Desired Level Of Glycemic Control Research Articles

Explaining Poor Medication Adherence among Adults with Type 2 Diabetes in an Urban Community Health Center.

Nonadherence to diabetes medication is a common and costly problem, significantly precluding the evidence-based benefits of diabetes care. Nonadherence is also a poorly understood multifactorial behavior, particularly among African Americans with type 2 diabetes receiving care in under-resourced primary care settings. We investigated several known or suspected individual-level factors influencing diabetes medication adherence among a predominantly African American group of adults with diabetes at a local community health center. Overall diabetes medication adherence was observed to be surprisingly low at 23% (95% confidence interval (CI) = 19%-26%) and did not differ by medication type (p=.435). Common sociodemographic factors were poor predictors of adherence. However, self-perceived health and presence of comorbid conditions were significant. The strongest independent predictors of diabetes medication adherence in this population were a heart attack and having maintained a desired level of glycemic control, indicating the importance of specific comorbidities and motivation for self-care in tailoring interventions to improve adherence.

219: Low 180' glucose level at Oral Glucose Tolerance Test (OGTT)- implications for glucose control

To determine the clinical significance of a low glucose value at 3 hours oral glucose tolerance test (OGTT) among women with a single abnormal value. A retrospective cohort study at a single community women's health clinic between 2009 and 2017. All participants were healthy pregnant women at 24-28 weeks of gestation. Women with a single abnormally high glucose value in the OGTT and otherwise normal plasma glucose values (control group) were compared to women with one abnormally high OGTT glucose value and a low 180' value defined as a plasma glucose level of ≤60 mg/dl (study group). The primary outcome was the need for pharmacological treatment to achieve desired level of glycemic control. Secondary outcomes included suboptimal maternal glycemic control (defined as >30% hyperglycemic measurements), birthweight, large-for-gestational-age and polyhydramnion, . We also compared gestational age at delivery, mode of delivery, rates of preeclampsia, placental pathology and neonatal outcome measures, and composite neonatal complications. Overall 82 women were included in the study group and 96 women in the control group. The groups were similar with regard to demographic and clinical characteristics (Table 1). The rate of women needed insulin to achieve an euglycemic state in the study group was higher in comparison to the control group (7.3% vs. 4.1% for, p< 0.05). There was no significant difference in the need for any other medication between the two groups. Women in the study group had a higher incidence of suboptimal glucose control and polyhydramnion (11% vs. 5.2% and 12.2% vs. 5.2%, respectively, p< 0.05). No difference was found in relation to birthweight, the rate of LGA and for the secondary outcome measures (Table 2). An abnormally low glucose at 180' and abnormally high additional value on OGTT is associated with suboptimal maternal glycemic control and might predict the need for insulin treatment to control glucose levels during pregnancy.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Can we predict the need for pharmacological treatment according to demographic and clinical characteristics in gestational diabetes?

Objective: To determine the ability to predict the need for pharmacological treatment in gestational diabetes mellitus (GDM).Method: A retrospective cohort study. Data were collected from medical records of 1324 GDM patients including demographic data, family history of diabetes, obstetrical history, laboratory results, treatment modality and level of glycemic control. Patients who were identified as pre-gestational diabetes were excluded.Results: Overall, 143 (10.8%) GDM patients required pharmacological therapy. Of women who had GDM in their previous pregnancy; only 11.65% achieved desired glycemic control solely by diet treatment. Moreover, 62.5% of patients requiring pharmacological therapy in their previous pregnancy achieved desired level of glycemic control only by diet. Of patients who achieved desired level of glycemic control on diet until the second antenatal visit, 95% continued to maintain desired level glycemic control throughout pregnancy. Pre-pregnancy BMI >30, fasting plasma glucose >95 mg/dL and maternal age above 30 were associated with increase need for pharmacological treatment. One abnormal value in the OGTT and GCT result >2 mg/dL did not predict the need for pharmacological therapy. Primigravida and family history of GDM were not found to be predictors for treatment modality.Conclusion: Using clinical and demographical data can predict the need for pharmacological treatment for GDM.

283: Metabolic syndrome and gestational diabetes: the impact of achieving desired level of glycemic control on adverse pregnancy outcome

283: Metabolic syndrome and gestational diabetes: the impact of achieving desired level of glycemic control on adverse pregnancy outcome

Glyburide in gestational diabetes – prediction of treatment failure

Objective. To identify factors predicting failure of glyburide treatment in women with gestational diabetes mellitus (GDM).Methods. A retrospective study of all women with GDM that were treated with glyburide in a single tertiary referral center. Patients were switched from glyburide to insulin if they failed to achieve glycemic goals, and were then classified as glyburide failure.Results. Overall, 124 women with GDM treated with glyburide were included in the study, of which 31 (25%) failed to achieve glycemic control. Women in the failure group were characterized by a higher weight gain during pregnancy, higher rates of GDM on previous pregnancies, and a glucose challenge test (GCT) result. On multivariate logistic regression analysis, a GCT value of >200 mg/dl (OR=7.1, 95% CI 2.8–27.6) and weight gain ≥12 kg (OR=3.9, 95% CI 1.2–13.0) were the only significant and independent predictors of glyburide failure. Most women who were successfully treated with glyburide required a daily dose of 5 mg or less and the time required to achieve glycemic control in these cases was 12.4±4.9 days (range 5–24 days). Of the women who failed to achieve glycemic control with gluburide, 26/31 were switched to insulin, of them only 12 (46%) achieved desired level of glycemic control.Conclusion. Most women with GDM achieved desired level of glycemic control under glyburide treatment.

Therapy with biphasic insulin aspart 30/70 (NovoMix 30) improves glycemic control in patients with type 2 diabetes mellitus: resultsfrom a Russian cohort of IMPROVE observational program designed to study safety and efficiency of biphasic insulin aspart 30 inroutine clinical practice

Aim. To assess efficiency and safety of therapy at the onset and after intensification of the treatment with biphasic insulin aspart 30/70 (NovoMix 30)in patients with type 2 diabetes who failed to reach the desired level of glycemic control by using other forms of insulin. Materials and methods. The study included the Russian cohort of patients participating in the global IMPROVE program - a multi-center and multinationalopen observational non-randomized study for the evaluation of safety and efficiency of biphasic insulin aspart 30. Patients with type 2 diabetesmellitus were treated during 26 weeks under conditions of routine clinical practice. A total of 4869 patients enrolled in the program receivedantidiabetic treatment in the period preceding the study. 2430 of them were given oral hypoglycemic (OHG) agents alone and 2343 insulin +/- GHG.95 patients were preciously untreated. The dosage regime was prescribed by the attending physician on an individual basis. Most patients were poorlycompensated prior to the onset of the study. Their mean HbA1c level of 9.2% amounted to 9.9% in the untreated patients. Results of the treatment were analysed by the standard statistical methods for the entire cohort and for separate groups formed depending on previous therapeutic modality. Results. Six months after beginning of treatment with NovoMix 30, the HbA1c level significantly decreased by 2.34% in the entire cohort, 2.50% inthe previously untreated patients, and 2.13% in the two treated groups (p

Pharmacoeconomic analysis of clinical efficiency of combined metformin (Siofor) - insulin therapy in patients with type 2 diabetes mellitus

Aim. To assess expedience of metformin combination with long-acting insulin, determine optimal doses of metformin for patients with type 2 diabetesmellitus (DM2), and accomplish pharmacoeconomic analysis of clinical efficiency of various therapeutic modalities. Materials and methods. Patients with decompensated DM2 (n=126) were under observation for 1 year during which they received rational hypoglycemictherapy with metformin and long-acting insulin (LAI) at bedtime, with the dose being titrated until the desired level of glycemic control wasachieved. The patients were randomly allocated to the following 3 groups: group 1 (sulponylurea derivatives (SUD), LAI, and metformin at a doseof 1000 mg b.i.d.), group 2 (SUD, LAI, and metformin at 500 mg b.i.d.), group 3 (SUD and LAI). In case of postprandial glycemia &gt;9 mmol/l at amaximum dose of SUD, it was replaced by short-acting insulin. Cost-effectiveness analysis of different therapeutic regimes was performed. Results. The cost of examination and treatment of patients given SUD and LAI in combination with metformin at a daily dose of 2000 mg to achievethe desired quality of glycemic control was lower compared with two other groups. Moreover, this therapy was most efficacious and ensured the desiredlevel of glycemic control in a greater number of patients. Cost-effectiveness analysis confirmed advantages of this treatment. Conclusion. Combined hypoglycemic therapy with SUD, LAI, and metformin (200 mg daily) has the advantage of lowest cost and maximum efficiencycompared with other modalities.

Obesity, gestational diabetes and pregnancy outcome

The prevalence of both obesity and gestational diabetes mellitus (GDM) is rising worldwide. The complications of diabetes affecting the mother and fetus are well known. Maternal complications include preterm labor, pre-eclampsia, nephropathy, birth trauma, cesarean section, and postoperative wound complications, among others. Fetal complications include fetal wastage from early pregnancy loss or congenital anomalies, macrosomia, shoulder dystocia, stillbirth, growth restriction, and hypoglycemia, among others. The presence of obesity among diabetic patients compounds these complications. The above-mentioned short-term complications can be mediated by achieving the desired level of glycemic control during pregnancy. However, GDM during pregnancy is associated with increased risk of early obesity, type 2 diabetes during adolescence and the development of metabolic syndrome in early childhood. Additionally, GDM is a marker for the development of overt type 2 diabetes and metabolic syndrome for the mother in the early future.

Approaches to Help People With Diabetes Overcome Barriers for Improved Health Outcomes

Diabetes has reached epidemic proportions, and studies have shown that many patients do not reach optimal glycemic control. Evidence suggests that often there is a long lapse between treatment failure and therapy advancement. A better understanding of the pharmacotherapeutic treatment options, realistic goal-setting, and continued follow-up to support treatment adherence are crucial to improving diabetes care and outcomes. Many possible barriers prevent patients from achieving the desired level of glycemic control, eg, side effects of medications, psychosocial issues, and access to support services. Strategies to overcome these barriers will be presented. Pramlintide, an adjunct to insulin therapy, is the first antihyperglycemic agent to be approved for both type 1 and type 2 diabetes since insulin was developed. Educating patients about the dosing, administration, and side effects of pramlintide before adding it to insulin therapy may improve patient adherence and ultimately optimize treatment outcomes and success.

Pregnancy outcome in obese and morbidly obese gestational diabetic women

Objective We sought to determine whether pregnancy outcome differs between obese and morbidly obese GDM patients and to assess pregnancy outcome in association with mode of treatment and level of glycemic control. Methods A cohort study of 4830 patients with gestational diabetes (GDM), treated in the same center using the same diabetic protocol, was performed. Obesity was defined as prepregnancy BMI >30 and <35 kg/m 2; morbid obesity was defined as prepregnancy BMI ≥35 kg/m 2. Well-controlled GDM was defined as mean blood glucose <105 mg/dl. Pregnancy outcome measures included the rates of large for gestational age (LGA) and macrosomic babies, metabolic complications, the need for NICU admission and/or respiratory support, rate of shoulder dystocia, and the rate of cesarean section. Results Among the GDM patients, the rates of obesity and morbid obesity were 15.7% (760 out of 4830, BMI: 32.4 ± 1.6 kg/m 2) and 11.6% (559 out of 4830, BMI: 42.6 ± 2.2 kg/m 2), respectively. No differences were found with regard to maternal age, ethnicity, gestational age at delivery or oral glucose tolerance test (OGTT) results. Moreover, similar rates of cesarean section, fetal macrosomia, shoulder dystocia, composite outcome, and metabolic complications were noted. Insulin treatment was initiated for 62% of the obese and 73% of the morbidly obese GDM patients ( P < 0.002). Similar rates of obese and morbidly obese patients achieved desired levels of glycemic control (63% versus 61%, respectively). In both obese and morbidly obese patients who achieved a desired level of glycemic control (<105 mg/dl), no difference was found in pregnancy outcome except that both neonatal metabolic complications and composite outcomes were more prevalent in diet-treated subjects in comparison to insulin-treated GDM patients. Conclusion In obese women with GDM, pregnancy outcome is compromised regardless of the level of obesity or treatment modality.