Changes In Metabolic Control Research Articles

Impact of changes in metabolic control on progression to photocoagulation for clinically significant macular oedema: a 20 year study of type 1 diabetes

Aims/hypothesisAlthough increasing hyperglycaemia, arterial hypertension and longer duration of diabetes raise the risk of progression of diabetic retinopathy, short-term benefits in terms of improved metabolic control and lowered blood pressure have not been demonstrated. We therefore examined the effect of changes in glycaemia and arterial blood pressure on the incidence of clinically significant macular oedema in a population of diabetic patients.MethodsWe performed a retrospective review of all patients with type 1 diabetes who attended the retinopathy screening clinic at the Steno Diabetes Center from 1988 to 2008, using the endpoint referral to first photocoagulation treatment for clinically significant diabetic macular oedema. The analysis included 1,878 patients (median observation, 8 years). Changes were defined as the inter-visit change; in the case of an event the last event-free interval before referral, where the median screening interval was 6 months.ResultsRisk of progression to photocoagulation for macular oedema increased with duration of diabetes (p < 0.001), current HbA1c (p < 0.0001) and with the magnitude of changes in HbA1c (p = 0.0002) and systolic blood pressure (p < 0.0001) in a multiple regression model. A recent decrease of ≥0.5 percentage points or an increase in HbA1c of >0.5 percentage points per 6 months was associated with HRs of 3.04 and 1.28, respectively, compared with lesser changes in HbA1c.Conclusions/interpretationIn this study, large recent changes in metabolic control and systolic blood pressure, irrespective of direction, were independent risk factors for progression to photocoagulation for diabetic macular oedema. The effects of metabolic and haemodynamic stability on diabetic retinopathy should be examined in prospective studies.

Structured self monitoring of blood glucose in Iranian people with type 2 diabetes; A cost consequence analysis

BackgroundSelf-Monitoring of Blood Glucose (SMBG) is considered as a key factor in management of people with diabetes which is a growing and cost demanding health problem. The purpose of this study was to investigate the effect of comprehensive patient management using structured SMBG on metabolic control as well as its cost consequence analysis.MethodsSixty subjects were recruited in an observational study for a period of 6 months. They were provided with the ACCU-CHEK 360° View tool to fill in the values of the 7-point blood glucose profiles in three consecutive days during the study on a monthly basis. Changes in metabolic control were assessed by HbA1c and lipid profile measurement at the beginning and at the end of the study. In addition, cost consequence analysis was done considering different level of health care professionals with or without insurance coverage. The Average Cost Effectiveness Ratio (ACER) as well as Cost saving analysis were calculated and compared.ResultsThe analysis showed significant reduction in HbA1c during the 6-month period in all subjects (P = 0.000). Furthermore, a positive effect was observed on lipid profile. The cost of endocrinologist’s visit in private sector was estimated to be 265.76 USD while this figure was149.15 USD for general practitioner in public sector with insurance coverage. Total complications and mortality cost saving was 154.8 USD. The lowest ACER was calculated for intervention with general practitioner in public sector with insurance coverage.ConclusionStructured SMBG results in significant improvement of glycemic status. Moreover, it is more cost saving in public sector with insurance coverage. It seems that general practitioner visits with insurance coverage is the most affordable option for people with type 2 diabetes.

The effects of Pilates on metabolic control and physical performance in adolescents with type 1 diabetes mellitus

Physical activity is a substantial method in the management of children and adolescents with Type 1 diabetes mellitus but it is not considered as a treatment for diabetes. The aim of this study was to investigate the effects of Pilates exercises on metabolic control and physical performance in patients with type 1 diabetes mellitus. Thirty one sedentary patients with type 1 diabetes mellitus, ranging in age from 12 to 17 (experimental group, n=17 and control group, n=14) were submitted to 12 weeks of Pilates training. Participants underwent tests to determine the physical performance and metabolic control before and after 12 weeks of Pilates session. At the end of study, there were significant alterations in physical performance of the study group. Peak power, mean power, vertical jump and flexibility of study group increased. There were no alterations for this parameters in the control group. There was no significant difference for glycated hemoglobin (HbA1c) in both groups. Conclusions: Physical performance increased via Pilates exercises in the patients with type 1 DM. However there were no changes in metabolic control. In the present study, the positive effects of exercise on metabolic control could not be shown in patients with Type 1 DM.

Changes in Metabolic Control of Phenylketonuria in Children Attending a Summer Camp

The objective of this study was to determine the change in blood phenylalanine (Phe; mg/dL) as a marker for metabolic control in 18 children ages 7 to 15 years with classical phenylketonuria (PKU) attending a 5-day summer overnight camp in Sandwich, Massachusetts, in 2003. The authors validated their results with a group of 20 children who attended camp in 2002. The mission was to provide children with a camp experience in which their diet was facilitated by the staff. The children were encouraged to take responsibility for their dietary management with minimal direct intervention. Blood samples were collected on filter papers for analysis by tandem mass spectroscopy on the first and last evenings of camp. Mean blood Phe at the beginning of camp was 8.8 mg/dL (SD = 4.5), and the final Phe was 4.6 mg/dL (SD = 2.5; mean difference = 4.2; 95% confidence interval: 2.6, 5.8). This difference is both clinically and statistically significant (P &lt; .0001). Prior year results validated the authors’ findings. Short-term effects of the camp environment resulted in improved metabolic control. Factors speculated as attributing to this improvement include decreased barriers to dietary compliance (variety of readily available low-protein foods, reinforcement of diet through recording intake in diet record books, increased acceptance of the diet because of a large number of other campers also with PKU) and readily available staff to assist with diet adherence.

Follow-up of Adolescents with Diabetes after Transition from Paediatric to Adult Care: Results of a 10-year Prospective Study

Our main objective in this study was to identify the type of clinical care received by young type 1 diabetic patients who have made the transition from paediatric to adult care, and to assess the metabolic status of long-term treatment after the transition. A standardized questionnaire was used prospectively to follow 99 patients with type 1 diabetes mellitus after their transition to adult care. This survey was done once a year, from 1998 to 2008. Directly after transition from paediatric care 38.4% of patients were found at specialised outpatient units; whereas 41.1% received care at a diabetes centre and 20.5% were monitored by general practitioners or specialists in internal medicine. Five-year results showed that 25.0% had continued to visit an outpatient unit; 41.7% were still visiting a diabetes centre; and 33.3% had remained in the care of general practitioners or internal specialists. We observed a trend showing slight improvements in the HbA1c values over time, however no major changes in metabolic control were observed after transition. Transition marks a critical phase for young, diabetic patients as they may frequently switch from one physician or centre to another. The individual optimization of therapy, established during paediatric care, provides the decisive groundwork for disease control in young adults.

Self-care coping strategies in people with diabetes: a qualitative exploratory study

BackgroundThe management of diabetes self-care is largely the responsibility of the patient. With more emphasis on the prevention of complications, adherence to diabetes self-care regimens can be difficult. Diabetes self-care requires the patient to make many dietary and lifestyle changes. This study will explore patient perceptions of diabetes self-care, with particular reference to the burden of self-care and coping strategies among patients.MethodsA maximum variation sample of 17 patients was selected from GP practices and diabetes clinics in Ireland to include patients with types 1 and 2 diabetes, various self-care regimens, and a range of diabetes complications. Data were collected by in-depth interviews; which were tape-recorded and transcribed. The transcripts were analysed using open and axial coding procedures to identify main categories, and were reviewed by an independent corroborator. Discussion of the results is made in the theoretical context of the health belief, health value, self-efficacy, and locus of control frameworks.ResultsPatients' perceptions of their self-care varied on a spectrum, displaying differences in self-care responsibilities such as competence with dietary planning, testing blood sugar and regular exercise. Three patient types could be distinguished, which were labeled: "proactive manager," a patient who independently monitors blood glucose and adjusts his/her self-care regime to maintain metabolic control; "passive follower," a patient who follows his/her prescribed self-care regime, but does not react autonomously to changes in metabolic control; and "nonconformist," a patient who does not follow most of his/her prescribed self-care regimen.ConclusionPatients have different diabetes self-care coping strategies which are influenced by their self-care health value and consequently may affect their diet and exercise choices, frequency of blood glucose monitoring, and compliance with prescribed medication regimens. Particular attention should be paid to the patient's self-care coping strategy, and self-care protocols should be tailored to complement the different patient types.

Predictors of Metabolic Control among Adolescents with Diabetes: A 4-Year Longitudinal Study

To employ a risk and resistance framework to examine changes in metabolic control over early to middle adolescence. We interviewed 70 girls and 62 boys (mean age 12 years) annually for 4 years. Risk and resistance factors, including demographics, disease-related variables, self-care behavior, and psychosocial variables were assessed. Hemoglobin A1c was obtained from medical records. Multilevel modeling showed metabolic control deteriorated with age. Self-care behavior interacted with age to predict the decline, such that self-care was more strongly related to poor metabolic control for older adolescents. Eating disturbances, depression, and peer relations were related to poor metabolic control, whereas good family relations were related to better metabolic control for girls. Independent risk factors for poor metabolic control included poor self-care, disturbed eating behavior, depression, and peer relations; parental support was an independent resistance factor for girls. Future research should examine mechanisms by which these relations emerge.

Continuous subcutaneous insulin infusion leads to immediate, stable and long‐term changes in metabolic control

Evaluations of continuous subcutaneous insulin infusion (CSII) usually focus on one pre- and one post-CSII measurement to assess metabolic therapy outcome. Extending this research, the aim of the present study was to provide a more fine-grained analysis of achieved glycaemic control. In 52 patients with type 1 diabetes (mean age of 37.85 years at CSII begin; s.d. +/- 12.41), haemoglobin A(1c) (HbA(1c)) levels were assessed every 3 months over a period of 5 years (1 year before and 4 years after the introduction of CSII). Mixed models were utilized to describe changes in glycaemic control. The pre-post course showed that already in the first quarter, a statistically significant lower HbA(1c) level was obtained [7.30%, in contrast to 8.21% at the last quarter with intensified conventional therapy (ICT)]. In the following 15 quarters, the mean HbA(1c) levels remained constantly lower than that with ICT. Overall, the aggregated mean HbA(1c) level of patients with CSII therapy was 7.19%, in contrast to 8.08% with ICT; thus, an overall decrease by 11% was achieved. In addition, individual differences in blood glucose level and age of diabetes onset as a predictor for therapy success were analysed. The data show an immediate, stable and long-term effect of CSII on HbA(1c). In addition, a significant relationship between metabolic control and age of diabetes onset was found, as well as a reduction of variance in HbA(1c) levels between subjects after change to CSII.

Effects of blood pressure lowering and metabolic control on systolic left ventricular function in Type II diabetes mellitus

Decreased left ventricular long-axis function may be the earliest stage in subclinical heart failure in Type II diabetes. To assess whether a decrease in SBP (systolic blood pressure) or a change in metabolic control would improve the long-axis function, 48 Type II diabetic patients participating in the CALM II (Candesartan and Lisinopril Microalbuminuria II) study were included in the present study. Patients were examined with tissue Doppler echocardiography at baseline and after 3 and 12 months of follow-up. Corresponding blood pressure, fructosamine and HbA(1c) (glycated haemoglobin) values were obtained. During the follow-up period, a decrease in SBP of 8 mmHg was seen (from 141+/-11 mmHg at baseline to 133+/-12 mmHg; P<0.001) and the peak systolic strain rate was significantly improved (from -1.10+/-0.25 at baseline to -1.25+/-0.22; P<0.01). There was a highly significant relationship between the changes in systolic strain rate, HbA(1c) (P<0.001) and fructosamine (P<0.05), and similarly to changes in left ventricular mass (P<0.05), whereas the correlation to the SBP reduction was not significant. Patients with improved glycaemic control, defined as a reduced HbA(1c) value after 12 months of follow-up, had a significantly improved strain rate (from -1.07+/-0.3 s(-1) at baseline to -1.32+/-0.25 s(-1); P<0.01) compared with patients with increases in HbA(1c) (from -1.14+/-0.25 s(-1) at baseline to -1.16+/-0.27 s(-1); P=not significant). The two groups had comparable baseline values of SBP, left ventricular mass, age and disease duration. In conclusion, changes in left ventricular systolic long-axis function are significantly correlated with changes in left ventricular mass, as well as metabolic control, in hypertensive patients with Type II diabetes mellitus.

Changes in Depressive Symptoms and Metabolic Control over 3 Years among African Americans with Type 2 Diabetes

It is established that individuals with diabetes have high rates of depression, but the longitudinal relationship between depression and glycemic control has not been well examined, particularly among African Americans. The objective of this study was to evaluate the longitudinal relationship between depressive symptoms and metabolic control. We conducted an earlier cross-sectional study that demonstrated marginal and significant associations between depressive symptoms (using the Center for Epidemiologic Studies Depression Scale [CES-D]) and metabolic control (HbA1c, lipids, blood pressure) among 183 African Americans with type 2 diabetes. In this report, we present data on these individuals, followed for three years, and examine the relationship between change in depressive symptoms and change in metabolic control over that time period. Results showed that that there were no statistically significant associations between baseline or change in depressive symptoms and metabolic control over three years. Limited statistical power may explain this negative finding. This study provides insight into the relationship between depression and metabolic control. Prospective observational studies are needed to further evaluate this relationship.

Multisystemic Treatment of Poorly Controlled Type 1 Diabetes: Effects on Medical Resource Utilization

To determine whether multisystemic therapy (MST), an intensive, home-based psychotherapy, could decrease rates of hospital utilization and related costs of care among adolescents with poorly controlled type diabetes. Thirty-one adolescents were randomly assigned to receive either MST or standard care. MST lasted approximately 6 months, and all participants were followed for 9 months. Rates of inpatient admissions and emergency room (ER) visits were calculated for a 9-month prestudy period and during the 9 months of study participation. The relationship between changes in inpatient admissions and changes in metabolic control was also investigated. Intervention participants had a decreasing number of inpatient admissions from the baseline period to the end of the study, whereas the number of inpatient admissions increased for controls. Use of the emergency room did not differ. Related medical charges and direct care costs were significantly lower for adolescents receiving MST. Correlational analyses conducted with a subset of participants indicated that decreases in inpatient admissions were associated with improved metabolic control for MST but not control participants. Findings suggest that MST has the potential to decrease inpatient admissions among adolescents with poorly controlled type 1 diabetes.

Cardiac and vascular function in adolescents and young adults with type 1 diabetes.

The objective was to prospectively define cardiac and vascular function in adolescents and young adults with type 1 diabetes over a 3-year period. Thirty-three subjects with type 1 diabetes were studied in 1998, and 28 returned for follow-up in 2001. There were 28 controls without diabetes. All subjects underwent ultrasonography of the carotid artery to determine distensibility, compliance, and intimal-medial thickness, as well as echocardiographic studies, lipid profile, and measurement of hemoglobin A1c (HbA1c) levels and urinary albumin excretion rate. The diabetes group showed no significant change over the 3-year follow-up in lipid profile, HbA1c level, or albumin excretion rate, but a significant increase in body mass index. The diabetes and control groups were similar in age, lipid profile, and albumin excretion rate. Carotid artery distensibility and compliance in the diabetes group increased significantly from baseline to follow-up but did not differ significantly from controls. The intimal-medial thickness of the diabetes group remained unchanged over time but tended to be higher than controls. Echocardiographic studies showed no difference between the diabetes and control groups, but there was a small change in left ventricular posterior diastolic wall diameter in the subjects with diabetes over the 3-year period. There was an overall improvement in carotid function and no change in cardiac measures in subjects with diabetes over the 3 years, such that cardiac and vascular function were similar to those of controls. The reason for the improvement is uncertain, but may relate to the improvement of insulin sensitivity at the end of the pubertal growth period, rather than to changes in metabolic control or lipid profiles.

Self-monitoring of blood glucose significantly improves metabolic control in patients with type 2 diabetes mellitus: the Auto-Surveillance Intervention Active (ASIA) study

Self monitoring of blood glucose (SMBG) in type 2 diabetes is a topic of current interest (imbalance between increased health-care costs and improvement in compliance with treatment and diet). An open label randomized prospective study was designed to compare changes in metabolic control over 6 months in patients managed with usual recommendations alone (conventional assessment group) or combined with SMBG. Patients not treated with insulin or previously self monitored, 40 to 75 years of age, with a diagnosis of type 2 diabetes > 1 year and standardized HbA(1c) level > =7.5 and< =11% were randomized to either a control group or SMBG group. They were followed up every 6 weeks over 24 weeks. Patients in the SMBG group were given the same device (Ascensia Esprit Discmeter, Bayer) and were required to perform at least 6 capillary assays a week (3 different days of the week, including weekend). Management of patients was standardized, including drugs, diet and physical activity. The primary efficacy criterion was change in HbA(1c) level in Intent To Treat (ITT) patients. Assays were performed at baseline, at 3 and 6 months using the calibrated DCA 2000(R) device (Bayer). Two hundred sixty five general practitioners randomized 988 patients (ITT Population), but 689 patients were evaluable for the primary criterion. At the endpoint, HbA(1c) was lower in the SMBG group (8.1 +/- 1.6%) than in the conventional treatment group (8.4 +/- 1.4%, P=0.012). The change in HbA(1c) levels between baseline and endpoint was classified into two classes: improvement if a change > 0.5% occurred, stability or worsening in case of a change< =0.5%; 57.1% of patients in the SMBG group vs 46.8% in the control group had an improvement in HbA(1c) level (P=0.007) after 3 months. A steady state was reached during the last 3 months. A multivariate logistic regression analysis was performed and identified factors predictive of improvement in HbA(1c) levels: HbA(1c) at baseline: odd ratio (OR)=1.749 (P<0.001), SMBG group (reference value: SMBG group): OR=0.665 (P=0.015), duration of diabetes: OR=0.953 (P=0.001) and BMI: OR=0.962 (P=0.039). This study is the first multicenter, controlled, prospective trial conducted on a large number of patients demonstrating that SMBG was statistically associated with a better quality of metabolic control than usual traditional recommendations alone in type 2 diabetes.

Fenofibrate treatment is associated with better glycemic control and lower serum leptin and insulin levels in type 2 diabetic patients with hypertriglyceridemia

Background: Hertriglyceridemia is commonly encountered in type 2 diabetic patients. Fibrates are a group of drugs that efficiently decrease triglycerides, increase HDL, and improve the prognosis in both diabetic and nondiabetic patients. However, the effects of fibrates on glycemic control, blood pressure, fasting serum insulin, and leptin concentrations are not clear. The present study addresses the question of whether fenofibrate treatment in hypertriglyceridemic type 2 diabetic patients leads to changes in metabolic control, body mass index, leptin, free fatty acids, plasma insulin, and blood pressure. Methods: Thirty-one type 2 diabetic patients who had serum triglyceride levels between 250 and 400 mg/dl were included in the study. They were given 250 mg/day fenofibrate once daily for 3 months. Antidiabetic and antihypertensive treatments were kept unchanged throughout the study. Results: Fenofibrate treatment resulted in better glycemic control, as evidenced by lower fasting and postprandial blood glucose and HbAlc, decreased fasting serum insulin and leptin levels, as well as a reduction in hypertrigyceridemia and serum free fatty acids, and an increase in HDL cholesterol. Blood pressure, body mass index, and LDL remained unchanged. Fenofibrate was well tolerated in all patients. Conclusion: Fenofibrate treatment in hypertriglyceridemic type 2 diabetic patients is beneficial not only in terms of lipid profile, but also for glycemic control and insulin resistance.

Persistent Differences Among Centers Over 3 Years in Glycemic Control and Hypoglycemia in a Study of 3,805 Children and Adolescents With Type 1 Diabetes From the Hvidøre Study Group

Twenty-one international pediatric diabetes centers from 17 countries investigated the effect of simple feedback about the grand mean HbA(1c) level of all centers and the average value of each center on changes in metabolic control, rate of severe hypoglycemia, and insulin therapy over a 3-year period. Clinical data collection and determination of HbA(1c) levels were conducted at a central location in 1995 (n = 2,780, age 0-18 years) and 1998 (n = 2,101, age 11-18 years). Striking differences in average HbA(1c) concentrations were found among centers; these differences remained after adjustment for the significant confounders of sex, age, and diabetes duration. They were apparent even in patients with short diabetes duration and remained stable 3 years later (mean adjusted HbA(1c) level: 8.62 +/- 0.03 vs. 8.67 +/- 0.04 [1995 vs. 1998, respectively]). Three centers had improved significantly, four centers had deteriorated significantly in their overall adjusted HbA(1c) levels, and 14 centers had not changed in glycemic control. During the observation period, there were increases in the adjusted insulin dose by 0.076 U/kg, the adjusted number of injections by 0.23 injections per day, and the adjusted BMI by 0.95 kg/m(2). The 1995 versus 1998 difference in glycemic control for the seven centers could not be explained by prevailing insulin regimens or rates of hypoglycemia. This study reveals significant outcome differences among large international pediatric diabetes centers. Feedback and comparison of HbA(1c) levels led to an intensification of insulin therapy in most centers, but improved glycemic control in only a few.

Blockade of the Growth Hormone (GH) Receptor Unmasks Rapid GH-Releasing Peptide-6-Mediated Tissue-Specific Insulin Resistance

The roles of GH and its receptor (GHR) in metabolic control are not yet fully understood. We studied the roles of GH and the GHR using the GHR antagonist pegvisomant for metabolic control of healthy nonobese men in fasting and nonfasting conditions. Ten healthy subjects were enrolled in a double blind, placebo-controlled study on the effects of pegvisomant on GHRH and GH-releasing peptide-6 (GHRP-6)-induced GH secretion before and after 3 days of fasting and under nonfasting conditions (n = 5). Under the condition of GHR blockade by pegvisomant in the nonfasting state, GHRP-6 (1 microg/kg) caused a increase in serum insulin (10.3 +/- 2.1 vs. 81.3 +/- 25.4 mU/L; P < 0.001) and glucose (4.2 +/- 0.3 vs. 6.0 +/- 0.6 mmol/L; P < 0.05) concentrations. In this group, a rapid decrease in serum free fatty acids levels was also observed. These changes were not observed under GHR blockade during fasting or in the absence of pegvisomant. We conclude that although these results were obtained from an acute study, and long-term administration of pegvisomant could render different results, blockade of the GHR in the nonfasting state induces tissue-specific changes in insulin sensitivity, resulting in an increase in glucose and insulin levels (indicating insulin resistance of liver/muscle), but probably also in an increase in lipogenesis (indicating normal insulin sensitivity of adipose tissue). These GHRP-6-mediated changes indicate that low GH bioactivity on the tissue level can induce changes in metabolic control, which are characterized by an increase in fat mass and a decrease in lean body mass. As a mechanism of these GHRP-6-mediated metabolic changes in the nonfasting state, direct nonpituitary-mediated GHRP-6 effects on the gastroentero-hepatic axis seem probable.

Development and validation of the Diabetes Quality of Life Clinical Trial Questionnaire.

The objective of this study was to develop a valid and reliable health-related quality of life (HRQOL) questionnaire for use in multinational clinical trials of patients with type I and type II diabetes. Through patient focus groups and expert clinician panels in the United States (US) and France, relevant HRQOL domains for patients with type I and type II diabetes were identified. A draft questionnaire was developed by including validated, widely used generic and diabetes-specific domains and by developing original questions as required. A pilot study (n = 123) was conducted to evaluate the psychometric properties of the draft questionnaire with revisions being subsequently made. Data collected from two multinational clinical trials of patients with type I and type II diabetes were used to further validate and enhance the questionnaire (DQLCTQ). A total of 942 patients were recruited in the clinical trials from Canada, France, Germany, and the United States. The mean age was 33.8 years for patients with type I diabetes (n = 468) and 58.2 years for patients with type II diabetes (n = 474). The mean HbAlc level at baseline was 8.6. The revised version of the questionnaire (DQLCTQ-R) contains a total of 57 questions comprising 8 generic and disease-specific domains, as follows: Physical Function; Energy/Fatigue; Health Distress; Mental Health; Satisfaction; Treatment Satisfaction; Treatment Flexibility; and Frequency of Symptoms. Intraclass correlation coefficients range from 0.74 to 0.90 and Cronbach's alphas range from 0.77 to 0.90. With very few exceptions, all eight domains were able to discriminate between type I and type II diabetes, tight and poor metabolic control, male and female, and good and poor self perceived control of diabetes. Four domains (Treatment Satisfaction, Health/Distress, Mental Health, and Satisfaction) were responsive to clinical change in metabolic control. The DQLCTQ-R is a reliable, valid, and comprehensive HRQOL instrument. It is suitable in multinational clinical trials to evaluate new or alternative treatments for patients with type I and type II diabetes.

P145 Serum lipoproteins and metabolic control changes in various albuminuria stage of Taiwanese NIDDM patients

P145 Serum lipoproteins and metabolic control changes in various albuminuria stage of Taiwanese NIDDM patients

Pen injection and change in metabolic control and quality of life in insulin dependent diabetes mellitus

A second follow-up of metabolic control and quality of life in insulin dependent diabetes mellitus (IDDM) patients who had switched 3 years before from syringe to multiple pen injection treatment, was carried out. A total of 73 consecutive outpatients were enrolled in the initial follow-up study in 1988, 1 year after their changeover to insulin pen, with their metabolic control and quality of life examined. The present study concerns the reexamination of 65 of them in 1990. Their HbA 1c level was recorded yearly, already from 1987, on. After an enhancement of metabolic control in 1988, exhibited primarily by patients with fewer syringe injections before pen treatment, control up to 1990 was found to have regressed to about baseline level or to have gradually declined. Patients who perceived their ability to self-test blood glucose to have decreased exhibited the least satisfactory course of metabolic control. This is seen to indicate that maintaining self-testing in multiple injection insulin treatment is a very real challenge to this regimen.

Acarbose and nutrient intake in non-insulin dependent diabetes mellitus

We carried out a double-blind, placebo-controlled cross-over trial to evaluate changes in nutrient intake during acarbose therapy and short-term changes in metabolic control in Finnish patients with non-insulin dependent diabetes mellitus. The efficacy and tolerability of acarbose was also assessed during this short 8-week treatment period. Patients were treated either with diet only (18 subjects) or with diet and sulphonylurea (9 subjects) prior to entering this trial. The nutrient intake was assessed using food records kept during the last 2–5 days of each treatment period. Treatment with acarbose did not affect body weight or the intake of energy and carbohydrates, but it was associated with a slight decrease in the dietary fat intake. Both fasting and 2-h postprandial blood glucose levels fell continuously during acarbose but the change did not reach statistical significance during the 8-week treatment period. The 2-h serum insulin response was not affected. The results were similar in patients treated with acarbose alone and in those receiving acarbose together with sulphonylurea regimen. The acarbose regimen was relatively well tolerated although mild gastrointestinal side-effects were observed in many patients. In conclusion, treatment with acarbose has no major effects on nutrient intake in diabetic patients. To monitor changes in metabolic control after the introduction of acarbose to the treatment regimen a longer than 8-week period is needed.