Adequate Glycemic Control Research Articles

Determination of Factors Associated with Glycemic Control in Women with Type 2 Diabetes: Nutrition and Physical Activity Level

Aim: Effective diabetes management is achieved with adequate glycemic control. Nutrition and physical activity have an important role in glycemic control. This study was conducted to determine the relationship between glycemic control and nutrition attitude, Mediterranean diet adherence and physical activity levels of women with Type 2 diabetes aged 20-64 years who applied to a state hospital in Konya province. Material and Methods: This correlational study was conducted with 246 women aged 20-64 years with Type 2 diabetes who applied to the Internal Medicine and Endocrinology outpatient clinics of a hospital in Konya. Individuals were selected by random sampling method. Data were collected using a questionnaire form, Attitudes Toward Healthy Eating Scale, Mediterranean Diet Adherence Scale and International Physical Activity Questionnaire Short Form (IPAQ-SF). Descriptive statistics, Chi-Square, Fisher's exact test, Kruskal Wallis test, Spearman correlation analysis and logistic regression analysis were used to analyze the data collected by face-to-face interviews. Results: In the study, glycated hemoglobin A1c (HbA1c) and fasting blood glucose (FBG) were used to assess glycemic control. 55.3% and 56.9% of the individuals had poor glycemic control in terms of HbA1c and FBG, respectively. According to logistic regression analysis, for HbA1c; having diabetes for more than 10 years (OR=0.291, 95% Cl=0.095-0.894), high triglycerides (OR=0.440, 95% Cl=0.190-1.017) and low high density lipoprotein (HDL) (OR=0.293, 95% Cl=0.114-0.753); For FBG, increased frequency of skipping medication and insulin use (OR=2.431, 95% Cl=1.090-5.424) and low HDL level (OR=0.269, 95% Cl=0.110-0.653) were significant risk factors. Among the individuals, 73.2% had a moderate attitude towards healthy eating, 46.3% had a moderate adherence to the Mediterranean diet and 60.6% were physically inactive. In addition, there was a very weak negative significant correlation (p

The relationship between residual insulin secretion and subclinical cardiovascular risk indices in young adults with type 1 diabetes.

Patients with type 1 diabetes (DM1), even in the setting of adequate glycaemic control, have an excess risk for developing cardiovascular disease. Residual insulin secretion (RIS), measured by detectable C-peptide levels in patients with DM1, might protect against diabetes-related complications. This study aimed to examine the relationship between residual insulin secretion and prognostic markers of cardiovascular complications in patients with DM1. A total of 137 patients with DM1 were included in this analysis. They were of young age (<45 years), with an established diagnosis of over two years before the study entry and without a history of cardiovascular complications. All patients underwent complete clinical and laboratory evaluation. A c-peptide measurement of ≥0.05 ng/ml was used to identify the presence of RIS. Pulse wave velocity (PWV), cardiac autonomic function assessed both at rest, by total power of heart rate variability and dynamically, by the expiration to inspiration (e/i) index, albumin to creatinine ratio (ACR), and high sensitivity CRP (hs-CRP) were used as predictive biomarkers of cardiovascular complications. Female participants represented 63.5% of the population [mean age: 29.7 (±8.1) years, mean HbA1c: 7.6% (±1.4), median diabetes duration:15 (10-21) years, median age at diabetes diagnosis: 13 (8-17) years]]. The median value of fasting c-peptide was 0.04 (0.03-0.05) ng/ml, and RIS was detected in 32 patients (23.4%). Patients with RIS had a shorter diabetes duration, an older age at diagnosis and a lower BMI, while no significant association was found between residual c-peptide and age or HbA1c. RIS was significantly associated with lower PWV values [8.1 m/s² (7-8.7) vs 9.2 m/s² (7.8-10.1), p <0,001], higher total power values [1124 Hz (600-3277) vs 577 Hz (207-2091), p <0,001], and higher E/I measurements [1.4 (1.2-1.5) vs. 1.3 (1.2-1.4), p=0.01]. No significant association was noted between RIS and either ACR or hs-CRP. In multivariable linear regression analysis, the association between RIS and lower PWV values remained significant (p= 0.007) regardless of age, sex, diabetes duration or age of diagnosis, blood pressure and BMI. Similarly, residual insulin secretion retained a significant independent association with total power (p= 0.032) and E/I (p=0.045). In young patients with DM1, free of macrovascular complications, residual insulin secretion is independently associated with more favorable prognostic markers of subclinical atherosclerosis and cardiac autonomic function.

Safety of GLP-1 Receptor Agonists and Other Second-Line Antidiabetics in Early Pregnancy

JAMA Intern Med. 2024;184(2):144–152. doi: 10.1001/jamainternmed.2023.6663 Metformin is the first-line treatment in T2D. However, more patients are taking second-line antidiabetic medications (ADMs) as well to achieve adequate glycemic control. In pregnancy, insulin has historically been used due to its safety profile and metformin administration is now also common. With the recent increased use of ADMs, unintended exposure in early pregnancy is occurring and the risk of major congenital malformations (MCMs) in the infant is unknown. This large multinational study looked at the use and safety of GLP-1 receptor agonists and other noninsulin ADMs early in pregnancy in comparison to insulin.

Glycemic Control and Adult Height: A Nationwide Swedish Cohort Study on Childhood Type 1 Diabetes

Abstract Context Normal growth throughout childhood and adolescence is considered an indicator of adequate glycaemic control in patients with type 1 diabetes. While it has been suggested that growth in type 1 diabetes is reduced, the literature is conflicting and differences in final adult height and the risk of short stature depending on glycaemic control remain largely unexplored. Objective This work aims to assess adult height outcomes across levels of glycemic control in children and adolescents with type 1 diabetes, as well as to investigate the effect of sex, age at disease onset, and timing of glycemic control in relation to puberty. Methods In this population-based Swedish cohort study, we collected data on glycemic control and height from specialist health-care visits of all individuals with childhood-onset type 1 diabetes in the National Diabetes Register. Using linear and logistic regression, we compared suboptimal (glycated hemoglobin A1c [HbA1c] 53-75 mmol/mol [7.0-9.0%]) and poor (HbA1c &amp;gt; 75 mmol/mol [&amp;gt;9.0%]) to optimal (HbA1c &amp;lt; 53 mmol/mol [&amp;lt;7.0%]) glycemic control in relation to final adult height and the risk of short stature. Results Poor glycemic control was associated with lower final adult height (−2.91 cm [95% CI, –3.48 to −2.33] for males, −1.83 cm [−2.42 to −1.23] for females) as well as a higher risk of short stature in males (odds ratio 1.90 [1.07-3.35]) but not in females (0.73 [0.36-1.51]). For females, adult height was lower only among those with type 1 diabetes since before puberty and if the poor glycemic control occurred before puberty. For males, adult height was lower irrespective of their age at diabetes onset, but only if they had poor glycemic control during or after puberty. Conclusion Poor glycemic control after the onset of type 1 diabetes, compared to optimal control, is associated with lower adult height in males and females. The prepubertal period seems to be more critical for females than males.

The Complex Relationship Between Tuberculosis and Hyperglycemia.

Hyperglycemia and tuberculosis are dual global pandemics. Each has a propulsive and amplifying effect on the other, and, because of this, we must consider hyperglycemia and tuberculosis together. Hyperglycemia is immunosuppressive and increases the risk of tuberculosis by threefold. It also leads to a more advanced presentation of pulmonary tuberculosis, thus increasing the likelihood of being smear positive and having cavitating lesions, and it impacts the duration and outcomes of treatment, with an increased one year mortality seen in patients with tuberculosis and diabetes. Additionally, any degree of hyperglycemia can have an impact on susceptibility to tuberculosis, and this effect is not limited to poorly controlled diabetes. Conversely, tuberculosis itself is associated with hyperglycemia and worsens hyperglycemia in those with diabetes mellitus. The impact of this relationship varies based on the base rates of each disease in different regions of the world. In order to successfully achieve the World Health Organization's goals of tuberculosis eradication and adequate glycemic control, we must improve our understanding, co-management, and screening of hyperglycemia and tuberculosis. This review aims to explore the current research investigating the relationship between tuberculosis and diabetes, including the changes in disease susceptibility, presentation, geographic distribution, and effects on treatment.

RSSDI Expert Consensus for Optimal Glucose Monitoring in Diabetes Mellitus in India and Recommendations for Clinical Practice

Effective management of diabetes warrants accurate and regular monitoring of glucose levels to prevent serious diabetes-associated complications and long-term health consequences. Hence, achieving target glucose levels and maintaining adequate glycemic control is essential in diabetes to prevent episodes of hypoglycemia. Multiple glucose monitoring tools have been developed over time, each with differing degrees of precision, convenience, and real-time input. The management of diabetes has been considerably improved by using these various glucose monitoring devices, both in terms of treatment outcomes and patient quality of life. However, in India, the lack of awareness, patient education, availability, and affordability of glucose monitoring devices poses a significant concern resulting in poor adherence to glucose monitoring and low medication adherence thereby increasing disease burden. Consequently, there is an urgent need for healthcare professionals and policymakers in India to collaborate and address the challenges associated with glucose monitoring in patients with diabetes, while also providing recommendations to overcome these concerns. This recommendation article offers a comprehensive evaluation of various glucose monitoring tools available for use by patients suffering from different types of diabetes, explores the challenges associated with glucose monitoring in India, and also presents expert panel recommendations to enhance diabetes management effectively.

Effects of glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter-2 inhibitors and their combination on mitochondrial-derived peptide-c and on markers of neurohumoral activation

Abstract Background/Introduction Type-2 diabetes mellitus (T2DM) is associated with increased prevalence of cardiovascular disease. Purpose We investigated the effects of insulin, glucagon like peptide-1 receptor agonists (GLP-1RA), sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and their combination on mitochondrial-derived peptide-c (MOTS-c), N-terminal pro B-type natriuretic peptide (NT-proBNP), growth differentiation factor (GDF)-15, oxidant and antioxidant biomarkers and cardiovascular function of T2DM patients. Methods A total of 160 T2DM patients were randomized to insulin (n = 40), liraglutide (n = 40), empagliflozin (n = 40) or their combination (GLP-1RA+SGLT-2i) (n = 40) as add-on to metformin. We measured at baseline, at 4 and at 12 months of treatment: a) plasma levels of MOTS-c, NT-proBNP and GDF-15, b) thiobarbituric acid reactive substances (TBARS), as an oxidant biomarkers, and 2,2′-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS), as an antioxidant biomarker, and c) global left ventricular longitudinal strain (GLS) and global work index (GWI) using speckle-tracking imaging. Results Twelve months after treatment, treatment with SGLT-2i and GLP-1RA+SGLT-2i improved MOTS-c (14.89 ± 11.27 vs. 7.26 ± 4.21 ng/mL, p=0.009, 6.49 ± 3.91 vs. 5.6 ± 3.38 ng/mL, p=0.029, respectively), while treatment with insulin and GLP-1RA had a neutral effect on this biomarker (p &amp;gt; 0.05; Table). GLP-1RA, SGLT-2i and their combination showed a greater reduction of NT-proBNP (-43.1% vs. -54.2% vs. -56.9% vs. -14.7%; Figure) and GDF-15 (-14.8% vs. -15.2% vs. -16.1% vs. -0.9%) than insulin (p &amp;lt; 0.05 for all comparisons), despite the fact that all patient achieved adequate glycemic control. GLP-1RA or GLP-1RA+SGLT-2i provided a remarkable reduction of TBARS and increase of GLS and GWI compared to insulin or SGLT-2i (p &amp;lt; 0.05). In all patients, at 4 and at 12 months, the percentage reduction of NT-proBNP was associated with the improvement of TBARS, GLS and GWI (p &amp;lt; 0.05). The percentage reduction of GDF-15 was correlated with the increase of ABTS and with the improvement of GLS at 4 and 12 months (p &amp;lt; 0.05). In SGLT-2i group, the percentage increase of MOTS-c was related with the percentage reduction of GDF-15 (r = 0.81, p = 0.005) at 12 months. Conclusions Twelve-month treatment with GLP-1RA, SGLT-2i and their combination resulted in reduction of cardiac biomarkers in parallel with a greater decrease of oxidative stress than insulin in T2DM. SGLT-2i appears more effective in the improvement of MOTS-c and markers of neurohumoral activation.TableFigure

Barriers to Insulin Therapy Initiation by Adult Type 2 Diabetics at Family Health Centers in Sudan

Type Two Diabetes Mellitus is a progressive disease by nature so most patients will inevitably require insulin therapy to maintain adequate glycaemic control. Insulin use is delayed in many patients who would benefit from such treatment. Patient’s beliefs and perceptions regarding insulin therapy create barriers contributing to the delay in its initiation. Aimed to study the barriers to insulin initiation from a patient’s perspective, by performing a Cross-sectional study in the East Nile locality Khartoum; between February 2019 to May 2020. A questionnaire included demographic features, the status of insulin initiation, barriers to insulin initiation and knowledge about insulin therapy for Type 2 diabetes were administered during face-to-face interviews, which resulted in the majority of 307 participants being females aged 45 – 56, (57.7%) of them had HbA1c higher than 7. The commonest barrier to insulin use was found to be fear of hypoglycemia (72.0%), followed by insulin should be a final option and when started should not be stopped (64.5%) 60% thought that insulin leads to weight gain and (59.9%) of them had needle phobia. The conclusion is that Patients' concerns and beliefs regarding insulin use are multiple. a major factor behind diabetes patients' refusal of initiation of this therapy appears to be a lack of adequate information and misconceptions relating to insulin use, such as benefits and side effects.

6957 5-Year Follow-Up of Acute, micro, and Macrovascular Complications of Patients With Type 2 Diabetes Managed by a Multi-Disciplinary Team In A Hospital in Northeastern Mexico

Abstract Disclosure: M. Romero Ibarguengoitia: None. D.P. Morales Rodríguez: None. A. Garza-Silva: None. A. Rivera-Cavazos: None. I. Fernández-Chau: None. A. Cepeda-Medina: None. A. González-Cantú: None. Type 2 Diabetes Mellitus (T2DM) is a condition associated with various acute and chronic complications, which constitute the leading cause of disability, morbidity and mortality globally. During the SARS-CoV-2 pandemic, vulnerable individuals such as those with T2DM faced a restriction in access to primary healthcare services. Therefore, we decided to compare the presence of micro and macrovascular complications before and during the SARS-CoV-2 pandemic, as well as the incidence of acute complications. A retrospective observational cohort study from 2018 to 2022 was conducted in a hospital in northeastern Mexico on patients with T2DM who were treated by a multidisciplinary team composed of an internist or geriatrician based on the patient's age, endocrinologist, nutritionist, and other diabetes-related specialties. Levels of HbA1C, fasting serum glucose (FSG), low-density lipoprotein cholesterol (LDLc), blood pressure (BP), and microalbuminuria were analyzed. Consequently, presence of micro and macrovascular complications and incidence of acute complications was described. A total of 999 subjects were analyzed, 516 (51.7%) males, with an average age (SD) of 60.1 (12.7) years. There was an increase in the proportion of patients with adequate glycemic control based on HbA1C of 15.2% between 2018 and 2022 (p&amp;lt;0.001) and a 42.3% increase in FSG control during the same period (p&amp;lt;0.001). LDLc showed a decrease in the control proportion of 5.1% between 2018 and 2022 (p&amp;lt;0.001). Systolic BP control in 2018 was 82.7% and 80.1% in 2022 (p&amp;lt;0.001). Diastolic BP control in 2018 was 89.6%, with an increase to 91.4% in 2022 (p=0.01). Microalbuminuria control increased from 80.5% in 2018 to 89% in 2022 (p=0.002). There were 78 (7.8%) cases of microvascular complications, with diabetic neuropathy being the most prevalent (n=35, 3.6%), and a higher incidence in 2021 with 15 (1.6%) cases. A total of 15 (1.5%) patients presented a macrovascular complication, with ischemic heart disease being the most frequent with 11 (1.1%) subjects, and a higher incidence of cases in 2021 (n=4, 0.4%). Hypoglycemia was found to be the most frequent acute complication with 14 (1.4%) cases, with a higher incidence in 2020 (n=5, 0.5%). The low incidence of complications in our population, emphasizes the importance of coordinating patient’s care between a multidisciplinary team to maintain an overall disease control, optimize T2DM treatment and enhance patient’s quality of life. Presentation: 6/1/2024

Prevalence of Diabetic Macular Edema Using Optical Coherence Tomography in Type 2 Diabetics With Nephropathy in Comparison With Type 2 Diabetics Without Nephropathy.

The primary vision-threatening complication in patients with diabetic retinopathy (DR) is diabetic macular edema (DME). Diabetic nephropathy (DN) often has DR that threatens their vision and has a risk of developing DME. Hence, the presence of DN could be the only risk factor for developing DME without the presence of other factors. Hence, this study proposes to predict the prevalence of DME using optical coherence tomography (OCT) in type 2 diabetics with nephropathy in comparison with diabetics without nephropathy. This is a cross-sectional study done on patients visiting the Ophthalmology Department at Saveetha Medical College and Hospital, Chennai, for one year. A total of 120 patients were included in the study, with 60 diabetic patients without nephropathy in Group 1 and 60 diabetic patients with nephropathy in Group 2. A detailed history was recorded. Their recent blood reports of fasting blood sugar, postprandial blood sugar, hemoglobin A1c (HbA1c), renal function test, and urine protein/creatinine ratio were all noted. Chronic kidney disease (CKD) staging in nephropathy patients as done by the nephrologist was also documented. The best corrected visual acuity (BCVA) was assessed for distant and near vision. A slit lamp examination and dilated fundus examination were done. Fundus findings were independently graded according to the Early Treatment Diabetic Retinopathy Study (ETDRS) classification. OCT was done in all patients to confirm DME. In our study. males and females were 60 each in number. The majority of patients(32.5%) were >70 years old. A small percentage of patients (1.7%) in Group 1 had DM of >10 years, and 41.7% of the patients in Group 2 had DM of >10 years. Meanwhile, 73.3% of the patients in Group 1 had an HbA1c level between 6% and 7.5%, and 83.3% of the patients in Group 2 had an HbA1c level >7.5%. The percentage of patients with DME in Group 1 was 1.7%, and that in Group 2 was 21.7%. The majority of patients who had BCVA of 6/6 were in Group 1. The majority of patients with DME (46.4%) had stage V nephropathy. The coexistence of nephropathy in diabetic patients increases the incidence of DME. With long-standing diabetes and uncontrolled blood sugar levels being risk factors for developing DN and subsequently DME, such patients are to be screened regularly and advised on adequate glycemic control for achieving good visual prognosis and limit retinopathy progression. Moreover, the severity of DN should be kept in mind by nephrologists, and patients are to be promptly referred to the ophthalmology department for complete evaluation.

Major adverse cardiovascular events' reduction and their association with glucose-lowering medications and glycemic control among patients with type 2 diabetes: A retrospective cohort study using electronic health records.

Cardiovascular diseases are a common cause of death among patients with type 2 diabetes (T2DM). Major adverse cardiovascular event (MACE) risks can be significantly reduced under adequate glycemic control (GC). This study aims to identify factors that influence MACE risk among patients with T2DM, including Hemoglobin A1c variability score (HVS) and early use of MACE-preventive glucose-lowering medications (GLMs). We conducted a longitudinal cohort study to retrospectively review electronic health records between 2011 and 2022. Patients with T2DM ≥18 years without previous stroke or acute myocardial infarction (AMI) were included. Cox regression was utilized to investigate MACE risk factors and compare MACE risk reduction associated with early use of MACE-preventive GLMs. A total of 19 685 subjects were included, with 5431 having MACE, including 4453 strokes, 977 AMI, and 1 death. There were 11 123 subjects with good baseline GC. Subjects with good baseline GC had 0.837 (confidence interval [CI]: 0.782-0.895) times lower MACE risk than their counterpart. Subjects with a single MACE-preventive GLM at baseline with continuous use >365 days showed a decreased MACE hazard ratio (0.681; CI: 0.635-0.731). Among all MACE-preventive GLMs, semaglutide provided a more significant MACE-preventive effect. This study identified that GLM, early GC, and HVS are MACE determinants among patients with T2DM. Novel GLM, adequate GC, and reduction of HVS can benefit MACE outcomes.

Periodontitis and Metabolic Control of Adults with Type 1 Diabetes.

Periodontitis has been reported with increased incidence and prevalence in patients with diabetes mellitus (DM). Noncommunicable diseases burden the South African public health system, and there are no data reporting on this relationship in this population. This is required to inform management protocols in type 1 diabetes mellitus (T1DM), which currently exclude the importance of periodontal treatment. The aim of this study was to determine whether there was an association between periodontitis and the glycemic control of adult patients with T1DM at a tertiary institution in South Africa. A cross-sectional study was conducted on adults diagnosed with T1DM. Bleeding on probing, periodontal pocket depth, and radiographical bone loss were assessed and the periodontal status of the patient was compared to their glycemic control, measured by HbA1c. An HbA1c level of ≤7% was considered to indicate adequate glycemic control. There were 120 adult participants, of whom 61.7% (74) were female and 38.3% (46) were male. The majority were nonsmokers and younger than 44 y. There were 78 (65%) participants with uncontrolled blood glucose and 42 (35%) with good control (HbA1c ≤ 7%). The median HbA1c level was 8.75 (range, 6.1 to 12.2). Most participants (94%) had periodontitis, and 97% of them had uncontrolled blood glucose. There was an association between percentage bleeding score (P < 0.001) and metabolic control in adults with T1DM treated at a tertiary hospital in Cape Town, South Africa. Periodontitis severity as described by staging was not associated with T1DM in this sample. The high prevalence of periodontitis in this sample (94%) highlights the need for periodontal management to form a part of holistic patient care in patients with T1DM in this setting. The study results highlight the role of periodontitis severity and gingival bleeding scores on the metabolic control of adults with T1DM and thus emphasizes the importance of periodontal care in whole-person health in this patient population.

Correlation between glycemic control and retinal nerve fiber layer parameters in type 2 diabetics without retinopathy: a case control study

Background Retinal neurodegenerative changes were found to develop in patients with diabetes mellitus (DM) before the onset of microvascular changes of diabetic retinopathy (DR). Such changes usually affect inner retinal layers in the form of retinal nerve fiber layer (RNFL) thinning. Aim To correlate the degree of glycemic control [in the form of hemoglobin A1c (HBA1c) levels] with changes in peripapillary RNFL thickness in patients with type 2 DM without DR using optical coherence tomography (OCT). Patients and methods Participants are divided into three groups each including 28 eyes: group 1: uncontrolled type 2 DM without DR (HBA1c≥7%), group 2: controlled type 2 DM without DR (HBA1c&lt;7%), group 3: healthy age and sex-matched controls. Peripapillary RNFL and macular ganglion cell complex (GCC) thickness were evaluated in all participants using RTVue spectral domain OCT device (Optovue, Fremont, USA). Results Peripapillary RNFL and macular GCC were significantly thinner in the uncontrolled type 2 DM group in comparison to both the controlled type 2 DM group and the healthy control group. No significant difference in OCT parameters between the controlled type 2 DM group and the healthy control group. HBA1c shows a statistically significant negative correlation with average, superior and inferior RNFL thickness as well as average, superior, and inferior GCC thickness. Conclusion Early and adequate glycemic control, indicated by HBA1c less than 7%, is of critical importance in delaying and reducing early neurodegenerative changes in the form of RNFL and GCC thinning in patients with type 2 DM without DR.

Efficacy and Safety of Pioglitazone/Metformin Fixed-Dose Combination Versus Uptitrated Metformin in Patients with Type 2 Diabetes without Adequate Glycemic Control: A Randomized Clinical Trial.

We aim to evaluate the efficacy and safety of pioglitazone/metformin fixed-dose combination (FDC) versus uptitrated metformin in patients with type 2 diabetes mellitus (T2DM) without adequate glycemic control. A total of 304 patients were recruited from 15 hospitals in China and randomly assigned (1:1) to the test group (pioglitazone/metformin FDC, 15/500mg) or the control group (uptitrated metformin, 2000-2500mg/day). The primary endpoint was the proportion of patients with glycated hemoglobin A1c (HbA1c) ≤ 6.5% and ≤ 7.0% at week 16. The secondary outcomes included the change from baseline in glucose, serum lipids, and liver function. Full analysis set (FAS) and per-protocol set (PPS) were used for analyses. In the test group, 103 (69.59%) patients reached HbA1c ≤ 7.0% (FAS, P = 0.009), with 68 (45.95%) patients achieved HbA1c ≤ 6.5 (FAS, P = 0.043). More reduction in HbA1c, homeostatic model assessment for insulin resistance, and diastolic pressure was found. Bodyweight, body mass index, and high-density lipoprotein cholesterol increased markedly. The changes of triglycerides, alanine transaminase, aspartate aminotransferase, and high-sensitivity C-reactive protein decreased noticeably. There were no significant differences in rates of adverse events between the two groups. Pioglitazone/metformin FDC was superior to uptitrated metformin among patients with T2DM without adequate glycemic control. This trial is registered with the Chinese Clinical Trial Registry (ChiCTR1900028606).

Causality analysis of myopathy secondary to dapagliflozin therapy in type II Diabetes – A case study

Diabetes mellitus is a chronic metabolic condition that is becoming more prevalent globally. Diabetic patients must maintain adequate glycemic control in order to avoid or postpone diabetic complications. Diabetes care has evolved since the introduction of sodium-glucose co-transporter 2 inhibitors (SGLT2i). Postmarketing surveillance has shown cases of diabetic ketoacidosis and increased bone fracture risk associated with the use of SGLT2 inhibitors. We present a case of a 55-year-old female with a 6-year history of diabetes who exhibited weakness, muscular pains, and a burning feeling in her left thigh as a result of Dapagliflozin. Before initiating dapagliflozin treatment, the patient's fasting blood sugar (FBS) was 314 mg/dl and postprandial blood sugar (PPBS) was 343 mg/dl. After adding dapagliflozin as part of the therapy, the FBS improved to 179.24 mg/dl, and the PPBS decreased to 214.39 mg/dl, indicating a significant reduction in blood glucose levels. The introduction of Dapagliflozin in the treatment reduces the therapeutic gap compared to earlier treatment schedule, but retain the same side effect and became rechallenge. The instance of myopathy linked to dapagliflozin was confirmed following the causality evaluation by WHO Schales. It exemplifies the need for detecting drug-induced myopathy. Recently, minimal evidence has emerged showing a link between prolonged SGLT2 inhibitor use and accelerated myopathy. Myopathy is the generalised loss of skeletal muscle mass and function that occurs with ageing. Its existence is linked to negative health outcomes such as physical impairment, low quality of life, and death. Clinically, no other cause of myopathy was detected, and biochemical analysis indicated that dapagliflozin was the cause of her myopathy.

Pathogenic Mechanisms That May Link Periodontal Disease and Type 2 Diabetes Mellitus-The Role of Oxidative Stress.

Given the posited role of oxidative stress in the pathogenesis of both periodontitis and type 2 diabetes mellitus (T2DM), it may also serve as a link between these highly prevalent chronic inflammatory diseases. This view is supported by an ample body of evidence indicating that the severity and progression of periodontitis is in part driven by diabetes, while periodontal infection may hinder the attainment of adequate glycemic control in diabetic patients. Thus, this review focuses on the potential synergistic interactions along the oxidative stress-inflammation pathway characterizing both conditions. Because periodontitis and T2DM share the same risk factors and compromise patients' quality of life, to develop effective strategies for combatting both conditions, their mutual influence needs to be explored.

Efficacy and safety of dapagliflozin add-on to evogliptin plus metformin therapy in patients with type 2 diabetes: A randomized, double-blind, placebo-controlled study.

To evaluate the efficacy and safety of dapagliflozin versus placebo as an add-on in patients with type 2 diabetes who did not achieve adequate glycaemic control with evogliptin and metformin combination. In this multicentre, randomized, double-blind, placebo-controlled Phase 3 trial, patients with glycated haemoglobin (HbA1c) levels ≥7.0% (≥53 mmol/mol) and ≤10.5% (≤91 mmol/mol) who had received stable-dose metformin (≥1000 mg) and evogliptin (5 mg) for at least 8 weeks were randomized to receive dapagliflozin 10 mg or placebo once daily for 24 weeks. Participants continued treatment with metformin and evogliptin. The primary endpoint was change in HbA1c level after 24 weeks of treatment from baseline level. In total, 198 patients were randomized, and 195 patients were included in the efficacy analyses (dapagliflozin: 96, placebo: 99). At Week 24, dapagliflozin significantly reduced HbA1c levels. The least squares mean difference in HbA1c level change from baseline after 24 weeks of treatment was -0.70% (-7.7 mmol/mol)(p < 0.0001). The proportion of participants achieving HbA1c <7.0% (≥53 mmol/mol)was higher in the dapagliflozin group than in the placebo group. Compared to placebo, dapagliflozin significantly reduced fasting plasma glucose, mean daily glucose, 2-h postprandial plasma glucose, fasting insulin, uric acid and gamma-glutamyl transferase levels, homeostatic model assessment for insulin resistance index, body weight, hepatic steatosis index, and albuminuria. Adiponectin level significantly increased from baseline level after 24 weeks of dapagliflozin treatment. Adverse event rates were similar in the two groups. Dapagliflozin add-on to evogliptin plus metformin improved glycaemic control and was well tolerated by the target patients.

A randomized controlled trial comparing two antenatal care regimes in the management of mild to moderate gestational diabetes in a low-middle income country.

The prevalence of gestational diabetes mellitus (GDM) in the Indian subcontinent has increased exponentially, especially after new diagnostic criteria. Identifying women who need close monitoring is a challenge. Ultrasound has been used to guide therapy but its use in the management of GDM has been used indiscriminately due to paucity of information. The use of ultrasound to guide the number of antenatal visits for adequate glycemic control has not been researched adequately. There is also a need to contrive antenatal care strategies that can obtain optimal neonatal outcomes without burdening the health system in low-middle income countries (LMIC). Our study was to compare pragmatic standard management of GDM with an ultrasound-guided regime (USGR) to prevent neonatal complications to ensure optimal care. A randomized controlled trial was done in a tertiary hospital between May 2019 and September 2021 in South India. Five hundred and eighty-eight women were randomized to a standard regime or USGR. χ2 and t-test were used to compare outcomes. Maternal and neonatal outcomes between standard and ultrasound USGR showed no significant difference in outcomes. Fetuses in USGR with AC ≥ 70th centile had macrosomia (3.59% vs 26.67%, P < 0.001), increased severity of diabetes (2.97% vs 16.67%, P < 0.001), 3rd- and 4th-degree perineal tear (2.95% vs 27.27%, P < 0.001). The increased number of visits did not decrease adverse outcomes. This small well-designed study did not show any advantage with USGR as compared to the pragmatic simple standard regime, in the treatment of women with GDM.

Validation of the Arabic version of the diabetes self-management questionnaire in patients with type 2 diabetes mellitus: a cross-sectional study

BackgroundThe number of instruments available for measuring diabetes self-management activities in Arabic countries has been limited to date. To our knowledge, no multidimensional instrument suitable for measuring diabetes self-management is currently available in Arabic. This study assessed the validation of the Arabic version of the Diabetes Self-Management Questionnaire (A-DSMQ) in patients with type 2 diabetes mellitus (T2DM).MethodsThis cross-sectional study was conducted from May to August 2022 at primary healthcare centers within the Riyadh region of Saudi Arabia. Four steps were followed during the translation and adaptation of the DSMQ: forward translation, consulting an expert panel, backward translation, and pilot testing on the target population. The data were collected using a convenience sample of 154 patients with T2DM. Cronbach’s α coefficient, criterion validity, and known-group validity were determined.ResultsCronbach’s α coefficient for internal consistency was 0.76. The A-DMSQ “sum scale” scores were negatively correlated with glycosylated hemoglobin (HbA1c) levels (Pearson’s r = − 0.48, p < 0.01) and body mass indices (r = − 0.29, p < 0.01) and positively correlated with Self-Rated Health Scale scores (r = 0.41, p < 0.01). Mean A-DSMQ “sum scale” scores differed significantly among groups with adequate, partially adequate, and inadequate glycemic control (F = 23.193, p < 0.001).ConclusionsThese results indicate that the A-DSMQ is a reliable and valid tool for measuring diabetes self-management in patients with T2DM. The A-DSMQ can be used by researchers and healthcare providers interested in assessing diabetes self-management in this population. Healthcare providers should remain alert for suboptimal diabetes self-management, which may lead to significant economic costs in emergency and healthcare utilization.

Comparative study of spirometry parameters in chronic smokers with and without Type 2 Diabetes Mellitus (T2DM).

The study aimed to know the changes in spirometry parameters in chronic smokers and evaluate how the presence of type 2 diabetes mellitus (T2DM) affects their lung function. A prospective, cross-sectional, observational study was done for 12 months at a tertiary care hospital in the western region of Maharashtra State in India. Two groups of patients and one group of healthy volunteers aged 18 years or more were studied (with 50 in each group, n = 150). Group A consisted of smokers with T2DM, Group B- smokers without T2DM and Group 3- healthy controls who were non-smokers and non-diabetic. Spirometry was done for the following parameters: forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC ratio, and peak expiratory flow (PEF) and results compared between the three groups. The mean age of the participants was 51.13 ± 10.74 years. There were 137 (91.3%) males and 13 (8.6%) females. Among the enrolled subjects, 66% had smoked for more than ten years. All spirometry parameters were significantly different across all three groups. When the spirometry parameters were compared between smokers with and without T2DM, all the parameters were significantly decreased (P < 0.05). FEV1 and FEV1/FVC were significantly decreased in T2DM patients with HbA1c >7%. The presence of T2DM in smokers significantly affects their pulmonary function tests. Uncontrolled T2DM (HbA1c >7%) can result in increased abnormality in the spirometry parameters studied. Thus, adequate glycemic control and cessation of smoking can be beneficial for the improvement of lung functions in smokers.