Control Of Glycemia In Patients Research Articles

Review of data on comparative pharmacokinetics, pharmacodynamics, efficacy and safety of the superfast insulin drug lispro

Diabetes mellitus remains one of the main socially significant health problems worldwide. Glycemic control plays a key role in the prevention of all complications of diabetes mellitus. One of the most important factors in the overall control of glycemia in patients with both type 1 and type 2 diabetes mellitus is postprandial glucose levels, as a leading risk factor for delayed vascular complications. Modern possibilities for controlling postprandial glycemia include the use of not only ultrashort insulin preparations, but also ultrafast action. One of the superfast insulin preparations available today is the drug Lumzhev ® (inLisFast), which contains lyspro insulin as an active ingredient. A number of studies on the comparative pharmacokinetics and pharmacodynamics of inLisFast compared with insulin lispro consistently demonstrate a shift in the pharmacokinetic and pharmacodynamic profile to the left, which indicates faster absorption, an increase in early insulin exposure and a decrease in late insulin exposure. inLisFast provides flexibility in the regulation of food intake, which can play a significant role in optimizing glycemic control and improving the quality of life of patients with diabetes.

Inadequate diabetes knowledge is associated with poor glycemia control in patients with type 2 diabetes

ObjectiveTo identify the association between glycemia control with level of diabetes knowledge, diabetes education, and lifestyle variables in patients with type 2 diabetes. DesignCross-sectional analytical study. SiteClinics of the Mexican Institute of Social Security (IMSS), Mexico. ParticipantsPatients with type 2 diabetes. Main measurementsGlycated hemoglobin (HbA1c), glucose, and lipid profile levels were measured from fasting venous blood samples. Assessment of disease knowledge was performed using the Diabetes Knowledge Questionnaire (DKQ-24). Systolic and diastolic blood pressure was measured. Weight and abdominal circumference were measured, as well as body composition using bioimpedance. Sociodemographic, clinical, and lifestyle variables were obtained. ResultsA total of 297 patients were included, sixty-seven percent (67%) were women with a median of six years since the diagnosis of diabetes. Only 7% of patients had adequate diabetes knowledge, and 56% had regular knowledge. Patients with adequate diabetes knowledge had a lower body mass index (p=0.016), lower percentage of fat (p=0.008), and lower fat mass (p=0.018); followed a diet (p=0.004) and had received diabetes education (p=0.002), and to obtain information about their illness (p=0.001). Patients with low levels of diabetes knowledge had a higher risk of HbA1c≥7% (OR: 4.68; 95% CI: 1.48,14.86; p=0.009), as well as those who did not receive diabetes education (OR: 2.17; 95% CI: 1.21–3.90; p=0.009) and those who did not follow a diet (OR: 2.37; 95% CI: 1.01,5.55; p=0.046). ConclusionInadequate knowledge of diabetes, lack of diabetes education, and dietary adherence are associated with poor glycemia control in patients with diabetes.

Investigating the Effectiveness of Very Low-Calorie Diets and Low-Fat Vegan Diets on Weight and Glycemic Markers in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis.

Caloric restriction and vegan diets have demonstrated protective effects for diabetes, however their role in improving clinically relevant outcomes has not been summarized. Our aim was to evaluate the evidence for low-calorie diets (VLCD) and vegan diets on weight and glycemic control in the management of patients with Type 2 Diabetes. Database searches were conducted using Cochrane Library, MEDLINE (Ovid) and Embase. Systematic Review Registration: CRD42022310299. Methodological quality of studies was assessed using Cochrane RoB Tool for RCTs, Cochrane ROBINS-I RoB Tool for non-RCTs and NIH Quality Assessment tool for other studies. Sixteen studies with a total of 834 individuals were included and assessed to have a moderate to high risk of bias. Statistically significant changes in weight, BMI, and HbA1c were not observed in vegan diet cohorts. However, LDL cholesterol was significantly decreased by vegan diet. VLCDs significantly improved glycaemic control, with reductions in fasting glucose, pooled mean difference (MD) -1.51 mmol/L (95% CI -2.89, -0.13; p = 0.03; 2 studies) and HbA1c, pooled MD -0.66% (95% CI -1.28, -0.03; p = 0.04; 3 studies) compared to non-dietary therapy. Both diets suggested a trend towards improved weight loss and anthropometric markers vs. control. VLCD diet intervention is associated with improvement in glycaemia control in patients with Type 2 Diabetes.

Relationship of type 2 diabetes mellitus and cardiovascular pathology: significance of glycemic control on the way to solving the problem

Cardiovascular diseases (CVD) is the most frequent cause of death in diabetes mellitus (DM) patients, and diabetes, in turn, significantly increases the risk of cardiovascular pathology, and therefore the implementation of measures for primary and secondary prevention of complications in patients with DM and CVD is a topical direction of modern medicine. In case of diabetes, CVDs occur 2-5 times more frequently than in persons without this pathology. There is also a high risk of developing conditions such as coronary heart disease (CHD), myocardial infarction (MI), arterial hypertension (AH), acute cerebrovascular disease (ACVD). Thus, 69% of patients with DM have dyslipidemia, 80% - AH, 50-75% - diastolic dysfunction, 12-22% - chronic heart failure (CHF). Mortality from MI among patients with DM is 1.5-2 times higher than among people who do not suffer from this disease, both in the acute stage of MI, and in prolonged observation. Therefore, it is necessary to work out a common approach to this problem on behalf of both cardiologists and endocrinologists, and patients, which will improve the quality of treatment and prevent the development of DM complications. Intensive control of glycemia in patients is essential to prevent the development and progression of DM complications, which is proved by a number of fundamental studies presented in this article. Regular and competent self-control by patients allows maintaining normal or close to normal blood glucose levels. It is a reliable, convenient and patient-friendly way to prevent the development of diabetic complications.

Moderate intensity exercise in hypoxia increases IGF-1 bioavailability and serum irisin in individuals with type 1 diabetes.

Aim:This study aimed to determine the effect of moderate intensity continuous exercise (Ex) and hypoxia (Hyp) on serum brain-derived neurotrophic factor (BDNF), insulin-like growth factor-1 (IGF-1) and its binding protein-3 (IGFBP-3), irisin and cytokines levels in patients with type 1 diabetes (T1D).Methods:A total of 14 individuals with T1D (age: 28.7 ± 7.3 years) and 14 healthy adults (age: 27.1 ± 3.9 years) performed 40-min continuous Ex at moderate intensity (50% lactate threshold) on a cycle ergometer in normoxia (Nor) and Hyp (FiO2 = 15.1%) Biochemical factors, glucose concentrations and physiological variables were measured at rest, immediately and up to 24 h after both Ex protocols.Results:Patients with T1D had significantly lower pre-Ex serum concentrations of BDNF (p < 0.05, p < 0.01), and total IGF-1 (p < 0.001, p < 0.05) and significantly higher irisin levels (p < 0.05, p < 0.01) in Nor and Hyp, compared with healthy subjects. Ex significantly increased in T1D group serum BDNF (in Nor only p < 0.05) and total IGF-1 levels in Nor and Hyp (p < 0.001 and p < 0.01, respectively). Immediately after Ex in Hyp, freeIGF-1 (p < 0.05) and irisin levels (p < 0.001) were significantly higher compared with the levels induced by Ex alone. Free IGF-1 and irisin serum levels remained elevated in 24 h post-Ex in Hyp. In T1D, significant blood glucose (BG) decrease was observed immediately after Ex in Hyp (p < 0.001) and in 24 h recovery (p < 0.001) compared with pre-Ex level.Conclusion:The study results suggest that moderate intensity continuous Ex has beneficial effect on BDNF and IGF-1 levels. Ex in hypoxic conditions may be more effective in increasing availability of IGF-1. The alterations in the post-Ex irisin levels and IGF-1 system may be contributing to more effective glycaemia control in patients with T1D.

The relationship of vitamin D status with the development and course of diabetes mellitus type 1

Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disease that develops as a result of a genetic predisposition and environmental factors. Literature data indicate that the suboptimal status of vitamin D can be considered as a risk factor for the development of T1DM, especially at some stages of life. Adequate vitamin D supplementation in childhood may provide a protective effect and reduce the risk of developing T1DM at a later age. Pathogenesis of T1DM predisposes to abnormalities in the metabolism of vitamin D, including the development of vitamin D deficiency. Moreover, the immunomodulating effect of calcitriol (induction of immune tolerance and T-cell anergy, impaired B-cell activity and antibodies production) suggests the therapeutic potential of vitamin D in autoimmune diseases, including T1DM. A number of studies have demonstrated the positive clinical effects of various vitamin D preparations with respect to maintaining residual -cell function, improving glycemia control in patients with T1DM. Determining the optimal doses of vitamin D for patients with T1DM may contribute to disease control and prevention of complications.

Mifepristone enhances insulin-stimulated Akt phosphorylation and glucose uptake in skeletal muscle cells

Mifepristone is the only FDA-approved drug for glycaemia control in patients with Cushing's syndrome and type 2 diabetes. Mifepristone also has beneficial effects in animal models of diabetes and patients with antipsychotic treatment-induced obesity. However, the mechanisms through which Mifepristone produces its beneficial effects are not completely elucidated. PurposeTo determine the effects of mifepristone on insulin-stimulated glucose uptake on a model of L6 rat-derived skeletal muscle cells. ResultsMifepristone enhanced insulin-dependent glucose uptake, GLUT4 translocation to the plasma membrane and Akt Ser473 phosphorylation in L6 myotubes. In addition, mifepristone reduced oxygen consumption and ATP levels and increased AMPK Thr172 phosphorylation. The knockdown of AMPK prevented the effects of mifepristone on insulin response. ConclusionsMifepristone enhanced insulin-stimulated glucose uptake through a mechanism that involves a decrease in mitochondrial function and AMPK activation in skeletal muscle cells.

Re-evaluation of glycated hemoglobin and glycated albumin with continuous glucose monitoring system as markers of glycemia in patients with liver cirrhosis.

[This retracts the article DOI: 10.3892/br.2016.808.].

Re-evaluation of glycated hemoglobin and glycated albumin with continuous glucose monitoring system as markers of glycemia in patients with liver cirrhosis.

Liver cirrhosis (LC) is frequently accompanied by glucose intolerance. The present study was designed to determine whether glycated hemoglobin A1c (HbA1c) and glycated albumin (GA) were predictive markers of glycemia, as determined by a continuous glucose monitoring system (CGMS), in patients with LC. A total of 30 patients with LC, including 3, 19, 5, 2 and 1 with LC due to hepatitis B virus, hepatitis C virus, non-alcoholic steatohepatitis, alcohol and unknown causes, respectively, were assessed by CGMS. The average, maximum and minimum blood glucose (BG) levels were measured by CGMS, and correlated with HbA1c and GA. The average, maximum and minimum BG in these individuals were 142±38.7, 209.3±65.7 and 85.1±25.4 mg/dl, respectively. HbA1c was significantly correlated with average BG (r=0.447, P=0.015) and maximum BG (r=0.523, P=0.004). In addition, GA was significantly correlated with average BG (r=0.687, P<0.001) and maximum BG (r=0.648, P<0.001). Neither HbA1c nor GA was significantly correlated with minimum BG. Correlation analysis yielded formulas by which HbA1c and GA were predictive of average BG in individuals with LC: Average BG=19.2 × HbA1c (%) + 36.5 and average BG=6.6 × GA (%) + 13.0, respectively. In conclusion, HbA1c and GA showed significant correlations with average and maximum BG, as determined by CGMS. The derived formulas allow for estimates of average BG based on HbA1c and GA, and may contribute to the control of glycemia in patients with LC.

Effective intervention of self-care on glycaemia control in patients with type 2 diabetes.

Background:Diabetes is one of the most common diseases, which requires lifelong self-care to improve the quality of life.Objectives:The current study aimed to determine the impact of self-care education programs on reducing HbA1c in patients with type 2 diabetes.Patients and Methods:The current experimental study was conducted on 138 female patients with type 2 diabetes in Zahedan city, Iran. The data were collected by a self-administered questionnaire which included items on demographics, awareness, beliefs, Self-care behaviors. Before the educational intervention, the (HbA1c) test check list was completed for the patients in both groups. Then the training was applied for the intervention group in five 60-minute educational sessions within one month. Three months following the training, the data collection based on the check list was repeated for both groups. Data were analyzed using SPSS software.Results:The mean scores of awareness, beliefs, Self-care behaviors of the educational group, were 46.6 ± 8.57, 46.5 ± 0.86 and 29.06 ± 10.02, respectively; and it was found that after the education, knowledge, attitude, and self-care scores increased significantly (P < 0.001 Before the training, the scores of self-care, beliefs, and awareness were less than average in the intervention and control groups. In addition, the levels of HbA1c in the patients were higher than the normal levels. Following the intervention, the mean of self-care and HbA1c of the intervention group significantly reduced as compared with those of the control group (P < 0.001).Conclusions:Self-care training instructions led to improve knowledge, attitude, and performance of the subjects under study and also the average HbA1c. Therefore, the nurses and health care staff should be educated accordingly.

Effects of four weeks intermittent exposure to hypoxia environment and or endurance exercise on glucose homeostasis and body weight in obese mice with Type 2 diabetes

Background: It has been reported that intermittent exercise in hypoxia environments results inbetterweight loss effect thanexercise in normoxia conditions in individuals with obesity. There has also been a recent report that 1h of exercise in a hypoxic environment resulted in acute improvement of insulin sensitivity and short term glycaemia control in patients with Type 2 diabetes (T2DM). The aim of this study was to examine the effects of 4 weeks exposure to ahypoxic environment,withorwithout exercise, onglucose homeostasis and body weight in obese mice with T2DM. Methods: Eight-week old male C57BL/6 J mice were fed with a high-fat diet (14% protein, 21% carbohydrates and 55% fat) for approximately 12weeks to induce T2DM. Themicewere then allocated into three experimental groupswithn=7 in each: (1) hypoxia at 15%O2, no exercise, (2) hypoxia at 15%O2 and submaximal treadmill exercise and (3) normoxia and submaximal treadmill exercise. These groups were given the corresponding intervention with 1h per session, 6 sessions per week, for 4 weeks. There were also two control groups: (4) normal diet (14% protein, 72% carbohydrates and 4% fat) control group, and (5) diabetes control group (fed by the high-fat diet), both were not exposed to exercise and hypoxia. Before and after the 4 weeks intervention, mice were assessed for fasting blood glucose level (FBS) and weight change. Results: The 4 weeks intervention resulted in a significant reduction of FBS in the three intervention groups (from14.17, 13.74 and 13.87mmol/l to 9.43, 8.83 and 8.86mmol/l, respectively), but no significant difference between pre-FBS and post-FBS in control groups (9.1 vs 9.07mmol/l in the normal control group, and 13.56 vs 13.03mmol/l in the diabetes control group). The body weight of all groups increased during the intervention (an average of 20.8% of increase in the intervention groups, and 56.8% of increase in the control groups); however significant differences between preweight and post-weightwere only found in the two control groups. Discussion: The 4 weeks of intermittent hypoxia intervention reduced the FBS of the obese mice with T2DM to normal level, and sloweddown the trendof theirweight increase. The studyprovided new evidence that intermittent exposure to hypoxia environment for 4 weeks, with or without exercise, can be beneficial in management of blood glucose and body weight in mice with T2DM.

Glucocorticoid pulse therapy аnd carbohydrate metabolism in rheumatic diseases

Glucocorticoids are used in clinical practice for more than 50 years and are a great advance in the treatment of systemic inflammatory diseases. High doses of intravenous glucocorticoids (pulse therapy) are effective in conditions requiring rapid immunosuppression and antiinflammatory effect, such as systemic lupus erythematosus, rheumatoid arthritis, glomerulonephritis and systemic vasculitides. The advantage of this method are increased efficacy and lower rate of complications associated with prolonged administration of glucocorticoids. At the same time, glucocorticoid pulse therapy is associated with increased risk of hyperglycemia or even can be a cause of steroid-induced diabetes in patients without known hyperglycemia, as well as worsen glycemia control in patients with diabetes. Increased hepatic gluconeogenesis, inhibition of glucose uptake and metabolism in peripheral tissues and altered both receptor and post-receptor insulin action can lead to an increased serum glucose levels. In patients with inadequate compensatory reserves of pancreas, a clinical picture of diabetus mellitus can develop while treated with glucocorticoids. Blood glucose levels begin to rise 6-12 hours after the infusion of high doses of glucocorticoids. Risk factors for developing glucose intolerance and diabetes include advanced age, obesity, family history of diabetes and high cumulative doses of glucocorticoids. Glucocorticoid-induced diabetes is a common complication of pulse therapy, but exact causes are still not elucidated yet, current literature data on glucocorticoid-induced hyperglycemia are scarce.

The effect of nutrition and exercise in addition to hypoglycemic medications on HbA1C in patients with type 2 diabetes mellitus: a systematic review protocol

The effect of nutrition and exercise in addition to hypoglycemic medications on HbA1C in patients with type 2 diabetes mellitus: a systematic review protocol

INFLUENCE OF CONTROL GLYCEMIA ON PARAMETERS OF HEART RHYTHM VARIABILITY, QTAND JT-INTERVALS IN PATIENTS WITH ISCHEMIC HEART DISEASE AND TYPE 2 DIABETES

The aim. The study was parameters of heart rhythm variability, QT- and JT-intervals in patients with ischemic heart disease and type 2 diabetes (DM). Material and methods. 131 patients aged 3069 years with unstable angina and acute myocardial infarction has been included in research. Among observable in 101 (71.6 %) patients the DM is diagnosed. Results. It is revealed, that absence of the adequate control of glycemia in patients with DM (level of glycosylated hemoglobin more than 6.5%) resulted in decrease as parasympathetic and sympathetic influences of vegetative nervous system on the sinus node. Development of repeated coronary events in patients with DM within one year of supervision associated with reduction of mainly sympathetic influences by heart (decrease of the parameter LF and relation of spectra LF/HF) that was accompanied by infringement depolarization and repolarization of myocardium. The greatest reduction of parameter LF came to light in patients with fatal outcome within one year of supervision. Conclusion. Absence of the adequate control glycemia is accompanied by infringement of regulation of vegetative nervous system in patients with ischemic heart disease and type 2 diabetes.

Effect of Helicobacter pylori eradication on glycaemia control in patients with type 2 diabetes mellitus and comparison of two therapeutic regimens

Background and study aimsThe eradication rate of Helicobacter pylori (H. pylori) has been reported as being lower in patients with type 2 diabetes mellitus (DM) than in those without DM. The aim of the study was to assess the efficacy of the two H. pylori eradication regimens in patients without and with type 2 DM and to study the effect of H. pylori treatment on glycaemia control. Patients and MethodsA total of 93 consecutive type 2 DM (non-insulin users) and 98 non-diabetic age- and sex-matched patients were enrolled. Patients were randomly assigned to one of the two treatment protocols all given twice daily: (a) a 14-day quadruple therapy comprising of omeprazole 20mg, metronidazole 500mg, amoxicillin 1g and bismuth subcitrate 240mg (OMAB) and (b) a 14-day triple regimen comprising of omeprazole 20mg plus clarithromycin 500mg and amoxicillin 1g (OCA). Cure was defined as a negative 13C-urea breath test at least 6weeks after treatment. ResultsThe H. pylori eradication rate with the OCA regimen was 63% in patients with type 2 DM (non-insulin users) and 87.7% in the control group (p=0.017). The H. pylori eradication rate with the OMAB regimen was 38.2% in patients with type 2 DM and 55.1% in the control group (p<0.001). Mean decrease of fasting plasma glucose and HbA1c level shows no statistically significant difference after H. pylori eradication. ConclusionThis study suggests that the eradication rate of H. pylori with OCA or OMAB treatment is lower in patients with type 2 diabetes than in non-diabetics and H. pylori treatment in patients with type 2 DM has no role in the control of the glycaemia. The triple therapy (OCA) is superior to the quadruple protocol (OMAB) in H. pylori eradication of both DM and non-DM cases.

Drugs for diabetes: part 9 prescribing for patients with cardiac disease

Up to one-third of patients with heart disease have diabetes. Cardiological status should be considered when deciding on treatment for diabetes. Patients with stable coronary disease can be treated with metformin, sulphonylureas or pioglitazone. Following an acute coronary syndrome, intensive insulin therapy with multi-dose insulin has been shown to reduce mortality, and longerterm treatment with pioglitazone may reduce recurrent events. There is little trial information for glycaemia control in patients with chronic heart failure, and metformin and insulin are both frequently used. Dipeptidylpeptidase-4 (DPP-4) inhibitors are new oral antidiabetic drugs, which are weight neutral, and the injected glucagon-like peptide-1 (GLP-1) receptor agonists reduce weight. Long-term outcome studies are awaited to see if they have cardiovascular advantages in any particular group of patients.

Comparison of glucose-insulin-potassium and insulin-glucose as adjunctive therapy in acute myocardial infarction: a contemporary meta-analysis of randomised controlled trials

BackgroundThere is conflicting evidence regarding two different insulin regimens for acute myocardial infarction (AMI), one focusing on delivering insulin (‘insulin focus’, glucose-insulin-potassium (GIK)) and one focusing on tight glycaemic control...

Critical care glycemia control in patients suffering from severe subarachnoid hemorrhage

Critical care glycemia control in patients suffering from severe subarachnoid hemorrhage

Propionate inhibits glucose‐induced insulin secretion in isolated rat pancreatic islets

Dietary fibers, probably by generating short chain fatty acids (SCFA) through enterobacterial fermentation, have a beneficial effect on the control of glycemia in patients with peripheral insulin resistance. We studied the effect of propionate on glucose-induced insulin secretion in isolated rat pancreatic islets. Evidence is presented that propionate, one of the major SCFA produced in the gut, inhibits insulin secretion induced by high glucose concentrations (11.1 and 16.7 mM) in incubated and perfused pancreatic islets. This short chain fatty acid reduces [U-(14)C]-glucose decarboxylation and raises the conversion of glucose to lactate. Propionate causes a significant decrease of both [1-(14)C]- (84%) and [2-(14)C]-pyruvate (49%) decarboxylation. These findings indicate pyruvate dehydrogenase as the major site for the propionate effect. These observations led us to postulate that the reduction in glucose oxidation and the consequent decrease in the ATP/ADP ratio may be the major mechanism for the lower insulin secretion to glucose stimulus induced by propionate.