Glycemic Goals Research Articles

Evaluation of type 1 diabetic patients: A single center experience

We evaluated patients diagnosed with type 1 DM who were followed at our clinic by conducting a retrospective chart review. Medical records of a total of 147 patients with type 1 DM (70 females, 77 males) with a mean (±SD) age of 31.2±9.7 years were reviewed retrospectively. The study patients had a mean duration of follow-up of 13.9±9.5 years, mean duration of follow-up of 4±2.6 years at our clinic and a mean HbA1c value of 8.3±2.1%. Microvascular complications were recorded in medical files for 128 patients. There were 48 (37.5%) patients with at least one microvascular complication. Medical records showed that out of 128 patients, 23 (18%) had diabetic neuropathy alone, 4(3%) had diabetic retinopathy alone and 5 (4%) had diabetic nephropathy alone. Ten patients (8%) had both diabetic nephropathy and diabetic retinopathy and 6 (4.7%) patients had all three microvascular complications. No significant difference was observed between patients with or without microvascular complications in terms of HbA1c (HbA1c 8.3% versus 8.1%; p=0.85). A history of diabetic foot ulcer was present in 4 patients in the study sample (4/147=2.7% of all patients).Twenty-two (15%) patients were on insulin pump therapy during follow-up. Insulin pump users had a significantly lower HbA1c value (7.9%) compared to those not using insulin pump (8.5%) (p=0.02). At our clinic, special efforts are being made to ensure type 1 diabetic individuals have regular outpatient examinations. Despite all these measures, our patients are still far from reaching their target HbA1c values, suggesting that we have to do much more help patients achieve their glycemic goals.

Practical Strategies to Help Reduce Added Sugars Consumption to Support Glycemic and Weight Management Goals.

Overconsumption of added sugars is a key contributor to the growing obesity, prediabetes, and type 2 diabetes pandemics. The nutrition therapy guidance of the American Diabetes Association recognizes that using low- and no-calorie sweeteners (LNCS) to reduce consumption of added sugars can reduce low–nutrient-density sources of calories and carbohydrate to beneficially affect glycemia, weight, and cardiometabolic health. This article provides information for primary care providers, diabetes care and education specialists, and other diabetes clinicians on the safety of LNCS and summarizes research evidence on the role of LNCS in glycemic and weight management. It also provides practical strategies for counseling individuals about how to integrate LNCS into their healthy eating pattern.

Assessment of Clinical Experience of Triple Drug Fixed-dose Combination of Glimepiride, Metformin and Voglibose in the Management of Type 2 Diabetes Mellitus: A Retrospective Study

Introduction: Poor adherence of patients to the polypharmacy approach is a crucial challenge in the management of Type 2 Diabetes Mellitus (T2DM) and use of triple Fixed-Dose Combination (FDC) of metformin, glimepiride, and voglibose is effective in achieving glycaemic control and would aid in improved drug adherence. Aim: To analyse clinical profile and treatment patterns of FDC of glimepiride, metformin, and voglibose with or without other antidiabetic therapy in patients with T2DM. Materials and Methods: A retrospective, observational, multi- centric study conducted during August 2019 to March 2020. Included patients of either sex, ≥18 years of age with T2DM and who had received treatment with FDC of glimepiride, metformin, and voglibose of varying strengths with or without other antidiabetic therapy. Data extracted from medical records included demographic characteristics, duration of disease, co- morbidities, concomitant medications and dosage pattern. Data were analysed using Chi-square test and Mann-Whitney U test. Results: A total of 2650 patients with T2DM were included, of which 1689 (63.7%) were males. The mean (standard deviation {SD}) age was 54.2 (11.4) years. The average Body Mass Index (BMI) was 27.2 (4.3) kg/m2 and hypertension 1656 (62.5%) and dyslipidaemia 1109 (41.9%) were the most common co-morbidities. Dipeptidyl peptidase-4 inhibitors 908 (34.3%) and antihypertensives 1601 (60.4%) were the most common concomitant diabetic and non diabetic medications received, respectively. Glimepiride (2 mg)+metformin (500 mg)+voglibose (0.2 mg) FDC twice-a-day 878 (33.1%) was a common triple FDC. A total of 2449 (92.4%) patients were compliant and 2585 (97.9%) achieved glycaemic goal with triple FDC treatment. During the therapy, the majority of patients had decreased weight 1106 (67.2%). The mean Haemoglobin A1c (HbA1c) levels significantly decreased post-treatment (mean change 1.45%; p-value <0.001). Family history of diabetes mellitus, obesity, sedentary lifestyle were the most common risk factors and smoking being prevalent in males. Conclusion: Overall results demonstrate that triple FDC of glimepiride, metformin, and voglibose was effective in reducing HbA1c and weight and was well tolerated. Also, it improves compliance in Indian patients with T2DM.

Evolution of Glycemic Targets in Management of Diabetes

How goals of diabetes management evolved over the last hundred years was largely dependent on the understanding of association of hyperglycemia with chronic complications, development of safe and effective therapeutic options and monitoring capabilities. Insulin ended the era of death in type 1 diabetes (T1D) but an era of chronic complications emerged. The medical community and policy makers were not convinced that near normal glycemia would prevent these complications. Diabetes Control and Complication Trial (DCCT) has a huge impact on how diabetes is managed today, hemoglobin A1C (A1C) of less than 7% emerged as a main therapeutic objective. However DCCT and later United Kingdom Prospective Diabetes Study (UKPDS) in type 2 diabetes (T2D), failed to show a safe lower cutoff where microvascular complications could be maximally reduced without additional risk of hypoglycemia. Moreover macrovascular complications could not be adequately addressed in these study populations. An over enthusiastic approach in the Action to Control Cardiovascular Risk in Type 2 Diabetes (ACCORD) trial resulted in an increase in overall and cardiovascular mortality, this led to concept of individualization of glycemic targets and “lower the better” is not appropriate for everyone. At the same time the follow up epidemiological data of DCCT and UKPDS reveal that good glycemic control earlier has long term benefits, the concept of legacy effect and led to the idea of “earlier the better”. Later advances in therapeutic options and monitoring capabilities have made it possible to safely achieve intensive glycemic goals, however widespread availability and cost precludes its common use.

Our Journey with Type 1 Diabetes for over a Half Century: A Dialogue between Patient Spouse and Her Physician Caregiver

A personal perspective and a narration by a patient and her Physician spouse caregiver regarding coping with evolution in therapeutic modalities including ongoing changing insulin formulations and insulin administration devices. Narration also encompasses and establishes the utility of the improving glycemic monitoring tools in assisting in attaining desirable glycemic goals.

Real-time continuous glucose monitoring versus self-monitoring of blood glucose in adults with insulin-treated type 2 diabetes: a protocol for a randomised controlled single-centre trial

IntroductionMedical treatment options for type 2 diabetes (T2D) have increased over the last decade and enhance the possibility of individualised treatment strategies where insulin is still one of them. In...

A practical approach to the clinical challenges in initiation of basal insulin therapy in people with type 2 diabetes.

Initiating insulin therapy with a basal insulin analogue has become a standard of care in the treatment of type 2 diabetes mellitus (T2DM). Despite increasing choices in pharmacological approaches, intensified glucose monitoring and improvements in quality of care, many patients do not achieve the desired level of glycaemic control. Although insulin therapy, when optimized, can help patients reach their glycaemic goals, there are barriers to treatment initiation on both the side of the patient and provider. Providers experience barriers based on their perceptions of patients' capabilities and concerns. They may lack the confidence to solve the practical problems of insulin therapy and avoid decisions they perceive as risky for their patients. In this study, we review recommendations for basal insulin initiation, focussing on glycaemic targets, titration, monitoring, and combination therapy with non‐insulin anti‐hyperglycaemic medications. We provide practical advice on how to address some of the key problems encountered in everyday clinical practice and give recommendations where there are gaps in knowledge or guidelines. We also discuss common challenges faced by people with T2DM, such as weight gain and hypoglycaemia, and how providers can address and overcome them.

Glyburide therapy for gestational diabetes: Glycaemic control, maternal hypoglycaemia, and treatment failure

AimsThe recommended first-line treatment for women with gestational diabetes mellitus (GDM) in the case of failure of diet is insulin. Recent results suggest that there is a potential role for glyburide therapy and highlight the need for better knowledge of glycaemic control with glyburide. The objective of this study was to describe and quantify in women with GDM the quality of glycaemic control, including the risk of maternal hypoglycaemia and of therapy failure. MethodsThis is a secondary analysis of the French INDAO non-inferiority trial from 2012 to 2016, in which 890 women with GDM randomized to receive glyburide or insulin treatment were compared for perinatal outcomes. Blood glucose concentrations were assessed prospectively during pregnancy. Optimal glycaemic control was defined as less than 20% of blood glucose values exceeding the targets. ResultsMore than 50% of the women had optimal glycaemic control with glyburide, similar to that with insulin. Around 40% of the women had at least one episode of hypoglycaemia, more than with insulin. However, those hypoglycaemic episodes were mostly moderate and the rate of severe hypoglycaemia decreased significantly during the course of the trial.Failure of glyburide treatment (switch to insulin therapy) occurred in 18% of women and had few predictors. However, when failure occurred, glycaemic control was improved after switching to insulin. ConclusionsGlyburide is an effective treatment for reaching glycaemic goals during pregnancy in women with GDM. The risk of maternal hypoglycaemia may be minimized by clinical practice experience. These findings could be taken into account in the management of GDM.

P55 Factores asociados a meta glucémica en diabetes tipo 2

Introducción: el logro de meta glucémica es un problema de gran impacto sanitario. El control glucémico previene y enlentece las complicaciones crónicas de la diabetes y prolonga la sobrevida.Objetivos: investigar el porcentaje de personas con diabetes tipo 2 (DM2) que logra el objetivo del tratamiento (A1C) y las variables que se asocian con logro de meta glucémica.Materiales y métodos: estudio multicéntrico, descriptivo, observacional de corte transversal, en 28 centros de Argentina especializados en diabetes (Grupo FRADYC III), año 2018. Se evaluó examen físico, laboratorio y tratamiento de la DM2 en la práctica habitual. El objetivo glucémico fue A1C <7%. Evaluamos adherencia al tratamiento farmacológico con el test de Morisky-Green-Levine y calidad de vida con el test OMS-5 considerándose bajo bienestar puntaje menor de 50 y síntomas de depresión menor a 28. Se realizó análisis univariado y regresión logística múltiple de factores que se asocian con menor logro de objetivos de tratamiento. Consideramos grupos etarios (menor de 50 años, entre 50 a 65 años y mayor de 65 años). Se consideró significativo todo valor de p<0,05 (2 colas) con el Software Intercooler STATA.

O15 Insulinoterapia en diabetes tipo 2 en Argentina. ¿Cómo insulinizamos los especialistas?

Introducción: la terapia con insulina es una herramienta eficaz para lograr la meta glucémica (A1C). El porcentaje de personas con DM2 tratadas con insulina y los esquemas utilizados varían según el país.Objetivos: identificar frecuencia, tipos y esquemas de insulinoterapia en el tratamiento de la DM2 por médicos especialistas en Argentina.Materiales y métodos: estudio descriptivo, observacional de corte transversal en personas con DM2 en 28 centros tratados por especialistas en Argentina (grupo FRADYC III) año 2018. Se evaluó: examen clínico, laboratorio y tratamiento en la práctica habitual. Se realizó análisis univariado y regresión logística múltiple, se consideró significativo todo valor de p<0,05 (2 colas) con el Software Intercooler STATA.

Temporal changes in diabetes prevalence and achievement of care goals in urban South Asia from 2010 to 2016 - The Center for Cardio-metabolic Risk Reduction in South Asia Study.

Achievement of treatment targets among individuals with diabetes remains suboptimal in many parts of the globe. We aimed to assess changes in diabetes prevalence and achievement of diabetes care goals in South Asia using two consecutive cross-sectional population-based surveys. Two representative samples of South Asian adults were recruited using identical methods from Chennai, Delhi, and Karachi in 2010-11 (n=16,288; response rate-94.7%) and 2015-16 (n=14,587; response rate-94.0%) through the Center for Cardio-metabolic Risk Reduction in South Asia (CARRS) Study. Quality of care goals were defined as HbA1c <53mmol/mol (7.0%), blood pressure (BP) control: <140/90mmHg, lipid control: LDL cholesterol <2.56mmol/l (100mg/dl), and self-reported non-smoking. Weighted prevalence of self-reported diabetes increased by 9.0% [13% (95%CI: 13-14) to 15% (14-15)] while that of newly diagnosed diabetes decreased by 16% [6.1% (5.7-6.6) to 5.1% (4.6-5.6)]. There were improvements in achieving glycaemic (25% to 30%, p=0.002) and lipid (34% to 45%, p<0.001) goals, but no notable improvements in BP control or smoking status. The proportion of individuals with self-reported diabetes meeting more than one target also increased. Diabetes prevalence continues to grow among urban South Asians and large gaps still exist in the attainment of treatment targets. Concerted policy, systemic, clinical and individual efforts are needed to close these care gaps.

PERI-OPERATIVE MANAGEMENT IN DIABETES MELLITUS

In diabetic patients, managing the glycemic levels in the perioperative period is challenging. Surgical stress and anesthesia have great impact on blood glucose levels, thus the healthcare professionals should be more cautious to maintain the optimal glycemic level. Almost 50% of diabetes patient undergoing surgery, has great chance of post-operative mortality when compared with normal glucose tolerant patient. In addition to this, there is 5 times greater risk of developing end organ damage and infections in uncontrolled diabetic patients. Hence, there is a need to optimize and improve the blood glycemic control before surgery. Tight glycemic control with intensive insulin therapy (IIT) has shown to reduce morbidity and mortality and improve the survival after the surgery. However, evidence suggest that severe hypoglycaemia and adverse outcomes with tight glycemic control brings its safety and efficacy into query. Hence, avoidance of hyperglycemia is clearly beneficial in the perioperative patients, although IIT continues to be standard of care, current consensus guidelines recommend less stringent glycemic goals, typically between 80-150mg|dl.

Impact of COVID-19 lockdown on flash and real-time glucose sensor users with type 1 diabetes in England

AimsPeople with type 1 diabetes (T1D) face the daily task of implementing self-management strategies to achieve their glycaemic goals. The UK COVID-19 lockdown has had an impact on day-to-day behaviour, which may affect diabetes self-management and outcomes. We assessed whether sensor-based outcomes pre- and during lockdown periods were different in a cohort of glucose sensor users with T1D.MethodsData were collected from Freestyle Libre (FSL) or Dexcom G6 sensor users who remotely shared their data with the diabetes clinic web platform. Sensor metrics according to international consensus were analysed and compared between pre-lockdown period and 2 and 3 weeks into lockdown (periods 1 and 2).ResultsTwo hundred and sixty-nine T1D patients (baseline HbA1c 57 ± 14 mmol/mol) were identified as FSL (n = 190) or Dexcom G6 (n = 79) users. In patients with sensor use > 70% (N = 223), compared to pre-lockdown period percentage TIR 3.9–10 mM (TIR) significantly increased during period 1 (59.6 ± 18.2 vs. 57.5 ± 17.2%, p = 0.002) and period 2 (59.3 ± 18.3 vs. 57.5 ± 17.2%, p = 0.035). The proportion of patients achieving TIR ≥ 70% increased from 23.3% pre-lockdown to 27.8% in period 1 and 30.5% in period 2. A higher proportion also achieved the recommended time below and above range, and coefficient of variation in periods 1 and 2. Dexcom G6 users had significantly lower % time below range (< 3.9 mM) compared to FSL users during both lockdown periods (period 1: Dexcom G6 vs. FSL: 1.8% vs. 4%; period 2: 1.4% vs. 4%, p < 0.005 for both periods).ConclusionSensor-based glycaemic outcomes in people with T1D in the current cohort improved during COVID-19 lockdown, which may be associated with positive changes in self-management strategies. Further work is required to evaluate long-term sustainability and support.

The Impact of COVID-19 on CGM Use in the Hospital.

In 1995 the movie Outbreak was released, and we shivered but were amused. The fictional virus “Motaba” was soon replaced by the very real H1N1, severe acute respiratory syndrome coronavirus (SARS-CoV, which causes SARS), and Ebola. Fortunately, the overall devastation of these potential pandemics, with the concern of deaths in the thousands or millions, never materialized. However, now the world is faced with SARS-CoV-2, the virus known to cause coronavirus disease 2019 (COVID-19), and the 2020 “Outbreak” movie is not fictional. This virus is real, and we are racing to find ways to save lives from this deadly disease while protecting the health and well-being of frontline health care workers. There is now a strong body of evidence that diabetes, established cardiovascular disease, and other metabolic risk factors (particularly visceral fat accumulation) are associated with increased risk of need for mechanical ventilation, acute kidney injury, and mortality (1–4). Hyperglycemia during hospitalization for COVID-19 has also been established as a poor prognostic indicator (4,5). Some studies report that those with previously poorly controlled diabetes tend to have higher morbidity and mortality (4). However, another recent study found that previous insulin use, not HbA1c, was a predictor of mortality (6). More recently reported was that COVID-19 survivors had lower mean glucose during hospitalization than nonsurvivors (7). This finding brings some of the old controversy about glycemic management in the hospital to light, raising the question of whether lowering glycemic goals may help mitigate the acute on top of chronic inflammatory response and improve outcomes. A report in 2001 on critically ill surgical patients gained wide attention (8). Intensive insulin therapy in the intensive care unit (ICU) improved morbidity and mortality, and much of the diabetes world extrapolated these findings to all patients in all hospitals. Unfortunately, …

Birinci basamakta Diyabetes Mellitus’da akılcı ilaç kullanımı

Diabetes mellitus (DM); is a metabolic progressive di-sease with a rapidly increasing prevalence. The most important factors in the treatment of DM is the education of individuals with diabetes and rational drug use. Multiple insulin therapy is started with the diagnosis in type 1 DM (T1DM), oral antidiabetic drugs (OAD) and insulin treatments are initiated together according to the glycemic status in Type 2 DM (T2DM). Problems causing irrational drug use related to OAD in DM; advanced age, multidrug use, complex drug intake program, lack of knowledge, drug-related side effects, and patient disbelief. Problems causing irrational drug use related to insulin; hypoglycemia, lipodystrophy, incorrect injection technique, insufficient and high dose administration. This situation appears as macrovascular and microvascular diseases with not reaching target HbA1c values by causing glycemic dysregulation in DM. The success of the holding of treatment in optimal status with prevention for glycemia and metabolic condition raises the quality of life in patients, prolong the patient’s life expectancy and reduces costs. Doctors and insulin educators raising awareness of rational drug use in the diabetic population ensures that correct the irrational behaviors performed in the diabetic population and adopt appropriate behaviors as a lifestyle. Thus it will improve the educational content given to people with diabetes, help to improve diabetes management and behavioral change, thereby achieving appropriate glycemic goals and increasing secondary rational gains from drugs with treatment.

Evaluating the Evidence behind the Novel Strategy of Early Combination from Vision to Implementation.

Type 2 diabetes mellitus (T2DM) is a complex and progressive chronic disease characterised by elevating hyperglycaemia and associated need to gradually intensify therapy in order to achieve and maintain glycaemic control. Treating hyperglycaemia with sequential therapy is proposed to allow holistic assessment of the efficacy and risk-to-benefit ratio of each added component. However, there is an array of evidence supporting the scientific rationale for using synergistic, earlier, modern drug combinations to achieve glycaemic goals, delay the deterioration of glycaemic control, and, therefore, potentially preserve or slow down the declining β-cell function. Additionally, implementation of early combination(s) may lead to opportunities to combat clinical inertia and other hurdles to optimised disease management outcomes. This review aims to discuss the latest empirical evidence for long-term clinical benefits of this novel strategy of early combination in people with newly diagnosed T2DM versus the current widely-implemented treatment paradigm, which focuses on control of hyperglycaemia using lifestyle interventions followed by sequentially intensified (mostly metformin-based) monotherapy. The recent reported Vildagliptin Efficacy in combination with metfoRmin For earlY treatment of T2DM (VERIFY) study results have provided significant new evidence confirming long-term glycaemic durability and tolerability of a specific early combination in the management of newly diagnosed, treatment-naïve patients worldwide. These results have also contributed to changes in clinical treatment guidelines and standards of care while clinical implementation and individualised treatment decisions based on VERIFY results might face barriers beyond the existing scientific evidence.

Level of glycemic control among US type 2 diabetes mellitus patients on dual therapy of metformin and sodium–glucose cotransporter 2 inhibitor: a retrospective database study

Objective To assess the level of glycemic control among type 2 diabetes patients on sodium-glucose cotransporter 2 inhibitor (SGLT2i) and metformin dual therapy. Methods Observational, retrospective database study in adult type 2 diabetes mellitus patients from the IQVIA Electronic Medical Record (EMR) database was conducted. The observation period was June 2015 to June 2018. Patient’s earliest encounter in the observation period while on SGLT2i and metformin dual therapy served as the index date. Patients were required to have at least one HbA1c measure in the 12 months prior to the index date and be on SGLT2i and metformin dual therapy and no other antihyperglycemic treatment as of the HbA1c measurement date or any time during the 90 days prior. The associations between sociodemographic factors and clinical burden on achievement of HbA1c <8% were assessed using multivariable logistic regression with backward stepwise selection. Results Of 3491 patients, 2176 (62.3%) achieved HbA1c <8%, with a median distance to goal of 1.1% (IQR 0.5–2.3%) for those not at glycemic target. Mean age was 56.5 years and 52.6% were male. At baseline, 28.3% of patients had established cardiovascular disease/chronic kidney disease, and of those 63.8% had HbA1c <8%. African American patients had lower odds of attaining HbA1c <8% when compared with white patients [OR 0.69], while older patients had marginally higher odds [OR 1.01]. Conclusion Approximately 3 out of 5 patients on metformin and SGLT2i dual therapy achieved HbA1c <8%, with African Americans having a lower likelihood of achieving this glycemic goal.

Hypoglycaemia and Cardiovascular Disease Risk in Patients with Diabetes.

Hypoglycaemia represents an important side effect of insulin therapy and insulin secretagogues. It can occur in both type 1 and type 2 diabetes mellitus patients. Also, some associations between hypoglycaemia and cardiovascular (CV) risk have been reported. Several mechanisms may be involved, including the sympathoadrenal system, hypokalaemia, endothelial dysfunction, coagulation, platelets, inflammation, atherothrombosis and impaired autonomic cardiac reflexes. This narrative review discusses the associations of hypoglycaemia with CV diseases, including coronary heart disease (CHD), cardiac arrhythmias, stroke, carotid disease and peripheral artery disease (PAD), as well as with dementia. Severe hypoglycaemia has been related to CHD, CV and all-cause mortality. Furthermore, there is evidence supporting an association between hypoglycaemia and cardiac arrhythmias, potentially predisposing to sudden death. The data linking hypoglycaemia with stroke, carotid disease and PAD is limited. Several factors may affect the hypoglycaemia-CV relationships, such as the definition of hypoglycaemia, patient characteristics, co-morbidities (including chronic kidney disease) and antidiabetic drug therapy. However, the association between hypoglycaemia and dementia is bilateral. Both the disorders are more common in the elderly; thus, glycaemic goals should be carefully selected in older patients. Further research is needed to elucidate the impact of hypoglycaemia on CV disease.

A Prospective Longitudinal Study on the Relationship Between Glucose Fluctuation and Cognitive Function in Type 2 Diabetes: PROPOSAL Study Protocol.

IntroductionAlthough the risk of dementia among patients with type 2 diabetes mellitus (T2DM) is double that of those without T2DM, the mechanism remains to be elucidated and the glycemic goal to prevent progression of cognitive impairment is unclear. Results from cross-sectional studies suggest that glucose fluctuations are associated with impairment of cognitive function among T2DM patients. Therefore, the aim of the longitudinal study described here is to evaluate the relationships between glucose fluctuation indexes assessed by continuous glucose monitoring (CGM) and cognitive function among elderly patients with T2DM.MethodsThis will be a prospective, single-center, 2-year longitudinal study in which a total of 100 elderly patients with T2DM showing mild cognitive impairment (MCI) will be enrolled. Glucose fluctuations, assessed using the FreeStyle Libre Pro continuous glucose monitoring system (Abbott Laboratories), and results of cognitive tests, namely the Montreal Cognitive Assessment (MoCA) and Alzheimer’s Disease Assessment Scale (ADAS), will be evaluated at baseline, 1-year visit and 2-year visit. The primary endpoint is the relationships between indexes of glucose fluctuation and change in MoCA and ADAS scores. Secondary endpoints are the relationships between the indexes of glucose fluctuation or cognitive scores and the following: indexes representing intracranial lesions obtained by magnetic resonance imaging and angiography of the head; Geriatric Depression Scale score; Apathy Scale score; carotid intima-media thickness assessed by echography; inflammatory markers; fasting glucose; glycated hemoglobin; blood pressure; and the development of cardiovascular and renal events.Planned OutcomesThe current study is scheduled for completion in June 2022. The results could lead to the elucidation of novel glycemic goals to prevent the progression of cognitive impairment and/or of relationships between glucose fluctuations and cognitive function among T2DM patients. The findings of the study will be reported in publications and conference presentations.Trial RegistrationUniversity Hospital Medical Information Network Clinical Trial Registry (UMIN000038546).

Effective Initiation and Treatment With Basal Insulin in People With Type 2 Diabetes: Focus on Mitigating Hypoglycemia in Patients at Increased Risk: Executive Summary.

Many people with type 2 diabetes are treated with insulin with the goal of achieving a specific A1C target. The most prominent risk for people on insulin therapy is hypoglycemia. When basal insulin analogs are used appropriately, the risk of hypoglycemia can be reduced while still achieving individualized glycemic goals. In a series of short videos now available on the Clinical Diabetes website, the authors discuss approaches to optimizing basal insulin initiation and treatment in people with type 2 diabetes, including those at high risk such as individuals with renal impairment and older adults, with a focus on reaching A1C goals while mitigating the risk for hypoglycemia. This article is intended to briefly summarize those discussions, and readers are encouraged to view the videos in their entirety at https://clinical.diabetesjournals.org/content/basal-insulin-videos. ### Introduction (Available at https://bcove.video/2Q2Rb9b) Approximately 50% of people with type 2 diabetes have poorly controlled disease and are vulnerable to long-term micro- and macrovascular complications (1). As type 2 diabetes progresses, many patients will require insulin to maintain glycemic control. The appropriate use of insulin requires a balance between the need for tight glucose control and the potential risk for hypoglycemia. Definitions of hypoglycemia have evolved over time, and the American Diabetes Association (ADA) now uses a three-level classification of hypoglycemia severity (2). Mitigating the risk for hypoglycemia is crucial to the successful treatment of people with type 2 diabetes. In the following series of videos, the authors discuss the use of available insulin formulations in the context of hypoglycemia risk. ### Basal Insulin Therapy—Balancing Glycemic Control With Risk for Hypoglycemia (Available at https://bcove.video/3h3Y85h) The achievement of tight glycemic control reduces micro- and macrovascular complications, and adherence to treatment improves quality of life and decreases health care costs (3–9). The authors discuss the association between A1C reduction and microvascular complications, as reported in the UK …