Inadequate Glucose Control Research Articles

Current State and Future Perspective of Diabetic Wound Healing Treatment: Present Evidence from Clinical Trials.

Diabetes is a chronic metabolic condition that is becoming more common and is characterised by sustained hyperglycaemia and long-term health effects. Diabetes-related wounds often heal slowly and are more susceptible to infection because of hyperglycaemia in the wound beds. The diabetic lesion becomes harder to heal after planktonic bacterial cells form biofilms. A potential approach is the creation of hydrogels with many functions. High priority is given to a variety of processes, such as antimicrobial, pro-angiogenesis, and general pro-healing. Diabetes problems include diabetic amputations or chronic wounds (DM). Chronic diabetes wounds that do not heal are often caused by low oxygen levels, increased reactive oxygen species, and impaired vascularization. Several types of hydrogels have been developed to get rid of contamination by pathogens; these hydrogels help to clean up the infection, reduce wound inflammation, and avoid necrosis. This review paper will focus on the most recent improvements and breakthroughs in antibacterial hydrogels for treating chronic wounds in people with diabetes. Prominent and significant side effects of diabetes mellitus include foot ulcers. Antioxidants, along with oxidative stress, are essential to promote the healing of diabetic wounds. Some of the problems that can come from a foot ulcer are neuropathic diabetes, ischemia, infection, inadequate glucose control, poor nutrition, also very high morbidity. Given the worrying rise in diabetes and, by extension, diabetic wounds, future treatments must focus on the rapid healing of diabetic wounds.

Knowledge and Attitude Towards Insulin Therapy in Type 2 Diabetes Mellitus Patients and Associated Factors at an Adult Endocrine Clinic of SPHMMC Addis Ababa Ethiopia

<i>Background:</i> Diabetes Mellitus (DM), a chronic disease characterized by elevated blood glucose levels, is associated with severe complications. Type 2 DM (T2DM), the most prevalent form of DM in adults, is characterized by varying degrees of insulin deficiency or resistance. The prevention or delay of macrovascular and microvascular problems associated with DM depends on achieving appropriate glycemic control. The percentage of T2DM patients failing to reach glycemic targets keeps rising even with the expanded availability of numerous anti-hyperglycemic drugs and evidence-based treatment guidelines. The delay in treatment intensification despite inadequate glucose control—often referred to as clinical or therapeutic inertia-contributes significantly to this trend.<i> Objective:</i> This study aims to evaluate the understanding and perceptions of insulin therapy among patients with T2DM. The study focuses on patients under follow-up care at the Adult Endocrine Clinic of St. Paul Hospital Millennium Medical College.<i> Method and Material:</i> An institutional-based, cross-sectional study was carried out from January to March 2021 to evaluate knowledge and attitudes regarding insulin therapy and related factors. A structured questionnaire was used for interviews with a representative sample of 271 T2DM patients who are receiving follow-up care at the endocrine clinic at SPHMMC. The SPSS, version 25, was the software utilized. The statistical significance of the relationship between the dependent and independent variables was assessed using a 95% confidence interval and a p-value less than 0.05.<i> Results:</i> The majority of the respondents were between the ages of 56 and 65, with a mean age of 57.35 years. More than half of the participants, accounting for 231 (85.2%) of the total, were from urban areas. Out of the 271 respondents, approximately 85.6% demonstrated poor knowledge of insulin therapy, and around 37.6% exhibited negative attitudes towards it. Factors such as age, occupation, and a history of long-term Oral Antidiabetic Drug use were found to be associated with the level of knowledge about insulin. In addition to these factors, marital status and a family history of insulin use were found to be associated with patients’ attitudes towards insulin. <i>Conclusions:</i> Our study identified a significant knowledge gap about insulin usage among T2DM patients in the designated study area. We recommend the implementation of regular, structured health education programs, delivered by trained health professionals. This approach is expected to enhance both the knowledge and attitudes toward insulin usage among patients attending follow-up sessions at the SPHMMC diabetic clinic.

Predictors of non-obstructive coronary slow flow in poorly controlled type 2 diabetes mellitus: a cross-sectional study

BackgroundCoronary slow flow (CSF) can occur due to various factors, such as inflammation, small vessel disease, endothelial dysfunction, and inadequate glucose control. However, the exact pathological mechanisms behind CSF remain incompletely understood.The objective of this study was to identify the risk factors associated with slow coronary flow in individuals with Type 2 Diabetes Mellitus (T2DM) who have non-obstructive coronary artery disease (CAD) and experience CSF.MethodsWe conducted a prospective cohort study involving 120 patients with T2DM who were referred for invasive coronary angiography due to typical chest pain or inconclusive results from non-invasive tests for myocardial ischemia. Using a 2 × 2 design, we categorized patients into groups based on their glycemic control (adequate or poor) and the presence of CSF (yes or no), defined by a TIMI frame count > 27. All patients had non-obstructive CAD, characterized by diameter stenosis of less than 40%. We identified many variables associated with CSF.ResultsOur investigation revealed no significant differences in age, sex, family history of coronary artery disease, ECG ischemia abnormalities, or echocardiographic (ECHO) data between the groups. In patients with adequate glycemic control, hypertension increased the risk of CSF by 5.33 times, smoking by 3.2 times, while dyslipidemia decreased the risk by 0.142. Additionally, hematocrit increased the risk by 2.3, and the platelet-to-lymphocyte ratio (PLR) increased the risk by 1.053.Among patients with poor glycemic control, hematocrit increased the risk by 2.63, and the Neutrophil-to-Lymphocyte Ratio (NLR) by 24.6. Notably, NLR was positively correlated with glycemic control parameters in T2DM patients with CSF.ConclusionsIn T2DM patients with CSF, various factors strongly correlate with glycemic control parameters and can be employed to predict the likelihood of CSF. These factors encompass hypertension, smoking, increased body mass index (BMI), elevated platelet count, hematocrit, NLR, PLR, and C-reactive protein (CRP).Trial registrationRegistry: ZU-IRB (ZU-IRB#9419–3-4-2022), Registered on: 3 April 2022, Email: IRB_123@medicine.zu.edu.eg.

Be mindful of the blood glucose measurement: The relevance of blood glucose in the eye emergency department

Aims/Purpose: Diabetic eye disease is a leading cause of blindness worldwide and diabetes‐related eye conditions are frequent presentations in Eye Emergency Departments (EEDs). Early detection and intervention of inadequate blood glucose control in the EED could be sight‐saving.The aims of this study are to determine the: prevalence of pre‐existing diabetes mellitus (DM) in the EED. prevalence of suboptimal (HbA1c 53–70 mmol/mol) or poor (HbA1c >70 mmol/mol) glycaemic control in the EED. proportion of diabetes patients with this diagnosis documented in the EED. proportion of EED patients at risk of undiagnosed diabetes. number of EED patients that had a capillary blood glucose measurement (BgM). Methods: A retrospective review of 683 patients attending the EED over 10 consecutive weekdays at Manchester Royal Eye Hospital, Manchester, United Kingdom. The following parameters were assessed: EED documentation: patient age, gender, presentation, diagnosis, management plan and whether a BgM was done. General Practitioner records: diabetes diagnosis cross‐referenced with EED documentation. If diabetes patients: diabetes type, duration, and glycaemic control. Potentially undiagnosed diabetes. Results: The prevalence of diabetes patients was 9.5%–64.6% of these patients had diabetes documented in EED and 1 had a capillary BgM. 70.7% of diabetes patients had pre‐existing suboptimal [33.8%] or poor [36.9%] glycaemic control. 8.5% of patients were considered high‐risk for undiagnosed diabetes of which 1 had a BgM.Conclusions: There is a high prevalence of diabetes patients in the EED, and most have inadequate glycaemic control. This makes the EED an important setting to detect patients at high risk of diabetes‐related ocular disease and complications. BgM testing for all suspected patients is a quick test to allow earlier detection and intervention of inadequately controlled diabetes and reduce the risk of diabetes‐related vision loss.

Evaluation of a digital tool supporting therapeutic decision making for the personalized management of patients with type 2 diabetes not treated with insulin: A pilot study

AimsTo investigate the benefits of using the Personalized Treatment Tool (PTT), a web-based clinical decision support tool assisting the diabetologist in the evaluation of patient’s clinical characteristics and SMBG data, in the management of patients with non-insulin treated type 2 diabetes and inadequate glucose control. MethodsWe conducted a single-center, 16-week, cluster-randomized controlled trial. ResultsEighty-two patients with 64.3 ± 9.4 years of age, disease duration 13.2 ± 9.1 years and HbA1c 7.8 ± 0.6%, 41 in the PTT group and 41 in the control group, completed the study. At follow-up, changes in indicators of glucose control and variability were not statistically different between the two groups. However, when considering the subgroup of patients on a single anti-diabetes drug at baseline (9 in the PTT group, 14 in the control group), changes in HbA1c and CGM-derived TIR 70–140 mg/dl, 24-hour MSG, GRADE, and HBGI were significantly improved in the PTT group compared to the control group. ConclusionWhen performed in a structured manner and used to modify the diabetes therapy through an algorithm-driven digital tool, SMBG can lead to significant improvements of glycemic control and variability in patients with type 2 diabetes not treated with insulin.

Switching from Multiple Insulin Injections to a Fixed Combination of Degludec and Liraglutide in Patients with Type 2 Diabetes Mellitus: Results from the Simplify Study After 6Months.

This study aimed to evaluate the effectiveness and safety of switching from basal bolus insulin treatment (BBIT) to a fixed combination of insulin degludec and liraglutide (IDegLira) in patients with type 2 diabetes mellitus (T2DM) who had preserved insulin secretion but inadequate glucose control. The study also aimed to assess the feasibility of implementing this therapeutic approach in common clinical practice settings. This was a non-randomized, open-label, multicenter, prospective, single-arm study involving 234 patients with T2DM who were receiving BBIT. Inclusion criteria were duration of diabetes mellitus > 60months, stable total daily dose of insulin (TDDI) ranging from > 20 to < 70IU/day (approx. > 0.3 to < 0.7IU/kg body weight/day), C-peptide levels > 10% above the lower limit, HbA1c levels > 7% and < 10% (Diabetes Control and Complications Trial), and body mass index > 25kg/m2. The primary endpoints were changes in glycated hemoglobin (HbA1c) and body weight at week 28 after treatment switching. Secondary endpoints included changes in the 7-point glycemic profile, hypoglycemia frequency, blood pressure, blood lipids, liver enzymes, insulin dose, and a patient questionnaire focusing on treatment satisfaction, concerns and impact on daily activities. A subgroup of 55 patients underwent continuous glucose monitoring (CGM) with the evaluation of CGM-derived parameters, such as time in range (TIR), time above range (TAR), time below range (TBR), hypoglycemia, and glucose variability. A significant decrease in HbA1c (8.6% vs. 7.6%; p < 0.0001) and body weight (97.8 vs. 94.0kg; p < 0.0001) was observed at week 28 after treatment switching. Significant improvements were also seen in all measurements of the 7-point glycemic profile (p < 0.0001), reduction in the number of hypoglycemia episodes per patient, and the proportion of patients with at least one hypoglycemia event (p < 0.001). Furthermore, there was a significant decrease in daily insulin dose (55.6 vs. 32.7IU/day; p < 0.0001), as well as improvements in blood pressure, blood lipids, and liver enzymes (gamma glutamyl transferase and alanine aminotransferase). The subgroup of patients who underwent CGM showed a significant increase in TIR (57.9% vs. 69.0%; p < 0.01) and a decrease in TAR (40.1% vs. 28.8%; p < 0.01), while TBR, hypoglycemia (number of episodes per patient and proportion of patients), and glucose variability did not change significantly. The results of this study suggest that switching from BBIT to IDegLira in patients with T2DM and preserved insulin secretion can simplify treatment without compromising glycemic control. The switch to IDegLira was associated with significant improvements in various glucose control parameters, including HbA1c, glycemic profile, hypoglycemia, insulin doses, and CGM-derived parameters TIR and TAR. Additionally, it led to significant reductions in body weight, blood pressure, lipid profile, and liver enzyme levels. Switching to IDegLira may be considered a safe and beneficial approach in clinical practice settings, offering metabolic and individual advantages.

Energy Alterations in Patients with Diabetes Type 1 and Type 2

According to Western medicine, diabetes is a disease characterized by inadequate glucose control. According to traditional Chinese medicine, diabetes comes from Yin deficiency and Heat retention. The purpose of this study is to demonstrate that patients with type 1 and 2 diabetes have in common, energy deficiency inside the five internal massive organs (Liver, Heart, Spleen, Lungs, and Kidney), and the treatment of this condition rebalancing (using Chinese dietary counseling, auricular acupuncture with apex ear bloodletting) and replenishing the energy of these organs using highly diluted medications such as homeopathic according to the theory Constitutional Homeopathy of the Five Elements Based on Traditional Chinese Medicine is of paramount importance to treat the cause of diabetes formation and not just treating the symptoms. Methods: two case reports, one patient with diabetes type 1, and one patient with diabetes type 2. All of them were submitted to the measurement of the energy of the five internal massive organs (Liver, Heart, Spleen, Lungs, and Kidney) through the radiesthesia procedure using a crystal pendulum. Results: all of them were presenting the lowest level of energy in all five internal massive organs rated one out of eight. The treatment of this condition rebalancing these energies using Chinese dietary counseling, auricular acupuncture with apex ear bloodletting, and replenishing the energy of these organs using highly diluted medications such as homeopathic according to the theory of Constitutional Homeopathy of the Five Elements Based on Traditional Chinese Medicine can reduce the hyperglycemia reducing the need for hyperglycemic medication and also insulin. The conclusion of this study is to demonstrate that patient with any kind of diabetes type one or two has in common, energy deficiency inside the five internal massive organs and the treatment of this condition is of paramount importance to treat the cause of hyperglycemia symptoms, that are the energy deficiencies inside the five internal massive organs leading to hyperglycemia symptoms.

Association between primary graft function and 5-year outcomes of islet allogeneic transplantation in type 1 diabetes: a retrospective, multicentre, observational cohort study in 1210 patients from the Collaborative Islet Transplant Registry

Allogeneic islet transplantation is a validated therapy in type 1 diabetes; however, there is decline of transplanted islet graft function over time and the mechanisms underlying this decline are unclear. We evaluated the distinct association between primary graft function (PGF) and 5-year islet transplantation outcomes. In this retrospective, multicentre, observational cohort study, we enrolled all patients from the Collaborative Islet Transplant Registry who received islet transplantation alone (ITA recipients) or islet-after-kidney transplantation (IAK recipients) between Jan 19, 1999, and July 17, 2020, with a calculable PGF (exposure of interest), measured 28 days after last islet infusion with a validated composite index of islet graft function (BETA-2 score). The primary outcome was cumulative incidence of unsuccessful islet transplantation, defined as an HbA1c of 7·0% (53 mmol/mol) or higher, or severe hypoglycaemia (ie, requiring third-party intervention to correct), or a fasting C-peptide concentration of less than 0·2 ng/mL. Secondary outcomes were graft exhaustion (fasting C-peptide <0·3 ng/mL); inadequate glucose control (HbA1c ≥7·0% [53 mmol/mol] or severe hypoglycaemia); and requirement for exogenous insulin therapy (≥14 consecutive days). Associations between PGF and islet transplantation outcomes were explored with a competing risk analysis adjusted for all covariates suspected or known to affect outcomes. A predictive model based on PGF was built and internally validated by using bootstraps resampling method. In 39 centres worldwide, we enrolled 1210 patients with a calculable PGF (of those without missing data, mean age 47 years [SD 10], 712 [59·5%] were female, and 865 (97·9%) were White), who received a median of 10·8 thousand islet-equivalents per kg of bodyweight (IQR 7·4-13·5). 986 (82·4%) were ITA recipients and 211 (17·6%) were IAK recipients. Of 1210 patients, 452 (37·4%) received a single islet infusion and 758 (62·6%) received multiple islet infusions. Mean PGF was 14·3 (SD 8·8). The 5-year cumulative incidence of unsuccessful islet transplantation was 70·7% (95% CI 67·2-73·9), and was inversely and linearly related to PGF, with an adjusted subhazard ratio (sHR) of 0·77 (95% CI 0·72-0·82) per 5-unit increase of BETA-2 score (p<0·0001). Secondary endpoints were similarly related to PGF. The model-adjusted median C-statistic values of PGF for predicting 5-year cumulative incidences of unsuccessful islet transplantation, graft exhaustion, inadequate glucose control, and exogenous insulin therapy were 0·70 (range 0·69-0·71), 0·76 (0·74-0·77), 0·65 (0·64-0·66), and 0·72 (0·71-0·73), respectively. This global multicentre study reports a linear and independent association between PGF and 5-year clinical outcomes of islet transplantation. The main study limitations are its retrospective design and the absence of analysis of complications. Public Health Service Research, National Institutes of Health, Juvenile Diabetes Research Foundation International, Agence National de la Recherche, Fondation de l'Avenir, and Fonds de Dotation Line Renaud-Loulou Gasté.

Factors associated with poor glycemic control in diabetic patients in Kirkuk

Background Iraq's health-care system has faced tremendous obstacles in its recovery from the Islamic State's conflict. There is no public insurance system in place. Iraq has set targets to prevent and control noncommunicable diseases (NCDs) such as diabetes, but safety confrontation and governmental insecurity have made these objectives difficult to achieve. Better glycemic control is critical in allowing patients to perform at their best in terms of diabetes management and preventing long-term complications. The goal is to identify the roadblocks to better glycemic management. The participants in this cross-sectional study were recruited from a diabetes out-patient clinic at Baba Gurgur diabetic facility. From April to December 2019, K1 hospital – North oil company in Kirkuk city. A validated questionnaire was used to interview those with an uncontrolled glycemic index (AIC7%). Patients were asked to name the primary causes of inadequate glucose control and to select more than one response based on their opinion. The mean A1C was 8.3 2.1 percent, with 256 (22.5 percent) patients having an A1C less than 7% and 880 (77.5 percent) having an A1C equal to or greater than 7. Poor glycemic control is caused by a lack of medication and/or a lack of drug supply from PHC in 51.1 percent of cases. Diet and medication non-compliance, as well as illiteracy, account for 35.1 percent and 19.8 percent of the population, respectively. Glycemic regulation is greatly influenced by one's financial situation. However, security issues and political instability play a significant impact. Conclusion: Diabetic patients confirmed poor glycemic control, with the majority of cases being linked to Iraq's current health situation.

The The use of oral glucose-lowering agents (GLAs) in β-thalassemia patients with diabetes: Preliminary data from a retrospective study of ICET-A Network.

Objective:The management of prediabetes and hyperglycemia is an increasingly important aspect of care in patients with thalassemia. In light of the limited evidence about the management of GD (glucose dysregulation) with glucose-lowering agents (GLAs), we have conducted a retrospective survey in TDT and NTDT patients with diabetes mellitus to collect more detailed information on GLA use in order to make preliminary recommendations.Study design and method:A questionnaire was prepared and distributed to the tertiary thalassemia care Centers of ICET-A Network.Results:Eight thalassemia care Centers [Bulgaria, Greece, Iran, Italy (4 Centers) and Qatar], following 1.554 with transfusion-dependent thalassemia (TDT), 132 (8.4%) with diabetes and 687 with non-transfusion-dependent thalassemia (NTDT), 27 (3.9%) with diabetes, participated in the retrospective survey. The records of 117 TDT patients and 9 NTDT patients with diabetes treated with GLAs were analyzed. Metformin, a biguanide, was the most frequently used drug (47.6 %), followed by alpha-glucosidase inhibitors (5.5 %), incretins (4.7%) and insulin secretagogues (3.1%). In 68 (61.2) patients GLAs was prescribed as monotherapy, while the remaining 49 (38.8%), who had inadequate glucose control with metformin, were treated with combination treatment. Fifty-one patients of 126 (40.4%) initially treated with oral GLA, for a mean duration of 61.0 ± 35.6 months (range: 12- 120 months), required insulin therapy for better metabolic control.Conclusion:This retrospective study covers an unexplored area of research in patients with thalassemia and GD. Oral GLAs appear to be safe and effective for the treatment of diabetes mellitus in patients with thalassemia, and can achieve adequate glycemic control for a substantial period of time. (www.actabiomedica.it)

Diabetes and COVID-19 Vaccination

Diabetes is one of the major comorbidities associated with increased risk of mortality and severe clinical outcomes in coronavirus disease 19 (COVID-19) patients. Thus, timely and appropriate vaccination is the most effective strategy for mitigating the risk of COVID-19 infection in people with diabetes. Recent studies have shown that immune response after vaccination is significant in both diabetes and non-diabetes groups, but slightly lower in patients with diabetes. Inadequate glucose control might impair the immune response. Blood glucose monitoring is required more often than usual for several days after vaccination. If a patient’s blood glucose is not controlled adequately, appropriate management should be provided.

Possible ocular effects of anti-diabetes medications, and their relevance to contact lens wear

Purpose. To asses what information on ocular effects of anti- diabetes medications are provided in medicines prescribing information, and whether or not any current guidelines actu- ally mention contact lens wear. Material and Methods. Medicines directories and patient information leaflets (PILs) for 28 diabetes medicines (insulin and various oral hypoglycaemic drugs) were searched for any information on possible ocular effects. A PubMed search was also undertaken on the medicines in relation to ocular side effects. Results. Almost all information sources examined included notes that a change in vision after taking anti-diabetes med- ications could indicate inadequate glucose control. The use of all diabetic medications can result in mild to moderate allergic reactions that could involve the conjunctiva, eyelids and eyelashes. A possible adverse effect of use of older oral hypoglycaemics (such as the sulfonylureas and acarbose) is a warning to patients of possible ‘yellowing of the eyes’ and of the skin. In the vast majority of published studies identified, almost no information has been provided on the oral anti- diabetes medications being used so it is essentially unknown if diabetic medications per se can have adverse effects on the cornea and conjunctiva. However, the information search (in both medical directories, PILs) revealed nothing in relation to contact lens wear and/or that there should be any obvious caution in prescribing contact lenses to diabetic patients. Conclusion. Information indicating that contact lens wear is potentially problematic is not obviously included in medicines directories, so contact lens wear can offer a viable option for vision correction in diabetics. Keywords Diabetes, medication, contact lens wear

AMPK Activity: A Primary Target for Diabetes Prevention with Therapeutic Phytochemicals

Diabetes is a metabolic syndrome characterized by inadequate blood glucose control and is associated with reduced quality of life and various complications, significantly shortening life expectancy. Natural phytochemicals found in plants have been traditionally used as medicines for the prevention of chronic diseases including diabetes in East Asia since ancient times. Many of these phytochemicals have been characterized as having few side effects, and scientific research into the mechanisms of action responsible has accumulated mounting evidence for their efficacy. These compounds, which may help to prevent metabolic syndrome disorders including diabetes, act through relevant intracellular signaling pathways. In this review, we examine the anti-diabetic efficacy of several compounds and extracts derived from medicinal plants, with a focus on AMP-activated protein kinase (AMPK) activity.

Awareness about diabetes and pregnancy among diabetes specialists and fellows: The YoSID diabetes and pregnancy project

Background and aimsDespite evidence that pregnancy planning improves outcomes, in Italy, as in many other countries worldwide, <50% of women with diabetes prepare their pregnancy. The aim of this study was to document training and knowledge on diabetes and pregnancy (D&P) among diabetes professionals. Methods and resultsWe administered an anonymous online questionnaire, focused on diabetes and pregnancy planning, to diabetes team members. Between Nov-2017 and Jul-2018, n = 395 professionals (60% diabetes/endocrinology/internal medicine specialists, 28% fellows) completed the survey. Fifty-nine percent of the specialists, mainly (78%) those completing their fellowship after 2006, reported having received training on D&P during fellowship. Considering specialists reporting training, 43% correctly identified fetal risks of inadequate preconceptional glucose control and 55% maternal risks, 38% identified risks associated with overweight/obesity, and 39% would prescribe hormonal contraception to women with diabetes only if glucose control is good. ConclusionsThe results of our survey suggest the need to improve training and awareness of professionals in the area of diabetes and pregnancy.

Intravascular Follistatin gene delivery improves glycemic control in a mouse model of type 2 diabetes.

Type 2 diabetes (T2D) manifests from inadequate glucose control due to insulin resistance, hypoinsulinemia, and deteriorating pancreatic β-cell function. The pro-inflammatory factor Activin has been implicated as a positive correlate of severity in T2D patients, and as a negative regulator of glucose uptake by skeletal muscle, and of pancreatic β-cell phenotype in mice. Accordingly, we sought to determine whether intervention with the Activin antagonist Follistatin can ameliorate the diabetic pathology. Here, we report that an intravenous Follistatin gene delivery intervention with tropism for striated muscle reduced the serum concentrations of Activin B and improved glycemic control in the db/db mouse model of T2D. Treatment reversed the hyperglycemic progression with a corresponding reduction in the percentage of glycated-hemoglobin to levels similar to lean, healthy mice. Follistatin gene delivery promoted insulinemia and abundance of insulin-positive pancreatic β-cells, even when treatment was administered to mice with advanced diabetes, supporting a mechanism for improved glycemic control associated with maintenance of functional β-cells. Our data demonstrate that single-dose intravascular Follistatin gene delivery can ameliorate the diabetic progression and improve prognostic markers of disease. These findings are consistent with other observations of Activin-mediated mechanisms exerting deleterious effects in models of obesity and diabetes, and suggest that interventions that attenuate Activin signaling could help further understanding of T2D and the development of novel T2D therapeutics.

Does Bariatric Surgery Reduce Risk for Birth Defects

Obesity has been associated with pregnancy complications stemming in part from inadequate maternal glucose control. To evaluate the effects of

Cardiorenal Protection: Potential of SGLT2 Inhibitors and GLP-1 Receptor Agonists in the Treatment of Type 2 Diabetes.

Recent large clinical trials on sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists, with the aim of verifying cardiovascular safety, have revealed that these medications have a preventative advantage on adverse cardiovascular outcomes, including worsening of heart failure and deterioration of nephropathy, in patients with type 2 diabetes (T2D). These observed benefits do not seem to correlate with the glucose-lowering effect, and the underlying mechanism is being intensively investigated. Given the results from recent studies, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) recommend that patients with T2D and clinical cardiovascular disease (CVD) with inadequate glucose control despite treatment with metformin should receive an SGLT2 inhibitor or GLP-1 receptor agonist. In this review we summarize the results of recent cardiovascular outcome trials and discuss the potential clinical advantage of SGLT2 inhibitors and GLP-1 receptor agonists. We also present practical implications of these glucose-lowering agents for reducing the risk of adverse cardiovascular events and progressive renal comorbidity in patients with T2D and CVD.

Prevalence of Xerostomia in Diabetes Mellitus at lower Sindh.

Introduction: Xerostomia is a common problem in apparently normal as well as in ill individuals. Diabetes mellitus is a common endocrine disorder in which Xerostomia is complained frequently. Xerostomia contributes to altered eating habits and increase risk of dental caries and oral infection if there is inadequate blood glucose control. Factors affecting Xerostomia includes socioeconomic and medical condition, includes uncontrolled diabetes mellitus, presence of peripheral neuropathy, use of medications, gender and age.&#x0D; Objective: To document the prevalence of Xerostomia among diabetic patients.&#x0D; Methodology: This prospective, cross sectional study was conducted on known cases of Diabetes mellitus attending medical OPD at Muhammad Medical College, Mirpurkhas Sindh from March 2017 to August 2017. During this period 100 patients were included according to inclusion criteria. Demographic details were recorded. Fox questionnaire was filled in, the data collected was analyzed by SPSS version 22, and presented as number and percentage.&#x0D; Result: Among100 patients; 37% were xerostomic and 63% were non xerostomic, age range of xerostomic was 50 ±7years and non xerostomic was 35 ±11 years. 21 females had Xerostomia and 29 had no Xerostomia .16 males were xerostomic, and 34 males were non xerostomic. Among xerostomic patients 15 were insulin dependent and 21 were non-insulin dependent. Where as in non xerostomic 22 were insulin dependent and 42 were non-insulin dependent. The mean duration of diabetes mellitus was 10 ±5 years in Xerostomic and it was 8 ±3 years in non xerostomic diabetes mellitus.&#x0D; Conclusion: Xerostomia is common in elderly diabetics and in females and is dependent on glycemic control and duration of diabetes.&#x0D; Key words: Xerostomia, Diabetes mellitus, Elderly and Duration of Diabetes Mellitus.

The association between diabetes status, HbA1c, diabetes duration, microvascular disease, and bone quality of the distal radius and tibia as measured with high-resolution peripheral quantitative computed tomography\u2014The Maastricht Study

SummaryIn this small cross-sectional study of predominantly well-treated participants with relatively short-term type 2 diabetes duration, HbA1c > 7% (53 mmol/mol) was associated with lower cortical density and thickness and higher cortical porosity at the distal radius, lower trabecular thickness at the distal tibia, and higher trabecular number at both sites.IntroductionTo examine the association between diabetes status and volumetric bone mineral density (vBMD), bone microarchitecture and strength of the distal radius and tibia as assessed with HR-pQCT. Additionally—in participants with type 2 diabetes (T2DM), to examine the association between HbA1c, diabetes duration, and microvascular disease (MVD) and bone parameters.MethodsCross-sectional data from 410 (radius) and 198 (tibia) participants of The Maastricht Study (mean age 58 year, 51% female). Diabetes status (normal glucose metabolism, prediabetes, or T2DM) was based on an oral glucose tolerance test and medication history.ResultsAfter full adjustment, prediabetes and T2DM were not associated with vBMD, bone microarchitecture, and strength of the radius and tibia, except for lower trabecular number (Tb.N) of the tibia (− 4%) in prediabetes and smaller cross-sectional area of the tibia (− 7%) in T2DM. In T2DM, HbA1c > 7% was associated with lower cortical vBMD (− 5%), cortical thickness (− 16%), higher cortical porosity (+ 20%) and Tb.N (+ 9%) of the radius, and higher Tb.N (+ 9%) and lower trabecular thickness (− 13%) of the tibia. Diabetes duration > 5 years was associated with higher Tb.N (+ 6%) of the radius. The presence of MVD was not associated with any bone parameters.ConclusionsIn this study with predominantly well-treated T2DM participants with relatively short-term diabetes duration, inadequate blood glucose control was negatively associated with cortical bone measures of the radius. In contrast, trabecular number was increased at both sites. Studies of larger sample size are warranted for more detailed investigations of bone density and bone quality in patients with T2DM.

Comparison of Different Self-Adjustment Regimens of Basal Insulin in Outpatients with T2DM

Self-adjustment of basal insulin dose were proved to be effective and widely used in clinical practice. However, no study compares the efficacy and safety of different self-adjustment regimens of basal insulin in T2DM. T2DM with inadequate glucose control on OADs who were to start basal insulin from our outpatient clinics were enrolled and randomized to two groups. Patients in Group A were guided to adjust insulin dose 2-6U weekly; those in Group B adjusted insulin dose 2-3U every 3 days. Dose titration was based on self-monitored blood glucose (SMBG) to achieve a target FBG of 6.1mmol/L. The titration regimen is shown in Table. A total of 648 patients aged 53.9 years old finished the 12-week visits. The baseline characteristics were even between groups. The FBG achieving rates were similar between Group A (75.7%) and Group B (74.4%). Compared with baseline, FBG and HbA1c decreased in both groups (FBG:10.7mmol/L vs. 6.6mmol/L in Group A, 10.8mmol/L vs. 6.5mmol/L in Group B; HbA1c:9.3% vs. 6.9% in group A, 9.5% vs. 6.8% in Group B, respectively, All P&amp;lt;0.001). The reduction of FBG (-4.1mmol/L vs. -4.2mmol/L) and HbA1c (-2.4% vs. -2.7%) were similar between groups, so as the hypoglycemic incidences (17.9% vs. 20.1%). The frequency of SMBG was higher in Group B (5.21 times/week vs. 4.69 times/week, p=0.02). In conclusion, both self-adjustment regimens in this study are effective and safe in T2DM.Table. Insulin Titration Protocol.Fasting blood glucose(mmol/L)Dose adjustment (U)Group AGroup B&amp;lt;4.4-2U-2∼3U4.4-6.1No changeNo change6.2-7.8+2U+2∼3U7.9-9.9+4U+2∼3U&amp;gt;10.0+6U+2∼3U Disclosure X. Hu: None. X. Yang: None. W. Xu: None. H.R. Deng: None. X. Guo: None. B. Yao: None. L. Zeng: None. J. Weng: None.