Indicator Of Glycemic Control Research Articles

Indicators of diabetes mellitus after liraglutide, sitagliptin/metformin, linagliptin, and sitagliptin

The control of diabetes mellitus is multifactorial, the different therapeutic options make it necessary to compare the effectiveness with previous therapeutic schemes. Analize the indicators of control of diabetes mellitus after incorporating liraglutide, sitagliptin/metformin, linagliptin, and sitagliptin. Observational, analytical, longitudinal study. Glucose, glycosylated hemoglobin, and blood pressure were compared after the inclusion of new cues in patients with diabetes mellitus; in addition to the control indicators reported in the unit in october, november, and december 2000, with those of 2021 in the same months. A descriptive analysis was performed, T for related samples and McNemar, a value of < .05 was considered significant, a confidence level of 95%, with the IBM-SPSS 24 software. 352 files were analyzed, 59% women, aged 26 to 88 years, and the percentage of control decreased after the change of scheme (38.4% vs 35.8%) without a statistical difference (p .503). There was no statistical difference between the levels of glucose, glycated hemoglobin, weight, and blood pressure before and six months after the change. In the unit, the regimen glycemic control indicator improved in October, November, and December 2020 compared to the same months in 2021, it increased (from 17.2, 18.7, and 16.3, to 41.6, 47.2, and 46.5%). Blood pressure control went from 64.5, 66.7, and 67 to 82.4, 85.1, and 83.1%. The control indicators in the unit improved, however, the patients who used the new keys did not show any difference.

A Cross-Sectional Study Investigating Lumbar Proprioception Impairments in Individuals with Type 2 Diabetes Mellitus: Correlations with Glycated Hemoglobin Levels.

Impaired proprioception is a recognized complication in individuals with type 2 diabetes mellitus (T2DM), contributing to balance deficits and increased risk of falls. However, limited research has focused on lumbar proprioception in this population. This study aimed to investigate lumbar proprioception in individuals with T2DM, as well as healthy individuals. Additionally, this study aimed to examine the correlation between lumbar proprioception and glycated hemoglobin (HbA1c) levels, which is a marker of long-term glycemic control in T2DM. A cross-sectional study was conducted, comparing lumbar joint reposition errors (JRE) between a T2DM group (n = 85) and a healthy group (n = 85). Lumbar JRE was assessed in flexion, extension, lateral bending left, and lateral bending right using a dual inclinometer device. HbA1c levels were measured as an indicator of glycemic control. Significant differences in lumbar JRE were found between the T2DM and healthy groups, with individuals with T2DM exhibiting larger JRE values, indicating impaired lumbar proprioception (p < 0.001). The correlation analysis revealed significant positive associations between HbA1c levels and lumbar JRE. Higher HbA1c levels were correlated with greater joint JRE in flexion (r = 0.49, p < 0.001), extension (r = 0.51, p < 0.001), left lateral bending (r = 0.45, p < 0.001), and right lateral bending (r = 0.48, p < 0.001) in the T2DM group. This study provides evidence of impaired lumbar proprioception in individuals with T2DM, as evidenced by larger lumbar JRE compared to the healthy group.

Retrospective analysis of the relationship between neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and glycemic regulation in patients with type 2 diabetes mellitus followed up at an internal medicine outpatient clinic

Background/Aim: Type 2 diabetes mellitus (T2DM) is a common chronic disease with an increasing incidence worldwide and its effects are being seen in many countries. Insulin resistance is the main factor in the pathophysiology. T2DM leads to an increase in mortality and morbidity due to macrovascular and microvascular complications. Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) are effective parameters in monitoring the inflammatory response. The primary aim of this study was to investigate glycemic control in patients with type 2 diabetes by focusing on their correlation with inflammatory markers, such as NLR and PLR, glycated hemoglobin (HbA1c), and fasting blood glucose levels. Methods: The present study was carried out in 2022 within the purview of the Internal Medicine Clinic at Balikesir İvrindi State Hospital. Data from the initial annual consultations of patients with T2DM, either newly diagnosed or previously diagnosed and visiting for follow-up, were utilized. Our study excluded patients under the age of 18 and those diagnosed with cirrhosis, heart failure, type 1 diabetes mellitus, malignancy, epilepsy, acute infection, pregnancy, or chronic inflammatory disease. We further excluded those on medications including steroids, antivirals, anticonvulsants, antipsychotics, antithyroids, and chemotherapeutic drugs that impact the leukocyte count. Based on their HbA1c levels, patients were systematically categorized into two distinct cohorts: those with controlled blood sugar (HbA1c ≤7%) and those with uncontrolled blood sugar (HbA1c &gt;7%). In the ambit of this study, we incorporated data from 205 patients. We employed a cross-sectional study that retrospectively examined the correlation between NLR, PLR, and glycemic regulation in T2DM patients. SPSS 22.0 software was used to perform statistical calculations. Results: It was observed that patients with poor glycemic control had longer disease durations and this disparity bore statistical significance (P=0.005). Patients exhibiting poor glycemic control demonstrated elevated levels of CRP (C-reactive protein), a difference that reached statistical significance (P=0.003). The group exhibiting poor glycemic control demonstrated a notable elevation in NLR, indicating statistical significance (P=0.001). Although it was not statistically significant, PLR was found to be higher in patients with uncontrolled T2DM (P=0.441). Conclusion: This research investigates the correlation between HbA1c levels and inflammatory markers, specifically NLR and TLR, in T2DM patients who exhibit poor control of glycemia. Our findings highlight the potential of these markers as indicators of glycemic control, thus emphasizing the need for integrated strategies for managing inflammation and improving glycemic control in T2DM patients. The novelty of this area of research contributes to the scarcity of available literature, underlining the importance and timeliness of this study. Based on our findings, we suggest an increased focus on regular monitoring of inflammatory markers, for instance NLR and PLR, to assess the glycemic control in T2DM patients. The significant correlation of these markers with HbA1c levels implies that they could potentially serve as useful tools in personalizing diabetes management strategies, leading to improved patient outcomes. Not only does our research contribute to filling this knowledge gap, but it also underscores the potential for utilizing inflammatory markers in tracking disease progression and optimizing treatment efficacy in T2DM.

Comparative efficacy and safety of glucagon-like peptide 1 receptor agonists for the treatment of type 2 diabetes: A network meta-analysis.

This study aimed to evaluate the clinical efficacy and safety of 4 weekly formulations of glucagon-like peptide 1 receptor agonists (GLP-1RAs) on glycemic control, including glycemic control, by using a network meta-analysis (NMA). PubMed, EMBASE, and Cochrane Library Central Register of Controlled Trials were searched from inception until June 10, 2022. Randomized clinical trials (RCTs) enrolling participants with diabetes mellitus type 2 and a follow-up of at least 12 weeks were included, for which 4 eligible GLP-1RAs Exenatide, Dulaglutide, Semaglutide, Loxenatide were compared with either each other or placebo. The primary outcome is the change of hemoglobin A1c level. Secondary outcomes including additional glycemic control indicators and adverse events (AE). Frequentist random-effect NMA were conducted for effect comparison. This meta-analysis was registered on PROSPERO, CRD42022342241. The NMA synthesized evidence from 12 studies covering 6213 patients and 10 GLP-1RA regimens. A pairwise comparison of glycosylated hemoglobin type A1C (HbA1c) lowering effects showed that once-weekly GLP-1 receptor agonists were significantly better than placebo, and their glucose-lowering intensity was Semaglutide 2.0mg, Semaglutide 1.0mg, Dulaglutide 4.5mg, and Semaglutide 0.5mg, Dulaglutide 3.0mg, PEX168 200ug, Dulaglutide 1.5mg, PEX168 100ug and Dulaglutide 0.75mg. The GLP-1RA regimen has a comparable safety profile for hypoglycemia. And with the exception of PEX168, all other long-acting GLP-1RA drugs had lower rates of diarrhea, nausea and vomiting than placebo. Regimens of GLP-1RAs had differential glycemic control. The efficacy and safety of Semaglutide 2.0mg in comprehensively lowering blood sugar showed the best performance.

Glucose variability: a new risk factor for cardiovascular disease.

Glucose variability (GV) is increasingly considered an additional index of glycemic control. Growing evidence indicates that GV is associated with diabetic vascular complications, thus being a relevant point to address in diabetes management. GV can be measured using various parameters, but to date, a gold standard has not been identified. This underscores the need for further studies in this field also to identify the optimal treatment. We reviewed the definition of GV, the pathogenetic mechanisms of atherosclerosis, and its relationship with diabetic complications.

1436-P: Glycemic Variability as a Risk Factor for In-Hospital Mortality among CKD, Type 2 DM Patients Admitted for COVID-19—Retrospective Cohort Study

Background: COVID-19 severity is affected by multiple factors and it is theorized that better glycemic control results in lower mortality. Also, the use of glycemic variability through Time In Range (TIR) may be a better indicator of glycemic control. Objective: To determine the association of glycemic control (ie TIR and HbA1c) during admission with in-hospital mortality among patients with COVID-19, CKD, and T2DM Methods: A single center retrospective study was conducted on admitted CKD T2DM COVID patients from September 2020 to December 2021. Participants were excluded with mild COVID-19, post kidney transplant, no CBG monitoring, admitted for &amp;lt; 24 hours. A survival analysis was used to determine the association of glycemic control &amp; mortality. Results: Among 148 patients, 42.0% (n = 63) had in-hospital mortality. Glycemic control within range was achieved in 4.7% (4 out of 85) of the survivor group and 1.6% (1 out of 63) of the non survivor group and no significant difference noted between the two groups (HR 0.41 95% CI 0.06 to 3.03). For HbA1c level on admission, no significant difference between the two groups (HR 1.22 95% CI 0.74 to 2.01). Conclusion: This study concluded that glycemic control did not show association with in-hospital mortality among CKD T2DM patients with COVID-19 infection. Additionally, HBA1c on admission was not associated with mortality. Disclosure N.G.Mangugan: None.

795-P: Elucidating the Role of Weight Loss and Glycemia with Observed Benefits of GLP-1 Receptor Agonist Treatment in Patients with T2D

Weight loss has been associated with reduced cardiovascular disease (CVD) risk in people with type 2 diabetes (T2D). Glucagon-like peptide-1 receptor agonists (GLP-1RA) are an advancement in T2D treatment that can regulate glycemia and promote weight loss. However, the impact of weight loss, independent of glycemic control, on real-world clinical outcomes is not well understood. Here, the Cleveland Clinic electronic health record system was utilized to investigate the independent contributions of glycemic control and body mass index (BMI) change on clinical outcomes such as CVD, chronic kidney disease (CKD), hypertension, dyslipidemia, and time to insulin initiation in patients with T2D treated with GLP-1RA. Patients (n=4161) with T2D seen at the Cleveland Clinic between 8/2/2005 and 12/31/2021 who initiated GLP-1RA treatment without documented congestive heart failure, insulin use, and/or an estimated glomerular filtration rate &amp;lt;30 mL/min at the time of treatment initiation were retrospectively analyzed. Patients were required to be receiving GLP-1RA treatment for ≥12 months and have &amp;lt;18 months between physician encounters. Independent of glycemic control, each 1% reduction in BMI was associated with a 4% reduction in CVD risk (P=.008) and a 3% reduction in insulin initiation risk (P=.002). Independent of BMI change, each 1% reduction in HbA1c was associated with a 4% reduction in CKD risk (P=.001) and a 16% reduction in insulin initiation risk (P&amp;lt;.0001). Associations between BMI variability and CVD (HR=1.12, P&amp;lt;.0001) and osteoarthritis (HR=1.09, P=.014) and between HbA1c variability and CKD (HR=1.73, P=.032) and hypertension (HR=1.07, P&amp;lt;.0001) were observed. Durable BMI reduction was associated with a 28% decrease in CKD risk (P=.016) and a 61% reduction in hypertension risk (P=.005). In the real-world setting, decreased BMI was independently associated with reduced risk of CVD, CKD, hypertension, osteoarthritis, and insulin initiation. Disclosure A.Sharma: None. B.Burguera: Research Support; Novo Nordisk. M.Kattan: Consultant; Renalytix, Verici, Research Support; Novo Nordisk, Bayer Inc. A.D.Misra-hebert: Research Support; Bayer Inc., Merck Sharp &amp; Dohme Corp., Novo Nordisk. K.M.Pantalone: Consultant; AstraZeneca, Bayer Inc., Corcept Therapeutics, Diasome, Eli Lilly and Company, Merck &amp; Co., Inc., Novo Nordisk, Sanofi, Research Support; Bayer Inc., Merck &amp; Co., Inc., Novo Nordisk, Twin Health, Speaker's Bureau; AstraZeneca, Corcept Therapeutics, Merck &amp; Co., Inc., Novo Nordisk. D.M.Rotroff: Research Support; Novo Nordisk, Stock/Shareholder; Clarified Precision Medicine. A.Mariam: None. E.Zacherle: None. A.Milinovich: Research Support; Novo Nordisk, Merck &amp; Co., Inc., AbbVie Inc., Amgen Inc., Bayer Inc., Eli Lilly and Company, Twin Health. J.Bauman: None. D.S.Sugano: None. J.Noone: Employee; Novo Nordisk. J.R.Rajpura: Employee; Novo Nordisk. R.S.Zimmerman: Speaker's Bureau; Xeris Pharmaceuticals, Inc.

#3637 ROLE OF CONTINUOUS GLUCOSE MONITORING OF BLOOD GLUCOSE CONTROL IN PATIENTS WITH DIABETES UNDERGOING HEMODIALYSIS: A PILOT STUDY

Abstract Background and Aims End-stage kidney disease (ESKD) is a global health problem, with a steep increase in its prevalence. Diabetes is a major cause and common comorbidity in patients with ESKD. As already known, glycemic control is an important factor in preventing micro- and macrovascular complications in diabetes. Besides, glycemic variability has recently been considered an important factor in the treatment of diabetes. However, both hypoglycemia and hyperglycemia can frequently occur in patients with diabetes undergoing hemodialysis. This study aimed to determine the role of continuous glucose monitoring (CGM) for glycemic control and glycemic variability stabilization in patients with diabetes undergoing hemodialysis. Method Eighteen patients aged ≥18 years with type 1 or 2 diabetes and ≥3 months on hemodialysis at the Eulji Medical Center, Daejeon, Republic of Korea between November 2021 and May 2022 were included. Patients underwent 7-day CGM twice: the baseline study period (T0) and the follow-up study period (T1), at a 12-week interval. Physicians modified the treatment strategy according to the T0 results, and then patients conducted T1. iPro2 CGM (MMT-7745) and Enlite glucose sensors MMT-7008A (Medtronic Minimed, Northridge, CA, USA) were used to assess glycemic control. As indicators of glycemic control, the mean glucose levels and glycated hemoglobin A1c (HbA1c) were measured. As indicators of glycemic variability, standard deviation (SD) and %coefficient variation (%CV) were measured. Results Data from 18 patients were analyzed. The mean age was 62.0±11.2 years, male/female ratio was 13 (72.2%)/5 (27.8%). The mean dialysis duration was 5.2±3.5 years. Among the 18 patients, only one had type 1 diabetes, and the mean diabetes duration was 22.9±7.0 years. The mean glucose levels decreased from 179.1±42.3 mg/dL during T0 to 153.2±25.6 mg/dL during T1 (P = 0.001). HbA1c decreased from 7.4±1.3% during T0 to 6.9±1.2% during T1 (P = 0.023). SD improved from 55.7±19.8 mg/dL during T0 to 42.6±15.3 mg/dL during T1 (P = 0.001). %CV improved from 30.5±7.3% during T0 to 25.5±5.5% during T1 (P &amp;lt; 0.001). During T0, the mean glucose level was significantly lower on a day with hemodialysis than on a day without (P≪0.05), and SD and %CV were significantly higher on a day with hemodialysis than on a day without (P≪0.05). After the physicians modified the treatment according to the T0 results, the mean blood glucose levels decreased on both the hemodialysis-on and hemodialysis-off days, as compared to those values during T0 (from 174.7±46.5 to 154.6±29.7 mg/dL, and from 184.7±50.5 to 156.3±28.7 mg/dL, respectively), and consequently there were no statistically significant differences between the hemodialysis-on and hemodialysis-off days during T1 (P = 0.638). SD improved on both the hemodialysis-on and hemodialysis-off days compared to those values during T0 (from 46.9±21.5 to 33.2±14.6, and from 39.5±20.6 to 32.3±13.3, respectively), and consequently, there were no statistically significant differences between the hemodialysis-on and hemodialysis-off days during T1 (P = 0.384). %CV improved from 27.8±10.9 on the hemodialysis-on day during T0 to 21.4±9.2 on that during T1, and there was no statistically significant difference between the hemodialysis-on and hemodialysis-off days during T1 (P = 0.166). Conclusion CGM could be a promising tool for individualizing treatment strategies in patients with diabetes undergoing hemodialysis.

Relationship between Helicobacter pylori and glycated hemoglobin: a cohort study.

Helicobacter pylori (H. pylori) has increasingly been shown to be related to extragastric diseases. Glycated hemoglobin A1c (HbA1c), an indicator of glycemic control, is closely linked to the event of diabetes. The purpose of this research was to analyze the association between H. pylori and HbA1c through a cohort study. The population who underwent multiple physical checkups in the physical examination center of Taizhou Hospital was included. All of them underwent urea breath test, serological examination and physical parameter measurement. Multiple regression was used for analyzing the influencing factors of HbA1c. In addition, the result of HbA1c on H. pylori infection was studied by restricted cubic spline (RCS) analysis. The triglyceride glucose (TyG) index represents the level of insulin resistance (IR) in the population. The population was classified on the basis of primary and last H. pylori infection, therefore, the variations of HbA1c and TyG index among totally different teams were investigated. Multiple regression demonstrated that H. pylori was an influential factor in HbA1c. RCS analysis showed a nonlinear relationship between HbA1c and H. pylori infection. When HbA1c>5.7%, the chance of H. pylori infection was considerably enlarged. Additionally, long-term H. pylori infection increased HbA1c levels, while HbA1c levels decreased after H. pylori eradication. Similarly, long-term H. pylori infection also increased the TyG index. Prediabetes increases the danger of H. pylori infection, long-term H. pylori infection increases HbA1c and IR levels, and wipeout of H. pylori could have a positive impact for glycemic control in the population.

The Effects of Omega 3 and Omega 6 Fatty Acids on Glucose Metabolism: An Updated Review.

Massive changes have occurred in our diet. A growing consumption of vegetal oils rich in omega-6 (ω-6) and a depletion of omega-3 (ω-3) fatty acids (FAs) in our food has led to an imbalance between ω-3 and ω-6. In particular, eicosapentaenoic (EPA)/arachidonic acid (AA) ratio seems to be an indicator of this derangement, whose reduction is associated to the development of metabolic diseases, such as diabetes mellitus. Our aim was therefore to investigate the literature on the effects of ω-3 and ω-6 FAs on glucose metabolism. We discussed emerging evidence from pre-clinical studies and from clinical trials. Notably, conflicting results emerged. Source of ω-3, sample size, ethnicity, study duration and food cooking method may be responsible for the lack of univocal results. High EPA/AA ratio seems to be a promising indicator of better glycemic control and reduced inflammation. On the other hand, linoleic acid (LA) appears to be also associated to a minor incidence of type 2 diabetes mellitus, although it is still not clear if the outcome is related to a reduced production of AA or to its intrinsic effect. More data derived from multicenter, prospective randomized clinical trials are needed.

Acute and adaptive cardiovascular and metabolic effects of passive heat therapy or high-intensity interval training in patients with severe lower-limb osteoarthritis.

Exercise is painful and difficult to perform for patients with severe lower-limb osteoarthritis; consequently, reduced physical activity contributes to increased cardiometabolic disease risk. The aim of this study was to characterize the acute and adaptive cardiovascular and metabolic effects of two low or no impact therapies in patients with severe lower-limb osteoarthritis: passive heat therapy (Heat) and high-intensity interval training (HIIT) utilizing primarily the unaffected limbs, compared to a control intervention of home-based exercise (Home). Participants completed up to 12 weeks of either Heat (20-30 min immersed in 40°C water followed by ~15-min light resistance exercise), HIIT (6-8 × 60-s intervals on a cross-trainer or arm ergometer at ~90-100% peak O2 ) or Home (~15-min light resistance exercise); all 3 sessions/week. Reductions in systolic (12 & 10 mm Hg), diastolic (7 & 4 mm Hg), and mean arterial (8 & 6 mm Hg) blood pressure (BP) were observed following one bout of Heat or HIIT exposure, lasting for the duration of the 20-min monitoring period. Across the interventions (i.e., 12 weeks), resting systolic BP and diastolic BP decreased with Heat (-9 & -4 mm Hg; p < 0.001) and HIIT (-7 & -3 mm Hg; p ≤ 0.011), but not Home (0 & 0 mm Hg; p ≥ 0.785). The systolic and diastolic BP responses to an acute exposure of Heat or HIIT in the first intervention session were moderately correlated with adaptive responses across the intervention (r ≥ 0.54, p ≤ 0.005). Neither intervention improved indices of glycemic control (p = 0.310). In summary, both Heat and HIIT induced potent immediate and adaptive hypotensive effects, and the acute response was moderately predictive of the long-term response.

Diabetes and obesity and risk of pyogenic liver abscess

Few literatures discussed the relationship of glycemic control and body mass index (BMI) with the risk of pyogenic liver abscess. We conducted a population-based cohort study using participants of a community-based health screening program in Taiwan from 2005 to 2008 (n = 125,865). Information on fasting plasma glucose (FPG), BMI, and other potential risk factors of liver abscess were collected at baseline. Incidence of pyogenic liver abscess was ascertained using inpatient records from the National Health Insurance database. During a median 8.6 years of followed up, 192 incident cases of pyogenic liver abscess were reported. The incidence rate of pyogenic liver abscess was 70.2 and 14.7 per 100,000 in the diabetic and non-diabetic population respectively. In multivariable Cox regression analysis, the adjusted hazard ratio (HR) was 2.18 (95% confidence interval (CI) 1.22–3.90) in patients with diabetes with good glycemic control (FPG ≤ 130 mg/dl) and 3.34 (95% CI 2.37–4.72) in those with poor glycemic control (FPG > 130 mg/dl), when compared with non-diabetics. In the dose–response analysis, the risk of liver abscess increased monotonically with increasing FPG. After adjusting for diabetes and other comorbidities, overweight (25 ≤ BMI < 30) (adjusted HR: 1.43, 95% CI 1.05–1.95) and obese (BMI ≥ 30) (adjusted HR: 1.75, 95% CI 1.09–2.81) populations had a higher risk of liver abscess when compared to people with normal weight. Diabetes, especially poorly controlled disease, and high BMI were associated with higher risk of pyogenic liver abscess. Improving glycemic control and weight reduction may reduce the risk of developing pyogenic liver abscess.

Efficacy and Safety of Meal Replacement in Patients With Type 2 Diabetes.

Meal replacement (MR) is beneficial for the management of type 2 diabetes (T2D). However, MR prescription and patient characteristics vary substantially between studies using MR in T2D patients. This work aimed to evaluate the efficacy and safety of MR in T2D patients by meta-analysis, with a focus on subgroup analysis of variable participant characteristics and MR prescription. We searched PubMed, CENTRAL, Embase, Web of Science, and the clinical trial registration database up to March 2022. We included randomized controlled trials (RCTs) of 2 weeks or more assessing the effect and safety of MR in T2D patients in comparison with conventional diabetic diets (CDs). A total of 17 RCTs involving 2112 participants were ultimately included. Compared with CDs, MR significantly reduced glycated hemoglobin A1c (HbA1c) (MD -0.46%; P < .001), fasting blood glucose (FBG, -0.62 mmol/L; P < .001), body weight (-2.43 kg; P < .001), and body mass index (BMI, -0.65; P < .001), and improved other cardiometabolic risk factors. In subgroup analyses, total MR showed greater improvement in HbA1c (-0.72% vs -0.32%; P = .01), FBG (-1.45 vs -0.56 mmol/L; P = .02), body weight (-6.57 vs -1.58 kg; P < .001), and BMI (-2.78 vs -0.37; P < .001) than partial MR. MR with caloric restriction showed more reduction in body weight (-3.20 vs -0.75 kg; P < .001) and BMI (-0.84 vs -0.24; P = .003) compared with those without caloric restriction. MR showed similar benefits in studies that included patients using insulin and those that did not. Both partial and total MR were well tolerated. Compared with CDs, the MR-based dietary pattern further improved the glycemic control and adipose indicators in T2D patients. Appropriate calorie restriction and total MR might be more beneficial, while both patients treated with or without insulin treatment could similarly benefit from MR usage.

Prepregnancy body mass index and glycated albumin in the third trimester may predict infant complications in gestational diabetes mellitus: a retrospective cohort study.

Maternal hyperglycemia,obesity, and hypertension with gestational diabetes mellitus (GDM) are risk factors for infant complications. This study aimed to investigate maternal factors and glycemic control indicators that affect infant complications in GDM. We conducted a retrospective cohort study including112 mothers with GDM and their infants. Multivariate logistic regression analysis was used to investigate the variables associated with good and adverse infant outcomes. We determined the cutoff values of variables that showed a significant difference in the multivariate logistic regression analysis for predicting infant complications by performing receiver operating characteristic curve analysis. Inthe multivariate logistic regression analysis, prepregnancyBMI and GA in the third trimester were significantly related to good and adverse infant outcomes(adjusted odds ratios [aORs], 1.62; 95% CIs 1.17-2.25, p = 0.003 and aORs, 2.77; 95% CIs 1.15-6.64, p = 0.022, respectively). The cutoff values for prepregnancyBMI and GA in the third trimester were 25.3kg/m2 and13.5%, respectively. The importance of weight control before pregnancy and the usefulness of GA in the third trimester to predict infant complications weresuggested in this study.

Prevalence of Prediabetes in First Degree Relatives of Patients with Type 2 Diabetes Mellitus in a Tertiary Centre in Southern Nigeria

<i>Introduction:</i> Prediabetes confers about a sixfold increased risk of diabetes and a two to threefold increased risk of cardiovascular events. A family history of diabetes is a major risk factor for the development of diabetes. The detection of prediabetes in its early stages in persons at risk could lead to the delay or prevention of the disease and subsequent adverse sequalae. <i>Methods:</i> A total of 180 first-degree relatives (FDR) of patients with type 2 diabetes and 90 controls were assessed. A fasting venous blood sample was collected for fasting plasma glucose. Following 75g of anhydrous glucose ingestion, the 2-hour post glucose load and glycated haemoglobin was assessed. Statistical significance was set at a p value <0.05. <i>Results:</i> The mean age of the cases who were first degree relatives of type 2 DM was 38.2±12.3 years with a female to male ratio of 1.4:1. The prevalence of prediabetes was 23.9% which was significantly higher than in the controls (10%; χ²=8.385, p=0.015). Using the various indices of glycaemic control, impaired fasting glucose, impaired glucose tolerance and elevated HbA1c in the FDR’s was found in 15.0%, 12.2% and 15.6% respectively. <i>Conclusion:</i> Relatives of Type 2 DM patients should be considered as primary target for diabetes preventive programs as this will necessitate institution of effective measures early to delay or prevent the onset of type 2 diabetes mellitus.

Experience in the Treatment of Type 2 Diabetes Mellitus With Modern Hypoglycemic Drugs

The article describes the results of testing in Kyrgyzstan of innovative drugs jardine and dapazine (sodium-glucose cotransporter type 2 inhibitors) on the basis of the Endocrinological Center at the Ministry of Health of the Kyrgyz Republic. The drugs significantly improved the indicators of glycemic control as part of double and triple hypoglycemic therapy, expanded therapeutic possibilities in patients with DM2 with a long course and unsatisfactory control of the disease. These drugs had a positive effect on blood pressure and weight of patients with DM2.

Gut Microbiota Contribution to Weight-Independent Glycemic Improvements after Gastric Bypass Surgery.

Roux-en-Y gastric bypass surgery (RYGB) leads to improved glycemic control in individuals with severe obesity beyond the effects of weight loss alone. Here, We addressed the potential contribution of gut microbiota in mediating this favourable surgical outcome by using an established preclinical model of RYGB. 16S rRNA sequencing revealed that RYGB-treated Zucker fatty rats had altered fecal composition of various bacteria at the phylum and species levels, including lower fecal abundance of an unidentified Erysipelotrichaceae species, compared with both sham-operated (Sham) and body weight-matched to RYGB-treated (BWM) rats. Correlation analysis further revealed that fecal abundance of this unidentified Erysipelotrichaceae species linked with multiple indices of glycemic control uniquely in RYGB-treated rats. Sequence alignment of this Erysipelotrichaceae species identified Longibaculum muris to be the most closely related species, and its fecal abundance positively correlated with oral glucose intolerance in RYGB-treated rats. In fecal microbiota transplant experiments, the improved oral glucose tolerance of RYGB-treated compared with BWM rats could partially be transferred to recipient germfree mice, independently of body weight. Unexpectedly, providing L. muris as a supplement to RYGB recipient mice further improved oral glucose tolerance, while administering L. muris alone to chow-fed or Western style diet-challenged conventionally raised mice had minimal metabolic impact. Taken together, our findings provide evidence that the gut microbiota contributes to weight loss-independent improvements in glycemic control after RYGB and demonstrate how correlation of a specific gut microbiota species with a host metabolic trait does not imply causation. IMPORTANCE Metabolic surgery remains the most effective treatment modality for severe obesity and its comorbidities, including type 2 diabetes. Roux-en-Y gastric bypass (RYGB) is a commonly performed type of metabolic surgery that reconfigures gastrointestinal anatomy and profoundly remodels the gut microbiota. While it is clear that RYGB is superior to dieting when it comes to improving glycemic control, the extent to which the gut microbiota contributes to this effect remains untested. In the present study, we uniquely linked fecal Erysipelotrichaceae species, including Longibaculum muris, with indices of glycemic control after RYGB in genetically obese and glucose-intolerant rats. We further show that the weight loss-independent improvements in glycemic control in RYGB-treated rats can be transmitted via their gut microbiota to germfree mice. Our findings provide rare causal evidence that the gut microbiota contributes to the health benefits of metabolic surgery and have implications for the development of gut microbiota-based treatments for type 2 diabetes.

Usefulness of continuous glucose monitoring of blood glucose control in patients with diabetes undergoing hemodialysis: A pilot study.

Blood glucose stability has recently been considered important in the treatment of diabetes. Both hypoglycemia and hyperglycemia can frequently occur in patients with diabetes undergoing hemodialysis. This study aimed to determine the usefulness of continuous glucose monitoring (CGM) for glycemic control and glycemic variability stabilization in patients with diabetes undergoing hemodialysis. Eighteen patients aged ≥18 years with type 1 or 2 diabetes and ≥3 months on hemodialysis at the Eulji Medical Center, Daejeon, Republic of Korea between November 2021 and May 2022 were included. Patients underwent 7 days CGM twice: the baseline study period (T0) and the follow-up study period (T1), at a 12 weeks interval. Physicians modified the treatment strategy according to the T0 results, and then patients conducted T1. As indicators of glycemic control, the mean glucose levels, glycated hemoglobin A1c (HbA1c), and time in range were measured. As indicators of glycemic variability, standard deviation (SD) and % coefficient variation (%CV) were measured. Data from 18 patients were analyzed. The mean glucose levels, HbA1c, SD, and %CV improved in T1 compared to T0 (P < 0.05). During T0, the mean glucose level was significantly lower on a day with hemodialysis than on a day without (P < 0.05), and SD and %CV were significantly higher on a day with hemodialysis than on a day without (P < 0.05). After the physicians modified the treatment according to the T0 results, there were no differences in the mean glucose levels, SD, and %CV between days with and without hemodialysis during T1. Continuous glucose monitoring could be a promising tool for individualizing treatment strategies in patients with diabetes undergoing hemodialysis.

The Quality of Preoperative Glycemic Control Predicts Insulin Sensitivity During Major Upper Abdominal Surgery: A Case-Control Study.

To examine the association of the quality of preoperative glycemic control and insulin sensitivity during major upper abdominal surgery. In cardiac surgery, glycated hemoglobin A1c (HbA1c), an indicator of glycemic control during the preceding 3 months, correlated with intraoperative insulin sensitivity. Furthermore, insulin resistance showed a significant association with adverse clinical outcomes. This study is a post hoc exploratory analysis of a randomized controlled trial in patients undergoing elective hepatectomy and receiving the hyperinsulinemic-normoglycemic clamp (HNC) as a potential intervention to reduce surgical site infections (ClinicalTrials.gov NCT01528189). Immediately before skin incision, the HNC was initiated by infusing insulin at the rate of 2 mU/kg/min. Dextrose was administered at rates titrated to maintain normoglycemia (4.0-6.0 mmol/L). The average of 3 consecutive dextrose infusion rates during steady state was used as a measure of insulin sensitivity. Primary outcome was the relationship between preoperative HbA1c and insulin sensitivity during surgery. Secondary outcomes were the associations of insulin sensitivity with the patient's body mass index (BMI) and postoperative morbidity. Thirty-four patients were studied. HbA1c (Y = -0.52X + 4.8, P < 0.001, R2 = 0.29), BMI (Y = -0.12X + 5.0, P < 0.001, R2 = 0.43) showed negative correlations with insulin sensitivity. The odds ratio of postoperative complications within 30 days of surgery for every increase in insulin sensitivity by 1 mg/kg/min was 0.22 (95% confidential interval, 0.06-0.59; P = 0.009). We demonstrate significant associations of the quality of preoperative glycemic control and body mass index with insulin sensitivity during hepatectomy. The degree of insulin resistance correlated with postoperative morbidity.

Association between low‐carbohydrate diets and continuous glucose monitoring‐derived time in ranges

ABSTRACTAimsLow‐carbohydrate diets have become popular in the general community. The mutual relationship between the percentage of total energy intake from carbohydrates (CHO/E), glycemic control indices, and diabetes complications remains unclear.Materials and MethodsThis cross‐sectional study included 177 patients with type 2 diabetes mellitus who regularly visited outpatient clinics. In this study, dietary questionnaires were used to assess the intake ratio of the three macronutrients, and the low‐carbohydrate‐diet score was calculated. We investigated the association between the low‐carbohydrate‐diet score, continuous glucose monitoring (CGM)‐derived short‐term glycemic control indices, and diabetes complications in patients with type 2 diabetes mellitus.ResultsThe results are presented as medians (interquartile ranges) unless otherwise stated. Hemoglobin A1c was 7.1% (6.6–7.7%), CGM‐derived time in range (TIR) was 75.3% (62.8–87.0%), body mass index (BMI) was 24.0 (22.1–26.3) kg/m2, and CHO/E was 49.8% (44.8–55.6%). BMI, triglycerides, and CGM‐derived time above range decreased significantly with increasing low‐carbohydrate‐diet scores. However, no significant association was found between the low‐carbohydrate‐diet score and glycemic control indices, including TIR, mean amplitude of glycemic excursions, and vascular complications of type 2 diabetes mellitus.ConclusionModerate‐carbohydrate diets positively impact weight control and lipid metabolism but may have a limited effect on short‐term glycemic variability in Japanese patients with type 2 diabetes mellitus.