Average Blood Sugar Research Articles

Continuous Glucose Monitoring System Versus Self-Monitoring Blood Glucose in Type 1 Diabetes Mellitus Children: A Randomised Controlled Trial (RoSEC)

Objectives: The primary and secondary objectives were to compare the glycaemic control and frequency of hypoglycaemia between continuous glucose monitoring system (CGMS) and self-monitoring blood glucose (SMBG). Methods: A single centre, randomised, parallel-group controlled trial was conducted involving twenty-two type one Diabetes Mellitus (T1DM) patients with the mean age of 13.8 years assigned to either intervention or control group. All respondents wore the CGMS device at the beginning of the study. Intervention group (n=11) had their insulin adjusted based on the CGMS data, while the control group (n=11) was based on SMBG. Monthly average blood sugar level (BSL) and monthly mean hypoglycemic events per week (HE/wk) were measured at baseline, first month, second month, and third month. HbA1c levels were measured at baseline and in the third month. Results: The baseline characteristics were similar. The data were analysed using repeated measure analysis of variance (ANOVA). The mean difference of HbA1c within the group was not statistically significant with p=0.322. There were significant differences in the monthly mean HE/wk within and between groups, p=0.004, and p=0.037. Conclusion: In conclusion, CGMS is equivalent to SMBG in optimising glycaemic control but is more effective in detecting hypoglycaemia in children.

Antidiabetes Serbuk Umbi Tanaman Yakon (<i>Smallanthus sonchifolius</i>) pada Kadar Gula Darah Tikus Putih (<i>Rattus norvegicus</i>)

The routine and long-term use of oral antidiabetic drugs in DM patients can make the public's perception worried about the side effects of the drug. In the Yakon (SS) plant tuber there is Fructooligosacaraide (FOS) which can reduce blood sugar levels. The research objective was to determine the effect of Yakon plant tubers on blood sugar levels in white rats with type 2 diabetes mellitus model. This type of research was experimental with a pre-post test design with control-group design. Independent variable, administration of Yakon plant tuber powder, dependent variable, blood glucose levels. The sample was divided into 2 groups (dose 1, dose 2) and a control group, each of 6 rats. The mice were given a high carbohydrate diet for 9 weeks. Treatment dose 1 (100 mg / kgBB) for 3 days. Measurement of blood sugar levels using Gluco-Dr. Data analysis used Paired Sample T-test, Independent Sample T-test, and One Way Anova. The results showed that the rats in the treatment group dose 1 experienced a decrease in the average blood sugar level of 122.83 mg / dl (p 0.002) (p 0.009). This shows that there is an effect of using Yakon plant tuber powder on blood sugar levels. The results of this study were the control group and the treatment group dose 1 (Sig. (2-tailed) = 0.000, α = 0.05). Meanwhile, the comparison results showed that there was a difference between the control group and the treatment group at dose 1, Based on the above research, Yakon tubers can be used to reduce blood sugar levels.

The Effect of Yacon Leaf Powder (Smallanthus Sonchifolius) on White Rats (Rattus norvegicus) Blood Glucose Levels with High Sugar Diet

Maintaining a lifestyle can reduce the incidence of DM (diabetes mellitus). DM occurs due to insulin disorders so that blood glucose levels increase, which can lead to various complications. The management of blood glucose levels by activating the insulin function can be done by using natural ingredients such as the Yakon (Smallanthus sonchifolius) plant. Yakon leaves contain phenol which can reduce blood glucose. The design of this study was experimental with a pre-posttest approach with control-group design, using male and healthy white rats (Rattus norvegicus). Rats were divided into 3 groups, treatment dose 1, treatment dose 2 and control. The rats were given a high carbohydrate diet during 9 weeks to make the rats hyperglycemic. In the treatment group, dose 1 was 150 mg/kg BW, dose 2 was 300 mg kg BW, and was given for 3 days. The results showed that the rats in the treatment group dose 1 had decreased in the average blood sugar level of 114.10 mg / dl (p 0.002) and dose 2 was 105.27 mg / dl (p 0.005). This showed that there was an effect of treatments on blood sugar levels. The comparison results showed that there was a significant difference between the dose 1, the dose 2 group and the control (Sig. (2-tailed) = 0.001 (α) = 0.05). There was no significant difference in the treatment group dose 1 and treatment dose 2 (Sig. (2-tailed) = 0.693, (α) = 0.05). Yakon leaves can be used alternative to lower to control blood glucose levels in rats receiving a high-carbohydrate diet

RELATIONSHIP OF MACRO NUTRITION CONSUMPTION PATTERNS WITH LIPID PROFILE IN TYPE II DIABETES MELLITUS PATIENTS

Diabetes mellitus (DM) is a disease caused by metabolic disorders both genetically and clinically characterized by an increase in blood sugar (hyperglycemia) chronically. Intake of carbohydrates, fats, proteins is a factor that can control the body's glycemic. Poor glycemic control is thought to have contributed to changes in lipid profiles in DM patients. The purpose of this study was to determine the relationship between carbohydrate, fat, and protein intake with the lipid profile of patients with Type II DM. Cross sectional design method with 3 days recall and lipid profile levels. The research sample is a consecutive sampling of 31 samples. The analysis used Univariate and Bivariate and the data were analyzed by correlation test. The results of the correlation test showed that the average respondent's blood sugar level was 297 mg/dl ± up to 90, the average intake of carbohydrates = 339.9 grams ± SD 139.32, fat = 128.6 grams ± SD 177.222 and protein = 51 .1 gram ± SD 22.42. The average lipid profile is Triglyceride level = 179.9 mg/dl ± SD 111.99, total cholesterol level = 199.93 mg/dl ± SD 59.91, HDL level = 40 0.0 mg/dl ± SD 10.74, LDL level=146.77 mg/dl ± SD 181.29. Bivariate test there was a significant relationship between fat intake and triglycerides at P=0.009 (p≤0.05), the relationship between fat with LDL with a value of P=0.018 (p≤0.05), the relationship between protein intake and cholesterol at P=0.030 (p=≤0.005). Intake of nutrients that have a significant relationship is fat with triglycerides, fat with LDL and protein with cholesterol.

Improvements in Glycemic Control Achieved by Altering the tmax Setting in the iLet® Bionic Pancreas When Using Fast-Acting Insulin Aspart: A Randomized Trial.

IntroductionWe investigated the safety of, and glucose control by, the insulin-only configuration of the iLet® bionic pancreas delivering fast-acting insulin aspart (faster aspart), using the same insulin-dosing algorithm but different time to maximal serum drug concentration (tmax) settings, in adults with type 1 diabetes.MethodsWe performed a single-center, single-blinded, crossover (two 7-day treatment periods) escalation trial over three sequential cohorts. Participants from each cohort were randomized to a default tmax setting (t65 [tmax = 65 min]) followed by a non-default tmax setting (t50 [tmax = 50 min; cohort 1], t40 [tmax = 40 min; cohort 2], t30 [tmax = 30 min; cohort 3]), or vice versa, all with faster aspart. Each cohort randomized eight new participants if escalation-stopping criteria were not met in the previous cohort.ResultsOverall, 24 participants were randomized into three cohorts. Two participants discontinued treatment, one due to reported ‘low blood glucose’ during the first treatment period of cohort 3 (t30). Mean time in low sensor glucose (< 54 mg/dl, primary endpoint) was < 1.0% for all tmax settings. Mean sensor glucose in cohorts 1 and 2 was significantly lower at non-default versus default tmax settings, with comparable insulin dosing. The mean time sensor glucose was in range (70–180 mg/dl) was > 70% for all cohorts, except the default tmax setting in cohort 1. No severe hypoglycemic episodes were reported. Furthermore, there were no clinically significant differences in adverse events between the groups.ConclusionThere were no safety concerns with faster aspart in the iLet at non-default tmax settings. Improvements were observed in mean sensor glucose without increases in low sensor glucose at non-default tmax settings.Trial RegistrationClinicalTrials.gov, NCT03816761.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13300-021-01087-x.

593-P: Effectiveness of Digital Therapeutics to Improve Clinical Outcomes in Patients with Type 2 Diabetes Mellitus on Insulin Therapy

Background: Diabetes self-management education and support (DSMES) is integral towards maintaining continuity of care between physician visits especially for patients on insulin therapy to facilitate healthy coping. The present study explores the usage patterns and real-world effectiveness of the Wellthy CARE™ digital therapeutic (WDTx) platform in achieving glycemic control among patients with type 2 diabetes mellitus (T2DM) on insulin therapy. Methods: The WDTx platform consists of a smartphone application with a 52-week program to provide DSMES through self-monitoring of blood glucose, access to evidence-based content regarding insulin usage and remote guidance by a health coach to enable lifestyle modifications and healthy coping. All app interactions were analyzed at baseline and during the program to determine factors driving patient engagement and clinical outcomes. Results: Study participants (n=106) had a mean age of 51.4 years (SD 14.0 years) and consisted of 39 females (36.8%). Overall, a significant mean decrease in average blood sugar (ABS) by 29.9 mg/dl (95%CI 16.6-43.3 mg/dl, P&amp;lt;0.001) was observed with a 31.9% reduction in proportion of hypoglycemia logs and an average of 6.1 app interactions per patient per week on the platform thus proving continuity of care provided through WDTx. Users in the highest tertile for early app interactions (within week 1) demonstrated a significant mean decrease in ABS by 30.8 mg/dl (95%CI 7.5-54.0 mg/dl, P&amp;lt;0.01) while no significant change was seen in the corresponding lowest tertile. Over the entire program, users in the tertile with highest app engagement showed a significant mean decrease in ABS of 27.4 mg/dl (95%CI 8.8-46.1 mg/dl, P&amp;lt;0.01) as compared to no significant change in the lowest tertile. Conclusion: This study thus demonstrates the effectiveness of the WDTx platform to impart critical DSMES, maintain continuity of care and improve clinical outcomes in patients with T2DM on insulin therapy. Disclosure R. R. Adhikary: Employee; Self; Wellthy Therapeutics Pvt Ltd. S. Kolwankar: Employee; Self; Wellthy Therapeutics Pvt Ltd. R. Verma: Consultant; Self; Wellthy Therapeutics Pvt Ltd. J. Bhatt: Employee; Self; Wellthy Therapeutics Pvt Ltd. K. L. Pakhale: None. R. Sahay: Advisory Panel; Self; Cipla Inc., USV Private Limited, Speaker's Bureau; Self; Eli Lilly and Company, Novo Nordisk Pharma Ltd.

LONGER MASTICATION CYCLES TEND TO LOWER POST-PRANDIAL BLOOD SUGAR LEVELS

Diabetes Mellitus (DM) is a metabolic syndrome occurred because of the lack of insulin hormone secretion or some factors disturbing insulin hormone or both of them. The mastication cycle is one of the factors related to the increasing in blood glucose. The research aims to analyse the relation between mastication cycle and DM risk factor on Faculty of Medicine students, Universitas Islam Bandung. The methodology was an experimental study. The subjects were 18 male Faculty of Medicine, Unisba, who fulfil the inclusive and exclusive criteria. First, scanning was conducted to know DM risk by questioners. Those students were divided into three groups of mastication cycle (15,30,45 cycle). Each group consisted of six students. The result showed that the tendency of average blood sugar was lower in the group with 45 cycles of mastication, compared to 30 and 15 cycles (86.5 vs 89.5 vs 92 mg/dL). However, according to a statistical calculation, there was no significant relationship between the mastication cycle and blood glucose (P =0.413; P&gt;0.05). The average blood insulin level of 45 times the mastication cycle was the lowest compared to 30 and 15 mastication cycles (2.44 vs 2.97 vs 3.58 µg/ml). The result was that the mastication cycle was longer than the initial insulin release to work in the cell more effectively. In conclusion, DM needs to do more cycle in mastication food to maintain glucose in the blood.

PENGARUH HIDROTERAPI TERHADAP PENURUNAN KADAR GULA DARAH SEWAKTU PADA PASIEN DIABETES MELLITUS TIPE 2 DI PUSKESMAS BINJAI SERBANGAN KABUPATEN ASAHAN TAHUN 2020

Hydrotherapy or water therapy is a method of treatment and healing with water for get the profit therapeutic in the treatment of disease. Diabetes Mellitus is a degenerative disease, which need an effort to suppress the increased.incidence of the disease. This,the aims of the research.to determine the effect of hydrotherapy to decrease blood sugar.random diabetes mellitus type 2 patients. The method of this research is a quasi experimental Two Grup pretest posttest design, the sampling, techniques used purposive sampling approach. Total respondent are 22 peoples, 11 respondents, for the control group and 11 intervention group. Data collection Uses A direct observation.sheet and measurement of blood sugar. Statistic analysis using independent T test. Indicates that there was a discreption between the average blood sugar and the action of hidroterapy in control grup and intervention groups (p=0,0001). Therefore it is assumed that hydrotherapy.would lower the blood sugar when DM 2, hydrotherapy patients can be used as a hyperglycemic management of diabetes mellitus.

Pengaruh Seduhan Kayu Manis Terhadap Kadar Gula Darah Pada Penderita DM tipe II

&lt;p&gt;&lt;strong&gt;&lt;em&gt;Background: &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;Diabetes Mellitus Type II is the most common form of diabetes. It causes vary from predominantly insulin resistance to insulin resistance defects. According to the data from the Community Health Office of Sungai Penuh City from 2016 to 2018, Diabetes Mellitus is the most cases found in Kumun Community Health Center. They were 299 cases insulin receptor protein on cells. This study aims to determine The Influence of Cinnamon Steeping toward Blood Sugar Levels in Patients with Type II DM in Kumun Kota Sungai Penuh Community Health Center Working Area in 2020. &lt;strong&gt;Methods:&lt;/strong&gt; It was a Quasi Experiment with one group pretest posttest design approach. This research was carried out on November to December 2020. The population was all diabetes mellitus sufferers type II in Kumun Community Health Center Working Areaby using purposive sampling technique, 20 people were chosen as the samples. The data were processed by computerization with univariate and bivariate analysis by using the Paired Sample T Test. &lt;strong&gt;Results&lt;/strong&gt;: The results showed that the average blood sugar level after being given steeping cinnamon was 148.95 mg/dL. Based on the statistical test, it was found that p = 0.000. &lt;strong&gt;Conclusion: &lt;/strong&gt;It can be concluded that there is an effect of cinnamon infusion on reducing blood sugar levels in diabetes mellitus patients type II. It is hoped that all parties use cinnamon to help reduce blood sugar levels in patients with diabetes mellitus type II.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Keywords: &lt;em&gt;Cinnamon, Diabetes Mellitus, Blood Sugar Levels&lt;/em&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;em&gt;&lt;br /&gt;&lt;/em&gt;&lt;/p&gt;

Cloning, expression and purification of fructosyl amino acid oxidase (FAOX) in Escherichia Coli

Introduction: The level of serum HbA1c is an indicator of the average blood sugar level in the last three months. HbA1c can be quantified using assays involving the enzyme fructosyl amino acid oxidase (FAOX). This study aims to produce GST-tagged FAOX-TE (GST/FAOX-TE), a thermal stable and specific variant of FAOX, for future application studies.&#x0D; Materials and methods: The E. coli strains DH5α and BL21 (DE3) were used as cloning and expression hosts, respectively. The FAOX-TE sequence was synthesized at IDT (US) and clonned into pGEX-4T3 vector, which was confirmed by Colony PCR. The expression was induced at 16°C, 0.5 mM IPTG in LB media containing 50 µg/ml ampicilin. The protein expression profile was analyzed by SDS-PAGE. The cell pellet was sonicated and purified by Glutathione Sepharose 4 Fast Flow (Cytiva, US). The catalytic activity of GST/FAOX-TE with fructosyl valine was determined using high performance anion exchange chromatography with pulsed amperometry detection (HPAEC-PAD).&#x0D; Results: The fusion protein was successfully expressed in Escherichia coli using the plasmid pGEX-4T3 and purified to high purity 93%. Recombinant GST/FAOX-TE was shown to be active on fructosyl valine.&#x0D; Conclusions: Active GST/FAOX-TE was successfully expressed in E. coli BL21 (DE3) and purified, which will be used for future development of biosensors for fructosyl valine quantification.

Knowledge of Hemoglobin A1c and Glycemic Control in an Urban Population.

Aim: Our study aims to assess the knowledge of hemoglobin A1c (HbA1c) and glycemic control in patients with diabetes mellitus (DM) at an urban academic institution.Methods: This was a retrospective cross-sectional study that included a survey of 100 adult patients with DM. Our patient cohort was divided into those with recent HbA1c < 8.0% and those with HbA1c ≥ 8.0% for subgroup analysis.Results: The majority (71%) of patients correctly defined HbA1c and half were aware of their HbA1c target, but they were unable to correlate the correct average blood glucose for an HbA1c level of 7%. Worse control, defined as an HbA1c level of ≥ 8%, was associated with co-morbid disease, but was not associated with understanding HbA1c definition, target or socioeconomic disparities. Perceived glycemic control was congruent with the actual control in 46% of our patients. Ninety percent of those with HbA1c ≥ 8% perceived their control to be better than it actually was, and 97% of those with HbA1c < 8% perceived their control worse than it actually was (P < 0.00001).Conclusion: Although most patients knew the definition of HbA1c, they were unable to correlate HbA1c with average blood sugar. There remain opportunities to increase education for this vulnerable population with co-morbid disease on the use of the HbA1c disease marker as an education tool.

Characterization of the Oral Microbiome of Medicated Type-2 Diabetes Patients.

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease that is becoming a significant global health care problem. Several studies have shown that people with diabetes are more susceptible to oral problems, such as periodontitis and, although the causes are still inconclusive, oral microbiota is considered to play a major role in oral health. This study aimed to characterize the oral microbiome of a sample representing T2DM patients from Portugal and exploit potential associations between some microorganisms and variables like teeth brushing, smoking habits, average blood sugar levels, medication and nutrient intake. By sequencing the hypervariable regions V3-V4 of the 16S rRNA gene in 50 individuals belonging to a group of diabetes patients and a control group, we found a total of 232 taxa, from which only 65% were shared between both groups. No differences were found in terms of alpha and beta diversity between categories. We did not find significant differences in the oral microbiome profiles of control and diabetes patients. Only the class Synergistia and the genus TG5, which are related to periodontitis, were statistically more frequent in the control group. The similar microbiome profiles of medicated diabetics and the control group indicates that the relationship between the T2DM and the oral microbiome might be more related to either the lifestyle/diet rather than diabetes per se. Moreover, this study provides, for the first time, insights into the oral microbiome of a population with a high prevalence of diabetes.

A study of association of proteinuria with HbA1C in diabetes mellitus

The term HbA1c refers to glycated haemoglobin. It develops when haemoglobin, a protein within red blood cells that carries oxygen throughout your body, joins with glucose in the blood, becoming ‘glycated’. By measuring glycated haemoglobin (HbA1c), clinicians are able to get an overall picture of what our average blood sugar levels have been over a period of weeks/months. For people with diabetes this is important as the higher the HbA1c, the greater the risk of developing diabetes-related complications. When the body processes sugar, glucose in the bloodstream naturally attaches to haemoglobin. The amount of glucose that combines with this protein is directly proportional to the total amount of sugar that is in your system at that time.

Novel Receptor for Advanced Glycation End Products-Blocking Antibody to Treat Diabetic Peripheral Artery Disease.

BackgroundExpression of receptor for advanced glycation end products (RAGE) plays an important role in diabetic peripheral artery disease. We proposed to show that treatment with an antibody blocking RAGE would improve hind limb perfusion and muscle viability in diabetic pig with femoral artery (FA) ligation.Methods and ResultsPurpose‐bred diabetic Yucatan minipigs with average fasting blood sugar of 357 mg/dL on insulin to maintain a glucose range of 300 to 500 mg/dL were treated with either a humanized monoclonal anti‐RAGE antibody (CR‐3) or nonimmune IgG. All pigs underwent intravascular occlusion of the anterior FA. Animals underwent (201Tl) single‐photon emission computed tomography/x‐ray computed tomography imaging on days 1 and 28 after FA occlusion, angiogenesis imaging with [99mTc]dodecane tetra‐acetic acid–polyethylene glycol–single chain vascular endothelial growth factor (scVEGF), muscle biopsies on day 7, and contrast angiogram day 28. Results showed greater increases in perfusion to the gastrocnemius from day 1 to day 28 in CR‐3 compared with IgG treated pigs (P=0.0024), greater uptake of [99mTc]dodecane tetra‐acetic acid‐polyethylene glycol‐scVEGF (scV/Tc) in the proximal gastrocnemius at day 7, confirmed by tissue staining for capillaries and vascular endothelial growth factor A, and less muscle loss and fibrosis at day 28. Contrast angiograms showed better reconstitution of the distal FA from collaterals in the CR‐3 versus IgG treated diabetic pigs (P=0.01). The gastrocnemius on nonoccluded limb at necropsy had higher 201Tl uptake (percentage injected dose per gram) and reduced RAGE staining in arterioles in CR‐3 treated compared with IgG treated animals (P=0.04).ConclusionsA novel RAGE‐blocking antibody improved hind limb perfusion and angiogenesis in diabetic pigs with FA occlusion. Contributing factors are increased collaterals and reduced vascular RAGE expression. CR‐3 shows promise for clinical treatment in diabetic peripheral artery disease.

Diabetogenic potential of dexamethasone and effect Annona muricata methanolic bark extract as post-exposure therapy in albino rats

Diabetes mellitus (DM) is a metabolic disorder leading to high level of morbidity and mortality in human population and it has been identified as the leading cause of death from non-infectious diseases. The use of dexamethasone has been on the increase due to wide array of therapeutic effects it has and the use has mostly been without prescription, since it is a non- prescription drug. Therefore, the potential of dexamethasone to induce DM was studied. Some of the drugs currently used in the treatment of diabetes have their own problematic effects and also expensive, Annona muricata methanolic bark extract(AMMBE) was used in the treatment of dexamethasone-induced diabetes in rats. The research was carried out on albino rats in Federal College of Animal Health and Production Technology, Ibadan and lasted for twenty-eight (28) days. The rats were allotted into four groups (A, B, C and D). Group B, C and D were induced with glucocorticoid (Dexamethasone) (2mgkg-1) daily for seven (7) days intraperitoneally, while group A which was the positive control were given distilled water throughout without induction with glucocorticoid. Group B (the negative control) was induced with glucocorticoid with noAMMBE administration. Group C, was induced and treated with AMMBE at 400 mgkg-1for 14 days. While Group D, was induced with glucocorticoid and were treated with the standard drug (glibenclamide) at 2.5mgkg-1body weight of the rats daily for 14 days. Organ samples of liver, kidney and pancreas were collected for histopathological lesions evaluation. The result showed that dexamethasone induced diabetes after seven (7) days of intraperitoneal administration of 2 mgkg-1 body weights with the glucometer readings in most of the albino rats up to and above 129 mgdL-1. The average blood sugar levels in induced groups (B, C and D) were 132.0±4.05, 129.0±1.41 and130.0±2.93, respectively which were not statistically significant (P&gt;0.05). After administration of AMMBE, the average blood sugar level for group B (126.0±1.41) was significantly different (P&lt;0.05) from C (91.0±1.72) and D (87.0±2.97). Clinical signs of alopecia, dehydration, writhing, paw-licking were observed. There were massive losses of pancreatic cell mass grossly afterinduction with dexamethasone. Histopathological lesions observed ranges from no visible lesion in the control and glibenclamide treated groups to accentuation of hepatocytes in the AMMBE treated rats, and marked vacuolar degeneration of hepatocytes in periportal areas to centrilobular area with Kidney degeneration and multifocal coagulation necrosis of tubular epithelium in group induced with dexamethasone but untreated (group B)Diabetogenic potential of dexamethasone and effect Annona muricata methanolic bark extract degeneration, multifoci coagulation and necrosis. The blood sugar levels post exposure to AMMBE and Glibenclamide showed reduction in the sugar levels. It could be concluded that dexamethasone has the potential of inducing diabetes when its use is prolonged and AMMBE has antidiabetic effect which could be fully explored.

Glucagon-Like Peptide-1 Receptor Agonist Utilization in Type 2 Diabetes in Japan: A Retrospective Database Analysis (JDDM 57).

IntroductionThere are limited real-world data on the prescribing of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for patients with type 2 diabetes mellitus (T2DM).MethodsThis was a retrospective analysis of the CoDiC® database of the Japan Diabetes Clinical Data Management Study Group (JDDM). Demographic and clinical characteristics, concomitant treatment patterns, and GLP-1 RA treatment persistence or modification in patients with T2DM initiating GLP-1 RA therapy were evaluated.ResultsThe analysis included 932 eligible patients with T2DM who had their first GLP-1 RA prescription (index date) between September 2016 and July 2018. Mean age was 63.8 years and 56.0% were male. Most patients had an index GLP-1 RA of dulaglutide (65.7%) or liraglutide (29.1%). Common comorbidities were obesity (58.7%), hypertension (54.7%), dyslipidemia (52.0%), retinopathy (11.3%), and nephropathy (10.2%). Mean hemoglobin A1c (HbA1c) levels decreased from 8.3 to 7.8% over 6 months after GLP-1 RA initiation, and the proportion of patients achieving HbA1c < 7.0% increased from 14.4% at index date to 22.9% at 6 months. Reductions occurred in mean body weight, body mass index, triglycerides, total cholesterol, low-density lipoprotein cholesterol, and adjusted urinary albumin over 6 months. Antidiabetic medication use decreased after GLP-1 RA initiation, whereas non-antidiabetic medication prescribing showed little change. Index GLP-1 RA persistence rates were 80.5%, 66.2%, and 51.6% at 6, 12, and 18 months post-index, respectively, with a median persistence until discontinuation or switch of 600 days. Persistence rates at 6, 12, and 18 months post-index, respectively, were 81.9%, 70.7%, and 65.4% for dulaglutide and 79.7%, 60.0%, and 30.4% for liraglutide.ConclusionThe study shows real-world benefits of GLP-1 RA therapy for T2DM, including improvements in HbA1c, body weight, and blood lipid profile, and supports the high rates of long-term persistence previously reported with dulaglutide, the GLP-1 RA most commonly prescribed for T2DM in Japanese clinical practice.Supplementary InformationThe online version of this article (10.1007/s13300-020-00977-w) contains supplementary material, which is available to authorized users.

Insulin Management Protocol for Obstetric Patients With Gestational or Type 2 Diabetes

Type 2 and gestational diabetes place the newborn at an increased risk of developing hypoglycemia after birth. Research has indicated that a significant reduction in neonatal hypoglycemia is linked to an intravenous insulin and dextrose protocol to control maternal blood glucose levels during labor. A multidisciplinary team at the University of Alabama at Birmingham (UAB) created a new insulin protocol with the goal to better control glucose levels during labor and birth for patients with Type 2 or gestational diabetes, thereby, positively affecting neonatal hypoglycemic episodes. Hypoglycemia was defined as a plasma glucose level less than 40 mg/dl. This value was taken from the UAB newborn nursery hypoglycemia algorithm. Data were collected from delivery logs and newborn charts 3 months before initiation of the new intravenous insulin and dextrose protocol. The new protocol was presented to all labor and delivery nurses. All nurses were given a copy of new algorithm for reference. In addition, they were given two case studies to evaluate competency in application of the new protocol. Data collection was repeated from delivery logs and newborn charts at 3-months postprotocol initiation for comparison of data. This study was Institutional Review Board–exempt. Blood glucose levels of 29 newborns were reviewed during the preinitiation period. Fourteen newborns had at least one hypoglycemic event within the first 24 hours of life (48% hypoglycemic rate). Additional breakdown revealed that average blood glucose was 58 mg/dl and average minimum blood glucose was 45 mg/dl. Glucose levels of 32 newborns were reviewed during the postinitiation period. Ten newborns had a hypoglycemic event within the first 24 hours of life (31% hypoglycemic rate). The average blood sugar was 60 mg/dl and the average minimum blood sugar was 47 mg/dl. An additional key finding was that blood glucose levels improved as gestational age increased. The findings indicate an inverse relationship of maternal blood glucose level and neonatal hypoglycemia. The postinitiation data show a decrease in neonatal hypoglycemia. Additional research is needed to determine an evidence-based protocol to maintain maternal euglycemia and decrease the risk of neonatal hypoglycemia.

Pengaruh Senam Diabetes Terhadap Penurunan Kadar Gula Darah Pasien Diabetes Mellitus di Puskesmas Bah Kapul Pematangsiantar Tahun 2019

This study aims to determine the effect of diabetes gymnastics on the decrease in blood sugar levels of diabetic patients at the puskesmas Bah Kapul Pematangsiantar. This research was conducted in Juni - Agustus 2017, the design of this study was comparative. The sample size in this study were 21 respondents obtained by total population sampling. Data were obtained through questionnaires, interviews and direct capillary blood sampling of respondents to then measured blood sugar levels by using glucose meter. Data analysis was done gradually including descriptive and paired samples t-test. The results of this study showed that before doing gymnastics in the first week of the average blood sugar levels of respondents was 272.4 mg / dl and after doing gymnastics in the fourth week of the average blood sugar levels of respondents was 257.04 mg / dl, blood sugar of 15.36 mg / dl. Result of paired samples t-test significantly decrease blood sugar level at respondent with p value of 0,041. This means that there is influence of diabetes gymnastics to the decrease of blood sugar level of diabetic patient. It is expected for health service to be a motivator and provide intensive counseling for people with diabetes mellitus to do gymnastic gymnastics routine to lower blood sugar level and prevent complication of diabetes mellitus.&#x0D; Keywords: gymnastics diabetes; blood sugar

The management of diabetes in everyday life study: Design and methods for a pragmatic randomized controlled trial comparing the effectiveness of text messaging versus health coaching

BackgroundAfrican American patients with uncontrolled diabetes living in medically underserved areas need effective clinic-based interventions to improve self-care behaviors. Text messaging (TM) and health coaching (HC) are among the most promising low-cost population-based approaches, but little is known about their comparative effectiveness in real-world clinical settings.ObjectiveUse a pragmatic randomized controlled trial design to determine the comparative effectiveness of TM and HC with enhanced usual care (EC) in African American adults with uncontrolled diabetes and multiple chronic health conditions.Methods/designThe Management of Diabetes in Everyday Life (MODEL) study is randomizing 646 patients (n = 581with anticipated 90% retention) to 3 intervention arms: TM, HC, and EC. Participants are African American adults living in medically underserved areas of the Mid-South, age ≥ 18, with uncontrolled diabetes (A1c ≥ 8), one or more additional chronic conditions, and who have a phone with texting and voicemail capability. Primary outcome measures: the general diet, exercise, and medication adherence subscales of the revised Summary of Diabetes Self-Care Activities questionnaire assessed at one year. Secondary outcomes: diabetes-specific quality of life, primary care engagement, and average blood sugar (A1c). The study will also assess heterogeneity of treatment effects by six key baseline participant characteristics.ConclusionsWe describe the design and methods of the MODEL study along with design revisions required during implementation in a pragmatic setting. This trial, upon its conclusion, will allow us to compare the effectiveness of two promising low-cost primary care-based strategies for supporting self-care behaviors among African Americans individuals with uncontrolled diabetes.ClinicalTrials.gov registration number: NCT02957513

Pediatric data of the usefulness of estimated average glucose (eAG) in glycemic control and cardiovascular risk reduction.

The Estimated Average Glucose (eAG) is assumed to provide patients a better understanding of their recent average blood sugar levels comparing to HbA1c, therefore better control their glycemic levels. However, since its inception, debates on its clinical utility have been over several years leading to an unpopular laboratory and clinical practice of adoption; and there is no evidence to support or against the usefulness of eAG in real world medical practice.Data set presented in this article is related to our research paper entitled “Usefulness of Estimated Average Glucose (eAG) in glycemic Control and Cardiovascular Risk Reduction”, available in Clinical Biochemistry [1]. In this article, we compared population lipid and glycemic controls in pediatric diabetic patients of the regional health authority (RHA) zone 1.1 in New Brunswick, Canada, before and after the eAG implementation in January 2010, and with other 7 zones that do not report the parameter. Data (7,355 HbA1c values and 2,062 LDL-c values) was extracted from all pediatric diabetic patients in the Provincial Diabetes Registry from 2008 to 2014. The proportions of patients achieving therapeutic targets (HbA1c<53 mmol/mol (7.0%) and LDL-c<2.6 mmol/L) and the distributions of HbA1c and LDL-c values pre/post the eAG implementation in RHA Zone 1.1 were assessed. Additionally, to investigate whether the glycemic and cholesterol control in pediatric diabetic patients in RHA Zone 1.1 after the implementation of eAG was better than in other zones, we also compared the medians and inter quartile ranges of HbA1c and LDL-c from different zones from 2010 to 2014.