Glycemic Control In Patients Research Articles

Glycemic Control Improvement amongst Patients with Diabetes Mellitus during a COVID-19 Lockdown in Jordan

Aims: The purpose of this study is to evaluate the effects of lockdown measures by the Jordanian government to contain the spread of the novel corona virus (COVID-19) on glycemic control of patients with diabetes mellitus.
 Methods: This cross-sectional study was conducted in Jordan University Hospital. A total of 264 patients with type 2 or type 1 diabetes mellitus were sampled. The authors evaluated the extent of glycemic control reached by patients with type 2 or type 1 diabetes mellitus by measuring change in glycosylated hemoglobin (A1C) values, in addition to the number of hypoglycemic episodes experienced by patients during lockdown. The authors conducted a questionnaire via telephone interviews to record information about drug adherence and availability, diet, physical activity, and telephone consultations. A paired sample t-test was used to compare values before and after lockdown.
 Results: A significant reduction in HbA1C values was found during lockdown (p=0.038), with only 33.6% of patients experiencing one or more hypoglycemic episodes; both factors suggest controlled blood glucose levels. Medication adherence was found to be the main reason for improvement, with 74.8% of our population being strongly adherent to their medications.
 Conclusions: In Jordanian patients with diabetes mellitus, glycemic control was significantly improved during COVID-19 lockdown and this was found to be associated with strong medication adherence.

Glycemic Patterns and Impact of Early Hyperglycemia in Patients with Cardiogenic Shock on Mechanical Circulatory Support.

Hyperglycemia has been an established predictor of poor outcomes in critically ill patients. The aim of the current study is to assess the pattern of early glycemic control in patients with cardiogenic shock (CS) on temporary mechanical circulatory support (MCS) and its impact on short term outcomes. All adult patients admitted to the Cleveland Clinic Cardiac Intensive Care Unit (CICU) between 2015 - 2019 with CS necessitating MCS with Intra-Aortic Balloon Pump (IABP), Impella or Venous Arterial- Extra Corporeal Membrane Oxygenation (VA- ECMO) exclusively for CS were retrospectively analyzed. Blood glucose values were collected for the first 72 hrs from the time of MCS insertion. Patients were categorized into three groups (group 1 = mean blood glucose (MBG) < 140, group 2 = MBG between 140-180, and group 3 = MBG >180). The primary outcome was 30-day all-cause mortality. A total of 393 patients with CS on temporary MCS (Median age [Q1, Q3], 63 [54,70], 42% females), were admitted to our CICU during the study period. Of these, 144 patients (37%) were on IABP, 121 patients (31%) were on Impella, and 128 (32%) were on VA-ECMO. Upon stratifying the patients into groups depending on MBG during the initial time period after MCS placement, 174 patients (44%) had MBG less than 140 mg/dl, 126 patients (32%) had MBG between 140-180 mg/dl whereas 93 (24%) patients had MBG > 180 mg/dl. Overall, patients on IABP had the best glycemic control during the early period whereas those on ECMO had the highest MBG during the initial timeframe. Comparison of 30-day mortality revealed that patients with MBG >180 mg/dl had worse outcomes compared to the other two groups (p = 0.005). Multivariable logistic regression revealed that hyperglycemia was an independent predictor of poor outcomes in CS patients on MCS when undifferentiated by device type (aOR 2.27, 95% CI 1.19-4.42, p = 0.01). However, upon adjusting for the type of MCS device, this effect was no longer present. A significant proportion of patients with CS on MCS manifest early hyperglycemia regardless of diabetic status. The presence of early hyperglycemia in these patients acted predominantly as a surrogate of the underlying shock severity and was associated with worse short-term outcomes. Future studies should assess whether strategies to optimize the glycemic control in this high-risk cohort can independently improve clinical outcomes.

Comparison of Glucose Control Profile in Patients With Depression and Type 2 Diabetes Receiving Bupropion or Venlafaxine: A Randomized Controlled Clinical Trial

Background and Objective This study aims to compare the effects of bupropion and venlafaxine on glucose control of patients with depression and type 2 diabetes (T2D). Materials &amp; Methods TThis randomized controlled trial was carried out in endocrinology clinic affiliated to Babol University of Medical Sciences on adult patients with comorbid T2D and depression in two groups. The first group (n=19) received venlafaxine 37.5-150 mg daily, while the second group (n=16) was treated with bupropion 75-300 mg per day. The primary outcomes were the severity of depressive symptoms and the glucose control profile. Depressive symptoms were assessed with the Beck depression inventory (BDI). Data was analyzed in SPSS software, version 17 package. P&lt;0.05 was considered as statically significant. Results A significant decrease in depressive symptoms for both groups was reported, but the difference between the two groups was not statistically significant (P=0.342). Venlafaxine caused a significant increase in HbA1c from 7.64 to 8.03 (P=0.04), while bupropion caused a decrease in HbA1c from 7.35 to 7.23 (P=0.06). These changes were significantly different between the two groups (P=0.028). Conclusion Venlafaxine can reduce depression, but it is not suggested as a proper drug for treating depression in people with T2D. However, bupropion seems to be a good choice due to its positive effect on depressive symptoms and glycemic control in patients with comorbid T2D and depression.

Does the Insulin Pump Improve Satisfaction and Glycaemic Control in Moroccan Patients with Type 1 Diabetes?

Introduction: Insulin pump therapy is recommended more and more to achieve and maintain optimal glycaemic control in patients with type 1 diabetes mellitus. The objective of our study was to evaluate the satisfaction of patients using insulin pump therapy and to determine its effectiveness in improving metabolic control in type 1 diabetic patients. Patients-Methods: This is a retrospective, descriptive and analytical study including 20 type 1 diabetic patients treated by insulin pump, between 2017 and 2021. All patients received a clinical evaluation, analysis of capillary blood glucose monitoring and a dosage of HbA1c at the time of the start of insulin pump and during the evolution. Insulin pump satisfaction was assessed using the Diabetes Treatment Satisfaction Questionnaire (DTSQ). Statistical analysis was performed by SPSS version-21. Results: The mean age of the patients was 16,8 ± 8,1 years with a sex ratio (M/F) of 0,42. Thirty per-cent were children. The mean duration of diabetes was 5,8 ± 4,8 years. Seventy-five per-cent of patients practiced functional insulin therapy. The indications for insulin pump treatment were mainly hypoglycaemia and instable diabetes. During follow-up, we found a statistically significant decrease in insulin requirements, improvement in mean HbA1c and maintenance of glycaemic control during follow-up, with a marked reduction in the number of hypoglycaemia events per week. The overall satisfaction score was calculated at 34,6 ± 2,5 out of 36 with a decrease in the score for perception of hyperglycaemia or hypoglycaemia. Conclusion: Insulin pump therapy appears to be reliable and effective when used appropriately, combined with appropriate therapeutic education and glycaemic monitoring to maintain long-term glycaemic control and improved quality of life.

Association between initial in-hospital heart rate and glycemic control in patients with acute ischemic stroke and diabetes mellitus

BackgroundA high resting heart rate (HR) has been associated with an increased risk of diabetes mellitus. This study explored the association between initial in-hospital HR and glycemic control in patients with acute ischemic stroke (AIS) and diabetes mellitus.MethodsWe analyzed data from 4,715 patients with AIS and type 2 diabetes mellitus enrolled in the Chang Gung Research Database between January 2010 and September 2018. The study outcome was unfavorable glycemic control, defined as glycated hemoglobin (HbA1c) ≥ 7%. In statistical analyses, the mean initial in-hospital HR was used as both a continuous and categorical variable. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression analysis. The associations between the HR subgroups and HbA1c levels were analyzed using a generalized linear model.ResultsCompared with the reference group (HR < 60 bpm), the adjusted ORs for unfavorable glycemic control were 1.093 (95% CI 0.786–1.519) for an HR of 60–69 bpm, 1.370 (95% CI 0.991–1.892) for an HR of 70–79 bpm, and 1.608 (95% CI 1.145–2.257) for an HR of ≥ 80 bpm. Even after adjusting for possible confounders, the HbA1c levels after admission and discharge among diabetic stroke patients increased significantly in the subgroups with higher HRs (p < 0.001).ConclusionsHigh initial in-hospital HR is associated with unfavorable glycemic control in patients with AIS and diabetes mellitus, particularly in those with an HR of ≥ 80 bpm, compared with those with an HR of < 60 bpm.

Pre-treatment with IL-6 potentiates β-cell death induced by pro-inflammatory cytokines

BackgroundType I Diabetes mellitus (T1D) is characterized by a specific destruction of β-cells by the immune system. During this process pro-inflammatory cytokines are released in the pancreatic islets and contribute for β-cells demise. Cytokine-induced iNOS activation, via NF-κB, is implicated in induction of β-cells death, which includes ER stress activation. Physical exercise has been used as an adjunct for better glycemic control in patients with T1D, since it is able to increase glucose uptake independent of insulin. Recently, it was observed that the release of IL-6 by skeletal muscle, during physical exercise, could prevent β-cells death induced by pro-inflammatory cytokines. However, the molecular mechanisms involved in this beneficial effect on β-cells are not yet completely elucidated. Our aim was to evaluate the effect of IL-6 on β-cells exposed to pro-inflammatory cytokines.ResultsPre-treatment with IL-6 sensitized INS-1E cells to cytokine-induced cell death, increasing cytokine-induced iNOS and Caspase-3 expression. Under these conditions, however, there was a decrease in cytokines-induced p-eIF2-α but not p-IRE1expression, proteins related to ER stress. To address if this prevention of adequate UPR response is involved in the increase in β-cells death markers induced by IL-6 pre-treatment, we used a chemical chaperone (TUDCA), which improves ER folding capacity. Use of TUDCA increased cytokines-induced Caspase-3 expression and Bax/Bcl-2 ratio in the presence of IL-6 pre-treatment. However, there is no modulation of p-eIF2-α expression by TUDCA in this condition, with increase of CHOP expression.ConclusionTreatment with IL-6 alone is not beneficial for β-cells, leading to increased cell death markers and impaired UPR activation. In addition, TUDCA has not been able to restore ER homeostasis or improve β-cells viability under this condition, suggesting that other mechanisms may be involved.

Venom Peptides, Polyphenols and Alkaloids: Are They the Next Antidiabetics That Will Preserve β-Cell Mass and Function in Type 2 Diabetes?

Improvement of insulin secretion by pancreatic β-cells and preservation of their mass are the current challenges that future antidiabetic drugs should meet for achieving efficient and long-term glycemic control in patients with type 2 diabetes (T2D). The successful development of glucagon-like peptide 1 (GLP-1) analogues, derived from the saliva of a lizard from the Helodermatidae family, has provided the proof of concept that antidiabetic drugs directly targeting pancreatic β-cells can emerge from venomous animals. The literature reporting on the antidiabetic effects of medicinal plants suggests that they contain some promising active substances such as polyphenols and alkaloids, which could be active as insulin secretagogues and β-cell protectors. In this review, we discuss the potential of several polyphenols, alkaloids and venom peptides from snake, frogs, scorpions and cone snails. These molecules could contribute to the development of new efficient antidiabetic medicines targeting β-cells, which would tackle the progression of the disease.

A 7 day inpatient diabetes education program improves quality of life and glycemic control 12 months after discharge

For long-term management of diabetes, patients with type 2 diabetes mellitus require a high level of treatment adherence, which is associated with treatment satisfaction and their quality of life (QOL). To achieve it, patient education about diabetes self-management is essential. We routinely conduct a 7 day inpatient diabetes education program and administer the diabetes treatment-related (DTR)-QOL questionnaire to all participants, both before admission and at discharge. Here, we investigated whether our program improves QOL and post-discharge glycemic control. This retrospective study utilized data from patients with type 2 diabetes mellitus who participated in our program between July 2017 and March 2020 and who had been treated in our outpatient department for more than 1 year. We evaluated the relationship between at admission and at discharge diabetes treatment-related quality of life scores and glycemic control after discharge. Data from 140 patients were analyzed in this study, which showed a significant improvement in the total, 'Anxiety and dissatisfaction with treatment', and 'Satisfaction-with-treatment' scores. A significant improvement was evident in HbA1c at 12 months after discharge. Multiple regression analysis showed that HbA1c after 12 months was independently associated with gender, duration of diabetes, and HbA1c at admission. Our program effectively improves quality of life and post-discharge glycemic control in patients with type 2 diabetes mellitus. It is particularly effective in patients of the male gender, with a shorter duration of diabetes mellitus and higher HbA1c at admission.

A mechanistic modeling platform of SGLT2 inhibition: Implications for type 1 diabetes.

Type 1 diabetes mellitus (T1DM) is an autoimmune disease characterized by abnormally high blood glucose concentrations due to dysfunction of the insulin-producing beta-cells in the pancreas. Dapagliflozin, an inhibitor of renal glucose reabsorption, has the potential to improve often suboptimal glycemic control in patients with T1DM through insulin-independent mechanisms and to partially mitigate the adverse effects associated with long-term insulin administration. In this work, we have adapted a systems pharmacology model of type 2 diabetes mellitus to describe the T1DM condition and characterize the effect of dapagliflozin on short- and long-term glycemic markers under various treatment scenarios. The developed platform serves as a quantitative tool for the in silico evaluation of the insulin-glucose-dapagliflozin crosstalk, optimization of the treatment regimens, and it can be further expanded to include additional therapies or other aspects of the disease.

Adjusting the Use of Glucose-Lowering Agents in the Real-World Clinical Management of People with Type 2 Diabetes: A Narrative Review

Despite the availability of new treatment classes, glycaemic control in patients with diabetes remains suboptimal globally. The latter is associated with high risk of premature mortality related to diabetes and its microvascular and macrovascular complications. Practice guidelines typically focus on glycated haemoglobin < 7.0% as a therapeutic goal in type2 diabetes (T2D). Reducing glycated haemoglobin has been proven to reduce the risk of these complications while early attainment of glycaemic goal can have a legacy effect in later life. Both glucocentric and cardiorenal-centric treatment strategies have complementary effects in reducing the trajectory of cardiorenal diseases. In real-word settings, implementation of practice guidelines developed in the USA and Europe may not be applicable to regions such as Asia, where differences in epidemiology, patient phenotypes, cultures, resource availability, and treatment affordability are important considerations. In the present review, we discuss the need to use a pragmatic, albeit evidence-based approach, to combine glucocentric and cardiorenal risk reduction strategies to improve the outcomes in patients with T2D, with particular relevance to Asia Pacific.

Influence of Nutritional Guidance/Consulting on Glycemic Control During the Coronavirus Disease 2019 Pandemic in Patients with Type 2 Diabetes Mellitus.

Objective The coronavirus disease 2019 (COVID-19) pandemic has led to a global restriction of public behavior due to lockdowns in various major cities. Lifestyle changes and reduced rates of outpatient lifestyle guidance/consulting may have had some impact on glycemic control in patients with type 2 diabetes. This study analyzed the impact of changes in the frequency of nutritional guidance/consulting (NGC) during the COVID-19 pandemic on outpatient care for type 2 diabetes. Methods Among 785 patients, 67 who received regular NGC during the COVID-19 pandemic were assigned to the continuation group (CG), 143 whose NGC was discontinued after the pandemic were assigned to the discontinuation group (DG), and 575 who did not receive regular NGC regardless of the COVID-19 pandemic status were assigned to the irregular NGC group (IGG). The three groups were followed up for two years. Analyses among the three categories were performed using the chi-square test or an analysis of covariance. Results The number of diabetes medications after the declaration of the COVID-19 emergency did not markedly increase in the CG (2.0±1.4 to 2.1±1.5, p>0.05) but significantly increased from 2.2±1.4 to 2.6±1.4 in the DG (p<0.005) and from 2.2±1.4 to 2.4±1.4 in the IGG (p<0.005). The increase in HbA1c adjusted for confounders was unchanged at 0.12%±1.06% for the CG and -0.07%±1.29% for the IGG but was significantly increased at 0.19%±1.49% for the DG (p<0.05). Conclusion In patients with type 2 diabetes mellitus, regular nutritional guidance may be important for maintaining good glycemic control, even during the COVID-19 pandemic.

Medication adherence, its associated factors and implication on glycaemic control in patients with type 2 diabetes mellitus: A cross-sectional study in a Malaysian primary care clinic.

Medication adherence and metabolic control remain suboptimal among patients with diabetes mellitus in Malaysia despite the clear benefits of reduced vascular complications and mortality risk. This study examined the factors associated with medication adherence and glycaemic control in patients with type 2 diabetes mellitus in a primary care clinic. This cross-sectional study was conducted in a public health clinic in Pagoh, Johor, among 386 patients recruited via systematic random sampling. Data were obtained using a validated 7-item structured questionnaire, glycated haemoglobin (HbA1c) test and medical record review. Logistic regression analysis was performed to determine the factors associated with medication adherence. The mean patient age was 60.04± 10.75 years, and the mean HbA1c level was 8.3±2.0%. Approximately 60.3% of the participants were adherent to their medication, and an increasing age was significantly associated with medication nonadherence (adjusted odds ratio [OR]: 0.959; confidence interval [CI]: 0.934-0.985). Medication adherence (adjusted OR: 2.688; CI: 1.534- 4.708) and use of combined oral medications (adjusted OR: 5.604; CI: 3.078-10.203), combined oral medications with insulin (adjusted OR: 23.466; CI: 8.208-67.085) and insulin only (adjusted OR: 6.528; CI: 1.876-22.717) were associated with good glycaemic control. Older age (adjusted OR: 0.954; CI: 0.923-0.986) and Malay ethnicity (adjusted OR: 0.284; CI: 0.101-0.794) were associated with poor glycaemic control. Suboptimal medication adherence and glycaemic control are prevalent in primary care settings, especially among elderly patients. Counselling should be targeted to patients and their caretakers to improve medication adherence and optimise metabolic control.

The Impact of a Lockdown for the COVID-19 Pandemic on Seasonal HbA1c Variation in Patients with Type 2 Diabetes.

Glycemic control in patients with type 2 diabetes may be disrupted due to restricted medical service access and lifestyle changes during COVID-19 lockdown period. This retrospective cohort study examined changes of HbA1c levels in adults with type 2 diabetes 12 weeks before and after May 19 in 2021, the date that COVID-19 lockdown began in Taiwan. The mean levels of HbA1c-after were significantly lower than HbA1c-before in 2019 (7.27 ± 1.27% vs 7.43 ± 1.38%, p < 0.001), 2020 (7.27 ± 1.28% vs 7.37 ± 1.34%, p < 0.001), and 2021 (7.03 ± 1.22% vs 7.17 ± 1.29%, p < 0.001). Considering the seasonal variation of HbA1c, ΔHbA1c values (HbA1c-after minus HbA1c-before) in 2020 (with sporadic COVID-19 cases and no lockdown) were not significantly different from 2021 (regression coefficient [95% CI] = 0.01% [-0.02%, 0.03%]), while seasonal HbA1c variation in 2019 (no COVID-19) was significantly more obvious than in 2021 (-0.05% [-0.07, -0.02%]). In conclusion, HbA1c level did not deteriorate after a lockdown measure during the COVID-19 pandemic in Taiwan. However, the absolute seasonal reduction in HbA1c was slightly less during the COVID-19 pandemic compared with the year without COVID-19.

Decreased peroxidase activity of glycated hemoglobin inversely correlated with levels of glycated hemoglobin in type 2 diabetes patients

Background and objectives: Diabetes mellitus is a metabolic disorder with diverse etiological factors. Imbalances between oxidative stress and antioxidant defenses play critical roles in the pathogenesis and progression of diabetes. peroxidase, an antioxidant enzyme similar to superoxide dismutase and catalase, is involved in the etiology and progression of diabetes. This study aimed to elucidate the relationship between peroxidase activity of hemoglobin and glycated hemoglobin with fasting blood glucose levels in patients with type-2 diabetes mellitus. Methods: Sixty-four patients with type-2 diabetes mellitus and an equal number of healthy controls were recruited for the study. Peroxidase activity of hemoglobin and glycated hemoglobin was assayed using L. Goth's method for serum catalase assay, with further modification and standardization. Results: Peroxidase activity of hemoglobin was significantly reduced (P&lt;0.0001) in patients with type 2 diabetes compared to healthy controls, as was peroxidase activity of glycated hemoglobin (P&lt; 0.001). In both patients and controls, peroxidase activity of glycated hemoglobin was significantly higher than normal hemoglobin. In patients with type 2 diabetes, glycated hemoglobin showed a significant negative correlation (r=- 0.308, P= 0.013) with its peroxidase activity, indicating increased activity is associated with poorer glycemic control. Furthermore, peroxidase activiy of normal hemoglobin positively correlated with peroxidase activity of glycated hemoglobin (mainly HbA1c )(r= 0.305, P=0.014). Conclsions: Peroxidase activity of glycated hemoglobin increases with glycated hemoglobin levels, indicating deteriorating glycemic control in patients with type 2 diabetes.

Neutrophil to Lymphocyte Ratio as a Denotative of Type II Diabetes Mellitus

Introduction: The neutrophil-lymphocyte ratio (NLR) is an economically accessible tool useful in cases of Type II Diabetes Mellitus (T2DM). It can be utilized as a laboratory index, indicating systemic inflammation. The sensitivity of NLR to HbA1c must be validated to utilize for its prognostic potential. Correlation of HbA1c with NLR and other parameters have been analyzed to assess the utility of NLR in chronic cases of T2DM, thereby evaluating the utility of NLR as a marker of systemic inflammation in diabetes. Place and Duration of study: Department of Pathology, Saveetha Medical College, Chennai, One year. Objectives: 1. To compare levels of NLR and other parameters in diabetics with those of healthy people and observe the nature of correlation between HbA1c and other parameters.2. To find the linear relationship between HbA1c and other parameters in the diabetic population. Material and methods: An observational study conducted at our Institute from January to October 2020. Blood profiles of 240 T2DM patients and 100 healthy controls were recorded. Results: The NLR (5.35) of T2DM group was significantly elevated (p 0.001) compared to NLR of control group (2.16). Urea and creatinine levels had positive regression coefficients with HbA1c indicating susceptibility of diabetic patients to diabetic nephropathy. Conclusion: NLR showed significance in T2DM. Increased NLR is associated with elevated HbA1c and poor glycemic control in patients with T2DM. It can be used as a prognostic tool during the follow up of diabetic patients.

Adherence to Oral Antidiabetic Drugs in Patients with Type 2 Diabetes: Systematic Review and Meta-Analysis.

Poor adherence to oral antidiabetic drugs (OADs) in patients with type 2 diabetes (T2D) can lead to therapy failure and risk of complications. The aim of this study was to produce an adherence proportion to OADs and estimate the association between good adherence and good glycemic control in patients with T2D. We searched in MEDLINE, Scopus, and CENTRAL databases to find observational studies on therapeutic adherence in OAD users. We calculated the proportion of adherent patients to the total number of participants for each study and pooled study-specific adherence proportions using random effect models with Freeman-Tukey transformation. We also calculated the odds ratio (OR) of having good glycemic control and good adherence and pooled study-specific OR with the generic inverse variance method. A total of 156 studies (10,041,928 patients) were included in the systematic review and meta-analysis. The pooled proportion of adherent patients was 54% (95% confidence interval, CI: 51-58%). We observed a significant association between good glycemic control and good adherence (OR: 1.33; 95% CI: 1.17-1.51). This study demonstrated that adherence to OADs in patients with T2D is sub-optimal. Improving therapeutic adherence through health-promoting programs and prescription of personalized therapies could be an effective strategy to reduce the risk of complications.

Relationship between Glycated Hemoglobin (HbA1c) in Adolescents with Type 1 Diabetes Mellitus (T1DM) and Parental Anxiety and Depression

IntroductionT1D is the most common chronic endocrine pathology in children. The management of type 1 diabetes requires strong diet, physical activity, lifelong insulin therapy, and proper self-monitoring of blood glucose and is usually complicated and, therefore may result in a psychosocial problem for the whole family. Metabolic control of the disease is determined by glycated haemoglobin (HbA1c), the main criterion for diabetes compensation. It is assumed that anxiety and depression symptoms negatively affect glycemic control. A correlation was observed between anxiety and depression level and glycaemic control, as well as a three-way interaction among HbA1c, frequency of blood glucose monitoring, and diabetes-related stress (Buchberger et al., 2016). Parental psychological distress was associated with higher child self-report of stress and depressive symptoms, and it had negative effects on diabetes management.ObjectivesTo evaluate the relationship between parental depression and anxiety and metabolic control of their adolescents with T1DM.MethodsThe cross-sectional study recruited adolescents with T1D (N=251) and their parents (N=251). The 7-item Generalized Anxiety Disorder (GAD-7) scale measured anxiety level. The Patient Health Questionnaire – 9 (PHQ-9) detected depressive symptoms. Glycaemic control of patients was assessed using the last glycated haemoglobin (HbA1c) values. GLM mediation analysis was performed to determine the potential mediating effect of parent’ mental health depression and anxiety on the relationship between depression and anxiety of child on the level of HbA1c.Results502 respondents were eligible for screening. Mediation analysis was performed to assess the mediating role of parent GAD-7 on the linkage between HbA1c and child GAD-7 and child PHQ-9. the results relevated that the total effect of child GAD-7 on HbA1c was significant but the total effect of child PHQ-9 was not significant. With the inclusion of the mediating variable (parent GAD-7) (Figure 1), the impact of child GAD-7 and child PHQ-9 was founding insignificant (p ≥ 0.05) but the indirect effect of child GAD-7 and child PHQ-9 on HbA1c though parent GAD-7 was found significant (p ≤ 0,01) (Table 1). This indicates that the relationship between HbA1c and child GAD-7 and PHQ-9 is fully mediated by parent GAD-7.Image:Image 2:ConclusionsGlycated haemoglobin in adolescents with Type 1 diabetes is related to adolescents’ mental health via parents’ anxiety. It means that parents’ anxiety plays more significant role in the level of glycated haemoglobin in adolescents than depression and anxiety of the adolescent.Disclosure of InterestNone Declared

Effects of anti-inflammatory therapies on glycemic control in type 2 diabetes mellitus.

The overall evidence base of anti-inflammatory therapies in patients with type 2 diabetes mellitus (T2DM) has not been systematically evaluated. The purpose of this study was to assess the effects of anti-inflammatory therapies on glycemic control in patients with T2DM. PubMed, Embase, Web of Science, and Cochrane Library were searched up to 21 September 2022 for randomized controlled trials (RCTs) with anti-inflammatory therapies targeting the proinflammatory cytokines, cytokine receptors, and inflammation-associated nuclear transcription factors in the pathogenic processes of diabetes, such as interleukin-1β (IL-1β), interleukin-1β receptor (IL-1βR), tumor necrosis factor-α (TNF-α), and nuclear factor-κB (NF-κB). We synthesized data using mean difference (MD) and 95% confidence interval (CI). Heterogeneity between studies was assessed by I2 tests. Sensitivity and subgroup analyses were also conducted. We included 16 RCTs comprising 3729 subjects in the meta-analyses. Anti-inflammatory therapies can significantly reduce the level of fasting plasma glucose (FPG) (MD = - 10.04; 95% CI: -17.69, - 2.40; P = 0.01), glycated haemoglobin (HbA1c) (MD = - 0.37; 95% CI: - 0.51, - 0.23; P < 0.00001), and C-reactive protein (CRP) (MD = - 1.05; 95% CI: - 1.50, - 0.60; P < 0.00001) compared with control, and therapies targeting IL-1β in combination with TNF-α have better effects on T2DM than targeting IL-1β or TNF-α alone. Subgroup analyses suggested that patients with short duration of T2DM may benefit more from anti-inflammatory therapies. Our meta-analyses indicate that anti-inflammatory therapies targeting the pathogenic processes of diabetes can significantly reduce the level of FPG, HbA1c, and CRP in patients with T2DM.

Metabolic effects of monounsaturated fatty acid−enriched diets on glycaemic control in patient with type 2 diabetes: an evidence-based case report

Introduction: Diabetes mellitus type 2 (T2D) is the most common type of diabetes. There is an ongoing debate as to whether nutrient quality or quantity is mainly responsible for the effects on hyperglycaemic control of patients with T2D. Monounsaturated fatty acid (MUFA) has a metabolic effect in reducing the risk factor for metabolic syndrome to prevent and control hyperglycaemia in patients with T2D and is recommended by professional organizations.&#x0D; Methods: Literature searching was conducted by advanced searching in Pubmed, Cochrane Library, Scopus, and ProQuest database using MeSH Terms combined with Title/Abstract. After removing duplicates, the literature were screened based on the eligibility criteria. Critical appraisal and level of evidence of the selected literature were determined based on Oxford Centre for Evidence-Based Medicine.&#x0D; Results: Two selected literature were relevant to answer our clinical question, both literature are systematic review/meta-analysis studies. The first literature is a study by Fumiaki et al. (2016), while the second is by Frank Qian et al. (2016). All literature provided evidence that a diet high in MUFA could improve glucose-insulin homeostasis among patients with T2D. These effects were marked by lower fasting blood glucose and haemoglobin A1c (HbA1c), and insulin level in the enriched MUFA diet group compared to PUFA.&#x0D; Conclusion: Nutrient quality is mainly responsible for the effects on glycaemic control profile in patients with T2D, with a high MUFA diet consistent with favourable effects to improve fasting glucose and HbA1c.

Effect of endodontic treatment on clinical outcome in type 2 diabetic patients with apical periodontitis

BackgroundPrevious research has demonstrated that poor controlled diabetic showed higher prevalence of AP compared to well-controlled patients and endodontic treatment may improve metabolic control of patients with diabetes. The purpose of this trial was to clinically assess the effects of endodontic treatment on glycemic control in patients with type 2 diabetes mellitus (T2DM) and apical periodontitis (AP). Study designFor present trial, AP + T2DM with patients insulin injection (Group1, G1,n = 65), AP + T2DM patients with hypoglycaemic agents (Group2, G2, n = 82), and AP patients without DM (Group3, G3, n = 86) were enrolled. After demographic characteristics and clinical examination were achieved, root canal treatment (RCT) was performed for each patient. Subjects were followed up at 2-week, 3- and 6-month. At each visit, blood samples were taken and clinical laboratory studies were performed. At 6-month follow-up, Periapical Index (PAI) score was used to assess the periapical status. ResultsA total of 237 subjects who met the including criteria were allocated in three groups and 223 subjects (94.1%) completed the treatments and the follow-up assessments. After treatment, taking PAI into consideration, both groups showed significant improvement of AP in each group (P < 0.05). Patients in G3 had a continued significant lower concentration of fasting plasma glucose (FPG) levels at follow-up (P < 0.05). A continued reduction of hemoglobin glycation (HbA1c) was observed in most of time points (P < 0.05). Throughout the trial, there are also significant changes in inflammatory factors in short-term. ConclusionEndodontic therapy improved AP healing, glycemic control and systemic inflammation in patients with T2DM and/or AP in each group. However, a continued reduction in inflammatory factors and decreasing of HbA1c in short-term could not be observed in this trial.