Glucose Control Research Articles

Glycated Hemoglobin as a Predictor of Dyslipidemia and Cardiovascular Risk in Type 2 Diabetes Mellitus

Background: Type 2 Diabetes Mellitus (T2DM) is a globally prevalent metabolic disorder that significantly increases the risk of cardiovascular disease (CVD) through mechanisms such as dyslipidemia, characterized by elevated triglycerides, low high-density lipoprotein (HDL) levels, and small dense low-density lipoprotein (LDL) particles. Glycated hemoglobin (HbA1c) is a key biomarker of glucose control and has been associated with CVD risk. Methods: This cross-sectional study aimed to evaluate the relationship between glycated hemoglobin (HbA1c) levels and lipid profiles, specifically lipid ratios, in a Jordanian population with type 2 diabetes mellitus (T2DM). A total of 140 patients with T2DM and 20 healthy controls participated. Blood samples were analyzed for fasting blood sugar (FBS), HbA1c, total cholesterol, triglycerides, high-density lipoprotein (HDL-C), and low-density lipoprotein (LDL-C) levels. HbA1c levels were grouped: A (≤7%), B (7–9%), C (9–11%), and D (>11%). Results: The T2DM group showed significantly elevated HbA1c levels compared to controls. Patients with higher HbA1c levels (Groups C and D) exhibited abnormal lipid profiles, including increased total cholesterol and triglycerides and reduced HDL-C. The LDL-C/HDL-C ratio was notably higher in patients with HbA1c >9%, indicating a potential elevated cardiovascular risk. This correlation between HbA1c and lipid profile abnormalities supports the association between poor glycemic control and lipid metabolism dysregulation. Conclusion: HbA1c levels are significantly associated with dyslipidemia, and lipid ratios serve as sensitive indicators for cardiovascular risk in T2DM patients. These findings underscore the clinical importance of monitoring HbA1c and lipid ratios to improve risk assessment and guide intervention strategies in high-risk populations.

A Rare Case of HNF1B and NR3C1 Genetic Mutations Leading to Severe Electrolyte Derangements and Impaired Glucose Control

A Rare Case of HNF1B and NR3C1 Genetic Mutations Leading to Severe Electrolyte Derangements and Impaired Glucose Control

Using continuous glucose monitoring to measure and improve quality metrics: Updates on the Healthcare Effectiveness Data and Information Set 2024 Glucose Management Indicator measure.

Value-based diabetes care is a proactive approach to providing quality care to individuals with diabetes. This approach focuses on improving clinical outcomes rather than the volume of services provided. Implementation of value-based diabetes care requires an established set of standardized quality measures against which all stakeholders can assess and benchmark their performance. The National Committee for Quality Assurance recently added the Glucose Management Indicator to its Healthcare Effectiveness Data and Information Set. The Glucose Management Indicator can be used as a measure of glucose control. This article discusses the benefits of value-based care, the importance of diabetes quality measures, and how the rapidly increasing adoption of continuous glucose monitoring is impacting these measures while improving the lives of individuals with diabetes.

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.

Gestational diabetes mellitus - Neonatal and maternal outcomes in women treated with insulin or diet: A propensity matched analysis

AimsPregnant women worldwide face the risk of developing gestational diabetes mellitus (GDM), if left untreated, can cause complications. The study explores factors influencing the choice between diet control and insulin therapy for pregnant women with GDM. It aims to understand how these choices impact maternal and neonatal outcomes. MethodsIn this quasi-experimental study, clinicians determined treatment (diet control or insulin) for 1030 individuals with GDM at a private practice from 2010 to 2020 based on baseline characteristics. Propensity scores (PS), reflecting the probability of treatment allocation, were derived through multiple logistic regression. ResultsAfter PS matching, 386 individuals were paired from two study groups. The insulin-treated group exhibited a 4.43 times higher risk of neonatal hypoglycemia than the diet group. Insulin-treated individuals, stratified by PS, revealed that the high-risk quartile had significantly higher mean insulin requirements and a doubled dose at full term compared to the lower-risk quartiles. The mean insulin dose did not significantly differ in the first three quartiles, but the last quartile showed a significant increase (p = 0.008), particularly for individuals with PS exceeding 0.70, indicating a higher insulin dose requirement for effective glucose control. ConclusionThis study reveals that individuals with a bad obstetrics history, a family history of diabetes, obesity, and elevated baseline glycemic parameters necessitate higher insulin doses. This insight improves clinicians' decision-making in diagnosis and treatment planning, enhancing the precision of medical practices.

Perioperative Fully Closed-loop versus Usual Care Glucose Management in Adults Undergoing Major Abdominal Surgery - A Two-centre Randomised Controlled Trial.

To assess the efficacy and safety of fully closed-loop (FCL) compared with usual care (UC) glucose control in patients experiencing major abdominal surgery-related stress hyperglycaemia. Major abdominal surgery-related stress and periprocedural interventions predispose to perioperative hyperglycaemia, both in diabetes and non-diabetes patients. Insulin corrects hyperglycaemia effectively, but its safe use remains challenging. In this two-centre randomised controlled trial, we contrasted subcutaneous FCL with UC glucose management in patients undergoing major abdominal surgery anticipated to experience prolonged hyperglycaemia. FCL (CamAPS HX, Dexcom G6, mylife YpsoPump 1.5x) or UC treatment was used from hospital admission to discharge (max 20d). Glucose control was assessed using continuous glucose monitoring (masked in the UC group). The primary outcome was the proportion of time with sensor glucose values in target range 5.6-10.0mmol/L. Thirty-seven surgical patients (54% pancreas, 22% liver, 19% upper gastrointestinal, 5% lower gastrointestinal), of whom 18 received FCL and 19 UC glucose management, were included in the analysis. Mean±SD percentage time with sensor glucose in target range was 80.1±10.0% in the FCL and 53.7±19.7% in the UC group (P<0.001). Mean±SD glucose was 7.5±0.5mmol/L in the FCL and 9.1±2.4mmol/L in the UC group (P=0.015). Time in hypoglycaemia (<3.0mmol/L) was low in either group. No study-related serious adverse events occurred. The FCL approach resulted in significantly better glycaemic control compared to UC management, without increasing the risk of hypoglycaemia. Automated glucose-responsive insulin delivery is a safe and effective strategy to minimise hyperglycaemia in complex surgical populations.

Benefit and Safety of Sodium-Glucose Co-Transporter 2 Inhibitors in Older Patients with Type 2 Diabetes Mellitus.

People with type 2 diabetes mellitus (T2DM) are at higher risk of developing cardiovascular disease, heart failure, chronic kidney disease, and premature death than people without diabetes. Therefore, treatment of diabetes aims to reduce these complications. Sodium-glucose co-transporter 2 (SGLT2) inhibitors have shown beneficial effects on cardiorenal and metabolic health beyond glucose control, making them a promising class of drugs for achieving the ultimate goals of diabetes treatment. However, despite their proven benefits, the use of SGLT2 inhibitors in eligible patients with T2DM remains suboptimal due to reports of adverse events. The use of SGLT2 inhibitors is particularly limited in older patients with T2DM because of the lack of treatment experience and insufficient long-term safety data. This article comprehensively reviews the risk-benefit profile of SGLT2 inhibitors in older patients with T2DM, drawing on data from prospective randomized controlled trials of cardiorenal outcomes, original studies, subgroup analyses across different age groups, and observational cohort studies.

Management Strategies for Obese Diabetes

In recent years, there has been a growing emphasis on the relationship between obesity and diabetes. An analysis of Korean data revealed that more than 75% of diabetic patients were overweight or obese, with two-thirds having abdominal obesity. Traditional treatment goals for diabetes have primarily focused on lowering blood glucose levels to prevent and treat microvascular and macrovascular complications, which is known as the glucocentric approach. However, with the recognition of the shared pathophysiology of insulin resistance in both diabetes and obesity, a weight-centric approach has emerged, particularly beneficial for patients in whom insulin resistance is a primary driver of type 2 diabetes. Of note, the overlap of various physiological aspects in diabetic patients necessitates a multicentric approach for effective type 2 diabetes management. Recent guidelines now recommend weight loss as a primary treatment goal alongside blood glucose control for overweight and obese diabetic patients, highlighting the significance of weight management in diabetes care. Medications such as glucagon-like peptide-1 (GLP-1) receptor agonist or dual glucose-dependent insulinotropic polypeptide/GLP-1 receptor agonist with weight-loss effects are recommended for this patient population. Ongoing research is exploring the potential of various gut hormone-based therapies, offering hope for effective weight management and improved diabetes outcomes in the growing population of obese diabetic individuals.

The Effects of Music Therapy on Self-Management, Depression, and Stress in Patients with Type 2 Diabetes Mellitus

Background: Among type 2 diabetes patients hospitalized for blood sugar control, stress and depression are high and have a negative effect on blood sugar control. Therefore, this study sought to determine whether listening to music helps reduce stress and depression and affects blood sugar control.Methods: This is a randomized, controlled, pre- and post-design study conducted from April 2017 to September 2019 in patients with type 2 diabetes hospitalized for blood glucose control at Kyung Hee University Hospital at Gangdong. After diabetes education was provided to both the control and experimental groups, the experimental group listened to music for 30 minutes a day with a tablet PC and the control group was prohibited from listening to music during the study period. Stress was evaluated using the PAID (Problem Areas in Diabetes) scores, depression using the CES-D (Center for Epidemiologic Studies Depression) scale, and self-management using the SDSCA (Summary of Diabetes Self-Care Activities) questionnaire.Results: A total of 59 patients (41.5 ± 12.6 years, 75.0% male) were enrolled and randomized into the control group (n = 28) and experimental group (n = 31). Music therapy had no statistically significant relationship with blood sugar (&lt;i&gt;P&lt;/i&gt; = 0.887), depression (&lt;i&gt;P&lt;/i&gt; = 0.248), stress (&lt;i&gt;P&lt;/i&gt; = 0.994), or self-management (&lt;i&gt;P&lt;/i&gt; = 0.959). However, in both groups, blood glucose control, stress, and self-management were all significantly improved at discharge compared to at the beginning of hospitalization (&lt;i&gt;P&lt;/i&gt; = 0.031).Conclusion: It was confirmed that intensive medical treatment and diabetes education for hospitalized patients with type 2 diabetes improved not only blood glucose control but also depression, stress, and self-management, regardless of listening to music.

Alpha(α)-mangostin (Xanthone of Garcinia mangostana L.): Augmenting Macrophages Activity for an Effective Diabetic Wound Healing

Diabetic wounds are particularly difficult to treat medically because they heal at a slower pace than regular wounds. Macrophages are essential in all stages of normal wound healing, including inflammation, proliferation and rem odelling. When wound healing is affected, macrophages can reduce the level of growth factor and increase the level of interleukin-6 (IL-6), disrupt the balance between tissue inhibitors of metalloproteinase (TIMPs) and matrix metalloproteinase (MMPs), which can slow down healing. Alpha(α)-mangostin, a natural xanthone derived from the pericarp of the mangosteen, has gained considerable attention due to its anti-inflammatory properties, suggesting its potential to promote wound healing. However, its exact role in healing diabetic foot ulcers, common in diabetes, remains unclear. Hence, this study aims to explore how α-mangostin might affect diabetic wound healing by evaluating its impact on PDGF, CTGF, BFGF, VEGF, TGF-β, MMP-9, TIMP-2 and IL-6 secretion in macrophage cells. Human monocytic macrophages (THP-1) were incubated with a 35 mM glucose solution for 72 h to create a glucose-enriched medium. The cells were then incubated with α-mangostin (0.15, 2.5 and 5 µg/mL) together with 35 mM glucose. Carboxymethyl cellulose (CMC) served as positive controls; glucose-enriched media and media-alone served as negative controls. Protein expression was measured using ELISA. α-mangostin (2.5 µg/mL) increased the levels of PDGF and VEGF and decreased the level of MMP-9 compared to glucose controls. There was no significant difference in other growth factors, TIMP-2 and IL-6 protein levels across any of the treatment groups compared to glucose controls. In conclusion, α-mangostin particularly at 2.5 µg/mL demonstrated a significant increase in PDGF and VEGF levels while simultaneously reducing MMP-9 in macrophage cells under glucose-induced conditions. These findings suggest that α-mangostin holds the potential for enhancing the healing of chronic wounds in diabetic conditions. HIGHLIGHTS Treatment of macrophages (THP-1 cells) with 2.5 µg/mL Alpha (α)-mangostin in a high glucose medium led to a significant increase in PDGF and VEGF secretion compared to glucose control. Treatment of the cells with 2.5 µg/mL Alpha (α)-mangostin in a high glucose medium led to a significant reduction of MMP-9 secretion compared to glucose control. There is no significant effects of Alpha (α)-mangostin on IL-6 and TIMP secretion compared to controls This study suggests that Alpha (α)-mangostin may be beneficial in promoting diabetic wound healing via stimulation of PDGF and VEGF secretion and reducing MMP-9 levels. GRAPHICAL ABSTRACT

Utilization of Smart Healthcare for Gestational Diabetes Mellitus Management

Gestational diabetes mellitus (GDM) poses significant health risks to both mothers and newborns, requiring rigorous self-management and frequent medical consultations. Advances in information and communications technology (ICT) have shown promising results in reducing the number of in-person visits for GDM management. ICT enhances patient self-care engagement, with some studies reporting reductions in average blood glucose and HbA1c levels. ICT for GDM management has demonstrated benefits such as fewer in-person visits, improved adherence to self-monitoring of blood glucose, increased global user satisfaction, and maintenance of blood glucose control and perinatal outcomes. Common barriers to ICT for GDM include technological literacy, inadequate education, limited technical support, the additional burden of non-customized applications, and restricted interoperability. Further research is needed on the impact of technology on GDM management to optimize digital health solutions.

Estimating the Biological Variables of Thyroid Patients and Their Impact on Diabetics in Kirkuk

Background: Investigating the impact of sugar on biochemical variables in patients with thyroid dysfunction in Kirkuk, including some previously unmeasured biological variables. Materials and Techniques: From November to May, this study occurred in Kirkuk. Blood samples were collected from 120 patients aged 20 to 80 years, including 40 diabetics, 40 with both hyperthyroidism and diabetes, and 40 with both hypothyroidism and diabetes, as well as 40 healthy individuals aged 20 to 40 without chronic diseases. Levels of TSH, T4, T3, HbA1c, GPT, GOT, ALP, and HBs were measured in the serum using Beckman Coulter Access2, Spectrophotometer, and Boditech Med INC I-Chroma AFP-25 devices. Results: The study found that TSH levels were significantly elevated in patients with diabetes and hypothyroidism (P≤0.01), while T4 and T3 levels were significantly decreased (P≥0.01). HbA1c levels showed a significant increase (P≤0.01) in all groups: diabetes with hypothyroidism, diabetes with hyperthyroidism, and diabetes alone. Enzyme levels (GOT, GPT, ALP, HBs) were also significantly elevated (P≤0.01) in these groups. Conclusion: In conclusion, TSH regulation is vital, with high levels indicating hypothyroidism related to obesity and diabetes. Elevated HbA1c shows poor glucose control, and hyperthyroidism with diabetes worsens liver function and glucose metabolism, stressing the need for integrated management.

Body weight training versus series 7 diabetes dance: their influence on glucose levels in patients with type 2 diabetes mellitus

Managing blood glucose levels is critical for preventing complications associated with type 2 diabetes mellitus (T2DM). Physical activity has been shown to be an effective strategy for glucose control, with various forms of exercise yielding different results. This research aims to explore the effects of body weight training and series 7 diabetes dance on reducing blood glucose levels in patients with T2DM, and to compare the efficacy of these two interventions in achieving glucose control. The type of research was a quasi-experiment with a two groups pre-test post-test design. The series 7 diabetes dance group performed the exercise 4 times a week (duration: 170 minutes 8 seconds/week), while the body weight training group performed exercise 3 times a week (8 movements, number of repetitions close to failure, circuit system, 3 sets per training session). Both groups were doing an exercise program for three months. The research sample was for about 16 patients of type 2 diabetes mellitus (8 people per group, devided randomly), taken by using non probability sampling technique, purposive sampling type (effect size 1.6, significant level (α) 0.05 and Power 0.8). The data analysis used the paired sample t test and the independent t test with a significance level of α = 0.05.The results showed that 1) there is no significant effect of series 7 diabetes dance towards the decreasing the level of blood sugar of the patients with type 2 diabetes mellitus), 2) there is a significant effect of body weight training towards the decreasing level of blood glucose of the patients with type 2 diabetes mellitus, 3) dody weight training is more effective in decreasing the level of blood glucose of patients with type 2 diabetes mellitus compared to series 7 diabetes dance. Future research must be carried out as a true experiment with a larger number of samples and with the HbA1c research instrument.

GLP-1 Receptor Agonists and SGLT2 Inhibitors in Type 2 Diabetes: Pleiotropic Cardiometabolic Effects and Add-on Value of a Combined Therapy.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2is) have proven efficacy and safety in randomized clinical trials and observational real-life studies. Besides improving glucose control, reducing body weight, and lowering arterial blood pressure (surrogate endpoints), the breakthroughs were the demonstration of a significant reduction in cardiovascular and renal events in patients with type 2 diabetes at high risk. GLP-1RAs reduce events linked to atherogenic cardiovascular disease (especially ischemic stroke) and also renal outcomes (FLOW trial with semaglutide), with a limited effect on heart failure. The most striking protective effects of SGLT2is were a marked reduction in hospitalization for heart failure and a remarkable reduced progression of chronic kidney disease. These benefits have been attributed to numerous pleiotropic effects beyond glucose-lowering action. Underlying mechanisms contributing to cardiovascular and renal protection are at least partially different between GLP-1RAs (mainly anti-atherogenic and vascular effects) and SGLT2is (mainly systemic and intrarenal hemodynamic changes). Thus, patients at high risk may benefit from complementary actions when being treated with a GLP-1RA/SGLT2i combination. Such combination has proven its efficacy on surrogate endpoints. Furthermore, posthoc subgroup analyses of cardiovascular outcome trials have suggested a greater cardiorenal protection in patients treated with a combination versus either monotherapy. The benefits of a combined therapy have been confirmed in a few retrospective cohort studies. A dedicated prospective trial comparing a combined therapy versus either monotherapy is ongoing (PRECIDENTD); however, several challenges still remain, especially the higher cost of a combined therapy and the worldwide underuse of either GLP-1RAs or SGLT2is in clinical practice, even in patients at high cardiorenal risk.

Study on the Clinical Application of Nutritional Management Combined with Clinical Monitoring of Glycated Albumin in Diabetic Nephropathy Dialysis Patients

Objective: To explore the clinical application of nutritional management combined with clinical monitoring of glycated albumin (GA) in diabetic nephropathy (DN) dialysis patients. Methods: A total of 20 diabetic nephropathy dialysis patients admitted to the People’s Hospital of Guandu District from January 2022 to February 2023 were included in the study. They were randomly divided into a conventional group (n = 10) and an observation group (n = 10). The study evaluated the blood glucose control, nutritional status, dialysis efficacy, and quality of life scores of both groups. Results: Before the intervention, there were no significant differences in fasting plasma glucose (FPG), GA, serum albumin, body mass index (BMI), dialysis efficiency values, urea clearance rate, or quality-of-life scores between the two groups (P &gt; 0.05). After the intervention, the observation group showed significantly lower FPG and GA levels, higher serum albumin, dialysis efficiency values, urea clearance rate, and improved quality-of-life scores compared to the conventional group (P &lt; 0.05), with no difference in BMI (P &gt; 0.05). Conclusion: Nutritional management combined with clinical monitoring of glycated albumin has a significant effect on the clinical application of diabetic nephropathy dialysis patients. It can effectively improve patients’ blood glucose control and nutritional status, reduce the risk of complications, and enhance the quality of life, demonstrating clinical value for broader application.

The Interplay between COVID-19 and Diabetes: Understanding Hyperglycemia, Complications, and Management Challenges in Diabetic Patients

The COVID-19 pandemic has significantly impacted individuals with diabetes, revealing a complex interplay between the virus and pre-existing hyperglycemia. This review explores how COVID-19 exacerbates hyperglycemia in diabetic patients, primarily through mechanisms such as stress response, cytokine storms, and increased insulin resistance. Diabetic individuals are particularly susceptible to severe COVID-19 outcomes, including heightened mortality rates, due to compromised immune responses and coexisting conditions like cardiovascular and renal complications. The review also addresses the unique challenges of managing diabetes during COVID-19, including the need for adjustments in insulin therapy and the impact of COVID-19 treatments, such as corticosteroids, on glucose control. Additionally, it highlights the potential long-term effects of COVID-19 on diabetic patients, including the onset of new diabetes and persistent metabolic issues. The review emphasizes the importance of glycemic control, vaccination, and holistic care approaches to mitigate the severity of COVID-19 in diabetic patients. Furthermore, it examines the psychological and socioeconomic impacts of the pandemic on this vulnerable population. As ongoing research continues to investigate the interaction between COVID-19 and diabetes, this review provides a comprehensive understanding of the challenges and future directions in managing diabetic patients during and after the pandemic. Keywords: COVID-19, Diabetes, Hyperglycemia, Complications, Management Challenges, Diabetic Patients

Exploring the influencing factors of non-insulin drug prescriptions in discharged patients with type 1 diabetes.

The aim of this study was to evaluate the admission indicators and characteristics of individuals diagnosed with type 1 diabetes (T1D) to ascertain potential impact on the choice of glucose control therapy after discharge. A total of 398 eligible T1D patients were selected. We conducted multivariable logistic regression analysis to determine the independent influence of predictors on the selection of glucose control therapy after discharge. To explore the influencing factors of different subgroups, we additionally performed subgroup analyses based on gender and age. Our study revealed that body mass index (BMI) was noteworthy influence factor for prescription of insulin and non-insulin antidiabetic drug (NIAD prescription) in T1D patients of general population [OR = 1.109 (1.033-1.195), p = 0.006], male [OR = 1.166 (1.040-1.318), p = 0.011] and individuals below the age of 30 years [OR = 1.146 (1.020-1.301), p = 0.028]. Diastolic blood pressure (DBP) was a protective factor for NIAD prescription in the general population [OR = 0.971 (0.949-0.992), p = 0.008] and women [OR = 0.955 (0.923-0.988), p = 0.008]. The other risk factor of NIAD prescription in men was dyslipidemia [OR = 4.824 (1.442-22.246), p = 0.020]. Pulse pressure [OR = 1.036 (1.007-1.068), p = 0.016] constituted an additional risk factor of NIAD prescription among individuals below the age of 30 years. The risk factors of NIAD prescription for people aged 30 to 50 years were length of stay [OR = 1.097 (1.014-1.196), p = 0.026] and initial blood glucose [OR = 1.078 (1.007-1.168), p= 0.047]. In the case of individuals aged above 50 years, physicians exhibited a higher tendency to prescribe supplementary non-insulin medications to men [OR = 9.385 (1.501-87.789), p = 0.029]. We identified notable factors that influence discharge prescriptions in patients with T1D. In order to enhance the treatment outcome for the patient, clinicians ought to have a special focus on these indicators or factors.

Dietary Determinants of Metabolic and Gut Microbial Health in Patients with Inflammatory Bowel Disease.

Background: Diet has been linked to gut dysbiosis and the onset, course, and response to treatment of patients with IBD and metabolic disease. Methods: This single-centre prospective case-control study investigated the relationship between dietary intake, metabolic profile, and stool microbial composition in 57 individuals with IBD in clinical remission and 24 healthy individuals (HC). Participants' baseline anthropometric measurements, serum metabolic parameters, lipid profiles, and oral and stool samples for microbiota testing were collected. Their dietary intake and physical activity were documented. A partially corrected correlation was performed to examine the associations between variables and p-values adjusted for multiple comparisons using the Benjamini-Hochberg equation (adj-p). Results: In participants with IBD, the intake of saturated fat correlated positively, and the intake of dietary fibre correlated negatively with anthropometric indices (saturated fat and BMI: r = 0.37, adj-p = 0.04, fibre and BMI: r = -0.45, adj-p = 0.01). Higher anthropometric indices were associated with poorer glucose control and a less favourable serum lipid profile (BMI and insulin: r = 0.48, p < 0.01, WHR and triglycerides: r = 0.57, p < 0.01). The stool microbiota of participants in the IBD group was less diverse and more similar to their oral microbiota than was observed in the HC group (Mann-Whitney U test p = 0.03). Within the IBD group, a higher intake of added sugar and processed meat and a higher serum insulin level was associated with lower stool microbial alpha diversity (processed meat intake and Shannon's diversity: r = -0.43, adj-p = 0.02; added sugar and Shannon's diversity: r = -0.39, adj-p = 0.03; insulin and Shannon's diversity: r = -0.45, adj-p = 0.02). Neither the dietary intake nor stool microbial composition correlated with the risk of disease flaring. Conclusions: Our findings suggest that dietary intake is associated with the metabolic health and gut microbial composition of IBD patients.

Initiation of Intermittently Scanned Continuous Glucose Monitoring Is Associated With Reduced Hospitalization for Acute Diabetes Events and Cardiovascular Complications in Adults With Type 1 Diabetes.

We assessed the impact of intermittently scanned continuous glucose monitoring (isCGM) compared with blood glucose monitoring (BGM) on rates of hospitalization for metabolic and vascular complications of diabetes and on HbA1c levels for adults with type 1 diabetes. This retrospective study using data from the Swedish National Diabetes Register and the Swedish National Patient Register comprised adults with type 1 diabetes and an isCGM initiation date after 1 June 2017 and matched control individuals using BGM. Hospital admission rates were calculated per 100 person-years of follow-up. We identified 11,822 adults with type 1 diabetes and an isCGM index date after 1 June 2017 and HbA1c baseline values 3-8 months prior to the index date. Compared with 3,007 BGM users, isCGM users had a significantly lower relative risk of hospitalization for hypoglycemia (0.32; 95% CI 0.14, 0.74), diabetic ketoacidosis (0.55; 0.35, 0.87), stroke (0.48; 0.37, 0.64), acute myocardial infarction (0.64; 0.46, 0.91), atrial fibrillation (0.59; 0.38, 0.94), heart failure (0.25; 0.16, 0.39), peripheral vascular disease (0.21; 0.07, 0.62), kidney disease (0.48; 0.35, 0.66), or hospitalization for any reason (0.32; 0.29, 0.35). Compared with BGM users, change in mean HbA1c for isCGM users was -0.30% (-3.3 mmol/mol) at 6 months and -0.24% (-2.6 mmol/mol) at 24 months (both P < 0.001). This study shows that adults with type 1 diabetes in Sweden who initiate isCGM have significantly reduced hospitalization rates for acute diabetes events, kidney disease, and cardiovascular complications, along with improved glucose control, compared with BGM users.

Preoperative Carbohydrate Loading in Pediatric Surgery: A Scoping Review of Current Evidence

Abstract* Introduction Preoperative carbohydrate loading (PCL), part of Enhanced Recovery After Surgery (ERAS) protocols, involves giving carbohydrate-rich liquids before surgery instead of traditional fasting. It improves glucose control, reduces insulin resistance, and enhances patient comfort. Methods This scoping review aims to assess the current evidence on the effects and safety of PCL in pediatric surgery. A multi-database search strategy would be used, with eligibility criteria including recent original English articles on pediatric PCL. Data extraction would focus on PCL type, sample sizes, and perioperative outcomes. Results The scoping review examined 10 studies on PCL in pediatric surgery, covering various procedures with sample sizes ranging from 18 to 1200 participants. Most studies showed that PCL improved metabolic outcome and reduced postoperative recovery time. However, outcomes like hospital stay length and postoperative complications, such as nausea and vomiting, varied. Conclusions PCL in pediatric surgery may stabilize blood glucose, reduce metabolic risks, and enhance recovery, including anxiety reduction.