Glucose Control Research Articles

COVID-19 and DKA of Type 2 Diabetes, Impact and Outcome

Abstract Background Recent evidence suggests a potential link between COVID-19 infection and the development of insulin dependence in individuals with diabetes, particularly through direct damage to pancreatic insulin-producing beta-cells mediated by the virus's affinity for ACE2 receptors. This association bears similarities to the role of other viruses like enteroviruses and mumps in causing fulminant ketoacidosis. While it is feasible that the insulin dependence seen in diabetic ketoacidosis (DKA) during COVID-19 arises from SARS-CoV-2-induced beta cell dysfunction, stronger evidence supports an alternate pathway involving indirect factors like systemic hypoxia, sepsis, inflammatory responses, and cytokine storms resulting from the infection. Aim of the Work This study aimed to assess the risk factors and outcomes related to DKA in COVID-19-infected patients with type 2 diabetes. Patients and Methods The research analyzed data from 70 patients, comprising 35 with DKA and 35 without DKA, focusing on variables such as age, sex, comorbidities, laboratory results, and clinical symptoms. The mean age was found to be significantly higher in the DKA group, aligning with previous studies that linked older age to increased DKA susceptibility during COVID-19. Sex distribution did not show significant differences between the DKA and non-DKA groups. Results Notably, patients with DKA displayed longer diabetes duration and significantly higher hemoglobin A1c levels, suggesting a potential role of poor glucose control in precipitating DKA during COVID-19 infection. Furthermore, DKA patients exhibited more severe acid-base disturbances and electrolyte imbalances compared to their non-DKA counterparts. These imbalances, along with respiratory and cardiovascular symptoms, characterized the clinical presentation of DKA during COVID-19. Conclusion Ultimately, the mortality rate was found to be markedly higher among DKA patients than among non-DKA patients. These findings emphasize the importance of recognizing the complex interplay between COVID-19 infection, diabetes, and DKA, especially in older individuals with longer diabetes duration and poor glycemic control. This study provides valuable insights into the risk factors and clinical outcomes associated with DKA in COVID-19-infected patients with type 2 diabetes, contributing to our understanding of the multifaceted relationship between these medical conditions. Further research is needed to elucidate the underlying mechanisms and optimize management strategies for this vulnerable patient population.

Perioperative Glycemic Variability Influences Infection Rates Differently Following Revision Hip and Knee Arthroplasty

BackgroundRecent investigations have determined that abnormal postoperative glycemia following primary total joint arthroplasty is associated with adverse events. Our study aimed to determine if hyperglycemia and glycemic variability following aseptic revision total joint arthroplasty were associated with periprosthetic joint infection (PJI) within two years postoperatively. MethodsA retrospective review was performed of 2,208 patients within a single institution undergoing aseptic revision total joint arthroplasty from 2012 to 2019. Postoperative glucose values were recorded. Glycemic variability was measured via three parameters: coefficient of variation, mean amplitude of glycemic excursions, and J-index. Logistic regression analyses were performed to examine associations with PJI at 90-day, 1-, and 2-year follow-up. ResultsIn revision hips, all glycemic measures were not associated with PJI at any time point in logistic regression analyses, except for the mean amplitude of glycemic excursions, which predicted PJI at one year (P = 0.045); body mass index was the only factor associated with PJI at all timepoints in all models. In revision knees, all glycemic measures were not associated with PJI at any timepoint in logistic regression analyses; however, PJI rates differed between diabetics and nondiabetics at all time points (P < 0.05). ConclusionsOur findings illustrate that decreasing preoperative body mass index and postoperative glycemic variability may be critical in reducing PJI rates in revision hips. Furthermore, patients who have diabetes should be counseled that they remain at higher risk of PJI regardless of perioperative glucose control after revision knee surgery.

Efficacy and safety of henagliflozin combined with continuous subcutaneous insulin infusion in the treatment of Chinese inpatients with type 2 diabetes mellitus based on a continuous glucose monitoring system: protocol of a multicentre, open-label, inpatient, randomised, controlled trial

IntroductionThe role of sodium-glucose cotransporter 2 inhibitors (SGLT2is) in diabetes treatment is expanding; however, few studies have investigated the efficacy and safety of combining SGLT2is with insulin pump therapy. Notably,...

Glycated Hemoglobin as a Predictor of Dyslipidemia and Cardiovascular Risk in Type 2 Diabetes Mellitus

Background: Type 2 Diabetes Mellitus (T2DM) is a globally prevalent metabolic disorder that significantly increases the risk of cardiovascular disease (CVD) through mechanisms such as dyslipidemia, characterized by elevated triglycerides, low high-density lipoprotein (HDL) levels, and small dense low-density lipoprotein (LDL) particles. Glycated hemoglobin (HbA1c) is a key biomarker of glucose control and has been associated with CVD risk. Methods: This cross-sectional study aimed to evaluate the relationship between glycated hemoglobin (HbA1c) levels and lipid profiles, specifically lipid ratios, in a Jordanian population with type 2 diabetes mellitus (T2DM). A total of 140 patients with T2DM and 20 healthy controls participated. Blood samples were analyzed for fasting blood sugar (FBS), HbA1c, total cholesterol, triglycerides, high-density lipoprotein (HDL-C), and low-density lipoprotein (LDL-C) levels. HbA1c levels were grouped: A (≤7%), B (7–9%), C (9–11%), and D (&gt;11%). Results: The T2DM group showed significantly elevated HbA1c levels compared to controls. Patients with higher HbA1c levels (Groups C and D) exhibited abnormal lipid profiles, including increased total cholesterol and triglycerides and reduced HDL-C. The LDL-C/HDL-C ratio was notably higher in patients with HbA1c &gt;9%, indicating a potential elevated cardiovascular risk. This correlation between HbA1c and lipid profile abnormalities supports the association between poor glycemic control and lipid metabolism dysregulation. Conclusion: HbA1c levels are significantly associated with dyslipidemia, and lipid ratios serve as sensitive indicators for cardiovascular risk in T2DM patients. These findings underscore the clinical importance of monitoring HbA1c and lipid ratios to improve risk assessment and guide intervention strategies in high-risk populations.

A Rare Case of HNF1B and NR3C1 Genetic Mutations Leading to Severe Electrolyte Derangements and Impaired Glucose Control

A Rare Case of HNF1B and NR3C1 Genetic Mutations Leading to Severe Electrolyte Derangements and Impaired Glucose Control

Estimation of Meal-Time Insulin Based on Glycemic Load versus Carbohydrate Counting among Patients with Type 1 Diabetes Using Insulin Pump

Abstract Background Dietary carbohydrates have a major effect on postprandial glycemic response. Therefore, the current guidelines recommend the usage of insulin/carbohydrate ratio for calculation of prandial insulin dose based on the carbohydrate count in a given meal. However, some studies pointed to the importance of the quality of carbohydrates, as reflected by their glycemic index, in addition to their quantity on the regulation of postprandial glucose level. Objectives To identify a safe, feasible and effective method for calculation of prandial insulin dose based on the glycemic load of a meal. This could minimize postprandial glycemic variability in type 1 diabetic patients. Patients and Methods Our study included 15 type 1 diabetic participants; their ages ranged from 8 to 15 years. The participants were given a breakfast with the same amount of fat, protein and carbohydrates, which was prepared similarly in all studied patients. Sequence, quality and amounts of meals consumed during the first week of the study were replicated during the second week. Calculation of prandial insulin doses using one regimen for 1 week and a crossover to the other regimen for an additional week was done. A detailed medical history was collected, including the age of onset of diabetes, disease duration, and symptoms of diabetic complications. Results Blood glucose postprandial excursions was significantly lower during the glycemic load counting (GLC) than the carbohydrate counting (CC) period from baseline to 120 min (-10.20 ± 8.18 vs 8.47 ± 6.65 mg/dl, respectively, p = &amp;lt; 0.001), baseline to 180 min (-11.80 ± 8.16 vs 5.13 ± 7.01 mg/dl, respectively, p = &amp;lt; 0.001) and baseline to 240 min (-9.60 ± 6.07 vs -0.53 ± 7.31 mg/dl, respectively, p = 0.007). However, there was no postprandial glucose difference between the two periods from baseline to 60 min (-2.87 ± 8.09 vs 2.53 ± 7.76 mg/dl, respectively, p = 0.083). Conclusion The data from this study showed that glycemic load counting for prandial insulin doses is a feasible and effective method in short term glucose control.

Using continuous glucose monitoring to measure and improve quality metrics: Updates on the Healthcare Effectiveness Data and Information Set 2024 Glucose Management Indicator measure.

Value-based diabetes care is a proactive approach to providing quality care to individuals with diabetes. This approach focuses on improving clinical outcomes rather than the volume of services provided. Implementation of value-based diabetes care requires an established set of standardized quality measures against which all stakeholders can assess and benchmark their performance. The National Committee for Quality Assurance recently added the Glucose Management Indicator to its Healthcare Effectiveness Data and Information Set. The Glucose Management Indicator can be used as a measure of glucose control. This article discusses the benefits of value-based care, the importance of diabetes quality measures, and how the rapidly increasing adoption of continuous glucose monitoring is impacting these measures while improving the lives of individuals with diabetes.

Objetivos del tratamiento de la diabetes mellitus tipo 1

There are three ways to assess blood glucose control in type 1 diabetes (DM1): glycated hemoglobin (HbA1c, general target less than or equal to 7%), time in the 70–180mg/dl range (general target 70% or higher), and capillary blood glucose. Diabetes education is a fundamental element in achieving self-management of the disease. It is based on three fundamental pillars: nutrition, insulin therapy, and management of diabetes technology (sensors, insulin pumps, smart insulin pens, and mobile applications). Drug treatment for DM1 consists of intensive insulin therapy using multiple dose injection (MDI) or continuous subcutaneous insulin infusion (CSII). The choice of treatment regimen should be based on patient characteristics and other clinical considerations (e.g., pregnancy, presence of undetected hypoglycemia, or variable insulin requirements). There are currently no other insulin adjuvant therapies approved for use in DM1, although DM2 drugs such as GLP-1 analogs or SGLT2 inhibitors that may provide benefits in blood glucose control or weight loss have been used. Kidney-pancreas or pancreatic islet transplantation is considered a final option in patients with end-stage chronic kidney disease together with or following renal transplantation or in individuals with undetected or severe recurrent hypoglycemia that does not respond to optimized management.

Gestational diabetes mellitus - Neonatal and maternal outcomes in women treated with insulin or diet: A propensity matched analysis

AimsPregnant women worldwide face the risk of developing gestational diabetes mellitus (GDM), if left untreated, can cause complications. The study explores factors influencing the choice between diet control and insulin therapy for pregnant women with GDM. It aims to understand how these choices impact maternal and neonatal outcomes. MethodsIn this quasi-experimental study, clinicians determined treatment (diet control or insulin) for 1030 individuals with GDM at a private practice from 2010 to 2020 based on baseline characteristics. Propensity scores (PS), reflecting the probability of treatment allocation, were derived through multiple logistic regression. ResultsAfter PS matching, 386 individuals were paired from two study groups. The insulin-treated group exhibited a 4.43 times higher risk of neonatal hypoglycemia than the diet group. Insulin-treated individuals, stratified by PS, revealed that the high-risk quartile had significantly higher mean insulin requirements and a doubled dose at full term compared to the lower-risk quartiles. The mean insulin dose did not significantly differ in the first three quartiles, but the last quartile showed a significant increase (p = 0.008), particularly for individuals with PS exceeding 0.70, indicating a higher insulin dose requirement for effective glucose control. ConclusionThis study reveals that individuals with a bad obstetrics history, a family history of diabetes, obesity, and elevated baseline glycemic parameters necessitate higher insulin doses. This insight improves clinicians' decision-making in diagnosis and treatment planning, enhancing the precision of medical practices.

Perioperative Fully Closed-loop versus Usual Care Glucose Management in Adults Undergoing Major Abdominal Surgery - A Two-centre Randomised Controlled Trial.

To assess the efficacy and safety of fully closed-loop (FCL) compared with usual care (UC) glucose control in patients experiencing major abdominal surgery-related stress hyperglycaemia. Major abdominal surgery-related stress and periprocedural interventions predispose to perioperative hyperglycaemia, both in diabetes and non-diabetes patients. Insulin corrects hyperglycaemia effectively, but its safe use remains challenging. In this two-centre randomised controlled trial, we contrasted subcutaneous FCL with UC glucose management in patients undergoing major abdominal surgery anticipated to experience prolonged hyperglycaemia. FCL (CamAPS HX, Dexcom G6, mylife YpsoPump 1.5x) or UC treatment was used from hospital admission to discharge (max 20d). Glucose control was assessed using continuous glucose monitoring (masked in the UC group). The primary outcome was the proportion of time with sensor glucose values in target range 5.6-10.0mmol/L. Thirty-seven surgical patients (54% pancreas, 22% liver, 19% upper gastrointestinal, 5% lower gastrointestinal), of whom 18 received FCL and 19 UC glucose management, were included in the analysis. Mean±SD percentage time with sensor glucose in target range was 80.1±10.0% in the FCL and 53.7±19.7% in the UC group (P<0.001). Mean±SD glucose was 7.5±0.5mmol/L in the FCL and 9.1±2.4mmol/L in the UC group (P=0.015). Time in hypoglycaemia (<3.0mmol/L) was low in either group. No study-related serious adverse events occurred. The FCL approach resulted in significantly better glycaemic control compared to UC management, without increasing the risk of hypoglycaemia. Automated glucose-responsive insulin delivery is a safe and effective strategy to minimise hyperglycaemia in complex surgical populations.

Benefit and Safety of Sodium-Glucose Co-Transporter 2 Inhibitors in Older Patients with Type 2 Diabetes Mellitus.

People with type 2 diabetes mellitus (T2DM) are at higher risk of developing cardiovascular disease, heart failure, chronic kidney disease, and premature death than people without diabetes. Therefore, treatment of diabetes aims to reduce these complications. Sodium-glucose co-transporter 2 (SGLT2) inhibitors have shown beneficial effects on cardiorenal and metabolic health beyond glucose control, making them a promising class of drugs for achieving the ultimate goals of diabetes treatment. However, despite their proven benefits, the use of SGLT2 inhibitors in eligible patients with T2DM remains suboptimal due to reports of adverse events. The use of SGLT2 inhibitors is particularly limited in older patients with T2DM because of the lack of treatment experience and insufficient long-term safety data. This article comprehensively reviews the risk-benefit profile of SGLT2 inhibitors in older patients with T2DM, drawing on data from prospective randomized controlled trials of cardiorenal outcomes, original studies, subgroup analyses across different age groups, and observational cohort studies.

Management Strategies for Obese Diabetes

In recent years, there has been a growing emphasis on the relationship between obesity and diabetes. An analysis of Korean data revealed that more than 75% of diabetic patients were overweight or obese, with two-thirds having abdominal obesity. Traditional treatment goals for diabetes have primarily focused on lowering blood glucose levels to prevent and treat microvascular and macrovascular complications, which is known as the glucocentric approach. However, with the recognition of the shared pathophysiology of insulin resistance in both diabetes and obesity, a weight-centric approach has emerged, particularly beneficial for patients in whom insulin resistance is a primary driver of type 2 diabetes. Of note, the overlap of various physiological aspects in diabetic patients necessitates a multicentric approach for effective type 2 diabetes management. Recent guidelines now recommend weight loss as a primary treatment goal alongside blood glucose control for overweight and obese diabetic patients, highlighting the significance of weight management in diabetes care. Medications such as glucagon-like peptide-1 (GLP-1) receptor agonist or dual glucose-dependent insulinotropic polypeptide/GLP-1 receptor agonist with weight-loss effects are recommended for this patient population. Ongoing research is exploring the potential of various gut hormone-based therapies, offering hope for effective weight management and improved diabetes outcomes in the growing population of obese diabetic individuals.

The Effects of Music Therapy on Self-Management, Depression, and Stress in Patients with Type 2 Diabetes Mellitus

Background: Among type 2 diabetes patients hospitalized for blood sugar control, stress and depression are high and have a negative effect on blood sugar control. Therefore, this study sought to determine whether listening to music helps reduce stress and depression and affects blood sugar control.Methods: This is a randomized, controlled, pre- and post-design study conducted from April 2017 to September 2019 in patients with type 2 diabetes hospitalized for blood glucose control at Kyung Hee University Hospital at Gangdong. After diabetes education was provided to both the control and experimental groups, the experimental group listened to music for 30 minutes a day with a tablet PC and the control group was prohibited from listening to music during the study period. Stress was evaluated using the PAID (Problem Areas in Diabetes) scores, depression using the CES-D (Center for Epidemiologic Studies Depression) scale, and self-management using the SDSCA (Summary of Diabetes Self-Care Activities) questionnaire.Results: A total of 59 patients (41.5 ± 12.6 years, 75.0% male) were enrolled and randomized into the control group (n = 28) and experimental group (n = 31). Music therapy had no statistically significant relationship with blood sugar (&lt;i&gt;P&lt;/i&gt; = 0.887), depression (&lt;i&gt;P&lt;/i&gt; = 0.248), stress (&lt;i&gt;P&lt;/i&gt; = 0.994), or self-management (&lt;i&gt;P&lt;/i&gt; = 0.959). However, in both groups, blood glucose control, stress, and self-management were all significantly improved at discharge compared to at the beginning of hospitalization (&lt;i&gt;P&lt;/i&gt; = 0.031).Conclusion: It was confirmed that intensive medical treatment and diabetes education for hospitalized patients with type 2 diabetes improved not only blood glucose control but also depression, stress, and self-management, regardless of listening to music.

Alpha(α)-mangostin (Xanthone of Garcinia mangostana L.): Augmenting Macrophages Activity for an Effective Diabetic Wound Healing

Diabetic wounds are particularly difficult to treat medically because they heal at a slower pace than regular wounds. Macrophages are essential in all stages of normal wound healing, including inflammation, proliferation and rem odelling. When wound healing is affected, macrophages can reduce the level of growth factor and increase the level of interleukin-6 (IL-6), disrupt the balance between tissue inhibitors of metalloproteinase (TIMPs) and matrix metalloproteinase (MMPs), which can slow down healing. Alpha(α)-mangostin, a natural xanthone derived from the pericarp of the mangosteen, has gained considerable attention due to its anti-inflammatory properties, suggesting its potential to promote wound healing. However, its exact role in healing diabetic foot ulcers, common in diabetes, remains unclear. Hence, this study aims to explore how α-mangostin might affect diabetic wound healing by evaluating its impact on PDGF, CTGF, BFGF, VEGF, TGF-β, MMP-9, TIMP-2 and IL-6 secretion in macrophage cells. Human monocytic macrophages (THP-1) were incubated with a 35 mM glucose solution for 72 h to create a glucose-enriched medium. The cells were then incubated with α-mangostin (0.15, 2.5 and 5 µg/mL) together with 35 mM glucose. Carboxymethyl cellulose (CMC) served as positive controls; glucose-enriched media and media-alone served as negative controls. Protein expression was measured using ELISA. α-mangostin (2.5 µg/mL) increased the levels of PDGF and VEGF and decreased the level of MMP-9 compared to glucose controls. There was no significant difference in other growth factors, TIMP-2 and IL-6 protein levels across any of the treatment groups compared to glucose controls. In conclusion, α-mangostin particularly at 2.5 µg/mL demonstrated a significant increase in PDGF and VEGF levels while simultaneously reducing MMP-9 in macrophage cells under glucose-induced conditions. These findings suggest that α-mangostin holds the potential for enhancing the healing of chronic wounds in diabetic conditions. HIGHLIGHTS Treatment of macrophages (THP-1 cells) with 2.5 µg/mL Alpha (α)-mangostin in a high glucose medium led to a significant increase in PDGF and VEGF secretion compared to glucose control. Treatment of the cells with 2.5 µg/mL Alpha (α)-mangostin in a high glucose medium led to a significant reduction of MMP-9 secretion compared to glucose control. There is no significant effects of Alpha (α)-mangostin on IL-6 and TIMP secretion compared to controls This study suggests that Alpha (α)-mangostin may be beneficial in promoting diabetic wound healing via stimulation of PDGF and VEGF secretion and reducing MMP-9 levels. GRAPHICAL ABSTRACT

Estimating the Biological Variables of Thyroid Patients and Their Impact on Diabetics in Kirkuk

Background: Investigating the impact of sugar on biochemical variables in patients with thyroid dysfunction in Kirkuk, including some previously unmeasured biological variables. Materials and Techniques: From November to May, this study occurred in Kirkuk. Blood samples were collected from 120 patients aged 20 to 80 years, including 40 diabetics, 40 with both hyperthyroidism and diabetes, and 40 with both hypothyroidism and diabetes, as well as 40 healthy individuals aged 20 to 40 without chronic diseases. Levels of TSH, T4, T3, HbA1c, GPT, GOT, ALP, and HBs were measured in the serum using Beckman Coulter Access2, Spectrophotometer, and Boditech Med INC I-Chroma AFP-25 devices. Results: The study found that TSH levels were significantly elevated in patients with diabetes and hypothyroidism (P≤0.01), while T4 and T3 levels were significantly decreased (P≥0.01). HbA1c levels showed a significant increase (P≤0.01) in all groups: diabetes with hypothyroidism, diabetes with hyperthyroidism, and diabetes alone. Enzyme levels (GOT, GPT, ALP, HBs) were also significantly elevated (P≤0.01) in these groups. Conclusion: In conclusion, TSH regulation is vital, with high levels indicating hypothyroidism related to obesity and diabetes. Elevated HbA1c shows poor glucose control, and hyperthyroidism with diabetes worsens liver function and glucose metabolism, stressing the need for integrated management.

Utilization of Smart Healthcare for Gestational Diabetes Mellitus Management

Gestational diabetes mellitus (GDM) poses significant health risks to both mothers and newborns, requiring rigorous self-management and frequent medical consultations. Advances in information and communications technology (ICT) have shown promising results in reducing the number of in-person visits for GDM management. ICT enhances patient self-care engagement, with some studies reporting reductions in average blood glucose and HbA1c levels. ICT for GDM management has demonstrated benefits such as fewer in-person visits, improved adherence to self-monitoring of blood glucose, increased global user satisfaction, and maintenance of blood glucose control and perinatal outcomes. Common barriers to ICT for GDM include technological literacy, inadequate education, limited technical support, the additional burden of non-customized applications, and restricted interoperability. Further research is needed on the impact of technology on GDM management to optimize digital health solutions.

Body weight training versus series 7 diabetes dance: their influence on glucose levels in patients with type 2 diabetes mellitus

Managing blood glucose levels is critical for preventing complications associated with type 2 diabetes mellitus (T2DM). Physical activity has been shown to be an effective strategy for glucose control, with various forms of exercise yielding different results. This research aims to explore the effects of body weight training and series 7 diabetes dance on reducing blood glucose levels in patients with T2DM, and to compare the efficacy of these two interventions in achieving glucose control. The type of research was a quasi-experiment with a two groups pre-test post-test design. The series 7 diabetes dance group performed the exercise 4 times a week (duration: 170 minutes 8 seconds/week), while the body weight training group performed exercise 3 times a week (8 movements, number of repetitions close to failure, circuit system, 3 sets per training session). Both groups were doing an exercise program for three months. The research sample was for about 16 patients of type 2 diabetes mellitus (8 people per group, devided randomly), taken by using non probability sampling technique, purposive sampling type (effect size 1.6, significant level (α) 0.05 and Power 0.8). The data analysis used the paired sample t test and the independent t test with a significance level of α = 0.05.The results showed that 1) there is no significant effect of series 7 diabetes dance towards the decreasing the level of blood sugar of the patients with type 2 diabetes mellitus), 2) there is a significant effect of body weight training towards the decreasing level of blood glucose of the patients with type 2 diabetes mellitus, 3) dody weight training is more effective in decreasing the level of blood glucose of patients with type 2 diabetes mellitus compared to series 7 diabetes dance. Future research must be carried out as a true experiment with a larger number of samples and with the HbA1c research instrument.

GLP-1 Receptor Agonists and SGLT2 Inhibitors in Type 2 Diabetes: Pleiotropic Cardiometabolic Effects and Add-on Value of a Combined Therapy.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2is) have proven efficacy and safety in randomized clinical trials and observational real-life studies. Besides improving glucose control, reducing body weight, and lowering arterial blood pressure (surrogate endpoints), the breakthroughs were the demonstration of a significant reduction in cardiovascular and renal events in patients with type 2 diabetes at high risk. GLP-1RAs reduce events linked to atherogenic cardiovascular disease (especially ischemic stroke) and also renal outcomes (FLOW trial with semaglutide), with a limited effect on heart failure. The most striking protective effects of SGLT2is were a marked reduction in hospitalization for heart failure and a remarkable reduced progression of chronic kidney disease. These benefits have been attributed to numerous pleiotropic effects beyond glucose-lowering action. Underlying mechanisms contributing to cardiovascular and renal protection are at least partially different between GLP-1RAs (mainly anti-atherogenic and vascular effects) and SGLT2is (mainly systemic and intrarenal hemodynamic changes). Thus, patients at high risk may benefit from complementary actions when being treated with a GLP-1RA/SGLT2i combination. Such combination has proven its efficacy on surrogate endpoints. Furthermore, posthoc subgroup analyses of cardiovascular outcome trials have suggested a greater cardiorenal protection in patients treated with a combination versus either monotherapy. The benefits of a combined therapy have been confirmed in a few retrospective cohort studies. A dedicated prospective trial comparing a combined therapy versus either monotherapy is ongoing (PRECIDENTD); however, several challenges still remain, especially the higher cost of a combined therapy and the worldwide underuse of either GLP-1RAs or SGLT2is in clinical practice, even in patients at high cardiorenal risk.

Study on the Clinical Application of Nutritional Management Combined with Clinical Monitoring of Glycated Albumin in Diabetic Nephropathy Dialysis Patients

Objective: To explore the clinical application of nutritional management combined with clinical monitoring of glycated albumin (GA) in diabetic nephropathy (DN) dialysis patients. Methods: A total of 20 diabetic nephropathy dialysis patients admitted to the People’s Hospital of Guandu District from January 2022 to February 2023 were included in the study. They were randomly divided into a conventional group (n = 10) and an observation group (n = 10). The study evaluated the blood glucose control, nutritional status, dialysis efficacy, and quality of life scores of both groups. Results: Before the intervention, there were no significant differences in fasting plasma glucose (FPG), GA, serum albumin, body mass index (BMI), dialysis efficiency values, urea clearance rate, or quality-of-life scores between the two groups (P &gt; 0.05). After the intervention, the observation group showed significantly lower FPG and GA levels, higher serum albumin, dialysis efficiency values, urea clearance rate, and improved quality-of-life scores compared to the conventional group (P &lt; 0.05), with no difference in BMI (P &gt; 0.05). Conclusion: Nutritional management combined with clinical monitoring of glycated albumin has a significant effect on the clinical application of diabetic nephropathy dialysis patients. It can effectively improve patients’ blood glucose control and nutritional status, reduce the risk of complications, and enhance the quality of life, demonstrating clinical value for broader application.

The Interplay between COVID-19 and Diabetes: Understanding Hyperglycemia, Complications, and Management Challenges in Diabetic Patients

The COVID-19 pandemic has significantly impacted individuals with diabetes, revealing a complex interplay between the virus and pre-existing hyperglycemia. This review explores how COVID-19 exacerbates hyperglycemia in diabetic patients, primarily through mechanisms such as stress response, cytokine storms, and increased insulin resistance. Diabetic individuals are particularly susceptible to severe COVID-19 outcomes, including heightened mortality rates, due to compromised immune responses and coexisting conditions like cardiovascular and renal complications. The review also addresses the unique challenges of managing diabetes during COVID-19, including the need for adjustments in insulin therapy and the impact of COVID-19 treatments, such as corticosteroids, on glucose control. Additionally, it highlights the potential long-term effects of COVID-19 on diabetic patients, including the onset of new diabetes and persistent metabolic issues. The review emphasizes the importance of glycemic control, vaccination, and holistic care approaches to mitigate the severity of COVID-19 in diabetic patients. Furthermore, it examines the psychological and socioeconomic impacts of the pandemic on this vulnerable population. As ongoing research continues to investigate the interaction between COVID-19 and diabetes, this review provides a comprehensive understanding of the challenges and future directions in managing diabetic patients during and after the pandemic. Keywords: COVID-19, Diabetes, Hyperglycemia, Complications, Management Challenges, Diabetic Patients