Improvement In Metabolic Control Research Articles

Unveiling the Spectrum of Glucose Variability: A Novel Perspective on FreeStyle Libre Monitoring Data.

Since the introduction of insulin therapy, it has become apparent that type 1 diabetes (T1D) is accompanied by long-term microvascular and macrovascular complications. In the context of the many benefits of continuous glucose monitoring (CGM), there remain opportunities to study the large amount of data now available in order to maximise its potential in the endeavour to reduce the occurrence of diabetes tissue complications in the longer term. Continuous glucose monitoring values were downloaded for 89 type 1 diabetes mellitus (T1D) individuals for up to 18 months from 2021 to 2023. Data for patient demographics was also taken from the patient record which included Sex, Date of Birth, and Date of Diagnosis. The recorded laboratory glycated haemoglobin (HbA1c) test results were also recorded. The glucose management index (GMI) was calculated from average glucose readings for 18 months using the formula GMI (%) = (0.82-(Average glucose/100)). This was then adjusted to give GMI (mmol/mol) = 10.929 * (GMI (%) - 2.15). Average Glucose Fluctuation (AGF) was calculated by adding up the total absolute change value between all recorded results over 18 months and dividing by the number of results minus one. The % Above Critical Threshold (ACT) was calculated by summing the total number of occurrences for each result value. A cumulative 95% limit was then applied to identify the glucose value that only 5% of results exceeded in the overall population. Using this value, we estimated the percentage of total tests that were above the Critical Threshold (ACT). The mean age of the participants was 42.6years, and the mean duration of T1D was 18.4years. A total of 3.22 million readings were analysed, yielding an average blood glucose level of 10.3mmol/l and a GMI of 57.2mmol/mol. There was a strong correlation between GMI and measured HbA1c (r2 = 0.82). However, there were patients who had an above-critical threshold (ACT) of 4-10% at a GMI of 60mmol/mol or less. The percentage average value at the time of day (%AVTD) was applied to all blood glucose readings at each 15-min interval throughout the day, averaged over 18months. The %AVTD of GMI (overall average 57.2mmol/mol) increased after midday, dipped at 18:00, and peaked at 22:00. The %AVTD of AGF (overall average 0.60mmol/l) showed higher change rates after 09:00 declining at the end of the day. The %AVTD of ACT peaked at 22:00, with those having the highest %ACT showing an additional peak at 15:00. We have shown here that the percentage glucose results above 18mmol/l (top 5% of distribution) increased exponentially above 54mmol/mol HbA1c. The %AVTD is introduced as a useful measure. Our data indicate that over the 24-h period, improvement in metabolic control could be focussed on the afternoon and evening, when there are higher-than-average levels of GMI, a higher-than-average degree of glucose change, and higher-than-average risks of being above the critical threshold. In conclusion, a measure of glycaemic variation based on the amplitude of glucose change to a population mean could be used to provide valuable clinical insights into glucose change over a 24-h period.

Remission of corneal and peripheral neuropathy after bariatric surgery in people with diabetes

PurposeDiabetic peripheral neuropathy can be detected using non-invasive in vivo confocal microscopy of the cornea (IVCM) and such abnormalities may precede the development of clinical neuropathy. The current study aimed to assess any progression or remission of corneal and peripheral neuropathy in patients with type 2 diabetes undergoing bariatric surgery. MethodsPeople with known type 2 diabetes for at least five years and listed for bariatric surgery were recruited. Participants were assessed before, and 12, 26, and 52 weeks following bariatric surgery. IVCM and corneal sensitivity measurements were performed. A modified total neuropathy score (mTNS) was obtained from neuropathy questionnaire, clinical assessment and biothesiometry. ResultsTwenty-nine participants (M:F, 11:18) with mean BMI of 44.7 ± 6.4 kg/m2, and 11 ± 7.6 years duration of diabetes, were assessed. Corneal sub-basal nerve fibre length (CNFL), displayed an increase from a baseline mean of 12.20 ± 1.00 to 17.48 ± 0.92 mm/mm2 at 52 weeks (p < 0.0001). Corneal sensitivity threshold displayed a decrease over time, thus corneal sensitivity improved, falling from a mean of 1.11 ±0 .15 to 0.62 ± 0.11 (mBAR) (p < 0.0001). Clinical neuropathy scores demonstrated significant improvements from baseline, displaying a decrease in average mTNS score from 3.29 ± 0.68 to 0.76 ± 0.30 (p < 0.0001). A significant inverse relationship was shown between CNFL and sensitivity (β coefficient = −0.047, p < 0.001), and CNFL and mTNS (β coefficient = −0.178, p < 0.001). ConclusionBariatric surgery led to an improvement in metabolic control of diabetes and weight loss, along with improvement in corneal nerve microstructure, corneal sensitivity, and neuropathic symptoms, suggesting a reversal of both small and large fibre neuropathy.

Utility of time in tight range (TITR) in evaluating metabolic control in pediatric and adult patients with type 1 diabetes in treatment with advanced hybrid closed-loop systems

PurposeTo analyze the time in tight range (TITR), and its relationship with other glucometric parameters in patients with type 1 diabetes (T1D) treated with advanced hybrid closed-loop (AHCL) systems.MethodsA prospective observational study was conducted on pediatric and adult patients with T1D undergoing treatment with AHCL systems for at least 3 months. Clinical variables and glucometric parameters before and after AHCL initiation were collected.ResultsA total of 117 patients were evaluated. Comparison of metabolic control after AHCL initiation showed significant improvements in HbA1c (6.9 ± 0.9 vs. 6.6 ± 0.5%, p < 0.001), time in range (TIR) (68.2 ± 11.5 vs. 82.5 ± 6.9%, p < 0.001), TITR (43.7 ± 10.8 vs. 57.3 ± 9.7%, p < 0.001), glucose management indicator (GMI) (6.9 ± 0.4 vs. 6.6 ± 0.3%, p < 0.001), time below range (TBR) 70–54 mg/dl (4.3 ± 4.5 vs. 2.0 ± 1.4%, p < 0.001), and time above range (TAR) > 180 mg/dl (36.0 ± 7.6 vs. 15.1 ± 6.4%, p < 0.001). Coefficient of variation (CV) also improved (36.3 ± 5.7 vs. 30.6 ± 3.7, p < 0.001), while time between 140–180 mg/dl remained unchanged. In total, 76.3% achieved TITR > 50% (100% pediatric). Correlation analysis between TITR and TIR and GRI showed a strong positive correlation, modified by glycemic variability.ConclusionsAHCL systems achieve significant improvements in metabolic control (TIR > 70% in 93.9% patients). The increase in TIR was not related to an increase in TIR 140–180 mg/dl. Despite being closely related to TIR, TITR allows for a more adequate discrimination of the achieved control level, especially in a population with good initial metabolic control. The correlation between TIR and TITR is directly influenced by the degree of glycemic variability.

#2926 The impact of GLP-1 receptor agonists on metabolic control and diabetic kidney disease progression

Abstract Background and Aims Diabetic kidney disease is the leading cause of end-stage kidney disease in developed world. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are a class of drugs that have shown benefits beyond glycemic control, with a reduction in cardiovascular risk and renoprotective effects. The aim of this study was to assess the effect of GLP-1 RA in metabolic control and progression of CKD. Our objective was to analyze the impact and efficacy of GLP-1 RA in patients with chronic kidney disease (CKD). Method This was a retrospective cohort study, that included type 2 diabetic patients with CKD, followed in Nephrology outpatient clinic, who started treatment with GLP-1 RA between January 2019 and February 2022. Clinical, demographic and laboratory data were collect at the initiation of the therapy, 6 months and 1 year during follow-up. Results A total of 66 patients were included, of whom 63.6% (n = 42) males with a mean age of 67.8 ± 10.9 years. 95.5% (n = 63) had history of hypertension, 59.1% (n = 39) heart failure and 16.7% (n = 11) peripheral arterial disease. The median estimated glomerular filtration rate (eGFR) at beginning of the treatment was 45 [31.8-65] mL/min/1.73 m2, mean HbA1c of 9.1 ± 1.7%, and mean weight 89.4 ± 15.4 kg. The most frequently prescribed GLP-1 RA were liraglutide (34.8%, n = 23) and dulaglutide (34.8%, n = 23), followed by semaglutide (21.2%, n = 14) and exenatide (1.5%, n = 1). Regarding concomitant therapy, all of the patients were on renin-angiotensin-aldosterone system antagonists, 90.9% (n = 60) were on SGLT2 inhibitors, and 68.2% (n = 45) were on insulin. At 6 months follow-up, there was a statistically significant reduction in HbA1c (9.2 ± 1.8 VS 7.8 ± 1.7, p &amp;lt; 0.001) and weight (89.4 ± 15.4 VS 86.8 ± 15.7, p = 0.002). There were no significant differences in eGFR, lipidic profile and albuminuria. At 1 year follow-up, there was significant reduction of HbA1c (Z = −4.6, p &amp;lt; 0.001), weight (Z = −3.1, p = 0.002), and a statistically significant increase of eGFR (49.5 ± 25.4 VS 56.9 ± 27.0, p = 0.007), with no significant differences in lipidic profile and albuminuria. During the follow-up period, 5 patients voluntarily discontinued the treatment, and 1 patient suspended it due to gastrointestinal adverse effects. Conclusion Our study findings reinforce the existing evidence supporting the renoprotective effects of GLP-1 RA. We observed a notable improvement in metabolic control, as evidenced by significant reduction of HbA1c and weight, particularly at the 6th month. There were no significant differences in albuminuria during the follow up time, but an unexpected increase in eGFR.

Linagliptin in combination with insulin suppresses apoptotic unfolded protein response in ovaries exposed to type 1 diabetes.

Type 1 diabetes mellitus (T1DM) is one of the main causes of ovarian atresia, but its molecular effect on the ovaries is not fully understood. Accumulating evidence suggests that T1DM causes excessive endoplasmic reticulum(ER) stress and insufficient adaptive unfolded protein response that triggers proapoptotic signaling pathways in ovarian tissue. In addition, problems such as amenorrhea and infertility, which are frequently seen in women with T1DM, continue despite the intensification of insulin therapy and improvement of metabolic control. Therefore new, and adjunctive treatments for women with T1DM need to be explored. We aimed to examine how the use of linagliptin, which has blood sugar-lowering effects and high antioxidant activity, together with insulin affects the expression levels of proteins and genes that play a role in ERstress in type 1 diabetic mouse ovaries. Eighty-four Balb/C 6-week-old female mice were randomly divided into seven groups: control, vehicle, diabetes + insulin, diabetes + linagliptin, diabetes + linagliptin + insulin, diabetes + TUDCA, and diabetes + TUDCA + insulin. TUDCA (an inhibitor of ER stress) groups are positive control groups created to compare linagliptin groups in terms of ER stress. Linagliptin and TUDCA were given by oral gavage and 1U insulin was administered subcutaneously for 2 weeks. A significant decrease was observed in the MDA and NOX1 levels and the number of atretic follicles in the ovaries of the diabetes + linagliptin + insulin group compared to the diabetes + insulin group. The use of linagliptin and insulin increased the expression of pro-survival XBP1s transmembrane protein and decreased the expression of proapoptotic ATF4, pJNK1/2, cleaved caspase 12, and cleaved caspase 3 in mouse ovaries. Our study provides new therapeutic evidence that linagliptin administered in addition to insulin induces ER stress mechanism-dependent survival in ovaries with type 1 diabetes.

The Impact of Using Carbohydrate Counting on Managing Diabetic Patients: A Review.

Carbohydrate counting (CC) is a meal planning practice for diabetic patients, focusing on tracking the amount of carbohydrates in grams consumed at meals to manage blood glucose (BG) levels. The purpose of this narrative review is to evaluate the impact of CC in helping people with diabetes manage their condition. It reveals that CC offers superior glycemic control and flexibility compared to other food planning techniques. Specifically, when applied to children and teenage patients diagnosed with type 1 diabetes mellitus (T1DM), CC demonstrates the potential for substantial improvements in metabolic control without any adverse effects on weight or increased insulin requirements. In the context of T1DM, the combination of CC and the use of automated bolus calculators (ABCs) contributes to lowering glycated hemoglobin (HbA1c) levels. Furthermore, the study highlights that CC also holds promise in the management of type 2 diabetes mellitus (T2DM). In T2DM patients, adhering to a low glycemic index (GI) diet has proven to be more effective in controlling HbA1c and fasting BG levels compared to a higher GI diet or standard dietary control. This research underscores the evolving significance of CC as a pivotal component in diabetes management, attributed to increased awareness and education among patients. CC emerges as a versatile tool that can benefit individuals with various forms of diabetes by enhancing their glycemic control and overall quality of life. The findings affirm the impact of CC in improving patient outcomes, solidifying its status as a vital strategy in the multifaceted landscape of diabetes care.

The perception of patients, mothers and healthcare professionals regarding introduction of home visits for adolescents with type 1 diabetes.

Despite advancements in diabetes management, a subgroup of patients does not achieve an acceptable level of metabolic control. To achieve treatment goals for high-risk patients, a higher frequency of contact with healthcare professionals is essential. However, socioeconomic challenges often lead to nonattendance at the outpatient clinic. Therefore, home visits were introduced as a supplement/an alternative to consultations at the paediatric diabetes clinic. The aim of this study was to uncover the perception of patients, mothers and healthcare professionals regarding home visits versus consultations at the outpatient clinic in order to being able to improve the services offered. Semistructured interviews with patients, mothers and healthcare professionals were conducted to explore the experiences and perspectives of the concept at two paediatric diabetes clinics in Denmark. Paired t tests were used to compare the glycated hemoglobin A1c (HbA1c) levels at the start of the intervention with HbA1c 1 year before and HbA1c at the end of the intervention. Both patients, mothers and healthcare professionals found consultations in familiar surroundings to result in stronger relationships between healthcare professionals and families, creating greater opportunities to discuss personal issues aimed at improving the outcome of diabetes. Furthermore, home visits facilitated finding alternative methods of helping patients and the families integrating diabetes into everyday life. Overall, home visits were found to contribute toward creating a more constructive relationship. However, it was still a challenge to keep the scheduled appointments, and during this short study, no improvement in metabolic control could be observed.

Relationship Between Vitamins and Diabetes.

This review article aims to examine the relationship between specific vitamins and type 2 diabetes. Individuals with diabetes have been observed to have lower levels of specific antioxidant vitamins such as A, C, and E, possibly due to the need to manage oxidative stress caused by glucose metabolic abnormalities. Retinol-binding protein, which has adipocytokine activities, has a modulatory effect. Levels of thiamine, pyridoxine, and biotin are also lower in individuals with diabetes. While the reasons for this are unclear, some improvement in metabolic control has been observed with supplementation. Although metformin is the preferred treatment for type 2 diabetes, it has been found to limit the absorption of certain nutrients, including vitamin B9 and vitamin B12, necessitating regular supplementation of these nutrients for people with diabetes. Diabetes and its consequences, including cardiovascular disease, are more likely in those with low vitamin D levels. Although some research suggests that vitamin K intake may improve glucose metabolism, further evidence is required. Research on the effectiveness of multivitamins has produced inconsistent results, and there are no clear guidelines for vitamin supplementation in individuals with type 2 diabetes mellitus. However, people who use metformin for extended periods may benefit from additional folic acid and vitamin B12 supplements.

Switching to an advanced hybrid closed-loop system in real-world practice improves hypoglycemia awareness and metabolic control in adults with type 1 diabetes, particularly in those with impaired perception of hypoglycemia symptoms

AimsTo evaluate the efficacy of an advance closed-loop (AHCL) system in restoring awareness of hypoglycemia in patients with type 1 diabetes (T1D). MethodsWe conducted a prospective study including 46 subjects with T1D flash glucose monitoring (FGM) or continuous glucose monitoring (CGM) switching to a Minimed 780G® system. Patients were classified in three groups according to the therapy used before switching to Minimed® 780G: multiple dose insulin (MDI) therapy + FGM (n = 6), continuous subcutaneous insulin infusion + FGM (n = 21), and sensor-augmented pump with predictive low-glucose suspend (n = 19). FGM/CGM data were analyzed at baseline, after 2 and 6 months on AHCL. Clarke’s score of hypoglycemia awareness was compared at baseline and 6 months recordings. We also compared the efficacy of the AHCL system in improving A1c among patients with appropriate perception of symptoms of hypoglycemia compared to those presenting with impaired awareness of hypoglycemia (IAH). ResultsParticipants had a mean age of 37 ± 15 and a diabetes duration of 20 ± 10 years. At baseline, 12 patients (27%) showed IAH as defined by a Clarke’s score ≥ 3. Patients with IAH were older and had lower estimated glomerular filtration rate (eGFR) compared with those who did not have IAH; with no differences in baseline CGM metrics or A1c. An overall decrease in A1c was observed after 6 months on AHCL system (from 6.9 ± 0.5% to 6.7 ± 0.6%, P < 0.001), regardless of prior insulin therapy. The improvement in metabolic control was greater in patients with IAH, showing a reduction in A1c from 6.9 ± 0.5 to 6.4 ± 0.4% vs 6.9 ± 0.5 to 6.8 ± 0.6% (P = 0.003), showing a parallel increase in total daily boluses of insulin and automatic bolus correction administered by the AHCL system. In patients with IAH Clarke’s score decreased from 3.6 ± 0.8 at baseline to 1.9 ± 1.6 after 6 months (P < 0.001). After 6 months on AHCL system, only 3 patients (7%) presented with a Clarke’s score ≥ 3, resulting in an absolute risk reduction of 20% (95% confidence interval: 7–32) of having IAH. ConclusionsSwitching from any type of insulin administration to AHCL system improves restoration of hypoglycemia awareness and metabolic control in patients with T1D, particularly in adults with impaired perception of hypoglycemia symptoms. Trial RegistrationClinicalTrial.gov ID NCT04900636.

Use of Continuous Glucose Monitoring in Pump Therapy Sensor Augmented Pump or Automated Insulin Delivery in Different Age Groups (0.5 to

Insulin pump, continuous glucose monitoring (CGM), and sensor augmented pump (SAP) technology have evolved continuously leading to the development of automated insulin delivery (AID) systems. Evaluation of the use of diabetes technologies in people with T1D from January 2018 to December 2021. A patient registry (Diabetes Prospective Follow-up Database [DPV]) was analyzed for use of SAP (insulin pump + CGM ≥90 days, no automated dose adjustment) and AID (HCL or LGS/PLGS). In total 46,043 people with T1D aged 0.5 to <26 years treated in 416 diabetes centers (Germany, Austria, Luxemburg, and Switzerland) were included and stratified into 4 groups A-D according to age. Additionally, TiR and HbA1c were analyzed. From 2018 to 2021, there was a significant increase from 28.7% to 32.9% (sensor augmented pump [SAP]) and 3.5% to 16.6% (AID) across all age groups, with the most frequent use in group A (<7 years, 38.8%-40.2% and 10.3%-28.5%). A similar increase in SAP and AID use was observed in groups B (7 to <11 years) and C (11 to <16 years): B: +15.8 PP, C: +15.9 PP. HbA1c improved significantly in groups C and D (16 to <26 years) (both P < .01). Time in range (TiR) increased in all groups (A: +3 PP; B: +5 PP; C: +5 PP; D: +5 PP; P < 0.01 for each group). Insulin pumps (61.0% versus 53.4% male) and SAP (33.5% versus 28.9% male) are used more frequently in females. In recent years, we found an increasing use of new diabetes technologies and an improvement in metabolic control (TiR) across all age groups.

Epidemiological aspects in phenylketonuria patients from a region in northwestern Romania

Introduction. Phenylketonuria (PKU), a genetic disease with autosomal dominant transmission, is the most frequent inborn error in aminoacidic metabolism. The variations in phenylalanine-hydroxylase (PAH) gene lead to a lowered enzymatic activity causing hyperphenylalaninemia. PKU has a mean European prevalence of 1:10,000 newborns, with a large variation in different ethnicities and geographic regions. The large genetic variability (over 1200 genetic variants known) as well as other factors determines a wide spectrum of metabolic phenotypes. Untreated, PKU leads to irreversible intellectual disability, low stature, hypopigmentation, motor deficits, seizures, but the early diagnosis and treatment enables almost normal somatic and mental development. Aim. The aim of this study is the determination of the impact of non-genetic factors over the clinical phenotype of PKU patients in a region of north-west Romania. Material and method. The study group is formed from 44 patients diagnosed with phenylketonuria in the 1981 – 2021 period, found in the database of Bihor Regional Center for Medical Genetics, Emergency Clinical County Hospital, Oradea, Romania. The collected data was referring to the age, sex and domicile of the patients, the age of the diagnosis and the beginning of the treatment, also the metabolic control over the years, the metabolic phenotype of the patients and its impact on the clinical phenotype (IQ, the presence or absence of intellectual disability or the existence of a specific clinical phenotype). Results. The majority of patients (66%) were diagnosticated with phenylketonuria in the first 4 months of life, although there were cases with a late diagnosis, 20.5% of the patients were diagnosticated after the age of 1 year. Based on the pre-treatment plasmatic levels of phenylalanine, the majority of cases (72.7%) had a severe metabolic phenotype (classic PKU - cPKU), 20.5% of cases had a milder form of PKU (mPKU) and 6.8% of patients were found with a mild hyperphenylalaninemia (HPA). In the case of 23 patients, an optimal metabolic control was not obtained. The specific phenotype (blonde hair, light skin, blue eyes) was found in 22.7% of cases, 77.3% not having these features. At 68.2% of cases intellectual disability was found, with different levels of severity: 5 patients (11.5%) had liminal intellect, 9 patients (20.5%) had mild mental retardation, 6 patients (13.6%) had moderate mental retardation, 9 cases (20.5%) were with severe mental retardation and 1 patient (2.3%) had profound mental retardation; 31.8% of cases had normal intellect. The prevalence in Bihor county is 1:7,843 newborns. Discussions. A partial or, in rare cases, total lack of dietetic treatment was observed in all patients over 20 years old (current age). The delay in treatment initiation or an insufficient treatment, with a suboptimal metabolic control, will affect patient’s intellect, regardless of metabolic phenotype. If in 20 years old patients, or older, the main reason for mental retardation is the lack of dietetic treatment availability in the first years of life, for the younger patients the reason for mental retardation is usually a lack of compliance with the treatment. The majority of metabolic phenotypes is cPKU, in concordance with the literature data; the mild phenotype (HPA) was observed in a small percentage of patients, smaller than the data reported in the literature. In the first two studied decades the mild phenotypes were seldom observed. In the absence of screening tests or suggestive clinical manifestation it can be assumed that HPA patients remained undiagnosed, which would explain the small HPA percentage in the study group. A significant improvement in metabolic control in younger patients compared with older ones was observed, which denotes a better access to specific alimentation on one side, and o the other side, a better understanding of the disease from the patients and their families. Also, this study confirms a known fact that the diet in PKU is of great importance in the disease evolution. In this study there were included patients with severe metabolic phenotype with good metabolic control which reached adulthood without intellectual deficits, with higher education, social integrated and also patients with mild metabolic phenotype but with a poor metabolic control which developed intellectual deficiency. Conclusions. The PKU prevalence in Bihor county is higher than the estimated national value. The late diagnosis and treatment or the poor metabolic control led to intellectual disability, regardless of the metabolic phenotype. PKU screening and the better access to treatment allows younger generations of patients to enjoy a superior quality of life than the patients from the first two studied decades.

The effectiveness of social media intervention in people with diabetes: An integrative review.

This integrative review aimed to synthesise the available quantitative and qualitative studies on the effectiveness of diabetes self-management education (DSME) delivered through social media on glycaemic control (HbA1c), knowledge, health-related quality-of-life (HRQoL), anxiety, depression and self-efficacy in people with diabetes mellitus. DSME is the main component of diabetes management which contributes to behavioural changes and the improvement of metabolic control and self-monitoring skills. Due to limited face-to-face access to healthcare services, social media has increasingly been used to deliver DSME for people with diabetes. However, there is a paucity of reviews addressing the effectiveness of using social media in delivering DSME. An integrative review was conducted based on Whittemore and Knafl's (2005) methodology. The following databases were searched for relevant studies published between 2000 and 2020: Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, Cochrane Library, PsycINFO, EMBASE, EMCare and Google Scholar. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool. The PRISMA checklist for systematic reviews was used. A total of 13studies met the inclusion criteria and were included in this review. Facebook and WhatsApp were the most common social media platforms used to deliver DSME intervention. Nurses were the most frequent DSME providers. The duration and content of DSME in the reviewed studies varied. Consistent positive outcomes were found on glycaemic control, diabetic knowledge and self-efficacy. No studies considered the effect of DSME on HRQoL, anxiety and depression. Social media DSME can be effective in reducing HbA1c levels, increasing diabetic knowledge and self-efficacy. Further studies are needed to examine the effectiveness of using social media to deliver DSME intervention on HRQoL, anxiety and depression. This review provides nurses and healthcare professionals with evidence to support the use of social media to deliver DSME for people with diabetes. DSME delivered via social media supported by nurses would overcome limitations of face-to-face delivery such as geographical distance, travelling time, or other limited resources by patients with diabetes.

MO640: Treatment with Sodium–Glucose Cotransporter 2 Inhibitors Increases Klotho in Type 2 Diabetic Patients

Abstract BACKGROUND AND AIMS Klotho (KL) is a transmembrane protein mainly expressed by the tubular cells of the kidneys, with an additional soluble form that is present in blood and urine. Preserved KL has been related to physiological protection of the kidneys. Sodium–glucose cotransporter type-2 inhibitors (SGLT2i) are a new class of anti-diabetic drugs with important renal benefits. The aim of the present study was to analyze the effect of treatment with SGLT2i on soluble KL concentrations as well as on mRNA expression levels of the KL gene in renal tubular cells. METHOD Fifty-seven patients (30 males and 27 females; mean age 61 ± 5 years) with type 2 diabetes and chronic kidney disease stage G2-A2, all treated with metformin and blockers of the renin–angiotensin system, were included in the study. All patients were in need of intensified anti-diabetic therapy at the discretion of their physicians in accordance with the routine clinical practice. Forty-five received SGLT2i during 3 months (15 empagliflozin, 15 canagliflozin and 15 dapagliflozin), and the evolution was compared with a group of 12 patients matched by age, sex and stage of CKD who received DPP4 inhibitors (control group). Serum and urine levels of soluble KL and tumor necrosis factor-alpha (TNFa) were determined by ELISA. In addition, the effect on mRNA expression levels of KL was assessed in vitro in renal tubular cells cultures. RESULTS Baseline values of serum and urinary KL and TNFa were similar in both groups. Urinary KL was inversely correlated with albuminuria (r = −0.45, P &amp;lt; 0.001) and urine TNFa excretion (r = −0.40, P &amp;lt; 0.01). At the end of the study, there was a similar improvement in metabolic control in both groups; however, only patients treated with SGLT2i showed a significant reduction in albuminuria and urinary TNFa (P &amp;lt; 0.01). Serum and urinary KL increased by 5.2% and 38.9%, respectively, only in patients receiving SGLT2i (P &amp;lt; 0.001 versus baseline), without changes in controls (P &amp;lt; 0.01 between groups). There were no differences among the three drugs in the SGLT2i group. The reduction in albuminuria (β = −0.35, P &amp;lt; 0.01) and urinary TNFa (β = −0.57, P &amp;lt; 0.001) were independently associated with the increase in urine KL, while the change in albuminuria was related to the increase in serum KL (β = −0.39, P &amp;lt; 0.05). Cultured renal tubular cells under high glucose, inflammatory stimulus with TWEAK or serum bovine albumin decreased Klotho mRNA and protein expression within 24 h, an effect that was prevented by all the SGLT2i when added to the cultures. CONCLUSION In type 2 diabetic patients, treatment with SGLT2i induces a reduction in albuminuria and modulates inflammation (as reflected by a decrease in the urinary excretion of TNFa), which is associated with a significant increase in soluble KL concentrations. In addition, SGLT2i prevent the reduction in protein and mRNA expression levels of the KL gene in renal tubular cells. The preservation of KL by SGLT2i may be an important mechanism of renal protection.

Impact of intermittently scanned continuous glucose monitoring with alarms on sleep and metabolic outcomes in children and adolescents with type 1 diabetes.

Data about sleep quality and quantity are not available in patients with type 1 diabetes (T1D) using intermittently scanned continuous glucose monitoring (isCGM). We questioned whether the isCGM with alarms could fragment sleep in patients and parents, compared to isCGM without alarms. A prospective, observational study including 47 child-adolescents with T1D who had experience with isCGM without alarms (Freestyle Libre 1-FSL1). They were asked to wear the isCGM with alarms (Freestyle Libre 2-FSL2) for 14days. Patients enrolled and their caregiver (s), during a 14day period with FSL1 and the following 14days with FSL2, completed psychosocial and sleep-related questionnaires. Furthermore they wore an actigraph that was downloaded to a web platform and processed by the validated and certified algorithm "Dormi®." By the switch to the alarmed FSL2 we found about a 5% increase in Time In Range (from 62.5 to 67.8%), a reduction in time spent in hypoglycemia, number of weekly hypoglycemic events, and coefficient of variation. We did not find significant differences in sleep parameters in patients and their parents; therefore, alarms did not worsen the duration and quality of sleep. A significant improvement in the Quality of Life was perceived by parents using FSL2. Introduction of alarms in isCGM systems gives, in the short term, an improvement in metabolic control in terms of time in range and reduction in hypoglycemia, without worsening duration and quality of sleep, measured by actigraphy, in children-adolescent and their parents.

Epidemiological study on short and long-term weight loss with improvement of metabolic control in obese diabetic patients with a standardized multidisciplinary weight loss program (DIAMEX Study).

Purpose of Study: Obesity in Mexico has risen since the 1980s affecting 30% of the adult population, and 15% of adults had diabetes in Mexico. The rise in the rates of obesity and diabetes is linked to an increased consumption of calorically dense foods and sedentary lifestyle. The present study (DIAMEX) was aimed to evaluate the effect of a VLCK diet as part of a commercial weight loss program (PnKDiaprokal®) in patients with Diabetes and Obesity. It is an epidemiological study on weight loss and improvement of metabolic control in obese diabetic patients with a standardized multidisciplinary program that includes diet, physical exercise, and emotional support.

Evaluation of FreeStyle Libre in pediatric t1dm: improved glycemic control, reduction in diabetic ketoacidosis and severe hypoglycemia

Self-monitoring of blood glucose (SMBG) with glucometers provides only a snapshot of the glycemic profile and is accompanied by significant psychological discomfort and pain, especially in children. Flash Glucose Monitoring System - FreeStyle Libre (FSL) overcomes many of the barriers associated with glucose measurement and improves metabolic control. To evaluate the efficacy of FSL in children with type 1 diabetes mellitus (T1DM) in terms of glycemic control, episodes of severe hypoglycemia (SH) and diabetic ketoacidosis (DKA). A multicenter, prospective, observational study in real clinical practice was carried out. A total of 469 subjects (258 boys and 211 girls) aged 4-18 were included in the study. The median age was 11.3 (8.4-14.6) years, duration of T1DM - 4.2 (2.1-7.1) years. After FSL start, patient was followed up for 6 months. After 3 and 6 months of FSL use, HbA1c significantly decreased from 7.4% to 7.1% and 7.2%, respectively (p&lt;0.001). The number of children with HbA1c &gt;&lt;7.5% increased from 51% to 60% and 58% at 3 and 6 months, respectively (p&gt;&lt;0.001). The incidence of DKA and SH, as well as the proportion of patients experiencing at least one episode of DKA and SH, were significantly reduced after 6 months of FSL use compared with baseline (p&gt;&lt;0.001). The Study demonstrated a significant improvement in metabolic control in children with T1DM 6 months after FSL start: decrease in HbA1c, accompanied by reduction in incidence of DKA and SH.

Amplifying the antidiabetic actions of glucagon-like peptide-1: Potential benefits of new adjunct therapies.

Clinically approved for the treatment of diabetes and obesity, glucagon-like peptide-1 (GLP-1) receptor agonists display prominent glucose- and weight-lowering effects as well as positive cardioprotective and neuroprotective actions. Despite these benefits, bariatric surgery remains superior in producing robust and sustained weight loss alongside improvements in metabolic control with possible diabetes remission. The current review considers the potential for adjunct therapies to augment the therapeutic actions of GLP-1 receptor agonists. In this regard, several gut-derived hormones also, modulated by bariatric surgery, display additive properties when combined with GLP-1 receptor agonists in both preclinical and clinical studies. In addition, glucocorticoids and oestrogen have shown promise in augmenting the biological actions of GLP-1 in animal models. Additionally, GLP-1 efficacy can also be enhanced by use of compounds that prolong GLP-1 receptor coupling to potentiate downstream receptor signalling. Taken together, therapies that activate GLP-1 receptor signalling, in combination with various other cell signalling pathways, show potential for treating type 2 diabetes and obesity with superiority over GLP-1 receptor agonist therapy alone.

Enhanced renoprotective actions of Paricalcitol and omega-3 fatty acids co-therapy against diabetic nephropathy in rat

IntroductionAlthough the synthetic vitamin D analogue, Paricalcitol, and omega-3 Fatty acids (ω-3) alleviated diabetic nephropathy (DN), their combination was not previously explored. ObjectivesThis study measured the potential ameliorative effects of single and dual therapies of Paricalcitol and/or ω-3 against DN. MethodsForty rats were assigned as follow: negative (NC) and positive (PC) controls, Paricalcitol, ω-3 and Paricalcitol + ω-3 groups. Diabetes was generated by high-fat/high-fructose diet and a single streptozotocin injection (40 mg/kg). DN was confirmed by raised fasting blood glucose (FBG), polyuria, proteinuria, and decreased urine creatinine levels. Paricalcitol intraperitoneal injections (0.25 µg/Kg/day; 5 times/week) and oral ω-3 (415 mg/kg/day; 5 times/week) started at week-9 and for eight weeks. ResultsThe PC group showed hyperglycaemia, dyslipidaemia, abnormal renal biochemical parameters, elevated caspase-3 expression, and increased apoptosis by TUNEL technique. The mRNAs and proteins of the pathogenic molecules (TGF-β1/iNOS) and markers of tissue damage (NGAL/KIM-1) augmented substantially in the PC renal tissues relative to the NC group. The oxidative stress (MDA/H2O2/protein carbonyl groups) and pro-inflammatory (IL1β/IL6/TNF-α) markers increased, whereas the anti-inflammatory (IL10) and anti-oxidative (GSH/GPx1/GR/SOD1/CAT) declined, in the PC renal tissues. The monotherapy groups were associated with ameliorated FBG, lipid profile and renal functions, and diminished TGF-β1/iNOS/NGAL/KIM-1/Caspase-3 alongside the apoptotic index than the PC group. The oxidative stress and pro-inflammatory markers decreased, whilst the anti-oxidative and anti-inflammatory molecules escalated, in the monotherapy groups than the PC group. Although the Paricalcitol renoprotective actions were better than ω-3, all the biomarkers were abnormal than the NC group. Alternatively, the Paricalcitol + ω-3 protocol exhibited the best improvements in metabolic control, renal functions, oxidative stress, inflammation, and apoptosis. However, FBG and tissue damage were persistently higher in the co-therapy group than controls. ConclusionsBoth monotherapies showed modest efficacy against DN, whereas their combination displayed boosted renoprotection, possibly by enhancing renal anti-oxidant and anti-inflammatory pathways.

676-P: Semaglutide Achieves Better Metabolic and Weight Control than Other GLP-1 RA in Real Life after 12 Months of Follow-up

Background and Aims: Weekly sc Semaglutide (WS) has demonstrated safety and efficacy in type 2 diabetes mellitus (T2D) in an extensive clinical development program. The main objective of the study was to assess the change in HbA1c and weight loss greater than 5% after 12 months of follow-up in real life. Materials and Methods: Retrospective observational study. Inclusion criteria:patients ≥ 18 years of age with T2D, eGFR ≥ 15 ml/min/1.73 m2 treated with WS. Main outcome variable: change in HbA1c (%) and weight ≥ 5% (kg). Secondary outcome variables: adverse events, withdrawal. Statistics: descriptive, student’s t, McNemar, multivariate logistic regression; SPSS vs. 19.0. Results: 247 patients, 55.4% men, age 62.8 ± 11.20 years, T2D evolution 10.4 ± 7.9 years; 14% smokers, 42.5% ex-smokers; 58% macroangiopathy, 54% microangiopathy; BMI 36.47 ± 6 Kg/m2; HbA1c 7.53 ± 1.4%; eGFR &amp;lt; 60 ml/min/1,73m2 46.5% and MAU &amp;gt; 30 mg/g 29.6%. In their baseline therapy, 55.9% used a GLP1 aR, (Liraglutide 66.7%, Dulaglutide 29.7%, ExenatideLAR 3.6%) and 44.8% insulin therapy. WS was suspended in 6.9% (44% digestive intolerance). 6.1% of patients on insulin had mild hypoglycemia. Overall, change in HbA1c -0.84 ± 1.1% (p &amp;lt;0.0001), change in weight -8 ± 16.6 kg (p &amp;lt;0.0001), weight change ≥ 5% 64.5%. The best compliance on weight change in people over 65 years of age with an OR 1.8 (95% CI: 1.02-3.17). Subpopulations analysis showed a change in HbA1c of -1.1 ± 1.2% (GLP1 aR naive) vs. -0.6 ± 1.9% (GLP1 aR prior-switch) (p 0.0001); weight change ≥ 5% -9.3 ± 6.4 Kg (GLP1aR naive) vs. -6.5 ± 6.7 Kg (GLP1 aR prior - switch) (p 0.0001). Significantly improved TAS (-7.5 ± 12.7 mmHg, p &amp;lt;0.0005), TAD (5.5 ± 9.4 p &amp;lt;0.0005), LDL -13.7 ± 30.11 mg/dl, p &amp;lt;0.0005, MALB 83.2 ± 432.4 mg/g, p &amp;lt;0.001. Conclusions: In real clinical practice, WS leads to an improvement in metabolic control and weight, both in patients T2D naïve to GLP1 aR (greater benefit), and in T2D patients previously treated with a different GLP1 aR, after one year. Disclosure M. Garcia de lucas: Advisory Panel; Spouse/Partner; Boehringer Ingelheim International GmbH, Novo Nordisk Inc., Speaker’s Bureau; Spouse/Partner; AstraZeneca, Lilly Diabetes, Sanofi. L. Pérez-belmonte: None. B. Aviles: None. A. Jimenez: None. J. Fernandez: None. F. Rivas ruiz: None.

The presence of microvascular complications is associated with a poor evolution of metabolic control in patients with type 1 diabetes mellitus

ObjectiveTo report the evolution of metabolic control and to assess the clinical and metabolic factors associated with the presence of microvascular complications in patients with type 1 diabetes mellitus (T1DM). Material and methodsThis was a retrospective, observational study analysing clinical, laboratory, and therapeutic data from a registry of patients with T1DM created in 2010. ResultsData recorded from 586 patients (males: 50.2%; mean age: 36.1±13.5 years; T1DM duration: 18.0±12.1 years) followed for a mean of 6.0±3.1 years were assessed, and 8133 HbA1c levels (13.2±7.6 measurements/patient) were analysed, with a mean evolutionary HbA1c of 7.9%±1.2%. The mean annual HbA1c level gradually improved from 8.6%±1.6% in 2010 to 7.5%±1.4% in 2019, with 34.3% and 69.0% of patients having HbA1c levels ≤7% and ≤8% respectively. Patients with T1DM duration of <10 years and ≥20 years, non-smokers, CSII users, and those using the insulin/carbohydrate ratio had better current and evolutionary HbA1c levels. The presence of microvascular complications was independently associated with T1DM lasting ≥20 years, the presence of HBP, and evolutionary HbA1c≥7.0%. ConclusionA progressive but still inadequate improvement in metabolic control over 10 years was seen in patients with T1DM. Poor metabolic control (mean HbA1c over 10 years ≥7%) was independently associated with the presence of microvascular complications.