Long-term Glycemic Control Research Articles

A Cross-Sectional Study Investigating Lumbar Proprioception Impairments in Individuals with Type 2 Diabetes Mellitus: Correlations with Glycated Hemoglobin Levels.

Impaired proprioception is a recognized complication in individuals with type 2 diabetes mellitus (T2DM), contributing to balance deficits and increased risk of falls. However, limited research has focused on lumbar proprioception in this population. This study aimed to investigate lumbar proprioception in individuals with T2DM, as well as healthy individuals. Additionally, this study aimed to examine the correlation between lumbar proprioception and glycated hemoglobin (HbA1c) levels, which is a marker of long-term glycemic control in T2DM. A cross-sectional study was conducted, comparing lumbar joint reposition errors (JRE) between a T2DM group (n = 85) and a healthy group (n = 85). Lumbar JRE was assessed in flexion, extension, lateral bending left, and lateral bending right using a dual inclinometer device. HbA1c levels were measured as an indicator of glycemic control. Significant differences in lumbar JRE were found between the T2DM and healthy groups, with individuals with T2DM exhibiting larger JRE values, indicating impaired lumbar proprioception (p < 0.001). The correlation analysis revealed significant positive associations between HbA1c levels and lumbar JRE. Higher HbA1c levels were correlated with greater joint JRE in flexion (r = 0.49, p < 0.001), extension (r = 0.51, p < 0.001), left lateral bending (r = 0.45, p < 0.001), and right lateral bending (r = 0.48, p < 0.001) in the T2DM group. This study provides evidence of impaired lumbar proprioception in individuals with T2DM, as evidenced by larger lumbar JRE compared to the healthy group.

Establishment of a feline glycated hemoglobin reference interval for a novel dried-blood-spot assay and the effects of anemia on assay results.

Glycated hemoglobin A1c (HbA1c) reflects long-term (months) glycemic control and has been previously investigated as a monitoring and diagnostic tool in diabetic cats. However, a standardized, reliable, and globally available test and reference intervals (RIs)have not been established. A novel dried-blood-spot card system (A1Care, Baycom Diagnostics) allows for easy collection and evaluation of HbA1c levels in feline patients. We aimed to establish an RI for HbA1c values in healthy adult cats using the A1Care (Baycom Diagnostics) dried-blood-spot card system. Forty-one healthy client-owned adult cats were enrolled in this study. The RI for HbA1c was calculated according to the recommendation of the American Society for Veterinary Clinical Pathology. The A1Care HbA1c RI for cats was determined to be 1.9%-3.1%. In healthy cats, A1Care HbA1c values were positively correlated with age (Spearman rho = 0.4 [95% CI 0.1 to 0.6], P = 0.01). In 50% of anemic cats, the A1Care HbA1c value was above 3.1%. There was a weak negative correlation between the A1Care HbA1c value and PCV (Spearman rho = -0.4 [95% CI -0.6 to -0.1]). This study established an RI for HbA1c in healthy adult cats similar to previously reported RIs. Future clinical studies are necessary to substantiate that this RI can differentiate diabetic from nondiabetic cats. Further long-term clinical studies will be valuable to determine if HbA1c values can be used as a screening test for prediabetes in cats.

Effect of Early Glycemic Control in Youth-Onset Type 2 Diabetes on Longer-Term Glycemic Control and β-Cell Function: Results From the TODAY Study.

Little is known about the impact of early attainment of tight glycemic control on long-term β-cell function and glycemic control in youth-onset type 2 diabetes. We examined the effect of the initial 6 months of glycemic control on β-cell function and glycemic control longitudinally over 9 years and the impact of sex, race/ethnicity, and BMI on these relationships in adolescents with youth-onset type 2 diabetes in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study. Oral glucose tolerance tests were performed longitudinally through year 9 to derive estimates of insulin sensitivity and secretion. Early glycemia was defined by mean HbA1c during the first 6 months postrandomization, categorized into five HbA1c groups (<5.7%, 5.7 to <6.4%, 6.4 to <7.0%, 7.0 to <8.0%, and ≥8.0%). The long-term period was defined as the period between years 2 and 9. A total of 656 participants (64.8% female, baseline mean age 14 years, diabetes duration <2 years) had longitudinal data available over an average of 6.4 ± 3.2 years of follow-up. HbA1c significantly increased in all early glycemic groups during years 2-9, with a steeper increase (+0.40%/year) among participants with the tightest initial control (mean early HbA1c <5.7%), in parallel to a decline in the C-peptide-derived disposition index. Nevertheless, the lower HbA1c categories continued to have relatively lower HbA1c over time. Early tight glycemic control in the TODAY study was related to β-cell reserve and translated to better long-term glycemic control. However, tight early glycemic control on the randomized treatment in the TODAY study did not prevent deterioration of β-cell function.

Trajectories of glycated hemoglobin of T2DM and progress of arterial stiffness: a prospective study

AimThis study aimed to describe the different trajectories groups of HbA1c during the long-term treatment of diabetes and explore the effect of glycemic control on the progression of arterial stiffness.MethodThe study participants registered at the National Metabolic Management Center (MMC) of Beijing Luhe hospital. The latent class mixture model (LCMM) was used to identify distinct trajectories of HbA1c. We calculated the change value of baPWV (ΔbaPWV) of each participant between the whole follow-up time as the primary outcome. Then we examined the associations between each HbA1c trajectory pattern and ΔbaPWV using covariate-adjusted means (SE) of ΔbaPWV, which were calculated by multiple linear regression analyses adjusted for the covariates.ResultsAfter data cleaning, a total of 940 type 2 diabetes patients aged 20–80 years were included in this study. According to the BIC, we identified four discrete trajectories of HbA1c: Low-stable, U-shape, Moderate-decrease, High-increase, respectively. Compared with the low-stable group of HbA1c, the adjusted mean values of baPWV were significantly higher in U-shape, Moderate-decrease, and High-increase groups (all P < 0.05, and P for trend < 0.001), the mean values (SE) were 82.73 (0.08), 91.19 (0.96), 116.00 (0.81) and 223.19 (11.54), respectively.ConclusionWe found four different trajectories groups of HbA1c during the long-term treatment of diabetes. In addition, the result proves the causal relationship between long-term glycemic control and arterial stiffness on a time scale.

944-P: Continuous Glucose Monitoring (CGM) Sampling Duration to Estimate Long-Term Glycemic Control in Adults with T2D Not Using Insulin

Objective: Current consensus is that 10-14 days of continuous glucose monitoring (CGM) sampling time is adequate to assess long-term glycemic control in T1D and insulin-using T2D populations. Optimal CGM sampling duration has not been widely studied in people with T2D not using insulin. We studied the relationship between true and estimated long-term (90-day) glycemic control in people with T2D not using insulin. Methods: The study population (N = 829) was composed of adults with T2D enrolled in Level2, a virtual specialty clinic, with CGM data on 75% (68) of the 90 days preceding an A1c lab result and no insulin fills during this period. The mean age and A1c were 56 years and 6.7% respectively. We computed the median absolute percentage error (MAPE) and Pearson correlations (R) between glycemic metrics from sampling periods of increasing duration and the full 90-day period. Because this population was at low risk for hypoglycemia glucose management indicator (GMI) and time above range (&amp;gt;180 mg/dL, TAR) were the primary outcomes of interest. We also assessed the correlations between GMI and A1c. Results: GMI and TAR from 14-day measurements were highly correlated (R = 0.92) with 90-day values, increasing to R = 0.94 with 30-day measurements. Correlations of GMI and A1c were high with 14 and 30 days (R = 0.79, R = 0.82) but did not exceed R = 0.85 with longer sampling periods. MAPE was 2.2 (SD = 2.6) and 1.5 (SD = 2.1) for GMI with 14- and 30-day measurements, respectively, and 29.2 (SD = 47.4) and 21.2 (SD = 27.1) for TAR. Conclusion: In the T2D population not using insulin, 14 days of CGM data is sufficient to estimate long-term mean glucose and the discordance with A1c is consistent with previous studies of people with T1D and insulin-using T2D. TAR is subject to greater error than in previous studies of people with T1D and insulin-using T2D and more work is needed to understand this discrepancy. Disclosure S.Bacon: Employee; Optum Labs, Research Support; Level2. N.Thompson: Employee; Level2, Stock/Shareholder; UnitedHealth Group. D.Ferrell: Stock/Shareholder; Level2, Medexpress Urgent Care. J.Fung: Employee; Level2.

Short-term use of CGM in youth onset type 2 diabetes is associated with behavioral modifications.

Continuous glucose monitoring (CGM) is beneficial to glycemic control in youth with type 1 diabetes (T1D) and adults with type 2 diabetes (T2D); however, studies in youth with T2D are limited. Determine if 10-day trial CGM use in youth with T2D improves glycemic control and behavioral modifications. Youth with T2D > 3 months, on insulin, with no prior CGM use were enrolled. Staff placed CGM and provided education. Participants received 5-day and 10-day follow-up phone calls to review CGM data, behavioral modifications, and adjust insulin doses as needed. We compared 5-day to 10-day TIR, and baseline to 3-6 month HbA1c via paired t-test. Participants (n=41) had median age of 16.2 y, were 61% female, 81% NH Black, median diabetes duration of 0.8 y, and baseline HbA1c of 10.3%. A majority had household income<$50,000 (81%) and parental education level of HS or less (73%). Average 5-day TIR 49% was similar to 10-day TIR 51% (p=0.62). There was no change in HbA1c after 3-6 months (10.2% v 10.3%, p=0.89). Nineteen participants completed full 10-day CGM use; of those, 84% wanted a CGM long-term. Adolescents reported behavioral changes including increased blood sugar checks, increased insulin administration and overall improved diabetes management. Although 10-day CGM use did not impact short-term or long-term glycemic control in youth with T2D, most participants reported behavioral changes and wanted to continue using CGM. Future studies with longer use of CGM may clarify the potential impact of CGM in youth with T2D.

EVALUATION OF HBA1C IN THE DIAGNOSIS OF DIABETES MELLITUS

Diabetes mellitus is a prevalent metabolic disorder that requires early detection and effective management. Glycated hemoglobin (HbA1c) evaluation has emerged as a valu- able tool in diagnosing diabetes mellitus. This study evaluated 62 cases, with 21 diabetic and 41 non-diabetic, and found a significant p-value for HbA1c levels. The mean HbA1c level was 6.36, with a standard deviation of 1.90 and a variance of 3.6189. Comparative analysis showed an increased case detection rate in HbA1c testing. HbA1c testing improves accuracy and convenience of diabetes diagnosis, correlates with long-term glycemic control, and is a prognostic marker for cardiovascular risk. The study highlights the importance of incorporating HbA1c testing into clinical practice, monitoring treatment effectiveness and guiding therapeutic decisions. The findings support the growing recognition of HbA1c as a reliable diagnostic tool for diabetes mellitus, with its ability to reflect average blood glucose levels over a prolonged period. Further research is needed to explore its applicability across different populations and establish standardized guidelines for HbA1c interpretation and utilization. Keywords: Diabetes mellitus, HbA1c, Diagnostic tool, Glycemic control, Fasting, Post prandial

Glycemic variability leads to higher levels of auto-oxidized oxysterol species in patients with type 1 diabetes mellitus.

Hyperglycemia and glycemic variability (GV) are associated with oxidative stress in patients with diabetes mellitus (DM). Oxysterol species, produced by the non-enzymatic oxidation of cholesterol, are potential biomarkers of oxidative stress. This study examined the relationship between auto-oxidizedoxysterols and GV in patients with type 1 DM. Thirty patients with type 1 DM using a continuous subcutaneous insulin infusion pump therapy and a healthy control group (n = 30) were included in this prospective study. A Continuous Glucose Monitoring System device was applied for 72h. Blood samples were taken for oxysterols produced by non-enzymatic oxidation [7-ketocholesterol (7-KC) and cholestane-3β, 5α, 6β-triol (Chol-Triol)] levels at 72h. Short-term glycemic variability parameters, mean amplitude of glycemic excursions (MAGE), the standard deviation of glucose measurements (Glucose-SD), and mean of daily differences (MODD) were calculated with continuous glucose monitoring data. HbA1c was used to evaluate glycemic control and HbA1c-SD (the SD of HbA1c over the past year) for long-term glycemic variability. 7-KC and Chol-triol levels were significantly higher in the study group than in the control group. Strong positive correlations were found between 7-KC with MAGE(24-48h) and Glucose-SD(24-48h). 7-KC was positively correlated with MAGE(0-72h) and Glucose-SD(0-72h). No significant correlation was found between HbA1c and HbA1c -SD with oxysterol levels. The regression models showed that SD(24-48h) and MAGE(24-48h) predicted 7-KC levels while HbA1c did not. Glycemic variability leads to higher levels of auto-oxidized oxysterol species in patients with type 1 DM independent of long-term glycemic control.

Physio Biochemical Aspects of Sleeping Patterns in Relation to Plasma Glycated Haemoglobin Level in Type 2 Diabetic Patients

Introduction: Diabetes mellitus is a persistent metabolic condition distinguished by raised levels of glucose in the bloodstream, commonly referred to as hyperglycemia. This phenomenon arises due to insufficient endogenous insulin production or impaired insulin utilization by the body. Insulin is a hormone that is biosynthesized and secreted by the pancreatic gland, functioning to modulate the concentration of blood glucose in the body. Glycated hemoglobin, typically referred to as hemoglobin A1c or HbA1c, is a variant of hemoglobin that undergoes glycation upon prolonged exposure to elevated levels of glucose within the bloodstream. Hemoglobin is a crucial protein that is present within erythrocytes and is primarily responsible for the transportation of oxygen across the various tissues of the body. The assessment of HbA1c serves as a means of determining an individual's mean blood glucose levels during the preceding two to three months. The monitoring of long-term glycemic control in individuals with diabetes mellitus is widely recognized to be of utmost importance, with a valuable marker for this purpose being deemed necessary. The levels of HbA1c are commonly reported as a proportion of the total hemoglobin within the circulating blood in the form of a percentage. Objective: To compare the effects of sleeping patterns and plasma glycated haemoglobin levels in type 2 diabetic and non diabetic patients Study Design: Quantitative cross sectional Settings: Punjab Rangers Teaching Hospital, Lahore Duration: Four months i.e. 1st August 2022 to 31st December 2022 Data Collection Procedure: A pre validated questionnaire was used. Study was carried out at Punjab Rangers Teaching Hospital, Lahore. The total numbers of faculty members were 70 who participated after taking the informed consent. The study was done by simple random sampling technique. A fasting blood glucose analysis was conducted on all subjects through the collection of a 5cc blood sample. The study enrolled participants who were divided into two distinct groups based on their fasting blood glucose levels in which 35 were diabetic and 35 were controlled. Mean &amp; standard deviation was calculated. P value is &lt;0.005 means significant. Results: There were 70 participants in the study which equally divided into two groups i.e. thirty five each namely diabetic and controlled one. The participants in diabetic group include 18 males and 17 females while in control group 22 males and 13 females. After analyzing the data we came to know the statistical significant results were shown by insomnia severity index and HbA1c parameters as indicating major difference when compared both controlled and diabetic group in each parameter. Epworth sleepiness scale did not show any significant difference. Conclusion: It is concluded in this study that patients with poor diabetic control have less diabetic HbA1c control which increase higher levels of insomnia which clearly noted in the diabetic group when compared to control one. If we control the glycemic control of patients then definitely the level of insomnia decreases by providing the sleep comfort in daily life. Keywords: Diabetes mellitus, glycated haemoglobin, sleeping patterns, Type 2 diabetes, Insulin

The impact glycosylated hemoglobin level on admission plasma beta amyloid in patients with acute myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by Regione Friuli Venezia Giulia (grant for the project “Lo scompenso cardiaco quale morbo di Alzheimer del cuore: opportunita ` diagnostiche e terapeutiche—HEARTzheimer”). Background A strong relationship exists between Diabetes Mellitus and Alzheimer’s disease (AD) and the most recent researches in order to underline this strong connection are talking about type 3 diabetes. Plasma beta amyloid (Aβ) has pro-atherosclerotic and pro-inflammatory traits and has been associated with AD, aging, atherosclerotic processes, depression and diabetes. Aim and Methods We aimed to study the levels of Aβ 40 in a large population of patients with acute myocardial infarction and to evaluate if any association exists with long-term glycemic control. Hemoglobin A1c, Aβ 40, Vitamin D, hs CRP and TNF alpha were measured at hospital admission. Results In this study were included 603 patients admitted for acute myocardial infarction; according to hemoglobin A1c (HbA1c level), patients were classified into three groups: group 1 including 181 patients without diabetes (HbA1C &amp;lt; 39 mmol/mol), group 2 with 303 patients with pre-diabetes (HbA1C 39-47 mmol/mol) and group 3 comprising 199 patients with diabetes mellitus (HbA1C ≥48 mmol/mol). The levels of Aβ 40 significantly increase through group 1 to group 3 (76.1 [48-116], Vs. 91.3 [53.3-132], Vs. 101.6 [62.6-146.5], respectively, p&amp;lt;0.05, Figure 1). Also the levels of inflammatory markers CRP and TNF alpha were significantly higher in the group 3 respect to the other two groups. Independent predictors of Aβ 40 levels at regression analysis were presence of diabetes mellitus (OR 12.4, CI 95% 3.2-21.6, p=0.008), Vitamin D levels (OR 0.43, CI 95% 0.09-0.78, p 0.012) and renal function (OR 33.6, 95%CI 28.7-38.5, p&amp;lt;0.0001). Conclusions A better glyco-metabolic control in patients with myocardial infarction may reduce the risk of low-grade inflammation and production of biomarkers such as Aβ 40, associated with worse outcome. Further studies are necessary to evaluate if Aβ 40 levels are associated with post-MI depression and therapeutic non-compliance who lead to worse outcome.

Six months of aerobic exercise training does not prevent a worsening of glucose tolerance in individuals with acute spinal cord injury

Individuals with spinal cord injuries (SCI) have a greater incidence of Type 2 Diabetes (T2D) than their non-injured peers. The increased incidence of T2D has been noted in individuals within the first few years after injury, and incidence increases with time since injury. Aerobic exercise training improves long-term glycemic control in non-injured individuals and results in improved glycemic control in individuals with chronic SCI (&gt;10 years). However, it is unknown whether individuals with acute injuries (&lt;3 years) display altered glucose control, and if aerobic training may prevent worsening of glucose control and T2D. Therefore, we assessed blood glucose regulation in individuals &lt;3 years post SCI injury. Glucose regulation was assessed through fasting blood glucose, insulin, hemoglobin A1C (HbA1C), homeostatic model assessment for insulin resistance (HOMA-IR), and an oral glucose tolerance test (OGTT). In addition, body composition was estimated via dual energy x-ray absorptiometry. These assessments were made prior to, and following 3- and 6-months (mo) of aerobic exercise training consisting of hybrid functional electrical stimulation rowing. Data were analyzed with 1-way RMANOVA. Eight individuals (1F, 7M, age 20-45 years) with SCI 9-27 mo post-injury and a neurological level of injury from spinal cord segments C3 to T3 were enrolled. Individuals exercised for 30min per session, at ~60% VO2peak, 2-3 times per week. Fasting glucose (Pre:85±9, 3m:88±8, 6m:86±2 mg/dL, p=0.55), insulin (Pre:6.0±3.8, 3m:5.7±2.5, 6m:3.9±2.5 uIU/mL, p=0.25), HbA1C (Pre:4.9±0.3, 3m:5.0±0.3, 6m:4.8±0.1%, p=0.73) and HOMA-IR (Pre:1.4±1.0, 3m:1.2±0.7, 6m:0.7±0.4, p=0.26) did not change after 6-mo of training. In contrast, the dynamic assessment of glucose tolerance (OGTT) showed dramatic worsening (AUC Pre:15.7±3.8, 3m:17.8±5.9, 6m:17.6±5.8 units, p=0.04) from pre-exercise to 3-mo. Moreover, following 6-mo of exercise training, 1 individual met the diagnostic criteria for impaired glucose tolerance and another 2 for diabetes. Exercise training did not change visceral adipose mass (Pre:1.4±0.9, 3m:1.4±1.2, 6m:1.3±1.2 kg, p=0.96) or total body lean mass (Pre:50.4±9.5, 3m:49.6±9.6, 6m:49.5±9.5kg, p=0.98). These results suggest that fasting measures alone are not sensitive enough in detecting impairments in glucose metabolism in the acute period following a SCI. Interestingly, in people with SCI, whole-body aerobic exercise does not prevent the occurrence of impaired glucose metabolism. The worsening of glucose tolerance occurs despite a conservation of lean mass and no increase in visceral adiposity. It will be of importance to determine the mechanisms underlying the worsening of glycemic control and develop therapies to prevent metabolic disease in SCI. R01 HL117037, F32 HL156675 This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Sodium-Glucose Cotransporter 2 Inhibitors in Patients with Diabetes and Coronary Artery Disease: Translating the Benefits of the Molecular Mechanisms of Gliflozins into Clinical Practice.

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) were initially developed for the treatment of diabetes due to their antihyperglycemic activity. However, in the light of the most recent clinical studies, they are revolutionizing the approach to cardiovascular disease in patients with and without diabetes. We aimed to generate real-world data about the use of SGLT2i in patients with T2DM and coronary artery disease (CAD), focusing on their effectiveness in glycemic control, adherence, long-term efficacy, and safety outcomes. On the basis of the inclusion and exclusion criteria, 143 patients were enrolled. Patients were treated with canagliflozin (n = 33 patients; 23%), dapagliflozin (n = 52 patients, 36.4%), empagliflozin (n = 48 patients; 33.6%), or ertugliflozin (n = 10 patients; 7%) as monotherapy or in combination with other antidiabetic drugs. All patients performed a clinical visit, and their medical history, blood sampling, and anthropometric parameters were measured at discharge and at 1-year follow-up. The reduction in HbA1c % value at 12 months was significant (8.2 vs. 7.4; p < 0.001). Trends in body weight and body mass index also confirmed the positive effect of the treatment (p < 0.0001), as did the reduction in abdominal adiposity (expressed via waist circumference). At 1-year follow-up, 74.1% of patients were adherent to the treatment, and 81.1% were persistent to the treatment. A total of 27 patients (18.8%) had to discontinue treatment early due to drug intolerance caused by genitourinary infections (11.9%), the drub being permanently ineffective (HbA1c not at target or decreasing: 4.9%), or because of expressing. a desire not to continue (2%). No major drug-related adverse events (diabetic ketoacidosis, Fournier's gangrene, lower-limb amputations) occurred at follow-up, while MACE events occurred in 14 patients (9.8%). In real-world patients with T2DM and CAD, SGLT2i have been effective in long-term glycemic control and the improvement in anthropometric indices with good tolerance, high adherence, persistence to treatment, and no major adverse events at 1-year follow-up.

Screening hydrogels for antifibrotic properties by implanting cellularly barcoded alginates in mice and a non-human primate.

Screening implantable biomaterials for antifibrotic properties is constrained by the need for in vivo testing. Here we show that the throughput of in vivo screening can be increased by cellularly barcoding a chemically modified combinatorial library of hydrogel formulations. The method involves the implantation of a mixture of alginate formulations, each barcoded with human umbilical vein endothelial cells from different donors, and the association of the identity and performance of each formulation by genotyping single nucleotide polymorphisms of the cells via next-generation sequencing. We used the method to screen 20 alginate formulations in a single mouse and 100 alginate formulations in a single non-human primate, and identified three lead hydrogel formulations with antifibrotic properties. Encapsulating human islets with one of the formulations led to long-term glycaemic control in a mouse model of diabetes, and coating medical-grade catheters with the other two formulations prevented fibrotic overgrowth. High-throughput screening of barcoded biomaterials in vivo may help identify formulations that enhance the long-term performance of medical devices and of biomaterial-encapsulated therapeutic cells.

Association between personality traits and glycemic control after inpatient diabetes education

AimsThe longitudinal effect of personality traits on glycemic control is unclear. This prospective observational study explored the relationship between personality traits and glycemic control in patients with uncontrolled diabetes after inpatient diabetes education. MethodsPatients with diabetes mellitus (HbA1c ≥ 7.5%, measured by high-performance liquid chromatography) who received inpatient diabetes education were scored on the Big Five personality traits: neuroticism, extraversion, openness, agreeableness, and conscientiousness. Multiple linear analysis was used to determine whether any personality traits were independently associated with HbA1c on admission and HbA1c change from admission to 1, 3, and 6 months after discharge. ResultsOne hundred seventeen participants (mean age 60.4 ± 14.5 years; 59.0% male) were enrolled. HbA1c values on admission and 1, 3, and 6 months after discharge were 10.2 ± 2.1%, 8.3 ± 1.4%, 7.6 ± 1.4%, and 7.7 ± 1.5%, respectively. Multiple linear analysis showed that no personality traits were associated with HbA1c on admission. Neuroticism was negatively associated with the HbA1c change from admission to 3 months (β = −0.192, P = 0.025) and 6 months after discharge (β = −0.164, P = 0.043). ConclusionsNeuroticism was associated with good long-term glycemic control after inpatient diabetes education.

Negative energy balance hinders prosocial helping behavior

The internal state of an animal, including homeostatic requirements, modulates its behavior. Negative energy balance stimulates hunger, thus promoting a range of actions aimed at obtaining food. While these survival actions are well established, the influence of the energy status on prosocial behavior remains unexplored. We developed a paradigm to assess helping behavior in which a free mouse was faced with a conspecific trapped in a restrainer. We measured the willingness of the free mouse to liberate the confined mouse under diverse metabolic conditions. Around 42% of adlibitum-fed mice exhibited a helping behavior, as evidenced by the reduction in the latencies to release the trapped cagemate. This behavior was independent of subsequent social contact reward and was associated with changes in corticosterone indicative of emotional contagion. This decision-making process was coupled with reduced blood glucose excursions and higher Adenosine triphosphate (ATP):Adenosine diphosphate (ADP) ratios in the forebrain of helper mice, suggesting that it was a highly energy-demanding process. Interestingly, chronic (food restriction and type 2 diabetes) and acute (chemogenetic activation of hunger-promoting AgRP neurons) situations mimicking organismal negative energy balance and enhanced appetite attenuated helping behavior toward a distressed conspecific. To investigate similar effects in humans, we estimated the influence of glycated hemoglobin (a surrogate of long-term glycemic control) on prosocial behavior (namely charity donation) using the Understanding Society dataset. Our results evidenced that organismal energy status markedly influences helping behavior and that hypothalamic AgRP neurons are at the interface of metabolism and prosocial behavior.

Does diabetic ketoacidosis at diagnosis of type 1 diabetes mellitus predict poorer long-term glycemic control.

Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus. This study aimed to determine (1) whether DKA at diagnosis of type 1 diabetes is associated with poorer long-term glycemic control and (2) whether there are confounding factors which may impact the mode of presentation of type 1 diabetes mellitus or subsequent glycemic control. This study was conducted via review of 102 patient files extracted from the Young Person's Type 1 Diabetes Clinic at Cork University Hospital. Glycemic control was measured using the average of the patient's three most recent HbA1C levels, recorded a median of 11years post-diagnosis of type 1 diabetes mellitus. Data analysis revealed a positive association between DKA at diagnosis and poorer long-term glycemic control, with HbA1c levels tracking 6.58mmol/mol (0.6%) higher at follow up in the group with DKA compared to the group without DKA at diagnosis. Certain sociodemographic factors were found to predict worse glycemic control at follow-up: Individuals using recreational drugs and those reporting mental health difficulties were found to have higher levels of HbA1C at follow up (p = ·006,·012, respectively) compared to individuals who did not. Diabetic ketoacidosis at diagnosis of type 1 diabetes mellitus was shown to be associated with poorer long-term glycemic control in this study. Furthermore, individuals who utilize recreational drugs or have mental health difficulties had significantly worse glycemic control at follow-up.

Does the Insulin Pump Improve Satisfaction and Glycaemic Control in Moroccan Patients with Type 1 Diabetes?

Introduction: Insulin pump therapy is recommended more and more to achieve and maintain optimal glycaemic control in patients with type 1 diabetes mellitus. The objective of our study was to evaluate the satisfaction of patients using insulin pump therapy and to determine its effectiveness in improving metabolic control in type 1 diabetic patients. Patients-Methods: This is a retrospective, descriptive and analytical study including 20 type 1 diabetic patients treated by insulin pump, between 2017 and 2021. All patients received a clinical evaluation, analysis of capillary blood glucose monitoring and a dosage of HbA1c at the time of the start of insulin pump and during the evolution. Insulin pump satisfaction was assessed using the Diabetes Treatment Satisfaction Questionnaire (DTSQ). Statistical analysis was performed by SPSS version-21. Results: The mean age of the patients was 16,8 ± 8,1 years with a sex ratio (M/F) of 0,42. Thirty per-cent were children. The mean duration of diabetes was 5,8 ± 4,8 years. Seventy-five per-cent of patients practiced functional insulin therapy. The indications for insulin pump treatment were mainly hypoglycaemia and instable diabetes. During follow-up, we found a statistically significant decrease in insulin requirements, improvement in mean HbA1c and maintenance of glycaemic control during follow-up, with a marked reduction in the number of hypoglycaemia events per week. The overall satisfaction score was calculated at 34,6 ± 2,5 out of 36 with a decrease in the score for perception of hyperglycaemia or hypoglycaemia. Conclusion: Insulin pump therapy appears to be reliable and effective when used appropriately, combined with appropriate therapeutic education and glycaemic monitoring to maintain long-term glycaemic control and improved quality of life.

Venom Peptides, Polyphenols and Alkaloids: Are They the Next Antidiabetics That Will Preserve β-Cell Mass and Function in Type 2 Diabetes?

Improvement of insulin secretion by pancreatic β-cells and preservation of their mass are the current challenges that future antidiabetic drugs should meet for achieving efficient and long-term glycemic control in patients with type 2 diabetes (T2D). The successful development of glucagon-like peptide 1 (GLP-1) analogues, derived from the saliva of a lizard from the Helodermatidae family, has provided the proof of concept that antidiabetic drugs directly targeting pancreatic β-cells can emerge from venomous animals. The literature reporting on the antidiabetic effects of medicinal plants suggests that they contain some promising active substances such as polyphenols and alkaloids, which could be active as insulin secretagogues and β-cell protectors. In this review, we discuss the potential of several polyphenols, alkaloids and venom peptides from snake, frogs, scorpions and cone snails. These molecules could contribute to the development of new efficient antidiabetic medicines targeting β-cells, which would tackle the progression of the disease.

Association of appetite hormone levels with HbA1c in obese type-2 diabetes mellitus patients

Background: Nesfatin-1 and leptin are hormones that control appetite and affect glycemic control. Nesfatin-1 and leptin levels are affected by body mass index (BMI). Hemoglobin A1c (HbA1c) is an objective parameter to assess long-term glycemic control. This present research aims to know the relationship between levels of nesfatin-1 and leptin with HbA1c values ​​as an indicator of long-term objective glycemic control in patients with T2DM with obesity. Methods: Cross-sectional study on 54 obese T2DM subjects. Measurement of nesfatin-1 and leptin levels using the enzyme linked immunosorbent assay (ELISA) method. The value of HbA1c was measured by the fluorescent immunoassay (FIA) method. The correlation between nesfatin-1 and leptin with Hb1c was tested using the Spearman correlation analysis test (p &lt;0.05 was considered significant). Results: The median value of nesfatin-1 levels was 1,824.0 (134.0-5,255.0) pg/mL, the median value of leptin levels was 14.0 (0.4 - 66.4) ng/mL, and the median value of HbA1c was 7.70 (4.9-15.0)%. There is no correlation between nesfatin-1 levels and HbA1c values (p = 0.282 and r = 0.149). There is no correlation between leptin levels and HbA1c values (p value = 0.895 and r = 0.018). Conclusion: HbA1c levels are not associated with an increased appetite, as evidenced by no association between appetite biomarkers and glycemic control.

Diabetes management in patients undergoing total pancreatectomy: A single center cohort study.

Total pancreatectomy (TP) has been increasingly performed in recent years. However, studies on diabetes management after TP during different postoperative periods are still limited. This study aimed to evaluate the glycemic control and insulin therapy of patients undergoing TP during the perioperative and long-term follow-up period. Ninety-three patients undergoing TP for diffuse pancreatic tumors from a single center in China were included. Based on preoperative glycemic status, patients were divided into three groups: nondiabetic group (NDG, n = 41), short-duration diabetic group (SDG, preoperative diabetes duration ≤12 months, n = 22), and long-duration diabetic group (LDG, preoperative diabetes duration >12 months, n = 30). Perioperative and long-term follow-up data, including the survival rate, glycemic control, and insulin regimens, were evaluated. Comparative analysis with complete insulin-deficient type 1 diabetes mellitus (T1DM) was conducted. During hospitalization after TP, glucose values within the target (4.4-10.0 mmol/L) accounted for 43.3% of the total data, and 45.2% of the patients experienced hypoglycemic events. Patients received continuous intravenous insulin infusion during parenteral nutrition at a daily insulin dose of 1.20 ± 0.47 units/kg/day. In the long-term follow-up period, glycosylated hemoglobin A1c levels of 7.43 ± 0.76% in patients following TP, as well as time in range and coefficient of variation assessed by continuous glucose monitoring, were similar to those in patients with T1DM. However, patients after TP had lower daily insulin dose (0.49 ± 0.19 vs 0.65 ± 0.19 units/kg/day, P < 0.001) and basal insulin percentage (39.4 ± 16.5 vs 43.9 ± 9.9%, P = 0.035) than patients with T1DM, so did those using insulin pump therapy. Whether in the perioperative or long-term follow-up period, daily insulin dose was significantly higher in LDG patients than in NDG and SDG patients. Insulin dose in patients undergoing TP varied according to different postoperative periods. During long-term follow-up, glycemic control and variability following TP were comparable to complete insulin-deficient T1DM but with fewer insulin needs. Preoperative glycemic status should be evaluated as it could guide insulin therapy after TP.