Glycemic Control In Diabetic Patients Research Articles

Recent drug development of dorzagliatin, a new glucokinase activator, with the potential to treat Type 2 diabetes: A review study.

Type 2 diabetes mellitus (T2DM) is a complicated disease related to metabolism that results from resistance to insulin and sustained hyperglycemia. Traditional antidiabetic drugs cannot meet the demand of different diabetes patients for reaching the glycemic targets; thus, the identification of new antidiabetic drugs is urgently needed for the treatment of T2DM to enhance glycemic control and the prognosis of patients suffering from T2DM. Recently, glucokinase (GK) has attracted much attention and is considered to be an effective antidiabetic agent. Glucokinase activators (GKA) represented by dorzagliatin could activate GK and mimic its function that triggers a counter-regulatory response to blood glucose changes. Dorzagliatin has shown great potential for glycemic control in diabetic patients in a randomized, double-blind, placebo-controlled Phase 3 trial (SEED study) and had a favorable safety profile and was well tolerated (DAWN study). In the SEED study, dorzagliatin significantly reduced glycosylated hemoglobin (HbA1c) by 1.07% and postprandial blood glucose by 2.83 mol/L, showing the great potential of this drug to control blood glucose in diabetic patients, with good safety and good tolerance. An extension of the SEED study, the DREAM study, confirmed that dorzagliatin monotherapy significantly improved 24-h glucose variability and increased time in range (TIR) to 83.7% over 46 weeks. Finally, the clinical study of dorzagliatin combined with metformin (DAWN study) confirmed that dorzagliatin could significantly reduce HbA1c by 1.02% and postprandial blood glucose by 5.45 mol/L. The current review summarizes the development of GK and GKA, as well as the prospects, trends, applications, and shortcomings of these treatments, especially future directions of clinical studies of dorzagliatin.

Comparison of Glycated Hemoglobin (Hba1c%) between High Performance Liquid Chromatography (HPLC) and Non-HPLC Methodology

Background: Glycated hemoglobin (HbA1c) serves as a pivotal marker for the long-term management of glucose levels in patients with diabetes. Accurate measurement of HbA1c is crucial for effective diabetes management and prevention of associated complications. While High-Performance Liquid Chromatography (HPLC) is widely used, non-HPLC methods have also gained popularity due to their simplicity and cost-effectiveness. Discrepancies in measurement between these methods have been a concern, impacting clinical decisions. Objective: The objective of this study was to compare the measurement of HbA1c% using HPLC and non-HPLC methods in a cohort of diabetic patients, evaluating the consistency and reliability of these methodologies. Methods: A cross-sectional study was conducted at Hayatabad Medical Complex, MTI, Peshawar from November 2023 to March 2024. A total of 65 diabetic patients aged between 18 and 70 years were enrolled. Participants were excluded if they had conditions known to affect HbA1c measurement. HbA1c levels were measured using both HPLC and non-HPLC methods. Statistical analysis was performed using SPSS version 25, employing t-tests to compare the mean HbA1c levels and Bland-Altman analysis to assess agreement between the two methods. Results: The HPLC method showed a mean HbA1c% of 8.2 (SD = 1.4) while the non-HPLC method showed a mean HbA1c% of 7.6 (SD = 1.3). The Bland-Altman analysis indicated that 91.5% of the values fell within the limits of agreement, suggesting substantial agreement between the methods. The mean difference in HbA1c% between methods was 0.6%, with limits of agreement from -0.3 to 1.5. Conclusion: Both HPLC and non-HPLC methods provided reliable HbA1c measurements, with a high degree of agreement. Despite minor discrepancies in mean values, both methodologies are suitable for the clinical monitoring of glycemic control in diabetic patients. Further studies with larger sample sizes and multiple centers are recommended to validate these findings.

Oral Health Education in Patients with Diabetes: A Systematic Review.

Diabetes is known as a "silent epidemic" and is a public health problem that accounts for 9% of all deaths worldwide. The prevention of diabetes is a significant challenge, as its prevalence and incidence are both increasing rapidly. According to the World Health Organization (WHO), education is the cornerstone of diabetes treatment. Since the severity of oral diseases is significantly higher in diabetic patients, this systematic review aims to highlight the oral care of diabetic patients as a priority for glycemic control and the importance of education for diabetic patients' oral health. We evaluated 20 clinical studies and 15 meta-analyses from PubMed and Google Scholar over the last five years. Their main themes are the direct relationship between diabetes and oral health, especially periodontitis, and the necessity of education and behaviors that can lead to a better quality of life. Our analysis indicated that good oral health is a critical factor of glycemic control in diabetic patients and can be enhanced by targeted educational programs, backed by long-term medical and dental follow-up. Healthcare personnel should be encouraged to develop their knowledge of oral health in relation to the disease so that behaviors can be adopted to improve patients' quality of life. Telemedicine could also contribute to patient education and self-management of the disease.

Glycaemic control among adults with type 2 diabetes mellitus in the Gulf Cooperation Council countries: an updated review.

Type 2 diabetes mellitus (T2DM) has become a major public health concern, causing significant disability and death worldwide. Fuelled by a modern sedentary lifestyle and poor dietary practices, T2DM affects at least 10.5% of the world's population. This paper seeks to review the progress made by the Gulf Cooperation Council (GCC) countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates) in addressing T2DM, focusing on glycaemic control proportions and comparing it with the 2015 review. The results indicate no significant improvement in glycaemic control proportions since the last review, with only 9.2% to 56.9% of patients having good control (glycosylated haemoglobin < 7%). However, there are no significant differences in glycaemic control between the GCC countries and other places worldwide despite being considered hotbeds of T2DM. Many factors contribute to poor glycaemic control. Specifically, evidence shows that being overweight or obese is the most common modifiable risk factor for T2DM incidence and poor glycaemic control. The GCC countries have higher rates of obesity. Additionally, poor glycaemic control is mainly related to a lack of adherence to insulin and medication use. Poor diet, rich in calories and low in fruits and vegetables, and a sedentary lifestyle also significantly contribute to poor glycaemic control and obesity. Therefore, to reduce the incidence of disease and improve glycaemic control in diabetic patients, educational programs promoting lifestyle changes should be implemented. Ongoing research is also necessary to assess the trend of glycaemic control and its risk factors in our region.

Impact of Anemia on the Determination of Glycated Haemoglobin by High-Performance Liquid Chromatography in Diabetic Patients

Introduction: Glycated haemoglobin is considered an objective element in monitoring glycaemic control in diabetic patients. High-performance liquid chromatography (HPLC) is the reference method for measuring HbA1c. However, even this method can be affected by certain conditions such as anemia. Purpose: To study the impact of anaemia on the measurement of glycated haemoglobin levels by HPLC in diabetic patients. Methodology: We conducted a prospective, descriptive and comprehensive study from November 2022 to April 2023, on 06 months at the Mali Hospital, measuring glycated haemoglobin, blood glucose and haematological parameters (CBC). Results: We included 71 diabetic patients, 42.3% were men and 57.7% women. In our study population, 33.8% were anaemic, among them 16.9% were women and 16.9% men. The age group [50-80] years constituted the majority (n = 14) of anaemic patients. The most common type of anaemia in our diabetic patients was normocytic anaemia. HbA1c &gt;7% was found in 91.6% (n=22) of our anaemic patients. The mean haemoglobin level was not statistically significantly different from the HbA1c level (P = 0.0595). There was a statistically significant difference between MCHC and HbA1c (P = 0.04). To our knowledge, we did not observe any significant impact of anaemia on the measurement of HbA1c by the HPLC method. Conclusion: Our study showed a high frequency of normocytic anaemia in diabetic patients. We also noted that the reliability of HPLC in measuring HbA1c was not affected by a minor decrease in total haemoglobin levels.

Insulin Analogs and the Mode of Insulin Delivery: Recent Advances and Challenges.

Diabetes is a medical condition associated with impaired glucose regulation caused either due to insufficient insulin production or resistance to insulin (Type 2 diabetes, gestational diabetes) or the absence of insulin through the selective killing of beta cells in the pancreas (Type 1 diabetes). Irregular insulin production leads to various health complications. To prevent such complications, patients must adhere to medical recommendations before availing of any advanced insulin therapy(ies), considered productive for the treatment. Natural insulin, although highly effective in controlling blood glucose levels, patients are often at risk of developing hypoglycemia and many other complications. This has led to the development of insulin analogs, the modified variants of natural insulin having a minimal risk of causing hypoglycemia. Besides the development of analogs, the mode of insulin delivery is also considered critical in achieving better glycemic control in diabetic patients. Until recently, various exogenous insulin delivery methods were practiced, but effective glycemic control without any associated risk and ease of delivery remains a subject of paramount concern. It countered attenuation or delayed onset of diabetes-associated complications without a permanent cure, raising an unmet demand for insulin formulations and delivery methods that offer stability, biocompatibility, reproducibility, precision dosing, non-immunogenicity, and safety. The current practice utilizes non-physiological delivery methods with less invasive administration routes, offering glycemic stability and therapeutic effectiveness. This review focuses on the recent advances made and future perspectives envisioned about newer insulin therapies and delivery methods that tend to improve the management of diabetes by inculcating ideas to reduce the disease's severity and improve the quality of life.

Chronic Kidney Disease and SGLT2 Inhibitors

Sodium glucose cotransporter 2 (SGLT2) inhibitors were initially developed to enhance glycemic control in diabetic patients, but they have emerged as a promising treatment for individuals with chronic kidney disease (CKD) regardless of diabetic status. A collaborative meta-analysis of large-scale SGLT2 inhibitor trials has provided compelling evidence supporting recommendations for the use of these agents in CKD patients, regardless of their primary kidney disease diagnosis or whether they have diabetes. Notably, the kidney-protective benefits of SGLT2 inhibitors have been observed across various stages of CKD, including advanced stage 4 CKD, and across all levels of albuminuria. Given the robust evidence highlighting the benefits of SGLT2 inhibitors across a broad spectrum of CKD patients, these agents should be considered foundational therapy for CKD, in order to mitigate the progression to kidney failure and its associated complications. Although the beneficial effects of SGLT2 inhibitors may not be immediately apparent, they are expected to grow over time, potentially altering the prognosis for numerous CKD patients.

Public health insurance: An approach to mitigate the burden of diabetes in low resource settings

Background: Diabetes mellitus is a significant public health concern globally as well as in Owerri, Nigeria. The deleterious effects of diabetes have been linked to poor glycemic control. According to the International Diabetes Federation, poor glycemic control is reflected in glycosylated hemoglobin levels greater than 7.0%, which are associated with substantial morbidity and mortality. Studies have shown a dramatic rise in diabetic complications in Nigeria, particularly in Owerri. However, evidence is lacking on specific risk factors associated with poor glycemic control among diabetes mellitus patients in Owerri. There is a gap in the literature regarding the association between health insurance and glycemic control in diabetic patients in Owerri. With health insurance assuming a significant position in healthcare service delivery in Nigeria, addressing this gap is valuable. Methods: We performed a cross-sectional study of health insurance as a determinant of glycemic control among 160 type 2 diabetic patients attending the family medicine clinic at the Federal University Teaching Hospital, formerly the Federal Medical Center, Owerri. Participants were measured as not insured, insured-private, and insured-public/National Health Insurance Scheme. The dependent variable was glycemic control measured using glycosylated hemoglobin. We used ecosocial theory as the theoretical framework of this research. SPSS was used for data analysis; multiple logistic regression was applied to assess the association between insurance status and glycemic control in the participants. Results:In the patients without health insurance coverage, the prevalence of poor glycemic control was 93.8% whereas in those with health insurance coverage, the prevalence was 60.0%. Logistic regression analysis showed that lack of access to health insurance was a determinant of glycemic control, with uninsured subjects at 28 times and 6 times increased risk of poor glycemic control compared with insured-private and insured-public subjects, respectively. Conclusion: We have shown in our study that insured enrollees have an increased likelihood of good glycemic control relative to uninsured subjects. This finding has the potential to promote positive social change through optimization of the National Health Insurance Scheme. Enabling regulations and designing policies to explicitly cover diabetes preventive and control services in the scheme could lead to improved glycemic control, and, thus, reduce the burden of the disease.

Poor Prestroke Glycemic Control Increases the Rate of Symptomatic Intracranial Hemorrhage after Mechanical Thrombectomy.

(1) Background: Diabetes is a well-established risk factor for acute ischemic stroke (AIS). This study evaluated the impact of prestroke glycemic control in diabetic patients on their 3-month clinical outcome after mechanical thrombectomy (MT). (2) Methods: AIS patients with a premorbid modified Rankin scale (mRS) score of 0-2 who were admitted within 6 h after stroke onset and treated with MT between January 2020 and August 2023 were retrospectively analyzed. The study evaluated the effect of prestroke glycemic control on the stroke severity, reperfusion rate, symptomatic intracranial hemorrhage (sICH) and favorable clinical outcome (modified Rankin scale score 0-2) at 3 months after endovascular treatment. (3) Results: A total of 364 patients were analyzed, with 275 cases of non-diabetes (ND), 66 of well-controlled diabetes (WCD) and 23 of poorly controlled diabetes (PCD). There was no significant difference in the baseline neurological deficit expressed according to the National Institutes of Health Stroke Scale among the three groups. The time from stroke onset to groin puncture was similar in the ND, WCD and PCD groups (median 215 min, 194.5 min and 222.5 min, respectively). There was no significant difference in the favorable 3-month clinical outcomes among these three groups (35.2% of ND patients, 42.4% of WCD patients and 39.1% of PCD patients) or full recovery (12.4% of ND patients, 11.0% of WCD patients and 17.4% of PCD patients). The rate of sICH was significantly higher in the PCD group as compared to the ND and WDP groups (21.7% of PCD patients versus 7.6% of ND patients, p = 0.038, and 6.0% of WCD patients, p = 0.046), but the 3-month mortality did not differ between the three groups (21.8% of ND group, 19.7% of WCD group and 26.1% of PCD group). (4) Conclusions: This study shows that poor prestroke glycemic control in AIS diabetic patients does not change the chance of a good clinical functional outcome after endovascular treatment. However, the increased risk of hemorrhagic complications in this group of patients should be considered.

Effect of Resveratrol as an adjunct to Scaling and Root Planing in Chronic Periodontitis Patients with Type 2 Diabetes

Resveratrol is a polyphenol stilbene found in red wine, red grape skins and other plants such as mulberries and peanuts. Resveratrol exhibits a wide range of beneficial properties such as anticarcinogenic agent, platelet antiaggregation agent, antiallergenic, antioxidant, and anti- inflammatory agent. Material and Methods A total of 30 patients diagnosed as chronic periodontitis with diabetes were included in this study. and divided into 2 groups, Group-I(SRP+ resveratrol, n=15) &amp; Group-II (SRP alone, n=15). Resveratrol capsules once daily were prescribed for 3 weeks. Plaque index(PI), Gingival index (MSBI), probing pocket depth (PPD), clinical attachment level (CAL) and serum venous blood sample collection for HbA1c levels. All the parameters were recorded at baseline and at 3 months post-operative. Results All the parameters in both Group I and Group II showed statistically significant (P≤0.001) reduction from baseline to 3 months. improvement from baseline to 3 months. When compared between the two groups, a significant difference was observed in Group I in relation with PI and HbA1c levels at 3 months post-operatively. Conclusion Resveratrol as adjunctive to SRP has shown reduction in periodontal parameters in chronic periodontitis along with improved glycemic control in diabetes patients. Key Words: Diabetes, Glycated hemoglobin levels, Resveratrol, Scaling and root planing

D-dimer variation in diabetic and non-diabetic patients of COVID-19

Diabetes mellitus is one of the serious comorbidities in patients with COVID-19. D-dimer which is a marker of fibrinolysis, the levels of which were quite different between the diabetic and nondiabetic groups. Hence, it is important to assess the levels of D-dimer in COVID-19 patients. The present study aimed to assess the variability of D-dimer in diabetic and non-diabetic patients with COVID-19 and its association with the severity of COVID-19 illness with glycemic control of diabetic patients. All the hospitalized patients of COVID-19 were included and diabetic and non-diabetic populations were differentiated based on their previous history, fasting blood sugar, random blood sugar and glycated hemoglobin (HbA1c). Outcomes were assessed based on evaluation of HbA1c levels with D-Dimer values and assessing the severity of illness by Computed tomography severity index (CTSI) and duration of hospital stay. Also, D-dimer variation in the two groups of COVID-19 with outcomes was observed. The D-dimer levels, CTSI and hospital stay of the diabetic patients were significantly higher than non-diabetic patients. Association for patients with D-dimer values and HbA1c of class interval 6.5–7.5 %, 7.6–9 % and > 9 % was highly significant, suggesting that patients having higher levels of D-dimer were associated with uncontrolled glycemic values. Poor glycemic control was associated with higher D-dimer values and higher CT severity Index. All COVID-19 patients with diabetes be followed closely to detect complications at early stage as the disease is more severe in diabetics as compared to non-diabetics.

The effect of preoperative different dexamethasone regimens on postoperative glycemic control in patients with type 2 diabetes mellitus undergoing total joint arthroplasty: a retrospective cohort study

BackgroundConcerns have been raised regarding the impact of preoperative intravenous dexamethasone on postoperative glycemic control in diabetic patients undergoing total joint arthroplasty (TJA). This study aimed to determine relationships between preoperative different dexamethasone regimens and postoperative fasting blood glucose (FBG), as well as to identify risk factors for postoperative FBG ≥ 200 mg/dl in diabetic patients undergoing TJA.MethodsThis retrospective study included 1216 diabetic patients undergoing TJA and categorized into group A (dexamethasone = 0 mg), group B (dexamethasone = 5 mg), and group C (dexamethasone = 10 mg). All dexamethasone was administered before skin incision. FBG levels were monitored until postoperative day (POD) 3. Analyses were conducted for periprosthetic joint infection (PJI) and wound complications during 90 days postoperatively. And the risk factors for postoperative FBG ≥ 200 mg/dl were identified.ResultsPreoperative dexamethasone administration resulted in a transiently higher FBG on POD 0 and POD 1 (all P < 0.001). However, no differences were observed on POD 2 (P = 0.583) and POD 3 (P = 0.131) among three groups. While preoperative dexamethasone led to an increase in postoperative mean FBG and postoperative maximum FBG (all P < 0.001), no differences were found in wound complications (P = 0.548) and PJI (P = 1.000). Increased HbA1c and preoperative high FBG, but not preoperative dexamethasone, were identified as risk factors for postoperative FBG ≥ 200 mg/dl. Preoperative HbA1c level of ≥ 7.15% was associated with an elevated risk of postoperative FBG ≥ 200 mg/dl.ConclusionsAlthough preoperative intravenous administration of 5 mg or 10 mg dexamethasone in diabetic patients showed transient effects on postoperative FBG after TJA, no differences were found in the rates of PJI and wound complications during 90 days postoperatively. Notably, patients with a preoperative HbA1c level of ≥ 7.15% and elevated preoperative FBG may encountered postoperative FBG ≥ 200 mg/dl.

Factors linked to poor glycemic control in an outpatient diabetic clinic: a cross-sectional study in Saint-Nicolas Hospital, Haiti

Background Adequate glycemic control prevents acute complications and reduces the risk of long-term complications, the use of services, and societal costs. In clinical practice, achieving good glycemic control for a diabetic patient over the long term is a challenge, considering the complexity of the factors. No study to date has been carried out on diabetic patients and the factors that may be linked to poor glycemic control in Haiti. The main objective of this study was to identify factors related to poor glycemic control in diabetic patients. Methods This analytical cross-sectional study was designed to evaluate the long-term management of diabetic patients. Patients seen in an outpatient clinic in Saint-Nicolas Hospital (Saint-Marc, Haiti) from March to May 2022 were recruited. During this period, 268 diabetic patients were seen during their routine medical visits, of which 226 met our criteria and agreed to participate. They were interviewed by the examiners, with questions that allowed us to assess the association of poor glycemic control according to the American Diabetes Association objectives, with demographic and clinical factors identified from our literature review. The analysis included descriptive, bivariate and multivariate logistic regression using Epi Info 7.2.2.6. P value &lt;0.05 was considered statistically significant. Results The majority, 84.96%, was of female sex with a mean age of 60 ±9.87. More than half of the patients (59.29%) had their diagnosis for at least 5 years, and 67.26% had poor glycemic control. According to the Morisky score, 50.88% had good adherence. The main comorbidities were hypertension and obesity/overweight, 95% and 59%, respectively. Multivariate analysis after logistic regression showed that pathological proteinuria (odds ratio (OR)= 2.20, 95% confidence interval (CI) 1.0356 - 4.6920, p=0.04) and patients receiving both oral hypoglycemic drugs and insulin (OR=2.58, 95% CI: 1.0613 - 6.3109, p=0.03) increased the probability of having poor glycemic control. Conclusions Patients on oral hypoglycemic drugs and insulin who also had pathological proteinuria were linked to poor glycemic control. Strengthening patient education before optimizing pharmacological treatment would improve glycemic control, preventing renal complications. A larger study considering other potential barriers would be necessary to add further knowledge to what this study has presented.

Correlation of Fasting and Postprandial Blood Glucose with Hba1c in monitoring Glycemic Control of Diabetic Patients in FCT Abuja, Nigeria

Achieving glycemic control or reduction of hyperglycemia would significantly decrease most of the complications associated with hyperglycemia in diabetes mellitus. It has been stated that measurement of glycosylated hemoglobin (HbA1C) remains the gold standard for the assessment of glycemic control; there is no consensus whether the Fasting or Postprandial is a better predictor of glycemic control in poor resource setting where HbA1C is not easily accessed or available. The aim of this research is to determine fasting and postprandial plasma glucose and their correlation with HbA1C in glycemic control. A cross sectional case control study was carried out from January, 2023 to July, 2023; a total of 203 participants were recruited into the study. Fasting blood glucose (FBG), 2 hours post prandial blood glucose (2HPBG) were determined in all the subjects using the enzymatic glucose oxidase method for glucose estimation according to the instruction of the manufacturer, while HbA1C was determined using Boroaffinity Chromatographic method according to the instruction of the manufacturer. Statistical data analysis was carried out using SPSS software (Version 25.0, IBM Corp., Armonk, New York USA), and p&lt;0.001 were defined as statistically significant; the correlation between the parameters was carried out using Pearson’s correlation. Both the FBG and the 2HPBG showed positive correlation with HbA1C in the diabetic and control subjects; however, the level of correlation varies. The correlation of FBG and 2HPBG with HbA1C is directly proportional to the concentration of blood glucose level. The FBG for the control and the subjects are 7.40±1.59 and 143.67±5.01, with HbA1C of 4.45±0.05; 6.26±1.47 respectively. The 2HPBG for the control and the subjects are 120.70±1.75 and 192.92±7.05, with HbA1C of 5.56±0.07; 7.82±0.22 respectively. The FBG correlation to HbA1C is r= 0.875, p&lt;0.001; while 2HPBG is r= 0.908, NEWPORT INTERNATIONAL JOURNAL OF PUBLIC HEALTH AND PHARMACY (NIJPP) Volume 4 Issue 2 2023 OPEN ACCESS ©NIJPP ONLINE ISSN: 2992-5479 Publications 2023 PRINT ISSN: 2992-605X Page | 10 p&lt;0.001. The study showed positive correlation of FBG and 2HPBG with HbA1C, since HbA1C is the value of the percentage concentration of glucose at a given period of time; FBG, 2HPBG and HbA1C can be used to evaluate the degree of glycemic control in diabetic patients’ management, in order to minimize or avoid diabetic complications. Keywords: FBG, PBG, Diabetes, HbA1C, Correlation, Complications

Glycemic Control in Diabetic Patients During COVID-19 Pandemic, A Study from North Al-Batinah, Oman

Glycemic Control in Diabetic Patients During COVID-19 Pandemic, A Study from North Al-Batinah, Oman

IBC-Oxford University2023_BJSOral_3Tailored Bilio-Pancreatic Limb Length and Haemoglobin A1c Levels 10 years following Mini-Gastric Bypass Original Technique of One Anastomosis Gastric Bypass

Abstract Introduction The need for or the ideal length of the Biliopancreatic Bypass limb (BPL) length is a controversial topic. The Mini Gastric Bypass original technique (MGB-OT) version of the One Anastomosis Gastric Bypass (OAGB) includes a “Tailored” BPL length. This study aimed to investigate the 1 to 10-year outcomes of the “Tailored’ BPL length in patients undergoing MGB-OT in diabetic patients with Class III obesity. Methods The study is a retrospective chart review of 114 patients who underwent the Mini Gastric Bypass original technique (MGB-OT) with a tailored Biliopancreatic Limb length as described by Rutledge et al. These cases were performed between June 2008 and December 2009. The study investigated the relationship between the length of the BPLL and glycaemic control, primarily as measured by the change in (Delta) HbA1c levels, in morbidly obese diabetic patients undergoing the MGB-OT. The mean BPL length in the study was 185 cms, with a range of 120-350 cms. The study analysed preoperative, post-operative, and Delta HbA1c levels as the primary outcomes. The critical outcome goal for the study was HbA1c levels of less than 7%, which is a commonly used target for glycaemic control in diabetic patients. Results Only 89 of 114 (78%) patients completed the 10-year follow-up. The mean preoperative HbA1c was 9.2+/-1.6 (range 6.8-14.7). Longer BPL length were selected for patients based on a variety of patient factors including the patient’s preoperative HbA1c levels. Patients with longer BPL length had greater weight loss (R2 0.8.) The mean HbA1c levels were 5.50+/-0.36, 5.65+/-0.35, and 5.82+/-0.41 at 1, 5, and 10 years post-op. 100% of patients evaluated at 1 and 5 years had HbA1c levels below 7%, and only 1 out of 89 patients at 10 years had HbA1c levels above 7%. The correlation between BPL length and the 10-year Delta HbA1c was high, with a correlation coefficient (r) of 0.8. The Delta HbA1c was significantly greater in the patients with BPL length &amp;gt; 150 cm (3.99 +/- 1.87 vs 2.08 +/- 0.71 in the BP150 patients difference 1.91, SEM 0.40, 95% CI 1.12 to 2.69, P &amp;lt; 0.0001) i.e., longer BPL length (&amp;gt; 150cms) had significantly greater Delta HbA1c than 150 cm BPL length. Conclusions The study suggests that individualized tailoring of the biliopancreatic limb length in the OAGB procedure can potentially lead to a combination of excellent weight loss and near-complete normalization of HbA1c levels for up to 10 years. However, this a small and incomplete study and the optimal length may vary based on individual patient factors. Further research is needed to confirm these findings and establish standardized guidelines for determining the appropriate BPL length. Overall, the study highlights the importance and potential value of continued research and individualized treatment approaches for patients with obesity and diabetes.

Reducing Hemoglobin A1C Levels in Type II Diabetes: A Retrospective Analysis of the Renew Procedure.

Periodontal disease and type 2 diabetes are interrelated, with inflammation playing a significant role in the progression of both conditions. Previous research has demonstrated the potential of various treatments, such as diet, exercise, and periodontal therapies, to improve glycemic control in diabetic patients. This study proposed a novel surgical approach, the Renew Procedure, as a potential solution to enhance glycemic control in type 2 diabetic patients with periodontal issues. The procedure involves the removal of all teeth, the elimination of oral and maxillofacial infections, the placement of dental implants, and the provision of implant-supported and implant-retained removable dentures. Preliminary findings indicated a significant reduction in HbA1c levels post-surgery, suggesting that this approach may improve overall oral health, reduce inflammation, and consequently lower HbA1c levels. Further research is necessary to confirm the efficacy of the proposed solution, but these initial results highlight the importance of addressing oral health through comprehensive strategies for diabetic and periodontitis patients.

Why and by How Much is Insulin Absorption Reduced by Insulin-derived Amyloidosis? A Scoping Review.

Insulin therapy is one of the central treatments for diabetes mellitus. Insulin-derived localized amyloidosis (IDLA) is a known skin-related complication of insulin injection. This is one of the causes of poor glycemic control in diabetic patients on insulin therapy. The aim of this study was to review and update the findings on the extent and mechanism of reduced insulin absorption in IDLA. A literature search was conducted on decreased insulin absorption and its mechanisms, and nine references were selected, with seven of these on decreased insulin absorption and four on mechanisms. Insulin absorption at IDLA sites was reported to be 27-94% lower compared with normal sites. In addition, a comparison between nonpalpable and palpable IDLA sites revealed a significant decrease in insulin absorption at the palpable IDLA site. The mechanism of insulin malabsorption was found to be a reduction in insulin absorption at the palpable IDLA sites. Four mechanisms of decreased insulin absorption were identified: decreased subcutaneous blood flow, adsorption of administered insulin onto insulin amyloid fibers, impaired diffusion of insulin subcutaneously, and physical factors such as shaking of the insulin preparation. These mechanisms should be investigated in vivo in the future.

Continuous insulin infusion versus sliding scale for perioperative glycemic control in diabetic patients undergoing elective hip arthroplasty

Continuous insulin infusion versus sliding scale for perioperative glycemic control in diabetic patients undergoing elective hip arthroplasty

B-033 Impact of Red Blood Cell Sediment on HbA1c Measurement

Abstract Background HbA1c testing using EDTA whole blood as specimens is essential for monitoring glycemic control in diabetic patients. In the laboratory that using total laboratory automation system, the transportation process might be impact the quality of HbA1c result according to red blood cell sedimentation. This study, we aimed to evaluate the impact of HbA1c result from red blood cell sediment which happen in transportation process of total laboratory automation system. Methods HbA1c samples (n = 50) were mixed once and HbA1c levels were determined by using an Alinity c analyzer at an initial time point (T0 = 0 min.), followed by three additional time points (T1 = 7 min., T2 = 15 min., and T3 = 30 min.). The HbA1c levels and samples analyzed at each time point were then used to calculate correlation coefficient, slope, intercept values. The percent difference in these parameter values from all time points was calculated using the analytical criteria of 5% bias according to the National Glycohemoglobin Standardization Program (NGSP) criteria. Results We discovered that the correlation coefficient, slope, and intercept values obtained from the samples at T1 are 0.999, 0.994, 0.008, respectively, T2 are 0.999, 0.982, 0.042, respectively and T3 are 0.999, 0.979, 0.028, respectively. The percent difference of all criteria was 0.00% which were not significantly different from those at the initial time point (T0). Conclusion This study shows that, the time that using in transportation process in total laboratory automation system at 7, 15 and 30 minutes will not impact quality of HbA1c result even though red blood cell might be sediment before aspirate in the analyzer.