Glycemic Levels Research Articles

Predictors of glycemic control among type 1 pediatric diabetes patients—Northeast Ethiopia

IntroductionType 1 diabetes mellitus is the most common endocrine–metabolic disorder in children and adolescents worldwide. This study aims to determine the metabolic glycemic control levels and predictors among pediatric type 1 diabetes patients.MethodsAn institution-based prospective cross-sectional study was conducted from July 01, 2022 to October 30, 2022 among patients attending pediatric chronic follow-up at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia. Patients on follow-up for more than 3 months and aged under 18 years were enrolled in the study consecutively based on their visits. Data were entered into Epidata version 3.1 and exported to SPSS version 26 for analysis. Bivariate and multivariate analyses were done to identify the factors affecting glycemic control.ResultAmong 203 patients with type 1 diabetes, the average age was 8.72 ± 4.25 years, with the largest group of participants being over 10 years old (77 patients, 37%). The majority of the patients were female, totaling 126 (62.1%), and about 69 (34.0%) were in grades 7–10. Retinopathy, nephropathy, and diabetic ketoacidosis were commonly observed diabetic-related complications in this study. More than half of the patients, 107 (52.7%), had good diabetic control, while 96 (47.3%) had poor diabetic control. Factors significantly associated with poor glycemic control include having diabetes for more than 5 years (aOR: 1.45; 95% CI: 0.47, 0.91), being a third-born child (aOR: 0.22; 95% CI: 0.05, 0.92), having a comorbid disease condition (aOR: 1.84; 95% CI: 0.29, 0.92), and experiencing diabetes-related complications (aOR: 0.26; 95% CI: 0.08, 0.97).ConclusionThe study found that glycemic control is significantly poor among pediatric patients with type 1 diabetes. As a result, these patients require special attention to prevent the long-term consequences of diabetes.

Dapagliflozin combined with metformin improves blood glucose, bone metabolism and bone mineral density in elderly patients with type 2 diabetes mellitus complicated with osteoporosis.

The incidence of type 2 diabetes mellitus (T2DM) complicated with osteoporosis (OP) (T2DM-OP) is growing. Dapagliflozin and metformin are commonly prescribed to manage glycemic levels in T2DM patients. We investigated the clinical efficacy of combining dapagliflozin with metformin in elderly patients with T2DM-OP. Totally 144 T2DM-OP patients were prospectively enrolled and allocated into two groups: the Metformin and Dapagliflozin + Metformin groups. Each group received treatment for 12 months. Fasting peripheral blood samples were collected before and after 12 months of treatment. Glycemic parameters and bone metabolic parameters were measured using oral glucose tolerance test, automatic biochemical analyzers, or liquid chromatography. Bone mineral density (BMD) changes at lumbar vertebrae (L1-4), femoral neck (FN) and total hip (TH) were assessed using dual-energy X-ray bone mineral densitometry. Pain severity was evaluated using the visual analog scale (VAS). The total effective rate, fracture incidence, and adverse reaction rate were also evaluated. After 12 months, both groups showed improvements in glycemic parameters, bone metabolic parameters, and BMD at L1-4, FN, and TH, and reductions in VAS scores. The Dapagliflozin + Metformin group exhibited more significant improvements. The overall effective rate was higher and fracture incidence, was lower in Dapagliflozin + Metformin group, with comparable rates of adverse reactions and safety profiles between the two groups. Taken together, treatment with a combination of dapagliflozin and metformin led to improvements in blood glucose levels, bone metabolism, and BMD in elderly patients with T2DM-OP, demonstrating superior efficacy and safety compared to metformin monotherapy.

Maternal Glycemia and Its Pattern Associated with Offspring Neurobehavioral Development: A Chinese Birth Cohort Study

Background/Objectives: This study investigates the impact of maternal glycemic levels during early and late pregnancy on offspring neurodevelopment in China. Methods: Fasting plasma glucose (FPG) and triglyceride (TG) levels were measured in maternal blood during pregnancy, and the TyG index was calculated to assess insulin resistance. Hyperglycemia was defined as FPG > 5.1 mmol/L. Neurodevelopmental outcomes in offspring aged 6–36 months were evaluated using the China Developmental Scale for Children, focusing on developmental delay (DD) and developmental quotient (DQ). Mothers were categorized into four glycemic groups: healthy glycemia group (HGG), early pregnancy hyperglycemia group (EHG), late pregnancy hyperglycemia group (LHG), and full-term hyperglycemia group (FHG). Linear and logistic regression models were applied. Results: Among 1888 mother–child pairs, hyperglycemia and FPG were associated with an increased risk of overall DD (aOR = 1.68; 95% CI 1.07–2.64) and lower DQ (aBeta = −1.53; 95% CI −2.70 to −0.36). Elevated FPG was linked to DD in fine motor and social behaviors. Compared to HGG, LHG and FHG significantly increased the risk of overall DD (aOR = 2.18; 95% CI 1.26–3.77; aOR = 2.64; 95% CI 1.38–5.05), whereas EHG did not. Male offspring were particularly vulnerable to early pregnancy hyperglycemia (aBeta = −2.80; 95% CI −4.36 to −1.34; aOR = 2.05; 95% CI 1.10–3.80). Conclusions: Maternal glycemic levels during pregnancy influence offspring neurodevelopment, with persistent hyperglycemia significantly increasing DD risk. Early pregnancy hyperglycemia particularly affects male offspring, underscoring the need for glycemic management during pregnancy.

Telehealth Occupation-Based Coaching for Rural Parents of Children With Type 1 Diabetes: A Randomized Controlled Trial.

Because of the complexity of their child's diabetes management, parents often assume all care duties and report needing additional assistance to resume family routines. To examine the preliminary efficacy of a telehealth occupation-based coaching intervention for rural parents of a child living with Type 1 diabetes (T1D) to improve child glycemic levels, family quality of life, and parental self-efficacy. Double-blinded, two-arm, pilot randomized controlled trial. Telehealth video conferencing at home. 16 dyads of rural parents and children ages 2 to 12 yr diagnosed with T1D. Occupation-based coaching delivered through telehealth sessions, once weekly for 12 wk, informed by community partners. Child measures: hemoglobin A1c and glucose time in range. Family measures: Parenting Sense of Competence, World Health Organization Quality of Life Brief Questionnaire, Goal Attainment Scale, Evidence of Independent Capacity Rating Scale (EICRS), and caregiver talk. Families in the intervention group were more likely to achieve family-centered participation goals (p = .006) than those in the controlled group. Caregiver talk increased significantly over the 12-wk period (p = .034), and the average rating on the EICRS also improved significantly (p < .001). There were no statistically significant changes in glycemic levels or family quality of life. OBC may be more efficacious in helping families to improve health management routines after a child's diagnosis with T1D than usual endocrinology care alone. Most child health outcomes were in target range at the start of the study; therefore, it was not expected to see significant improvements. Plain-Language Summary: Occupational therapy is an untapped resource in the provision of care for children with Type 1 diabetes (T1D). Occupational therapy practitioners can also provide families with evidence-based support to address the self-management skills of children with this chronic condition. This clinical trial examined the preliminary efficacy of a new 12-wk telehealth occupational therapy intervention for rural families with a child living with T1D to improve caregiver diabetes management skills, family participation, and child health. Families who received occupational therapy services were more likely to improve their family participation in meaningful activities and diabetes self-efficacy; however, there were no differences in the child's health outcomes or the family's quality of life.

Comparison of Lipid Profile and Insulin Sensitivity in Rabbits Fed with High-Fat or High Fructose Diets

Obesity and metabolic syndrome are significant global health challenges influenced by dietary and lifestyle factors. This study aimed to develop an experimental rabbit model of obesity and metabolic syndrome using high-fat and high-fructose diets over 11 weeks. Rabbits were divided into three groups: group A (control) fed a basal diet, group B fed a high-fat diet, and group C fed a high-fructose diet. Key metrics assessed included body weight, fat mass, basal glycemia, glucose infusion rate (GIR), total cholesterol, triacylglycerol (TAG), and non-esterified fatty acid (NEFA) levels.Group B (high-fat diet) showed the highest body weight (2640±70g) and fat mass (90±12.2g), while group A (control) had the lowest values (2420±40g and 63.3±9.5g, respectively). Group C (high-fructose diet) exhibited the highest basal glycemia (5.52±0.31 mmol/l) and TAG levels (2±0.30 mmol/l). GIR was highest in group A (18.5±1.2 mg/kg/min) and lowest in group B (12.9±2.0 mg/kg/min). Total cholesterol was highest in group A (2.04±0.14 mmol/l) and lowest in group C (1.83±0.14 mmol/l). NEFA levels peaked in group C (0.41±0.04 mmol/l) and were lowest in group A (0.3±0.04 mmol/l).The study demonstrated that high-fat and high-fructose diets induce distinct metabolic changes in rabbits, modeling key features of obesity and metabolic syndrome. These findings highlight the differential impacts of these diets, providing a basis for further research into the mechanisms and dietary influences driving these conditions

Impact of Diet and Exercise Interventions on Glycemic Control and Weight Management in Adults with Type 2 Diabetes: A Systematic Review of Randomized Controlled Trials and Observational Studies

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic condition characterized by insulin resistance and impaired insulin production, leading to high blood glucose levels. It is the most common form of diabetes, accounting for 90%-95% of all cases globally. With an increasing prevalence of T2DM, effective management strategies are crucial to control glycemic levels and prevent associated complications. Diet and exercise are considered key interventions to improve glycemic control and manage weight in individuals with T2DM. Objective: This systematic review aims to evaluate the effects of diet and exercise interventions on glycemic control and weight management in adults with Type 2 diabetes. The review focuses on the impact of various diet plans, including low-carbohydrate and Mediterranean diets, as well as different exercise regimens. Methodology: A comprehensive search of randomized controlled trials (RCTs) and observational studies was conducted to identify research on the effects of diet and exercise interventions in managing T2DM. Studies assessing glycemic control (e.g., HbA1c levels) and weight loss outcomes were analyzed to determine the effectiveness of these interventions. Results: The review found that both diet and exercise interventions led to significant improvements in glycemic control and weight management. Low-carbohydrate diets and Mediterranean diets, in particular, demonstrated positive effects on blood glucose levels and insulin sensitivity. Regular physical activity, especially aerobic and resistance exercises, also contributed to improved glycemic control and weight reduction. Conclusion: Diet and exercise interventions are effective strategies for managing Type 2 diabetes, improving both glycemic control and weight management. Incorporating tailored diet plans and exercise regimens into clinical practice may significantly benefit individuals with T2DM. Further studies are needed to refine intervention protocols and address barriers to patient adherence.

Screening assessment of psycho-emotional state and cardiometabolic risk factors in combatants and civilians during the war in Ukraine

Objective — to conduct the screening assessment of symptoms of psycho‑emotional disorders (post‑traumatic stress disorder (PTSD), general anxiety, perceived stress) and their relationships with metabolic disorders and body composition indicators in combatants and civilians during the war in Ukraine. Materials and methods. 21 combatants with the duration of participation in active hostilities up to 6 months and 20 civilians of the comparison group who permanently resided in Kharkiv and the unoccupied part of Kharkiv region since the beginning of the war were examined. The study included men aged 25 to 55 years without cardiovascular diseases and diabetes. Questionnaires were surveyed using the Post Traumatic Stress Disorder (PTSD) Checklist Scale‑5 (PCL‑5), the Generalized Anxiety Disorder 7 (GAD‑7), and the Perceived Stress Scale 10 (PSS‑10). The body mass index was determined, visceral fat level, percentage of total body fat mass, and muscle mass were measured by bioimpedance. The levels of lipids, blood glucose, glycated hemoglobin were determined, and the triglyceride‑glucose index (TyG) was calculated. Results. Combatants’ PCL‑5 severity scores were only numerically higher than civilians’, and the GAD‑7 severity score was higher (p=0.028). Perceived stress in civilians corresponded to the low level, in combatants — to the moderate level. The PSS‑10 scale scores in combatants was significantly higher than in the comparison group (p=0.018). Among combatants the proportion of individuals with signs of probable PTSD (33.33%) was significantly higher than in civilians (5.00%, p=0.022). Compared to the civilians among the combatants there were also significantly more individuals with moderate and severe general anxiety (28.6% versus 5.0%, respectively, p=0.045). The combatants had higher systolic blood pressure, lower body fat percentage and greater skeletal muscle percentage than the civilians. Metabolic changes in military personnel were characterized by elevated triglyceride levels and lower glycemic indices in comparison to the civilians. In the cоmbatants the assessed severity of PTSD symptoms and perceived stress level were positively correlated with skeletal muscle mass. There were negative correlations between the general anxiety level and fasting glucose, and between the perceived stress level and body fat mass. In the civilians, the severity of symptoms of probable PTSD was positively correlated with body mass index, body fat and visceral fat accumulation, and the triglyceride‑glucose index. The increase in general anxiety and perceived stress levels were associated with the increase in glycemic indices. In addition, the level of general anxiety was inversely correlated with high density lipoprotein cholesterol. Conclusions. In the conditions of ongoing war, the higher proportion of individuals with signs of probable PTSD were found among combatants than among civilians. Compared with civilians, military personnel had higher levels of general anxiety and perceived stress. In civilians, the increase in psycho‑emotional disorders was associated with adverse changes in metabolic parameters and body composition, while in military personnel the accumulation of stressful experiences was correlated with the increase in skeletal muscle mass, the decrease in fat body mass and in glycemia levels.

Insulin Degludec vs Insulin Glargine for Glycemic Control in Critical Illness Hyperglycemia.

Hyperglycemia is a serious condition and associated with an increased risk of complications and mortality in both critically ill and non-critically ill people. Improvement in the glycemic level reduces the length of hospital stay, systemic infections and short- and long-term mortality. The aim was to test the effectiveness of insulin degludec vs insulin glargine and regular insulin in controlling blood sugar in patients with critical hyperglycemia. Using random control trial, the patients were randomly divided into three equal groups-group R, group G and group D. Each group included 30 patients. Group G was managed using regular insulin together with an insulin glargine. Group D was managed using regular insulin together with an insulin degludec. However, group R was managed using only regular insulin. The incidence of hypoglycemia was statistically more significant in the group of regular insulin than in groups G and group D with a p-value 0.0069. There was no statistically significant difference between the three groups regarding the frequency of hypoglycemia. Ultra-long-acting insulin can effectively control random blood sugar (RBS) with a decrease in the total dose of insulin used. It is recommended that using insulin degludec is a safe and effective alternative to regular insulin for glycemic control in critically ill patients. El Sherif IM, Haggag AM, Abbas MH, Kamel WY. Insulin Degludec vs Insulin Glargine for Glycemic Control in Critical Illness Hyperglycemia. Indian J Crit Care Med 2025;29(1):52-58.

Тhe Role of Retinal Vascular Reactions in the Development and Regression of Diabetic Retinopathy

Objective: to study retinal vascular reactions (RVR) with a glycemic gradient, vitrectomy (VE) without panretinal photocoagulation (PRP) and after IVI aflibercept in patients with diabetes mellitus (DM).Methods. In three independent groups, variations in retinal vessel (RV) caliber were studied with a glycemic gradient (DR progression factor), after VE without PRP and after IVI (DR/PDR regression factors). Retinal images were obtained using Heidelberg Retinal tomograph HRT II (Germany).Results. With an increase in the level of glycemia, the tendency to increase the diameter of the RV in DM1 and DM2 was revealed both in eyes without DR and in the presence of DR. However, only in DR were the changes significant. After VE without PRP in the eyes with PDR, the diameter of the veins decreased by 7 % 2 months after VE and by 14 % after 18 months (p &lt; 0.01); the arteries had persistent and significant changes in caliber after 2 months. After IVI aflibercept, the caliber of retinal vessels in DMO significantly decreased from the first to the third injection.Conclusion. Patients with DM initially represent a heterogeneous group in terms of the severity of RVR, depending on the presence or absence of ДР. After treatment, BCVA indicators improved against the background of retinal vasoconstriction in all study groups. After VE without PRP there was a persistent and significant reduction of PV diameters. Thus, the dynamics of retinal vessel caliber may reflect the phases of DR/PDR evolution: progression or regression. Persistent PDR remission can be achieved without lasercoagulation of the retinal “avascular zones”.

Experimental type 2 diabetes increases the number of insulin-positive cells in rat spleen

Type 2 diabetes (T2D) is a chronic metabolic disease, being one of the leading causes of death and disability worldwide. Immune system disorders play an important role in the T2D pathogenesis, and immune system is exposed to increased stress resulting both of changes in immunometabolic regulation and disruption of tissue homeostasis caused by oxidative stress and chronic inflammation. Opportunities for adaptation of immune organs in T2D are of interest, especially, potential ectopic expression of insulin. Under hyperglycemic conditions, insulin-containing cells were detected in various organs, including the spleen. The aim of the present work was to estimate the number of insulin-positive cells (IPCs) in the spleen of rats with experimental T2D. The disorder was induced in mature male Wistar rats by intraperitoneal administration of 110 mg/kg nicotinamide followed by 65 mg/kg streptozotocin. 30 days later, blood samples and spleens were obtained. The level of glycemia, insulin contents, activity of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in blood were assessed as well as markers of oxidative stress in the spleen. Biochemical studies revealed an increase in ALT activity in blood, along with increase in malondialdehyde (MDA) levels and decreased levels of reduced glutathione (GSH) in the spleen tissue of rats with experimental T2D. Meanwhile the activity of superoxide dismutase (SOD) and catalase in the spleen did not change. An increase in MDA level associated with unchanged activity of antioxidant enzymes and decreased GSH content suggests the development of oxidative stress in the tissue. Microscopy of spleen tissues was examined by immunohistochemistry using antibodies to proinsulin and insulin, showing an increased number of insulin-positive cells (IPCs) in the spleen tissue of rats with experimental T2D compared with diabetes-free animals. Optical density of the IPC cytoplasm was found to be increased in diabetic rats, thus suggesting increased functional activity of IPCs. Increase of numbers and functional activities of IPCs in the spleen in experimental model of T2D may indicate an adaptive role of extra-pancreatic insulin expression under the conditions of oxidative stress and cytolysis, including those in immunopoietic organs.

Health and Liver Diagnostic Markers Influencing Glycemia in Subjects with Prediabetes: Preview Study.

Glucose homeostasis may be dependent on liver conditions and influence health-related markers and quality of life (QoL) objective measurements. This study aimed to analyze the interactions of glycemia with liver and health status in a prediabetic population. This study included 2220 overweight/obese prediabetics from the multinational PREVIEW project. Anthropometrics; clinical, metabolic and other health-related markers; and QoL variables were analyzed. Univariate and multilinear-adjusted regression models were run to explain the interrelationships and effect modification between glycemia, health-related QoL (applying SF-12) and metabolic/liver health (using the HSI, a putative marker of fatty liver). Relevant age/sex interactions were found concerning the levels of insulin, HOMA-IR, C peptide and transaminases in this prediabetic population. Multivariate models identified age, sex, glucose, WC and QoL as important predictors of HSI variability (adj. R value = 0.1393, p < 0.001), whereas the QoL status was statistically related to age, sex, HOMA-IR and HSI (adj. R value = 0.1130, p < 0.001) in this glycemia-impaired group. Furthermore, the QoL values declined with increased HSI scores, where a significant interaction was found (p = 0.011) when the data were analyzed when comparing lower glycemia vs. higher glycemia in prediabetics. Indeed, an effect modification was featured depending on the glycemia levels concerning the QoL and HSI worsening. Glycemia associations with the QoL status and liver metabolism markers were evidenced, with clinical implications for diabetes and liver disease precision management given the modification of the QoL outcomes depending on the liver status and glycemia concentrations. Notably, independent associations of circulating glucose with age, sex, adiposity, inflammation and C peptide levels were found.

Anti-Obesogenic and Antioxidant Potential of Lychee Seed Flour in Zebrafish Fed a High-Fat Diet

Objective Obesity has become one of the major public health issues and is associated with various comorbidities, including type 2 diabetes mellitus, dyslipidemia, and hypertension. Lychee seeds are considered promising ingredients for developing functional foods owing to their nutraceutical properties and phytochemical composition. This study aimed to induce obesity in zebrafish (Danio rerio) through a hyperlipidic diet supplemented with different concentrations of lychee seed flour and to evaluate its effects on adipose tissue, biochemical parameters, oxidative stress, and caudal fin regeneration. Methods A total of 200 adult zebrafish were u anded and divided into five experimental groups: control, hyperlipidic diet (HFD), and HFD supplemented with 2%, 4%, and 6% lychee seed flour. After 12 wk of feeding, biochemical parameters (glycemia, triglycerides, total cholesterol, high-density lipoprotein-HDL, aspartate aminotransferase-AST, alanine aminotransferase-ALT, and cortisol) and oxidative stress biomarkers, such as Catalase (CAT), Superoxide Dismutase (SOD), Glutathione-S-Transferase (GST), Glutathione (GSH), and Reactive Oxygen Species (ROS), were evaluated. Results The results showed that the HFD4% group exhibited a significant reduction in the diameter of visceral adipocytes compared with the control, HFD, and HFD2% groups. There was a higher prevalence of severe steatosis in the control and HFD groups and mild steatosis in the HFD6% group. The HFD4% and HFD6% groups had the lowest glycemic levels, whereas the HFD6% group had the highest HDL levels. Supplementation with lychee seed flour also positively modulated oxidative stress biomarkers, with increased CAT and GST activity in the HFD6% group and reduced ROS in the HFD4% and HFD6% groups compared with the HFD group. Conclusion It was concluded that adding 4 to 6% lychee seed flour may have beneficial effects on biochemical parameters and oxidative stress markers in HFD-fed zebrafish. The results indicate that lychee seed flour shows promise for use in foods and supplements targeting obesity prevention and management.

Effect of Vitamin D on Fasting Blood Sugar and HbA1c in Type 2 Diabetes Mellitus Patients

ABSTRACT:Objective: To evaluate the impact of vitamin D supplementation on fasting blood sugar &amp; HbA1c in Type-2 diabetes mellitus patients.Methodology: This was an analytical case control study and was carried out by the Pharmacology Department at the Basic Medical Sciences Institute (BMSI, JPMC) with the collaboration of Diabetic OPD, JPMC, Karachi for the duration of 6 months. In this study 80 patients were selected by non-probability purposive sampling method and open EPI 3.01 version was used to estimate the sample size.Results: The study revealed that pre and post plasma vitamin D proportions in the intervention group were significant (P&lt;0.001) as compared to the group labeled as control which did not show any difference at the end of study (P=0.16). However, there was an insignificant relationship between Vit D and HbA1c with no improvement observed in glycemic control (P=0.74) or HbA1c levels (P=0.20) in the intervention group.Conclusion: According to the study's findings, vitamin D addition has improved plasma vitamin D3 levels and improved insulin sensitivity in patients with T2DM. The current analysis did not find a significant contribution to reducing HbA1c or enhancing glycemic control in individuals with T2DM.

Identify unmet needs in diabetes care in Shandong, China: a secondary analysis of a cross-sectional study using cascade of care framework

BackgroundThe continuum management of diabetes remains under-evaluated in China. This study aimed to estimate the proportions of diabetes adults at each stage of the cascade of care framework in Shandong, China.MethodsWe conducted a secondary analysis using the 2018 China Adult Chronic Disease and Nutrition Surveillance (CACDNS) data in Shandong. This nationwide cross-sectional survey was conducted between September and November 2018, investigating the major chronic diseases among Chinese adults through interviews, physical examinations, and laboratory tests. We employed the cascade model to examine the proportion of diabetes adults, including both type 1 and type 2, from diabetes screening, diagnosis, pharmaceutical and non-pharmaceutical treatments, to single and comprehensive management targets, and quantified the attrition between each stage. Diabetes screening was defined as participants reported to have ever received a blood glucose test. Diabetes diagnosis was defined as: 1) fasting plasma glucose (FPG) ≥ 126 mg/dL, or 2) 2-h oral glucose tolerance test (2 h-OGTT) ≥ 200 mg/dL, or 3) hemoglobin A1c (HbA1c) ≥ 6.5%, or 4) self-reported diabetes. Diabetes management targets included: 1) single glycemic target of personalized HbA1c level, 2) comprehensive ABC targets of personalized HbA1c level, blood pressure (BP) < 140/80 mm Hg, and low-density lipoprotein cholesterol (LDL-c) level < 2.6 mmol/L, 3) lifestyle target of not currently smoking. The estimated proportion was calculated through self-reported diabetes status and FPG, 2h-OGTT and HbA1c. The number of diabetes cases in Shandong was extrapolated using the 2018 provincial census data for adults aged 18 years and above (N = 80.6 million). The cascade of diabetes care was further examined by age, sex, and Basic Public Health Service (BPHS) enrollment.ResultsThis secondary analysis included 8,462 individuals (47.8% males, median age: 49.0), among whom 12.4% had diabetes (self-reported: 4.2%, newly diagnosed: 8.2%) and 41.1% had prediabetes. In 2018, an estimated 9.2 million adults in Shandong had diabetes, with 6.4 million (69.6%) receiving diabetes screening but 6.2 million (67.7%) remaining unaware of their conditions. Among self-reported diabetes adults, 2.7 million (86.4%) and 2.8 million (89.6%) received pharmaceutical and non-pharmaceutical treatment, respectively. Of those with treatments, 1.2 million (58.2%) met personalized glycemic target. A rapid decline, however, was observed in BP (31.1%) and LDL-c (39.3%) control among diabetes patients with multimorbidity (≥ 2 diseases). Ultimately, 0.1 million self-reported diabetes adults (3.8%) achieved the ABC targets. BPHS Enrollment slightly improved comprehensive management with ABC targets.ConclusionsA significant unmet need exists for diabetes adults from screening to management, particularly the comprehensive management of glycemia, BP and LDL-c levels among those with multimorbidity. Tailored strategies and appropriate allocation of healthcare resource is needed to addressing gaps in care continuum and reduce long-term disease burden.

Integrated Analysis of Oral Microbiome and Metabolome in T2DM Patients With Varying Glycemic Status.

This study aimed to analyze the subgingival and salivary microbiome and metabolome in diabetic periodontitis patients with varying glycemic levels. Forty-two diabetic periodontitis patients were sampled of saliva, gingival crevicular fluid (GCF), and blood, and categorized into three groups based on systemic glycemic status. The microbiome was assessed using full-length 16S rRNA gene sequencing. Gas chromatography-mass spectrometry was performed for metabolome analysis. The similarity in the structure and function of the flora in saliva and GCF was evident under good blood glucose control. Conversely, inadequate blood glucose control demonstrated a more distinct separation from saliva flora. Both salivary and GCF microorganisms exhibited greater periodontal pathogenicity, with salivary metabolites showing stronger associations with inflammation when Hemoglobin A1c (HbA1c) > 6.5%. Some periodontal pathogens, such as Veillonella atypica, showed significantly positive correlations with proinflammatory metabolites, including lactic acid and putrescine, etc. Salivary microbes demonstrated more sensitive responses than GCF to changes in blood glucose levels among type 2 diabetes mellitus (T2DM) patients. Under active blood glucose control, it indicates lower periodontal pathogenicity and inflammatory correlation in the oral microecology of T2DM patients. Saliva appears to offer superior diagnostic and monitoring value compared to GCF in the context of systemic disease surveillance.

The Role of Dapagliflozin in the Modulation of Hypothermia and Renal Injury Caused by Septic Shock in Euglycemic and Hyperglycemic Rat Models.

Recent research has validated the efficacy of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in reducing glucose levels and exerting a nephroprotective role. This study aimed to examine the impact of dapagliflozin in preventing sepsis-induced acute kidney injury (AKI) and related consequences. The study used both normal and diabetic rat models to investigate whether the effectiveness of dapagliflozin is influenced by glycemia levels. Normal and diabetic Wistar albino rats were treated with dapagliflozin for two weeks and then received a single dose of lipopolysaccharide (LPS). After sepsis induction, skin and deep body temperatures were recorded every two hours. Blood and kidneys were collected for analysis using histological examination and biochemical assays. Dapagliflozin attenuated the consequences of sepsis through mitigation of LPS-induced hypothermia and AKI in the normal and diabetic septic groups. Dapagliflozin regulated the serum levels of AKI markers, including creatinine and blood urea nitrogen, as well as ion levels. Dapagliflozin attenuated LPS-induced AKI through modulation of renal inflammation and oxidative stress, which showed well-abundant glomeruli. These results indicated the protective effect of dapagliflozin against LPS-induced hypothermia and AKI, which was likely unrelated to its glucose-lowering properties, as evidenced in the non-diabetic septic group. The outcomes suggest that dapagliflozin has a potential impact in preventing sepsis-induced hypothermia and AKI via modulation of inflammation and oxidative stress, irrespective of glycemic levels.

Fear of hypoglycemia relates to glycemic levels during and after real-world physical activity in adolescents with type 1 diabetes.

We explore the association between hypoglycaemia fear (FH) and glycaemia during and after exercise sessions in a large sample of physically active youth with type 1 diabetes (T1D). We used data from the Type 1 Diabetes Exercise Initiative Paediatric (T1DEXIP) Study. Youth self-reported on FH using the Hypoglycaemia Fear Survey-Child (HFS-C). They used a smart phone application to self-report food intake and insulin dosing (multiple daily injection only). We collected pump and continuous glucose monitoring data directly from the device. Our sample included n = 251 youth (mean age: 14 ± 2 years, 55% closed loop pump; 42% women). Youth reporting higher HFS-C Total and Helplessness/Worry scores (HFS-C subscale) had slightly fewer competitive and fewer high intensity exercise events compared to youth with lower HFS-C Total and Helplessness/Worry scores. Youth reporting the highest Maintain High Blood Glucose scores (HFS-C subscale) had the lowest percent glucose time in range, higher mean glucose levels, and higher percent time above range during exercise. Youth reporting the highest Maintain High Blood Glucose scores also tended to have higher mean glucose levels post-exercise and a smaller drop in glucose during exercise. FH relates to glycaemia during and after exercise in adolescents with T1D and may signal an inclination for some youth to engage in avoidance behaviours to reduce their vulnerability to exercise-induced hypoglycaemia.

Salivary advanced glycated end products, their receptors, and aMMP-8 in periodontitis patients with varying glycemic levels: A cross-sectional study.

Advanced glycation end products (AGE) and their receptors (RAGE) have been implicated in developing periodontal complications in diabetic patients. This study aimed to identify salivary AGE, RAGE, soluble RAGE (sRAGE), and active-matrix metalloproteinase-8 (aMMP-8) levels at varying glycemic levels in periodontitis patients. Ninety-eight participants were categorized into uncontrolled DM-PD group (n=27)-periodontitis patients with uncontrolled Type 2 diabetes mellitus (T2DM) (glycated hemoglobin [HbA1c] ≥7%); controlled DM-PD group (n=33)-periodontitis patients with controlled T2DM (HbA1c 5.7%-6.9%); SH-PD group (n=18)-systemically healthy periodontitis patients; and SH-PH group (n=20)-systemically and periodontally healthy individuals. HbA1c along with the periodontal parameters bleeding on probing (BoP), periodontal probing depth (PPD), clinical attachment loss (CAL), number of missing teeth, and periodontal inflamed surface area (PISA) were estimated. Enzyme-linked immunosorbent assay (ELISA) was used for analyzing salivary AGE, RAGE, sRAGE, and aMMP-8. Multiple linear regression analysis was conducted to develop predictive models for HbA1c based on relevant predictor variables. Periodontitis participants with uncontrolled T2DM exhibited significantly higher BoP, PPD, CAL, number of missing teeth, and PISA, along with elevated AGE, RAGE, and aMMP-8, compared to other groups (p<0.01). A significant positive association was observed between RAGE and HbA1c levels (p<0.01). Among the predictors, BoP (p=0.046) and CAL (p<0.001) demonstrated a significant positive effect on salivary AGE. PPD was positively associated with RAGE (p<0.05), and BoP was negatively associated with salivary sRAGE levels (p=0.038). Salivary biomarkers like RAGE and aMMP-8 exert a potential role in monitoring periodontal health and glycemic control in T2DM patients. Advanced glycation end products (AGE) and their receptors (RAGE) have been implicated in developing periodontal complications in diabetic patients. This study aimed to identify salivary AGE, RAGE, soluble RAGE (sRAGE), and aMMP-8 levels at varying glycemic levels in periodontitis patients. Ninety-eight participants were categorized into Group 1 (n=27)-periodontitis patients with uncontrolled Type 2 diabetes mellitus (T2DM); Group 2 (n=33)-periodontitis patients with controlled T2DM; Group 3 (n=18)-systemically healthy periodontitis patients; and Group 4 (n=20)-systemically and periodontally healthy individuals. Enzyme-linked immunosorbent assay (ELISA) was used for analyzing salivary AGE, RAGE, sRAGE, and aMMP-8. The study revealed that participants with uncontrolled T2DM and severe periodontitis exhibited significantly higher levels of salivary AGE, RAGE, and aMMP-8, along with increased periodontal parameters, compared to controlled T2DM and systemically healthy groups. Conversely, salivary sRAGE levels were significantly lower in the uncontrolled T2DM group. The study also found significant associations between salivary RAGE levels and glycated hemoglobin (HbA1c), as well as between aMMP-8, AGE, and clinical periodontal parameters. The findings of this study highlight the potential clinical utility of salivary biomarkers, particularly RAGE and aMMP-8, as noninvasive diagnostic and monitoring tools to evaluate glycemic control and periodontal health in individuals with diabetes.

The impact of diet and physical activity on the management of Type 1 diabetes mellitus in children

Nutritionists suggest that people with type 1 diabetes mellitus (T1DM) should engage in physical activity in conjunction with healthy diet habits. This study was designed to determine the effect of diet and physical activity on the course of T1DM in children aged 8 to 15 years. Young T1DM patients were enrolled in this quasi-experimental descriptive study at the Sebdou and Maghnia hospitals (wilaya of Tlemcen – north-west Algeria), from December 2018 to March 2019. The study was based on a questionnaire and the prescription of dietary measures and physical exercises. Anthropometric (BMI) and biological parameters (glycaemia, HbA1c) were measured at baseline and at three months of follow up. Comparison tests were performed using statistical software at a significance level of p &lt; 0.05. Thirty T1DM patients were recruited. The sex-ratio was 0.76 and the average age 12.83 ± 1.98 years. BMI, which was 22.36 ± 5.16 kg/m2 at baseline, was improved to 21.72 ± 3.71 kg/m2 after experimentation. Glycated hemoglobin and glycaemia levels also decreased from 9.02 ± 0.80 % and 1.51 ± 1.007 g/L, respectively, at baseline to 7.72 ± 1.01 % and 1.57 ± 0.41 g/L, respectively, at the end of the experimentation. Drug treatment combined with a healthy lifestyle and regular monitoring of biological parameters; improve the quality of life of diabetic children.

Predicting Surgical Site Infections in Spine Surgery: Association of Postoperative Lymphocyte Reduction.

Postoperative lymphopenia is reported as an excellent indicator to predict surgical-site infection (SSI) after spine surgery. However, there is still controversy concerning which serological markers can predict spinal SSI. This study aims to evaluate excellent and early indicators for detecting SSI, focusing on spine instrumented surgery. This study included 268 patients who underwent spinal instrumented surgery from January 2022 to December 2023 (159 female and 109 male, average 62.9 years). The SSI group included 20 patients, and the non-SSI group comprised 248 patients. Surgical time, intraoperative blood loss, and glycemic levels were measured in both groups. The complete blood cell counts, differential counts, albumin, and C-reactive protein (CRP) levels were measured pre-surgery and postoperative on Days 1, 3, and 7. In comparing the groups, the Mann-Whitney U test analysis was used for continuous variables, while the chi-squared test and Fisher's exact test were used for dichotomous variables. The incidence of SSI after spinal instrumentation was 7.46% and was relatively higher in scoliosis surgery. The SSI group had significantly longer surgical times (248 min vs. 180 min, p = 0.0004) and a higher intraoperative blood loss (772 mL vs. 372 mL, p < 0.0001) than the non-SSI group. In the SSI group, the Day 3 (10.5 ± 6.2% vs. 13.8 ± 6.0%, p = 0.012) and Day 7 (14.4 ± 4.8% vs. 18.8 ± 7.1%, p = 0.012) lymphocyte ratios were lower than the non-SSI group. Albumin levels on Day 1 in the SSI group were lower than in the non-SSI group (2.94 ± 0.30 mg/dL vs. 3.09 ± 0.38 mg/dL, p = 0.045). There is no difference in CRP and lymphocyte count between the two groups. SSI patients had lower lymphocyte percentages than non-SSI patients, which was a risk factor for SSI, with constant high inflammation. The Day 3 lymphocyte percentage may predict SSI after spinal instrumented surgery.