Glycemic Control In Patients Research Articles

Use of the ‘cuidando do pé’ app for risk classification and orientation regarding diabetic foot

1. Shah SZA, Karam JA, Zeb A, et al. Movement is improvement: The therapeutic effects of exercise and general physical activity on glycemic control in patients with type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials. Diabetes Therapy. 2021;12:707–732. https://doi.org/10.1007/s13300.... CrossRef Google Scholar

0398 Efficacy of Suvorexant for Insomnia Disorder in Patients with Poorly-Controlled Type 2 Diabetes

Abstract Introduction Sleep disturbance is a common and underappreciated feature of diabetes and sleep may contribute to glycemic control in patients with type two diabetes (T2D). We conducted a randomized placebo-controlled 3-month trial to examine the efficacy of suvorexant in improving sleep and other aspects of health in patients with suboptimally-controlled type 2 diabetes and insomnia. Methods This double-blind, randomized placebo-controlled 3-month trial was conducted using the sequential parallel comparison design (SPCD). Sixty-nine poorly-controlled T2D patients (HbA1c≥6.5) were randomized to placebo and/or suvorexant (10-20 mg). The primary outcome was subjective total sleep time (STST), and secondary outcomes were Insomnia Severity Index (ISI) score and wake time after sleep onset (WASO). Exploratory outcomes included sleep efficiency, hemoglobin A1c (HbA1c), and C-reactive protein (CRP). Exploratory analyses were conducted on relationships of sleep and diabetes outcomes. Results There were no significant improvements in STST, ISI, or WASO among patients taking suvorexant compared to those taking placebo. There were also no significant changes in any of the exploratory endpoints. Improvements in sleep were associated with improvements in both objective (i.e. HbA1c) and subjective (i.e. Diabetes Distress Scale) measures of diabetes, across treatment assignments. Conclusion Our negative findings for suvorexant efficacy for insomnia in poorly-controlled T2D may be related to inadequate sample size or due to the complex and multiple contributions to insomnia in this patient population. The associations of improved sleep with improvements in diabetes-related metrics across groups highlights the importance of identifying and treating sleeping difficulties in this population. Support (if any) This research was funded by an investigator-initiated grant from Merck Pharmaceuticals.

Global comparison of the effect of non-pharmacological interventions on glycemic control in patients with type 2 diabetes: A network meta-analysis from 107 randomized controlled trials

ObjectiveTo investigate the effectiveness of non-pharmacological interventions (NPIs) on glycemic control in patients with type 2 diabetes (T2D) and to provide guidance for clinical healthcare-giver. DesignNetwork meta-analysis (NMA). Setting and participantsRandomized controlled trials comparing the effect of NPIs with usual care, waitlist, or other NPIs on glycemic control in patients with T2D. MethodsThis NMA was guided by frequentist framework. PubMed, Embase, the Cochrane Library Central Register of Controlled Trials, Cumulated Index to Nursing and Allied Health Literature, and Web of Science were searched from their inception until January 2023. The primary outcome was HbA1c and secondary outcomes were cardiovascular risk scores and related psychosocial scores. Mean differences and standardized mean differences were pooled using NMA. Study quality was assessed with the Confidence in Network Meta-analysis. ResultsA total of 107 studies (10,496 participants) were included. The median sample size of the included studies was 64 (range, 10–563) and the median duration was 3 months (range, 1–24). Compared to usual care, all NPIs except acupuncture (MD: −0.28; 95 % CI: −1.02, 0.26) and psychological therapy (MD: −0.29; 95 % CI: −0.66, 0.08) showed significantly differences in improving glycemic control in patients with T2D. And according to the results of surface under the cumulative ranking analysis and Cluster ranking, meditation therapy was considered to the best choice when balancing the efficacy of glycemic control with self-efficacy and diabetes related problems, while nutrition therapy was considered to the best choice when balancing quality of life with risk of cardiovascular complications. ConclusionsThese findings validate the efficacy of NPIs for glycemic control in patients with T2D and suggest that healthcare-giver should consider both the efficacy of interventions and the psychosocial needs of patients when developing NPIs programs.

Retraction Note: Probiotic assisted weight management as a main factor for glycemic control in patients with type 2 diabetes: a randomized controlled trial

Retraction Note: Probiotic assisted weight management as a main factor for glycemic control in patients with type 2 diabetes: a randomized controlled trial

Efficacy of combination therapy with GABA, a DPP-4i and a PPI as an adjunct to insulin therapy in patients with type 1 diabetes.

The purpose of this retrospective clinic chart review study was to determine the potential of a combination therapy (CT) consisting of γ-aminobutyric acid (GABA), a dipeptidyl peptidase-4 inhibitor (DPP-4i), and a proton pump inhibitor (PPI) to improve glycemic control as an adjunct to insulin therapy in patients with type 1 diabetes (T1D). Nineteen patients with T1D on insulin therapy were treated with additional CT in oral form. Fasting blood glucose (FBG), HbA1c, insulin dose-adjusted HbA1c (IDA-A1c), daily insulin dose, insulin/weight ratio (IWR), and fasting plasma C-peptide were measured after 26-42 weeks of treatments. FBG, HbA1c, IDA-A1c, insulin dose and IWR were all significantly decreased while plasma C-peptide was significantly increased by the CT. Treatment outcomes were further analyzed by separation of the 19 patients into two groups. One group started on the CT within 12 months of insulin treatment (early therapy, 10 patients) and another group started on this therapy only after 12 months of insulin treatment (late therapy, 9 patients). FBG, IDA-A1c, insulin dose, and IWR decreased significantly in both the early and late CT groups, however to a better extent in the early therapy group. Moreover, plasma C-peptide increased significantly only in the early therapy group, and 7 of the 10 patients in this group were able to discontinue insulin treatment while maintaining good glycemic control to study end compared with none of the 9 patients in the late therapy group. These results support the concept that the combination of GABA, a DPP-4i and a PPI as an adjunct to insulin therapy improves glycemic control in patients with T1D, and that the insulin dose required for glycemic control can be reduced or even eliminated in some patients receiving this novel therapy.

Type 2 diabetes with obesity and hypertension: prevalence and sociodemographic risk factors in Yemen

BACKGROUND: Diabetes Mellitus is a rapidly growing and challenging health issue of the 21st century. Type 2 diabetes (T2D) is a major risk factor for obesity and hypertension (HTN). The prevalence of HTN and obesity in T2D patients is not well documented in the country of Yemen. AIM: The focus of this study was to assess the prevalence of hypertension and obesity in patients with type 2 diabetes mellitus in Yemen.METHODS: A cross-sectional study was carried out in Dhamar city hospitals. Patients diagnosed with diabetes (300 males and females: 30 years old and/or above) visiting an endocrinology and diabetes clinic in Dhamar city hospital for the first time were examined and evaluated for blood glucose levels, mode of treatment, duration of the disorder and body mass index. Socio-demographic and clinical data were collected using pretested questionnaires. Ethical approval was obtained from corresponding ethical committees from Dhamar University and hospitals. Data were analyzed using SPSS 23 version.RESULTS: The prevalence of overweight and/or obesity in T2D was 60.67%, and hypertension was 35.66%. The occurrence of T2D was predominant in females (56.33%), patients with an age over 50 years (61%), and rural dwellers (74%). The mode of treatment was mainly through oral antihyperglycemic and hypoglycemic agents (79.3%). A large population (66.3%) showed poor control of blood glucose levels ranging from more than 131 to 500 mg/dL and the type of work these patients were involved in was mostly physically inactive (64%). The body mass index revealed that more than 35% were found to be overweight and 23% to be obese. Patients with hypertension and undergoing treatment for the same showed a significant (P < 0.001) increase in blood glucose level compared to those who were not diagnosed with HTN.CONCLUSION: The prevalence of obesity, HTN, and poor glycemic control in patients with T2D is high, especially in females.

Updates in Diabetes Control in Cancer Patients Receiving Cytotoxic Drugs Management: A Systematic Review

Background/Objectives: Diabetes is frequent among cancer patients. Diabetes and cancer co-occurrence may result in a worse prognosis and complications in cancer patients. This systematic review aims to investigate the impact of glycemic control in patients having both cancer and diabetes. Methods: PubMed, Web of Science, Science Direct, and Google Scholar were systematically searched to include the relevant literature. Rayyan QRCI was used throughout this systematic approach. Results/ Interpretation: A total of thirteen studies with 13550 patients were included in this review. The reported follow-up duration ranged from 2 to 12 months. Cancer patients with diabetes are more likely to get infections, be hospitalized, and require chemotherapy reductions or discontinuation. Having cancer with comorbid diabetes affects diabetes self-management and results in poor glycemic control. Applying clinical pharmaceutical programs to raise awareness about compliance with diabetic medication along with cancer treatment was found to have positive outcomes. Evidence-based practice recommendations or policies should be developed that advocate assessing diabetes patients' glycemic state at the time of cancer diagnosis.

Religion, spirituality and improved glycemic control among people with type 2 diabetes: A systematic review.

This systematic review investigates the association between measures of religiosity or spirituality (R/S) and glycemic control in patients with type 2 diabetes. A systematic literature review was conducted for all English language articles published between 1966 and August 2022 in six relevant databases: PubMed, PSYCHinfo, CINAHL, ATLA, Scopus, Sociological Abstracts, and the Cochrane Central Register of Controlled Clinical Trials. Search terms for religious variables included, "religion", "religiosity", "spirituality", "religious attendance". Search terms for diabetes outcomes included, "diabetes", "hemoglobin A1c", "blood glucose", "glycemic control." The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO). A total of 758 studies examining correlations between R/S and glycemic control were screened from relevant databases. Forty studies were evaluated for eligibility and inclusion. Eight studies were selected and analyzed. Three studies showed positive associations, two studies showed positive and neutral associations, two studies showed positive and negative associations, and one study showed a neutral association. Limitations included small sample sizes and heterogeneity of study designs. Involvement in religious and spiritual practices may be associated with improved glycemic control in patients with type 2 diabetes. Specific mechanisms for associations may be partially explained by more effective self-management practices, increased positive social contacts, and regular community support. Further research is needed to clarify these associations.

Clinical Experience of Using Telemedicine for the Management of Patients Using Continuous Subcutaneous Insulin Infusion in a Highly Complex Latin American Hospital

Continuous subcutaneous insulin infusion (CSII) has emerged as a potential solution for diabetes management during the pandemic, as it reduces the need for in-person visits and allows for remote monitoring of patients. Telemedicine has also become increasingly important in the management of diabetes during the pandemic, as it allows healthcare providers to provide remote consultations and support. Here, we discuss the implications of this approach for diabetes management beyond the pandemic, including the potential for increased access to care and improved patient outcomes. We performed a longitudinal observational study between 1 March 2020 and 31 December 2020 to evaluate glycemic parameters in diabetic patients with CSII in a telehealth service. Glycemic parameters were time in range (TIR), time above range, time below range, mean daily glucose, glucose management indicator (GMI), and glycemic variability control. A total of 36 patients were included in the study, with 29 having type 1 diabetes and 6 having type 2 diabetes. The study found that the proportion of patients achieving target glucose variability and GMI remained unchanged during follow-up. However, in patients with type 2 diabetes, the time in target range increased from 70% to 80%, and the time in hyperglycemia decreased from 2% to 0%. The results of this study suggest that telemedicine is a strategy for maintaining glycemic control in patients using CSII. However, the lack of access to the internet and adequate telemonitoring devices make it difficult to use on a large scale in emerging countries like ours.

Effects of E-health-based interventions on glycemic control for patients with type 2 diabetes: a Bayesian network meta-analysis.

https://www.crd.york.ac.uk/prospero, identifier CRD42022299896.

Efficacy of polyethylene glycol loxenatide versus insulin glargine on glycemic control in patients with type 2 diabetes: a randomized, open-label, parallel-group trial.

Objective: This trial aimed to evaluate the glycemic control of polyethylene glycol loxenatide measured with continuous glucose monitoring (CGM) in patients with type 2 diabetes mellitus (T2DM), with the hypothesis that participants given PEG-Loxe would spend more time in time-in-range (TIR) than participants were given insulin glargine after 24weeks of treatment. Methods: This 24-week, randomized, open-label, parallel-group study was conducted in the Department of Endocrine and Metabolic Diseases, Longhu Hospital, Shantou, China. Participants with T2DM, who were ≥45years of age, HbA1c of 7.0%-11.0%, and treated at least 3 months with metformin were randomized (1:1) to receive PEG-Loxe or insulin glargine. The primary endpoint was TIR (blood glucose range: 3.9-10.0mmol/L) during the last 2 weeks of treatment (weeks 22-24). Results: From March 2020 to April 2022, a total of 107 participants with T2DM were screened, of whom 78 were enrolled into the trial (n = 39 per group). At the end of treatment (weeks 22-24), participants given PEG-Loxe had a greater proportion of time in TIR compared with participants given insulin glargine [estimated treatment difference (ETD) of 13.4% (95% CI, 6.8 to 20.0, p < 0.001)]. The tight TIR (3.9-7.8mmol/L) was greater with PEG-Loxe versus insulin glargine, with an ETD of 15.6% (95% CI, 8.9 to 22.4, p < 0.001). The time above range (TAR) was significantly lower with PEG-Loxe versus insulin glargine [ETD for level 1: -10.5% (95% CI: -14.9 to -6.0), p < 0.001; ETD for level 2: -4.7% (95% CI: -7.9 to -1.5), p = 0.004]. The time below range (TBR) was similar between the two groups. The mean glucose was lower with PEG-Loxe versus insulin glargine, with an ETD of -1.2mmol/L (95% CI, -1.9 to -0.5, p = 0.001). The SD of CGM glucose levels was 1.88mmol/L for PEG-Loxe and 2.22mmol/L for insulin glargine [ETD -0.34mmol/L (95% CI: -0.55 to -0.12), p = 0.002], with a similar CV between the two groups. Conclusion: The addition of once-weekly GLP-1RA PEG-Loxe to metformin was superior to insulin glargine in improving glycemic control and glycemic variability evaluated by CGM in middle-aged and elderly patients with T2DM.

Use of Flash Glucose Monitoring and Glycemic Control in Patients with Type2 Diabetes Mellitus Not Treated with an Intensive Insulin Regimen: 1-Year Real-Life Retrospective Cohort Study.

Estimation of laboratory-derived glycated hemoglobin (HbA1c) cannot be individually used to monitor clinically significant trends in glucose variability. Hence, clinicians advise use of continuous glucose monitoring (CGM) devices such as the Freestyle Libre™ flash glucose monitoring system (FLASH) to optimize glycemic control by estimating glucose monitoring index (GMI) values, which convert mean glucose into an estimate of simultaneously measured laboratory HbA1c. This study aimed to investigate the sustainability of intermittently scanned continuous glucose monitoring (isCGM) in patients with type2 diabetes mellitus (T2DM) not on intensive insulin regimen, and correlations between GMI values obtained from isCGM and laboratory-derived HbA1c values. A retrospective review of 93 patients with T2DM not on intensive insulin regimen, using FLASH device, was conducted at a major tertiary hospital in Saudi Arabia, over 1year of continuous device use. To determine the sustainability of isCGM, various glycemic markers such as average glucose and time in range were evaluated. Paired ttest or Wilcoxon signed-rank test was used to assess differences in markers of glycemic control, and Pearson's correlation was used to determine correlations between HbA1c and GMI values. Descriptive analysis shows the mean HbA1c value significantly decreased following continued use of isCGM. Pre-isCGM mean HbA1c value of 8.3% improved to 8.1% (p < 0.001) and 7.9% (p < 0.001) in the first 90 and last 90days of device use, respectively. For both 90-day time periods, correlation analysis revealed a statistically significant positive correlation and linear regression between laboratory-derived HbA1c and GMI values (first 90days r = 0.7999, p < 0.001; last 90days r = 0.6651, p < 0.001). Continuous use of isCGM demonstrated reductions in HbA1c levels for patients with T2DM not on an intensive insulin regimen. The GMI values showed high levels of agreement with measured HbA1c, indicating their accuracy in glucose management.

Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Guidelines on Cardiovascular Disease Prevention

We present the Spanish adaptation of the 2021 European Guidelines on Cardiovascular Disease (CVD) prevention in clinical practice. The current guidelines besides the individual approach greatly emphasize on the importance of population level approaches to the prevention of cardiovascular diseases. Systematic global CVD risk assessment is recommended in individuals with any major vascular risk factor. Regarding LDL-Cholesterol, blood pressure, and glycemic control in patients with diabetes mellitus, goals and targets remain as recommended in previous guidelines. However, it is proposed a new, stepwise approach (Step 1 and 2) to treatment intensification as a tool to help physicians and patients pursue these targets in a way that fits patient profile. After Step 1, considering proceeding to the intensified goals of Step 2 is mandatory, and this intensification will be based on 10-year CVD risk, lifetime CVD risk and treatment benefit, comorbidities and patient preferences. The updated SCORE algorithm—SCORE2, SCORE-OP— is recommended in these guidelines, which estimates an individual’s 10-year risk of fatal and non-fatal CVD events (myocardial infarction, stroke) in healthy men and women aged 40–89 years. Another new and important recommendation is the use of different categories of risk according different age groups (< 50, 50−69, ≥70 years).Different flow charts of CVD risk and risk factor treatment in apparently healthy persons, in patients with established atherosclerotic CVD, and in diabetic patients are recommended. Patients with chronic kidney disease are considered high risk or very high-risk patients according to the levels of glomerular filtration rate and albumin-to-creatinine ratio. New lifestyle recommendations adapted to the ones published by the Spanish Ministry of Health as well as recommendations focused on the management of lipids, blood pressure, diabetes and chronic renal failure are included.

Abstract #1413249: Acute Exacerbations of Chronic Obstructive Pulmonary Disease and its Association with Glycaemic Control

Hyperglycemia is associated with poor outcomes in patients with pneumonia, myocardial infarction, and stroke but the effect of hyperglycemia on outcomes during AECOPD has not been definitely established. This study was aimed to find out the relationship between the glycaemic status and AECOPD This real world, retrospective longitudinal study was carried out among 280 adults having T2DM with the co-morbidity of COPD who also visits OPD seeking consultation for AECOPD episodes. Study was carried on for a period of 2.5 years. The patients were divided into 3 Groups according to mean HbA1c status. (A<7%, B≥7% to ≤8% and C>8% to ≤9.5%). The follow up visits were scheduled once every 3 months, (extra OPD visits were encouraged for exacerbation of any respiratory symptom). 85 patients needed hospitalisation for episodes of AECOPD, out of which 26 patients needed admission in the ICU with 7 patients needing invasive ventilation. 3 patients out of these 7 died. Men weighed 89±24 kg, with a body mass index (BMI) of 31.5±9.1 kg/m2. Participants had a 65±43 pack-year smoking history. Highest percentage of AECOPD episodes (43%) were observed with Group A whereas group B it was 35% and Group C it was 40%. Exacerbations were characterised by increased dyspnoea (100%), wheeze (83%), chest tightness (72%) and cough (69%). Of the 85 patients needing hospitalisation, majority (84%) belonged to Group C (HbA1c >8%). This study showed that factors other than glycaemic control are also responsible for episodes of AECOPD in patients of T2DM, though a poor glycaemic control (Group C) has a greater risk of hospitalisation. Hence other factors like increasing age, longer duration of COPD, malnutrition, irregular inhalation therapy, etc. needs to be looked into details as aetiology, leading to episodes of AECOPD besides glycaemic control in patients of T2DM.

Challenges with point of care glucose measurements for management of hypoglycemia in neonates.

Guidelines from the Canadian Paediatric Society recommend investigating hypoglycemia at a patient blood glucose concentration of 2.6 mmol/L for patients less than 72 hours of age and 3.3 mmol/L for patients 72 hours of age or older (1). Patients with blood glucose <2.8 mmol/L after 72 hours of age require additional investigation with samples sent to the laboratory for glucose (to confirm), beta-hydroxybutyrate, bicarbonate, lactate, free fatty acids, insulin, growth hormone, cortisol, carnitine, and acylcarnitines (1). Neonatal blood glucose concentrations are frequently monitored using point of care testing (POCT) glucose metres. In Canada, there are currently two glucose metres approved by Health Canada for use in hospitals, the Accu-Chek Inform II (Roche Diagnostics) and the StatStrip (Nova Biomedical). POCT glucose metres are accurate for monitoring glycemic control in patients with diabetes (2). However, the accuracy and precision limitations of these metres struggle to match clinical need in the context of neonatal hypoglycemia. POCT glucose results have been shown to differ by as much as 10–20% from central laboratory methods for measurements in the hypoglycemic range; importantly, this difference, or bias, is not consistent between vendors (3,4). The extent of this bias can also shift over time due to variable performance of different lot numbers of test strips, highlighting the need for ongoing evaluation of metre performance.

Investigating glycemic control in patients undergoing lower extremity bypass within an enhanced recovery pathway at a single institution

BackgroundEnhanced recovery pathways (ERPs) aim to lower perioperative stress to facilitate recovery. Limited fasting combined with carbohydrate loading is a common ERP element. The effect of limited fasting has not been elucidated in patients with diabetes. Given the known deleterious effects of poor glycemic control in the perioperative period, such as increased rates of surgical site infection, the associations of preoperative limited fasting with perioperative glycemic control and early outcomes after lower extremity bypass (LEB) were investigated. MethodsA single institutional retrospective review of patients who underwent infrainguinal LEB from 2016 to 2022 was performed. The ERP was initiated in May 2018. Patients were stratified by diabetes diagnosis and preoperative hemoglobin A1C (HbA1C) levels. Perioperative glycemic control was compared between the limited fasting and traditional fasting patients (nil per os at midnight). Limited fasting was defined as a clear liquid diet until 2 hours before surgery with recommended carbohydrate loading consisting of 400 cc of a clear sports drink (approximately 30 g of carbohydrates). All limited fasting patients were within the ERP. Early perioperative hyperglycemia (EPH) was defined as blood glucose of >180 mg/dL within the first 24 hours of surgery. Perioperative outcomes such as surgical site infection, readmission, reinterventions, and complications were also compared. ResultsA total of 393 patients were included (limited fasting patients N = 135; traditional fasting patients N = 258). A trend toward EPH was seen in all limited fasting groups. Evaluating limited fasting within diabetic patients revealed that 74.5% of limited fasting-diabetic patients had EPH compared with 49.6% of traditional fasting-diabetic patients (P = .001). When stratified by the HbA1C level, a significantly higher rate of EPH was seen in the HbA1c >8.0% groups, with 90.5% in the limited fasting patients compared with 67.9% in traditional fasting patients (P = .05). Limited fasting-diabetic patients experience a longer postoperative length of stay at 5.0 days (interquartile range: 3, 9) vs 4.0 days (2, 6) in nondiabetic patients (P = .016). ConclusionsERP limited fasting was associated with early perioperative hyperglycemia after LEB, particularly in patients with HbA1C >8.0%. Due to the high prevalence of diabetic patients undergoing LEB under ERP, the role of limited fasting and common glycemic elements of ERP may need to be re-evaluated in this subpopulation.

A Hypothesis on the Progression of Insulin-Induced Lipohypertrophy: An Integrated Result of High-Frequency Ultrasound Imaging and Blood Glucose Control of Patients.

To put forward a scientific hypothesis about the progression of insulin-injection-induced lipohypertrophy (LH) according to the high-frequency ultrasonic imaging of insulin injection sites and the blood glucose control of patients. A total of 344 patients were screened for LH by means of high-frequency ultrasound scanning. The results of their ultrasound examination were described in detail and categorized into several subtypes. Seventeen patients with different subtypes of LH were followed up to predict the progression of LH. To further verify our hypothesis, the effects of different types of LH on glycemic control of patients were observed by comparing glycated hemoglobin A1c (HbA1C) and other glycemic-related indicators. LH was found in 255 (74.1%) patients. According to the high-frequency ultrasonic imaging characteristics, LH can be categorized into three subtypes in general. Among all the LHs, the most common type observed was nodular hyperechoic LH (n = 167, 65.5%), followed by diffuse hyperechoic LH (n = 70, 27.5%), then hypoechoic LH (n = 18, 7.0%). At the follow-up after six months, all 10 patients with nodular hyperechoic LH had LH faded away. Of the five patients with diffuse hyperechoic LH, two had inapparent LH, and three had diffuse hyperechoic parts which had shrunk under ultrasound. No obvious changes were observed in the two cases of hypoechoic LH. Compared with the LH-free group, the mean HbA1C of the nodular hyperechoic LH group increased by 0.8% (9 mmol/mol) (95% CI:-1.394~-0.168, p = 0.005), that of the diffuse hyperechoic LH group increased by 2.0% (21 mmol/mol) (95% CI: -2.696~-1.20, p < 0.001), and that of the hypoechoic LH group increased by 1.5% (16 mmol/mol) (95% CI: -2.689~-0.275, p = 0.007). It was hypothesized that the earlier stage of LH is nodular hyperechoic LH. If nodular LH is not found in time and the patient continues to inject insulin at the LH site and/or reuse needles, LH will develop into a diffuse type or, even worse, a hypoechoic one. Different subtypes of LH may represent differences in severity when blood glucose control is considered as an important resolution indicator. Further studies are needed to confirm our hypothesis on the progression and reversion of insulin-induced lipohypertrophy.

Using Machine Learning for the Risk Factors Classification of Glycemic Control in Type 2 Diabetes Mellitus.

Several risk factors are related to glycemic control in patients with type 2 diabetes mellitus (T2DM), including demographics, medical conditions, negative emotions, lipid profiles, and heart rate variability (HRV; to present cardiac autonomic activity). The interactions between these risk factors remain unclear. This study aimed to use machine learning methods of artificial intelligence to explore the relationships between various risk factors and glycemic control in T2DM patients. The study utilized a database from Lin et al. (2022) that included 647 T2DM patients. Regression tree analysis was conducted to identify the interactions among risk factors that contribute to glycated hemoglobin (HbA1c) values, and various machine learning methods were compared for their accuracy in classifying T2DM patients. The results of the regression tree analysis revealed that high depression scores may be a risk factor in one subgroup but not in others. When comparing different machine learning classification methods, the random forest algorithm emerged as the best-performing method with a small set of features. Specifically, the random forest algorithm achieved 84% accuracy, 95% area under the curve (AUC), 77% sensitivity, and 91% specificity. Using machine learning methods can provide significant value in accurately classifying patients with T2DM when considering depression as a risk factor.

Association between personality traits and glycemic control after inpatient diabetes education

AimsThe longitudinal effect of personality traits on glycemic control is unclear. This prospective observational study explored the relationship between personality traits and glycemic control in patients with uncontrolled diabetes after inpatient diabetes education. MethodsPatients with diabetes mellitus (HbA1c ≥ 7.5%, measured by high-performance liquid chromatography) who received inpatient diabetes education were scored on the Big Five personality traits: neuroticism, extraversion, openness, agreeableness, and conscientiousness. Multiple linear analysis was used to determine whether any personality traits were independently associated with HbA1c on admission and HbA1c change from admission to 1, 3, and 6 months after discharge. ResultsOne hundred seventeen participants (mean age 60.4 ± 14.5 years; 59.0% male) were enrolled. HbA1c values on admission and 1, 3, and 6 months after discharge were 10.2 ± 2.1%, 8.3 ± 1.4%, 7.6 ± 1.4%, and 7.7 ± 1.5%, respectively. Multiple linear analysis showed that no personality traits were associated with HbA1c on admission. Neuroticism was negatively associated with the HbA1c change from admission to 3 months (β = −0.192, P = 0.025) and 6 months after discharge (β = −0.164, P = 0.043). ConclusionsNeuroticism was associated with good long-term glycemic control after inpatient diabetes education.

Prevalence, risk factors and evolution of diabetes mellitus after treatment in primary aldosteronism. Results from the SPAIN-ALDO registry.

To evaluate the prevalence, risk factors and evolution of diabetes mellitus (DM) after targeted treatment in patients with primary aldosteronism (PA). A retrospective multicenter study of PA patients in follow-up at 27 Spanish tertiary hospitals (SPAIN-ALDO Register). Overall, 646 patients with PA were included. At diagnosis, 21.2% (n = 137) had DM and 67% of them had HbA1c levels < 7%. In multivariate analysis, family history of DM (OR 4.00 [1.68-9.53]), the coexistence of dyslipidemia (OR 3.57 [1.51-8.43]) and advanced age (OR 1.04 per year of increase [1.00-1.09]) were identified as independent predictive factors of DM. Diabetic patients were on beta blockers (46.7% (n = 64) vs. 27.5% (n = 140), P < 0.001) and diuretics (51.1% (n = 70) vs. 33.2% (n = 169), p < 0.001) more frequently than non-diabetics. After a median follow-up of 22months [IQR 7.5-63.0], 6.9% of patients developed DM, with no difference between those undergoing adrenalectomy and those treated medically (HR 1.07 [0.49-2.36], p = 0.866). There was also no significant difference in the evolution of glycemic control between DM patients who underwent surgery and those medicallytreated (p > 0.05). DM affects about one quarter of patients with PA and the risk factors for its development are common to those of the general population. Medical and surgical treatment provides similar benefit in glycemic control in patients with PA and DM.