HbA1c Levels In People Research Articles

Relationship between diabetes diet-related quality of life and dietary fiber intake among people with type 2 diabetes: a cross-sectional study.

Diet therapy is one of the most important treatments for people with type 2 diabetes (T2D). However, dietary restrictions due to diet therapy may reduce quality of life (QOL). This cross-sectional study aimed to investigate the association between diabetes diet-related QOL and dietary fiber intake in 238 people with T2D. The Diabetes Diet-related Quality of Life-Revised version (DDRQOL-9-R) and the brief-type self-administered diet history questionnaire were used to evaluate diabetes diet-related QOL and nutritional intake, respectively. Higher scores of each DDRQOL-9-R subscale means greater satisfaction with diet, perceived merits of diet therapy, and lower burden of diet therapy, which indicates good QOL. The median scores for perceived merits of diet therapy, satisfaction with diet, and burden of diet therapy were 58.3 [41.7-75.0], 75.0 [66.7-91.7], and 66.7 [50.0-75.0] points, respectively. HbA1c levels in people with high perceived merits of diet therapy (7.3 [6.7-7.8] vs. 7.5 [7.1-8.2] %, p = 0.007) and people with high satisfaction with diet (7.3 [6.8-7.8] vs. 7.5 [7.1-8.4] %, p = 0.010) were lower than those without. Dietary fiber intake was higher in people with high perceived merits of diet therapy (11.6 [8.8-16.7] vs. 10.0 [7.9-13.8] g/day, p = 0.010), high satisfaction with diet (11.4 [8.8-16.1] vs. 9.7 [7.8-13.2] g/day, p = 0.007), and low burden of diet therapy (11.8 [8.7-16.5] vs. 9.7 [7.8-12.6] g/day, p = 0.004) than in those without. Dietary fiber intake was related to perceived merits of diet therapy (Odds ratio [OR]1.07 [95%CI: 1.00-1.15], p = 0.049), burden of diet therapy (OR 0.90 [95%CI: 0.82-0.98], p = 0.022), and satisfaction with diet (OR 1.18 [95%CI: 1.09-1.27], p < 0.001) after adjusting for covariates. Dietary fiber intake is associated with diabetes diet-related QOL in people with T2D.

The effect of nurse-led telephone-based interventions on glycosylated hemoglobin levels in people with type 2 diabetes: A meta-analysis.

Telenursing interventions can contribute to achieving optimal glycemic control. This meta-analysis aimed to determine the effect of nurse-led telephone-based interventions on glycosylated hemoglobin (HbA1c) levels in people with type 2 diabetes. We searched electronic databases for studies published in English up to January 2023. This study was conducted in accordance with the PRISMA 2020 checklist. The intervention effects were pooled using a random-effects model. Two authors independently assessed the risk of bias using the Cochrane Collaboration tool. Eight studies involving 1179 people with type 2 diabetes were included in this study. Interventions were performed for 15-30 min and 5-16 calls. There was no evidence of a significant publication bias. The evaluation of meta-analysis data showed that nurse-led telephone-based interventions significantly reduced HbA1c levels in people with type 2 diabetes (mean difference = -0.53, 95% Confidence Interval [-0.89, -0.17], p = .003). Nurse-led telephone-based interventions focused on reducing glycosylated hemoglobin levels in people with type 2 diabetes can be used as an effective intervention to achieve glycemic control. We recommend holding an average of 15-25 min interviews once or twice a week.

Comparative Efficacy of Tirzepatide, Teneligliptin, and Empagliflozin in HbA1c Reduction in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis

This study’s objective was to evaluate the effectiveness of three different families of drugs (Empagliflozin [an SGLT-2 inhibitor], Tirzepatide [a GLP-1 receptor co-agonist], and Teneligliptin [DPP-4 inhibitor] used in the treatment of type 2 diabetes in lowering HbA1c levels in people with type 2 diabetes mellitus (T2DM). The effectiveness of different families of diabetic drugs was assessed using a meta-analytic approach. Data were gathered from a variety of research publications using ICTRP, CT.gov, and PubMed databases. The data were analyzed, and conclusions were drawn using forest plots. Teneligliptin (a DPP-4 Inhibitor) substantially lowered HbA1c levels in T2DM patients compared to other classes of T2DM drugs with a P-value of 0.0002 and 95% CI -0.63 [-0.97 to -0.30] after reviewing many pertinent articles. The pooled data analysis showed that Tirzepatide and Empagliflozin did not significantly lower HbA1c levels, with the P-value for Tirzepatide being P = 0.55 and for Empagliflozin, it was P = 0.64. According to our research, Teneligliptin may be more effective than Empagliflozin and Tirzepatide as a monotherapy for lowering HbA1c levels in T2DM patients. To corroborate these findings, further research studies are required.

Asupan zat gizi makro dan kepatuhan minum obat antidiabetik terhadap kadar HbA1c pada penyandang diabetes melitus tipe 2

Macronutrient intake and adherence to antidiabetic drugs on HbA1c levels in type 2 diabetes mellitusBackground: Diabetes mellitus is a disease whose prevalence continues to increase worldwide, including in Indonesia, due to lifestyle changes; DI Yogyakarta Province has the 2nd highest prevalence in Indonesia, and Sleman Regency is the largest. In the current era, the increasing number of diabetes mellitus and uncontrolled blood sugar levels or HbA1c levels are closely related to lifestyle changes, unhealthy eating patterns, and non-regularly taking medicine. Therefore, controlling blood sugar levels is vital in treating type 2 diabetes mellitus.Objective: This study aims to analyze the relationship between macronutrient intake and antidiabetic medication adherence on HbA1c levels in people with type 2 diabetes mellitus.Methods: A cross-sectional survey of 78 respondents using purposive sampling by filling out the SQ-FFQ and MMAS-8 questionnaires. The analysis used the Chi-Square test and logistic regression test.Results: There was a significant relationship between carbohydrate intake, fat intake, and antidiabetic medication adherence with HbA1c (p&lt;0,05), but there was no significant relationship between protein intake with HbA1c levels in type 2 diabetes mellitus prolanis participants (p&gt;0,05). The multivariate test results showed that carbohydrate intake, fat intake, antidiabetic medication adherence, and body mass index were simultaneously associated with HbA1c (p&lt;0,05).Conclusion: Carbohydrate, fat, and antidiabetic medication adherence were significantly associated with HbA1c levels in type 2 diabetes mellitus.

751-P: Effect Of Once-Weekly Semaglutide on Weight Change and Metabolic Control in People with Type 1 Diabetes—Six-Months Results from the Real-World STEMT Trial

Introduction: the SUSTAIN trials have shown significant improvements in weight and HbA1c levels in people with type 2 diabetes, but the effect and safety of semaglutide in people with type 1 diabetes (T1D) has not been explored yet. Aims &amp; Methods: In this real-world exploratory study 1.0 mg semaglutide once-weekly was started in adults with T1D and overweight/obesity. To be included, people needed to have stable glycemic control (ΔHbA1c &amp;lt; 0.3 %) , bodyweight (Δ &amp;lt; 3 %) , and insulin type and dose (Δ insulin dose &amp;lt; 5 %) in the last year. Pregnancy or pregnancy wish also was an exclusion criterion. Weight, total daily insulin dose (TDI) and HbA1c were assessed at start and at six months. Results: Twenty subjects (55 % males, mean age 46.3 ± 9.9 y, diabetes duration 29.6 ± 12.5 y, HbA1c 7.4 ± 0.6 %) were included. Body mass index (BMI) was 33.0 ± 4.4 kg/m2 at baseline, with 80 % of subjects being obese. Two subjects discontinued treatment, both due to gastrointestinal intolerance. Mean bodyweight evolution was -8.5 ± 7.8 kg, ranging between +1.5 and -24.7 kg. Three subjects experienced mild weight gain (ranging 0.2 to 1.5 kg) . Relative weight loss ≥ 5 % was attained in 60 % of cases, and 40 % reached ≥ % weight loss. Mean HbA1c reduction was 0.3 ± 0.7 %, with six subjects (30 %) not showing a reduction in HbA1c. An HbA1c reduction of ≥ 0.5 % was seen in 35 % of cases. A moderate correlation was seen between weight loss and HbA1c reduction (r = 0.52, p = 0.020) . Relative TDI reduction was 13.5 % (IQR 17.8) . Conclusion: Adding semaglutide 1.0 mg once-weekly in people with T1D was safe, well-tolerated and resulted in promising effects on weight, insulin requirement and glycemic control. Acknowledgements: JM and HDW claim shared first authorship. Disclosure J.Mertens: None. H.T.De winter: None. H.Mazlom: None. F.W.Peiffer: None. E.L.Dirinck: None. N.Bochanen: None. L.Van gaal: Advisory Panel; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck &amp; Co., Inc., Novo Nordisk. C.De block: Advisory Panel; Abbott Diagnostics, AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Medtronic, Novo Nordisk, Research Support; Indigo Diabetes, Speaker's Bureau; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk.

Effectiveness of Melpredia Prediabetes Self Management Education Based on Android Applications on HbA1c Levels in People with Prediabetes

Introduction: Prediabetes is a condition that will develop into type 2 Diabetes Mellitus (DMT2) within 3-5 years. Glycaemic control is the primary intervention in long-term management, so structured education with appropriate and sustainable media is needed using mobile health technology. Objectives: The development of the "Melpredia" application based on an android application as a media for health promotion and its effect on HbA1c glycaemic control and self-care management. Methods: The Research type was Research and Development (R&amp;D), and model testing using Quasi-experiments with pre-test post-test control group design was carried out for three months from January to April 2021. The purposive sampling technique consisted of 15 intervention groups and 15 control groups. The data were tested using Paired t-test and an independent t-test. The research instrument used by application "Melpredia." Results: The Android-based Melpredia application obtained a percentage of 89% (Fair) and the feasibility test for material aspects with a percentage of 90% (excellent). Using the Melpredia application has the effect of Prediabetes Self-Management Education based on an android application on HbA1c levels of 5.927 ± 0.1831 in people with prediabetes than conventional health promotion (p = 0.001). Conclusions: Application "Melpredia" android based and can effectively improve the HbA1c levels and self-care management of prediabetes in preventing diabetes mellitus by utilizing educational menu, meal planning, physical activity, and reminders use applications. "Melpredia" is more effective than conventional.

HbA1C in Type 2 Diabetic Population is inversely related to Serum Vitamin D

Background: Vitamin D is involved in the regulation of calcium levels, insulin secretion, and insulin action. Diabetes is a non-communicable condition that results in insulin insufficiency and insulin resistance in the body. The question in this case was whether or not vitamin D levels were associated with type 2 diabetes. Aim To determine if vitamin D has an effect on HbA1c levels in people with Type 2 diabetes. Methods: In tertiary care, a three-month retrospective investigation was conducted. We looked at FBS, PPBS, HbA1c, and Vitamin D. FBS was the most common. The data were analysed with the help of SPSS version 23. Results: In the study, 65 percent of the 52 patients had vitamin D deficiency, while 26 percent had insufficient vitamin D levels. HbA1c values were higher than 6.5 percent in 77 percent of patients, whereas levels were lower than 6.5 percent in 23 percent of patients. The blood sugar level HbA1c and vitamin D revealed a negative connection. Conclusion: Clearly, vitamin D levels and HbA1c levels are inversely related. Keywords: Type 2 Diabetes, Vit. D,

Protocol for a randomised controlled trial to investigate the effect of home- and gym-based resistance exercise training on glycaemic control, body composition and muscle strength

BackgroundResistance exercise is known to be effective in reducing glycated haemoglobin (HbA1c) in people with type 2 diabetes. However, studies, so far, have employed supervised resistance exercise in a laboratory or gym facility which limits the future translation of such exercise in to clinical practice and recommendations. Our primary aim, therefore, is to test the hypothesis, in a randomized controlled trial, that home-based resistance exercise training and gym-based resistance exercise training both reduce HbA1c levels in people with type 2 diabetes compared to control. We will also investigate the effects of home- and gym-based resistance exercise training on muscle strength and body composition.MethodsThe current study is a three-arm randomised controlled trial which will be conducted with 150 eligible people with type 2 diabetes to compare home-and gym-based resistance exercise training with usual care in Kuwait. The interventions will be delivered by exercise specialists and last for 32 weeks. The primary outcomes are HbA1c with secondary outcomes measuring muscle function, body composition, physical activity and quality of life.DiscussionEthical approval has been granted by the Dasman Diabetes Institute ethical review committee (RA/197/2019). Study findings will be disseminated through presentation at scientific conferences and in scientific journals.Trial registrationNCT04136730: Retrospectively registered on 21 October 2019

Control del paciente diabético en Atención Primaria: influencia de cartera de servicios y otros factores

ObjectiveTo study the effect of the type of follow-up according to Service Portfolio and other associated factors, in the reduction of HbA1c levels in people with a new diagnosis of type 2 diabetes and poor initial control. DesignAnalytical observational study of a cohort under routine clinical practice conditions. Location262 Primary Health Care Centres in Madrid. Participants1,838 individuals older than 18 years with a new diagnosis of type 2 DM and initial HbA1c levels ≥ 7%, or ≥ 8.5% if older than 75 years. InterventionsThe exposure variable was the type of follow-up according to Portfolio, categorised as minimum, medium, and optimal, according to the number of interventions performed and periodicity of type of therapeutic-pharmacological plan. Main measurementsA study was made of the comorbidity, therapeutic-pharmacological plan, diet - exercise advice and deprivation index. The main outcome was the difference between the final and initial HbA1c. ResultsAfter 2 years of follow-up there was a mean decrease in HbA1c by -1.7 percentage points (95% CI: -1.6;-1.8), which was 0.36 points higher in patients with optimal follow-up: -2.1 (95% CI: -1.7;-2.4). The factors associated with a decrease in HbA1c were the optimal follow-up -0.29 (95% CI: -0.5;-0.1), the medium follow-up -0.26 (95% CI: -0.5; -0.0), and the initial HbA1c value -0.9 (95% CI: -0.9; -0.9. The factors associated with the increase were insulin treatment and living in socially disadvantaged areas. ConclusionsGlycaemic control was improved in patients with a new diagnosis of diabetes in which optimal follow-up is performed as proposed in the Service Portfolio.

Retinopathy develops at similar glucose levels but higher HbA1c levels in people with black African ancestry compared to white European ancestry: evidence for the need to individualize HbA1c interpretation.

To examine the association of HbA1c and glucose levels with incident diabetic retinopathy according to black African or white European ancestry. In this retrospective cohort study of 202 500 US Veterans with diabetes (2000-2014), measures included HbA1c , outpatient random serum/plasma glucose, and incident retinopathy [conversion from negative to ≥2 positive evaluations (ICD-9 codes), without a subsequent negative]. At baseline, the study population had a mean age of 59.3 years, their mean BMI was 31.9 kg/m2 , HbA1c level was 57 mmol/mol (7.4%) and glucose level was 8.8 mmol/l, and 77% were of white European ancestry(whiteindividuals) and 21% of black African ancestry (blackindividuals). HbA1c was 0.3% higher in black vs whiteindividuals (P < 0.001), adjusting for baseline age, sex, BMI, estimated glomerular filtration rate (eGFR), haemoglobin, and average systolic blood pressure and glucose. Over 11 years, incident retinopathy occurred in 9% of black and 7% of whiteindividuals, but blackindividuals had higher HbA1c , glucose, and systolic blood pressure (all P < 0.001); adjusted for these factors, incident retinopathy was reduced in black vs whiteindividuals (P < 0.001). The population incidence of retinopathy (7%) was associated with higher mean baseline HbA1c inindividuals with black vs white ancestry [63 mmol/mol (7.9%) vs 58 mmol/mol (7.5%); P < 0.001)], but with similar baseline glucose levels (9.0 vs 9.0 mmol/l; P = 0.660, all adjusted for baseline age, sex and BMI). Since retinopathy occurs at higher HbA1c levels in black people for a given level of average plasma glucose, strategies may be needed to individualize the interpretation of HbA1c measurements.

Associations between quality of work features in primary health care and glycaemic control in people with Type 2 diabetes mellitus: A nationwide survey

AimsTo describe and analyse the associations between primary health care centres’ (PHCCs’) quality of work (QOW) and individual HbA1c levels in people with Type 2 diabetes mellitus (T2DM). MethodsThis cross-sectional study invited all 1152 Swedish PHCCs to answer a questionnaire addressing QOW conditions. Clinical, socio-economic and comorbidity data for 230,958 people with T2DM were linked to data on QOW conditions for 846 (73.4%) PHCCs. ResultsOf the participants, 56% had controlled (≤52mmol/mol), 31.9% intermediate (53–69mmol/mol), and 12.1% uncontrolled (≥70mmol/mol) HbA1c. An explanatory factor analysis identified seven QOW features. The features having a call-recall system, having individualized treatment plans, PHCCs’ results always on the agenda, and having a follow-up strategy combined with taking responsibility of outcomes/results were associated with lower HbA1c levels in the controlled group (all p<0.05). For people with intermediate or uncontrolled HbA1c, having individualized treatment plans was the only QOW feature that was significantly associated with a lower HbA1c level (p<0.05). ConclusionsThis nationwide study adds important knowledge regarding associations between QOW in real life clinical practice and HbA1c levels. PHCCs’ QOW may mainly only benefit people with controlled HbA1c and more effective QOW strategies are needed to support people with uncontrolled HbA1c.

The impact of telehealth remote patient monitoring on glycemic control in type 2 diabetes: a systematic review and meta-analysis of systematic reviews of randomised controlled trials

BackgroundThere is a growing body of evidence to support the use of telehealth in monitoring HbA1c levels in people living with type 2 diabetes. However, the overall magnitude of effect is yet unclear due to variable results reported in existing systematic reviews. The objective of this study is to conduct a systematic review and meta-analysis of systematic reviews of randomised controlled trials to create an evidence-base for the effectiveness of telehealth interventions on glycemic control in adults with type 2 diabetes.MethodsElectronic databases including The Cochrane Library, MEDLINE, EMBASE, HMIC, and PsychINFO were searched to identify relevant systematic reviews published between 1990 and April 2016, supplemented by references search from the relevant reviews. Two independent reviewers selected and reviewed the eligible studies. Of the 3279 references retrieved, 4 systematic reviews reporting in total 29 unique studies relevant to our review were included. Both conventional pairwise meta-analyses and network meta-analyses were performed.ResultsEvidence from pooling four systematic reviews found that telehealth interventions produced a small but significant improvement in HbA1c levels compared with usual care (MD: -0.55, 95% CI: -0.73 to − 0.36). The greatest effect was seen in telephone-delivered interventions, followed by Internet blood glucose monitoring system interventions and lastly interventions involving automatic transmission of SMBG using a mobile phone or a telehealth unit.ConclusionCurrent evidence suggests that telehealth is effective in controlling HbA1c levels in people living with type 2 diabetes. However there is need for better quality primary studies as well as systematic reviews of RCTs in order to confidently conclude on the impact of telehealth on glycemic control in type 2 diabetes.

The new FreeStyle libre flash glucose monitoring system improves the glycaemic control in a cohort of people with type 1 diabetes followed in real-life conditions over a period of one year.

SummaryAimsUsing the novel FreeStyle Libre (FSL), glucose monitoring (FGM) system becomes increasingly popular among people with type 1 diabetes (T1D) and is associated with less and shorter hypoglycaemic events without deterioration of HbA1c. There are not yet data reporting the impact of FGM in people with T1D in real‐life conditions. We sought of evaluating the tolerance, the acceptance and the efficacy of the FGM system in routine medical practice.MethodsThis 12‐month observational study included 120 individuals with T1D evaluated every 3 months. After having been instructed about FGM utilization, participants were trained to optimize the glycaemic control.ResultsParticipants stopped immediately of measuring capillary blood glucose (2.88 ± 0.12 per day) (mean ± SEM) after having received the first FSL device and the number of scans per day increased up to 8.87 ± 0.58 per day. HbA1c levels decreased from 8.51% ± 0.14% at baseline to 7.77% ± 0.09% after 3 months to slightly increase to 7.92% ± 0.09% at 12 months, in correlation with the number of scans per day. The number (but not the duration) of hypoglycaemic events slightly increased from 16.9 ± 1.44 per month at baseline to 24.0 ± 2.91 per month at 12 months, after reaching a peak of 26.4 ± 2.31 per month at 6 months. They were correlated with improved HbA1c.ConclusionOur study shows that using the FGM system improves HbA1c levels in people with T1D along with a moderate increase in the number of mild hypoglycaemic events. The new FGM system facilitates the therapeutic empowerment of people with T1D, but in a context of structured education.

Socio‐economic status and HbA1c in type 2 diabetes: A systematic review and meta‐analysis

Up until now, differences in HbA1c levels by socio-economic status (SES) have been identified, but not yet quantified in people with type 2 diabetes. The aim of this study was therefore to assess the difference in HbA1c levels between people with type 2 diabetes of different SES in a systematic review and meta-analysis. A systematic literature search was conducted in MEDLINE, Embase, Ebsco, and the Cochrane Library until January 14, 2018. Included studies described adults with type 2 diabetes in whom the association between SES and HbA1c levels was studied. Studies were rated for methodological quality and data were synthesized quantitatively (meta-analysis) and qualitatively (levels of evidence), stratified for type of SES variable, i.e., education, income, deprivation, and employment. Fifty-one studies were included: 15 high, 27 moderate, and 9 of low methodological quality. Strong evidence was provided that people of low SES have higher HbA1c levels than people of high SES, for deprivation, education, and employment status. The pooled mean difference in HbA1c levels between people of low and high SES was 0.26% (95% CI, 0.09-0.43) or 3.12mmol/mol (95% CI, 1.21-5.04) for education and 0.20% (95% CI, -0.05 to 0.46) or 2.36mmol/mol (95%CI, -0.61 to 5.33) for income. In conclusion, our systematic review and meta-analysis showed that there was an inverse association between SES and HbA1c levels in people with type 2 diabetes. Future research should focus on finding SES-sensitive strategies to reduce HbA1c levels in people with type 2 diabetes.

Effect of Family History of Diabetes on Hemoglobin A1c Levels among Individuals with and without Diabetes: The Dong-gu Study.

PurposeWe investigated associations between family history of diabetes (FHD) and hemoglobin A1c (HbA1c) level, among people with and without diabetes.Materials and MethodsIn total, 7031 people without diabetes and 1918 people with diabetes who participated in the Dong-gu Study were included. Data on FHD in first-degree relatives (father, mother, and siblings) were obtained. Elevated HbA1c levels in people without diabetes and high HbA1c levels in people with diabetes were defined as the highest quintiles of HbA1c ≥5.9% and ≥7.9%, respectively.ResultsIn people without diabetes, the odds of elevated HbA1c levels [odds ratio (OR) 1.34, 95% confidence interval (CI) 1.13−1.59] were significantly greater in people with any FHD than in those without. Specifically, the odds of elevated HbA1c levels in people without diabetes with an FHD involving siblings were greater than in those without an FHD involving siblings. Additionally, in people with diabetes, the odds of high HbA1c levels (OR 1.33, 95% CI 1.02−1.72) were greater in people with any FHD than in those without such history. Moreover, people with diabetes with maternal FHD had increased odds of high HbA1c levels.ConclusionFHD was associated not only with high HbA1c levels in people with diabetes, but also with elevated HbA1c levels in people without diabetes.

Individual and partner's level of occupation and the association with HbA1c levels in people with Type 2 diabetes mellitus: the Dutch Diabetes Pearl cohort.

Individual indicators of socio-economic status have been associated with glycaemic control in people with Type 2 diabetes, but little is known about the association between partner's socio-economic status and HbA1c levels. We therefore examined the cross-sectional association between individual and partner's level of occupation on HbA1c levels in people with Type 2 diabetes in the Netherlands. We included people with Type 2 diabetes with a partner who were treated in primary, secondary and tertiary care in the Diabetes Pearl cohort. Occupational level was classified according to International Standard Classification of Occupations (ISCO)-08 skill levels. Linear regression analyses were performed stratified for sex, and corrected for age, recruitment centre and diabetes medication. In total, 3257 participants (59.8% men, mean 62.2±9.4 years) were included. For men, having a partner with an intermediate level of occupation was associated with lower HbA1c levels [e.g. ISCO level 3: -2 mmol/mol (95% CI -4;-1) or-0.2% (95% CI -0.4;-0.1)], compared with having a partner of the highest occupational level (ISCO level 4). In women, having an unemployed partner was associated with higher HbA1c levels [14 mmol/mol (95% CI 6; 22) or 1.3% (95% CI 0.6; 2.0)], compared with having a partner of the highest occupational level. Partner's occupational status provided additional information on the association between socio-economic status and HbA1c levels in people with Type 2 diabetes. Women seemed to benefit from a partner with a higher occupational status, while men seemed to benefit from a partner with a lower status. Because of the cross-sectional nature of the present study, more research is necessary to explore this association.

Impact of accelerometer and pedometer use on physical activity and glycaemic control in people with Type 2 diabetes: a systematic review and meta-analysis.

Self-directed pedometer use increases physical activity levels in the general population; however, evidence of benefit for Type 2 diabetes is unclear and has not been systematically reviewed for accelerometers. To examine the impact of using physical activity monitoring devices (pedometers and accelerometers) on free-living physical activity and HbA1c levels in people with Type 2 diabetes. We conducted a systematic literature review. Bibliographic databases included Medline, Embase, Web of Science, CINAHL, SportDiscus and the Cochrane Central Register of Controlled Trials. We included controlled trials evaluating interventions based on the use of pedometers or accelerometers to promote physical activity in people with Type 2 diabetes. Primary outcomes were physical activity (min/week or steps) and HbA1c [mmol/mol (%)]. Secondary outcomes were weight, blood pressure and lipid profile. Twelve trials (1458 participants) were identified, of which nine studied pedometers and three accelerometers. Random-effects meta-analysis showed an overall increase in physical activity (standardized mean difference 0.57, 95% CI 0.24, 0.91) in the intervention groups. Accelerometers and pedometers produced a similar effect size. No significant differences were observed in HbA1c , BMI, blood pressure or lipid profile. People with Type 2 diabetes, provided with an accelerometer or pedometer, substantially increased their free-living physical activity. There is no evidence that monitor use alone improves HbA1c or other clinical outcomes. Further trials are needed to compare the relative effects of activity monitors within differing complex interventions.

Economic evaluation of chronic disease self-management for people with diabetes: a systematic review.

To systematically review the evidence on the costs and cost-effectiveness of self-management support interventions for people with diabetes. Self-management support is the provision of education and supportive interventions to increase patients' skills and confidence in managing their health problems, potentially leading to improvements in HbA1c levels in people with diabetes. Randomized controlled trials, observational studies or economic modelling studies were eligible for inclusion in the review. The target population was adults with diabetes. Interventions had to have a substantial component of self-management support and be compared with routine care. Study quality was evaluated using the Consensus on Health Economic Criteria and International Society of Pharmacoeconomic Outcomes Research questionnaires. A narrative review approach was used. A total of 16 costing and 21 cost-effectiveness studies of a range of self-management support interventions were identified. There was reasonably consistent evidence across 22 studies evaluating education self-management support programmes suggesting these interventions are cost-effective or superior to usual care. Telemedicine-type interventions were more expensive than usual care and potentially not cost-effective. There was insufficient evidence regarding the other types of self-management interventions, including pharmacist-led and behavioural interventions. The identified studies were predominantly of poor quality, with outcomes based on short-term follow-up data and study designs at high risk of bias. Self-management support education programmes may be cost-effective. There was limited evidence regarding other formats of self-management support interventions. The poor quality of many of the studies undermines the evidence base regarding the economic efficiency of self-management support interventions for people with diabetes.

Education for diabetes self-management improves quality of life and reduces HbA1c levels in people with diabetes

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Automated bolus advisor control and usability study (ABACUS): does use of an insulin bolus advisor improve glycaemic control in patients failing multiple daily insulin injection (MDI) therapy? [NCT01460446

BackgroundPeople with T1DM and insulin-treated T2DM often do not follow and/or adjust their insulin regimens as needed. Key contributors to treatment non-adherence are fear of hypoglycaemia, difficulty and lack of self-efficacy associated with insulin dose determination. Because manual calculation of insulin boluses is both complex and time consuming, people may rely on empirical estimates, which can result in persistent hypoglycaemia and/or hyperglycaemia. Use of automated bolus advisors (BA) has been shown to help insulin pump users to more accurately meet prandial insulin dosage requirements, improve postprandial glycaemic excursions, and achieve optimal glycaemic control with an increased time within optimal range. Use of a BA containing an early algorithm based on sliding scales for insulin dosing has also been shown to improve HbA1c levels in people treated with multiple daily insulin injections (MDI). We designed a study to determine if use of an automated BA can improve clinical and psychosocial outcomes in people treated with MDI.Methods/designThe Automated Bolus Advisor Control and Usability Study (ABACUS) is a 6-month, prospective, randomised, multi-centre, multi-national trial to determine if automated BA use improves glycaemic control as measured by a change in HbA1c in people using MDI with elevated HbA1c levels (#62;7.5%). A total of 226 T1DM and T2DM participants will be recruited. Anticipated attrition of 20% will yield a sample size of 90 participants, which will provide #62;80% power to detect a mean difference of 0.5%, with SD of 0.9%, using a one-sided 5% t-test, with 5% significance level. Other measures of glycaemic control, self-care behaviours and psychosocial issues will also be assessed.DiscussionIt is critical that healthcare providers utilise available technologies that both facilitate effective glucose management and address concerns about safety and lifestyle. Automated BAs may help people using MDI to manage their diabetes more effectively and minimise the risk of long-term diabetes related complications. Findings from a recent study suggest that BA use positively addresses both safety and lifestyle concerns; however, randomised trials are needed to confirm these perceptions and determine whether bolus advisor use improves clinical outcomes. Our study is designed to make these assessments.Trial registrationNCT01460446