change in fructoseamin, HbA1c, serum insulin or insulin resistance in treatment groups. Conclusion: The results of the present study provide evidence for the effects of combination of Mg, Zn and vitamin C and E supplementations on improvement of fasting blood glucose but not fructosamine, HbA1c, serum insulin or insulin resistance in type 2 diabetic patients.
Annie C. H. Fung
Full Text Available Background and objectivesUndiagnosed depression is an important comorbidity in type 2 diabetes (T2D which can be detected using the Geriatric Depression Scale (GDS-15 questionnaire. In this cross-sectional study, we examined the associations of depression using GDS score with control of cardiometabolic risk factors and health status in elderly patients with T2D.Setting and participantsBetween February and December 2013, patients aged ≥65 years who underwent structured comprehensive assessment as a quality improvement program at the Diabetes Center of a teaching hospital were invited to complete the GDS-15 questionnaire.Main outcome measuresDepression was defined as a GDS score ≥7. Demographic data, prior history of co-morbidities, frequency of self-reported hypoglycemia, and attainment of treatment targets defined as HbA1c, <7%, blood pressure <130/80 mmHg, and LDL-C <2.6 mmol/L were documented.ResultsAmong 325 participants (65% male, median [interquartile range] age: 69  years, 42 (13% had depression. Patients with depression had longer disease durations (mean ± SD: 15.1 ± 9.1 vs. 11.6 ± 8.1 years, P = 0.02, more frequent self-reported hypoglycemic events (17 vs. 6%, P = 0.03 and were less likely to attain all three treatment targets (0 vs. 16%, P = 0.004 than those without depression. On multivariable analysis, patients with depression had an odds ratio of 2.84 (95% confidence intervals: 1.35–6.00, P = 0.006 of reporting prior history of co-morbidities.ConclusionIn elderly patients with T2D, depression was not uncommon especially in those with poor control of risk factors, hypoglycemia, and co-morbidities. Inclusion of GDS-15 questionnaire during structured assessment for complications and risk factors can identify these high-risk patients for more holistic management of their physical and mental health.
Taghizadeh, Mohsen; Asemi, Zatolla
The aim of this study was to determine the effects of synbiotic food consumption on glycemic status and serum high sensitivity C-reactive protein (hs-CRP) levels of Iranian pregnant women. This randomized placebo-controlled clinical trial was performed among 52 pregnant women, primigravida, aged 18-35 year old, in their third trimester. After a 2-wk run-in period, subjects were randomly assigned to consume either a synbiotic (n=26) or control food (n=26) for 9 weeks. The synbiotic food consisted of a probiotic Lactobacillus sporogenes (1×107 CFU), 0.04 g inulin as prebiotic with 0.38 g isomalt, 0.36 g sorbitol and 0.05 g stevia as sweetener per 1 g. Control food (the same substance without probiotic bacteria and inulin) was packed in identical 9-gram packages. Patients were asked to consume the synbiotic and control foods two times a day. Fasting blood samples were taken at baseline and after a 9-wk intervention for quantification of related factors. Consumption of a synbiotic food did not show any significant change regarding the impact of insulin actions in the synbiotic group; nonetheless, compared to the control food, it resulted in a significant decrease in serum insulin levels (-0.26 vs. 6.34 µIU/mL, P=0.014) and HOMA-IR (-0.13 vs. 1.13, P=0.033), a significant difference in HOMA-B (5.30 vs. 34.22, P=0.040) and a significant rise in QUICKI score (0.002 vs. -0.02, P=0.022). Consumption of a synbiotic food for 9 weeks by pregnant women had beneficial effects on insulin actions compared to the control food, but did not affect FPG and serum hs-CRP concentrations.
Multinational study in children and adolescents with newly diagnosed type 1 diabetes: association of age, ketoacidosis, HLA status, and autoantibodies on residual beta-cell function and glycemic control 12 months after diagnosis
Mortensen, H.B.; Swift, P.G.F.; Holl, R.W.
.005), and by stimulated C-peptide (p IA; p = 0.02) and glutamic acid decarboxylase antibodies (GADA; p = 0.0004) at 1 month. HbA1c at 12 months was predicted by HbA1c at diagnosis (p ... (p = 0.002). Conclusions: Younger age, ketoacidosis at diagnosis, and IA and GADA 1 month after diagnosis were the strongest explanatory factors for residual beta-cell function at 12 months. Glycemic control at 12 months was influenced predominantly by ethnicity, HbA1c at diagnosis, and GADA at 1......Objective: To identify predictors of residual beta-cell function and glycemic control during the first 12 months after the diagnosis of type 1 diabetes (T1D). Subjects and Methods: Clinical information and blood samples were collected from 275 children. HbA1c, antibodies, HLA typing and mixed meal...
Exploring effects of self-management on glycemic control using a modified information-motivation-behavioral skills model in type 2 diabetes mellitus patients in Shanghai, China: A cross-sectional study.
Chen, Qi; Wang, Huwen; Wang, Yichen; Wang, Zezhou; Zhao, Daijun; Cai, Yong
The original information-motivation-behavioral skills (IMB) model has been verified in type 2 diabetes mellitus (T2DM) patients, but the effects of the model on glycemic control remain unclear. The aim of this study was to modify the IMB model to explore the effects of self-management on glycemic control in T2DM patients in Shanghai, China. A cross-sectional study was conducted on participants recruited using a convenience sampling method between June and August 2015 in three tertiary hospitals and four community health service centers; 796 participants meeting the inclusion criteria (age ≥18 years and a diagnosis of T2DM) completed a questionnaire and blood test for glycemic control. Structural equation models were used to test the IMB framework. The modified model demonstrated an acceptable fit of the data. Paths from information to self-management behaviors (β = 0.119, P = 0.001) and HbA1c (β = -0.140, P motivation to behavioral skills (β = 0.670, P motivation varied with each other (r = 0.350, P Type 2 diabetes mellitus patients with poor control of glucose levels may be a better target population for application of the modified IMB model. © 2018 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.
Full Text Available Background: The purpose of this study was to analyze the effects of a long-term, community-based, combined exercise program developed with low-cost exercise strategies on glycemic control and cardiovascular risk factors in middle-aged and older patients with type 2 diabetes. Methods: Participants (n = 124; 63.25 ± 7.20 years old engaged in either a 9-month supervised exercise program (n = 39; consisting of combined aerobic, resistance, agility/balance, and flexibility exercise; three sessions per week; 70 min per session or a control group (n = 85 who maintained their usual care. Glycemic control, lipid profile, blood pressure, anthropometric profile, and the 10-year risk of coronary artery disease were assessed before and after the 9-month intervention. Results: A significant time * group interaction effect (p < 0.001 was identified in the values of the glycated hemoglobin, fasting plasma glucose, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, systolic blood pressure, diastolic blood pressure, body mass index, waist circumference, and the 10-year risk of coronary artery disease. Conclusions: A long-term, community-based, combined exercise program developed with low-cost exercise strategies was effective in inducing significant benefits on glycemic control, lipid profile, blood pressure, anthropometric profile, and the 10-year risk of coronary artery disease in middle-aged and older patients with type 2 diabetes. Clinical Trial Identification Number: ISRCTN09240628.
Mendes, Romeu; Sousa, Nelson; Reis, Victor Machado; Themudo-Barata, Jose Luis
The purpose of this study was to analyze the effects of a long-term, community-based, combined exercise program developed with low-cost exercise strategies on glycemic control and cardiovascular risk factors in middle-aged and older patients with type 2 diabetes. Participants ( n = 124; 63.25 ± 7.20 years old) engaged in either a 9-month supervised exercise program ( n = 39; consisting of combined aerobic, resistance, agility/balance, and flexibility exercise; three sessions per week; 70 min per session) or a control group ( n = 85) who maintained their usual care. Glycemic control, lipid profile, blood pressure, anthropometric profile, and the 10-year risk of coronary artery disease were assessed before and after the 9-month intervention. A significant time * group interaction effect ( p exercise program developed with low-cost exercise strategies was effective in inducing significant benefits on glycemic control, lipid profile, blood pressure, anthropometric profile, and the 10-year risk of coronary artery disease in middle-aged and older patients with type 2 diabetes. Clinical Trial Identification Number: ISRCTN09240628.