Good Blood Sugar Control Research Articles

The role of family in improving the management of diabetes mellitus patients

Introduction: diabetes mellitus is a chronic disease that requires long-term management involving patients and their families. The role of the family in improving the management of diabetes mellitus patients is very important to achieve good blood sugar control and prevent long-term complications. This study aims at the role of family in improving the management of diabetes mellitus patients. Methods: this research is a quantitative method with a quasi-experimental research design with a non-equivalent control group research design with a sample size of 20 respondents Results: shows that in the intervention group, most family roles have a good category where respondents have family roles are as many as 7 people (70%) and respondents who have poor family roles are as many as 3 people (30%). While in the control group, respondents who had poor family roles were as many as 8 people (80%) and respondents who had good family roles were as many as 2 people (20%). In the final measurement (Post-test) in the intervention group and the control group, p = 0, 028 or p < 0.05 means that there are differences in family roles in both groups in the final measurement (Post-test) Conclusions: the role of the family is very important in improving the management of diabetes mellitus patients. Family support and involvement in assisting patients in living a healthy diet, following the right medication regimen, and maintaining an active lifestyle can help achieve good blood sugar control and prevent long-term complications. Factors such as knowledge of diabetes, emotional support, and ability to manage diabetes-related situations also influence the family's role in the management of this condition. Therefore, education to families about diabetes, the psychological and practical support they provide to patients, as well as their involvement in healthy lifestyle changes are important things to note.

Nursing Agency in Improving Self Care Activities in Diabetes Mellitus Patients

Nurses are important role in motivating diabetes mellitus patients to be willing and able to carry out self-care independently at home to achieve good blood sugar control, prevent complications and improve quality of life. This research contributes to determining the development of self-care in diabetes mellitus patients and determine the role of nurses in providing a supportive education system, while the specific target to be achieved in this research is changes in good self-care for diabetes mellitus patients so that it can improve the quality of life and to encourage nurses to provide independent nursing care with a supportive education system to diabetes mellitus patients. This research method used quasi-experimental research design with a one group pretest-posttest approach. The population in this study was 32 respondents of diabetes mellitus patients at the Banyuurip health center. The sampling technique used a purposive sampling technique, namely sampling based on certain criteria. This research will be carried out at the Banyuurip Community Health Center, Purworejo Regency. The results of the paired t-test statistical analysis showed : p Value 0.000 < 0.05, which shows that there is an influence of nursing agencies in increasing self-care activities for diabetes mellitus patients. Conclutions that Diabetes mellitus is a chronic disease that requires special independent management behavior throughout life. Through a good self-care approach, patients can improve blood sugar control and reduce the risk of future complications. Therefore, the role of health workers to provide education and support patients to improve self-care behavior is very important.

Evaluation and Management of Diabetic Neuropathy from the Perspective of People with Diabetes

Diabetic foot ulcers (DFU) and infections are the most common complications of diabetic foot disease. Mortality and financial burdens for both patients and society on the whole are caused by the prevalence of complications. Peripheral neuropathy, peripheral arterial disease, and immune response dysfunction are just a few of the main contributing factors that must be understood in order to effectively treat the condition. In order to treat diabetic foot disease, you must first get a comprehensive physical examination and a detailed history of your condition. Diabetic neuropathy and peripheral vascular disease, as well as any evidence of diabetic foot ulcers or infection, should be examined during this procedure. Patients with diabetes mellitus were studied to see if there was a link between cognitive impairment and the condition of their feet and whether or not they followed their doctor's recommendations for glycemic control. Using a random sample of diabetes patients, researchers conducted a prospective study to see how many people had the condition. The Mini-Mental State Valuation, the Trail Making Judgments, and the Michigan Screening Instrument were used to assess cognitive abilities. In the one-month follow-up, glycated hemoglobin (HB1Ac >7 %) was linked to the MMSE and medication adherence, but no link was seen between cognitive function and neuropathy. According to the results of a ROC curve investigation, HB1Ac and the MNSI score both significantly (p< 0,05) mitigate towards eventual adherence to medicine for foot problems. For the purpose of determining if DFU was associated with cognitive impairment, the Chi square valuation was used in the statistical examination. As a determinant of MMSE and MoCA scores, the researchers used linear regression to come to their conclusion. Diabetic foot issues should be managed with good blood sugar control and less acute neuropathy, and this does not seem to be linked to cognitive dysfunction. More study is required in order to personalize treatments for diseases of the central and peripheral nervous systems appropriately. Cognitive dysfunction should be taken into account by doctors and podiatrists while treating diabetic foot problems

INVERSE RELATION OF 25-OH VITAMIN D LEVEL WITH SEVERITY OF DIABETIC RETINOPATHY AND HBA1C IN TYPE 2 DIABETES PATIENTS: SUPPLEMENTATION MAY HALT SEVERITY

Objective: Our aim was to analyze the relationship of 25-OH Vitamin D level with severity of diabetic retinopathy (DR) and HbA1c in Type 2 diabetes patients. Methods: In the present observational study, we enrolled 140 cases of type 2 diabetic patients (98 with DR and 42 without DR). A complete ophthalmological evaluation was done. 25-OH vitamin D levels were compared with the severity of DR and HbA1c levels. The serum concentration of 25-hydroxyl vitamin D was measured by the radioimmunoassay method. Vitamin D deficiency was considered when the 25-hydroxyl vitamin D level was <20 ng/mL. Results: There was no significant difference in age, sex, calcium, parathyroid hormone, and phosphate levels between groups. Sixty-nine out of 98 patients with retinopathy and 15 out of 42 without retinopathy had a 25-hydroxyl vitamin D level <20 ng/mL. DR patients have a higher proportion of subjects with vitamin D deficiency as compared to those without DR (p=0.045). We also found a significant inverse correlation between serum 25- OH vitamin D and severity of DR on ANOVA and HbA1c levels (p<0.001) on Pearson’s correlation. Conclusion: 25-OH vitamin D deficiency is associated with DR and increased HbA1c levels. Vitamin D supplementation with good blood sugar control may decrease the severity of DR in type 2 diabetes. All patients with type 2 diabetes mellitus, besides undergoing fundoscopic examinations, must be assessed for their vitamin D status.

Medication Adherence, Glycemic Control and Quality of Life in Patients with Type 2 Diabetes Mellitus: a cross-sectional study

Medication adherence is important in controlling blood sugar levels (HbA1c) in patients with Diabetes Mellitus (DM). Studies on the relationship between medication adherence and blood sugar control on the quality of life (QoL) in Type 2 DM patients are limited in Indonesia. This study aims to assess the relation between medication adherence with blood sugar control and the quality of life of Type 2 DM patients. This study used a cross-sectional design conducted at Universitas Indonesia Hospital. It used Medication Adherence questionnaires and EuroQoL 5D-5L questionnaires to assess patients’ medication adherence and quality of life. This study involved a total of 74 Type 2 DM patients with an average age of 57 ± 10.74 years. Medication adherence with good blood sugar control (HbA1c <7%) showed a significant relationship (p-value <0.05) with COR values of 3.74 (1.21 - 11.6) compared to non-adherent patients. But not on the QoL Index and VAS (Visual Analog Scale) values, where the value is lower in patients with high adherence and good blood sugar control. Factor asscociated with blood sugar controlled were comorbidites and medication adhrence while factor that associated with quality of life were comorbidities, ages, education and employment status

Education model on SMS gateway on blood sugar levels of diabetes mellitus patients

Introduction: Diabetes has become a global epidemic over the last two decades, the prevalence has doubled, from 4.6% to 9.3% in the population aged 20-79 years. Based on data from the International Diabetes Federation (IDF) 2019, it is estimated that 463 million people in the above age group live with diabetes of which 90% Diabetes, Indonesia faces the same diabetes threat as the world, within five years. West Sumatra is at number 21 out of 34 provinces with diabetes cases. Based on data from the Padang City Health Office in 2020, from 23 health centers in Padang City, Andalas Health Center is the highest coverage of type 2 diabetes mellitus, which is 1017 people. Of the 10 sub-districts in the Andalas Community Health Center working area, Jati sub-district is the highest case of diabetes mellitus. Good blood sugar control is one of the important factors and has been shown to reduce the risk of complications in people with diabetes, to achieve good blood glucose control, holistic management is needed including education, education with an SMS gateway approach can provide continuous and continuous information. Objectives: see the effect of SMS gateway-based education model on blood sugar levels of diabetics. Methods: Pre-experiment using the One Group Pretest-Posttest design approach. Data analysis using Paired T-test sample. Results: The results showed that there was an effect of education model based on sms gateway based education model on blood sugar levels of diabetics with p-value = 0.002. Conclusions: SMS gateway-based education model affects blood sugar levels of diabetics.

Perception of ocular complications among patients with diabetes mellitus attending tertiary hospitals in Enugu, Nigeria

Background: Diabetes mellitus can lead to sight and life-threatening complications. It affects people in both developed and developing countries. Many diabetics present to the eye clinics with undetected advanced eye complications. Aim: The study aimed at evaluating the perception of the ocular complications of diabetes and how it influences the attitude and practice of the diabetics attending the eye clinics. Materials and Methods: A cross-sectional study was conducted in two tertiary hospitals in Enugu over a 3-month period. An interviewer-administered questionnaire was used to assess their perception, and hence their attitude and practice toward diabetic eye complications after obtaining their informed consents. Results: A total of 884 diabetics participated. There were 337 (38.1%) males and 547 (61.9%) females. A majority, 523 (59.2%), were in the age range of 51–70 years. Only 40.7% knew that diabetes affects the eyes; 60.2% did not know that good blood sugar control will help prevent eye complications; 41.1% knew they needed to see the eye specialist from time to time but not necessarily for routine check-up. Only 9.1% saw the eye specialists routinely; the remaining 90.9% never went for routine eye check as only 40.72 knew it affects the eyes. Conclusion: There was poor perception of the disease and its complications, which led to poor practice such as no regular, periodic eye examinations. There is a dire need for education of the diabetics, building of multidisciplinary effective strategies and policies with the view to decreasing the burden of the disease especially in the developing countries.

Osilodrostat for the Treatment of Cushing’s Disease: A Plain Language Summary of the LINC 4 Study

What is this summary about? This is a summary of an article discussing the results of the LINC 4 study, which was originally published in the Journal of Clinical Endocrinology and Metabolism. The study included 73 adults with Cushing's disease who were treated with a drug called osilodrostat (also known by the brand name Isturisa®). What is Cushing's syndrome and Cushing's disease? Endogenous Cushing's syndrome is a condition whereby the body produces too much of the hormone cortisol due to different causes (pituitary tumour, adrenal tumour, and other tumours that produce adrenocorticotrophic hormone, a hormone that stimulates cortisol production). Cushing's disease is a specific type of Cushing's syndrome in which excess cortisol is caused by a tumour formed in the pituitary gland. People with Cushing's disease, compared with people without this condition, are at greater risk of other serious illnesses and early death, with signs and symptoms varying between individuals. Based on data from other studies, collectively called the LINC programme, osilodrostat is approved as a treatment taken by mouth for adults with Cushing's syndrome (in Europe, Switzerland and Japan), including Cushing's disease (in the USA). What happened in the LINC 4 study? The LINC 4 study looked at osilodrostat in 73 adult participants with Cushing's disease from 14 countries. The researchers wanted to learn how effective osilodrostat was in patients with Cushing's disease and what the side effects were. The term ‘side effect’ refers to any effect that a person experienced during the LINC 4 study. Side effects may or may not be caused by osilodrostat. What were the results? The study showed that osilodrostat was better than placebo (a dummy sugar pill) at lowering cortisol levels to normal, and that cortisol was then maintained at normal levels during continued treatment with osilodrostat through to week 48 of the study. In addition, signs and symptoms of Cushing's disease improved during treatment with osilodrostat, including lowered blood pressure, better control of blood sugar, and improved quality of life. The side effects of osilodrostat treatment were generally mild or moderate in severity, and very few study participants stopped taking the drug because of them. What do the results of the study mean? These results support osilodrostat as an effective medical treatment for people with Cushing's disease. Clinical Trial Registration: NCT02697734 ( ClinicalTrials.gov )

Effect of Nigella sativa supplementation on kidney function, glycemic control, oxidative stress, inflammation, quality of life, and depression in diabetic hemodialysis patients: study protocol for a double-blind, randomized controlled trial

Background and objectivesThe kidney is probably the most crucial target of microvascular damage in diabetes, which can ultimately eventuate end-stage renal disease (ESRD). Hemodialysis is the most usual way of renal replacement therapy in ESRD. Patients receiving hemodialysis are susceptible to many complications like hyperglycemia, inflammation, depression, anxiety, and poor quality of life. So, they are constrained to consume many drugs. Medicinal herbs are used in different cultures as a reliable source of natural remedies. This study aims to determine the efficacy of Nigella sativa (NS) oil supplementation on blood glucose, kidney function tests, inflammation, oxidative stress, quality of life, and depression in hemodialysis patients.Methods and analysisThis double-blind, randomized controlled trial will enroll 46 patients with diabetes mellitus who give hemodialysis thrice a week. Patients who have an inflammatory or infectious disease and who are receiving nonsteroidal anti-inflammatory drugs will be excluded. Patients will be randomized to the treatment and control group, which will be recommended using two soft gels of NS and paraffin oil, respectively. Laboratory tests will be assessed at baseline and end of the study, including fasting blood sugar, glycated albumin, insulin, creatinine, blood urea nitrogen, urea, uric acid, superoxide dismutase, malondialdehyde, total antioxidant capacity, high sensitive C reactive protein, and 24-h urine volume. Also, the kidney disease and quality of life and hospital anxiety and depression scale questionnaires will be evaluated.DiscussionPrevious studies have reported a positive effect of Nigella sativa supplementation in chronic kidney disease, but there is no evidence that this plant is safe in hemodialysis patients. The results of this study can be helpful in better control of blood sugar and kidney function and reduce complications in diabetic hemodialysis patients.Trial registrationIranian Registry of Clinical Trials . Registered on 31 May 2020

Vitamin-D deficiency in adults of Mumbai city: Change in the last decade.

ABSTRACTBackground:Vitamin-D deficiency is a pandemic that is being linked to various noncommunicable diseases. The present study is an attempt to study the demographic profile and the prevalence of comorbidities in association with the vitamin-D status of the Mumbai-based study population. The authors also attempt to understand the change in prevalence over the last decadeMethodology:Fasting blood samples were collected from consenting asymptomatic adults visiting the hospital and were analyzed for the prevalence of vitamin-D deficiency and diabetes mellitus, and participants were clinically examined for the presence of hypertension (as defined by AHA guidelines) and obesity (as defined by body mass index of more than equal to 30)Results:It was found that 57% of participants were deficient, 25% had insufficient, and 18% had adequate vitamin-D levels. There were a greater number of younger (P = 0.003) and upper-middle-class participants in the deficient group (P = 0.043816). Prevalence of obesity, hypertension, and diabetes mellitus and the distribution of genders was comparable in the deficient and sufficient vitamin-D groups. However, diabetic vitamin-D-sufficient participants had better control of blood sugar compared to diabetic vitamin-D-deficient participantsConclusion:Although the prevalence of vitamin-D deficiency has slightly reduced compared to the previous decade, it is still highly prevalent. Diabetic vitamin-D-sufficient participants had better glycemic control compared to diabetic vitamin-D-deficient participants. Thus, it is highly recommended for primary care physicians to screen everyone for vitamin-D deficiency.

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.

Effect of Different Doses of Metformin Tablets on Metabolic Syndrome Componenets in Women with Type 2 Diabetes Mellitus in Gorgan (South East of Caspian Sea)

Studies on oral anti-hyperglycemic drugs have been shown in some studies to help and treat type 2 diabetic patients. The present study was designed to evaluate and compare the effect of different doses of metformin tablets on metabolic syndrome components in type 2 diabetic women in Gorgan, South East of Caspian Sea.Forty type 2 diabetic patients received 500 mg/day and 1000 mg/day metformin tablets for 12 months and forty healthy women were included in this study. The ATP III criteria were used to determine metabolic syndrome components, and lipid profiles, HbA1c and insulin were measured. Significant differences were found between blood sugar, triglycerides, high-density lipoprotein (HDL)-cholesterol, hemoglobin A1c (HbA1c) and insulin of the patients received 500 mg/day and 1000 mg/day metformin monotherapy. The blood sugar, triglycerides and insulin were significantly lower in patients received 500 and 1000 mg/day metformin than control groups. In both groups, HDL-cholesterol was higher than control groups, but HbA1c was significantly higher and lower in patients received 500 and 1000 mg/day metformin than control groups, respectively. In both study groups, positive significant correlation was found between blood glucose and HbA1c and, blood glucose and triglyceride levels.Our study showed the efficacy of the 1000 mg/day metformin monotherapy on better control of blood sugar, HbA1c, triglyceride and HDL-cholesterol levels, but Metformin had no effect on waist circumference and blood pressure. Treatment with this dose of metformin may be more beneficial for type 2 diabetic patients than those other doses.

Factors related to the uncontrolled fasting blood sugar among type 2 diabetic patients attending primary health care center, Abha city, Saudi Arabia.

To identify risk factors related to uncontrolled fasting blood sugar among type 2 diabetic patients. A systematic random sampling technique was followed to include 450 diabetic patients attending Al-Qabil Primary Health Care Center in Abha City, Saudi Arabia. Collected data comprised sociodemographic characteristics (age, gender, height, weight, education, employment, body mass index, and smoking), while disease-related characteristics included duration of diabetes, fasting blood sugar control, hypertension, and regularity of follow up visits. Fasting blood sugar was uncontrolled among 76.9% of selected patients with type 2 diabetes mellitus. Overweight and obesity were present among 81.6%. Significant risk factors for uncontrolled blood sugar included older age, male gender (P=.037), illiteracy (P=.020), being employed (P=.003), longer duration of disease (P=.023), hypertension (P=.010), and smoking (P=.001). Prevalence of uncontrolled fasting blood sugar is high among patients with type 2 diabetes mellitus. Risk factors associated with uncontrolled fasting blood sugar include older age, male gender, illiteracy, being employed, longer duration of disease, hypertension, smoking, and obesity. Therefore, for better control of blood sugar among diabetics, it is recommended to control the blood pressure and body weight of diabetics and avoid smoking.

Does routine antenatal fetal testing in well-controlled diabetic pregnancies improve pregnancy outcomes? A systematic review and meta-analysis

Background: Various fetal surveillance tests are proposed to reduce the rate of stillbirth in diabetic mothers, however there is no sufficient evidence to support this. Objective: The purpose of the present systematic review was to assess the effects of fetal testing on reducing fetal mortality in pregnancies with diabetes. Materials and Methods: The databases were searched to find English and Persian articles published from 1975-2018 about antenatal fetal assessment in pregnancies complicated with diabetes. Relevant sources cited in the selected publications were also searched manually. Keywords were GDM, pregnancy, fetal testing, fetal surveillance, NST, BPP, CTG. A total of 1954 studies were identified. Of these, 1913 were excluded on the basis of title and abstract review. Results: Among the 41 studies retrieved for detailed full-text analysis, a total of 10 fulfilled the inclusion criteria for the analysis. Still birth rate was 5.6/1000, cesarean rate was 418/1000. In diabetic pregnant women (gestational and overt diabetes) with well controlled blood sugar who did fetal surveillance tests the intrauterine fetal death rate isn’t different with general population. Conclusion: As this systematic review suggests, fetal mortality is rare with fetal surveillance tests in pregnant diabetic women with good blood sugar control. No randomized clinical trial has been conducted to investigate this claim.

An observational study to estimate the level of essential trace elements and its implications in type 2 diabetes mellitus patients.

Background and Objectives:Insulin action of reducing blood glucose has been found to be enhanced by trace elements.Material and Methods:This was a cross sectional study including 150 patients with Type 2 Diabetes Mellitus (T2DM) and 50 controls. Serum concentrations of zinc, copper, chromium, selenium and magnesium was measured by colorimetric kit. Fasting Blood Glucose and Glycated Haemoglobin (HbA1c) were assayed using the standard kit.Results:Out of 150 patients, 85.4% (n = 128) of the cases had uncontrolled blood sugar with HbA1c ≥7 and only 14.6% (n = 22) had good control of blood sugar with HbA1c <7%. Hypertension (42%) and hypothyroidism (14%) were the most commonly associated comorbidities among patients with T2DM. Following percentage of diabetic patients had complications such as peripheral neuropathy (45.3%), diabetic retinopathy (36.7%), coronary artery disease (20.7%), diabetic nephropathy (17.3%), peripheral vascular disease (8.7%), and cerebrovascular accident (6%) respectively. The mean level of zinc, copper, selenium and magnesium was significantly lower in patients with T2DM than the control cases (62.89 vs. 74.95 μg/dL, P < 0.05; 116.30 vs. 150.39 μg/dL, P < 0.001; 8.57 vs. 16.16 μg/dL, P < 0.001; 1.92 vs. 2.31 mg/dL, P < 0.05, respectively). Multivariate analysis showed that there was a significant trend between levels of zinc, copper, selenium, and magnesium and the prevalence of T2DM.Conclusions:The levels of selenium, zinc, copper, and magnesium were significantly lower in patients with T2DM when compared to healthy counterparts.

Characteristics of Hypoglycemic Diabetic Patients Visiting the Emergency Room.

Introduction Severe hypoglycemia can be life-threatening; therefore, it is important to identify the characteristics of the hypoglycemic patients. The aim of this study is to analyze the type and characteristics of diabetic patients with hypoglycemia who visited an emergency room. Methods We included diabetic patients with hypoglycemia who visited the emergency room of St. Mary's Hospital in Seoul from January 2009 to August 2018 in the study. Hypo_S group patients visited the emergency room once whereas Hypo_M group patients visited twice or more. We also compared the incidence of cardiovascular disease between the groups within 5 years after hypoglycemia. Results A total of 843 patients were included in this study, with a mean age of 71 ± 14 years and average glycated hemoglobin (HbA1c) level of 6.7 ± 1.4%. For patients with hypoglycemia, lower body mass index, lower HbA1c, shorter diabetes duration, and lower glomerular filtration rate have a statistically significant relationship with patient characteristics in the emergency room group (all p < 0.001). Hypoglycemia symptoms were most frequently observed between 6:00 and 12:00 am (p < 0.001). Cardiovascular diseases within 5 years after discharge were more frequent in the Hypo_S group than in the Hypo_M group; however, there was no statistical significance. The frequency of aneurysms was significantly higher in patients with hypoglycemia than in other patients in the emergency room (p < 0.05). Conclusion Relatively thin older patients with a diabetes duration shorter than 10 years and good blood sugar control showed higher frequency of visits to the emergency room due to hypoglycemia. For these patients, medical staff should always be mindful of their susceptibility to hypoglycemia when prescribing insulin or OHA and educate them on the prevention of hypoglycemia.

Life satisfaction, disease management attitudes and nutritional status of diabetes mellitus patients in Azad Kashmir, Pakistan: a hospital based cross-sectional study

BACKGROUND: The life satisfaction of diabetes mellitus patients in association with the disease management attitudes and nutritional status have never been investigated yet in Pakistani administered Azad Jammu Kashmir.&#x0D; AIM: The purpose of this study is to analyze the patient satisfaction about life with diabetes mellitus in association with disease management and nutritional status.&#x0D; METHODS: A cross sectional survey was conducted among 496 patients in DHQ hospital, Mirpur Azad Jammu Kashmir. The questionnaire comprised of two sections: 1) Diabetes Attitude Scale (DAS-3); 2) Patient profile, DM history, nutritional status and dietary habits. The findings are generated by binary logistic regression and multivariate regression analyses.&#x0D; RESULTS: Overall, 64% of the patients interviewed reported dissatisfaction with their life with DM. Majority of the patients were females (66%), BMI value above 25.0 (56%). Gender male (AOR=1.82; 95%CI=1.15-2.88) and low income (AOR=3.16; 95%CI= 1.13-8.80) and middle income (AOR=4.70; 95%CI=1.52-15.5) were significantly associated with life dissatisfaction. There was higher likelihood of life dissatisfaction among patients with low food intake (AOR=1.82; 95%CI= 1.20-2.76); patients belief on: no need of taking insulin to treat their diabetes have a mild disease (AOR=1.56; 95%CI= 1.01-2.41); not much use in trying to have good blood sugar control because complications of diabetes happen anyway (AOR= 1.63; 95%CI= 1.18-2.23); emotional effects of diabetes are small (AOR=1.47; 95%CI= 1.02-2.14); decisions regarding daily diabetes care should be made by the patient (AOR= 2.15; 95%CI= 1.19-3.88).&#x0D; CONCLUSION: Findings implied the need of organizing counselling sessions for DM patients that promote regular physical activity to improve health and disease management. The consultation and regular visits of a nutritionist may help the patients in achieving better health outcomes.

Upaya yang Dilakukan Diabetisi yang Menggunakan BPJS dalam Mengendalikan Gula Darah.

Diabetes Mellitus is a chronic metabolic disease in which people with diabetes can not produce enough insulin or the body is unable to use insulin effectively resulting in excess sugar in the blood. Good blood sugar control is a key factor in preventing complications. This can be achieved by administering antidiabetic drugs, lifestyle changes, as well as regular blood glucose and laboratory measurements. Although research on the experience of people with diabetes in controlling blood sugar has been overwhelming, there remains a need to differentiate between factors and processes involved in other blood sugar controls such as the process in the use of BPJS for people with diabetes and gain experience of people with Type II diabetes who use BPJS in controlling blood sugar . This research is a qualitative research with 4 participants of BPJS users. The interviews were structured thematicly analyzed using a phenomenological approach. The result of the research is the exploration of the utilization of people with diabetes in controlling blood sugar, obstacles felt by people with BPJS in controlling Blood sugar, the attempts made by people with BPJS in controlling blood sugar. So it can be concluded that the theme obtained from the results of in-depth interviews can answer research questions that experience diabetisi using BPJS in controlling blood sugar require special efforts in the form of 5 pillars of sustainable DM so that BPJS utilization can be implemented as well as possible. It is also recommended for people with diabetes to better understand the flow of reference / use of BPJS as a basis for controlling blood sugar maximum.&#x0D;

Patient Empowerment: An Effective Strategy to Improve Management of GDM

Background: GDM is a public health issue, affecting mostly the South East Asian region, as well in Bangladesh (prevalence 9.7% - 12.9%). It has a significant adverse impact on maternal and foetal outcome. So it needs to be addressed energetically to avoid maternal and foetal morbidity and mortality. Also it will contribute a lot to the pool of Type II Diabetes as substantial number of GDM mother and their offspring may develop type II DM in near future. Self-management of GDM is well-known globally but there is still lacking in adequate handling of diabetes by the patients themselves. Nevertheless the lacking can be minimized through ‘Patient Empowerment’ by clear understanding of the disease and its consequences along with intense learning, training, monitoring and evaluation of the clients involved. Also it will help in emotional stability of the client which is an essential component of diabetes management during pregnancy. The innovative strategy may contribute significantly in GDM management at low cost in a resource constraint setting.&#x0D; Objective: To find the effectiveness of ‘patient empowerment’ promoting better self-management of GDM.&#x0D; Methodology: This quasi experimental study was done on 96 cases (48 in each group) by purposive sampling technique at Shaheed Suhrawardy Medical College Hospital (ShSMC) as study group &amp; Rajshahi Medical College Hospital (RMCH) as control group, from August 2012 – August 2015. Both group were matched of age, parity, education and income. Ethical clearance was taken from ethical committee of both ShSMC and RMCH&#x0D; Result: In the study group good glycemic control achieved with diet &amp; exercise (75%) and Insulin required in only 25% cases, while in control group Insulin given in 75% cases. In the study group NVD (67%) were more than control group (33.3%). There were no obstructed labour in study group but control group (12.50%). Majority of the study group (74.6%) had no or minimum antenatal complication, in comparison to control group (74.66%). Regarding Neonatal outcome, neonatal resuscitation required none in study group but 12 (25%) in control group. So, overall adverse outcome observed less in study group than control group&#x0D; Conclusion: Patient empowerment can be an effective tool to manage GDM cases with an outcome of good control of blood sugar; less antenatal, intrapartum and post natal complications, good foetal and neonatal outcome and low requirement of insulin.&#x0D; J Shaheed Suhrawardy Med Coll, December 2018, Vol.10(2); 91-94

Operational immune tolerance towards transplanted allogeneic pancreatic islets in mice and a non-human primate.

Patients with autoimmune type 1 diabetes transplanted with pancreatic islets to their liver experience significant improvement in quality of life through better control of blood sugar and enhanced awareness of hypoglycaemia. However, long-term survival and efficacy of the intrahepatic islet transplant are limited owing to liver-specific complications, such as immediate blood-mediated immune reaction, hypoxia, a highly enzymatic and inflammatory environment and locally elevated levels of drugs including immunosuppressive agents, all of which are injurious to islets. This has spurred a search for new islet transplant sites and for innovative ways to achieve long-term graft survival and efficacy without life-long systemic immunosuppression and its complications. We used our previously established approach of islet transplant in the anterior chamber of the eye in allogeneic recipient mouse models and a baboon model of diabetes, which were treated transiently with anti-CD154/CD40L blocking antibody in the peri-transplant period. Survival of the intraocular islet allografts was assessed by direct visualisation in the eye and metabolic variables (blood glucose and C-peptide measurements). We evaluated longitudinally the cytokine profile in the local microenvironment of the intraocular islet allografts, represented in aqueous humour, under conditions of immune rejection vs tolerance. We also evaluated the recall response in the periphery of the baboon recipient using delayed-type hypersensitivity (DTH) assay, and in mice after repeat transplant in the kidney following initial transplant with allogeneic islets in the eye or kidney. Results in mice showed >300days immunosuppression-free survival of allogeneic islets transplanted in the eye or kidney. Notably, >70% of tolerant mice, initially transplanted in the eye, exhibited >400days of graft survival after re-transplant in the kidney without immunosuppression compared with ~30% in mice that were initially transplanted in the kidney. Cytokine and DTH data provided evidence of T helper 2-driven local and peripheral immune regulatory mechanisms in support of operational immune tolerance towards the islet allografts in both models. We are currently evaluating the safety and efficacy of intraocular islet transplantation in a phase 1 clinical trial. In this study, we demonstrate immunosuppression-free long-term survival of intraocular islet allografts in mice and in a baboon using transient peri-transplant immune intervention. These results highlight the potential for inducing islet transplant immune tolerance through the intraocular route. Therefore, the current findings are conceptually significant and may impact markedly on clinical islet transplantation in the treatment of diabetes.