Control HbA1c Research Articles

Trend of body mass index and its impact on glycemic control in Finnish patients with type 2 diabetes

Abstract Background Obesity prevalence has increased in Finland and is prevalent in patients with type 2 diabetes (T2D). Understanding the trend in body mass index (BMI) and its impact on glycemic control helps in the assessment of treatment strategies for T2D. We aimed to investigate the current trend in BMI among Finnish patients with T2D and the glycated hemoglobin (HbA1c) control across different BMI categories. Methods Regional data on electronic health records (EHRs) covering all public health care in North Karelia, Finland, were used. Patients with T2D (ICD-10 code E11) in 2012-2022 were identified from EHRs. In each study year, patients with ≥1 measurement of BMI and HbA1c were included in data analysis. Generalized estimating equations regression analyses were performed to evaluate the trends. Results The annual number of patients in the analyses ranged from 5149 to 10216 in 2012-2022. The unadjusted mean BMI remained stable. However, an increasing trend in BMI was observed in the age-adjusted model and remained unchanged with further adjustment for sex, duration of diabetes, and antidiabetic medication use, reflecting the aging of the patient population and lower BMI in aged patients. Patients with higher BMI had higher HbA1c levels in 2012-2022. The increasing trends in HbA1c over time were observed across different BMI categories (except for the obsess class III) accounting for age, sex, and duration of diabetes. However, a decreasing trend in HbA1c was found in the obese class III category with further adjustment for antidiabetic medication use, along with the highest usage rates of the new antidiabetic medications during the follow-up. Conclusions Our findings suggest that weight management requires increased attention in Finnish patients with T2D and is also important for better glycemic control. Multimodal treatment, including effective lifestyle counseling, self-care support, and medication management, is needed. Key messages • More attention and resources are needed to achieve optimal weight control. • Weight management could aid in better glycemic control.

Prevalence and Correlation between HbA1c Control and Duration of Diabetes with Blindness in the Eastern Part of Libya: Double Centers Study

A prospective cross-sectional study of diabetic patients registered at the Eye department of Tobruk Medical Center in Tobruk-Libya between (01.06.2023 to 29.02.2024). At the same time data was collected in the eye department in Alwahda Derna Teaching Hospital, Data was collected using the same administered questionnaire. Grading of DR was done by slit-lamp examination and Fundoscopy by an ophthalmologist. Descriptive analysis included percentage mean, median, and p - value by using SPSS 25. There were 185 diabetic patients, ages ranging between 30 and 90 years, with a mean of 58, the majority (97.6%) were of Libyan nationality. There were 86 males and 99 females. Patients with a duration of diabetes ranging between 11 and 15 years were at almost a five-fold risk of developing DR compared to those with a duration of < 10 years. Most of advanced complicated diabetic retinopathy cases had diabetes for more than fifteen years, and no advanced disease in the cases with a duration of less than 10 years. The patients with poor controlled blood sugar and HbA1c > 9 throughout the disease were at almost five-folded risk of developing DR compared to those with moderate controlled diabetes cases were HbA1c between (7.5 - 9), patients with poor control of diabetes HbA1c> 9 was 25-folded risk of developing PRP than cases with good control HbA1c < 7.5. The majority of advanced diabetic retinopathy cases were correlated with non-controlled diabetes mellitus HbA1c > 9, where no advanced complication was recorded in well-controlled cases.

7636 Once-weekly Insulin Icodec versus Once-daily Long-acting Insulins for Type 2 Diabetes Mellitus: Systematic Review and Meta-analysis

Abstract Disclosure: S.G. Ribeiro: None. M.P. Chavez: None. L.C. Hespanhol: None. A.B. Neto: None. M.D. Gauza: None. E. Paqualotto: None. C.A. Balieiro: None. C.C. Padovese: None. J.R. Sa: None. Background: Insulin icodec is a novel, long-acting, once-weekly basal insulin analog. Its comparative efficacy and safety with basal once-daily insulins in type 2 diabetes mellittus is uncertain. Objective: Evaluate potential efficacy, benefits and risks associated with icodec compared to once-daily basal insulin analogs (degludec or glargine). Methods: We systematically searched PubMed, Cochrane, and Embase for randomized controlled trials (RCTs) published until June 2023 comparing icodec versus long-acting insulin analogs (degludec and glargine) in type 2 diabetes mellitus (T2DM) with at least 12 weeks of follow-up. Binary endpoints were assessed with risk ratios (RRs) and continuous endpoints were compared using weighted mean differences (WMDs), with 95% confidence intervals (CIs). The protocol was registered in PROSPERO (CRD42023452468). Results: A total of seven RCTs and 3,286 patients with T2DM were included, of whom 1,509 (60.6%) received icodec treatment. The follow-up period ranged from 16 to 78 weeks. Compared with once-daily basal insulin analogs, icodec led to a greater improvement in HbA1c (WMD -0.15%; 95% CI -0.21, -0.10; p<0.0001; I²=0%) and time in range (TIR) (WMD 2.83%; 95%CI 0.94; 4.71; p=0.003; I2=22%). Body weight was increased with icodec treatment (WMD 0.78 Kg; 95%CI 0.42, 1.15; p<0.01; I2=86%). There was also a higher rate of injection site reactions (RR 1.89; 95%CI 1.12, 3.18; p=0.016; I²=0%) and nasopharyngitis (RR 1.94; 95%CI 1.11, 3.38; p=0.020; I²=0%) in the icodec group, compared with once-daily regimens. There was no significant difference between groups in fasting plasma glucose. Conclusions: In this meta-analysis of RCTs, insulin icodec led to better control of HbA1c and TIR as compared with once-daily insulin regimens, albeit with increased weight gain and a higher rate of injection site reaction in the Icodec group. Presentation: 6/3/2024

6687 Indicators of Diabetes Management: Predicting Unplanned Healthcare Utilization and Mortality in a Suburban Integrated Delivery Network

Abstract Disclosure: K.M. Barton: None. J.Y. Yip: None. K.C. Geckeler: None. A. Popelka: None. D.J. Ramsey: None. Purpose: To explore whether patients with diabetes mellitus (DM) who met Comprehensive Diabetes Care Healthcare Effectiveness Data and Information Set (HEDIS) metrics had a reduced likelihood of experiencing unplanned emergency department (ED) visits, hospitalizations, or mortality. Introduction: The prevalence of DM among U.S. adults is approximately 15% and continues to rise. To enhance care for individuals with DM, Comprehensive Diabetes Care HEDIS quality measures have been established. These measures encompass criteria such as blood pressure control, hemoglobin A1c (HbA1c) levels, and the completion of an annual eye examination. However, the connection of these metrics to health outcomes remains insufficiently studied. Methods: This study comprised a retrospective, cross-sectional exploratory analysis of established patients aged 18 years or older with DM receiving primary care within a suburban integrated delivery network (IDN). Multivariate logistic regression was used to analyze patient characteristics, including demographics, sociomedical factors, and biometrics. Outcome variables encompassed one or more unplanned ED visits (including urgent care), one or more unplanned hospitalizations, or mortality within the one-year study period. Results: Out of 28,929 patients with DM, 5293 (18.3%) had ≥1 ED visit, 3725 (12.9%) had ≥1 hospital admission, and 614 (2.1%) died during 2022. After controlling for available demographic and sociomedical factors, patients with poor HbA1c control (considered HbA1c > 9.0) in the year prior were more likely to experience an ED visit in the study year (adjusted odds ratio [aOR] = 1.292, 95% CI, 1.121-1.489, p < 0.001). Patients who achieved HbA1c control (considered HbA1c < 8.0) in the year prior were less likely to experience an ED visit (aOR = 0.845, 95% CI, 0.763-0.936, p = 0.001) and less likely to experience a hospitalization in the study year (aOR = 0.878, 95% CI, 0.779-0.989, p = 0.032). Patients who completed an eye exam in the year prior were less likely to experience a hospitalization (aOR = 0.913, 95% CI, 0.847-0.984, p = 0.017) or die (aOR = 0.694, 95% CI, 0.579-0.831, p < 0.001) in the study year. Finally, patients who completed microalbumin testing in the year prior were less likely to experience an ED visit (aOR = 0.902, 95% CI, 0.84-0.968, p = 0.004), or die (aOR = 0.464, 95% CI, 0.389-0.554, p < 0.001). Conclusion: Achieving HbA1c control in the previous year is linked to decreased likelihood of experiencing an unplanned ED visit or hospitalization. An eye exam in the year prior was associated with decreased likelihood of hospitalization or death. Further research into interventions aimed at enhancing DM management and reducing associated complications may have potential to enhance patient health outcomes while reducing health care costs. Presentation: 6/3/2024

8261 Achievement of Diabetes Treatment Goals in Mexico from 2016 to 2022

Abstract Disclosure: D. Ramirez Garcia: None. C.A. Fermin Martinez: None. P.N. Mendez Labra: None. N.E. Antonio Villa: None. J.A. Seiglie: None. O.Y. Bello-Chavolla: None. Background: Optimal diabetes care involves achieving goals with treatment in key metabolic parameters including HbA1c, blood pressure (BP), low density lipoprotein cholesterol (LDL-C) levels, and smoking cessation. Evaluation of diabetes care in Mexico has been incomplete, with previous studies focusing primarily on glycemic control, but not on a comprehensive analysis of combined treatment targets. Objective: To estimate achievement of diabetes treatment goals (HbA1c [A], BP [B], LDL-C [C], smoking cessation [N], and combined targets [AB, BC, AC, ABC, ABCN]) using data from nationally representative surveys from 2016-2022 among individuals with diagnosed diabetes in Mexico. Methods: We analyzed serial cross-sectional National Health and Nutrition Surveys from 2016-2022. A total of 2,689 adults with diagnosed diabetes ≥20 years were identified amongst 21,248 adults ≥20 years. Weighted prevalence estimates were obtained for glycemic control (HbA1c <7% in those <65 years, and <7.5% in those ≥65 years), BP control (<130/80 mmHg), LDL-C control (<70 mg/dL), smoking cessation, and combined targets. We also fitted logistic regression models to estimate the odds of achieving treatment targets according to age, sex, educational level, indigenous identity, and survey cycle. Results: In 2022, the prevalence of HbA1c, BP, and LDL-C control among individuals with diagnosed diabetes in Mexico was 41.2% (95% CI 30.5-52.0%), 46.0% (95% CI 36.5-55.5%), and 17% (95% CI 10.2-25.2%), respectively. Non-smoking prevalence was 92.4% (95% CI 88.6-96.2%). Combined target achievement was low, with a prevalence of 10.8% (95%CI 6.2-15.5%) for BC and 4% (95% CI 1.7-6.3%) for ABCN. The proportion of goal achievement was relatively stable across 2016-2022 for every parameter analyzed, except for LDL-C. LDL-C had the lowest proportion of control across all cycles, although a gradual increase was observed: 8.1% (95% CI 4-12.3%) in 2016 to 17% (95% CI 10.2-25.2%) in 2022. The increase in LDL-C control coincides with greater prevalence of statin use across survey cycles. Men had lower odds of achieving ABCN combined control (OR 0.49, 95%CI 0.45-0.54) than women. Similarly, compared with individuals <45 years, participants 45-64 years (OR 0.36, 95%CI 0.32-0.40) and ≥65 years (OR 0.41 95%CI 0.35-0.47) had lower odds of achieving composite control. Conclusions: Achievement of diabetes treatment goals in Mexico is suboptimal. Less than half of individuals with diagnosed diabetes achieve HbA1c or BP goals, less than a fifth achieve LDL-C control, and only 1 in 20 individuals achieve ABCN control. Greater efforts are needed to the improve the comprehensive care of individuals with diabetes in Mexico. Presentation: 6/3/2024

A Study of Psychological Features in Patients With Type 2 Diabetes Mellitus.

There is a lack of multidisciplinary studies examining the link between psychological factors and glycemic control in individuals with chronic illnesses. The aim of this study is to investigate the relationship between psychological factors such as resilience, perceived stress, emotional regulation, aggressiveness, and glycated hemoglobin (HbA1c) levels in patients with type 2 diabetes. Additionally, the study seeks to determine the predictive value of perceived stress and resilience on HbA1c levels and to explore the role of anger expression and emotion regulation strategies in glycemic control, comparing diabetic patients to healthy controls. The study was conducted between November 2021 and November 2023 at the Clinic of Endocrinology and Metabolic Diseases at the St. George University Hospital, Bulgaria, and the Department of Science and Research at the Medical University of Plovdiv, Bulgaria. Of these 84 individuals were diagnosed with type 2 diabetes, divided into two groups of 42 individuals each, who had poor and fair glycated hemoglobin. The third group was a healthy control consisting of 42 individuals in the same age group who had no established chronic diseases. When comparing the study groups on HbA1c and individual psychological characteristics, there were statistically significant differences in resilience, perceived stress, emotion regulation suppression, and anger expression. When comparing the mean values of mental resilience with glycated hemoglobin levels, we find that there are statistically significantly higher mean values between the poor HbA1c control and the healthy group. From the regression analysis, we conclude that the psychological characteristics positively associated with perceived stress (β=0.502; p<0.001) and inversely associated with mental resilience (β=-0.359; p<0.001) are the most predictive. Less influential was the straight correlation with emotion regulation-expressive inhibition (β=0.226; p<0.05), the positive correlation with anger (β=0.170; p<0.001), and general aggressiveness (β=0.151; p<0.05). From the present study, we note that glycated hemoglobin level is strongly influenced by two psychological predictors, namely subjective perception of stressful situations and resilience level.

Longitudinal assessment of SNPs rs72552763 and rs622342 in SLC22A1 over HbA1c control among Mexican-Mestizo diabetic type 2 patients.

Background: In Mexico, 75% of diabetes mellitus type 2 (DMT2) patients are not in glycaemic control criteria (HbA1c<7%); this entails a significantly variable drug response. Amongst the factors influencing such variability, are genetics, more specifically, single nucleotide polymorphisms (SNPs). Three genes implied in metformin pharmacokinetics are SLC22A1, SLC22A2, and SLC22A3, which are polymorphic. While there have been cross-sectional studies on their SNPs impact over drug response, a longitudinal study would contribute valuable information on their effect over time. Methods: SNPs of SLC22A1 (rs72552763, rs622342, rs12208357, rs2282143, rs594709, rs628031, and rs683369), SLC22A2 (rs316019), and SLC22A3 (rs2076828), were determined through PCR-TR. The clinical records of 69 patients undergoing metformin monotherapy were retrospectively assessed. Metformin is the first line treatment against DMT2. A level of HbA1c <7% (time 0) was considered as an inescapable inclusion criterion. The study's cases were those patients who reported HbA1c ≥ 7% (time1) after time 0 (t0). Kaplan-Meier curves including a Log-Rank test and a Cox multivariate analysis of proportional risks were performed. Aim: Determining clinical, biochemical, and genetic variables which may affect non-control (HbA1c ≥ 7%) survival time spans amongst DMT2 Mexican-Mestizo patients undergoing metformin monotherapy at Hospital Regional de Alta Especialidad de Ixtapaluca (HRAEI) between October 2013 and December 2023. Results: All 69 patients were monitored over a median period of 642 days (273-1,134). A comparison between time 0 and time 1 (t1) revealed differences in weight (p = 0.036), metformin dose mg/kg/day (p = 0.003), plasmatic glucose mg/dL (p = 0.048), and HbA1c (p < 0.001). The median non-control survival rate was different across the 3 genotypes of rs62552763 in SLC22A1 (p = 0.0034) and the dominant genotypic model GAT/GAT vs. GAT/del + del/del (p = 0.009). There were differences between rs622342 genotypes as well (p = 0.041). In GAT/GAT the Cox model found HR = 0.407 (IC95%: 0.202-0.818, p = 0.011) in the univariate analysis and HR = 0.418 (IC95%: 0.204-0.856, p = 0.034) in the multivariate analysis, adjusted by initial metformin dose (mg/kg/day), initial weight (kg), and final metformin dose (mg/kg/day). Genotype A/A of rs622342 in SLC22A1, reported HR = 0.392 (IC95%: 0.169-0.910, p = 0.029) in the multivariate analysis as well. Conclusion: Among DMT2 Mexican-Mestizo patients undergoing metformin monotherapy the minor allele del in rs72552763 and the minor allele C in rs622342 reported a significantly shorter survival median respect to the wild type variant. Patients carrying del in rs72552763 or C in rs622342, both in SLC22A1, will reach non-control in less time with respect to other patients. Therefore these genotypes may constitute a therapeutic response biomarker for this population.

A clinical audit exploring the relationship between HbA1c control and appointment adherence among young adult diabetes clinic patients

A clinical audit exploring the relationship between HbA1c control and appointment adherence among young adult diabetes clinic patients

Effects of a Paleolithic diet compared to a diabetes diet on leptin binding inhibition in secondary analysis of a randomised cross-over study

BackgroundBeneficial effects from practising a Paleolithic diet as compared to a diabetes diet on weight, waist circumference, satiety, leptin, HbA1c and glucose control in randomised controlled trial participants with type 2 diabetes could be due to lower leptin resistance. Support for this hypothesis comes from an in vitro experiment that showed that digested wheat gluten, which is excluded from a Paleolithic diet, inhibits leptin from binding to its receptor, thus indicating a possible dietary cause of leptin resistance. However, the clinical relevance of the latter finding is unclear since removal of enzyme activity from the gluten digest by heat treatment also abolished leptin binding inhibition. Assessment of leptin binding inhibition in vivo is possible by comparison of total leptin levels with those of ‘biologically active’ leptin bound to its receptor (bioLep).ObjectivesTo assess the effects of a Paleolithic diet compared to a diabetes diet on leptin binding inhibition and to replicate our in vitro study.MethodsBioLep and total leptin levels were measured in secondary analysis of fasting plasma samples from our open label random order three plus three-month long cross-over trial performed in 2005–2007, that compared a Paleolithic diet with a diabetes diet in participants with type 2 diabetes without insulin treatment (per protocol). BioLep was also measured in vitro for known recombinant leptin concentrations incubated with a series of concentrations of 10 kDa spin-filtered digested wheat gluten, with or without prior heat treatment, at 100ºC for 30 min and centrifugation.ResultsThere was no difference between diets when comparing differences between bioLep and total leptin levels and their ratio in the 13 participants, three women and 10 men, aged 52–74 years with a mean BMI of 30 kg/m2 and a mean diabetes duration of eight years. We found no carry-over or period effect for bioLep and total leptin. In vitro, wheat gluten digest inhibited leptin binding in a dose-dependent manner but not after heat treatment.ConclusionsWe found no leptin binding inhibition after the Paleolithic or diabetes diet, possibly due to its abolishment from cooking-related heat treatment of wheat gluten.Trial registrationRegistered on 14/02/2007 at ClinicalTrials.gov Identifier: NCT00435240.

Efficacy of Adjunctive Local Antimicrobials to Non-Surgical Periodontal Therapy in Pocket Reduction and Glycemic Control of Patients with Type 2 Diabetes: A Network Meta-Analysis.

This network meta-analysis [NMA] investigated the efficacy of adjunctive use of subgingivally delivered antimicrobials to non-surgical periodontal therapy [NSPT] in the glycemic control and periodontal pocket depth (PPD) reduction in patients with type 2 diabetes (T2D). Seven databases, grey literature, and registry platforms were searched up to February 2024 to identify randomized clinical trials (RCT) fulfilling the eligibility criteria. The risk of bias was assessed through Cochrane's tool (RoB 2). Two frequentist NMA were performed using a random-effects model to calculate mean differences (MD) as an effect measure and to quantitatively evaluate the glycated hemoglobin (HbA1c) and PPD. The certainty of evidence was assessed through the GRADE approach in a partially contextualized framework for interpreting results. Ten RCTs were included. In total, 261 patients were treated with eight different local antimicrobials adjuvants to NSPT (azithromycin gel, clarithromycin gel, tetracycline fiber or ointment, chlorhexidine gel, doxycycline nanospheres, minocycline gel, and satranidazole gel), while 249 patients received NSPT alone or associated to placebo. Considering PPD reduction (8 included studies), the best results were found after six months for satranidazole gel (MD -2.64mm; 95%CI -3.56, -1.72; moderate evidence certainty). For HbA1c control (7 included studies), doxycycline gel (MD - 0.80%; 95%CI -1.70, 0.10), chlorhexidine gel (MD -0.68%; 95%CI -1.34, -0.02), and tetracycline fiber (MD -0.62%; 95%CI -0.85, -0.39) showed promising results after three months (low evidence certainty). The adjunctive use of satranidazole gel probably reduces PPD after a 6-month follow-up, while doxycycline gel, chlorhexidine gel, and tetracycline fiber may decrease HbA1c values in patients with T2D and periodontitis treated with NSPT after a 3-month follow up.

Association between Glycosylated Hemoglobin Levels and Vaccine Preventable Diseases: A Systematic Review.

People with diabetes are at higher risk of serious complications from many vaccine-preventable diseases (VPDs). Some studies have highlighted the potential impact of glycosylated hemoglobin levels (HbA1c), but no systematic review has synthesized these findings. Of the 823 identified studies, 3 were included, for a total of 705,349 participants. Regarding the incidence of herpes zoster (HZ), one study found that higher HbA1c levels at the baseline (>10.3%) were associated with a significantly higher risk of HZ of 44%, compared to those with a good HbA1c control (6.7%). On the contrary, the second one reported that when compared to the reference group (HbA1c of 5.0-6.4%), participants with a HbA1c less than 5.0% were at higher risk of HZ of 63%, whilst participants with a HBA1c more than 9.5% had a similar risk. Finally, the third study observed that diabetes, defined using a value of HbA1c more than 7.5%, was associated with an increased risk of mortality in men with COVID-19. In conclusion, both high and low HBA1c levels appear to be associated with a higher risk of HZ. Regarding COVID-19, a value of HbA1c more than 7.5% was associated with a higher risk of death in COVID-19, but only in men.

The Impact of Hand Strength on HbA1c, Body Mass Index and Body Composition by Group According to Sedentary Behaviour: Cross-Sectional Study in Japanese Patients with Type 2 Diabetes Mellitus.

The impact of hand strength in consideration of sedentary behaviour on diabetes management in patients with type 2 diabetes mellitus (T2DM) is unclear. The purpose of this study was to examine the impact of hand strength on HbA1c, body mass index (BMI) and body composition by group according to the duration of sedentary behaviour in Japanese patients with T2DM. In this retrospective, cross-sectional, single-centre study, hand strength standardised by bodyweight (GS) and sedentary time (ST), were obtained and analysed in a total of 270 Japanese T2DM outpatients in 2021. After dividing the patients into four categories of median values (high and low GS, and long and short ST), odds ratios (ORs) for good control of HbA1c, BMI, waist circumference (WC) and intra-abdominal fat (IAF) were investigated using logistic regression models. The high GS/short ST group was found to have a significantly higher (OR = 2.01; 95% CI: 1.00, 4.03; P = 0.049) for controlled HbA1c compared with that of the low GS/long ST group. The high GS/short ST and the high GS/long ST groups had significantly higher ORs for controlled BMI, WC and IAF compared with the OR of the low GS/long ST group. In addition, the ORs were significantly increased with a positive trend in order from low GS/long ST, low GS/short ST, high GS/long ST, to high GS/short ST in all models (P < 0.001 for trend). Hand strength, with modest effects from sedentary behaviour, could be helpful for diabetes management in T2DM patients.

582-P: Enhanced Patient Education—Use of Body Composition and Muscle Strength Data to Improve HbA1c Control in Early Diabetes

582-P: Enhanced Patient Education—Use of Body Composition and Muscle Strength Data to Improve HbA1c Control in Early Diabetes

MDI versus CSII in Chinese adults with type 1 diabetes in a real-world situation: based on propensity score matching method

BackgroundCompared with multiple daily insulin injections (MDI), continuous subcutaneous insulin infusion (CSII) is significantly more expensive and has not been widely used in Chinese type 1 diabetes mellitus (T1DM) patients. So there are still significant knowledge gaps regarding clinical and patient-reported outcomes in China.AimsThis study aims to compare the glycated hemoglobin (HbA1C), insulin therapy related quality of life (ITR-QOL), fear of hypoglycemia (FOH) of adult T1DM patients treated with MDI and CSII based on propensity score matching in real-world conditions in China.MethodsFour hundred twenty adult T1DM patients who were treated with MDI or CSII continuously for more than 12 months in a national metabolic center from June 2021 to June 2023 were selected as the study subjects. Their QOL and FOH were evaluated with Insulin Therapy Related Quality of Life Measure Questionnaire-Chinese version (ITR-QOL-CV) and the Chinese Version Hypoglycemia Fear Survey-Worry Scale (CHFSII-WS), and their HbA1C were collected at the same time. Potential confounding variables between the two groups were matched using propensity score matching.ResultsOf the 420 patients included in the study, 315 were in MDI group and 105 were in CSII group. 102 pairs were successfully matched. After matching, the total score of ITR-QOL-CV scale in CSII group was significantly higher than that in MDI group (87.08 ± 13.53 vs. 80.66 ± 19.25, P = 0.006). Among them, the dimensions of daily life, social life, and psychological state were all statistically different (P < 0.05). The scores of CHFSII-WS (8.33 ± 3.49 vs. 11.77 ± 5.27, P = 0.003) and HbA1C (7.19 ± 1.33% vs. 7.71 ± 1.93%, P = 0.045) in CSII group were lower than those in MDI group.Conclusions25.0% of T1DM adults are treated with CSII. Compared with adult T1DM patients treated with MDI, those treated with CSII have higher ITR-QOL, less FoH, and better control of HbA1C in real-world conditions in China. Therefore, regardless of economic factors, CSII is recommended for adult T1DM patients to optimize the therapeutic effect and outcomes.

The relationship between HbA1c control pattern and atherosclerosis progression of diabetes: a prospective study of Chinese population

BackgroundThis study aims to comprehensively explain of glycosylated Hemoglobin (HbA1c) control patterns and help determine the causal relationship between glycemic control patterns and atherosclerosis progression, thereby contributing to the effective management of diabetes complications.MethodAll participants registered at the National Metabolic Management Center (MMC) of Beijing Luhe Hospital. The HbA1c pattern was described by HbA1c variability and trajectory groups of HbA1c. Then we examined the associations between the HbA1c pattern and the changes of intima-media thickness (ΔIMT) using covariate-adjusted means (SE) of ΔIMT, which were calculated by multiple linear regression analyses adjusted for the covariates. Finally, a cross-lagged panel model (CLPM) was performed to further verify the bidirectional relationship between IMT and HbA1c.ResultsAfter data cleaning, a total of 1041 type 2 diabetes patients aged 20–80 years were included in this study. Except for average real variability (ARV), the other variation variables of HbA1c were associated with ΔIMT% (P < 0.05). Four discrete trajectories of HbA1c were identified in trajectory analysis. Comparing with the low-stable trajectory group of HbA1c, the covariate-adjusted means (SE) of ΔIMT% were significantly higher in Moderate-increase, U-shape and relative high trajectory groups, the mean (SE) were 7.03 (0.031), 15.49 (0.185), 14.15 (0.029), respectively. Meanwhile, there were significant bidirectional cross-lagged associations between HbA1c and IMT after adjusting for covariates.ConclusionWe found four discrete trajectory groups of HbA1c during the long-term follow-up of diabetes. There was a positive association between HbA1c variability and the progression of atherosclerosis. Our study suggested that patients with diabetes should avoid roller coaster changes in glucose over a long period when controlling blood glucose.

Comparation of fixed-ratio (IDegLira and iGlarLixi) versus free combination of basal insulin and glucagon-like peptide-1 receptor agonist for uncontrolled type 2 diabetes: A systematic review and network meta-analysis.

This study aimed to evaluate the safety and efficacy of the fixed-ratio combination (FRC) and free combination of basal insulin and glucagon-like peptide-1 receptor agonist (GLP-1RA) in patients with type 2 diabetes mellitus (T2DM). PubMed, Web of Science, Embase, The Cochrane Library, and four Chinese databases were searched for relevant studies from inception to April 13, 2023. Phase III clinical trials involving FRC or free combination in patients with uncontrolled T2DM were included. A network meta-analysis (NMA) was used to evaluate the effects of FRC and free combination. The Cochrane Collaboration's tool was used to evaluate the risk-of-bias. The primary outcomes were changes in hemoglobin A1c (HbA1c), body weight, and incident hypoglycemia. Secondary outcomes included changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP). This study was registered with PROSPERO (CRD42023409585). Forty-two trials with 23,619 patients were included in the NMA, and treatments were categorized as FRC, free combination and NOINSGLP (neither FRC nor free combination). The forest plots revealed comparable HbA1c control (mean difference (MD)=0.07%, 95% confidence interval (CI): -0.17 to -0.30) between free combination and FRC. However, there were significant differences in the body weight (MD=-2.06kg; 95% CI: -3.34 to -0.77), SBP (MD=-1.22mmHg; 95% CI: -2.41 to -0.04), and DBP (MD=-1.09mmHg; 95% CI: -1.94 to -0.24) between the two groups. In patients with uncontrolled T2DM, the safety and efficacy of FRC and free combination therapy were comparable. The use of FRC is justifiable in patients requiring free combination.

The effect of psyllium on fasting blood sugar, HbA1c, HOMA IR, and insulin control: a GRADE-assessed systematic review and meta-analysis of randomized controlled trials

There is equivocal evidence that psyllium can prevent or attenuate increases in fasting blood sugar. Therefore, this systematic review and meta-analysis sought to investigate the influence of psyllium on hemoglobin A1C (HbA1c), fasting blood sugar (FBS), insulin, and Homeostatic Model Assessment of Insulin Resistance (HOMA IR). We searched PubMed, ISI Web of Science (WOS), and Scopus for eligible publications, up to 15 July 2022, including randomized controlled trials (RCT) assessing the effect of psyllium on HbA1c, FBS, insulin, and HOMA IR levels in adults. Using a random effects model, we report the weighted mean differences (WMD) with 95% confidence intervals (CI). In this article, 19 RCT studies, consisting of 962 participants, were included. Psyllium significantly decreased FBS, HbA1c, and HOMA IR levels, but not insulin levels, as compared to placebo (FBS: WMD): -6.89; 95% CI: -10.62, -3.16; p < .001), HbA1c: (WMD: -0.75; 95% CI: -1.21, -0.29; p < .001), HOMA IR: (WMD: -1.17; 95% CI: -2.11, -0.23; p < .05), and insulin: (WMD: -2.08; 95% CI: -4.21, -0.035; p > .05)). Subgroup analyses illustrated differences in the effects of psyllium on FBS: dosages less than and more than 10 g/d showed significant differences (p value < 0.05). However, it was not significant in intervention durations less than 50 days (p value > 0.05). For HbA1c: psyllium consumption less than 10 g/d (p value > 0.05) was non-significant. For HOMA IR and insulin: no significant changes were noted with psyllium consumption less than vs. more than 10 g/d. In conclusion, we found that psyllium could significantly decrease FBS, HbA1c, and HOMA IR levels, but not insulin levels, as compared to placebo.

Comparison of baseline clinical characteristics among people with type 2 diabetes on second-line therapy previously added with dapagliflozin or another oral glucose-lowering drug: AGORA study

IntroductionType 2 diabetes mellitus (T2D) has acquired epidemic proportions worldwide. In recent years, new oral glucose-lowering drugs (OGLD) have emerged that improve the cardiovascular–kidney–metabolic control in T2D people. ObjectivesTo compare the baseline clinical–biological characteristics among T2D people to whom had added-on dapagliflozin (DAPA group) or another OGLD (SOC group) second-line hypoglycaemic therapies among the AGORA study population. MethodsThis is a multicentre cross-sectional observational study of the baseline characteristics of T2D people recruited through competitive sampling among 46 primary care health centres in Spain for the AGORA study. The inclusion and exclusion criteria of participants, and justification of the sample size are reported. After verifying the data necessary to be evaluated and informed consent, 317 subjects were included to the DAPA group and 288 to the SOC group. Both categorical and continuous variables were analysed and compared with the usual statistics. Cohen's d was used to assess the standardised difference in means. ResultsSix hundred and five patients with T2D were assessed (mean age 63.5 [SD±8.1] years, 61.8% men), whom 17.4% were smokers, 47.6% had obesity, 74.8% hypertension, 87.3% dyslipidaemia, and 41.7% reported physical inactivity, with no significant differences between both comparison groups. The mean (SD) evolution time of T2D was 10.1 (5.6) years. Most baseline clinical–biological characteristics at recruitment were similar in both groups. However, DAPA group was younger (2.9 years), and had lower systolic blood pressure (SBP) (2.8mmHg), higher body weight (BW) (3.7kg), and higher glycated haemoglobin A1c (HbA1c) (0.3%) than SOC group. Only 11.5% of participants had poor glycaemic control (HbA1c>8%) at recruitment, 54.9% had good glycaemic control (HbA1c<7%), being significantly lower in the DAPA group (47.3%) than in the SOC group (63.4%). The percentage of T2D patients with high vascular risk (VR) was 46.3%, and 53.7% with very high VR, being significantly higher in the DAPA group (57.4%) than in the SOC group (49.6%). ConclusionsMost baseline cardiovascular–kidney–metabolic characteristics were similar in T2D patients whom had added dapagliflozin on second-line hypoglycaemic therapy as those whom had added-on another OGLD. However, patients whom had added-on dapagliflozin had higher VR, lower SBP, higher BW, and slightly worse HbA1c control. Future research is necessary to explain the causes of these differences in cardiometabolic control.

Once-weekly insulin icodec versus once-daily long-acting insulins for type 2 diabetes mellitus: Systematic review and meta-analysis

BackgroundInsulin icodec is a novel, long-acting, once-weekly basal insulin analog. Its comparative efficacy and safety with basal once-daily insulins in type 2 diabetes mellittus is uncertain. ObjectiveEvaluate potential efficacy, benefits and risks associated with icodec compared to once-daily basal insulin analogs (degludec or glargine). MethodsWe systematically searched PubMed, Cochrane, and Embase for randomized controlled trials (RCTs) published until June 2023 comparing icodec versus long-acting insulin analogs (degludec and glargine) in type 2 diabetes mellitus (T2DM) with at least 12 weeks of follow-up. Binary endpoints were assessed with risk ratios (RRs) and continuous endpoints were compared using mean differences (MDs), with 95% confidence intervals (CIs). The protocol was registered in PROSPERO (CRD42023452468). ResultsA total of seven RCTs and 3286 patients with T2DM were included, of whom 1509 (60.6%) received icodec treatment. The follow-up period ranged from 16 to 78 weeks. Compared with once-daily basal insulin analogs, icodec led to a greater improvement in HbA1c (MD -0.15%; 95% CI -0.21, −0.10; p < 0.0001; I2 = 0%) and time in range (TIR) (MD 2.83%; 95%CI 0.94; 4.71; p = 0.003; I2 = 22%). Body weight was increased with icodec treatment (MD 0.78 Kg; 95%CI 0.42, 1.15; p < 0.01; I2 = 86%). There was also a higher rate of injection site reactions (RR 1.89; 95%CI 1.12, 3.18; p = 0.016; I2 = 0%) and nasopharyngitis (RR 1.94; 95%CI 1.11, 3.38; p = 0.020; I2 = 0%) in the icodec group, compared with once-daily regimens. There was no significant difference between groups in fasting plasma glucose. ConclusionsIn this meta-analysis of RCTs, insulin icodec led to better control of HbA1c and TIR as compared with once-daily insulin regimens, albeit with increased weight gain and a higher rate of injection site reaction in the Icodec group.

Impact of HbA1c control and type 2 diabetes mellitus exposure on the oral microbiome profile in the elderly population

ABSTRACT Objective To investigate the associations of the oral microbiome status with diabetes characteristics in elderly patients with type 2 diabetes mellitus. Methods A questionnaire was used to assess age, sex, smoking status, drinking status, flossing frequency, T2DM duration and complications, and a blood test was used to determine the glycated haemoglobin (HbA1c) level. Sequencing of the V3-V4 region of the 16S rRNA gene from saliva samples was used to analyze the oral microbiome. Results Differential analysis revealed that Streptococcus and Weissella were significantly enriched in the late-stage group, and Capnocytophaga was significantly enriched in the early-stage group. Correlation analysis revealed that diabetes duration was positively correlated with the abundance of Streptococcus (r= 0.369, p= 0.007) and negatively correlated with the abundance of Cardiobacterium (r= -0.337, p= 0.014), and the level of HbA1c was not significantly correlated with the oral microbiome. Network analysis suggested that the poor control group had a more complex microbial network than the control group, a pattern that was similar for diabetes duration. In addition, Streptococcus has a low correlation with other microorganisms. Conclusion In elderly individuals, Streptococcus emerges as a potential biomarker linked to diabetes, exhibiting elevated abundance in diabetic patients influenced by disease exposure and limited bacterial interactions.