Management Of T2DM Research Articles

Gestational Diabetes Mellitus

Gestational diabetes mellitus (GDM) has historically been defined as glucose intolerance first identified during pregnancy. The definition fails to distinguish overt (pre-gestational) diabetes diagnosed during pregnancy from glucose intolerance induced by pregnancy. Recently, the recognition that overt diabetes may first be identified in pregnancy has led to the recommendation that diabetes diagnosed in the first trimester should be termed type 2 diabetes (T2DM) rather than GDM , a clinically relevant difference in terminology as the outcomes and management of T2DM in pregnancy are distinct from outcomes and management of GDM. This chapter discusses the epidemiology, pathophysiology, screening, diagnosis, treatment and impact of GDM, as well as the obstetric management of GDM and management of GDM after pregnancy. This review contains 8 tables, and 56 references. Keywords: Gestational diabetes mellitus, diabetes mellitus, stillbirth, glucose control, type 2 diabetes mellitus, pregnancy

The Effects from Physical Exercise on the Blood Glucose Levels, HbA1c and Quality of Life of Type 2 Diabetes Mellitus Patients: A Systematic Review

Introduction: The present study aimed to analyze the effects of aerobic exercise, resistance and a combination of both on blood levels, HbA1c and of life for patients with T2DM. Methods: This systematic review used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). Scopus, Science Direct and PubMed online databases were extensively searched, focusing on the last five years. The search utilized the phrases diabetes, exercise,” glucose and quality of The inclusion criteria in the study regarding the literature was that it had to be an original article, that the source was a journal, that the article was in English and that it was available in full text. Results: We identified 1017 articles where 17 were considered to be relevant for this systematic review. The combination of resistance and aerobic physical exercise seems to have a greater impact on glucose, HbA1c and of life. Aerobic exercise, resistance exercise and a combination of both have benefits when it comes to reducing blood levels and HbA1c, as well as improving the of life of patients with T2DM. Conclussion: The type and intensity of the exercise chosen for the management of T2DM must be adjusted to the clinical condition and the patient’s individual physical fitness

The Effects from Physical Exercise on the Blood Glucose Levels, HbA1c and Quality of Life of Type 2 Diabetes Mellitus Patients: A Systematic Review

Introduction: The present study aimed to analyze the effects of aerobic exercise, resistance and a combination of both on blood glucose levels, HbA1c and quality of life for patients with T2DM.Methods: This systematic review used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). Scopus, Science Direct and PubMed online databases were extensively searched, focusing on the last five years. The search utilized the phrases "diabetes," "physical exercise,” "glucose" and "quality of life." The inclusion criteria in the study regarding the literature was that it had to be an original article, that the source was a journal, that the article was in English and that it was available in full text.Results: We identified 1017 articles where 17 were considered to be relevant for this systematic review. The combination of resistance and aerobic physical exercise seems to have a greater impact on glucose, HbA1c and quality of life. Aerobic exercise, resistance exercise and a combination of both have benefits when it comes to reducing blood glucose levels and HbA1c, as well as improving the quality of life of patients with T2DM.Conclussion: The type and intensity of the exercise chosen for the management of T2DM must be adjusted to the clinical condition and the patient’s individual physical fitness

Treat liver to beat diabetes

Management of Type 2 Diabetes (T2DM) with existing strategies of life style and pharmaceutical interventions has gained limited success as evidenced by its uncontrolled progression. Two key organs which are involved in pathophysiology of T2DM are liver and pancreas, both are the derivatives of endoderm with common precursor. In the invertebrates, hepatopancreas performs function of both liver and pancreas. It is known that derangement in glycolysis, neoglucogenesis, and glycogenolysis lead to hyperglycemia in T2DM although insulin levels are high. Several studies have reported implication of abnormal liver function in the development of metabolic syndrome i.e. T2DM. Partial hepatectomy has been shown to improve glycemic status in animal models of diabetes. This could be because liver and pancreas share same regenerating factors. These evidences suggest that abnormal liver status can impair pancreatic beta cell function and survival along with peripheral insulin resistance. We therefore hypothesize that restoring deranged liver functions may aid in the better control and management of T2DM. If found true, it may shift current intervention strategy towards liver rather than pancreas in the treatment of T2DM.

The impact of low mineral content water on cardiac function in diabetic rats: focus on oxidative stress.

The aim of this study was to estimate the effects of natural low mineral water from the source "Sneznik-1/79" in Serbia on glycemia as well as heart function in rats with diabetes mellitus type 2 (T2DM), with the special emphasis on the role of the oxidative stress. Twenty Wistar albino rats (males, 4weeks old at the beginning of the study, body weight 180 ± 20g) were included in the study. Rats were divided randomly into 2 groups (10 animals per group): T2DM: rats with diabetes mellitus type 2 with free access to tap water; T2DM + SW: rats with diabetes mellitus type with free access to natural mineral water from "Sneznik-1/79". Glucose level, ex vivo cardiac function as well as systemic and cardiac redox state were assessed. At the end of the study protocol, glucose level was lower in diabetic rats who consumed mineral water. Moreover cardiac function wasn't affected by mineral water intake, however, significant antioxidant effects were observed. Our study suggests that 4-week consumption of low mineral water from the spring "Sneznik-1/79" has important role in regulation of glycemia and altering redox state in favor of elevated antioxidant capacity without affecting heart function. Based on our findings we may assume that low mineral water from the spring "Sneznik-1/79" has the potential to be used either as preventive strategy or as additional therapeutic strategy in management of T2DM.

Understanding Reasons for Treatment Discontinuation, Attitudes and Education Needs Among People Who Discontinue Type2 Diabetes Treatment: Results from an Online Patient Survey in the USA and UK.

IntroductionType 2 diabetes mellitus (T2DM) requires long-term treatment to achieve and maintain glycaemic control; however, up to 50% of people with T2DM discontinue treatment by 1 year. It is therefore important to understand the patient perspective of therapeutic adherence and persistence.MethodsAn online questionnaire was presented to people with T2DM in the USA and UK on PatientLive®, a platform of Carenity, an online patient community. Those who discontinued at least one T2DM treatment within the last 6 months answered open-ended questions aimed to assess the reasons for discontinuation, how discontinuation could have been prevented, and what would have improved the experience with the discontinued treatment. Thematic qualitative analysis was performed on respondents’ answers to these questions.ResultsOral antidiabetics were the most commonly discontinued treatments (93/161), followed by insulin (40/161) and glucagon-like peptide 1 receptor agonists (13/161). Main reasons for treatment discontinuation overall were side effects (57/161), mostly gastrointestinal side effects and weight gain. The second most reported reason was drug efficacy issues (42/161). Key factors stated to prevent discontinuation were an improved care pathway (45/161) and more efficacious treatments with fewer side effects (41/161). In the USA, treatment cost played an important role in discontinuation (14/89) and discontinuation prevention (12/89). More information about T2DM and associated treatments (56/161), help with T2DM management (24/161), and increased and informative patient–physician interaction (12/161) would have been helpful for many respondents in both countries, while some patients noted that no additional information would have been useful to improve their understanding and experience with their T2DM treatment (64/161).ConclusionsThese results emphasise the need for focused medical education and improved communication to enhance patient experience and prevent treatment discontinuation. Understanding of attributes preferred by people with T2DM can help improve therapeutic adherence and outcomes with current medications, and guide development of future therapies.

669-P: Serial Online Education Helps Break Down Primary Care Practitioner Barriers to Insulin Therapy for T2DM Management

Introduction: Clinicians in primary care settings play key roles in T2DM care, yet data and past educational outcomes suggest they’re ill-prepared in insulin replacement therapy delivery, including recognition of need, and its optimization. Methods: An online interactive CME series for health care providers (HCPs) launched live-online in June 2019 and remained online for 6 months. “Insulin Replacement Therapy: Evolving Treatments and their Clinical Implications” included three 1-hour sessions focusing on: 1) insulin treatment options; 2) indications for initiation/advancement of insulin; and, 3) individualization/optimization. Sessions included polling and live Q and A segments. Faculty included physicians and a clinical pharmacist who specialize in diabetes and endocrinology. Evaluation included pre/post/2-mos. post surveys measuring knowledge, competence and self-reported clinical impact. In total, 2,230 learners participated in the series, including 819 physicians, 397 NPs/PAs, and 169 pharmacists. Primary care, internal medicine and diabetes specialists totaled 1,318. Results: Follow-up results indicated that 76% of learners reported positive educational impact on clinical practice and 128 examples were shared of specific clinical improvements, many relative to insulin use for T2DM. Additionally, 76% of respondents reported positive impact on patient outcomes and/or satisfaction, with 106 specific impact examples shared. Knowledge and competence questions that aligned with learning objectives consistently yielded improvements, all of which (12 questions) demonstrated statistically significant pre to post change. Conclusion: CME on diabetes management and insulin use leads to increased clinical confidence among HCPs, ultimately improving the quality of care of T2DM people who are in need of insulin replacement therapy. Data continue to confirm previous results about the positive impact of continuing education for clinicians. Disclosure W. Turell: None. C. Drexel: None. R.S. Beaser: None. Funding Eli Lilly and Company; Novo Nordisk; Medtronic; MannKind Corporation

1026-P: Physician-Related Factors Associated with Delay Insulin Initiation in Type 2 Diabetes Mellitus Patients with Oral Antihyperglycemic Agent Treatment Failure

Aims: Despite the availability of numerous glucose-lowering therapies and clear guidelines for T2DM management, only 1/3 of the patient with T2DM in Thailand can achieve their glycemic targets. Timely initiation of insulin therapy has been suggested as one of the strategies to solve this problem. Therefore, the purpose of this study was to identify physician’s attitudes among the internal medicine residents regarding insulin initiation. Methods: The questionnaire adapting from Physician Attitudes to Insulin Therapy questionnaire was used to conduct a questionnaire-based survey among the internal medicine residents in Siriraj Hospital, Mahidol University. Results: The questionnaire was sent to 100 internal medicine residents. The response rate was 80%. The majority of respondents (60%, n=48/80) were willing to initiate insulin therapy for the patients with T2DM, who failed oral antihyperglycemic drug (OHD) treatment at HbA1c level between 7.5-9.5%. In addition, 45% (n=36/80) of respondents use HbA1c threshold of above 8.5% to initiate insulin treatment add on to OHD. However, if the internal medicine residents themselves were diabetes mellitus, they would decide to receive insulin at HbA1c level between 7.0-8.5%. The main reasons regarding insulin initiation barrier by physicians were a consideration of burden on the patients and families to initiate insulin therapy (88%, n=70/80), time-consuming for an explanation about insulin devices, monitoring and adjustment (74%, n=59/80) and difficult to advise the patients who fear the injection drugs to use insulin (70%, n=56/80). Conclusions: Physician-related factors associated with delay insulin initiation need to be addressed for better diabetes management. Internal medicine resident aspects according to high HbA1c thresholds, high effort regarding explanation, and motivation, and the patients and family burdens are the main barriers for insulin initiation. Disclosure T. Sitasuwan: None. S. Choksakunwong: None. W. Srivanichakorn: None.

Costus pictus D. Don leaf extract stimulates GLP-1 secretion from GLUTag L-cells and has cytoprotective effects in BRIN-BD11 β-cells

Costus pictus D. Don, commonly known as insulin plant, is a traditional Indian antidiabetic herbal medicine with glucose-lowering and insulin secretory effects having been reported in animal models and humans with Type 2 diabetes. However, its effects on GLP-1 secretion from intestinal endocrine L-cells and potential metabolic and protective effects in insulin secreting pancreatic β-cells are not yet fully understood. This study is aimed to elucidate the effects of Costus pictus D. Don leaf extract (CPE) on L-cell function and GLP-1 secretion using the established murine GLUTag L-cell model and to investigate its potential cytoprotective effects against detrimental effects of palmitate and cytokines in pancreatic β-cells using BRIN-BD11cells. Costus pictus D. Don dried leaf powder was extracted by soxhlet method. Cell viability was determined by MTT assay. Changes in gene and protein expression were quantified by qPCR and western blotting, respectively. GLP-1 and insulin secretion were measured by ELISA. CPE significantly enhanced the percentage of viable BRIN-BD11 and GLUTag cells and protected BRIN-BD11cells against palmitate- and proinflammatory cytokine-induced toxicity. CPE enhanced acute GLP-1 secretion 6.4-16.3-fold from GLUTag cells at both low (1.1mM) and high (16.7mM) glucose (P<0.01) concentrations. Antioxidant (Nrf2, Cat & Gpx1) and pro-proliferative (Erk1 and Jnk1) gene expression were upregulated by 24h culture with CPE, while proinflammatory transcription factor NF-κB was downregulated. Diminished postprandial GLP-1 secretion and loss of insulin secreting β-cells are known contributors of T2DM. Our data suggests that CPE acutely stimulates GLP-1 secretion from L-cells. Long term exposure of the BRIN-BD11cells to CPE enhances cell number and may protect against palmitate and proinflammatory cytokines by activating multiple pathways. Thus, the current study suggests that the possible antidiabetic properties of CPE may be linked to enhanced GLP-1 secretion and β-cell protection which could be beneficial in the management of T2DM.

Glycemic and Non-Glycemic Effects of Teneligliptin

The gut enzymes are released in response to intake of meal, those are GLP-I (glucagon link peptide-I) &amp; GIP (glucose-dependent insulin tropic polypeptide) along with DPP-4(Dipeptidyl peptidase-4). GLP-I has vital role in control of glucose levels and it may also has capacity reduce body weight and it can manage some micro &amp; macro-vascular complications. Unfortunately it has very shorter half-life 1-2 min, and eventually it was degraded by DPP-4 enzyme. Therefore GLP-I has ineffective to perform its tasks. To overcome this incidence essential to inhibit DPP-4 enzyme is benefited in diabetics and in non diabetics suffering with micro, macro vascular complications. Ubiquitous Dipeptidyl peptidase (DPP) - 4 has pleiotropic effects because it is widely distributed other than intestine. DPP-4 enzyme inhibition has a promising effect on glycemic control. DPP-4 inhibition is also involved in the improvement of non-glycemic effects as directly or indirectly the DPP-4 enzyme is linked with some pathological conditions of particular organs, such as DPP-4 is linked with the intestinal secretion of triglycerides, and DPP-4 is expressed in the glomerulus in uncontrolled diabetics which in turn leads to nephritis. DPP-4 release strongly correlates with adipocyte size, potentially representing an important source of DPP-4 in obesity. DPP-4 inhibition produces an anti-inflammatory activity because the activity of DPP-4 results in reduced production of cytokines including interleukins and interferon-G. All these anti-inflammatory agents are inhibited by the DPP-4 enzyme which can lead to pathogenesis of cardiovascular diseases and provokes atherosclerosis &amp; psoriasis. Serum sodium and brain natriuretic peptide (BNP) levels are also regulated by inhibition of the DPP-4 enzyme and which can produce vascular protection &amp; regulates blood pressure. Teneligliptin is a recently developed oral DPP-4 inhibitor indicated for the management of T2DM in adults along with diet and exercise. Teneligliptin is recently available in India and is also available in combination with other oral hypoglycemic agents at affordable prices. This review is aimed at exploring the status of teneligliptin with emphasis on its glycemic effects and non-glycemic clinical benefits associated with increasing GLP-1 &amp; GIP.

SUN-693 What Else Should Be Done in Patients with Uncontrolled Type 2 Diabetes and Severe Insulin Allergy?

Introduction: Insulin allergy in patients with diabetes mellitus is a very rare condition. The immediate vital implications for the patient call for prompt diagnosis and management of insulin allergy. We present a case of a patient that was unable to tolerate the insulin desensitization process, however; he was successfully treated with antidiabetics’ medications following the AACE guidelines for the management of type 2 diabetes (T2DM).Case description:31 years old obese Caucasian male with a BMI of 35, a history of T2DM and insulin allergy who was admitted to the hospital with hyperglycemia and osteomyelitis of the right foot. Endocrinology was consulted for the management of diabetes. Laboratory results showed hemoglobin A1C 11.1%, C peptide level 2.79 with blood glucose 283 mg/dl with negative insulin specific IgG level and elevated Ig E levels. The patient was actually diagnosed with T2DM in 2001, then started on metformin, glyburide initially. Given uncontrolled diabetes he was started on insulin in 2007 however, he developed an allergic reaction to different types of insulin (including anaphylactic reaction) so he was referred to allergy and immunology for further testing and possible desensitization. He had an allergy to human, bovine and porcine insulin. Exclusion of other causes of allergy including latex, protamine, and zinc was performed by the immunologist. Trial of insulin desensitization (using NPH and regular Insulin) failed. He also developed an allergic reaction to different medications including sulfonylurea, SGLT2 inhibitors, DDP4 inhibitors, and alpha-glucosidase inhibitors. During the inpatient setting in 2019, we assessed the patient and considered different options available; bromocriptine versus amylin products versus fish insulin versus IGF1 (as of last resort). Other options were another desensitization process in the ICU setting with transitioning to an insulin pump, however, the patient refused that option. We started the patient on bromocriptine mesylate(cyclocet) with pioglitazone and the A1C improved in the next 3 months from 11.1%-->9.8%. The patient is still following up with us and plans for desensitization once the osteomyelitis of the foot is controlled. Discussion and conclusion: Insulin allergy is a rare but severe condition that calls for immediate work-up. It can be managed well in close cooperation between the endocrinologist and the immunologist. Our patient developed IgE-mediated symptoms occurring immediately after insulin injection and confirmed by intradermal skin testing. Specific immunotherapy has been reported in case reports in the literature and should be considered for these patients Following AACE guidelines for the management of T2DM with the addition of bromocriptine mesylate until desensitization was a beneficial option for our patient.

Adverse Changes in HbA1c, Body Weight and Insulin Use in People with Type1 Diabetes Mellitus Following Dapagliflozin Discontinuation in the DEPICT Clinical Trial Programme.

IntroductionDapagliflozin is an orally active inhibitor of sodium-glucose co-transporter 2 (SGLT2) that is indicated for use in adults with type 1 diabetes (T1DM) (with a body mass index (BMI) of at least 27 kg/m2 in Europe, no such BMI limit in Japan), when insulin alone does not provide adequate glycaemic control. The aim of this study was to evaluate changes in glycated haemoglobin (HbA1c), body weight and insulin dose following discontinuation of dapagliflozin for the management of T1DM in the DEPICT clinical trial programme.MethodsThe interrelationship between treatment discontinuation, insulin requirement and outcomes post-discontinuation was evaluated using descriptive summary statistics and linear regression modelling. Data were analysed from individuals with T1DM discontinuing dapagliflozin in DEPICT-1 or DEPICT-2 (unplanned or end of study). HbA1c and body weight were measured over the 56-week study period (consisting of a 52-week treatment period and a 4-week follow-up period) at 4–8 weekly intervals. Following discontinuation of dapagliflozin, 1-year change in HbA1c (%) and weight (kg) following discontinuation of dapagliflozin was estimated; total daily insulin doses were descriptively summarised.ResultsOf the 1059 individuals that received dapagliflozin during the DEPICT trials 91 met the eligibility criteria and were included in the analyses of HbA1c and body weight. The mean duration of follow-up was 209 days in both analyses. Following dapagliflozin discontinuation, estimated annualised changes in HbA1c and body weight were + 0.99% (95% CI 0.39, 1.59) and + 3.75 kg (1.65, 5.86), respectively. An increase in insulin dose was observed around the time of discontinuation; insulin dose in the 2-week post-discontinuation was + 3.6 IU and + 4.4 IU higher with dapagliflozin 5 mg and 10 mg than 2 weeks pre-discontinuation, respectively.ConclusionDiscontinuation of dapagliflozin is predicted to lead to clinically meaningful increases in HbA1c and body weight, in addition to higher insulin doses. These findings are important in the management of people with T1DM among whom insulin is the only existing pharmacological treatment option.Electronic supplementary materialThe online version of this article (10.1007/s13300-020-00807-z) contains supplementary material, which is available to authorized users.

Why do physicians prescribe new antidiabetic drugs? A qualitative study in the Greek healthcare setting

ObjectivesUnderstanding the process of new drug adoption can inform the development of policies to promote appropriate diffusion of new drugs that result in improved outcomes and are cost-effective. The present study aims to explore factors influencing adoption of new antidiabetic drugs for T2DM in the Greek setting. MethodsThe study employs a qualitative descriptive approach. Semi-structured interviews were performed with physicians involved in management of T2DM in adults. Eligible participants were identified using generic purposive sampling. Interviews were audio-recorded, transcribed verbatim and analyzed using framework analysis. Rogers’ Diffusion of Innovations theory informed the development of the interview guide and the coding scheme. Results10 physicians were interviewed. The mean interview duration was 44 min. Three main themes were derived: (1) Factors influencing prescribing of new medicines for T2DM, (2) Perceptions on pharmaceutical innovation, (3) Use of information sources during the new drug adoption process. The attributes of the new drug, patient-related factors, external influences and prescriber needs and characteristics affected the adoption decision. Physicians reported utilizing information from a variety of sources in the process of adoption. ConclusionsThe present study brought forward the importance of relative advantage and compatibility in the adoption of new antidiabetic agents and also highlighted that adoption is a process during which new drug attributes are continuously re-evaluated.

DAS: The Diabetes Awareness and Insight Scale

Background and aimsDiabetes mellitus affects approximately 8.5% of the world’s population with the majority of cases diagnosed with type 2 diabetes (T2DM). Impaired awareness or denial of T2DM is a common yet understudied construct that may negatively contribute to clinical outcomes. The aim of this study was to develop the Diabetes Awareness and Insight Scale (DAS), a self-report scale that measures illness awareness in persons with T2DM. MethodsNine items were developed for the DAS that measure four domains of illness awareness, namely General Illness Awareness, Accurate Symptom Attribution, Awareness of Need for Treatment, and Awareness of Negative Consequences attributable to T2DM (www.illnessawarenessscales.com). A total of 100 participants with a diagnosis of T2DM were recruited using a digital data collection platform. ResultsThe DAS demonstrated good convergent and discriminant validity, internal consistency, and one-month test-retest reliability. An exploratory factor analysis showed that the DAS exhibited three factors. ConclusionsOverall, the DAS is a novel and easy-to-administer scale that comprehensively measures subjective illness awareness in persons with T2DM. As the first scale of its kind, the DAS holds promise for use in epidemiology studies to examine the extent to which impaired illness awareness or illness denial contributes to clinical outcomes and T2DM management.

Antioxidant Effects and Mechanisms of Medicinal Plants and Their Bioactive Compounds for the Prevention and Treatment of Type 2 Diabetes: An Updated Review.

Diabetes mellitus is a metabolic disorder that majorly affects the endocrine gland, and it is symbolized by hyperglycemia and glucose intolerance owing to deficient insulin secretory responses and beta cell dysfunction. This ailment affects as many as 451 million people worldwide, and it is also one of the leading causes of death. In spite of the immense advances made in the development of orthodox antidiabetic drugs, these drugs are often considered not successful for the management and treatment of T2DM due to the myriad side effects associated with them. Thus, the exploration of medicinal herbs and natural products as therapeutic sources for the treatment of T2DM is promoted because they have little or no side effects. Bioactive molecules isolated from natural sources have been proven to lower blood glucose levels via regulating one or more of the following mechanisms: improvement of beta cell function, insulin resistance, glucose (re)absorption, and glucagon-like peptide-1 homeostasis. In recent times, the mechanisms of action of different bioactive molecules with antidiabetic properties and phytochemistry are gaining a lot of attention in the area of drug discovery. This review article presents an update of the findings from clinical research into medicinal plant therapy for T2DM.

Dipeptidyl peptidase 4 inhibitors reduce costs in T2DM management

Dipeptidyl peptidase 4 inhibitors reduce costs in T2DM management

Efficacy and Safety of Novel Dipeptidyl-Peptidase-4 Inhibitor Evogliptin in the Management of Type 2 Diabetes Mellitus: A Meta-Analysis.

Aims:No meta-analysis is available which has summarized and holistically analyzed the efficacy and safety of evogliptin. We undertook this meta-analysis to address this gap in knowledgeMethods:Electronic databases were searched for RCTs involving diabetes patients receiving evogliptin in intervention arm and placebo/active comparator in control arm. Primary outcome was to evaluate changes in HbA1c. Secondary outcomes were to evaluate alterations in fasting glucose, postprandial glucose, lipids, insulin resistance, patients achieving glycemic targets of HbA1c <7% and <6.5%, and adverse events.Results:From initially screened 57 articles, data from six RCTs involving 887 patients was analyzed [three having sitagliptin/linagliptin as active comparator; three having placebo in control group]. Evogliptin was noninferior to sitagliptin/linagliptin regarding HbA1c reduction at 12 weeks [mean difference (MD) -0.06%; 95%CI: -0.23–0.11%; P = 0.48] and 24 weeks (MD 0.04%; 95%CI: -0.11–0.19%; P = 0.60) follow-up. Evogliptin was superior to placebo regarding HbA1c reduction at 12-weeks (MD -0.57%; 95%CI: -0.62– -0.52%; P < 0.001) and 24 weeks (MD -0.28%; 95%CI: -0.47 – -0.09%; P = 0.004). Evogliptin was noninferior to sitagliptin/linagliptin regarding patients achieving HbA1c <7% and <6.5% at 12 weeks and 24 weeks follow-up. Total adverse events [Risk ratio (RR) 0.98; 95% CI: 0.72–1.32; P = 0.89] and severe adverse events (RR 0.65; 95% CI: 0.25–1.67; P = 0.37) were not significantly different among groups. Patients receiving evogliptin did not have increased symptomatic (RR 0.46; 95% CI: 0.10–2.16; P = 0.32) and asymptomatic (RR 1.09; 95% CI: 0.61–1.97; P = 0.77) hypoglycaemia.Conclusion:Evogliptin is well tolerated and has good glycemic efficacy over 6 months use for T2DM management

Analysis of the relationship between lifestyle habits and glycosylated hemoglobin control based on data from a Health Management Plan.

BACKGROUND/OBJECTIVESType 2 Diabetes mellitus (T2DM) is a hereditary disease that is also strongly dependent on environmental factors, lifestyles, and dietary habits. This study explored the relationship between lifestyle habits and glycosylated hemoglobin management in T2DM patients to provide empirical outcomes to improve T2DM management and patient health literacy.SUBJECTS/METHODSThis study enrolled 349 diabetic patients with more than 5 care visits to a Diabetes Mellitus care network under the Health Management Plan led by Taiwan Department of Health (DOH). Based on relevant literature, an Outpatient Record Form of Diabetes Mellitus Care was designed and lipid profile tests were conducted for data collection and analysis.RESULTSWhen modeling the data, the results showed that the odds for HbA1c > 7.5% in T2DM patients duration over 10 years was 3.785 (P = 0.002) times that in patients with disease duration of fewer than 3 years. The odds of HbA1c > 7.5% in illiterate patients was 3.128 (P = 0.039) times that in patients with senior high school education or above. The odds of HbA1c > 7.5% in patients with other chronic illness was 2.207 (P = 0.019) times that in participants without chronic illness. Among 5 beneficial lifestyle habits, the odds of HbA1c > 7.5% in patients with 2 or 3 good habits were 3.243 (P = 0.003) and 3.424 (P = 0.001) times that in patients with more than 3 good habits, respectively.CONCLUSIONThis empirical outcome shows that maintaining a good lifestyle improves T2DM management and patients' knowledge, motivation, and ability to use health information. Patients with longer disease duration, education, or good lifestyle habits had optimal HbA1c management than those in patients who did not. Thus, effective self-management and precaution in daily life and improved health literacy of diabetic patients are necessary to increase the quality of T2DM care.

A novel hypoglycemic agent: polysaccharides from laver (Porphyra spp.).

Type-II diabetes mellitus (T2DM) has become one of the most prevalent diseases on Earth and some treatments have been developed to manage it. One intestinal enzyme α-amylase can break down starch to glucose. Inhibiting its activity will control blood glucose and provide an essential approach for the management of T2DM. Alpha-amylase inhibitor (α-AI) specifically inhibits the activity of α-amylase, and reduces the blood glucose level efficiently. To develop a novel α-AI, the red seaweed laver (Porphyra spp.) was exploited in this work, whose extracts contain polysaccharides showing an inhibitory effect against α-amylase. The crude polysaccharides were extracted using hot water (85 °C) and degraded to low-molecular-weight polysaccharides with 7% of H2O2. One polysaccharide PD-1 exhibiting a competitive binding mode with an IC50 of 12.72 mg mL-1 was separated from these degraded polysaccharides, showing approximately 98.78% of α-amylase inhibition activity. In vivo, PD-1 could efficiently suppress postprandial blood glucose levels in normal and diabetic rats. The polysaccharide inhibitor from red seaweed laver could be regarded as a novel functional food ingredient in T2DM management.

Utilising clinical settings to identify and respond to the social determinants of health of individuals with type 2 diabetes-A review of the literature.

Type 2 diabetes (T2DM) is increasing in global prevalence. It is more common among people with poor social determinants of health (SDoH). Social determinants of health are typically considered at a population and community level; however, identifying and addressing the barriers related to SDoH at an individual and clinical level, could improve the self‐management of T2DM. This literature review aimed to explore the methods and strategies used in clinical settings to identify and address the SDoH in individuals with T2DM. A systematic search of peer‐reviewed literature using the electronic databases MEDLINE, CINAHL, Scopus and Informit was conducted between April and May 2017. Literature published between 2002 and 2017 was considered. Search results (n = 1,119) were screened by title and abstract against the inclusion and exclusion criteria and n = 56 were retained for full text screening. Nine studies met the inclusion criteria. Review and synthesis of the literature revealed written and phone surveys were the most commonly used strategy to identify social determinant‐related barriers to self‐management. Commonly known SDoH such as; income, employment, education, housing and social support were incorporated into the SDoH assessments. Limited strategies to address the identified social needs were revealed, however community health workers within the clinical team were the primary providers of social support. The review highlights the importance of identifying current and individually relevant social determinant‐related issues, and whether they are perceived as barriers to T2DM self‐management. Identifying self‐management barriers related to SDoH, and addressing these issues in clinical settings, could enable a more targeted intervention based on individually identified social need. Future research should investigate more specific ways to incorporate SDoH into the clinical management of T2DM.