Delayed breakfast in type 2 diabetes: Critical gaps and translation barriers.

Hyperglycemia and hypoglycemia are common during coronary artery bypass graft (CABG) and are associated with a variety of postoperative outcomes. Therefore, the strategy of intraoperative glycemic control is an important issue for the patients undergoing CABG. This systematic review aims to evaluate the effect of different intraoperative glycemic control strategies on postoperative outcomes. We will perform this systematic review of randomised controlled trials (RCTs) according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Relevant studies will be searched in Medline, Embase, Cochrane Library and Web of Science. Two independent reviewers will conduct study selection, data extraction, risk of bias and quality assessment. The primary outcome is postoperative mortality, and the secondary outcomes include the duration of mechanical ventilation in the intensive care unit (ICU), the incidence of postoperative myocardial infarction (MI), the incidence of postoperative atrial fibrillation (AF), the type and volume of blood product transfusion, the rate of rehospitalization, the rate of cerebrovascular accident, the rate of significant postoperative bleeding, the rate of infection, the incidence of acute kidney failure (AKF), hospital and ICU lengths of stay (LOS). ReviewManager 5.4 will be used for data management and statistical analysis. The Cochrane risk-of -bias tool 2.0 and GRADEpro will be applied for risk of bias and quality assessment of the evidence. There is no consensus that which strategy of glycemic control is better for improving postoperative complications of patients undergoing CABG. The results of our study might provide some evidence for the relationship between intraoperative glycemic control strategies and postoperative outcomes in patients undergoing CABG.

IntroductionHyperglycemia and hypoglycemia are common during coronary artery bypass graft (CABG) and are associated with a variety of postoperative outcomes. Therefore, the strategy of intraoperative glycemic control is an important issue for the patients undergoing CABG. This systematic review aims to evaluate the effect of different intraoperative glycemic control strategies on postoperative outcomes.Methods and analysesWe will perform this systematic review of randomised controlled trials (RCTs) according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Relevant studies will be searched in Medline, Embase, Cochrane Library and Web of Science. Two independent reviewers will conduct study selection, data extraction, risk of bias and quality assessment. The primary outcome is postoperative mortality, and the secondary outcomes include the duration of mechanical ventilation in the intensive care unit (ICU), the incidence of postoperative myocardial infarction (MI), the incidence of postoperative atrial fibrillation (AF), the type and volume of blood product transfusion, the rate of rehospitalization, the rate of cerebrovascular accident, the rate of significant postoperative bleeding, the rate of infection, the incidence of acute kidney failure (AKF), hospital and ICU lengths of stay (LOS). ReviewManager 5.4 will be used for data management and statistical analysis. The Cochrane risk-of -bias tool 2.0 and GRADEpro will be applied for risk of bias and quality assessment of the evidence.DiscussionThere is no consensus that which strategy of glycemic control is better for improving postoperative complications of patients undergoing CABG. The results of our study might provide some evidence for the relationship between intraoperative glycemic control strategies and postoperative outcomes in patients undergoing CABG.

Background: Inflammation is well-known to worsen glycemia in people with type 1 diabetes (T1D). COVID-19 vaccines are vital for protection against SARS-CoV-2 infection, but by necessity trigger an acute immune response. Case reports have described hyperglycemic crises shortly after a booster dose. However, effects of COVID-19 vaccines on glycemic control in T1D is poorly understood. Methods: This was a prospective cohort study of adults with T1D receiving a COVID-19 booster dose. At the baseline visit a blinded Dexcom G6 Pro CGM was placed, subjects received COVID-19 booster vaccine 3-4 days later, and returned 6 days post-vaccination to have the CGM removed. Primary outcome was change in mean daily glucose level from baseline. Secondary outcomes included total daily insulin dose (TDI), total daily insulin resistance (TDIR = mean glucose * TDI), and time in range (TIR = %glucose readings between 70-180mg/dL). Data were transformed as necessary to maintain normality. Results: We enrolled 20 adults with T1D; one subject was excluded for nonadherence with study procedures. Baseline characteristics included (mean±SD) age: 48.9±19.4y, sex: 68.4%F, BMI: 29.6±6.2kg/m2, A1c: 7.0±1.0%. 42% received a Moderna and 58% Pfizer-BioNTech booster. Mean glucose on Day#2 post-vaccination was significantly greater than baseline (165.1±27.4 vs 154.5±30.2 mg/dL, p=0.04), as was TDIR (7970±4113 vs 7036±3999; p=0.02). No other days had significant differences in glycemic metrics as compared to baseline. There were no differences in any outcome metrics between booster vaccine manufacturers. Conclusions: These results suggest that adults with T1D may experience transient glycemic elevations after receiving a COVID-19 booster. Clinicians may need to warn people with T1D to be more vigilant with glucose testing and insulin dosing temporarily after vaccination. Larger studies are warranted to corroborate these findings. Disclosure M.Zilbermint: Consultant; EMD Serono, Other Relationship; American Association of Clinical Endocrinologists. M.Motevalli: None. K.Batty: None. J.Venner-walcott: None. A.Edwards: None. T.Burley: None. K.Jackson: None. M.Akhtar: None. A.Demidowich: Research Support; Dexcom, Inc. Funding Dexcom, Inc. (IIS-2021-136)

As our understanding of the pathophysiology of type 2 diabetes (T2D) has advanced, new oral and injectable medications have been developed that target a growing number of the pathophysiological processes that cause hyperglycemia. In addition, weight-loss therapy, involving lifestyle interventions, antiobesity medications, or bariatric surgery, has been demonstrated to be highly effective in T2D management. The expanded number of treatment options has provided an increased capacity for glycemic control. Even so, T2D remains a progressive disease, requiring the intensification of therapy over time, and many patients still do not achieve HbA1c targets. Therefore, new therapeutic strategies for effective and safe glycemic control are critically needed. In this issue of Diabetes Care , Rajagopalan et al. (1) present a new therapeutic strategy for treatment of T2D. The strong point of the study is that the authors have developed and studied a novel therapeutic approach in T2D that could elucidate new disease mechanisms involving the role of the duodenum in metabolic regulation. The authors present a 6-month interim analysis of a phase I, single-arm, nonrandomized cohort study assessing safety and efficacy of endoscopic duodenal mucosal resurfacing (DMR) for treatment of T2D. This is a first-in-human experience with this intervention, which ablates the duodenal mucosa between the ampulla of Vater and the ligament of Treitz in a two-step endoscopic procedure. First, a catheter with a terminal balloon is passed into the duodenum that has three needles spaced at 120° around the balloon’s circumference. The needles are used to inject saline into the submucosal space in order to circumferentially separate and lift the mucosa from underlying tissues in the duodenal wall. A second catheter then introduces another balloon that thermally ablates (i.e., burns) the lifted mucosa at a temperature of ∼90°C (194°F). The conceptual basis of the procedure is derived from observations that …

ObjectiveTo analyze association between different perioperative glycemic control strategies and postoperative outcomes in patients with diabetes undergoing cardiac surgery.MethodsMEDLINE, Cochrane Library, Web of Science, EMBASE, Wanfang Data, China National Knowledge Infrastructure (CNKI) and China Biology Medicine (CBM) databases were searched from inception to January 31, 2019. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias of included studies, and consensus was reached by discussion with a third researcher.ResultsSix RCTs were included in the meta-analysis. We analyzed the effect of liberal (>180 mg/dl or 10.0 mmol/L), moderate (140–180 mg/dl or 7.8–10.0 mmol/L) and strict (<140 mg/dl or 7.8 mmol/L) glycemic control strategies in patients with diabetes undergoing cardiac surgery. The pooled results showed that strict glycemic control strategy was associated with a significant reduction in the risk of atrial fibrillation [OR = 0.48, 95%CI (0.32, 0.72), P < 0.001] and sternal wound infection [OR = 0.28, 95%CI (0.14, 0.54), P < 0.001], while there was no significant differences in postoperative mortality, stroke, and hypoglycemic episodes when compared with moderate control. In addition, there is no significant difference between moderate and liberal glycemic control strategies in postoperative mortality. However, moderate control was beneficial in reducing atrial fibrillation [OR = 0.28, 95%CI (0.13, 0.60), P = 0.001] compared with the liberal glycemic control strategy.ConclusionsThis meta-analysis showed when compared with moderate glycemic control strategy in patients with diabetes undergoing cardiac surgery, maintained strict glycemic control was associated with lower risk of atrial fibrillation and sternal wound infection. No benefit was found with liberal glycemic control strategy, so it could be a poor glycemic control strategy.

ObjectivesTo describe the prevalence of previously diagnosed diabetes among Mexican adults, to characterize the associated risk factors, and to describe which glycemic control strategies are the most used.MethodsWe analyzed data from 8,631 adults aged ≥20 years who participated in the ENSANUT-2016 and from whom we gathered data about previously diagnosed diabetes, risk factors, glycemic control strategies, and measures to prevent complications.ResultsThe prevalence of previously diagnosed diabetes in Mexican adults was 9.4% (10.3% in women and 8.4% in men). The adjusted OR for having diabetes was higher in adults aged ≥60 years (OR = 11.0 in women and OR = 30.7 in men) than in adults aged 20–39 years (OR = 1.0). The adjusted OR for having diabetes was higher in overweight men (OR = 1.7) than in men with normal BMI (OR = 1.0). A total of 30.5% of adults with diabetes did not report any control strategies, 44.9% measured their venous blood glucose, and 15.2% used the HbA1C as an indicator of glycemic control. Only 46.4% of them reported preventive measures.DiscussionDiabetes is a common disease among Mexican adults. Being older or overweight are risk factors for an adult to be diagnosed with diabetes. Most adults with diabetes evaluate their glycemic control but only half practice preventive measures.

To describe the prevalence of previously diagnosed diabetes among Mexican adults, to characterize the associated risk factors, and to describe which glycemic control strategies are the most used. We analyzed data from 8,631 adults aged ≥20 years who participated in the ENSANUT-2016 and from whom we gathered data about previously diagnosed diabetes, risk factors, glycemic control strategies, and measures to prevent complications. The prevalence of previously diagnosed diabetes in Mexican adults was 9.4% (10.3% in women and 8.4% in men). The adjusted OR for having diabetes was higher in adults aged ≥60 years (OR = 11.0 in women and OR = 30.7 in men) than in adults aged 20-39 years (OR = 1.0). The adjusted OR for having diabetes was higher in overweight men (OR = 1.7) than in men with normal BMI (OR = 1.0). A total of 30.5% of adults with diabetes did not report any control strategies, 44.9% measured their venous blood glucose, and 15.2% used the HbA1C as an indicator of glycemic control. Only 46.4% of them reported preventive measures. Diabetes is a common disease among Mexican adults. Being older or overweight are risk factors for an adult to be diagnosed with diabetes. Most adults with diabetes evaluate their glycemic control but only half practice preventive measures.

Purpose: This study examined factors influencing glycemic control among type 2 diabetes mellitus (T2DM) patients using data from the seventh Korea National Health and Nutrition Examination Survey. Methods: The subjects were 1,459 patients aged 30 years and older who with T2DM. The subjects were divided into three groups according to glycated hemoglobin A (HbA1c) values: good glycemic control group (good GCG, HbA1c<7%), insufficient GCG (7≤HbA1c< 8%), and poor GCG (8%≥HbA1c). Univariate multiple multinomial logistic regression was used. Results: The patients were distributed as follows: 52.7%, good GCG; 28.4%, insufficient GCG; and 18.9%, poor GCG. In the insufficient GCG, DM duration was a significant factor influencing glycemic control in T2DM. In the poor GCG, age, DM duration, hypertriglyceridemia, waist circumference and muscular exercise were significant factors influencing glycemic control in T2DM. Conclusion: Strategies for insufficient glycemic control should include intensive glucose control interventions for patients with a DM duration over 5 years. Strategies for poor glycemic control should include intensive glucose control interventions for younger age groups, those with a DM duration >1 year, and those with hypertriglyceridemia. In addition, nursing interventions for weight loss and muscular exercise are needed.

Background and Objectives: Hyperbaric oxygen is a recognised treatment for a range of medical conditions, including treatment of diabetic foot disease. A number of studies have reported an impact of hyperbaric oxygen treatment on glycaemic control in patients undergoing treatment for diabetic foot disease. There has been no systematic review considering the impact of hyperbaric oxygen on glycaemia in people with diabetes. Materials and Methods: A prospectively PROSPERO-registered (PROSPERO registration: CRD42021255528) systematic review of eligible studies published in English in the PUBMED, MEDLINE, and EMBASE databases, based on the following search terms: hyperbaric oxygen therapy, HBO2, hyperbaric oxygenation, glycaemic control, diabetes, diabetes Mellitus, diabetic, HbA1c. Data extraction to pre-determined piloted data collection form, with individual assessment of bias. Results: In total, 10 eligible publications were identified after screening. Of these, six articles reported a statistically significant reduction in blood glucose from hyperbaric oxygen treatment, while two articles reported a statistically significant increase in peripheral insulin sensitivity. Two articles also identified a statistically significant reduction in HbA1c following hyperbaric oxygen treatment. Conclusions: There is emerging evidence suggesting a reduction in glycaemia following hyperbaric oxygen treatment in patients with diabetes mellitus, but the existing studies are in relatively small cohorts and potentially underpowered. Additional large prospective clinical trials are required to understand the precise impact of hyperbaric oxygen treatment on glycaemia for people with diabetes mellitus.

The objective of this study was to analyze the effectiveness of telephone interventions as a strategy for glycemic control in adult Type 2 Diabetes Mellitus patients. An integrative literature review was undertaken in April and May 2011 through surveys in the Cochrane, PubMed/Medline, Lilacs and Cinahl databases. Nine studies complied with the inclusion criteria, mainly randomized controlled clinical trials. Concerning the time period analyzed in each study, it varied from eight weeks to twelve months. 1294 patients participated in the study, being 671 randomized to telephone follow-ups and 479 to usual care. In eight studies analyzed, glycemic control was based on the levels of glycated hemoglobin (HbA1c). The information found showed that the interventions are effective for glycemic control in patients who have type 2 Diabetes. Self-management was improved and possible complications of the disease were reduced.

Diabetes results in excess cardiovascular mortality.Unexpectedly,more strict glucose control induced more death in a large scale clinical trial and the increased hypoglycemia was a suspected offender.In order to decrease the risk of hypoglycemia,three steps should be taken into consideration in future treatment of hyperglycemia in diabetic patients with cardiovascular disease: ( 1 ) Identifying hypoglycemia early even in its paradoxical feature.( 2 )Achieving glucose targets with personality.( 3 ) Designing the strategy of lowering plasma glucose more carefully,to pay special attention avoiding hypoglycemia. Key words: Diabetes mellitus; Cardiovascular disease; Hyperglycemia; Hypoglycemia

The aim of this study was to evaluate the impact of the Dietary Approaches to Stop Hypertension (DASH) diet on glycaemic control and consumption of processed (PF) and ultraprocessed (UPF) foods in pregnant women with pre-gestational diabetes mellitus (PGDM). This is a randomised, controlled, single-blind clinical trial with forty-nine adult women with PGDM, followed at a public maternity hospital in Rio de Janeiro, Brazil. The control group (CG) received a standard diet consisting of 45-55 % of the total energy intake of carbohydrates, 15-20 % of proteins and 25-30 % of lipids. The DASH group (DG) received an adapted DASH diet, which did not differ from the standard diet in the percentage of macronutrients, but had higher contents of fibre, unsaturated fats and minerals such as Ca, Mg and K; and lower contents of Na and saturated fats than the standard diet. In the analysis by protocol, the DG presented a higher incidence of glycaemic control after 12 weeks of intervention (57·1 v. 8·3 %, P = 0·01, moderate effect size) and a lower mean consumption of UPF (-9·9 %, P = 0·01) compared with the CG. There was no statistically significant difference in fasting and postprandial blood glucose concentrations, or in the consumption of PF between the groups (P > 0·05). The DASH diet may be a strategy for glycaemic control in pregnant women with PGDM, favouring the adoption of a nutritionally adequate diet with lower consumption of UPF. Further studies are needed to investigate the effect of the DASH diet on glycaemic profile, and maternal and perinatal outcomes in women with PGDM.

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 perioperatório beneficia a recuperação do paciente cirúrgico, destacando-se a atuação da equipe de enfermagem para a implantação bem-sucedida da medida.

Aims: This review aims to identify and analyze the main strategies for glycemic control and the management of acute complications in children with type 1 diabetes (T1D), focusing on the effectiveness of technologies, nutritional interventions, and structured education. Study Design: Systematic literature review. Place and Duration of Study: Database searches (PubMed, SciELO, LILACS, BVS, and MEDLINE) were conducted between March and April 2025. Methodology: Studies published in the last 10 years were selected according to inclusion criteria targeting children with T1D. Articles addressing glycemic control (e.g., insulin therapy, continuous glucose monitoring, closed-loop systems), nutritional therapy, diabetes education, and management of acute complications (hypoglycemia and diabetic ketoacidosis) were analyzed. Data extraction was performed independently by two reviewers and thematically organized. Results: The findings revealed that insulin pumps and continuous glucose monitoring significantly improve glycemic control compared to multiple daily injections. Nutritional therapy with a low glycemic index and structured educational programs enhance adherence and metabolic outcomes. Acute complications such as severe hypoglycemia and diabetic ketoacidosis remain leading causes of hospitalization, especially in settings with limited access to technology. Differences between public and private healthcare systems affect outcomes, and multidisciplinary education is crucial in both hospital and home care. Conclusion: Glycemic control in children with T1D is more effective when technology, nutrition, and education are integrated. However, disparities in access to care and technologies persist. Healthcare professionals should adopt a comprehensive, individualized approach, and policymakers must ensure equitable access to effective interventions across healthcare systems.

Recently, several large, long-term rendomized controlled trails (ACCORD, ADVANCE, VADT) and long-term epidemiologic follow-up studies (UKPDS, STENO-2) have compared the effects of intensive versus standard glycemic control on cardiovascular disease events. Based on reviewing aforementioned studies, the present article would suggest that intensive glycemia control is still considered as one of the principal therapies for the prevention of cardiovascular events in diabetes while stressing on safety and individualization for glucose-lowering strategy. Key words: Intensive glycemic control; Prevention of CVD; Glycemic control strategy