Glycated Hemoglobin Levels Research Articles

Automated Insulin Delivery in Women with Pregnancy Complicated by Type 1 Diabetes

BackgroundHybrid closed-loop insulin therapy has shown promise for management of type 1 diabetes during pregnancy; however, its efficacy is unclear.MethodsIn this multicenter, controlled trial, we randomly assigned pregnant women with type 1 diabetes and a glycated hemoglobin level of at least 6.5% at nine sites in the United Kingdom to receive standard insulin therapy or hybrid closed-loop therapy, with both groups using continuous glucose monitoring. The primary outcome was the percentage of time in the pregnancy-specific target glucose range (63 to 140 mg per deciliter [3.5 to 7.8 mmol per liter]) as measured by continuous glucose monitoring from 16 weeks’ gestation until delivery. Analyses were performed according to the intention-to-treat principle. Key secondary outcomes were the percentage of time spent in a hyperglycemic state (glucose level >140 mg per deciliter), overnight time in the target range, the glycated hemoglobin level, and safety events.ResultsA total of 124 participants with a mean (±SD) age of 31.1±5.3 years and a mean baseline glycated hemoglobin level of 7.7±1.2% underwent randomization. The mean percentage of time that the maternal glucose level was in the target range was 68.2±10.5% in the closed-loop group and 55.6±12.5% in the standard-care group (mean adjusted difference, 10.5 percentage points; 95% confidence interval [CI], 7.0 to 14.0; P<0.001). Results for the secondary outcomes were consistent with those of the primary outcome; participants in the closed-loop group spent less time in a hyperglycemic state than those in the standard-care group (difference, −10.2 percentage points; 95% CI, −13.8 to −6.6); had more overnight time in the target range (difference, 12.3 percentage points; 95% CI, 8.3 to 16.2), and had lower glycated hemoglobin levels (difference, −0.31 percentage points; 95% CI, −0.50 to −0.12). Little time was spent in a hypoglycemic state. No unanticipated safety problems associated with the use of closed-loop therapy during pregnancy occurred (6 instances of severe hypoglycemia, vs. 5 in the standard-care group; 1 instance of diabetic ketoacidosis in each group; and 12 device-related adverse events in the closed-loop group, 7 related to closed-loop therapy).ConclusionsHybrid closed-loop therapy significantly improved maternal glycemic control during pregnancy complicated by type 1 diabetes. (Funded by the Efficacy and Mechanism Evaluation Program; AiDAPT ISRCTN Registry number, ISRCTN56898625.)

Stress level in patients with coronary heart disease and type 2 diabetes mellitus in wartime conditions

Objective — to assess the levels of stress disorders and anxiety and their relationship with metabolic disorders and indicators of adipose tissue accumulation in civilian patients with coronary heart disease (CHD) and type 2 diabetes mellitus (T2DM) during military operations.&#x0D; Materials and methods. Examinations involved 106 civilians who have permanently lived in the city of Kharkiv and the unoccupied part of the Kharkiv region since the beginning of the war. The study included 44 patients with stable CHD and T2DM, 40 patients with CHD without diabetes, and 22 individuals of the control group without coronary artery disease and diabetes. Questionnaire survey was performed with the use of scales for assessing symptoms of post‑traumatic stress disorder (PTSD) (PCL‑5 scale), the Generalized Anxiety Disorder (GAD‑7), and the perceived stress scale (PSS‑10). The body mass index was determined, the level of visceral fat, the percentage of total body fat mass, and the percentage of muscle mass of the body were measured by the bioimpedance method. The levels of lipids, insulin, blood glucose, glycated hemoglobin were determined, and the HOMA‑IR index was calculated.&#x0D; Results. According to the results of the survey on the PCL‑5 scale, CHD patients with T2DM had the highest score, which significantly exceeded the indicators of the control group (p=0.014) and CHD patients without diabetes (p=0.037). Among patients with coronary heart disease with diabetes, the largest proportion of patients with signs of probable PTSD was noted (27.77%), while in the control group such persons were 9.09% (p=0.089), and in the group of patients with CHD without diabetes this position was 7.50% (р=0.018). The level of general anxiety according to the GAD‑7 scale in CHD patients with T2DM, in CHD patients without diabetes, and in the control group was almost the same and met the criteria for moderate anxiety. The sum of points on the PSS‑10 perceived stress scale in CHD patients with T2DM was greater than in the control group (p=0.047) and CHD patients without diabetes (p=0.097)) and corresponded to the average level of stress. In patients with CHD with T2DM with probable PTSD glycated hemoglobin level was higher than in patients without probable PTSD (p=0.037). In patients with CHD with T2DM positive correlations between the sum of points on the PTSD scale and the level of total cholesterol and non‑high‑density lipoprotein cholesterol, between the sum of points on the PSS‑10 scale and the level of visceral fat were revealed. The sum of points on the GAD‑7 scale was negatively correlated with muscle mass.&#x0D; Conclusions. In in the conditions of war in Ukraine civilian patients with CHD with T2DM have more pronounced psychoemotional disorders than healthy individuals of the control group and patients with CHD without diabetes. In patients with CHD with T2DM, an increase in the degree of psychoemotional disorders was associated with worsening glycemic control and lipid parameters, with the accumulation of visceral fat and a decrease in muscle mass.&#x0D;

Glycaemic control, body weight, and safety of tirzepatide versus dulaglutide by baseline glycated haemoglobin level in Japanese patients with type 2 diabetes: A subgroup analysis of the SURPASS J-mono study.

To evaluate glycaemic control, body weight, and safety outcomes following treatment with tirzepatide or dulaglutide in patients with type 2 diabetes (T2D) with a baseline haemoglobin (HbA1c) level of ≤8.5% (≤69 mmol/mol) versus >8.5% (>69 mmol/mol). SURPASS J-mono was a 52-week, multicentre, randomized, double-blind, parallel, active-controlled, phase 3 study conducted in Japan. In this exploratory subgroup analysis of SURPASS J-mono, we examined mean change in HbA1c and body weight and the incidence of adverse events (AEs) in patients with a baseline HbA1c of ≤8.5% versus >8.5% after treatment with tirzepatide (5, 10 or 15 mg) or dulaglutide 0.75 mg. Of 636 randomized participants, 203 had a baseline HbA1c of >8.5% and 433 had a baseline HbA1c of ≤8.5% (range ≥7.0% to ≤10.0%). Both subgroups showed significantly greater reductions in HbA1c and body weight with any-dose tirzepatide versus dulaglutide 0.75 mg, with greater HbA1c reductions observed in patients with a baseline HbA1c of >8.5% treated with tirzepatide (least squares mean [LSM] differences of -3.13% to -3.86%) or dulaglutide (LSM -1.81%) compared with patients with a baseline HbA1c of ≤8.5% (LSM -2.00% to -2.32%) or dulaglutide (LSM -1.05%; treatment-by-baseline HbA1c subgroup interaction P ≤ 0.001). For the tirzepatide treatment arms, LSM change from baseline in body weight ranged from -6.7 to -10.7 kg for the baseline HbA1c ≤8.5% subgroup and from -4.0 to -10.6 kg for the baseline HbA1c >8.5% subgroup, compared with -0.6 kg and -0.4 kg, respectively, for the dulaglutide arm. The incidence of hypoglycaemia was low, with no substantial difference in hypoglycaemia or treatment-emergent AEs between subgroups. Regardless of baseline HbA1c (≤8.5% or >8.5%), tirzepatide at doses of 5, 10 and 15 mg is effective in Japanese patients with T2D compared with dulaglutide 0.75 mg in terms of glycaemic control and body weight reduction, with an adequate safety profile consistent with previous reports.

Utility of the NIH Toolbox Cognition Battery in middle to older aged adults with longstanding type 1 diabetes: The DCCT/EDIC study

Objective: Adults with type 1 diabetes (T1D) face an increased risk for cognitive decline and dementia. Diabetes-related and vascular risk factors have been linked to cognitive decline using detailed neuropsychological testing; however, it is unclear if cognitive screening batteries can detect cognitive changes associated with aging in T1D. Method: 1,049 participants with T1D (median age 59 years; range 43–74) from the Diabetes Control and Complications Trial (DCCT), and the follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study, completed the NIH Toolbox Cognition Battery (NIHTB-C) and Montreal Cognitive Assessment (MoCA). Neuropsychological assessments, depression, glycated hemoglobin levels (HbA1c), severe hypoglycemia, T1D complications, and vascular risk factors were assessed repeatedly over 32 years to determine associations with current NIHTB-C performance. Available cognitive data was clinically adjudicated to determine cognitive impairment status. Results: NIHTB-C scores had moderate associations (r = 0.36–0.53) with concurrently administered neuropsychological tests. In multivariate models, prior severe hypoglycemic episodes, depression symptoms, nephropathy, lower BMI, and higher HbA1c and LDL cholesterol were associated with poorer NIHTB-C Fluid Cognition Composite scores. The NIHTB-C adequately detected adjudicated cognitive impairment (Area Under the Curve = 0.86; optimal cut score ≤90). The MoCA performed similarly (Area Under the Curve = 0.83; optimal cut score ≤25). Conclusions: The NIHTB-C is sensitive to the cognitive effects of diabetes-related and vascular risk factors, correlated with neuropsychological testing, and accurately detects adjudicated cognitive impairment. These data support its use as a screening test in middle to older aged adults with T1D to determine if referral for detailed neuropsychological assessment is needed.

Evolution of Guideline Recommendations on Insulin Therapy in Type 2 Diabetes Mellitus Over the Last Two Decades: A Narrative Review.

The prevalence of type 2 diabetes mellitus has been increasing worldwide. As the therapeutic options for type 2 diabetes mellitus have evolved over the last 2 decades, national and global guidelines related to type 2 diabetes mellitus pharmacotherapy issued by various organizations have tended to vary in their recommendations. This narrative review aimed to analyze the key recommendations by major global and national guidelines on the initiation of insulin therapy in patients with type 2 diabetes mellitus over the last 20 years. Strategies for insulin therapy for titration and intensification were also assessed. All guidelines recommend initiation of insulin (basal/ premixed/other formulations) when glycemic targets are not achieved despite lifestyle measures and oral antidiabetic drugs. In the recent decade, early initiation of insulin has been recommended when the glycated hemoglobin levels are >10% or blood glucose levels are ≥300 mg/dL (16.7 mmol/L). Initiation is recommended at a dose of 10 units or 0.1-0.2 U/kg. Titration is advised to achieve the optimal dosage, while intensification is recommended when glycemic targets are not achieved despite titrating to an acceptable level. Glucose monitoring at periodic intervals is recommended for adequate glycemic control. The guidelines further suggest that the choice of insulin should be individualized, considering the clinical status of patients with type 2 diabetes mellitus. The physicians as well as patients should be a part of the decisions made regarding the therapeutic choice of regimen, preparation, and delivery device.

Add-on effect of proprietary Ayurvedic medicine Diabrishta-21 in managing glucose variability measured through continuous glucose monitoring device: A case report

Abstract: In the scenario of modern health issues, Type 2 Diabetes Mellitus (T2DM) has gained much importance as “adult-onset diabetes” which represents a combination of genetic, environmental, and lifestyle choices. It predominantly shows hyperglycemia or increased blood glucose levels, insulin deficiency, and insulin resistance, which typically characterizes this metabolic disorder whilst manifesting life-threatening complications. This report presents the case of a 55-year-old male with T2DM whose glucose levels were monitored during a period when he was on his prescribed antidiabetic medicines, followed by the addition of an Ayurvedic preparation Diabrishta-21. His glucose summary, obtained by the Continuous Glucose Monitoring (CGM) approach depicts a change in the average value of blood sugar levels and glycated hemoglobin levels, decreasing from 167 to 108 mg/dL, and from 7.4% to 5.4%, respectively. Moreover, the percentage of time the blood glucose levels were in the desired target range increased from 29% to 79%. Thus, Diabrishta-21 in this case report appears to be beneficial in the management of T2DM by aiding in controlling the glucose variability and lowering the blood glucose levels.

Prevalence of Self-care Practices among Type 2 Diabetes Mellitus Patients and its Effect on Glycemic Control: A Cross-sectional Study in Secondary and Tertiary Health-care Centers in Lucknow.

Globally, prevalence of diabetes is 10.5%, and in 2019, approximately 463 million adults were living with diabetes by 2045; this will increase to 700 million (10.9%). India is a diabetic capital of world, prevalence of diabetes in India is 8.3%. This study aimed to assess self-care practices (SCPs) among type 2 diabetes mellitus (T2DM) patients, its predictors, and effect of SCP on glycemic control. A cross-sectional hospital-based study was conducted among 300 known T2DM patients in the age group of 18-60 years attending noncommunicable diseases clinic at Secondary and Tertiary Care Hospitals of Lucknow, Uttar Pradesh, selected using two-stage purposive sampling method. Data were collected using a predesigned and pretested semi-structured questionnaire. Data were collected from consenting respondents on the sociodemographic profile (about their residence, gender, marital status, type of family, educational status, family income, employment status, etc.). SCP was assessed using Summary of Diabetes Self-Care Activities. Data were analyzed using SPSS. Among 300 patients with a mean age 50 ± 8.9 years, the prevalence of good SCPs was 37%. Out of 189 T2DM patients with poor SCPs, 66.4% had uncontrolled blood sugar level (285.4 ± 67 mg/dL). Out of 73 T2DM patients with poor SCPs, 65.7% had uncontrolled glycated hemoglobin level (8.4% ± 2%), and this was statistically significant. The practice of self-care was found to be suboptimal among patients with T2DM in the study.

Physiotherapy in the treatment of the metabolic syndrome associated with the right-sided scoliosis

The purpose of the work was to study the effect of targeted physical therapy in scoliotic disease on changes in carbohydrate metabolism in patients with metabolic syndrome. The dependence of visceral fat and glycated hemoglobin levels on the C-shaped right-sided thoracic scoliosis as stimulated through comprehensive physical therapy is being investigated. A hypodynamic lifestyle and a forced posture when sitting during working hours causes a change in the spinal rotation which deform the thorax and affect functioning of the organs. Materials and Methods: the study involved 36 patients split into two groups. The level of glycated hemoglobin was higher than 5.93% in women and 6.05% in men. The same physical and diet therapy was prescribed for the two groups. However, the main study group combined targeted exercises and kinesio-taping to reduce the scoliosis. Results: based on the distribution of χ2 the classical method of processing statistical data was applied to the study, which is well applicable for a small amount of data. The statistical data showed a linear dependence between the Cobb angle and glycosylated hemoglobin level which was especially pronounced in women prior to physical therapy. The correlation between glycosylated hemoglobin level and the Cobb angle declined in both men and women with an improvement in posture. Conclusions: with a decrease in the Cobb angle, the correlation between it and the level of glycosylated hemoglobin decreased in both men and women, which confirms the hypothesis that carbohydrate metabolism is associated with changes in the pancreas that occur due to rotational changes in the spine. By studying metabolic syndrome, even in small groups of patients, general practitioners will be able to expand the list of treatment recommendations.

Blood pressure and hypertension in type 1 diabetes mellitus patients with long duration

Type 1 diabetes mellitus (T1DM) has significantly better prognosis which has led to increased cardio-vascular diseases (CVD) prevalence. The detection of CVD risk factors and their treatment become tasks of paramount importance. Among them, high blood pressure (BP) is a target of primary purpose. Aim: to explore the blood pressure values, the prevalence of hypertension (HTN) and its management in patients with T1DM with long duration and without overt CVD, in comparison to matched controls. Participants and methods: totally, 124 patients with T1DM were matched to 59 controls by sex, age and approximate body mass index (BMI). All participants filled in questionnaires with information on demographics, physical activity, life style, concomitant diseases, treatments, presence of complications, etc. Blood samples were taken for laboratory and biomarkers investigation. Blood pressure was measured by investigators twice and the mean of the two measurements was used. HTN was accepted using standard definitions. BP values were compared using t-test. Multiple linear regression models with dependent variable BP measures and age, sex, BMI, presence of T1DM, glycated hemoglobin levels, creatinine levels as independent variables were created. ANOVA method was used to test the interaction of sex and presence of T1DM. Results: The mean age of the participants was 43.47 &amp;plusmn; 10.1 years, 54% were males. The mean duration of T1DM was 25.31 &amp;plusmn; 8.2 years and the mean HbA1c was 8.42 &amp;plusmn; 1.8% for diabetic patients. The mean blood pressure measures in T1DM groups were higher than in controls, both in males and females. The difference reached significance for SBP and pulse pressure (PP). The presence of T1DM independently affected the BP values, after adjusting for major confounders. The mean adjusted differences between T1DM and controls were 8.37 mm Hg for SBP, 4.92 mm Hg for DBP, and 5.19 mm Hg for PP (p &lt; 0.001). HTN was significantly more frequent in T1DM patients than in controls &amp;ndash; 54% vs. 27%, p = 0.0001, mainly due to already known hypertension. BP control was insufficient &amp;ndash; in only 36% and 13% of the treated hypertensive participants, respectively, for BP &lt; 140/90 and &lt; 130/80 mm Hg. The majority of the patients with HTN were treated with combination therapy, mostly single-pill fixed dosage but 30% of the hypertensive patients with diabetes did not take antihypertensive medications. Inhibitors of the renin-angiotensin system were the preferred class of medications. Conclusions: SBP and PP were significantly higher in middle-aged patients with T1DM with long duration than their control counterparts. The presence of HTN was significantly more common in T1DM. Although treated according to the current recommendations, the control of BP was far from effective. These results show the need for constant screening of patients with T1DM for HTN and other risk factors and for more aggressive antihypertensive treatment to prevent future CVD events.

Клинический случай двусторонней тракционной отслойки сетчатки у пациента с сахарным диабетом 2 типа

Aim. To analyze a clinical case of traction retinal detachment in both eyes in a patient with normal blood glucose levels. To determine additional diagnostic methods for verifying the diagnosis of diabetes mellitus in patients with normal levels of glucose and glycated hemoglobin with diabetic microvascular disorders. Methods. A patient with bilateral retinal traction detachment and without previous diagnosis of diabetes mellitus was observed. The patient had his blood glucose and glycated hemoglobin level within normal laboratory values. Results. A clinical case of a patient with retinal complications of type 2 diabetes mellitus was analyzed and the features of laboratory diagnostics with an initially normal blood glucose level were noted. Conclusions. 1. The level of glycated hemoglobin does not fully reflect the level of glycemic control in diabetes mellitus, unlike indicators such as Time in Range (TIR) and glycemic variability. 2. Decrease of TIR correlates with higher risk of microvascular complications, of progression including diabetic retinopathy. TIR can be calculated with Continuous Glucose Monitoring installed for 14 days, however, due to high cost of equipment, this type of monitoring is not very common. If it is impossible to use special equipment, careful self-monitoring of glycemia up to 6 times a day (before and 2 hours after meals) should be carried out. 3. This clinical case clearly demonstrates that even with a normal level of glycated hemoglobin, development and progression of microvascular complications is possible and confirms the need for more careful self-monitoring of glycemia. Key words: traction retinal detachment; proliferative diabetic retinopathy (PDR).

Periodontitis is associated with insulin resistance in adults living with diabetes mellitus in Uganda: a cross- sectional study

IntroductionEvidence suggests that majority of patients with diabetes mellitus in Uganda have poor glycaemic control as well as periodontal disease. This study set out to determine the association between periodontitis and insulin resistance in adult patients with diabetes mellitus in Uganda using the triglyceride glucose index.MethodsTwo hundred and twenty-three adult study participants with confirmed diabetes mellitus were enrolled in a cross-sectional study. Oral examination was carried with the aid of a periodontal probe to determine the periodontal status and findings recorded using the WHO Oral Health Assessment Tool for Adults, 2013. We recorded clinical details for body mass index (BMI in kg/m2) and laboratory parameters including fasting blood sugar (mmol/L), glycated hemoglobin levels (HbA1c, %) and serum triglycerides (mmol/L) using a study questionnaire. Data were analyzed using R version 4.10. The glucose triglyceride index was used as a measure of insulin resistance. Logistic regression analysis carried out to determine the factors associated insulin resistance.ResultsThe majority of the study participants was female (70%) with an average age of 48.5 years (SD+/- 11.1). The mean body mass index was 29.6 kg/m2 (SD+/- 5.82). The mean serum triglyceride index was 9.48 (SD+/- 0.675). Eighty-six-point 1% of the participants had periodontal disease. Bivariate analysis revealed high odds for male sex (OR = 1.31, 95% C.I = 0.44–4.84, p = 0.65) and periodontitis (OR = 3.65, 95% C.I = 0.79–26.15, p = 0.13) but low odds for a high BMI (OR = 0.45. 95% C.I = 0.07–1.67, p = 0.30). Multivariate regression revealed a significant association between insulin resistance and periodontitis. (AOR = 3.52, 95% C.I = 1.19–1.83, p = 0.03).ConclusionInsulin resistance is highly prevalent in patients with diabetes mellitus in Uganda and is associated with periodontitis and low body weight.

Do GLP-1 Analogs Have a Place in the Treatment of PCOS? New Insights and Promising Therapies.

Polycystic ovary syndrome (PCOS) is the most prevalent endocrinopathy in women of reproductive age. This condition is characterized by hyperandrogenism and either oligo- or anovulation. PCOS patients often present comorbidities such as obesity, insulin resistance, impaired glucose metabolism, dyslipidemia, hypertension, metabolic syndrome, and an increased risk of diabetes. Given the profound implications of metabolic impairment in PCOS, the accurate diagnosis and management of these facets are imperative. The first-line approach to treatment involves lifestyle modifications, including dietary adjustments and exercise aimed at achieving weight loss, a strategy consistently emphasized across the literature. Supplementation with probiotics, vitamin D, and L-carnitine have also provided additional benefits to patients. In select cases, pharmacological interventions are needed for optimal therapeutic results. The most common medications used in PCOS include metformin, thiazolidinediones, inositols, and two classes of antidiabetic agents: dipeptidyl peptidase-IV (DPP-IV) inhibitors, and sodium-glucose cotransporter-2 (SGLT-2) inhibitors. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are a new addition to the therapeutic arsenal for the metabolic management of PCOS. GLP-1 receptor agonists cause insulin release in a glucose-dependent manner, yielding clinical benefits such as heightened satiety, reduced appetite, and appetite regulation. GLP-1RAs have demonstrated efficacy in reducing glycated hemoglobin levels and promoting weight loss while ameliorating hyperlipidemia. Prior to initiating GLP-1RA therapy, patients should undergo screening for contraindications, including history of pancreatitis, diabetic retinopathy, or thyroid cancer. The effects of treatment should be monitored using laboratory testing and body weight measurements. Effective communication between clinician and patient should be maintained with regular check-in for a period of 6 to 12 months.

Baicalin: A potential therapeutic agent for diabetes and renal protection

Background: Diabetes is a complex metabolic disease manifested by raised glucose levels in the blood and impaired insulin function leading to various organ complications, including diabetic nephropathy. Baicalin, a flavonoid derived from Scutellaria baicalensis Georgi, has garnered substantial attention for its diverse beneficial effects, including anti-inflammatory, anti-allergic, anti- apoptotic properties, etc. Intriguingly, in vivo studies in rats have further unveiled baicalin’s potential to directly modulate pancreatic beta cells, suggesting a promising role as an anti-diabetic agent.Objective: The purpose of this study is to comprehensively explore the anti-diabetic effect of baicalin, focusing on key parameters such as plasma insulin levels, glucose levels, hemoglobin, and glycated hemoglobin levels in streptozotocin-induced diabetic rats. Additionally, we sought to explore Baicalin’s ability to provide renal protection by evaluating serum renal markers. Methodology: This study involved a total of 30 Wistar albino male rats. Diabetes was created in rats by a single intraperitoneal streptozotocin injection (40 mg/kg). After 72 hours, the rats with diabetes were segregated into four treatment groups (Group II to Group V) comprising 6 animals each. Group I consists of six normal control rats (without diabetes). The groups received different treatment protocols, including normal saline, DMSO, Baicalin (50 mg/kg/day), and glibenclamide (6 mg/kg/day) for 45 days. Throughout the study, meticulous observations were made regarding the animals’ general appearance, body weight, behavior, and their fasting glucose levels in venous blood.Results: Oral dosing with Baicalin at the rate of 50 mg/kg body weight revealed notable enhancements in insulin secretion and hemoglobin levels, alongside notable reductions in blood levels of glucose and glycated hemoglobin compared to the glibenclamide-treated type 2 diabetic rats. Additionally, Baicalin displayed a protective action on renal tissue, as shown by reduced serum creatinine, uric acid, and urea levels.Conclusion: Our investigation unveils Baicalin’s potential as a promising anti-diabetic agent with the added benefit of renal tissue protection. The observed improvements in various physiological parameters warrant further exploration of Baicalin’s therapeutic mechanisms and clinical applications, presenting it as a compelling candidate for diabetes management and diabetic nephropathy prevention. IAEC Approval No: AVMC/IAEC/2019/07/25/08 Keywords: Baicalin, Blood glucose, Diabetes, Male wistar rats, Streptozotocin

Optimization of cardiovascular risk factor management in patients with BCR::ABL1 negative chronic myeloproliferative neoplasms, current knowledge, and perspectives.

The exact prognostic role of cardiovascular (CV) risk factors in patients with BCR::ABL1 negative chronic myeloproliferative neoplasms (MPNs) remains unknown as it is often masked by other MPN-related features that bear strong prognostic impact on thrombotic risk. Therefore, current MPN treatment is not primarily guided by presence of CV risk factors. Treatment of CV risk factors in MPN patients usually mirrors that from the general population, despite the fact that CV risk factors in MPNs have their own specificities. Moreover, the optimal target levels for different metabolic deflections in MPNs (i.e., low-density lipoprotein, serum uric acid, or glycated hemoglobin levels) have not been defined. In the current review, we separately discuss the most important aspects of every individual CV risk factor (arterial hypertension, hyperlipidemia, chronic kidney disease, smoking, diabetes mellitus, hyperuricemia, and obesity and cachexia) in MPNs, summarize recent advances in the field, and propose future directions and research areas which may be needed to appropriately manage CV risk factors in MPNs.

Assessment of Serum Apelin Level in Iraqi Type 2 Diabetic Nephropathy Patients

The present study is investigated the relationship between Apelin concentration and various biochemical parameters in patients with type2 diabetic nephropathy. A total of 30 patients diagnosed with Diabetic Nephropathy at Al-Yarmouk and Al-Karama teaching hospitals were included in the study and compared to 40 healthy individuals forming the control group. The study was identified a significant increase in Apelin concentration among patients with type 2 diabetic nephropathy, compared to the control group. Additionally, various biochemical parameters were analyzed, and a strong correlation was found between their concentrations and Apelin levels. Considerable elevation of serum nitrogen compounds like urea and creatinine, as well as fasting blood glucose and glycated hemoglobin (HbA1c) were observed in the type 2 diabetic nephropathy patients. A positive correlation between Apelin and both creatinine and glycated hemoglobin levels was observed. Conversely, a negative correlation was observed between Apelin and the glomerular filtration rate (GFR), indicating potential implications for kidney function in these patients. These findings emphasize the significance of monitoring Apelin concentration along with other biochemical variables as essential indicators for the management and understanding of type 2 diabetic nephropathy. Further research in type 2 diabetic nephropathy could offer valuable insights into potential interventions and treatment strategies for improving patient outcomes.

Detailed descriptions of physical activity patterns among individuals with diabetes and prediabetes: the Lolland-Falster Health Study

IntroductionThis study aimed to describe objectively measured physical activity patterns, including daily activity according to day type (weekdays and weekend days) and the four seasons, frequency, distribution, and timing of...

Klinio mobile app for diabetes self-care: A pilot study of HbA1c improvement in type 2 diabetes patients

Diabetes mellitus (DM) is one of the leading causes of death globally. The incidence rate of DM is growing, and public health scientists estimate that the total number of patients diagnosed with the disease will reach 366 million in 2030. Given the scarcity of data on the effectiveness of mobile applications (apps) for diabetes control, we conducted a retrospective study reviewing the data from people using a diabetes mellitus management app called Klinio. The main objective of this study was to determine if there was a change in disease control reflected by changes in the level of HbA1c in the group of people using the mobile app. A logistic regression analysis was performed that could describe the factors (such as the number of logins, total time of use, gender, age, and BMI) linked to decreasing HbA1c. The main finding of this study was that users with type 2 diabetes and long and frequent use of the diabetes control app Klinio reduced their glycated hemoglobin level significantly. Users who logged into the app for 19 days and had at least 85 days from their first to their last login had a greater than two-fold increase in their chance to reduce the absolute HbA1c value by 0.5%.

Left ventricular longitudinal strain in patients with type 2 diabetes mellitus is independently associated with glycated hemoglobin level.

Left ventricular and left atrial strain are sensitive and reliable markers for evaluating cardiac function in patients with type 2 diabetes mellitus (T2DM), with interactions between the two parameters. The present study aimed to analyze the correlation between global longitudinal strain (GLS) of the left ventricle and glycated hemoglobin (HbA1c) levels in patients with T2DM. A total of 292 patients clinically diagnosed with T2DM were selected and divided into three groups according to HbA1c level. The strains of the left atrium and left ventricle in the three groups of T2DM patients with different HbA1c levels were compared. Univariate and multivariate (including left atrial functional indicators) linear regression analyses were performed to assess the relationship between strain indicators and HbA1c levels. Generalized additive models were used to examine the relationship between strain indicators and HbA1c levels. There were significant differences among the three groups in terms of age, microalbuminuria, total cholesterol, fasting blood glucose, postprandial blood glucose, and HbA1c level, and left atrial conduit longitudinal strain (LAScd) and GLS (p < .05). Univariate and multivariate linear regression analyses revealed that, as HbA1c levels increased, the absolute value of GLS gradually decreased (p < .001). Curve fitting revealed a positive correlation between HbA1c level and GLS, which was not affected by left atrial function. Left ventricular GLS was independently correlated with HbA1c level in patients with T2DM and was not affected by left atrial function.

A population-based longitudinal study on glycated hemoglobin levels and new-onset chronic kidney disease among non-diabetic Japanese adults

Chronic kidney disease (CKD) is a major global public health problem. Recent studies reported that diabetes and prediabetes are risk factors for developing CKD; however, the exact glycated hemoglobin (HbA1c) cut-off value for prediabetes remains controversial. In this study, we aimed to examine the relationship between HbA1c levels and subsequent CKD development in greater detail than previous studies. Longitudinal data of annual checkups of 7176 Japanese non-diabetic people (male: 40.4%) from 1998 to 2022 was analyzed. HbA1c values were categorized into < 5.0%, 5.0–5.4%, 5.5–5.9%, and 6.0–6.4%. CKD was defined as an estimated glomerular filtration rate < 60 ml/min/1.73 m2. The descriptive statistics at study entry showed that higher HbA1c values were associated with male, older, overweight or obese, hypertensive, or dyslipidemic people. During a mean follow-up of 7.75 person-years, 2374 participants (male: 40.0%) developed CKD. The Weibull accelerated failure time model was selected because the proportional hazards assumption was violated. The adjusted time ratios of developing CKD for HbA1c levels of 5.5–5.9% and 6.0–6.4% compared with 5.0–5.4% were 0.97 (95% confidence interval: 0.92–1.03) and 1.01 (95% confidence interval: 0.90–1.13), respectively. There was no association between HbA1c in the prediabetic range and subsequent CKD development.

The Effect of Home-Based Cardiac Rehabilitation on Cardiovascular Risk Factors Management.

To compare the efficacy of home-based cardiac rehabilitation (HBCR) and center-based cardiac rehabilitation (CBCR) in cardiovascular risk factor management. We performed retrospective review of the electronic medical records of 72 patients who were hospitalized for acute coronary syndrome and participated in a cardiac rehabilitation (CR) program for the first time. The participants were stratified into the HBCR group, receiving educational programs and performing self-exercise at home, and the CBCR group, participating in electrocardiogram monitoring monitoring exercise training in hospital settings. The results of the Lifestyle Questionnaire survey were investigated at baseline, 3 months, and 6 months. Both groups showed significant improvements in serum low-density lipoprotein levels, frequency of alcohol consumption, eating habits and psychological status. Moderate-intensity exercise duration and the maximal metabolic equivalents values improved significantly in both groups but slightly more in the CBCR group. However, the number of current smokers increased in both groups, and no significant changes were found in body mass index, serum glycated hemoglobin levels, serum high-density lipoprotein levels, or high-intensity exercise duration. Regardless of the CR program type, a patient's lifestyle can be modified. Therefore, patients should continue participating in any type of CR program.