Good Glycemic Control Research Articles

Assessment of Elderly Type 2 Diabetic Patients who Self-adjust Their Insulin Regimen in Al-Qassim Region

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a multifactorial chronic disease. To avoid long-term and short-term complications, good glycemic control must be achieved. The majority of T2DM patients who require insulin therapy have their doses modified by their physicians; this procedure takes time and may not result in the optimal glycemic control. AIM: This study aims to ascertain whether elderly T2DM patients in Al-Qassim region modify their own insulin regimen and its effect on their glycemic control. METHODS: This cross-sectional study was conducted in Al-Qassim University Medical City and Diabetic Centers in Buraydah, Saudi Arabia. Data were collected using a questionnaire. RESULTS: A total of 384 participants were enrolled with a mean age of 70.2 ± 6.0 (61–94) years, majority (53.6%) of whom were females. About half (50.8%) were not educated and two-third (66.1%) giving insulin injections by themselves. Less than half (40.6%) of the participants changed their insulin dose, out of which 8.3% changed the dose by themselves. The mean hemoglobin A1C (HbA1c) level was 8.8 ± 1.9 with a range of 5.2–17. About 30.5% had recent hypoglycemic attacks, majority (47.9%) of whom had only one episode. Diabetic complications were seen among 127 participants with retinopathy as the most common (43.3%) complication. Hypoglycemic attacks and insulin dose adjusting were not found to be significantly associated (p = 0.476). The last HbA1c level was found to be significantly associated with adjusting insulin dose. CONCLUSION: Self-adjusting insulin dose was found to be rare. Moreover, HbA1c in patients who self-adjust their insulin dose was found to be significantly lower.

Barriers of Good Glycemic Control Of Known Diabetic Patients in a Tertiary Care Hospital

Introduction: uncontrolled Diabetes mellitus is a growing cause of disability and premature death. HbA1C is an indicator of glycemic control status over the previous three months. Therefore, to minimize the morbidity and mortality of diabetic patients, it would be necessary to identify the factors associated with poor glycemic control, which may not be similar to developed countries. Objective: To identify factors acting as a barrier to reasonable glycemic control of known diabetic patients in Bangladesh Materials and methods: This is a hospital-based descriptive cross-sectional study among diabetic patients with poor glycemic control in the indoor and outdoor Medicine and Endocrinology departments of Dhaka medical college hospital, Dhaka, from July 2019 to December 2019 (6 months). For at least three months, patients who had uncontrolled Diabetes were selected by purposive and convenient sampling method. Results: One hundred and six patients with poor glycemic status were included in the analysis. Aged persons were at risk for poor glycemic control, especially age range of 50-69 years (65.0%) P-value was .004. Duration of Diabetes and educational status were significantly associated with poor glycemic control. P values were 0.001 and .003, respectively. Conclusion: Patient education plays a pivotal role in controlling glycemic control, favoring treatment success, reducing adverse drug events, and preventing further complications of Diabetes. J Dhaka Med Coll. 2022; 31(1) : 9-14

Incidence of Fetal Myocardial Hypertrophy in Mother with Diabetes Mellitus by Using Cardio-Spatiotemporal Image Correlation (STIC) M-Mode.

The aim was to demonstrate the prevalence of fetal myocardial hypertrophy (FMH) in diabetes mellitus (DM) pregnant women using spatio-temporal image correlation (STIC) M-mode. This prospective descriptive study was conducted at Bhumibol Adulyadej Hospital (BAH) Royal Thai Air Force between April and December 2022. Participants were singleton DM pregnant women with gestational age (GA) between 18 and 40 weeks who had antenatal care and delivery at BAH. DM screening was randomized blood sugar obtained from all participants. All participants underwent fetal heart exams by four-dimension ultrasound with STIC M-mode. One hundred and forty-five participants were recruited and classified as pregestational (PDM) and gestational DM (GDM) at 31 and 114 cases, respectively. The mean age of participants was 31.7 years old. Fasting blood sugar (FBS) of PDM was significantly higher than GDM (105.1 vs 87.0 mg%). GDMA2 had more elevated FBS than GDMA1 (p < 0.001). PDM had significantly greater FBS and two-hour postprandial blood sugar (2hr-PP) than GDM (105.1/87.0 and 151.5/117.9 mg%, respectively). FBS and 2hr-PP of GDMA2 were more than GDMA1 with statistical significance. Good glycemic control of GDM was significantly better than PDM. GDMA1 had better glycemic control than GDMA2 with statistical significance. Four-fifth (115/145) of participants had FMH. FMH and estimated fetal weight among PDM and GDM were comparable. Both good and poor glycemic control had similar FMH. Neonatal outcomes of FMH or non-FMH infants were similar. The prevalence of FMH in diabetic pregnant women was 79.3%. Glycemic control had no correlation to FMH.

Effect of thermal processing on debittering process and its impact on the functional properties of palmyrah young shoot flour

Palmyrah young shoot is rich in starch and fiber and provides good glycemic control. Unfortunately, the consumption rate is limited by the presence of bitter and toxic compounds. Reported literatures reveal that thermal treatment especially dry heat processes like milling the flour at more than 80 °C had an impact on toxicity reduction rather than wet heat processes like boiling. As a result, the current study was aimed to investigate the combined effect of wet (boiling) and dry (radio frequency) heat processing on the debittering of young shoot flour in comparison with tray drying. In the study the flour obtained by a combination of boiling and drying was considered as treated flour and without boiling and drying was considered as untreated flour. The combined effect of wet and dry heat processing had an impact on the nutrients but had no effect on bitterness reduction. The study found tray dried untreated flour favored the feasibility of bitterness reduction as compared to other samples. The compounds (FlabelliferinsB, Flabelliferins–II, isomers of flabelliferins, and vitamin C) responsible for bitterness and its intensity were identified by FTMS. Furthermore, the study revealed that debittering process improved the functional properties of young shoot flour compared to raw flour.

COMPLETE AUDIT CYCLE: PERI-OPERATIVE GLYCEMIC CONTROL IN CMH LAHORE

Hyperglycemia is associated with an increased risk of complications in patients undergoing surgery. Hyperglycemia from diabetes must be differentiated from stress-induced hyperglycemia, which typically presents post-operatively and resolves as the surgery-induced stress subsides. It is imperative to differentiate between the two due to the severe complications of diabetic hyperglycemia, which can often be confused with its stressed induced counterpart. Good glycemic control is the best strategy to avoid post-operative complications and morbidity. An assessment of peri-operative blood glucose levels of known diabetics admitted to CMH Lahore was done, and recommendations were introduced to achieve better glycemic control. Subsequently preventing post-surgical complications, improving wound healing and overall recovery, and ultimately decreasing morbidity. The aim of the audit was the assessment of peri-operative glycemic control in known diabetics admitted for surgery in CMH Lahore. Existing problems regarding poor glycemic control were identified, and recommendations were given to rectify said problems. We aimed to study the effectiveness of glucose control due to these planned interventions. Patients were included based on eligibility criteria, and a record of the patients was updated daily on the Excel sheet using the glucose control audit tool (attached below). The highest BSR reading per day was added. Good or poor glycemic control was determined by the highest BSR readings on post-op days 0, 1, and 2. If 2 or more readings met the criteria for good glycemic control, the patient was labeled to have good glycemic control. In Cycle 1, patients were managed peri-operatively with insulin as per the sliding scale. 13% of patients had good glycemic control on this regimen. Interventions were introduced for Cycle 2, with the recommendation of altering insulin/drug regimens as per NHS/ADA guidelines. 16.6% of patients were found to achieve good glycemic control; however, it was noted that these recommendations were not followed consistently. Based on the results, it can be concluded that the management of inpatient diabetes is a team effort, interventions recommended using established guidelines should be followed stringently, and existing protocols should be updated accordingly. Proper management of inpatient hyperglycemia starts with each team member performing their respective role to their best; this is vital in preventing post-operative complications associated with poor glycemic control.

The associations between physical activity, health-related quality of life, regimen adherence, and glycemic control in adolescents with type 1 diabetes: A cross-sectional study

BackgroundAdolescents with Type 1 Diabetes (T1D) display a greater than two-fold higher risk of developing diabetes-related complications compared with their healthy peers and the risk increases markedly as glycated hemoglobin (HbA1c) increases. The majority of the known factors associated with improved glycemic control in adolescents with T1D are geared toward Western populations. Therefore, this study examined the associations between Physical Activity (PA), Health-Related Quality of Life (HRQoL), and regimen adherence on glycemic control in a Middle Eastern population of adolescents with T1D MethodsThe study utilized a cross-sectional design of Jordanian adolescents (aged 12–18) with T1D (n = 74). Self-reported measures used were the Pediatric Quality of Life-Diabetes Module, the International Physical Activity Questionnaire, and the Summary of Diabetes Self-Care Activities. HbA1c values were obtained from the medical records. Correlation analyses were conducted using Pearson’s and Spearman’s correlation tests. Multiple regression analyses were conducted to determine if HRQoL, PA, and regimen adherence predict glycemic control. ResultsOnly 14.8 % of the participants demonstrated good glycemic control (HbA1c ≤ 7.5 %). Participants with poor control had a statistically significant lower mean PA of MET-minutes/week (3531.9 ± 1356.75 vs. 1619.81 ± 1481.95, p < .001) compared to those with good control. The total sample was found to demonstrate low HRQoL (47.70 ± 10.32). Participants were within the acceptable range of PA (1885.38 ± 1601.13) MET-minutes/week. HbA1c significantly inversely correlated with PA (r = −0.328, p = .010) and regimen adherence (r = −0.299, p = .018). The regression analysis revealed that PA significantly predicted glycemic control (β = −0.367, p < .01) as adherence (β = −0.409, p < .01) and disease duration did (β = 0.444, p < .01). ConclusionBetter glycemic control was significantly associated with higher PA and regimen adherence levels. The correlation between PA and glycemic control depends highly on the level of regimen adherence or arguably, adherence acts as a buffer in the correlation between PA and glycemic control. There was no significant association between glycemic control and HRQoL.

Association between personality traits and glycemic control after inpatient diabetes education

AimsThe longitudinal effect of personality traits on glycemic control is unclear. This prospective observational study explored the relationship between personality traits and glycemic control in patients with uncontrolled diabetes after inpatient diabetes education. MethodsPatients with diabetes mellitus (HbA1c ≥ 7.5%, measured by high-performance liquid chromatography) who received inpatient diabetes education were scored on the Big Five personality traits: neuroticism, extraversion, openness, agreeableness, and conscientiousness. Multiple linear analysis was used to determine whether any personality traits were independently associated with HbA1c on admission and HbA1c change from admission to 1, 3, and 6 months after discharge. ResultsOne hundred seventeen participants (mean age 60.4 ± 14.5 years; 59.0% male) were enrolled. HbA1c values on admission and 1, 3, and 6 months after discharge were 10.2 ± 2.1%, 8.3 ± 1.4%, 7.6 ± 1.4%, and 7.7 ± 1.5%, respectively. Multiple linear analysis showed that no personality traits were associated with HbA1c on admission. Neuroticism was negatively associated with the HbA1c change from admission to 3 months (β = −0.192, P = 0.025) and 6 months after discharge (β = −0.164, P = 0.043). ConclusionsNeuroticism was associated with good long-term glycemic control after inpatient diabetes education.

Evaluation of some immune and inflammatory responses in diabetes and HIV co-morbidity.

Co-existence of diabetes in the HIV infected reportedly further complicates the attendant impairment of immunity and increases susceptibility to opportunistic infections. This study aimed to evaluate some immune and inflammatory parameters in HIV and type 2 diabetes (T2D) co-morbidity: Immunoglobulin M and G (IgM and IgG), Interleukin-6, CD4+ T-cells and C-reactive protein. The study involved 200 subjects grouped according to their HIV and diabetes status: Group 1 'Diabetic HIV seropositive' (n=40), Group 2 'Non diabetic HIV seropositive'(n=60), Group 3 'Diabetic HIV seronegative'(n=50), and Group 4 'Control non diabetic HIV seronegative'(n=50). Blood samples were collected for testing. CRP levels were significantly elevated in diabetes and HIV co-morbidity compared to other groups. IL-6 levels were significantly higher in diabetics with or without HIV infection. In addition, IL-6 was significantly elevated in individuals with poor glycemic control (HbA1c > 9.0%) compared to those with good glycemic control. IgG and IgM levels in diabetic HIV seropositive subjects were highest compared with other groups. The increased IL-6, CRP, IgG, IgM and decreased CD4+ T cell counts observed in co-morbidity suggest that HIV and T2D co-morbidity exacerbate the immune and inflammatory impairment observed in either disease entity.

Ocular Manifestations of Diabetes: A Cross-Sectional Study

Purpose: To describe the ocular manifestations of diabetes mellitus in patients of a tertiary care hospital of Pakistan. Study Design: Cross-sectional study. Place and Duration of Study: Ophthalmology Department, DHQ Teaching Hospital, Gujranwala from 1st October, 2022 to 31st December 2022 (3 months). Methods: After taking informed consent and approval from ethical review committee, a self-designed questionnaire was used to collect data which included biodata, type, duration and control of diabetes, associated comorbidities and treatment. Visual acuity and intraocular pressure was measured. Anterior segment examination was performed on slit-lamp bio microscope and posterior segment examination was done with the help of Volk 90D lens after pupillary dilatation with Tropicamide 1% eye drops. All findings were saved on excel spreadsheets and analyzed through Statistical Package for Social Sciences (SPSS) version 25. Results: Out of total 500 patients, 208 (41.6%) were male and 292 (58.4%) were female. Ages ranged from 35 to 77 years with mean age of 55.7 years. Type II diabetes was present in 467 (93.4%) patients and only 147 (29.4%) patients had good glycemic control. Most common anterior segment finding was cataract in 321 (64.2%) patients followed by dry eye and posterior blepharitis in 300 (60.0%), delayed pupillary response in 103 (20.6%) patients. In posterior segment, most common finding was Non-proliferative Diabetic Retinopathy (NPDR) in 90 (18%) patients. Conclusion: Cataract and non-proliferative diabetic retinopathy are the commonest manifestations of diabetes.

A Rare Case of Diabetic Papillopathy Presenting with Pseudo-Foster Kennsedy Syndrome

Pseudo-Foster Kennedy syndrome (PFKS) is defined as unilateral disc oedema with contralateral optic nerve pallor, in the absence of intracranial pathologies. Diabetic papillopathy is a rare ocular manifestation of diabetes mellitus (DM). We report a rare case of PFKS secondary to diabetic papillopathy in a young patient with type 2 DM who had poor glucose control. There was optic disc swelling over the right eye and optic disc pallor over the left eye. His visual field assessment showed right inferior field defect and general depression in the left. Optical coherence tomography retinal nerve fibre layer showed normal thickness over the right eye and generalized thinning over the left eye. Neuroimaging and other laboratory investigations were unremarkable. With good glycemic control, the optic disc swelling over the right eye resolved. Visual field defect remained the same but retinal nerve fiber layer showed thinning in areas where the edema had resolved.

Glycemic Control and Its associated Determinants among Type II Diabetic Patients at Tertiary Care Hospital in North India

Introduction: Good glycemic control has been defined as achieving a target of fasting plasma glucose level of between 80 and 110 mg/dl, or glycosylated haemoglobin (HbA1C) of &lt;7.0%. Poor glycemic control is highly correlated with chronic conditions related to the damaging effects of hyperglycaemia, resulting in serious complications. To restrict and delay the complications of diabetes mellitus, good glycemic control is essential. Objective: To identify the determinants associated with poor glycemic control among Type 2 diabetes mellitus patients. Method: A cross sectional study was conducted among 403 confirmed type 2 diabetic patients who attendedone of the tertiary care hospitals of North India over a period of six months (July- December 2021). The collected data was analysed using IBM SPSS version 28. Chi-square test was applied to compare various determinants of glycemic control. A p-value of &lt;0.05 was considered to be statistically significant. Results: Out of 403 participants, 57.6% had poor glycemic control of diabetic condition. Higher age of participants, illiteracy, being overweight, having positive history of smoking and alcohol, longer duration of diabetes, participants taking both oral and insulin treatment for diabetes, taking medicine irregularly were the significant determinants of poor glycemic control. Conclusion: Higher percentage(57.6%) of poor glycemic control was observed in the study.To improve the glycemic control, efforts should be made towards improving modifiable factors like overweight, smoking, alcohol, regularity of medication etc. Good lifestyle interventions help in control of poor glycemic control.

Treatment of Diabetic Foot Syndrome By Means of Hyaluronidase Infusion Therapy – Single Patient Case Report

Background: Diabetic foot syndrome (DFS) is one of the most severe secondary complications of diabetes mellitus. It is currently treated with improvement and maintenance of good glycemic control, pain drugs, antibiotics, and drugs and surgical measures to improve the vascular blood flow into the legs. In late stages, foot amputation (in part or total) is the only means to safe the patient’s life. Case Report: A 56-year-old woman with type 1 diabetes for more than 40 years, suffered from diabetic foot syndrome with complete closure of the arteria fibularis and a non-healing foot ulcer at the left leg. The need for lower ankle amputation was already determined. We tried to improve the vascular situation by means of a series of intravenous hyaluronidase infusions over a period of three weeks. An immediate improvement of the general condition was observed. The ulcer healed completely within 8 weeks, and a re-opening of the previously closed vessel as well as further additional collateral blood-flow into the left foot could be determined by means of an angiogram six months later. Discussion: The observed beneficial impact of intravenous hyaluronidase treatment on atherosclerotic lesions can be explained by the molecular action of the enzyme on the glycocalix, the extracellular hyaluronan layer that separates the endothelial cells from the blood stream. Successful treatment of DFS with hyaluronidase infusions has been reported already 50 years ago but research on this topic ceased, when stents and other apparently more compelling vascular treatment methods were detected. Conclusions: In a severe case of DFS, we were able to re-open a critical arterial vessel and improve the entire vascular blood flow by means of intravenous hyaluronidase infusions. Clinical studies are required to confirm the value of hyaluronidase infusions as treatment alternative to amputation for DFS.

Physical activity during COVID-19 pandemic and its impact on glycemic control in children with type 1 diabetes mellitus

Background: Physical activity is one of the important factors affecting glycemic control in type 1 diabetes mellitus (T1DM). During COVID-19 pandemic the government imposed restrictions to prevent the spread of COVID and physical activity of children was curtailed. We assessed the physical activity during COVID-19 pandemic restrictions (from September 2020 to September 2021) and its association with their glycemic control. Methods: 48 children with T1DM receiving treatment in paediatric endocrinology outpatient department (OPD), AIIMS, New Delhi were enrolled. Socio-clinical data were collected using pre-validated and tested self-structured tool, physical activity was assessed using global physical activity questionnaire and glycemic control was assessed by glycated haemoglobin (HbA1C) and compared to baseline level before the onset of pandemic. Results: Among 48 children (11.2±3.7 years, 25 M: 23 F), 79.2% fulfilled the 60 minutes’ requirement of physical activity/day. Moderate negative correlation was found in recommended physical activity duration and HbA1c during COVID-19 pandemic. However, there was a significant increase in the HbA1C level from 7.6±1.5 to 8.5±1.8 during COVID-19 pandemic. Conclusions: There was a moderate negative correlation between duration of physical activity and HbA1c of children. In spite of restrictions imposed by the government, children who were physically active were able to maintain good glycemic control. Although there was significant increase in the mean HbA1c of children during COVID-19 pandemic but the percentage of hyperglycemic events was significantly lower among the children who had walked/rode bicycle for going from one place to another and who had more rooms to play at home had good glycemic control.

Impact of Balya Protex Powder on Fatigue Levels in Patients with Diabetes Mellitus Adhering to the Ayurveda-Based Comprehensive Diabetic Care Program

Chronic fatigue in diabetic patients can be the outcome of protein deficiency. Plant based protein is closer to nature and bodily acceptable, hence we chose to assess plant-based protein “Balya Protex Powder” over whey protein. A prospective, multicentre, post-market study was conducted in India. Patients with a diagnosis of diabetes mellitus aged 18 years and above were included in this study. All patients adhered to the Comprehensive Diabetic Care (CDC) Program. Comparative data of change in fatigue score was collected retrospectively from type 2 diabetes mellitus patients assigned a low carbohydrate low calorie diet for 90 days. A total of 101 patients were included in this study, 50 patients consumed the Balya Protex Powder whilst 51 did not consume the Balya Protex powder whilst adhering to the CDC program. Weight of the patients decreased by 7.92% and 5.52% in the Balya Protex Powder consumption and Balya Protex Powder non-consumption group, respectively. Body mass index decreased by 5.93% and 5.18% in the Balya Protex Powder consumption and Balya Protex Powder non-consumption group, respectively. Abdomen girth decreased by 8.39% and 4.67% in the Balya Protex Powder consumption and Balya Protex Powder non-consumption group, respectively. Weakness grade decreased by 83.69% and 47.61% in the Balya Protex Powder consumption and Balya Protex Powder non-consumption group, respectively. All patients showed significant reduction in glycated hemoglobin (HbA1c) levels, however patients in the subgroup who were taking 30 gm of Balya Protex Powder daily showed 50% greater reduction in chronic fatigue score. It can be concluded that Balya Protex Powder consumption leads to good glycemic control with reduced fatigue in diabetic patients whilst adhering to the CDC program.

Unintentional Weight Loss from Metformin Despite Good Glycaemic Control in a Newly Diagnosed Diabetic Patient

Aim: To present a case of unintentional weight loss from Metformin despite good glycaemic control in a newly diagnosed diabetic patient.&#x0D; Case Presentation: A 60-year-old previously diagnosed hypertensive and recently diagnosed type 2 diabetic patient with good glycaemic and blood pressure control presented with progressive weight loss in the last one year while on medication. Her normal state weight was 84.6kg, height 1.70m2 (BMI 29.27kg/m2) which dropped to 70kg (BMI 20.26Kg/mg2) at the point she was diagnosed with type 2 diabetes mellitus (T2DM). She was counselled about dietary and lifestyle modification. She was then commenced on Metformin and she achieved a good blood glucose level control but her weight dropped further to 58kg despite adherence with diet and lifestyle. She was then changed to Sulphonylurea (Glipizide). She had a significant improvement in her weight which she had maintained with good glycaemic control.&#x0D; Discussion: Oral hypoglycemic agents (OHAs) are the most common initial pharmacologic treatments for type 2 diabetes and they are associated with changes in weight. Sulphonylureas (SUs) are widely used in routine clini­cal practice, not only in combination with metformin, but also as first-line monotherapy. Patients often gain weight due to the side effects of current therapies, particularly SU, insulin and glitazone therapies.&#x0D; Conclusion: It is important for clinicians to consider not only the antihyperglycemia effects of selected medications used in the treatment of diabetes, but also the effect they may have on the patient’s body weight.

Secure Messaging for Diabetes Management: Content Analysis

Secure messaging use is associated with improved diabetes-related outcomes. However, it is less clear how secure messaging supports diabetes management. We examined secure message topics between patients and clinical team members in a national sample of veterans with type 2 diabetes to understand use of secure messaging for diabetes management and potential associations with glycemic control. We surveyed and analyzed the content of secure messages between 448 US Veterans Health Administration patients with type 2 diabetes and their clinical teams. We also explored the relationship between secure messaging content and glycemic control. Explicit diabetes-related content was the most frequent topic (72.1% of participants), followed by blood pressure (31.7% of participants). Among diabetes-related conversations, 90.7% of patients discussed medication renewals or refills. More patients with good glycemic control engaged in 1 or more threads about blood pressure compared to those with poor control (37.5% vs 27.2%, P=.02). More patients with good glycemic control engaged in 1 more threads intended to share information with their clinical team about an aspect of their diabetes management compared to those with poor control (23.7% vs 12.4%, P=.009). There were few differences in secure messaging topics between patients in good versus poor glycemic control. Those in good control were more likely to engage in informational messages to their team and send messages related to blood pressure. It may be that the specific topic content of the secure messages may not be that important for glycemic control. Simply making it easier for patients to communicate with their clinical teams may be the driving influence between associations previously reported in the literature between secure messaging and positive clinical outcomes in diabetes.

Advanced Hybrid Closed Loop in Adult Population With Type 1 Diabetes: A Substudy From the ADAPT Randomized Controlled Trial in Users of Real-Time Continuous Glucose Monitoring.

This analysis reports the findings from a predefined exploratory cohort (cohort B) from the ADAPT (ADvanced Hybrid Closed Loop Study in Adult Population with Type 1 Diabetes) study. Adults with type 1 diabetes (T1D) with suboptimal glucose control were randomly allocated to an advanced hybrid closed-loop (AHCL) system or multiple daily injections of insulin (MDI) plus real-time continuous glucose monitoring (RT-CGM). In this prospective, multicenter, exploratory, open-label, randomized controlled trial, 13 participants using MDI + RT-CGM and with HbA1c ≥8.0% were randomized to switch to AHCL (n = 8) or continue with MDI + RT-CGM (n = 5) for six months. Prespecified endpoints included the between-group difference in mean change from baseline in HbA1c, CGM-derived measures of glycemic control, and safety. The mean HbA1c level decreased by 1.70 percentage points in the AHCL group versus a 0.60 percentage point decrease in the MDI + RT-CGM group, with a model-based treatment effect of -1.08 percentage points (95% confidence interval [CI] = -2.17 to 0.00 percentage points; P = .0508) in favor of AHCL. The percentage of time spent with sensor glucose levels between 70 and 180 mg/dL in the study phase was 73.6% in the AHCL group and 46.4% in the MDI + RT-CGM group; model-based between-group difference of 28.8 percentage points (95% CI = 12.3 to 45.3 percentage points; P = .0035). No diabetic ketoacidosis or severe hypoglycemia occurred in either group. In people with T1D with HbA1c ≥8.0%, the use of AHCL resulted in improved glycemic control relative to MDI + RT-CGM. The scale of improvement suggests that AHCL should be considered as an option for people not achieving good glycemic control on MDI + RT-CGM.

Evaluation of the Corneal Endothelium Following Cataract Surgery in Diabetic and Non-Diabetic Patients.

The aim of this study was to evaluate the influence of phacoemulsification cataract surgery on the state of the corneal endothelium in diabetic versus non-diabetic patients. We compared the corneal cell morphology in 48 diabetics with good glycemic control and 72 non-diabetic patients before and after uneventful phacoemulsification. Corneal cell density, central corneal thickness, and hexagonality were measured preoperatively and post-surgery (at 1 and 4 weeks) by specular microscopy. The effect of age, gender, axial length, and anterior chamber depth on the parameters of the corneal endothelium were evaluated. We noticed a drop in the endothelial density in both groups postoperatively: a mean endothelial cell loss of 472.7 ± 369.1 in the diabetic group was recorded versus 165.7 ± 214.6 mean loss in the non-diabetic group after the first week. A significant increase in central corneal thickness was also noticed in both groups one week after phacoemulsification, but no statistical significance after 4 weeks in the diabetic group. In terms of cell hexagonality, statistically significant differences were noticed after 4 weeks in both groups. Overall, a significant difference between diabetic and non-diabetic population was noticed in terms of corneal endothelial cell loss after uneventful phacoemulsification cataract surgery. Routine specular microscopy and HbA1c evaluation is recommended before cataract surgery, while intraoperative precautions and high monitorisation in terms of pacho power intensity and ultrasound energy, along with a proper application of the dispersive viscoelastic substances are essential to reduce the risk of endothelial damage.

Medication adherence, its associated factors and implication on glycaemic control in patients with type 2 diabetes mellitus: A cross-sectional study in a Malaysian primary care clinic.

Medication adherence and metabolic control remain suboptimal among patients with diabetes mellitus in Malaysia despite the clear benefits of reduced vascular complications and mortality risk. This study examined the factors associated with medication adherence and glycaemic control in patients with type 2 diabetes mellitus in a primary care clinic. This cross-sectional study was conducted in a public health clinic in Pagoh, Johor, among 386 patients recruited via systematic random sampling. Data were obtained using a validated 7-item structured questionnaire, glycated haemoglobin (HbA1c) test and medical record review. Logistic regression analysis was performed to determine the factors associated with medication adherence. The mean patient age was 60.04± 10.75 years, and the mean HbA1c level was 8.3±2.0%. Approximately 60.3% of the participants were adherent to their medication, and an increasing age was significantly associated with medication nonadherence (adjusted odds ratio [OR]: 0.959; confidence interval [CI]: 0.934-0.985). Medication adherence (adjusted OR: 2.688; CI: 1.534- 4.708) and use of combined oral medications (adjusted OR: 5.604; CI: 3.078-10.203), combined oral medications with insulin (adjusted OR: 23.466; CI: 8.208-67.085) and insulin only (adjusted OR: 6.528; CI: 1.876-22.717) were associated with good glycaemic control. Older age (adjusted OR: 0.954; CI: 0.923-0.986) and Malay ethnicity (adjusted OR: 0.284; CI: 0.101-0.794) were associated with poor glycaemic control. Suboptimal medication adherence and glycaemic control are prevalent in primary care settings, especially among elderly patients. Counselling should be targeted to patients and their caretakers to improve medication adherence and optimise metabolic control.

Twice-daily injections and multiple daily injections of insulin in toddlers with type 1 diabetes: a retrospective cohort study.

Twice-daily injections and multiple daily injections of insulin in toddlers with type 1 diabetes: a retrospective cohort study.