Conventional Diabetes Care Research Articles

A Compendium on Various Traditional Plants Used in the Management of Diabetes Mellitus

Background: The prevalence of diabetes mellitus has escalated globally, posing a significant public health challenge. While modern pharmacological interventions are available, there is growing interest in traditional medicinal agents as alternative or complementary treatments for diabetes. Aims and Objectives: This study aims to identify and evaluate the efficacy of conventional drugs in the treatment of diabetes, particularly focusing on herbal plants used in various traditional medicines. The primary objectives include identifying anti-diabetic herbal plants, evaluating their efficacy, and conducting docking studies to assess their anti-diabetic actions. Methodology: Relevant databases are searched to compile a comprehensive list of herbal plants with documented anti-diabetic properties. Information on each plant, including its botanical name, family, and components used, is collected. Evaluation of efficacy is conducted through a literature review and analysis of reported studies. Docking studies are performed to assess the molecular interactions between the active components of herbal plants and targets related to diabetes. Results and Discussion: The study has identified a range of traditional medicinal plants with potential anti-diabetic properties. Various botanical species from diverse families have been documented for their effectiveness in managing diabetes symptoms. The evaluation of efficacy suggests promising outcomes for several herbal plants in controlling blood sugar levels and improving metabolic functions. Docking studies reveal potential molecular mechanisms underlying the anti-diabetic actions of these plants, providing insights into their therapeutic effects. Conclusion: The findings highlight the potential of herbal plants as alternative or complementary treatments for diabetes. Further research and clinical trials are warranted to validate the efficacy and safety of these plants in diabetic management. Integrating traditional medicines into conventional diabetes care may offer additional therapeutic options and improve outcomes for patients.

Prevalence of Complementary and Alternative Medicine Use and Its Associated Factors among Iranian Diabetic Patients: A Cross-Sectional Study

ObjectiveThis cross-sectional study aimed to assess the prevalence of complementary and alternative medicine (CAM) use and its associated factors among diabetic patients in Fasa, a city in southern Iran. MethodsData were collected from diabetic patients who visited the endocrinology clinics at Fasa University of Medical Sciences. A structured questionnaire was administered to gather information on CAM use, including the types of CAM modalities used, and reasons for use. The patient's demographic and clinical characteristics, such as age, gender, duration of diabetes, glycosylated hemoglobin (HbA1c) levels, and quality of life (QoL) were also recorded. Descriptive statistics were used to determine the prevalence of CAM use, while logistic regression analysis was employed to identify factors associated with CAM use. ResultsA total of 376 diabetic patients participated in the study, with more than 89% reporting CAM use within the past year. Herbal preparations were the most commonly used type of CAM, with a prevalence rate of 99.4%. Factors associated with CAM use included patients’ psychological health, attitude towards the safety of CAM, belief in the synergistic effects of combining routine medications with CAM, and previous positive experiences with CAM. ConclusionThe high prevalence of CAM use highlights the importance of considering it in diabetes management and the need for healthcare professionals’ engagement in open discussions with patients about their CAM practices. Understanding the factors influencing CAM use can inform healthcare providers and policymakers in developing appropriate strategies for integrating CAM approaches into conventional diabetes care.

Pancreas Transplantation: Current Challenges, Considerations, and Controversies.

Pancreas transplantation (PTx) reestablishes an autoregulating source of endogenous insulin responsive to normal feedback controls. In addition to achieving complete β-cell replacement that frees the patient with diabetes from the need to monitor serum glucose and administer exogenous insulin, successful PTx provides counterregulatory hormone secretion and exocrine function. A functioning PTx mitigates glycemic variability, eliminates the daily stigma and burden of diabetes, restores normal glucose homeostasis in patients with complicated diabetes, and improves quality of life and life expectancy. The tradeoff is that it entails a major surgical procedure and requisite long-term immunosuppression. Despite the high likelihood of rendering patients euglycemic independent of exogenous insulin, PTx is considered a treatment rather than a cure. In spite of steadily improving outcomes in each successive era coupled with expansion of recipient selection criteria to include patients with a type 2 diabetes phenotype, a decline in PTx activity has occurred in the new millennium related to a number of factors including: (1) lack of a primary referral source and general acceptance by the diabetes care community; (2) absence of consensus criteria; and (3) access, education, and resource issues within the transplant community. In the author's experience, patients who present as potential candidates for PTx have felt as though they needed to circumvent the conventional diabetes care model to gain access to transplant options. PTx should be featured more prominently in the management algorithms for patients with insulin requiring diabetes who are failing exogenous insulin therapy or experiencing progressive diabetic complications regardless of diabetes type. Furthermore, all patients with diabetes and chronic kidney disease should undergo consideration for simultaneous pancreas-kidney transplantation independent of geography or location.

853-P: Comparing Telemedicine with Conventional Diabetes Care in Assessing Long-Term Outcomes in 451 Patients over 15 Years

Pros and cons of telemedicine (TM) in diabetes have been debated during Covid-19. Diabetes Tele Management System (DTMS®) which include a disease specific EMR, customized targets integrated with remote monitoring capabilities supported 24/7 by a multidisciplinary team has been actively delivering patient care for more than 2 decades. We assessed long-term outcomes in patients adhering to DTMS® for 15 ± 3 years(y) [Treatment group(TG)] compared with those on conventional care[Control Group (CG)]. Patients having a Virtual Consultation(VC) ≥ 1 in 3 months, Physical Visit(PV) ≥ 1 in 3y, and attended group diabetes education ≥ 1 in 3y were included.T2D (n=451, age 62.91 ± 11.64 y, avg. duration of diabetes 8.41 ± 2.78 at baseline) were deidentified and their clinical characteristics were extracted from EMR. DTSQ and Eq-5D were administered to capture treatment satisfaction and QoL respectively. TG demonstrated sustained improvements and maintenance of glycemic and non-glycemic parameters over 15y. Subjects expressed significant level of satisfaction with TM(Table). Judicious use of TM with customized frequency for virtual consultations, counselling and coaching significantly averts the long term complications of diabetes and is superior to conventional care. Nonetheless connectivity issues and economic loss to hospital are among the foremost challenges observed with TM.View largeDownload slideView largeDownload slide DisclosureJ. Kesavadev: None. J. Ajith: None. S. Jothydev: None. A. Shankar: None. G. Krishnan: None. A. David: None. G. Sanal: None. K. Jothydev: None. G. B. Chandran: None. A. Basanth: None. S. T. s. : None.

The Clinical Effectiveness and Cost Effectiveness of Bariatric Metabolic Surgery for Obese with Poorly Controlled Type 2 Diabetes Patients In Malaysia - A Study Protocol

Abstract Objectives Bariatric Surgery is a major breakthrough in diabetes care. Complete remission is attainable in a great percentage of patients. However, there is slow progress in this procedure in Malaysia. With the overwhelming rate of obesity and diabetes in the country, the potential advantage of this treatment modality is underestimated. Conventional diabetes care only controls 22% of the diabetics and healthcare expenditure has ballooned due to complications costs amounting to at least RM 2 billion in a year eating up 10% of the government's budget on healthcare. Furthermore, this burden will increase in the next decades as diabetes is predicted to increase by 69% by 2030. While this procedure is beneficial, it is an expensive intervention with risks of complications. This raises the question of whether bariatric surgery is cost-effective in the context of this country? Evidence must be available to decision-makers weighing the risk-benefit ratio of the procedure. This study aims to assess the clinical effectiveness and cost-effectiveness of bariatric surgery in managing obesity among the Malaysian population. It will specifically investigate the short term and long-term effects of the procedure investigating anthropometric and metabolic disease blood indicator changes while assessing direct, indirect costs, QALYs gained and complications associated with the procedure. Methods We will review charts of all patients who have undergone bariatric surgery procedures from 2014 to 2016 in HUKM, Department of Surgery and in Andrea Bariatric Surgery Clinic. We will look at their weight, BMI, and some blood parameter results before and after surgery one-year post-surgery for the short-term effect and 3–5 years post-surgery for the long-term effect. We will also assess the mortality risks and complications of the procedures. Study Population: All patients who underwent Bariatric Surgery procedures from 2014–206 in HUKM and in Andrea Bariatric Surgery ClinicStudy Site/Location: HUKM, Department of Surgery & Andrea Bariatric Surgery Clinic Results N/A - Study Protocol Conclusions The result of this study can contribute to the decision making of patients, doctors, and Health Insurance Companies in Malaysia Funding Sources Center for Research Management, Taylor's University.

Cost-Effectiveness Evaluation of Bariatric Surgery for Morbidly Obese with Diabetes Patients in Thailand.

Background Bariatric surgery is a choice for treatment in morbidly obese patients with type 2 diabetes mellitus (DM type 2) who have inadequate diabetes control with only medical treatment. However, bariatric surgery requires highly sophisticated equipment, and thus the cost of surgery seems to be very high following the procedure compared with the cost of conventional diabetes care. This raises the question of whether bariatric surgery is cost-effective for morbidly obese people with diabetes in Thailand. Objective To perform a cost-effectiveness evaluation of bariatric surgery compared with ordinary treatment for diabetes control in morbidly obese DM type 2 patients in Thailand. Methods Cost-effectiveness study was conducted, using a combination of decision tree and Markov model in analysis. Treatment outcomes and healthcare costs were incurred by data from literature review and retrospective cohort in King Chulalongkorn Memorial Hospital from September 2009 to March 2016 for the conventional and bariatric surgery group, respectively. One-way sensitivity was used for analysis of the robustness of the model. Cost-effectiveness was assessed by calculating incremental cost-effectiveness ratios (ICERs). Monetary benefits at a threshold of 150,000 to 200,000 Thai baht (THB) per quality-adjusted life-year (QALY) based on the Thailand gross domestic products (GDP) value was regarded as cost-effectiveness of bariatric surgery. Results Bariatric surgery significantly improves the clinical outcome including long-term diabetes remission rate, hemoglobin A1C, and body mass index (BMI). The incremental cost per QALY of bariatric surgery compared with the medication control is 26,907.76 THB/QALY which can consider bariatric surgery as a cost-effective option. Conclusions Use of bariatric surgery in morbidly obese with DM type 2 patients is a cost-effective strategy in Thailand's context.

Effects of vacuum compression therapy on lower limb vascular parameters in people with type 2 diabetes

Background/Aims: Vacuum compression therapy (VCT) is used as an adjunct to the treatment of diabetic ulcers. This study assessed the efficacy of VCT on lower limb vascular parameters in people with type 2 diabetes who do not have ulcers in comparison with conventional therapy for diabetes. Methods: Forty patients who had diabetes for at least 5 years were included in the study. Thorough foot evaluations, including assessments of motor, sensory and circulatory functions, were carried out. Over 4 weeks, those in the intervention group (n=20) received conventional diabetes care plus VCT and those in the control group (n=20) received conventional diabetes care alone. The circulatory function of all participants was assessed using the ankle–brachial index, skin temperature at the dorsum of the foot and capillary refill time measurements at the initial assessment, after 2 weeks of therapy, after the completion of treatment (after 4 weeks) and at 1 month follow-up post-treatment. Results were analysed using repeated ANOVA measures (CI 95%, p<0.05). Results: Statistically significant improvements were seen in foot circulation in participants in the intervention group compared with the control group, which was maintained at 1 month follow-up after therapy had been stopped. Conclusion: VCT is an effective treatment modality to improve lower limb vascular parameters in people with type 2 diabetes and may help to prevent ulcer formation.

Metabolic Disease Puts Up a Fight: Are diet and exercise helpful for the heart?

Given the multisystemic nature of the metabolic syndrome, the field is now aiming at perusing both intrinsic and environmental factors from a biological and therapeutic standpoint. Physicians often advise obese individuals suffering from type 2 diabetes to lose weight through exercise and healthy diets. Although it may be an obvious recommendation, a large study has recently shown that weight loss achieved through these lifestyle changes does not significantly reduce cardiovascular disease events in these patients compared to conventional diabetes care. In 'Bedside to Bench', Julie A. Lovshin and Daniel J. Drucker discuss the limitations of this study, the conclusions that can be drawn regarding the true benefit of weight loss in this context and the molecular factors that deserve further attention at the bench in light of this trial. In 'Bench to Bedside', Eleftheria Maratos-Flier examines the role of antidiabetic drugs in both host and gut microbiota metabolism. These effects in the intestinal flora support advocating an increase in our understanding of how the gut microbiome affects obesity for finding the means to harness its therapeutic potential.

GW24-e2325 An effective complementary therapy for reducing blood pressure in hypertensive adults with type II diabetes

ObjectivesThe purpose of the present study was to investigate the effects of Ba Duan Jin, a kind of traditional Chinese heath-care Qigong, for reducing blood pressure in hypertensive type II...

Determinants and prognostic implications of Cardiac Troponin T measured by a sensitive assay in Type 2 Diabetes Mellitus

BackgroundThe cardiac troponins are biomarkers used for diagnosis of myocardial injury. They are also powerful prognostic markers in many diseases and settings. Recently introduced high-sensitivity assays indicate that chronic cardiac troponin elevations are common in response to cardiovascular (CV) morbidity. Type 2 diabetes mellitus (T2DM) confers a high risk of CV disease, but little is known about chronic cardiac troponin elevations in diabetic subjects. Accordingly, we aimed to understand the prevalence, determinants, and prognostic implications of cardiac troponin T (cTnT) elevations measured with a high-sensitivity assay in patients with T2DM.MethodscTnT was measured in stored, frozen serum samples from 124 subjects enrolled in the Asker and Bærum Cardiovascular Diabetes trial at baseline and at 2-year follow-up, if availabe (96 samples available). Results were analyzed in relation to baseline variables, hospitalizations, and group assignment (multifactorial intensive versus conventional diabetes care for lowering CV risk).ResultsOne-hundred thirteen (90 %) had detectable cTnT at baseline and of those, 22 (18 % of the total population) subjects had values above the 99th percentile for healthy controls (13.5 ng/L). Levels at baseline were associated with conventional CV risk factors (age, renal function, gender). There was a strong correlation between cTnT levels at the two time-points (r = 0.92, p > 0.001). Risk for hospitalizations during follow-up increased step-wise by quartiles of hscTnT measured at baseline (p = 0.058).ConclusionsElevations of cTnT above the 99th percentile measured by a highly sensitive assay were encountered frequently in a population of T2DM patients. cTnT levels appeared to be stable over time and associated with conventional CV risk factors. Although a clear trend was present, no statistically robust associations with adverse outcomes could be found.

Comprehensive care for bedsore infections diabetes in aged patients

Objective To observe the clinical effect of comprehensive care for aged diabetes patients infected the 3rd or 4th period of pressure ulcer.Methods 100 aged patients with diabetes and infected bedsore were divided into two groups randomly. To all the patients, normal series of conventional diabetes care was offered and, hydrogen peroxide solution was used to wash the raw surface while changing dressing. For 50 cases in Control Group, Iodophors and furacillin solution were used as disinfectant. But for the rest 50 cases in Experimental Group, after disinfection with amikacin, Jianshuneng was sprayed on the raw surface Control group(50cases) the introduction of 2.5% Jianshuneng solution disinfection. Infrared radiation was applied in both groups. Clinical effect and clinical healing time were measured. Results The efficient tale of Experimental Group was 100% while that of Control group was 82.0%; Clinical Healing time for the Experimental Group was (14.12+3.27)d, which was obviously shorter thanthat (24.37+3.87)d in Control Group. There was significant difference between two groups in both efficient tare and clinical healing time (P<0.05). Conclusions comprehensive diabetes care for the aged diabetes patients infected bedsore had excellent clinical efficacy, it is safe, effective and worth the clinical practice and should be spreaded. Key words: Diabetes; Bedsore; Amikacin; Jianshuneng; Infrared Radiation; Comprehensive Care

Lowering the Bariatric Surgery Minimum Body Mass Index Threshold

JAMA Adjustable Gastric Banding and Conventional Therapy for Type 2 Diabetes: A Randomized Controlled Trial John B. Dixon, MBBS, PhD; Paul E. O’Brien, MD; Julie Playfair, RN; Leon Chapman, MBBS; Linda M. Schachter, MBBS, PhD; Stewart Skinner, MBBS, PhD; Joseph Proietto, MBBS, PhD; Michael Bailey, PhD, MSc(stats); Margaret Anderson, BHealthMan Context: Observational studies suggest that surgically induced loss of weight may be effective therapy for type 2 diabetes. Objective: To determine if surgically induced weight loss results in better glycemic control and less need for diabetes medications than conventional approaches to weight loss and diabetes control. Design, Setting, and Participants: Unblinded randomized controlled trial conducted from December 2002 through December 2006 at the University Obesity Research Center in Australia, with general community recruitment to established treatment programs. Participants were 60 obese patients (BMI > 30 and Interventions: Conventional diabetes therapy with a focus on weight loss by lifestyle change vs laparoscopic adjustable gastric banding with conventional diabetes care. Main Outcome Measures: Remission of type 2 diabetes (fasting glucose level Results: Of the 60 patients enrolled, 55 (92%) completed the 2-year follow-up. Remission of type 2 diabetes was achieved by 22 (73%) in the surgical group and 4 (13%) in the conventional-therapy group. Relative risk of remission for the surgical group was 5.5 (95% confidence interval, 2.2-14.0). Surgical and conventional-therapy groups lost a mean (SD) of 20.7% (8.6%) and 1.7% (5.2%) of weight, respectively, at 2 years (P Conclusions: Participants randomized to surgical therapy were more likely to achieve remission of type 2 diabetes through greater weight loss. These results need to be confirmed in a larger, more diverse population and have long-term efficacy assessed. Trial Registration: actr.org Identifier:ACTRN012605000159651 JAMA. 2008;299(3):316-323.

Improvements in HbA1c remain after 5 years – a follow up of an educational intervention focusing on patients’ personal understandings of type 2 diabetes

This paper reports a 5-year follow-up from a study aimed at evaluating whether an intervention which focused on patients’ personal understanding of their illness was more effective than conventional diabetes care with regard to metabolic control among patients with type 2 diabetes mellitus (DM2). The study was conducted within Swedish primary health care and included 102 patients (mean age 63 years). At clinic level they were randomised into control or intervention groups. The intervention directed at patients consisted of ten two-hour group sessions over 9 months, focusing on patients’ own needs and questions. The mean HbA1c at baseline was 5.71% (S.D. 0.76) in the intervention group and 5.78% (S.D. 0.71) in the control group. At the 5-year follow-up, the mean HbA1c in the intervention group still was 5.71% (S.D. 0.85) while among the controls it had increased to 7.08% (S.D. 1.71). The adjusted difference was 1.37 ( p < 0.0001). Treatment upgrade, BMI, total cholesterol, HDL, LDL and triglycerides at baseline did not influence the difference in HbA1c. These findings indicate that group sessions in patients with DM2 focusing on patients’ personal understanding of their illness are more effective than conventional diabetes care with regard to metabolic control.

Long-Term Effect of the Internet-Based Glucose Monitoring System on HbA1c Reduction and Glucose Stability

To investigate the long-term effectiveness of the Internet-based glucose monitoring system (IBGMS) on glucose control in patients with type 2 diabetes. We conducted a prospective, randomized, controlled trial in 80 patients with type 2 diabetes for 30 months. The intervention group was treated with the IBGMS, while the control group made conventional office visits only. HbA1c (A1C) was performed at 3-month intervals. For measuring of the stability of glucose control, the SD value of A1C levels for each subject was used as the A1C fluctuation index (HFI). The mean A1C and HFI were significantly lower in the intervention group (n = 40) than in the control group (n = 40). (A1C [mean +/- SD] 6.9 +/- 0.9 vs. 7.5 +/- 1.0%, P = 0.009; HFI 0.47 +/- 0.23 vs. 0.78 +/- 0.51, P = 0.001; intervention versus control groups, respectively). Patients in the intervention group with a basal A1C >or=7% (n = 27) had markedly lower A1C levels than corresponding patients in the control group during the first 3 months and maintained more stable levels throughout the study (P = 0.022). Control patients with a basal A1C <7% (n = 15) showed the characteristic bimodal distribution of A1C levels, whereas the A1C levels in the intervention group remained stable throughout the study with low HFI. Long-term use of the IBGMS has proven to be superior to conventional diabetes care systems based on office visits for controlling blood glucose and achieving glucose stability.

When Conventional Diabetes Care Is Viewed as Complementary: Perspectives of a Chinese Client

When Conventional Diabetes Care Is Viewed as Complementary: Perspectives of a Chinese Client

Diabetes care in rural area: clinical and metabolic evaluation.

To evaluate the efficacy of conventional diabetes care in a rural area, metabolic control and the presence of late complications were studied in 622 diabetic patients treated by general practitioners beyond the reach of diabetic centers. Seventy-three (12%) of the patients were classified as type I diabetics (age, 38.0 +/- 16.1 yr; duration of diabetes, 12.8 +/- 9.3 yr) and 549 as type II diabetics (age, 67.0 +/- 10.8 yr; duration of diabetes, 7.3 +/- 5.8 yr). Fifty-eight percent of type I diabetic patients administered insulin once daily and 42% twice daily, whereas most (83%) type II diabetics on insulin received only one insulin injection per day. Treatment of type II diabetic patients consisted of sulfonylureas (58%), diet alone (22%), insulin (18%), and biguanides or a combination of sulfonylurea with biguanides (2%). Poor therapeutic efficacy was observed in all patients, and postprandial hyperglycemia (blood glucose greater than 160 mg/dl) was predominant both in type I diabetics (86%) and in type II diabetics on insulin (80%) as well as off insulin (55%). HbA1c above normal (greater than 5.8%) was seen in 96% of type I and in 90 and 73% of type II diabetics with or without insulin therapy, respectively. Accompanying glucosuria was present in type I (73%) and in type II diabetics (on insulin, 71%; off insulin, 33%). Mean prevalence of late diabetic complications was greatest for insulin-treated patients (type I, type II with, and type II without insulin treatment: retinopathy, 41, 56, 22%; proteinuria, 13, 14, 3%; peripheral neuropathy, 21, 51, 12%), whereas macroangiopathy (16, 53, 31%) predominated in type II diabetic patients.(ABSTRACT TRUNCATED AT 250 WORDS)