Fasting Plasma Glucose Research Articles

Clinical Utility of Fasting Plasma Glucose and Hemoglobin A1C (HbA1C) for the Prediction of Type 2 Diabetes Mellitus Diagnosed by Oral Glucose Tolerance Testing in Cirrhotic Patients with Impaired Fasting Plasma Glucose

Objective: Use of fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) levels has been ineffective in diagnosing diabetes in cirrhotic patients. The aim of this study was to determine the prevalence and optimal cut-off levels of FPG and HbA1c for effective prediction of type 2 diabetes mellitus (T2DM) as definitely diagnosed by the 75-gram oral glucose tolerance test (75-g OGTT) in cirrhotic patients with impaired fasting plasma glucose (IFG).Material and Methods: This single-center, cross-sectional study conducted in Nan Hospital included cirrhotic patients with IFG that were diagnosed as T2DM or non-T2DM via 75-g OGTT. The clinical factors associated with the presence of T2DM were investigated using univariate and multivariate regression models.Results: T2DM was diagnosed according to 75-g OGTT in 55 of the 103 participants (53.40%); impaired glucose tolerance (IGT) was diagnosed in 22.33%, and normal OGTT results were found in 24.27%. An FPG level of ≥104.5 mg/dL and an HbA1c level of ≥5.25% were found to be the optimal cut-off levels for the prediction of T2DM. The FPG level had a sensitivity of 76.4%, 95% confidence interval (CI) [63.0%, 86.8%], and a specificity of 37.5%; 95% CI [24.0%, 52.6%]. HbA1c levels had a sensitivity of 67.3%; 95% CI [53.3%, 79.3%] and a specificity of 37.5%; 95% CI [24.0%, 52.6%]. Hepatitis C virus (HCV) infection, high Child-Pugh score, and high level of FPG before the 75-g OGTT testing were significantly associated with T2DM.Conclusion: More than half of the cirrhotic patients with IFG had T2DM diagnosed by 75-g OGTT. An FPG level of ≥104.5 mg/dL and an HbA1c level of ≥5.25% were found to be the optimal cut-off levels for the prediction of the presence of T2DM in those with cirrhosis and IFG.

A prospective, multicentre study evaluating safety and efficacy of a fixed dose combination of Remogliflozin etabonate, Vildagliptin, and Metformin in Indian patients with type 2 diabetes mellitus (Triad-RMV)

AimsThe ICMR INDIAB-17 study revealed a diabetes prevalence of 11.4% in India, emphasizing the need for effective treatment for glycemic control. A Phase IV study was conducted to evaluate the safety and efficacy of a Fixed Dose Combination (FDC) of Remogliflozin, Metformin and Vildagliptin (RMV) in Type 2 Diabetes Mellitus (T2DM) patients uncontrolled on Metformin plus SGLT2 inhibitor or Metformin plus DPP4 inhibitor dual therapy.MethodsA total of 215 patients (mean age: 46.4 years; 64% male, 36% female) were enrolled across multiple centers in India. The study population included patients with a baseline HbA1c ≥ 8% at the time of screening. The primary objective was to assess safety based on treatment-emergent adverse events (TEAEs), while the secondary. aim was to evaluate effectiveness in terms of glycemic (HbA1c, fasting plasma glucose, postprandial glucose) and extra-glycemic measures (renal and lipid parameters). Statistical analysis was conducted using paired t-tests and the Wilcoxon signed-rank test for within-group comparisons, and the Bonferroni correction was applied to adjust for multiple comparisons. Effectiveness was evaluated at baseline, week 12, and week 24.ResultsThe study demonstrated statistically significant reductions in mean HbA1c levels from baseline to both week 12 and week 24 (p < 0.00001). At 24, weeks, 45.1% of patients achieved target HbA1c levels of ≤ 7%. Significant reduction was also observed in fasting plasma glucose (FPG) and postprandial glucose (PPG) levels. Renal parameters remained stable or improved, and lipid profile parameters, including LDL-C and triglycerides, showed favorable changes. Adverse events of special interest, including hypoglycemia and urinary tract infections, were reported in 4.7% of patients, with no serious adverse event recorded.ConclusionsThe twice daily triple FDC of RMV was well tolerated, safe and effective in patients with Type 2 Diabetes Mellitus uncontrolled on dual drug therapy of Metformin plus SGLT2i or Metformin plus DPP4i. The treatment led to significant improvements in glycemic control and other metabolic parameters over 24 weeks, without compromising renal function or causing serious adverse events.Trial registrationCTRI, CTRI/2022/05/042581. Registered 17 May 2022, https//ctri.nic.in/Clinicaltrials/rmaindet.php? trialid=68,757&EncHid=36127.16500&modid=1&compid=19.

Vascular volume changes in radiological patterns of usual interstitial pneumonia in patients with type 2 diabetes

ObjectiveThis research primarily focuses on exploring the changes in intrapulmonary vascular volume (IPVV) in radiological patterns of usual interstitial pneumonia (UIP) associated with Type 2 Diabetes Mellitus (T2DM), thereby inferring the possible mechanisms of the co-occurrence of diabetes and UIP patterns.MethodsThin-layer data were post-processed on the basis of high-resolution computed tomography (HRCT) and quantitatively assessed for IPVV. Changes in IPVV were compared between T2DM combined with UIP modality and T2DM non-UIP modality. Correlations between UIP patterns and various markers and confounders, including IPVV, were determined via logistic regression analysis. In this study, the potential of IPVV as a predictor for UIP presence was analysed through the application of subject operating characteristic curve analysis.ResultsIn patients with T2DM, the IPVV demonstrated smaller size in those with combined UIP patterns compared to T2DM patients without UIP patterns (164.4 ± 68.7 vs 202.9 ± 76.3 mL, P = 0.005). We detected a positive correlation between IPVV levels and several variables, including fasting plasma glucose (FPG) (r = 0.404, P < 0.0001), glycated hemoglobin (HbA1c) (r = 0.225, P = 0.022), serum uric acid (SUA) (r = 0.332, P = 0.0007) and HRCT scores (r = 0.288, P = 0.024). Conversely, negative correlations were noted with total cholesterol (TC) (r = –0.220, P = 0.028) and cystatin-C (Cys-C) (r = –0.215, P = 0.038). Multivariate logistic regression analysis identified independent associations between the presence of UIP and several factors: IPVV, age, smoking history, and FPG. In assessing the combined UIP pattern among T2DM patients, IPVV levels exhibited a sensitivity of 70.5% and a specificity of 58.5%, generating an AUC of 0.645.ConclusionIn individuals diagnosed with T2DM alongside UIP, a substantial decline in IPVV was documented. This diminution correlates with the presence of UIP, suggesting that IPVV may serve as a potent biomarker for detecting UIP patterns in individuals with T2DM. This may suggest that the mechanism behind the co-occurrence of T2DM with UIP patterns is attributed to alterations in the pulmonary microvasculature, potentially representing one of the vascular complications associated with diabetes.

Identify unmet needs in diabetes care in Shandong, China: a secondary analysis of a cross-sectional study using cascade of care framework

BackgroundThe continuum management of diabetes remains under-evaluated in China. This study aimed to estimate the proportions of diabetes adults at each stage of the cascade of care framework in Shandong, China.MethodsWe conducted a secondary analysis using the 2018 China Adult Chronic Disease and Nutrition Surveillance (CACDNS) data in Shandong. This nationwide cross-sectional survey was conducted between September and November 2018, investigating the major chronic diseases among Chinese adults through interviews, physical examinations, and laboratory tests. We employed the cascade model to examine the proportion of diabetes adults, including both type 1 and type 2, from diabetes screening, diagnosis, pharmaceutical and non-pharmaceutical treatments, to single and comprehensive management targets, and quantified the attrition between each stage. Diabetes screening was defined as participants reported to have ever received a blood glucose test. Diabetes diagnosis was defined as: 1) fasting plasma glucose (FPG) ≥ 126 mg/dL, or 2) 2-h oral glucose tolerance test (2 h-OGTT) ≥ 200 mg/dL, or 3) hemoglobin A1c (HbA1c) ≥ 6.5%, or 4) self-reported diabetes. Diabetes management targets included: 1) single glycemic target of personalized HbA1c level, 2) comprehensive ABC targets of personalized HbA1c level, blood pressure (BP) < 140/80 mm Hg, and low-density lipoprotein cholesterol (LDL-c) level < 2.6 mmol/L, 3) lifestyle target of not currently smoking. The estimated proportion was calculated through self-reported diabetes status and FPG, 2h-OGTT and HbA1c. The number of diabetes cases in Shandong was extrapolated using the 2018 provincial census data for adults aged 18 years and above (N = 80.6 million). The cascade of diabetes care was further examined by age, sex, and Basic Public Health Service (BPHS) enrollment.ResultsThis secondary analysis included 8,462 individuals (47.8% males, median age: 49.0), among whom 12.4% had diabetes (self-reported: 4.2%, newly diagnosed: 8.2%) and 41.1% had prediabetes. In 2018, an estimated 9.2 million adults in Shandong had diabetes, with 6.4 million (69.6%) receiving diabetes screening but 6.2 million (67.7%) remaining unaware of their conditions. Among self-reported diabetes adults, 2.7 million (86.4%) and 2.8 million (89.6%) received pharmaceutical and non-pharmaceutical treatment, respectively. Of those with treatments, 1.2 million (58.2%) met personalized glycemic target. A rapid decline, however, was observed in BP (31.1%) and LDL-c (39.3%) control among diabetes patients with multimorbidity (≥ 2 diseases). Ultimately, 0.1 million self-reported diabetes adults (3.8%) achieved the ABC targets. BPHS Enrollment slightly improved comprehensive management with ABC targets.ConclusionsA significant unmet need exists for diabetes adults from screening to management, particularly the comprehensive management of glycemia, BP and LDL-c levels among those with multimorbidity. Tailored strategies and appropriate allocation of healthcare resource is needed to addressing gaps in care continuum and reduce long-term disease burden.

Efficacy and safety of switching to insulin glargine 300 U/mL in people with type 2 diabetes uncontrolled on basal insulin in China: A post hoc subpopulation analysis of the INITIATION study.

To evaluate the efficacy and safety of insulin glargine 300 U/mL (Gla-300) in people with uncontrolled type 2 diabetes (T2D) switching from another basal insulin (BI). INITIATION was an interventional, single-arm, phase IV study conducted in China. In this post hoc subpopulation analysis, the efficacy and safety of switching to Gla-300 was investigated in individuals with uncontrolled T2D (HbA1c 7.5%-11.0% [58-97 mmol/mol]) with previous BI. The primary endpoint was HbA1c change at week 24. Other measures of glycaemia, hypoglycaemia, insulin dose and weight change were assessed. Three hundred and two participants switched to Gla-300 from another BI, including 232 from insulin glargine 100 U/mL (Gla-100) and 55 from insulin degludec (IDeg). At week 24, the mean ± standard error (SE) HbA1c change from baseline was -0.87% ± 0.06% (-9.5 ± 0.7 mmol/mol; p <0.001). Significant reductions in fasting plasma glucose (least-squares mean [LSM] change -1.13 mmol/L) and fasting self-measured blood glucose (LSM change -1.36 mmol/L) were also observed (both p <0.001). The mean daily BI dose increased from 18.86 U (0.27 U/kg) at baseline to 28.83 U (0.41 U/kg) at week 24. During the 24-week treatment period, the incidence of any hypoglycaemia was 43.8% for all hypoglycaemia and 15.1% for nocturnal hypoglycaemia; the incidence of severe hypoglycaemia was low (0.7%). Minimal body weight change was documented. Gla-300 improved glycaemic control with a relatively low hypoglycaemia risk and minimal weight gain in Chinese people with T2D uncontrolled on previous BI.

Relationship of adiponectin, leptin and reproductive endocrine hormones with insulin resistance in polycystic ovary syndrome patients with normal BMI

Objective This study aimed to analyze the correlation of adiponectin (APN) and leptin (LEP), reproductive endocrine hormones with insulin resistance (IR) in polycystic ovary syndrome (PCOS) patients with normal body mass index (BMI). Methods Totally 160 PCOS patients were categorized into the Normal BMI (BMI: 18.5–25 kg/m2, n = 62) and High BMI (BMI > 25 kg/m2, n = 98) groups. Glucose indicators [fasting plasma glucose, fasting insulin and Homeostasis Model Assessment of Insulin Resistance (HOMA-IR)], lipid indicators [total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C)], adipokines [APN and LEP] and reproductive endocrine hormones [luteinizing hormone (LH), follicle stimulating hormone (FSH), prolactin (PRL), total testosterone (TT), dehy-droepiandrosterone sulfate (DHEAS) and estradiol (E2)] were collected, and their correlations were analyzed. The relationship of HOMA-IR with APN, LEP and reproductive endocrine hormones was subjected to multiple linear regression analysis. Results Correlation analysis revealed positive correlations of HOMA-IR with TC, TG, LDL-C, LEP, PRL, DHEAS and TT and negative correlations with HDL-C, APN, LH, FSH and E2 in PCOS patients with normal BMI. Multiple linear regression analysis showed that LH, FSH and E2 negatively affected HOMA-IR, while PRL positively affected HOMA-IR. Conclusion There were strong correlations of HOMA-IR in PCOS patients with normal BMI with APN, LEP, and reproductive endocrine hormones. Besides, LH, FSH, E2 and PRL expression had an important effect on IR in normal BMI PCOS patients, which provided a theoretical basis for the exploration of pathogenic mechanisms in normal BMI PCOS patients.

Association between cardiovascular health and perceived quality of life in ethnically diverse adults: insights from the Community of Mine study using the American Heart Association's Life's Simple 7.

The association between cardiovascular health (CVH) with perceived quality of life (PQoL) and variations by sex and Hispanic ethnicity is not well understood. This study included 583 participants (42% Hispanic, 56% female, mean age 59years). Linear regression modeled the covariate-adjusted associations between CVH, using the combined 7 components of Life's Simple 7 (LS7; ideal and intermediate, compared to poor), and PQoL (total and physical, social, and cognitive health domains). For individual LS7 components, we assessed effect modification by sex and Hispanic ethnicity. Compared to individuals with poor CVH, those with intermediate (β [95% CI] = 0.22 [0.09, 0.35]) and ideal (β [95% CI] = 0.22 [0.08, 0.36]) CVH had higher overall PQoL. This effect was dominated by the physical PQoL domain. Of LS7 components, ideal body mass index (BMI) (β [95% CI] = 0.17 [0.03, 0.31]) and physical activity (β [95% CI] = 0.26 [0.12, 0.40]) were associated with overall PQoL. Ideal diet (β [95% CI] = 0.32 [0.08, 0.56]) and fasting plasma glucose (β [95% CI] = 0.32 [0.06, 0.58]) were associated with the physical PQoL domain. A higher PQoL score was associated with intermediate BMI in women, and physical PQoL was associated with smoking for women. A BMI*Hispanic interaction resulted in larger associations between intermediate/ideal BMI and physical PQoL in non-Hispanics. Ideal or intermediate CVH health factors and health behaviors were associated with higher PQoL. Sex and ethnicity differences suggest that perceived quality of life is associated with BMI for women and non-Hispanics.

Global burden of Alzheimer’s disease and other dementias attributed to metabolic risks from 1990 to 2021: results from the global burden of disease study 2021

ObjectiveThe risk of Alzheimer’s disease (AD) and other dementias increases with greater global exposure to metabolic risks, making this a crucial public health issue. This study aimed to report the metabolism-attributable global burden of AD and other dementias from 1990 to 2021.MethodsThe Global Burden of Disease Study (GBD) 2021 collected data on the number of deaths and disability-adjusted life-years (DALYs) related to AD and other dementias caused by metabolic risks, including high fasting plasma glucose (FPG) and high body mass index (BMI). The analysis assessed the disease burden and temporal patterns worldwide, examining data by region, country, level of social development, age group, and sex.ResultsGlobally, the count of AD and other dementia-related deaths due to metabolic risks grew from 98,608 to 399,824, a 4.1-fold increase. For dementias related to high FPG and high BMI, the age-standardized mortality rates (ASMR) and age-standardized DALY rate (ASDR) increased with age and were higher in females than in males. In 2021, the highest burden was observed in high-income North America. The ASMR and ASDR have grown worldwide between 1990 and 2021. The burden of metabolism-related AD and other dementias was positively correlated with the Socio-Demographic Index (SDI), with higher ASMR and ASDR in high SDI regions but showing more pronounced increases in low and low-middle SDI regions.ConclusionsMetabolism-related global burden of AD and other dementias is increasing, particularly among women and in high-income regions. Targeted prevention programs for dementia should be developed, along with early interventions for risk factors.

Epidemiological shifts in chronic kidney disease: a 30-year global and regional assessment

BackgroundChronic kidney disease (CKD) presents a growing global health challenge, with significant variability in disease burden across different regions and countries. This study aimed to analyze the trends in incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for CKD from 1990 to 2019, utilizing data from the Global Burden of Disease Study.MethodsWe conducted an in-depth study on the global and age-standardized incidence, prevalence, mortality, and DALYs of CKD, and assessed trends over a 30-year period. Additionally, we explored the associations between healthcare access and quality (HAQ), the Socio-Demographic Index (SDI), and CKD. Furthermore, we conducted a detailed analysis of six risk factors closely related to CKD, and based on these findings, provided strong evidence for enhancing the management of CKD.ResultsIn 2019, there were 18,986,903 cases of CKD, with an average annual percent change (AAPC) of 1.82 (95% CI = 1.8 to 1.82) in incidence since 1990. The age-standardized incidence rate increased from 192.45 per 100,000 in 1990 to 233.65 per 100,000 in 2019. Prevalence also rose, with a total of 69,729,430 cases in 2019 and an AAPC of 1.19 (95% CI = 1.19 to 1.2). Mortality and DALYs have increased correspondingly, with the mortality rate reaching 18.29 per 100,000 and total DALYs at 41,538,592 in 2019. The analysis showed that higher HAQ levels are associated with better outcomes in terms of lower mortality and DALY rates, whereas lower HAQ levels correlate with poorer outcomes. In addition, high fasting plasma glucose and high systolic blood pressure are the main contributors to CKD-related deaths, with their population attributable fraction (PAF) significantly decreasing as the SDI decreases.ConclusionThe burden of CKD has significantly increased over the past three decades, influenced by demographic changes and variations in healthcare quality and access. Effective public health strategies and improvements in healthcare delivery are needed to address the disparities in CKD outcomes globally.

Screening fasting glucose before the OGTT: near-patient glucometer- or laboratory-based measurement?

The measurement of fasting glucose is a common practice for lowering the risk of hyperglycemia before an oral glucose tolerance test (OGTT). In this study we analyze advantages and limitations of near-patient measurement of capillary fasting glucose with a portable glucometer or blood sampling and measurement of plasma glucose with laboratory instrumentation. The final study population consisted of 241 subjects (mean age: 36±8 years; 97.9 % pregnant women) referred to our local phlebotomy center for an OGTT. Fasting glucose was measured in capillary blood using a near-patient glucometer (glucometer-based strategy) and in plasma with laboratory instrumentation using the hexokinase reference assay (laboratory-based strategy). The mean turnaround time from sample collection to obtaining the glucose value was longer with the laboratory-based strategy (32 min 8 vs. 8 s). The imprecision of the glucometer was higher than that of the laboratory assay (3.4 vs. 0.8 %). A negative bias of-3.3 % in fasting glucose was found with the glucometer compared to the laboratory measurement. The diagnostic accuracy, sensitivity and specificity of the glucometer for detecting fasting glucose values≥7.0 mmol/L were 99.2 , 50.0 and 100.0 % compared to the laboratory assay. The glucometer-based strategy had an incremental cost of 0.17€ per patient compared to the laboratory-based strategy. Screening fasting glucose in capillary blood with a near-patient glucometer instead of measuring fasting plasma glucose with laboratory instrumentation allows faster patient management in the phlebotomy center but is associated with higher imprecision, inaccuracy, costs and avoidable finger pricks.

Visceral adiposity index, cardiorespiratory fitness, and fasting plasma glucose associations in adolescents.

The global rise in the prevalence of type 2 diabetes mellitus (T2DM) in children and adolescents is partly linked to the increasing rates of childhood obesity and physical inactivity. To explore the independent relationships of visceral adiposity index (VAI) and cardiorespiratory fitness (CRF) with fasting plasma glucose (FPG) in adolescents. This descriptive cross-sectional study included 403 adolescents (202 boys and 201 girls) aged 11-19 years. Participants were evaluated for VAI, CRF, and FPG. Regression models, adjusted for age and maturity status, were used to assess the associations between VAI, CRF, and FPG. The prevalence of T2DM risk was 15.3% (girls = 7.4%; boys = 7.9%). In boys, high VAI was positively associated with FPG (β = 0.190, P = 0.009), while low CRF was negatively associated with FPG (β = -0.206, P = 0.010). These associations persisted even after adjusting for CRF and VAI. However, no significant associations between VAI, CRF, and FPG were observed in girls (P > 0.05). Adolescents with high VAI and low fitness levels demonstrated poorer glycemic profiles. Among boys, both VAI and CRF were independently associated with T2DM risk, with CRF showing a stronger association. These associations were not observed in girls. Promoting regular aerobic exercise and healthy diets may serve as essential public health promotion strategies in preventing and managing T2DM risk in adolescents.

Assessment of cognitive disorders in elderly type 2 diabetic patients with obesity

ABSTRACT Background Cognitive impairment is common in the elderly and can result from many chronic illnesses. The risk of CI is around one-third for older persons with diabetes. Diabetes increases the incidence of numerous common geriatric syndromes in older persons, including polypharmacy, CI, depression, urine incontinence, injurious falls, and chronic pain. Additionally, obesity raises the risk of high blood pressure, and DM and promotes arterial aging, which are known to be independent risk factors for CI. Objective The current study evaluated cognitive disorders in elderly type 2 diabetic patients with obesity. Material and Methods A sample of 120 elderly persons was divided into 3 groups: Group (1): 40 elderly non-obese non-diabetics (Control), Group (2): 40 elderly obese non-diabetic patients, and Group (3): 40 elderly obese type 2 diabetic patients. Fasting plasma glucose (FPG), 2 hPPPG (2 hour post prandial plasma glucose), glycosylated hemoglobin (HA1C) were measured. Obesity was assessed using height, weight, body mass index (BMI), and waist circumference (WC). Cognitive impairment in the elderly was detected using a questionnaire called the Montreal Cognitive Assessment (MoCA). Results There was statistical significance between the three investigated groups concerning HbA1c, FPG, and 2-hour PPG. Also, there was statistical significance between the three study groups in terms of total MOCA score. Weight, BMI, and WC showed statistical significance between the three study groups. Conclusion: Cognitive impairment is related to obesity and type 2 diabetes in elderly.

Clinical utility of liver function tests for resolution of metabolic dysfunction-associated steatotic liver disease after weight loss in the Diabetes Remission Clinical Trial.

Ectopic fat is reduced by effective weight management, but difficult to assess clinically. We evaluated paired data on 42 participants in the intervention group of the Diabetes Remission Clinical Trial (DiRECT) at baseline, 12 and 24 months after weight loss as indicators of liver fat content measured by 3-point Dixon MRI. Baseline liver fat was elevated at 13.0 [7.8-23.3]% with fasting plasma glucose 7.9 [7.1-10.1] mmol/L. Prevalence of baseline MASLD was 86.4%. After weight loss of 11.9 ± 1.2 kg (0-37 kg) at 12 months, remission of MASLD occurred in 74% and liver fat normalised for many (1.8 [1.2-5.2]%; p < 0.0001) as did fasting glucose (5.9 [5.5-7.2] mmol/L; p < 0.0001). Alanine aminotransferase (ALT) and gamma glutamyl transferase (GGT) decreased at 12 months by 38 [19-60]% (p < 0·0001) and 38 [16-53]% (p < 0.0001) respectively. The positive predictive value for decrease in liver fat, with baseline values of >40 IU/L, was 100% for ALT and 87.5% for GGT. As expected, change in liver fat correlated with change in ALT (r = 0.64; p < 0.0001), GGT (r = 0.38; p = 0.013), AST (r = 0.36; p = 0.018), fatty liver index (r = 0.50; p < 0.0001) and hepatic steatosis index (r = 0.44; p < 0.0001). Metabolic dysfunction-associated steatotic liver disease, an important marker of ill-health is improved by intentional weight loss. If enzyme levels are raised at baseline, following weight loss, changes in ALT and GGT usefully reflect change in liver fat content, with high positive predictive value. Monitoring liver enzymes can provide a simple way to assess change in liver fat following weight loss in day-to-day clinical practice.

Frequency of Insulin Omission and It’s Associated Factors in Patients with Type 2 Diabetes Mellitus on Insulin Therapy

ABSTRACT Background: Poor adherence to prescribed insulin regimen leads to poor glycemic control. This study was intended to see the frequency of insulin omission and it's associated factors among patients with inadequate glycemic control on insulin therapy. Methods: This cross-sectional observational study enrolled 384 patients with type 2 diabetes on insulin therapy recruited by convenient sampling from the Department of Endocrinology of BIRDEM General Hospital. As per study protocol, investigation reports were collected from patient records. Data were analyzed by SPSS version 25. Results: Forty-six percent of patients had some form of insulin omission. A documented event of one or more episodes of hypoglycemia (70.7%) was found to be the prime reason behind the omission of insulin. Worsened glycemic control (fasting plasma glucose, 2-h postprandial glucose, and glycated hemoglobin) and health hazard (obesity) were statistically significantly higher among the subjects who omitted their insulin. Only a few people in the insulin omission group were compliant with diet (2.8%), exercise (5.1%), and weekly self-monitoring of blood glucose (2.8%). Only 22.5% and 21.3% knew about target blood glucose and the insulin dose adjustment, respectively, in the omission group. Conclusions: High frequency of insulin omission due to several lifestyle-related factors and lack of structured diabetic education predisposed the patients to poor glycemic control.

Efficacy of Dapagliflozin + Sitagliptin + Metformin Versus Sitagliptin + Metformin in T2DM Inadequately Controlled on Metformin Monotherapy: A Multicentric Randomized Trial.

A slower adoption rate of fixed dose combinations (FDC) in diabetes management is partly due to insufficient data. This study evaluates the safety and efficacy of an FDC of dapagliflozin + sitagliptin + metformin hydrochloride extended release (XR), compared to a dual FDC of sitagliptin + metformin hydrochloride XR among patients with type2 diabetes mellitus (T2DM) with poor glycemic control when treated with metformin monotherapy. A total of 274 patients with T2DM were randomized (1:1) to either armX, receiving FDC of dapagliflozin (10mg) + sitagliptin (100mg) + metformin hydrochloride XR (1000mg) (Dapa + Sita + Met) tablets, or armY, receiving sitagliptin phosphate (100mg) + metformin hydrochloride XR (1000mg) (Sita + Met) tablets, and treated for 16weeks. The outcome measures included changes in hemoglobinA1c (HbA1c)(%), fasting plasma glucose (FPG), 2-h post-prandial glucose (PPG), weight, and the proportion of patients achieving target HbA1c levels of < 7.0% by week16 of the study period. The reduction in HbA1c at week16 was significantly higher in armX than in armY [estimated treatment difference (ETD), -0.65% (95%CI -0.76 to -0.53; P < 0.0001)]. ArmX showed a marked decrease in FPG [ETD -15.42mg/dl; 95%CI (17.63, 13.22; P < 0.0001)], PPG [ETD -30.39mg/dl; 95%CI (35.59, 25.19; P < 0.0001)], and weight [ETD -1.47kg; 95%CI (1.59, 1.28; P < 0.0001)] after 16weeks. In armX, 54% of patients reached HbA1c < 7.0% compared to 29.9% in armY. The incidence of adverse events was comparable [13.14% (armX) vs 12.4% (armY)]. There was no severe hypoglycemia-led treatment discontinuation. Among patients with T2DM who have poor glycemic control with metformin monotherapy, triple FDC (Dapa + Sita + Met) effectively helped achieve better glycemic response compared to dual FDC (Sita + Met), with a comparable safety and tolerability profile. CTRI/2022/01/039857.

Pre-pregnancy LDL/HDL and total Cholesterol/HDL ratios are strong predictors of gestational diabetes mellitus in women undergoing assisted reproductive technologies

Background & ObjectiveTo analyze whether there is an association between pre-pregnancy lipid parameters and gestational diabetes mellitus (GDM) in women undergoing assisted reproductive technologies (ART), a group especially at risk for GDM, and if so, which parameter is associated the strongest.MethodsData was collected at the Reproductive and Genetic Hospital CITIC-Xiangya in Changsha, China from January 2017 to December 2018. The measured lipid parameters include LDL (low-density lipoprotein), HDL (high-density lipoprotein), TC (total cholesterol), and TG (triglycerides).Results119 (15.5%) of the 767 patients developed GDM. On average, women who developed GDM were older, had a higher BMI, LDL, TC, and TG, and lower HDL. After adjusting for confounders, LDL and HDL showed a significant association with GDM (p < 0.05), but TC and TG did not. Binary LDL/HDL and TC/HDL ratios showed the strongest association with GDM incidence (OR 1.957 [95%CI 1.258–3.044] and 1.942 [1.243–3.034] respectively). Subgroup analysis showed that an elevated LDL/HDL ratio also increased GDM risk in subgroups with a typically lower prevalence of GDM, such as young women with a low BMI and low blood pressure. Both lipid ratios (LDL/HDL and TC/HD) show strong interactions with baseline age, fasting plasma glucose, and LH.ConclusionsIn this cohort of Chinese women undergoing ART, pre-pregnancy LDL/HDL and TC/HDL were associated with GDM the strongest from the lipid parameters and could be useful to estimate GDM risk even before ART treatments and pregnancy.Clinical trial numberNCT03503006 registered on the 21st of March 2018 (on clinicaltrials.gov). https://clinicaltrials.gov/study/NCT03503006?locStr=Changsha,%20Hunan,%20China&country=China&state=Hunan&city=Changsha&cond=ivf&rank=2.

Long-Term clinical efficacy of liraglutide for type 2 diabetes: real-world evidence and outcomes from Pakistan.

Liraglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, has demonstrated efficacy in improving glycemic control and promoting weight loss in clinical trials. However, real-world data from diverse populations, particularly from South Asia, are limited. The study aims to evaluate the long-term efficacy and safety of liraglutide in a real-world setting among Pakistani patients with type 2 diabetes mellitus (T2DM). A retrospective cohort study of 624 patients initiated on liraglutide was conducted. Data were collected at baseline and 6, 12, 18, and 24 months. Primary outcomes were HbA1c and weight changes. Secondary outcomes included fasting plasma glucose, lipid profile, and blood pressure. Statistical analyses were performed using appropriate methods. In study population the mean HbA1c reduction of -1.45 ± 0.67% was observed at 24 months, with 30.6% achieving HbA1c ≤ 7.5%. A rapid and sustained weight loss of -7.51 kg was achieved, with 27.2% experiencing ≥5% weight loss. Additionally, liraglutide led to a significant reduction in LDL cholesterol, with 46.7% of patients achieving a ≥ 10% reduction at 24 months. Liraglutide was well-tolerated, with a low discontinuation rate of 4.6%. Liraglutide demonstrated sustained efficacy and safety in a diverse Pakistani population with T2DM, regardless of baseline characteristics. These findings support the use of liraglutide as an effective treatment option for T2DM in real-world clinical practice.

Obesity indices may affect and reflect the blood glucose and lipid profile values

The aim of the present study was to observe the association between obesity indices, blood glucose, and lipid profiles as indicators for its levels. In a cross-sectional study, 491 Jordanian adults were included. Socio-demographic and anthropometric data were measured. Blood samples were collected and tested for fasting plasma glucose (FPG), insulin, and lipid profile. Obesity indices [Conicity Index (CI), Body adiposity index (BAI), Abdominal volume index (AVI), A Body Shape Index (ABSI), Body Roundness Index (BRI), and Weight-adjusted-waist index (WWI)] were calculated using standard formulas. AVI, BRI, and WWI had a higher impact on FPG and lipid profile. They explain 6.2%, 6.6%, and 4.1% of changes observed in FPG and explained 3.1%, 4.1%, and 3.5% of changes observed in total cholesterol (TC), respectively. In addition, they explain 9.9%, 9.7%, and 7.9% of changes in triglyceride (TG), 9.6%, 8.4%, and 6.0% of the variability observed in the high-density lipoprotein cholesterol (HDL), as well as 1%, 1.6%, and 1.5 of change in low-density lipoprotein cholesterol (LDL), and 7.0%, 8.6%, and 6.6% in LDL/HDL ratio; respectively (p&lt;0.001). AVI, BRI, and WWI among obesity indices had the highest impact on blood glucose and lipid profile. The most affected tests were TG, HDL, and LDL / HDL ratio. These indices may be used as noninvasive rapid indicators for high glucose and lipid profiles.

Association of systemic immunity-inflammation index with type 2 diabetes and insulin resistance in NHANES 2005–2018

Although the interplay between inflammation and diabetes is increasingly recognized, it is unclear whether the systemic immunity-inflammation index (SII), as a biomarker of systemic inflammatory response, is associated with type 2 diabetes (T2D) and insulin resistance (IR). This cross-sectional study was performed in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018, and finally enrolled 17,017 participants. To explore the relationship between SII and T2D and IR, a series of statistical analyses were conducted including weighted multivariate linear regression, logistic regression, and subgroup analysis. The fully adjusted multivariate linear regression revealed a positive correlation between SII and fasting plasma glucose (β = 0.13, 95% CI: 0.01, 0.24), fasting serum insulin (β = 12.90, 95% CI: 6.77, 19.04), and homeostasis model assessment of insulin resistance (β = 0.68, 95% CI: 0.25, 1.10). A per-SD increase in SII was found to be associated with a 4% increase in the odds of T2D, and a 5% increase in the odds of IR. The trend was significant across all SII quartile groups. Subgroup analysis revealed a stronger positive association existed between SII and T2D and IR in female, younger, and obese populations. SII was positively associated with the risk of T2D and IR, indicating that reducing SII levels may help prevent these conditions in the general population.

Safety and efficacy of different basal insulin in type 2 diabetes mellitus with chronic kidney disease in Ramadan: prospective observational study

BackgroundDiabetic kidney disease populations are categorized as high risk for fasting in Ramadan due to various potential fasting-related complications. Insulin analogues are recommended to be used in place of human insulin during fasting, as they carry a lower risk of hypoglycaemia and stable glycaemic variability. A paucity of data exits on the safety and efficacy of different basal insulin types during fasting for this population. This study aims to evaluate the safety and efficacy of three basal insulin among patients with Type 2 Diabetes Mellitus and concomitant mild to moderate chronic kidney disease who are keen to fast during Ramadan.Materials and methodsA single-centered, prospective observational study was conducted among 46 patients with type 2 diabetes mellitus and concomitant chronic kidney disease stage 2 and 3 who were on three different types of basal insulin (Glargine U-100, Levemir, and Insulatard), fasted in Ramadan 2022. All variables were listed as median (IQR). Hypoglycaemia events and glycemic variability obtained from Freestyle Libre continuous glucose monitoring were compared between insulin groups. Changes in glycated haemoglobin, fasting plasma glucose, renal profile, body weight, body mass index, and waist circumference pre and post-Ramadan were evaluated. ResultsThe glycaemic variability was found highest in Insulatard with a median (IQR) of 37.2(33)% versus Levemir 34.4(32.4)% versus Glargine U-100 36.8(30.6)%, p = NS. Levemir had reported the lowest median time of below range of 2.5(13)% followed by Glargine 4(25)% and Insulatard 5(8)%; p = NS. The findings of this study indicated that glycated haemoglobin, fasting plasma glucose, renal profile, body weight, body mass index, and waist circumference did not alter statistically between the three groups post-Ramadan. Individually, Insulatard showed a significant reduction in weight and waist circumference (0.9kg, p = 0.026; 0.44 cm, p = 0.008) while Levemir showed a reduction in waist circumference (0.75cm, p = 0.019).ConclusionThis study revealed that Insulatard, Levemir, and Glargine demonstrated similar levels of safety and efficacy among those with diabetic kidney disease who observed fasting during Ramadan.