Good Glucose Control Research Articles

Asuhan Keperawatan Keluarga pada Tn. A dengan Diabetes Melitus di Desa Kalibuntu RT 02 RW 02 Kecamatan Losari Kabupaten Berebes

Diabetes Mellitus (DM) is a chronic metabolic disease that often occurs in the elderly, characterized by hyperglycemia due to impaired insulin secretion or action. This research focuses on family nursing care for Mr. A, a DM sufferer, in Kalibuntu Village, Losari District, Brebes Regency. Based on data, the prevalence of diabetes in Indonesia is very high, with Indonesia ranking third in Southeast Asia. In Brebes Regency, the prevalence of DM is also significant, requiring special attention in management. The Friedman model is used in family nursing care, which emphasizes the role of the family in supporting the patient's health management. The care process includes assessment, diagnosis, planning, implementation, and evaluation. The assessment is carried out by collecting family data using clear and simple language. Nursing diagnoses are established based on data analysis, while nursing interventions are designed to meet the patient's specific needs. Implementation is carried out by carrying out the plans that have been prepared, followed by ongoing evaluation to assess the effectiveness of the intervention and make necessary adjustments. Management of DM in Mr. A involves five main pillars: education, meal planning, physical exercise, pharmacological interventions, and blood sugar checks. A positive attitude towards treatment plays an important role in achieving good glucose control and improving quality of life. These findings emphasize the importance of family involvement in DM care to ensure effective and sustainable management.

Enhanced recovery after surgery in elective cesarean section patients with gestational diabetes mellitus does not lead to glucose-related maternal and neonatal complications.

For elective cesarean section patients with gestational diabetes mellitus (GDM), there is a lack of evidence-based research on the use of enhanced recovery after surgery (ERAS). This study aims to compare the ERAS after-surgery protocol and traditional perioperative management. In this retrospective cohort study, singleton pregnancies with good glucose control GDM, delivered by elective cesarean sections under intravertebral anesthesia at least 37 weeks from January 1 to December 31, 2022, were collected at the Third Affiliated Hospital of Sun Yat-sen University. We divided all enrolled pregnant women and newborns into an ERAS group and a control group (the traditional perioperative management group) based on their adherence to the ERAS protocol. The primary outcome was the preoperative blood glucose level, with an increase of more than 1 mmol/L indicating clinical significance when compared to the control group. The secondary outcome was centered around an adverse composite outcome that affected both mothers and newborns. We collected a total of 161 cases, with 82 in the ERAS group and 79 in the control group. Although the mean preoperative blood glucose level in the ERAS group was significantly higher than in the control group (5.01 ± 1.06 mmol/L vs. 4.45 ± 0.90 mmol/L, p<0.001), the primary outcome revealed that the mean glycemic difference between the groups was 0.47 mmol/L (95% CI 0.15-0.80 mmol/L), which was below the clinically significant difference of 1 mmol/L. For the secondary outcomes, the ERAS group had an 86% lower risk of a composite adverse outcome compared to the control group. This included a 73% lower risk of perioperative maternal hypoglycemia and a 92% lower rate of neonatal hypoglycemia, all adjusted by age, hypertensive disorder of pregnancy, BMI, gestational weeks, primigravidae, primary pregnancy, GDM, surgery duration, and fasting glucose. Implementing a low-dose carbohydrate ERAS in pregnant women with GDM prior to elective cesarean section, compared to traditional perioperative management, does not lead to clinically significant maternal glucose increases and thus glucose-related maternal or neonatal perioperative complications.

Telemedicine maintains good glucose control in children with type 1 diabetes but is not time saving for healthcare professionals: KITES randomized study

AimsTo evaluate glucose control non-inferiority and time benefits of telemedicine follow-up in children with type 1 diabetes (CwD). MethodsIn a single-center 9-month-long randomized controlled study (clinicaltrials.gov NCT05484427), 50 children were randomized to either telemedicine group (TG) followed-up distantly by e-mail, or to face-to-face group (FFG) attending standard personal visits. The primary endpoint was non-inferiority of HbA1c at final visit (level of non-inferiority was set at 5 mmol/mol). The secondary endpoints were subcutaneous glucose monitoring parameters and time consumption from both study subjects’ and the physicians’ point of view. ResultsNon-inferiority of HbA1c in the TG was proven (mean HbA1C 45.8 ± 7.3 [TG] vs. 50.0 ± 12.6 [FFG] mmol/mol, 6.3 vs. 6.7 % DCCT, p = 0.17; between groups HbA1C difference 95 % CI −10.2 to 1.9 mmol/mol). Telemedicine saved time for participants (mean visit duration [MVD] 50 [TG] vs. 247 min [FFG], p < 0.001). There were no other differences between groups neither in CGM parameters nor physician’s time consumption (MVD 19 [TG] vs. 20 min [FFG], p = 0.58). ConclusionsNine-month telemedicine follow-up of the children with well-controlled T1D is not inferior to standard face-to-face visits. Telemedicine visits saved time for the participants but not for their diabetologists.

Association of Microalbuminuria with Glucose Levels, Microvascular and Macrovascular Complications in Relation with Blood Pressure in Diabetes Mellitus Type 2

Objectives: Determine the association of Microalbuminuria (MAU) with glucose markers, micro vascular and macrovascular complications in relation with blood pressure in patients with type 2 diabetes mellitus. Material and Method: This study was cross sectional study and data collected in Chemical laboratory of pathology department of Dr Akbar Niazi Teaching Hospital. It carried out during the time period of December 2021 to January 2022. Patients were divided into 2 groups which fulfill the inclusion and exclusion criteria patients having diabetes mellitus type 2 with good glucose control, HbA1c &lt; 7% (n=33) patients having diabetes mellitus type 2 with bad control HbA1c ≥7% (n=33) each group were further divided into 2 sub-groups Patients with Pre-hypertension (n) and patients with HTN (n). The sampling technique of this study was non-probability convenience sampling was done. Data/Documentation was collected by Performa and laboratory investigation. Spss version 21 used to analyze the data. Normality of data was assessed by KS test. Quantitative test was measured as mean and standard deviation. Qualitative variables were calculated as number percentage. ANCOVA test and chi square test were used for comparison of quantitative and qualitative variables respectively. Pearson correlation was applied to determine the association of MAU with glucose levels and diabetes related complications. Result: Among total 66 patients, the sample of patients were included 47 males (71.2%) and 19 females (28.8%). Patients of type 2 diabetes mellitus in HbAlc ≥7% group showed higher levels of Blood Glucose level, MAU, Systolic BP and Diastolic BP as compared to HbA1c &lt; 7% group. The comparison of the variables between 2 groups showed statistical differences in nephropathy and cardiovascular complications. In HbA1c ≥ 7% group, correlation of MAU with Systolic BP, Diastolic BP, Fasting Blood Glucose (FBG), HbA1c, Nephropathy, and Cardiovascular events were statistically significant. In Pre-HTN group, MAU was significantly correlated with Fasting blood glucose level, HbA1c, Nephropathy and cardiovascular complications. Patients of HTN showed more significant association with blood pressure (BP), Blood Glucose, HbA1c, Cardiovascular events with MAU as evident by higher r-values as compared to pre-HTN group. Regarding nephropathy, r-value was slightly higher in Prehypertensive group. Conclusion: Patients with uncontrolled diabetes mellitus have increased risk of developing HTN, MAU as well as diabetes related complication including nephropathy and cardiovascular events. More over MAU showed significant positive association with BP, blood glucose levels, nephropathy and cardiovascular events. Both pre- hypertensive and hypertensive patients showed significant positive association of MAU with blood glucose levels and diabetes related complication including nephropathy and cardiovascular events. This study suggested that Prehypertensive and hypertensive patients with altered blood glucose levels have increased risk of MAU, that why proper evaluation and treatment of MAU may lead to early diagnosis and decrease progression of HTN, diabetes mellitus type 2 and its related complications.

Short- and Long-Term Effects on Glucose Control of Nonadherence to Insulin Therapy in People With Type 2 Diabetes An In Silico Study.

Strict adherence to multiple daily insulin (MDI) therapy is a cornerstone for the achievement of good glucose control in people with advanced type 2 diabetes (T2D). Here, we aim to in silico assess glucose control in T2D subjects with poor adherence to MDI therapy. We tuned the Padova T2D Simulator, originally describing early-stage T2D physiology, around advanced T2D people. One hundred in silico advanced T2D subjects were generated and equipped with optimal MDI therapy: specifically, basal and bolus insulin amounts and injection times were individualized for each subject by applying titration algorithms that iteratively update insulin dose based on glucose deviation from its target. Then, the effect of nonadhering to MDI therapy was assessed using standard glucose control metrics calculated in two 6-month 3-meal/day in silico scenarios: in Scenario 1, subjects received the optimal basal and prandial insulin bolus at each meal; in Scenario 2, subjects received optimal basal insulin and randomly delayed or skipped the prandial insulin bolus in 3 lunches during working days and 1 dinner during weekends. A statistically significant degradation was found in all glucose control outcome metrics in Scenario 2 versus Scenario 1: e.g., percent time above 180 mg/dL increased by 22.2% and glucose management index by 0.2%. Impaired adherence to MDI therapy in T2D leads to glucose control deteriorations in both short and long terms. Interestingly, short-term hyperglycemia seems being contrasted by residual endogenous insulin secretion, which statistically increased by 3-fold after delayed/skipped insulin boluses compared with optimal ones.

Dominant PDX1 deficiency causes highly penetrant diabetes at different ages, associated with obesity and exocrine pancreatic deficiency: Lessons for precision medicine

ObjectiveHeterozygous pathogenic or likely pathogenic (P/LP) PDX1 variants cause monogenic diabetes. We comprehensively examined the phenotypes of carriers of P/LP PDX1 variants, and delineated potential treatments that could be efficient in an objective of precision medicine. MethodsThe study primarily involved a family harboring a novel P/LP PDX1 variant. We then conducted an analysis of documented carriers of P/LP PDX1 variants, from the Human Gene Mutation Database (HGMD), RaDiO study, and Type 2 Diabetes Knowledge Portal (T2DKP) including 87 K participants. ResultsWithin the family, we identified a P/LP PDX1 variant encoding p.G232S in four relatives. All of them exhibited diabetes, albeit with very different ages of onset (10–40 years), along with caudal pancreatic agenesis and childhood-onset obesity. In the HGMD, 79 % of carriers of a P/LP PDX1 variant displayed diabetes (with differing ages of onset from eight days of life to 67 years), 63 % exhibited pancreatic insufficiency and surprisingly 40 % had obesity. The impact of P/LP PDX1 variants on increased risk of type 2 diabetes mellitus was confirmed in the T2DKP. Dipeptidyl peptidase 4 inhibitor (DPP4i) and glucagon-like peptide-1 receptor agonist (GLP1-RA), enabled good glucose control without hypoglycemia and weight management. ConclusionsThis study reveals diverse clinical presentations among the carriers of a P/LP PDX1 variant, highlighting strong variations in diabetes onset, and unexpectedly high prevalence of obesity and pancreatic development abnormalities. Clinical data suggest that DPP4i and GLP1-RA may be the best effective treatments to manage both glucose and weight controls, opening new avenue in precision diabetic medicine.

More Physical Exercise is Required for Overweight or Obese Women with Gestational Diabetes Mellitus to Achieve Good Plasma Glucose Control During Pregnancy: Finding from a Prospective Cohort in Shanghai

More Physical Exercise is Required for Overweight or Obese Women with Gestational Diabetes Mellitus to Achieve Good Plasma Glucose Control During Pregnancy: Finding from a Prospective Cohort in Shanghai

MiniMedTM 780G Advanced Hybrid Closed-Loop System Study in Pregnant Women with Type 1 Diabetes.

Background: Evaluate the impact of the MiniMed™ 780G advanced hybrid closed-loop (AHCL) system on the glucose profile of pregnant women with type 1 diabetes (T1D) and maternal-neonatal complications. Methods: From April 2021 to September 2022, pregnant women with T1D treated with the AHCL system were included in an observational multicenter retrospective study. Continuous glucose monitoring parameters were analyzed monthly during pregnancy as well as maternal-neonatal complications. Results: Thirteen pregnant women, including a twin pregnancy (age: 33 ± 3 years, hemoglobin A1c [HbA1c]: 7.3% ± 0.7%, insulin doses: 0.72 ± 0.21 U/kg/day) were analyzed. At delivery, gestational age was 37 ± 2 weeks. During first 2 weeks of pregnancy, time in range (TIR, 63-140 mg/dL) was 46% (34-55) and increased to 54% (51-59) (P < 0.01), 64% (48-68) (P < 0.01), and 66% (60-70) (P < 0.001) during the first, second, and third trimester, respectively. During the night, TIR (63-140 mg/dL) was >70% throughout pregnancy. Time below the range <63 mg/dL increased from 0.5% (0-2) to 1.3% (0.7-2.2), 2% (1.2-3.5) (P < 0.05), and 1.3% (1.31-3) (P < 0.05) during the first, second, and third trimester, respectively. At delivery, insulin doses increased to 0.89 ± 0.35 IU/kg/day (P < 0.01), and HbA1c decreased to 6.4% ± 0.6% (P = 0.005). The reported carbohydrate amount increased from 167 ± 363 g/d during early pregnancy to 243 ± 106 g/d (P < 0.01) at delivery. The birthweight was 3134 ± 711 g, with 5/14 macrosomia and 2/14 neonatal hypoglycemia. Moreover, 5/13 patients had a preeclampsia and 9/13 a cesarean section, including three cases of scarred uterus. The Clinical Trial Registration number is: CE-2022-55. Conclusion: The AHCL system provided good glucose control during pregnancy and recommendation targets were reached during the nocturnal period only. The maternal and neonatal complications remained high.

Psychovigilance In Diabetes.

Diabetes is associated with a myriad of mental health challenges, ranging from distress and depression to schizophrenia and substance abuse. These conditions are associated with hyperglycaemia, and also interfere with efforts to achieve good glucose control. One way in which this can be handled is by screening, early diagnosis, and timely management of mental health dysfunction and disorders. We term this action as psychovigilance.

Augmented Glycemic Gap is a Marker for Predicting the Early Neurological Outcomes in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis

Background and Purpose: Glycemic Gap (GG) as an index reflecting the acute fluctuation of glycemia, has been proved to be associated with poor functional outcomes in Acute Ischemic Stroke (AIS) patients. However, it predictive value on post-thrombolysis Early Neurological Outcomes (ENOs) are still controversial. This study aimed to use GG to evaluate the influence of pretreatment relative glucose changes on post-thrombolysis ENOs, and we further explored the predictive value of GG in different glycemic control status. Methods: Early Neurological Deterioration (END) was defined as a National Institutes of Health Stroke Scale Score (NIHSS) =4, Early Neurological Improvement (ENI) was defined as a =4-point decrease in NIHSS score or a complete resolution of neurological deficits, between the time of admission and 24 hours after intravenous recombinant tissue-type plasminogen activator (IV-rtPA). GG was calculated as Admission Blood Glucose level (ABG)- estimated average blood glucose level (eAG), eAG could be derived from HbAlc according to the equation eAG=28.7*HbAlc-46.7 Results: Increased GG was significantly associated with post-thrombolysis END and poor functional outcome at discharge (OR, 1.982; 95% CI, 1.213-3.238; P=0.006) (OR, 2.079; 95% CI, 1.305-3.312; P=0.002). Its predictive value on END was more pronounce in diabetic patients (OR, 2.434; 95% CI, 1.079-5.491; P=0.032), after dichotomizing glycemic control status, its significance was only maintained in diabetic patients with good previous glucose control (OR, 6.946; 95% CI, 1.217-39.636; P=0.029). Conclusion: An evaluated GG was associated with high risk of post-thrombolysis END and poor functional outcome at discharge in AIS patients, and the previous glucose control should be considered when predicting ENOs.

Association between time in range 70-180 mg/dl in early stage and severity with in patients acute pancreatitis

BackgroundIt is not well understood whether glucose control in the early stage of acute pancreatitis(AP) is related to outcome. This study aimed to investigate the association between blood glucose time in range (TIR) of 70–180 mg/dL in the first 72 h(h) on admission and the progression of AP.MethodsIndividuals admitted with AP to the Gastroenterology Department of the Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University between January 2017 and December 2021 were included and retrospectively evaluated. The percentage of TIR between 70 and 180 mg/dL in the first 72 h was calculated. According to the progress of AP at discharge, patients were divided into mild pancreatitis(MAP), and moderately severe acute pancreatitis (MSAP), or severe acute pancreatitis (SAP) groups. We examined the association between TIR or TIR ≥ 70% and AP severity using logistic regression models stratified by a glycosylated hemoglobin (HbA1c) level of 6.5%. Receiver operating characteristic (ROC) curves were generated to assess the ability of the TIR to predict MSAP or SAP.ResultsA total of 298 individuals were included, of whom 35 developed MSAP or SAP. Logistic regression analyses indicated that TIR was independently associated with the incidence of more serious AP (odds ratio [OR] = 0.962, 95% CI = 0.941–0.983, p = 0.001). This association remained significant in individuals with HbA1c levels ≤ 6.5% (OR = 0.928, 95% CI = 0.888–0.969, p = 0.001). A TIR ≥ 70% was independently associated with reduced severity only in people with well-antecedent controls (OR = 0.238; 95% CI = 0.071–0.802; p = 0.020). TIR was not powerful enough to predict the severity of AP in both patients with poor antecedent glucose control (AUC = 0.641) or with HbA1c < 6.5% (AUC = 0.668).ConclusionsTIR was independently associated with severity in patients with AP, particularly those with good antecedent glucose control.

563-P: Outcomes of the Dulce Digital–COVID Aware (DD-CA) Discharge Texting Platform for U.S./Mexico–Border Hispanics with Diabetes

Hispanic individuals are disproportionally impacted by type 2 diabetes (T2D) and COVID-19 compared to non-Hispanic White individuals. Notably, T2D is associated with greater COVID-19 disease severity and mortality; however, with good glucose control, prognosis improves. During the COVID-19 pandemic, N=172 Hispanic patients with T2D hospitalized near the US/Mexico border in California were randomized to receive Dulce Digital-COVID Aware (DD-CA) texting platform or usual care. The DD-CA program provides culturally tailored, educational, and motivational text-messaging related to diabetes management and COVID prevention, remote glucose monitoring, and automated, tailored feedback on behavioral and glucose metrics for 6 months post-discharge. Participants were on average 58 ± 13 years, 52% male, 9.3% COVID+, with a mean BMI of 32.7 ± 8.2 and mean baseline HbA1c of 9.6% ± 2.2%. In unadjusted analyses, DD-CA did not reduce 30- or 90-day hospital readmission rates compared to usual care (28% vs 15%, p = 0.06; and 37% vs 35%, p = 0.9, respectively). Follow up HbA1c completion rates were low; however, HbA1c improvement was significantly greater among those in DD-CA compared to usual care at 3 months (n=56; −2.69% vs. −1.45%, p=0.05), with slight attenuation of effect at 6 months (n=64; −2.03% vs −0.91%, p=0.07). Given the reduction of in-person clinical care and emphasis on staying at home amid the pandemic, DD-CA represented an alternative pathway for delivering diabetes- and COVID-related education and support to high-risk individuals during this time. While the DD-CA intervention did not significantly impact readmission rates, it was effective in achieving a clinically significant, &amp;gt;1% greater improvement in HbA1c relative to usual care post-hospital discharge. Additional analyses will be presented on clinical and patient-reported outcomes. Disclosure S.R.Spierling bagsic: None. A.Philis-tsimikas: Advisory Panel; Dexcom, Inc., Novo Nordisk A/S, Sanofi, Other Relationship; Medtronic, Research Support; Novo Nordisk A/S, Lilly, Viking Therapeutics, NIH − National Institutes of Health. O.M.Padilla neely: None. H.Sandoval: None. A.Bastian: None. R.Belasco: None. N.Orendain: None. E.Soriano: None. L.Talavera: None. A.L.Fortmann: Employee; Dexcom, Inc. Funding National Institutes of Health (R01DK112322-05S1)

Real-world performance of the MiniMed 780G advanced hybrid closed loop system in Latin America: Substantial improvement in glycaemic control with each technology iteration of the MiniMed automated insulin delivery system.

We studied real-world performance of MiniMed (MM) 780G system users from Argentina, Brazil, Colombia and Chile (geographical analysis), and the effect of each technology iteration of the MM system on glycaemic control (technology iteration analysis). CareLink data from August 2020 to September 2022 were extracted. Endpoints included continuous glucose monitoring metrics. For the geographical analysis, aggregated endpoints for MM780G system users were calculated. For the technology iteration analysis, MM780G system user outcomes were compared with outcomes when the same individuals were still using the MM640G or MM670G system. On average, 1025 MM780G system users from the geographical analysis were followed for 136 (SD 135) days, spent 91.5 (14.3)% in advanced hybrid closed loop, showed a glucose management indicator (GMI) of 6.7 (0.3)%, a time in range between 70 and 180 mg/dl (TIR) of 76.5 (9.0)%, and a time below range 70 mg/dl (TBR) of 2.7 (2.1)%. The percentage of users reaching targets of GMI <7%, TIR >70% and TBR <4% was 80.8%, 78.1% and 80.1%, respectively. The technology iteration analysis on users transitioning from MM640G to MM780G system (N=381) showed 0.4% decrease in GMI (7.1% to 6.7%, p < .0001), 10.7% increase in TIR (65.9% to 76.6%, p < .0001), while TBR remained. The percentage of insulin delivered automatically increased as well (47.5%-57.7%, p < .0001). Users transitioning from MM670G system (N=78) showed a similar but less pronounced pattern. Real-world Latin American MM780G users on average showed good glucose control, achieving international targets. Glycaemic control increased with every technology iteration of the MM system, providing more automation each time.

Self-care educational guide for mothers with gestational diabetes mellitus: A systematic review on identifying self-care domains, approaches, and their effectiveness.

Gestational Diabetes Mellitus (GDM) is a common form of poor carbohydrate intolerance, prevalent among pregnant women and associated with unhealthy lifestyle behaviors. Given the dearth of information on self-empowerment among mothers with GDM, a self-care health education package needs to be developed to prevent related complications. This review aimed to identify self-care approaches, domains, and their effectiveness for a proper self-care educational guide package for women with GDM. A systematic review using electronic literature databases published between January 2016 and December 2022 was conducted. Web of Science, Scopus, and Ovid databases were used. This review utilized the PICO (Population, Intervention, Comparison, and Outcomes) framework to screen the retrieved articles for eligibility in which mothers with GDM, educational materials, standard practice or intervention, and effectiveness were considered the PICO, respectively. The CIPP (Context, Input, Process, Product) model served as a framework for adopting the education development model. Mixed methods appraisal tool was used for quality assessment. Data extraction and synthesis without meta-analysis were presented as evidence tables. A total of 19 articles on GDM were included in the final analysis (16 Intervention studies, two qualitative studies, and one mixed-methods study). Four broad domains emerged from the analysis: 1) information or knowledge of GDM, 2) monitoring of blood glucose levels, 3) practice of healthy lifestyles, and 4) other non-specific activities. The majority of the articles employed a face-to-face approach in executing the educational group sessions, and most studies disclosed their positive effects on GDM management. Other methods of evaluating intervention effectiveness were described as improved self-care behavior, increased satisfaction score, enhanced self-efficacy, good glucose control, and better pregnancy outcome. Knowledge or information about GDM, healthy diet, and exercise or physical activity was found to be the most applied domains of intervention. Framework domains based on the present review can be used in the future development of any interventional program for GDM women in enhancing health information reaching the targeted group in promoting self-efficacy. CRD42021229610.

Social support from family, associated factors and relationship with glycemic control among diabetic patients in Uganda: a cross-sectional study.

social support from family members in diabetes management is a predictor of optimal glucose control. There is limited evidence of the relationship in Uganda. The objective was to determine association of social support from family and glycemic control, and association of social demographic and clinical characteristics with family support among diabetic patients in eastern Uganda. this was a cross-sectional study involving 405 adult patients attending diabetic clinics between May 2021 and June 2021. Socio-demographics, clinical characteristics, social support from family, and glycemic control data were collected. Descriptive statistics were done and associations were determined using Pearson chi-square and Fisher´s exact tests. Generalized linear model was used to determine independent association with social support from family. the mean age was 52 years, (60%) were female, majority (49.4%) were 45-64 years old. Perceived social support from family (PSS-fa) and good glucose control were found in; (95.3%) and (20.99%) respectively. PSS-fa was associated with good glucose control. Financial contribution from family members to cost of care, cohesion among family members in support of care, being (married/cohabiting) and monthly income ≥28 USD were associated with PSS-fa. Factors independently associated with PSS-fa were; female gender, financial contribution to cost of care and cohesion among family in support of care. social support from family was associated with good glycemic control. Factors associated with PSS-fa were; female gender, financial contribution from family to cost of care and cohesion among family in support of care.

Traditional Chinese medicine body constitution predicts new-onset diabetic albuminuria in patients with type 2 diabetes: Taichung diabetic body constitution prospective cohort study

This prospective cohort study explored whether body constitution (BC) independently predicts new-onset albuminuria in persons with type 2 diabetes mellitus (T2DM) enrolled in the diabetes care management program (DCMP) of a medical center, providing evidence of integrating traditional Chinese medicine into DCMP for improving care quality. Persons with T2DM (n = 426) originally without albuminuria enrolled in DCMP were recruited in 2010 and were then followed up to 2015 for detecting new-onset albuminuria. The participants received urinalysis and blood test annually. Albuminuria was determined by an elevated urinary albumin/creatinine ratio (≥ 30 µg/mg), and poor glucose control was defined as Glycosylated hemoglobin above or equal to 7%. BC type (Yin deficiency, Yang deficiency, and phlegm stasis) was assessed using a well-validated body constitution questionnaire at baseline. Risk factors for albuminuria (sociodemographic factors, diabetes history, lifestyle behaviors, lipid profile, blood pressure, and kidney function) were also recorded. Hazard ratios (HR) of albuminuria for BC were estimated using multivariate Cox proportional hazards model. During the 4-year follow-up period, albuminuria occurred in 30.5% of participants (n = 130). The HR indicated that Yin deficiency was significantly associated with an increased risk of new-onset albuminuria in persons with T2DM and good glucose control after adjustment for other risk factors (HR = 2.09; 95% confidence interval = 1.05-4.17, P = .04), but not in those with poor glucose control. In persons with T2DM and poor glucose control, phlegm stasis was also significantly associated with a higher risk of albuminuria (2.26; 1.03-4.94, P = .04) after multivariate adjustment, but not in those with good glucose control. In addition to already-known risk factors, BC is an independent and significant factor associated with new-onset albuminuria in persons with T2DM. Our results imply Yin deficiency and phlegm stasis interacting with glucose control status may affect new-onset albuminuria in persons with T2DM.

PSUN258 New-Onset Ketosis-Prone Diabetes (A- β+) Associated with Covid-19: A Unique Form of Atypical Diabetes

Abstract Since the beginning of the Covid-19 pandemic in December 2019, much has been written about its bidirectional prognostic association with newly diagnosed diabetes, which can either be precipitated new-onset or unmasked previously undiagnosed diabetes, both often presenting as diabetic ketoacidosis. Various mechanisms have been proposed, including stress- or drug-induced hyperglycemia, proinflammatory direct and indirect effects on insulin secretion and activity, as well as direct viral cytolytic effect on the pancreatic β cells via action on the ACE2 receptor integral to islet cell homeostasis. We present a case of a 51-year-old normosthenic male with no known comorbidities, who came in with 2-day history of nausea and epigastric discomfort along with progressively worsening dyspnea and nonproductive cough. He tested positive for Covid-19 by TMA, with elevated acute-phase reactants (CRP and ferritin), and had received his first dose of Covid vaccine 10 days prior. Further evaluation was consistent with diabetic ketoacidosis (glucose 487 mg/dL, pH 7.22, anion gap 27, HCO3 10 mmol/L, beta-hydroxybutyrate 9.71 mmol/L) with concurrent pancreatitis (lipase 2327 U/L, no leukocytosis, lactate 1.41 mmol/L) and acute kidney injury (EGFR 58). His BMI at presentation was 26 kg/m2 with a hemoglobin A1c of 16.9, and no personal history of diabetes. His father and paternal grandmother both had type 2 diabetes. He was managed with hydration and insulin drip titrated as per protocol, with subsequent resolution of DKA and transition to subcutaneous basal-bolus insulin on the second hospital day. Mild-moderate respiratory Covid symptoms improved with dexamethasone, remdesivir, and oxygen supplementation via nasal cannula. Glucose was controlled throughout the hospital stay, and he was discharged improved on the fifth hospital day with twice-daily basal insulin. When he presented to the DKA clinic for follow-up five months post-hospital discharge, his HbA1c was remarkably down to 7.1. There was no evidence of any macrovascular or microvascular complications. GAD-65 and islet cell antibodies were negative. Given good glucose control and adequate β cell function as confirmed by C-peptide level of 3.50 ng/mL, we were hence able to further decrease his basal insulin to once daily and start metformin. With an increasing number of reports of patients with new-onset DKA following Covid-19 infection, without a typical phenotype of type 1 diabetes, it is possible that Covid-19 is associated with a unique form of provoked A- β+ Ketosis Prone Diabetes (KPD). Identical to our case, patients belonging to this subgroup resemble type 2 diabetes patients in that they have adult-onset diabetes, are overweight or obese, lack islet autoantibodies and have substantial β cell functional reserve measured shortly after the index episode of DKA. Awareness of this phenomenon is important as it can help guide a unique treatment path for these patients and avoid injudicious use of insulin moving forward. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Teeth and gums in diabetes

Teeth and gums in diabetes

Role of glycated hemoglobin in microvascular complications in type 2 diabetes mellitus: cross sectional study

Background. Diabetes mellitus (DM) is a complex disorder which defects mainly vascular complications. Complications increase the morbidity and mortality associated with the disease, reducing life expectancy by 10–15 years. Diabetic neuropathy (DN) is a frequent complication of DM and is defined as the presence of peripheral nerve dysfunction after exclusion of other causes. Poor glycaemic control and chronic hyperglycaemia are the major risk factors for DN. Most important treatment of DN remains good glucose control generally noted as HbA1c ≤ 7.5 %. The purpose of this cross-sectional study is to investigate the role of glycated hemoglobin in microvascular complications in type 2 diabetes mellitus. Materials and methods. This cross-sectional study was carried out in Teerthanker Mahaveer Medical College and Research Center, Moradabad from Jan 2016 to December 2016 in which 100 type 2 diabetic mellitus (T2DM) patients in the age group of 35–69 years were included. Patients were divided into 2 groups of 50 each. Group 1 constituted of T2DM patients without any microvascular complication and group 2 includes T2DM patients with microvascular complications. Examination of patients included recording of medical history, pulse rate and blood pressure. Neuropathy was assessed by clinical examination based on modified NDS procedure, which included examination of vibration, pin prick sensation, temperature sensation on dorsum of foot and Achilles tendon reflex. Blood samples were collected by venepuncture and accordingly biochemistry analysis was carried out (Fasting Blood Glucose, post prandial blood glucose and HbA1c were recorded). HbA1c estimation was done by using COBAS fully automated analyser. Results. Among recruited patients, Mean fasting, PPBS level, HbA1c among test group was significantly more than control group. In control group significant correlation of HbA1c is found with age, weight and BMI and in test group significant correlation of HbA1c is observed with age and duration of DM. Significant correlation of HbA1c with FBS and PPBS seen in both control group and in test group. Among test group, 19 patients were found to have DN and significant correlation of HbA1c is observed with NDS score. Conclusions. Increased HbA1c is closely associated with DN in T2DM patients and could be considered as a potent indicator for DN in these patients.

The prevalence of poor sleep quality and its association with the risk of obstructive sleep apnea and restless legs syndrome in diabetic patients treated with cyanoacrylate glue for varicose veins.

This study aimed to assess the prevalence of poor sleep quality and to describe its predictors in diabetic patients having chronic venous insufficiency and varicose veins treated with cyanoacrylate glue. This single-center, prospective cohort study was conducted between March 2018 and March 2021. A total of 103 patients with diabetes mellitus and chronic venous insufficiency (CEAP classification at stages C3-C6) treated with cyanoacrylate glue for varicose veins were recruited. A questionnaire form, Pittsburg Sleep Quality Index, Berlin Questionnaire, and Diagnostic Criteria for Restless Legs Syndrome were used for data collection. A Doppler USG assessment was performed in the first clinical examination. Almost half of the participants had had diabetes mellitus for 10years or more, and 52% had good glucose control. Among the study sample, 61% were poor sleepers, 47% of the participants were RLS positive, and 51% had a high risk of sleep apnea. RLS, HbA1c, and dressing at home had positive associations with poor sleep quality (p < 0.05) on the fifth day after the peripheral embolization. One month after the operation, participants had better sleep quality; however, there were no statistically significant differences between the assessments of RLS and the risk of OSA compared to the fifth day after the operation (p > 0.05). This prospective study showed that restless legs syndrome, a high level of HbA1c, and dressed injection area of the skin are associated with poor sleep quality in patientswith diabetes having chronic venous insufficiency and varicose veins treated with cyanoacrylate glue. Additionally, participants had better sleep quality 1month after the peripheral embolization compared to the fifth day after the operation.