Management Of Diabetic Patients Research Articles

Data-driven diabetes management: a statistical assessment information system leveraging big data

ABSTRACT Amidst the escalating global burden of diabetes and its multifaceted complications, there arises an urgent need for robust healthcare information systems tailored to address the complexities of diabetic patient management. This paper introduces a novel statistical assessment healthcare information system engineered to meticulously analyze diabetes-related data by harnessing the power of big data technologies. Diabetes, affecting millions worldwide, exerts substantial strain on healthcare infrastructures, necessitating innovative solutions to optimize patient outcomes and treatment efficacy. Leveraging advancements in data processing and analytics alongside vast medical datasets, this study pioneers a statistical assessment model explicitly crafted for diabetes analysis within a big data paradigm. The model’s efficacy is rigorously evaluated using key performance metrics such as accuracy and F-measure, within the Hadoop framework. Remarkably, the results demonstrate a significant enhancement in performance compared to conventional methodologies, affirming the model’s potential to revolutionize the accuracy and efficiency of diabetes analysis within a big data milieu. Moving forward, further research avenues include refining the model’s algorithms to accommodate diverse data sources and expanding its applicability to encompass a broader spectrum of diabetes-related factors.

International dietary quality index and its association with diabetes in RaNCD cohort study

Diabetes and its complications pose a significant threat to global health. Various factors contribute to the development of diabetes, with diet being an important trigger. The Dietary Quality Index-International (DQI-I) serves as an indicator of changes in diet and its association with chronic diseases, including diabetes. The aim of this study is to examine the association between DQI-I and diabetes in adults. Data from the first phase of the Ravansar Non-Communicable Disease Cohort Study (RaNCD) were used for this cross-sectional study. The study included individuals from western Iran aged between 35 and 65 years. The DQI-I was used to assess diet quality and the essential aspects of a healthy diet. Multiple logistic regression analyses were performed to compare DQI-I total score and diabetes. A total of 7,079 individuals were included, including 608 diabetic and 6,471 healthy individuals. The mean DQI-I score was 60.51 ± 8.47 in healthy individuals and 63.12 ± 8.64 in diabetics. The odds of developing diabetes were higher in individuals with a higher DQI-I (adjusted odds ratio: 1.49, 95% CI: 1.30–1.73). The variety was 13.43 ± 4.47 in diabetics and 12.59 ± 4.79 in healthy individuals. Adequacy was 33.23 ± 3.71 in diabetics and 33.79 ± 3.37 in healthy individuals. Moderation was 13.27 ± 6.05 in diabetics and 11.79 ± 5.47 in healthy individuals. The overall balance was 2.88 ± 2.21 in the healthy group and 2.61 ± 2.13 in the diabetics. The macronutrient ratio was 2.15 ± 1.88 in the healthy group and 2.04 ± 1.84 in the diabetics. The fatty acid ratio was 0.72 ± 1.29 in the healthy group and 0.56 ± 1.17 in the diabetic group. The overall balance score was higher in the healthy subjects. The DQI-I total score was higher in diabetics, indicating a positive association between diabetes and the DQI-I. Therefore, the importance of continuous dietary management and education of diabetic patients should be emphasized.

Correlation Between Diverse Smoking Habits and the Risk of Developing Type 2 Diabetes: A Comparative Analysis.

Diabetes mellitus (DM) is a prevalent metabolic illness that arises as a result of a complex interplay between genetic predisposition, environmental influences, and lifestyle choices. The precise mechanisms elucidating the association between smoking and the onset of DMremain incompletely understood, despite the proposal of several ideas. The objective of this study ‎was to conduct a comparative analysis of blood glucose levels, hemoglobin A1c (HbA1c) levels, insulin hormone levels, and homeostasis model assessment of insulin resistance (HOMA-IR) ‎levels in diabetic patients who smoked and those who did not. The study included a total of 320 volunteers divided into four groups, with each group consisting of 80 volunteers. The first group served as the control group and consisted of ‎healthy individuals. The remaining three groups consisted of type 2 diabetes mellitus (T2DM) patients, categorized based on their smoking habits. The second ‎group comprised T2DM patients who did not smoke, the third group consisted of T2‎DM patients who smoked cigarettes, and the fourth group included T2DM patients ‎who smoked e-cigarettes.‎At recruitment, data on age, fat %, waist circumference (cm), and body mass index (kg/m2) was collected. Biochemical markers measured were fasting blood glucose (FBG), HbA1c, insulin, and HOMA-IR‎ levels. The findings demonstrated a statistically significant increase (P<0.001) in the levels of each parameter, particularly among patients with T2DM who engaged in e-cigarette smoking, compared to the control group.‎ It was found that engaging in dual smoking, which involves the use of both traditional cigarettes and e-cigarettes, was associated with a higher likelihood of elevated HbA1c levels and other negative health effects. When it comes to the management of diabetic patients, abstaining from smoking and participating in smoking cessation programs, for patients who smoke, should be the essential approaches. It was found that dual smokingled to a higher likelihood of elevated HbA1c levels and this association was most pronounced among male individuals, those who were physically inactive, and thoseclassified as obese. Further studies should be conducted on the detrimental health consequences associated with e-cigarettes, with a particular focus on enhancing the awareness of healthcare professionals and their patients of the potential risks. This is particularly significant due to the prevailing perceptionthat e-cigarettes are inherently "safe".

Deep Learning‐Coupled Metabolic Heat Integrated Sensing System for Noninvasive Continuous Monitoring of Blood Glucose

The dynamic and continuous monitoring of blood glucose (BG) concentration is crucial for the health management of diabetic patients. Despite its importance, significant challenges remain in the development of effective BG monitoring technologies. Metabolic heat conformation (MHC) offers a promising solution due to its noninvasiveness and reliability. However, progress in MHC technology is hindered by the complexities of multisensor integration and the intricate correlation between MHC and BG. Herein, a wearable BG continuous monitoring device based on metabolic heat integrated sensing (MHIS) is developed, combined with a deep learning network to enable continuous BG detection using MHC principles. The MHIS device integrates a miniaturized circuit and intelligent secondary signal processing, allowing for the simultaneous acquisition and integrated operation of various physiological parameters, including metabolic heat production. By integrating a gate recurrent unit neural network, a model is established to facilitate continuous BG monitoring. The wearable device has a certain accuracy, and when analyzed in comparison with commercial noninvasive glucose meters, the mean absolute relative error meets international standards. The deep learning‐enhanced MHIS system proposed in this work enables noninvasive BG monitoring, paving the way for advancements in personalized healthcare management and offering new opportunities in digital healthcare consultation.

8152 Benefits of Inpatient Diabetes Management by a Specialized Diabetes Team

Abstract Disclosure: M. Bojarian: None. A. Ohri: None. C. Buettner: None. Background: Inpatient dysglycemia is associated with poor clinical outcomes such as prolonged length of stay (LOS), increased risk of ICU admission, and in-hospital mortality. The benefits of managing diabetic patients in the hospital with a dedicated diabetes team, as opposed to standard care on episodes of hypoglycemia or hyperglycemia, reduction in LOS, and 30-day readmission rates, remain uncertain. A potential confounder is the likelihood that patients receiving a diabetes consult may be sicker than those without a consult. Given the growing evidence supporting the role of specialized diabetes teams in improving care for diabetes patients, we sought to examine these benefits at our hospital. We plan to address confounding variables through propensity score matching. Objective: To assess whether diabetes patients experience reduced LOS, hypoglycemia, hyperglycemia, and 30-day readmission rates when managed by a specialized diabetes team compared to inpatients managed by a hospitalist team. Material and Methods: This quality improvement study compared LOS, hypoglycemia (glucose &amp;lt;70 mg/dL), hyperglycemia (glucose &amp;gt;180 mg/dL), and 30-day readmission rates in diabetes patients managed by a specialized diabetes team versus a hospitalist team at our hospital between June 2022 and December 2022. Results: 5676 patients with diabetes were admitted between June and December 2022 at our hospital, and a specialized diabetes team managed 417 patients (7.34%). In a preliminary analysis in which no propensity matching was performed yet, the 30-day readmission rate was significantly lower (87,16.6%) in patients who received a diabetes consult compared to patients who did not receive a diabetes consult (320,17.9%). The rate of hypoglycemia was higher (24.4%) in the specialized diabetes consult group than in the non-diabetes consults group (19.9%). Additionally, LOS was longer in patients with a specialized diabetes consult (7.1 vs. 3.1 days), and hyperglycemia (glucose &amp;gt;180 mg/dL) was more prevalent in the specialized diabetes consult group (78.9%) compared to the non-diabetes consult group (39.2%). Conclusion: In this retrospective analysis, patients managed by a specialized diabetes team showed lower readmission rates despite longer hospitalization and increased dysglycemic episodes. This could be attributed to sicker patients receiving diabetes consults, influencing dysglycemia rates. To account for such confounders, ongoing propensity score matching aims to provide a clearer understanding. Reduced readmission rates suggest improved care transitions, potentially resulting in significant cost savings for the healthcare system. Presentation: 6/1/2024

A Prospective Cross-Sectional Study on the Correlation of Adenosine Deaminase and HbA1c With Microvascular Complications in Type 2 Diabetes Mellitus at a Tertiary Care Hospital in Central India.

Background Type 2 diabetes mellitus (T2DM) is a prevalent chronic condition characterized by hyperglycemia, which can lead to various microvascular complications, including diabetic nephropathy, neuropathy, and retinopathy. Identifying reliable biomarkers for early detection and risk stratification of these complications is crucial for improving patient outcomes. Adenosine deaminase (ADA) and HbA1c have emerged as potential markers associated with immune function, inflammation, and long-term glycemic control. This study investigates the correlation between ADA and HbA1c levels and microvascular complications in patients with T2DM. Material and methods This prospective observational cross-sectional study involved 150 patients diagnosed with T2DM, focusing on those with diabetic nephropathy, neuropathy, and retinopathy. Clinical data were collected through patient interviews, clinical examinations, and laboratory tests, including measurements of fasting blood glucose, HbA1c, serum creatinine, ADA levels, and urine protein creatinine ratio (UPCR). Fundus examinations and nerve conduction velocity (NCV) tests were performed to assess diabetic retinopathy and neuropathy, respectively. Data were analyzed using SPSS version 25.0 (IBM Corp., Armonk, New York), with statistical tests to evaluate the correlation between ADA and HbA1c levels and microvascular complications. Results The study found a significant correlation between elevated ADA and HbA1c levels and microvascular complications in patients with T2DM. Higher ADA levels were particularly associated with diabetic nephropathy (p=0.003), while HbA1c levels showed a positive correlation with all three complications: nephropathy, neuropathy, and retinopathy. The findings suggest that ADA and HbA1c levels can serve as valuable biomarkers for identifying patients at higher risk of developing these complications. Conclusion This study highlights the potential of ADA and HbA1c as biomarkers for early detection and risk assessment of microvascular complications in T2DM patients. Routine monitoring of these markers could improve the management and prognosis of diabetic patients by enabling timely interventions to prevent or mitigate the progression of complications. Further research is needed to explore the underlying mechanisms linking ADA with diabetic complications and to validate its clinical utility.

Hydrogel Capacitors Based on MoS2 Nanosheets and Applications in Glucose Monitoring.

Non-invasive/minimally invasive continuous monitoring of blood glucose and blood glucose administration have a high impact on chronic disease management in diabetic patients, but the existing technology is yet to achieve the above two purposes at the same time. Therefore, this study proposes a microfluidic microneedle patch based on 3D printing technology and an integrated control system design for blood glucose measurement, and a drug delivery control circuit based on a 555 chip. The proposed method provides an improved preparation of a PVA-PEG-MoS2 nanosheet hydrogel, making use of its dielectric properties to fabricate a microcapacitor and then embedding it in a microfluidic chip. When MoS2 nanosheets react with interstitial liquid glucose (and during the calibration process), the permittivity of the hydrogel is changed, resulting in changes in the capacitance of the capacitor. By converting the capacitance change into the square-wave period change in the output of the 555 chip with the control circuit design accordingly, the minimally invasive continuous measurement of blood glucose and the controlled release of hypoglycemic drugs are realized. In this study, the cross-linking structure of MoS2 nanosheets in hydrogel was examined using infrared spectroscopy and scanning electron microscopy (SEM) methods. Moreover, the critical doping mass fraction of MoS2 nanosheets was determined to be 2% via the measurement of the dielectric constant. Meanwhile, the circuit design and the relationship between the pulse cycle and glucose concentration is validated. The results show that, compared with capacitors in series, the microcapacitors embedded in microfluidic channels can be connected in parallel to obtain better linearized blood glucose measurement results.

Pharmacological Treatments for Erectile Dysfunction in Diabetic Patients: Efficacy, Safety, and Emerging Therapies

Men with diabetes mellitus, particularly those with type 2 diabetes (T2DM), are known to experience erectile dysfunction (ED), a condition whose prevalence has risen to 75% in recent years. The pathophysiology of ED in diabetic patients involves vascular impairment, neuropathy, hormonal dysregulation, and chronic hyperglycemia, all of which contribute to endothelial dysfunction, reduced nitric oxide availability, and nerve damage. Phosphodiesterase type 5 (PDE5) inhibitors, such as sildenafil, tadalafil, and vardenafil, are the first-line pharmacological treatments for ED, though their efficacy is reduced in diabetic patients due to the extent of vascular and neurological damage. Other treatments, including testosterone replacement therapy (TRT), intracavernosal injections, and vacuum erection devices (VEDs), provide alternatives for patients unresponsive to PDE5 inhibitors. Emerging therapies such as low-intensity extracorporeal shockwave therapy (LI-ESWT) and regenerative medicine approaches, including stem cell and platelet-rich plasma (PRP) injections, show potential in improving erectile function in diabetic patients. Glycemic control plays a critical role in both preventing ED and enhancing the efficacy of treatments by improving vascular function and reversing nerve damage. This review was conducted through an extensive analysis of current literature on pharmacological and emerging treatments for ED in diabetic patients. In conclusion, integrating traditional pharmacotherapy with emerging treatments and emphasizing glycemic control holds promise for optimizing ED management in diabetic patients. Keywords: Erectile Dysfunction (ED), Diabetes Mellitus (T2DM), Phosphodiesterase Type 5 (PDE5) Inhibitors, Testosterone Replacement Therapy (TRT), Glycemic Control

Comparative effects of glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter-2 inhibitors on heart failure with preserved ejection fraction in diabetic patients: a meta-analysis

BackgroundHeart failure with preserved ejection fraction (HFpEF) is common in type 2 diabetes mellitus (T2D), leading to high morbidity and mortality. Managing HFpEF in diabetic patients is challenging with limited treatments. Sodium-glucose co-transporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP1-RA) have shown potential cardiovascular benefits. This meta-analysis compares the effects of GLP1-RA and SGLT2 inhibitors on HFpEF in T2D patients.MethodsWe conducted a meta-analysis of randomized controlled trials (RCTs) and observational studies evaluating GLP1-RA and SGLT2 inhibitors’ impact on HFpEF in T2D patients. Databases searched included PubMed, MEDLINE, and Cochrane Library up to July 2024. Primary outcomes were changes in left ventricular ejection fraction (LVEF), myocardial fibrosis (extracellular volume fraction, ECV), and functional capacity (6-minute walk test, 6MWT). Secondary outcomes included HbA1c, body weight, and systolic blood pressure (SBP). ResultsTwelve studies with 3,428 patients (GLP1-RA: 1,654; SGLT2 inhibitors: 1,774) were included. Both GLP1-RA and SGLT2 inhibitors significantly improved LVEF compared to placebo (GLP1-RA: mean difference [MD] 2.8%, 95% confidence interval [CI] 1.5 to 4.1, p < 0.001; SGLT2 inhibitors: MD 3.2%, 95% CI 2.0 to 4.4, p < 0.001). SGLT2 inhibitors significantly reduced myocardial fibrosis (MD -3.5%, 95% CI -4.2 to -2.8, p < 0.001) more than GLP1-RA (MD -2.3%, 95% CI -3.0 to -1.6, p < 0.001). Functional capacity improved significantly with both treatments (GLP1-RA: MD 45 m, 95% CI 30 to 60, p < 0.001; SGLT2 inhibitors: MD 50 m, 95% CI 35 to 65, p < 0.001). Secondary outcomes showed reductions in HbA1c (GLP1-RA: MD -1.1%, 95% CI -1.4 to -0.8, p < 0.001; SGLT2 inhibitors: MD -1.0%, 95% CI -1.3 to -0.7, p < 0.001) and body weight (GLP1-RA: MD -2.5 kg, 95% CI -3.1 to -1.9, p < 0.001; SGLT2 inhibitors: MD -2.0 kg, 95% CI -2.6 to -1.4, p < 0.001). Both treatments significantly lowered SBP (GLP1-RA: MD -5.2 mmHg, 95% CI -6.5 to -3.9, p < 0.001; SGLT2 inhibitors: MD -4.8 mmHg, 95% CI -6.0 to -3.6, p < 0.001).ConclusionsGLP1-RA and SGLT2 inhibitors significantly benefit HFpEF management in T2D patients. SGLT2 inhibitors reduce myocardial fibrosis more effectively, while both improve LVEF, functional capacity, and metabolic parameters. These therapies should be integral to HFpEF management in diabetic patients. Further research is needed on long-term outcomes and potential combined therapy effects.

Evaluation of Prothrombin and Activated Partial Thromboplastin Time in Patients with Diabetes Mellitus

Diabetes mellitus (DM) is a metabolic disease accompanied by high blood glucose due to a defect in insulin secretion, insulin activity, or both. High blood glucose levels may lead to serious damage to some organs of the body, mainly blood vessels and nerves. Therefore, this study was conducted to evaluate prothrombin time (PT) and activated partial thromboplastin time (APTT) in diabetic patients. 100 venous blood samples were collected from diabetic patients attending the diabetes clinic in Sebha. Of them, 57 were males and 53 were females, and their ages ranged between 15-88 years. out of 100, 48 Were treated with insulin-regulating tablets and 52 Were treated with insulin injections. 34 blood samples were collected from healthy people (15 females and 19 males). They were used as a control group, aged between 14-55 years. 4 ml of venous blood was drawn, and 2 ml was placed in containers containing the anticoagulant sodium citrate to perform the PT and APTT. Place 2 ml of sample in tubes containing sodium fluoride anticoagulant to perform a fasting blood sugar (FBS). Place the tubes in a centrifuge at 3000 rpm to obtain plasma. The results showed the mean of PT in patients was (19.4 ± 3.6), the mean APTT was (35.9 ± 1.5) and the Mean FBS was (229.7 ± 80.39), whereas the mean PT, APTT, and FBS in control were (12.8 ± 1.6), (25.4 ± 2.1), and (91.9 ± 12.5) respectively. there was a significant increase of PT and APTT in patients compared to control (P&lt;0.05), PT and FBS were higher in patients who used insulin injection with significant differences(P&lt;0.05), while no significant differences were in APTT (P &gt; 0.05). The present study observed a statistically significant increase in PT and APTT among patients compared to controls, it would be helpful to incorporate coagulation screening as a routine investigation for the better management of diabetic patients.

Comparative Effects of GLP-1 Receptor Agonists and Metformin on Glaucoma Risk in Type 2 Diabetes Patients

PurposeTo compare effects of glucagon-like peptide-1 (GLP-1) receptor agonists and metformin on the risk of primary open-angle glaucoma (POAG), ocular hypertension, and the need for first-line glaucoma treatments in patients with type 2 diabetes. DesignA retrospective cohort study was conducted using electronic medical records (EMR) data from the from an international electronic health record network, covering a period from May 2006 to May 2024. ParticipantsPatients diagnosed with type 2 diabetes mellitus (T2DM) who were treated with either GLP-1 receptor agonists or metformin. MethodsData from 120 healthcare organizations across 17 countries were analyzed. Patient outcomes were assessed at 1, 2, and 3 years. Propensity score matching (PSM) was used to balance covariates such as demographics, comorbidities, and medication usage. Risk ratios (RR) with 95% confidence intervals (CI) were calculated. Main Outcome MeasuresIncidence of POAG, ocular hypertension, and the need for first-line treatments including beta-blockers, prostaglandin analogues, brimonidine, brinzolamide, dorzolamide, netarsudil, and laser trabeculoplasty. ResultsAfter PSM, both groups included 61,998 patients at the 1-year follow-up, 27,414 at the 2-year follow-up, and 14,100 at the 3-year follow-up. Patients treated with GLP-1 receptor agonists had a significantly decreased risk of developing POAG compared to those on metformin at 1 year (RR 0.59, 95% CI 0.39-0.88), 2 years (RR 0.50, 95% CI 0.32-0.78), and 3 years (RR 0.59, 95% CI 0.37-0.94). Similar protective effects were observed for ocular hypertension with risk reductions of 56% at 1 year (RR 0.44, 95% CI 0.31-0.62), 57% at 2 years (RR 0.43, 95% CI 0.30-0.62), and 49% at 3 years (RR 0.51, 95% CI 0.34-0.75). The risk of first-line therapy initiation was also lower in the GLP-1 receptor agonists group at 1 year (RR 0.63, 95% CI 0.53-0.74), 2 years (RR 0.71, 95% CI 0.59-0.85), and 3 years (RR 0.75, 95% CI 0.62-0.91). ConclusionsGLP-1 receptor agonists are associated with a significantly lower incidence of POAG, ocular hypertension, and the need for first-line glaucoma treatments compared to metformin in patients with type 2 diabetes. These findings highlight the potential ocular benefits of GLP-1 receptor agonists and their expanding role in the clinical management of diabetic patients.

Incidence of Various Tuberculous Lesions in Indian Patients with Diabetes Mellitus: A Cross-Sectional Study

Background: Globally, TB is a major health issue, especially in low- and middle-income nations. Diabetes mellitus (DM) increases TB risk and complicates treatment. Due to the greatest worldwide TB burden and rising DM incidence, India faces a double public health problem. This study investigated the incidence and types of tuberculous lesions in Indian patients with diabetes mellitus. Methods: A total of 250 individuals with a history of DM and respiratory symptoms were included. Data were collected through patient interviews, clinical examinations, and diagnostic tests. The association between diabetes-related factors and the incidence of tuberculous lesions was analyzed. Results: Out of 250 patients, 70 (28%) were diagnosed with tuberculous lesions. Pulmonary tuberculosis was the most common type (16%), followed by extrapulmonary tuberculosis (8%) and disseminated tuberculosis (4%). The duration of diabetes and higher HbA1c levels were considerably correlated with an increased risk of tuberculous lesions (p&lt;0.05). Patients commonly presented with cough with sputum (85.7%), weight loss (78.6%), and loss of appetite (71.4%). Sputum examination for Acid-Fast Bacilli (AFB) was positive in 64.3% of cases, and chest X-rays showed lesions in 71.4% of patients. Conclusion: The study highlights a significant incidence of tuberculous lesions among diabetic patients, with pulmonary tuberculosis being the predominant type. Poor glycemic control and longer duration of diabetes are critical risk factors. These findings emphasize the need for regular TB screening and proactive management in diabetic patients to prevent complications and improve outcomes. Recommendation: Healthcare providers should integrate routine TB screening into the care protocols for diabetic patients, particularly those with poor glycemic control and long-standing diabetes. Public health strategies should focus on the dual burden of TB and DM to enhance early detection and treatment, thereby improving patient outcomes. Keywords: Tuberculosis, Diabetes Mellitus, Incidence, Glycemic Control

Electronic Glycemic Management System Improved Glycemic Control and Reduced Complications in Patients With Diabetes Undergoing Coronary Artery Bypass Surgery: A Randomized Controlled Trial.

In-hospital hyperglycemia poses significant risks for patients with diabetes mellitus undergoing coronary artery bypass graft (CABG) surgery. Electronic glycemic management systems (eGMSs) like InsulinAPP offer promise in standardizing and improving glycemic control (GC) in these settings. This study evaluated the efficacy of the InsulinAPP protocol in optimizing GC and reducing adverse outcomes post-CABG. This prospective, randomized, open-label study was conducted with 100 adult type 2 diabetes mellitus (T2DM) patients post-CABG surgery, who were randomized into two groups: conventional care (gCONV) and eGMS protocol (gAPP). The gAPP used InsulinAPP for insulin therapy management, whereas the gCONV received standard clinical care. The primary outcome was a composite of hospital-acquired infections, renal function deterioration, and symptomatic atrial arrhythmia. Secondary outcomes included GC, hypoglycemia incidence, hospital stay length, and costs. The gAPP achieved lower mean glucose levels (167.2 ± 42.5 mg/dL vs 188.7 ± 54.4 mg/dL; P = .040) and fewer patients-day with BG above 180 mg/dL (51.3% vs 74.8%, P = .011). The gAPP received an insulin regimen that included more prandial bolus and correction insulin (either bolus-correction or basal-bolus regimens) than the gCONV (90.3% vs 16.7%). The primary composite outcome occurred in 16% of gAPP patients compared with 58% in gCONV (P < .010). Hypoglycemia incidence was lower in the gAPP (4% vs 16%, P = .046). The gAPP protocol also resulted in shorter hospital stays and reduced costs. The InsulinAPP protocol effectively optimizes GC and reduces adverse outcomes in T2DM patients' post-CABG surgery, offering a cost-effective solution for inpatient diabetes management.

Inpatient diabetes management.

Diabetes mellitus is currently approaching epidemic proportions and disproportionately affects patients in the hospital setting. In the United States, individuals living with diabetes represent over 17 million emergency department visits and 8 million admissions annually. The management of these patients in the hospital setting is complex and differs considerably from the outpatient setting. All patients with hyperglycemia should be screened for diabetes, as in-hospital hyperglycemia portends a greater risk for morbidity, mortality, admission to an intensive care unit, and increased hospital length of stay. However, the definition of hyperglycemia, glycemic targets, and strategies to manage hyperglycemia in the inpatient setting can vary greatly depending on the population considered. Moreover, the presenting illness, changing nutritional status, and concurrent hospital medications often necessitate thoughtful consideration to adjustments of home diabetes regimens and/or the initiation of new insulin doses. This review article will examine core concepts and emerging new literature surrounding inpatient diabetes management, including glycemic targets, insulin dosing strategies, noninsulin medications, new diabetes technologies, inpatient diabetes management teams, and discharge planning strategies, to optimize patient safety and satisfaction, clinical outcomes, and even hospital financial health.

Perceived Penalties for Sharing Patient Beliefs with Health Care Providers.

Health care interactions may require patients to share with a physician information they believe but is incorrect. While a key piece of physicians' work is educating their patients, people's concerns of being seen as uninformed or incompetent by physicians may lead them to think that sharing incorrect health beliefs comes with a penalty. We tested people's perceptions of patients who share incorrect information and how these perceptions vary by the reasonableness of the belief and its centrality to the patient's disease. We recruited 399 United States Prolific.co workers (357 retained after exclusions), 200 Prolific.co workers who reported having diabetes (139 after exclusions), and 244 primary care physicians (207 after exclusions). Participants read vignettes describing patients with type 2 diabetes sharing health beliefs that were central or peripheral to the management of diabetes. Beliefs included true and incorrect statements that were reasonable or unreasonable to believe. Participants rated how a doctor would perceive the patient, the patient's ability to manage their disease, and the patient's trust in doctors. Participants rated patients who shared more unreasonable beliefs more negatively. There was an extra penalty for incorrect statements central to the patient's diabetes management (sample 1). These results replicated for participants with type 2 diabetes (sample 2) and physician participants (sample 3). Participants believed that patients who share incorrect information with their physicians will be penalized for their honesty. Physicians need to be educated on patients' concerns so they can help patients disclose what may be most important for education. Understanding how people think they will be perceived in a health care setting can help us understand what they may be wary to share with their physicians.People think that patients who share incorrect beliefs will be viewed negatively.Helping patients share incorrect beliefs can improve care.

Apple Cider Vinegar in the Combat Against Type 2 Diabetes and Obesity – An Overview of Recent Research

ABSTRACT Introduction Apple Cider Vinegar, primarily composed of acetic acid, is gaining more recognition for its possible health advantages, especially its anti-diabetic effects and its beneficial impact on weight loss. Aim of this study The aim of this review is to discuss the current state of knowledge regarding the influence of ACV on glycemic indices and weight management in diabetic and obese patients, explore the possibilities of preventing comorbidities, and assess the safety of ACV consumption. Materials and Methods Research was performed based on Pubmed and Google Scholar databases. The literature was reviewed using the keywords : Apple Cider Vinegar, Diabetes, Glucose, Obesity. Results Studies have confirmed that apple cider vinegar exhibits significant anti-obesity and anti-diabetic properties. It demonstrates dose- and time-dependent effects on reducing fasting glucose, postprandial glucose, glycated hemoglobin, and lipid parameters. It positively impacts weight loss, reducing waist and hip circumference, and enhances tissue sensitivity to insulin. Additionally, apple cider vinegar has been shown to potentiate the effects of metformin, with liquid consumption yielding better results than pill form. Conclusions Although initial findings are encouraging, additional research with a larger participant pool and an extended duration of vinegar consumption is necessary. The brevity of the study period restricts the observation of long-term effects, and a larger sample size would improve the applicability of the findings. Key words: apple cider vinegar; diabetes; glucose; obesity

W122 - Diabetes Management in Patients With Substance Use Disorder Served in a Network of Federally Qualified Health Centers in Florida: A Retrospective Analysis Using EHR Data

W122 - Diabetes Management in Patients With Substance Use Disorder Served in a Network of Federally Qualified Health Centers in Florida: A Retrospective Analysis Using EHR Data

NURSES’ KNOWLEDGE AND ATTITUDES TOWARDS DIETARY MANAGEMENT OF PATIENTS WITH DIABETES MELLITUS

Proper dietary management is crucial for patients with diabetes mellitus, and nurses play a key role in educating and managing these patients. Understanding nurses' knowledge and attitudes towards dietary management can help improve patient care. Objective: To assess the knowledge and attitudes of nurses towards dietary management of patients with diabetes mellitus. Methods: A cross-sectional study was conducted in the Nursing Department of Lahore General Hospital, Multan, from June 2023 to June 2024. A total of 150 nurses from medical and surgical wards were selected through convenience sampling. Data were collected using a self-administered questionnaire, which was anonymous and took 15-20 minutes to complete. The questionnaire was divided into three sections: demographic, social, and professional information; a modified version of the 20-item Nutritional Management of Diabetes Knowledge Test; and a 14-item Nurses’ Attitudes about Nutritional Management of Diabetes Questionnaire. Descriptive statistics were used to summarize the data, and Pearson’s correlation analysis was employed to explore the relationship between knowledge and attitudes. Results: The mean knowledge score among the nurses was 11.20 ± 1.90, with scores ranging from 5 to 17. After standardization, 90 nurses (60%) exhibited moderate knowledge of nutritional management for diabetes. The mean attitude score was 59.71 ± 5.98, with 129 participants (86%) demonstrating a favorable attitude. Pearson’s correlation analysis showed no statistically significant association between knowledge and attitude (r= -0.070, p= 0.419). Conclusion: The study found that nurses generally had moderate knowledge and a favorable attitude toward the dietary management of diabetic patients. These findings suggest a need for targeted educational interventions to enhance nurses' knowledge in this area, potentially improving patient outcomes.

New ways of mitigating aldosterone in cardiorenal disease.

Steroidal mineralocorticoid receptor antagonists (MRAs) bind to the mineralocorticoid receptor and antagonize the effects of aldosterone, which contributes to the development and progression of cardio- and renovascular diseases. Guidelines recommend steroidal MRAs in patients with heart failure with reduced or mildly reduced ejection fraction, as they reduce morbidity and mortality. In heart failure with preserved ejection fraction, MRAs have not convincingly shown to improve prognosis. Steroidal MRAs delay the progression of chronic kidney disease, reduce proteinuria and lower blood pressure in resistant hypertension but can induce hyperkalaemia. Due to their limited selectivity to the mineralocorticoid receptor, steroidal MRAs can cause significant adverse effects, i.e. libido loss, erectile dysfunction, gynaecomastia, and amenorrhoea, leading to low rates of persistance. Against this background, new avenues for developing non-steroidal, selective (ns)MRAs and aldosterone-synthase inhibitors have been taken. Finerenone has been shown to delay the progression of diabetic nephropathy and lower the incidence of heart failure hospitalizations in patients with chronic kidney disease and diabetes compared with placebo. Finerenone has therefore been recommended by the 2023 European Society of Cardiology Guidelines for the management of diabetes in patients with type 2 diabetes and chronic kidney disease. Further randomized controlled trials assessing the safety and effectiveness of finerenone in patients with heart failure are currently ongoing. Esaxerenone provides antihypertensive effects and has been approved for the treatment of hypertension in Japan. Baxdrostat and lorundostat, novel selective aldosterone-synthase inhibitors, are currently under investigation. In phase II trials, baxdrostat and lorundostat were safe and effective in lowering blood pressure in resistant hypertension. In this review, we summarize and critically discuss the evidence for new drugs mitigating aldosterone in heart failure, hypertension, and chronic kidney disease.

Technology in the management of diabetes in hospitalised adults.

Suboptimal glycaemic management in hospitals has been associated with adverse clinical outcomes and increased financial costs to healthcare systems. Despite the availability of guidelines for inpatient glycaemic management, implementation remains challenging because of the increasing workload of clinical staff and rising prevalence of diabetes. The development of novel and innovative technologies that support the clinical workflow and address the unmet need for effective and safe inpatient diabetes care delivery is still needed. There is robust evidence that the use of diabetes technology such as continuous glucose monitoring and closed-loop insulin delivery can improve glycaemic management in outpatient settings; however, relatively little is known of its potential benefits and application in inpatient diabetes management. Emerging data from clinical studies show that diabetes technologies such as integrated clinical decision support systems can potentially mediate safer and more efficient inpatient diabetes care, while continuous glucose sensors and closed-loop systems show early promise in improving inpatient glycaemic management. This review aims to provide an overview of current evidence related to diabetes technology use in non-critical care adult inpatient settings. We highlight existing barriers that may hinder or delay implementation, as well as strategies and opportunities to facilitate the clinical readiness of inpatient diabetes technology in the future.