Glycemic Control In Type 2 Diabetes Mellitus Patients Research Articles

The association between serum high-density lipoprotein and hemoglobin A1c in T2DM: Evidence from a nationwide cross-sectional study in diabetic patients

IntroductionThe prevalence of Type 2 Diabetes Mellitus (T2DM) is expected to rise, increasing the risk of cardiovascular disease. This study explores the relationship between high-density lipoprotein cholesterol (HDL) and glycemic control in T2DM patients, measured by hemoglobin A1c (HbA1c). While HDL is known to confer cardiovascular benefits, its impact on glycemic control remains unclear. MethodsThis cross-sectional study analyzed 30,195 Thai adults with T2DM data from the 2018 Thailand DM/HT database. Well-controlled HbA1c was defined as less than 53 mmol/mol (7 %). The study utilized multivariable linear, piecewise linear, and logistic regression analyses to investigate the relationship between HDL levels and glycemic control. ResultsThe impact of HDL on HbA1c levels was nonlinear, showing a U-shaped relationship among the study participants with an HDL inflection point of 59 mg/dl. In females, a U-shaped relationship was also observed at the same inflection point, where increased HDL above this level was associated with a rise in HbA1c (Adjusted β = 0.205, P < 0.001). In contrast, a linear model better explained the consistent negative relationship between HDL and HbA1c in males (Adjusted β = –0.076, P < 0.001). Furthermore, in the poorly controlled HbA1c group, a significant U-shaped pattern was observed with an inflection point at 59 mg/dl. ConclusionThis study found a nonlinear, gender-specific relationship between HDL and HbA1c in T2DM patients. Males with higher HDL are more likely to achieve glycemic control, while a U-shaped relationship is observed in females. Further research is needed to understand the differing correlation between well-controlled and poorly controlled groups.

Real-world Safety and Effectiveness of Insulin Glargine 300 U/mL in Participants with Type 2 Diabetes Mellitus During the Period of Ramadan in Four Countries (Egypt, Jordan, Lebanon, and Turkey): A Prospective Observational Study.

This non-interventional observational study aimed to describe the clinical outcomes of patients with T2DM treated with Gla-300 during the period of Ramadan. Type 2 diabetes mellitus (T2DM) patients who decide to fast during the holy month of Ramadan face several challenges in achieving glycemic control without increasing the risk of hypoglycemia. Insulin glargine-300 (Gla-300) has well-established safety and efficacy in improving glycemic control in multiple randomized clinical trials (RCTs). However, limited evidence is available regarding its safety and effectiveness during fasting. The objective of this study was to assess the safety and clinical outcomes of insulin glargine-300 (Gla-300) in T2DM patients before, during, and after Ramadan. We conducted a prospective, observational, non-comparative, multicenter study on patients with T2DM currently treated with Gla-300 who planned to fast and continue on Gla-300 during Ramadan in four countries (Egypt, Jordan, Lebanon, and Turkey). The study outcomes included the change in glycemic parameters and incidence of hypoglycemia before, during, and after Ramadan. One hundred and forty T2DM patients were included. Nearly 61% of the included patients had a duration of diabetes of <10 years. The mean Gla-300 daily doses during the pre-Ramadan, Ramadan, and post-Ramadan periods were 22.2 ±7.4, 20.4 ±7.5, and 22.5 ±4.7 IU, respectively. The mean change values from pre-Ramadan to Ramadan and post-Ramadan were -1.7 ±6.9 IU and 0.5 ±4.7 IU, respectively, among the included patients. The mean HbA1c decreased during the study period initiating from 7.9% ±1.4% pre-Ramadan to 6.9% ±0.4% post-Ramadan. The overall HBA1c target value was 6.9% ±0.4%, while the HbA1c target was achieved by 29 patients (21.9%). The mean fasting blood glucose (FPG) showed a reduction from baseline value in the post-Ramadan period by -0.9 ±2.3 mmol/L. Five patients (3.57%) had symptomatic documented hypoglycemia during Ramadan, and none was considered to have severe hypoglycemia. Our study showed that insulin Gla-300 maintained the glycemic control of T2DM patients who decided to fast during the holy month of Ramadan without increasing the risk of hypoglycemia. Regular self-monitoring of blood glucose levels during Ramadan is highly recommended to avoid possible complications.

Ketogenic Diets Hold Therapeutic Potential Against Periodontal Inflammation

Abstract Purpose of Review Periodontitis, one of the most prevalent diseases in the world, is caused by the accumulation of dysbiotic microbial biofilm on the teeth leading to chronic inflammation of the tissues surrounding the teeth. Type 2 diabetes mellitus (T2DM), obesity, chronic stress, and smoking are some of the risk factors for the disease. A high-carbohydrate diet also increases the risk of periodontal inflammation. Modifying diet and nutrition could serve as a preventive and therapeutic tool to target multiple risk factors simultaneously. Recent Findings Emerging evidence shows that the ketogenic diet induces hormetic stress and switches on various cell-protective anti-inflammatory and antioxidant mechanisms. The ketogenic diet also improves mitochondrial function, DNA repair, and autophagy. The diet can effectively treat periodontitis risk factors such as T2DM and obesity. By restricting carbohydrates, the diet improves glycaemic control in T2DM patients and can effectively produce fat loss and reduce BMI (body-mass index) in obese patients. Poor long-term compliance and high cost are the drawbacks of the diet and the potential of the diet to increase cardiovascular disease risk needs further investigation. Summary Taken together, ketogenic diets, through various mechanisms reduce inflammation, mitigate oxidative stress, improve metabolic health, and can be used as a therapeutic tool to treat periodontal inflammation. Since robust scientific evidence for the ketogenic diet is currently scarce, future research should study the diet's efficacy, effectiveness, and safety in managing periodontal inflammation.

The role of social support and self-management on glycemic control of type 2 diabetes mellitus with complications in Ghana: A cross-sectional study.

Diabetes mellitus (DM) can result in detrimental complications which are connected with long-term impairments and disabilities. Chronic complications are well-known consequences of type 2 diabetes mellitus (T2DM) progression, which reduce patient quality of life, place a burden on the healthcare system, and increase mortality. Measures to promote health outcomes for people with DM are scanty; the study therefore aimed at determining the effects of self-management and social support on glycemic control of T2DM with complications in Ghana. A cross-sectional design using convenience sampling was conducted on 400 T2DM patients using Hensarling's Diabetes Family Support Scale and Summary of Diabetes Self‑Care Activities scale. Data analysis was conducted using descriptive, Pearson Moment Product Correlation and Binary Logistic Regression on self-management, social support, and glycemic control in T2DM patients. Social support among participants was high and there was a positive correlation or relationship between social support and T2DM self-management. There was a correlation between social support and self-management (r = 0.149, p < 0.05) and diet control (r = 0.221, p < 0.05). The results also showed a significant correlation between medication adherence and glycemic management (r = 0.116, p < 0.05) while female T2DM participants, individuals with at least primary education were less likely to have low self-management relative to T2DM. Though the level of T2DM self-management was high it does not translate to good glycemic control. Focused health education programs should be incorporated into patients' care plans which will be particularly relevant for patients with T2DM and will contribute to positive physiological and psychological outcomes. Furthermore, a more robust monitoring and follow-up scheme should be scaled up or instituted for patients with T2DM.

Effects of prediabetes and type 2 diabetes on cognitive functions.

We aimed to investigate the effect of glycemic impairment in prediabetes on cognitive impairment and the impact of glycemic control on cognitive function in patients with diabetes. This age- and sex-matched case-control study included a total of 80 individuals: 20 patients with prediabetes, 20 patients with well-controlled type 2 diabetes mellitus (T2DM) (HbA1C < %7.5), 20 patients with poorly controlled T2DM (HbA1C >% 7.5), and 20 healthy controls. The poorly controlled T2DM patients performed significantly worse than controls and patients with prediabetes in the verbal memory process test (p = 0.041). In Trail Making Test B, the well-controlled and poorly-controlled groups with diabetes performed significantly worse (p = 0.015) than patients with prediabetes and controls, and in the Wisconsin Card Sorting Test (WCST), all three patient groups performed significantly worse (p = 0.007) than controls. T2DM causes early brain aging and declines cognitive functions since the prediabetic stage. Poor glycemic control in T2DM patients contributes to cognitive impairments, especially in learning.

Glycemic Control Is Associated With Lipid Profile and Atherogenic Index of Plasma in Type 2 Diabetes Mellitus

BACKGROUND: Dyslipidemia is a common complication among type 2 diabetes mellitus (T2DM), and a major risk factor for cardiovascular events. This study aimed to investigate the association of glycemic control with lipid profile and atherogenic index of plasma (AIP) in patients with T2DM. METHODS: A total of 565 adult diabetic men were included in this cross-sectional study. Glycemic and lipid parameters were measured using an auto-analyzer with standard methods. Subjects were categorized into good (HbA1c &lt; 7), inadequate (HbA1c 7-7.9), and poor (HbA1c ≥ 8). The association between glycemic control and lipid profile was evaluated using the analysis of variance and covariance. RESULTS: A significant association was found between poor glycemic control and total cholesterol, triglyceride, and AIP. Significance remained after adjustment for confounders. Results indicated no relationship between glycemic control and other lipid parameters before or after adjustment. CONCLUSION: Findings from this study underlined the importance of glycemic control in T2DM patients for targeted interventions to prevent cardiovascular events. Further studies are needed to confirm these results.

Glycemic Control Is Associated With Lipid Profile and Atherogenic Index of Plasma in Type 2 Diabetes Mellitus

BACKGROUND: Dyslipidemia is a common complication among type 2 diabetes mellitus (T2DM), and a major risk factor for cardiovascular events. This study aimed to investigate the association of glycemic control with lipid profile and atherogenic index of plasma (AIP) in patients with T2DM. METHODS: A total of 565 adult diabetic men were included in this cross-sectional study. Glycemic and lipid parameters were measured using an auto-analyzer with standard methods. Subjects were categorized into good (HbA1c &lt; 7), inadequate (HbA1c 7-7.9), and poor (HbA1c ≥ 8). The association between glycemic control and lipid profile was evaluated using the analysis of variance and covariance. RESULTS: A significant association was found between poor glycemic control and total cholesterol, triglyceride, and AIP. Significance remained after adjustment for confounders. Results indicated no relationship between glycemic control and other lipid parameters before or after adjustment. CONCLUSION: Findings from this study underlined the importance of glycemic control in T2DM patients for targeted interventions to prevent cardiovascular events. Further studies are needed to confirm these results.

Effect of Mobile Apps on Medication Adherence of Type 2 Diabetes Mellitus: A Systematic Review of Recent Studies.

Medication adherence is a critical aspect of managing type 2 diabetes mellitus (T2DM) and achieving optimal clinical outcomes. Mobile app-based interventions have emerged as a promising tool to enhance adherence and glycemic control in T2DM patients. This systematic review aims to evaluate the effectiveness of mobile app interventions in improving medication adherence and glycated hemoglobin among T2DM patients. A comprehensive search was conducted in PubMed, Cochrane Library, and Google Scholar for studies published between September 2018 and September 2023. Studies were included if they were published in English and investigated the effectiveness of mobile apps in enhancing medication adherence among patients with T2DM. Studies were excluded if they included additional interventions, such as electronic pillboxes, phone calls, or SMS text messages, or if they focused on populations with chronic illnesses other than T2DM. Five studies involving 527 participants from diverse geographic locations were included in the review. The findings from the included studies show that mobile-based app interventions can significantly improve medication adherence in patients with T2DM. From the included studies, the mean HbA1c change for the intervention group was -0.664 (95%CI -0.823 to -0.506), while the mean change in HbA1c for the control group was -0.103 (95%CI -0.305 to 0.099). Studies have demonstrated the potential of mobile app-based interventions to enhance medication adherence and improve glycemic control in T2DM; further research is needed to determine the long-term effects of these interventions.

The Association Between Serum Magnesium and Type 2 Diabetes Mellitus in Adult Patients at a Tertiary Hospital in Malaysia

Introduction: Magnesium (Mg) has an important role in glucose metabolism and acts as a cofactor for many enzymatic reactions. However, Mg deficiency frequently goes unnoticed. The aim of this study was to determine the association between serum Mg and type 2 diabetes mellitus (T2DM). Methods: A cross-sectional study was done among T2DM patients who were followed-up at the Diabetic Clinic at Hospital Melaka. Serum Mg test was added to the routine investigations of all patients with diabetes who participated. Results: Prevalence of hypomagnesaemia was 21.5%. There was a significant difference in age, duration of T2DM and diabetic complications that include retinopathy, neuropathy, nephropathy, coronary heart disease and cerebrovascular accident as well as all laboratory parameters except high-density lipoprotein cholesterol between the hypomagnesaemia and normomagnesaemia groups. Glycated haemoglobin (HbA1c), fasting plasma glucose and duration of diabetes independently predicted serum Mg levels in T2DM patients. Conclusion: These findings support the use of serum Mg as an indirect biomarker of glycaemic control in T2DM patients, whereby hypomagnesaemia indicates poor control.

Retrospective analysis of the relationship between neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and glycemic regulation in patients with type 2 diabetes mellitus followed up at an internal medicine outpatient clinic

Background/Aim: Type 2 diabetes mellitus (T2DM) is a common chronic disease with an increasing incidence worldwide and its effects are being seen in many countries. Insulin resistance is the main factor in the pathophysiology. T2DM leads to an increase in mortality and morbidity due to macrovascular and microvascular complications. Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are effective parameters in monitoring the inflammatory response. The primary aim of this study was to investigate glycemic control in patients with type 2 diabetes by focusing on their correlation with inflammatory markers, such as NLR and PLR, glycated hemoglobin (HbA1c), and fasting blood glucose levels. Methods: The present study was carried out in 2022 within the purview of the Internal Medicine Clinic at Balikesir İvrindi State Hospital. Data from the initial annual consultations of patients with T2DM, either newly diagnosed or previously diagnosed and visiting for follow-up, were utilized. Our study excluded patients under the age of 18 and those diagnosed with cirrhosis, heart failure, type 1 diabetes mellitus, malignancy, epilepsy, acute infection, pregnancy, or chronic inflammatory disease. We further excluded those on medications including steroids, antivirals, anticonvulsants, antipsychotics, antithyroids, and chemotherapeutic drugs that impact the leukocyte count. Based on their HbA1c levels, patients were systematically categorized into two distinct cohorts: those with controlled blood sugar (HbA1c ≤7%) and those with uncontrolled blood sugar (HbA1c &gt;7%). In the ambit of this study, we incorporated data from 205 patients. We employed a cross-sectional study that retrospectively examined the correlation between NLR, PLR, and glycemic regulation in T2DM patients. SPSS 22.0 software was used to perform statistical calculations. Results: It was observed that patients with poor glycemic control had longer disease durations and this disparity bore statistical significance (P=0.005). Patients exhibiting poor glycemic control demonstrated elevated levels of CRP (C-reactive protein), a difference that reached statistical significance (P=0.003). The group exhibiting poor glycemic control demonstrated a notable elevation in NLR, indicating statistical significance (P=0.001). Although it was not statistically significant, PLR was found to be higher in patients with uncontrolled T2DM (P=0.441). Conclusion: This research investigates the correlation between HbA1c levels and inflammatory markers, specifically NLR and TLR, in T2DM patients who exhibit poor control of glycemia. Our findings highlight the potential of these markers as indicators of glycemic control, thus emphasizing the need for integrated strategies for managing inflammation and improving glycemic control in T2DM patients. The novelty of this area of research contributes to the scarcity of available literature, underlining the importance and timeliness of this study. Based on our findings, we suggest an increased focus on regular monitoring of inflammatory markers, for instance NLR and PLR, to assess the glycemic control in T2DM patients. The significant correlation of these markers with HbA1c levels implies that they could potentially serve as useful tools in personalizing diabetes management strategies, leading to improved patient outcomes. Not only does our research contribute to filling this knowledge gap, but it also underscores the potential for utilizing inflammatory markers in tracking disease progression and optimizing treatment efficacy in T2DM.

Interventional metabology: A review of bariatric arterial embolization and endovascular denervation for treating metabolic disorders.

The rising prevalence of metabolic disorders such as obesity and type 2 diabetes mellitus (T2DM) poses a major challenge to global health. Existing therapeutic approaches have limitations, and there is a need for new, safe, and less invasive treatments. Interventional metabolic therapy is a new addition to the treatment arsenal for metabolic disorders. This review focuses on two interventional techniques: bariatric arterial embolization (BAE) and endovascular denervation (EDN). BAE involves embolizing specific arteries feeding ghrelin-producing cells to suppress appetite and promote weight loss. EDN targets nerves that regulate metabolic organs to improve glycemic control in T2DM patients. We describe the current state of these techniques, their mechanisms of action, and the available safety and effectiveness data. We also propose a new territory called "Interventional Metabology" to encompass these and other interventional approaches to treating metabolic disorders.

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.

Impact of Myo B &amp;lt;i&amp;gt;Basti&amp;lt;/i&amp;gt; on Type 2 Diabetes Mellitus Patients with Low Body Mass Index

Type 2 Diabetes Mellitus (T2DM) is a syndrome characterized by a dysregulated metabolism and genetic immune-mediated involvement, and it progressively gets worse with the appearance of life-threatening complications and pathological changes that cause cardiac issues. A negative calorie balance with a low-carb diet is a very effective tool to manage T2DMwith a reduction in orally administered antihyperglycemic agents (OHA) support. As per the twin cycle hypothesis, negative calorie balance can reduce insulin resistance by the reduction in excess adipose tissue but in normal to low BMI T2DM, weight reduction is not advisable. So, the concept of a low-carb and low-calorie diet for good glycemic control is difficult to apply. This study aimed to evaluate impact of 240 ml of Sneha Basti (Myo B Basti: per rectal oil-based herbal formulation) along with an 800 cal/day (<i>Prameh) </i>diet to achieve good glycemic control in T2DM patients with low body mass index. The Myo B <i>Basti</i> shows a mean change of HbA1c in one month from 9.44 to 8.15mmol/mol. Myo B <i>Basti</i> was found to significantly improve HbA1c, BMI, body weight, abdominal girth, SBP, and DBP at the end of the study period i.e., 30th day. Allopathic dependency was also reduced to a great extent. Despite of an 800cal/day diet no major weight loss was observed. Thus, it can be concluded that Myo B <i>Basti</i> can be used as an efficient and safe therapeutic alternative for the treatment of T2DM.

Association of High sensitivity C-reactive protein (Hs-CRP) with poor Glycaemic control and Coronary Heart Disease in Type 2 Diabetes Mellitus

High sensitivity C-reactive protein (Hs-CRP) is a sensitive marker of subclinical inflammation associated with atherosclerosis. Uncontrolled diabetes mellitus (DM) is one of the important risk factors of coronary heart disease (CHD). The aim of this study was to evaluate the association between Hs-CRP levels and both glycaemic control and CHD in Syrian type 2 diabetes mellitus (T2DM) patients. A random sample of 108 subjects was selected from T2DM and/or CHD patients seen in the National Centre for Diabetes, and the outpatient clinic of cardiology department at Tishreen University Hospital in Latakia. Four groups were formed: Group 1 [T2DM (+) CHD (-), N=29], Group 2 [T2DM (-) CHD (+), N=25], Group 3 [T2DM (+) CHD (+), N=29], and Group 4 (T2DM (-) CHD (-), N=25). Serum Hs-CRP and glycated haemoglobin (HBA1C) were determined. The SPSS 25.0 program was used for the statistical analysis. Probability (P) value less than 0.05 was considered statistically significant. Mean Hs-CRP level was higher in T2DM subjects with (5.23±1.56mg/l) or without (2.29±0.78mg/l) CHD compared to T2DM (-) CHD (-) patients (0.16±0.04mg/l), (p&lt;0.0001 for both). Mean Hs-CRP level in T2DM with CHD was not only higher than T2DM patients without CHD (p&lt;0.0001), but also than non-diabetic subjects with CHD (2.56±0.45mg/l) (p&lt;0.0001). There was a positive correlation between serum Hs-CRP and HBA1C in T2DM patients with CHD (r=0.781, P&lt;0.0001), Similarly, Hs-CRP levels were positively and significantly correlated with HBA1C in T2DM patients without CHD (r=0.800, p&lt;0.0001). We also noticed that for every 1.0% increase in HbA1c there was an 77% increase in the likelihood of having an elevated Hs-CRP. We concluded that Hs-CRP was strongly correlated with glycaemic control in T2DM patients. The highest Hs-CRP level was observed in T2DM with CHD patients. Hs-CRP could predict the incidence of coronary heart disease in T2DM patients.

INSULIN THERAPY IN T2DM PATIENTS IN DIABETES OUTPATIENT CLINIC, DR. SOETOMO GENERAL ACADEMIC HOSPITAL, SURABAYA, INDONESIA

Highlights1. The occurrence of macrovascular and microvascular problems is strongly associated with high mortality in type 2 diabetes mellitus (T2DM).2. Combinations of rapid-acting and long-acting insulin were the most frequent kind of insulin. AbstractBackground: High mortality in type 2 diabetes mellitus (T2DM) has a strong correlation with the presence of macrovascular and microvascular complications. The risk of these complications can be reduced through good glycemic control. As the disease progresses, patients may need to add or switch to insulin therapy rather than oral antihyperglycemic drugs to achieve desirable glycemic control. Objective: To determine the pattern of insulin therapy and glycemic control in T2DM patients. Material and Method: Data for this study were obtained from the medical records of the Diabetes Outpatient Clinic at the Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. This study was an observational descriptive. In June-July 2016, total samples were collected from 124 patients who received insulin therapy between February 2015 and March 2015. Result: According to the data obtained, the most commonly used insulin was a combination of rapid-acting and long-acting insulin (75.8%). While basal bolus insulin (75.8%) accounts for the most common regimen used to administer insulin, only 27.4% and 45% of total patients achieved good glycemic control based on FPG and PPG testing, respectively. HbA1c testing was done on 44 out of 124 people, with 9 people (20.5%) met the target of HbA1c &lt;7%. Conclusion: Glycemic control in T2DM patients who received insulin therapy was relatively low.

Hypovitaminosis D causes suboptimal glycemic control in type 2 diabetic patients

Background: Vitamin D deficiency and associated complications are widely prevalent in the Indian subcontinent. Hypovitaminosis D is known to play deleterious effects on cardiovascular and skeletal functions in human beings. Yet, its effect on carbohydrate metabolism and diabetes mellitus (DM) is less known. Aim and Objectives: In the current case– control study, our primary aim is to find out the potential effect of hypovitaminosis D on glycemic control in type 2 DM (T2DM) patients. Materials and Methods: The study population comprised 250 T2DM patients recruited primarily from Madhya Pradesh, India. The case group of 125 T2DM patients with hypovitaminosis D was compared with a control group of 125 T2DM patients with sufficient vitamin D. We mainly investigated the effect of hypovitaminosis D (both deficiency and insufficiency) on glycemic control in T2DM patients. Results: We observed that both fasting and 2-h postprandial blood glucose were found to be elevated significantly in T2DM patients with hypovitaminosis D (P &lt; 0.01). The glycated hemoglobin level was also elevated (P &lt; 0.01) in the case group suggesting impaired glycemic control for a chronic period. An inverse association is found between glycemic status and serum vitamin D (OH)D3 levels. Conclusions: Our results show the significance of maintaining sufficient plasma vitamin D levels, along with hypoglycemic medication in T2DM patients to improve their glycemic control and avoid diabetic comorbidities.

Effect of Pharmacist-Led Interventions on Medication Adherence and Glycemic Control in Type 2 Diabetic Patients: A Study from the Chinese Population.

Medication adherence plays an important role in glycemic control in type 2 diabetes mellitus (T2DM) self-management. To analyze the factors influencing medication adherence in T2DM patients and the effect of pharmacist-led interventions, we conducted a study in Beijing, China. T2DM patients with hypoglycemic drugs for at least 6 months were enrolled. A pharmacist-led survey was conducted followed by individualized interventions for those non-adherent patients monthly within 3 months. FPG, HbA1c, and 2hPG were measured as the comprehensive glycemic control. Medication adherence was determined according to the patient's self-reported compliance with prescribed medication during the last 3 months. A total of 763 T2DM patients were included. The average age was 63.26±11.89 years, with 363 males. After pharmacist intervention, the patients with good adherence increased from 34.21% to 39.06%, while poor adherence decreased from 32.5% to 24.5% (p < 0.001). The average adherence score was a significant increase (p < 0.001) from 27.846±4.185 to 29.831±7.065. Furthermore, our study demonstrated that pharmacist-led interventions significantly increased glycemic control (FPG from 42.33% to 53.60%, p < 0.001; 2hPG from 41.68% to 48.75%, p = 0.005; HbA1c from 24.12% to 29.23%, p = 0.024). The results found that body mass index (OR 0.643, 95% CI 0.437-0.945), use of medications empirically (occasionally (OR=3.066, 95% CI 2.069-4.543); often (OR=2.984, 95% CI 1.107-8.044)), following the doctor's advice to visit (OR 2.129, 95% CI 1.079-4.202) and lifestyle compliance (OR 2.835, 95% CI 1.094-7.346) were the independent risk factors of non-adherence (p < 0.05), the area under the ROC curve was 0.716. Self-reported medication adherence and glycemic control in T2DM patients were poor which can be improved by pharmacist-led interventions. Interventions should focus on empirical medication behavior, non-adherence to lifestyle, and failure to follow the doctor's advice. The recall bias with self-reported results needs further objective data to verify.

Interplay between Myokine Profile and Glycemic Control in Type 2 Diabetes Mellitus Patients with Heart Failure.

Type 2 diabetes mellitus (T2DM) remains a powerful predictor of progressive heart failure (HF), but it is not clear whether altered glycemic control interferes with HF progression via an impaired profile of circulating myokines. The aim was to investigate plausible effects of glucose control on a myokine signature in T2DM patients affected by chronic HF. We selected 372 T2DM patients from the local database and finally included 314 individuals suffering from chronic HF and subdivided them into two groups according to glycosylated hemoglobin (HbA1c) levels (&lt;6.9% and ≥7.0%). Echocardiography and Doppler examinations along with biomarker measurements were performed at the baseline of the study. The results showed that irisin levels were significantly lower in patients with HbA1c ≥ 7.0% than in those with HbAc1 &lt; 6.9%, whereas concentrations of apelin, myostatin and adropin did not significantly differ between these two groups. We also identified numerous predictors of poor glycemic control, but only N-terminal brain natriuretic propeptide (odds ratio [OR] = 1.07; 95% confidence interval [CI] = 1.02-1.10, p = 0.04) and irisin (OR = 1.09; 95% CI = 1.04-1.17, p = 0.001) remained independent predictors of the dependent variable. In conclusion, we found that decreased levels of irisin were associated with poor glycemic control in T2DM patients with HF regardless of clinical conditions and other biomarkers.

Medication adherence and its impact on glycemic control in type 2 diabetes mellitus patients with comorbidity: A multicenter cross-sectional study in Northwest Ethiopia.

Medication nonadherence in patients with chronic diseases, particularly in type 2 diabetes mellitus (T2DM) with comorbidity, has continued to be the cause of treatment failure. The current study assessed medication adherence and its impact on glycemic control in T2DM patients with comorbidity. An institutional-based multicenter cross-sectional study was conducted among T2DM patients with comorbidity at the selected hospitals in Northwest Ethiopia. Medication adherence was measured using a structured questionnaire of the General Medication Adherence Scale (GMAS). A logistic regression model was used to identify predictors of the level of medication adherence and glycemic control. P < 0.05 at 95% confidence interval (CI) was statistically significant. A total of 403 samples were included in the final study. This study showed that more than three-fourths (76.9%) of the participants were under a low level of medication adherence. Source of medication cost coverage [AOR = 10.593, 95% CI (2.628-41.835; P = 0.003], monthly income (P < 0.00), self-monitoring of blood glucose (SMBG) practice [AOR = 0.266, 95% CI (0.117-0.604); P = 0.002], number of medications [AOR = 0.068, 95% CI (0.004-0.813); P = 0.014] and medical conditions [AOR = 0.307, 95% CI (0.026-0.437); P = 0.018] were found to be significant predictors of medication adherence. Significantly, majority (74.7%) of participants had poor levels of glycemic control. Patients who had a high level of medication adherence [AOR = 0.003, 95% CI (0.000-0.113); P = 0.002] were found less likely to have poor glycemic control compared with patients who were low adherent to their medications. The current study concluded that medication adherence was low and significantly associated with poor glycemic control. Number of medical conditions and medications were found to be associated with medication adherence. Management interventions of T2DM patients with comorbidity should focus on the improvement of medication adherence.

A Randomized Controlled Trial of R-Form Verapamil Added to Ongoing Metformin Therapy in Patients with Type 2 Diabetes

ContextThere is a medical need for effective insulin-independent antidiabetic drugs that can promote pancreatic β-cell function and have a low risk of hypoglycemia in type 2 diabetes mellitus (T2DM) patients. R-form verapamil (R-Vera), which is able to enhance the survival of β-cells and has higher cardiovascular safety margin compared with racemic verapamil, was developed as a novel approach for T2DM treatment.ObjectiveThis randomized, double-blind, placebo-controlled clinical trial was designed to evaluate the efficacy and safety of 3 dosages of R-Vera added to ongoing metformin therapy in T2DM patients who had inadequate glycemic control on metformin alone.MethodsParticipants were randomly assigned in an equal ratio to receive R-Vera 450, 300, or 150 mg per day, or matching placebo, in combination with metformin. The primary endpoint was change in hemoglobin A1c (HbA1c) after 12 weeks of treatment.ResultsA total of 184 eligible participants were randomized to receive either R-Vera or placebo plus metformin. At week 12, significant reductions in HbA1c were observed for R-Vera 300 mg/day (−0.36, P = 0.0373) and 450 mg/day (−0.45, P = 0.0098) compared with placebo. The reduction in HbA1c correlated with decreasing fasting plasma glucose levels and improved HOMA2-β score. Treatment with R-Vera was well tolerated with no hypoglycemic episodes occurring during the trial.ConclusionAddition of R-Vera twice daily to ongoing metformin therapy significantly improved glycemic control in T2DM patients. The favorable efficacy and safety profile of R-Vera 300 mg/day can be considered as the appropriate dose for clinical practice.