Glycemic Control In Diabetic Patients Research Articles

P086 Clinical outcome and in vitro antifungal susceptibility of clinical isolates of rhino-orbito-cerebral mycosis associated with post COVID 19 from North India

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM ObjectivesThis study aimed primarily to determine the etiology, clinical features, and comorbidities of patients with rhino-orbito-cerebral mycosis. Secondly, antifungal susceptibility pattern of the isolates and lineage by ITS-sequencing was also studied.MethodsThe study was conducted from May to December 2021 on all suspected cases of rhino-orbito-cerebral mycosis in post-COVID-19 patients at a tertiary care center. Data pertaining to demographics, recent COVID-19 infection, clinical features, comorbidities, laboratory, radiological investigations, management, and outcomes were collected after obtaining informed consent from all patients. Staging of ROCM was done using the proposed code Mucor and diagnosis of COVID-19 was done on basis of real-time polymerase chain reaction (RT-PCR) test. KOH Mount examination, fungal culture, and histopathological examination was performed on samples collected endoscopically or post-debridement. Mucormycosis was proven based on fungal culture or specific histological features from biopsy specimens. In vitro susceptibility profiles for antifungal drugs as per CLSI microbroth dilution method (M38-A2) was studied by HiMIC™ plate (HiMedia) for amphotericin B, voriconazole, posaconazole, itraconazole, and isavuconazole. MIC ranges and the drug concentrations required to inhibit 50% (MIC50) or 90% of isolates (MIC90) were determined. ITS Sequencing was also performed on representative isolates.ResultsA total of 70 patients were diagnosed with mucormycosis. Rhino-orbital and rhino-orbito-cerebral forms were observed in 35.7% of cases each. Diabetes mellitus (DM) was present in 95.7% patients while 78.5% of the patients were treated with corticosteroids in recent past, and 25.7% presented with active COVID-19 pneumonia. Most cases showed onset of symptoms of mucormycosis between 29 ± 17 days from diagnosis of COVID-19. On imaging, orbit was involved in 52.8% and cranial involvement is seen in 35.7% of patients. Diagnosis of mucormycosis was established on KOH direct microscopy 68.6%, culture 47.14%, histopathology 55.7%. Isolates obtained were Rhizopus arrhizus (42.4%), Apophysomyces variabilis (3.03%), and Aspergillus spp (69.7%) while mixed infection was seen in 42.4%. The MIC50 and MIC90 of amphotericin B for R. arrhizus strains were 0.25 and 4 μg/ml; and MIC50 and MIC90 results for itraconazole, posaconazole, and isavuconazole were 8 and 8, 2 and 2, and 2 and 8 μg/ml respectively. Aspergillus spp was susceptible to amphotericin B (38.8%), itraconazole (50%), voriconazole (50%), posaconazole (11.1%), and isavuconazole (44.4%). Overall treatment included intravenous amphotericin B along with functional endoscopic sinus surgery (FESS)/paranasal sinus (PNS) debridement in 68.2%, orbital exenteration in 4.2%, orbital decompression in 11.4% patients and partial maxillectomy in 22.8% cases. Intraorbital injection of amphotericin B was administered in 15.7%. At final follow-up, mortality was 19.7%. In vitro MICs showed that amphotericin B was the most active compound against most species.ConclusionHigh index of suspicion, early diagnosis, and appropriate management of mucormycosis can improve survival. Rational use of steroids and strict glycemic control in diabetic patients can prevent occurrence of mucormycosis. Use of standard methods for antifungal susceptibility testing to guide antifungal treatment may be clinically useful in cases of treatment failure.

Retrospective study on the relationship between glycemic control and dental treatment-associated infection among diabetic patients

BackgroundStandard glycemic control for diabetic patients receiving dental treatment is not established and administration of postoperative oral antibiotics is not recommended on global guidelines. Therefore, we investigated the relationship between glycemic control and infection after dental treatment as primary endpoint. Second endpoint was to reveal the efficacy of the preventive antibiotics administration for diabetic mellitus (DM) patients. MethodsTotal of 139 diabetic patients received dental treatments in our study. For the evaluation of blood glucose (BG) control, patients with before BG of ≥ 150 mg/dL were divided into those with persistent hyperglycemia (after BG of ≥ 150 mg/dL) and improved hyperglycemia (after BG of < 150 mg/dL). Patients with before and after BG of < 150 mg/dL and those with late-onset hyperglycemia (before BG of < 150 mg/dL, after BG of ≥ 150 mg/dL) were also assessed for infection risk. ResultsThe overall incidence of infection after dental treatment was 17.3 % (24/139). The use of preventive oral antibiotics after dental treatment did not significantly reduce the incidence of infections, compared with the patients were treated without antibiotics (16.1 % vs 23.8 %, P = 0.58). In infected patients, 59.1 % of patients were absence of hyperglycemia before and after dental treatments, while there was not significantly difference in the incidence of infections with BG controls (P = 0.99). ConclusionsIn conclusion, our data suggest that glycemic control is not a risk factor for infection after dental treatments and postoperative prophylaxis of oral antibiotics is not necessary for DM patients.

C-peptide levels and glycemic indices in COVID-19 patients

Type 2 diabetes (T2DM) is a common comorbidity in COVID-19 patients, which could favor disease progression. Our study aimed to evaluate the impact of some glycemic biomarkers on characteristic features of COVID-19. Electronic medical records of patients consecutively admitted to a COVID-19 ward were analyzed. Demographic and anthropometric as well as clinical and laboratory parameters were obtained. T2DM was present in 47% of the patients, with 22.58% of diabetic patients being newly diagnosed at admission. The most important predictors of severe COVID-19 were age (OR 1.214 [1.078-1.366], p = 0.001), creatinine levels (OR 1.018 [1.003-1.034], p = 0.017), glucose above 7.0 mmol/L at admission (OR 7.800 [2.232-27.255], p = 0.001) and HbA1c ≥ 6.5% (OR 4.840 [1.428-16.405], p = 0.011) irrespective of the presence of DM. C-peptide levels correlated positively with age, creatinine level, the severity of hypoxia and ferritin levels of patients (p < 0.05 for all) and appeared to be a significant predictor of leukocytosis. Suboptimal glycemic indices and impaired kidney function might predict COVID-19 disease worsening. Early detection of DM and optimization of glycemic control in diabetic patients should be among the priorities of the public health systems during COVID-19 pandemics.

Hemoglobin A1C as a prognostic factor and the pre-diabetic paradox in patients admitted to a tertiary care medical center intensive cardiac care unit

BackgroundHemoglobin A1C (HbA1c) is a form of glycated hemoglobin used to estimate glycemic control in diabetic patients. Data regarding the prognostic significance of HbA1c levels in contemporary intensive cardiac care unit (ICCU) patients is limited.MethodsAll patients admitted to the ICCU at a tertiary care medical center between January 1, 2020, and June 30, 2021, with documented admission HbA1c levels were included in the study. Patients were divided into 3 groups according to their HbA1c levels: < 5.7 g% [no diabetes mellitus (DM)], 5.7–6.4 g% (pre-DM), ≥ 6.5 g% (DM).ResultsA total of 1412 patients were included. Of them, 974 (69%) were male with a mean age of 67(± 15.7) years old. HbA1c level < 5.7 g% was found in 550 (39%) patients, 5.7–6.4 g% in 458 (32.4%) patients and ≥ 6.5 g% in 404 (28.6%) patients. Among patients who did not know they had DM, 81 (9.3%) patients had high HbA1c levels (≥ 6.5 g%) on admission. The crude mortality rate at follow-up (up to 1.5 years) was almost twice as high among patients with pre-DM and DM than in patients with no DM (10.6% vs. 5.4%, respectively, p = 0.01). Interestingly, although not statistically significant, the trend was that pre-DM patients had the strongest association with mortality rate [HR 1.83, (95% CI 0.936–3.588); p = 0.077].ConclusionsAlthough an HbA1c level of ≥ 5.7 g% (pre-DM & DM) is associated with a worse prognosis in patients admitted to ICCU, pre-DM patients, paradoxically, have the highest risk for short and long-term mortality rates.

Analytical performances of a glycated albumin assay that is traceable to standard reference materials and reference range determination.

BackgroundGlycated albumin (GA) is an intermediate‐term marker for monitoring glycemic control (preceding 2–3 weeks) in patients with diabetes mellitus. We evaluated the performance of Lucica Glycated Albumin‐L, a new GA assay that is traceable to standard reference materials and determined the reference range in healthy subjects without diabetes.MethodsThe performance and reference range studies were conducted in accordance with Clinical and Laboratory Standards Institute (CLSI) Guidelines. The traceability was established using reference material recommended by the Japan Society of Clinical Chemistry (JSCC).ResultsThe coefficient of variation (CV) of overall repeatability, within‐laboratory precision, and overall reproducibility values of GA values were not more than 2.6%, 3.3%, and 1.6%, respectively, among laboratories. The GA values showed good linearity from 173 to 979 mmol/mol (9.4%–54.9%) across the assay range. The GA reference range in 262 healthy subjects was between 183 and 259 mmol/mol (9.9%–14.2%) while that of subjects with diabetes was 217–585 mmol/mol (11.8–32.6%). The reagent was stable for 2 months on the bench at room temperature. The limits of blank, detection, and qualification were 6.9, 7.9, and 9.7 μmol/L for GA concentration, and 3.8, 7.0, and 21.8 μmol/L for albumin concentration, respectively. Hemoglobin slightly affected the assay, while other classical interfering substances had no significant impact.ConclusionsThe present GA assay shows comparable performance to current clinical assays and could be used for intermediate‐term monitoring of glycemic control in diabetes patients.

Impact of COVID-19 lockdown on glycemic control in diabetic patients hospitalized in emergency months

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Should the Quality of Glycemic Control Guide Dental Implant Therapy in Patients with Diabetes? Focus on Implant Survival.

Optimal glycemic control is crucial to dental implant long-term functional and esthetic success. Despite HbA1c levels of 7% or lower used is as an indicator for good glycemic control, however, this level may not be attainable for all diabetic patients. Most dentists do not consider patients with poor glycemic control candidates for implant therapy due to higher implant failure, infection or other complications. This review challenges the concept of one size fits all and aims to critically appraise the evidence for the success or failure rate of dental implants and peri-implant health outcomes in patients with less than optimal glycemic control. Evidence suggests that estimating glycemic control from HbA1c measurement alone is misleading. Moreover, elevated preoperative HbA1c was not associated with increased mortality and morbidity after major surgical procedures. Literature for the survival or success of implants in diabetic patients is inconsistent due to a lack of standardized reporting of clinical data collection and outcomes. While a number of studies report that implant treatment in patients with well controlled diabetes has a similar success rate to healthy individuals, other studies suggest that the quality of glycemic control in diabetic patients does not make a difference in the implant failure rate or marginal bone loss. This discrepancy could indicate that risk factors other than hyperglycemia may contribute to the survival of implants in diabetic patients. In the era of personalized medicine, the clinician should utilize individualized information and analyze all risk factors to provide the patient with evidence-based treatment options.

Relationship Between Periodontal Disease and Glycemic Control in Pediatric Patients with Type 2 Diabetes Mellitus

IntroductionType 2 Diabetes Mellitus (T2DM) is a disease of heterogeneous etiology, in which the patient presents alterations in metabolism, which are associated with a total or relative deficiency in insulin production and variable degrees of resistance to it1,2.T2DM and periodontal disease are chronic diseases, the evidence suggests an association between the two. Studies report that T2DM worsens the periodontal disease and glycemic control plays a fundamental role in this3.4.ObjectiveTo determine the relationship between periodontal disease and glycemic control in pediatric patients with T2DM.MethodologyAn observational, descriptive, cross‐sectional, prospective, homodemic and single‐center study was carried out in the pediatric stomatology service of the “Hospital para el Niño Poblano” (Puebla city, Mexico) in the period January‐July 2019 with 20 patients (between 6 to 18 years old) diagnosed with T2DM and were under treatment for their glycemic control.ResultsThe population was classified into patients with glycemic control based on glycated hemoglobin (HbA1c ≤ 7.5%) and patients without glycemic control (HbA1c&gt; 7.5%).The prevalence of periodontal disease for patients diagnosed with T2DM was higher in uncontrolled patients who were classified within high Community Periodontal Index (CPI) codes between 3 (71.4%) and 4 (28.6%)5(Table 1).Similarly, it was observed that in the group of patients without glycemic control presented averages of Simplified Oral Hygiene Index (OHI‐S) cataloged between fair (57.1%) and poor (42.9%) (Table 2).DiscussionSimilar results were obtained by Janket (2005)6and Carneiro (2015)7, who relate a higher rate of periodontal disease in patients with higher HbA1c values.ConclusionIt was determined a relationship between glycemic control and periodontal disease in children, because patients with poor glycemic control (HbA1c&gt; 7.5%) presented CPI with degrees of inflammation and presence of periodontal pockets and poor OHI‐S.References Islas S, Revilla MC. Diabetes Mellitus: Actualizaciones. IMSS. México, D.F.: Editorial Alfil. 2013. Menon S, Francis J, Zdraveska N, Dusabimana A &amp; Bhattacharyya S. La epidemiología de la hiperglucemia inducida por TB intransitoria en individuos con diabetes mellitus 2 no diagnosticada previamente: un protocolo para una revisión sistemática y un metanálisis. Revisiones sistemáticas. 2019; 8 (1): 1‐5. Britos MR, Sin CS, &amp; Ortega SM. Enfermedad periodontal y su implicancia en la diabetes mellitus: revisión de la literatura. Rev. Ateneo Argent. Odontol. 2019: 33‐40. Pérez I. Diabetes Mellitus. Gac Med Mex. 2016;152(1):50‐55. IPC. OMS (online, July 2019). URL available at: https://es.scribd.com/doc/84956710/Indice‐Periodontal‐de‐Russell‐forma‐OMS Janket S, Wightman A, Baird AE, Van Dyke T, Jones J. Does periodontal treatment improve glycemic control in diabetic patients? A meta‐analysis of intervention studies. J Dent Res. 2005;84(12):1154‐1159. Carneiro V, Calixto F, Morais F, Pegoretti T, Borges AC, da Silva M. The influence of glycemic control on the oral health of children and adolescents with diabetes mellitus type 1. Arch Endocrinol Metab. 2015;59(6):535‐540.

Factors associated with poor glycemic control in diabetic patients in Kirkuk

Background Iraq's health-care system has faced tremendous obstacles in its recovery from the Islamic State's conflict. There is no public insurance system in place. Iraq has set targets to prevent and control noncommunicable diseases (NCDs) such as diabetes, but safety confrontation and governmental insecurity have made these objectives difficult to achieve. Better glycemic control is critical in allowing patients to perform at their best in terms of diabetes management and preventing long-term complications. The goal is to identify the roadblocks to better glycemic management. The participants in this cross-sectional study were recruited from a diabetes out-patient clinic at Baba Gurgur diabetic facility. From April to December 2019, K1 hospital – North oil company in Kirkuk city. A validated questionnaire was used to interview those with an uncontrolled glycemic index (AIC7%). Patients were asked to name the primary causes of inadequate glucose control and to select more than one response based on their opinion. The mean A1C was 8.3 2.1 percent, with 256 (22.5 percent) patients having an A1C less than 7% and 880 (77.5 percent) having an A1C equal to or greater than 7. Poor glycemic control is caused by a lack of medication and/or a lack of drug supply from PHC in 51.1 percent of cases. Diet and medication non-compliance, as well as illiteracy, account for 35.1 percent and 19.8 percent of the population, respectively. Glycemic regulation is greatly influenced by one's financial situation. However, security issues and political instability play a significant impact. Conclusion: Diabetic patients confirmed poor glycemic control, with the majority of cases being linked to Iraq's current health situation.

Is REmogliflozin an effective Drug in MANaging Type-2 diabetes mellitus: A comparative study – (REDMAN)

Background and Aims: Remogliflozin is a new addition to class of Sodium Glucose Cotransporter-2 (SGLT-2) inhibitors available in India. The drug is introduced and marketed at a lower price range as compared to other gliflozins. Remogliflozin is expected to gain preference over other gliflozins as it is cheaper. However, the pragmatic value of remogliflozin in establishing and maintaining blood glucose control is yet to be established. This objective of this study was to establish the efficacy of remogliflozin in maintaining glycemic control in patients of T2DM when switching from other gliflozins.Methods: The study was conducted for a duration of four months in 159 diabetic patients, previously on combination of one gliflozin and other anti-hyperglycaemic agents. Patients were prescribed remogliflozin with instructions to not modify their dietary practices. Pre- and post-remogliflozin switch levels of conjugated haemoglobin were used to ascertain the effect of the drug on patients.Results: The mean pre- and post-remogliflozin switch HbA1c levels were found to be significantly different (p<0.000). HbA1c levels increased marginally but significantly in the patients after switching to remogliflozin. There were significant differences in the mean HbA1c levels and the mean difference in HbA1c levels among the patients switching from empagliflozin, canagliflozin or dapagliflozin.Conclusion: Although, remogliflozin is comparatively cheap and is a potential drug of choice for patients of T2DM to reduce their out-of-pocket expenditure. Its potential to maintain optimum glycemic control in diabetic patients is limited and its use and prescription required vigilant monitoring.

Bioactive compounds of corn silk and their role in management of glycaemic response.

Management of glycaemic response is perhaps the most critical part of antidiabetic therapy. Hypoglycaemia is an avoidable complication caused by conventional drugs used in the treatment of diabetes. It triggers commonly during the intensification of anti-hyperglycemic therapy used to render glycemic control in diabetic patients. The commercial oral hypoglycaemic drugs, insulin, herbal medicines and plant extracts are therefore used as a part of the treatment of diabetes. The demand for treating diabetes, through herbal and plant resources is due to their lesser adverse reactions and better phytochemical benefits. Corn silk has been shown to have anti-allergic, anti-inflammatory, and anti-hypertensive effects when extracted in various solvents. Corn silk has medicinal characteristics and has long been used as a traditional medicine in many nations, although the mechanism of action is unknown. The hypoglycaemic effects of corn silk are investigated in this review. The phytochemical components present in corn silk-like flavonoids, phenolics, terpenoids, tannins, sterols, and alkaloids are phytochemical components that have hypoglycemic activity and a mechanism for lowering blood glucose levels. There is a lack of a homogenized database on the hypoglycemic properties of corn silk thus the present review attempts to critically analyse it and provide specific recommendations of its doses.

Effect of achieving sustained virological response with direct-acting antiviral agents on glycemic control in diabetic patients with chronic hepatitis C infection

BackgroundHepatitis C virus (HCV) is a significant cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma worldwide. Liver disease is not the only problem caused by chronic HCV infection; many extrahepatic complications, such as insulin resistance, can be associated with HCV infection. The aim of this study was to assess the effect of achieving a sustained virological response after treatment with directly acting antiviral drugs on insulin resistance in patients with chronic HCV infection.ResultsThis prospective study was conducted on 46 HCV patients with type 2 diabetes mellitus who received directly acting antiviral drugs for HCV infections. Fasting insulin, fasting blood glucose, and lipid profiles were assessed in all patients at three time points: before treatment, at the end of treatment, and 12 weeks after the end of treatment. Despite using three different directly acting antiviral drug regimens, all patients achieved a sustained viral response, regardless of the regimen used. the Homeostatic Model Assessment for Insulin Resistance decreased significantly at the end of treatment; however, when recalculated at week 12 after end of treatment, the reduction of the Homeostatic Model Assessment for Insulin Resistance was not significant compared to the baseline levels. Total cholesterol and low-density lipoproteins increased at the end of treatment and continued to increase for 12 weeks after the end of treatment.ConclusionsImprovements in insulin resistance and glycemic control were noted in HCV patients at the end of treatment with directly acting antiviral drugs; this effect was also apparent after 12 weeks. An increase in the levels of total cholesterol and low-density lipoprotein can be expected after treatment with directly acting antiviral drugs.

Investigating the Effectiveness of Dialectical Behavior Therapy on Resilience, Psychological Flexibility, and Glycemic Control of Diabetic Patients

Aims Diabetes is a widespread chronic disease that, in addition to affecting the individual’s clinical condition, imposes high costs on societies worldwide. This study aims to investigate the effectiveness of dialectical behavior therapy on the resilience, psychological flexibility, and glycemic control of diabetic patients. Methods &amp; Materials This research was practical in purpose and semi-experimental in method with a pre-test/post-test design with a control group. The statistical population comprised all people with diabetes who were referred to Sayad Hospital in Gorgan City, Iran, in 2022. From this statistical population, 30 patients were selected via the available sampling method and randomly divided into an experimental (n=15) and a control group (n=15). The experimental group was trained in dialectical behavior therapy, while the control group did not receive any psychological intervention during the implementation of the research. The research tool was the Connor and Davidson resilience questionnaire (2003) and the Dennis psychological flexibility questionnaire (2010). Research data were analyzed by multivariate covariance analysis using the SPSS software, version 24. Findings The Mean±SD of the post-test total score of resilience, psychological flexibility, and glycemic control in the experimental group were respectively 80.60±20.62, 91.00±25.64, and 198.10±26.52. These numbers were respectively 77.20±22.86, 75.60±22.29, and 204.30±30.18 for the control group. Dialectical behavior therapy had a significant effect on the resilience, flexibility, and glycemic control of diabetic patients (P&lt;0.05). Conclusion By performing mindfulness exercises and emotional experience modulation, dialectical behavioral therapy training has led to the promotion of mental health, improvement of resilience skills, and flexibility of diabetic patients. Therefore, this method can be used as a new approach to increase the self-care skills of patients with diabetes in health-related centers.

A Novel Non-Invasive Device For Screening And Optimized Management To Improve Heart Failure Outcomes In Patients With Diabetes Mellitus

<h3>Background</h3> Evidence shows diabetes mellitus (DM) is major independent risk factor for several cardiovascular disorders including heart failure (HF). Large, randomized clinical trials for screening and revascularization of stable macrovascular disease in diabetics, have failed to demonstrate a significant reduction in cardiac events and HF episodes. Studies have demonstrated that early detection of left ventricular dysfunction and prevention of microvascular complications through glycemic control in diabetes patients is a critical mechanism for reducing the incidence and severity of left ventricular dysfunction and HF. There is a need for a non-invasive, affordable, accurate, absolute and actionable method to facilitate optimized management of diabetes patients across the continuity of care. HEMOTAG, is a small portable device that uses micro-sensors to capture cardiac vibrations and electrocardiogram, transduced via thoracic electrodes. It is a viable option to measure cardiac time intervals (CTIs), surrogate markers for measurements of left ventricular dysfunction. <h3>Methods</h3> In 98 diabetes patients, the predictability value of HEMOTAG-derived CTIs- systolic time ratio index (STRi) = aortic valve opening/ (aortic valve opening to aortic valve closing) normalized by heart rate, aortic valve closing (AVC) and mitral valve opening (MVO) were assessed as valid markers for left ventricular dysfunction measured simultaneously at the time of transthoracic echocardiogram; to determine reduced ejection fraction (EF) <50%, <35%; elevated E/e'>14; and elevated left atrial volume index (LAVI) > 34 ml/m². Linear correlation analysis was performed. Sensitivity, specificity, positive, and negative predictive values were calculated. <h3>Results</h3> Mean age was 70.3 ± 11.6 years, mean EF was 59.0 ± 12.7%, mean E/e' was 17.9 ± 8.5, mean LAVI was 35.4 ± 16.1 ml/m², 30.2% were women. The following was noted with a paired dichotomous interpretation; for STRi and EF <35%: sensitivity 100%, specificity 88%, AUC 0.94; for STRi and EF <50%: sensitivity 94%, specificity 87%, AUC 0.93; for MVO and E/e' >14: sensitivity 92%, specificity 45%, AUC 0.63; for AVC and LAVI>34 ml/m²: sensitivity 92%, specificity 53%, AUC 0.65. <h3>Conclusions</h3> HEMOTAG detected systolic and diastolic dysfunction with high sensitivity and high specificity. This preliminary study has demonstrated the feasibility of estimating left ventricular dysfunction using a portable, non-invasive device that can facilitate screening and optimized management to improve HF outcomes in patients with DM. Further studies are required to validate HEMOTAG as a point-of-care non-invasive assessment for patients with DM. HEMOTAG® development and the clinical study is supported by NHLBI SBIR grant # R44HL149561.

IDF21-0623 Precipitating factors of hypoglycemia in diabetic patients undergoing treatment in Taksin hospital

Background: Hypoglycemia is the most common complication and also the most important obstacle to overcome in order to achieve good glycemic control in diabetic patients. It causes serious consequences, leading to increased morbidity and mortality.

The Association Between Coronary Artery Disease and Type 2 Diabetes Mellitus in Libyan Adults: A Cross-Sectional Study

Background and objectives. Diabetes mellitus is a highly prevalent chronic multisystem disease and it has a significant impact on the health of many important organs in our body, including the cardiovascular system (CVS). This study aimed to determine the association between Type 2 diabetes mellites (T2DM) and the development of coronary artery disease (CAD). Methods. A retrospective cross-sectional study was conducted on patients who were diagnosed with CAD and T2DM. We examined the likelihood occurrence of CAD in T2DM patients using the Bayesian one sample test. Results. About 97 patients were confirmed to have CAD and were included in the study. The mean age of participants was 60±11.89. Approximately, 53 (54.6%) of patients were females, while 44 (45.4%) were males. The vast majority of patients had T2DM and CAD at 69 (71.1%) as opposed to only 28 (28.9%) of patients who did not have T2DM but had CAD. Moreover, there was a statistically significant increase in the likelihood of occurrence of CAD amongst the T2DM group. The percentage of patients who have T2DM with CAD was significantly higher than those who were not diagnosed with T2DM but had CAD at 69 (71.1%) compared to 28 (28.9%) (P = 0.002) for the group of T2DM concomitant with CAD, and the group of non-T2DM concomitant with CAD, respectively. Conclusion. There was a significant relationship between T2DM and CAD, suggesting the importance of intensive glycemic control in diabetic patients possibly via lifestyle modifications or medications in order to reduce or delay the possibility of occurrence of CAD amongst diabetic patients, in particular.

Changes in the glycosylated hemoglobin levels and body mass index after decompression surgery in patients with lumbar spinal stenosis in a tertiary care center, Saudi Arabia

Objectives: Lumbar spinal decompression surgery is a well-studied intervention in its benefit in pain control. It can also improve physical activity that indirectly facilitates glycemic control in diabetic patients and weight loss in obese patients. This study aimed to assess the changes of glycosylated hemoglobin (HbA1c) and body mass index (BMI) in patients with lumbar spinal stenosis (LSS) post-intervention at 6- and 12-month follow-ups. Methods: This was a retrospective cohort study of patients with LSS who had lumbar decompression, with or without instrumentation at King Abdulaziz Medical City, from 2016 and 2020. Patients over 18 years, treated surgically for LSS, were included with a minimum of a 1-year follow-up. Patients with Type 1 diabetes mellitus, with comorbidities, that limited physical activity, or without follow-up records were excluded from the study. Results: In total, 140 patients were included in the study. They had three underlying diseases: LSS (n = 87, 62.1%), spondylolisthesis (n = 37, 26.4%), and degenerative disc disease (n = 16, 11.4%). Results showed that obese patients were associated with the lower BMI at 6- and 12- month follow-ups compared to the non-obese. In addition, there was a statistical difference in HbA1c change at follow-ups between controlled (HbA1c &lt;7) and uncontrolled diabetes groups (HbA1c ≥7). Conclusion: Lumbar spinal decompression can help in the reduction of BMI of obese patients with LSS. However, there is a need for extensive investigation of the reasons for the contradicting results of an increase in the HbA1c level at 12-month follow-up in the current study.

Habitual Dietary Fiber Intake, Fecal Microbiota, and Hemoglobin A1c Level in Chinese Patients with Type 2 Diabetes.

High-fiber diet interventions have been proven to be beneficial for gut microbiota and glycemic control in diabetes patients. However, the effect of a low level of fiber in habitual diets remains unclear. This study aims to examine the associations of habitual dietary fiber intake with gut microbiome profiles among Chinese diabetes patients and identify differential taxa that mediated associations of dietary fiber with HbA1c level. Two cross-sectional studies and one longitudinal study were designed based on two follow-up surveys in a randomized trial conducted during 2015–2017. The study included 356 and 310 participants in the first and second follow-ups, respectively, with 293 participants in common in both surveys. Dietary fiber intake was calculated based on a 3-day 24-h diet recall at each survey and was classified into a lower or a higher group according to the levels taken based on the two surveys using 7.2 g/day as a cut-off value. HbA1c was assayed to assess glycemic status using a cut-off point of 7.0% and 8.0%. Microbiome was profiled by 16S rRNA sequencing. A high habitual dietary fiber intake was associated with a decrease in α-diversity in both the cross-sectional and longitudinal analyses. At the first follow–up, phylum Firmicutes and Fusobacteria were negatively associated with a higher dietary fiber intake (p < 0.05, Q < 0.15); at the second follow-up, genus Adlercreutzia, Prevotella, Ruminococcus, and Desulfovibrio were less abundant in patients taking higher dietary fiber (p < 0.05, Q < 0.15); genus Desulfovibrio and Ruminococcaceae (Unknown), two identified differential taxa by HbA1c level, were negatively associated with dietary fiber intake in both the cross-sectional and longitudinal analyses, and mediated the dietary fiber-HbA1c associations among patients taking dietary fiber ≥ 7.2 g/day (mediation effect β [95%CI]: −0.019 [−0.043, −0.003], p = 0.018 and −0.019 [−0.046, −0.003], p = 0.016). Our results suggest that habitual dietary fiber intake has a beneficial effect on gut microbiota in Chinese diabetes patients. Further studies are needed to confirm our results.

'Analogy-Based Comprehensive Diabetes Education' (ABCDE) Improves Glycemic Control of Diabetic Patients in an Underserved Population: Results of a Retrospective Chart Analysis.

Diabetes is the leading global cause for blindness, kidney failure and amputations. Preventing these complications requires optimal glycemic control, and it is imperative that diabetic patients understand the fundamental concepts of diabetes care. Although patients attend formal diabetes education classes, many do not comprehend basic concepts of diabetes, and are often noncompliant with diet, exercise and medications. A novel approach termed ‘analogy-based comprehensive diabetes education’ (ABCDE) was developed to educate HIV-patients with diabetes about basic concepts of diabetes care. The object of this manuscript is to report the results of a retrospective chart review on the impact of ABCDE on glycemic outcomes in 24 patients who had failed usual care (including formal diabetes education, physician visits, and diabetic medications), and were non-adherent with diet and medications. They received only the ABCDE without any changes in pharmacotherapy. The impact on glycosylated hemoglobin (HbA1c) and fasting blood glucose (FBG) was assessed at subsequent visits. HbA1c was found to decline by 22% and 33% after 3 and 6 months, respectively, with corresponding declines in FBG by 53% and 59%, respectively. These results suggest that ABCDE in outpatient diabetes clinics could be effective in behavior modification toward improving glycemic control, and warrants additional investigation.

Sex Differences in the Effects of CDKAL1 Variants on Glycemic Control in Diabetic Patients: Findings from the Korean Genome and Epidemiology Study.

Using long-term data from the Korean Genome and Epidemiology Study, we defined poor glycemic control and investigated possible risk factors, including variants related to type 2 diabetes mellitus (T2DM). In addition, we evaluated interaction effects among risk factors for poor glycemic control. Among 436 subjects with newly diagnosed diabetes, poor glycemic control was defined based on glycosylated hemoglobin trajectory patterns by group-based trajectory modeling. For the variants related to T2DM, genetic risk scores (GRSs) were calculated and divided into quartiles. Risk factors for poor glycemic control were assessed using a logistic regression model. Of the subjects, 43% were in the poor-glycemic-control group. Body mass index (BMI) and triglyceride (TG) were associated with poor glycemic control. The risk for poor glycemic control increased by 11.0% per 1 kg/m2 increase in BMI and by 3.0% per 10 mg/dL increase in TG. The risk for GRS with poor glycemic control was sex-dependent (Pinteraction=0.07), and a relationship by GRS quartiles was found in females but not in males. Moreover, the interaction effect was found to be significant on both additive and multiplicative scales. The interaction effect was evident in the variants of cyclin-dependent kinase 5 regulatory subunit-associated protein 1-like (CDKAL1). Females with risk alleles of variants in CDKAL1 associated with T2DM had a higher risk for poor glycemic control than males.