Differences In Glycemic Control Research Articles

Increased Prevalence of Bell's Palsy in First Nations Populations with Type 2 Diabetes Mellitus in Manitoba.

Bell's palsy is acute facial palsy due to inflammation involving the facial nerve related to infections. Rates have not been noted to differ by ethnicity. We studied the lifetime prevalence in First Nations and all other Manitobans in people with type 2 diabetes mellitus aged 7 and older in 2013-2014 and 2016-2017. We found a crude lifetime prevalence of 9.9% [95% CI 9.4-10.4%] in the First Nations population versus 3.9% [95% CI 3.8-4.0%] in all other Manitobans. It is unknown if there were differences in glycemic control. The increased prevalence was found in all five provincial health regions. This study indicates that ethnicity may be an important risk factor for Bell's palsy.

Improving Medication Adherence in Geriatric T2DM Patients: A Factorial Randomized Controlled Trial

Abstract Background: The complexity of managing type 2 diabetes (T2D) in the elderly is compounded by the need to balance over-prescription, under-prescription, and appropriate prescription. Managing hyperglycemia and its complications, along with geriatric syndromes such as cognitive impairment and falls, often leads to use of an increased number of medications. Quality improvement measures, while aimed at better management, can inadvertently contribute to the burden of polypharmacy. Addressing medication non-adherence is crucial, as it is a significant contributor to poor clinical outcomes, increased hospitalizations, and healthcare costs. Objectives: This study thus aimed to evaluate the effectiveness of interventions to improve medication adherence among elderly patients with T2D. It assessed the impact of a medication adherence device, clinical pharmacological intervention, and their combination compared to standard of care (SOC) alone on adherence rates, adverse drug reactions (ADRs), and glycemic control. Materials and Methods: This pilot study was a factorial randomized controlled trial. A total of 120 elderly T2D patients with a medication adherence rate of less than 80% over the past year were randomized into four groups: (1) medication adherence device + SOC, (2) clinical pharmacological intervention + SOC, (3) combined intervention + SOC, and (4) SOC alone. The primary outcome was medication adherence, assessed through pill counting. ADRs were evaluated using the Naranjo ADR causality assessment scale, and glycemic control was monitored through HbA1c levels. Statistical analyses included chi-square tests and ANOVA, with significance set at P < 0.05. Results: Interim analysis showed the highest adherence rate in the combined intervention group (82.1%), followed by the clinical pharmacological intervention + SOC group (75.3%), the medication adherence device + SOC group (73.1%), and the SOC alone group (70.0%). The combined intervention group also recorded the lowest ADR rate (6.6%). Regarding glycemic control, 81% of the combined intervention group achieved an HbA1c level of less than 7%, compared to 80% in the clinical pharmacological intervention + SOC group, 78% in the medication adherence device + SOC group, and 69% in the SOC alone group. Differences in glycemic control were not statistically significant (P = 0.950). Conclusions: The study indicates that combined interventions including medication adherence devices along with SOC significantly improve medication adherence and reduce ADRs in elderly T2D patients. Future research should focus on diverse populations and long-term sustainability of these interventions.

Advanced Hybrid Closed-Loop Therapy Compared With Standard Insulin Therapy Intrapartum and Early Postpartum in Women With Type 1 Diabetes: A Secondary Observational Analysis From the CRISTAL Randomized Controlled Trial.

To determine efficacy and safety of intrapartum and early postpartum advanced hybrid closed-loop (AHCL) therapy compared with standard insulin therapy in pregnant women with type 1 diabetes (T1D). CRISTAL was a double-arm, open-label, randomized controlled trial performed in Belgium and the Netherlands that assigned 95 pregnant participants with T1D 1:1 to a MiniMed 780G AHCL system (n = 46) or standard insulin therapy (n = 49). This prespecified, secondary observational analysis focused on differences in glycemic control and safety outcomes between participants from the original AHCL group who continued AHCL intrapartum (n = 27) and/or early postpartum (n = 37, until hospital discharge) and those from the original standard insulin therapy group using standard insulin therapy intrapartum (n = 45) and/or early postpartum (n = 34). Of the 43 and 46 participants in the AHCL and standard insulin therapy groups, respectively, completing the trial, 27 (62.8%) in the AHCL group continued AHCL and 45 in the standard insulin therapy group (97.8%) continued standard insulin therapy intrapartum. Compared with standard insulin therapy, intrapartum AHCL was associated with more time in range 3.5-7.8 mmol/L (71.5 ± 17.7% vs. 63.1 ± 17.0%, P = 0.030) and numerically lower time above range >7.8 mmol/L (27.3 ± 17.4% vs. 35.3 ± 17.5%, P = 0.054), without increases in time below range <3.5 mmol/L (1.1 ± 2.4% vs. 1.5 ± 2.3%, P = 0.146). Early postpartum, 37 (86.0%) participants randomized to AHCL continued AHCL, with a median increase in insulin-to-carbohydrate ratios of 67% (interquartile range -14 to 126). Similar tight glycemic control (3.9-10.0 mmol/L: 86.8 ± 6.7% vs. 83.8 ± 8.1%, P = 0.124) was observed with AHCL versus standard insulin therapy. No severe hypoglycemia or diabetic ketoacidosis was reported in either group. AHCL is effective in maintaining tight glycemic control intrapartum and early postpartum and can be safely continued during periods of rapidly changing insulin requirements.

A comprehensive of Age-Related Differences in Glycemic Control and Complications in Type 2 Diabetes

Type 2 diabetes was a chronic condition that increasingly affected individuals across the age spectrum, with significant implications for glycemic control and the development of complications. This review comprehensively examined age-related differences in glycemic control and the incidence of diabetes-related complications, highlighting the contrasting experiences of younger and older patients. This review paper utilized a systematic literature search across multiple databases to gather and analyze studies assessing the impact of age on glycemic control and complications in type 2 diabetes. Evidence suggested that younger individuals often exhibit poorer glycemic control, characterized by higher HbA1c levels and increased cardiovascular risk factors, compared to older adults who may achieve better glycemic management despite a higher prevalence of complications. The underlying mechanisms for these differences were explored, including variations in disease pathophysiology, treatment responses, and lifestyle factors. Understanding these age-related disparities was crucial for tailoring diabetes management strategies to optimize outcomes across different age groups. Keywords: Glycemic control. Type 2 diabetes, Microvascular and macrovascular complications, Complications in older adults, Cardiovascular risk factors.

Excellence in the management of Advanced Hybrid Closed-Loop Systems: Lessons from the Polish cohort

BackgroundThe aim of the study was to analyze the real-world performance of MiniMed 780G (MM780G) Advanced Hybrid Closed Loop (AHCL) system users from Poland (PL) and compare it to the European region excluding Poland (EU-PL) in order to identify factors contributing to potential differences. The former achieved some of the best Time in Range (TIR) results globally using this technology. MethodsCareLink Personal data uploaded by MM780G system users from August 2020 to December 2022 were analyzed. ResultsThe Polish users (N=1304) on average reached to TIR of 79.1 ± 8.7 % (vs 73.0 ± 10.0 % for EU-PL, N=55659), a TBR<54 mg/dL of 0.6 ± 0.7 % (vs 0.4 ± 0.6 %) and a TBR<70 mg/dL of 2.9 ± 2.1 % (vs 2.1 ± 1.8 %). The adoption rate of optimal settings (i.e, GT=100 mg/dL, AIT=2hr) in PL was high (19.7 % vs 6.3 %), and filtering on optimal setting users led to less pronounced differences in glycemic control between PL and EU-PL. A univariable analysis with post-AHCL TIR showed that geography itself (PL vs EU-PL) is not a significant contributor to a high post-AHCL TIR (p = 0.15), and that much of the Polish post-AHCL TIR can be explained by the high pre-AHCL TIR. ConclusionThe Polish MM780G users achieved better glycemic control than the general European population (excluding Poland). This is largely attributable to the adoption of optimal settings in Poland and the already high glycemic outcomes at system start. As these characteristics can be implemented elsewhere, we believe this outstanding result can be obtained in other countries as well.

Impact of Vitamin D Supplementation on Glycaemic Control in Type 2 Diabetes Patients: A Double Blind Randomized Controlled Trial

Introduction: Vitamin D deficiency is a global health concern affecting diverse populations and it has been linked to various ailments. This study aimed to investigate vitamin D levels among T2DM patients and evaluate the impact of supplementation on those deficient, alongside its effect on quality of life and comorbidities. Methodology: A double-blinded randomized controlled trial was conducted among T2DM patients aged 18-75 years with HbA1c ≥ 7% and vitamin D deficiency (&lt;12 ng/mL). Participants were divided into intervention (vitamin D supplementation) and control (placebo) groups. Data on demographics, diabetic status, and comorbidities were collected. Blood samples were analyzed for HbA1c and Vitamin D levels. Results: Of the 66 participants initially recruited, 60 completed the study. No adverse effects were observed. There was no significant difference in glycemic control between the intervention and control groups at 3 and 6 months. Quality of life showed no significant improvement with supplementation. Conclusion: This study did not find evidence supporting the efficacy of vitamin D supplementation in improving glycemic control or quality of life among T2DM patients with vitamin D deficiency. Further research is warranted to explore alternative interventions or factors influencing glycemic control and quality of life in T2DM patients.

Impact of Gliclazide Modified Release or Glimepiride as Add-on Therapy to Metformin on Glycemic and Oxidative Stress Parameters in Type 2 Diabetic Patients

Background: Type 2 diabetes mellitus is a condition characterized by an elevation of oxidative stress, which has been implicated in diabetic progression and its vascular complications. Aim: Assessing the impact of gliclazide modified release (MR) versus glimepiride on oxidative stress markers, glycemic indices, lipid profile, and estimated glomerular filtration rate in uncontrolled type 2 diabetic patients on metformin monotherapy. Methods: This was an observational comparative study conducted in Thi-Qar specialized diabetic, endocrine, and metabolism center. Sixty-six patients were randomized into two groups based on the addition of the sulfonylureas (SUs). Group 1 (33 patients) was on gliclazide MR, whereas Group 2 (33 patients) was on glimepiride. The measured oxidative stress markers were reduced glutathione (GSH), superoxide dismutase (SOD), malondialdehyde (MDA), and protein carbonyl (PC) evaluated before and after 16 weeks of SUs addition. Results: There were significant drops in SOD (P &lt; 0.001), MDA (P &lt; 0.001), and PC (P = 0.001) and a significant increase in GSH (p = 0.029) levels after gliclazide MR add-on therapy. There were significant drops in SOD (P = 0.026) and MDA (P &lt; 0.001) levels with non-significant changes in both GSH (P = 0.214) and PC (P = 0.538) after glimepiride add-on therapy. There was a significant difference in improvement of PC level (P = 0.048) in the gliclazide group compared to the glimepiride group, with a non-significant numerically higher improvement of GSH, SOD, and MDA in gliclazide MR than glimepiride. At the end of the study, there were no significant differences in glycemic control, lipid profile, or eGFR improvement between the two groups. Conclusion: Glycemic control plays a pivotal role in decreasing oxidative stress. The control of diabetes with the gliclazide-MR-metformin combination reduced oxidative stress more than the glimepiride-metformin combination, indicating its antioxidant property. Keywords: Oxidative Stress, T2DM, Gliclazide MR, Glimepiride, Metformin.

Effectiveness of Jena DM® Herbal Formulation as Complementary Therapy to Conventional Oral Hypoglycemic Agents in Type-2 Diabetes Mellitus: A Quasi-experimental Study.

There is vast preclinical evidence that indicates that extracts from several Artemisia plant species have significant antidiabetic benefits. However, clinical evidence is limited to this effect. We sought to evaluate the effectiveness ofJena DM® (anArtemisia annua-based poly-herbal formulation) on glycemic control (Hb A1C) and insulin metabolism (HOMA), when administered as a complementary therapy in type-2 diabetes mellitus (T2DM). This study was supported by a research grant (JRD005) from Jena Herbals (U) Ltd, which is a local herbal medicines manufacturing facility in Uganda. We conducted a 12-week quasi-experimental study, involving 118 patients under routine follow-up at a diabetes and endocrinology clinic. Random assignment to either conventional or experimental study groups was done using a random number generator (Microsoft Excel version 16.0). Participant sociodemographic and clinical data as well as whole blood samples (3-5 mL) were obtained at scheduled clinic visits. Medication adherence was assessed using the Hill-Bone Scale, and adverse drug events (ADEs) using the Naranjo causality and the National Institute of Allergy and Infectious Diseases, Division of AIDS (DAIDS) scales. Group differences in glycemic control (HbA1C), fasting serum insulin (FSI) indices (% HOMA2-B, HOMA-IR), and other cardiometabolic parameters were assessed using independent samples t-test, and Pearson chi-square statistical tests were used. A p-value <0.05 was considered statistically significant. Ethical approvals were obtained before the study commencement. 12-week daily complementary therapy withJena DM® showed no significant effect on Hb A1C reduction (0.1 (95% CI: -0.56, 0.80) %;p=0.798); however, we observed a significant reduction in total body weight (2.0 (95% CI: 0.73, 3.28) kg;p=0.002). The overall frequency of self-reported ADEs including dizziness was significantly higher among patients that usedJena DM® (p=0.001).Epigastric pain was the most severe ADE necessitating clinical management. There was no significant difference in the homeostatic model assessment for insulin resistance (HOMA2-IR) between study groups. In contrast to a few studies that previously showed significanthypoglycemic effects ofArtemisia-basedextracts, this study did not show a statistically significant reduction on HbA1C during a 12-week complementary use ofJena DM® in patients withT2DM. Based on the findings of this study, future research should evaluate the long-term effects ofJena DM® on body weight, overall insulin metabolism, and the subsequent effect on glycemic control in T2DM.

The effect of cognitive behavioral therapy for insomnia on sleep and glycemic outcomes in people with type 2 diabetes: A randomized controlled trial

Study objectivesInvestigate whether aiding sleep by online cognitive behavioral therapy for insomnia (CBT-I) can improve glycemic and metabolic control, mood, quality of life (QoL) and insomnia symptoms in people with type 2 diabetes and assess the mediating role of lifestyle factors. MethodsAdults with type 2 diabetes and insomnia symptoms were randomly assigned to CBT-I or care as usual. At baseline, three and six months we assessed HbA1c as primary outcome and glycemic control, metabolic outcomes, sleep, mood and QoL as secondary outcomes. Mixed models were used to determine within-person and between-persons differences in outcomes and mediation analysis for lifestyle factors. ResultsWe randomized 29 participants to CBT-I and 28 to care as usual. Intention-to-treat analysis showed no significant differences in glycemic control, metabolic outcomes, anger, distress or QoL, but showed a significantly larger decrease in insomnia (−1.37(2.65: 0.09)) and depressive symptoms (−0.92(-1.77: 0.06)) and increase in BMI (0.29 kg/m2(0.00:0.57)) in the intervention compared to the control group. Only half of the intervention participants completed the CBT-I. Per protocol analysis showed a not statistically significant decrease in HbA1c (−2.10 mmol/l(-4.83:0.63)) and glucose (−0.39 mmol/l(-1.19:0.42)), metabolic outcomes and increase in QoL. Furthermore, the intervention group showed a significant decrease in insomnia (−2.22(-3.65: 0.78)) and depressive symptoms (−1.18(-2.17: 0.19)) compared to the control group. Lifestyle factors partially mediated the effect of the intervention. ConclusionsCBT-I might improve insomnia symptoms and mood, and perhaps improves glycemic control, albeit not significant, in people with type 2 diabetes and insomnia symptoms, compared to care as usual.

The effect of closed-loop glucose control on C-peptide secretion in youth with newly diagnosed type 1 diabetes: the CLOuD RCT

Background We assessed whether a sustained period of intensive glucose control with hybrid closed-loop for 12 months following diagnosis of type 1 diabetes in children and adolescents can preserve C-peptide secretion compared to standard insulin therapy. Methods In an open-label, multicentre, randomised, parallel trial, youth aged 10–16.9 years were randomised within 21 days of type 1 diabetes diagnosis to hybrid closed-loop or standard insulin therapy (control). Primary end point was the difference in mixed-meal C-peptide area under the curve 12 months post diagnosis. Key secondary end points included time spent in target glucose range, glycated haemoglobin and time spent below target glucose range at 12 months. Analysis was by intention to treat. The Closed Loop from Onset in Type 1 Diabetes consortium secured external funding for participants to continue on beyond 12 months, but the funding by National Institute for Health and Care Research and the results reported here refer only to the 12 months follow-up. Results We randomised 97 participants (mean ± standard deviation age 12 ± 2 years), 51 to closed-loop and 46 to control therapy. There was no difference in C-peptide area under the curve at 12 months between groups [geometric mean (interquartile range) closed-loop (n = 46): 0.35 pmol/ml (0.16, 0.49) vs. control (n = 37): 0.46 pmol/ml (0.22, 0.69); mean adjusted difference –0.06 (95% confidence interval –0.14 to 0.03); p = 0.19]. The proportion of time in target range 3.9–10.0 mmol/l based on 14-day masked LibrePro (Abbott Diabetes Care, Maidenhead, UK) sensor glucose data at 12 months was 10 percentage points (95% confidence interval 2 to 17) higher in the closed-loop group (64 ± 14%) compared to control group (54 ± 23%). Arithmetic mean glycated haemoglobin A1c was lower in the closed-loop group by 4 mmol/mol (0.4%) [95% confidence interval 0 to 8 mmol/mol (0.0% to 0.7%)] at 12 months. The mean difference in time spent &lt; 3.9 mmol/l between groups was 0.9 percentage points (95% confidence interval –1.0 to 2.8). Three severe hypoglycaemic events occurred in the closed-loop group (two participants), and one in the control group; one diabetic ketoacidosis occurred in the closed-loop group. Conclusions A sustained period of hybrid closed-loop glucose control following diagnosis of type 1 diabetes in children and adolescents does not slow down the decline in residual C-peptide secretion compared with standard insulin therapy. Despite the lack of effect on C-peptide, glycaemic control was sustained in the closed-loop group, whereas glycaemic control deteriorated in the control group 6 to 9 months after diagnosis and closed-loop safely accommodated the variability in exogenous insulin requirements which occur with beta-cell recovery post diagnosis. Limitations of the study included no central measurement of auto-antibodies at diagnosis. There was imbalance in the rate of diabetic ketoacidosis at diagnosis which is associated with a more rapid decline in C-peptide secretion, but this was adjusted for in the analyses. This highlights the need for improved therapies to allow youth to achieve recommended glycaemic targets from onset of type 1 diabetes irrespective of the lack of effect on residual C-peptide secretion. Future work includes ongoing follow-up of the study population for up to 4 years after diagnosis to observe how any differences in glycaemic control between treatment groups develop over time. Trial registration This trial is registered as Clinicaltrials.gov NCT02871089. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Efficacy and Mechanism Evaluation (EME) programme (NIHR award ref: 14/23/09), the Helmsley Trust (2016PG-T1D045 and 2016PG-T1D046), and JDRF (22-2013-266 and 2-RSC-2019-828-M-N), and is published in full in Efficacy and Mechanism Evaluation; Vol. 11, No. 8. See the NIHR Funding and Awards website for further award information. Additional support for the artificial pancreas work was from the NIHR Cambridge Biomedical Research Centre and NIHR Oxford Biomedical Research Centre. Abbott Diabetes Care supplied free glucose monitoring devices, and Dexcom supplied discounted continuous glucose monitoring devices. Medtronic supplied discounted insulin pumps, phone enclosures, continuous glucose monitoring devices, and pump consumables.

Glycaemic control among adults with type 2 diabetes mellitus in the Gulf Cooperation Council countries: an updated review.

Type 2 diabetes mellitus (T2DM) has become a major public health concern, causing significant disability and death worldwide. Fuelled by a modern sedentary lifestyle and poor dietary practices, T2DM affects at least 10.5% of the world's population. This paper seeks to review the progress made by the Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates) in addressing T2DM, focusing on glycaemic control proportions and comparing it with the 2015 review. The results indicate no significant improvement in glycaemic control proportions since the last review, with only 9.2% to 56.9% of patients having good control (glycosylated haemoglobin < 7%). However, there are no significant differences in glycaemic control between the GCC countries and other places worldwide despite being considered hotbeds of T2DM. Many factors contribute to poor glycaemic control. Specifically, evidence shows that being overweight or obese is the most common modifiable risk factor for T2DM incidence and poor glycaemic control. The GCC countries have higher rates of obesity. Additionally, poor glycaemic control is mainly related to a lack of adherence to insulin and medication use. Poor diet, rich in calories and low in fruits and vegetables, and a sedentary lifestyle also significantly contribute to poor glycaemic control and obesity. Therefore, to reduce the incidence of disease and improve glycaemic control in diabetic patients, educational programs promoting lifestyle changes should be implemented. Ongoing research is also necessary to assess the trend of glycaemic control and its risk factors in our region.

Differences in Glycemic Control for Inpatients with Type 1 Diabetes on Insulin Pump Versus Subcutaneous Insulin Therapy.

Inpatient use of insulin pump therapy has been increasing due to greater availability of this technology, however there is a paucity of research that investigates glycemic control of inpatient insulin pump users. To compare the glycemic control of hospitalized patients with type 1 diabetes (T1D) who used insulin pump vs. multiple daily injections(MDI). Retrospective chart review. Patients with T1D who were hospitalized between January 1, 2017, and December 31, 2019, in an academic medical center in the New York metropolitan area. Patients were categorized into three groups based on their method of insulin administration: "pump only" groupused insulin pump exclusively, "MDI only" group used MDI only, and "intermittent pump" group used a combination of both methods. The primary endpoints are mean blood glucose, rates of hypoglycemic events (blood glucose < 70mg/dL), and rates of hyperglycemic events (blood glucose > 250mg/dL).Separate multivariable Poisson regressions were performed to determine the association between the type of insulin administration and rate outcomes (i.e., rate of hypoglycemic events and rate of hyperglycemic events). The study included 78 patients with a mean age of 51, who were mostly male (54%), and white (72%). The average proportion of glucose measurements that were hyperglycemic for the "pump only", "MDI only", and "intermittent pump" groups were 0.11 (SD = 0.11), 0.25 (SD = 0.19), and 0.24 (SD = 0.25), respectively. The "pump only" group has a significantly lower proportion of hyperglycemic events as compared to the "MDI only" group (p = 0.0227). In this sample, patients who exclusively used their insulin pump while inpatient had a lower rate of hyperglycemic events than patients who used MDI only; suggesting that select patients can safely continue their insulin pump therapy in the inpatient setting.

Brisk Walking Untuk Menurunkan Kadar Glukosa Darah Pada Pasien Diabetes Mellitus Tipe 2: A Literature Review

Background: One of the non-communicable diseases (NCDs) that has received a lot of attention is Diabetes Mellitus. Diabetes management is divided into two ways. The first way is with non-drug therapy (non-pharmacological) and second with drug therapy. Drug therapy in the form of oral hypoglycemic drugs or insulin. Non-pharmacological methods with food planning and physical exercise. The type of light physical exercise recommended for patients with type II diabetes mellitus is walking and brisk walking. Objective: To determine the effect of brisk walking to reduce blood glucose levels in patients with type 2 diabetes mellitus. Methods: This review uses the literature review method. Searches were conducted in PubMed, Garuda, and Google Scholar. The search strategy used keywords with "brisk walking", "physical exercise", "glycemic control", "diabetes mellitus, type II",. Results: Seven articles were reviewed in this literature review. Six articles discussed brisk walking, one article discussed the difference in glycemic control in low - high intensity interval training with endurance training. The overall results of this review show that doing physical activity brisk walking has an effect in reducing blood glucose levels, reducing blood glucose levels by 49.75 mg/dL. Physical activity sessions can be done for 3 - 7 sessions per week with a duration of 15 - 60 minutes. Conclusion: The effect of brisk walking is proven to reduce blood glucose levels in patients with type 2 diabetes mellitus.

Fetal Overgrowth and Preterm Delivery in Women With Type 1 Diabetes Using Insulin Pumps or Multiple Daily Injections: A Post Hoc Analysis of the EVOLVE Study Cohort.

To compare the risk of fetal overgrowth and preterm delivery in pregnant women with type 1 diabetes (T1D) treated with insulin pumps versus multiple daily injections (MDI) and examine whether possible differences were mediated through improved glycemic control or gestational weight gain during pregnancy. The risk of pregnancy and perinatal outcomes were evaluated in a cohort of 2,003 pregnant women with T1D enrolled from 17 countries in a real-world setting during 2013-2018. In total, 723 women were treated with pumps and 1,280 with MDI. At inclusion (median gestational weeks 8.6 [interquartile range 7-10]), pump users had lower mean HbA1c (mean ± SD 50.6 ± 9.8 mmol/mol [6.8 ± 0.9%] vs. 53.6 ± 13.8 mmol/mol [7.1 ± 1.3%], P < 0.001), longer diabetes duration (18.4 ± 7.8 vs. 14.4 ± 8.2 years, P < 0.001), and higher prevalence of retinopathy (35.3% vs. 24.4%, P < 0.001). Proportions of large for gestational age (LGA) offspring and preterm delivery were 59.0% vs. 52.2% (adjusted odds ratio [OR] 1.36 [95% CI 1.09; 1.70], P = 0.007) and 39.6% vs. 32.1% (adjusted OR 1.46 (95% CI 1.17; 1.82), P < 0.001), respectively. The results did not change after adjustment for HbA1c or gestational weight gain. Insulin pump treatment in pregnant women with T1D, prior to the widespread use of continuous glucose monitoring or automated insulin delivery, was associated with a higher risk of LGA offspring and preterm delivery compared with MDI in crude and adjusted analyses. This association did not appear to be mediated by differences in glycemic control as represented by HbA1c or by gestational weight gain.

SAT096 Disparities Associated With Technology Use And Diabetes Control In A Minority Cohort Of Children And Adolescents

Abstract Disclosure: A. Granados: None. D. Baboun: None. R. Alvarez-Salvat: None. A. Martinez Sanchez: None. A. Carrillo: None. Background: Children and adolescents of racial and ethnic minorities exhibit suboptimal glycemic control and have the lowest rates of diabetes technology use. The utilization of technology has been found to improve overall diabetes control in children and adolescents. Objective: The purpose of this study is to determine whether technology use impacts diabetes control in a minority cohort of children and adolescents with either type 1 or type 2 diabetes. Methods: A retrospective study was conducted among a minority cohort of children and adolescents with diabetes seen at a multidisciplinary clinic. Data were collected from January to November of 2022. Patients who used their continuous glucose monitors (CGMs) and/or insulin pumps were categorized as technology users, whereas patients who did not were categorized as non-technology users. Demographic data, glycated hemoglobin (HbA1C) levels, BMI z-scores, LDL levels, and psychological functioning scores (PHQ-9 and DEPS-R) were collected for all participants during clinic visits. Chi-squared and t-tests were performed to compare all collected data according to device use. Results: We analyzed data from 170 children and adolescents with diabetes. Of the 170 patients, 125 (73.53%) were Hispanic, 7 (4.12%) were Non-Hispanic White, and 39 (22.94%) were Black; 85 (50.00%) were female; and the age range was 4-20 years (mean 13.62 ± 3.33). Of the 165 patients who had health insurance, 124 (75.15%) were publicly insured, and 41 (24.85%) were privately insured. Large racial-ethnic disparities in technology use existed, as 95 (76.00%) Hispanics, 5 (71.43%) Non-Hispanic Whites, and 20 (51.28%) Blacks were categorized as technology users (p = 0.007). There was no difference between the HbA1C levels of technology users (9.1%) and non-technology users (9.4%) (p = 0.6). The BMI z-score was lower in technology users (0.33) than in non-technology users (1.39) (p = 0.05). Likewise, LDL levels were lower in technology users (93.80 mg/dl) than in non-technology users (108.53 mg/dl) (p = 0.05). There was no significant difference in PHQ-9 and DEPS-R between the groups. Conclusions: The results provide novel insights into the impact of technology in diabetes control in a minority cohort of children and adolescents. Despite the high overall rate of technology use, there was no significant difference in glycemic control between technology users and non-technology users. This finding suggests that the utilization of diabetes technology may not be correlated with better glycemic control in minority groups. However, BMI z-scores and LDL levels were lower in technology users. Further research is needed to determine the root causes of disparities in diabetes control in children and adolescents of racial and ethnic minorities. Presentation: Saturday, June 17, 2023

Comparison of Glycemic Control Between In-Person and Virtual Diabetes Consults in Hospitalized Patients With Diabetes.

There is limited evidence that the diabetes in-person consult in hospitalized patients can be replaced by a virtual consult. During COVID-19 pandemic, the diabetes in-person consult service at the University of Miami and Miami Veterans Affairs Healthcare System transitioned to a virtual model. The aim of this study was to assess the impact of telemedicine on glycemic control after this transition. We retrospectively analyzed glucose metrics from in-person consults (In-person) during January 16 to March 14, 2020 and virtual consults during March 15 to May 14, 2020. Data from virtual consults were analyzed by separating patients infected with COVID-19, who were seen only virtually (Virtual-COVID-19-Pos), and patients who were not infected (Virtual-COVID-19-Neg), or by combining the two groups (Virtual-All). Patient-day-weighted blood glucose was not significantly different between In-person, Virtual-All, and Virtual-COVID-19-Neg, but Virtual-COVID-19-Pos had significantly higher mean ± SD blood glucose (mg/dL) compared with others (206.7 ± 49.6 In-person, 214.6 ± 56.2 Virtual-All, 206.5 ± 57.2 Virtual-COVID-19-Neg, 229.7 ± 51.6 Virtual-COVID-19-Pos; P = .015). A significantly less percentage of patients in this group also achieved a mean ± SD glucose target of 140 to 180 mg/dL (23.8 ± 22.5 In-person, 21.5 ± 20.5 Virtual-All, 25.3 ± 20.8 Virtual-COVID-19-Neg, and 14.4±18.1 Virtual-COVID-19-Pos, P = .024), but there was no significant difference between In-person, Virtual-All, and Virtual-COVID-19-Neg. The occurrence of hypoglycemia was not significantly different among groups. In-person and virtual consults delivered by a diabetes team at an academic institution were not associated with significant differences in glycemic control. These real-world data suggest that telemedicine could be used for in-patient diabetes management, although additional studies are needed to better assess clinical outcomes and safety.

Health-related Quality of Life among Type 2 Diabetes Patients in Southern Province of Saudi Arabia using WHOQOL-BREF: A Cross-section Study.

Quality of life has become a more important health outcome with advancements in medical therapies and disease management, leading to better lives for people in general, particularly those living with chronic diseases. Diabetes has a direct impact on the physical, psychological, and social aspects of personal health. This study aimed to determine healthrelated quality of life (HRQOL) and its predictors in patients with type 2 diabetes. A cross-sectional study was carried out on 420 patients with type 2 diabetes who presented to primary healthcare centers in Samtah Town, Saudi Arabia, from March 2017 to February 2018. The HRQOL of the study participants was determined using the World Health Organization Quality of Life-BREF. Multi-level linear regression was employed to ascertain the factors associated with HRQOL among patients with type 2 diabetes. Female sex was significantly associated with higher HbA1c, anxiety, depression, and stress scores and a lower HRQL in the physical, psychological, and environmental health subscales than males (P<0.001). All subscales of HRQOL were significantly lower in the > 50 years age group. When compared to those with low levels of education (illiterate, primary, or elementary school), patients with secondary and bachelor's degrees had significantly higher HRQOL in all subscales (P<0.001). In addition, there were significant differences in glycemic control and HRQL with a longer duration of diabetes, the presence of one or more diabetes complications, and the presence of comorbid hypertension (P<0.001). However, no significant differences in the Depression Anxiety and Stress Scale (DASS) index were observed with a longer duration of diabetes and the presence of comorbid hypertension. Patients with diabetes on combined therapy and healthy diet and exercise showed significantly higher HRQOL on physical functioning (P<0.001). Type 2 diabetes was significantly associated with impaired health-related quality of life and mental health among study participants. Females appeared to have worse quality of life and mental health than males. Age, duration of diabetes, comorbid hypertension, diabetes complications, and level of education were significantly associated with lower HRQOL and mental health scores. Healthy diet and exercise, when combined with hypoglycemic and insulin therapy, were found to improve HRQOL and mental health among patients with diabetes. Scales based on a broad definition of health, such as the WHOQOL-BREF, are appropriate for use in primary care settings and can enhance patient management and care.

Perbandingan Efektivitas Antara Metformin dan Glimepiride Berdasarkan Kadar Gdp pada Pasien Dm Tipe 2 di Rsud Dr.M.Soewandhie pada Tahun 2019

Diabetes Mellitus is a chronic metabolic disease characterized by elevated blood sugar levels and impaired carbohydrate, lipid, and protein metabolism due to betta pancreatic-cell dysfunction or insulin resistance in body cells. The prevalence of diabetes mellitus continues to increase worldwide. Indonesia itself has a prevalence of type 2 diabetes mellitus reaching 90% of all diabetes (WHO, 2016) (Riskesdas, 2018). The management of type 2 diabetes mellitus is very diverse, ranging from non-pharmacological therapy to pharmacological therapy such as insulin injection and oral anti-diabetes. Each anti-diabetic drug has a variety of ways of working, administration, and side effects. This study aims to analyze the comparison of the effectiveness of anti-diabetic medications based on blood sugar levels from the use of metformin and glimepiride (sulfonylureas) or a combination of both in patients with type 2 diabetes mellitus at Dr. Soewandhie Regional Public Hospital. This research is an analytic retrospective observational using secondary data in the form of medical records of patients with type 2 Diabetes Mellitus (outpatient) at Dr. Soewandhie Regional Public Hospital in 2019. The sample of this study consisted of 121 samples that met the inclusion criteria (43 patients on metformin therapy, 40 patients on glimepiride therapy, and 38 patients on combination therapy). The analysis of this study used data on FBG (Fasting Blood Glucose) before and three months after receiving metformin or sulfonylurea (glimepiride) therapy or a combination of both in the medical record. Data analysis of this study was performed using the Friedman test. This study showed that there was no significant difference in glycemic control (∆FBG) of metformin, glimepiride, and combination therapy in patients with type 2 diabetes mellitus (p value=0.575). There was no significant difference in the effectiveness of metformin, glimepiride, and combination therapy in patients with type 2 diabetes mellitus in Dr. Soewandhie Regional Public Hospital in 2019. In a study conducted in Japan showed that there’s efficacy of high-dose metformin use in patients with type 2 diabetes mellitus in Japan. The efficacy and safety of metformin are similar when used either twice daily or thrice daily. Further research needs to be done to assess the glycemic control (∆FBG) rate of metformin, glimepiride, and combination therapy in patients with type 2 diabetes mellitus by taking into account other factors such as medication adherence, diet, and physical activity.

Achieving comparability in glycemic control between antidiabetic treatment strategies in pregnancy when using real world data.

Healthcare utilization databases often lack information on glycemic control, a key confounder when studying the safety of antidiabetic treatments, since patients with worse control are channeled to second-line agents, in particular insulin, versus first-line agents such as metformin. We evaluated whether adjustment for measured characteristics attains balance in glycemic control when comparing antidiabetic treatment strategies in pregnant women with pregestational type 2 diabetes (T2DM). In a US insurance claims database, we identified 3360 women with T2DM pregnant between 2004 and 2015, of whom a subset of 996 had data on hemoglobin A1c (HbA1c ) levels. We selected insulin only as the comparator group and used propensity score (PS)-matching on comorbidities and proxies of diabetes severity, but not on HbA1c , to adjust for confounding. We used standardized differences (st.diff) to assess balance in claims-based covariates and mean HbA1c (% ± SD) in the subset. There were imbalances in claims-based covariates before PS-matching, with smaller differences when both treatment strategies included insulin. After PS-matching, balance was achieved in most claims-based covariates (st.diff <0.1). Mean HbA1c was similar before and after PS-matching when both treatments included insulin (e.g., 7.1 ± 1.5 vs. 7.7 ± 1.8 and 7.1 ± 1.5 vs. 7.5 ± 1.7, respectively, for metformin + insulin vs. insulin only). Differences in mean HbA1c remained after PS-matching when non-insulin treatments were compared to treatments including insulin (e.g., 6.3 ± 1.1 vs. 7.6 ± 1.7 for metformin only vs. insulin only). Balance in both claims-based characteristics and glycemic control was attained after restricting the population to women with T2DM and comparing treatment strategies indicated for patients with similar diabetes severity. When comparing treatment strategies with versus without insulin, differences in glycemic control persisted after PS-matching even when balance was attained for other measured characteristics.

The impact of pharmacist interventions, follow-up frequency and default on glycemic control in Diabetes Medication Therapy Adherence Clinic program: a multicenter study in Malaysia

BackgroundPharmacist’s involvement in optimizing medication adherence among diabetic patients has been implemented for over a decade. Diabetes Medication Therapy Adherence Clinic (DMTAC) was set up to educate diabetic patients, monitor treatment outcomes, and manage drug-related problems. While evidence shows that pharmacist-led DMTAC was effective in reducing HbA1c, there was limited data regarding the impact of different intervention types and default to follow-up on glycemic control.AimTo assess the impact DMTAC on glycemic control and the difference in glycemic control between hospital and health clinic settings as well as defaulter and non-defaulter. In addition, the impact of pharmacist’s interventions, DMTAC follow-up frequencies, and duration of diabetes on glycemic control were also determined.MethodsA retrospective study was conducted among diabetes patients under DMTAC care between January 2019 and June 2020 in five hospitals and 23 primary health clinics. Patients’ demographics data, treatment regimens, frequencies of DMTAC visits, defaulter (absent from DMTAC visits) and types of pharmacists’ intervention were retrieved from patients’ medical records and electronic database. HbA1c was collected at baseline, 4–6 months (post-1), and 8–12 months (post-2).ResultsWe included 956 patients, of which 60% were females with a median age of 58.0 (IQR: 5.0) years. Overall, the HbA1c reduced significantly from baseline (median: 10.2, IQR: 3.0) to post-1 (median: 8.8, IQR: 2.7) and post-2 (median: 8.3, IQR: 2.6%) (p < 0.001). There were 4317 pharmacists’ interventions performed, with the majority being dosage adjustment (n = 2407, 55.8%), followed by lab investigations (849, 19.7%), drugs addition (653, 15.1%), drugs discontinuation (408, 9.5%). Patients treated in hospitals received significantly more interventions than those treated in primary health clinics (p < 0.001). We observed significantly less reduction in HbA1c in DMTAC follow-up defaulters than non-defaulters after 1 year (− 1.02% vs. − 2.14%, p = 0.001). Frequencies of DMTAC visits (b: 0.19, CI: 0.079–0.302, p = 0.001), number of dosage adjustments (b: 0.83, CI: 0.015–0.151, p = 0.018) and number of additional drugs recommended (b: 0.37, CI: 0.049–0.691, p = 0.024) had positive impact on glycemic control whereas duration of diabetes (b: − 0.0302, CI: − 0.0507, − 0.007, p = 0.011) had negative impact.Conclusion Glycemic control improved significantly and sustained up to one year among patients in pharmacists-led DMTAC. However, DMTAC defaulters experienced poorer glycemic control. Considering more frequent visits and targeted interventions by pharmacists at DMTAC resulted in improved HbA1c control, these strategies should be taken into account for future program planning.