Blood Glucose Control In Type Research Articles

Acceptability and Satisfaction With a Telecarer Approach to the Management of Type 2 Diabetes

To examine patients' views of the acceptability of and satisfaction with telephone care center support provided to improve blood glucose control in type 2 diabetes. The Pro-Active Call-Center Treatment Support (PACCTS) Trial randomized patients from 47 general practices in a deprived urban area in northwest England to usual care or to proactive call center support in addition to usual care. Satisfaction with care was assessed in all 591 patients at baseline and the end of the study using the Diabetes Satisfaction and Treatment Questionnaire (DTSQ). Acceptability was assessed in 394 intervention patients after at least three proactive calls from the call center and at the end of the trial. A purposive sample of 25 patients took part in in-depth semistructured interviews. The response rates to the questionnaires were 79% (DTSQ) and 65% (acceptability). Persons receiving the intervention continued to report high levels of satisfaction with their treatment (95% CI 32.3-33.2 at 1 year), and >90% strongly agreed or agreed that the telecarer approach was acceptable. Qualitative comments pointed to the importance of a personalized service; increased feelings of well-being, including confidence and self-control; help with problem-solving; and patients developing rapport and a strong bond with the telecarers. A personalized PACCTS approach is acceptable to patients. A service giving priority to the interpersonal dimension leads to increased commitment from patients to improve long-term glycemic control.

How to ADVANCE prevention of cardiovascular complications in type 2 diabetes

Patients suffering from type 2 diabetes are at increased risk of macrovascular and microvascular disease. This review assesses the available evidence for hypertension and hyperglycemia as risk factors for vascular disease in type 2 diabetes mellitus. Several studies showing a benefit of antihypertensive treatment and glucose-lowering therapy on the prevention of macrovascular and microvascular disease are discussed. However, questions remain concerning the overall balance of benefits and risks of intensive target-driven blood pressure and blood glucose control in type 2 diabetes. More well-powered intervention and prevention studies are therefore needed to provide the necessary reliable evidence to answer these questions. The Action in Diabetes and Vascular disease: PreterAx and DiamicroN modified release Controlled Evaluation (ADVANCE) study is discussed as a trial designed to resemble clinical practice that promises to provide answers concerning the value conferred by blood pressure-lowering therapy and intensive glucose control therapy in type 2 diabetes patients at high risk for cardiovascular disease.

Complications, co-morbidity, and blood glucose control in type 2 diabetes mellitus patients in Germany--results from the CODE-2 study.

In this study, prevalence and incidence of complications as well as co-morbidity in type 2 diabetes patients in Germany were evaluated as part of a cost-of-illness study (CODE-2(TM), Costs of Diabetes in Europe - Type 2)In a pre-study, 197 general practitioners and diabetes specialists all over Germany provided data on the complication status of 2701 randomly selected patients with type 2 diabetes. The patients were grouped into five mutually exclusive strata. This pre-study was performed to generate a general overview on complication status to select proper patients for the main study. The main study was performed on stratified samples derived from the pre-study. Irrespective of the real prevalence of the five strata, an equal number of 160 were randomly selected from each stratum. Thus, rare complications were also covered in the study. Data from 809 patients were collected retrospectively on the basis of medical files during interviews with the physician. To achieve representative estimates of absolute prevalence and incidence of diabetes-related complications in Germany, results were weighted using frequencies of the strata. Severe complications were diagnosed in 50% of these patients. Prevalences were: 10.56% myocardial infarction, 6.66% stroke, 3.97% foot ulcer, 2.30% amputations and 1.34% blindness. Overall incidences in the diabetes population were estimated at 0.78% myocardial infarction, 1.28% stroke and 0.80% amputations. 23% of the diabetes patients suffered from 2 or more complications. The complication status became considerably worse with increasing time since the diagnosis of diabetes. The mean HbA1c level was 7.51% (i.e. 122% of the upper limit of the respective normal ranges). The presence of complications and co-morbidity in type 2 diabetes patients was a frequent finding. This underlines the importance of complications in diabetes patients and the necessity to increase any means of prevention in order to relieve the personal and economic burden of type 2 diabetes.

Education and multidisciplinary team care concepts for pediatric and adolescent diabetes mellitus.

The DCCT scientifically established the basis for optimizing blood glucose control in type 1 diabetes mellitus around the world using a multidisciplinary team approach and patient-centered adjustments of food and insulin based upon blood glucose data generated by the patient. Pediatric diabetologists no longer believe that it is prudent to allow higher blood glucose levels in prepubertal children but much educational emphasis must be placed upon minimizing serious episodes of hypoglycemia. Individualized treatment should be determined by a close working relationship between highly trained diabetes nurses, educators and dieticians with the patient as the focus of self-care decisions, and a pediatric diabetologist ideally setting the philosophical and medical goals. Rather than the diabetes health care team being the only ones to initiate treatment, patient and parents should be empowered to analyze their own data, identify patterns, solve problems with food and activity, and do so based upon actual blood glucose results. This empowerment paradigm helps decrease care frustrations and improve treatment outcomes. Survival education followed by in-depth problem solving education and organized follow-up education are all needed steps for successful diabetes management. Identification of psychosocial barriers and energy diverting behavioral and family issues just as knowledge about learning styles play key roles in this process. Dogma should be avoided. More physiological utilization of insulin analogs, greater insulin dosing flexibility with a multidose insulin regimen coupled with adaptation of insulin to food and activity, should allow maximum benefit. Four major types of learning styles are reviewed: concrete sequential learners, abstract sequential learners, abstract random learners and concrete random learners. Health Belief Models, Locus of Control constructs, and Self-Efficacy models all provide sophisticated ways to help identify and overcome learning and self-care barriers. Parental, child, adolescent and young adult responsibility for care also needs to be addressed and placed in the context of family functioning and glycemic goals. Age and developmental stages as well as parental and societal roles play important roles in the care needed to live well with a chronic illness. The role of the health care professionals who are part of the diabetes care team involves not only setting the stage and providing guidance but also supervising appropriate short- as well as long-term complications monitoring for early detection and treatment of microangiopathy. Applying not only telephone but also fax, e-mail and computers in modern diabetes care should facilitate applications of these psychological, educational and medical models to improve short-term and long-term diabetes treatment outcomes.

Increase of serum phosphatidylcholine hydroperoxide dependent on glycemic control in type 2 diabetic patients

In order to clarify the relationship between serum phosphatidylcholine hydroperoxide (PCOOH) levels and blood glucose control in type 2 diabetes patients (DM), DM ( n=61) and normal control ( n=11) were enrolled. High-density lipoprotein (HDL) was separated from serum by the addition of sodium phosphotungstate and magnesium chloride, and the precipitated fraction was prepared as non-HDL. Phospholipids were extracted from whole serum, non-HDL and HDL to estimate PCOOH level with chemiluminescence high performance liquid chromatography (CL-HPLC). PCOOH level (nmol/l, mean±S.D.) was higher in DM than in control (33.1±9.5 vs. 23.0±8.2 for serum; P<0.01, 17.0±5.5 vs. 10.6±3.8 for non-HDL; P<0.01, and 16.1±6.3 vs. 12.3±5.5 for HDL; not significant, respectively). DM was divided into five groups according to hemoglobin A 1c (HbA 1c) levels (%): (1) less than 6, (2) 6–6.4, (3) 6.5–6.9 (4) 7.0–7.4, and (5) over than 7.5. Increase of PCOOH levels was dependent on HbA 1c. We concluded that (1) serum and non-HDL PCOOH increased in DM, (2) the level was strongly correlated with diabetic control, and (3) approximately a half amount of serum PCOOH was present in HDL of both control and DM.

Glycemic index, eating patterns, and blood glucose control in type 2 diabetic women

Glycemic index, eating patterns, and blood glucose control in type 2 diabetic women

Review: self monitoring does not improve blood glucose control in type 2 diabetes mellitus

(2000) Diabet Med 17, 755. Coster S, Gulliford MC, Seed PT, et al. . Self-monitoring in type 2 diabetes mellitus: a meta-analysis. . Nov; . : . –61. . [OpenUrl][1][CrossRef][2][PubMed][3][Web...

Review: Self-monitoring does not improve blood glucose control in type 2 diabetes mellitus

Review: Self-monitoring does not improve blood glucose control in type 2 diabetes mellitus

Day-to-Day Consistency in Amount and Source of Carbohydrate Intake Associated with Improved Blood Glucose Control in Type 1 Diabetes

Objective: To determine if a relationship exists between blood glucose control and variability in nutrient intake from day-to-day in subjects with type 1 diabetes.Methods: Two three-day diet records and one measurement of glycated hemoglobin (HbA1c) were obtained from 272 subjects with type 1 diabetes treated with a mixture of regular and NPH insulins before breakfast and supper and using a standardized algorithm to adjust insulin dose according to the results of self-monitoring of blood glucose two to four times daily. Day-to-day variation in nutrient intake was expressed as the coefficient of variation (CV=SD×100/mean).Results: Nutrient intakes in the study population (mean±SD) were energy 8.35±2.43 MJ, fat 81±30 g, protein 94±28 g, carbohydrate 227±68 g, starch 126±38 g and dietary fiber 20±6 g with diet glycemic index being 84.2±7.4. Neither energy, nutrient intakes nor insulin dose was significantly related to HbA1c. Day-to-day variation of carbohydrate (p=0.0097) and starch (p=0.0016) intakes and diet glycemic index (p=0.033) was positively related to HbA1c, and the associations remained significant when adjusted for age, sex, duration of diabetes and BMI. Day-to-day variation in energy, protein or fat intakes was not related to HbA1c.Conclusions: Consistency in the amount and source of carbohydrate intake from day-to-day is associated with improved blood glucose control in people with type 1 diabetes, a result which supports continued educational efforts to achieve adherence to a diabetes diet plan. This conclusion may not apply to people on intensified insulin therapy who adjust their insulin dose based on their actual carbohydrate intake at each meal.

A model-based algorithm for blood glucose control in type I diabetic patients.

A model-based predictive control algorithm is developed to maintain normoglycemia in the Type I diabetic patient using a closed-loop insulin infusion pump. Utilizing compartmental modeling techniques, a fundamental model of the diabetic patient is constructed. The resulting nineteenth-order nonlinear pharmacokinetic-pharmacodynamic representation is used in controller synthesis. Linear identification of an input-output model from noisy patient data is performed by filtering the impulse-response coefficients via projection onto the Laguerre basis. A linear model predictive controller is developed using the identified step response model. Controller performance for unmeasured disturbance rejection (50 g oral glucose tolerance test) is examined. Glucose setpoint tracking performance is improved by designing a second controller which substitutes a more detailed internal model including state-estimation and a Kalman filter for the input-output representation. The state-estimating controller maintains glucose within 15 mg/dl of the setpoint in the presence of measurement noise. Under noise-free conditions, the model-based predictive controller using state estimation outperforms an internal model controller from literature (49.4% reduction in undershoot and 45.7% reduction in settling time). These results demonstrate the potential use of predictive algorithms for blood glucose control in an insulin infusion pump.

U.K. Prospective Diabetes Study 16: Overview of 6 Years' Therapy of Type II Diabetes: A Progressive Disease

The objective of the U.K. Prospective Diabetes Study is to determine whether improved blood glucose control in type II diabetes will prevent the complications of diabetes and whether any specific therapy is advantageous or disadvantageous. The study will report in 1998, when the median duration from randomization will be 11 years. This report is on the efficacy of therapy over 6 years of follow-up and the overall incidence of diabetic complications. Subjects comprised 4,209 newly diagnosed type II diabetic patients who after 3 months' diet were asymptomatic and had fasting plasma glucose (FPG) 6.0–15.0 mmol/l. The study consists of a randomized controlled trial with two main comparisons: 1) 3,867 patients with 1,138 allocated to conventional therapy, primarily with diet, and 2,729 allocated to intensive therapy with additional sulfonylurea or insulin, which increase insulin supply, aiming for FPG &amp;lt;6 mmol/l; and 2) 753 obese patients with 411 allocated to conventional therapy and 342 allocated to intensive therapy with metformin, which enhances insulin sensitivity. In the first comparison, in 2,287 subjects studied for 6 years, intensive therapy with sulfonylurea and insulin similarly improved glucose control compared with conventional therapy, with median FPG at 1 year of 6.8 and 8.2 mmol/l, respectively (P &amp;lt; 0.0001). and median HbA1c of 6.1 and 6.8%, respectively (P &amp;lt; 0.0001). During the next 5 years, the FPG increased progressively on all therapies (P &amp;lt; 0.0001) with medians at 6 years in the conventional and intensive groups, FPG 9.5 and 7.8 mmol/l, and HbA1c 8.0 and 7.1%, respectively. The glycemic deterioration was associated with progressive loss of β-cell function. In the second comparison, in 548 obese subjects studied for 6 years, metformin improved glucose control similarly to intensive therapy with sulfonylurea or insulin. Metformin did not increase body weight or increase the incidence of hypoglycemia to the same extent as therapy with sulfonylurea or insulin. A high incidence of clinical complications occurred by 6-year follow-up. Of all subjects, 18.0% had suffered one or more diabetes-related clinical endpoints, with 12.1% having a macrovascular and 5.7% a microvascular endpoint. Sulfonylurea, metformin, and insulin therapies were similarly effective in improving glucose control compared with a policy of diet therapy. The study is examining whether the continued improved glucose control, obtained by intensive therapy compared with conventional therapy (median over 6 years HbA1c 6.6% compared with 7.4%), will be clinically advantageous in maintaining health.

U.K. prospective diabetes study 16. Overview of 6 years' therapy of type II diabetes: a progressive disease. U.K. Prospective Diabetes Study Group

The objective of the U.K. Prospective Diabetes Study is to determine whether improved blood glucose control in type II diabetes will prevent the complications of diabetes and whether any specific therapy is advantageous or disadvantageous. The study will report in 1998, when the median duration from randomization will be 11 years. This report is on the efficacy of therapy over 6 years of follow-up and the overall incidence of diabetic complications. Subjects comprised 4,209 newly diagnosed type II diabetic patients who after 3 months' diet were asymptomatic and had fasting plasma glucose (FPG) 6.0-15.0 mmol/l. The study consists of a randomized controlled trial with two main comparisons: 1) 3,867 patients with 1,138 allocated to conventional therapy, primarily with diet, and 2,729 allocated to intensive therapy with additional sulfonylurea or insulin, which increase insulin supply, aiming for FPG < 6 mmol/l; and 2) 753 obese patients with 411 allocated to conventional therapy and 342 allocated to intensive therapy with metformin, which enhances insulin sensitivity. In the first comparison, in 2,287 subjects studied for 6 years, intensive therapy with sulfonylurea and insulin similarly improved glucose control compared with conventional therapy, with median FPG at 1 year of 6.8 and 8.2 mmol/l, respectively (P < 0.0001). and median HbA1c of 6.1 and 6.8%, respectively (P < 0.0001). During the next 5 years, the FPG increased progressively on all therapies (P < 0.0001) with medians at 6 years in the conventional and intensive groups, FPG 9.5 and 7.8 mmol/l, and HbA1c 8.0 and 7.1%, respectively. The glycemic deterioration was associated with progressive loss of beta-cell function. In the second comparison, in 548 obese subjects studied for 6 years, metformin improved glucose control similarly to intensive therapy with sulfonylurea or insulin. Metformin did not increase body weight or increase the incidence of hypoglycemia to the same extent as therapy with sulfonylurea or insulin. A high incidence of clinical complications occurred by 6-year follow-up. Of all subjects, 18.0% had suffered one or more diabetes-related clinical endpoints, with 12.1% having a macrovascular and 5.7% a microvascular endpoint. Sulfonylurea, metformin, and insulin therapies were similarly effective in improving glucose control compared with a policy of diet therapy. The study is examining whether the continued improved glucose control, obtained by intensive therapy compared with conventional therapy (median over 6 years HbA1c 6.6% compared with 7.4%), will be clinically advantageous in maintaining health.

Beneficial effect of a low glycaemic index diet in type 2 diabetes.

Low glycaemic index foods produce low blood glucose and insulin responses in normal subjects, and improve blood glucose control in Type 1 and well-controlled Type 2 diabetic patients. We studied the effects of a low glycaemic index diet in 15 Type 2 diabetic patients with a mean fasting blood glucose of 9.5 mmol l-1 using a randomized, crossover design. Patients were given pre-weighed diets (59% energy as carbohydrate, 21% fat, and 24 g 1000-kcal-1 dietary fibre) for two 2-week periods, with a diet glycaemic index of 60 during one period and 87 during the other. On the low glycaemic index diet, the blood glucose response after a representative breakfast was 29% less than on the high glycaemic index diet (874 +/- 108 (+/- SE) vs 204 +/- 112 mmol min l-1; p less than 0.001), the percentage reduction being almost identical to the 28% difference predicted from the meal glycaemic index values. After the 2-week low glycaemic index diet, fasting serum fructosamine and cholesterol levels were significantly less than after the high glycaemic index diet (3.17 +/- 0.12 vs 3.28 +/- 0.16 mmol l-1, p less than 0.05, and 5.5 +/- 0.4 vs 5.9 +/- 0.5 mmol l-1, p less than 0.02, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Catecholamines and Blood Glucose Control in Type 1 Diabetes

To evaluate the influence of blood glucose control on serum catecholamine levels (which reflect both plasma and platelet levels), six healthy non-diabetic subjects, seven well-controlled Type 1 diabetic patients, and six poorly controlled Type 1 diabetic patients were studied before (baseline) and after standardized exercise. A significant correlation was found between serum noradrenaline and HbA1 at baseline (r = 0.53, p less than 0.025) and after exercise (r = 0.71, p less than 0.001). Similar results were found for serum adrenaline (r = 0.68, p less than 0.005 and r = 0.61, p less than 0.005, respectively) and consequently total serum catecholamine content (r = 0.65, p less than 0.005 and r = 0.75, p less than 0.001, respectively). However, no relationship was found between serum catecholamine levels and actual blood glucose levels, age, body mass index or insulin dose. A moderate correlation was found between systolic blood pressure and serum levels of noradrenaline and total catecholamines after exercise (r = 0.48 and r = 0.48, both p less than 0.025).

Knowledge, Attitudes, Technical Competence, and Blood Glucose Control of Type 1 Diabetic Patients During and After an Education Programme

Thirty-one Type 1 diabetic patients entered a 12-month education programme in which attitudes to diabetes, knowledge of diabetes, and technical competence were assessed using questionnaires and practical tests. A closely matched group of 25 control patients continued to receive routine clinic care. Patients completing the education programme showed improved blood glucose control (HbA1 decreased from 11.8 +/- 0.4% to 10.5 +/- 0.3%, mean +/- SE, p less than 0.01), whereas blood glucose control was not altered in the control group (HbA1 11.8 +/- 0.5% before and 11.6 +/- 0.4% after 12 months). Patients completing the education programme also showed greater knowledge (p less than 0.001), more favourable attitudes (p less than 0.03), and increased competence in technical skills (p less than 0.02) compared with the control group. Six months after completing the programme blood glucose control deteriorated (HbA1 11.0 +/- 0.4%, p less than 0.05), although knowledge, attitudes, and technical competence were unchanged. This might reflect the withdrawal of extrinsic motivation and attention provided during the programme. Thus consideration should be given to development of the patient's intrinsic motivation to prolong the benefits of diabetes education programmes.

Intramuscular Versus Subcutaneous Injection of Unmodified Insulin: Consequences for Blood Glucose Control in Patients with Type 1 Diabetes Mellitus

Using the perpendicular injection technique lean diabetic patients may often inject insulin intramuscularly (IM). Guided by ultrasound measurements of the subcutaneous (SC) thickness of the thigh, the aim of the present study was to re-evaluate the absorption kinetics of unmodified insulin from IM and SC injection sites and to evaluate the consequences of IM injection of unmodified insulin for blood glucose control in Type 1 diabetic patients. T50% values (time until 50% of the injected insulin is absorbed from the injection site) of SC injected, radioactively labelled, human unmodified insulin (125I-Actrapid) were 338 +/- 13 (+/- SE) min, 289 +/- 27 min, and 287 +/- 27 min during rest, light physical activity, and strenuous exercise, respectively. Intramuscularly injected unmodified insulin was absorbed faster, T50% 232 +/- 20 min, 113 +/- 13 min, and 112 +/- 5 min during the same levels of physical activity in the same order. When unmodified insulin (Actrapid) was given IM 30 min before breakfast, lunch, and dinner together with intermediate-acting insulin (Protaphane) SC at 2200 h, a more physiological profile of plasma free insulin and a more stable blood glucose profile was obtained than with SC administration into the thigh. The coefficient of variation of blood glucose concentration during the study (3 days each route) was lower with IM than with SC injection of unmodified insulin (33 +/- 4 vs 43 +/- 3%, p less than 0.01). No difference in frequency of hypoglycaemic attacks was found and patients claimed that IM injection was no more painful than SC injection. These data suggest that IM injection of soluble insulin into the thigh is beneficial.

An Analysis of Glycosylated Blood Proteins and Blood Glucose Profiles Over One Year in Patients with Type 1 Diabetes

The clinical value of prospective measurement of several direct and indirect measures of blood glucose control in the management of Type 1 diabetes has been investigated. Ninety-eight Type 1 diabetic patients were followed over a period of 1 year after a 6-week period of intensification of management, with monthly measurements of blood glucose profiles and 3-monthly HbA1, glycosylated serum albumin, and fructosamine measurements. All measures improved markedly after the initial 6-week period (p less than 0.001), and all except glycosylated serum albumin and fructosamine then remained relatively stable. Of fourteen serial comparisons, glycosylated blood proteins were significantly correlated more often with levels of mean blood glucose and M value (on 4-7 occasions, rs 0.30-0.58) than with fasting blood glucose levels (on only 2-3 occasions, rs 0.34-0.44). Serum fructosamine levels correlated significantly with mean blood glucose on four occasion (rs 0.30-0.50), whilst glycosylated serum albumin and HbA1 correlated with mean blood glucose on six occasions (rs 0.36-0.54). Glycosylated serum albumin correlated with HbA1 and fructosamine levels throughout the year (rs 0.47-0.68 and 0.48-0.76, respectively), but HbA1 and fructosamine were less clearly correlated with each other (rs 0.38-0.44), with no significant association immediately after the period of intensive management or 3 months later.(ABSTRACT TRUNCATED AT 250 WORDS)

Hyperalimentation as cause of markedly worsened metabolic control in a patient with autoantibodies to the insulin receptor

Patients with type B insulin resistance and acanthosis nigricans have autoantibodies to their insulin receptors and usually have signs and symptoms of other autoimmune diseases. The first case demonstrating that hyperalimentation markedly disturbs blood glucose control in type B insulin-resistant patients is described. Neither prednisone, insulin (up to 240 units per hour), nor tolbutamide appeared to help this patient's metabolic control. After the addition of cyclophosphamide for one week, the anti-insulin receptor auto-antibody titer dropped from greater than 1: 1,000 to 1: 1. Six months later, the patient had a complete remission, which is rare, with only three other reported remissions in these patients with type B insulin resistance.

Serum fructosamine concentration as measure of blood glucose control in type I (insulin dependent) diabetes mellitus.

Serum fructosamine activity was studied in 42 patients with type I (insulin dependent) diabetes mellitus and 30 non-diabetic volunteers as an index of blood glucose control. There was a significant correlation both between fructosamine and glycosylated haemoglobin values (r = 0.82) and between fructosamine and the fasting C peptide concentration (r = -0.81). Test results in 14 of the diabetics reflected the mean plasma glucose concentration calculated from 25 serial estimations in a single 24 hour period (r = 0.75; p less than 0.01) but not the mean amplitude of glycaemic excursion (r = 0.23; p greater than 0.05). Fructosamine concentrations measured in these multiple blood specimens did not change significantly throughout the day (mean coefficient of variation 4.1%) despite wide variability of the respective plasma glucose concentrations (mean coefficient of variation 36.2%). It is concluded that a single random serum sample analysed for fructosamine concentration provides a simple and reliable assessment of glucose homoeostasis in patients with type I diabetes mellitus.

Diets for insulin pump and multiple daily injection therapy.

The role of diet in achieving and maintaining normalized blood glucose control in type I diabetic patients using insulin pumps or multiple daily injection (MDI) regimens is not well defined. We describe herein dietary guidelines that have proved effective in the management of such patients over 3 yr. The guidelines stress the importance of a careful dietary history, the regularity and consistency of diet during the preliminary adjustment period, the establishment of a variable insulin dosage schedule based on meal size and content as well as blood glucose, the appropriate treatment for hypoglycemia, and dietary adjustments for exercise. While insulin pump and MDI therapy may ultimately provide increased flexibility in certain aspects of dietary therapy, the diet must be carefully controlled if these innovative modes of insulin delivery are to succeed.