Diabetes Regimen Research Articles

Relationship Between COVID-19-related Factors and Self-management Behaviors in People with Type-2 Diabetes: A Cross-sectional Study

Background: Coronavirus disease 2019 (COVID-19) is a risk factor for long-term complications and mortality in people with diabetes. Diabetes self-management can prevent the adverse effects of COVID-19. Objectives: This study aimed to investigate the association between COVID-19-related personal, familial, and psychological factors and diabetes self-management. Methods: The research was conducted using the simple non-probability sampling method at the Institute of Endocrinology and Metabolism of Iran University of Medical Sciences. A total of 102 people with type-2 diabetes participated in the study. Their inclusion criteria were a diagnosis of type-2 diabetes for at least one year, an age of 30 to 65 years, literacy, and no personal or family history of COVID-19 for the past two months. The Diabetes Self-management Questionnaire assessed the participants' self-management behaviors. Their personal and family data were recorded in a personal information form. The Diabetes Distress Scale and the Patient Health Questionnaire measured diabetes distress and depressive symptoms, respectively. COVID-19-related psychological factors were evaluated using the COVID-19-related Psychological Distress Scale, the Coronavirus Anxiety Scale, and the Fear of COVID-19 Scale. Results: The Pearson correlation test showed that the number of times one or their family members were infected or hospitalized due to COVID-19, diabetes distress, and depressive symptoms were negatively related to diabetes self-management. Doses of COVID-19 vaccine injection were also positively related to self-management and negatively correlated with depressive symptoms and diabetes distress (P < 0.05). Multivariate linear regression analysis revealed diabetes regimen and interpersonal distress, COVID-19-related psychological distress, and the number of one's family members with chronic disease as the predictors of diabetes self-management (adjusted R2 = 96%, P < 0.001). Conclusions: People with diabetes can improve their participation in self-management activities by taking care of themselves and their families against COVID-19 and controlling negative emotions. COVID-19 vaccination can reduce the depressive symptoms and diabetes distress in people with type-2 diabetes and facilitate their participation in self-management.

Evaluation of Diabetes Mellitus Type 2 Control in Home-Based Primary Care Patients Managed by Clinical Pharmacy Specialists.

Purpose To evaluate the impact of pharmacist-led diabetes care in a Home-Based Primary Care (HBPC) setting. Methods This was a single-center, retrospective, cohort chart review in HBPC veterans with diabetes mellitus type 2 (DMII) at Columbia VA Health Care System. A sample size of 80 patients was calculated to meet power of 80% and a P-value of less than 0.05 was used to determine clinical significance. The primary outcome was mean hemoglobin A1C (HgbA1C) change after up to 18 months of Clinical Pharmacy Specialist (CPS) diabetes-led care stratified by baseline HgbA1C. Secondary outcomes included change in the number of diabetes medications and doses per day stratified by baseline HgbA1C. Results One hundred twelve patients were included in the final analysis based on inclusion and exclusion criteria. The mean absolute HgbA1C reduction was 0.51%, 95% CI -0.20 to -0.82 from 8.1% at baseline. For the subgroup analyses, patients with baseline HgbA1C less than 8.5%, had a nonsignificant increase in their HgbA1C, while patients with HgbA1C 8.5% or more showed significant reductions in HgbA1C (P < 0.05). Patients with baseline HgbA1C less than 6.5% had a significant decrease of 0.52, 95% CI -0.18 to -0.87 and patients with baseline HgbA1C 6.5% or more had a nonsignificant increase in the number of diabetes medications (P > 0.05). Patients with baseline HgbA1C of less than 7.5% and 9.5% or more had a decrease in the number of diabetes medication doses with results being significant for patients with HgbA1C less than 6.5%, 95% CI -0.58 to -1.89. Conclusion The results of this study suggest that HBPC CPSs are improving glycemic control in HBPC veterans while simplifying diabetic regimens with attention to hypoglycemic risk reduction.

977-P: Utilization of Glucose Management Team–Conducted Remote Patient Visits Decreases Hospital Readmissions for Patients with Diabetes

Introduction: Hospital readmissions are more common in persons admitted with diabetes as a primary diagnosis, accounting for approximately 20% of unplanned readmissions.1 Poor clinical outcomes and higher costs result.2 Helping people remain out of the hospital with improved diabetes self-management is both patient-centered and cost effective.1 Remote patient care improves access to care, removes transportation as a barrier and lessens the time required versus in person diabetes visits.3 Methods: The glucose management team (GMT) at Atrium Health Wake Forest Baptist Medical Center, comprised of advanced practice providers and an endocrinologist, offered post-discharge telehealth visits within 7 days to patients with insulin treated complex diabetes from 1/1 - 3/24/21. Patients’ diabetes regimens and glucose readings were reviewed and recommendations for treatment changes were offered. Results: A total of 88 patients were scheduled for post-discharge visits, and 55.7% (n=49) participated in a scheduled telehealth visit, while 36.4% did not (n=32) . Of patients who no-showed, there were zero 30 day readmissions and fourteen 90 day readmissions (43.8%) . Of patients who had a telehealth visit, there were two 30 day readmissions (4%) and eleven 90 day readmissions (22.4%) . Odds ratio for 90 day readmission was 2.69 (p=0.042) in those who did not attend a post-discharge telehealth visit. Conclusion: While 30-day readmissions were higher in the group that had a telehealth visit, this may be due to global struggles with nonadherence in the no-show group. An odds ratio of over 2.5 for 90 day readmission compared to patients who completed a post-discharge telehealth visit supports this view. Post-discharge telehealth visits decreased unplanned readmissions at 90 days by providing access to expert clinicians for support, instruction on self-directed glucose management and treatment regimen recommendations. Disclosure A.Johns: None. C.E.Price: None. J.A.Aloi: Research Support; Abbott Diabetes, Medtronic. C.Burns: None.

937-P: Multicenter application of EFR (Endocrine Final Recommendation) Note Embedded in EMR Improves the Accuracy of Diabetes Discharge Regimen in Hospitalized Patients with Diabetes

Patients with diabetes who are hospitalized often have changes in diabetes treatment regimen during hospitalization. In the ReCoDED study done at our institution, it was found that discharge instructions provided by Endocrine teams were not always accurately translated into discharge recommendations by primary teams. To address this issue, we implemented a “diabetes discharge recommendations note” (EFR Note) which clearly specifies discharge instructions for primary teams, which we embedded in the institution’s EMR in January 2019. Preliminary data evaluating the efficacy of the EFR Note at our academic center showed significantly improved accuracy in the discharge regimen. In this study, we investigated the patient data from two other centers, specifically inner-city community hospitals, from January to December 2021. We identified 40 patients through EMR for whom an EFR Note was utilized (EFR Group) and randomly selected 40 patients from the same centers for comparison (Control Group) . There were no significant differences in baseline characteristics between the two groups (All p values &amp;gt; 0.25) Results: We find that the accuracy of diabetes regimens provided by primary teams at discharge was significantly higher when EFR Note was utilized, relative to control (88% vs. 60%; χ2 (1) = 6.46, p = 0.011) . The most common error was incorrect insulin type/dosing, accounting for 76% of all errors. Insulin dosing errors were similarly less prevalent in the EFR Group relative to control (8% vs. 33%; χ2 (1) = 6.33, p = 0.012) . Conclusion: These results demonstrate that tools like EFR Note with specific instructions regarding discharge regimen can ameliorate deficiencies in discharge process. We plan to take steps to enhance awareness regarding the efficacy of EFR Note among endocrinology providers at multiple centers within our institution to facilitate a safer transition from inpatient to outpatient setting. Disclosure J.Lloyd: None. T.Abdulwahid: None. J.Levin: None. D.Pinkhasova: None.

Calendula officinalis Phytochemicals for the Treatment of Wounds Through Matrix Metalloproteinases-8 and 9 (MMP-8 and MMP-9): In Silico Approach

Diabetic foot ulceration is a common complication of an uncontrolled diabetic regimen and is considered a serious type of wound. Matrix metalloprteinases (MMPs) are the common key enzymes in wound management, overexpression of MMPs can lead to chronic wounds and ulcers. Calendula officinalis extract has established its efficacy in treating wounds in folk medicine. In this research work, we will focus on the chemical constituents of this promising herb and will investigate its abilities to target matrix metalloprteinase-8 (MMP-8) and matrix metalloprteinase-9 (MMP-9) proteins through the usage of computer-aided drug design tools. In the current study, several promising dual inhibitors are identified, such as quercetin, isoquercetin, isorhamnetin, and isorhamnetin 3-O glycoside, they showed to be good inhibitors for both enzyme subtypes with greater docking score energies than RND-336, which has been reported as a selective MMP-9 inhibitor. Binding scores and amino acid interactions in addition to molecular dynamics (MD) will be discussed in detail through this research work.

Physical Fitness as a Prognostic Marker for Infectious Events in Kidney Transplant Recipients

Introduction: Infectious events are one of the leading causes of death in kidney transplant recipients (KTRs). KTRs have reduced cardiorespiratory fitness (CRF), a predictor for infections in other populations. The aim of this study was to investigate whether CRF and muscle strength are prognostic markers for infectious events in KTRs. Methods: In this retrospective cohort study, 155 KTRs underwent an incremental, maximal cardiopulmonary exercise test (CPET) 3 months after transplantation. CRF was analyzed with peak oxygen consumption (VO₂ peak) while muscle strength with isometric handgrip (HG) test. Laboratory blood samples and drug therapy were collected. The median follow-up period was 54 (interquartile range 38–62) months. Cox regression analyses were performed to evaluate predictors of infectious events adjusting for potential confounders. Results: During this study, severe infectious events occurred in 41 subjects (26.5%). 15.5% (n = 24) of patients had a severely reduced CRF, defined as a VO₂ peak below the 5th percentile of the reference values reported for a matched healthy population. The hazard ratio for infectious events in this subgroup was 2.389 (95% CI = 1.188–4.801, p = 0.014), independently of gender, age, BMI, time on dialysis, hemoglobin concentration, eGFR, diabetes, and immunosuppressive regimen. On the contrary, no significant association of HG strength and infections was found. Conclusion: Therefore, low CRF may be considered as a modifiable predictor of severe infectious events in KTRs. A CPET should thus be recommended for cardiovascular screening, evaluation of CRF, and tailored exercise prescription to reduce the risk of infections and potentially improve long-term outcomes of transplantation.

Preoperative Management of Diabetic Patients, an Overview

Glycemic control is critical in the perioperative setting, especially in diabetic patients. The consequences of surgical tension and anesthesia on blood sugar levels are distinct, and should be considered in order to maintain optimal glycemic control. Each stage of surgery presents its own set of challenges in terms of keeping glucose levels within the target range. Furthermore, there are some surgical conditions that necessitate specific glucose management protocols. Authors hope to highlight the most crucial factors to consider when developing a perioperative diabetic regimen, while still allowing for specific adjustments based on sound clinical judgement. Overall, by carefully managing glycemic control in perioperative patients, we may be able to reduce morbidity and mortality while improving surgical outcomes.

AACE2021-A-1029: Identifying and Addressing the Determinants That Affect Successful Control of Diabetes Mellitus Type II

Various life variables are known not essential to the advancement of type 2 diabetes including weight, absence of adequate physical action, terrible eating routine, anxiety, and urbanization. A number of dietary factors such as consumption of sugar-sweetened drinks in excess and the type of fats in the diet also appear to play a role. Objectives: Estimating the prevalence of successful control of type 2 diabetes mellitus (DM) and its determinants at Diabetic Centre, Prince Mansur Military Hospital for Community Medicine, Taif, Kingdom of Saudi Arabia A cross-sectional study was adopted. It included adult DM type 2 patients (18-60 years), at (PMFCH), Armed Forces Hospital, Taif region. Successful control of type 2 DM has been defined strictly by achievement of targeted glycemic control glycated hemoglobin (HBA1C) <7. An Arabic self-administered questionnaire was utilized to collect data from patients. It includes demographic data, disease history, and lifestyle (social factors). HBA1C was recorded from the file of the patient. Trained nurse measured the weight (in kg) and height of each patient to calculate body mass index (BMI). Among 370 diabetic patients, 331 returned completed questionnaire giving a response rate of 89.5%. More than one-quarter of them (27.2%) aged over 60 and 48.4% aged between 40 and 60 years. DM was controlled among only 27.5% of the diabetic patients (HBA1C <7%) while it was uncontrolled among most of them (72.5%). In logistic regression analysis, the duration of DM, diabetes treatment, BMI, family support, and compliance with diabetic diet regimen were all significantly related to glycemic control based on HBA1C value. The patients with poor glycemic control were high, which is nearly comparable to that reported from many countries. Longer duration of diabetes, and not adherent to diabetes self-care management behaviors, obesity, combination therapy, and lack of family support were associated with poor glycemic control.

Toward Building a Provincial Diabetes Registry of Children and Youth Living With Diabetes in British Columbia, Canada

ObjectivesPediatric diabetes health-care providers and decision-makers in British Columbia (BC) have prioritized the creation of a provincial pediatric diabetes clinical registry to improve care quality. Our objective is to build the first BC Pediatrics Diabetes Registry (BC-PDR) for quality improvement and coordination of pediatric diabetes care across the province. MethodsPatients <19 years of age and diagnosed with diabetes were invited to participate in our study. Recruitment began in 2017 at the BC Children’s Hospital (BCCH) and expanded to 6 community-based pediatric diabetes clinics in the Interior Health Authority (HA) in 2019. In response to COVID-19, recruitment shifted from in-person to virtual using an electronic consent system. Patient-level (e.g. age at diabetes onset, ethnicity) and visit-level (e.g. glycated hemoglobin [A1C], blood pressure, diabetes regimen, technology use, medications) data were collected in addition to screening for and presence of diabetes complications. ResultsAs of January 2021, 635 patients from the BCCH and Interior HA were included in the BC-PDR. From the BCCH, 94% of 590 patients were diagnosed with type 1 diabetes and the median A1C was 7.8% and increased with age. Just under half of the BCCH patients were using insulin pump technology and/or a continuous glucose monitoring system. ConclusionsOver the last 3 years, we have worked to adapt and operationalize the BC-PDR. The next steps for the BC-PDR include engaging diabetes stakeholders in the development of an electronic benchmarking dashboard along with linkage of the data to patient-reported outcome and experience measures and provincial administrative databases.

Long-term follow-up of a randomized clinical trial comparing glycemic excursion minimization (GEM) to weight loss (WL) in the management of type 2 diabetes

IntroductionWe previously reported the physical, psychological and behavioral 3-month post-treatment results of a randomized controlled trial comparing glycemic excursion minimization (GEM) versus conventional weight loss (WL) therapy in the management...

Relationship between Diabetes Family Conflicts or Problem Recognition in Illness Self-Management and Quality of Life of Adolescents with T1DM and Their Parents.

This study aimed to investigate the relationship between diabetes family conflicts or problem recognition in illness self-management (PRISM) and the parental perceived quality of life (QoL) of adolescents with type 1 diabetes mellitus (T1DM) and their parents. This was a cross-sectional study, and the participants comprised 111 parents of type 1 diabetes adolescents; data were collected via an online survey and analyzed by descriptive statistics, correlation, and multiple linear regression analysis using the IBM SPSS 25.0 program. The explanatory power of the QoL model in parents of adolescents with T1DM, constructed using three variables—diabetes family conflict (B = −0.56), regimen pain and bother (B = −11.25), and peer interactions (B = −7.48), which are PRISM barriers—was 35.7% (F = 5.70, p < 0.001). Diabetes family conflicts (B = −0.86) and peer interactions (B = −9.04) explained 57.3% of the variance in the parental perceived QoL of adolescents with T1DM (F = 12.33, p < 0.001). In order to improve the QoL in parents and adolescents with type 1 diabetes, interventions to effectively manage diabetes family conflicts and improve peer interactions are necessary.

The use of metformin in the treatment of gastrointestinal cancer

Type 2 diabetes mellitus and malignancies have several common risk factors, such as obesity, metabolic syndrome, hyperinsulinemia, and chronic inflammation. Currently these factors are considered as possible mechanisms that increase the risk of the development of malignanttumors, including gastrointestinal cancer. Epidemiological studies and meta-analyses indicate that patients with diabetes have a higher incidence and mortality from malignancies. Metformin is well-known oral hypoglycemic drug that belongs to the biguanide class and is being used to treat diabetes mellitus for almost a century. It has been established that in patients with diabetes mellitus, long-term use of metformin reduces the incidence of tumors and mortality from various cancers. The results of recent studies suggest that metformin may have direct pleiotropic anticancer activity against many tumor cells and their microenvironment. Its potential mechanisms include both insulin-dependent and insulin-independent. Moreover, metformin promotes antitumor immunosuppressive metabolic control of T lymphocytes and cancer cells, it is able to modulate the intestinal microbiota and renders a systemic effect on a body metabolism. The article presents data that reveal possible mechanisms of anticancer action of metformin and justify the use of metformin as a drug that may be useful for the treatment of gastrointestinal cancer. Although most of the clinical trials have retrospective design, they are often limited in time and patient bias, recent data from preclinical studies on the antitumor effects of metformin suggest that its effects on carcinogenesis and gastrointestinal cancer progression need to be further investigated. Future studies should consider the diabetic status, prognostic biomarkers, disease stage, and treatment regimens. Given that metformin is a safe and widely available drug with low cost, the feasibility of further study of its anti-cancer effects is beyond doubt.

Weight loss differences seen between glucagon-like peptide–1 receptor agonists and sodium–glucose cotransporter–2 inhibitors for treatment of type 2 diabetes

BackgroundWeight loss is an advantageous quality for diabetic medications because it can improve insulin sensitivity and glucose control and reduce cardiovascular risk factors and comorbidities. Glucagon-like peptide–1 (GLP-1) receptor agonists and sodium–glucose cotransporter–2 (SGLT-2) inhibitors are both preferred agents for use after metformin therapy, and both cause modest weight loss. ObjectiveThe aim of this study was to evaluate the difference in weight loss between GLP-1 receptor agonists and SGLT-2 inhibitors in patients with type 2 diabetes (T2D). MethodsThis was a retrospective study that was conducted at a level 3 patient-centered medical home in Buffalo, NY. The participants were adults with T2D treated with either a GLP-1 receptor agonist or an SGLT-2 inhibitor, in addition to background diabetes medications, between January 1, 2012, and September 20, 2017. The outcome measures included the median weight loss after 6 months of consecutive therapy compared between the 2 antidiabetic classes and the median differences in blood pressure, glycosylated hemoglobin (A1C) levels, and renal function markers compared between the 2 classes. ResultsA total of 73 patients were included in the final analysis, with 31 receiving SGLT-2 inhibitors and 42 receiving therapy with GLP-1 receptor agonists. The SGLT-2 inhibitor cohort presented a median weight loss of –2.80 kg (interquartile range [IQR] –5.40 to –1.50), and the GLP-1 receptor agonist cohort presented a median weight loss of –1.15 kg (IQR –3.38 to 0.975) (P = 0.014). There were no statistically significant differences in A1C levels, blood pressure, or renal function markers. ConclusionSGLT-2 inhibitors, when used in combination with background diabetes regimens, can lead to more statistically significant weight loss than GLP-1 receptor agonists without compromising renal function.

Is metformin use associated with changes in urinary parameters in stone formers?

Diabetes mellitus (DM) is associated with an increased risk of nephrolithiasis and is often treated with metformin. The relationship between metformin and nephrolithiasis formation remains unclear, as studies have demonstrated conflicting results. We conducted a cross-sectional analysis of stone-forming patients at our stone clinic prior to the initiation of stone-directed medical management. Patients were grouped based on diabetic status and diabetic medication regimen. Outcomes evaluated were 24-hour urinary parameters and specimen stone type using univariate Kruskal-Wallis and Chi-squared analyses. Multivariate analyses controlling for metabolic syndrome components and HbA1c were performed. Data were available for 505 patients, of whom 147 were diabetic and 358 were not. On multivariate analyses controlling for HbA1c and other comorbidities, diabetic patients on metformin still had worse urinary parameters, including urine pH, than non-diabetic patients (pH=-0.33, -0.37, p<0.05). Patients with DM on metformin did not exhibit significant differences in 24-hour urine findings compared to patients with DM not on metformin (p>0.05 for all urinary parameters). Stone-forming patients with DM on metformin were associated with urinary abnormalities similar to those not on metformin. Cohort studies comparing urinary parameters of patients prospectively started on metformin are necessary to further elucidate metformin's role, if any, in combatting nephrolithiasis.

Effect of Instructional Program on Patients' Knowledge Regarding Adherence to Therapeutic Regimen of Type 2 Diabetes Mellitus

Background: Type 2 diabetes mellitus is considered a serious, an increasing global health burden, and leading cause of premature morbidity and worldwide mortality due to its complications. Aim: This study aimed to examining the effect of instructional program on knowledge regarding adherence to therapeutic regimen among type 2 diabetic patients. Subjects and method: Design: A quasi-experimental research design was utilized. Setting: This study was carried out at diabetic out-patient clinic in Medical Specialized Hospital affiliated to Mansoura University. Subjects: a sample of 53 participants who fulfilled the inclusion criteria of the study was selected. Tool: A structured interview which included four parts was used in carrying out this study. Results; 73.6% of the studied patients were females; and 79.2% had low socioeconomic level. Regarding the total score level of knowledge, 84.9% of the studied sample had satisfactory score level after applying the instructional program, 98.1% of them had satisfactory beliefs after applying the instructional program. And, 58.5% of the sample had high score level of adherence after applying the instructional program. The mean ±SD of glycosylated hemoglobin of the subjects was decreased significantly from 9.5±1.7 to 7.9±1.2 after applying the instructional program. Conclusion and Recommendations; improving diabetic patients' knowledge regarding type 2 diabetes mellitus was very important for improving adherence to the therapeutic regimen .Developing instructional plan based on issues related to diabetic regimen and personal perceptions that militate against adherence.

Using Photovoice to understand physical and social living environment influence on adherence to diabetes.

Within the past several years, a considerable body of research on adherence to diabetes regimen has emerged in public health. However, the focus of the vast majority of these studies has been on the individual traits and attitudes affecting adherence. Still little is known on the role of the social and physical context in supporting or hindering diabetes self-management, particularly from a qualitative standpoint. To address these limitations, this paper presents the findings of a Photovoice study on a sample of 10 type 2 diabetic older adults living in a deprived neighbourhood of an Italian city. The findings reveal that the possibility to engage in diet, exercise and blood sugar monitoring seems to be more affected by physical and social elements of the respondents' environment than by the interviewees' beliefs and attitudes. Both environmental barriers and social isolation emerge as barriers to lifestyle changes and self-care activities related to blood sugar monitoring. The predominance of bonding social capital, the scant level of trust and the negative perception of local health services result in a low level of social cohesion, a limited circulation of health information on diabetes management and, consequently, in poor health outcomes.

Necrotizing Pancreatitis Secondary to Dulaglutide Use

Introduction/ Background: GLP-1 agonists are an essential component of the anti-diabetes armamentarium. Common side effects include mild gastrointestinal distress and headaches. Uncommon side effects include acute pancreatitis and can limit use. We report a case of acute severe necrotizing pancreatitis most likely attributed to dulaglutide.Clinical Case: A 69-year-old man presented lethargic with diffuse abdominal pain associated with nausea and vomiting of 1-day duration. His past medical history consisted of type 2 diabetes, hyperlipidemia, hypertension, and hypothyroidism. His diabetes regimen included metformin, glipizide, and empagliflozin. Dulaglutide was added three months prior at 0.75 mg weekly, and the dose was increased to 1.5 mg weekly three days before presentation, the patient having received one such dose. Initial workup showed lipase 2800 units/mL, amylase 1185 units/mL, lactate 12.6 mmol/L, white blood cells 20 x 109/L, glucose 348 mg/dL, AST 30 unit/L, hematocrit 51.5%, blood urea nitrogen 24 mg/dL, and serum creatinine 1.57 mg/dL, calcium 8.1 mg/dL. No stones or CBD dilation were noted on ultrasound. Initial CT showed an enlarged pancreas with peripancreatic stranding and slightly diminished enhancement consistent with early signs of necrotizing pancreatitis. The patient became increasingly hypoxic and hypotensive and required intubation and triple pressor support to maintain adequate perfusion. On the second day of hospitalization, his hematocrit was 35.7%, blood urea nitrogen 37 mg/dL, calcium 6.8 mg/dL, and bicarbonate 21 mmol/L. AST and ALT peaked at 209 and 398 unit/L respectively. Calculated 48 hours Ranson’s score was 7. He completed 7 days of meropenem for necrotizing pancreatitis. He developed cholecystitis secondary to inflammatory damage of the biliary tract and received a cholecystostomy tube. A follow-up CT scan 7 days after the initial scan showed a prominent pancreas with extensive inflammation and without cysts, with several areas of nonenhancement/poor perfusion in the pancreatic head consistent with pancreatic necrosis. The patient made a full recovery and was discharged to a rehabilitation unit. Investigation into other causes of pancreatitis revealed triglycerides 104 mg/dL, a normal distribution of IgG subclasses (IgG4 36 mg/dL), no significant alcohol use, and no family history of pancreatitis.Conclusion: Pancreatic safety studies of dulaglutide have shown a good safety profile1. However, FDA safety warning exists on GLP-1 agonist prescriptions. Necrotizing pancreatitis with GLP-1a is rarely reported. We present a case of severe necrotizing pancreatitis due to dulaglutide use with the existence of temporality, after ruling out other causes of pancreatitis.Reference: 1. Nauck MA et al. Assessment of Pancreas Safety in the Development Program of Once-Weekly GLP-1 Receptor Agonist Dulaglutide. Diabetes Care 2017;40:647–54.

Myocardial ischemia-reperfusion and diabetes: The crux of animal model choice

Due to the failure of the translation of cardioprotective drugs against myocardial infarction from bench to bedside, revising animal models has become a necessity. Owing to its current growing incidence, type 2 diabetes (T2D) represents one of the main risk factors of co-morbidities in myocardial infarction, yet discrepancies exist between reported animal and human studies. We aimed to compare the impact of diabetes on infarct size after cardiac ischemia-reperfusion in a human cohort of ST elevation myocardial infarction (STEMI) patients with a diet-induced mouse model of T2D, using a high-fat high-sucrose diet for 16 weeks (HFHSD). Infarct size was evaluated by MRI in a cohort of 250 STEMI patients after primary percutaneous intervention. For mouse study, T2D was induced by 16 weeks of HFHSD versus a standard diet (SD) then in vivo 45 mins ischemia followed by 24 hrs of reperfusion were performed to compare myocardial infarct size. To mimic the diabetic medication regimen, 6 weeks of oral gavage with Metformin was performed in the HFHSD group: cell death upon in vitro 70 min hypoxia-2 h reoxygenation (H/R) on isolated cardiomyocytes was analysed by propidium-iodide staining. A small fraction (< 14%) of STEMI patients were diabetic and did not show a bigger infarct size when compared to non-diabetic ones. HFHSD mice had bigger infarct size compared to SD (HFHSD 47.8 [43.5, 49.0] vs. SD 37.3 [33.5, 43.6] %, n = 8–9/group, P < 0.05). Metformin treatment reduced cell death after H/R in the HFHSD cardiomyocytes, to a similar extent as in SD cells. Our data highlight that anti-diabetic medications may have a protective effect, thus they should be included in the pre-clinical studies of cardioprotective approaches in diabetic models. However, the relatively low number of diabetic patients in the STEMI population should also lead us to think about the inclusion of other risk factors in our animal models, notably aging.

The magnitude of non-adherence and contributing factors among adult outpatient with Diabetes Mellitus in Dilla University Referral Hospital, Gedio, Ethiopia.

The global prevalence of Diabetes Mellitus (DM) has increased alarmingly over the last two decades. On top of this, the issues of non-adherence to the prescribed medicines further fuel the DM- related complications to become one of the top causes of mortality and morbidity. Despite the considerable efforts in addressing the poor adherence issues, there are still plenty of problems ahead of us yet to be addressed. The objective of this study was to determine the extent of non-adherence and its contributing factors among diabetic patients attending the medical Referral clinic of Dilla University Referral Hospital. The institutional-based descriptive cross-sectional study was carried out among patients with diabetes mellitus attending the medical referral clinic of Dilla University Referral Hospital. A systematic random sampling method was used to recruit study participants, and tool was adopted to assess for adherence. A pretested semi-structured questionnaire was used to collect information on factors influencing non-adherence to the diabetic medications, and in-depth interview questionnaire was used for key informant interviews for the qualitative part. Data analysis was carried out using SPSS-20. The overall prevalence of non-adherence to diabetic treatment regimen among the study participants was 34.0%. The study revealed that cost of transport to the hospital and taking alcohol were significantly associated with non-adherence to the diabetic treatment regimen with the (AOR = 6.252(13.56, 28.822); p < 0.000) and (AOR = 13.12(8.06, 44.73); p<0.002) respectively. The study revealed that significant numbers of participants were non-adherent to the Diabetes Mellitus treatment regimens. Intensive counseling, and health education on the importance of good adherence and negative consequences of poor adherence need to be discussed with the patients before starting the medications, and amidst follow up.

A Cross-Sectional Study on Ultrasonographic Measurements of Parotid Glands in Type 2 Diabetes Mellitus.

Background Diabetes mellitus is a metabolic disease which is seen increasing globally and is diagnosed and monitored on basis of invasive blood investigations. Salivary glands are affected in diabetes mellitus. The objective of this study was to assess ultrasonographic measurements of parotid glands and correlate with the glycosylated hemoglobin levels in type 2 diabetic mellitus and duration of type 2 diabetic mellitus and treatment regimens. Materials and Methods This study was conducted on 50 subjects of type 2 diabetes mellitus and on 50 healthy controls. After HbA1C analysis of selected individuals, 100 individuals were grouped into group I (above 5.7) and group II (below 5.7). Ultrasonographic measurements (length (L), transverse dimension (TD), depth lateral to the mandible (DLM), and depth dorsal to the mandible (DDM)) of bilateral parotid glands were calculated. Statistical analysis was done using the chi-square test of significance and Spearman correlation coefficients. Results On correlation with measurement of right (L, DLM, DDM) and left (TD, DLM, DDM) of parotid glands with duration of type 2 diabetes mellitus, we found a moderate positive relationship, whereas as for right (TD) and left (L), we found a low-positive relationship. Similarly, for right (L, TD, DLM, DDM) and left (TD, DDM) parotid glands with HbA1C, we found a low-positive relationship, whereas for left parotid gland (L, DLM) with HbA1C, we found a moderate positive relationship. The mean DLM of right and left parotids in the insulin group was found to be slightly more than that in the combined group which was statistically insignificant. Conclusion Ultrasonographic measurements of parotid glands were found to be higher in study subjects as compared to control subjects, and they increased with increased HbA1C levels; also, there was no difference in treatment regimen. Ultrasonography could be a prospective diagnostic test for detection and monitoring of diabetes mellitus, and still further studies are required for this.