Level Of Diabetes Control Research Articles

Bone remodeling and responsiveness to mechanical stimuli in individuals with type 1 diabetes mellitus.

Type 1 diabetes mellitus (T1DM) has been linked to increased osteocyte apoptosis, local accumulation of mineralized lacunar spaces, and microdamage suggesting an impairment of the mechanoregulation network in affected individuals. Diabetic neuropathy might exacerbate this dysfunction through direct effects on bone turnover, and indirect effects on balance, muscle strength, and gait. However, the in vivo effects of impaired bone mechanoregulation on bone remodeling in humans remain underexplored. This longitudinal cohort study assessed consenting participants with T1DM and varying degree of distal symmetric sensorimotor polyneuropathy (T1DM, n = 20, median age 46.5yr, eight female) and controls (CTRL; n = 9, median age 59.0yr, four female) at baseline and 4-yr follow-up. Nerve conduction in participants with T1DM was tested using DPNCheck and bone remodeling was quantified with longitudinal high-resolution peripheral quantitative-computed tomography (HR-pQCT, 82μm) at the standard distal sites. Local trabecular bone formation (Tb.F) and resorption (Tb.R) sites were captured by implementing 3D rigid image registration of HR-pQCT images, and the mechanical environment across the bone microarchitecture at these sites was simulated using micro-finite element analysis. We calculated odds ratios to determine the likelihood of bone formation (ORF) and resorption (ORR) with increasing/decreasing strain in percent as markers for mechanoregulation. At the distal radius, Tb.F was 47% lower and Tb.R was 59% lower in T1DM participants compared with CTRL (P < .05). Tb.F correlated positively with nerve conduction amplitude (R=0.69, P < .05) in participants with T1DM and negatively with glycated hemoglobin (HbA1c) (R= -0.45, P < .05). Additionally, ORF was 34% lower and ORR was 18% lower in T1DM compared with CTRL (P < .05). Our findings represent in vivo evidence suggesting that bone remodeling in individuals with T1DM is in a state of low responsiveness to mechanical stimuli, resulting in impaired bone formation and resorption rates; these correlate to the degree of neuropathy and level of diabetes control.

Optimizing Telehealth for Diabetes Management in the Deep South of the United States: Qualitative Study of Barriers and Facilitators on the Patient and Clinician Journey.

The Deep South of the United States, and Louisiana in particular, bears a greater burden of obesity, diabetes, and heart disease compared with other regions in the United States. Throughout the COVID-19 pandemic, there has been a substantial increase in telehealth visits for diabetes management to protect the safety of patients. Although there have been significant advancements in telehealth and chronic disease management, little is known about patient and provider perspectives on the challenges and benefits of telehealth visits among people living with diabetes and providers who care for patients with diabetes in Louisiana. This study aimed to explore barriers, facilitators, challenges, and benefits to telehealth for patients with diabetes and health care providers as they transitioned from in-person to remote care during the early COVID-19 pandemic to understand potential optimization. A total of 24 semistructured qualitative interviews were conducted with 18 patients living with diabetes and 6 clinicians who served patients with diabetes to explore their experiences and perceptions of telehealth services for diabetes care. Approximately half of the participants identified as Black or African American, half as White, and 75% as female. Interviews were recorded, transcribed, and coded by experienced qualitative researchers using inductive and deductive techniques. A narrative, descriptive approach to the patient and clinician journey framed the study, including the development of internal journey maps, and reflexive thematic analysis was applied to the transcripts, with special attention to barriers and facilitators. In total, 5 themes illustrated barriers and facilitators for participants: convenience, safety, and comfort are the benefits of telehealth for patients and clinicians; yet telehealth and in-person visits are valued differently; the convenience of telehealth may have a downside; technology acts as a double-edged sword; and managing expectations and efficiency of the visit experience was an important factor. Individual experiences varied in relation to several factors, including comfort level and access to technology, health system protocols for providing telemedicine, and level of diabetes control among patients. Recommendations for optimization include providing support to help guide and inform patients about what to expect and how to prepare for telehealth visits as well as allowing clinicians to schedule telehealth and in-person visits during discrete blocks of time to improve efficiency. Further research should address how hybrid models of telehealth and in-person care may differentially impact health outcomes for patients with diabetes, particularly for people with multiple chronic conditions in settings where access to technology and connectivity is not optimal.

QUALITY OF LIFE AND GLYCAEMIC CONTROL AMONG OLDER POPULATION WITH DIABETES IN THREE DISTRICTS OF PENINSULAR MALAYSIA

The older population is increasing in numbers worldwide. Most of them have multiple comorbidities including diabetes. The diabetic control in elderly is usually challenging. Their quality of life and socioeconomic condition either in rural or urban area could affect their disease progress. This study aims to measure the diabetic control and its associated factors, including quality of life among the older population with diabetes in three different districts of Malaysia. The patients’ health and background details were recorded. Validated Malay version of diabetes quality of life questionnaire was used. 485 elderly diabetic patients were recruited based on two proportion formula comprising all clinics in those districts representing urban vs rural area. Data were analyzed using simple and multiple logistic regression for the association. Only 30.5% of the patients have good diabetic control with patients in Kuala Terengganu district achieved better sugar control (p &lt; 0.001). However, the only significant diabetic control predictor is the quality of life of the elderly patients (OR = 1.32, CI 1.047 – 1.224). Level of diabetes control in these three districts are poor, concomitant with the poor control of the elderly non-communicable disease profiles. It is essential to embark on holistic approach in dealing with the elderly diabetic management and identify measures to improve quality of life in those with poor glycaemic control in order to have better disease outcome.

Diabetes Technology and the Human Factor.

Diabetes Technology and the Human Factor.

Assessment of Diabetes Control Level and Associated Cardiovascular Risk Factors

Assessment of Diabetes Control Level and Associated Cardiovascular Risk Factors

RF28 | PSUN216 Insulin Use Among Asian and Pacific Islander Adults with Diabetes Receiving Pharmacotherapy

Abstract Introduction Diabetes prevalence continues to increase in the US, although the burden of diabetes varies by race/ethnicity. Diabetes prevalence is higher in US Asian compared to non-Hispanic White adults and Asian adults may develop diabetes at an earlier age. Some studies suggest that Asians with diabetes have reduced insulin secretory capacity, but lower rates of insulin use have also been reported. This study seeks to characterize insulin use in a large clinical population of US Asian and Pacific Islanders (PI) with diabetes. Methods This cross-sectional observational study includes adult health plan members aged 45-79 years with diabetes prior to 2015 and receipt of diabetes pharmacotherapy in 2019. To estimate diabetes duration, those with diabetes identification during their first year of health plan membership (pre-existing diabetes) were excluded. Those without weight assessment in 2019 were also excluded. Race/ethnicity and Asian/PI subgroup were determined from self-reported data in health record databases. The primary outcome was insulin treatment in 2019, based on outpatient pharmacy records. Covariates included age, sex, BMI, diabetes duration, HbA1C, and calculated Charlson Comorbidity Index (CCI). A neighborhood deprivation index (NDI) was estimated using US Census data. Modified Poisson regression with robust variance was used to examine the association between ethnicity and insulin therapy, reporting relative risk (RR) with 95% confidence intervals (CI). Results Among 81,692 adults with diabetes (47% female), 21,187 (26%) were Asian/PI, 32,435 (40%) non-Hispanic White, 8901 (11%) Black, 16,855 (21%) Hispanic/Latinx, and 2314 (3%) Other/unknown. Compared to other racial/ethnic groups, Asians were less likely to use insulin (25% of Asian vs. 38%, 39%, and 37% of non-Hispanic White, Black, and Hispanic/Latinx, respectively, p&amp;lt;0.01). Within Asian/PI subgroups, the prevalence of insulin use varied: Japanese (32%), Native Hawaiian/Pacific Islander (33%), Filipino (28%), South Asian (23%), Chinese (21%) and Southeast Asian (20%). However, age, sex, duration of diabetes, level of diabetes control (HbA1c), BMI, and comorbid burden also varied among these populations. In multivariable analyses adjusting for these covariates, non-Hispanic White (RR 1.4, CI 1.3-1.4), Black (RR 1.1, CI 1.1-1.2), and Hispanic (RR 1.2, CI 1.2-1.2) adults had a higher relative risk of insulin use when compared to Asian/PI adults in aggregate. However, among the different Asian/PI subgroups, with Chinese as reference, only Japanese adults were more likely to use insulin (RR 1.2, CI 1.1-1.3) with no differences seen for Filipino, other Southeast Asian, and Native Hawaiian/PI. Conclusions This study provides insight into use of diabetes pharmacotherapy and specifically insulin use among Asian/PI subgroups compared to other populations. The lower rate of insulin use observed among Asian/PI subgroups is consistent with past studies and is likely multifactorial. Further research is needed to understand barriers against insulin treatment which will help optimize treatment and reduce diabetes burden in this population. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m., Monday, June 13, 2022 1:00 p.m. - 1:05 p.m.

Evaluation of plasma glucose control in diabetic patients on hemodialysis a single center study

Objectives: The aim of study is to evaluate plasma glucose control in diabetic patient on hemodialysis by measure plasma glycated albumin and HbA1c and correlate them with parameters like serum electrolytes blood urea, serum creatinine, hemoglobin, serum albumin, total serum bilirubin, serum uric acid, parathyroid hormone, serum ferritin; to evaluate the effects of these parameters on the level of diabetic control.&#x0D; Methods: This is a cross sectional study which included type 2 diabetic patients on hemodialysis these patients are currently undergoing hemodialysis and are on hemodialysis for more than three months. Total 50 type 2 diabetic patients on hemodialysis; between ages of 47-62 years of either gender were selected randomly and comparison done between the effect of different factors on HbA1c and glycated albumin.&#x0D; Results: There were 50 patients enrolled in this study with a mean age of 54.5 ± 4.7 (range: 47 – 62) years. Males represented 58% (29 patients) while female represent 42% (21 patients) of the studied group with male to female ratio of 1.38 to one. The duration of diabetes (DM) ranged 4 – 20 years and two thirds of the cases had duration of 15 years or less. Regarding the treatment of DM, 35 patients (70%) were on soluble insulin while 15 patients neither receive insulin nor oral antidiabetic agent and their treatment was off. poor glycemic control was significantly associated with younger age, patients aged &lt; 50 years were more frequent among the poor glycemic. good glycemic control had significantly lower HbA1C% level.&#x0D; Conclusion: Most of our diabetic patient on HD has controlled diabetes reflected by the level of HbA1c and GA. Serum ferritin levels is positively correlate with HbA1c levels in diabetic patient on hemodialysis which suggests that serum ferritin levels can be a marker of glycemic control in type 2 DM.

Low Subjective Cardiovascular Disease Risk Perceptions among Hypertensive Patients in Addis Ababa, Ethiopia.

BackgroundAccurate cardiovascular disease (CVD) risk appraisal is essential for hypertensive patients to identify correctly their risk status and take efficient behavioral measures timely to avoid major adverse outcomes. However, hypertensive patients’ risk perceptions of CVD events in Ethiopia are unknown. Thus, the study aimed to compare the subjective CVD risk perception level of patients with the nonlaboratory Framingham Risk Score (nl-FRS).MethodsA cross-sectional design was used. The Attitudes and Beliefs about Cardiovascular Disease Risk Questionnaire and the nl-FRS were used to compare subjective versus objective measures of CVD risk. Agreement between participants’ risk perceptions and the nl-FRS were examined using the kappa statistic. Bivariate chi-square test and multinomial logistic regression analyses were run to identify factors associated with risk perceptions. The statistical significance was set at a p-value < 0.05 level.ResultsParticipants (n=377) had a mean age of 53.61 ± 12.80-years, range (18–82 years), 51.2% were males, 42.7% had less than high school education, 45.1% achieved target BP control, and mean HTN duration was 8.01 ± 6.07 years. The majority (58.62%) of the participants had a low subjective risk perception of CVD events (mean 17.79, 95% CI: 17.43–18.15). Approximately three-fourths (72.4%) had a moderate nl-FRS risk calculation (mean, 13.84, 95% CI: 13.36–14.33). Agreement between participants perceived-risk and the nl-FRS was poor (kappa = 0.0002, standard error = 0.023, p =0.99). Participants’ CVD risk-perception inaccuracy was also high (76%) primarily due to underestimation. Hypertension duration, frequency of physician visits, and level of diabetes control were significant predictors of CVD risk underestimation.ConclusionHypertensive patients had inaccurate and low subjective risk perceptions of CVD events compared to moderate objective risks identified using the nl-FRS. Planned education on HTN and CVD risk factors is essential to improve patients’ CVD risk perception to reduce adverse CVD events.

Relationship between frailty, according to three frail scores, and clinical and laboratory parameters of the geriatric patients with type 2 Diabetes Mellitus.

SUMMARYOBJECTIVE:Type 2 diabetes mellitus is associated with significant morbidity and mortality. The term “frailty in the elderly” has become increasingly important with the increase of the elderly population, especially in diabetic subjects. Frailty is established by various scoring scales, such as Edmonton, Frail, and Prisma-7 scores. We aimed to evaluate the association between frailty and clinical and laboratory parameters of the geriatric type 2 diabetic patients.METHODS:Diabetic patients over 65 years of age who presented to outpatient internal medicine clinics of our institution between June 2020 and January 2021 were enrolled to the study. Edmonton, Frail, and Prisma-7 scores were administered to the subjects. Study parameters were compared between well-controlled and poorly controlled diabetic groups according to diabetes control level and between frail and non-frail groups, according to each frailty scores.RESULTS:Frailty according to Edmonton score was associated with increased risks of hospitalization (p=0.005) and mortality (p=0.02). Frailty according to frail score was associated with increased risk of hospitalization (p=0.009). Frailty according to Prisma-7 score was associated with increased risk of mortality (p<0.001).CONCLUSION:We suggest that Edmonton frail score is superior to Frail and Prisma-7 scores in determining frailty in geriatric patients with type 2 diabetes mellitus, since it is associated with both increased risk of hospitalization and mortality within 6 months.

SGLT-2 inhibitory a jejich uplatnění v praxi - update 2022

Cardiovascular diseases are still the most common cause of mortality in patients with type 2 diabetes. Studies on the cardiovascular safety of new antidiabetic treatments, that have significantly expanded the treatment options for type 2 diabetes over the last 20 years, have provided evidence not only for the cardiovascular safety of SGLT-2 inhibitors (SGLT-2i, gliflozins), but also unexpectedly showed a significant effect on the reduction of cardiovascular risk, incidence and progress of heart failure and nephroprotectivity. For the first time, a reduction in cardiovascular and overall mortality was demonstrated for empagliflozin in 2015 in patients at very high cardiovascular risk. Further studies with gliflozins in patients with diabetes, but also in non-diabetic individuals, show that gliflozins have more pharmacological similarities than differences, especially in terms of protection against the development and progression of heart failure and maintenance of glomerular filtration rate. The revolutionary contribution of SGLT-2i is therefore perceived today not only by diabetologists, but also by cardiologists and nephrologists. In ESC guidelines, SGLT-2i are recommended as a first-line antidiabetic treatment for patients with diabetes at high cardiovascular risk, attacking the hitherto unshakable position of metformin at this pole position, and their indications should be considered in patients with type 2 diabetes with atherosclerosis, heart and renal failure regardless of the level of diabetes control (values of HbA1c). In the treatment of heart failure with reduced ejection fraction (with or without diabetes), dapagliflozin and empagliflozin have been recommended by cardiologists since 2021 to prevent hospitalizations for heart failure and to reduce mortality with the strongest class and level of evidence.

Time below Range

Background: Patients with diabetes mellitus (DM) need to be regularly monitored for analyzing their levels of glycemic control as well as for ruling out the risk of hypoglycemia. Assessing the time in range (TIR) (70–180 mg/dL) is a novel measure of pointing out these risks. Aim: This research aims to detect hypoglycemia in routine clinical practice based on continuous glucose monitoring (CGM). Besides detecting hypoglycemia in patients with near-normal A1C levels, this study also aims to look at the incidence and occurrence of hypoglycemia in individuals with higher A1C. Methodology: HbA1c levels were recorded for n = 227 adult participants and used to categorize them into groups based on their levels of diabetes control (HbA1c groups of &lt;7%, 7%–8%, 8%–9%, and &gt;9%). Their 24-h blood glucose levels were measured through CGM with a flash glucose monitor (FGM) device. Data from the FGM device were downloaded, and TIR values in different participant groups were further determined. Statistical analysis of these results was done to calculate their significance in terms of P value. Results: 17.6% of participants had good glycemic control (HbA1c below 7%), 22.5% had HbA1c levels within the range of 7%–8%, 33.5% had their HbA1c within the range of 8%–9%, and 26% of the participants presented with poor glycemic control with HbA1c above 9%. Participants with HbA1c levels below 7% spent the maximum time below range (TBR) compared with participants in the other groups (P = 0.0016). Participants with poor glycemic control spent the minimum TBR (P = 0.0001). Those having HbA1c levels within the range of 7–8 (P = 1.00) and 8–9 (P = 0.0008) spent nearly 10% of their TBR indicating time spent in hypoglycemia and the risk of more severe hypoglycemia. No statistical differences in the time spent below range were found between male and female participants and based on treatment regimen. 77.5% of patients having A1C levels below 7%, 54% of patients with A1C levels between 7% and 8%, between 8-9%, and 40.6% of patients with A1C levels above 9% spent more than 5% of their TBR. Conclusion: In our research, it was found that although individuals with HbA1c levels below 7% were at maximum risk of hypoglycemia spending more than 5% of their TBR, patients with poor glycemic control also spent a significant amount of TBR. Thus, all patients with DM are at an increased risk of hypoglycemia regardless of their levels of glycemic control and the type of treatment regimen.

Which Aspect of Patient-Provider Relationship Affects Acceptance and Adherence of Insulin Therapy in Type 2 Diabetes Mellitus? A Qualitative Study in Primary Care.

PurposeIn type 2 diabetes mellitus (T2DM), insulin therapy is often recommended to achieve the optimal control of disease, thereby preventing the onset and progression of diabetes-related complications. Despite knowing about the benefits, it has been reported that 71% of patients refuse insulin and the adherence rate ranges from 30 to 80%. Patient–provider relationship (PPR) may affect such insulin-related behaviours, but little is known about which aspect of PPR affects this. This study aimed to explore the key aspect of the patient–provider relationship that affects the initial insulin acceptance and continued adherence.Patients and MethodsWe used the grounded theory approach in this qualitative research. The study was conducted at two primary care clinics between September 2019 and January 2021. Patients with T2DM on basal or premixed insulin were recruited using maximum variation sampling. Data were collected using semi-structured in-depth interviews and transcribed verbatim for analysis using constant comparison and synthesis.ResultsTwenty-one participants with different levels of diabetes control and adherence were recruited. Four themes that emerged were 1) patient–provider interaction, 2) addressing the psychological fears, 3) gaining confidence in handling insulin equipment and 4) follow-up after insulin initiation. Among the subthemes, trust in doctors, provider’s communication skills, patient-centred decision-making and continuity of care positively influenced insulin acceptance and adherence. Conversely, fear of being judged by the provider hindered open communication around non-adherence. Various aspects of interaction with nurses helped in alleviating patient’s fear of injection and gaining confidence with the insulin equipment.ConclusionMany aspects of PPR affect insulin acceptance and adherence. Among these, gaining patients’ trust, effective patient–provider communication, patient-centred decision-making, and ensuring continuity of care improve both insulin acceptance and treatment adherence. Various interactions with nurses help in addressing fears surrounding injection and gaining acceptance towards insulin therapy. Patients’ fear of being blamed or judged by the provider negatively affects open communication around non-adherence.

New Options to Simplify the Treatment of Severe Hypoglycemia in Long-Term Care

New Options to Simplify the Treatment of Severe Hypoglycemia in Long-Term Care

Poor risk factor control among stroke survivors - A cross-sectional survey

Objectives: A cross-sectional survey was done to find out the prevalence and control status of cardiovascular risk factors among stroke survivors within a post-stroke period of 3 months to 1 year. Methodology: The data on the prevalence of risk factors were taken from past medical history and medical records. The risk factor control is defined as achieving the targeted levels of blood pressure, blood sugars and cholesterol. Data on a diet, physical activity, tobacco use, and alcohol consumption were also collected. Standard instruments were used to measure blood pressure, weight, height, and waist circumference (WC). The blood sugar and lipid values were taken from labratory reports. Results: Stroke survivors (N = 240) participated. Around 75% of the participants were obese or overweight. Normal WC was found only in 25% of the participants. Majority of the participants were not following a healthy diet (62.5%) or doing recommended physical activity (87.1%). The prevalence of diabetes (61.2%), hypertension (88.6%), and dyslipidemia (96%) were high among stroke survivors. The targeted level of diabetic control and hypertension control level was achieved by 26% and 36.2, respectively, while around 72% attained lipid control. Conclusion: The prevalence of cardiovascular risk factors is very high among stroke survivors, and it is poorly controlled.

Preliminary study on the relationship between different blood glucose levels and periodontitis in patients with diabetes mellitus type 2

Objective: To determine the correlation between the diabetes mellitus control and periodontitis. Methods: This study was a cross-sectional survey using stratified system sampling model design. The target population was the patients with diabetes investigated from May to July 2018 in Huangpu District of Shanghai. In the present study, severe periodontitis was defined as at least at two sites in different quadrants with probing depth (PD)≥6 mm and clinical attachment loss (CAL)≥ 5 mm. Edentulous induced by periodontitis were also classified as severe periodontitis and the others were classified as non-severe periodontitis subjects. Diabetes control levels were divided into the following three groups: poorly controlled group [glycated hemoglobin (HbA1c)>7.5% and fasting blood glucose (FPG)>7.0 mmol/L], well controlled group (6.5%≤HbA1c≤7.5％ or 6.1 mmol/L≤FPG≤7.0 mmol/L) and ideally controlled group (HbA1c<6.5% and FPG<6.1 mmol/L). SPSS 25.0 was used for statistical analysis. Chi square test was used for demographic data and frequency distribution, α=0.05, two-sided test. Ordinal regression model was used for PD and diabetes control status to balance confounding factors (including age, gender, education and smoking status). After matching the propensity scores between severe periodontitis group and non-severe periodontitis group, logistic regression analysis was used to analyze the level of diabetes control and periodontitis. Results: A total of 5 220 adults over the age of 18 with a medical history of diabetes participated in the survey, of which 3 064 subjects with diabetes mellitus type 2 (T2DM) who were given both oral and laboratory examinations and were included in this study. Statistics showed that the prevalence of moderate and severe periodontitis was 10.57% (324/3 064). In the severe periodontitis group, 79.01% (256/324) of the subjects were over 65 years old, 55.56% (180/324) were male, 58.33% (189/324) had lower education level than high school level, and 21.91% (71/324) were smokers, which were significantly higher than those in the non-severe periodontitis group (P<0.01). In different T2DM status groups, the percentage of severe periodontitis increased with the aggravation of T2DM status. In severe periodontitis group, the proportion of patients with poor glycemic control was higher. T2DM patients with poor glycemic control accounted for 68.52% (222/324) in severe periodontitis group, which was significantly higher than the proportion of non-severe periodontitis group of 60.99% (1 671/2 740) (P<0.05). The regression coefficient of PD was 0.191, and PD had a significant negative effect on the level of blood glucose (P<0.01). There was a significant positive correlation between diabetes glycemic control and severe periodontitis (OR=2.800, P<0.05). Conclusions: In Huangpu District of Shanghai, among T2DM patients, the age of severe periodontitis group was higher than that of non-severe periodontitis group, most of them were male, with lower education level and higher proportion of smoking. The severity of diabetes was related to periodontitis and the proportion of severe periodontitis was higher in patients with poor glycemic control.

Hysterectomy Complications Relative to HbA1c Levels: Identifying a Threshold for Surgical Planning

To evaluate whether diabetes diagnosis and level of diabetes control as reflected by higher preoperative glycosylated hemoglobin (HbA1c) levels are associated with increased complication rates after hysterectomy and to identify a threshold of preoperative HbA1c level past which we should consider delaying surgery owing to increased risk of complications. Retrospective cohort study. Hospitals in the Michigan Surgical Quality Collaborative between June 4, 2012, and October 17, 2017. Women with and without a diabetes diagnosis. Hysterectomy. Data on demographics, preoperative HbA1c values, surgical approach, composite postoperative complications, readmissions, emergency department visits, and reoperations were abstracted. The risk of a postoperative complication when diabetes was stratified by preoperative HbA1c level was evaluated in a sensitivity analysis, and independent associations were identified in a mixed, multivariate logistic regression model. We identified 41 286 hysterectomies performed at 70 hospitals to be included for analysis. The sensitivity analysis identified 4 groups of risk for postoperative complications: group 1: no diabetes diagnosis and no HbA1c value; group 2: no diabetes diagnosis, with HbA1c levels between 4% and 6.5%; group 3: diabetes diagnosis and no HbA1c value or HbA1c levels <9%; and group 4: diabetes diagnosis with HbA1c levels ≥9%. In the adjusted model, there were significant 32% and 34% increased odds of postoperative complications for groups 2 and 3, respectively, compared with group 1. There were more than 2-fold increased odds of complications for women with diabetes and a preoperative HbA1c level ≥9% (group 4) compared with the women in group 1. Diabetes diagnosis with preoperative HbA1c levels ≥9% had increased odds of complications compared with diabetes diagnosis with preoperative HbA1c levels <9%. Patients with well-controlled diabetes seemed to have increased odds of complications with laparoscopic surgery. Diabetes diagnosis and measurement of preoperative HbA1c levels provide risk stratification for postoperative complications after hysterectomy, with the highest observed effect among patients with diabetes with a preoperative HbA1c level ≥9%.

Oral microbiota in children with type 1 diabetes mellitus.

The oral cavity is aunique ecosystem in which the microbiome is formed by the colonization of billions of bacteria, viruses, and fungi. Aim of the study was to assess the quality and quantity of bacterial microbiota of the oral cavity in children with type 1 diabetes in comparison to healthy children. The study group consisted of 50 randomly selected type 1 diabetic children aged 10-18 years divided into 2groups (25 people each) according to the level of diabetes control: well-controlled group (WC) - HbA1c ≤ 7.5%) and poorly-controlled group (PC) - HbA1c>7.5%. The control group (GC) consisted of 25 randomly selected children with no systemic diseases. The material for microbiological tests was collected as two swabs: one from the bottom of the oral cavity and the other one from the posterior part of the dorsum of the tongue). The statistical analysis revealed statistically significant differences in the total number of isolated microorganisms between PC and GC (post hoc test p=0.003) and WC and GC (post hoc test p<0.001). There were no statistically significant differences in the number of isolated microorganisms between PC and WC (p=0.195). Oral microbiome in type 1 diabetic children is significantly quantitatively different in comparison to healthy children. There are also visible qualitative differences in the profile of oral microbiota in type 1 diabetic children and healthy children.

Can we improve dental treatment outcomes in patients with high-risk factors?

Aim The aim of the study was to identify best practice in relation to improving the periodontal conditions of patients and increasing the rate of treatment success, through the identification of risk factors and implementation of changes in lifestyle.Methods and materials The study used two search strategies to identify papers describing best practices and important lifestyle changes which improved periodontal conditions and treatment outcomes in patientsResults The study demonstrated that the two most important factors in terms of interventions to improve periodontal conditions and treatment outcomes were to improve the level of diabetes control and remove aggravating factors such as smoking.Conclusion Many studies have focused on improving treatment outcomes in patients with high-risk factors such as smoking and medical conditions. Strategies, guidelines and protocols that reflect the best practices and lifestyle changes to improve the level of treatment success in high-risk patients should be adapted within treatment planning and follow-up. Successful treatment outcomes are best achieved through controlling diseases affecting the oral cavity and supporting structures.

A Comprehensive Quality Assurance Platform in Canada for National Point-of-Care Chronic Kidney Disease Screening: The Kidney Check Program

A Comprehensive Quality Assurance Platform in Canada for National Point-of-Care Chronic Kidney Disease Screening: The Kidney Check Program

Correlation between Serum Magnesium Levels and HbA1C in Type 2 Diabetes Mellitus

Background and Objective: Type 2 Diabetes Mellitus is a chronic disease resulting from acomplex inheritance, environmental interaction along with risk factors such as obesity andsedentary life style. Magnesium has been stated to have potential role in improving insulinsensitivity and preventing diabetes related complications. Hypomagnesaemia is proposed as oneof the factor in the pathogenesis of diabetic complications. The aim of our study is to estimatethe correlation between serum Magnesium levels and the level of Glycemic control (HbA1c) inpatients with Type 2 Diabetes Mellitus.Methods: This is an observational study conducted in SVRRGGH and SVMC, Tirupati, AndhraPradesh which included 94 patients with type 2 Diabetes mellitus of more than 5 years duration.These patients were divided into 2 groups based on level of Diabetic control. Group A included30 patients with HbA1c below 7.0mg/dL (good glycemic control) and Group B included 64patients with HbA1c above 7.0mg/dL (poor glycemic control). In both the groups SerumMagnesium levels were estimated.Results: Mean Serum Magnesium levels in Group A was 2.280±0.3955mg/dL while in Group Bit was 2.087±0.5834 mg/dL with a p-value 0.0379 (&lt;0.05) which is statistically significant. Inour study though the mean values of serum Magnesium are within normal reference range, meanvalues of serum Magnesium levels in patients with poor glycemic control(HbA1c&gt;7.0) arestatistically low as compared to patients with good glycemic control (HbA1c &lt;7.0).Discussion: It has been reported that Serum Magnesium levels are lower in uncontrolleddiabetics when compared to controlled diabetics and also serum magnesium levels vary withtreatment for diabetes. In our study, although the mean values of serum magnesium in bothgroups are within Normal reference range (1.7-2.2mg/dL), they are statistically low in groupwith poor glycemic control (HbA1c &gt;7.0mg/dL) when to group with good glycemic control(HbA1c&lt; 7.0mg/dL).Thus this gives an insight into the association of hypomagnesaemia andlevel of diabetic control.Conclusion: This effective comparative study of deals with varying Magnesium levels inspecific diabetic therapies and analysed the effect of urinary magnesium detected inHypermagnesuria with Magnesium supplementation.