Lack Of Glycemic Control Research Articles

Lack of glycemic control in type two diabetes mellitus patients is associated with reduced serum epidermal growth factor level and increased insulin resistance.

The prevalence of type 2 diabetes mellitus (T2DM) is steadily increasing worldwide in an alarming fashion. Importantly, poor glycemic control is associated with development of various health sequalae's due to glucolipotoxicity, oxidative stress and increased inflammatory cytokines. The aim of the present study was to examine the effect of glycemic control on the relative abundance of inflammatory markers in patients with controlled and uncontrolled T2DM, and to test their association with the glycemic status in diabetic patients in Jordan. An observational cross-sectional study design was used. Patients with T2DM with controlled diabetes [glycated hemoglobin (HbA1c) ≤7.0%, n=110] and age-, sex- and body mass index (BMI)-matched uncontrolled diabetic patients (HbA1c >7.0%, n=105) were recruited. An antibody membrane array was used to examine the relative abundance of inflammatory cytokines and growth factors in the sera of the study subjects, followed by enzyme-linked immunosorbent assay (ELISA) to confirm the results. Fasting blood glucose, serum insulin, triglyceride and homeostatic model assessment for insulin resistance (HOMA-IR) score were significantly elevated in the uncontrolled T2DM group (P<0.05). Antibody membrane array showed that serum epidermal growth factor (EGF) is significantly decreased in the uncontrolled T2DM group, and this was confirmed by ELISA (158.77±111.7 vs. 95.9±82.7 pg/ml, P=0.002). The binary logistic model was used to predict the likelihood of being uncontrolled diabetic based on EGF levels. After controlling for age, sex and BMI, EGF was statistically associated with diabetes control, where lower EGF levels predicted uncontrolled diabetes. Additionally, Pearson's product-moment correlation showed a statistically significant negative correlation between EGF and HbA1c (r=-0.25, P<0.0001), and a positive correlation between HOMA-IR and HbA1c, (r=0.32, P<0.0001). The current data identify a novel link between serum EGF levels and the status of HbA1c indicative of diabetic control.

Factors Affecting Glycemic Control in Patients with Type 2 Diabetes in Kalasin Province, Thailand: An Analytical Cross-Sectional Study

Background: Optimal glycemic management is critical since it can predict all associated essential causes of death, even after accounting for other risk factors. Objectives: This study investigated the factors associated with glycemic control in patients with type 2 diabetes mellitus (T2DM), particularly self-care behaviors. Methods: An analytical cross-sectional study examined 385 patients with T2DM in 1 general and 17 community hospitals in Kalasin Province. The samples were collected using mixed-method sampling. Data were collected using a validated questionnaire with six parts and laboratory examination records between September 2021 and December 2022. Descriptive statistics (e.g., percentages and means ± SD) were used to analyze the data. The relationship between relevant factors and lack of glycemic control was analyzed by multivariate logistic regression using SPSS version 25. Results: Results showed that most patients were female (78.18%), and the mean age was 59.84 ± 9.05 years. Additionally, a significant proportion of the patients (79.74%) had poor glycemic control. Several factors are significantly associated with poor glycemic control in patients with T2DM. These factors included subjects under the age of 60 years (OR = 2.95, 95% CI: 1.57 to 5.54; p-value &lt; 0.001), a diabetes duration of over 10 years (OR = 3.95, 95% CI: 1.90 to 8.22; p-value &lt; 0.001), poor knowledge about diabetes (OR = 3.92, 95% CI: 1.59 to 9.67; p-value &lt; 0.003), and inadequate self-care behaviors (OR = 6.12, 95% CI: 3.20 to 11.68; p-value &lt; 0.001). Conclusions: In conclusion, proper interventions for controlling glycemic level behaviors are necessary to improve proper self-care behaviors in patients who have a low knowledge level of T2DM, have had diabetes for over ten years, and are aged &lt; 60 years. This approach can reduce the likelihood of experiencing disabilities and economic hardship.

Evaluation of Vascular Complication and Lack of Glycemic Control as Factors in the Development of Ovarian Cancer in Female Nigerian Type 2 Diabetic Population

Evaluation of Vascular Complication and Lack of Glycemic Control as Factors in the Development of Ovarian Cancer in Female Nigerian Type 2 Diabetic Population

Leptin and the rs2167270 Polymorphism Are Associated with Glycemic Control in Type Two Diabetes Mellitus Patients on Metformin Therapy.

Background and Objectives: Type two diabetes mellitus (T2DM) is a chronic disease with debilitating complications and high mortality. Evidence indicates that good glycemic control delays disease progression and is hence a target of disease management protocols. Nonetheless, some patients cannot maintain glycemic control. This study aimed to investigate the association between serum leptin levels and several SNPs of the LEP gene with the lack of glycemic control in T2DM patients on metformin therapy. Materials and Methods: In a hospital-based case-control study, 170 patients with poor glycemic control and 170 patients with good glycemic control were recruited. Serum leptin was measured. Patients were genotyped for three SNPs in the LEP gene (rs7799039, rs2167270, and rs791620). Results: Serum leptin was significantly lower in T2DM patients with poor glycemic control (p < 0.05). In multivariate analysis, serum leptin levels significantly lowered the risk of having poor glycemic control (OR = 0.985; CI: 0.976-0.994; p = 0.002); moreover, the GA genotype of rs2167270 was protective against poor glycemic control compared to the GG genotype (OR = 0.417; CI: 0.245-0.712; p = 0.001). Conclusions: Higher serum leptin and the GA genotype of the rs2167270 SNP of the LEP gene were associated with good glycemic control in T2DM patients on metformin therapy. Further studies with a larger sample size from multiple institutions are required to validate the findings.

Poor quality of sleep in Mexican patients with type 2 diabetes and its association with lack of glycemic control

AimsTo determine the association between sleep quality and lack of glycemic control in a Mexican population of type 2 diabetes patients. MethodsCross-sectional study. Two hundred two patients between 20 and 60 years old with a previous diagnosis of diabetes were included. Sleep quality was assessed with the Pittsburgh Sleep Quality Index and lack of glycemic control as a glycated hemoglobin A1c level ≥ 7 %. Univariate and multivariate analyses using logistic regression were performed. ResultsThe study population showed poor sleep quality and a lack of glycemic control of 70.3 % and 69.8 %, respectively. The prevalence of patients with both conditions was 52.5 %. In multivariate analysis, poor sleep quality was significantly associated with a lack of glycemic control (OR = 2.3, p = 0.030). Other associated variables were napping (p = 0.015), diabetes duration (p = 0.011), insulin use (p = 0.024), and diastolic blood pressure ≥ 85 mmHg (p = 0.029). ConclusionsThe prevalence of lack of glycemic control in the study population is high. Poor sleep quality significantly doubles the risk of lack of glycemic control, even in the presence of other risk factors.

Single Nucleotide Polymorphism in the ADIPOQ Gene Modifies Adiponectin Levels and Glycemic Control in Type Two Diabetes Mellitus Patients.

Diabetes mellitus (DM) is the ninth leading cause of death worldwide. Mortality from DM is largely attributed to disease complications. Glycemic control of DM patients reduces mortality. Studies indicated that the lack of glycemic control in DM patients could be influenced by the genetic background of the patients. Evidence suggests that adiponectin levels are dysregulated in DM patients with poor glycemic control. Serum adiponectin level is a heritable trait influenced by single nucleotide polymorphisms (SNPs) in the ADIPOQ gene. It is hypothesized that SNPs in ADIPOQ could modify glycemic control in DM patients. To test this hypothesis, 375 type 2 DM (T2DM) patients were recruited. Patients were classified into good vs. poor glycemic control according to hemoglobin A1c levels. Study subjects were genotyped for variations of four SNPs in ADIPOQ (rs17300539, rs266729, rs2241766, and rs1501299). Adiponectin levels were measured from the serum. Our analysis showed that reduced serum adiponectin, a longer duration of treatment, and increased insulin resistance were all significant predictors of poor glycemic control. Moreover, the T allele and the TT genotype of rs2241766 were significantly more frequent in patients with poor glycemic control (P < 0.05). Individuals with the TT genotype of rs2241766 had significantly lower levels of serum adiponectin (P < 0.05). It was concluded that lower levels of serum adiponectin and the T allele of rs2241766 SNP in ADIPOQ were associated with poor glycemic control in T2DM patients.

Latent M.tuberculosis infection is associated with increased inflammatory cytokine and decreased suppressor of cytokine signalling (SOCS)-3 in the diabetic host.

Tuberculosis (TB) outcomes are worsened by type II diabetes mellitus (DM). Protective immunity against Mycobacterium tuberculosis (MTB) is driven by cytokines. Latent TB (LTBi) is common but its effect on the diabetic host is not well understood. We investigated mycobacterial antigen-stimulated responses in peripheral blood mononuclear cell (PBMC) isolated from healthy endemic controls (EC), those with LTBi, DM groups with and without LTBi, as compared with TB patients. Cytokines were measured using a Luminex-based assay. Gene expression was determined by RT-PCR. In DM-LTBi cases, PPD-stimulated proinflammatory cytokines; IFN-γ, IL-6, IL-2, TNF-α and GM-CSF and anti-inflammatory cytokines, IL-5 and IL-13 were raised as compared with EC. DM-LTBi PPD-stimulated IFN-γ, IL-6 and TNF-α mRNA titres were found raised in DM-LTBi, whilst suppressor of cytokine signalling (SOCS)-3 expression was lowered. Within DM cases, stratification based on HbA1c levels revealed raised IFN-γ but lowered IL-6 gene expression in those with controlled levels as compared with uncontrolled glycaemic levels. Further, SOCS1 expression levels were found higher in DM cases with controlled glycaemia when compared with EC. Overall, we show that diabetics with LTBi manifest raised levels of inflammatory and anti-inflammatory cytokines concomitant with reduced SOCS3 mRNA expression. Reduced glycaemic control results in further inflammatory dysregulation impacting conversing impacting IFN-γ and IL-6 activation. These results suggest that dysregulated immune activation in diabetes is exacerbated by LTBi, lack of glycaemic control may further compromise immunity against MTB infection.

Social Distancing, Physical Activity, and COVID-19: Implications for Type 1 Diabetes Mellitus in Brazil.

A lack of glycemic control and diabetes are risk factors for complications related to COVID-19, and social isolation can hinder adherence to physical activity. Thus, this study sought to assess the impacts of social distancing on the practice of physical activity of individuals with type 1 diabetes mellitus (T1DM). This was a transversal study carried out using an online form to collect sociodemographic, practice of physical activity, and social distancing data. Of the 472 participants, 85.6% reported that they were respecting the steps of social distancing. Social distancing affected the practice of physical activity in adherence to the habit of practicing in frequency, duration, and perception of change in intensity. An association was found between noticing a lot of stress in the home environment and stopping physical activity; lower levels of tolerance to social distancing were associated with less physical activity, and maintaining the habit of practicing physical activity was associated with decreasing the intensity of the practice. Hence, social distancing harmed the practice of physical activity as part of the treatment of individuals with T1DM, both in the habit of practicing and in the characteristics of these practices of physical activity, such as frequency, duration, and intensity.

The Influence of Knowledge, Lifestyle and Culture on the Incidence of Tuberculosis A Literature Review

Background: TB is a public health problem whose incidence is still high in Timor Leste. TB is an infectiousdisease which is one of the leading causes of death in the world caused by an infectious agent Mycobacteriumtuberculosis. The purpose of this study was to review scientific articles focusing on the Influence ofKnowledge, Lifestyle and Culture on the Incidence of Tuberculosis. Method: The method used was aliterature review. Articles used as literature review materials came from SagePub, BMC Public Health,Elsevier, Google Scholar, Pubmed, Proquest and others. The articles were selected based on the researchfocus, which was the Influence of Knowledge, Lifestyle and Culture on the Incidence of Tuberculosis.Results and Conclusions: Knowledge is very important in TB control efforts. Good knowledge needs to befollowed by a good perception. Such knowledge is not only for the TB patients but also for the families andhealth workers. Lifestyles that are very risky to increase health vulnerability in TB patients are smoking,drinking alcohol, using illegal drugs, inadequate consumption, living in a slum environment, lack of airventilation, lack of exercise, lack of sleep, urban life, lack of glycemic control, sugar consumption, andliving with TB patients. Cultural influences include inter-racial disparities, culture of seeking local treatmentor not going to health facilities, delay in initial screening, TB sputum examination, lack of PPE, poor localTB surveillance, traditional medicine, stigma and culture carried by

Characteristics and Comorbidities at Start of Tuberculosis Treatment in Three Regions of the Philippines: The St-ATT Cohort

Background: Diabetes and undernutrition are common risk factors for tuberculosis (TB), associated with poor treatment outcomes and exacerbated by TB. Here we describe the characteristics and non-communicable multimorbidity (co-occurrence of 2 or more medical conditions) in Filipino adults at the time of initiating a new TB treatment regimen enrolled into the Starting Anti-TB Treatment (St-ATT) Cohort. Methods and Findings: Nine-hundred participants (69.6% male) were enrolled from 13 public health facilities in Metro Manila (N=184), Negros Occidental (N=372) and Cebu (N=344) within 5 days of starting treatment including 133 (14.8%) initiating the 9 month WHO shorter treatment regimen for multi-drug resistant TB (MDR-TB). Diabetes was defined as HbA1c ≥6.5% and/or current diabetes medication; hypertension as systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg and/or current anti-hypertensive medication, anaemia as haemoglobin <11 g/dl and moderate/severe undernutrition as body-mass-index <17 kg/m2. The most common comorbidities were moderate/severe undernutrition 23.4% (210/899), diabetes 22.5% (199/881), hypertension 19.0% (164/864) and moderate/severe anaemia 13.5% (121/899). Fifty-eight percent had ≥1 of these comorbid conditions (496/847), with 17.1% having ≥2; the most common combination being diabetes and hypertension (N=57, 6.7%). Just over half of diabetes (54.8%) and hypertension (54.9%) was previously undiagnosed, and lack of glycemic control (HbA1c<8.0%) was common in those already on medication (N=50/73, 68.5%). MDR-TB treatment was associated with increased odds of diabetes (Adjusted odds ratio (AOR) = 2.48, 95% CI: 1.55-3.95); but decreased odds of hypertension (AOR=0.55, 95% CI: 0.39-0.78). HIV infection was only associated with anaemia (AOR=4.51, 95% CI: 1.01-20.1). Previous TB treatment was associated with moderate/severe undernutrition (AOR = 1.98, 95% CI: 1.40-2.80), as was increased duration of TB-symptoms before starting treatment and household food insecurity. No associations for sex, alcohol or tobacco use were observed. MDR-TB treatment was marginally associated with having ≥2 comorbidities (OR = 1.52, 95% CI: 0.97-2.39). Conclusions: TB treatment programmes need to consider planning for a large proportion of persons requiring diagnosis and management of comorbidities with the potential to adversely affect TB treatment outcomes and quality of life. Of the conditions examined here, dietary advice and nutritional management are considered usual components of comprehensive care.

Factores fisiológicos, función y disfunción sexual en mujeres con diabetes tipo 2

El objetivo de este estudio fue determinar la relación que existe entre los valores de HbA1c, el tiempo de padecer diabetes, la edad, el índice de masa corporal (IMC), los niveles de triglicéridos, el colesterol y la tensión arterial (TA) con la función y disfunción sexual en mujeres con diabetes mellitus tipo 2 (DM2). El diseño fue descriptivo, correlacional y transversal. El muestreo fue no probabilístico, 113 mujeres con DM2 y vida sexual activa. Se aplicó una cédula de datos personales, el índice de función sexual femenina (Rosen et al., 2000), los dispositivos A1cNOW+ y Cardiochek se utilizaron una báscula con estadiómetro así como un baumanómetro de mercurio. Se encontró un alto porcentaje de mujeres con obesidad y descontrol glucémico, además de una relación negativa de la edad con la disfunción sexual femenina (rs = -0.237; p = 0.01). En el grupo de mujeres que presentaron disfunción sexual se halló relación de la edad con las etapas de deseo (R2 = 6.3%; F[89] = 4.31; p = 0.01), excitación (R2 = 7.6%; F[89] = 7.12; p = 0.00) y lubricación (R2 = 12.5%; F[89] = 12.38; p = 0.01). Los resultados contribuyen a robustecer el conocimiento científico sobre la sexualidad femenina ante un estado de enfermedad crónica

Regional differences in the management of cardiovascular risk factors among adults with diabetes: An evaluation of the Diabetes Collaborative Registry

AimsTo compare cardiovascular risk factor control in adults with diabetes participating in a national diabetes registry to those in the general population and to ascertain regional differences in diabetes care. MethodsAdults with diagnosed diabetes in the Diabetes Collaborative Registry (DCR) were compared with those in the National Health and Nutrition Examination Survey (NHANES) from 2015 to 2016; standardized mean difference (SMD) > 0.2 defined significance. Regional differences were assessed in the DCR cohort; p < .05 defined significance. ResultsThe DCR cohort was older (61 vs. 57 years, SMD = 0.38), more insured (99.7% vs. 91.0%, SMD = 0.42), and less ethnically diverse (83% non-Hispanic white vs. 76%, SMD = 0.30) compared with NHANES. The proportion of overweight/obesity, A1c < 7% (<53 mmol/mol), and BP < 140/90 were similar, but DCR participants had higher proportion with LDL < 2.59 mmol/L (61% vs. 41%, SMD = 0.39) and fewer tobacco users (17% vs. 32%, SMD = 0.35). Regionally, obesity, lack of glycaemic control, and tobacco use were highest in the Midwest, BP control was the lowest in the South, and LDL control was lowest in the Northeast. ConclusionsSignificant regional differences in diabetes care delivery and outcomes were identified using a national diabetes registry. Serial analyses of the DCR may supplement national evaluations to deepen our understanding of diabetes care in the US.

Hyperglycemia: the metabolic syndrome component that aggravates erectile dysfunction in Mexican patients

&#x0D; Objectives: To analyze the relationship between erectile dysfunction and metabolic syndrome in a group of Mexican patients, study the influence of other morbidity factors on erectile dysfunction, and define the specific metabolic syndrome components most associated with erectile dysfunction severity.&#x0D; Materials and methods: A descriptive, cross-sectional study was conducted on a group of 86 adult Mexican patients previously diagnosed with erectile dysfunction. Participants were classified as presenting with or not presenting with metabolic syndrome. Anthropometric, biochemical, and clinical parameters were determined and erectile dysfunction severity, alcohol or tobacco consumption, and depressive behavior were identified through validated questionnaires. The results were compared between the two groups.&#x0D; Results: The anthropometric measures, laboratory values, and clinical characteristics were significantly different between the two groups. More patients with severe and moderate erectile dysfunction were identified in the group with metabolic syndrome. Of the metabolic syndrome components, glycated hemoglobin &gt;5.7% and fasting glucose &gt;110 mg/dl were significantly associated with the development of erectile dysfunction.&#x0D; Limitations: The size of our study sample was a limitation, as was the observational and cross-sectional study design.&#x0D; Originality: Our study results suggest that metabolic syndrome contributed to the progression of erectile dysfunction in the Mexican sample analyzed, with hyperglycemia being the most strongly associated factor.&#x0D; Conclusions: Metabolic syndrome components were shown to aggravate erectile dysfunction, particularly the lack of glycemic control. The inclusion of fasting glucose and glycated hemoglobin as complementary biochemical screening in patients with erectile dysfunction should be assessed.

Hyperglycemia: the metabolic syndrome component that aggravates erectile dysfunction in Mexican patients

&#x0D; Objectives: To analyze the relationship between erectile dysfunction and metabolic syndrome in a group of Mexican patients, study the influence of other morbidity factors on erectile dysfunction, and define the specific metabolic syndrome components most associated with erectile dysfunction severity.&#x0D; Materials and methods: A descriptive, cross-sectional study was conducted on a group of 86 adult Mexican patients previously diagnosed with erectile dysfunction. Participants were classified as presenting with or not presenting with metabolic syndrome. Anthropometric, biochemical, and clinical parameters were determined and erectile dysfunction severity, alcohol or tobacco consumption, and depressive behavior were identified through validated questionnaires. The results were compared between the two groups.&#x0D; Results: The anthropometric measures, laboratory values, and clinical characteristics were significantly different between the two groups. More patients with severe and moderate erectile dysfunction were identified in the group with metabolic syndrome. Of the metabolic syndrome components, glycated hemoglobin &gt;5.7% and fasting glucose &gt;110 mg/dl were significantly associated with the development of erectile dysfunction.&#x0D; Limitations: The size of our study sample was a limitation, as was the observational and cross-sectional study design.&#x0D; Originality: Our study results suggest that metabolic syndrome contributed to the progression of erectile dysfunction in the Mexican sample analyzed, with hyperglycemia being the most strongly associated factor.&#x0D; Conclusions: Metabolic syndrome components were shown to aggravate erectile dysfunction, particularly the lack of glycemic control. The inclusion of fasting glucose and glycated hemoglobin as complementary biochemical screening in patients with erectile dysfunction should be assessed.

The impact of modifiable risk factors on the long-term outcomes of non-alcoholic fatty liver disease.

Cardiovascular (CV) disease is the leading cause of mortality in patients with non-alcoholic fatty liver disease (NAFLD). The American Heart Association (AHA) developed 7 CV health metrics (poor, intermediate and ideal health) to improve CV health. To assess population-attributable fractions (PAFs) of CV health metrics to all-cause and CV mortality among NAFLD patients METHODS: We included adult participants from National Health and Nutrition Examination Survey (NHANES 1988-1994) with clinical and mortality data. NAFLD was defined as the presence of hepatic steatosis on ultrasonography in the absence of other chronic liver diseases and excessive alcohol use. A total of 4040 adults with NAFLD and 7515 without were included. NAFLD had fewer ideal health metrics than non-NAFLD (age-standardised prevalence: 20% vs 10% for ≤1 ideal health metric; 5.1% vs 8.7% for ≥6, all P<.001). Following median follow-up of 19.2years (IQR: 17.5-21.0years), 1,136 NAFLD subjects (327 CV deaths) and 1600 non-NAFLD subjects (447 CV deaths) died. Increased number of ideal health metrics (all trend P<.0001) correlated with lower risk for all-cause and CV mortality. If all NAFLD subjects achieved 7 ideal health metrics, 66% of all-cause deaths and 83% of CV deaths were preventable. Among NAFLD subjects, lack of glycaemic control (adjusted PAF=28.3% all-cause; 38.1% CV) and hypertension (adjusted PAF of 23% all-cause; 52.8% CV) were the largest mortality contributors. Ideal physical activity level obtainment provided an adjusted PAF=13.9% all-cause and 13.8% CV mortality. Attainment of ideal CV health metrics provides protection against all-cause and CV deaths in NAFLD.

OR14-3 The Association of Glycemic Control and Glycemic Variability with Treatment Patterns and Diabetes-Related Events in the Adult Patients (Pts) with Type 1 Diabetes (T1D): Results from the T1D Exchange Clinic Registry

This cross-sectional analysis evaluated the association of A1C control/variability with treatment patterns and outcomes in adult pts with T1D.The association of A1C control (categorized into <7.0%; 7.0-8.0%; 8.0-9.0%; and ≥9.0%) and variability (defined as intrapersonal mean [M] and adjusted standard deviation [SD] of A1C values, categorized into low M/low SD = low; low M/high SD = medium; high M/low SD = high; and high M/high SD = very high) with pt characteristics, treatment patterns, and diabetes-related events (e.g. diabetic ketoacidosis [DKA], hypoglycemia, and comorbidities) were evaluated using T1D Exchange Clinic Registry data (05-01-2016 to 07-31-2017). Pts were required to have A1C values and key outcomes at exam, and ≥4 A1C values measured within 1 year from exam date for A1C variability analysis. Pts with a history of pancreas or islet cell transplant or currently pregnant were excluded. The association between A1C control/variability and diabetes-related outcomes were evaluated using multiple logistic regression adjusting for covariates.8331 and 2466 pts were included for A1C control and A1C variability analysis, respectively. The majority of the adult T1D pts did not achieve A1C<7.0% (78% pts had A1C≥7.0%) and had increased A1C variability (65% pts in medium to very high groups).Compared with the A1C<7.0% group, pts in the A1C≥9.0% group were significantly younger (29 vs 43 years) and with significantly shorter T1D duration (16 vs 25 years); both p<0.001. Ethnic minorities, lower socioeconomic status, being single, and smoking were also associated with poor A1C control; all p<0.001. Pts on pump or other adjunctive treatment (non-insulin injection, statin use, continuous glucose monitoring [CGM] use) were more likely to have better A1C control (all p<0.001). Poor A1C control (≥9.0%) was significantly associated with greater risk for DKA (adjusted odds ratio [aOR] of 5.7 for the A1C≥9.0% group vs <7.0%), retinopathy (aOR 2.5), neuropathy (aOR 1.8), micro nephropathy (aOR 1.9), and renal disease (aOR 1.9); all p<0.01.Similar associations were observed between A1C variability and pt demographics and disease duration. Pts on pump, statin use, or CGM use were more likely to have low A1C variability; all p<0.001. The very high A1C variability group (high M/high SD) was significantly associated with greater risk for DKA (aOR of 13.5 vs the low A1C variability group), severe hypoglycemia (aOR 4.8), neuropathy (aOR 2.2), micro nephropathy (aOR 2.3), and renal disease (aOR 2.8); all p<0.05.Lack of glycemic control and stability are associated with younger age, shorter disease duration, ethnic minorities, and low socioeconomic status. This study confirms the previously established association between glycemic control and diabetes-related complications and highlights the association of glycemic variability across both acute and long-term diabetes-related complications.

Baja saturación de oxígeno como factor de riesgo para desarrollar pie diabético

&lt;p&gt;&lt;strong&gt;Objetivo:&lt;/strong&gt; evaluar la saturación de oxígeno en extremidades pélvicas de acuerdo con la presencia de pie diabético en pacientes con diabetes mellitus tipo 2 (dm2). &lt;strong&gt;Métodos:&lt;/strong&gt; estudio transversal analítico. Se incluyeron pacientes con dm2 de más de cinco años de evolución, de 20 a 80 años de edad que acudieron a la Unidad de Medicina Familiar (umf) no. 28, en la Ciudad de México. Para estadificar la severidad del pie diabético se utilizó la clasificación de Meggit-Wagner, se consideró la presencia de pie diabético en pacientes de grados 1 a 3. Mediante oximetría de pulso se determinó el valor de saturación de oxígeno (SpO2) en extremidades pélvicas. Se evaluaron otras variables como atrofia y resequedad en la piel, antecedente de hipertensión arterial, índice de masa corporal (imc) y descontrol glucémico. Se realizó prueba de &lt;span&gt;χ&lt;/span&gt;2 para diferencia de proporcionesy U de Mann-Whitney para diferencia de medianas. Para conocer los factores de riesgo asociados a pie diabético se realizó un modelo de regresión logística. &lt;strong&gt;Resultados: &lt;/strong&gt;se incluyó un total de 126 pacientes,&lt;strong&gt; &lt;/strong&gt;23% presentó pie diabético (n=29), de los cuales, 90% presentó Meggit-Wagner grado 1 (n=26) y 10% Wagner grado 3 (n=3). Los pacientes con pie diabético mostraron una mediana de SpO2 90% en comparación con una SpO2 95% en los pacientes sin pie diabético (p&amp;lt;0.001). En el modelo multivariado, la SpO2 &amp;lt;90% mostró un or 10.5 (ic 95% 2.6, 41.6). Las variables de atrofia y resequedad de piel y antecedente de hipertensión arterial también fueron factores de riesgo para desarrollar pie diabético. &lt;strong&gt;Conclusión:&lt;/strong&gt; los pacientes con pie diabético mostraron menor SpO2. Un nivel de saturación menor a 90% es un factor de riesgo independiente de otros factores para el desarrollo de pie diabético.&lt;/p&gt;

Early Neuronal Inflammation May Be a Contributing Factor to Changes in Epidermal Innervation Associated with Neuropathy in Prediabetic Mice

Neuropathy, a crippling diabetic complication, was initially purported to result from lack of glycemic control. However, recent research has linked neuropathy to obesity in individuals without diabetes. Furthermore, evidence indicates mice show signs of neuropathy after high fat feeding. However, the pathogenesis of neuropathy induced by a high fat diet is still unknown.PURPOSEThe purpose of this study was to determine if early neuronal inflammation is a contributing factor to changes in epidermal innervation and mechanical hypersensitivity associated with neuropathy in prediabetic mice fed a high fat diet.METHODSMale C57Bl/6 mice were randomized to a standard diet (Std, 15% kcal from fat) or high fat diet (HF, 54% kcal from fat) for 2, 4, or 8 weeks (n = 11–12 mice per group). Inflammatory mediators (IL‐1α, IL‐1β, IL‐2, IL‐3, IL‐4, IL‐5, IL‐6, IL‐10, IL‐12p70, IL‐17, MCP‐1, IFN‐γ, TNF‐α, MIP‐1α, GMCSF, RANTES) were quantified in the lumbar dorsal root ganglia (DRG) using Multiplex ELISA. Additionally, qRT‐PCR was performed to measure mRNA expression of genes associated with inflammation (IL‐1β, IL‐6, IL‐10, MCP‐1, TNF‐α, RANTES) in epididymal adipose. Mechanical sensitivity associated with neuropathy was determined using the von Frey test and measured every other week, beginning the week before the dietary intervention. In order to quantify intraepidermal nerve fiber (IENF) density and a specific population of peptidergic nociceptive nerve fibers (TrkA) in the hindpaw footpad skin, fluorescence immunohistochemistry was performed.RESULTSCompared to Std, HF had greater bodyweight, fasting blood glucose, and insulin after 8 wks. After 2 wks, IL‐1α was higher in HF compared to Std. After 4 wks, IL‐5, IENF, and TrkA nerve fiber density were higher in HF compared to Std. There were no significant differences in hindpaw sensitivity or adipose mRNA expression of IL‐1β, IL‐10, IL‐6, TNF‐α, RANTES, or MCP‐1 after 2, 4, or 8 wks.CONCLUSIONIn mice fed a high fat diet for 4 wks, increased IENF and TrkA nerve fiber density was accompanied by an increase in the inflammatory mediators IL‐1α and IL‐5 in the lumbar DRG despite lack of increased inflammatory gene expression in the adipose. This suggests a high fat diet causes an early increase in neuronal inflammation and increased nociceptive nerve fiber density that may be responsible for mechanical hypersensitivity, a sign associated with “painful” neuropathy in prediabetic miceSupport or Funding InformationSupported by Southern Illinois University Edwardsville Seed Grants for Transitional and Exploratory ProjectsThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

A mathematical model appraising the effect of metabolic control on joint mobility in young diabetic patients: a preliminary study

Objective. The impairment of glycemic control can induce limited joint mobility even in young type 1 diabetic (T1DM) patients. The aims of this study were to verify the presence of ankle joint mobility (AJM) deficits in young T1DM subjects and define a mathematical model of diabetes mellitus long-term effects on AJM. Methods. AJM was evaluated using an inclinometer in 37 patients and 53 healthy, sex- BMI- and age-matched controls. To set up the mathematical model, we assumed that reduced metabolic control affects AJM according to a lognormal function: requiring some time for development of a reduction of joint mobility, which then persists for a long period, before fading out over time (if glycemic control has been recovered). A non-linear optimization determined the model parameters to achieve the best fit for a series of patients. Results. Both plantar and dorsiflexion AJM was significantly lower in diabetic subjects than in controls (plantarflexion: 28.5°±7.5 vs 35.2°±6.5; dorsiflexion: 93.9°±16.0 vs 104.7±12.8; p<0.01). The defined model approximates the experimental data with good accuracy; after optimization, the lognormal curve obtained is in line with empirical estimates: lack of glycemic control needs to persist for at least a few months before producing a significant effect, that lasts up until one year. The fitting procedure indicated the optimal solution is p = (37; 30; 3:5; 6:7; 137); thus, the optimal _im(t) corresponds to the curve reported. Conclusion. AJM was significantly reduced in young T1DM patients. The mathematical model represents the experimental data accurately.

Barrier of Self Care Management on Urban Type 2 Diabetic Patients in Bali

Successful glycaemic control could be achieved by diabetes self-care management. The purpose of this study was to explore the barrier of diabetes self-care management to type 2 diabetes patients in urban living. This study used a descriptive phenomenology design. The study was conducted at Mengwi village, Badung regency, Bali, with 20 participants was selected through purposive sampling. The data was collected using the in-depth interview. The result of the study showed most of the participant was male, the age was ranged between 45–60 years old and have been suffering from diabetes mellitus for 5–12 years. Three factors were found related to being the barrier of diabetes self-care management: lack of knowledge of diabetes management, lack of glycemic control, and complications of diabetes management. From the results, it can be concluded that patients with type 2 diabetes mellitus have been having trouble with doing self-care management. The type 2 diabetes mellitus patients experienced difficulties in performing diabetes self-care management.