Glycemic Status In Patients Research Articles

An Association Between Different Doses of Inhaled Corticosteroids and Glycaemic Status in Patients with Chronic Obstructive Pulmonary Disease

Introduction: Inhaled corticosteroids effective medications for the treatment of asthma. Higher doses of inhaled fluticasone (1000 μgm / day) are commonly used in COPD. Such high doses have been associate with significant systemic effects such as pneumonia, glaucoma, cataracts, adrenal suppression and accelerated bone turnover. Aim of the study: The aim of the study was to evaluate the association between different doses of inhaled corticosteroids (Fluticasone Propionate µgm / day) and glycaemic status in Patients with Chronic Obstructive Pulmonary Disease. Material & Methods: This was a cross-sectional analytical study. This study was conducted at the department of Internal Medicine in Bangobandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, during May, 2016-April, 2017. The protocol of this study was approved by IRB and ethical committee. A total of 80 patients with COPD were included in this study, of them clinically diagnosed 40 consecutive COPD patients who were receiving both bronchodilator & inhaled corticosteroids were recruited as case group and clinically diagnosed 40 consecutive COPD patients receiving only bronchodilator without inhaled corticosteroid/systemic steroid were recruited as control, group. Spirometry was done for confirmation and staging of COPD according to GOLD at indoor and OPD patients of Department of Internal Medicine, BSMMU. Results: In case group, the inhaled corticosteroid dose (5000) was counted 02 (5%) and the mean of FPG value was 6.25±1.34, the inhaled corticosteroid dose (1000) was counted 27 (67.5%) and the mean of FPG value was 5.7±1.58, the inhaled corticosteroid dose (2000) was counted 11 (27.5%) and the mean of FPG value was 6.58±2.24. The total FPG mean of the doses was 5.97±1.78. Among case group according to inhaled corticosteroid dose in case group, the inhaled corticosteroid dose (500) was counted 02 (5%) and the mean of 2HABF value was 9.65±3.18, the inhaled corticosteroid dose (1000) was counted 27 (67.5%) and the mean of 2HABF value was 8.71±2.84, the inhaled corticosteroid dose (2000) was counted 11 (27.5%) and the mean of 2HABF value was 9.51±2.9. The total mean of 2HABF value of the doses was 8.98±2.82. In case group, the inhaled corticosteroid dose (500) was counted 02 (5%) and the mean of HbA1C value was 5.85±1.06, the inhaled corticosteroid dose (1000) was counted 27 (67.5%) and the mean of HbA1C value was 6.07±0.7, the inhaled corticosteroid dose (2000) was counted 11 (27.5%) and the mean of HbA1C value was 6.7±0.74. The total mean of HbA1C value of the doses was 6.23±0.77. Conclusion: We had found that 32% of cases and 7.5% of control group were diagnosed as diabetic when fasting plasma glucose taken into account, while in case of 2 hours after breakfast plasma sugar the number were 32.5% and 10% respectively and in case of HbA1c the number were 23.5% and 10% respectively.

Proportion and severity of periodontitis and correlation of periodontal inflamed surface area with glycemic status in patients with type 2 diabetic neuropathy with and without diabetic foot.

The association between diabetic neuropathy with and without diabetic foot and periodontitis remains unaddressed in the literature. The present study was conducted to evaluate the frequency of patients with periodontitis and its severity, and to correlate clinical attachment loss (AL) and periodontal inflamed surface area (PISA) with HbA1c in Type 2 Diabetic Neuropathy (T2DN) patients with and without diabetic foot. In this cross-sectional study 310 patients with type 2 diabetic neuropathy (T2DN) were randomly selected, and the study comprised of 120 patients with T2DN with diabetic foot and 155 patients with T2DN without diabetic foot. All patients were assessed for periodontal parameters (bleeding on probing, probing depth, clinical AL, oral hygiene index-simplified), plaque index, and PISA) and systemic parameters (HbA1c, fasting blood glucose, post prandial blood glucose, urinary albumin creatine ratio, erythrocyte sedimentation rate, and high-sensitivity C-reactive protein).Unpaired t-test and Chi-Square test were used to analyze quantitative data and qualitative data, respectively. The frequency of patients with periodontitis in patients with T2DN with and without diabetic foot was 91.7% and 88.4%, respectively. The severity of periodontitis, PISA, and clinical AL were higher in the diabetic foot group. Clinical AL and PISA were significantly related with HbA1c in patients with T2DN with and without diabetic foot. Percentage of patients with periodontitis and the severity of periodontal destruction were high in type 2 diabetic neuropathy with diabetic foot. A significant correlation of PISA, clinical AL with glycemic status was found in patients with T2DN with and without diabetic foot.

Effect of Artemisia extract on glycemic control: A systematic review and meta-analysis of randomized controlled trial.

Animal and human studies have indicated anti-diabetic effect of Asteraceae. The present study aimed to systematically review and analyse randomized controlled trials assessing the effect of Artemisia extract on glycemic status in patients with impaired glycemic control. Web of Science, Cochrane library, EMBASE and PubMed databases were searched from the earliest possible date up to 7th October 2020. Six studies were included in the meta-analysis. Analysis showed that supplementation with Artemisia extract decreased homeostatic model assessment of insulin resistance (HOMA-IR) (-0.734, 95% CI: -1.236 to -0.232, P=.019) in comparison to placebo. However, reductions in fasting blood glucose (FBG) (-0.595, 95% CI: -1.566 to 0.376, P=.164), insulin (-0.322, 95% CI: -1.047 to 0.404, P=.286) and glycated haemoglobin (-0.106, 95% CI: -0.840 to 0.629, P=.678) were not statistically significant. Supplementation with Artemisia extract may reduce HOMA-IR, but beneficial effects on other markers such as FBG requires further investigations.

English

BACKGROUND Hyperglycemia, observed in type 2 diabetus mellites (T2DM) patients, is the primary root cause for the development of life threatening - diabetes induced micro- & macrovascular complications. Generally, in fasting state, gluconeogenesis accounts for about 30 % of overall hepatic glucose output and the increase in type 2 diabetic subjects may be much more than this level. The majority of gluconeogenic precursors may originate from muscle glycolysis and in the form of glucogenic amino acids including alanine. We wanted to assess fasting plasma total amino acid levels in T2DM patients and correlate the levels with the glycaemic status of T2DM patients in this study. METHODS The observational comparative study was undertaken at Research and Development department, from October 2019 to November 2020 and it consisted of 157 subjects, including 75 normal control subjects, and 82 T2DM patients. The T2 diabetic patients attending medical OPD of Subbaiah Institute of Medical Sciences, Purle, Shivamogga (SUIMS) were randomly selected and were sub-grouped in to 3 groups depending on their fasting plasma glucose (FPG) levels. The group 1 patients were having FPG level in the range of 150 – 200 mg / dl, group 2 patients having in the range of 201 - 250 mg / dl and the group 3 patients were having FPG above 251 mg / dl. RESULTS It is evident from the present study that FPG levels as well as AAN levels are significantly (P > 0.001) elevated in T2DM patients as compared to normal control subjects and there is a proportional rise in AAN levels in relation to FPG Levels in T2dm patients. CONCLUSIONS The rise in plasma AN levels is proportional to glycemic status in T2DM patients and can be employed to assess the glycemic status in these patients. KEY WORDS Amino Acids, Gluconeogenesis, Type 2 Diabetes Mellitus

1095-P: Glycemic Trend in Metropolitan versus Non-metropolitan Cities of India: One-Year Results of LANDMARC

Data on glycemic status in patients with diabetes from metropolitan and non-metropolitan cities of India are unavailable. Hence, glycemic trend was evaluated among patients from metropolitan versus non-metropolitan cities during the first year of LANDMARC trial (a 3-year nationwide prospective observational study; CTRI/2017/05/008452). A total of 6236 patients with type 2 diabetes (T2D) taking ≥2 antihyperglycemic medications (with/without glycemic control) were enrolled, of which 5654 completed 1-year follow-up visit. The age, T2D duration, baseline A1C were comparable across patients from metropolitan and non-metropolitan cities (Table). At 1-year, a decrease in all glycemic parameters was noted. However, the difference in fall in A1C from baseline between patients from metropolitan and non-metropolitan cities was not significant (mean [95% CI]: -0.5% [-0.5, -0.4] vs. -0.5% [-0.5, -0.4]; p=0.86). For FPG and PPG, the difference in change from baseline between the two groups was also not significant (p>0.05) (Table). In the first-year, patients from both metropolitan and non-metropolitan cities showed marked improvement in glycemic status with similar trends for change in glycemic parameters. These results help compare the longitudinal glycemic patterns among patients with T2D in metropolitan and non-metropolitan cities across India.View largeDownload slideView largeDownload slide DisclosureA. Unnikrishnan: Advisory Panel; Self; Sanofi-Aventis, Other Relationship; Self; Novo Nordisk A/S, Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes. R. Ghosh: Employee; Self; Sanofi. S. Krishnan: Employee; Self; Sanofi. A. Nair: Employee; Self; Sanofi. S. Mohanasundaram: Employee; Self; Sanofi. S. K. Menon: Employee; Self; Sanofi. V. Salvi: Employee; Self; Sanofi. D. Chodankar: Employee; Self; Sanofi. C. Trivedi: None. S. Wangnoo: None. A. H. Zargar: None. A. K. Das: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk, Roche Pharma, Sanofi. N. Rais: None. S. Joshi: Advisory Panel; Self; Abbott, AstraZeneca, Biocon, Franco Indian, Glenmark, Lupin, Marico, Roche, Twinhealth, Zydus, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novartis Pharmaceuticals Corporation, Novo Nordisk, Sanofi, Serdia Pharmaceuticals (India) Pvt. Ltd. A. Mithal: Advisory Panel; Self; Eris Lifesciences Limited, Consultant; Self; Glenmark Pharmaceuticals Limited, Lupin Pharmaceuticals, Inc., USV Private Limited, Speaker’s Bureau; Self; Abbott, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Intas Pharmaceuticals Ltd., Novo Nordisk, Sanofi. S. Kalra: Speaker’s Bureau; Self; Eli Lilly and Company, Novo Nordisk, Sanofi. K. Kumar: Advisory Panel; Self; Sanofi-Aventis. H. Thacker: None. B. Sethi: None. S. Chowdhury: None.FundingSanofi

Lifestyle changes as a result of COVID-19 containment measures: Bodyweight and glycemic control in patients with diabetes in the Japanese declaration of a state of emergency.

To clarify the association between lifestyle changes as a result of coronavirus disease 2019 containment measures and changes in metabolic and glycemic status in patients with diabetes, a cross‐sectional, single‐center, observation study was carried out. A self‐reported questionnaire was provided to ascertain the frequency of various lifestyle activities before and after the coronavirus disease 2019 containment measures in Japan. Among 463 patients, change in glycated hemoglobin was significantly associated with change in bodyweight. After stratification by age 65 years, binary logistic regression analysis showed that increased frequency of snack eating increased bodyweight (odds ratio 1.709, P = 0.007) and glycated hemoglobin (odds ratio 1.420, P = 0.025) in the younger group, whereas in the older patients, reduced walking activities resulted in weight gain (odds ratio 0.726, P = 0.010). In conclusion, changes in eating behavior and physical activity increased bodyweight and reduced glycemic control among diabetes patients, but by different processes depending on age under the coronavirus disease 2019 containment measures in Japan.

Prevalence of herpes virus in chronic periodontitis patients with and without type 2 diabetes mellitus: A clinico-microbiological study.

Background:Unfavorable modifications of tooth and its surrounding structures result in periodontal complications. Viruses, in specific herpes virus, are known to increase disease severity in periodontal patients. Periodontitis is known to be more established in type 2 diabetes mellitus (DM2) patients. Hence, the detection of the viral load, its effect on the prevalence of periodontitis and the glycemic control status of patients are to be evidenced. The study aimed to reveal the association of herpes virus with periodontal parameters and its prevalence in DM2 patients.Materials and Methods:The cross-sectional study involved a total of 120 patients falling into three groups; Group I (healthy), Group II (periodontitis without DM2) and Group III (periodontitis with DM2) were subjected for sampling. Subgingival samples of periodontitis patients were tested for clinical parameters, and DNA extraction was performed. The presence of herpes virus (Epstein–Barr virus [EBV-1] and human Cytomegalovirus [HCMV]) was detected using multiplex polymerase chain reaction primers. Glycemic status of patients was recorded as glycosylated hemoglobin and scored accordingly. Chi-square test was performed to analyze the association between the categorical variables, and t-test/Mann–Whitney U-test/analysis of variance/Kruskal–Wallis test was used for continuous data.Results:Significant levels of EBV-1 were detected in Group III (n = 21, 52.5%), followed by Group II (n = 16, 40%) and Group I (n = 2, 5%) (P < 0.0001). HCMV was not detected. A significant association of EBV-1 to periodontal site-specific parameters was observed in Group II patients (P < 0.05). EBV-1 was predominant with poor glycemic status patients.Conclusion:This study revealed that the incidence of herpes virus infection in periodontal patients was higher in diabetic patients and the examined patients were prone to EBV-1 infections.

Follow-up and treatment pattern during Ramadan and evaluation of the outcome of Ramadan fasting on clinical, biochemical and metabolic parameters in patients with type 2 diabetes mellitus: a realworld, multi-center, prospective observational study

Background: There are variable effects of Ramadan fasting on clinical and biochemical variables of diabetic people. Anti-diabetic agents are often adjusted during this time to reflect changes in lifestyle. The study was conducted to understand the diversity of follow-up, treatment pattern, clinical, and biochemical outcome of Ramadan fasting among type 2 diabetic patients who observed Ramadan fast.&#x0D; Methods: This real-world, multi-center, prospective, observational study was conducted at the diabetes outpatient department of National Healthcare Network (NHN) Uttara Center of Bangladesh Diabetic Somity (BADAS), Dhaka, Bangladesh and outpatient department of MARKS Hormone and Diabetes clinic, MARKS Medical College &amp;Hospital in Dhaka, Bangladesh upon randomly selected type 2 diabetic patients, recruited 1 to 12 weeks prior to the Ramadan and followed up till 12 weeks post-Ramadan period. Finally, a total of 271 participants completed satisfactory follow up. Data was collected before, during, and after Ramadan using a set of questionnaires in a face to face interview.&#x0D; Results: The majority (80.1%) of participants received pre-Ramadan education, counseling, adjustment of medication and other direction to help them cope with Ramadan fasting. A significant reduction of weight, body mass index (BMI)) and blood pressure were reported after Ramadan fast (p&lt;0.001). None of the studied participants experienced severe hyper/hypoglycemia or acute complications requiring hospitalization or an emergency room visit. Metformin was the commonest prescribed anti-diabetic medication. Premixed insulin was the commonest insulin regimen during study period. Three most commonly adjusted oral anti-diabetic drugs were gliclazide, glimepiride, metformin and insulin doses were also adjusted. Mean of fasting and prandial capillary blood glucose decreased from pre-Ramadan period to post-Ramadan period (P&lt;0.05). HbA1c decreased during post-Ramadan period compared to pre-Ramadan visit (P=0.13). A significant reduction in the triglyceride level was observed during post-Ramadan follow up (P&lt; 0.05).&#x0D; Conclusion: The study revealed that a safe fasting can be observed with proper pre-Ramadan work-up. Ramadan fasting resulted into significant reduction of weight, BMI, blood pressure, lipid profile and improved glycemic status in patients with type 2 diabetes.&#x0D; Birdem Med J 2021; 11(1): 30-38

Effects of green tea on glycemic status in female metabolic syndrome patients

Background: According to International Diabetic Federation, around 20-25% of world adult population have the clinical features of metabolic syndrome (MetS). Different organizations recommend to modify lifestyle and dietary habit as primary intervention. Green tea has several pharmacological effects on metabolic diseases including MetS.&#x0D; Objective: To evaluate the effects of green tea consumption on two glycemic variables in women with MetS.&#x0D; Method: This interventional study was conducted in the Department of Physiology, Dhaka Medical College from January 2016 to December 2016. After fulfilling the ethical aspect, a total number of 42 female patients with MetS aged 40 to 50 years were selected from the outpatient department of Endocrinology, Dhaka Medical College Hospital. Participants were randomly assigned in study group (n=22) and control group (n=20). Study group consumed green tea for 12 weeks and the control group did not consume green tea. In both groups fasting serum glucose (FSG) and glycosylated hemoglobin (HbA1c) were measured by glucose oxidase (GOD/ PAP) method and modified high performance liquid chromatography (HPLC) method respectively 2 times (before and after 12 weeks). Data were analyzed by paired Student’s ‘t’ test and unpaired Student’s ‘t’ test.&#x0D; Results: After 12 weeks of intervention, FSG &amp; HbA1c significantly (p&lt;0.001) decreased in the study group than those of their baseline value and these values were also significantly (p&lt;0.05) lower in comparison to those of control group.&#x0D; Conclusions: Regular consumption of green tea may improve glycemic status in patients with metabolic syndrome.&#x0D; J Bangladesh Soc Physiol. 2020, December; 15(2): 85-90

Impact of ductal interventions on diabetes in patients with chronic pancreatitis.

Even though ductal interventions in chronic pancreatitis (CP) are known to improve pain, its impact on diabetes is unclear. In this cohort study, we evaluated the impact of ductal interventions on diabetes in these patients. Consecutive patients with CP visiting the pancreas clinic between August 1, 2011, and July 21, 2012, were enrolled and followed until December 2018. Detailed clinical, laboratory, imaging, and treatment data were recorded at enrolment and follow-up. Patients were followed up every 6months through hospital visit and/or telephonic interview. Risk factors for diabetes were evaluated using logistic regression. The impact of ductal interventions on diabetes was evaluated using Kaplan-Meier survival analyses and Cox proportional hazards. A total of 644 patients were enrolled of which 137 were excluded. Of these, 326 (64.3%) patients had idiopathic CP, and 283 (55.8%) patients underwent ductal intervention. The cumulative incidence of diabetes was 57.9%. Median duration between symptom onset and ductal intervention was similar irrespective of diabetes (2.6 [0.6-6.0] vs 3.0 [1.0-5.5] years; P=0.69). Alcohol intake and pancreatic ductal calculi were independent risk factors for diabetes (odds ratio [95% confidence interval] of 2.05 (1.18-3.55), P=0.01, and 2.05 (1.28-3.28), P=0.003, respectively). Kaplan-Meier analyses revealed that diabetes free interval was significantly longer in patients undergoing ductal interventions, predominantly in those with idiopathic CP with obstructive ductal calculi (hazard ratio [95% confidence interval] 0.39 [0.28-0.55]; P<0.0001). There were no differences in glycemic status in patients with non-idiopathic CP and those with pre-existing diabetes. Early ductal intervention could delay development of diabetes in patients with idiopathic CP with obstructive ductal calculi.

RISK FACTORS OF TYPE 2 DIABETES MELLITUS DURATION AND NON-COMPLIANCE WITH MEDICATION TO POOR GLYCEMIC STATUS

Background: Type 2 diabetes mellitus is a chronic disease that is still a global health problem. Uncontrolled diabetes mellitus (DM) can result in poor glycemic status, with factors that affect patients including long-term DM and medication compliance. Purpose: This study aimed to determine the risk factors of long-term DM and non-compliance with medication on the poor glycemic control status of patients with type 2 DM. Methods: This type of research used observational analysis with a case–control design. Samples were taken from patients with type 2 DM, with 40 cases and 40 controls. The criteria for sample inclusion were that the patients had a glycosylated hemoglobin level check, were willing to be research respondents, and could communicate well. The exclusion criterion was patients experiencing a drastic decline in health status during the study. The sampling technique used was consecutive sampling. This research was conducted at the Panti Wilasa Citarum Hospital in Semarang City from July to September 2019. The relationship and the risk of long-term DM and adherence to taking medication with glycemic status were tested using the chi-square test. Results: This study showed that a duration of DM &gt;5 years (p = 0.01; Odss Ratio (OR) = 3.46; 95% confidence interval [CI] = 1.37 &lt; OR &lt; 8.69) and non-compliance with taking medication (p = 0.02; OR = 3.15; 95% CI = 1.25 &lt; OR &lt; 7.93) are risk factors for poor glycemic status. Conclusion: Duration of DM &gt;5 years and non-compliance with taking medication are risk factors for poor glycemic status in patients with type 2 DM.

Salivary Fructosamine as a Noninvasive Glycemic Biomarker: A Systematic Review

Standard diagnostic and monitoring methods for glycemic status involve invasive sample collection through venous puncture or fingerstick. Recent attention has been focused on exploring noninvasive methods through oral biofluids. Specifically, serum fructosamine has been established as a short-term (2- to 3-wk) marker of disease status in patients with diabetes. Fructosamine measured through noninvasive means such as saliva has shown promise, but its clinical applicability is unknown. Evaluate the available evidence on using salivary fructosamine as a reliable noninvasive marker to screen and diagnose patients with diabetes mellitus in the clinical setting. A comparative analysis of the correlative accuracy of salivary fructosamine measurements with established blood glycemic biomarkers such as serum fructosamine, blood glucose, and HbA1c will be conducted. Six electronic databases (PubMed, PubMed Central, MEDLINE, EMBASE, Scopus, Cochrane Library) were searched for original research papers (clinical and animal studies) that were relevant to the objective of this systematic review. The search was initiated on May 28, 2020. The systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Bias risk assessment, overall quality, and level of evidence were based on the Oxford Centre for Evidence-Based Medicine, Appraisal Tool for Cross-Sectional Studies, and Collaborative Approach to Meta-Analysis and Review of Animal Data from Experimental Studies tool. Heterogeneity was assessed using the National Institutes of Health quality assessment tool for cross-sectional studies. A total of 174 records were identified. Full-text articles screened for eligibility (n = 21) identified only 6 original research articles relevant to the research question and were thus included in the systematic review. The types of studies identified were cross-sectional and in vivo studies. Three studies (3/6) showed positive correlation of salivary fructosamine with blood glucose levels, while 1 study (1/6) demonstrated a positive correlation with glycated hemoglobin (HbA1c). Limitations related to sample size and selection were identified along with a fair level of interstudy heterogeneity. Based on the evidence evaluated, the utility of salivary fructosamine as a noninvasive marker to screen and diagnose patients with diabetes is doubtful. The overall level of evidence was low (IIIB) and the risk of bias was determined to be high. Further evidence in the form of large-scale well-controlled studies is needed prior to recommending salivary fructosamine as a noninvasive diagnostic tool for glycemic status in patients with diabetes mellitus.

Evaluation of serum electrolytes and their relation to glycemic status in patients with T2DM

Diabetes mellitus is a chronic disease that requires long-term medication to limit the development of its ruinous complications. The complications of diabetes are metabolic imbalance, blood vessel degeneration; effect on electrolyte concentration can offset the proportion of electrolytes. Since there is a direct association of serum electrolytes with diabetes mellitus (DM), the study was planned to investigate the electrolytes disturbance and their association with glycemic status in T2DM patients. This was cross-sectional hospital-based study; 60 participants who were diagnosed to have T2DM between the age group 30 to 60 years were recruited. Fasting glucose, glycated hemoglobin and serum electrolytes such as sodium, potassium, calcium and magnesium were estimated. Descriptive statistics was expressed as mean &amp; SD. Pearson’s correlation analysis was performed to find the association and degree of relationship between serum electrolytes and glycemic status in T2DM. All the biochemical parameters were altered in T2DM patients. There was no significant association between FBS, HbA1c and serum electrolytes. The present study showed an alteration in electrolytes status, but there was no statistically significant association between fasting blood glucose, glycemic control and serum electrolytes consideration of the multifactorial origin of electrolyte imbalance, a cause-specific treatment is required to avoid any risk.

An Evaluation of a Nutraceutical with Berberine, Curcumin, Inositol, Banaba and Chromium Picolinate in Patients with Fasting Dysglycemia.

AimTo evaluate if a nutraceutical containing Berberine, Curcumin, Inositol, Banaba, and Chromium Picolinate (Reglicem®), can ameliorate glycemic status in patients with dysglycemia.MethodsWe enrolled 148 patients with impaired fasting plasma glucose or impaired glucose tolerance, not taking any hypoglycemic compounds. Patients were randomized to take nutraceutical or placebo for 3 months, in a randomized, double-blind, placebo-controlled design. Both nutraceutical and placebo were self-administered once a day, 1 tablet during the breakfast.ResultsA reduction of fasting and post-prandial plasma glucose was observed with the nutraceutical combination (p < 0.05 vs baseline and p < 0.05 vs placebo, respectively). Furthermore, a decrease of glycated hemoglobin, and fasting plasma insulin was observed with the nutraceutical combination (p < 0.05 vs baseline and p < 0.05 vs placebo, respectively). Then, there was a reduction of homeostasis model assessment index with the nutraceutical combination (p < 0.05 vs baseline and p < 0.05 vs placebo). M value was higher (p < 0.05 vs baseline and p < 0.05 vs placebo) in the nutraceutical combination group at the end of the treatment. We observed a reduction of total cholesterol (TC) (p < 0.05 vs baseline) and triglycerides (Tg) (p < 0.05 vs baseline and p < 0.05 vs placebo) with the nutraceutical combination, respectively. Finally, high sensitivity C-reactive protein was reduced after 3 months with nutraceutical combination therapy (p < 0.05 vs baseline and p < 0.05 vs placebo, respectively).ConclusionA nutraceutical containing Berberine, Curcumin, Inositol, Banaba, and Chromium Picolinate can be helpful in improving glyco-metabolic compensation, TC and Tg value, and in reducing inflammatory status in patients with dysglycemia.

Ilex paraguariensis, white mulberry and chromium picolinate in patients with pre-diabetes.

to evaluate if a nutraceutical compound containing Ilex paraguariensis, White Mulberry and Chromium Picolinate can ameliorate glycemic status in patients with pre-diabetes. we enrolled patients with IFG or IGT, not taking other hypoglycemic compounds. Patients were randomized to take placebo or the nutraceutical compound for 3 months, in a randomized, double-blind, placebo-controlled design. Both treatments were self-administered once a day, 1 tablet during the breakfast. a reduction of FPG was observed with the nutraceutical combination (-7.8%). Furthermore, there was a decrease of HOMA-IR with the nutraceutical combination (-7.9%). M value was higher (p < 0.05 vs baseline and p < 0.05 vs placebo) at the end of the treatment. We obtained a reduction of Tg with the nutraceutical combination (-8.3%). About 16.6% of patients treated with nutraceutical returned to have a normal glycemia (< 100 mg/dL), and all patients had an improvement of insulin-resistance, in particular 67% of patients returned to have a M value inside range of normal insulin sensitivity. a nutraceutical containing Ilex paraguariensis, White Mulberry and Chromium Picolinate at 500 mg can be helpful in improving glycemia and Tg value, in patients with pre-diabetes.

Glycemic status in patients with primary hypothyroidism and its relation to disease severity

Background: Primary hypothyroidism can be defined as an increase in serum thyroid-stimulating hormone (TSH) level, and the concentration of free T3, free T4, T3, and T4 is low. Hypothyroidism is a prevalent disease mostly affecting middle-aged women. One of the most important determinants of glucose homeostasis is thyroid hormones. Hypothyroid patients have a higher prevalence of insulin resistance and tendency to Type 2 diabetes mellitus than the normal individual. Objective: To investigate the correlation between TSH and hemoglobin A1c (HbA1C) in patients with primary hypothyroidism; so, to study the effects of hypothyroidism on glucose metabolism. Subjects and Methods: Ninety-five Iraqi primary hypothyroidism patients and 40 healthy persons taken as control were selected from Specialized Centre for Endocrinology and Diabetes during the period from June 2017 to January 2018. The patients were diagnosed previously as cases of primary hypothyroidism, and they were on treatment and still on treatment. All patients were sent to investigate TSH, T4, T3, and HbA1c. The patients were subdivided into three main groups: first is uncontrolled nondiabetic primary hypothyroid group (36 patients), second is controlled nondiabetic primary hypothyroid group (43) and third is the diabetic primary hypothyroid group (16 patients). Results: A significant difference (P

The effect of nettle (Urtica dioica) supplementation on the glycemic control of patients with type 2 diabetes mellitus: A systematic review and meta‐analysis

Type 2 diabetes mellitus (T2DM) is a major health problem, worldwide, that is associated with increased morbidity and mortality. Several randomized controlled clinical trials (RCTs) have investigated the effect of nettle (Urtica dioica) supplementation on markers of glycemic status in patients with T2DM, with conflicting results. Therefore, the present study assessed the effect of nettle on some glycemic parameters in patients with T2DM. A comprehensive search was conducted in PubMed, Scopus, Cochrane Library, and Web of Science, from database inception up to June 2019, to identify RCTs investigating the effect of nettle supplementation on glycemic markers, including fasting blood sugar (FBS) concentrations, insulin levels, homeostasis model assessment-estimated insulin resistance index, and glycosylated hemoglobin percentage in adults with T2DM. The Cochrane Collaboration tool was used to assess the methodological quality of the included studies. Results of this meta-analysis were reported based on the random effects model. Eight RCTs, comprising 401 participants, were included in the present systematic review and meta-analysis. Based on the Cochrane Collaboration risk of bias tool, five studies were considered as good quality, one was fair, and two studies were poor, respectively. The results of the meta-analysis revealed a significant reduction in FBS concentrations (weighted mean difference [WMD]: -18.01 mg/dl, 95% confidence interval [CI]: -30.04 to -5.97, p < .001, I2 = 94.6%) following nettle supplementation. However, no significant reduction was observed in insulin levels (WMD: 0.83 Hedges' g, 95% CI: -0.26 to 1.92, p = .13, I2 = 89.4%), homeostasis model assessment-estimated insulin resistance index (WMD: -0.22, 95% CI: -0.83 to 0.40, p = .49, I2 = 69.2%), or glycosylated hemoglobin percentage (WMD: -0.77%, 95% CI: -1.77 to 0.22, p = .12, I2 = 83.0%). The findings of the present study suggest that nettle supplementation may be effective in controlling FBS for T2DM patients. However, further studies are needed to confirm the veracity of these results.

The therapeutic efficnecy of ranolazine in comparison with conventional therapy in diabetic individuals with ischemic heart disease; a randomized clinical trial

Introduction: Patients with diabetes mellitus (DM) have higher risk of coronary artery disease (CAD) and angina than the general population. Objectives: We sought to assess the impact of ranolazine as an antianginal agent to diminish hemoglobin A1c (Hb A1c) level in diabetic individuals under treatment with metformin and gliclazide. Patients and Methods: This study was a randomized parallel-group clinical trial to compare the therapeutic effects of ranolazine versus conventional treatment in patients with concomitant T2DM and stable angina. TERISA (type 2 diabetes mellitus evaluation of ranolazine in subjects with chronic stable angina) was employed to assess the efficiency of ranolazine in lowering the frequency of angina attacks. The study was performed on diabetic patients with symptomatic angina under treatment with either sublingual nitroglycerin or up to two types of antianginal agents. The patients in the intervention group received 1000 mg ranolazine twice a day while patients in the control group were administrated with conventional treatment. Reduction in baseline Hb A1c level was determined at 4 and 8 weeks after the interventions. Results: Ranolazine therapy resulted in up to 15% absolute reduction in Hb A1c level in diabetic patients who had baseline HbA1c level &gt;7%. Ranolazine was more efficient in reducing Hb A1c in patients with poorly controlled disease (i.e. HbA1c&gt;8%, P=0.017). Ranolazine did not affect the glycemic status of patients concomitantly treated with antidiabetic therapy (P=0.560). Conclusion: Concurrent administration of ranolazine along with anti-diabetic treatments (i.e. metformin and gliclazide) was safe to reduce the level of HbA1c in patients with poorly controlled diabetes and stable angina.

Effect of non-surgical periodontal treatment on gingival crevicular fluid and serum leptin levels in periodontally healthy chronic periodontitis and chronic periodontitis patients with type 2 diabetes mellitus.

The aim of the present study was to evaluate the effect of non-surgical periodontal therapy (NSPT) on gingival crevicular fluid (GCF) and serum leptin levels and glycemic status in periodontally healthy patients with chronic periodontitis (CP) with and without type 2 diabetes mellitus (T2DM). Ninety patients were divided into three groups: periodontally healthy (group 1), CP (group 2) and CP with T2DM (group 3). The groups were evaluated for clinical parameters of probing pocket depth (PPD), clinical attachment level (CAL), plaque index, gingival index, biochemical parameters of GCF, serum leptin levels, and glycemic status pre- and post-NSPT. The baseline PPD and CAL for group 2 was 4.98±0.49mm and 5.35±0.55mm, respectively; for group 3 it was 5.60±0.38mm and 6.01±0.38mm, respectively. There was a considerable reduction in these parameters post-NSPT, with group 2 showing better resolution. Pretreatment serum leptin levels revealed increasing values from group 1 to group 3 and decreasing GCF values from group 3 to group 1, exhibiting an inverse relationship. Group 3 also showed an improvement in glycemic status post-NSPT. NSPT was effective in improving clinical parameters, increasing GCF, reducing serum leptin levels, and also improving glycemic status in patients with CP and CP with T2DM.

761-P: Correlation of Periodontal Inflamed Surface Area with Glycemic Status in Patients with Controlled Type 2 Diabetes Mellitus and Uncontrolled Type 2 DM With and Without Microvascular Complications

The bidirectional relationship between periodontitis and diabetes mellitus has been well documented. Periodontitis causes systemic inflammatory burden through inflammatory mediators. The currently used tools such as Clinical Attachment Loss (CAL) and Probing Pocket Depth (PPD) to assess periodontitis are linear measurements, that do not exactly quantify the inflammatory burden of periodontitis. Periodontal Inflamed Surface Area (PISA) reflects the surface area of bleeding pocket epithelium and estimate the inflammatory burden. This study was undertaken to assess the proportion of periodontitis and correlation of PISA with glycemic status in controlled, uncontrolled type 2 diabetes mellitus (T2D) with and without micro-vascular complications. The study comprised of 180 T2D patients who were divided into three groups based on their Glycosylated Hb levels (HbA1c) (i) well controlled T2D group: (HbA1c ≤ 7%) (ii) Uncontrolled T2D group: (HbA1c &amp;gt; 7%) without complications, and (iii) Uncontrolled T2D group: (HbA1c &amp;gt;7%) with microvascular complications. All subjects were assessed for the periodontal parameters (Bleeding on Probing (BOP), PPD, CAL and PISA) and systemic parameters (HbA1c, FPG, and PPPG). The proportion of periodontitis among Uncontrolled T2D group without complication and Uncontrolled T2D group with micro-vascular complications was (93.4% and 96.6%) very high as compared to Well controlled T2D group (75%) (p &amp;lt;0.001). Extent and severity of periodontitis were high in uncontrolled T2D group. Uncontrolled T2D with micro-vascular complications group attained the highest mean score for PPD, CAL, BOP and PISA. Positive correlation was found between PISA and HbA1c among the groups (r = 0.079, 0.109, 0.248 respectively). A statistically significant positive correlation has been found between PISA and HbA1c among all study subjects (r= 0.393, p &amp;lt; 0.001). Disclosure C. Radhakrishnan: None. R.J. Vadakkekuttical: None. K. Anil: None. F.C. Parambath: None.