Decrease In A1c Research Articles

Effects of Vildagliptin on Ventricular Function in Patients With Type 2 Diabetes Mellitus and Heart Failure: A Randomized Placebo-Controlled Trial

ObjectivesThis study sought to examine the safety of the dipeptidyl peptidase-4 inhibitor, vildagliptin, in patients with heart failure and reduced ejection fraction. BackgroundMany patients with type 2 diabetes mellitus have heart failure and it is important to know about the safety of new treatments for diabetes in these individuals. MethodsPatients 18 to 85 years of age with type 2 diabetes and heart failure (New York Heart Association functional class I to III and left ventricular ejection fraction [LVEF] <0.40) were randomized to 52 weeks treatment with vildagliptin 50 mg twice daily (50 mg once daily if treated with a sulfonylurea) or matching placebo. The primary endpoint was between-treatment change from baseline in echocardiographic LVEF using a noninferiority margin of −3.5%. ResultsA total of 254 patients were randomly assigned to vildagliptin (n = 128) or placebo (n = 126). Baseline LVEF was 30.6 ± 6.8% in the vildagliptin group and 29.6 ± 7.7% in the placebo group. The adjusted mean change in LVEF was 4.95 ± 1.25% in vildagliptin treated patients and 4.33 ± 1.23% in placebo treated patients, a difference of 0.62 (95% confidence interval [CI]: −2.21 to 3.44; p = 0.667). This difference met the predefined noninferiority margin of −3.5%. Left ventricular end-diastolic and end-systolic volumes increased more in the vildagliptin group by 17.1 ml (95% CI: 4.6 to 29.5 ml; p = 0.007) and 9.4 ml (95% CI: −0.49 to 19.4 ml; p = 0.062), respectively. Decrease in hemoglobin A1c from baseline to 16 weeks, the main secondary endpoint, was greater in the vildagliptin group: −0.62% (95% CI: −0.93 to −0.30%; p < 0.001; −6.8 mmol/mol; 95% CI: −10.2 to −3.3 mmol/mol). ConclusionsCompared with placebo, vildagliptin had no major effect on LVEF but did lead to an increase in left ventricular volumes, the cause and clinical significance of which is unknown. More evidence is needed regarding the safety of dipeptidyl peptidase-4 inhibitors in patients with heart failure and left ventricular systolic dysfunction. (Effect of Vildagliptin on Left Ventricular Function in Patients With Type 2 Diabetes and Congestive Heart Failure; NCT00894868)

Dual Therapy Appears Superior to Monotherapy for Low-Income Individuals With Newly Diagnosed Type 2 Diabetes.

Background: There are variable recommendations regarding initiating monotherapy or dual therapy in patients with newly diagnosed type 2 diabetes (T2D). Clear initial strategies are of particular importance in underserved settings where access to care and financial burdens are significant barriers. Objectives: To provide descriptive data of metabolic outcomes to therapy regimens for low-income individuals with newly diagnosed T2D placed on oral hypoglycemic agents (OAs). Methods: We conducted a retrospective chart review of low-income individuals with newly diagnosed T2D initiated on OAs. We provided descriptive data and then evaluated the effects of OA regimens (ie, mono-, dual-, transition [from mono to dual or vice versa] therapy) on hemoglobin A1c (A1c) (baseline to 12 months). Results: A total of 309 patients were included in the study. At 12 months, the mean decrease in A1c for the entire sample was −2.36% (9.37% to 7.01%). Patients prescribed dual therapy had a greater change of A1c compared to those taking monotherapy with metformin (−1.11%, P < .01). Patients who transitioned therapies did not differ in change of A1c compared to monotherapy. Conclusion: Initiation of dual therapy was superior to metformin monotherapy or transitioning therapies and may be preferred for low-income individuals with newly diagnosed T2D.

Type 2 Diabetes (T2D) Management in Primary Care: Still Room for Improvement

The Diabetes Mellitus Assessment of Clinical managemenT In ONtario (DM-ACTION) program sought insights into the management of adults with T2D not at guideline recommended A1C. 88 primary care physicians completed practice surveys, 90% of whom saw >10 persons with diabetes/week. Between 9/2016 and 5/2017, data from 1165 adults with T2D, recent A1C ≥7.3%, and managed with lifestyle strategies ± non-insulin antihyperglycemic agents (AHAs) were analyzed. The cohort (60% men) had a median (interquartile range) age of 61 (53–68) years, T2D for 8 (5–12) years, A1C 7.8 (7.4–8.5)%, BP 126/78 (120–132/70–80) mmHg and LDL-C 1.9 (1.4–2.6) mmol/L. BP <130/80 mmHg was documented for 44%; LDL-C≤2.0 mmol/L for 57%; 28% met both targets. Most (86%) had a BMI ≥25.0 kg/m2; 66% had hypertension, 69% dyslipidemia and 10% had an eGFR<60 mL/min/1.73m2. Most (83%) were using ≤3 AHAs. Although 94% of the physicians reported typically initiating/adding an AHA within 3 months for unmet A1C goals, AHA uptitration/initiation/switching was only recorded for 56% of the patient cohort. Furthermore, the last two A1C measurements were 5 (3–7) months apart; only 21% had a≥0.5% A1C decrease while 34% had a≥0.5% increase. Suboptimal glycemic control was most commonly attributed to non-adherence.

Education and patient preferences for treating type 2 diabetes: a stratified discrete-choice experiment.

PurposeDiabetes is a chronic condition that is more prevalent among people with lower educational attainment. This study assessed the treatment preferences of patients with type 2 diabetes by educational attainment.MethodsPatients with type 2 diabetes were recruited from a national online panel in the US. Treatment preferences were assessed using a discrete-choice experiment. Participants completed 16 choice tasks in which they compared pairs of treatment profiles composed of six attributes: A1c decrease, stable blood glucose, low blood glucose, nausea, treatment burden, and out-of-pocket cost. Choice models and willingness-to-pay (WTP) estimates were estimated using a conditional logit model and were stratified by educational status.ResultsA total of 231 participants with a high school diploma or less education, 156 participants with some college education, and 165 participants with a college degree or more completed the survey. Participants with a college degree or more education were willing to pay more for A1c decreases ($58.84, standard error [SE]: 10.6) than participants who had completed some college ($28.47, SE: 5.53) or high school or less ($17.56, SE: 3.55) (p≤0.01). People with a college education were willing to pay more than people with high school or less to avoid nausea, low blood glucose events during the day/night, or two pills per day.ConclusionWTP for aspects of diabetes medication differed for people with a college education or more and a high school education or less. Advanced statistical methods might overcome limitations of stratification and advance understanding of preference heterogeneity for use in patient-centered benefit–risk assessments and personalized care approaches.

Association between dental visits for periodontal treatment and type 2 diabetes mellitus in an elderly Japanese cohort.

There is an association between type 2 diabetes mellitus (T2DM) and periodontitis. We examined the association between the dental visit status and diabetes status in the Japanese elderly population. In total, 14,551 participants, aged 75 or 80years, who underwent systemic health examinations were analysed. Three independent variables of dental visit status were investigated according to dental claims data, including whether dental treatment was received, type of dental treatment (no visit, periodontal treatment, or other dental treatment), and number of days of periodontal treatment (0, 1-4, or ≥5days). We performed multivariate logistic and linear regression analyses to examine the relationship between dental visit status and diabetes status. The multivariate odds ratio (OR) for T2DM was significantly lower (0.74, 95% confidence interval: 0.66-0.82) for subjects who received periodontal treatment compared with those who did not receive dental treatment. Subjects who received periodontal treatment had a significantly lower OR for T2DM, regardless of the number of days of treatment. In the multivariate linear regression model, receiving periodontal treatment was significantly associated with decrease in A1c (p<.05). Dental visits to receive periodontal treatment were associated with a better diabetes status in the Japanese elderly population.

A Multicenter Real-Life Study on the Effect of Flash Glucose Monitoring on Glycemic Control in Patients with Type 1 and Type 2 Diabetes

To assess the efficacy of ambulatory glucose profiling (AGP) generated by FreeStyle LibrePro™ flash glucose monitoring (FCGM) on glycemic control in patients with uncontrolled type 1 diabetes (T1D) and type 2 diabetes (T2D). Clinical and biochemical data were obtained from 5072 patients with diabetes who had an A1c ≥7% (2536 who had been initiated on FCGM-based AGP between March 2015 and October 2016 [cases] and 2536 age-, gender-, A1c-, site- and time-matched controls who were not initiated on AGP) across seven diabetes clinics in India. Anthropometric and clinical measurements were obtained through standardized techniques. Fasting and postprandial plasma glucose and glycated hemoglobin(A1c) were estimated before and after initiation of AGP. Overall, there was a significant decrease in A1c both in cases and controls; however, the magnitude of reduction was higher among cases (1% vs.0.7%; P < 0.001).The overall reduction in A1c among cases was higher in T2D (9.2% to 8.3%) compared with T1D (9.6% to 9.4%); however, the absolute difference in A1c reduction between cases and controls was higher among T1D (0.5% vs. 0.2%) patients. The reduction in glycemic parameters was irrespective of age or gender (P for trend <0.001) across all study sites. The greatest reductions in A1c were noted within 6 months of AGP initiation. Multiple logistic regression showed that those who did not use AGP had a 1.42 higher risk (95% CI: 1.24-1.64) of not achieving even 0.1% reduction in A1c compared with those who were initiated on AGP even after adjusting for age, gender, body-mass index, systolic blood pressure, time to follow-up A1c, and medication use. This study shows that FCGM-based AGP with FreeStyle LibrePro is associated with significant reductions in A1c levels in both T1D and T2D. In addition, improvement in A1c levels was maintained across all age groups and in patients enrolled at different diabetes clinics in India.

A Randomized, Placebo-Controlled Trial of Metformin for the Treatment of Overweight Induced by Antipsychotic Medication in Young People With Autism Spectrum Disorder: Open-Label Extension

A previous study reported on a 16-week placebo-controlled, randomized clinical trial (RCT) of metformin for weight stabilization in 61 children and adolescents 6 to 17 years old with autism spectrum disorder who were prescribed atypical antipsychotics. The present study describes the results of a 16-week open-label extension. Fifty-two participants from the acute trial (85%) entered the extension; 22 had been on metformin during the initial RCT and 30 had been on placebo. Participants were re-titrated to 500 mg twice a day (6- to 9-year-olds) or 850 mg twice a day (10- to 17-year-olds) during the open-label extension. Primary outcome measure was change in body mass index (BMI) z-score after 16 weeks; secondary outcomes were change in additional body composition and metabolic parameters. After 16 weeks of open-label treatment, participants initially taking placebo during the RCT had lower BMI z-scores (mean 16-week change-0.10, p= .004). Statistically significant improvements also were noted in secondary body composition measures (weight z-score and BMI and weight percentile) but not in metabolic variables. Participants who initially had been taking metformin during the 16-week RCT maintained prior decreases in BMI z-scores but did not have additional weight loss. Three participants discontinued treatment because of an adverse event. No significant changes were noted on metabolic measures, although the decrease in hemoglobin A1c was large (∼1mmol) and consistent across the acute and open-label phases. Metformin can be effective for decreasing weight gain associated with atypical antipsychotic use and maintaining prior improvement in children and adolescents with autism spectrum disorder. Clinical trial registration information-Treatment of Overweight Induced by Antipsychotic Medication in Young People With Autism Spectrum Disorders (ASD); http://clinicaltrials.gov/; NCT01825798.

Meta-analysis and critical review on the efficacy and safety of alpha-glucosidase inhibitors in Asian and non-Asian populations.

Aims/IntroductionTo evaluate the efficacy and safety of alpha‐glucosidase inhibitors (AGI) in Asian and non‐Asian type 2 diabetes patients.Materials and MethodsStudies were identified through a literature search of MEDLINE, EMBASE and other databases until December 2016. All statistical analyses were carried out in Review Manager statistical software by computing the weighted mean difference or odds ratio and 95% confidence interval.ResultsA total of 67 studies were included. AGI vs placebo: compared with the placebo, AGI treatment led to a greater decrease in hemoglobin A1c (HbA1c), fasting plasma glucose and postprandial plasma glucose. No significant difference was observed in HbA1c change, fasting plasma glucose change, postprandial plasma glucose change or incidence of hypoglycemia between Asian and non‐Asian patients. AGI vs active controls: in Asian patients, AGI treatment showed a lower reduction in HbA1c compared with dipeptidyl peptidase‐4 inhibitors and sulfonylurea. In non‐Asian patients, AGI treatment showed a lower reduction in HbA1c compared with thiazolidinedione. No significant difference was observed in HbA1c change and bodyweight change when comparing AGI with other oral hypoglycemic agents between Asian and non‐Asian patients.ConclusionsThe effects of AGI treatment on glycemic control and bodyweight reduction were superior to the placebo without an increased incidence of hypoglycemia, but with an increased incidence of gastrointestinal discomforts. The hypoglycemic effects of AGI were comparable between Asian and non‐Asian patients.

Changes in Cardiometabolic Risk Factors after High-Velocity Circuit Resistance or Treadmill Training in Older Adults

Cardiometabolic syndrome (CMS) is an aggregation of major risk factors that increases a person’s risk for developing cardiovascular disease, diabetes mellitus and the risk of mortality from cardiovascular disease. Continuous treadmill training (TM) has been shown to effectively attenuate the magnitude of CMS risk factors in a multitude of clinical populations. However, there is a paucity of research on the effects of high-velocity circuit resistance training (CRT) on CMS risk factors in older adults. PURPOSE: To compare the effects of CRT versus TM versus no exercise (CONT) on older adults with CMS risk factors. METHODS: Thirteen subjects (1M, 12F; 68.5 ± 7.3 years) with multiple risk factors for CMS participated in 12-weeks of CRT or TM. BMI, body fat % (BF), waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), fasting glucose (GLUC), glycated hemoglobin (A1C), and c-Reactive Protein (CRP) were measured before and after the training. Nutritional intake was monitored to eliminate influence on CMS biomarkers. RESULTS: A within-group analysis showed that CRT exhibited significant decreases in A1C (MD= -0.367, SE= .142, p=0.03), SBP (MD= -21.67, SE= 6.35, p<.01), and DBP (MD= 9.33, SE= 2.53, p=.01), while TM had a trend toward decreased LDL-C (MD= 15.25, SE= 8.16, p=.09), and CONT showed a trend toward increases in CRP (MD= -0.16, SE= .08, p=.08). CRT also exhibited greater decreases in BMI, BF, and CRP than TM and CONT after the intervention, although statistical significance was not reached. There were no significant changes in TC, LDL-C, TG, or GLUC in any group. A between-group analysis showed CRT had significantly greater decreases in DBP compared to TM (MD= -10.58, SE= 3.34, p=.03) and CONT (MD= -12.13, SE= 3.19, p= .01) and a trend toward decreased SBP compared to CONT (MD= -19.47, SE= 8.03, p= .08). CONCLUSION: These preliminary results indicate that CRT results in greater improvements in CMS risk factors than TM. Although statistical significance was not reached for certain risk factors, a larger subject pool may strengthen our results.

Telemedicine consultation for patients with diabetes mellitus: a cluster randomised controlled trial

Introduction There is a widening discrepancy between the increasing number of patients with diabetes mellitus and the health care resources available to manage these patients. Telemedicine has been used in a number of instances to improve and deliver health care where traditional care delivery methods may encounter difficulty. We conducted a cluster randomised controlled trial of telemedicine consultation to manage patients with diabetes mellitus. Methods Eleven primary care centres attached to one Veteran Administration tertiary care centre were randomised to provide patients with diabetes consultation referral either by usual consultation in diabetes clinic or telemedicine consultations via videoconference. Results Altogether, 199 patients were managed by telemedicine consultation and 83 by usual consultation. Patients in both groups showed a small decrease in haemoglobin A1c, with no statistical difference between the groups (telemedicine consultation −1.01% vs usual consultation −0.68%, p = 0.19). Surveys of patients and semi-structured interviews with primary care providers showed better response and satisfaction with telemedicine consultations. Discussion This study shows similar clinical outcomes as measured by glycaemic control for patients with diabetes mellitus having a specialist consultation using real-time telemedicine consultation as compared to in-clinic consultation. Telemedicine consultation was also associated with better patient and primary care provider satisfaction.

Induced and controlled dietary ketosis as a regulator of obesity and metabolic syndrome pathologies

A worsening epidemic of diabetes and its precursor, metabolic syndrome (MetS) is engulfing America. A healthy individual, with proper glucose regulation has an ability to switch between burning fat and carbohydrates. It has been suggested that signaling errors within this homeostatic system, characterized by impaired switching of substrate oxidation from glucose to fat in response to insulin, can contribute to the etiology of metabolic syndrome and occurs before the development of type II diabetes.Glucose regulation with restored insulin sensitivity facilitated through clinically regulated, benign dietary ketosis (BDK), may significantly reduce, regulate and reverse the adverse pathologies common to MetS and obesity. The study assessed if prolonged maintenance of induced and controlled physiological, dietary ketosis, would reverse pathological processes induced by MetS including a reduction in fasting triglycerides, BMI (body mass index) and body fat mass (BFM), weight, a significant decrease and/or normalization of hemoglobin A1c (HgA1c) and an increase in resting metabolic rate (RMR) and blood ketones. A group of 30 adults, previously diagnosed with MetS by their primary care physician, were randomly prescribed to one of three groups: a sustained ketogenic diet with no exercise, standard American diet (SAD) with no exercise or SAD with 3-5 days per week of exercise (30 min.). The results demonstrated that the change over time from week 0 to week 10 was significant (p=0.001) in the ketogenic group for weight, body fat percentage, BMI, HgA1c and ketones. All variables for the ketogenic group out-performed those of the exercise and non-exercise groups, with five of the seven demonstrating statistical significance.

Maternal and perinatal outcomes in pregnant women with type 1 diabetes treated with continuous subcutaneous insulin infusion and real time continuous glucose monitoring in two specialized centers in Medellin, Colombia

Objective: We assessed maternal and perinatal outcomes in pregnant women with type 1 diabetes, treated with continuous subcutaneous insulin infusion and real time continuous glucose monitoring.Methods: This is a retrospective study, analyzing the basal characteristics, glycemic control, maternal and perinatal outcomes of pregnant women with type 1 diabetes, who were on an insulin pump with continuous glucose monitoring between 2011 and 2015.Results: Fourteen patients were included. The median age was 33 and disease duration 12 years. Indications for therapy were mainly poor glycemic control and severe hypoglycemia. The median A1c decrease was 1.02% between the first and third trimester. Pregnancies were associated with complications: 7.1% of the patients had diabetic ketoacidosis, 7.1% had an abortion, 28.5% gestational hypertension and 12.2% preeclampsia. The median gestational age at birth was 37 weeks and four days; the frequency of preterm birth was 7.1% and macrosomia 21.4%. There were no congenital malformations or perinatal death.Conclusions: Baseline characteristics and results of patients in this study were similar to those reported in the previous literature. Continuous subcutaneous insulin infusion with continuous glucose monitoring is an alternative treatment option for pregnant women with type 1 diabetes before or during pregnancy.

Clinical Experience with U-500 Regular Insulin by Multiple Daily Injections and Continuous Subcutaneous Insulin Infusion.

The effectiveness of U-500 regular insulin was assessed in patients with type 2 diabetes who were previously treated with U-100 insulin. A retrospective chart review was conducted on all patients who were prescribed U-500 insulin between January 2012 and December 2013. The primary outcome measure was change in glycosylated hemoglobin (A1C) 1 year after switching from U-100 insulin to U-500 regular insulin. Secondary outcomes included change in body weight, total daily insulin dose, number of daily injections, and episodes of hypoglycemia. Sixty-six patients met inclusion criteria: U-500 regular insulin via multiple daily injections (MDI; n = 36) or continuous subcutaneous insulin infusion (CSII; n = 30). The A1C in patients using MDI decreased by 1.8%, whereas patients using CSII experienced an A1C decrease of 0.63% after 1 year of U-500 regular insulin use. There was an increase of 3.1 + 0.73 kg in body weight in both the MDI and CSII groups, which was significant (P < 0.001). Confirmed hypoglycemia with a blood glucose of 51-70 mg/dL occurred in 51 patients (77%), but there were no episodes of severe hypoglycemia requiring treatment assistance. The use of U-500 regular insulin in MDI and CSII patients can improve glycemic control, and it does not increase the frequency of hypoglycemia when compared with U-100 insulin hypoglycemic incidence reported in the literature.

Physician step prescription and monitoring to improve ARTERial health (SMARTER): A randomized controlled trial in patients with type 2 diabetes and hypertension.

AimsThere are few proven strategies to enhance physical activity and cardiometabolic profiles in patients with type 2 diabetes and hypertension. We examined the effects of physician‐delivered step count prescriptions and monitoring.MethodsParticipants randomized to the active arm were provided with pedometers and they recorded step counts. Over a 1‐year period, their physicians reviewed their records and provided a written step count prescription at each clinic visit. The overall goal was a 3000 steps/day increase over 1 year (individualized rate of increase). Control arm participants were advised to engage in physical activity 30 to 60 min/day. We evaluated effects on step counts, carotid femoral pulse wave velocity (cfPWV, primary) and other cardiometabolic indicators including haemoglobin A1c in diabetes (henceforth abbreviated as A1c) and Homeostasis Model Assessment‐Insulin Resistance (HOMA‐IR) in participants not receiving insulin therapy.ResultsA total of 79% completed final evaluations (275/347; mean age, 60 years; SD, 11). Over 66% of participants had type 2 diabetes and over 90% had hypertension. There was a net 20% increase in steps/day in active vs control arm participants (1190; 95% CI, 550‐1840). Changes in cfPWV were inconclusive; active vs control arm participants with type 2 diabetes experienced a decrease in A1c (−0.38%; 95% CI, −0.69 to −0.06). HOMA‐IR also declined in the active arm vs the control arm (ie, assessed in all participants not treated with insulin; −0.96; 95% CI, −1.72 to −0.21).ConclusionsA simple physician‐delivered step count prescription strategy incorporated into routine clinical practice led to a net 20% increase in step counts; however, this was below the 3000 steps/day targeted increment. While conclusive effects on cfPWV were not observed, there were improvements in both A1c and insulin sensitivity. Future studies will evaluate an amplified intervention to increase impact.

Effect of diacerein as an add-on to metformin in patients with type 2 diabetes mellitus and inadequate glycemic control.

To evaluate the effect of diacerein as an add-on to metformin in patients with type 2 diabetes mellitus (T2DM) and inadequate glycemic control. A randomized, double-blind, placebo-controlled clinical trial was carried out on 12 patients with T2DM and inadequate glycemic control [glycated hemoglobin A1c (A1C) ≥ 7%] with metformin as monotherapy (≥ 1500 mg per day) for at least the previous 90 days. Fasting and postprandial glucose were measured before and after the pharmacological intervention. A1C, lipid profile, creatinine and uric acid were also evaluated. After randomization, all patients continued with their dose of metformin. Six subjects received placebo and the other six volunteers took diacerein. Data were tested using the Wilcoxon signed-rank, Mann-Whitney U and chi-square tests. The Institutional Ethics Committee approved the study protocol. After 90 days of diacerein as an add-on to metformin, there was a significant decrease in fasting glucose (196 ± 79 vs. 149 ± 70 mg/dL, p < 0.05), postprandial glucose (262 ± 99 vs. 187 ± 70 mg/dlL, p < 0.05) and A1C (8.4 ± 2.0 vs. 6.7 ± 1.7 %, p < 0.05). Diacerein as an add-on to metformin in patients with T2DM improved their glycemic control.

Longterm Evaluation of Hemoglobin A1c Following Hepatitis C Therapy in Patients with and without HIV Co-infection

BackgroundHistorically, eradication of HCV with interferon-based treatments was linked with decreased incidence of diabetes. While viral clearance with direct acting agents (DAAs) may be associated with acute decreases in fasting glucose levels and hemoglobin A1c (HbA1c), there remains a need for larger prospective studies to address the longterm impact of sustained viral response (SVR) achieved with DAAs on glucose metabolism.MethodsProspective longitudinal cohort study of 251 subjects with chronic HCV (100% genotype 1a/b, 31% HIV+, 17% diabetes) evaluated pre- and post-DAA therapy with median follow-up of 28 mos. Change in HbA1c, glucose, lipid and transaminase levels were compared based on SVR, HIV, diabetes status and fibrosis stage.ResultsThere was no difference in change in HbA1c between subjects who achieved SVR (n = 241) compared with those who did not. Mean change in HbA1c did not differ from zero (−0.022 ± 0.53%) for those with SVR. Further, when subjects were grouped based on HIV, diabetes or fibrosis stage, there were no significant differences in changes in HbA1c or glucose following SVR. Subjects with HIV had smaller reductions in transaminase values (change ALT −33.3 ± 51 IU/L HIV+ vs. −47.8 ± 45 IU/L HIV-, P = 0.0007). Following SVR, total and LDL cholesterol increased (P = 0.0002 and P = 0.0003, respectively) whereas triglyceride levels decreased (P = 0.008). A greater proportion of subjects (7%) started or increased medication therapy for diabetes following SVR compared with the percentage who decreased diabetes therapy (3%). There was a statistically significant positive correlation between change in BMI and change in HbA1c (r=0.17, P = 0.006).ConclusionThe current study failed to identify sustained benefits in glucose or HbA1c in HCV treated patients, irrespective of HIV, diabetes or fibrosis stage. HIV infection blunted improvements in transaminase levels related to SVR. While HbA1c did not improve with HCV clearance, alterations in lipids were identified that warrant further investigation.Disclosures C. Gross, Merck: stock holder, Own stock; Pfizer: stock holder, Own stock; JohnsonandJohnson: stock holder, Own stock

The effectiveness of text message-based self-management interventions for poorly-controlled diabetes: A systematic review.

BackgroundPoorly controlled diabetes leads to debilitating complications at a significant cost to health systems. Text messaging is an ideal platform for the delivery of self-management interventions to patients with poorly controlled diabetes due to the ubiquity of mobile phones, and the ability of text messaging to reach people in their everyday lives when self-management of the condition is vital. This systematic review aimed to assess the effectiveness of short message service-based diabetes self-management interventions on glycaemic control in adults with poorly controlled diabetes.Methods/designMEDLINE, PubMed, EMBASE, The Cochrane Library and PsychINFO were searched from inception through to 23 January 2017 for randomised controlled trials investigating the use of text messaging based self-management interventions on haemoglobin A1c for patients with poorly controlled diabetes.ResultsSeven studies met the inclusion criteria and were included in the review. Three of the studies reported a significant decrease in haemoglobin A1c from baseline to follow-up in the intervention group compared to the control group. No clear relationship between positive outcomes and intervention dose, content and functionality was seen.DiscussionEvidence supporting text messaging for improvements in glycaemic control in people with poorly controlled diabetes is mixed. Previous reviews have reported positive impacts on glycaemic control for short message service interventions in patients with diabetes; however, when limited to those with poorly controlled diabetes the evidence is less clear. Large-scale studies with robust methodology and longer-term follow-up are needed to further understand the impact of text-messaging-based self-management interventions for people with poorly controlled diabetes.

Antihypertensive effect of an enzymatic hydrolysate from Styela clava flesh tissue in type 2 diabetic patients with hypertension.

BACKGROUND/OBJECTIVESIn this randomized, placebo-controlled, double-blind study, we evaluated the antihypertensive effects of enzymatic hydrolysate from Styela clava flesh tissue in patients with type 2 diabetes mellitus (T2DM) and hypertension.SUBJECTS/METHODSS. clava flesh tissue hydrolysate (SFTH) (n = 34) and placebo (n = 22) were randomly allocated to the study subjects. Each subject ingested two test capsules (500 mg) containing powdered SFTH (SFTH group) or placebo capsules (placebo group) during four weeks.RESULTSIn the SFTH group, systolic and diastolic blood pressure decreased significantly 4 weeks after ingestion by 9.9 mmHg (P < 0.01) and 7.8 mmHg (P < 0.01), respectively. In addition, the SFTH group exhibited a significant decrease in hemoglobin A1c with a tendency toward improvement in homeostasis model assessment of insulin resistance, triglyceride, apolipoprotein B and plasma insulin levels after 4 weeks. No adverse effects were observed in other indexes, including biochemical and hematological parameters in both groups.CONCLUSIONThe results of our study suggested that SFTH exerts a regulatory, antihypertensive effect in patients with T2DM and hypertension.

Long-Term Efficacy and Safety of Sensor Augmented Insulin Pump Therapy with Low-Glucose Suspend Feature in Patients with Type 1 Diabetes.

Literature supports short-term efficacy and safety of Sensor Augmented Insulin Pump (SAP) therapy in patients with type 1 diabetes (T1D). However, no data are available showing long-term outcomes. Our study describes the long-term outcomes of SAP therapy with low-glucose suspend feature (SAP+LGS) in hypoglycemia in a Colombian population with T1D and hypoglycemia. A cohort study was conducted with T1D patients receiving SAP+LGS therapy who initiated this therapy because of hypoglycemia at San Ignacio University Hospital diabetes center in Bogotá, Colombia. Glycated hemoglobin (A1c) was assessed at least every 6 months, severe hypoglycemia (SH) and hypoglycemia unawareness (HU) incidence yearly. Adherence to therapy was also evaluated. One hundred eleven patients were included in the analysis. Total daily insulin dose was reduced during follow-up (mean difference -0.22 U/kg; 95% confidence interval [CI] -0.18 to -0.26; P < 0.001). A1c levels were reduced from a baseline value of 8.8% ± 1.9% to 7.5% ± 1.0% at 5 months (mean difference -1.3%; 95% CI -1.09 to -1.50; P < 0.001) and 7.1% ± 0.8% (mean difference -1.7%; 95% CI -1.59 to -1.90; P < 0.001) at the end of follow-up (47 months on average). The incidence of SH and HU episodes decreased significantly since the first year, and this effect was maintained over time (P < 0.001). SAP+LGS therapy in T1D patients with hypoglycemia led to a significant and sustained decrease in A1c during long periods of follow-up, as well as a significant reduction in SH and HU. Future randomized clinical trials are desired.

What Do I Tell My Clients Who Want to Follow a Low Glycemic Index Diet?

What Do I Tell My Clients Who Want to Follow a Low Glycemic Index Diet?