Glycemic Control Rates Research Articles

C-peptide, glycaemic control, and diabetic complications in type 2 diabetes mellitus: A real-world study.

To explore the relationship between C-peptide and glycaemic control rate and diabetic complications (microvascular complication and cerebral infarction) and provide evidence for stratified treatment of type 2 diabetes mellitus (T2DM)-based C-peptide. This is a cross-sectional real-world observational study. According to the inclusion and exclusion criteria, we studied 1377 patients with T2DM, grouped by fasting C-peptide and HOMA-IR. Blood samples were collected after fasting overnight. Logistic regression was used to analyse the relationship among fasting C-peptide, HOMA-IR, C2/C0 ratio (the ratio of 2 h postprandial C-peptide to fasting C-peptide), glycaemic control rate, and occurrence of diabetic complications. Restricted cubic spline (RCS) curves based on logistic regression were used to evaluate the relationship between C-peptide, glycaemic control rate, and diabetic kidney disease (DKD). Patients were subdivided according to their fasting C-peptide in 4 groups (Q1,Q2,Q3,Q4). Patients of group Q3 (1.71 ≤ C-peptide < 2.51ng/ml) showed the lowest incidence of DKD, diabetic retinopathy (DR), and rate of insulin absorption as welll as higher glycaemic control rate. Logistic regression shows that the probability of reaching glycemic control increased with higher levels of C-peptide, compared with group Q1, after adjusting for age, gender, duration of diabetes, body mass index, systolic blood pressure, diastolic blood pressure, creatinine, low-density lipoprotein, triglyceride, total cholesterol, and high-density lipoprotein. RCS curve shows that, when C-peptide is ≤2.68ng/ml, the incidence of not reaching glycaemic control decreases with increasing C-peptide. The possibility of not reaching glycaemic control decreased with increasing C2/C0, when C-peptide is ≥1.71ng/ml. RCS curve shows that the relationship between C-peptide and DKD follows a U-style curve. When C-peptide is <2.84ng/ml, the incidence of DKD decreased with increasing C-peptide. With the increase in the C2/C0 ratio, the incidence of DKD, DR, and fatty liver did not decrease. When C-peptide is ≥ 1.71 and < 2.51 ng/ml, patients with T2DM had a higher glycemic control rate. Excessive C-peptide plays different roles in DKD and DR; C-peptide may promote the incidence of DKD but protects patients from DR. Higher C2/C0 ratio is important for reaching glycaemic control but cannot reduce the risk of DKD, DR, and fatty liver.

Perioperative Low Carb Diet in a Type 2 Diabetic Prior Duodenopacreatectomy

Background: There is a positive association between various types of cancer and diabetes. Duodenopancreatectomy is the treatment of choice for diabetic patients with duodenal tumors. Pancreatic resections may trigger endocrine insufficiency. There is an association between poor glycemic control and lower survival rates. Low carb diets appears to be an effective approach in the treatment of diabetic patients that require pancreatic resections. Case Presentation: We report the case of a type II diabetic diagnosed with resectable duodenum cancer. At the time of diagnosis he was jaundiced and with decompensated diabetes. The patient was submitted to a low carb diet for three weeks and, having improved its physiological and metabolic parameters, we performed a duodenopancreatectomy. The patient evolved without complications, with easy management of postoperative glycemia. Conclusions: Low carb diets can prove to be a powerful, inexpensive, and safe tool to add to our therapeutic arsenal before pancreatic resections.

Glycemic Control and Diabetes Related Complications in Adults with Type 1 Diabetes Mellitus and ADHD

Objective: To assess the correlation of co-morbid ADHD and diabetes-related complications in patients with type-1-diabetes-mellitus (T1DM). Methods: A retrospective cross-sectional study was conducted during 2018 using the Leumit-Health-Services(LHS) database. Diabetes-related complications were assessed in patients with T1DM and ADHD (T1DM-ADHD+) and compared with patients with T1DM alone (T1DM-ADHD−). Results: Out of 789 adult-patients with T1DM, 75 (9.5%) were T1DM-ADHD+, matched to 225 T1DM-ADHD−. HbA1C levels were higher in T1DM-ADHD+ patients (8.1% ± 1.6 vs. 7.4% ± 1.2, p < .01), as well as diabetes-related complications: neuropathy (22.7% vs. 5.8%, p < .01), ulcers (8% vs. 0.9%, p < .05), limb amputation (5.3% vs. 0.9%, p < .05), albuminuria (15.5% vs. 2.8%, p < .01), chronic renal failure (10.6% vs. 2.5%, p = .01), and emergency room admissions rate (26.7% vs. 15.1%, p < .05). In sub-analysis, lower average HbA1C levels and diabetic ulcer rates were found among ADHD patients treated with stimulants, all p < .05. Conclusion: Co-morbidity of ADHD and T1DM is associated with poor glycemic control and higher complication rates.

Predictors of poor glycemic control among type 2 diabetes mellitus patients treated with antidiabetic medications: A cross-sectional study in China.

This study aimed to clarify of the predictors of poor glycemic control in type 2 diabetes mellitus (T2DM) patients treated with antidiabetic medications in China.This study was a retrospective, cross-sectional study based on SuValue database. T2DM patients aged 18 years or older performing glycosylated hemoglobin A1c (HbA1c) examinations from January 1st, 2018 to December 31st, 2018 were included and have been treated with antidiabetic medications for at least 6 months. HbA1c < 7.0% was defined as adequate glycemic control. Multivariate analysis was performed for the factors associated with poor glycemic control.A total of 13972 T2DM patients were included in this study. The adequate glycemic control rate was 44.04% (n = 6153). In the multivariate analysis, predictors of poor glycemic control include longer T2DM duration (5–10 years vs <5 years and >10 years vs <5 years, odds ratio [OR] = 1.499 and 1.581, P < .001 and P = .008), myocardial infarction (OR = 1.141, P = .041), diabetic neuropathy (OR = 1.409, P < .001), secondary hospital (OR = 1.877, P < .001), underdeveloped regions (OR = 1.786, P < .001), insulin only (OR = 3.912, P < .001), combination of oral antidiabetic agents and/or insulin use (P < .001).In conclusion, longer T2DM duration, secondary hospital, myocardial infarction, diabetic neuropathy, undeveloped regions and use of polypharmacy and insulin were associated with poor glycemic control among T2DM patients treated with antidiabetic medications. Patient education and training of health care providers may be short-term strategy to achieve adequate glycemic control.

Effectiveness of quality improvement strategies for type 1 diabetes in children and adolescents: a systematic review protocol

Introduction: Optimal glycaemic control is often a challenge in children and adolescents with type 1 diabetes (T1D). Implementation of patient, clinician or organisation-targeted quality improvement (QI) strategies has been proven to be beneficial in terms of improving glycaemic outcomes in adults living with diabetes. This review aims to assess the effectiveness of such QI interventions in improving glycaemic control, care delivery, and screening rates in children and adolescents with T1D. Methods and analysis: MEDLINE, EMBASE, CINAHL and Cochrane CENTRAL databases will be searched for relevant studies up to January 2021. Trial registries, ClinicalTrials.gov and ICTRP, will also be explored for any ongoing trials of relevance. We will include trials which examine QI strategies as defined by a modified version of the Cochrane Effective Practice and Organisation of Care 2015 Taxonomy in children (&lt;18 years) with a diagnosis of T1D. The primary outcome to be assessed is glycated haemoglobin (HbA1c), although a range of secondary outcomes relating to clinical management, adverse events, healthcare engagement, screening rates and psychosocial parameters will also be assessed. Our primary intention is to generate a best-evidence narrative to summarise and synthesise the resulting studies. If a group of studies are deemed to be highly similar, then a meta-analysis using a random effects model will be considered. Cochrane Risk of Bias 1.0 tool will be applied for quality assessment. All screening, data extraction and quality assessment will be performed by two independent researchers. Dissemination: The results of this review will be disseminated through peer-reviewed publication in order to inform invested partners (e.g., Paediatric Endocrinologists) on the potential of QI strategies to improve glycaemic management and other related health outcomes in children with T1D, thereby guiding best practices in the outpatient management of the disorder. PROSPERO registration number: CRD42021233974 (28/02/2021).

The Association Between Body Mass Index and Glycemic Control in Patients with Type 2 Diabetes Across Eight Countries: A Literature Review

Objectives: To investigate the association between obesity and glycemic control based on country-specific glycemic control data from the USA and selected European and Asian countries by body mass index (BMI), or BMI data by glycemic control (HbA1c), in individuals with type 2 diabetes (T2D). Methods: Literature search of databases and abstracts to identify real-world studies (2015-2020) reporting HbA1c and BMI data. Results: Seventeen articles (China, including Hong Kong, n=10; Japan, n=3; USA, n=2; Spain, n=1; UK, n=1) were identified from 6696 de-duplicated references. Of the 13 studies reporting by BMI mean rates of glycemic control or likelihood of achieving glycemic control, eight found that achieving control significantly declined as BMI increased; one reported a clear trend but no statistics; two reported glycemic control rates for those with obesity to be significantly worse than for one other group; and two reported no significant difference with BMI. Of the six studies reporting average HbA1c levels by BMI, four reported HbA1c to increase with BMI. Two of three studies reporting mean BMIs by glycemic control found these increased with HbA1c. Conclusions: This review consolidates recent evidence on the glycemic control status of individuals with T2D reported by BMI in selected countries. Studies generally reported a lower chance of achieving glycemic control targets in those with overweight or obesity. Most studies found greater HbA1c in individuals with higher BMI, and average BMI greater in those with higher levels of HbA1c. Focused efforts are needed to improve glycemic control in patients with T2D and overweight/obesity.

Effect of Mobile Health for Standardized Management on Women with Gestational Diabetes Mellitus

Objective To explore the performance of mobile health platform for standardized management of pregnant women with gestational diabetes mellitus(GDM). Methods A randomized controlled trial was conducted,in which 295 women with GDM were randomized into two groups(traditional management group and mobile health management group)by a computer-generated sequence.The traditional management group accepted standardized GDM management,and the mobile health management group was supplemented by mobile health management based on the standardized management.The glycemic control rate and the incidences of low birth weight,macrosomia,preterm birth,premature rupture of membranes,postpartum hemorrhage after cesarean section,neonatal asphyxia,malformation,and admission to the neonatal intensive care unit were compared between the two groups. Results The glycemic control rate in mobile health management group was significantly higher than that in the traditional management group [(67.22±22.76)% vs.(60.69±21.28)%,P=0.004].The incidences of low birth weight,macrosomia,preterm birth,premature rupture of membranes,postpartum hemorrhage after cesarean section,neonatal asphyxia,malformation,and admission to the neonatal intensive care unit demonstrated no significant differences between groups(all P > 0.05). Conclusions Mobile health applied in standardized management is conducive to the glycemic control of GDM women,whereas it does not significantly improve the pregnancy outcomes.Due to the short time of intervention,the effects of mobile health on pregnancy outcomes need further study.

Racial Disparities in Pediatric Type 1 Diabetes: Yet Another Consequence of Structural Racism.

Racial Disparities in Pediatric Type 1 Diabetes: Yet Another Consequence of Structural Racism.

Correlation of baseline serum 25-hydroxyvitamin D level with the risk of type 2 diabetes mellitus: a prospective cohort study

To investigate the correlation of baseline serum 25(OH) D level with the risk of type 2 diabetes mellitus (T2DM) and blood glucose control in diabetic patients among the middle-aged and elderly individuals in Chengguan District of Lanzhou, Gansu Province. Residents aged 40 to 75 years in Lanzhou were selected from the "REACTION" study conducted in 2011 and had been followed up since 2014. A total of 5044 subjects with complete data from the two surveys were analyzed. Participants were divided into Q1, Q2, Q3, and Q4 subgroups based on quartiles of serum 25(OH)D level for comparison of the incidence of T2DM and blood glucose control. Baseline 25(OH)D level was not found to correlate with FPG, 2h-PG or HbA1c levels among the residents (P>0.05). The participants were followed up for a mean of 3.4±0.6 years, and compared with those in Q1 group, the participants in Q2, Q3 and Q4 groups did not show significantly lowered risk of prediabetes or diabetes regardless of glucose tolerance status. Among the patients with T2DM, the compliance rate of glycemic control after the follow-up was significantly higher than that before the follow-up (63.4% vs 60.6%), and the levels of HbA1c, FPG, and 2h-PG decreased obviously after the follow-up. But compared with Q1 group, Q2, Q3 and Q4 groups showed no significant changes in glycemic control compliance rate or levels of HbA1c, FPG and 2h-PG after the follow-up (P>0.05). There is no evidence that baseline 25(OH)D levels are associated with the risk of diabetes and blood glucose control in patients with T2DM.

Trends in HbA1c and Body Mass Index Among Individuals with Type 2 Diabetes: Evidence from a US Database 2012-2019.

IntroductionGiven the high rates of obesity and poor glycemic control among individuals with type 2 diabetes (T2D), this study examines current trends in HbA1c and body mass index (BMI) as well as the association between HbA1c and BMI among adults with T2D.MethodsData from the IBM® MarketScan® Explorys® Claims-EMR Data were used to construct eight annual cohorts for the years 2012–2019. Each annual cohort included adults identified with T2D who had at least one recorded HbA1c laboratory result and BMI value in the year of interest. Given these cohorts, trends in HbA1c and BMI were described over time using generalized estimating equation (GEE) tests.ResultsResults indicate that, over the study period from 2012–2019, average BMI increased significantly and there was a decrease in the percentage of adults with T2D who achieved glycemic control. In addition, for all years, higher BMI classification was associated with higher HbA1c values. When examining results for patients in different age groups, the findings were generally consistent with the overall population. In each age group, but most notably the age 18–44 group, the mean BMI increased over time and higher BMI was associated with higher HbA1c.ConclusionGiven the increase in BMI and decreasing percentage of individuals achieving glycemic control among adults with T2D found over the study period, therapies which decrease BMI as well as HbA1c can potentially have a significant impact on the management of T2D. The growing proportion of the younger age group with higher mean BMI may remain a key subgroup of interest.

Analysis of perioperative glucose metabolism using an artificial pancreas

Hyperglycemia associated with insulin resistance is common in surgical patients with and without diabetes and is associated with poor surgical outcomes. Several studies have recently shown that a closed-loop blood glucose monitoring system in the form of an artificial pancreas is safe and effective for surgical patients. In this study, we analyzed the risk factors for insulin resistance in patients using an artificial pancreas. We investigated 109 patients who underwent surgical management by an artificial pancreas for 24hours from the start of surgery during either major hepatectomy (MH), defined as resection of more than two liver segments, or pancreaticoduodenectomy (PD). The target glucose range was from 80 to 110mg/dL using an artificial pancreas. We analyzed the risk factors for and predictors of a high insulin dose, including sarcopenia markers, according to the median 24-hour total insulin infusion. The median total insulin dose and glycemic control rate (GCR), which is the rate of achieving the target blood glucose range, per 24hours were 78.0IU and 30.4% in the MH group and 82.6IU and 23.5% in the PD group, respectively. The muscle volume was the only independent factor in the high-dose subgroup, and the GCR was significantly lower in the high-dose subgroup despite a high insulin dose in both the MH and PD groups. The results of this study suggest that preoperative sarcopenia is closely associated with insulin resistance in the perioperative period. Clinicians must effectively manage sarcopenia, which may result in improved perioperative glycemic control and reduced postoperative complications.

Glycemic control and complication rate through pregnancy and thirteen-years post-partum in women with microalbuminuria (type 1 diabetes T1DM)

Glycemic control and complication rate through pregnancy and thirteen-years post-partum in women with microalbuminuria (type 1 diabetes T1DM)

Rate of glycemic control and associated factors among type two diabetes mellitus patients in Ethiopia: A cross sectional study.

To assess the rate of glycemic control and associated factors among type 2 diabetes mellitus patients at Dilchora Referral Hospital, Dire Dawa, Eastern Ethiopia. A cross-sectional study was conducted from 13 May to 16 August 2019. Type 2 diabetic patients on follow up at Dilchora Referral Hospital who fulfilled the inclusion criteria of the study were included. Systematic random sampling was used to select study participants. Data was collected by a face-to-face interview and review of medical records. The primary outcome was the level of blood glucose during three consecutive visits. Poor glycemic control was defined as a blood sugar level of more than 154 mg/dL based on the average of measurements from three consecutive visits. Multivariate logistic regression analysis was used to identify determinants of glycemic control. A total of 394 participants responded to the interview and were included in the final analysis. The overall prevalence of poor glycemic control was 45.2% (95%CI: 40.6%-50.0%). Patients who were on oral anti-diabetic drug plus insulin had more than two times greater chance of poor glycemic control than patients on oral anti-diabetic drug alone: 2.177(95%CI:1.10-4.29). The odds of poor glycemic control in patients who did not understand the pharmacist's instructions was two times higher than patients with good understanding of instructions 1.86(95%CI: 1.10-3.13). Patients who had poor level of practice were found to have poor glycemic control: 1.69(95% CI: 1.13-2.55). The overall prevalence of poor glycemic control was high among type 2 diabetes patients. Oral anti-diabetic drugs in combination with insulin, lack of understanding of pharmacist's advice, and poor practice of diabetic patients were significant factors of poor glycemic control. Pharmacists should reassure the understanding of patients before discharge during counseling. Optimization of the dose of antidiabetic medications and combination of oral hypoglycemic agents should be considered.

The Use of Cultural Competency in Decreasing Diabetes Outcomes Disparities in a Community Health Care Setting

In the United States, the prevalence of diabetes in the Latnix population is roughly 70% higher than in non-Latinx whites. Along with this, many studies have shown that the rate of complications, both macro- and microvascular, in this population is also disproportionately higher. Given that complication rates mirror glycemic control, as evidenced by studies such as the DCCT and UKPDS, the increased rate of poor glycemic control is likely one of the most important factors contributing to this. Most efforts at controlling diabetes in a population have aimed at a heterogeneous cohort in terms of race and ethnicity, yet poor control disproportionately affects the Latinx groups. North Shore Community Health Center is a Federally Qualified Health Center located around the communities of Salem, Peabody, and Gloucester, MA. These areas are ethnically diverse, and the vast majority of the Latinx population are Dominican. In fact, roughly 50% of the clinic population is Latinx. After prioritizing glycemic control as a goal for 2019, we utilized a population health strategy to identify patients with A1c >9% (poor control as defined by UDS measurements). These patients were given an appointment with the only endocrinologist in the clinic, who, through a Dominican Spanish translator and using joint decision making, decided on appropriate medication. They were then followed at least weekly at first by a nurse who also was Dominican and lived in the community. She counseled patients on culturally-appropriate diet recommendations, activity, screening, monitoring, and provided access to other specialties (e.g. podiatry, ophthalmology) as needed. The rate of A1c >9% in the clinic had been 35–40% prior 2019. At the end of 2019, the rate was 27%, with a disproportionaltly lower rate in the Latinx population (23%). Our conclusion is that a culturally sensitive diabetes program will eliminate these health disparities

Comparable Long-Term Glycemic Control and Insulin-Independent Rate at Less Cost By Using Intra-Operative vs. Islet Cell Laboratory Isolation for Total Pancreatectomy With Islet Auto-Transplantation

Total pancreatectomy with intraportal islet cell autotransplantation (TPIAT) allows for the islets to be isolated and subsequently re-infused to prevent the complications associated with post-pancreatectomy diabetes in patients with chronic or recurrent pancreatitis. TPIAT requires a complex islet isolation process of the explanted pancreas, and historically required a specialized lab to perform islet cell isolation. We report our unique 5-year experience comparing our new technique of intra-operative islet isolation to the prior use of off-site specialized islet lab, thereby making the isolation process simpler, faster, and more accessible. Method: We performed a retrospective, comparative effectiveness analysis of 50 adult patients who underwent TPIAT at our tertiary care center from 2012 to 2020 (excluding patients with partial- or completion pancreatectomy with IAT). From 2012–2015, isolation occurred at a remote location 130 miles away in which the pancreas was explanted at our center, transported to the islet isolation lab, and returned the same day to our center for portal system infusion. From 2015–2020, islet isolation was performed using the novel intra-operative technique at our institution without a specialized islet isolation lab. We measured the islet equivalents per body weight (IEQ/kg), monitored glycemic control, and compared insulin-independent rate for patients in each group yearly up to 5 years. Results: Twenty patients underwent TPIAT with remote isolation while thirty patients underwent intra-operative isolation of islet cells. Baseline characteristics were similar between these groups. Mean islet yields-IEQ/kg (4,294 remote group vs. 3,015 intra-op group, p=0.06) were not different between the groups. Post-operative mean c-peptide levels at 1 and 3 years were stable over time and were not different between the groups (1.51 and 1.65 ng/mL remote group vs. 0.91 and 0.98 ng/mL intra-operative group, p=0.1 and 0.15 respectively). Mean HbA1c levels at 1–5 years were 7.5–8.2% in the remote group vs. 7.1–7.4% intra-op group, p=0.67, which suggests reasonable and durable glycemic control in both groups. Insulin independent rate was also very similar (43% vs 41%, p=0.10) at 3 years after the surgery when both groups reached the same number of patients (n=20) for the comparison. Average cost of hospitalization was less in the intra-operative group ($104,398 remote vs $78,986 intra-op). Conclusion: Intra-operative islet isolation has similar effectiveness in regard to glycemic outcomes and insulin independent rates but at a lower cost when compared with the use of a dedicated islet cell isolation lab. This technique can allow many more centers without a dedicated islet cell lab to offer islet cell auto-transplantation, which in turn will help reduce the burden of difficult diabetes care post-pancreatectomy and improve quality of life for the appropriate patients.

Glycemic Control and Use of High-risk Antihyperglycemic Agents Among Nursing Home Residents With Diabetes in Ontario, Canada

This cohort study examines levels of glycemic control among nursing home residents with diabetes and compares rates of intensive glycemic control with high-risk antihyperglycemic agents across levels of cognitive impairment.

Effects of a Dedicated Inpatient Diabetes Management Service on Glycemic Control in a Community Hospital Setting.

Community hospitals account for over 84% of all hospitals and over 94% of hospital admissions in the United States. In academic settings, implementation of an Inpatient Diabetes Management Service (IDMS) model of care has been shown to reduce rates of hyper- and hypoglycemia, hospital length of stay (LOS), and associated hospital costs. However, few studies to date have evaluated the implementation of a dedicated IDMS in a community hospital setting. This retrospective study examined the effects of changing the model of inpatient diabetes consultations from a local, private endocrine practice to a full-time endocrine hospitalist on glycemic control, LOS, and 30-day readmission rates in a 267-bed community hospital. Overall diabetes patient days for the hospital were similar pre- and post-intervention (20,191 vs 20,262); however, the volume of patients seen by IDMS increased significantly after changing models. Rates of hyperglycemia decreased both among patients seen by IDMS (53.8% to 42.5%, P < .0001) and those not consulted on by IDMS (33.2% to 29.9%; P < .0001). When examined over time, rates of hypoglycemia steadily decreased in the 24 months after dedicated IDMS initiation (P = .02); no such time effect was seen prior to IDMS (P = .34). LOS and 30DRR were not significantly different between IDMS models. Implementation of an endocrine hospitalist-based IDMS at a community hospital was associated with significantly decreased hyperglycemia, while avoiding concurrent increases in hypoglycemia. Further studies are needed to investigate whether these effects are associated with improvements in clinical outcomes, patient or staff satisfaction scores, or total cost of care.

Comparison of compliance and outcomes in adolescents with type 1 diabetes mellitus attending a co-located pediatric and transition diabetes service

Abstract Objectives Adolescence is a challenging period for diabetes management, particularly when transitioning to adult care. There are reports highlighting concerns that transition to adult care may lead to poor glycemic control and clinic engagement. Our aim was to determine if a co-located pediatric and transition diabetes service would lead to better transition outcomes. Methods A retrospective medical records review was conducted on patients with type 1 diabetes attending a transition clinic in a metropolitan teaching hospital in Sydney, Australia. Patients referred from the hospital’s co-located pediatric diabetes clinic to the transition clinic were compared to those referred from external sources regarding important clinical outcomes such as glycosylated haemoglobin (HbA1c), clinic attendances, and complication rates between referral sources. Confounders such as age, gender, duration of diabetes and socioeconomic status were considered. Results Data was collected from 356 patients of which 121 patients were referred from the co-located pediatric diabetes clinic (IRG) and 235 patients from external sources (ERG). Improvements in HbA1c were only seen in the ERG at 6 and 12 months (p&lt;0.001). Altogether 93% attended one or more medical appointments in the IRG compared to 83% in the ERG (p=0.03). There were more admissions for acute diabetes complications (17 vs. 8%, p=0.01) and more microvascular complications (20 vs. 9%, p&lt;0.01) in the IRG vs. ERG group. Conclusions Although co-location of a pediatric and transition clinic improved medical engagement, this did not equate to better glycemic control or complication rates. Further research is warranted to determine what other strategies are required to optimise the transition process in diabetes care.

Factors associated with glycemic control among South African adult residents of Mkhondo municipality living with diabetes mellitus.

This study examines the rate and the influencing factors of glycemic control among adult residents living with DM in Mkhondo Municipality of South Africa.In this cross-sectional study, 157 individuals attending care for DM were recruited. Glycemic control status was categorized as poor if glycated hemoglobin (HbA1c) > 7% and very poor if HbA1c ≥ 9%. Multivariate regression analysis was used to identify the significant determinants of poor and very poor glycemic control.The majority of the study participants were females (84.71%) and above 45 years old (88.55%). The overall prevalence of poor glycemic control was 77.71% (n = 122), while very poor glycemic control occurred in 50.6% (n = 80) of the study cohort. In the multivariate logistic regression model analysis, African traditional [AOR = 0.15; 95% confidence interval (95% CI) 0.04–0.57], fast food consumption (AOR = 5.89; 95% CI 2.09–16.81), elevated total cholesterol (TC) [odds ratio (OR) = 2.33; 95% CI 1.50–5.17], elevated low-density lipoprotein cholesterol (LDL-C) (AOR = 5.28; 95% CI 1.89–14.69), and triglyceride (TG) (AOR = 4.39; 95% CI 1.48–13.00) were the independent and significant determinants of poor glycemic control. Age (AOR = 0.46; 95% CI 0.23–0.92) was the only independent and significant determinant of very poor glycemic control.We found a high rate of poor glycemic control (77.71%) possibly attributed to religious affiliation, fast food consumption, and dyslipidemia. On the contrary, about half of the study sample had very poor glycemic control (HbA1c ≥9%), which was predominant among younger cohort with diabetes mellitus. Interventions aimed at improving glycemic control in this population must also target religious practice, dietary patterns and dyslipidemia as well as tailored-approach for young people.

Diabetic Complications and Factors Affecting Glycemic Control Among Patients With Type II Diabetes Mellitus Attending the Chronic Illness Clinics at Tabuk, Saudi Arabia

BackgroundDiabetes mellitus (DM) is one of the most common diseases worldwide and affects many patients all over the globe. Diabetic complications vary between microvascular and macrovascular, affecting a wide range of organs and systems in the body. Understanding, determining, and in return, preventing such factors is essential to alleviate the quality of life of diabetic patients. Therefore, we aim to determine the poor glycemic control and the factors associated with it in our diabetes population.MethodsThis is a retrospective study where data was reviewed for all patients with Type II DM (T2DM) who attended the chronic illness clinic at King Khaled Hospital in Tabuk. We included patients aged ≥ 18 years, of Saudi nationality, and residents of the Tabuk region. Any patient not satisfying all the inclusion criteria was excluded from the current study. Diagnosis with diabetes was made according to the American Diabetes Association guidelines, 2020. Patients’ demographic data, medical history, and social and lifestyle history were extracted from records. In addition, age, body mass index (BMI), drugs (insulin vs. oral hypoglycemic agents), duration of the disease, lipid profile, and other comorbidities were also extracted from the files. A p-value of <0.05 was selected as the statistically significant level in all tests.ResultsA total of 697 patients were included in the current study, with a mean age of 58.2±11.6 years. The mean glycosylated hemoglobin (HbA1c) of the study participants was 8.4±1.7%, and their fasting blood sugar (FBS) level was 9.9±3.9 mmol/l. With HbA1c cut-off at 7%, the overall prevalence of poor glycemic control was 81.5% (565/693). A higher prevalence of poor glycemic control was reported among study participants with higher DM duration (p=0.002). Diabetes complications were found in 208 (29.8%) of the study participants, where microvascular complications were present in 140 patients, and microvascular ones were found in 102. In the logistic regression model, older patients were less prone to poor glycemic control (OR=0.98; 95% CI=0.96-0.99; p=0.010). In addition, longer disease duration was a predictive factor of poor glycemic control (OR=1.05; 95% CI=1.02-1.08; p=0.003). Furthermore, the usage of combined insulin and tablet treatments were associated with a higher risk of poor glycemic control when compared to insulin only treatments (OR=4.65; 95% CI=1.55-13.94; p=0.006).ConclusionThe results of this study indicate a high prevalence rate of poor glycemic control among Saudi patients, which is higher than previous reports have shown. More interest should be given to awareness programs with regard to promoting self-control protocols for the disease.