Indicator Of Glycemic Control Research Articles

A Framework for Integrating Continuous Glucose Monitor-Derived Metrics into Economic Evaluations in Type 1 Diabetes.

Economic models in type 1 diabetes have relied on a change in haemoglobin A1c as the link between the blood glucose trajectory and long-term clinical outcomes, including microvascular and macrovascular disease. The landscape has changed in the past decade with the availability of regulatory approved, accurate and convenient continuous glucose monitoring devices and their ability to track patients' glucose levels over time. The data emerging from continuous glucose monitoring have enriched the clinical understanding of the disease and indirectly of patients' behaviour. This has triggered the development of new measures proposed to better define the quality of glycaemic control, beyond haemoglobin A1c. The objective of this paper is to review recent developments in clinical knowledge brought into focus with the application of continuous glucose monitoring devices, and to discuss potential approaches to incorporate the concepts into economic models in type 1 diabetes. Based on a targeted review and a series of multidisciplinary workshops, an influence diagram was developed that captures newer concepts (e.g. continuous glucose monitoring metrics) that can be integrated into economic models and illustrates their association with more established concepts. How the additional continuous glucose monitoring-based indicators of glycaemic control may contribute to economic modelling beyond haemoglobin A1c, and more accurately reflect the economic value of novel type 1 diabetes treatments, is discussed.

Study Protocol Abstract: Effects of White Potato Consumption on Measures of Cardiometabolic Health in Individuals With Type 2 Diabetes Mellitus

ObjectivesThe incidence of type 2 diabetes mellitus (T2D) continues to increase in the United States, and the treatment of T2D and associated cardiovascular complications creates a large economic burden. Diet plays an important role in the prevention and treatment of T2D, and studies have suggested high glycemic index (GI) foods, in moderate amounts, may be safely incorporated in the diets of individuals with T2D. Potatoes (Solanum tuberosum) are nutrient-dense vegetables, containing vitamins, minerals (e.g., potassium), essential amino acids, fiber, and phytochemicals. Therefore, the hypothesis of this study is that daily consumption of white potatoes will contribute to improvements in cardiometabolic health and diet quality in individuals with T2D. We will address this hypothesis with a cross-sectional examination of epidemiological data (NHANES, 2010–2018), as well as with a randomized crossover intervention.MethodsFor the cross-sectional examination, NHANES 2010–2018 data will be used to: 1) compare total white potato intake and white potato intake by preparation method in individuals with T2D, prediabetes, and no diabetes; and 2) explore the relationship between total white potato consumption, potato preparation methods, and diet quality in adults with T2D. For the randomized cross-over study, participants with non-insulin-dependent type 2 diabetes (45–80 y, BMI 25–40 kg/m2) will be randomly assigned to receive baked white potato (100g cooked with skin; 100kcals) or a calorie-matched refined grain (75g cooked long-grain white rice; control) daily for each of two 12-week treatment period, separated by a 2-week washout. Outcome variables will include indices of glycemic control, blood pressure, lipid profile, endothelial function, inflammation, and body composition.ResultsStudy is currently ongoing.ConclusionsThis is the first study, to our knowledge, to 1) investigate the effects of white potato consumption on markers of cardiometabolic health in individuals with T2D, and 2) examine associations between white potato consumption, diet quality, and markers of cardiometabolic health in adults with T2D using the NHANES database.Funding SourcesAlliance for Potato Research and Education.

916-P: Evaluation of an Enhanced Primary Care Team Model to Improve Diabetes Care

Purpose: Primary care practices manage most patients with diabetes, and face significant operational, regulatory, and reimbursement pressures to improve care quality. The Enhanced Primary Care Diabetes (EPCD) model was developed to leverage the expertise of care team registered nurses and pharmacists to improve diabetes care. Methods: Utilizing a retrospective, interrupted time series design, we evaluated the EPCD model’s impact on a composite publicly reported quality measure of diabetes care (D5) , including indicators of glycemic control, blood pressure control, low-density lipoprotein, tobacco use, and aspirin use. We compared three groups of practices (32 total) that care for adults (age 18-75 years) with diabetes: staff clinician (physician and Advanced Practice Provider) practices with access to EPCD (5761 patients) , resident physician practices with access to EPCD (1887 patients) , and staff clinician practices without access EPCD (10,079 patients) . The primary outcome was a comparison of the pre-implementation trend (7 months) to the post-implementation trend (months) in the three groups for the percentage meeting the D5. Results: There was a positive difference in pre to post-implementation trends for patients meeting the D5 in the staff clinician practices in the EPCD group (Pre IRR 0.995, Post IRR 1.005; P= 0.01) . There was no difference in the trend for the trainee physician practices with access to EPCD (Pre IRR 0.999, Post IRR 1.011; P= 0.14) , and a significant negative trend in the staff clinician practices without access to EPCD (Pre IRR 1.001, Post IRR 0.994; P= 0.05) . Conclusion: The EPCD model significantly improved diabetes care quality. Further study of proactive, multidisciplinary chronic disease management led by care team nurses integrating clinical pharmacists is warranted. Disclosure J.Herges: None. J.Matulis: None. M.Kessler: None. L.L.Ruehmann: None. K.Mara: None. R.G.Mccoy: Consultant; Emmi. Funding National Institute of Diabetes and Digestive and Kidney Diseases (K23DK114497)

Web-based interventions for pregnant women with gestational diabetes mellitus: a systematic review and meta-analysis protocol

IntroductionGestational diabetes mellitus (GDM) is one of the most prevalent diseases during pregnancy, which is closely associated with many short-term and long-term maternal and neonatal complications and can incur heavy...

Association of breakfast consumption frequency with fasting glucose and insulin sensitivity/b cells function (HOMA-IR) in adults from high-risk families for type 2 diabetes in Europe: the Feel4Diabetes Study.

This study aimed to investigate the association of breakfast consumption frequency (BCF) with glycemic control indices in a cross-sectional sample of adults from families at high risk for type 2 diabetes mellitus (T2DM), exploring the role of sex and socioeconomic status (SES). In 2370 adults (40.8 ± 5.6 years) from 6 European countries, sociodemographic, lifestyle, anthropometric and biochemical characteristics were assessed through standardized procedures. Multivariable regression models were used to examine the association between fasting glucose (FG), fasting insulin (FI), and insulin resistance (HOMA-IR) (dependent variables) with BCF (independent variable) controlling for multiple possible confounders. A linear association of BCF with FG (β = -0.557, 95% CI (-0.834, -0.280)) and a quadratic association with FI and HOMA-IR with the highest point of curve observed at BCF = 2.989 (times/week) and at BCF = 2.746, respectively, independent of the used covariates. In males and in participants of high SES, BCF was linearly and inversely associated with FG, while with FI and HOMA-IR there was an association with BCF in quadratic function. In females, BCF was linearly and inversely associated with FG and HOMA-IR, and there was a quadratic association with FI. In low SES there was only a linear association with FG, yet with no statistically significant findings for FI and HOMA-IR. Regular breakfast consumption, especially >3 times/week is associated with improved indices of glycemic control. This association was diminished in low SES participants in the presence of the used covariates.

Measurement of erythrocyte creatine might be useful for diagnosing latent hemolysis

ObjectivesWhereas HbA1c values are low relative to glycemia in patients with hemolytic anemia, including compensatory anemia, low HbA1c levels along with negative results for conventional hemolysis indicators have been reported in patients with latent hemolysis. Conversely, glycated albumin (GA) is a glycemic control indicator unaffected by hemolysis. Erythrocyte creatine (EC) is a hemolysis indicator that reflects the mean age of red blood cells (MRBC). We recently reported a formula for obtaining MRBC based on EC. The present study examined the usefulness of EC measurements and MRBC calculated with EC for diagnosing latent hemolysis. Materials and methodsTwo patients with latent hemolysis and low HbA1c values relative to glycemia were investigated, while controls comprised 214 patients (including patients with hemolysis and/or type 2 diabetes mellitus). HbA1c was expressed in International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) units (iA1c). GA/iA1c ratios, reticulocyte counts, EC, and MRBC in patients with latent hemolysis were compared to non-hemolysis, compensatory hemolysis, and hemolytic anemia patients. ResultsBoth reticulocyte counts and haptoglobin levels were within reference ranges in patients with latent hemolysis. GA/iA1c ratios and EC were higher than reference values in patients with latent hemolysis, and MRBC values were 41.6 and 48.4 days, respectively, shorter than the reference range (49.1–66.8 days). ConclusionsEC measurement and MRBC values calculated on the basis of EC might be useful for diagnosing latent hemolysis.

MO611: Glycated Albumin Levels Predict The Type of Kidney Damage in Diabetic Patients

Abstract BACKGROUND AND AIMS Diabetes mellitus remains the most frequent cause of end-stage renal disease (ESRD) in developing countries. The main determinant of the onset of nephropathy in diabetes is hyperglycemia which brings to glycation of albumin and haemoglobin with higher concentration of AGEs (advanced glycation end products), finally leading to fibrosis, inflammation and albuminuria. Glycated albumin (GA) was introduced as an alternative to hemoglobin A1c (HbA1c) for glycemic control in the CKD population, with some advantages for diabetic patients with diabetic kidney disease (DKD), since it is not influenced by anemia and associated treatments and it is not affected by serum albumin levels. Although some evidences in literature demonstrated that GA is superior to HbA1c in assessing blood glucose control in DKD (Gan T et al. J Diabetes Complications. 2018); however, KDIGO Guidelines still recommend HbA1c, although underlying some limitations in the context of DKD, meaning that new markers are needed in order to monitor this class of diabetic patients. Kidney disease in diabetic patients can include different kind of renal damage ranging from real diabetic nephropathy (DN, with Kimmelstiel–Wilson lesions, glomerular basal membrane thickening, proliferation of mesangial matrix) to nondiabetic renal disease (NDRD), in the presence or absence of real DN, thus influencing prognosis and treatment. The purpose of the study was to evaluate the clinical utility of the GA dosage, alone or with other molecular and clinical markers as noninvasive biomarkers for the prediction of the progression and type of kidney damage in the diabetic patient. METHOD We enrolled 108 diabetic patients in follow-up at our center, 90 with a biopsy-proven diagnosis of kidney disease and 18 with no kidney dysfunction. Among the 90 patients, 51 had real diabetic nephropathy (DN) or mixed forms (DN + NDRD) and 39 had non-diabetic renal disease (NDRD). GA dosage was obtained by QuantILab® Glycated Albumin assay (Instrumentation Laboratory SpA, Milan, Italy). qPCR was used to evaluate urinary levels of miR27b-3p, a biomarker that predicts the kind of renal damage in diabetic patients and is related to kidney fibrosis (Conserva F et al. Sci Rep. 2019). Statistical analysis was performed using ‘SPSS Statistical Software.’ RESULTS We observed that GA values had a significantly different distribution among DN, NDRD and diabetic patients without renal dysfunction (P = 0.003); conversely, there was no statistical difference in HbA1c distribution although a trend was visible. In the entire cohort, only GA levels, but not HbA1c levels, were significantly correlated with fasting glucose (P = 0.001) and the duration of diabetes (P = .001). In the single classes, only in DN patients there was a significant correlation between GA and diabetes duration (P = .02) and GA and HbA1c (P = 0.01) but not in the NDRD class (P = 0.43). We then applied a multivariate logistic regression model to discriminate real DN and NDRD. We demonstrated that GA is the only significant predictor of real DN in a model corrected for sex, age and serum creatinine {P = 0.009; OR = 0.757–0.962; [95% confidence interval (CI)]}, whereas the same logistic regression model with HbA1c demonstrated no significance (P = 0.082). In the same cohort, we also evaluated miR-27b-3p expression levels, whose levels are correlated with renal fibrosis in DN, and we observed that there was a significant and direct correlation also with GA levels (P = 0.001), thus suggesting the possibility to integrate these biomarkers to predict the kind of renal damage in diabetic patients. CONCLUSION Our study described for the first time the role played by GA as a diagnostic marker in the identification of the different kind of renal damage in diabetic patients. All these evidences support the need to introduce GA as an index of glycemic control to be associated with other molecular markers, such as miRNAs, in order to noninvasively diagnose the kind of renal damage in diabetic patients.

Effect of curcuma longa on atherogenic index of plasma in alloxan induced diabetic rats.

Objective: To determine effects of Curcuma longa (CL) on the glycemic control, blood lipids and atherogenic index of plasma (AIP) in alloxan induced diabetic male Wistar albino rat model. Study Design: Experimental study. Setting: Department of Basic Medical Sciences, Suleman Roshan Medial College, Tando Adam, Sindh. Period: February 2019 to January 2021. Material & Methods: A sample of 100 rats was divided into negative controls (C-), positive (diabetic) control (C+), and experimental groups D, E and F. DM was induced by injecting Alloxan (120 mg/Kg body weight) intraperitoneally (i.p) to overnight fasting rats. Diabetic groups D, E, and F were treated with ethanol extract of Curcuma longa 100 mg, 300 mg and 500 mg orally daily for six weeks. Blood samples were collected for biochemical analysis. Atherogenic Index of Plasma (AIP) was calculated by log TAG/HDLc. Data analyzed on SPSS package (ver. 21.0, IBM, incorporation, USA) (p≤ 0.05). Results: Significant improvement in glycemic status and blood lipids was observed in Curcuma longa treated groups D, E and F (P=0.0001). Atherogenic index of plasma (AIP) in negative (C-) and positive (C+) control was 0.08±0.03 and 1.11 ±0.1 respectively (P=0.0001) that improved in Curcuma longa treated groups D, E and F noted as; 0.77±0.3, 0.68±0.3 and 0.62±0.4 respectively. Conclusion: Present study found ethanolic extract of Curcuma longa improves the glycemic control, lipid profile and atherogenic index of plasma (AIP) in alloxan induced diabetic rat model.

The personality meta-trait of stability and carotid artery atherosclerosis.

Several personality traits increase the risk for atherosclerotic cardiovascular disease. Because many of these traits are correlated, their associations with disease risk could reflect shared variance, rather than unique contributions of each trait. We examined a higher-order personality trait of Stability as related to preclinical atherosclerosis and tested whether any such relationship might be explained by correlated variation in cardiometabolic risk factors. Among 798 community volunteers, lower-order traits of Neuroticism, Agreeableness, and Conscientiousness were modeled as latent variables (from self- and informant ratings) and used to estimate the second-order factor, Stability. Cardiometabolic risk was similarly modeled from indicators of glycemic control, blood pressure, adiposity, and lipids. Carotid artery atherosclerosis was measured as intima-media thickness (IMT) by duplex ultrasonography. A structural equation model incorporating direct and indirect effects showed lower Stability associated with greater IMT, and this relationship was accounted for by the indirect pathway via cardiometabolic risk. Secondary analyses showed that: (1) Neuroticism, Agreeableness, and Conscientiousness were unrelated to IMT independent of Stability; and (2) Stability predicted variation in IMT when estimated from informant-, but not self-rated, traits. Personality traits may associate with atherosclerotic burden through their shared, rather than unique, variance, as reflected in Stability.

Effect of Nigella Sativa Oil on Oxidative Stress, Inflammatory, and Glycemic Control Indices in Diabetic Hemodialysis Patients: A Randomized Double-Blind, Controlled Trial.

Background and Aims Diabetes is a leading cause of renal failure. High levels of oxidative stress and inflammation in patients with renal diabetes lead to various disorders and mortality. This study was performed to determine the effect of Nigella sativa (NS) supplementation on superoxide dismutase (SOD), malondialdehyde (MDA), total antioxidant capacity (TAC), high-sensitivity C-reactive protein (hs-CRP), glycosylated hemoglobin (HbA1c), fasting blood sugar (FBS), and insulin (INS) in patients with diabetes mellitus undergoing hemodialysis (HD). Methods In this randomized, double-blind, placebo-controlled clinical trial, a total of 46 diabetic HD patients were randomly divided into NS (n = 23) and placebo (n = 23) groups. NS group received 2 g/day of NS oil, and the placebo group received paraffin oil for 12 weeks. Serum levels of SOD, MDA, TAC, hs-CRP, HbA1C, FBS, and INS were measured before and after the study. Results Compared to baseline values, SOD, TAC, and INS levels increased, whereas MDA, hs-CRP, HbA1c, and FBS significantly decreased. After adjusting for covariates using the ANCOVA test, changes in the concentrations of SOD (p = .040), MDA (p = .025), TAC (p=<.001), hs-CRP (p = .017), HbA1c (p = .014), and FBS (p = .027) were statistically significant compared to the placebo group. Intergroup changes in INS were not significant. Additionally, there were no notable side effects during the research. Conclusions This study found that NS supplementation significantly enhanced the levels of SOD, MDA, TAC, hs-CRP, HbA1c, and FBS in diabetic HD patients.

Factors associated with glycemic control among patients with type 2 diabetes: a cross-sectional study.

Achieving glycemic control significantly improves the progression of the disease among diabetes mellitus patients although this is not achieved by many diabetics. The aim of the study is to explore the factors associated with glycemic control among patients with type 2 diabetes. In addition to sociodemographic variables, beliefs about medications and medication adherence were evaluated using the validated Beliefs about Medications Questionnaire and the 4-item medication adherence scale. A cut-off point of HbA1c% <7 was used as an indicator of glycemic control. Stepwise binary logistic regression was conducted to explore the variables associated with poor glycemic control. A total of 287 patients participated in the study. More than half (58%) were found to have poor glycemic control‎. Females had significantly higher odds of having controlled diabetes (OR=2.28, p-value <0.01). Increasing necessity for diabetes medications was significantly associated with improved glycemic control (OR=2.75, p-value <0.01). Participants in low or moderate adherence groups had significantly higher odds of having uncontrolled diabetes. Future diabetes management programs should focus on emphasizing medication necessity and improving medication adherence, particularly for male patients, with the aim of improving glycemic control and health outcomes among patients with type 2 diabetes.

Diabetes in ischaemic stroke in a regional Australian hospital: uncharted territory.

Stroke and diabetes mellitus (DM) are significant interrelated healthcare issues but there is a dearth of data on the prevalence of DM among Australia's regional stroke population. We aimed to determine the prevalence of DM in stroke patients at a large regional centre, including subanalyses on stroke subtypes, glycaemic control and renal function in ischaemic stroke (IS). We conducted a retrospective analysis of all patients (n = 323) with IS or transient ischaemic attack (TIA) admitted to Ballarat Base Hospital from January 2015 to December 2016. Demographic data, cardiovascular risk factors, aetiology/territory of IS, pre-morbid DM status, indicators of glycaemic control and renal impairment were recorded. DM was present in 28.5% of IS and TIA patients, including 4% being newly diagnosed. Among diabetic IS patients, 45.3% had poor glycaemic control (HbA1c ≥7.0%) while 16% had moderate to severe renal impairment (estimated glomerular filtration rate of <30). The majority of IS were partial anterior circulation stroke (53.4%) and cardioembolism was the commonest mechanism (43.5%). We found no significant association between DM and a specific stroke location or mechanism. Almost one-third of IS/TIA patients had DM, with a significant proportion showing poor glycaemic control. The DM prevalence in our cohort was comparable with reported rates from other developed countries. Although we found no association between DM and a particular stroke type or mechanism, it is likely a reflection of our cohort size. Our study demonstrated that DM, as a significant risk factor in IS, warrants early detection and better management strategies.

IDF21-0224 Decline of Renal Function Stratified by Hematocrit Level in Hemoglobin E diabetic patients in Surin hospital, Thailand

Background: Diabetes is now the common cause of end-stage renal disease (ESRD). Hemoglobin E disorder is the most prevalent hemoglobinopathy in Surin, Thailand. Therefore, patients with diabetes who have concomitant hemoglobin E disorder are also frequently encountered. They have very high clinically varierity from severe anemia to clinical silent hemoglobin E disorder. However, the decline in kidney function have not been clearly identified. Aim: This research aims to study the rate of decline in estimated glomerular filtration rate (eGFR) in hemoglobin E disorder diabetic patients in Surin hospital. Method: This cohort study was conducted from 2009 to 2019. Patient’s general clinical information, fasting plasma glucose (FPG), HbA1c levels, lipid profile, complete blood count including hematocrit level, creatinine, systolic blood pressure and diastolic blood pressure were collected from the first visit of year 2009, retrospective to year at diagnosis and once time per year until 2019 or loss follow up or dead and eGFR were collected and stratified into 7 groups by hematocrit level. Subjects were confirmed diabetics who already had been treated either with insulin, oral hypoglycemic drugs or a physician-prescribed diet. Target of diabetic control follow standard treatment, not try to intensive control. The endpoint was rate of decline of eGFR per year. The hypothesis was that the cumulative average duration of disease was equally, the renal complication between all groups was not different. Results: From 2009 to 2019, 184 diabetic patients with hemoglobin E homozygote. There were no significant differences in regard to fasting plasma glucose (FPG), hemoglobin A1c (HbA1c) among all groups. During follow up, the listed hemoglobin A1c goals are levels that appear to achievement of HbA1c of <7.5%, mean 6.7% (95% confidence interval 6.37–7.05). The rate of decline in eGFR were 1.7 ml/min/1.73m2/year and significant much slower in hematocrit 37.0–38.9% group 0.11 ml/min/1.73m2/year (95% confidence interval 1.07–0.84). The other group were 1.54-2.75 ml/min/1.73m2/ (P<0.001), after adjusted confounding factors. Discussion: With long term cohort study, hemoglobin E disorder has artificial lower HbA1c. Diabetic patients with hemoglobin E disorder should be monitored using HbA1c level as an indicator for long-term glycemic control compare with use self-monitoring blood sugar level.

Correlation of vitamin D with glycemic control and body mass index in patients with type II diabetes mellitus

Correlation of vitamin D with glycemic control and body mass index in patients with type II diabetes mellitus

Ramadan Fasting Among Older Children and Adolescents With Type 1 Diabetes Mellitus: A Real-World Study From the UAE.

BackgroundRamadan fasting (RF) is a religious obligation for all healthy adult Muslims. The sick and pre-pubertal children are exempt, but many choose to fast for various reasons. In this “real world” study, glycaemic control has been investigated in the context of RF in children and adolescents with type 1 diabetes mellitus (T1DM) and compared multiple daily injections (MDI) and continuous subcutaneous insulin infusion (CSII) outcomes.MethodsChildren and adolescents with T1DM seen at Imperial College London Diabetes Centre who decided to fast in the ensuing Ramadan were educated with their families about diabetes mellitus management during RF using an adapted CHOICE (Carbohydrate, Insulin, and Collaborative Education) educational programme. Pertinent data including hypoglycaemia episodes and diabetic ketoacidosis (DKA) were obtained through patient/family interviews. Information on weight, glycated hemoglobin (HbA1c), and blood glucose levels from continuous glucose monitoring (CGM)/flash glucose monitoring (FGM) before (1 month prior), during, and after (1 month afterwards) Ramadan were retrieved retrospectively from the electronic database. Data are presented as mean ± SD.ResultsForty-two patients [age 13.5 ± 2.4 years; 27 (64.3%) males; T1DM duration 4.9 ± 3.1 years] were included in the study and were able to fast for 22 ± 9 days during Ramadan. Twenty-three (54.8%) of the patients were on MDI and 19 (45.2%) were on CSII. No statistically significant differences were seen in CGM/FGM generated mean blood glucose level before, during, and after Ramadan [one-way ANOVA (F(2, 80) =1.600, p = 0.21)]. HbA1c and weight after Ramadan did not change significantly compared to baseline (paired t-test; p = 0.02 and p = 0.08, respectively). Between MDI and CSII groups, there was no significant difference in fasting days (p = 0.49), frequency of hypoglycaemia episodes (p = 0.98), DKA frequency (p = 0.37), HbA1c level (p = 0.24), and weight (p = 0.11) after Ramadan.ConclusionData show no significant deterioration in indicators of overall glycaemic control which remained inadequate. RF should be discouraged in children with poorly controlled T1DM.

Carbohydrate-Energy Replacement Following High-Intensity Interval Exercise Blunts Next-Day Glycemic Control in Untrained Women.

BackgroundImproved glycemic control has been reported for ∼24 h following low-volume high-intensity interval exercise (HIIE), but it is unclear if this is a direct effect of exercise or an indirect effect of the exercise-induced energy deficit. The purpose of this study was to investigate the effect of carbohydrate-energy replacement after low-volume HIIE on 24 h glycemic control in women.MethodsSeven untrained women (age: 22 ± 2 yr; BMI: 22 ± 3 kg/m2; VO2peak: 33 ± 7 ml/kg/min) completed three 2-day trials in the mid-follicular phase of the menstrual cycle. Continuous glucose monitoring was used to measure blood glucose concentrations during, and for 24 h following three conditions: (1) HIIE followed by a high-carbohydrate energy replacement drink (EX-HC); (2) HIIE followed by a non-caloric taste-matched placebo drink (EX-NC); and (3) seated control with no drink (CTL). HIIE involved an evening session (1,700 h) of 10 × 1-min cycling efforts at ∼90% maximal heart rate with 1 min recovery. Diet was standardized and identical across all three 2-day trials, apart from the post-exercise carbohydrate drink in EX-HC, which was designed to replenish the exercise-induced energy expenditure. Postprandial glycemic responses to the following days breakfast, snack, lunch, and dinner, as well as 24 h indices of glycemic control, were analyzed.ResultsThe day after HIIE, postprandial glycemia following breakfast and snack were reduced in EX-NC compared to EX-HC, as reflected by lower 3 h glucose mean (breakfast: 5.5 ± 0.5 vs. 6.7 ± 1, p = 0.01, Cohen’s d = 1.4; snack: 4.9 ± 0.3 vs. 5.7 ± 0.8 mmol/L, p = 0.02, d = 1.4) and/or area under the curve (AUC) (breakfast: 994 ± 86 vs. 1,208 ± 190 mmol/L x 3 h, p = 0.01, d = 1.5). Postprandial glycemic responses following lunch and dinner were not different across conditions (p > 0.05). The 24 h glucose mean (EX-NC: 5.2 ± 0.3 vs. EX-HC: 5.7 ± 0.7 mmol/L; p = 0.02, d = 1.1) and AUC (EX-NC: 7,448 ± 425 vs. EX-HC: 8,246 ± 957 mmol/L × 24 h; p = 0.02, d = 1.1) were reduced in EX-NC compared to EX-HC.ConclusionPost-exercise carbohydrate-energy replacement attenuates glycemic control the day following a single session of low-volume HIIE in women.

PHARMACOTHERAPY POSSIBILITIES OF CARDIOVASCULAR AUTONOMOUS NEUROPATHY IN CHILDREN WITH TYPE 1 DIABETES MELLITUS AT THE PRECLINICAL STAGE

The aim of the article is to evaluate the effectiveness of the thioctic acid preparation in the complex therapy of type 1 diabetes mellitus (T1DM) in children with cardiovascular autonomic neuropathy at the preclinical stage.Materials and methods. A design is a prospective randomized study. A clinical and instrumental examination of 64 children with preclinical stage signs of diabetic cardiovascular autonomic neuropathy (DCAN) was carried out. The cohort was divided into 2 groups: in the main and control groups, glycemic control was normalized by adjusting a dose of insulin therapy; in the main group, the children additionally received thioctic acid at the dose of 600 mg/day for 3 months. To control the effectiveness of the therapy, the technique of laser Doppler flowmetry was used.Results. After the pharmacological intervention, there was an improvement in the disease course, normalization of carbohydrate and lipid metabolism, increased vasomotor mechanisms of the regulation of the tissue blood flow due to an increase in endothelial and neurogenic kinds of activity in combination with a decrease in the intravascular tone and an increase in the effective perfusion in tissues. An increase in the heart rate variability was detected, positive dynamics of cardiovascular tests indicators according to D. Ewing, temporal (pNN50%, SDNN) and spectral indicators (VLF) were diagnosed. Achievement and maintenance of the target values of glycemic control indicators, as well as the absence of glycemic variability, turned out to be clinically significant for reducing the manifestations of neuropathy. The non-invasive technique of laser Doppler flowmetry is informative for the early diagnosis of DCAN in T1DM children.Conclusion. The carried out studies have demonstrated the effectiveness of the lipoic acid use at the dose of 600 mg/day for 3 months in the children with DCAN signs at the preclinical stage. The method of laser Doppler flowmetry for determining indications and monitoring the effectiveness of therapy makes it possible to implement a personalized approach to prescribing preventive treatment in T1DM children.

Protein Intake Among Patients with Insulin-Treated Diabetes is Linked to Poor Glycemic Control: Findings of NHANES Data.

BackgroundNutrition therapy is considered a key component of diabetes management. Recently, high-protein diets have gained in popularity. Understanding the glycemic effect of dietary protein among patients with diabetes has been of particular interest.MethodsThis study is based on NHANES data of 990 participants aged 40 years and older from the NHANES cohorts of 2011–2012 and 2013–2014 surveys. Glycosylated hemoglobin (HbA1c level) was used as indicator of glycemic control. Patients were categorized into quartiles for daily protein intake. Average protein intakes for patients in quartile 1 to quartile 4 were 35.5 g, 58.7 g, 79.9 g, and 131.6 g, respectively. Covariates included in the analysis were gender, age, race, caloric intake, muscle strength, education, income, smoking, sedentary lifestyle, alcohol consumption, and BMI.ResultsAfter controlling for covariates, patients in quartile 4 of protein intake had 261% increased risk of poor glycemic control compared with those in quartile 1 (95% CI: 1.29–5.30). The association was not attenuated after further control for insulin use (OR = 1.94; 95% CI: 0.89–4.24). In conclusion, higher protein intake seems related to a worse glycemic control in diabetic subjects.

Fructosamine as an Index of Short-Term Glycemic Control in Pregnant Women with Diabetes: Before, During and After Ramadan

PurposeImpact of ramadan fasting on healthy and women with diabetes is already known. However, there is a scarcity of data on impact of fasting on pregnant women with diabetes. Moreover, religious and medical recommendations advise pregnant women against fasting as it is unsafe. Despite being exempted, many pregnant Muslim women with diabetes still choose to fast during ramadan. This study investigated different glycemic marker as an indicator for diabetes control in fasting pregnant women.Patients and MethodsThis is a prospective observational study. A total of 89 pregnant diabetes women were recruited. Blood glucose was self-monitored in all the pregnant women using glucose monitoring device at home. We measure the fructosamine, HbA1c levels before, during and after ramadan.ResultsPregnant women with type 1 diabetes were 14 (25%), type 2 diabetes were 21 (37.5%), and gestational diabetes were 21 (37.5%). The mean fructosamine level decreased during and after ramadan in gestation diabetes pregnant women compared to type 2 diabetes and type 1 diabetes pregnant women subjects (p = 0.009).ConclusionThe present study indicates that pregnant women with diabetes were able to fast during ramadan and there fructosamine level reduced during fasting. Utilization of fructosamine for short-term monitoring of glycemic control in addition to home glucose monitoring in pregnant women with diabetes will provide a good index of glycemic control.RecommendationReligious and medical recommendations advise pregnant women against fasting as it is unsafe, and they are under high risk. However, if they insist to do fast, they must do under strict medical supervision and fructosamine can be used as a glycemic control marker.

Hematological indices and their correlation with glucose control parameters in a prediabetic rat model.

Background and Aim:Chronic hyperglycemia in prediabetic individuals would progress to diabetes and lead to several systemic disruptions, including hematological parameters. This study aimed to investigate the correlation between prediabetes and hematological indices in a prediabetic rat model.Materials and Methods:Eighteen male rats were randomly divided into two groups of nine. Prediabetes was induced in nine rats by a 3-week high-fat and high-glucose diet, followed by low-dose streptozotocin (STZ) injection (30 mg/kg body weight). The oral glucose tolerance test was performed, and the fasting blood glucose (FBG) and insulin levels were measured 72 h after STZ administration. The control group of nine rats was given standard diets. At the end of the 3rd week, the animals fasted overnight before blood collection. Blood samples were drawn and used for the analysis of the FBG and fasting insulin levels and glycated albumin to define prediabetes criteria before hematology analysis.Results:We found a significant increase in the FBG and insulin levels in the prediabetic versus the control group. There were decreases in red blood cells, hemoglobin, and hematocrit levels and red cell distribution in prediabetic rats versus the control. At the same time, a significant increase in the platelet count was observed in the prediabetic group. There was a positive correlation between FBG and lymphocytes and neutrophil-lymphocyte ratio in prediabetic rats. On the other hand, we found a negative correlation between white blood cell count and glycated albumin.Conclusion:Correlations were found in several hematological parameters in the prediabetic rat models. The changes in hematological indices in prediabetic rats may be further used as a valuable indicator of glycemic control.