Management Of DM Research Articles

Behaviour model for diabetic ulcer prevention.

Diabetic ulcers are one of the complications that often occur in patients with DM. The aim is to develop a behaviour model for diabetic ulcer prevention by integrating Lawrance Green Theory and the Theory of Planned Behaviour. An explanative observational design was used with a cross-sectional approach. The population consisted of DM patients who had underwent treatment at the internal medicine clinic of Sidoarjo District Hospital. The sample size of 133 respondents was obtained through purposive sampling. The data analysis used Partial Least Square. Predisposing factors (knowledge), supporting factors (availability of health facilities and accessibility of health resources) and driving factors (the role of health workers and family support) significantly influence the main factors (attitudes toward behaviour, subjective norms and perceptions of self-control) with a statistical T value>1.96. The main factor influences intention (T = 48.650) and intention influences behaviour (T = 4.891). Intention is influenced by the attitudes toward behaviour, subjective norms and self-control perceptions. Good intentions can increase the preventive behaviour related to diabetic ulcers. Increasing the diabetic ulcer prevention behaviour can be done by providing regular education to both the patients and their families about diabetic ulcers and their prevention through the appropriate management of DM, lifestyle modification and regular foot care that requires active involvement from the family and health care workers.

Natural drug leads as novel DPP-IV inhibitors targeting the management of type 2 diabetes mellitus

Aim: Number of type 2 diabetes mellitus (T2DM) patients using incretin based therapeutics has significantly increased in past few years. The development of novel incretin based therapeutics from natural sources has become an interesting area of drug discovery. The current review emphasizes the plants having DPP-IV inhibitory activity that can be used in the development of novel anti-diabetic agents. Methods: The relevant literature was collected form data sources as PubMed, Web of Science and Google Scholar. The references of articles were also examined to obtain further information. Results: To date, number of plants were documented for its’ antidiabetic potential through DPP-IV inhibitory activity either in vivo or in vitro. The compounds which exert potent DPP-IV inhibitory action have been identified and their structures have been deduced in some research findings. The DPP-IV inhibitory activity has been compared with positive controls in most of the studies. Conclusion: The present review reports on natural DPP-IV inhibitors through the assessment of plant profile used in the management of DM and highlights a new pathway for the researches to develop novel molecules from herbal sources with DPP-IV inhibitory activity.

Natural Phyto-Active Antihyperglycemic Moieties as Preventive Therapeutics for Diabetes Type II

Diabetes mellitus type-II (DM II) is a state characterized by hyperglycemia as fallout of endocrine dysfunction. This condition comes under the category of lifestyle diseases. The impaired insulin secretion, resistance or a combination of both results in the dysregulation of carbohydrate, protein and lipid metabolism. The extremities of this state are associated with other detrimental complications such as cardiomyopathy, retinopathy, nephropathy, hepatopathy and neuropathy etc. DM II has now become a growing epidemic and a major health concern globally. Naturopathy deals with the development of promising therapeutics using herbal origin to ensure minimal or no other side effects with best efficacy of the drug as a promising candidate against a diseased condition. Therefore the review aims to find out a range of medicinal plants that can be used as a natural remedy for the management of DM II, through isolation of active plant moieties (specifically proteins) with antihyperglycemic properties. The active plant metabolites, with antidiabetic potential based on the available pharmacological reports are used as herbal cure against DM II. These isolated active plant moieties, possessing antihyperglycemic properties, might play a significant role in the development of a formulation of plant protein moieties (as a preventive therapeutic) to reduce the prevalence of DM II and to serve the mankind.

DIABETES SELF MANAGEMENT EDUCATION (DSME) TO IMPROVE DIABETES EDUCATION IN PATIENTS WITH DIABETES MELITUS: LITERATURE REVIEW

ABSTRACTBackground: Diabetes mellitus is a chronic disease that requires a change in the healthy behavior of the patient for his recovery. Diabetes Self Management Education (DSME) integrates the four pillars of Diabetes Mellitus Management independently emphasize the behavioral interventions which help people with diabetes to change their lifestyles in terms of diabetic self care.Objective: Identify diabetes self-management education (DSME) features to improve diabetes education for people with diabetes mellitus. Method: We conducted a literature from 3 online databases like PUBMED, Science Direct and Google Schoolar and used 5 literature for this review.Result and Discussion: The educational process of DSME are assessment, goal setting, education and evaluation based on health promotion model theory. DSME focus on management of DM, nutrition, phisical activity, blood glucose monitoring, avoid/prevent/treat chronic or acute complications, resolve the psichologycal impact and focus on behavioural changes. From 5 studies include in our analysis, we identified that DSME have a good relationship with the positive outcome of DM.Conclusion: DSME is an effective educational method for increasing the good behavioral changes in DM.Keywords: Behaviour, Diabetes Mellitus, Diabetes Self Management Education

Attitudinal Disposition and Management Perception among Diabetes Mellitus Patients in Selected Hospitals in Ibadan, Oyo State, Nigeria

Background: Diabetes mellitus is an emerging metabolic disorder of the 21st century and has continued to attract the attention of health practitioners, as it continues to decrease the efficiency of its victims without any promise of change in the near or far future if more is not done to avert the progressing chronic condition.
 Aim: To determine the attitudinal disposition and management perception among diabetics Mellitus patients in selected hospitals in Ibadan, Nigeria.
 Study Design: The study was a cross sectional survey design guided by a behavioral theory.
 Place and Duration of Study: using purposive sampling, the study was carried out among diabetic patient attending University College Hospital, Ring-Road State Hospital and Oluyoro Catholic Hospital, Ibadan, Oyo State. 
 Materials and Methodology: A systematic random sampling was used to select 600 out of 2,115 diabetes patients receiving treatment at University College Hospital, Ring-Road State Hospital and Oluyoro Catholic Hospital. A semi-structured questionnaire was used for data collection on respondents’ socio-demographic characteristics, attitudinal disposition and management perception. Descriptive statistics was used for data analysis.
 Results: Mean age of the respondents was 63.9 ± 8.6 years, 75.3% were married and 62.7% were females. Majority (94.0%) of the respondents had a positive attitude towards compliance with management of DM. Majority (91.5%) were of the attitude that it is not necessary for people living with DM to do regular exercise as exercise will not make them to breakdown and 97.0% were of the attitude that diabetic patients cannot take any amount of alcohol beverages he/she wants. Respondents’ mean perception score was 21.8 ± 4.8 and 69.2% had a positive perception to management of DM. most (69.2%) of the respondents were of the perception that DM is a lifelong disease and can only be controlled but cannot be cured.
 Conclusion: Many of the respondents had appropriate perceptions needed to cope with the disease. However, the positive attitude sustenance demonstrated by the respondent should be promoted if compliance with the management of DM must be ensured.

Repercussions of diabetes mellitus on the oral cavity

AbstractOral health is a cardinal element of nutritional as well as systemic well-being and plays a substantial part in sustaining optimum general health condition. Various factors influence oral health including metabolic diseases such as endocrine (diabetes mellitus [DM]), hematological, gastrointestinal, cutaneous, and neurological diseases. The intent of this review is to accentuate the correlation between DM and oral disorders, like those upsetting oral mucosa and supporting tissues. A review of literature was performed using relevant key words (“Oral Manifestations of Diabetes” OR “Oral Complications of Diabetes” OR “Oral Impacts of Diabetes” OR “Oral Repercussions of Diabetes“) in prominent journals pertaining to Endocrinology and Dentistry (Journal of Periodontology, Periodontology 2000, British Dental Journal, The Lancet Diabetes and Endocrinology, PloS ONE, and Nature Reviews Genetics). The most frequently witnessed diabetic manifestations in oral cavity include gingivitis and periodontitis leading to premature tooth loss, salivary dysfunctions, dental caries, delayed wound healing, bacterial and fungal infections, lichen planus, taste impairment, tongue abnormalities, neurosensory oral disorders, halitosis, and dry socket. In the end, I have comprehensively described the role of antidiabetic drugs in the management of DM and eventually leading to prevention of its oral complications. In this review, etiopathophysiology of each oral complication has been prudently analyzed to contemplate the establishment of a possible preventive and treatment approach.

IN SILICO ANALYSIS OF ACTIVE CONSTITUENTS OF SILYMARIN AS ΑLPHA-GLUCOSIDASE ENZYME INHIBITORS IN TYPE 2 DIABETES MELLITUS

Objective: Type 2 diabetes mellitus (T2DM) is an acute metabolic disorder, in which the vogue is increasing persistently globally. The maltase-glucoamylase/alpha-glucosidase inhibitor is an oral antidiabetic drug collectively, which is utilizing for regulating carbohydrates that ordinarily transformed into simple sugars and absorbed by the intestine. Researchers need to constantly explore alternative therapeutic strategies for the clinical management of DM due to the increased adverse event caused by conservative antidiabetic agents. The present study proposes a substitute drug to examine the seven bioactive phytocomponents of Silybum marianum (milk thistle) that can regulate the hyperglycemia by downregulating alpha-glucosidase and its activity.
 Methods: Different integrated web-based in silico tools and techniques were used to model the enzyme (receptor) as well as to determine the druggability of different active constituents of silymarin and their pharmacokinetics were predicted. Further, the active site of the enzyme was predicted followed by molecular docking method.
 Results: The results show silychristin A and silydianin having less carcinogenicity and strong interaction to the target protein (alpha-glucosidase) compare to the reference drugs (acarbose and miglitol) and these two molecules can be used for the best drug molecules in T2DM.
 Conclusion: In the proposed study, the in silico analysis helps researchers to utilize these compounds for clinical applications. The conclusion also suggests that synthetically and semi-synthetically, nucleus and peripheral modifications, either in the form of skeletal rearrangements or partial degradations as well as functional group addition and replacement of the active molecules present in silymarin giving access to new structural motifs, which can be used in future as a lead compounds for antagonising the alpha-glucosidase in the treatment of diabetes mellitus.

930-P: Blood Glucose Levels Prediction Accuracy for T1DM Patients Using Neural Networks to Combine Insulin Doses, Food Nutrients, and Heart Rate

This study analyzed the accuracy of a BGL predictive model (BGL-PM) for type 1 diabetes mellitus patients (T1DM) in a real-world environment. The study population consisted of 10 individuals with T1DM, half of them were female, age 33 (SD:11.2), BMI of 26.1 (4.2) and 60% were under carbohydrate-count treatment. After consent, patients underwent a medical evaluation and registered their daily activities using a smartphone application (GlucoTrends) for 28 days, with BGL and heart rate continuously monitored. BGL-PM was developed using a Deep Learning architecture, based on Recurrent Neural Networks. Models were trained for each patient using different training sets sizes (7, 14, 21 days). Prediction accuracy was evaluated by Mean Absolute Percentage Error (MAPE) on the last 5 days for different Prediction Horizons (PH): 30, 60, 120, 180 and 360 minutes, comparing full day and nocturnal period. The model predicted BGL with relevant accuracy for the dataset with 21 training days up to 60 minutes in both periods: full day (median MAPE 22.5%) and nocturnal (14.3%) (Figure). The BGL-PM was able to provide useful BGL predictions, especially during the night period, which can be improved by increasing the training period. Consequently, this BGL-PM poses as a complementary tool for the prevention of acute complications such as hypoglycemia and hyperglycemia in the management of DM. Disclosure M. Foss-Freitas: None. G.S. Moreira: Stock/Shareholder; Self; GlucoGear Tecnologia. V.P. Antloga: Stock/Shareholder; Self; GlucoGear Tecnologia. C.R. Neto: Research Support; Self; University of Sao Paulo. E.M. Rodrigues: Consultant; Self; GlucoGear Tecnologia. M.F. da Costa: Research Support; Self; GlucoGear. A.P. dos Santos: None. Y.K. Matsumoto: Board Member; Self; GlucoGear. Stock/Shareholder; Self; GlucoGear. Other Relationship; Self; GlucoGear.

442-P: Excess Burden of Adverse In-Hospital Outcomes in Patients with Diabetes Hospitalized for Stroke

Cerebrovascular accidents (CVA) represent a major complication in diabetes (DM). Real-life evidence as to whether modern management of CVA and DM have softened this relationship is currently limited. We assessed the prevalence of DM, previously known or newly-diagnosed, in all patients (N=542, males 51.5%) admitted for CVA at the Stroke Unit (SU) of Verona University Hospital from 1/1/2015 to 12/31/2016. DM was ascertained by previous diagnosis, glucose-lowering therapy at admission/discharge or admittance plasma glucose (PG) ≥11.1 mmol/L. Prevalence of DM was 21.03% (78.1% known-DM; 21.9% new-DM). In-hospital death rate was 10.5%. Compared to non-DM, patients with DM showed an increased risk of death (15.8 vs. 9.1%; OR 1.87 95% CI, 1.03-3.41) and complications (48.2 vs. 33.3%; 1.87, 1.22-2.86) with similar duration of hospitalization (mean±SEM, 9.14±1.06 vs. 8.80±0.39 days, p=0.72). All deaths occurred in the SU. The “survivors” with DM transferred to non-intensive ward had an out-of-SU hospital stay twice as longer than non-DM (2.32±1.02 vs. 0.98±0.19 days, p=0.038). After multivariable adjustment, DM remained predictor of complications (adj-OR 1.87, 1.22-2.86) but not mortality (1.79, 0.92-3.46). Patients in the highest PG quartile (≥6.55 mmol/L) displayed the highest risk of death (7.89, 2.73-22.79; PG<4.77 mmol/L, ref.) and complications (2.30, 1.24-4.23), independent of diabetes status, glucose-lowering medications, CVA treatment and established CVA risk factors. Individuals in the older age tertile (≥81 years) were at increased risk of death (3.25, 1.40-7.54; age <72 years, ref.), while risk of infectious/cardiorespiratory complications was higher at younger age (3.13, 1.42-6.9). No difference was observed in new-DM vs. known-DM. In conclusion, these data highlight that DM frequently occurs in patients admitted for CVA and adds an excess burden of adverse clinical outcomes that urgently calls for strategies to anticipate DM diagnosis in high-risk individuals. Disclosure M. Dauriz: None. E. Tregnaghi: None. L. Santi: None. T. Lucianer: None. A. Altomari: None. E. Rinaldi: None. S. Tardivo: None. C. Bovo: None. E. Bonora: None.

Diabetes Mellitus Among Pulmonary Tuberculosis Patients From 4 Tuberculosis-endemic Countries: The TANDEM Study.

Diabetes mellitus (DM) increases active tuberculosis (TB) risk and worsens TB outcomes, jeopardizing TB control especially in TB-endemic countries with rising DM prevalence rates. We assessed DM status and clinical correlates in TB patients across settings in Indonesia, Peru, Romania, and South Africa. Age-adjusted DM prevalence was estimated using laboratory glycated hemoglobin (HbA1c) or fasting plasma glucose in TB patients. Detailed and standardized sociodemographic, anthropometric, and clinical measurements were made. Characteristics of TB patients with or without DM were compared using multilevel mixed-effect regression models with robust standard errors. Of 2185 TB patients (median age 36.6 years, 61.2% male, 3.8% human immunodeficiency virus-infected), 12.5% (267/2128) had DM, one third of whom were newly diagnosed. Age-standardized DM prevalence ranged from 10.9% (South Africa) to 19.7% (Indonesia). Median HbA1c in TB-DM patients ranged from 7.4% (Romania) to 11.3% (Indonesia). Compared to those without DM, TB-DM patients were older and had a higher body mass index (BMI) (P value < .05). Compared to those with newly diagnosed DM, TB patients with diagnosed DM had higher BMI and HbA1c, less severe TB, and more frequent comorbidities, DM complications, and hypertension (P value < .05). We show that DM prevalence and clinical characteristics of TB-DM vary across settings. Diabetes is primarily known but untreated, hyperglycemia is often severe, and many patients with TB-DM have significant cardiovascular disease risk and severe TB. This underlines the need to improve strategies for better clinical management of combined TB and DM.

Epidemiology of Diabetic Retinopathy at Eye Clinic Svjetlost Sarajevo: Two Years Retrospective Single Center Study.

Introduction:Diabetic retinopathy (DR) is an important cause of blindness, and occurs as a result of long-term accumulated damage to the small blood vessels in the retina. 2.6% of global blindness can be attributed to diabetes. Disease severity was most often classified by the Early Treatment Diabetic Retinopathy Study (ETDRS) classification for DR severity. Patients are usually categorized based on the severity of DR as having mild nonproliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR, or proliferative diabetic retinopathy (PDR).Aim:To evaluate DR status among patients at Eye Clinic Svjetlost Sarajevo , both, type 1 and type 2 DM patients who presented in our clinic at 2 years period – from June 2016 to June 2018. This is single center study.Methods:Retrospective analysis of 753 diabetic patients that came for the first check up in our institution during those two years, 363 patients were male and 390 were female. Patients were divided in 3 groups (based on DR changes): a) No changes, b) Nonproliferative DR (with and without Diabetic macular edema–DME), c) Prolipherative DR (with and without DME + Advanced PDR).Results:There were 35% of patients with no ocular changes, 41.2% had NPDR and 24% had PDR. Prevalence of DR in our study was 65.32%. Distribution of NPDR was 66.27%, and PDR was 33.73%. DME was present in 33.70% cases. In NPDR, DME was presented in 51% of the cases, while in PDR was presented in 49% of the cases. In state of advanced PDR, PDR was presented in 30.52% cases, tractional detachment and haemophtalmus in 50.20% of cases and neovascular glaucoma in 19.28%. Sixty-three patients ended up with vitroretinal surgery (8.4%) while in other studies that number is up to 3%. Out of that number 9 patients were patient with virgin eyes (14.28%). Neovascular glaucoma occurred in 19.28% of diabetics with proliferative retinopathy and 4.60% in all of diabetics.Conclusion:Diabetic retinopathy status of patients presenting at Eye clinic Svjetlost Sarajevo, Bosnia and Herzegovina is quite poor. There is a big need for early DR screening measures, good prevention and management of DR risk factors. Adequate and ON TIME management of DM and its vision threatening complications is of major importance.

Management beyond Insulin in Gestational Diabetes Mellitus: A Review Update

Hyperglycemia is the most common endocrine disorder of pregnancy. As compared to Diabetes in pregnancy(DIP) the management of gestational DM(GDM) has always been a topic of controversy. Medical nutrition therapy(MNT) is the cornerstone of GDM management. 80-90% of GDM mothers can be treated by MNT alone and the rest will require drugs. Considerable controversy surrounds the use of oral anti-diabetic medications in pregnancy. The most widely studied drugs are glyburide and metformin. Conflicting results have been produced by different studies. However recent meta-analyses have shown that they can be an attractive alternative to insulin if long term safety data become available. Till then it might be too early to make a final comment on their use in GDM.Journal of National Institute of Neurosciences Bangladesh, 2018;4(2): 145-149

Diabetes mellitus and periodontal disease: awareness and practice among doctors working in public general out-patient clinics in Kowloon West Cluster of Hong Kong

BackgroundDiabetes mellitus (DM) and periodontitis are very common and they interact with each other bidirectionally. This survey studied public primary care doctors on their awareness of this bidirectional relationship and their corresponding practice.MethodsAll Family Medicine doctors in Kowloon West Cluster, Hospital Authority were invited to a cross-sectional questionnaire survey. Results were analyzed statistically.ResultsOne hundred sixty-eight questionnaires were sent out, 143 were returned (response rate 85.1%). One hundred forty valid questionnaires were analyzed. Ninety-two percent of participants were aware of a relationship between DM and periodontal disease and this awareness was not associated with their years of experience, training status and personal oral health behavior. Ninety percent knew the effect of poor DM control on periodontal disease but only 76% were aware of the reverse effect of periodontal disease on DM. The difference was statistically significant (p = 0.002, Related-samples Sign Test). In clinical practice on DM patients, only 5.7% asked dental history often (defined as 50% patients or above), 7.1% examined their mouths often and 12.1% recommended them to see dentist often. Logistic regression showed that awareness factors had no association with periodontology related clinical practice whereas clinical experience, being a Family Medicine specialist and personal interdental cleaning habit were linked with more positive practice.ConclusionsA high proportion of doctors in the study were aware of the relationship between DM and periodontal disease. However, this did not appear to influence their practice. Further measures among doctors and patients to promote comprehensive management of DM and periodontal disease should be explored.

Pengaruh durasi senam diabetes pada penurunan glukosa darah penderita diabetes mellitus tipe II

Background: The management of DM focused on four pillars: education, nutrition therapy, physical exercise, and pharmacological interventions. In type 2 diabetes, physical activity functions primarily in controlling diabetes.Objective: This study aims to determine the effect of differences in the duration of aerobic exercise on blood glucose levels.Method: This was quasi-experimental research with pre-post test design. A total of 24 respondents with type 2 diabetes were divided into two groups consisting of groups A that received aerobic exercise with a duration of 30 minutes and group B received aerobic exercise with a duration of 60 minutes for 6 weeks and frequency of exercise 3 times each week. Statistical tests use paired t-tests and independent t-tests.Results: The mean post-test blood sugar level based on HbA1c measurements in group A was 7.92±1.56% while group B was 7.13±0.99%. Mean pre-test - post-test blood sugar levels in the two groups were significantly different (p&lt;0.05). Aerobic exercise for 6 weeks with a frequency of 3 times each week can reduce HbA1c by -2.5±0.96% in group A while group B increased by 0.02±0.29%. There is a significant difference in HbA1c before and after 6 weeks of aerobic exercise between two groups (p=0.021).Conclusion: Aerobic exercise with a duration of 30 minutes for 6 weeks 3 times each week can reduce blood glucose (HbA1c) by -2.5±0.96% while the group duration of aerobic exercise 60 minutes an increase of 0.02±0.29%. There is a significant difference in HbA1c before and after 6 weeks of aerobic exercise between the two groups.

Diabetes mellitus: A review of some of the prognostic markers of response to treatment and management

Background: The WHO defined ‘diabetes mellitus’ (DM) as a metabolic disorder characterised by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from the defect in insulin secretion, or inaction, or both. When not identified early and controlled, acute and chronic life-threatening consequences may result. Identifying DM early for treatment and management, as well as clinically monitoring recovery and improvement during treatment, involves the assessments of biomarkers. The types, choice, sensitivity and descriptive information trends of these biomarkers are very important. Aim: Some prognostic biomarkers and parameters that this review identified include glycated haemoglobin, white blood cells, mean neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, total leukocytes and neutrophils, plasma low-density lipoprotein, high-density lipoprotein and very low-density lipoprotein, platelet, fibrinogen, D-dimer and C-reactive proteins. Results: These parameters display increases in DM, while red blood cell, haemoglobin concentration, activated partial thromboplastin time, prothrombin time and partial thromboplastin time are decreased. Conclusion: With sound knowledge of the variations of these markers and parameters, observed reversal during treatment and management of DM and its complications can be better monitored, and guided decisions can be made.

Cost-Effectiveness of Interventions to Prevent and Manage Diabetes—A Systematic Review and Update

Many interventions are available for preventing type 2 diabetes (DM) and managing DM, but their cost-effectiveness (CE) varies greatly. Previously, we conducted a systematic cost-effectiveness (CE) review of all DM interventions covering studies between 1985 and 2007. Here, we update the study for Jan 20to July 2017. We used the same search strategies (databases, MeSH terms and keywords, exclusion criteria and study quality assessment tool) to select studies. We grouped interventions by CE ratios (CER) in cost per quality-adjusted life years (QALY) or life year gained (LYG)—cost saving (CER ≤ 0); very cost-effective (0 &amp;lt; CER ≤ $25,000); cost-effective ($25,000 &amp;lt; CER ≤ $50,000); marginally cost-effective ($50,000 &amp;lt; ICER ≤ $100,000); or not cost-effective (&amp;gt;$100,000)—and whether evidence was strong, supportive, or uncertain. We used the median CER to represent the CE of an intervention if multiple evaluations exist. Costs and CER were expressed as 2015 U.S. dollars. The initial search yielded 18,195 titles; 46 prevention and 110 management papers were included in the review. Interventions that were cost-saving or very cost-effective with strong evidence included: for preventing type 2 DM, 1) imposing taxes on sweetened beverages and 2) structured lifestyle intervention and metformin in people at high risk; for management of DM and its complications, 1) ACE inhibitor therapy for intensive hypertension (HTN) control, 2) self-monitoring of blood glucose, 3) comprehensive foot care to prevent ulcers, 4) multi-component coordinated care with peer support for managing HTN, hyperglycemia, hyperlipidemia, and chronic kidney disease, and early detection of DM complications. The CERs of other interventions ranged from $30,000 to $4,817,000 per QALY or &amp;lt;$25,000 per QALY with a high degree of uncertainty. Our results provide critical information for making evidence-based clinical and public health policy decisions. Disclosure K.R. Siegel: None. X. Zhou: None. B. Ng: None. S. Jawanda: None. K. Proia: None. X. Zhang: None. P. Zhang: None.

Management of Diabetes Mellitus With Glucagonlike Peptide-1 Agonist Liraglutide in Renal Transplant Recipients: A Retrospective Study

BackgroundDiabetes mellitus (DM) is the major cause of end-stage renal disease (ESRD) in Taiwan. Despite the use of steroids and/or calcineurin inhibitors (CNIs) in renal transplantation (RTx), additional challenges occur when a patient displays persisting metabolic disease, carries on an unhealthy lifestyle, or experiences genetic effects. Although RTx recipients could get better glycemic control by oral anti-diabetic drugs (OADs) or several insulin agents, they still need more than two kinds of medication. Liraglutide, a GLP-1 receptor agonist, stimulates insulin secretion and inhibits glucagon secretion and hepatic glucose production in a glucose-dependent manner. In addition, it delays gastric emptying and suppresses appetite through the central pathways. Herein we report on the long-term benefits of liraglutide in the management of DM in RTx recipients. MethodsWe retrospectively retrieved 7 RTx patients in August 2015, who had been prescribed liraglutide due to their poor glycemic control; however, 2 of them discontinued their scheduled doses within 1 month. The mean follow-up period was 19.4 ± 7.6 (range 10.5–27.6) months. ResultsGlycemic control improved fasting blood sugar (FBS) from an initial 228.6 ± 39.1 mg/dL to a final FBS of 166.0 ± 26.6 mg/dL (P = .103), with a significant improvement in nadir glucose control (136.4 ± 5.8 mg/dL, P = .017) and with glycated hemoglobin (HbA1c) from an initial 10.0 ± 1.6% to a final 8.1 ± 0.8% (P = .043). The average body weight was from an initial of 78.0 ± 7.8 kg to a nadir of 75.1 ± 9.1 kg (P = .032). Graft renal function of the estimated glomerular filtration rate (eGFR) significantly improved from an initial 67.7 ± 18.7 to a nadir of eGFR 76.5 ± 18.7 mg/dL (P = .024). There was no significant change in urinary protein:creatinine ratio. ConclusionLiraglutide may be safe and effective for RTx recipients with poor diabetic glycemic control, although there have been incidences of intolerance in some patients, and potential concern regarding absorption of oral medications due to a delay of gastric emptying. Evidence of liraglutide in diabetic RTx recipients is limited, so additional prospective clinical studies should be undertaken in the future.

An audit of our adherence to BSPED/ISPAD guidelines in the management of DM in a Secondary Level Irish Hospital

An audit of our adherence to BSPED/ISPAD guidelines in the management of DM in a Secondary Level Irish Hospital

Phytochemical profile, aldose reductase inhibitory, and antioxidant activities of Indian traditional medicinal Coccinia grandis (L.) fruit extract.

Coccinia grandis (L.) fruits (CGFs) are commonly used for culinary purposes and has several therapeutic applications in the Southeast Asia. The aim of this work was to evaluate phytochemical profile, aldose reductase inhibitory (ARI), and antioxidant activities of CGF extract. The CGFs were extracted with different solvents including petroleum ether, dichloromethane, acetone, methanol, and water. The highest yield of total extractable compounds (34.82%) and phenolic content (11.7±0.43mg of GAE/g dried extract) was found in methanol extract, whereas water extract showed the maximum content of total flavonoids (82.8±7.8mg QE/g dried extract). Gas chromatography-mass spectroscopy (GC-MS) analysis of methanol and water extract revealed the presence of flavonoids, phenolic compounds, alkaloids, and glycosides in the CGFs. Results of the in vitro ARI activity against partially purified bovine lens aldose reductase showed that methanol extract of CGFs exhibited 96.6% ARI activity at IC50 value 6.12µg/mL followed by water extract 89.1% with the IC50 value 6.50µg/mL. In addition, methanol and water extracts of CGF showed strong antioxidant activities including ABTS*+ scavenging, DPPH* scavenging, and hydroxyl radical scavenging. Our results suggest that high percentage of both flavonoids and phenolic contents in the CGFs are correlated with the ARI and antioxidant activities. The fruits of C. grandis are thus potential bifunctional agents with ARI and antioxidant activities that can be used for the prevention and management of DM and associated diseases.

Model Pendampingan Melalui Kelompok Perpuluhan Dalam Meningkatkan Kemampuan Pengelolaan Diabetus Melitus di Rumah Pada Penyandang Diabetes Mellitus Type II

According to the Center for Data and Information PERSI (2003,) the prevalence of diabetes mellitus type II increased. WHOestimates that the global prevalence of type II diabetes will increase from 171 million in 2000 to 366 million in 2030, andIndonesia ranked fourth after the United States, China and India. Riskesdas (2013) showed that the prevalence of DM inYogyakarta in 2013 was 2.6% and the diagnosis based on the diagnosis and symptoms of 3.0%. Results of a preliminarystudy conducted by researchers obtained data on the number raised DM 2014 in Puskesmas I Gamping Sleman many as270 people. DM disease if left untreated can lead to complications or fatal complications such as coronary heart disease,kidney failure, blindness, infections due to ulcer until amputated the affected part ulcers and can lead to death. Dasawismaperpuluhan group is a group whose members consist of people or families with the same health problems who live nearby.This group is one way for fostering community participation in the health sector so that the public be aware of the healthproblems experienced thus participate in solving the problem. The purpose of this study to determine the effect throughperpuluhan group mentoring model to DM management improvement at home in persons with diabetes mellitus type II. Typeof this research is quasi experimental design with pretest-posttest design with control group. The number of samples in thisstudy were 64 respondents that were divided into 32 groups of respondents with assistance through the perpuluhan group(treatment group) and 32 respondents with assistance through Elderly Posyandu (the comparison group). Sampling usedconsecutive sampling. Data were analyzed using Mc Nemar test and Chi square. Respondents who received assistancethrough the perpuluhan group capable of managing diabetes at home as much as 25 respondents (39.06%), while thosegetting assistance through Elderly Posyandu were 14 respondents (21.89%). Respondents who received assistancethrough perpuluhan groups that are unable to manage diabetes at home as much as 7 respondents (10.94%), while thosegetting assistance through Posyandu Elderly many as 18 respondents (28.11%) p = 0.005 &lt;0.05. It can be concluded thatmentoring activities through a perpuluhan group is more effective than assistance through Posyandu Elderly in improving theability of the management of DM at home in the DM type II patient.