Glucose Control In Type Research Articles

HUBUNGAN POLA MAKAN DAN AKTIVITAS FISIK DENGAN KONTROL GLUKOSA DARAH PADA PENDERITA DM TIPE 2 DI RSUD CUT NYAK DHIEN MEULABOH

Diabetes mellitus sufferers have a high mortality rate and it is related to blood glucose control and lifestyle factors. Diabetes mellitus must be controlled routinely and sufferers must know the type of blood glucose control they have. Most sufferers' lifestyle factors include unbalanced diet and physical activity patterns. This study aims to determine the relationship between diet and physical activity with blood glucose control in type 2 DM sufferers at Cut Nyak Dhien Hospital, Meulaboh. This research is a type of quantitative descriptive research with a cross sectional design. The number of respondents was 68 patients using total sampling technique. The data obtained was processed statistically using the chi-square formula. Based on the results of the analysis, it was found that the majority had the characteristics of an average age of elderly 46-55 years (45.6%), gender was predominantly female (55.9%), high school respondent education (36.8%), housewife respondent's occupation (29.4%), glucose control uncontrolled blood pressure (61.8%), unhealthy diet (76.5%), low physical activity pattern (58.8%). The results of the study explain that there is a significant relationship between diet and activity patterns and blood sugar control with p-values ​​= 0.001 and 0.029 (p-value <0.05), respectively. It is recommended that people with type 2 diabetes mellitus be given education regarding what factors can trigger an increase in blood sugar levels.

Does “Engagement” in CGM Technology and Virtual Health Coaching Affect Glucose Control in Type 2 Diabetes? The LIBERATE Study

Does “Engagement” in CGM Technology and Virtual Health Coaching Affect Glucose Control in Type 2 Diabetes? The LIBERATE Study

6656 Frequently sampled HbA1c Shows Low-Sodium, High-Carbohydrate Rice Diet To Be Effective in Type 2 Diabetes

Abstract Disclosure: F.A. Neelon: None. S. Sanoff: None. P. Lin: None. Hemoglobin and glucose react to form HbA1c, which persists until red blood cells (RBCs) are removed from circulation. Since RBCs survive approximately 122 days, HbA1c is usually measured at intervals of months to years, but more frequent measurement can illuminate changes in blood glucose (BG). We used Beach’s equation for the kinetics of HbA1c formation, to construct graphical depictions of how HbA1c should decline over the 122 days after a drop from constantly high to constantly normal BG levels. As part of routine patient care (not an experimental protocol), we measured HbA1c at 2-4-week intervals in a convenience sample of 10 patients (one of whom was evaluated on 2 occasions) with Type 2 diabetes, obesity, and elevated HbA1c who attended the now defunct Rice Diet Program (RDP) in Durham, NC. All were fed 3 meals/day, comprising 800-1000 kcal of rice, fruits, grains, and vegetables (70-90% carbohydrates) and 300 mg of sodium. Two patients were initially taking insulin; 1, glipizide; and 1, sitagliptin, exenatide, metformin; all hypoglycemic agents were eventually discontinued, and none added. Mean initial HbA1c of 9.7% (range, 8.3-11.7) fell to a mean of 6.2% (range 5.3-8.4) after a mean of 82 days (range, 41-139). Variability in final HbA1c values reflects, at least in part, variable duration of voluntary residence at the RDP. In 9 patients, HbA1c declined in close accordance with the course predicted for complete normalization of blood glucose from the very start of the diet; in 1 patient, HbA1c declined slowly for 25 days, after which the rate increased to near that for complete normalization of BG. Plots of Hb1c values extrapolate back through the point of origin, implying normalization of BG occurs within days of starting the RDP, and is maintained thereafter. Data from frequent measurement of HbA1c show: 1) Normalization of BG occurs almost immediately upon dietary restriction, implying that hyperglycemia in Type 2 diabetes is driven by daily calorie excess, not by accumulated calorie excess (ie, obesity). 2) Contrary to some misperceptions, a high-carbohydrate, sodium- and calorie-restricted diet is not deleterious to ― and may actually benefit ― glucose control in Type 2 diabetes. Presentation: 6/3/2024

Objetivos del tratamiento de la diabetes mellitus tipo 1

There are three ways to assess blood glucose control in type 1 diabetes (DM1): glycated hemoglobin (HbA1c, general target less than or equal to 7%), time in the 70–180mg/dl range (general target 70% or higher), and capillary blood glucose. Diabetes education is a fundamental element in achieving self-management of the disease. It is based on three fundamental pillars: nutrition, insulin therapy, and management of diabetes technology (sensors, insulin pumps, smart insulin pens, and mobile applications). Drug treatment for DM1 consists of intensive insulin therapy using multiple dose injection (MDI) or continuous subcutaneous insulin infusion (CSII). The choice of treatment regimen should be based on patient characteristics and other clinical considerations (e.g., pregnancy, presence of undetected hypoglycemia, or variable insulin requirements). There are currently no other insulin adjuvant therapies approved for use in DM1, although DM2 drugs such as GLP-1 analogs or SGLT2 inhibitors that may provide benefits in blood glucose control or weight loss have been used. Kidney-pancreas or pancreatic islet transplantation is considered a final option in patients with end-stage chronic kidney disease together with or following renal transplantation or in individuals with undetected or severe recurrent hypoglycemia that does not respond to optimized management.

Circulating Levels of erythrocytes-derived vesicles are associated with glucose control in type 2 diabetes mellitus patients with atrial fibrillation

Circulating Levels of erythrocytes-derived vesicles are associated with glucose control in type 2 diabetes mellitus patients with atrial fibrillation

The impact of slowly digestible and resistant starch on glucose homeostasis and insulin resistance.

This review will summarize recent studies assessing the effect of slowly digestible starch (SDS) and resistant starch (RS) on glucose metabolism in healthy, prediabetic or type 2 diabetic adults. Currently, a particular interest in starch and its digestibility has arisen, with data showing a positive effect of SDS and RS on the glucose homeostasis of healthy, at-risk, prediabetic and type 2 diabetic patients but research is ongoing. Carbohydrates (CHO) and especially starch play a major role in the prevention and management of metabolic diseases such as type 2 diabetes (T2D). This largely depends on the quality and the digestibility (rate and extent) of the ingested starchy products, beyond their quantity. SDS have been poorly studied but display a beneficial effect on reducing glucose excursions in healthy and insulin-resistant subjects and a relevant potential to improve glucose control in type 2 diabetic individuals. As for RS, the results appear to be encouraging but remain heterogeneous, depending the nature of the RS and its role on microbiota modulation. Further studies are needed to confirm the present results and investigate the potential complementary beneficial effects of SDS and RS on long-term glucose homeostasis to prevent cardiometabolic diseases.

Glucose control during pregnancy in patients with type 1 diabetes correlates with fetal hemodynamics: a prospective longitudinal study

BackgroundMaternal diabetes adversely affects fetal cardiovascular system development. Previous studies have reported that the fetuses of mothers with diabetes exhibit both structural and functional changes; nevertheless, prior studies have not examined the association between glucose control and fetal cardiac morphology and performance. Thus, the objective was to determine the association between fetal cardiac morphology and function and maternal glucose control in type 1 diabetes and to compare the differences in measured cardiac parameters between the fetuses of mothers with diabetes and healthy controls.MethodsIn this prospective, longitudinal case-control study — including 62 pregnant women with type 1 diabetes mellitus and 30 healthy pregnant women — fetal cardiac assessment using B-mode, M-mode, and spectral pulsed-wave Doppler was performed in the second and third trimesters. In women with T1DM, glycated hemoglobin and data obtained from glucose sensors — including the percentage of time in, below, and above the range (TIR, TBR, and TAR, respectively), and coefficient of variation (CV) — were analyzed across three time periods: the last menstrual period to 13 (V1), 14–22 (V2), and 23–32 weeks (V3) of gestation. Fetal cardiac indices were compared between groups, and the correlation between glucose control and fetal cardiac indices was assessed.ResultsAt 28–32 weeks, the fetuses of women with T1DM exhibited increased left ventricular end-diastolic length, relative interventricular septum thickness, right ventricular cardiac output, and pulmonary valve peak systolic velocity compared with healthy controls. At 18–22 weeks, pulmonary and aortic valve diameters, left and right ventricular stroke volumes, and left cardiac output inversely correlated with the CV and glycated hemoglobin levels at V1 and V2. Furthermore, at 28–32 weeks, pulmonary and aortic valve diameters, left ventricular stroke volume, cardiac output, and right/left atrioventricular valve ratio inversely correlated with the TBR at V1, V2, and V3. Moreover, diastolic functional parameters correlated with the TAR and glycated hemoglobin levels, particularly after the first trimester.ConclusionIn women with T1DM, maternal hyperglycemia during pregnancy correlates with fetal diastolic function, whereas glucose variability and hypoglycemia inversely correlate with fetal left ventricular systolic function in the second and third trimesters.

Lowest Glucagon/Highest C-Peptide in Oral Glucose Tolerance Test: Clinical Utility in Monitoring Glucose Control in Type 2 Diabetes Mellitus.

Understanding factors that influence blood glucose levels in patients with type 2 diabetes mellitus (T2DM) is crucial for managing hyperglycemia. Currently, there is no standardized interpretation method for glucagon levels in oral glucose tolerance test (OGTT). This study aims to assess the relationship between the lowest glucagon/highest C-peptide ratio (Lglc/Hcp) in OGTT and glucose control levels in T2DM. Clinical data from 120 patients with T2DM were examined to compare the correlations of Lglc/Hcp and other pancreatic islet function-associated indices with fasting blood glucose (G0), glucose at 120 minutes in OGTT (G120), hemoglobin A1c (HbA1c), and the area under the glucose curve in OGTT (AUCglu). Additionally, the study investigated difference in Lglc/Hcp between patient groups based on the highest blood glucose levels (Hglu) in OGTT (Hglu ≥ 16.7 mmol/L vs Hglu < 16.7 mmol/L). The generalized linear model suggested that Lglc/Hcp significantly correlated with G0 (B = 0.85, P < 0.001), G120(B = 1.46, P < 0.001), HbA1c (B = 0.67, P < 0.001), and AUCglu (B = 3.46, P < 0.001). This correlation surpassed C-peptide and glucagon-related parameters, even after adjusting for confounding factors. Furthermore, Lglc/Hcp was notably higher in patients with Hglu ≥ 16.7 mmol/L compared to those with Hglu < 16.7 mmol/L (Z = -3.71, p < 0.001). Lglc/Hcp in OGTT closely relates to blood glucose control in patients with T2DM, potentially reflecting the overall pancreatic islet function in regulating glucose levels. Moreover, inhibiting glucagon secretion may be a crucial consideration for patients requiring insulin treatment.

Continuous glucose monitoring for better glucose control in type 2 diabetes?

This article reviews the use of continuous glucose monitoring (CGM) devices in the management of type 2 diabetes (T2D). Study results show that continuous CGM use improves glycemic control, lowers glycated hemoglobin (HbA1c) levels, and reduces hypoglycemic episodes compared with traditional monitoring methods. -Observational studies also suggest a reduction in diabetes-related emergencies and hospitalizations. In addition, sporadic use of CGM appears to be beneficial for certain groups of people with T2D. However, more research is needed to fully understand the long-term effects and limitations of this technology. This article discusses -innovative perspectives on T2D management.

Predicting three-month fasting blood glucose and glycated hemoglobin changes in patients with type 2 diabetes mellitus based on multiple machine learning algorithms

Fasting blood glucose (FBG) and glycosylated hemoglobin (HbA1c) are key indicators reflecting blood glucose control in type 2 diabetes mellitus (T2DM) patients. The purpose of this study is to establish a predictive model for blood glucose changes in T2DM patients after 3 months of treatment, achieving personalized treatment.A retrospective study was conducted on type 2 diabetes mellitus real-world medical data from 4 cities in Sichuan Province, China from January 2015 to December 2020. After data preprocessing, data inputting, data sampling, and feature screening, 16 kinds of machine learning methods were used to construct prediction models, and 5 prediction models with the best prediction performance were screened respectively. A total of 100,000 cases were included to establish the FBG model, and 2,169 cases were established to establish the HbA1c model. The best prediction model both of FBG and HbA1c finally obtained are realized by ensemble learning and modified random forest inputting, the AUC values are 0.819 and 0.970, respectively. The most important indicators of the FBG and HbA1c prediction model were FBG and HbA1c. Medication compliance, follow-up outcome, dietary habits, BMI, and waist circumference also had a greater impact on FBG levels. The prediction accuracy of the models of the two blood glucose control indicators is high and has certain clinical applicability.HbA1c and FBG are mutually important predictors, and there is a close relationship between them.

287-LB: Thiazolidinedione Ameliorates Lipotoxicity-Induced Pancreatic ß-Cell Ferroptosis Partly via ACSL4

Pancreatic β cells death is a major factor driving the deterioration of glucose control in type 2 diabetes mellitus (T2DM). Ferroptosis is a non-apoptotic form of lipid peroxidation-induced cell death. The long-chain acyl-CoA synthetase 4 (ACSL4) contributes significantly to lipid metabolism and determines ferroptosis sensitivity. Accounting for still limited understanding of lipotoxicity-related ferroptosis in β cells, we aim to identify pancreatic β cells ferroptosis in lipotoxicity-induced diabetes and the role of ACSL4 plays in this process. In this study, we found that fatty acids could induce apoptosis in pancreatic β cells, along with a new form of death called ferroptosis. Pancreatic islets of 16-week HFD-fed mice showed reduced mitochondrial cristae, decreased mitochondrial cristae, and increased bilayer membrane density compared to LFD-fed mice. Iron fluorescence staining showed increased intracellular Fe2+ levels in pancreatic islets. Ferroptosis inhibitor fer-1 had a specific protective effect of on HFD-induced β-cell ferroptosis. Through using the Cre-LoxP system, we performed a ACSL4 knockout model of the HFD-induced metabolic diseases, we found that lipid metabolism dictates ferroptosis in pancreatic β cells through ACSL4, which appear to be related to pancreatic β cells dysfunction. ACSL4 knockdown attenuated fatty acids-induced ferroptosis in pancreatic β cells in vivo and in vitro. ACSL4 overexpression induces ferroptosis in MIN6 cells. Moreover, we observed that troglitazone attenuated AA, DHA, PA and erastin induced ferroptosis in MIN6 cells. These results together provide definitive evidence linking β cells with lipotoxicity-induced ferroptosis and suggest the anti-ferroptosis effect of ACSL4 may be a new therapeutic target for the targeted therapy of T2DM. Disclosure M. Zhang: None. L. Qin: None. Y. Qin: None. Q. Wei: None. X. Chen: None. Funding National Natural Science Foundation of China (81974103)

835-P: First-in-Human Duodenal Endoscopic Recellularization via Electroporation Therapy for Type 2 Diabetes—An Interim Report

Background: We evaluated the feasibility and safety of endoscopic re-cellularization via electroporation therapy (ReCET) (Endogenex. Plymouth, MN) in restoring impaired duodenal signaling adversely impacting glucose control in type 2 diabetes (T2D). Method: We enrolled 30 adults with T2D: duration ≤10 years; HbA1c 7.5-11.0%; BMI of 24-40 kg/m2; C-peptide ≥333pmol/L; 1-4 non-insulin glucose-lowering medications (GLMs) at stable dose. Post-procedure GLMs were unchanged. Primary endpoint: Device or procedure-related serious adverse events (SAEs). Secondary endpoints: Changes in metabolic parameters at 24W. Results: The first 12 participants received single energy (Single Tx) then 18 received double energy application (Double Tx) with no device/procedure-related SAEs. Forty-five adverse events were reported in 23/30 participants (sore throat [17/30]; transient diarrhea [9/30]) and 80% were mild. HbA1c reduction at 24W was greater with double vs. single Tx (p&amp;lt;0.05). For double Tx vs. baseline: FPG was 7.5±1.7 mmol/L vs. 9.8±2.2 mmol/L (p&amp;lt;0.01), HOMA-IR 4.5±3.6 vs. 7.4±3.3 (p&amp;lt;0.01), Time-in-range 79.4±18.8 % vs. 59.0±24.2% (p&amp;lt;0.01), triglyceride 2.0±1.2mmol/L vs. 2.9±1.9mmol/L (P&amp;lt;0.05) and Δweight -5.1%±4.1% (p&amp;lt;0.01). Conclusions: Our data suggest that ReCET is safe and associated with clinically meaningful changes in metabolic control in T2D patients on GLMs. Disclosure C.Yuan: None. A.Sartoretto: Advisory Panel; Bariatek, Research Support; Endogenex, Erbe Electromedizin GMBH, Speaker's Bureau; Pfizer Inc., Stock/Shareholder; Apollo Endosurgery. B.Holt: None. G.Cameron: None. G.Marinos: None. F.E.Napier-flood: None. B.K.Abu dayyeh: Advisory Panel; Endogenex, Consultant; Apollo Endosurgery, Boston Scientific Corporation, Medtronic, Research Support; USGI, Endogastric Solutions. D.N.O'neal: None.

Fiber Intake and Vegan Lifestyle Behaviour on Blood Glucose Control in Type 2 Diabetes Mellitus Patients: A Case-Control Study.

The study aims to determine the relationship between blood glucose level control with a vegetarian diet and vegan lifestyle behavior in patients with T2DM. Diabetes prevalence escalates each year. Nutritional therapy is one of its management, by choosing a suitable diet to maintain nutrient intake. This was a case-control study including 46 patients with T2DM divided into 24 people for the case group and 22 people for the control group selected using purposive sampling method. Data was obtained using a general questionnaire; food intake with the SQFFQ; the 8-item Morisky Scale questionnaire, to assess medication adherence; the IPAQ, to assess physical activity. Blood sugar measurements were observed by measuring the respondents' fasting blood sugar in the last six months. The data was then analyzed using Chi-square statistical test and logistic regression. The results indicate a relationship between a vegetarian diet and a vegan lifestyle behavior that control blood sugar levels in patients with T2DM (P = 0.004). Diabetic patients on a nonvegetarian diet had a six times greater risk of having uncontrolled blood sugar (OR = 6.476). A significant relationship was found between a vegetarian diet and fasting blood sugar control based on bivariate analysis. In multivariate analysis, fiber intake was most significant to blood glucose control (OR=18.824; 95% CI 2.795-126.795). Vegetarian diet affects blood sugar control in T2DM patients. The type of nutritional intake needs to be more considered rather than the vegetarian diet in general, so that nutritional therapy in diabetics can be started by increasing fiber intake.

Impact of a Low-Carbohydrate Compared with Low-Fat Breakfast on Blood Glucose Control in Type 2 Diabetes: A Randomized Trial

BackgroundIn type 2 diabetes (T2D), consuming carbohydrates results in a rapid and large increase in blood glucose, particularly in the morning when glucose intolerance is highest. ObjectivesWe investigated if a low-carbohydrate (LC) breakfast (∼465 kcal: 25 g protein, 8 g carbohydrates, and 37 g fat) could improve glucose control in people with T2D when compared with a low-fat control (CTL) breakfast (∼450 kcal:20 g protein, 56 g carbohydrates, and 15 g fat). MethodsParticipants with T2D (N = 121, 53% women, mean age 64 y) completed a remote 3-month parallel-group randomized controlled trial comparing a LC with standard low-fat guideline CTL breakfast. The change in HbA1c was the prespecified primary outcome. Continuous glucose monitoring, self-reported anthropometrics, and dietary information were collected for an intention-to-treat analysis. ResultsHbA1c was reduced (−0.3%; 95% CI: −0.4%, −0.1%) after 12 wks of a LC breakfast, but the between-group difference in HbA1c was of borderline statistical significance (−0.2; 95% CI: −0.4, 0.0; P = 0.06). Self-reported total daily energy (−242 kcal; 95% CI: −460, −24 kcal; P = 0.03) and carbohydrate (−73 g; 95% CI: −101, −44 g; P < 0.01) intake were lower in the LC group but the significance of this difference is unclear. Mean and maximum glucose, area under the curve, glycemic variability, standard deviation, and time above range were all significantly lower, and time in the range was significantly higher, in the LC group compared with CTL (all P < 0.05). ConclusionsAdvice and guidance to consume a LC breakfast appears to be a simple dietary strategy to reduce overall energy and carbohydrate intake and improve several continuous glucose monitoring variables when compared with a CTL breakfast in persons living with T2D.The trial was registered at clinicaltrials.gov as NCT04550468.

TRELAGLIPTIN'S REAL WORLD EFFICACY AMONG TYPE 2 DIABETES PATIENTS IN CAMBODIA (TRELA -REAL STUDY)

Background: Trelagliptin is the rst once-weekly oral therapy for type 2 diabetes in Cambodia. The afrmation of its efcacy and safety in Cambodian Type 2 Diabetes patients is to be established for extending the clinical benet of this unique oral anti-diabetic agent in this population Objective: To conrm the effect of Trelagliptin (TRELA), a selective once weekly dipeptidyl peptidase-4 (DPP-4) inhibitor, on glycemic control in the management of Type 2 Diabetes Mellitus (T2DM) in real-world practice settings in Cambodia Methods: An open-label, multicentric prospective, observational single-arm study was conducted across Phnom Penh and three other provinces in Cambodia which will include Siem Reap, Kampong Cham, and Battambang in outpatient settings. One hundred and fty patients with Type 2 Diabetes were enrolled after seeking informed consent. Trelagliptin 100 mg one tablet per week was administered to patients with type 2 diabetes who showed poor glycemic control (HbA1c ≥6.5% ) on diet/exercise therapy alone or diet/exercise therapy plus other oral antidiabetic agents or insulin. The study primary endpoint(s) included changes in glycated hemoglobin (HbA1c) from baseline at the end of three months, and at the end of six months of the study. The secondary endpoints included patient satisfaction and investigator assessment at the end of treatment (6 months) to once weekly treatment to Trelagliptin. Result: Treatment with Trelagliptin 100 mg/week led to a mean change in HbA1c 0.86% (from 8.76 ± 2.02 to 7.9 ± 1.60, p &lt; 0.05, CI 95) at the end of 3 months. At the end of 6 months, the mean change in HbA1c was 1.26% (from 8.76 ± 2.02 to 7.5 ± 1.34), p&lt;0.05, CI 95) (p-value signicant) Patient satisfaction and preference with once-weekly trelagliptin treatment was reported in 97.04 % (n=131) patients. As per the investigator's assessment, 77.04 % (n=104) of the patients reported a “good” response to Trelagliptin treatment at the end of the study over a period of 6 months. In 14.07 % (n=19) patients investigators reported that “excellent” response was achieved. Whereas 5.19% (n=7) and 3.7% (n=5) patients reported average and poor responses, respectively. Trelagliptin treatment once a week was demonstrated to be clinically efcacious as monotherapy and in combination with other anti-hyperglycemic agents. Trelagliptin treatment was found to be efcacious in treatment naïve and treatment-experienced patients. The clinical benets of Trelagliptin were consistent across age groups, body mass index (BMIs), and associated co-morbidities like hypertension. Trelagliptin was well tolerated and was safely used in addition to Metformin, Sulfonylureas, Thiazolidinediones, SGLT2-inhibitors &amp; Insulin treatment. The glucose-lowering effect of Trelagliptin was comparable to other DPP4 inhibitors (gliptins), and other classes of oral anti-diabetic medications with the additional advantage of once-a-week dosing treatment regime. Conclusion: Treatment with once-a-week trelagliptin as initial monotherapy and in combination therapy with other anti-hyperglycemic agents for glucose control in Type 2 Diabetes was efcacious and well-tolerated. Trelagliptin 100 mg once a week treatment achieved treatment satisfaction in most patients and reported “good” investigator response in majority of type 2 diabetes patients. Trelagliptin 100 mg once-a-week treatment is a useful consideration in the management of type 2 diabetes patients

Menstrual Cycle, Glucose Control and Insulin Sensitivity in Type 1 Diabetes: A Systematic Review

The correlation between the menstrual cycle and glucose control in type 1 diabetes has been the focus of several studies since the 1920s, but a few critical aspects made it particularly challenging to reach conclusive evidence. The aim of this systematic review is to reveal more solid information about the impact of the menstrual cycle on glycaemic outcomes and insulin sensitivity in type 1 diabetes and highlight the less researched areas. The literature was searched by two authors independently using PubMed/MEDLINE, Embase and Scopus (last search on 2 November 2022). The retrieved data did not allow us to perform a meta-analysis. We included 14 studies published between 1990 and 2022, with sample sizes from 4 to 124 patients. We found a wide heterogeneity in the definition of the menstrual cycle phases, glucose metrics, techniques for determining insulin sensitivity, hormonal assessment and other interfering factors considered, with an overall high risk of bias. There is no conclusive evidence, and published data do not allow us to achieve quantitative results. In a subset of patients, a possible worsening of insulin sensitivity and hyperglycaemia in the luteal phase could be observed. From the clinical standpoint, a cautious strategy based on patient-specific patterns can be considered until new, solid evidence is obtained.

Self-Care Behavior of Type 2 Diabetes Patients with Symptoms of Peripheral Neuropathy during the Covid-19 Pandemic: A Qualitative Study

Purpose: This study aims to explore the experiences and perceptions of type 2 diabetes patients with symptoms of Diabetic Peripheral Neuropathy (DPN) in managing their self-care behavior during the COVID-19 pandemic. Methods: Qualitative research with a descriptive phenomenological approach reveals diabetes self-care behavior during the COVID-19 pandemic. Individual interviews were conducted at the participants’ homes with a semi-structured interview guide on twelve type 2 diabetes patients. All interviews were transcribed verbatim and analyzed using thematic content analysis. Results: A total of five themes were identified from the interview analysis, namely: 1) Perception of diabetes self-management; 2) Efforts to control blood sugar; 3) Barriers to blood sugar control; 4) Perceived disturbance; 5) Social support. Since its emergence, the Covid-19 pandemic has become a new obstacle in controlling blood glucose in diabetic patients. In addition to the covid-19 pandemic, negative spiritual coping, low self-motivation, and perceived physical effects are inhibiting factors for blood glucose control in type 2 diabetes patients with symptoms of DPN. Conclusions: Obstacles in efforts to control blood glucose in type 2 diabetes patients with symptoms of DPN include physical, psychological, social, and spiritual aspects. The suggestion in this study is that during the COVID-19 pandemic, it is necessary to adjust and modify diabetes self-management for patients with DPN symptoms. The interventions provided should not only focus on the physical aspect but also need holistic attention to the psychosocial and spiritual aspects simultaneously by involving family participation in the management of the patient’s diabetes.

Real-time artificial intelligence assisted insulin dosage titration system for glucose control in type 2 diabetic patients: a proof of concept study

ObjectiveThis study aims to develop an insulin dosage adjustment model using machine learning of high quality electronic health records (EHRs) notes and then to form an artificial intelligence-based insulin clinical decision support workflow (iNCDSS) implemented in the HIS system to give a real-time recommendation of insulin dosage titration. The efficacy and safety in clinical practice is evaluated in this proof-of-concept study.Research design and methodsWe extracted patient-specific and time-varying features from the original EHRs data and performed machine learning analysis through 5-fold cross validation. In the patient-blind, single-arm interventional study, insulin dosage was titrated according to iNCDSS in type 2 diabetic inpatients for up to 7 d or until hospital discharge. The primary end point of the trial was the difference in glycemic control as measured by mean daily blood glucose concentration during the intervention period.ResultsA total of 3275 type 2 diabetic patients with 38,406 insulin counts were included for the model analysis. The XGBoost model presented the best performance with root mean square error (RMSE) of 1.06 unit and mean absolute relative difference (MARD) of 6.0% in the training dataset, and RMSE of 1.30 unit and MARD of 6.9% in the testing dataset. Twenty-three patients with T2DM (male 14, 60.9%; age 58.8 ± 10.7 years; duration of diabetes 11.8 ± 8.8 years, HbA1c 9.1 ± 1.1%) were enrolled in the proof of concept trial. The duration of iNCDSS intervention was 7.0 ± 0.1 d. The insulin dose recommended by iNCDSS was accepted by physicians in 97.8%. The mean daily capillary blood glucose was markedly improved during the intervention period, with a reduction of mean daily capillary BG from 11.3(8.0, 13.9) mmol/L in the first 24 h to 7.9(6.5,8.9) mmol/L in the last 24 h of the trial (P < 0.001). In addition, the time range below 3.9 mmol/L was decreased from 1.1% to 0.5%.ConclusionsThe clinical decision support system of insulin dosage titration developed using a machine learning algorithm based on the EHRs data was effective and safe in glycemic control in in type 2 diabetic inpatients.Trial registrationsClinicalTrials.gov Identifier: NCT04053959.

Blood glucose control with different treatment regimens in type 2 diabetes patients hospitalized with COVID-19 infection: A retrospective study.

Coronavirus disease (COVID-19) is closely associated with hyperglycemia and a worse prognosis in patients with a previous diagnosis of type 2 diabetes mellitus. A few studies investigated the effects of diabetes treatment regimens in these patients during hospitalization. Here, we evaluate the impact of insulin and non-insulin therapy on glucose control in patients with type 2 diabetes admitted with COVID-19. This is a retrospective study including 359 COVID-19 patients with type 2 diabetes. Patients were divided into 2 groups according to diabetes treatment during hospitalization. The first group included patients treated with insulin only, and the second group patients treated with other antidiabetic agents with or without insulin. Average blood glucose was higher in the insulin-only treatment group (201 ± 66 mg/dL vs 180 ± 71 mg/dL, P = .004), even after excluding mechanically ventilated patients (192 ± 69 vs 169 ± 59 mg/dL, P = .003). In patients with moderate severity of COVID-19, average blood glucose was also significantly higher in the insulin-only treated group (197 ± 76 vs 168 ± 51 mg/dL, P = .001). Most patients (80%) in the combination treatment group received metformin. Moderately affected COVID-19 patients with type 2 diabetes could safely be treated with antihyperglycemic medications with or without insulin.

High Prevalence of Demodex Infestation is Associated With Poor Blood Glucose Control in Type 2 Diabetes Mellitus: A Cross-Sectional Study in the Guangzhou Diabetic Eye Study.

The aim of this study was to investigate the association between type 2 diabetes mellitus (T2DM) and ocular Demodex mite infection. About 381 patients with T2DM from nearby communities were enrolled, and 163 age-matched and sex-matched nondiabetic patients from the cataract clinic were included as the control group. All subjects underwent personal history and demographic data collection, ocular examination, and lash sampling, followed by microscopic identification and counting of Demodex mites. Binocular fundus photography was performed for diabetic patients. Statistical correlation between ocular Demodex infestation and T2DM and blood glucose control status was performed. The Demodex mite infestation rate (62.5% vs. 44.8%, P < 0.001) and count [3 (0-12) vs. 2 (0-9.6), P = 0.01], especially of Demodex brevis (18.9% vs. 4.9%, P < 0.001) [0 (0-1) vs. 0 (0-0), P < 0.001], were significantly higher in the T2DM patient group than that in the control group. The ratio of Demodex brevis to Demodex folliculorum in the T2DM patient group was significantly higher than that in the control group (1:3 vs. 1:9, P < 0.001). Diabetic patients presented with more cylindrical dandruff (55.1% vs. 39.3%, P = 0.001). Ocular Demodex infestation was strongly associated with poor blood glucose control (HbA 1 c > 7%) (odds ratio = 1.82; 95% confidence interval, 1.12-2.94; P = 0.2) and female sex (odds ratio = 1.69, 95% confidence interval, 1.08-2.65, P = 0.02). No association was found between Demodex infestation and the severity of diabetic retinopathy. Patients with T2DM, especially those with poor blood glucose control, tend to have a higher prevalence of ocular Demodex infestation, suggesting that high blood glucose is a risk factor for demodicosis .