Controlled Diabetes Mellitus Patients Research Articles

Improving insulin self-injection accuracy in patients with diabetes mellitus through a nursing project.

Non-standardized insulin injection has an impact on the efficacy of glucose control. The aim of the study was to explore the effectiveness of a nursing project in improving the insulin self-injection accuracy of diabetes mellitus patients. A total of 200 type 2 diabetes patients who received insulin therapy with an insulin pen were recruited at the First Affiliated Hospital of Army Medical University (Chongqing, China). Patients were randomly assigned to a control (n = 100) or intervention (n = 100) group. Conventional health education was conducted in the control group, while a nursing project and conventional health education were undertaken in the intervention group. The following parameters were analyzed between the 2 groups: standardized insulin pen use at admission and discharge, glycosylated hemoglobin (HbA1c), time in range (TIR), and adipose hyperplasia incidence rate 6 months after discharge. Concerning standardized insulin self-injection, the intervention group was superior to the control group, and the difference between the 2 groups was statistically significant (p < 0.05). The HbA1c levels (p = 0.000), TIR (p = 0.005) and adipose hyperplasia incidence rate 6 months after discharge (p = 0.000) all improved in the intervention group compared to the control group. The application of the nursing project effectively improved the efficacy of glucose control in diabetes mellitus patients.

Comparative analysis of glycated haemoglobin, fasting blood glucose and haematological parameters in Type-2 diabetes patients

ObjectiveDiabetes remains a major health problem, and Glycated hemoglobin (HBA1c) and fasting blood glucose (FBG) levels play important roles in its management. Also, chronic hyperglycemia coupled with high HBA1c levels impact inflammation and may alter haematological parameters in diabetes. Hence, the need to assess and correlate HBA1c and FBG levels with selected haematological parameters in patients with type-2 diabetes mellitus as the main objective of this study. The study was cross-sectional involving 384 participants. Five milliliters of blood was collected from each participant and analyzed for HBA1c, FBG levels and full blood count which were correlated statistically.ResultsFrom the data obtained and analyzed, there were statistically significant correlations between HBA1c and neutrophil count (p < 0.013), plateletcrit (p < 0.036), mean platelet volume (p < 0.019) and platelet distribution width (p < 0.002). There were also significant differences in FBG (p < 0.014), neutrophil count (p < 0.029), red cell distribution width (p < 0.046), mean platelet volume (p < 0.032) and platelet distribution width (p < 0.013) between diabetes patients with HBA1c less than 7.0% and HBA1c more than or equal to 7.0%. The outcome of the study indicates significant correlation of HBA1c with selected haematological parameters. This could make routine haematological parameters a cost-effective means of predicting poor glucose control in diabetes mellitus patients.

Effect of pre-operative HbA1c and blood glucose level on the surgical site infection after lumbar instrumentation surgery

BackgroundThis study aims to investigate the effect of pre-operative hemoglobin A1c (HbA1c) and pre-operative blood glucose control on the rate of surgical site infection (SSI) after posterior lumbar instrumentation surgery in diabetes mellitus (DM) patients. MethodsA total of 1046 patients who had undergone posterior lumbar instrumentation surgery were reviewed. Based on pre-operative HbA1c, patients were divided into three groups: non-DM group, low HbA1c group (HbA1c < 7.0 % in DM) and high HbA1c group (≥7.0). As well, based on the status of blood glucose control in DM patients immediately before surgery, patients were divided into two groups: good control group (post-prandial blood glucose [PBG] < 200 mg/dl) and poor control group (≥200). The rate of SSI was compared among these groups. ResultsSSI occurred in 1.9 % in non-DM group, 2.4 % in low HbA1c group, and 9.3 % in high HbA1c group. Compared with non-DM group, high HbA1c group had significantly higher rate of SSI (p = 0.001). There was not statistically different between non-DM and low HbA1c groups (p = 0.550). SSI occurred in 2.2 % in good control group, and 10.2 % in poor control group. The rate of SSI was significantly lower in good control group (p = 0.013). ConclusionThis study showed that the rate of SSI after posterior lumbar instrumentation surgery tend to be higher in DM patients with high HbA1c. However, the rate might be reduced to the same level as that of non-DM group by lowering PBG to <200 mg/dl immediately before surgery.

Assessment of cognitive function using the Montreal cognitive assessment test and its association with glycemic control in diabetes mellitus patients

Background: Diabetes mellitus (DM) is associated with decreased performance on cognitive domains. Diabetic patients have poor memory and attention. Cognitive dysfunction has emerged as significant morbidity of DM nowadays. Cognitive function can be screened rapidly by Montreal cognitive assessment test (MoCA). Aims and Objectives: The objective of this study was to study the effect of blood glucose levels and diabetic duration on MoCA score in diabetic patients. Materials and Methods: DM patients of both type 1(30) and type 2(30) from NCD clinic were selected as cases. Thirty persons with good health from master health checkup were selected as controls. Cognitive function was assessed in all the participants with MoCA after getting informed consent. Fasting and postprandial blood sugars were assessed with 2 mL of venous blood. Results: The mean MoCA score has decreased among diabetic cases than controls. Among cases, T1DM has decreased mean MoCA score than T2DM. Fasting blood sugar (FBS), post prandial blood sugar (PPBS), and diabetic duration were found to be correlated negatively with the score obtained in MoCA in controls and T1DM cases. In T2DM cases, FBS and PPBS were found to be correlated negatively with the score obtained in MoCA, but weak positive correlation was found between duration and MoCA score. Conclusion: Our study concludes an association between FBS, PPBS, and duration of diabetes with MoCA score in diabetic patients of both types. Strict glycemic control and regular screening for cognitive dysfunction can prevent dementia.

Correlation of Fructosamine and HbA1c (Glycosylated Haemoglobin) in Type 2 Diabetes Mellitus Patients with Chronic Kidney Disease

Background: In 2015, India had 69.2 million diabetes and 36.5 million impaired Glucose Tolerance (IGT) people (20-79yrs) which are expected to rise to 123.5 million and 63.6 million by 2040 respectively. Therefore need for assessing correct glycemic status of patients of Diabetes Mellitus as well as Diabetes Mellitus patients with CKD at correct time becomes necessary. Use of Fructosamine for the analysis of blood glucose levels might give better, comparatively fast results in these patients. Aims: The purpose of this study was to find out the correlation between Fasting Blood sugar, Fructosamine and HbA1c( Glycosylated haemoglobin) in patients of Type 2 Diabetes Mellitus with and without kidney disease Method: A total of 100 patients were taken and divided into 2 groups: Group A (n=50) – Patients with Diabetes Mellitus and Group B (n=50)- Patients with Diabetes Mellitus and Chronic Kidney Disease. 50 healthy controls (without DM and CKD) were taken. Result: Mean value of Fasting blood glucose in Group A – 186mg/dL SD- 52.2; Group B-182mg/dL, SD - 49.4. (t=0.781, p=0.437).The patients with DM and CKD (Group B) had lower levels of mean HbA1c (6.93%) as compared to Group A (DM), mean HbA1c -8.4%.There was significant difference between the groups (t=5.396, p&lt;0.001). The mean of Fructosamine in Group A-439, SD-127 , Group B-421,SD-112.(t=0.757,p=0.451).Our study also showed that in different stages of CKD ,there was no statistical difference between Fructosamine and HbA1c (HbA1c Vs GFR: r= - 0, 038, p=0.817, Fructosamine Vs GFR :r= -0.057, p=0.726). Conclusion: Serum Fructosamine is superior to HbA1c in assessing blood glucose control in Diabetes Mellitus patients with CKD.

Hubungan Dukungan Keluarga dengan Tingkat Kepatuhan Melakukan Kontrol Rutin pada Penderita Diabetes Mellitus di RSU. Imelda Pekerja Indonesia

Diabetes Mellitus (DM) is a chronic condition where there is an increase in glucose levels in the blood because the body cannot produce or produce insulin or the body cannot use insulin effectively. In improving the compliance of DM sufferers, it is very important to find out several factors that cause non-compliance in DM sufferers. This type of research is quantitative using a cross-sectional approach to see the relationship between family support and compliance with carrying out routine control in diabetes mellitus sufferers at RSU Imelda Workers Indonesia with a sample size of 37 respondents. From the results of the analysis using the SPSS Chi-Square test system, it shows that there is a positive and significant relationship between family support and compliance with routine control at the RSU. IPI Medan with a p-value = 0.017, so it can be concluded that Ha accepts that there is a significant relationship between family support and compliance with routine control in diabetes mellitus patients. The conclusion is that there is a relationship between family support and compliance with routine control in diabetes mellitus sufferers.

A review of the effectiveness of telemedicine in glycemic control in diabetes mellitus patients

This review aimed to evaluate the effectiveness of telemedicine as an intervention for patients with diabetes mellitus, considering blood glucose levels as the primary outcome. A comprehensive literature search was performed using the PubMed, Embase, Web of Science, and EBSCO databases. This narrative review covered randomized controlled trials published in English. The process of selecting studies adhered to the preferred reporting items for systematic reviews and meta-analyses guidelines. Nine studies were selected, and their data were analyzed and summarized. Five of the nine reviewed studies found that telemedicine counseling was effective in decreasing glycated hemoglobin A (HbA1c) levels in the blood. Due to methodological limitations, one study could not report HbA1c results, and two studies reported that telemedicine counseling did not lead to any significant changes in HbA1c levels. One study found that while HbA1c levels did not show a marked decrease, patients' treatment adherence and quality of life improved when telemedicine was combined with health counseling. Moreover, six studies found that telemedicine counseling was more effective than traditional counseling regarding secondary outcomes. The overall findings of this review suggest that telemedicine counseling is more effective than conventional counseling in achieving decreased blood glucose levels in patients with diabetes mellitus while increasing their treatment adherence and improving their quality of life.

Association of Glycosylated Hemoglobin with Long-Term Adverse Cardiac Events after Percutaneous Coronary Intervention in Non Diabetes and Controlled Diabetes Patients: An Observational Study from the Korean COACT Registry.

Glycosylated hemoglobin (HbA1c) is an established marker associated with cardiovascular risk, even if it is below the diagnostic threshold for diabetes mellitus (DM). However, whether or not prediabetic and controlled diabetic levels of HbA1c are associated with increased major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) remains unclear. This observational study included a total of 9128 patients who underwent PCI in the COACT registry from eight centers in Korea. A total of 2517 non-DM patients were divided into three groups (Groups I, II, III) according to their HbA1c levels and compared with 965 controlled DM patients (HbA1c &lt; 7.0%, Group IV). During 22 months of median follow-up, there was no significant differences in MACE (p = 0.294) and cardiac death (p = 0.105) among the four groups. In addition, there were also no significant differences in MACE (p = 0.058) between Group III and Group IV. Although patients were diagnosed as DM, they had a similar prognosis in the same range of newly diagnosed DM patients in HbA1c, if they were treated well. The results of this study suggest that intensive treatment is required to reach the Hba1c target in diabetic patients with PCI in order to have a similar prognosis to patients not previously diagnosed with diabetes.

Rhino-orbital-cerebral mucormycosis in post COVID-19 patients

Introduction-Mucormycosis is an angio invasive infection that occurs due to fungi Mucorales. It occurs primarily in severe immunocompromised individuals and in poorly controlled diabetes mellitus patients. Objectives-To study the clinical features and assess the severity of orbital involvement among the rhino-orbital mucormycosis patients. To study the management &amp; outcome in post covid rhino orbital mucormycosis patients. Methods- It was a Hospital based retrospective study conducted from a period June 2021 to August 2021(3 months) in Vinayaka Mission’s Kirupananda Variyar Medical College, Salem. Sample size of 50 taken from medical records section.Patient’s demographic data like age, gender were noted. Data such as presenting symptoms, signs, history of presenting illness, COVID history, and associated co morbidities were noted. Findings of anterior segment evaluation (done by slit lamp biomicroscopy in ambulatory patients, torch light examination for bed ridden patients) were noted. SPSS (Version 22.0) was used for analysis. Results-the most common age group was 40-60 years (58%), followed by &gt;60 years (24%), this suggest that mostly mucormycosis is more common after 40 years as per present study. most common duration was between 2-4 weeks when the symptoms of mucormycosis starts to seen from COVID seen in 58% of patients (p&gt;0.05).

Single Nucleotide Polymorphism in the ADIPOQ Gene Modifies Adiponectin Levels and Glycemic Control in Type Two Diabetes Mellitus Patients.

Diabetes mellitus (DM) is the ninth leading cause of death worldwide. Mortality from DM is largely attributed to disease complications. Glycemic control of DM patients reduces mortality. Studies indicated that the lack of glycemic control in DM patients could be influenced by the genetic background of the patients. Evidence suggests that adiponectin levels are dysregulated in DM patients with poor glycemic control. Serum adiponectin level is a heritable trait influenced by single nucleotide polymorphisms (SNPs) in the ADIPOQ gene. It is hypothesized that SNPs in ADIPOQ could modify glycemic control in DM patients. To test this hypothesis, 375 type 2 DM (T2DM) patients were recruited. Patients were classified into good vs. poor glycemic control according to hemoglobin A1c levels. Study subjects were genotyped for variations of four SNPs in ADIPOQ (rs17300539, rs266729, rs2241766, and rs1501299). Adiponectin levels were measured from the serum. Our analysis showed that reduced serum adiponectin, a longer duration of treatment, and increased insulin resistance were all significant predictors of poor glycemic control. Moreover, the T allele and the TT genotype of rs2241766 were significantly more frequent in patients with poor glycemic control (P < 0.05). Individuals with the TT genotype of rs2241766 had significantly lower levels of serum adiponectin (P < 0.05). It was concluded that lower levels of serum adiponectin and the T allele of rs2241766 SNP in ADIPOQ were associated with poor glycemic control in T2DM patients.

Statins versus PDE-5 inhibitors: A comparative study in controlled diabetes mellitus patients with erectile dysfunction

Statins versus PDE-5 inhibitors: A comparative study in controlled diabetes mellitus patients with erectile dysfunction

The Role of Glycemic Variability in Cardiovascular Disorders.

Diabetes mellitus (DM) is one of the most common and costly disorders that affect humans around the world. Recently, clinicians and scientists have focused their studies on the effects of glycemic variability (GV), which is especially associated with cardiovascular diseases. In healthy subjects, glycemia is a very stable parameter, while in poorly controlled DM patients, it oscillates greatly throughout the day and between days. Clinically, GV could be measured by different parameters, but there are no guidelines on standardized assessment. Nonetheless, DM patients with high GV experience worse cardiovascular disease outcomes. In vitro and in vivo studies showed that high GV causes several detrimental effects, such as increased oxidative stress, inflammation, and apoptosis linked to endothelial dysfunction. However, the evidence that treating GV is beneficial is still scanty. Clinical trials aiming to improve the diagnostic and prognostic accuracy of GV measurements correlated with cardiovascular outcomes are needed. The present review aims to evaluate the clinical link between high GV and cardiovascular diseases, taking into account the underlined biological mechanisms. A clear view of this challenge may be useful to standardize the clinical evaluation and to better identify treatments and strategies to counteract this DM aspect.

Accuracy of a Point-of Care Hemoglobin A1c Assay - A Community Outreach Project

Glycated hemoglobin (HbA1c) is an invaluable tool in diabetes mellitus (DM) management. Conventionally obtained via venous blood sampling, point-of-care (POCT) capillary HbA1c measurement offers an opportunity for immediate treatment modification, reduced cost & increased patient satisfaction. While previous studies using the POCT HbA1c test A1cNow+ have shown accuracy within a 0.5% range from the gold standard venous HbA1c, we noted discrepancy in our community health clinic & sought to evaluate the accuracy of POCT HbA1c levels compared to venous HbA1c levels to guide our clinical decision-making.In this 2-part study, we compared POCT HbA1c levels measured via a single use A1CNow+ HbA1c monitoring device & venous HbA1c samples measured by a standardized lab. Part1: after retrospective chart review, we identified 262 patients with prediabetes, Type1 or Type2 DM based on ADA guidelines who attended our clinic from January 2019-June 2019 & received POCT HbA1c with A1cNow+ testing during their visit. Of those cases, 47 patients also had a venous HbA1c at a standardized laboratory within 1 month of having their POCT HbA1c performed in our clinic. Part2: We noted variability in the temperature storage of A1CNow+ test strips. Storage was standardized to room temperature as per device instructions in June 2019. We subsequently reviewed charts from June 2019-December 2019 & identified 118 patients who had both POCT HbA1c & venous HbA1c measurement within a 1 month period.Patients was categorized into subgroups per ACP guidelines for DM control: prediabetic (HbA1c 5.7–6.4%), controlled DM (HbA1c 6.5 to 8.0%) & uncontrolled DM (HbA1c >8.0%). The average difference between POCT & venous HbA1c tests was calculated & analyzed for statistical significance using paired t test analysis. Part1: For patients in prediabetic, controlled & uncontrolled DM subgroups, the mean difference between A1cNow+ & standardized venous HbA1c testing was 0.68% (p= 0.004), 1.15% (p= <0.0001) and 1.36% (p= 0.0003) respectively. Part2: After standardization of test strip storage, the mean difference between A1cNow+ & venous HbA1c testing for prediabetic, controlled & uncontrolled DM patients was 0.33% (p= 0.002), 0.41% (p= 0.011) and 1.26% (p= <0.0001) respectively.POCT HbA1c provides a unique opportunity to immediately address glycemic control. Its advantages are especially apparent in a patient population with limited resources & poor follow up, as in our clinic. Although standardizing test storage improved overall concordance between A1cNow+ HbA1c testing & venous HbA1c, there was still a statistically significant larger mean difference in uncontrolled DM patients. In prediabetic & controlled DM patients, however, POCT HbA1c was accurate within previously published reports of a 0.5% range when compared to venous HbA1c. An algorithm has since been developed to guide our clinical decision making with these findings.

Compliance of checking HbA1c in a tertiary care hospital of Pakistan.

Background and Objectives:The prevalence of diabetes mellitus worldwide was 171 million one and half decade ago, while the prediction is 366 million patients by 2030 and more than 640 million people by 2040. HbA1c value represents average blood glucose over the past 2-3 months and accounts for both pre-prandial and post-prandial blood glucose levels. A link between HbA1c and diabetic complications has been confirmed. In general, patients with controlled diabetes mellitus should have at least biannual testing, while patients with uncontrolled diabetes mellitus or unmet glycemic targets should be tested every three months. The objective was to see compliance of checking HbA1c in tertiary care hospital of a developing world.Methods:This was a retrospective observational study done from 1st February 2019 to 31st March 2019 in the Department of Medicine and Surgery, The Aga Khan University Hospital, Karachi. All patients of age 18 years and above, admitted with a diagnosis of diabetes mellitus (DM)from 1st February 2019 to 31st March 2019 were included. If HbA1c was less than 7% the patients were labelled as having controlled DM, otherwise, uncontrolled DM. If HbA1c of patients with controlled DM was not checked in last six months and if HbA1c of patients with uncontrolled DM was not checked in last three months then it was labelled as non-compliance of checking HbA1c.Results:Out of 1732 diabetic patients only 94 patients fulfilled inclusion criteria. Out of these 94 patients 43 (45.7%) were male. Mean HbA1c was 7.90% (1.4) and 69 (73.4%) patients had uncontrolled diabetes mellitus. Overall, the compliance of checking HbA1c was 58.5%. In uncontrolled diabetes mellitus patients, the compliance of checking HbA1c was 45% and in controlled diabetes mellitus patients the compliance was 96%.Conclusion:The compliance of checking HbA1c is inadequate in diabetic inpatients. The considerable prevalence of diabetes and the benefits of timely interventions in diagnosed patients to prevent complications suggest the need for a comprehensive awareness among the doctors for checking HbA1c.

Factors contributing to glycemic control in diabetes mellitus patients complying with home quarantine during the coronavirus disease 2019 (COVID-19) epidemic

AimsThis study assessed factors contributing to glycemic control among diabetes mellitus patients complying with home quarantine during the epidemic of coronavirus disease 2019 (COVID-19). MethodsWe conducted an analytical cross-sectional study by telephone with 1159 patients with type 2 diabetes mellitus (T2DM) and 96 patients with type 1 diabetes mellitus (T1DM) who were discharged from the endocrinology department of a hospital from January 1, 2019, to January 24, 2020. According to their fasting blood glucose (FBG) and 2-h postprandial BG (2hPBG) values, the patients were divided into the well-controlled BG group and the poorly controlled BG group. The main evaluation indicators included sociodemographic variables, health risk variables and adherence to self-management behaviors. ResultsIn total, 74.46% of the T2DM patients and 64.89% of the T1DM patients had poor glycemic control. T2DM patients with poor glycemic control were more likely to be older (odds ratio (OR): 1.017 [95% confidence interval (CI) 1.003–1.030]; P = 0.013), have fewer than 12 years of education (OR: 1.646 [95% CI 1.202–2.255]; P = 0.002), lack a BG meter at home (OR: 2.728 [95% CI 1.205–6.179]; P = 0.016), have a lower degree of medicationcompliance (OR: 1.627 [95% CI 1.076–2.460]; P = 0.021), and engage in less self-monitoring of BG (SMBG) per week (OR: 10.884 [95% CI 5.883–20.139]; P < 0.001). Fewer than 12 years of education (OR: 3.031 [95% CI 1.112–8.263]; P = 0.030) was a risk factor for glycemic control in T1DM. ConclusionsGlycemic control among patients with T1DM and T2DM during home quarantine amid the COVID-19 pandemic is poor. Our results showed that more eduction, a higher frequency of SMBG, and improved medication compliance may contribute to glycemic control. Therefore, diabetic patients should be advised to increase the frequency of blood glucose measurements during home quarantine and be re-educated regarding the importance of medication compliance.

Dynamic monitoring of HbA1c in Russian regions: data comparison of mobile medical center (Diamodul) and national diabetes register of Russian Federation

BACKGROUND: Glikogemoglobin (HbA1c) is a key clinical marker for evaluating the effectiveness of glucose-lowering therapy for patients with diabetes mellitus (DM) and the quality of diabetic care.&#x0D; AIMS: to conduct dynamic monitoring of the quality of glycemic control in DM patients based on a comprehensive examination in mobile medical center (Diamodul) during repeated visits to the regions in 2019 compared with visits of Based Federal program Diabetes Mellitus (20052010) and data of the National diabetes register (NDR).&#x0D; MATERIALS AND METHODS: The object of the study: patients with T1DM and T2DM examined in Diamodul in 2019 in Voronezh region (Vr), Krasnodar region (Kr) (n = 600), there were dynamic group of re-examined (Vr n = 224; Kr n = 113), random group of new patients (Vr n = 72; Kr n = 191); group of adult patients from NDR with indicated HbA1c in 2019 (n = 2410067).&#x0D; RESULTS: According to Diamodul, the HbA1c levels are significantly worse than they were reported to NDR: the proportion of patients achieved HbA1c 7% for T1DM is 13.3% and 11.7%; T2DM 25.1% and 28.6%, in Kr and Vr, respectively; in NDR: T1DM 37.4%, T2DM 52.2%. The average HbA1c values in the Diamodul are higher than in NDR by 0.95% for T1DM, 1.41% for T2DM patients. The proportion of patients with HbA1c9% decrease in dynamic of examinations through years in T1: in Vr from 53.1% in 2005 and 55.8% in 2010 to 42.9% in 2019, in Kr from 53.2% in 2006 to 43.8% in 2019; also there were decreases in the average HbA1c values in Vr from 9.3% in 2005 and 9.4% in 2010 to 8.8% in 2019; in Kr from 9.1% in 2006 to 8.7% in 2019. In T2DM patients with the best parameters of DM control in a whole, the positive trends were less pronounced and are assessed as non-deterioration: the proportion of HbA1c9 % in Vr: 34.7%34.7%36.4%, in Kr 40.1%28.4%; average values of HbA1c: 8.2%8.4%8.5% and 8.6%8.4%, respectively.&#x0D; CONCLUSIONS: The data of the research clearly indicates the need for 100% inclusion of HbA1c in the examination standards in all DM patients at the primary level at least 1 time per year, in order to monitor the real clinical situation, the effectiveness of glucose-lowering therapy and its timely intensification to prevent development of complications.

Is Glycosylated Hemoglobin a Reliable Marker of Diabetes Management in Advanced Heart Failure Patients on Durable Mechanical Circulatory Support?

Background Diabetes mellitus (DM) is an independent predictor of mortality in patients with heart failure (HF). Glycosylated hemoglobin (HbA1c) testing is the standard of care for monitoring glycemic control in DM patients. We sought to investigate the reliability of HbA1c testing in Stage D HF patients who require left ventricular assist device (LVAD) support. Methods We retrospectively reviewed patients who underwent LVAD implantation at an academic medical center between 1/1/2012 and 12/31/2018. We reviewed pre-VAD clinical data to help identify patients who carried a pre-LVAD diagnosis of DM, based on the following American Diabetic Association (ADA) criteria: 1) pre-LVAD glycosylated hemoglobin (HbA1c) ≥6.5% or 2) pre-LVAD HbA1c Results Amongst 108 patients with LVAD implants, 52 (48%) carried a pre-LVAD diagnosis of DM based on the above outlined criteria. Baseline characteristics of DM vs non-DM patients were comparable for age (56 ±11.7 years), gender (male 70%), bridge-to-transplantation LVAD (54%), HeartWare LVAD (77%), and days on LVAD support (325 ±318.9 days), but different for ischemic HF etiology (39% vs 17%, p=0.016), BMI (31.5 ±5.9 vs 27.9 ±6.8 kg/m2, p=0.007), and length of stay following LVAD implant (39 ±29.7 vs 25 ±17.4 days, p=0.005). Thirty-eight out of 52 DM patients had more than 90 days of follow-up while on LVAD support, accounting for a cumulative set of 72 HbA1c/APG readings. Prior to LVAD implant, mean comparisons between HbA1c and eHbA1c were similar (7.2 ±1.4% vs 7.1 ±1.5%, p=0.517). During LVAD support, means of HbA1c and eHbA1c were different (6.4 ±1.6% vs 7.2 ±1.9%, p Conclusion Discrepancies noted between HbA1c and eHbA1c raises concern for the reliability of HbA1c testing for DM management in Stage D HF patients on LVAD support.

Management of diabetes mellitus in chronic kidney disease.

Diabetes mellitus (DM) and chronic kidney disease (CKD) are two chronic diseases whose prevalence and coprevalence are on the rise. CKD is also the most debilitating and expensive complication of DM while management of DM in CKD is most challenging. CKD is developing in much younger patients with DM, and its presentation is also changing. Various methods of glycemic assessment are affected by CKD and dosage of DM medications needs to be adjusted according to the kidney function. One of the significant barriers to glycemic control in DM patients with CKD is hypoglycemia; close monitoring of glucose levels is essential. Dialysis affects the glucose homeostasis and insulin pharmacokinetics; therefore diabetic medication regimen needs to be adjusted accordingly. Kidney transplants are being increasingly performed as an alternative to dialysis. With the increased survival of transplants secondary to improved immunosuppressive regimen, the prevalence of post-transplant diabetes mellitus is on the increase. Good glycemic control is necessary for the survival of the transplant.

Vitamin and HbA1C Status in Tuberculosis Patients with Diabetes and its Association

Diabetes mellitus (DM)-tuberculosis is associated with poor glycemic control in DM patients. 2. DM is the most common risk factor associated with tuberculosis (TB); TB is also the third cause of death due to non-communicable disease (NCD).&#x0D; Materials and Methods: Present study was conducted in Dept. of TB and Chest Vedanta Institute of Medical sciences, Vedanta Hospital. A total of 100 patients of Type 2 DM were enrolled in the study of which 60 were male and 40 were female. Written consent was obtained from each patient to participate in the study. The study will be conducted in the patients admitted in the Department of TB and Chest in collaboration with Dept. of Biochemistry, Intensive Coronary Care Unit at Vedanta Hospital. All patients of DM with TB infection are diagnosed by clinician and admitted in our hospital for treatment. Informed consent was taken from all patients, who participated in our study and the study was approved by the college ethics committee.&#x0D; Blood pressure, height, body weight, and waist and hip circumferences of each patient were measured as an anthropometric and dietary measurement. Body mass index (BMI) and ratios of waist to hip circumference was calculated. Blood pressure of each patient was measured after giving rest for at least 5 min.&#x0D; Results: HbA1C levels were higher in the selected group of DM + TB patients mean value being 8.1 ± 0.56 %. There was a significant difference in Vit. B12 levels between cases (218.15 ± 35.65) and controls (355.02 ± 23.39), where serum level was low in cases compared to control group. About 13(18.88%) patients had Vit. B12 level less than 150pg/ml and 28(40.58%) were lying in the intermediate level between 150pg/ml to 350pg/ml. Serum vit.B12 levels ranged from 118pg/ml to 315pg/ml. 25(OH) D3 levels were 17.09 ± 2.15 ng/ml in study group where as in control group the levels were found to be 22.88±4.01.The BMI was higher in those suffering from DM+TB (28.13± 3.24) in comparison to normal subjects (24.89 ± 3.95).&#x0D; Conclusion: Our study has showed high prevalence of TB-DM co-burden of disease in our hospital settings and TB+DM TB-DM were significantly associated with age. Also it is concluded that vitamin D is a link between PTB and DM. Vitamin D levels are lower in patients with TB with DM. This study recommends the importance of performing diabetes screening among pulmonary TB patients and further similar studies needs to be done to determine the feasibility of TB-DM co-management.

Assessment of memory and cognitive functions in controlled and uncontrolled Type 2 diabetes mellitus patients

Background: In Type 2 diabetes (T2D) mellitus, chronic hyperglycemia and hyperinsulinemia with resultant increased advanced glycosylated end products cause the acceleration of the brain aging in its structure and functions. This complication increases the risk of memory and cognitive dysfunctions. Aims and Objectives: This study was aimed to compare the memory and cognitive functions between controlled and uncontrolled T2D mellitus patients. Materials and Methods: The study is undertaken in the Department of Physiology, Velammal Medical College Hospital, Madurai. 100 known T2D mellitus patients aged between 30 and 50 years of both sexes are included after obtaining informed written consent. Patients with conditions and factors affecting memory and patients with defective hearing and speech are excluded from the study. Recent hemoglobin A1c (HbA1c), fasting blood sugar (FBS), and postprandial blood sugar (PPBS) values are collected from their hospital records. Cognition and memory assessment is done using Mini-Mental State Examination (MMSE) by 30-point questionnaire. Results: The average MMSE score of uncontrolled diabetes mellitus is less than the average MMSE score of controlled diabetes mellitus patients (HbA1c