Insulin Group Research Articles

Effect of Adding Metformin to Insulin Therapy in Pregnant Women with Uncontrolled Type I Diabetes as Regard Pregnancy Outcome

Aim: This study aimed to examine if addition of metformin to insulin is an effective alternative to insulin alone for women with type I Diabetes Mellitus to lower insulin dose, hospital stay, maternal and neonatal complications, particularly in a resource-poor setting.Materials and Methods: Our randomized controlled trial included eighty patients, who were recruited into two equal groups; group A treated with metformin and insulin and group B treated with insulin alone, in Cairo and Beni-suef University Hospitals.Results: We found that metformin plus insulin group (Group A) showed significant outcomes regarding shorted hospital stay, lower insulin dose and lower maternal weight gain (p values 0.04, 0.02, 0.03, respectively). Most of maternal and neonatal complications were non-significantly lower in group A.Conclusion: Oral metformin therapy is an effective and safe additional treatment option for women with type I diabetes during pregnancy to lower the insulin requirements, hospital stay and most maternal-fetal complications in settings with limited economic resources.

Glucose and insulin regulate cell proliferation and glucose transporter (GLUT) synthesis in the liver of overfed geese

Abstract In order to detect the role of glucose and insulin in cell proliferation of primary goose hepatocytes, Tianfu Meat Geese were overfed and the primary goose hepatocytes were treated with single insulin (50 nmol/l), single glucose (5 mmol/l), glucose (5 mmol/l) and insulin (50 nmol/l), respectively. The related parameters of cell proliferation and glucose transporter expression were measured. The results showed that after overfeeding, the serum concentration of insulin and glucose increased ( P<Â 0.05), the mRNA level of Cyclin D1 ( CCND1), Glucose transporter 1 ( GLUT1) and Glucose transporter 2 ( GLUT2) increased and the mRNA level of P21 decreased ( P<Â 0.05). Compared with the control group and the single treatment groups of glucose or insulin, the co-treatment of glucose and insulin had more dyed green bromodeoxyuridine (BrdU)-positive cells, higher G2/M phase and proliferative index (PI), indicating that the cell proliferation of primary hepatocytes was more evident. Secondly, compared with the control group, the co-treatment of glucose and insulin significantly increased the mRNA expression levels of CCND1, Cyclin D2 ( CCND2) and Cyclin D3 ( CCND3) ( P<Â 0.05). Compared with the control group, single treatments of glucose or insulin, and the co-treatment with glucose and insulin significantly increased the Cyclin D1 protein content ( P<Â 0.05). Also, compared with the control group, the co-treatment of glucose and insulin increased significantly ( P<Â 0.05) the mRNA levels of GLUT1 and GLUT2. In conclusion, the combined treatment of glucose and insulin had a stronger effect on cell proliferation, and GLUT1 and GLUT2 could indirectly induce cell proliferation of goose hepatocytes by regulating glucose uptake and insulin secretion of hepatocytes.

Estimation of glycemic control in patients with type 2 diabetes mellites with various forms of tuberculosis with dots

Since ancient times people are aware of the association between tuberculosis and diabetes mellitus. Patients with tuberculosis and diabetes experience worse clinical manifestations, increased risk of treatment failure, recurrence, and death. The present study was conducted to evaluate glycosylated hemoglobin (HbA1c) and blood glucose levels, in patients with Type - 2 diabetes mellitus with various forms of tuberculosis who are on RNTCP DOTS and antidiabetic regimens. The study subjects included Type-2 diabetes mellitus with tuberculosis who are registered under RNTCP DOTS, in Dept of Pulmonology, PESIMSR, Kuppam, Chittoor district. Study groups comprises, 20 cases of type 2 DM WITH TB who are on oral hypo glycemic agents (OHA), 20 cases of Type 2DM WITH TB who are on oral hypoglycemic agents (OHA) with insulin, 20 cases of Type 2 DM WITH TB who are on insulin. HbAc is measured by fully automatic Bio-Rad D10 - HbA1c Analyzer. Blood glucose levels are estimated by auto analyser VITROS 250 in PESIMSR, Kuppam. The mean HbA1c levels showed good control in those patients kept on insulin alone compared to OHA and OHA with insulin groups (P &amp;#60;0.001). The mean HbAC levels were high in OHA alone group compared to other groups (P&amp;#60;0.001). The study revealed that increased levels of Glycosylated haemoglobin (HbA1C) are observed in those patients kept on OHA alone with DOTS as compared with other two groups. There is strong interaction between anti tubercular drugs and OHA which in turn leads to poor glycemic control. Poor glycemic state in diabetic patients is having strong impact on TB treatment outcome.

Tetracarpidium conophorum seed extract improves markers of diabetic disease progression in streptozotocin-induced diabetic rats

BackgroundTetracarpidium conophorum is one of the medicinal plants with probable efficacy for managing diabetes mellitus. Its leaf, root and seed have been recently reported to possess antihyperglycemic activity but its therapeutic benefit on diabetic disease progression is missing in literatures. This study aimed at investigating effects of Tetracarpidium conophorum seed (TECOSE) extract on biomarkers of therapeutic response in streptozotocin-induced diabetic rats. MethodsPowdered TECOSE was extracted with methanol using standard extraction procedure. Hyperglycemia was induced in rats with single intraperitoneal dose of 75 mg/kg/bwt streptozotocin. The rats were divided into five groups (n = 5): A- normal control, B- diabetic control, C, D and E were diabetic rats treated with TECOSE, metformin and insulin respectively for four weeks. Samples were collected for biochemical and hematological studies. Data obtained were analysed using One Way Analysis of Variance. ResultsPercentage blood glucose reduction was 79, 79 and 73 in TECOSE, metformin and insulin groups respectively. HBA1c level was significantly (p<0.05) raised (14.89%) in diabetic-untreated rats when compared with normal control (2.84%), TECOSE (3.47%), metformin (5.68%) and insulin (6.36%) groups. TECOSE significantly (p<0.05) reduced levels of total cholesterol, low density lipoprotein cholesterol, haptoglobin, protein carbonyl content, lactate dehydrogenase and N-acetyl-glucosaminidase activities, platelet count, percentage lymphocyte, platelet/lymphocyte ratio, while it significantly (p<0.05) raised high density lipoprotein cholesterol, total leukocyte count, percentage neutrophil, and neutrophil/lymphocyte ratio when compared with untreated rats. ConclusionThe findings concluded that TECOSE improved biomarkers of therapeutic response and disease progression in diabetic rats.

Relation between Different Types of Treatment and Glycemic Control in Diabetic Pregnant Women

Gestational diabetes mellitus (GDM) is a common medical condition associated with pregnancy. GDM is defined as hyperglycemia that is diagnosed during pregnancy and is not clearly overt diabetes that existed prior to pregnancy. The sample of the study was sixty diabetic pregnant women who came for follow up at obstetrics and gynecology department in TMC in Tripoli medical center during the year 2016. The patients divided according to the type of treatments they received into three groups; A: Patients who took Oral hypoglycemic agents (OHA), B: Patients who took insulin, C: Patents who took both drugs (OHA and insulin), Glycemic control was assessed using HBA1c level, FBS and RBS. This study shows that about 70% of the patients who took OHA had type 1 diabetes and 30% had type 2 diabetes. About 77.8% of patients who took insulin had type 2 diabetes and 22.2% had type 1 diabetes. And 73.2% of the patients who were treated with the combination of drugs had type 2 diabetes and 26.8% had type 1 diabetes. The current study demonstrates that 80% of patients who took OHA had good control, 33.3% of patients who took insulin had good control and 53.7% of patients who took both drugs had good control. Regarding the fasting blood sugar of the patients, the result illustrates the following; High level was reported in 20% of OHA group, 33.3% of insulin group and 31.7% of both drugs group. On the birth weight, the macrosomia (&gt;4kg) was more in insulin group (33.3%) than other groups (10% of OHA and 31.7% of both drugs group). GDM is a condition that should be treated and prevented, as uncontrolled GDM can affect the mother and the fetal growth.

The effect of glucose control in liver surgery on glucose kinetics and insulin resistance

Clinical outcome is negatively correlated to postoperative insulin resistance and hyperglycemia. The magnitude of insulin resistance can be modulated by glucose control, preoperative nutrition, adequate pain management and minimal invasive surgery. Effects of glucose control on perioperative glucose kinetics in liver surgery is less studied. 18 patients scheduled for open hepatectomy were studied per protocol in this prospective, randomized study. In the treatment group (n=9), insulin was administered intravenously to keep arterial blood glucose between 6 and 8mmol/l during surgery. The control group (n=9) received insulin if blood glucose >11.5mmol/l. Insulin sensitivity was measured by an insulin clamp on the day before surgery and immediately postoperatively. Glucose kinetics were assessed during the clamp and surgery. Mean intraoperative glucose was 7.0mM (SD 0.7) vs 9.1mM (SD 1.9) in the insulin and control group respectively (p<0.001; ANOVA). Insulin sensitivity decreased in both groups but significantly (p=0.03, ANOVA) more in the control group (M value: 4.6 (4.4-6.8) to 2.1 (1.2-2.6) and 4.6 (4.1-5.0) to 0.6 (0.1-1.8) mg/kg/min in the treatment and control group respectively). Endogenous glucose production (EGP) increased and glucose disposal (WGD) decreased significantly between the pre- and post-operative clamps in both groups, with no significant difference between the groups. Intraoperative kinetics demonstrated that glucose control decreased EGP (p=0.02) while WGD remained unchanged (p=0.67). Glucose control reduces postoperative insulin resistance in liver surgery. EGP increases and WGD is diminished immediately postoperatively. Insulin seems to modulate both reactions, but mostly the WGD is affected. Intraoperative EGP decreased while WGD remained unaltered. ANZCTR 12614000278639.

354-P: Interstitial Fluid Glucose as a Measure of Hypoglycemia Burden in Elderly Subjects with Type 2 Diabetes Mellitus

Background: Elderly patients with type 2 diabetes mellitus (T2DM) are at high risk of severe hypoglycemia, but evidence addressing this problem is lacking. Aims: To assess and compare the burden of exposure to low interstitial fluid glucose (IFG) in elderly subjects with tightly controlled T2DM on sulphonylurea (SU) or insulin therapy. Methods: Outpatient T2DM subjects ≥65 years of age with HbA1c ≤7.5% were recruited to wear a Freestyle Libre-Pro sensor for 2 weeks. Collected data was analyzed for low IFG burden. Results: A total of 65 subjects (35 male, 30 female), 72.0 ± 5.0 years old with diabetes duration of 21.4 ± 11.1 years and HbA1c of 6.8 ± 0.5% were recruited; 27 were insulin treated and 38 were SU treated. Patients on insulin had longer diabetes duration (25.4 ± 10.9 vs. 18.0 ± 10.4 years, p&amp;lt;0.05) and poorer kidney function (eGFR 58.6 ± 24.7 vs. 87.3 ± 48.0, p&amp;lt;0.05). Greater proportion of the insulin group performed regular capillary blood glucose (CBG) monitoring (74.1% vs. 29.7%). This group also had more monthly self reported hypoglycemic events (0.85 ± 1.70 vs. 0.14 ± 0.35, p&amp;lt;0.05) and a lower GOLD score (2.42 ± 1.72 vs. 3.73 ± 1.75, p&amp;lt;0.05). While there was no difference in mean number of low IFG events with glucose &amp;lt;72.0mg/dL between the 2 groups (0.92 ± 0.79 vs. 0.59 ± 0.48 events, p value &amp;gt;0.05), very low IFG events with glucose &amp;lt;50.0mg/dL occurred in higher proportions (52% vs. 23%, p&amp;lt;0.05), higher frequency (0.48 ± 0.70 vs. 0.16 ± 0.19 events/person, p &amp;lt;0.05) and for longer durations (1.56 ± 2.94 vs. 0.27 ± 0.43 hours/day, p&amp;lt;0.05) in the insulin group. 62.2% of the SU group and 63.0% of insulin group had at least 1 episode of very low IFG, but none of the SU group and only 2 in the insulin group reported hypoglycemic symptoms. Conclusion: Low IFG was common among the studied population, with a greater burden in insulin treated patients. Majority were unable to detect events despite regular CBG monitoring suggesting the potential use of IFG in evaluating hypoglycemia burden. Disclosure K. Tian: None. L. C. Ang: None. Y. Bee: None. S. Goh: None. M. M. Teh: None.

Comparison of adverse effects among different GLP-1 receptor agonists added to basal insulin, and between GLP-1 receptor agonists and basal insulin versus Basal-plus or basal-bolus insulin in type 2 diabetes: A meta-analysis

Diabetes mellitus type 2/ DM2/ - is increasing in incidence in United states and throughout the world mostly due to increasing Obesity epidemy- around 40 % of adult people in USA. Two are the major defects of the disease- insulin resistance which sets up the stage 4-7 years before DM type 2 is diagnosed and relative to the increased resistance insulin deficiency. After the diagnosis of DM type 2 the Insulin resistance stays usually constant while the Insulin deficiency progresses necessitating the intensification of the therapy and eventually the need of Insulin . Initially the insulin is started usually as a basal and eventually as the DM type 2- progresses we add bolus rapid acting insulin to major meal- basal plus regimen/BP/ and eventually to every meal- basal- bolus /BB/ insulin. This intensification of the therapy is frequently able to control DM type 2 , but leads to significant 3-4 kg weight gain with risk of hypoglycemia. Other option of intensification of the therapy of DM type 2 is to add to the oral anti - diabetic medications only basal Insulin and GLP1- RAs. GLP1-RAs decrease post prandial blood sugar as the rapid acting insulin does and the long acting GLP1-RAs also decrease fasting blood sugar. GLP1- RAs suppress the appetite and theoretically might lead to weight loss and less incidence of hypoglycemia compare to BP/BB Insulin regimens, because they act on glucose dependent manner- increase the endogenous insulin production only if the blood sugar is elevated . In our meta- analysis we concentrated our efforts into looking at the side effect of GLP 1- RAs and basal- Insulin combination compare to BP/BB insulin combination like weight loss/gain, incidence of hypoglycemia, adverse events- mainly the gastrointestinal ones. Our secondary end point was the change in HbA1c between GLP1-RAs and basal insulin group compare to BP/BB insulin group in patients with HbA1c 7-11%. This is the first meta- analysis as far as we now comparing those 2- combinations – BB/BP insulin to GLP1-RAs and basal insulin in the terms of looking as a primary end point at the side effects of those combinations.

Metformin improves the outcomes in Chinese invasive breast cancer patients with type 2 diabetes mellitus

Early reports indicate that metformin, a clinical drug administered to treat type 2 diabetes mellitus (T2DM), was found to be associated with a better prognosis of cancer. The objective of this study was retrospectively analyzed the effect of metformin on the outcomes of Chinese breast cancer patients with T2DM. A total of 3757 primary invasive breast cancer patients who underwent surgery from January 2010 to December 2013 were enrolled. According to the medication treatment, all the patients were divided as non-diabetes group, metformin group and insulin group. The follow-up data for disease-free survival (DFS) and overall survival (OS) were obtained from 3553 patients (median follow up of 85 months) and estimated with the Kaplan–Meier method followed by a log-rank test. Multivariate Cox proportional hazards regression model was applied. The results showed that there was a significant survival difference among non-diabetes group, metformin group and insulin group, 5-year DFS was 85.8%, 96.1%, 73.0%, and 5-year OS was 87.3%, 97.1%, 73.3% respectively (P < 0.05). Prognostic analysis showed metformin was significantly associated with better DFS and OS. Our results suggested that metformin may have a good effect on the survival of invasive breast cancer patients with T2DM.

Cord serum metabolome and birth weight in patients with gestational diabetes treated with metformin, insulin, or diet alone

IntroductionRecent research has demonstrated the benefits of metformin treatment in gestational diabetes (GDM) on short-term pregnancy outcomes (including excessive fetal growth and pre-eclampsia), but its effects on fetal metabolism remain...

Clinical and radiographic variables related to implants with simultaneous grafts among type 2 diabetic patients treated with different hypoglycemic medications: a retrospective study

BackgroundThe influence of different hypoglycemic agents on peri-implant variables among type 2 diabetes mellitus patients is still unclear. Therefore, the aim of this study was to assess the radiographic marginal bone loss and clinical parameters around implants in patients using different hypoglycemic agents.MethodsIn this retrospective cohort study, the dental implant records of type 2 diabetes mellitus patients who met the inclusion criteria were collected. The patients using only single medication as follows: insulin, metformin, or glucagon-like peptide-1 (GLP-1) drugs, were grouped according to their medication. These patients received implant placement with the same initial status, and all the prosthesis restorations were cement-retained ceramic crowns. The peri-implant marginal bone levels were evaluated by periapical radiographs immediately after implant placement and at 1 and 2-year follow-up visits. The baseline characteristics were compared among groups. The peri-implant radiographic marginal bone loss and clinical parameters were preliminarily compared using the Kruskal–Wallis test, and then the covariates were controlled by covariance analysis. Bonferroni post hoc adjustment test was performed for the multiple comparisons.ResultsAfter a review of more than 7000 medical records, a total of 150 patients with 308 implants at 1-year follow-up were assessed. The peri-implant marginal bone loss in the GLP-1 drug group was significantly smaller than the insulin group and metformin group (P < 0.01). The radiographic bone loss in the metformin group was higher than the insulin group (P < 0.05). Some of these included patients were lost to follow-up. Only 74 patients with 129 implants completed the 2-year follow-up. The radiographic bone loss in the metformin group was still higher than the insulin group (P < 0.05) and GLP-1 group (P < 0.01). There was no significant difference in the BOP (+) and the mean PD among groups (P > 0.05).ConclusionsThe radiographic variables were not exactly the same among the patients with different hypoglycemic agents at both the 1 and 2-year follow-ups. After ensuring consistency in baseline characteristics, the positive effect of GLP-1 drugs on peri-implant bone remodeling may be no less than insulin or metformin. More studies are needed to verify the direct effect of these drugs on peri-implant bone.Clinical trial registration number ChiCTR2000034211 (retrospectively registered).

Pattern of anti-diabetic treatment and its relation with glycaemic control among diabetic patients in a tertiary care hospital of Bangladesh

Background: The main determinants of diabetes management, therapeutic habits and glycaemic control are likely to differ between populations. The pharmacological armamentarium to treat hyperglycaemia in type 2 diabetes mellitus (T2DM) has changed substantially over the past few years with the development of new therapeutic agents. This study evaluated relationships between pattern of pharmacological treatment and glycaemic control in patients with T2DM.&#x0D; Methods: This cross-sectional study was carried out among 486 T2DM patients attending the endocrinology outpatient clinic of MARKS Medical College &amp; Hospital, Dhaka, Bangladesh during the period between July 2018 and June 2019. After obtaining written informed consent, both the treatment pattern and the degree of glycaemic control were estimated from T2DM patients. Glycosylated hemoglobin A1C (HbA1c) was determined by liquid chromatography. Glycaermic control categorized as fair control (HbA1c &lt;7.0%), poor control (HbA1c ³7.0%- &lt;9.0%) and very poor control (HbA1c ³9.0%).&#x0D; Results: Out of 486 participants, 65.8% were females. A total 68.1% of the patients were treated with oral antidiabetic drugs (OADs) and 31.9% were treated with both insulin and oral agents. Metformin (92.4%) was the most commonly used OAD; [p=0.01]. Over one fifth (22.1%) were taking combinations of sulfonylurea and metformin [p&lt;0.05] and 19.5% were taking combination of sulfonylurea, metformin and dipeptidyl peptidase- IV inhibitors (DPP4i); [p=0.87]. More than one fourth (25.7%) were treated with two OADs along with insulin; [p=0.05]. In this context, familiar dual OADs combination (14.2%) was metformin and DPP4 inhibitors [p=0.86]. Premixed insulin (17.1%) was the frequently used regimen among different regimen of insulin used in both OADs and insulin group [p=0.22]. More than 50% of the subjects attained fair glycaemic target of HbA1c. But 46.3% accomplished poor and very poor glycaemic control [p=0.08].&#x0D; Conclusion: The study shows that the proportion of patients treated with only oral diabetic agent was high. In most instances, they were treated with two or three drus combination therapies. The proportion of patients with fair glycaemic control was higher than reports from many countries.&#x0D; Birdem Med J 2021; 11(2): 90-96

Effect of metformin versus insulin on maternal weight gain in women with gestational diabetes mellitus: A randomized controlled clinical trial

Aim: The aim of the study was to compare maternal weight gain in gestational diabetes mellitus (GDM) treated with metformin or insulin.Materials and Methods: The study included 124 women with GDM, 62 of them treated with metformin, and 62 with insulin, from the outpatient clinic of Ain Shams University Maternity Hospital.Results: The groups were comparable in age, BMI, gestational age at time of recruitment and positive family history of diabetes. Rate of maternal weight gain per week was statistically significantly lower in the metformin group compared to the insulin group. Average rate of maternal weight gain per week was 562.7 ± 111.7 gm/week in insulin group and 453.2 ± 99.58 gm/week in metformin group.Conclusion: Metformin in women with GDM can cause less rate of maternal weight gain rather than insulin in women with GDM. While has no impact on other pregnancy maternal or neonatal outcome.

Adiponectin does not improve the prediction of insulin need in pregnant women with gestational diabetes mellitus

AimsTo evaluate the performance of adiponectin in predicting insulin need during pregnancy. MethodsCase-control analysis, nested from an ongoing prospective cohort, including 254 singleton pregnancies of women with gestational diabetes mellitus (GDM) at a tertiary teaching hospital. Patients were divided into 2 groups (DIET group and INSULIN group) and were compared regarding clinical and laboratory variables. After univariate analysis, variables that presented statistical significance or clinical relevance were included in the logistic regression. Two prediction models (INITIAL model: clinical and laboratory data available after the diagnosis of GDM; and INITIAL plus adiponectin model) were developed to evaluate their accuracy in predicting insulin need. A p value < 0.05 was considered significant. Results202 patients (79.5%) were in the DIET group and 52 (20.5%) were in the INSULIN group. Prior GDM, presence of hypertension, first trimester fasting blood glucose value, fasting and first hour values at the oral glucose tolerance test and number of abnormal results at this test were associated with insulin requirement during pregnancy. In the prediction model, adiponectin was not a predictor of insulin need. ConclusionsConsidering that the addition of adiponectin does not improve the performance of the prediction model, it might not be used as a predictor of insulin need for glycemic control during pregnancy.

Local insulin application has a dose-dependent effect on lumbar fusion in a rabbit model.

The purpose of this study was to determine if locally applied insulin has a dose-responsive effect on posterolateral lumbar fusion. Adult male New Zealand White rabbits underwent posterolateral intertransverse spinal fusions (PLFs) at L5-L6 using suboptimal amounts of autograft. Fusion sites were treated with collagen sponge soaked in saline (control, n=11), or with insulin at low (5 or 10 units, n=13), mid (20 units, n=11), and high (40 units, n=11) doses. Rabbits were euthanized at 6weeks. The L5-L6 spine segment underwent manual palpation and radiographic evaluation performed by two fellowship trained spine surgeons blinded to treatment. Differences between groups were evaluated by analysis of variance on ranks followed by post-hoc Dunn's tests. Forty-three rabbits were euthanized at the planned 6weeks endpoint, while three died or were euthanized prior to the endpoint. Radiographic evaluation found bilateral solid fusion in 10%, 31%, 60%, and 60% of the rabbits from the control and low, mid, and high-dose insulin-treated groups, respectively (p<0.05). As per manual palpation, 7 of 10 rabbits in the mid-dose insulin group were fused as compared to 1 of 10 rabbits in the control group (p<0.05). This study demonstrates that insulin enhanced the effectiveness of autograft to increase fusion success in the rabbit PLF model. The study indicates that insulin or insulin-mimetic compounds can be used to promote bone regeneration.

(Ultra-)long-acting insulin analogues for people with type 1 diabetes mellitus.

(Ultra-)long-acting insulin analogues for people with type 1 diabetes mellitus.

A Cross-Sectional Study on Ultrasonographic Measurements of Parotid Glands in Type 2 Diabetes Mellitus.

Background Diabetes mellitus is a metabolic disease which is seen increasing globally and is diagnosed and monitored on basis of invasive blood investigations. Salivary glands are affected in diabetes mellitus. The objective of this study was to assess ultrasonographic measurements of parotid glands and correlate with the glycosylated hemoglobin levels in type 2 diabetic mellitus and duration of type 2 diabetic mellitus and treatment regimens. Materials and Methods This study was conducted on 50 subjects of type 2 diabetes mellitus and on 50 healthy controls. After HbA1C analysis of selected individuals, 100 individuals were grouped into group I (above 5.7) and group II (below 5.7). Ultrasonographic measurements (length (L), transverse dimension (TD), depth lateral to the mandible (DLM), and depth dorsal to the mandible (DDM)) of bilateral parotid glands were calculated. Statistical analysis was done using the chi-square test of significance and Spearman correlation coefficients. Results On correlation with measurement of right (L, DLM, DDM) and left (TD, DLM, DDM) of parotid glands with duration of type 2 diabetes mellitus, we found a moderate positive relationship, whereas as for right (TD) and left (L), we found a low-positive relationship. Similarly, for right (L, TD, DLM, DDM) and left (TD, DDM) parotid glands with HbA1C, we found a low-positive relationship, whereas for left parotid gland (L, DLM) with HbA1C, we found a moderate positive relationship. The mean DLM of right and left parotids in the insulin group was found to be slightly more than that in the combined group which was statistically insignificant. Conclusion Ultrasonographic measurements of parotid glands were found to be higher in study subjects as compared to control subjects, and they increased with increased HbA1C levels; also, there was no difference in treatment regimen. Ultrasonography could be a prospective diagnostic test for detection and monitoring of diabetes mellitus, and still further studies are required for this.

Neonatal outcomes in case of euglycemic control in gestational diabetes using insulin versus metformin. Randomized controlled trial

Background: Gestational diabetes mellitus (GDM) is a major global public health issue, with prevalence increasing in recent years due to the epidemic of obesity and type 2 diabetes. Aim of the Work: to compare different neonatal outcomes according to the different treatment modalities used in the management of GDM. Our hypothesis was that Metformin is as effective and safe as insulin in patients with gestational diabetes. Patients and Methods: The current non inferiority-Randomized controlled trial was conducted at Ain Shams Maternity hospital between June 2020 to February 2021. The study included 140 outpatient cases or admitted patients for antenatal care: Group A: women were given Metformin (Total 70) and Group B: Women were given insulin. (Total 70). Results: there was no significant difference between Metformin and Insulin groups regarding age, enrollment BMI, parity and family history of DM. There was no significant difference between Metformin and Insulin groups regarding gestational age at enrollment and delivery as well as pregnancy duration after intervention. BMI at delivery, BMI increase as well as BMI increase rate were significantly lower in Metformin group. There were no significant differences between Metformin and Insulin groups regarding fasting, two-hour postprandial and HbA1c blood glucose at enrollment and throughout treatment as well as their reduction after intervention. Maternal complications as hypoglycemia, hyperglycemia and preeclampsia were non-significantly less frequent among Metformin group than among Insulin group. Compliance to treatment was significantly more frequent among Metformin group than among Insulin group. Cesarean delivery was non­significantly less frequent among Metformin group than among Insulin group. There was no significant difference between Metformin and Insulin regarding birth weight APGAR-1, but APGAR-5 was significantly higher in Metformin group. Neonatal complications as IUFD, IUGR, macrosomia, congenital anomalies, neonatal hypoglycemia, respiratory distress and NICU admission were non-significantly less frequent among Metformin group. Conclusions: From the results of current study we can conclude that: Oral metformin was effective as insulin injection in control and management of GDM. BMI was controlled with oral metformin better than insulin injection. Maternal and neonatal complications specially birth weight were the same with both types of treatment. Women had better compliance to metformin treatment. Type of delivery wasn’t affected by type of treatment.

Repeated Preoperative Intranasal Administration of Insulin Decreases the Incidence of Postoperative Delirium in Elderly Patients Undergoing Laparoscopic Radical Gastrointestinal Surgery: A Randomized, Placebo-Controlled, Double-Blinded Clinical Study

Study ObjectivesThis study aimed to investigate the effects of repeated preoperative intranasal administration of insulin on the incidence of postoperative delirium (POD) and the levels of serum pro-inflammatory markers in elderly patients undergoing laparoscopic radical gastrointestinal surgery. DesignProspective, randomized, double-blinded, placebo-controlled clinical study. SettingGeneral Hospital of Western Theater Command from August 2019 to December 2019. PatientsNinety elderly patients underwent laparoscopic radical gastrointestinal tumor resections under general anesthesia. InterventionsPatients were randomly divided into a control group (0.5 mL saline administered intranasally) or an insulin group (20 U/0.5 mL insulin administered intranasally) for 2 days prior to surgery, with 45 patients in each group. MeasurementsThe incidence of delirium was measured at postoperative day 1 (T2), day 3 (T3), and day 5 (T4) using the Confusion Assessment Method for the intensive care unit (CAM-ICU). Plasma levels of interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α were measured at T0 (before insulin or saline administration), T1 (at the end of surgery), T2, T3, and T4 by enzyme-linked immunosorbent assay. Main ResultsCompared with the control group, the insulin group demonstrated a decreased POD incidence (12.5% vs. 47.5%, p = 0.001) within 5 days after surgery. The incidence of POD was significantly lower in the Ins group than in the Con group at T2 (12.5% vs. 32.5%, p = 0.032) and at T3 (2.5% vs. 20%, p = 0.034). The incidence of POD decreased in both groups over time and was similar at T4 (0% vs 10%, p = 0.116). Compared with the baseline value at T0, serum TNF-α, IL-6 and IL-1β concentrations increased significantly at T1-4 (p <0.05). Compared with the control group at the same time point, the expression levels of TNF-α, IL-6 and IL-1β in group I at T2 and T3 were significantly reduced (p <0.05). The incidence rates of adverse events were similar in the two groups. ConclusionsRepeated preoperative intranasal administration of insulin prevented the occurrence of delirium after laparoscopic radical gastrointestinal surgery in elderly patients and reduced TNF-α, IL-1β, and IL-6 levels.

Evaluation of Dipeptidyl Peptidase-IV Inhibitor Use in Hospitalized Patients With Diabetes.

Glycemic control within goal blood glucose (BG) ranges is essential to minimize hospital complications for patients with type 2 diabetes mellitus (T2DM). Optimal treatment in the non-intensive care unit (ICU) setting includes a basal insulin containing regimen. Dipeptidyl peptidase-IV (DPP-IV) inhibitors have minimal hypoglycemia incidence and may be an appropriate bolus insulin replacement in the inpatient setting. To determine the effect of basal insulin plus DPP-IV inhibitor compared with basal plus bolus insulin in hospitalized patients with T2DM. This multicenter cohort study included adult patients with T2DM admitted to the non-ICU setting and prescribed either basal insulin plus DPP-IV inhibitor or basal plus bolus insulin. Propensity-score matching was performed for age, sex, Charlson Comorbidity Index, first BG reading during hospitalization, and hemoglobin A1C (A1C). The primary outcome was the difference in mean daily BG during hospitalization. Secondary outcomes included hospital length of stay (LOS), total daily dose (TDD) of insulin, hypoglycemic events, and mean daily BG in patients with an A1C >8%. A total of 105 patients were included in each group. Mean daily BG during hospitalization was lower in the basal insulin plus DPP-IV inhibitor group (199.3 ± 52.5 vs 213.6 ± 45.8 mg/dL; P = 0.04). There was a significant difference in hospital LOS (5 [interquartile range = 3-8] vs 6 [4-11] days; P = 0.02) and short-acting insulin TDD (11.6 ± 9.1 vs 20.5 ± 21.2 units; P < 0.001). No differences were observed in basal insulin TDD and hypoglycemia. There was no difference in mean daily BG in the subgroup analysis of patients with a A1C >8%. A significant difference in mean daily BG and hospital LOS was found with a basal insulin plus DPP-IV inhibitor regimen. Use of a DPP-IV inhibitor to replace bolus insulin in hospitalized patients with T2DM should be considered.