Long-term Diabetes-related Complications Research Articles

Landscape of pharmacogenetic variants associated with non-insulin antidiabetic drugs in the Indian population

IntroductionGenetic variants contribute to differential responses to non-insulin antidiabetic drugs (NIADs), and consequently to variable plasma glucose control. Optimal control of plasma glucose is paramount to minimizing type 2 diabetes-related...

Knowledge Of Families Toward Type 1 Diabetes Among Children In AL-Diwaniyah City, Iraq: Cross-Sectional Study –College of Medicine/ University Of AL-Qadisiyah

Background: Type 1 diabetes is one of the most common chronic diseases in childhood, that is considered a challenge for parents especially when the child is not developmentally able to manage the disease independently. Since optimal glycemic control is required to prevent acute and long-term diabetes-related complications and enhance school performance, the importance of involving adults in the child diabetes management is essential. Aim of the study: The current study aimed to evaluate the knowledge, regarding children with T1DM among families living in Diwaniyah city. Subjects and Method: A cross sectional study conducted in Al Diwaniyah governate, Iraq on a sample of 400 caregivers of type 1 diabetes mellitus diagnosed children for a period of three months. Structured questionnaires were used for Knowledge. Chi -square test was applied to find the significant association between qualitative variables. Independent t test and one way ANOVA were applied to illustrate a significant difference between quantitative variable. In all Statistical analyses, a p value equal or below 5% was considered significant. Results: Majority of caregivers; 192 (48%), were in their forties and married. Mothers 239 (59.8%) were the main caregivers, more than half of the studied sample 237(59.3%) had university or institute educational attainment. The average score for knowledge was 9.39±2.9 scores ranging from 0-12 score. Poor knowledge was found among 64 (16%) of caregivers, while 42(10.5%) and 294(73.5%) scored moderate and good knowledge respectively. Education and urban residency were significantly associated with good knowledge. Lower HbA1C level was seen associated with good diabetes knowledge. Conclusion: Although good knowledge were reported. Such discrepancy requires an increase in public awareness about the T1DM. Using modern technology to disseminate the correct information to caregivers.

Patient perception towards shifting oral antihyperglycemic agents to injectable insulin and associated factors in the diabetes clinic of Tikur Anbessa specialized hospital: Cross-sectional study

BackgroundWith the growing understanding of the importance of preserving adequate glycemic control for the prevention of long-term diabetes-related complications, insulin therapy has become increasingly recommended for type 2 diabetes. However, insulin use in various healthcare settings remains low due to patients' low levels of acceptability of insulin therapy, which necessitates evaluating patients' attitudes. ObjectiveTo assess patients' perception toward shifting oral antihyperglycemic agents to insulin and associated factors at the ambulatory diabetes clinics of Tikur Anbessa Specialized Hospital (TASH). MethodA cross-sectional study design was applied using a pre-tested interviewer-administered questionnaire on adult type 2 diabetes patients on follow-up at the diabetes clinic of TASH, Ethiopia from July to September 2021. The questionnaire tool was adapted from Insulin Treatment Appraisal Scale with modifications to fit the purpose of the study. Data was gathered, cleaned up, entered, and analyzed using Statistical Package for the Social Sciences (SPSS) version 23 for descriptive and logistic regression. For logistic regression data, a p-value of 0.05 was used to determine the statistical significance. ResultOf 293 patients, 65.9% were female. Study participants had a mean age of 53.9 ± 10.9 years. About 45% and 75% of the participants have complications and comorbidities, respectively with a mean disease duration of 19.16 ± 8.2 years. Almost 54% of patients on oral antihyperglycemic agents were unwilling to start insulin. A perception score below the median was observed in 56.3% of the respondents. Patients with primary and secondary education were 45% and 42% less likely to have a poor perception of shifting oral antihyperglycemic agents to insulin than those who couldn't read or write (P < 0.05), respectively. The study found that participants who were taking only oral antihyperglycemic agents had a 2.76 times poor perception than those who are on insulin treatment (P < 0.001). ConclusionPoor perception toward shifting oral antihyperglycemic agents to insulin was found to be high among study participants. It was substantially correlated with low educational attainment, financial constraints, exclusively using oral antihyperglycemic agents, duration of disease, and absence of disease complications.

Physical Activity and Risk of Major Diabetes-Related Complications in Individuals With Diabetes: A Systematic Review and Meta-Analysis of Observational Studies.

Physical activity is a cornerstone in diabetes management; however, evidence synthesis on the association between physical activity and long-term diabetes-related complications is scarce. To summarize and evaluate findings on physical activity and diabetes-related complications, we conducted a systematic review and meta-analysis. We searched PubMed, Web of Science, and the Cochrane Library for articles published up to 6 July 2021. We included prospective studies investigating the association between physical activity and incidence of and mortality from diabetes-related complications, i.e., cardiovascular disease (CVD), coronary heart disease, cerebrovascular events, heart failure, major adverse cardiovascular events, and microvascular complications such as retinopathy and nephropathy, in individuals with diabetes. Study characteristics and risk ratios with 95% CIs were extracted. Random-effects meta-analyses were performed, and the certainty of evidence and risk of bias were evaluated with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) and Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tools. Overall, 31 studies were included. There was moderate certainty of evidence that high versus low levels of physical activity were inversely associated with CVD incidence, CVD mortality (summary risk ratio 0.84 [95% CI 0.77, 0.92], n = 7, and 0.62 [0.55, 0.69], n = 11), and microvascular complications (0.76 [0.67, 0.86], n = 8). Dose-response meta-analyses showed that physical activity was associated with lower risk of diabetes-related complications even at lower levels. For other outcomes, similar associations were observed but certainty of evidence was low or very low. Limitations include residual confounding and misclassification of exposure. Physical activity, even below recommended amounts, was associated with reduced incidence of diabetes-related complications.

Association of Serum Magnesium with Insulin Indices in Patients with Type 2 Diabetes Mellitus.

Introduction: Magnesium has a direct impact on glucose metabolism since it is a cofactor for numerous energy-metabolizing enzymes. Hypomagnesemia has been linked to poor glycemic control and a range of diabetes-related long-term complications. This study aimed to assess the association between blood magnesium levels and insulin sensitivity indices in patients with type 2 diabetes mellitus (T2DM). Material and methods:Two hundred newly diagnosed T2DM patients aged over 40 years were recruited after excluding those with a history of heart failure, kidney illness, liver disease, hypothyroidism, ascites, pregnancy, tumors, and complications such as diabetic ketoacidosis. Fasting glucose, serum magnesium, serum insulin, serum urea and creatinine were measured. Patients were divided into two groups based on their serum magnesium levels. Results:There were no age or sex differences between the subjects of the two groups. Participants in the group with low magnesium had significantly high fasting blood sugar (FBS), postprandial blood sugar (PPBS), glycated hemoglobin (HbA1c), serum insulin, homeostasis model assessment-estimated insulin resistance (HOMA-IR) (P < 0.001). The multivariable logistic regression analysis showed significant associations with PPBS [odds ratio (OR) 0.98 (95% CI 0.97-0.99)], HbA1c [OR 0.05 (95% CI=0.005-0.55)] and creatinine [OR 0.004 (95% CI=0.00-0.074)]. Correlation statistics showed a negative correlation between magnesium and PPBS (r =-0.204), HOMA-IR (r = -0.819) and creatinine (r = -0.151). Conclusion:Serum magnesium levels have a negative correlation with FBS and PPBS, as well as HOMA-IR. It may well be essential to include serum magnesium level as a regular assessment in patients with diabetes mellitus.

Severe hypoglycemia as a risk factor for cardiovascular outcomes in patients with type 2 diabetes: is it preventable?

Hypoglycemia in people with type 2 diabetes mellitus (T2DM) is troublesome and an important barrier to diabetes management. Although more intensive glycemic control is emphasized to prevent diabetes-related long-term complications, it raises the risk of hypoglycemia in people with T2DM. Severe hypoglycemia (SH), defined as critical events characterized by altered mental and/or physical status requiring assistance for recovery, is considered an advanced and life-threatening form of hypoglycemia. The detection of SH is an important issue because it is associated with further adverse clinical outcomes such as cardiovascular events, mortality, cognitive impairment, and decreased quality of life. By identifying the potential risk factors for SH and introducing measures to minimize SH, SH itself and subsequent harmful clinical outcomes could be prevented in people with T2DM. The traditional risk factors for SH in T2DM, such as older age, long-standing diabetes with decreased insulin secretion, advanced vascular complications, serious comorbidities, and insulin use, are usually unmodifiable. However, unhealthy lifestyle factors, defined as current smoking, heavy alcohol consumption, and lack of regular exercise, can be improved through active patient education. In recent research, greater adherence to healthy lifestyle factors and any improvement in unhealthy lifestyle habits were found to be associated with a substantially lower risk of SH in individuals with T2DM. As well as being an essential component of diabetes self-care and optimal glycemic control, lifestyle modification probably contributes to the prevention of SH in individuals with T2DM.

Continuous glucose monitoring overview: features and evidence.

The prevalence of diabetes is growing in the United States at an alarming rate. Early and intensive diagnosis and management of diabetes can reduce the economic burden and improve the societal burden of long-term diabetes-related complications. Healthcare providers practicing in the primary care setting are on the front line of screening, diagnosis, and managing a large majority of persons with diabetes.Until recently, blood glucose monitoring, along with timely A1C measurements, has been the recommended means by which patients can best achieve their prescribed metabolic targets. However, supplies and testing can be costly and burdensome, affecting patient compliance and medication adherence. The recent introduction of integrated diabetes technology including continuous glucose monitoring (CGM) has had a tremendous impact on treating patients to their prescribed glycemic targets safely and efficiently while minimizing their risk of developing treatment-emergent hypoglycemia. Patients who utilize CGM are able to reduce their risk of hospitalizations, minimize work absenteeism, lower their A1C, lower their risk of hypoglycemia, as well as long-term microvascular and macrovascular complications.The American Diabetes Association updated its evidence-based Standards of Medical Care in Diabetes in 2022 around the use of CGM, as has the American Association of Clinical Endocrinology. Because these devices can have a positive effect on the management of persons with diabetes, managed care and healthcare providers should allow technological integration for theirpatients.

Plasmatic Magnesium Deficiency in 101 Outpatients Living with Type 2 Diabetes Mellitus.

(1) Background: Magnesium deficiency is usually associated with type 2 diabetes mellitus (T2DM). Individuals living with T2DM with hypomagnesemia show a more rapid disease progression and have an increased risk for diabetes complications. (2) Methods: This is a cross-sectional and descriptive study in the National Institute of Nutrition and Food Technology of Tunis in Tunisia, including all adult outpatients (≥18 years old) with a diagnosis of T2DM from 1 September 2018 to 31 August 2019. The aim of this study was to evaluate the prevalence of plasmatic magnesium deficiency in a Tunisian population of T2DM and to study the relationship between magnesium status and intake, glycemic control and long-term diabetes-related complications. (3) Results: Among the 101 T2DM outpatients, 13 (12.9%) presented with a plasmatic magnesium deficiency. The mean age was 56 ± 7.9 years with a female predominance (62%, n = 63). The mean of the plasmatic magnesium level was 0.79 ± 0.11 mmol/L (0.5–1.1), and the mean of 24 h urinary magnesium excretion was 87.8 ± 53.8 mg/24 h [4.8–486.2]. HbA1c was significantly higher in the plasmatic magnesium deficiency group than the normal magnesium status group (10% ± 1.3 vs. 8.3% ± 1.9; p = 0.04), with a significant difference in participants with a poor glycemic control (HbA1c > 7%) (100%, n = 13/13 vs. 53%, n = 47/88; p = 0.001). A weak negative relationship was also found between plasmatic magnesium and HbA1c (r = −0.2, p = 0.03). Peripheral artery disease was more commonly described in individuals with low plasmatic magnesium levels than in individuals with normal levels (39%, n = 5 vs. 0%, n = 0; p < 0.001). The mean plasmatic magnesium level in participants without diabetic nephropathy and also peripheral artery disease was significantly higher compared to individuals with each long-term diabetes-related complication (0.8 mmol/L ± 0.1 vs. 0.71 mmol/L ± 0.07; p = 0.006) and (0.8 mmol/L ± 0.1 vs. 0.6 mmol/L ± 0.08; p < 0.001), respectively. (4) Conclusions: Hypomagnesemia was identified in individuals with T2DM, causing poor glycemic control and contributing to the development and progression of diabetes-related microvascular and macrovascular complications.

Hybrid Closed-Loop Systems for the Treatment of Type1 Diabetes: A Collaborative, Expert Group Position Statement for Clinical Use in Central and Eastern Europe.

In both pediatric and adult populations with type 1 diabetes (T1D), technologies such as continuous subcutaneous insulin infusion (CSII), continuous glucose monitoring (CGM), or sensor-augmented pumps (SAP) can consistently improve glycemic control [measured as glycated hemoglobin (HbA1c) and time in range (TIR)] while reducing the risk of hypoglycemia. Use of technologies can thereby improve quality of life and reduce the burden of diabetes management compared with self-injection of multiple daily insulin doses (MDI). Novel hybrid closed-loop (HCL) systems represent the latest treatment modality for T1D, combining modern glucose sensors and insulin pumps with a linked control algorithm to offer automated insulin delivery in response to blood glucose levels and trends. HCL systems have been associated with increased TIR, improved HbA1c, and fewer hypoglycemic events compared with CSII, SAP, and MDI, thereby potentially improving quality of life for people with diabetes (PwD) while reducing the costs of treating short- and long-term diabetes-related complications. However, many barriers to their use and regional inequalities remain in Central and Eastern Europe (CEE). Published data suggest that access to diabetes technologies is hindered by lack of funding, underdeveloped health technology assessment (HTA) bodies and guidelines, unfamiliarity with novel therapies, and inadequacies in healthcare system capacities. To optimize the use of diabetes technologies in CEE, an international meeting comprising experts in the field of diabetes was held to map the current regional access, to present the current national reimbursement guidelines, and to recommend solutions to overcome uptake barriers. Recommendations included regional and national development of HTA bodies, efficient allocation of resources, and structured education programs for healthcare professionals and PwD. The responsibility of the healthcare community to ensure that all individuals with T1D gain access to modern technologies in a timely and economically responsible manner, thereby improving health outcomes, was emphasized, particularly for interventions that are cost-effective.

Evaluation of machine learning applications using real-world EHR data for predicting diabetes-related long-term complications

ABSTRACT The biggest concern about diabetes-related complications is that they are unrecognised in the early stages but can be immutable and devastating with time. Identifying the population at high risk of developing such complications can help intervene in preventative care at an early stage. This study aims to present a data-driven approach to predict the patients at higher risk for diabetes-related complications using real-world data. We used comorbid diagnostic features from the electronic health records called “Cerner Health Facts EMR Data” to build machine learning-based prediction models for three diabetes-related long-term complications: (a) eye diseases, (b) kidney diseases, and (c) neuropathy. Our developed pipeline was able to generate highly accurate models for predictions. We deduced from the F1-scores that applying the class balancing techniques improved the overall performance of the models, and SVM with oversampling technique was the most consistent classifier for all three cohorts.

Effects of Glycated Glutenin Heat-Processing Conditions on Its Digestibility and Induced Inflammation Levels in Cells.

Protein is one of the three major macronutrients and is essential for health. The reaction of α-dicarbonyl compounds (α-DCs) with glutenin during heat processing can modify its structure, thereby reducing its digestibility. Furthermore, advanced glycation end products (AGEs) formed by the Maillard reaction are associated with long-term diabetes-related complications. In this study, we established a heat processing reaction system for α-DCs and glutenin by simulating common food processing conditions. An in vitro digestion model was used to study the digestibility of glycated glutenin; whereupon the effects of the digestion products on macrophage inflammatory response were further investigated. It was found that reaction conditions, including temperature, treatment duration, pH, and reactant mass ratio, can significantly affect the digestibility of glycation glutenin, in which the mass ratio of reactants has the most significant influence. We demonstrated that when the mass ratio of glutenin to methylglyoxal (MGO) was 1:3, the level of inflammation induced by glycated glutenin was the highest. The mass ratio of reactants significantly affects the digestibility of glycation glutenin and the level of macrophage-induced inflammatory response. This suggests that it is possible to protect the nutritional value of protein and improve food safety by controlling the heat processing conditions of wheat products.

Type1 diabetes: an update

Die Inzidenz des Diabetes mellitus Typ 1 (T1D) steigt seit 30 Jahren stetig an, insbesondere bei Kindern und Jugendlichen, sodass es alle 20 Jahre zu einer Verdoppelung der Fallzahlen in dieser Altersgruppe kommt. Die verspätete Diagnose oder falsche Interpretation der Symptome führt zur lebensgefährlichen diabetischen Ketoazidose, an der jedes dritte Kind in Deutschland bei Manifestation des T1D leidet. In der Insulintherapie des T1D bei Kindern, Jugendlichen und Erwachsenen gibt es keine prinzipiellen Unterschiede. Die Anwendung einer Insulinpumpentherapie und kontinuierlichen Glukosemessung nimmt stetig zu. Hiermit sollen hypo- und hyperglykämische Episoden reduziert, die Zeit im Zielbereich erhöht und das Hämoglobin‑A1c-Therapieziel unter 7 % erreicht werden. Neben der Vermeidung diabetesbedingter mikrovaskulärer Langzeitkomplikationen ist die rechtzeitige Erkennung und Behandlung kardiovaskulärer Risikofaktoren auch bei jungen Menschen mit T1D von außerordentlicher Bedeutung.

Assessment of long-term graft function following total pancreatectomy and autologous islet transplantation: the Leicester experience.

Total pancreatectomy and islet autotransplantation (TPIAT) is a recognised treatment for chronic pancreatitis (CP) with the potential to mitigate or prevent pancreatogenic diabetes. We present our 10-year follow-up of TPIAT patients. The University Hospitals of Leicester performed 60 TPIAT procedures from September 1994 to May 2011. Seventeen patients completed their 10-year assessment and were grouped using the modified Auto-Igls criteria; good response, n=5 (insulin-independent for first 5 years post-TPIAT); partial response, n=6 (insulin requirements <20 iU/day post-TPIAT) and poor response, n=6 (insulin requirements ≥20 iU/day post-TPIAT). C-peptide, haemoglobin A1c (HbA1c) and oral glucose tolerance test (OGTT) were undertaken preoperatively (baseline), then at 3, 6 months and then yearly for 10 years. Data was analysed using analysis of variance (ANOVA). Median C-peptide levels were significantly higher, 120 minutes following OGTT, in the "good response" compared to "partial" and "poor" groups (two-way ANOVA test, P<0.0001). All groups demonstrated preservation of C-peptide release. HbA1c levels were significantly lower in the "good response" compared to "partial" and "poor" groups (two-way ANOVA test, P<0.0003 and P<0.0001). Median fasting glucose levels at 30 and 120 min following OGTT, were significantly lower in the "good response" compared to "partial" and "poor" groups (two-way ANOVA test, P<0.0001 and P<0.0001). TPIAT preserves long-term islet graft functions in 10-year follow up. Even in patients in the poor response group, there is evidence of C-peptide release (>0.5 ng/mL) after OGTT stimulation potentially preventing long-term diabetes-related complications.

Insulin glargine 300 U/mL and insulin degludec: A review of the current evidence comparing these two second-generation basal insulin analogues.

For most people with type 2 diabetes (T2D), treatment intensification with the addition of basal insulin therapy is required to maintain glycaemic control. However, this often does not happen in real-life practice promoting the development of long-term diabetes-related complications. The second-generation basal insulin analogues glargine 300 U/mL (Gla-300) and degludec (IDeg) provide pharmacokinetic and pharmacodynamic improvements that may allow them to be more effective in appropriately managing diabetes compared with first-generation basal insulin analogues. Both Gla-300 and IDeg have been extensively studied vs the first-generation basal insulin glargine 100 U/mL, demonstrating comparable efficacy in terms of glycaemic control, and a lower risk of hypoglycaemia. The BRIGHT randomized controlled trial is the first direct comparison of the efficacy and safety profiles of Gla-300 and IDeg in patients with T2D. Moreover, real-world data have been used to assess the effectiveness of these basal insulins during routine clinical practice. Further research is required to determine if the properties of Gla-300 and IDeg may lead to improvements in healthcare-related costs and the quality of life of patients, which are important factors for informing clinical decisions.

How has psycho-behavioural research advanced our understanding of hypoglycaemia in type 1 diabetes?

Almost 100 years since the discovery of insulin, hypoglycaemia remains a barrier for people with type 1 diabetes to achieve and maintain blood glucose at levels which prevent long-term diabetes-related complications. Although hypoglycaemia is primarily attributable to the limitations of current treatment and defective hormonal counter-regulation in type 1 diabetes, the central role of psycho-behavioural factors in preventing, recognizing and treating hypoglycaemia has been acknowledged since the early 1980s. Over the past 25 years, as documented in the present review, there has been a substantial increase in psycho-behavioural research focused on understanding the experience and impact of hypoglycaemia. The significant contributions have been in understanding the impact of hypoglycaemia on a person's emotional well-being and aspects of life (e.g. sleep, driving, work/social life), identifying modifiable psychological and behavioural risk factors, as well as in developing psycho-behavioural interventions to prevent and better manage (severe) hypoglycaemia. The impact of hypoglycaemia on family members has also been confirmed. Structured diabetes education programmes and psycho-behavioural interventions with a focus on hypoglycaemia have both been shown to be effective in addressing problematic hypoglycaemia. However, the findings have also revealed the complexity of the problem and the need for a personalized approach, taking into account the individual's knowledge of, and emotional/behavioural reactions to hypoglycaemia. Evidence is emerging that people with persistent and recurrent severe hypoglycaemia, characterized by deeply entrenched cognitions and lack of concern around hypoglycaemia, can benefit from tailored cognitive behavioural therapy.

A cross-sectional study to evaluate diabetes management, control and complications in 1631 patients with type 2 diabetes mellitus in Vietnam (DiabCare Asia)

AimsTo assess diabetes care delivery and prevention of short- and long-term diabetes-related complications in patients with type 2 diabetes mellitus (T2DM) in Vietnam.MethodsDiabCare Asia is an observational, non-interventional, cross-sectional study of hospital-based outpatient care for patients diagnosed with T2DM.ResultsA total of 1631 patients (mean age 62.7 years; 58.9% female) participated in the study. The percentage of patients with HbA1c < 7.0% (< 53 mmol/mol) was 36.1% and mean (standard deviation) HbA1c was 7.9 ± 1.8% (63 ± 19 mmol/mol). The proportion of patients using insulin was 40%, at a mean total daily dose of 35.4 U. Apart from dyslipidemia (81.2%) and hypertension (78.4%), the most common diabetes-related complications were peripheral neuropathy (37.9%) and eye complications (39.5%). Current insulin therapy was associated with peripheral vascular disease (odds ratio [OR] = 2.28 [95% confidence interval (CI) 1.68; 3.09]) and eye complications (OR = 1.70 [95% CI 1.37; 2.11]).ConclusionIn this sample of patients with T2DM in Vietnam, the majority had poor glycemic and metabolic control. Concerted efforts are needed to optimize control and prevent complications in these patients. Trial registration: NCT02066766

OR14-3 The Association of Glycemic Control and Glycemic Variability with Treatment Patterns and Diabetes-Related Events in the Adult Patients (Pts) with Type 1 Diabetes (T1D): Results from the T1D Exchange Clinic Registry

This cross-sectional analysis evaluated the association of A1C control/variability with treatment patterns and outcomes in adult pts with T1D.The association of A1C control (categorized into <7.0%; 7.0-8.0%; 8.0-9.0%; and ≥9.0%) and variability (defined as intrapersonal mean [M] and adjusted standard deviation [SD] of A1C values, categorized into low M/low SD = low; low M/high SD = medium; high M/low SD = high; and high M/high SD = very high) with pt characteristics, treatment patterns, and diabetes-related events (e.g. diabetic ketoacidosis [DKA], hypoglycemia, and comorbidities) were evaluated using T1D Exchange Clinic Registry data (05-01-2016 to 07-31-2017). Pts were required to have A1C values and key outcomes at exam, and ≥4 A1C values measured within 1 year from exam date for A1C variability analysis. Pts with a history of pancreas or islet cell transplant or currently pregnant were excluded. The association between A1C control/variability and diabetes-related outcomes were evaluated using multiple logistic regression adjusting for covariates.8331 and 2466 pts were included for A1C control and A1C variability analysis, respectively. The majority of the adult T1D pts did not achieve A1C<7.0% (78% pts had A1C≥7.0%) and had increased A1C variability (65% pts in medium to very high groups).Compared with the A1C<7.0% group, pts in the A1C≥9.0% group were significantly younger (29 vs 43 years) and with significantly shorter T1D duration (16 vs 25 years); both p<0.001. Ethnic minorities, lower socioeconomic status, being single, and smoking were also associated with poor A1C control; all p<0.001. Pts on pump or other adjunctive treatment (non-insulin injection, statin use, continuous glucose monitoring [CGM] use) were more likely to have better A1C control (all p<0.001). Poor A1C control (≥9.0%) was significantly associated with greater risk for DKA (adjusted odds ratio [aOR] of 5.7 for the A1C≥9.0% group vs <7.0%), retinopathy (aOR 2.5), neuropathy (aOR 1.8), micro nephropathy (aOR 1.9), and renal disease (aOR 1.9); all p<0.01.Similar associations were observed between A1C variability and pt demographics and disease duration. Pts on pump, statin use, or CGM use were more likely to have low A1C variability; all p<0.001. The very high A1C variability group (high M/high SD) was significantly associated with greater risk for DKA (aOR of 13.5 vs the low A1C variability group), severe hypoglycemia (aOR 4.8), neuropathy (aOR 2.2), micro nephropathy (aOR 2.3), and renal disease (aOR 2.8); all p<0.05.Lack of glycemic control and stability are associated with younger age, shorter disease duration, ethnic minorities, and low socioeconomic status. This study confirms the previously established association between glycemic control and diabetes-related complications and highlights the association of glycemic variability across both acute and long-term diabetes-related complications.

PDB67 - ONCE-WEEKLY SEMAGLUTIDE VERSUS DULAGLUTIDE FOR THE TREATMENT OF PATIENTS WITH TYPE 2 DIABETES IN PORTUGAL: A LONG-TERM COST-EFFECTIVENESS ANALYSIS BASED ON SUSTAIN 7

Once-weekly semaglutide resulted in greater reductions in glycated hemoglobin (HbA1c) and body weight than dulaglutide in patients with type 2 diabetes uncontrolled on metformin in the SUSTAIN 7 clinical trial. Reductions in HbA1c and body weight reduce the risk of long-term diabetes-related complications. The aim of the present analysis was to assess the long-term cost-effectiveness of once-weekly semaglutide 0.5 mg and 1 mg versus dulaglutide 1.5 mg in Portugal. Long-term projections of clinical and cost outcomes were performed with the IQVIA CORE Diabetes Model over a 50-year time horizon. Baseline cohort characteristics and treatment effects were sourced from SUSTAIN 7. Costs were expressed in Euros (EUR) and estimated from a healthcare payer perspective. Quality-of-life utilities were obtained from published sources. Sensitivity analyses were performed. Once-weekly semaglutide 0.5 mg and 1 mg were associated with improvements in quality-adjusted life expectancy of 0.02 and 0.09 quality-adjusted life years (QALYs), respectively, versus dulaglutide 1.5 mg, resulting from reduced cumulative incidence and delayed time to onset of diabetes-related complications. Total direct costs with once-weekly semaglutide 0.5 mg and 1 mg were EUR 130 and EUR 140 higher than with dulaglutide 1.5 mg over patient lifetimes, with higher acquisition costs partially offset by cost savings due to avoidance of complications. Once-weekly semaglutide 0.5 mg and 1 mg were therefore associated with incremental cost-effectiveness ratios of EUR 7,202 and EUR 1,490 per QALY gained, respectively, versus dulaglutide 1.5 mg. These results were confirmed in sensitivity analyses. Based on a willingness-to-pay threshold of EUR 30,000 per QALY gained, once-weekly semaglutide 0.5 mg and 1 mg are likely to provide good value for money versus dulaglutide 1.5 mg for the treatment of patients with type 2 diabetes not achieving glycemic control on metformin in Portugal.

Management of Hypoglycemia in Patients with Type 2 Diabetes

The rate limiting step of intensive diabetes management for patients with diabetes is treatment induced hypoglycemia. Thus, hypoglycemia remains a significant barrier in optimizing glycemic control and reducing long-term diabetes related complications including cardiovascular death, stroke, and all cause-mortality [1]. Cardiovascular (CV) events are the leading cause of death among patients with diabetes. The risk of CV death is twice that of patients without diabetes [2]. Severe hypoglycemia (resulting in cognitive impairment) can occur across a broad spectrum of A1C levels. Patients achieving near-normal glycemia

Expectations and fear of diabetes-related long-term complications in people with type 2 diabetes at primary care level.

The quality report of patients enrolled in the disease management programmes of North Rhine Westphalia 2016 showed prevalence of long-term complications in diabetes type 2: neuropathy 24.2%, nephropathy 12.5%, retinopathy 8.2%. The aim of this study was to assess expectations and fear of diabetes-related long-term complications in people with diabetes type 2. We assessed expectations and fear of diabetes-related complications in 104 people with diabetes type 2 (age 67.0J, diabetes duration 6.6J, HbA1c 6.6%/48.6mmol/mol, neuropathy 20.2%, nephropathy 11.5%, retinopathy 1.9%) in an outpatient healthcare centre at primary care level. Fear of diabetes-related complications was assessed using the "Fear of Complications Questionnaire" (FCQ) with a range of 0-45 points (≥ 30 means clinically meaningful fear, higher scores imply higher level of fear). Furthermore, study participants estimated general and personal risk of suffering from diabetes-related long-term complications after 10years of diabetes duration on a scale of 0-100%. Mean FCQ score was 22.9 ± 11.5. 34/104 participants (32.7%) scored ≥ 30 points and thus had great fear. Participants estimated general risk of suffering from diabetes-related complications after 10years of diabetes duration on 55.1% and personal risk on 46.0%. Risk of diabetes-related complications scoring highest was impaired circulation of lower limb (62.1%), eye complications (57.3%) and kidney complications (54.7%). Prevalence of diabetes-related long-term complications was overestimated in people with diabetes type 2. Approximately one third of the participants showed even great fear. Patient expectation and fear about diabetes-associated complications did not correspondent with data on clinical reality.