Control HbA1c Research Articles

Ocular Complications in diabetic children in Aseer region

Background: Diabetes mellitus (DM), a multi-systemic disease marked by hyperglycaemia, is becoming more common around the world. Diabetes mellitus (DM) is a well-known cause of many ophthalmic problems, including diabetic retinopathy (DR), macular oedema, cataract, refractive change, and micro-vascular paralytic strabismus. A significant public health effort has been made to create ocular screening regimens for diabetic patients, beginning at a young age. Aim: to assess the knowledge of diabetic children regarding the risk of ocular complications and prevalence of ocular complications among diabetic children. Methodology: A descriptive cross-sectional study was used targeting all accessible diabetic children aged less than 18 years or their care givers in Aseer region. Data were collected from participants using an online pre-structured questionnaire. The questionnaire covered the following data: participants’ socio-demographic data, diabetes related clinical data. The third part covered participants’ knowledge using multiple responses and mutually exclusive questions. The questionnaire was uploaded online using social media platforms by the researchers during the period from 17 November 2021 to 2 June 2022. All accessible and eligible population in the study setting were invited to fill in the attached tool. Results: A total of 499 children fulfilling the inclusion criteria completed the study questionnaire. Exactly 275 (55.1%) were males and 224 (44.9%) were females. None of the sampled children had other co-morbidities. Exactly 188 (37.7%) children had been diagnosed with DM for 6-10 years, 179 (35.9%) diagnosed for 11-15 years while 43 (8.65%) were diagnosed for less than 5 years. About 88% of the study participants agreed that diabetes may cause eye-related complications, and 87.6% agreed that early detection of eye diseases associated with diabetes may reduce their complications. A total of 85.2% think that the annual visit to the ophthalmologist for diabetics is important. Good control of HbA1c as the best method to prevent diabetic eye complications was known by 67.3% of the study participants. Conclusions: In conclusion, the study revealed that diabetic eye complications among children were not frequent with poor diabetic control. Participants’ knowledge regarding diabetes eye related complications was on average especially for the significance of ophthalmologist visits and early detection of the disorders. Keywords: Diabetes, eye complications, children, care givers, knowledge, awareness, Saudi Arabia

Assessment of the knowledge on insulin therapy among adult diabetics patients in Jabir Abuleiz center, Khartoum, Sudan

ABSTRACTObjectives:The objective of the study is to assess the knowledge and practice concerning insulin therapy in adult diabetic Sudanese patients and relate it with their control of diabetes and selected demographic variables.Methods:Personal interview, using a specific pretested designed questionnaire was used to collect data from 200 adult diabetic patients in Jabir Abuleiz center in Khartoum state.Result:The result showed that only 15% of the respondent had adequate knowledge about insulin use. Also, good knowledge was associated with a higher level of education and good glycemic control (P < 0.001).Conclusion:Knowledge about insulin therapy has an important role in the control of diabetes mellitus. Those who are knowledgeable about insulin therapy are more likely to have good control of HbA1c.

The use of insulin in treatment for inpatients with diabetes in Can Tho, Vietnam 2017 to 2020

Context: Diabetes is a dangerous chronic disease with a rapidly increasing rate of hospitalization and death. Patients with uncontrolled diabetes are prone to dangerous acute and chronic complications. Aims: To determine the characteristics of insulin use and factors related to blood glucose control in inpatients with diabetes at the Department of General Medicine-Can Tho University of Medicine and Pharmacy Hospital. Methods: A cross-sectional descriptive study on 390 medical records of inpatients with diabetes at the Department of General Medicine-Can Tho University of Medicine and Pharmacy Hospital from 2017 to 2020. Results: Most hospitalized patients had poor control of HbA1c (52.3%). During the treatment, patients were regularly tested for blood sugar and 3.8% of them had hypoglycemic test patterns. The rate of good control of fasting blood glucose at hospital discharge accounted for the majority with 67.4%. Regarding the insulin use, premixed insulin was used the most with a rate of 77.5% and insulin monotherapy accounted for 73.3%. The mean insulin dose was 23.4 ± 10.6 UI/day. Factors such as HbA1c index, comorbidities, and insulin doses were associated with poor glycemic control of inpatients. Conclusions: The selection of insulin use in inpatients with diabetes was consistent with global guidelines and actual situations at the hospital. It is necessary to monitor factors such as HbA1c index, comorbidities, and insulin doses because these factors are associated with poor glycemic control of inpatients.

Effect of one Year of Yoga Therapy on Glycemic Control among Patients with Type 2 Diabetes Mellitus

Context: India is well-endowed in using yoga therapy for the management of type 2 diabetes mellitus (T2DM) which is a safe, effective, and easy-to-learn alternative treatment that can be practiced by elderly and persons with disabilities. Aim: Effect of 1 year of yoga therapy on glycemic control among patients having T2DM: A randomized controlled trial (RCT). Settings and Design: RCT conducted at and Urban Health Centre (UHC) for 1 year. Materials and Methods: One hundred and twenty diagnosed and registered for T2DM from UHC enrolled as participants who were divided into exercise and yoga interventional group by computer-generated, randomized number sequence method. The yogic practice was advised to 60 study participants and the reaming 60 participants were advised to do exercises for 1 year. The glycemic outcome was evaluated by Random Blood Sugar (RBS) and HbA1c which were examined at baseline, 6 months, and at the end of 1 year. Statistical Analysis Used: Paired and unpaired (independent) t-test. Generalized estimating equations models were performed on the glycemic control variables to assess the differences between the two intervention groups. Results: The post hoc analysis of 120 T2DM patient's data inferred that yoga and exercise have shown statistically significant (P &lt; 0.05) effect on reducing HbA1C. However, no statistically significant difference (P &gt; 0.05) was observed when the yoga group was compared with the exercise group on glycemic control (reducing HbA1c). Conclusions: Yoga is as effective as exercise, hence people with morbidities or who are unable to go for exercise can practice yoga at home which will help them for proper control of HbA1c and RBS.

Blood Biochemical Characteristics, Dietary Intake, and Risk Factors Related to Poor HbA1c Control in Elderly Korean Diabetes Patients: Comparison between the 4th(2007-2009) and the 7th(2016-2018) Korea National Health and Nutrition Examination Surveys

Blood Biochemical Characteristics, Dietary Intake, and Risk Factors Related to Poor HbA1c Control in Elderly Korean Diabetes Patients: Comparison between the 4^th(2007-2009) and the 7^th(2016-2018) Korea National Health and Nutrition Examination Surveys

Lipid control in adult Chinese patients with type 2 diabetes: a retrospective analysis of time trends and geographic regional differences.

Lipid control in adult Chinese patients with type 2 diabetes: a retrospective analysis of time trends and geographic regional differences.

Impact of Nurse-Led Titration Versus Physician Prescription of Hypoglycaemic Agents on HbA1c Level in Type 2 Diabetes Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

A nurse-led diabetic clinic to manage type 2 diabetes, which emphasizes medication adherence, titration of hypoglycemic agents, behavior modification, and motivation for lifestyle changes, is widely recommended and practiced in western countries.This review aims to examine the impact of a nurse-led diabetic clinic versus a standard physician-led diabetic clinic on glycaemic control of type 2 diabetes patients.Studies were obtained using a comprehensive search in the electronic databases of PubMed, Embase, SCOPUS, Cochrane Library, and gray literature through March 2021. We calculated the pooled effect estimate with 95% confidence intervals (CIs) comparing subjects with and without nurse-led titration of hypoglycemic agents using standardized mean difference (SMD) for continuous outcomes and risk ratio (RR) for dichotomous outcomes.Four trials comprising 470 participants (241 intervention group and 229 control group) met the inclusion criteria. Glycated hemoglobin (HbA1c levels and BMI were lower in participants with a nurse-led diabetic clinic (SMD = -0.54, 95% CI -0.89 to -0.20, I2 = 67%, p = 0.002) and (SMD = -0.26 (95% CI -0.45 to -0.07, I2 = 0%, p = .008), respectively, than in those attending a standard physician-led diabetic clinic. Similarly, the pooled result shown that patients attending the nurse-led diabetic clinic had a 31% higher satisfaction level (RR 0.69; 95% CI, 0.51 to 0.92, I2 = 0%, p= 0.01). On the other hand, there was no significant association of the nurse-led diabetic clinics on patients’ blood pressure and intensification of hypoglycemic agents. The certainty of the evidence assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was moderate for outcomes like HbA1c level, intensification of hypoglycemic agents, and patients' satisfaction and low for other secondary outcomes.Our meta-analysis allows for the conclusion that nurse-led titration of hypoglycemic agents is associated with better glycemic control and enhances patients' satisfaction. Therefore, it is recommended to establish and strengthen nurses-led diabetic clinics for better HbA1c control where physician-led diabetic services are limited. Further research is needed to enhance the quality of the evidence.

Improved HbA1c and reduced glycaemic variability after 1-year intermittent use of flash glucose monitoring

Flash glucose monitoring (FGM) was introduced in China in 2016, and it might improve HbA1c measurements and reduce glycaemic variability during T1DM therapy. A total of 146 patients were recruited from October 2018 to September 2019 in Liaocheng. The patients were randomly divided into the FGM group or self-monitoring blood glucose (SMBG) group. Both groups wore the FGM device for multiple 2-week periods, beginning with the 1st, 24th, and 48th weeks for gathering data, while blood samples were also collected for HbA1c measurement. Dietary guidance and insulin dose adjustments were provided to the FGM group patients according to their Ambulatory Glucose Profile (AGP) and to the SMBG group patients according to their SMBG measurements taken 3–4 times daily. All of the participants underwent SMBG measurements on the days when not wearing the FGM device. At the final visit, HbA1c, time in range (TIR), duration of hypoglycaemia and the number of diabetic ketoacidosis (DKA) events were taken as the main endpoints. There were no significant difference in the baseline characteristics of the two groups. At 24 weeks, the HbA1c level of the FGM group was 8.16 ± 1.03%, which was much lower than that of the SMBG group (8.68 ± 1.01%) (p = 0.003). The interquartile range (IQR), mean blood glucose (MBG), and the duration of hypoglycaemia in the FGM group also showed significant declines, compared with the SMBG group (p < 0.05), while the TIR increased in the FGM group [(49.39 ± 17.54)% vs (42.44 ± 15.49)%] (p = 0.012). At 48 weeks, the differences were more pronounced (p < 0.01). There were no observed changes in the number of episodes of DKA by the end of the study [(0.25 ± 0.50) vs (0.28 ± 0.51), p = 0.75]. Intermittent use of FGM by T1DM patients can improve their HbA1c and glycaemic control without increasing the hypoglycaemic exposure in insulin-treated individuals with type 1 diabetes in an developing country.

Abstract #1088834: Health Economic Analysis of Digital Twin Technology for Remission of Diabetes - Initial Insights From the Prospective Randomised Controlled Clinical Trial

We performed an initial analysis for health economic impact of ongoing randomized controlled trial of Twin Precision Treatment, a novel whole-body digital twin enabled precision nutrition for reversing diabetes. We evaluated patients (n=33) who completed 4 months longitudinal follow up and modeled the parameters for the health economics from the published literature to benchmark with our results. Mean age, duration of diabetes was 40 (±8.8) and 2.8 (±2.4) years, respectively. 19 and 13 patients achieved initial partial (HbA1c range 5.7-6.4 %) and complete (HbA1c < 5.7%) remission of diabetes, respectively. All patients achieved HbA1c less than 7%. All 12 patients on OAD did not need ongoing OAD, 2 patients on insulin did not need it at 90 days. There was a statistically significant improvement in HbA1c % (8.7 ± 1.5 to 5.6 ± 0.51; decrease -3.1, p< 0.0001), body weight (79 ± 12 to 70 ± 11; decrease -9.1 kg, p=0.0014), BMI (28 ± 3.3 to 24 ± 2.9; decrease -3.4 kg/m2, p< 0.0001), Systolic BP (131 ± 13 to 119 ± 12; decrease -12 mmHg, p=0.0002), Diastolic BP (89 ± 11 to 79 ± 8; decrease -10 mmHg, p< 0.0001), HDL-C (33 ± 5.1 to 37 ± 8.2; increase 4.1 mg/dl, p=0.0191), TG (224 ± 99 to 130 ± 93; decrease -94 mg/dl, p< 0.0001). The modeled adjusted health cost savings entail a cumulative annual per patient savings of USD 7800 attributed to the improvement in BMI, HbA1c and blood pressure control. The results indicate that an efficacious early technological intervention, through digital twin technology, powered by Internet of Things and Artificial Intelligence, as a modality to enable reversal of diabetes. We postulate that the substantial cost savings and propensity for decrease in medical claim induced by the Twin Precision Treatment deserves a larger exploration by the health care payers.

Abstract #1088672: Consensus for the Clinical Utility of Dapagliflozin in Indian Patients - Results of the Nationwide Mapping Exercise

We conducted a nationwide perception mapping exercise to understand the clinical utility and draw consensus for an advanced and affordable SGLT2 inhibitor dapagliflozin, in everyday clinical practice. 240 thought leaders in diabetes were invited through whatsapp and email, to respond to a structured questionnaire, developed through a customised technological virtual response system from February 26 to June 3, 2021. Anonymised data were analysed by using GraphPad software version 9.1.2. Mean experience, across 233 respondents, was 19 years (SD 12, 95% CI 18 to 21). Cumulative man-years experience was 4457 years. 83.7% (n=195) respondents were regular prescribers of SGLT2 inhibitors. 64.8% (n=151) opined that, pleiotropic effects had created a significant impact to choose dapagliflozin. Majority prescribe irrespective of the history of CV event 72.5% (n=169), followed by 18.4% (n=43) prescribe in patients with known CV event and 6.4% (n=15) for primary prevention. 93.5% (n=218) utilise in patients with eGFR above 30 ml/min/1.73m2. On a scale of 1 to 10, 80.6% (n=188) rated ≥ 8 for, that the economically priced dapagliflozin would enable a remarkable difference in diabetes care. 71.6% (n=167) opined that with access to affordable dapagliflozin, the use of sulphonylureas has reduced. 91.4 % (n=213) were satisfied for the patient’s satisfaction with the use of SGLT-2 inhibitors as adjunct to other ongoing therapies. 51% (n=119) responded that at least > 50% of patients on SGLT-2 inhibitors achieve glycemic control of HbA1c < 7%. The order of the unique perceived benefits of dapagliflozin as compared to other SGLT2 inhibitors was, effective decrease in HbA1c (82%), cardiovascular benefits (68%), reduction in body weight (61%), reduction in blood pressure (46%), improvement in the renal function (43%). The mean time to complete the mapping exercise was 14 minutes. Virtual expert nation-wide consensus mapping exercise revealed favourable agreement for utilization of dapagliflozin in Indian patients which is in concurrence with the emerging evidence for its favourable benefits including non-glycemic indications for benefits in heart failure and chronic kidney disease.

Social Support, Self-Care Behaviour and Self-Efficacy in Patients with Type 2 Diabetes during the COVID-19 Pandemic: A Cross-Sectional Study.

Diabetes mellitus is a major public health issue that considerably impacts mortality, morbidity, and healthcare costs worldwide. The COVID-19 pandemic has created havoc in diabetes management, too, like other spectrums of life. A descriptive, cross-sectional study was adopted to determine the effect of Social Support, Self-Care Behaviour and Self-Efficacy in Type 2 Diabetes Mellitus (T2D) during this COVID-19 pandemic. Two hundred T2D patients who satisfied the inclusion criteria were chosen using a convenient sampling procedure. The tool consists of four sections, including socio-demographic characteristics, Multidimensional Scale of Perceived Social Support (MSPSS), revised Summary of Diabetes Self-Care Activities (SDSCA) Scale and modified Diabetes Management Self-Efficacy Scale (DMS). Descriptive and inferential statistics were used to analyze the obtained data. The mean and SD of diabetic management self-efficacy is 5.74 (1.95) and 4.37 (1.4), respectively, for patients with HbA1c < 6.5% and HbA1c ≥ 6.5%. The self-care activities of the patients who had good glycemic control were 4.31 (2.06) compared to 3.50 (1.73) who did not. The social support received by the patients was 6.13 (2.13) vs. 5.31 (1.67) among patients with glycemic control vs. no control. The results show that social support (p = 0.04), self-efficacy (p =0.01) and self-care activities (p = 0.001) were significantly related to the level of glycemic control of the T2D patients. A significant relationship was also identified between gender (p = 0.036), age (p = 0.001) and education status (p = 0.000) with HbA1c control of the participants. This study demonstrates a significant relationship between social support, self-care behaviours, self-efficacy and glycemic management in T2D patients. During this COVID-19 pandemic, interventions to enhance the self-care activities like exercise and social support to boost their self-efficacy; for better diabetes management, reducing diabetes complications or prolonging their onset are the need of the hour.

Abstract 11002: Assessing Widening Disparities in Hba1c and Systolic Blood Pressure Re-Testing During the Covid-19 Pandemic in LGBTQ+ Focused Federally Qualified Health Centers in Chicago

Introduction: The COVID-19 pandemic caused disruptions in the health services delivery, especially among vulnerable populations. We assessed if the pandemic widened disparities in care for cardiometabolic conditions in a LGBTQ+-focused federally qualified health system in Chicago. Hypothesis: Disparities in monitoring cardiometabolic conditions present in 2019 worsened in 2020. Methods: We analyzed electronic health records from Howard Brown Health. We assessed HbA1c re-testing and control (≤9%) in 2019 and 2020 among people with diabetes (DM) and ≥1 HbA1c test in the prior year (2018 for 2019, 2019 for 2020) (n2019=818, n2020=1033). A similar assessment was done for hypertension (HTN) with systolic blood pressure (SBP) (n2019=2813, n2020=3660). Comparisons per demographic group per year were done using logistic regression adjusting for socio-demographic variables. Results: Re-testing rates declined from 2019 to 2020 for both HbA1c and SBP overall and across all groups. Adjusted analysis showed gay people with DM had higher rates of HbA1c re-testing than people of other sexual orientations in 2019 and experienced a significantly lower re-testing rate decline in 2020. Adjusted analysis for SBP showed that white (vs Hispanic) and straight (vs gay) people with HTN had lower SBP re-testing rates in 2019 and 2020. Rates of controlled SBP (&lt;140mmHg), but not HbA1c (≤9%), declined from 2019 to 2020. Adjusted analyses showed that straight (vs gay) patients had lower controlled HbA1c and SBP rates. Cis males (vs trans males) had lower controlled SBP and white (vs Asian/other) had lower controlled HbA1c. These disparities did not worsen in 2020. Conclusion: The pandemic had mixed impacts on cardiometabolic service disparities in a large LGBTQ+-focused health system. Disparities by sexual orientation for HbA1c widened during the pandemic. Similar worsening was not found for systolic blood pressure, nor for other demographic groups.

The Survival Benefit for Optimal Glycemic Control in Advanced Non-Small Cell Lung Cancer Patients With Preexisting Diabetes Mellitus.

BackgroundDiabetes mellitus (DM) is a frequent comorbidity in patients with cancer. This study aimed to evaluate the prognosis of advanced non-small cell lung cancer (NSCLC) patients with DM and to assess whether an optimal glycemic control improves overall survival (OS).MethodsA total of 1279 advanced NSCLC patients including 300 (23.5%) with preexisting DM were retrospectively reviewed. The continuous relationship between glycated hemoglobin A1C (HbA1c) level and OS was analyzed by restricted cubic spline (RCS) function. Optimal HbA1c cut-off point was determined using X-tile analysis. Survival was analyzed with the Kaplan–Meier method and compared among groups stratified by diabetes status and HbA1c. Multivariable Cox proportional hazards regression analysis was employed to identify prognostic factors for OS after adjusting for baseline characteristics.ResultsDM and non-DM patients had similar OS (median (95% CI): 22.85 (20.05-26.73) vs. 22.22 (20.35-24.76) months, P=0.950). The multivariate Cox regression analyses showed that DM status was not a prognostic factor for OS (HR: 0.952, 95% CI: 0.808-1.122, P=0.559). However, there existed a non-linear but generally positive relationship between the elevated HbA1c level and increased risk of overall mortality. HbA1c > 6.6% was a negative prognostic factor for OS (HR: 1.593, 95% CI: 1.113-2.280, P=0.011). The median OS (95% CI) for nondiabetic patients, DM patients with HbA1c ≤6.6% and those with HbA1c > 6.6% was 22.22 (20.01-24.43), 25.28 (21.79-28.77) and 15.45 (7.57-23.33) months, respectively. Well-controlled DM patients had a comparable crude OS (HR (95% CI): 0.90 (0.76-1.08), P=0.273] compared to nondiabetic patients while patients with HbA1c>6.6% had a worse crude OS than patients without DM (HR (95% CI): 1.70 (1.24-2.34), P=0.001]. The survival benefit of good HbA1c control was prominent in all subgroups.ConclusionImpaired glycemic level negatively affects survival for patients with advanced NSCLC while proper glycemic control with HbA1c ≤6.6% improves the OS.

Intensification of Diabetes Medications at Hospital Discharge and Clinical Outcomes in Older Adults in the Veterans Administration Health System

Transient elevations of blood glucose levels are common in hospitalized older adults with diabetes and may lead clinicians to discharge patients with more intensive diabetes medications than they were using before hospitalization. To investigate outcomes associated with intensification of outpatient diabetes medications at discharge. This retrospective cohort study assessed patients 65 years and older with diabetes not taking insulin who were hospitalized in the Veterans Health Administration Health System between January 1, 2011, and September 28, 2016, for common medical conditions. Data analysis was performed from January 1, 2020, to March 31, 2021. Discharge with intensified diabetes medications, defined as filling a prescription at hospital discharge for a new or higher-dose medication than was being used before hospitalization. Propensity scores were used to construct a matched cohort of patients who did and did not receive diabetes medication intensifications. Coprimary outcomes of severe hypoglycemia and severe hyperglycemia were assessed at 30 and 365 days using competing risk regressions. Secondary outcomes included all-cause readmissions, mortality, change in hemoglobin A1c (HbA1c) level, and persistent use of intensified medications at 1 year after discharge. The propensity-matched cohort included 5296 older adults with diabetes (mean [SD] age, 73.7 [7.7] years; 5212 [98.4%] male; and 867 [16.4%] Black, 47 [0.9%] Hispanic, 4138 [78.1%] White), equally split between those who did and did not receive diabetes medication intensifications at hospital discharge. Within 30 days, patients who received medication intensifications had a higher risk of severe hypoglycemia (hazard ratio [HR], 2.17; 95% CI, 1.10-4.28), no difference in risk of severe hyperglycemia (HR, 1.00; 95% CI, 0.33-3.08), and a lower risk of death (HR, 0.55; 95% CI, 0.33-0.92). At 1 year, no differences were found in the risk of severe hypoglycemia events, severe hyperglycemia events, or death and no difference in change in HbA1c level was found among those who did vs did not receive intensifications (mean postdischarge HbA1c, 7.72% vs 7.70%; difference-in-differences, 0.02%; 95% CI, -0.12% to 0.16%). At 1 year, 48.0% (591 of 1231) of new oral diabetes medications and 38.5% (548 of 1423) of new insulin prescriptions filled at discharge were no longer being filled. In this national cohort study, among older adults hospitalized for common medical conditions, discharge with intensified diabetes medications was associated with an increased short-term risk of severe hypoglycemia events but was not associated with reduced severe hyperglycemia events or improve HbA1c control. These findings indicate that short-term hospitalization may not be an effective time to intervene in long-term diabetes management.

Effects of Salvia hispanica L. Seeds (Azpro) on Cardiovascular Risk Factors in Patients with Type 2 Diabetes - A Retrospective Observational Study

Background: India is the diabetes capital of the world. Despite several pharmacological options, almost 70% of patients present with poor HbA1c control. Lifestyle modifications are one of the most important interventions for such chronic metabolic disorders. Therefore, adding Lifestyle Modifier, a dietary approach collectively utilizing efficacious nutrients (natural source of very high dietary fiber, omega-3, proteins, minerals, and vitamins) while maximizing adherence is the key to the management of type 2 diabetes mellitus (T2DM). Methodology: Patients were enrolled by adding Salvia hispanica L. Seeds (Azpro) along with standard medications to evaluate outcomes on risk factors in patients of T2DM. The objective was to determine the role of Salvia hispanica L. (Azpro), as an adjunct to conventional treatment in the reduction of major and emerging cardiovascular risk factors in individuals with type 2 diabetes. A retrospective analysis was conducted on fifty patient’s data available at Advanced Diabetes Centre, Surat, India. Salvia hispanica L. (Azpro) seeds were given 10 g twice a day for 3 months as an adjunct to the standard diabetes management therapy. HbA1c, body fat, visceral fat, BMI, and weight loss were calculated at three months. Results: Consumption of Salvia hispanica L. (Azpro) seeds for three months in addition to the standard treatment led to a total 1.13 kg weight loss (p=0.0008), and HbA1c reduction by 0.58% (p=0.016). Conclusion: This result affirms the role of Salvia hispanica L. seeds in the dietary management of diabetic patients with significant (P =0.0008) weight loss &amp; overall metabolic management. Keywords: Salvia hispanica L. (Azpro) seeds, Chia seeds, diabetes, type 2 diabetes, weight loss, HbA1c, BMI, total fat, visceral fat, cardiovascular risk, dietary fiber, omega 3 fatty acids

Effects of Iron Deficiency Anaemia on HbA1c Levels in Non-Diabetics and Diabetics

Background: Iron deficiency anaemia is one of the most common anaemia striking in our country. The level up to which blood sugar level is regulated is measured by HbA1c. HbA1c represents sugar level in the blood for 120 days. HbA1c could be dependent upon an assemblage of factors like variants of haemoglobinopathies, haemolytic anaemia, other deficiency anaemia, acute loss of blood, uraemia, and pregnancy. Thus, it is crucial to determine the role of HbA1c in iron deficiency anemia in diabetics and non-diabetics before treating the patients.&#x0D; Methods: Total of 58 articles were collected and based on our study objective total of 19 articles were included in this study. Iron deficiency anaemia, HbA1c, diabetics and non-diabetics has been added in pub med advanced searches and Google scholar. Original articles which compare the correlation between these two were taken. All the information was gathered from original and review articles. Articles which were qualified for review, their inclusion criteria, exclusion criteria, quality of assessment and data collections were taken into consideration. Structure of heme particle, basic mechanism of HbA1c formation in RBCs is elaborated. Review articles which were taken include RCT, retrospective analysis and observational studies. The results were all compared and concluded of each articles. Basic mechanism of formation of HbA1c in RBCs is shown. Also necessary conclusions were derived from each study.&#x0D; Results: In a wide range of studies, HbA1c was found to be raised in IDA. After iron supplements, studies showed a decrease in HbA1c. Our study showed there is a need to correct anemia in diabetic patients before starting treatment.&#x0D; Conclusions: Strict HbA1c control is not a prerequisite and prior anaemia correction should be done. Nevertheless, a study which will be conducted in representative population matching to the prevalence and incident of disease in our country also which should be interventional is required for the highest correction value of HbA1c in DM and NDM population.

Metabolic measures before surgery and long-term diabetes outcomes in recipients of total pancreatectomy and islet autotransplantation

In this single-center, retrospective cohort study, we aimed to elucidate simple metabolic markers or surrogate indices of β-cell function that best predict long-term insulin independence and goal glycemic HbA1c control (HbA1c≤6.5%) after total pancreatectomy with islet autotransplantation (TP-IAT). Patients who underwent TP-IAT (n=371) were reviewed for metabolic measures before TP-IAT and for insulin independence and glycemic control at 1, 3, and 5years after TP-IAT. Insulin independence and goal glycemic control were achieved in 33% and 68% at 1year, respectively. Although the groups who were insulin independent and dependent overlap substantially on baseline measures, an individual who has abnormal glycemia (prediabetes HbA1c or fasting glucose) or estimated IEQs/kg<2500 has a very high likelihood of remaining insulin dependent after surgery. In multivariate logistic regression modelling, metabolic measures correctly predicted insulin independence in about 70% of patients at 1, 3, and 5years after TP-IAT. In conclusion, metabolic testing measures before surgery are highly associated with diabetes outcomes after TP-IAT at a population level and correctly predict outcomes in approximately two out of three patients. These findings may aid in prognostic counseling for chronic pancreatitis patients who are likely to eventually need TP-IAT.

Lipohypertrophy Monitoring Study (LIMO): Effect of single use of 4 mm pen needles combined with education on injection site rotation on glycaemic control: Confirmation of an unpleasant truth.

To investigate whether single use of 4 mm needles combined with education about injection technique and lipohypertrophy affects HbA1c, hypoglycaemia and glucose variability. Insulin-injecting people with diabetes recruited from nine Belgian diabetes centres wereprospectively followed for 6months. They were provided 4 mm pen needles and education concerning injection technique using an online platform (BD and Me™) based on the international Forum for Injection Technique & Therapy Recommendations focused on avoidance of lipohypertrophy zones and reduction of needle reuse. A total of 171 people with diabetes were included of which 146 completed the study. At baseline, lipohypertrophy was present in 63.0% of those who completed the study, with 51.4% injecting in zones of lipohypertrophy, 37.0% incorrectly rotating and 95.9% reusing needles. After the intervention, 7.5% still injected in a lipohypertrophy zone, 4.1% rotated incorrectly and needle reuse decreased to 21.2%. The number of participants with severe hypoglycaemias (from 15.8% to 4.1%, p<0.001), unexplained hypoglycaemias (from 46.6% to 16.4%, p<0.001) and high glucose variability (from 64.4% to 29.5%, p<0.001) was significantly reduced. HbA1c and total daily insulin dose remained stable. The combination of 4 mm pen needles and online education on injection techniques significantly reduced the number of people with severe hypoglycaemic episodes, unexplained hypoglycaemia and high glucose variability but did not improve HbA1c control nor lower insulin needs. ClinicalTrials.gov NCT04659330.

Evaluation of an mHealth-enabled hierarchical diabetes management intervention in primary care in China (ROADMAP): A cluster randomized trial.

Glycemic control remains suboptimal in developing countries due to critical system deficiencies. An innovative mobile health (mHealth)-enabled hierarchical diabetes management intervention was introduced and evaluated in China with the purpose of achieving better control of type 2 diabetes in primary care. A community-based cluster randomized controlled trial was conducted among registered patients with type 2 diabetes in primary care from June 2017 to July 2019. A total of 19,601 participants were recruited from 864 communities (clusters) across 25 provinces in China, and 19,546 completed baseline assessment. Moreover, 576 communities (13,037 participants) were centrally randomized to the intervention and 288 communities (6,509 participants) to usual care. The intervention was centered on a tiered care team-delivered mHealth-mediated service package, initiated by monthly blood glucose monitoring at each structured clinic visit. Capacity building and quarterly performance review strategies upheld the quality of delivered primary care. The primary outcome was control of glycated hemoglobin (HbA1c; <7.0%), assessed at baseline and 12 months. The secondary outcomes include the individual/combined control rates of blood glucose, blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C); changes in levels of HbA1c, BP, LDL-C, fasting blood glucose (FBG), and body weight; and episodes of hypoglycemia. Data were analyzed using intention-to-treat (ITT) generalized estimating equation (GEE) models, accounting for clustering and baseline values of the analyzed outcomes. After 1-year follow-up, 17,554 participants (89.8%) completed the end-of-study (EOS) assessment, with 45.1% of them from economically developed areas, 49.9% from urban areas, 60.5 (standard deviation [SD] 8.4) years of age, 41.2% male, 6.0 years of median diabetes duration, HbA1c level of 7.87% (SD 1.92%), and 37.3% with HbA1c <7.0% at baseline. Compared with usual care, the intervention led to an absolute improvement in the HbA1c control rate of 7.0% (95% confidence interval [CI] 4.0% to 10.0%) and a relative improvement of 18.6% (relative risk [RR] 1.186, 95% CI 1.105 to 1.267) and an absolute improvement in the composite ABC control (HbA1c <7.0%, BP <140/80 mm Hg, and LDL-C <2.6 mmol/L) rate of 1.9% (95% CI 0.5 to 3.5) and a relative improvement of 21.8% (RR 1.218, 95% CI 1.062 to 1.395). No difference was found on hypoglycemia episode and weight gain between groups. Study limitations include noncentralized laboratory tests except for HbA1c, and caution should be exercised when extrapolating the findings to patients not registered in primary care system. The mHealth-enabled hierarchical diabetes management intervention effectively improved diabetes control in primary care and has the potential to be transferred to other chronic conditions management in similar contexts. Chinese Clinical Trial Registry (ChiCTR) IOC-17011325.

Protective Role of Vitamin D Therapy in Diabetes Mellitus Type II.

Diabetes Mellitus type II (DM II) is a worldwide disease with a rapidly growing parallel prevalence and adversities affecting multi-body systems. Hence, it is imperative to treat DM II effectively, maintaining glucose homeostasis to avoid complications such as diabetic nephropathy, peripheral neuropathy, and retinopathy. Vitamin D, among many benefits, has positive outcomes on hemoglobin A1c (HbA1c) control. It aids in insulin secretion and sensitivity. We systematically screened four databases for relevant information; PubMed, Medline, PMC, and Google scholar. Inclusion and exclusion criteria were applied, and quality appraisal was then done using certain checklist tools: Newcastle-Ottawa tool, AMSTAR (A Measurement Tool to Assess Systematic Reviews) checklist, SANRA (Scale for the Assessment of Narrative Review Articles) checklist, and Cochrane bias assessment. Data were collected from 14 articles, of which eight are systematic reviews and meta-analysis, one is a narrative review, five are randomized controlled trials and three are general information about DM II and Vitamin D. In addition, this article evaluates the clinical significance of Vitamin D administration in DM II from a glucose homeostasis perspective, and complications such as nephropathy, neuropathy, and retinopathy. Vitamin D had a clinical positive impact on glucose level, particularly on hemoglobin A1c (HbA1c) reduction, alleviation of diabetic neuropathy and nephropathy symptoms, and hyperglycemia induced-oxidative stress on the retinal cells.