Diabetes Glycemic Control Research Articles

MO1037WOMEN REPRESENTATION IN CLINICAL PRACTICE GUIDELINES AMONG MAJOR NEPHROLOGY GUIDELINES

Abstract Background and Aims While the percentage of women entering nephrology has increased over the years, women representation and sex disparities in the authorship of major nephrology Clinical practice guidelines (CPG) has not been examined. Our study evaluates current sex disparities and women representation, and the nationalities of women authors in nephrology CPGs developed by the Kidney Disease: Improving Global Outcomes (KDIGO), Kidney Disease Outcomes Quality Initiative (KDOQI), and the European Renal Best Practice (ERBP), the official guideline body of the ERA-EDTA. Method We examined the number of female versus male guideline workgroup members (panelists) for all available CPGs in each of the three organizations as of Dec. 2020, which are available on their respective websites. We discerned the sex of the panelists based on google search and their affiliated institutional websites. We obtained the nationalities of the workgroup members from the authorship information of the respective CPG. Results Of the total 488 panelists in all three organizations, 115 (23.6%) were females and 373 (76.4%) males. KDIGO had 184 panelists, of which 46 (25%) were females. The CPGs with the highest and the least women representation are ‘Diabetes in Chronic Kidney Disease (CKD)’ (41.2%) and ‘Anemia in CKD’ (11.8%), respectively. The countries with the highest number of women representations are the USA (20), followed by Canada (6), and China (4). In KDOQI, 39 (31%) of 127 panelists were female. While CPGs related to ‘Evaluation and management of CKD’ and ‘Nutrition in children with CKD’ each had 50% female panelists, ‘Blood pressure management in CKD’ CPG had 10% female panelists. 28 (72%) of the total 39 women were from the USA. The ERBP had 30 (17%) females of the total 177 panelists. ‘CKD in older patients’ CPG comprised 42.1% female panelists. CPGs for ‘Glycemic control in diabetes’ and ‘Glucose lowering drugs in diabetes’ had no female panelists. Belgium and UK each had six women representatives, while France and The Netherlands 4 women representatives each. Conclusion The guidelines developed by the most prominent organizations – KDIGO, KDOQI, and ERA-EDTA have less than 25% women representation. While it is encouraging to note that there is more women representation in some of the CPGs developed by KDIGO in 2020, evaluating the barriers contributing to the under-representation of women in major nephrology organizations is warranted. Also notable is a lack of women representation from developing countries.

Abstract P054: Duration Of Diabetes, Glucose Excursions, Glycemic Control, And Low Heart Rate Variability: The Atherosclerosis Risk In Communities (aric) Study

Introduction: Individuals with diabetes often have low heart rate variability (HRV)—a marker of autonomic dysfunction. How diabetes duration, glucose excursions, and poor glycemic control relate to HRV is not well characterized. Objectives: To evaluate the associations of diabetes status, duration of diabetes, and biomarkers of glucose excursions (1,5-anhydroglucitol [1,5-AG]—a measure of glycosuria) and glycemic control with HRV. Methods: We conducted a cross-sectional analysis of ARIC Study participants who underwent a 2-minute electrocardiogram at visit 4 (1996-98). We considered root mean square of successive differences in normal-to-normal R-R intervals (rMSSD, measure of parasympathetic activity), standard deviation of normal-to-normal R-R intervals (SDNN, total variability), low frequency (LF, primarily sympathetic activity), high frequency (HF, reflects parasympathetic activity), and LF/HF ratio (sympathetic-parasympathetic balance) as HRV indices. In persons with diabetes, we compared geometric means of HRV indices by diabetes duration (<5 years vs ≥5 years), 1,5-AG (<6 μg/mL vs ≥6 μg/mL), and glucose control (estimated A1C <8% vs ≥8%). We obtained p-values from linear regressions adjusted for age and sex. Results: Among 10169 participants (mean age 63, 57% female, 22% black), participants with diabetes had significantly lower rMSSD, SDNN, LF, HF, and LF/HF ratio compared to those without diabetes ( Table ). Among the 1667 participants with diabetes, longer duration of diabetes, low 1,5-AG, and poor glycemic control were associated with lower rMSSD, SDNN, LF, and HF. No statistically significant associations were found for diabetes duration, 1,5-AG, glycemic control with LF/HF ratio. Discussion: Our results demonstrate that longer duration of diabetes, glucose excursions, and poor glycemic control are associated with some measures of low HRV. This study underscores that cardiac autonomic neuropathy is a common but overlooked complication of long-standing and/or poorly managed diabetes.

Influence of Serum Albumin on HbA1c and HbA1c-Defined Glycemic Status: A Retrospective Study.

Background: Glycated hemoglobin (HbA1c) is commonly used in the diagnosis and evaluation of glycemic control in diabetes, and it may be influenced by several non-glycemic and glycemic factors, including albumin. This retrospective study investigated the influence of albumin on HbA1c and HbA1c-defined glycemic status.Methods: The demographic, hematological, and biochemical data were collected for 11,922 patients undergoing routine physical examination. Univariate and multivariate linear regression analyses, stratified analyses and interaction analyses, and multiple logistic regression were conducted to identify the association between albumin and HbA1c in people with different glycemic status.Results: HbA1c levels were inversely associated with serum albumin level (P < 0.0001) in all participants. Risk factors leading to the association included age > 45 years, high fasting plasma glucose (≥7.0 mmol/L), and anemia. The negative association between HbA1c and albumin was curved (P < 0.0001) and had a threshold effect in the HbA1c-defined diabetic population; the association was significantly stronger when the albumin level fell below 41.4 g/L (β: −0.31, 95% CI: −0.45 to −0.17, P < 0.0001). A 2 g/L increase in albumin reduced the odds of HbA1c-defined dysglycemia, diabetes, and poor glycemia control by 12% to 36%, after adjustment for all possible confounders.Conclusions: HbA1c was inversely associated with albumin level in all participants, and the association was significantly stronger in people with diabetes (defined by HbA1c criteria). For diabetic patients with lower albumin level, there was an increased risk of an erroneous HbA1c-based identification and management of glycemic status.

A Review on Diabetic Peripheral Neuropathy

Diabetic peripheral neuropathy (DPN) is a common complication of both type 1 and type 2 diabetes affecting over 90% of the diabetic patients. Due to the toxic effects of hyperglycemia there is development of this complication. It is typically characterized by significant deficits in tactile sensitivity, vibration sense, lower-limb proprioception, and kinesthesia. Painful DPN has been shown to be associated with significant reductions in overall quality of life, increased levels of anxiety and depression, sleep impairment, and greater gait variability. Hence DPN is often inadequately treated, and the role of improving glycaemic control in diabetes. Major international clinical guidelines for the management of DPN recommend several symptomatic treatments. First-line therapies include tricyclic antidepressants, serotonin–noradrenaline reuptake inhibitors, and anti-consultants that act on calcium channels. Other therapies include opioids and topical agents such as capsaicin and lidocaine. The objectives of this paper are to review current guidelines for the pharmacological management of DPN.&#x0D; Keywords: DPN, hyperglycemia, depression, lidocaine

Sleeping Duration, Napping and Snoring in Association with Diabetes Control among Patients with Diabetes in Qatar.

Background: Poor glycemic control is associated with chronic life-threatening complications. Several studies have revealed that sleep status is associated with glycemic control. Aim: to examine the association between sleep duration, quality and glycemic control among adults with diabetes. Methods: Data on 2500 participants aged 18–60 years were collected from the Qatar Biobank (QBB). Sleep duration and quality were assessed by a self-completed health and lifestyle questionnaire, and glycemic control was assessed using HbA1c. Logistic regression was used to assess the association between sleep duration, napping, snoring and poor glycemic control. Results: After adjusting for age and gender, sleep duration was not associated with poor glycemic control. Lack of association persisted after controlling for smoking, physical activity, education, BMI, fruit and vegetable intake, insulin and medication use. However, sleeping for long hours at night (≥8 h) had a trend in increasing the risk of poor glycemic control (OR = 1.28; 95% CI: 0.94–1.74). Napping was positively associated with poor glycemic control. After adjusting for age and gender, patients who reported “sometimes, frequently, or always” napping had more than 30% increased risk of poor control as compared to patients who reported “never/rarely” napping. Snoring was not associated with poor glycemic control among the study sample when adjusted for age and gender (p = 0.61). Other factors were found to be associated with a better glycemic control such as female, high educational and high physical activity level. Conclusions: our results suggest that napping may be an independent risk factor for a poor glycemic control in diabetes; further investigations are required.

Associations of Dietary Patterns and Nutrients with Glycated Hemoglobin in Participants with and without Type 1 Diabetes.

Background: Diet has been associated with poor glycemic control in diabetes. Few studies have examined this association in people with type 1 diabetes (T1D), who are at a higher risk for cardiovascular disease than people without diabetes. Methods: We report data from cross-sectional and longitudinal analyses from a coronary artery calcification in type 1 diabetes (CACTI) study (n = 1257; T1D: n = 568; non-diabetic controls: n = 689) collected between the years 2000 and 2002. Participants completed a validated food frequency questionnaire, a physical examination, and biochemical analyses. Dietary patterns based on variations in food group intake were created with principal components analysis. Linear regression was used to examine the associations of dietary patterns, macronutrients, and food groups with HbA1c in a model adjusted for relevant covariates and stratified by diabetes status. Results: Three dietary patterns were identified: “fruits, veggies, meats, cereal”, “baked desserts” and “convenience foods and alcohol” patterns. At baseline, a higher intake of the “baked dessert” pattern was significantly associated with higher HbA1c in T1D at baseline as well at year 6 of the study when adjusted for age, sex, BMI, total calories, and diabetes duration. No such associations were observed in the case of non-diabetic controls. Dietary saturated fats and animal fats were also positively associated with HbA1c in adults with T1D at baseline and/or at year 6. Conclusions: The habitual intake of a dietary pattern that is characterized by an increased intake of added sugar and saturated fats, such as in baked desserts, may increase risks of poor glycemic control in T1D.

Salivary inflammatory biomarkers and glycated haemoglobin among patients with type 2 diabetic mellitus

BackgroundType 2 diabetes mellitus has reached epidemic proportions worldwide and improved detection techniques and biomarkers are urgently needed across the spectrum of diabetes initiation and progression. Inflammatory biomarkers play a role in the development of the condition and blood is the gold standard body fluid for the diagnosis of diabetes mellitus. Serum glycated haemoglobin is a widely used marker of chronic hyperglycemia, and it is currently used to diagnose type 2 diabetes mellitus and it is the standard biomarker for the adequacy of management. However, saliva offers an alternative to serum as a biological fluid for diagnostic purposes. Non-invasive measures of inflammatory biomarkers (such as saliva diagnostics) are increasingly being investigated due to significant similarities between salivary and serum proteome. The role of saliva diagnostics in diabetes mellitus has not been explored in our study population.ObjectivesThis study investigated the association of selected salivary inflammatory biomarkers (Interleukin 6 [IL-6], C-reactive protein [CRP], and Tumour necrosis factor α [TNF-α]) to glycated haemoglobin (HbA1C) in type 2 diabetics.Materials and methodsSeventy-five participants, 39 type 2 diabetics (52%) and 36 (48%) healthy controls were recruited. Saliva and blood samples were collected for each participant. The levels of selected salivary inflammatory biomarkers (IL-6, CRP and TNF-α) were estimated by Enzyme Linked Immunosorbent Assay (ELISA) method and glycated haemogloin (HbA1C) was estimated using the liquid chromatography method. Periodontal status of the participants were determined using the Basic Periodontal Examination (BPE).ResultsThe mean salivary levels of CRP was significantly higher in diabetics, 0.05 ± 0.04 µg/ml than in controls, 0.02 ± 0.02 µg/ml (p < 0.001). Mean TNF-α was also significantly higher in diabetics, 5.39 ± 12.10 pg/ml than in controls, 1.51 ± 3.66 pg/ml (p = 0.036). Mean salivary IL-6 was also higher in diabetics compared with controls (47.20 ± 18.49 versus 41.94 ± 16.88 pg/ml), but the difference was not statistically significant, p = 0.204. In the multivariate analysis adjusting for age and periodontal status, only the mean salivary CRP was significantly higher in diabetics, 0.034 higher than controls (95% CI 0.009, 0.059 and p = 0.01). There was a positive correlation between salivary CRP and HbA1C levels, which was moderate with r-value 0.4929 and p-value < 0.0001.ConclusionsSalivary inflammatory biomarkers especially CRP are higher in diabetics compared with controls and CRP is positively correlated with serum HbA1C levels. The biomarkers show potentials as non-invasive alternative method to evaluate glycaemic control in diabetes.

Evaluation of ultrasound examination combined with intensive injection technique education on insulin-induced lipohypertrophy (LH) management: a prospective cohort study in China

This study was aimed to assess the impact of ultrasound examination combined with intensive injection technique education for LH management. A total of 120 patients with diabetes who were identified as existing clinical LH were enrolled into the study. All patients underwent ultrasound examination and received intensive injection technique education based on ultrasound detection results and Chinese guideline for diabetic injection technology in a prospective single study in China with a follow-up of 3 months. Injection Technique Questionnaire (ITQ) and assessment of glycemic control were used to assess the impact of ultrasound examination combined with intensive injection technique education for LH management. As expected, after 3 months of intensive injection technique education based on ultrasound examination, the proportion of patients who had mastered insulin injection technique was significantly increased (p<0.05). The mean HbA1c was decreased by 0.60 (0.28)% from 7.61 (0.34)% to 7.01 (0.23)%, mean FBG was decreased by 1.20 (1.05) mmol/L from 8.10 (1.02) mmol/L to 6.90 (0.71) mmol/L, mean 2hPG was decreased by 1.70 (1.31) mmol/L from 11.49 (1.25) mmol/L to 9.79 (0.87) mmol/L without increasing the insulin dosage. The glycemic variability (GV) indicators (LAGE, MBG, SDBG, and PPGE), hypoglycemic, hyperglycemic, and IM injection events were markedly decreased (p<0.05). Ultrasound examination combined with intensive injection technique education markedly improved glycemic control in diabetes with LH without increasing the insulin dosage, as well as reducing the occurrence of adverse blood glucose events. It can be a new effective approach for LH management.

Burden of Diabetes Mellitus in a Community Resident in an Area Designated as “High Risk” for Chronic Kidney Disease of Unknown Origin in Sri Lanka

Chronic kidney disease (CKD) where etiology cannot be attributed to any known etiology is named CKD of uncertain etiology (CKDu). The main aims of this study were to assess the prevalence of diabetes mellitus (DM), treatment coverage, and glycemic control and its effect on renal function of patients with DM in a rural community affected by CKDu in Sri Lanka. A cross-sectional representative household survey (n = 4803) was conducted in Anuradhapura district. A random blood sugar (RBS), blood pressure, bio-impedance measurements, and renal profile were measured using standard instruments and protocols. Prevalence of DM based on self-reports verified by records was 7.9% (95% confidence interval [CI]: 7.1–8.7). Among the 4425 who did not give a history of being diagnosed ever as having DM, 2.1% (95% CI: 1.7–2.5) were classified as “possible diabetes” (RBS of more than 200 mg/dl with no history of DM). Although 76.2% were on treatment, glycemic control was poor in 40.2% (95% CI: 34.9–45.0). The presence of DM was associated with poor renal function. One in ten individuals in the rural district of Anuradhapura has possible DM. DM poses a significant burden to CKD even in populations affected by CKDu. Hence, public health initiatives should be implemented to control both CKDu and DM in these rural communities.

Time in range–A1c hemoglobin relationship in continuous glucose monitoring of type 1 diabetes: a real-world study

IntroductionThe availability of easily accessible continuous glucose monitoring (CGM) metrics can improve glycemic control in diabetes, and they may even become a viable alternative to hemoglobin A1c (HbA1c) laboratory tests...

Glycemic Control in Diabetes Improved by Total Tooth Extraction Treatment in a Cat

Glycemic Control in Diabetes Improved by Total Tooth Extraction Treatment in a Cat

Eradication of hepatitis C virus with direct-acting antivirals improves glycemic control in diabetes: A multicenter study.

Background and AimHepatitis C virus (HCV) infection causes insulin resistance and diabetes as extrahepatic manifestations. We aimed to analyze the effect of HCV eradication by direct‐acting antiviral (DAA) agents on glucose tolerance.MethodsThe hemoglobin A1c (HbA1c) of 272 patients with HCV infection who achieved a sustained virologic response (SVR) was analyzed at baseline before DAA treatment, at the end of DAA therapy (ETR), and 12 weeks after therapy (Post12W).ResultsThere were no significant differences in HbA1c between baseline, ETR, and Post12W in the overall patients. When the data were stratified according to the presence or absence of diabetes, median HbA1c significantly decreased from baseline (7.2%) to ETR (6.8%) and Post12W (6.8%) in the 55 patients with diabetes, whereas there were no significant changes in the patients without diabetes. Basal HbA1c, fasting plasma glucose, and age were independently associated with the changes in HbA1c according to multivariate analysis, and the predictive formula for changes in HbA1c was found to be ΔHbA1c (%) = 1.449–0.4* HbA1c (%) + 0.012 × Age (year). There were no changes in body mass in diabetic or nondiabetic patients. In diabetic patients taking medication, 63.4% of patients needed less medication.ConclusionsEradication of HCV improves glycemic control, indicated by a 0.4% decrease in HbA1c in diabetes.

Escitalopram Ameliorates Cardiomyopathy in Type 2 Diabetic Rats via Modulation of Receptor for Advanced Glycation End Products and Its Downstream Signaling Cascades.

Type 2 diabetes mellitus (T2DM) has been recognized as a known risk factor for cardiovascular diseases. Additionally, studies have shown the prevalence of depression among people with diabetes. Thus, the current study aimed to investigate the possible beneficial effects of escitalopram, a selective serotonin reuptake inhibitor, on metabolic changes and cardiac complications in type 2 diabetic rats. Diabetes was induced by feeding the rats high fat-high fructose diet (HFFD) for 8 weeks followed by a subdiabetogenic dose of streptozotocin (STZ) (35 mg/kg, i. p.). Treatment with escitalopram (10 mg/kg/day; p. o.) was then initiated for 4 weeks. At the end of the experiment, electrocardiography was performed and blood samples were collected for determination of glycemic and lipid profiles. Animals were then euthanized and heart samples were collected for biochemical and histopathological examinations. Escitalopram alleviated the HFFD/STZ-induced metabolic and cardiac derangements as evident by improvement of oxidative stress, inflammatory, fibrogenic and apoptotic markers in addition to hypertrophy and impaired conduction. These results could be secondary to its beneficial effects on the glycemic control and hence the reduction of receptor for advanced glycation end products content as revealed in the present study. In conclusion, escitalopram could be considered a favorable antidepressant medication in diabetic patients as it seems to positively impact the glycemic control in diabetes in addition to prevention of its associated cardiovascular complications.

Liraglutide Activates Glucagon-Like Peptide 1 Receptor to Attenuate Hyperglycemia through Endogenous Beta-Endorphin in Diabetic Rats.

Liraglutide, an acylated analog of glucagon-like peptide 1 (GLP-1), could improve glycemic control in diabetes. Moreover, endogenous opioid peptides play a role in blood sugar regulation. Since GLP-1 receptors are also expressed in extra-pancreatic tissues, this study investigates the effect of liraglutide on endogenous opioid secretion in type 1-like diabetes. The endogenous opioid level was determined by enzyme-linked immunosorbent assay. The direct effect of liraglutide on endogenous opioid secretion was determined in the isolated adrenal medulla. Acute treatment with liraglutide dose-dependently attenuated hyperglycemia, and increased the plasma opioid neuropeptide, beta-endorphin (BER) levels in diabetic rats. These effects have been blocked by GLP-1 receptor antagonist, naloxone. Additionally, the effects of liraglutide were markedly reduced in adrenalectomized diabetic rats. In the isolated adrenal medulla, liraglutide induced BER secretion and increased the BER mRNA levels. Subcellular effects of liraglutide on the adrenal gland were further identified to mediate through the exchange proteins directly activated by cAMP, mainly using the pharmacological blockade. After repeatedly administering liraglutide, metabolic changes in diabetic rats were investigated, and genes associated with gluconeogenesis in the liver were downregulated. Naloxone pretreatment inhibited these effects of liraglutide, indicating the involvement of endogenous opioids. The present study indicated that liraglutide had an acute effect of reducing hyperglycemia by regulating endogenous opioid BER and modifying the glucose homeostasis.

Abstract 15729: Effect of Metformin on Outcomes of Catheter Ablation for Atrial Fibrillation

Background: Diabetes mellitus (DM) and glycemic control are risk factors for atrial fibrillation (AF). Metformin may have antifibrillatory properties by altering atrial metabolism. It is unknown whether metformin has favorable effects on the outcomes of catheter ablation (CA) for AF. Objective: To determine whether metformin use is associated with maintenance of sinus rhythm after CA for AF. Methods and Results: A 1 st CA was performed in 271 consecutive patients with DM and AF (age: 65±9 years, women: 34 %; and paroxysmal AF: 50%). A total of 182 (67%) patients were treated with metformin and 79/182 were also receiving other antidiabetics or insulin. HbA1c and preprocedural fasting blood glucose were similar among the patients treated with and without metformin (7.2±1.4% vs. 7.2±1.3%, P=0.95 and 162± 61 vs. 159±66 mg/dL, P=0.72). At a median of 10 months (IQR: 5-23, mean 15±13 months) after CA, 100/182 patients (55%) on metformin remained in sinus rhythm without concomitant antiarrhythmic drugs (AAD) compared to 36/89 patients (40%) not receiving metformin (P=0.03). On K-M analysis, patients on metformin were more likely to stay in sinus rhythm after CA, with or without AADs (P&lt;0.001, log-rank, Figure). On Cox proportional hazards analysis, adjusted for age, gender, BMI, type of AF(paroxysmal vs. non-paroxysmal), fasting blood glucose, AAD use, obstructive sleep apnea, chronic kidney disease, and left atrial diameter, metformin use was associated with a ~35% lower probability of recurrent atrial arrhythmia(HR: 0.65, ±95% CI: 0.44-0.97, P=0.04). Increase in left atrial diameter (per mm, HR: 1.05, ±95% CI:1.01-1.08, P=0.001) and non-paroxysmal AF (HR: 1.9, ±95% CI: 1.3-2.9, P=0.001) were associated with a higher risk of recurrence after CA of AF. Conclusion: In patients with DM, the use of metformin was associated with a significant reduction in recurrent atrial arrhythmias after CA for AF independent of the other risk factors, including preprocedural glycemic control.

Impact of Gender on Type II Diabetes Glycemic and Cardiovascular Markers Control and Treatment.

Type II Diabetes (T2D) is considered a major health burden locally, regionally and internationally. Gender differences in T2D prevalence were found in several epidemiological and observational studies. The primary goal of this study was to assess the prevalence of T2D-related comorbidities and treatment modalities and the impact of gender. This was a cross-sectional study that was conducted between June of 2013 and July of 2016 for patients with T2D at the 2 main outpatient diabetes clinics in Taif city, Saudi Arabia. Those with type I diabetes, gestational diabetes and drug-induced diabetes were excluded. A total of 945 patients with a mean age of 58.4±11.8 years with a nearly equal distribution among both genders but with slightly more male predominance (52.2%). When compared to females, male patients were more likely to be older (p<0.001) and exhibit a longer T2D duration (P 0.003), lower mean BMI (p<0.001), lower systolic blood pressure (P 0.062), higher diastolic blood pressure (P 0.468), less likely to have hypertension and be on ACE/ARB blockers (P 0.065 and 0.019, respectively), more likely to have hyperlipidemia and be on a statin (P 0.065 and 0.124, respectively), and more likely to have cardiac disease and stroke and to be on beta-blockers (P 0.005, 0.279, 0.005, respectively). Both genders exhibited comparable HbA1c levels. Medical treatment optimization along with controlling both measured cardiovascular makers and laboratory result levels was based on comorbidities and complications rather than gender.

Cost-Effectiveness of Passion Fruit Albedo versus Turmeric in the Glycemic and Lipaemic Control of People with Type 2 Diabetes: Randomized Clinical Trial

Background Robust evidence has related yellow passion fruit albedo and long turmeric to the metabolic and glycemic control of diabetes. Aim To analyze the incremental cost-effectiveness of the flour made from yellow passion fruit albedo versus long turmeric merged with piperine in the glycemic and lipid control of individuals with type 2 diabetes. Method Eighty-nine patients were enrolled in this randomized, placebo-controlled, clinical trial for 120 days. The first group was prescribed 500 mg capsules, three times a day, of yellow passion fruit albedo flour (FAMA). The second group was prescribed long turmeric capsules (500 mg), merged with piperine (5 mg) (CURPI), at fasting. The third group followed the standard advice recommendations, and ingested a placebo of carboxymethyl cellulose (500 mg) at fasting. Results The group using FAMA showed a higher reduction (−5.9%) of glycemia after fasting, compared to placebo (+9%), and CURPI (−3.2%) (p < 0.05). Regarding HbA1c, the study observed a significant and similar statistical reduction (−0.8%) in the intervention groups, in contrast with the placebo group (p < 0.05). The reduction in HOMA-IR in the CURPI group (−9.4%) was higher than the other groups (p < 0.05). The CURPI group also showed a higher reduction of serum triglyceride levels (−20.8%) compared to the placebo (−0.09%) and FAMA (+1.8%) (p < 0.05) groups. Conclusion It was concluded that turmeric is the most cost-effective in comparison with yellow passion fruit albedo, because of its decrease in the levels of triglycerides and HOMA-IR, even when adjusted for confounding variables. On the other hand, HbA1c cost-effectiveness relation was similar.

Paper-Based In-Situ Gold Nanoparticle Synthesis for Colorimetric, Non-Enzymatic Glucose Level Determination.

Due to its properties, paper represents an alternative to perform point-of-care tests for colorimetric determination of glucose levels, providing simple, rapid, and inexpensive means of diagnosis. In this work, we report the development of a novel, rapid, disposable, inexpensive, enzyme-free, and colorimetric paper-based assay for glucose level determination. This sensing strategy is based on the synthesis of gold nanoparticles (AuNPs) by reduction of a gold salt precursor, in which glucose acts simultaneously as reducing and capping agent. This leads to a direct measurement of glucose without any enzymes or depending on the detection of intermediate products as in conventional enzymatic colorimetric methods. Firstly, we modelled the synthesis reaction of AuNPs to determine the optical, morphological, and kinetic properties and their manipulation for glucose sensing, by determining the influence of each of the reaction precursors towards the produced AuNPs, providing a guide for the manipulation of nucleation and growth. The adaptation of this synthesis into the developed paper platform was tested and calibrated using different standard solutions with physiological concentrations of glucose. The response of the colorimetric signals obtained with this paper-based platform showed a linear behavior until 20 mM, required for glycemic control in diabetes, using the Red × Value/Grey feature combination as a calibration metric, to describe the variations in color intensity and hue in the spot test zone. The colorimetric sensor revealed a detection limit of 0.65 mM, depending on calibration metric and sensitivity of 0.013 AU/mM for a linear sensitivity range from 1.25 to 20 mM, with high specificity for the determination of glucose in complex standards with other common reducing interferents and human serum.

Glucose variability and the risks of stroke, myocardial infarction, and all-cause mortality in individuals with diabetes: retrospective cohort study

BackgroundPrevious research regarding long-term glucose variability over several years which is an emerging indicator of glycemic control in diabetes showed several limitations. We investigated whether variability in long-term fasting plasma glucose (FG) can predict the development of stroke, myocardial infarction (MI), and all-cause mortality in patients with diabetes.MethodsThis is a retrospective cohort study using the data provided by the Korean National Health Insurance Corporation. A total of 624,237 Koreans ≥ 20 years old with diabetes who had undergone health examinations at least twice from 2005 to 2008 and simultaneously more than once from 2009 to 2010 (baseline) without previous histories of stroke or MI. As a parameter of variability of FG, variability independent of mean (VIM) was calculated using FG levels measured at least three times during the 5 years until the baseline. Study endpoints were incident stroke, MI, and all-cause mortality through December 31, 2017.ResultsDuring follow-up, 25,038 cases of stroke, 15,832 cases of MI, and 44,716 deaths were identified. As the quartile of FG VIM increased, the risk of clinical outcomes serially increased after adjustment for confounding factors including duration and medications of diabetes and the mean FG. Adjusted hazard ratios (95% confidence intervals) of FG VIM quartile 4 compared with quartile 1 were 1.20 (1.16–1.24), 1.20 (1.15–1.25), and 1.32 (1.29–1.36) for stroke, MI and all-cause mortality, respectively. The impact of FG variability was higher in the elderly and those with a longer duration of diabetes and lower FG levels.ConclusionsIn diabetes, long-term glucose variability showed a dose–response relationship with the risk of stroke, MI, and all-cause mortality in this nationwide observational study.

Effects of Moringa oleifera in patients with type 2 diabetes.

Diabetes is a complex chronic illness that is associated with serious long-term complications.1 In 2017, diabetes affected 30.2 million individuals in the United States, and the prevalence is expected to increase.2 Management of diabetes requires a variety of lifestyle and pharmacological interventions. In addition, some patients may pursue complementary and alternative therapies. In 2012, it was estimated that 26.2% of US adults with diabetes used complementary and alternative medicines, with herbal therapies being the most common type.3 The effects of some herbal therapies, such as cinnamon, fenugreek, and milk thistle, on glycemic control in patients with type 2 diabetes have been investigated in clinical trials, with mixed results.4Moringa oleifera, a plant often referred to as the tree of life or miracle tree, has also recently been researched for this purpose.5 M. oleifera belongs to the genus Moringaceae, which is native to the tropics and sub-Himalayan areas of India, Pakistan, Bangladesh, and Afghanistan.5 The immature green pods, also known as drumstick, can be prepared for consumption in various ways, such as cooking the pods (as with green beans) or preparing the leaves in a manner similar to preparation of spinach. In addition to glycemic control in diabetes, M. oleifera has been used for medicinal purposes in conditions such as asthma, hyperlipidemia, hypertension, hormone disorders, and gastrointestinal disorders. Based on human studies, the plant has been proposed to reduce glucose levels by increasing insulin secretion and sensitivity and by inhibiting amylase and glucosidase activities.6,7 Additional potential mechanisms of action (as indicated by animal studies) include increased glucose uptake in the muscles and liver, inhibition of glucose uptake in the intestine, and decreased gluconeogenesis in the liver.8-11