Diabetes Management Goals Research Articles

Continuous glucose monitoring for self-management of diabetes in people living with type 2 diabetes mellitus on basal insulin therapy: A microsimulation model and cost-effectiveness analysis from a US perspective with relevance to Medicaid.

Reducing the risks of complications is a primary goal of diabetes management, with effective glycemic control a key factor. Glucose monitoring using continuous glucose monitoring (CGM) technology is an important part of diabetes self-management, helping patients reach and maintain targeted glucose and glycated hemoglobin (HbA1c) levels. Although clinical guidelines recommended CGM use, coverage by Medicaid is limited, likely because of cost concerns. To assess the cost-effectiveness of FreeStyle Libre CGM systems, compared with capillary-based self-monitoring of blood glucose (SMBG), in US individuals with type 2 diabetes mellitus using basal insulin. A patient-level microsimulation model was used to compare CGM with SMBG for a population of 10,000 patients. A 10-year horizon was used, with an annual discount rate of 3.0% for costs and utilities. Model population characteristics were based on US national epidemiology data. Patient outcomes were based on published clinical trials and real-world studies. Annual costs, reflective of 2023 values, included CGM and SMBG acquisition costs and the costs of treating diabetic ketoacidosis, severe hypoglycemia, and diabetes complications. The effect of CGM was modeled as a persistent 1.1% reduction in HbA1c relative to SMBG based on US real-world evidence. Disutilities were based on published clinical trials and other relevant literature. The primary outcome was cost per quality-adjusted life-year (QALY) gained. Sensitivity analyses were performed to test the validity of the model results when accounting for a plausible variation of inputs. In the base case analysis, CGM was dominant to SMBG, providing more QALYs (6.18 vs 5.97) at a lower cost ($70,137 vs $71,809) over the 10-year time horizon. A $10,456 increase in glucose monitoring costs was offset by a $12,127 reduction in treatment costs. Cost savings reflected avoidance of acute diabetic events (savings owing to reductions in severe hypoglycemia and diabetic ketoacidosis were $271 and $2,159, respectively) and a reduced cumulative incidence of diabetes complications, particularly renal failure (saving $5,292), myocardial infarction (saving $1,996), and congestive heart failure (saving $1,061). Scenario analyses were consistent with the base case results, and the incremental cost-effectiveness ratio for CGM vs SMBG ranged from dominant to cost-effective. In probabilistic analysis, CGM was 100% likely to be cost-effective at a willingness-to-pay threshold of $50,000/QALY. CGM is cost-effective compared with SMBG for US patients with type 2 diabetes mellitus receiving basal insulin therapy. This suggests that state Medicaid programs could benefit from broader coverage of CGM.

Wearable Insulin Biosensors for Diabetes Management: Advances and Challenges.

We present a critical review of the current progress in wearable insulin biosensors. For over 40 years, glucose biosensors have been used for diabetes management. Measurement of blood glucose is an indirect method for calculating the insulin administration dosage, which is critical for insulin-dependent diabetic patients. Research and development efforts aiming towards continuous-insulin-monitoring biosensors in combination with existing glucose biosensors are expected to offer a more accurate estimation of insulin sensitivity, regulate insulin dosage and facilitate progress towards development of a reliable artificial pancreas, as an ultimate goal in diabetes management and personalised medicine. Conventional laboratory analytical techniques for insulin detection are expensive and time-consuming and lack a real-time monitoring capability. On the other hand, biosensors offer point-of-care testing, continuous monitoring, miniaturisation, high specificity and sensitivity, rapid response time, ease of use and low costs. Current research, future developments and challenges in insulin biosensor technology are reviewed and assessed. Different insulin biosensor categories such as aptamer-based, molecularly imprinted polymer (MIP)-based, label-free and other types are presented among the latest developments in the field. This multidisciplinary field requires engagement between scientists, engineers, clinicians and industry for addressing the challenges for a commercial, reliable, real-time-monitoring wearable insulin biosensor.

Expert Consensus Recommendations on Time in Range for Monitoring Glucose Levels in People with Diabetes: An Indian Perspective.

Keeping up with the global scenario, diabetes prevalence is on rise in India. Inadequate glycemic control is a major cause of diabetes-related morbidity and mortality. The conventional standards of care (SOC) in diabetes, including self-monitoring of blood glucose and measurement of glycated hemoglobin, have supported achievement of glycemic control, yet there are a few limitations. With the use of current technologies and metrics, such as continuous glucose monitoring (CGM) and standardized CGM data reporting, the continuous real-time glucose levels can be measured, and importantly, the percentage of time above, below, and within the target glucose range can be calculated, which facilitates patient-centric care, a current goal in diabetes management. International consensus recommendations endorse the incorporation of CGM and CGM data reporting in SOC for diabetes management. The guidelines provide time in range (TIR) thresholds for different patient populations and different types of diabetes. However, extrapolation of these global guidelines does not aptly cover the Indian population, which has diverse diet, culture, and religious practices. In this context, a consensus meeting was held in India in 2021 with experts in the field of diabetes care. The purpose of the meeting was to develop consensus recommendations for TIR thresholds for different patient profiles in India. Those expert recommendations, together with an evidence-based review, are reported here. The aim of this agreement is to aid clinicians across India to routinely use CGM and CGM data reports for optimizing individualized diabetes care, by implementing clinical targets for TIR.

PSUN189 Psychological Treatment for Diabetes Distress is Associated with Reduction in HbA1c, Emergency Department Presentations and Improvement in Psychological Health.

Abstract Introduction Patients with diabetes distress (DD) experience poorer health outcomes than patients with diabetes mellitus (DM) who do not experience DD. However, few studies have examined whether treatment for DD delivered by a psychologist embedded in a multi-disciplinary team (MDT) improves not only psychological health, but glycaemic control and other physical health outcomes, especially in low socioeconomic populations. Method: This study examined the impact of intervention by a clinical psychologist, as part of an outpatient MDT at a tertiary referral hospital diabetes service, on glycaemic control, emergency presentations and hospital admissions, diabetes distress, depression, anxiety and stress symptoms. Inclusion criteria were high DD indicated by a Problem Areas in Diabetes (PAID) questionnaire score ≥ 40, together with either 1) recent diabetes-related hospitalisation, 2) HbA1c >8% or 3) conflict over diabetes management with family or healthcare professionals, such as difficulty aligning diabetes management goals. Measures at baseline and treatment completion were the PAID questionnaire, the 21-item Depression, Anxiety, Stress Scale (DASS21), HbA1c, and number of emergency department presentations and hospital admissions in the three months before and after treatment commencement. Participants were assessed and treated by a clinical psychologist in addition to existing treatment by the MDT (which could include a diabetes educator, endocrinologist and dietician). Psychological treatment was individually determined, based on participants’ needs, and included cognitive therapy for health beliefs, mindfulness, distress tolerance, behavioural activation, problem solving, interpersonal effectiveness, Cognitive Behaviour Therapy (CBT) for disordered eating, and blood glucose awareness training. CBT for depression or anxiety was used as an adjunct where clinically indicated. Length of treatment and frequency of sessions varied depending on individual needs. Results Participants were 67 outpatients with DM aged 16-82 years, (72% female) in an area with a high prevalence of socio-economic disadvantage. Forty five patients had Type 1DM, 21 had Type 2DM and 2 had other or undefined DM type. Mean HbA1c decreased from 9.25% pre-treatment to 8.27% in the three months post treatment (p<0.001). Emergency department presentations halved (p<0.05). All psychological variables showed significant improvement: DD measured by PAID decreased from 57.5 to 33.03 (p <0.0001); DASS21 depression scores reduced from 11.17 to 7.36, anxiety scores reduced from 9.4 to 6.03, and stress scores from 12.29 to 9.46 (p<0.0001 for all). Hospital admission numbers did not change post intervention. Controlling for diabetes type, duration and gender did not have a significant impact on any outcome variable. Conclusion This study provides evidence that treatment by a clinical psychologist can improve both physical and psychological health outcomes for people with diabetes distress and should be considered standard of care for people experiencing diabetes distress with high HbA1c, diabetes related hospitalisation or conflict with family or healthcare professionals around diabetes management. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

A centennial review of discoveries and advances in diabetes: Children and youth.

Diabetes is an increasingly common chronic metabolic disorder in children worldwide. The discovery of insulin in 1921 resulted in unprecedented advancements that improved the lives of children and youth with diabetes. The purpose of this article is to review the history of diabetes in children and youth over the last century and its implications for future developments in the field. We identified 68 relevant events between 1921 and 2021 through literature review and survey of pediatric endocrinologists. Basic research milestones led to the discovery of insulin and other regulatory hormones, established the normal physiology of carbohydrate metabolism and pathophysiology of diabetes, and provided insight into strategies for diabetes prevention. While landmark clinical studies were initially focused on adult diabetes populations, later studies assessed etiologic factors in birth cohort studies, evaluated technology use among children with diabetes, and investigated pharmacologic management of youth type 2 diabetes. Technological innovations culminated in the introduction of continuous glucose monitoring that enabled semi-automated insulin delivery systems. Finally, professional organizations collaborated with patient groups to advocate for the needs of children with diabetes and their families. Together, these advances transformed type 1 diabetes from a terminal illness to a manageable disease with near-normal life expectancy and increased our knowledge of type 2 diabetes and other forms of diabetes in the pediatric population. However, disparities in access to insulin, diabetes technology, education, and care support remain and disproportionately impact minority youth and communities with less resources. The overarching goal of diabetes management remains promoting a high quality of life and improving glycemic management without undermining the psychological health of children and youth living with diabetes.

Address Changes Are Associated With Unmet Glycemic Targets: Opportunities to Improve Processes and Outcomes of Care Among People With Type 2 Diabetes.

Introduction The objective of this study was to identify and operationalize measures of potential housing insecurity within existing electronic health record data and to quantify the association between address changes and diabetes management goals among patients with type 2 diabetes. Methods We conducted a retrospective cohort study to measure potential housing insecurity in electronic health record data by quantifying the number of address changes in 2018. We considered at least one address change as a potential marker for housing insecurity. We used multivariable modified Poisson regressions to analyze the association between address change and clinical, utilization and preventive care outcomes while adjusting for patient and health system factors. Results We identified 274,123 adults with type 2 diabetes who were members of Kaiser Permanente Northern California in 2018 and 6% (N = 17,317) had at least one address change during 2018. In multivariate analyses, we found that one or more address changes was associated with greater chance of hemoglobin A1C < 9 (ARR: 1.12, 95% CI: 1.09, 1.15), lower chance of hemoglobin A1C < 8 (ARR: 0.95, 95% CI; 0.94, 0.96), lower chance of controlled blood pressure (ARR: 0.99, 95% CI: 0.98-0.99), greater chance of emergency department visits (ARR: 1.25, 95% CI: 1.23, 1.27), and lower chance of having a flu shot (ARR: 0.94, 95% CI: 0.93, 0.95) when compared to no address change. Discussion Changes in address are associated with worse diabetes management outcomes. Conclusion Identifying patients with potential housing insecurity and providing resources aimed at continuity of care and stable health care access could improve diabetes management for vulnerable populations.

Knowledge about the Risk of Cardiovascular Disease among Adults with Type 2 Diabetes Visiting the Outpatient Clinics at Tertiary Hospital in Riyadh, Saudi Arabia: A Cross-Sectional Study.

Background: One of the primary goals of diabetes management is to prevent cardiovascular events. The rate of cardiovascular diseases (CVDs) is significantly high in the diabetic population. Inadequate knowledge of CVDs risk in diabetes may result in the failure of its early prevention, causing increased morbidity and mortality. The objectives of this study were to assess the CVD risk knowledge and determine the predictors of the knowledge among adults with type 2 diabetes. Methods: A cross-sectional study was conducted to examine the study objectives. Convenience sampling was used to recruit adults with type 2 diabetes mellitus (DM) who visited the King Saud University Medical City (KSUMC) outpatient clinics. Data were collected using the Heart Disease Fact Questionnaire. SPSS software (version 24.0) was used for data analysis. Results: A total of 383 patients were recruited. The level of CVD risk knowledge was high among all participants (19.04 ± 3.47). There were significant differences in knowledge scores between different groups, including age (p = 0.01), marital status (p = 0.01), and type of residence (p = 0.04). Participants who were older than 40 years, married, and lived in traditional houses had higher knowledge scores. Conclusion: The study findings indicated a high level of CVD risk knowledge in our study population. The presence of multidisciplinary intensive education programmes targeting type 2 DM patients, such as that conducted at KSUMC, might be responsible for the higher levels of knowledge among our study population. Thus, increasing the efforts towards the education of patients will improve the level of knowledge, including CVD risk knowledge.

A self-powered and drug-free diabetic wound healing patch breaking hyperglycemia and low H2O2 limitations and precisely sterilizing driven by electricity.

Accelerating diabetes-related chronic wound healing is a long-sought-after goal in diabetes management. However, therapeutic strategies based on antibiotics or catalysts still face great challenges to break the limitations of antimicrobial resistance, low H2O2 and the blocking effect of bacterial biofilms on antibiotic/catalyst penetration. Herein, we reported a glucose biofuel cell-powered and drug-free antibacterial patch, which consisted of an MAF-7 protected glucose oxidase/horseradish peroxidase anode and a horseradish peroxidase cathode, for treating diabetic wounds. This self-powered patch could take high blood glucose as fuel to generate electricity and abundant reactive oxygen species (ROS) in situ, synergistically regulating local hyperglycemia and breaking the limitations of insufficient ROS caused by low H2O2 levels. In particular, the electric field created by the GBFC could drive the negatively charged bacteria to adhere firmly to the electrode surface. As a result, the ROS produced in situ on the electrodes was localized to the bacteria, realizing precise sterilization. In vivo experiments confirmed that this self-powered patch enabled the wounds on diabetic mice to take a mere 10 days to eliminate inflammation and form mature skin with new hair follicles, demonstrating its great potential in treating bacteria-infected diabetic wounds.

The Comparison of Quality of Life in Children with Type 1 Diabetes Mellitus Based on Parents and Children Report

Background: The primary goal of current diabetes management for children and adolescents has shifted from purely medical to optimal glucose control, normal psychological development, and increase QoL. Parents who accompany their children in the routine treatment of diabetes also have their own perceptions of their children’s quality of life. The study regarding the QoL of T1D according to parents and children still vary. This research intends to compare between the QoL of T1D according to parents and children report in Indonesia. Methods: This is a cross sectional, conducted in a pediatric endocrine outpatient clinic, Dr. Soetomo Hospital, Surabaya, during November 2020 to August 2021. Comparison between variables were analyzed using an independent t-test and P &lt; 0.05 was statistically significant. Result: The overall average quality of life score from parents is 71, while from children is 73,14. From parents report, in each domain, the average scores regarding the disease; treatment I; treatment II; worries; communications are 66,1; 74,3; 81; 60,8; 72,8 respectively. while from children, in each domain, the average scores regarding the disease; treatment I; treatment II; worries; communications are 68,5: 75,8: 80,6; 61,7; 79,1 respectively. The P score in each domain regarding the disease; treatment I; treatment II; worries; communications are (P=0.978); (P=0.728); (P=0.766); (P=0.641); (P=0.531) respectively. Conclusion: There is no difference between parents and children report on the QoL of children with T1D for each domain.

Quantifying Remission Probability in Type 2 Diabetes Mellitus.

Type 2 diabetes mellitus (T2DM) is a chronic progressive disorder and is associated with significant morbidity and mortality. The concept of T2DM remission and the reversal of diabetic parameters to normal levels has been gaining momentum over the past years. T2DM remission is increasingly being recognized by various global guidelines. Multiple models have been developed and validated for quantifying the extent of remission achieved. Based on favorable clinical evidence, T2DM remission can be considered as the therapeutic goal in diabetes management and, in select cases, as an alternative to expensive treatment options, which can be burdensome as T2DM progresses. This narrative review discusses the available strategies, such as lifestyle interventions, physical activity, bariatric surgery, medical nutrition therapy, and non-insulin glucose-lowering medications, for achieving T2DM remission. Although the concept of T2DM remission has emerged as a real-world option, effective implementation in routine clinical practice may not be feasible until long-term studies prove the efficacy of different approaches in this regard.

The Adherence of Primary Care Providers to the cardiovascular protection in patients with the debut of Type 2 Diabetes Mellitus.

BackgroundThe major cause of death in patients with T2DM is major adverse negative cardiovascular events, consequently, hypoglycemic therapy with a cardioprotective effect has an advantage over other oral hypoglycemic agents. Primary care providers often demonstrate clinical inertia in managing patients with the onset of T2DM, underestimating their cardiovascular risk. ObjectiveTo evaluate adherence to ADA diabetes care standards in patients with high and low cardiovascular risk and newly diagnosed T2DM.Methods We conducted a retrospective study of medical records of patients with newly diagnosed T2DM. The subject of the study was medical records, according to which the cardiovascular risk of patients was calculated using ASCVD 2013 Risk Calculator from AHA/ACC. The patients were divided into 2 groups: low risk (ASCVD <7.5%) and high risk (ASCVD ≥ 7.5%). We used the definitions of the ADA 2021 standards for diabetes management processes and goals to assess glucose-lowering therapy.Results One hundred medical from primary care centers in Karaganda, Kazakhstan were selected for analysis. The average age of patients at the time of diagnosis is 50.7 years. The average HbA1C level is 7.2%. The level of systolic blood pressure is 131 mm Hg, diastolic - 85 mm Hg. The mean total cholesterol level is 5.8 mmol/l. The overall adherence of physicians to ADA standards prescribing glucose-lowering agents is 82.97%. In the high cardiovascular risk group adherence is 76.6%, in the low-risk group - 93.5% (chi-square 20.447, p = 0.039). ConclusionWe found suboptimal adherence to ADA standards for diabetes management among patients at high cardiovascular risk at the onset with type 2 diabetes.

The Magnitude, Types, and Roles of Social Support in Diabetes Management among Diabetics' in Southern Ethiopia: a Multilevel, Multicenter Cross-Sectional Study.

IntroductionLifelong medical management is the main intervention to reduce diabetes-related morbidities and premature deaths; yet, social support can be a vital intervention to improve diabetics’ health. Therefore, this study aimed to determine the magnitude, types, and role of social support in diabetes management in southern Ethiopia.MethodsA multi-stage systematic sampling was applied to recruit 634 adult diabetics from the three-tiered healthcare system in the region. We proportionally distributed the sample size between randomly selected ten health-care facilities across the hierarchy. Pretested questionnaires and checklist; Epi-Info, and SPSS software used for data collection; entry, and analyses, respectively, and the statistical significance was determined at a P-value ≤0.05.ResultsA total of 240 females and 356 males completed the study, and the overall magnitude of the social support was 50.20% [95% CI: 46.19%, 54.21%], and it was categorized into non-material and material with 44.13% [95% CI: 40.14%, 48.12%] and 34.23% [95% CI: 30.42%, 38.04%] magnitudes, respectively, and social support was left to the patients’ families and friends whereas formal institutions and the public sectors were rarely offering when the patients needed it. Though sex, educational level, and health-care hierarchy were not significantly associated with the social support, residence, some occupations, presence of diabetic family members, acute medical conditions, blood glucose level, compliance to medical follow-ups, treatment adherence, and taking anti-diabetic drugs a day before the current visit to health-care facility were all statistically significantly associated with social support.ConclusionOne of every two adult diabetic patients in southern Ethiopia was receiving any social support, and social support for diabetic people reduces medical follow-ups absenteeism, improves treatment adherence, glycemic level controlling, and helps lifestyle modifications. Therefore, to keep diabetic people healthy and achieve diabetes management goals, the Ethiopian healthcare system, institutions, and concerned stakeholders should strengthen the social support for diabetic patients.

1078-P: Disparities in HbA1c Testing and Diabetes Outcomes: SEARCH for Diabetes in Youth

Hemoglobin A1c (HbA1c) monitoring over time is thought to facilitate care and support diabetes management goals, but only half of youth and young adults with diabetes report ≥3 HbA1c tests/year despite poor glycemic control. We explored disparities in HbA1c testing over time and association with HbA1c levels and microvascular complications (retinopathy, neuropathy, or nephropathy) in the SEARCH for Diabetes in Youth study. Individuals diagnosed with diabetes at &amp;lt;20 years (n=707 type 1, n=112 type 2) did research visits at 8 and 13 years diabetes duration (mean ages 18 and 23 years, respectively). We used one logistic regression model per diabetes type to identify correlates of reporting ≥3 HbA1c tests/year at both visits, and used one multiple linear and one logistic regression model per type to examine associations of reporting ≥3 HbA1c tests/year at both visits with HbA1c levels or microvascular complications, adjusting for HbA1c testing correlates. In type 1 diabetes, odds of reporting ≥3 HbA1c tests/year at both visits decreased with older age at diagnosis (OR 0.91 [95%CI 0.88-0.95]), longer duration of diabetes (OR 0.91 [0.84-0.999]), not having a personal doctor (0.43 [0.30-0.62]), and lapses in health insurance (OR 0.51 [0.28-0.93]). In turn, HbA1c testing ≥3 times/year at both visits was associated with lower HbA1c levels (-0.32% [-0.61 to -0.03]) but not microvascular complications (OR 0.74 [0.49-1.10]) at 13 years duration. In type 2 diabetes, odds of reporting ≥3 HbA1c tests/year at both visits was lower when not receiving care from endocrinologists (OR 0.15 [0.04-0.48]), but not associated with other sociodemographic or clinical factors, and not observed to be associated with HbA1c levels or microvascular complications at 13 years duration. In conclusion, we report that mainly healthcare-related factors are associated with disparities in HbA1c testing frequency over time in youth-onset type 1 and type 2 diabetes, and these disparities are associated with HbA1c levels in type 1 diabetes. Disclosure K. A. Sauder: None. R. Dagostino: Consultant; Self; AstraZeneca, Biogen, Daiichi Sankyo. D. Dabelea: None. J. M. Stafford: None. S. R. Ehrlich: None. A. D. Liese: None. S. M. Marcovina: None. A. K. Mottl: Advisory Panel; Self; Bayer U. S. C. Pihoker: None. S. Saydah: None. A. S. Shah: None. Funding National Institutes of Health; Centers for Disease Control and Prevention

Impact of Diabetes Continuing Education on Knowledge and Practice of Diabetes Care among Health Care Professionals in Yemen

Background: This study aimed to evaluate the Impact of diabetes continuing education on knowledge and practice of diabetes care among health care professionals in Yemen.&#x0D; Methods: A quasi-experimental study was carried out among health care professionals. The original questionnaire consisted of 22 multiple choice questions. A total of 73 HCPs received continuing education (CE) intervention. Knowledge attitude and practice (KAP) was assessed using a validated questionnaire. &#x0D; Results: The result showed that majority of the HCPs has a good general knowledge on diabetes and its managements prior to the CE program. Evaluation of the general knowledge score of the HCPs found some improvement in the knowledge score, however the improvement was not significant (p=0.31). The result of this study found that HCPs has good knowledge on monitoring the sign, symptoms and laboratory parameters.&#x0D; Conclusion: Evaluation of the knowledge score on Goal of Diabetes Management of HCPs found significant (p=0.024) improvement in the knowledge score. The results indicated that the lab values were rated as the most important in the goal for the treatment of diabetes patients. The study also found no significant difference in practice score after CE program among HCPs.

The Evolution of Hemoglobin A1c Targets for Youth With Type 1 Diabetes: Rationale and Supporting Evidence.

The American Diabetes Association 2020 Standards of Medical Care in Diabetes (Standards of Care) recommends a hemoglobin A1c (A1C) of <7% (53 mmol/mol) for many children with type 1 diabetes (T1D), with an emphasis on target personalization. A higher A1C target of <7.5% may be more suitable for youth who cannot articulate symptoms of hypoglycemia or have hypoglycemia unawareness and for those who do not have access to analog insulins or advanced diabetes technologies or who cannot monitor blood glucose regularly. Even less stringent A1C targets (e.g., <8%) may be warranted for children with a history of severe hypoglycemia, severe morbidities, or short life expectancy. During the “honeymoon” period and in situations where lower mean glycemia is achievable without excessive hypoglycemia or reduced quality of life, an A1C <6.5% may be safe and effective. Here, we provide a historical perspective of A1C targets in pediatrics and highlight evidence demonstrating detrimental effects of hyperglycemia in children and adolescents, including increased likelihood of brain structure and neurocognitive abnormalities, microvascular and macrovascular complications, long-term effects, and increased mortality. We also review data supporting a decrease over time in overall severe hypoglycemia risk for youth with T1D, partly associated with the use of newer insulins and devices, and weakened association between lower A1C and severe hypoglycemia risk. We present common barriers to achieving glycemic targets in pediatric diabetes and discuss some strategies to address them. We aim to raise awareness within the community on Standards of Care updates that impact this crucial goal in pediatric diabetes management.

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.

Quality improvement project for improving inpatient glycaemic control in non-critically ill patients admitted on medical floor with type 2 diabetes mellitus

A significant number of patients admitted to the medical floor have type 2 diabetes mellitus (DM). Lack of a standardised inpatient hyperglycaemia management protocol leads to improper glycaemic control adding...

104-OR: Lifestyle Interventions in Persons with IGT Prolong the Time Free of Major Diabetes-Related Complications: 30-Year Results of the Da Qing Diabetes Prevention Outcome Study (DQDPOS)

Lifestyle interventions in persons with impaired glucose tolerance (IGT) delay the onset of diabetes, but freedom from complications is a major goal of diabetes prevention and management. The extent that lifestyle intervention can delay the onset of the common but serious complications of diabetes is ill-defined. We assessed freedom from any serious diabetes-related complication in the 30-year follow-up data from the Da Qing Diabetes Prevention study in which 576 adults with IGT, randomized to control or lifestyle intervention groups for six-years, were followed from the time of randomization to determine the onset of diabetes and occurrence of any serious diabetes-related complication defined as CVD events or death, severe retinopathy, nephropathy, neuropathy, or death due to acute diabetes complications or infection. We estimated differences between the intervention and control groups in the incidence and time free of serious complications. Lifestyle interventions significantly increased the time free of major serious diabetes-related complications (Table). The study provides yet further evidence supporting the value of implementing lifestyle interventions in persons with IGT. Disclosure Q. Gong: None. P. Zhang: None. J. Wang: None. Y. Chen: None. Y. An: None. X. Feng: None. Y.J. Cheng: None. J. Ma: None. P.H. Bennett: Advisory Panel; Self; World Health Organization. Stock/Shareholder; Self; Eli Lilly and Company, Pfizer Inc., Unilever, UnitedHealth Group. Other Relationship; Self; American Diabetes Association, European Association for the Study of Diabetes, European Diabetic Nephropathy Study Group, International Diabetes Federation, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. G. Li: None.

Should we prescribe abstinence or wine once a day with supper in diabetes and prediabetes?

The ultimate goal of diabetes management is to minimize complications and maintain quality of life in the context of comprehensive cardiovascular risk management and patient-centered care.

On-skin glucose-biosensing and on-demand insulin-zinc hexamers delivery using microneedles for syringe-free diabetes management

Patients who have diabetes must receive insulin administration two to three times every day via subcutaneous (SC) injection after measurement of blood glucose levels (BGLs) using lancet/blood-glucose meter with the side effects of pain and lipodystrophy. Achieving instrument-free glucose-biosensing and persistent glycaemic control in a painless and safe way is the ultimate goal of diabetes management. Here, we report the design of a microneedles (MNs) set comprising a glucose-biosensing microneedle patch (GBMP) and an insulin-delivery MP (IDMP). Once in the skin, the skin interstitial fluid (ISF) would diffuse into GBMP from epidermis to develop colour in abnormal glucose concentration which then quantified by smartphone. Subsequently, the IDMP composing of free insulin and biodegradable insulin-loaded glucose-responsive nanovesicles (IG-NVs) as an artificial on-skin pancreas, could be applied for hyperglycaemia-triggered insulin release to self-regulate BGLs and improve the health and quality of life for patients with type 1 and advanced type 2 diabetes. In chemically induced type 1 diabetic rats, the BGLs can be rapidly measured by GBMP and the BGLs can also be immediately reduced to and kept at normoglycaemic levels for up to 13 h by IDMP. The whole system permits the syringe-free diabetes management, avoiding both hyperglycaemia and hypoglycaemia.