Diabetic Medicine Research Articles

Abstract 010: Longitudinal Impact Of Glucose Homeostasis On Cardiac Structure And Function: Results From The Echocardiographic Study Of Latinos- 2 (echo-sol-2)

Introduction: We assessed whether a longitudinal association between change in glucose homeostasis and change in cardiac structure and function was present. Methods: Data from ECHO-SOL baseline and visit 2 exams were used including 1643 Hispanic/Latino participants aged 45-74 years with serial echocardiograms obtained on average 4.3 (2.8-6.7) years apart. Glucose hoemostasis was evaluated through fasting plasma glucose levels (FGP), 2 hour oral glucose tolerance test (OGTT) and hemoglobin A1C (A1C) . Glucose homeostasis was categorized as: normal glucose tolerance (NGT) (FPG<100 mg/dL, 2hr OGTT <140 mg/dL, or A1C <5.7%), prediabetes (PDM) (FPG 100–125 mg/dL, or 2h OGTT 140–199 mg/dL, or A1C 5.7–6.4%); among those with self-report of diabetes or currently taking diabetes medicine: controlled diabetes (CDM) (A1C<7), and uncontrolled diabetes (UDM) (A1C>7). Linear regression models were used to examine associations between change in glucose homeostasis [worsening (NGT to PDM, NGT to DM, PDM to DM, CDM to UDM) vs unchanged] with changes in left ventricular mass (LVM), relative wall thickness (RWT), ejection fraction (EF), global longitudinal strain (GLS) and E’ velocity. All analyses were weighted to account for the complex survey design. Results: At baseline (mean age 56.4 years ±0.35; 45.4% male), glucose regulation was as follows: NGT (29.1%), PDM (51.8%), CDM (9.2%) and UDM (9.9%). At visit 2, glucose downregulation was as follows: NGT to PDM (55.9%), NGT to DM (13.4%), PDM to DM (27.4%), CDM to UCDM (33.5%). Among those with worsening glucose homeostasis the average age was 55.2 ±0.50 years, 45.7% were male, FPG was 99.4±0.90mg/dL . Change from NGT to PDM compared to remaining at NGT was associated with increase LVM (b=4.0 ±0.9, p<0.001), worsening in GLS (b=0.6 ±0.1, p<0.001) and decrease in E’ velocity (b=-1.1 ±0.1, p<0.001). Neither change from NGT to DM nor from PDM to DM was associated with significant changes in cardiac structure and function. Change from CDM to UDM was associated with increase in RWT (b=0.1 ±0.0, p<0.05), compared to those with unchanged CDM. Worsening glucose homeostasis from any group was not associated with changes in EF. Conclusions: Early stages of worsening glucose homeostasis were associated with cardiac structural and functional changes. Identification of those at risk of developing prediabetes may provide opportunities to prevent future cardiac dysfunction.

Association of Mortality between Diabetic and Non Diabetic Patients with Covid 19

Objective: Aim of current study is to determine the comparison of death rates among diabetic and non diabetic patients with coronavirus disease. Study Design: Retrospective/Observational study Place and Duration: The study was conducted at Diabetes Hospital, Peshawar and Medicine department of Avicenna Medical & Dental College and Hospital, Lahore for the duration of six months from December 2020 to May 2021. Methods: There were one hundred and fifty patients of both genders either diabetic or non diabetic with ages 20-75 years were included in this study. After receiving informed written agreement, the demographics of enrolled patients were recorded, including age, gender, BMI, and socio-economic status. All patients who had a confirmed diagnosis of COVID-19, with polymerase chain reaction testing, were included in the study. Outcomes among all patients in terms of mortality rate were recorded among all cases. We used SPSS 21.version to analyze complete data. Results: Among 150 patients, 60 (40%) cases were diabetic and 90 (60%) were non-diabetic. Mean age of the patients was 35.14±11.44 years and mean BMI 29.31±8.55 kg/m2. We found most of the cases 85 (56.7%) were males and 65 (43.3%) were females. 95 (63.3%) patients had poor socioeconomic status. Most common comorbidity was hypertension found in 68 (45.3%) cases followed by cardiovascular disease in 45 (30%) cases. Frequency of mortality in diabetic patients was significantly higher found in 35 (58.3%) cases as compared to non diabetic patients in 27 (30%) cases with p value <0.005. Conclusion: Diabetic individuals with COVID-19 showed a considerably greater death rate compared to non-diabetics. As a result, diabetes patients must be educated about the risks of infection-related hyperglycemia, the necessity of following sick-day policies, and the consequences of social isolation. Keywords: Covid 19, Diabetic, Non Diabetic, Mortality, Hypertension

Sexual Crossing, Chromosome-Level Genome Sequences, and Comparative Genomic Analyses for the Medicinal Mushroom Taiwanofungus Camphoratus (Syn. Antrodia Cinnamomea, Antrodia Camphorata).

ABSTRACTTaiwanofungus camphoratus mushrooms are a complementary and alternative medicine for hangovers, cancer, hypertension, obesity, diabetes, and inflammation. Though Taiwanofungus camphoratus has attracted considerable biotechnological and pharmacological attention, neither classical genetic nor genomic approaches have been properly established for it. We isolated four sexually competent monokaryons from two T. camphoratus dikaryons used for the commercial cultivation of orange-red (HC1) and milky-white (SN1) mushrooms, respectively. We also sequenced, annotated, and comparatively analyzed high-quality and chromosome-level genome sequences of these four monokaryons. These genomic resources represent a valuable basis for understanding the biology, evolution, and secondary metabolite biosynthesis of this economically important mushrooms. We demonstrate that T. camphoratus has a tetrapolar mating system and that HC1 and SN1 represent two intraspecies isolates displaying karyotypic variation. Compared with several edible mushroom model organisms, T. camphoratus underwent a significant contraction in the gene family and individual gene numbers, most notably for plant, fungal, and bacterial cell-wall-degrading enzymes, explaining why T. camphoratus mushrooms are rare in natural environments, are difficult and time-consuming to artificially cultivate, and are susceptible to fungal and bacterial infections. Our results lay the foundation for an in-depth T. camphoratus study, including precise genetic manipulation, improvements to mushroom fruiting, and synthetic biology applications for producing natural medicinal products.IMPORTANCE Taiwanofungus camphoratus (Tc) is a basidiomycete fungus that causes brown heart rot of the aromatic tree Cinnamomum kanehirae. The Tc fruiting bodies have been used to treat hangovers, abdominal pain, diarrhea, hypertension, and other diseases first by aboriginal Taiwanese and later by people in many countries. To establish classical genetic and genomic approaches for this economically important medicinal mushroom, we first isolated and characterized four sexually competent monokaryons from two dikaryons wildly used for commercial production of Tc mushrooms. We applied PacBio single molecule, real-time sequencing technology to determine the near-completed genome sequences of four monokaryons. These telomere-to-telomere and gapless haploid genome sequences reveal all genomic variants needed to be studied and discovered, including centromeres, telomeres, retrotransposons, mating type loci, biosynthetic, and metabolic gene clusters. Substantial interspecies diversities are also discovered between Tc and several other mushroom model organisms, including Agrocybe aegerita, Coprinopsis cinerea, and Schizophyllum commune, and Ganoderma lucidum.

Precision Medicine in Diabetes: state of the art based on recent Consensus

There has long been strong emphasis on personalization in the treatment of diabetes; evidence of individual differences in symptomatology, presentation, behavior, preferences, social status, response to treatment, comorbidity or clinical course have led clinicians to seek greater focus on the individual. However, this approach cannot yet be called Precision Medicine in diabetes. In this article we want to describe the state of the art of Precision Medicine starting from the two Consensus documents published by the Precision Medicine in Diabetes Initiative (PMDI) born in 2018 within American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) with the aim of understanding the state of the art, the possibilities of application and future lines of research in the construction of a precision medicine applied to diabetes. The five pillars of precision medicine applied to diabetes will be examined: precision diagnosis, precision prevention, precision treatment, precision prognostics and precision monitoring. Following will be described the fields of applications and the possible developments and insights, also within italian diabetological reality. KEY WORDS precision medicine; diabetes; personalization; diagnosis; prevention.

Spatial Environment Affects HNF4A Mutation-Specific Proteome Signatures and Cellular Morphology in hiPSC-Derived β-Like Cells.

Studies of monogenic diabetes are particularly useful because we can gain insight into the molecular events of pancreatic β-cell failure. Maturity-onset diabetes of the young 1 (MODY1) is a form of monogenic diabetes caused by a mutation in the HNF4A gene. Human-induced pluripotent stem cells (hiPSCs) provide an excellent tool for disease modeling by subsequently directing differentiation toward desired pancreatic islet cells, but cellular phenotypes in terminally differentiated cells are notoriously difficult to detect. Re-creating a spatial (three-dimensional [3D]) environment may facilitate phenotype detection. We studied MODY1 by using hiPSC-derived pancreatic β-like patient and isogenic control cell lines in two different 3D contexts. Using size-adjusted cell aggregates and alginate capsules, we show that the 3D context is critical to facilitating the detection of mutation-specific phenotypes. In 3D cell aggregates, we identified irregular cell clusters and lower levels of structural proteins by proteome analysis, whereas in 3D alginate capsules, we identified altered levels of glycolytic proteins in the glucose sensing apparatus by proteome analysis. Our study provides novel knowledge on normal and abnormal function of HNF4A, paving the way for translational studies of new drug targets that can be used in precision diabetes medicine in MODY.

ADA/EASD Precision Medicine in Diabetes Initiative: An International Perspective and Future Vision for Precision Medicine in Diabetes.

ADA/EASD Precision Medicine in Diabetes Initiative: An International Perspective and Future Vision for Precision Medicine in Diabetes.

Role of Actionable Genes in Pursuing a True Approach of Precision Medicine in Monogenic Diabetes.

Monogenic diabetes is a genetic disorder caused by one or more variations in a single gene. It encompasses a broad spectrum of heterogeneous conditions, including neonatal diabetes, maturity onset diabetes of the young (MODY) and syndromic diabetes, affecting 1–5% of patients with diabetes. Some of these variants are harbored by genes whose altered function can be tackled by specific actions (“actionable genes”). In suspected patients, molecular diagnosis allows the implementation of effective approaches of precision medicine so as to allow individual interventions aimed to prevent, mitigate or delay clinical outcomes. This review will almost exclusively concentrate on the clinical strategy that can be specifically pursued in carriers of mutations in “actionable genes”, including ABCC8, KCNJ11, GCK, HNF1A, HNF4A, HNF1B, PPARG, GATA4 and GATA6. For each of them we will provide a short background on what is known about gene function and dysfunction. Then, we will discuss how the identification of their mutations in individuals with this form of diabetes, can be used in daily clinical practice to implement specific monitoring and treatments. We hope this article will help clinical diabetologists carefully consider who of their patients deserves timely genetic testing for monogenic diabetes.

Roles of plasma leptin and resistin in novel subgroups of type 2 diabetes driven by cluster analysis

BackgroundA novel classification has been introduced to promote precision medicine in diabetes. The current study aimed to investigate the relationship between leptin and resistin levels with novel refined subgroups in patients with type 2 diabetes mellitus (T2DM).MethodsThe k-means analysis was conducted to cluster 541 T2DM patients into the following four subgroups: mild obesity-related diabetes (MOD), severe insulin-deficient diabetes (SIDD), severe insulin-resistant diabetes (SIRD) and mild age-related diabetes (MARD). Individuals meeting the exclusion criteria were eliminated, the data for 285 patients were analyzed. Characteristics were determined using various clinical parameters. Both the leptin and resistin levels were determined using enzyme-linked immunosorbent assay.ResultsThe highest levels of plasma leptin were in the MOD group with relatively lower levels in the SIDD and SIRD groups (P < 0.001). The SIRD group had a higher resistin concentration than the MARD group (P = 0.024) while no statistical significance in resistin levels was found between the SIDD and MOD groups. Logistic regression demonstrated that plasma resistin was associated with a higher risk of diabetic nephropathy (odds ratios (OR) = 2.255, P = 0.001). According to receiver operating characteristic (ROC) curves, the area under the curve (AUC) of resistin (0.748, 95% CI 0.610–0.887) was significantly greater than that of HOMA2-IR (0.447, 95% CI 0.280–0.614) (P < 0.05) for diabetic nephropathy in the SIRD group.ConclusionsLeptin levels were different in four subgroups of T2DM and were highest in the MOD group. Resistin was elevated in the SIRD group and was closely related to diabetic nephropathy.

Onde os brasileiros obtiveram os medicamentos para o diabetes na pandemia de COVID-19? Resultados da DIABETESvid

Access to diabetes medications is critical to disease control. However, social distancing in the COVID-19 pandemic may have limited the provision of medicines and supplies. Thus, the objective of this study was to analyze the sources of obtaining diabetes drugs in the COVID-19 pandemic in Brazil. The data came from the DIABETESvid survey, and this analysis considered a convenience sample of 1608 participants who responded to the questionnaire published on social media of scientific societies related to diabetes. This is a cross-sectional study, conducted in the form of a web survey, from September 1 to October 19, 2020. The outcome analyzed was the sources for obtaining diabetes drugs categorized in pharmacies of the "Sistema Único de Saúde", pharmacies of the “Aqui tem Farmácia Popular” program, as well as private pharmacies and drugstores and other sources. Most participants self-reported a diagnosis of type 1 diabetes mellitus (49.8%), used insulin (61.9%), and had a private health plan (68.7%). Private pharmacies and drugstores and other sources were the main places where medicines for diabetes were supplied (47.5%). Participants residing in the Midwest region of the country had a lower frequency of supply in pharmacies in the “Aqui tem Farmácia Popular” program (0.57; 95%CI 0.36-0.92). In the studied sample, there was a higher frequency of supply of diabetes drugs in private pharmacies and drugstores and other sources with a reduction in frequency in public pharmacies during the COVID-19 pandemic in Brazil.

Factors associated with Pharmaceutical Benefits Advisory Committee decisions for listing medicines for diabetes and its associated complications.

Objective To retrospectively analyse the key factors associated with listing decisions by the Pharmaceutical Benefits Advisory Committee (PBAC) for medicines for diabetes and its complications on the Pharmaceutical Benefits Scheme. Methods The clinical and economic evidence were retrieved from public summary documents (PSD) of all major submissions between July 2005 and March 2020. A multivariate binary logit regression analysis was conducted to assess the relationship between the categorical explanatory variables and PBAC recommendations. Results We identified a total of 211 PSD of which 118 (56%) were recommended for listing. Clinical and economic uncertainty were significantly and inversely associated with the PBAC recommendation. Submissions with high clinical and economic uncertainty were less likely to be recommended. Conclusion Our findings will enhance the understanding of medical professionals, pharmaceutical companies, and other stakeholders about the rationale of PBAC reimbursement decisions for these medicines and assist prospective applicant sponsor companies in preparing their submissions.

Where did Brazilians get their diabetes drugs during the COVID-19 pandemic? DIABETESvid results

Access to diabetes medications is critical to disease control. However, social distancing in the COVID-19 pandemic may have limited the provision of medicines and supplies. Thus, the objective of this study was to analyze the sources of obtaining diabetes drugs in the COVID-19 pandemic in Brazil. The data came from the DIABETESvid survey, and this analysis considered a convenience sample of 1608 participants who responded to the questionnaire published on social media of scientific societies related to diabetes. This is a cross-sectional study, conducted in the form of a web survey, from September 1 to October 19, 2020. The outcome analyzed was the sources for obtaining diabetes drugs categorized in pharmacies of the "Sistema Único de Saúde", pharmacies of the “Aqui tem Farmácia Popular” program, as well as private pharmacies and drugstores and other sources. Most participants self-reported a diagnosis of type 1 diabetes mellitus (49.8%), used insulin (61.9%), and had a private health plan (68.7%). Private pharmacies and drugstores and other sources were the main places where medicines for diabetes were supplied (47.5%). Participants residing in the Midwest region of the country had a lower frequency of supply in pharmacies in the “Aqui tem Farmácia Popular” program (0.57; 95%CI 0.36-0.92). In the studied sample, there was a higher frequency of supply of diabetes drugs in private pharmacies and drugstores and other sources with a reduction in frequency in public pharmacies during the COVID-19 pandemic in Brazil.

Establishment of Japan's First "Podiatry Medicine Center" in a University Hospital.

Podiatry Medicine is well known medical field in Europe and the United States, which is a discipline that specializes in foot medical care. In Europe and the United States, it is common to see a podiatrist if there are any symptoms in the foot and they provide specialized medical for foot disease. However, in Japan, even if you feel that your foot hurts, there is no specialized medicine to be provided. In Japan, commonly podiatry medicine is often provided by each clinical field or department related to patient's symptoms and there was no university hospital in Japan that advocated Podiatry Medicine. As the aging society progresses in the future, maintaining "walking" is one of the important issues to extend the healthy life span. To overcome this issue and to provide specialized medical care for foot patients in Japan, Juntendo Hospital established the "Podiatry Center" to be the first time in Japan. This center comprehensively assesses the symptoms that occur in the foot, similar to podiatry medicine in Europe and the United States (medical treatment for the lower leg to the foot, not including the knee), and provides multidisciplinary treatment from foot care to cutting-edge medical treatment. The center cooperates with many clinical departments such as plastic and reconstructive surgery, dermatology, vascular surgeon, cardiovascular medicine, diabetes medicine, collagen disease medicine, kidney medicine, orthopedics, rehabilitation department, and nurses, prosthetist, and other professions to carry out diagnosis, treatment, and prevention promptly and effectively for the best for patients with foot diseases.

Patients should pick their own diabetes therapy, suggest UK researchers

Patients given trials of different diabetes medicines before choosing their own long-term therapy have better glycaemic control and fewer side effects, concludes a new study. In the TriMaster Study, published in Nature Medicine on 7 December 2022, researchers from the University of Exeter studied 448 people with type 2 diabetes mellitus (T2DM) who were already […]

Effectiveness of Integrative Chinese-Western Medicine for Chronic Kidney Disease and Diabetes: A Retrospective Cohort Study.

Diabetes and chronic kidney disease (CKD) are pandemic, requiring more therapeutic options. This retrospective cohort evaluated the effectiveness, safety profile and prescription pattern of a pilot integrative medicine service program in Hong Kong. Data from 38 patients with diabetes and CKD enrolled to receive 48-week individualized add-on Chinese medicine (CM) were retrieved from the electronically linked hospital database. A 1:1 cohort was generated with patients from the same source and matched by propensity score. The primary outcomes are the change of estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) analyzed by analysis of covariance and mixed regression model adjusted for baseline eGFR, age, gender, duration of diabetes history, history of hypertension, diabetic retinopathy, and the use of insulin and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. The rate of adverse events and the change of key biochemical parameters were analyzed. After a median of 51 weeks, patients who received add-on CM had stabilized eGFR (difference in treatment period: 0.74 ml/min/1.73m2, 95% CI: -1.01 to 2.50) and UACR (proportional difference in treatment period: 0.95, 95% CI: 0.67 to 1.34). Add-on CM was associated with significantly preserved eGFR (Inter-group difference: 3.19 ml/min/1.73m2, 95%CI: 0.32 to 6.06, [Formula: see text] 0.030) compared to standard care. The intergroup ratio of UACR was comparable (0.70, 95% CI: 0.45 to 1.08, [Formula: see text] 0.104). The result is robust in sensitivity analysis with different statistical methods, and there was no interaction with CKD stage and UACR. The rate of serious adverse events (8.1% vs. 18.9%, [Formula: see text] 0.174), moderate to severe hyperkalemia (8.1% vs. 2.7%, [Formula: see text] 0.304) and hypoglycemia (13.5% vs. 5.4%, [Formula: see text] 0.223), and the levels of key biochemical parameters were comparable between groups. The top seven most used CMs contained two classical formulations, namely Liu-wei-di-huang-wan and Si-jun-zi-tang. Individualized add-on CM was associated with significant kidney function preservation and was well tolerated. Further randomized controlled trials using CM prescriptions based on Liu-wei-di-huang-wan and Si-jun-zi-tang are warranted.

Clinical and biochemical outcomes of Sodium-Glucose CoTransporter-2 (SGLT2) Inhibitors in Type-2 Diabetes Mellitus Patients as a fourth oral anti diabetic medicine.

Objectives:To evaluate the clinical and biochemical effects of (SGLT2) inhibitors as a fourth oral anti-diabetic drug in patients with Type-2 diabetes mellitus (T2DM).Methods:In a tertiary hospital in Karachi, Pakistan, a retrospective assessment of patient medical records was conducted from January 1, 2017 to December 31, 2020.A total of one hundred patients (mean age [Standard Deviation]: 53.8 [9.63] years) with poorly controlled T2DM were included. Data was collected before the SGLT-2 inhibitor was added, as well as three and six months after the medicine was started. Weight, BMI, blood pressure (BP), HbA1c, SGPT, and Creatinine were measured at the start and during the studyResults:There was a significant reduction in HbA1c (p-value < 0.001) with a mean reduction (MR) of 0.81+1.02% at three months and 1.07+1.11% at six months. A mean weight reduction (p-value < 0.001) of 1.83+2.32 kg at three months and 4.02+6.04 kg at 6 months, respectively, was recorded. A mean BMI reduction of 0.69+0.95 kgm-2 at three months and 2.13+3.41 kgm-2 at six months of follow up, respectively were recorded. A systolic blood pressure (SBP) also showed a significant reduction (p-value < 0.05) with a MR of 5.9+15.76 mmHg at three months and 6.37+18.33 mmHg at 6 months, respectively. Non-significant variation in creatinine and SGPT was also noted.Conclusions:SGLT-2 is an effective oral anti-diabetic medicine that can help individuals with diabetes who are currently using glucose-lowering oral anti-diabetic medications. These medications can help diabetic patients stick to their regimen.

Therapeutic Efficacy and Antihyperglycemic Properties of Catharanthus roseus for Diabetes Mellitus: A Systematic Review

Diabetes mellitus refers to a group of metabolic diseases, in which the patient experiences high levels of blood glucose due to an insufficient production of insulin by the pancreas (Type I diabetes) or an inability of his/her body to respond to the insulin produced (Type II diabetes). <em>Catharanthus roseus</em> (<em>C. roseus</em>) is a plant that belongs to the Apocynaceae family, and has long been used as a natural medicine for Type-1 and Type-2 diabetes in the Ayurvedic system of medicine. This systematic review aims to summarize and provide an overview of the results of several studies that have been conducted to evaluate the plant's antidiabetic efficacy.

Possible ocular effects of anti-diabetes medications, and their relevance to contact lens wear

Purpose. To asses what information on ocular effects of anti- diabetes medications are provided in medicines prescribing information, and whether or not any current guidelines actu- ally mention contact lens wear. Material and Methods. Medicines directories and patient information leaflets (PILs) for 28 diabetes medicines (insulin and various oral hypoglycaemic drugs) were searched for any information on possible ocular effects. A PubMed search was also undertaken on the medicines in relation to ocular side effects. Results. Almost all information sources examined included notes that a change in vision after taking anti-diabetes med- ications could indicate inadequate glucose control. The use of all diabetic medications can result in mild to moderate allergic reactions that could involve the conjunctiva, eyelids and eyelashes. A possible adverse effect of use of older oral hypoglycaemics (such as the sulfonylureas and acarbose) is a warning to patients of possible ‘yellowing of the eyes’ and of the skin. In the vast majority of published studies identified, almost no information has been provided on the oral anti- diabetes medications being used so it is essentially unknown if diabetic medications per se can have adverse effects on the cornea and conjunctiva. However, the information search (in both medical directories, PILs) revealed nothing in relation to contact lens wear and/or that there should be any obvious caution in prescribing contact lenses to diabetic patients. Conclusion. Information indicating that contact lens wear is potentially problematic is not obviously included in medicines directories, so contact lens wear can offer a viable option for vision correction in diabetics. Keywords Diabetes, medication, contact lens wear

PP259 Invisible Resilience: The Value Of Medical Technology In Reducing Population And Health Systems’ Vulnerability To COVID-19.

IntroductionCOVID-19 has exposed population and health systems’ vulnerability to a highly infectious disease. People with diabetes have a higher risk of COVID-19 hospitalization and death than those without. Medicines that control blood glucose reduce this risk. We quantified COVID-19 hospital admissions and deaths averted by diabetes medicines in the UK during the March-May 2020 wave.MethodsWe estimated COVID-19 hospital and intensive care unit (ICU) admissions averted and COVID-19 hospital deaths avoided by diabetes medicines, considering a counterfactual where those medicines were not available. We used published UK-data sources on diabetes prevalence, proportion of patients achieving diabetes control with medicines, COVID-19 infection risk, probabilities for COVID-19 hospital admission, subsequent ICU admission and hospital death. We calculated the relative risk reduction of controlled vs. uncontrolled diabetes on COVID-19 hospital or ICU admission (71% and 66%, respectively), and hospital death (38%) from the UK Open Safely data.ResultsDiabetes medicines are estimated to have averted 17,417 hospital admissions, 2,752 ICU-admissions and 438 hospital deaths due to COVID-19 compared to a counterfactual where those medicines had not been available in the UK.ConclusionsEffective medicines to control diabetes contribute to population and health systems resilience against COVID-19. Health technology assessment and policy makers should recognize that adoption and usage of health technology reduces societies’ vulnerability to similar shocks.

Type 2 diabetes self-management: spirituality, coping and responsibility

BackgroundIn England, although The National Institute of Health and Care Excellence recommends that patients’ religious beliefs should be incorporated into individual healthcare plans, these components are often neglected in diabetes management care plans. A literature review identified a paucity of research regarding how the spirituality of British people may influence their approach to their self-management of type 2 diabetes (T2D).AimsTo explore how the spirituality of a small group of adults with T2D, living in England, influenced their coping strategies and self-management of diet and exercise.MethodsBiographic Narrative Interpretive Method of two interviews per participant and thematic analysis for data interrogation (n = 8). Data as glycated haemoglobin, living situation, age, length of time since T2D diagnosis, body mass index and diabetic medicines contextualised the interview data.ResultsParticipants’ spirituality, health beliefs, coping and sense of responsibility for T2D self-management overlapped in complex layers. Three themes were generated: (a) spirituality influences expectations in life; (b) beliefs influence coping styles of diabetes self-management; and (c) responsibility influences diabetes self-management. A model was created to assist nurses in addressing these components.ConclusionNurses should consider how patients’ self-management of T2D may be influenced by their spirituality, health beliefs, coping and sense of responsibility.

AACE2021-A-1097: Clinical and Biochemical Outcomes of Sodium-Glucose Co-Transporter-2 (SGLT2) Inhibitors in Type 2 Diabetes Mellitus Patients as a Fourth Oral Anti Diabetic Medicine.

SGLT-2 inhibitors are a group of oral medications that work independently of insulin working as anti-diabetics by enhancing the excretion of glucose. The purpose of our study was to assess the improvement in terms of HbA1c, weight, blood pressure and BMI and the hepatics and renal effect in terms of SGPT and Creatinine in patients already on three oral glucose lowering agents when SGLT-2 inhibitor was added to their medications.