Improvement In HbA1c Research Articles

Gamified applications for secondary prevention in patients with high cardiovascular disease risk: A systematic review of effectiveness and acceptability.

Gamified health mobile applications (apps) are promoted as innovative approaches to self-management and risk factor reduction. However, information is lacking on effectiveness or feasibility in older patients at high risk for cardiovascular diseases (CVD), which limits uptake and recommendations by nurses. This study aimed to evaluate the effectiveness and acceptability of gamified apps for CVD secondary prevention. EQUATOR PRISMA checklist was used to guide the systematic review. PubMed, Embase and SCOPUS were searched from inception to January 2020 for studies evaluating app interventions incorporating ≥2 game tactics and targeting secondary prevention in patients diagnosed with heart disease, hypertension, stroke or type 2 diabetes. Narrative summaries of results were used as meta-analysis were not possible. The PROSPERO ID number was CRD42020209791. Seven studies involving 657 patients were included. Gamified apps resulted in more improvement in physical activity, HbA1C and diabetes self-management empowerment compared to multiple different comparators, and more physical activity motivation compared to a neutral content control app. Heart failure knowledge also improved significantly. However, no benefits above usual care were evident for blood pressure or body mass index, or from app use for heart failure self-management, medication adherence or atrial fibrillation knowledge. App acceptability in terms of usage declined with time but was high for the game components of challenges, medication monitoring, viewing of leader boards and badges and walking training participation. Enjoyment was highest for elements that featured surprise/novelty, having teammates, challenges, good graphic design and clarity. Gamified mobile apps show the potential to improve secondary prevention in high CVD risk patients. Indications for acceptability were evident, with higher adherence than clinic-based secondary prevention programmes. However, further well-designed randomised controlled trials, which track app usage are needed to confirm this potential and encourage nurses to recommend these types of apps.

Lifestyle modification program, LIFE is LIGHT, in patients with type 2 diabetes mellitus and obesity: Results from a 48-week, multicenter, non-randomized, parallel-group, open-label study.

BackgroundObesity is a potential risk factor for development of type 2 diabetes mellitus (T2DM). To achieve long‐term weight reduction in patients with T2DM and obesity using comprehensive lifestyle management program (LMP).Materials and methodsThis 48‐week interventional, multicenter, parallel‐group, open‐label study included patients aged ≥18 years with T2DM and a body mass index (BMI) of 27–40 kg/m2. The primary objective was to demonstrate a clinically significant weight reduction (≥5%) from baseline in intensive lifestyle modification (ILM) and standard treatment (ST) groups.ResultsThe ILM group (N = 100) received recommendations for dietary and physical activity, and behavioral counseling. The ST group (N = 30) was managed in accordance with routine T2DM clinical practice. The patients in ST group were older (60.6 ± 8.9 vs. 54.6 ± 10.2 years in ILM group); overall more than 60% were women. At Week 48, the mean reduction in body weight was 5.8% (95% confidence interval [CI]: −6.9, −4.6) and 1.2% (95% CI: −2.6, 0.2) (p < 0.001) in the ILM and ST group, respectively. At Week 48, a weight loss of ≥5% was achieved by 50% of patients in the ILM group versus 13.3% in the ST group (p = 0.002). The decreases in BMI, waist‐to‐hip ratio and glycated hemoglobin (HbA1c) was significantly greater in the ILM versus ST group with between‐group differences of −1.63 (p ≤ 0.001), −0.03 (р ≤ 0.001) and −0.69% (p = 0.002), respectively.ConclusionA clinically significant weight reduction (≥5%) was demonstrated in patients with obesity and T2DM with use of a comprehensive LMP, along with improvements in BMI, waist‐to‐hip ratio, and HbA1c.

Diabetes management by either telemedicine or clinic visit improved glycemic control during the coronavirus disease 2019 pandemic state of emergency in Japan.

The purpose of this retrospective cohort study at a Tokyo diabetes clinic was to evaluate the effect of telemedicine and clinic visit on glycated hemoglobin (HbA1c) during the coronavirus disease 2019 state of emergency. The effect of telemedicine and clinic visit during the emergency period on the post‐emergency measured HbA1c was evaluated by multiple regression models and logistic regression models adjusted for age, sex, type of diabetes, pre‐emergency HbA1c and body mass index, and body mass index change during the emergency period. Among 2,727 patients who visited the clinic before and after the emergency period, the interval between clinic visits during the emergency period was significantly associated with HbA1c improvement. Telemedicine and clinic visit were independently associated with HbA1c improvement when pre‐emergency HbA1c was ≥7%. In conclusion, clinic visit and telemedicine during the coronavirus disease 2019 emergency period were both independently effective in HbA1c improvement in Japanese diabetes patients who had insufficient HbA1c control.

Improvement of HbA1c in Patients with Type 2 Diabetes Mellitus and Rheumatoid Arthritis Treated with bDMARDs.

ObjectiveThe aim of our study was to evaluate the possible role of biological treatments for rheumatoid arthritis (RA) in improving the glycemic profile in patients affected not only by RA but also by type 2 diabetes mellitus (2TDM).MethodsAn observational retrospective study was conducted using data from patients referred to our Rheumatology Unit. Patients with active RA despite standard DMARDs therapy and concomitant 2TDM were selected into one of five exposure groups to first-line bDMARDs (adalimumab, golimumab, etanercept, tocilizumab, sarilumab) and observed for the outcome of CRP, ESR, DAS28CRP and glycated hemoglobin (HbA1c) variations.ResultsAfter the start of treatment, there was a significant reduction in the values of acute phase reactants ESR and CRP (p<0.01), DAS28-CRP (p<0.01) and HbA1C (p<0.05), in the absence of any confounding factors such as a reduction in BMI or a change in steroid doses. There was no statistically significant difference between the various treatments. Anti-IL6 drugs appear to be associated with a slightly greater reduction in HbA1c values, bordering on statistical significance (p=0.047).ConclusionInitiation of a bDMARD appears to be associated with an improvement in concomitant 2TDM in patients with active RA, which, in the first hypothesis, is linked with a reduction of the inflammatory milieu.

ROLE OF SACUBITRIL/VALSARTAN IN THE TREATMENT OF CHRONIC HEART FAILURE WITH REDUCED EJECTION FRACTION IN ELDERLY HYPERTENSIVES WITH COMORBIDITY: FROM CLINICAL TRIALS TO REAL WORLD

Objective: Sacubitril/Valsartan (SV) has been shown to reduce cardiovascular mortality in ambulatory patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction (HFrEF). However there are few real-word evidences about its efficacy in elderly hypertensives with HFrEF and comorbidities. Design and method: In this prospective open-label study, 54 subjects (mean age 78.6 ± 8.2 years, 75.0% men), with HFrEF (29.8 ± 4.3%), in New York Heart Association (NYHA) class II-III were assigned to receive SV twice daily at different dosage of 24/26, 49/51, 97/103 mg. These patients were gender and age-matched with a control group of patients with HFrEF receiving optimal standard therapy for CHF. The office blood pressure (BP), the NT-pro-BNP, eGFR, blood glucose and glycated haemoglobin (HbA1c), uric acid (UA), left ventricular ejection fraction (LVEF) and NYHA class were evaluated at a mean follow-up of 14-months. Mortality and re-hospitalisation for HF were collected. Categorical variables were compared with the Pearson's test and difference of continuous variables, were evaluated by the analysis of variance for repeated measures. Results: NYHA class significantly improved in the SV than control group (24.9 vs. 6.4% moved from III-- &gt; II and 55.4 vs. 25.2% from II-- &gt; I classes, p &lt; 0.05). A significant improvement of LVEF and eGFR levels was found in the ARNIs than controls (42.4 vs. 34.2%, 73.8 vs. 61.2 ml/min for all p &lt; 0.001, respectively). The NT-pro-BNP, systolic BP, diastolic BP, blood glucose, HbA1c and UA values were lower in SV than controls (3107 vs 4552 pg/ml, 112.2 vs. 120.4 and 68.8 vs 75.6 mmHg, 108.4 vs 122.6 mg/dl, 5.4 vs. 5.9% and 5.9 vs 6.4 mg/dl, p &lt; 0.05). Mortality and re-hospitalisation for CHF was lower in the SV than controls (20.1 vs. 33.6 and vs. 27.7 vs. 46.3%, p &lt; 0.05). Conclusions: In elderly hypertensives with HFrEF and comorbidities SV treatment seems effective and safe. The improvement of LVEF, BP, eGFR, serum glucose, UA and HbA1c could be the mechanisms by which SV plays a beneficial role on clinical outcomes

Renoprotective Effects of Teneligliptin

Aim: The aim of this study was to validate the potential of teneligliptin in managing type 2 diabetes mellitus (T2DM) with renal impairment and to evaluate its effect on renal parameters in Indian subjects. Patients and Methods: The prospective observational study included 86 subjects aged &gt;40 years with suboptimal control of T2DM (HbA1c &gt;7.5). The demographic details of the selected subjects were recorded. The patients were continued on existing oral hypoglycemic agents (OHAs) and antihypertensives. The following clinical and anthropometric parameters were measured at baseline, 4 months, 8 months, and 12 months during the treatment using 20 mg of teneligliptin per day: HbA1c, eGFRs, UACR, FBG, and PPBG levels. Comparisons of anthropometric and laboratory parameters were carried out using analysis of variance (ANOVA) and t test for normal data, Kruskal–Wallis for nonnormal data, and chi-square test for counts data. Results: The mean age of the subjects was 54.28 ± 6.8 years and the male-to-female ratio noted was 1:0.65. The mean values of FBG (mg/dL ± SD) at 4, 8, and 12 months were found to be statistically significant (P &lt; 0.001, 117.12 ± 30.51, 109.69 ± 43.66, and 113.16 ± 56.93, respectively). t test carried out for PPBG indicated that the levels at respective intervals were significantly reduced as opposed to baseline (P &lt; 0.05). The difference in HbA1c (%) across baseline, 4, 8, and 12 months was found to be statistically significant (P &lt; 0.001) and the mean levels noted were 8.09 ± 2.26, 7.57 ± 1.84, 6.95 ± 1.80, and 6.46 ± 1.81, respectively. The difference in UACR across different intervals was found to be statistically significant (P &lt; 0.001) and the corresponding mean UACRs (mg/g ± SD) noted were 417.21 ± 182.87, 291.82 ± 98.30, 296.84 ± 109.48 and 284.18 ± 103.26. Conclusion: Teneligliptin monotherapy is well tolerated with a persistent reduction in HbA1C and significant improvement in renal function.

A systematic review for the efficacy of coenzyme Q10 in patients with chronic kidney disease.

The effects of coenzyme Q10 (CoQ10) supplementation in chronic kidney disease (CKD) patients remain controversial. A systematic review of current evidence was performed to systematically and comprehensively summarize the effects of CoQ10 on cardiovascular outcomes, oxidative stress, inflammation, lipid profiles, and glucose metabolism. MEDLINE, EMBASE, and the Cochrane Library database (Cochrane Central Register of Controlled Trials) were searched to identify eligible studies investigating the effects of CoQ10 supplementation on patients with CKD. Twelve independent studies (including seventeen publications) were included in this systematic review. For CKD patients, six studies reported variable cardiovascular outcomes, which yielded inconsistent results. Regarding oxidative stress and inflammation, pooled analysis showed that CoQ10 supplementation significantly reduced malonaldehyde (WMD: -1.15 95% CI -1.48 to -0.81) and high-sensitivity C reactive protein levels (WMD: -1.18 95% CI -2.21 to -0.15). Regarding glucose metabolism, we found that CoQ10 supplementation resulted in significant improvements in HbA1c (WMD: -0.80; 95% CI: -1.35 to -0.24) and QUICKI (WMD: 0.02; 95% CI: 0.01 to 0.03). The pooled results indicated that CoQ10 supplementation had no effects on total cholesterol, or LDL-cholesterol, or on HDL-cholesterol, and triglycerides. Our systematic review demonstrated that CoQ10 supplementation might have promising effects on oxidative stress. This work provided some clues that CoQ10 supplementation might have the potential to improve inflammation levels, glucose metabolism, cardiac structure, and cardiac biomarkers. However, the effects of CoQ10 supplementation should be confirmed in larger high-quality studies.

Effect of flash glucose monitoring in adults with type 1 diabetes: a nationwide, longitudinal observational study of 14,372 flash users compared with 7691 glucose sensor naive controls

Aims/hypothesisThe aim of this work was to evaluate changes in glycaemic control (HbA1c) and rates of severe hypoglycaemia over a 2 year period after initiation of flash glucose monitoring (FM) in type 1 diabetes.MethodsUsing data from the Swedish National Diabetes Registry, 14,372 adults with type 1 diabetes with a new registration of FM during 2016–2017 and with continued FM for two consecutive years thereafter, and 7691 control individuals using conventional self-monitoring of blood glucose (SMBG) during the same observation period, were included in a cohort study. Propensity sores and inverse probability of treatment weighting (IPTW) were used to balance FM users with SMBG users. Changes in HbA1c and events of severe hypoglycaemia were compared.ResultsAfter the start of FM, the difference in IPTW change in HbA1c was slightly greater in FM users compared with the control group during the follow-up period, with an estimated mean absolute difference of −1.2 mmol/mol (−0.11%) (95% CI −1.64 [−0.15], −0.75 [−0.07]; p < 0.0001) after 15–24 months. The change in HbA1c was greatest in those with baseline HbA1c ≥70 mmol/mol (8.5%), with the estimated mean absolute difference being −2.5 mmol/mol (−0.23%) (95% CI −3.84 [−0.35], −1.18 [−0.11]; p = 0.0002) 15–24 months post index. The change was also significant in the subgroups with initial HbA1c ≤52 mmol/mol (6.9%) and 53–69 mmol/mol (7.0–8.5%). Risk of severe hypoglycaemic episodes was reduced by 21% for FM users compared with control individuals using SMBG (OR 0.79 [95% CI 0.69, 0.91]; p = 0.0014)].Conclusions/interpretationIn this large cohort, the use of FM was associated with a small and sustained improvement in HbA1c, most evident in those with higher baseline HbA1c levels. In addition, FM users experienced lower rates of severe hypoglycaemic events compared with control individuals using SMBG for self-management of glucose control.Graphical abstract

Effects of a nurse led web-based transitional care program on the glycemic control and quality of life post hospital discharge in patients with type 2 diabetes: A randomized controlled trial

BackgroundIndividuals with type 2 diabetes have a heightened risk of developing serious complications post hospital discharge. Web-based transitional care is a promising intervention to improve the glycemic control and quality of life of this patient group; however, whether web-based transitional care can improve the glycemic control and quality of life of this group remains unknown. Further, the mechanisms underlying the relationships between the intervention and both glycemic control and quality of life have not been fully explored. ObjectivesThe aims of this study were to develop a web-based transitional care program and evaluate its effects on the glycemic control and quality of life of Chinese patients with type 2 diabetes and to explore the mediating roles of self-efficacy and treatment adherence. DesignRandomized controlled trial. Settings and participantsThis study was conducted in a large regional hospital in Guangzhou City, China. Patients diagnosed with type 2 diabetes were included. MethodsA total of 116 eligible participants were randomly assigned to receive either the 3-month web-based transitional care program or usual care. Assessments of hemoglobin A1c (HbA1c), self-efficacy, treatment adherence, and quality of life were conducted at baseline and at 3 months. Analysis followed the intention-to-treat principle. A generalized estimating equation was used to determine intervention effects on HbA1c and quality of life. Path analysis was used to assess the mediation of these effects by changes in self-efficacy and treatment adherence during the intervention. ResultsParticipants in the intervention group had significantly greater improvements in HbA1c (β = 2.87; p < 0.01) and quality of life (β = 7.69; p < 0.01) compared with the control group. The relationships between the intervention and both glycemic control and quality of life were significantly mediated by improved self-efficacy (indirect effect: β = 0.18, p < 0.05) and improved treatment adherence (indirect effect: β = 0.17, p < 0.05); overall, the model explained 52.5% of the variance in HbA1c and 34.2% of the variance in quality of life. ConclusionsOur study identified beneficial effects of a web-based transitional care program on glycemic control and quality of life post hospital discharge in people with type 2 diabetes, and the underlying mediating mechanisms. The effectiveness and feasibility of this web-based intervention program suggests that its application should be promoted in community settings to reduce poor outcomes in people with type 2 diabetes.Tweetable abstract: The web-based transitional care program can improve patients’ glycemic control and quality of life.Registration number: ChiCTR2000035603

Comparison between different types of exercise training in patients with type 2 diabetes mellitus: A systematic review and network metanalysis of randomized controlled trials

AimAim of the present meta-analysis and network metanalysis (NMA) is the assessment of the effects of physical exercise on glucose control and cardiovascular risk factors in type 2 diabetes. Data synthesisThis metanalysis includes all available trials exploring the effects of different exercise modalities in type 2 diabetes, with a duration of ≥3 months. The standardized difference in means (SDM) with 95% Confidence Intervals were calculated. Data were analyzed using MetaXL and Rev Man 5.0. Primary endpoint was the effect of exercise versus no exercise on HbA1c and fasting plasma glucose (FPG) at endpoint. Secondary endpoints were body weight and fat, waist circumference, and blood pressure. A comparison of different exercise training modalities (aerobic, resistance and combined) for the same endpoints was also performed, choosing ‘no exercise’ as the reference for indirect comparisons. We included 25 trials fulfilling all inclusion criteria. Physical exercise versus no exercise produced a small, but significant, improvement of HbA1c, body fat, and systolic blood pressure at endpoint (−0.3 [-0.1;-0.4]%, −1.44 [-2.22, −0.66]%, and −5.6 [-9.5, −1.6] mmHg, respectively). Combined, supervised aerobic and resistance exercise were associated with a significantly greater reduction of HbA1c (SDM, −0.4 [-0.6;-0.3], −0.2 [-0.4;-0.1], and −0.2 [-0.3;-0.1]%, respectively), but not of FPG, in comparison with no exercise. ConclusionsPhysical exercise produces small, but detectable, advantages on glycemic control and cardiovascular risk factors and should be suggested in type 2 diabetes. Combined aerobic/resistance training seems to be superior to aerobic training alone, but differences are small and the reliability of supporting evidence limited.

Subgrouping of Type 2 Diabetes Mellitus Based on Proteinuria and Diabetic Control for Treatment and Follow-Up

Patients with type 2 diabetes mellitus (T2DM) exhibit improved symptoms at the start of treatment, but their conditions subsequently deteriorate after a few months of treatment. In the present study, patients treated with glibenclamide and metformin were followed up for the evaluation of the efficacy of treatment based on some biochemical parameters in T2DM subgroups. The patients with T2DM were subgrouped according to their glycated hemoglobin (HbA1c), sex, urinary albumin to creatinine ratio (UACR), and uric acid UA levels. A total of 662 patients participated in the study, which aimed to follow up with glycated hemoglobin (HbA1c), fasting blood sugar (FBS), uric acid (UA), UACR, and lipid profiles at the beginning of treatment and after 2 and 4 months. Results showed that the best treatment effect occurred when patients were classified according to the UACR and HbA1c. In general, all parameters, especially lipid profile and UA levels, changed when patients exhibit proteinuria compared with those in normal UACR patients. Depending on the glycemic control subgroups, all parameters were higher in patients with poor glycemic control compared with those with the fair glycemic control, except for HDLc, which was lowest in the poor-control patients. The parameters revealed significant improvement (p < 0.05) in lipids, UA, UACR, and HbA1c after 2 months of treatment but subsequently remained slightly increased after 4 months of treatment. The parameters measured by using subgroups were better than those obtained from the whole group. The patients who initially experienced improved symptoms tended to ignore regular treatment and restricted diet, thereby worsening the measured parameters.

Evaluation of a Diabetes Remote Monitoring Program Facilitated by Connected Glucose Meters for Patients With Poorly Controlled Type 2 Diabetes: Randomized Crossover Trial.

BackgroundPatients with poorly controlled type 2 diabetes (T2D) experience increased morbidity, increased mortality, and higher cost of care. Self-monitoring of blood glucose (SMBG) is a critical component of diabetes self-management with established diabetes outcome benefits. Technological advancements in blood glucose meters, including cellular-connected devices that automatically upload SMBG data to secure cloud-based databases, allow for improved sharing and monitoring of SMBG data. Real-time monitoring of SMBG data presents opportunities to provide timely support to patients that is responsive to abnormal SMBG recordings. Such diabetes remote monitoring programs can provide patients with poorly controlled T2D additional support needed to improve critical outcomes.ObjectiveTo evaluate 6 months of a diabetes remote monitoring program facilitated by cellular-connected glucose meter, access to a diabetes coach, and support responsive to abnormal blood glucose recordings greater than 400 mg/dL or below 50 mg/dL in adults with poorly controlled T2D.MethodsPatients (N=119) receiving care at a diabetes center of excellence participated in a two-arm, 12-month randomized crossover study. The intervention included a cellular-connected glucose meter and phone-based diabetes coaching provided by Livongo Health. The coach answered questions, assisted in goal setting, and provided support in response to abnormal glucose levels. One group received the intervention for 6 months before returning to usual care (IV/UC). The other group received usual care before enrolling in the intervention (UC/IV) for 6 months. Change in hemoglobin A1c (HbA1c) was the primary outcome, and change in treatment satisfaction was the secondary outcome.ResultsImprovements in mean HbA1c were seen in both groups during the first 6 months (IV/UC −1.1%, SD 1.5 vs UC/IV −0.8%, SD 1.5; P<.001). After crossover, there was no significant change in HbA1c in IV/UC (mean HbA1c change +0.2, SD 1.7, P=.41); however, those in UC/IV showed further improvement (mean HbA1c change −0.4%, SD 1.0, P=.008). A mixed-effects model showed no significant treatment effect (IV vs UC) over 12 months (P=.06). However, participants with higher baseline HbA1c and those in the first time period experienced greater improvements in HbA1c. Both groups reported similar improvements in treatment satisfaction throughout the study.ConclusionsPatients enrolled in the diabetes remote monitoring program intervention experienced improvements in HbA1c and treatment satisfaction similar to usual care at a specialty diabetes center. Future studies on diabetes remote monitoring programs should incorporate scheduled coaching components and involve family members and caregivers.Trial RegistrationClinicalTrials.gov NCT03124043; https://clinicaltrials.gov/ct2/show/NCT03124043

44499 Heterogeneity of treatment effect among patients with type 2 diabetes and body mass index >=27kg/m^2 in the Jump Start Study

ABSTRACT IMPACT: This is the first study to use QUINT analyses to examine heterogeneity of treatment effect for group medical visits among individuals with type 2 diabetes. QUINT is a data driven method that assumes no a priori assumptions regarding effect moderators - an important step in the path towards personalized medicine. OBJECTIVES/GOALS: To examine heterogeneity of treatment effect (HTE) in Jump Start, a trial that compared the effectiveness of group medical visits (GMVs) focused on medication management only versus the addition of intensive weight management (WM) on glycemic control for patients with type 2 diabetes and body mass index &gt;=27kg/m^2. METHODS/STUDY POPULATION: Jump Start patients (n=263) were randomized to a GMV-based medication management plus low carbohydrate diet-focused WM program (WM/GMV; n = 127) or GMV-based medication management only (GMV; n = 136) for diabetes control. We used QUalitative INteraction Trees (QUINT), a tree-based clustering method, to determine if there were subgroups of patients who derived greater benefit from either WM/GMV or GMV. Subgroup predictors included 32 baseline demographic, clinical, and psychosocial factors. Outcome was hemoglobin A1c (HbA1c). We conducted internal validation via bootstrap resampling to estimate bias in the range of mean outcome differences among arms. RESULTS/ANTICIPATED RESULTS: QUINT analyses indicated that for patients who had not previously attempted weight loss, WM/GMV resulted in better glycemic control than GMV alone (mean difference in HbA1c improvement = 1.48%). For patients who had previously attempted weight loss and had lower cholesterol and blood urea nitrogen levels, GMV alone was better than WM/GMV (mean difference in HbA1c improvement = 1.51%). Internal validation resulted in moderate corrections in the mean HbA1c differences between arms; however, differences remained in the clinically significant range. DISCUSSION/SIGNIFICANCE OF FINDINGS: Among patients with diabetes and BMI&gt;=27kg/m^2, a low-carbohydrate, weight loss focus may better improve HbA1c in those who have never attempted weight loss. A medication management focus may be better in those who have attempted weight loss and have lower cholesterol and blood urea nitrogen.

Assessment of FreeStyle Libre Flash Glucose Monitoring System Implementation in Real Life Clinical Setting: A Prospective Observational Study.

Background: In this study, we investigated the effectiveness of FreeStyle Libre Flash Glucose Monitoring (FGM) implementation in a real life clinical setting with the emphasis on the effect of initial education on the use of the FGM system. Methods: This prospective observational study included 425 diabetes type 1 subjects followed up for 3 to 12 months (320 were followed up to 3 months, 267 up to 6 months and 147 up to period of one year). An FGM sensor was placed at study entry and all participants were educated through a period of 5 days on sensor usage and self-management of glycemia with follow up visits every 3 months. Results: HbA1c values significantly decreased from baseline (T0) to 3 months (T3) (p < 0.001), with a drop from 7.48% ± 0.1% to 7.30 ± 0.1%. There was no change in time spent in hypoglycemia from T3 to T12, although there was a decreasing trend present. The change in HbA1c values in the entire cohort was driven by change in the subgroup of patients with HbA1c ≥7% with a drop from 8.22% ± 1.14% to 7.68% ± 1.26% (p < 0.0001) in the first 3 months. Also, in individuals performing SMBG less than 5 times per day, there was a steady decrease in HbA1c levels up to 6 months (p < 0.05 and p < 0.001, respectively) as opposed to those who performed SMBG ≥5 times per day. Conclusions: The improvement in HbA1c was mainly driven by the increase in the number of scans per day. The subjects with poorer glycemic control and those who seldom performed SMBG benefited the most.

The application of multivariate adaptive regression splines in exploring the influencing factors and predicting the prevalence of HbA1c improvement.

Glycosylated hemoglobin (HbA1c) is directly proportional to the level of glucose in the blood, and it has been the gold standard to evaluate the status of long-term blood glucose levels. Exploring the factors that lead to HbA1c improvement is beneficial for effectively controlling of HbA1c levels. Data collected from 52 hospitals in five cities in northern China were divided into training and test sets at a ratio of 7:3. The training set was used to build models, and the test set was used to evaluate the generalizability of the models. The performance of multivariate adaptive regression splines (MARS) models and logistic regression was evaluated, namely, the accuracy, Youden's index, recall rate, G-mean and area under the ROC curve (AUC) with 95% confidence intervals (CIs). The prevalence of improvements in HbA1c levels was 38.35%. Doses of insulin less than 13 U, more than 3 kinds of oral medicine, exercise frequency greater than once per week and 2 h postprandial blood glucose (2hPBG) less than 10.56 mmol/L were found to improve HbA1c. The following interactions were negatively associated with improvement in HbA1c levels: patients with relative complications and 2hPBG less than 10.56 mmol/L, type 2 diabetes mellitus (T2DM) duration more than 7 years and insulin dose less than 13U. Compared to logistic regression, the MARS model performed better in the above aspects, except for accuracy. Given the interaction between factors affecting HbA1c improvement, medical staff should conduct comprehensive interventions to further reduce HbA1c levels in patients. In this study, the MARS model was superior to the traditional logistic regression in improving HbA1c levels. MARS had greater generalizability because it not only considered nonlinear relations in the process of model fitting but also adopted cross-validation. Nevertheless, more studies are needed to provide evidence for this result.

SGLT2 inhibitors and sleep apnea; how helpful are the medications: A meta-analysis

BackgroundSleep disordered breathing (SDB) has a close association with diabetes, especially in obese patients. The use of sodium-glucose co-transporter-2 (SGLT2) inhibitors in patients with diabetes with SDB is a debate with conflicting evidence. We aim to study the effect of SGLT2 inhibitors on SDB in diabetes patients. MethodsA literature search was done to identify articles comparing the outcomes of SGLT2 inhibitors in diabetes patients with SDB. The primary endpoint was apnea hypopnea index (AHI) and improvement in saturation. Secondary outcomes were improvement in HBA1C, systolic blood pressure, BMI. An unadjusted odds ratio (OR) with a 95% confidence interval (CI) were calculated using Review Manager (RevMan) 5.3. Results3 studies consisting of 65 patients were included with average age of 58.29±9.56 years (males 52.31%). Our study revealed comparable results for body mass index (BMI), systolic blood pressure with SGLT2 use; p=0.56 and p=0.10 respectively. The study revealed better HBA1C results with the use of SGLT2 inhibitors after subgroup analysis and correction of heterogeneity, p=0.03. The overall results for SPO2 and AHI were comparable pre and post-SGLT2 use. The heterogeneity among the outcomes of the studies was low to moderate after subgroup analysis and the methodological quality of the studies was moderate. ConclusionSGLT2 inhibitors had a significant effect in modifying HBA1C; However, the use of SGLT2 inhibitors did not statistically improve the SDB.

Benefit of Early Add-on of Linagliptin to Insulin in Japanese Patients With Type 2 Diabetes Mellitus: Randomized-Controlled Open-Label Trial (TRUST2).

This trial was conducted to assess the long-term safety, efficacy, and benefit of early add-on of linagliptin to insulin in patients with type 2 diabetes mellitus (T2DM). This trial enrolled 246 subjects. The subjects were randomized to the linagliptin group or the control group and were observed for 156weeks. After week 16, subjects in the control group were also allowed to add linagliptin to evaluate the benefit of early add-on of linagliptin to insulin. The primary end point was a change in HbA1c from baseline to week 16. Secondary end points included fasting plasma glucose, daily insulin dose, and frequency of adverse events. HbA1c and fasting plasma glucose levels significantly decreased from baseline to week 16 in the linagliptin group compared with the control group. The significant improvement in HbA1c continued until week 52. The daily insulin dose significantly decreased in the linagliptin group compared with the control group. The frequency of hypoglycemia and adverse events was comparable in both groups. Add-on of linagliptin to insulin was tolerated, improved glycemic control, and reduced the daily insulin dose. This study demonstrates the long-term safety, efficacy and benefit of early add-on of linagliptin to insulin in Japanese T2DM patients.

Remote Application and Use of Real-Time Continuous Glucose Monitoring by Adults with Type 2 Diabetes in a Virtual Diabetes Clinic.

The Onduo Virtual Diabetes Clinic (VDC) for people with type 2 diabetes (T2D) combines a mobile app, remote lifestyle coaching, connected devices, and live video consultations with board-certified endocrinologists. Adults with T2D (n = 594) who were evaluated by a VDC endocrinologist, remotely prescribed and mailed a real-time continuous glucose monitoring (rtCGM) device and used ≥1 sensor completed a CGM satisfaction questionnaire. The CGM satisfaction score was 4.5 ± 0.8 out of 5. Most respondents (94.7%) agreed/strongly agreed that they were comfortable inserting the sensor remotely and that rtCGM use improved understanding of the impact of eating (97.0%), increased diabetes knowledge (95.7%), and helped improve diabetes control when not wearing the sensor (79.4%). HbA1c (n = 372) decreased from 7.7% ± 1.6% to 7.1% ± 1.2% (P < 0.001; 10.2 months). These data suggest that it is feasible to provide rtCGM directly to individuals with T2D through a VDC without in-office training. Intermittent use of rtCGM was well-received by adults with T2D and was associated with improvement in HbA1c.

Comparison of compliance and outcomes in adolescents with type 1 diabetes mellitus attending a co-located pediatric and transition diabetes service

Abstract Objectives Adolescence is a challenging period for diabetes management, particularly when transitioning to adult care. There are reports highlighting concerns that transition to adult care may lead to poor glycemic control and clinic engagement. Our aim was to determine if a co-located pediatric and transition diabetes service would lead to better transition outcomes. Methods A retrospective medical records review was conducted on patients with type 1 diabetes attending a transition clinic in a metropolitan teaching hospital in Sydney, Australia. Patients referred from the hospital’s co-located pediatric diabetes clinic to the transition clinic were compared to those referred from external sources regarding important clinical outcomes such as glycosylated haemoglobin (HbA1c), clinic attendances, and complication rates between referral sources. Confounders such as age, gender, duration of diabetes and socioeconomic status were considered. Results Data was collected from 356 patients of which 121 patients were referred from the co-located pediatric diabetes clinic (IRG) and 235 patients from external sources (ERG). Improvements in HbA1c were only seen in the ERG at 6 and 12 months (p&lt;0.001). Altogether 93% attended one or more medical appointments in the IRG compared to 83% in the ERG (p=0.03). There were more admissions for acute diabetes complications (17 vs. 8%, p=0.01) and more microvascular complications (20 vs. 9%, p&lt;0.01) in the IRG vs. ERG group. Conclusions Although co-location of a pediatric and transition clinic improved medical engagement, this did not equate to better glycemic control or complication rates. Further research is warranted to determine what other strategies are required to optimise the transition process in diabetes care.

Bariatric surgery leads to an improvement in small nerve fibre damage in subjects with obesity.

Subjects with obesity have metabolic risk factors for nerve fibre damage. Because bariatric surgery improves these risk factors we have assessed whether this can ameliorate nerve fibre damage. Twenty-six obese subjects without diabetes (age: 46.23 ± 8.6, BMI: 48.7 ± 1.5, HbA1c: 38.0 ± 4.5) and 20 controls (age: 48.3 ± 6.2, BMI: 26.8 ± 4.2, HbA1c: 39.1 ± 2.6) underwent detailed assessment of neuropathy at baseline and 12 months after bariatric surgery. Obese subjects had normal peroneal (45.9 ± 5.5 vs. 48.1 ± 4.5, P = 0.1) and sural (46.9 ± 7.6 vs. 47.9 ± 10.6, P = 0.1) nerve conduction velocity, but a significantly higher neuropathy symptom profile (NSP) (4.3 ± 5.7 vs. 0.3 ± 0.6, P = 0.001), vibration perception threshold (VPT) (V) (10.2 ± 6.8 vs. 4.8 ± 2.7, P < 0.0001), warm threshold (C°) (40.4 ± 3.5 vs. 37.2 ± 1.8, P = 0.003) and lower peroneal (3.8 ± 2.2 vs. 4.9 ± 2.2, P = 0.02) and sural (8.9 ± 5.8 vs. 15.2 ± 8.5, P < 0.0001) nerve amplitude, deep breathing-heart rate variability (DB-HRV) (beats/min) (21.7 ± 4.1 vs. 30.1 ± 14, P = 0.001), corneal nerve fibre density (CNFD) (n/mm2) (25.6 ± 5.3 vs. 32.0 ± 3.1, P < 0.0001), corneal nerve branch density (CNBD) (n/mm2) (56.9 ± 27.5 vs. 111.4 ± 30.7, P < 0.0001) and corneal nerve fibre length (CNFL) (mm/mm2) (17.9 ± 4.1 vs. 29.8 ± 4.9, P < 0.0001) compared to controls at baseline. In control subjects there was no change in neuropathy measures over 12 months. However, 12 months after bariatric surgery there was a significant reduction in BMI (33.7 ± 1.7 vs. 48.7 ± 1.5, P = 0.001), HbA1c (34.3 ± 0.6 vs. 38.0 ± 4.5, P = 0.0002), triglycerides (mmol/l) (1.3 ± 0.6 vs. 1.6 ± 0.8, P = 0.005) and low-density lipoprotein cholesterol (mmol/l) (2.7 ± 0.7 vs. 3.1 ± 0.9, P = 0.02) and an increase in high-density lipoprotein cholesterol (mmol/l) (1.2 ± 0.3 vs. 1.04 ± 0.2, P = 0.002). There was a significant improvement in NSP (1.6 ± 2.7 vs. 4.3 ± 5.7, P = 0.004), neuropathy disability score (0.3 ± 0.9 vs. 1.3 ± 2.0, P = 0.03), CNFD (28.2 ± 4.4 vs. 25.6 ± 5.3, P = 0.03), CNBD (64.7 ± 26.1 vs. 56.9 ± 27.5, P = 0.04) and CNFL (20.4 ± 1.2 vs. 17.9 ± 4.1, P = 0.02), but no change in cold and warm threshold, VPT, DB-HRV or nerve conduction velocity and amplitude. Increase in CNFD correlated with a decrease in triglycerides (r = -0.45, P = 0.04). Obese subjects have evidence of neuropathy, and bariatric surgery leads to an improvement in weight, HbA1c, lipids, neuropathic symptoms and deficits and small nerve fibre regeneration without a change in quantitative sensory testing, autonomic function or neurophysiology.