Management Of Type 2 Diabetes Mellitus Research Articles

A novel α‐glucosidase inhibitor polysaccharide from Sargassum fusiforme

Summaryα‐Glucosidase inhibitors, which can inhibit α‐glucosidase to reduce the release of glucose after a mixed carbohydrate diet, has become a key tool in the management of type 2 diabetes mellitus (T2DM). SFP‐1, an α‐glucosidase inhibitor derived from Sargassum fusiforme (S. fusiforme), was studied as a food‐derived hypoglycaemic agent. By binding α‐glucosidase and then changing the conformation of the enzyme, SFP‐1 with a mixed inhibition type exerted an excellent inhibitory effect (IC50 value: 0.681 mg mL−1). Structural analyses suggested that the average molecular weight of SFP‐1 was 1.61 × 105 Da, mainly composed of glucuronic acid, fucose, galactose, glucose, mannose and xylose, and the relative molar ratio was 23.07: 15.17: 7.72: 4.92: 4.04: 1.99. FTIR and NMR analysis suggested that SFP‐1 was an acidic polysaccharide with both α‐type and β‐type glycosidic bonds. S. fusiforme polysaccharide (SFP‐1) has the potential to develop as functional foods and nutraceuticals in T2DM management.

Glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter 2 inhibitors for diabetes after solid organ transplantation.

Post-transplant diabetes mellitus (PTDM) is a common complication of solid organ transplantation and a major cause of increased morbidity and mortality. Additionally, solid organ transplant patients may have pre-existent type 2 diabetes mellitus (T2DM). While insulin is the treatment of choice for hyperglycemia in the first weeks after transplantation, there is no preferred first line agent for long-term management of PTDM or pre-existent T2DM. Glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter 2 (SGLT2) inhibitors improve glycemic control, lower body weight, and blood pressure, are recommended after lifestyle and metformin as initial therapy for diabetic patients with cardiovascular or kidney comorbidities regarding their cardiorenal benefits. Furthermore, the mechanisms of action of GLP-1RA may counteract some of the driving forces for PTDM, as calcineurin-induced β cell toxicity as per preclinical data, and improve obesity. However, their use in the treatment of PTDM is currently limited by a paucity of data. Retrospective observational and small exploratory studies suggest that GLP-1RA effectively improve glycemic control and induce weight loss in patients with PTDM without interacting with commonly used immunosuppressive agents, although randomized-controlled clinical trials are required to confirm their safety and efficacy. In this narrative review, we evaluate the risk factors and pathogenesis of PTDM and compare the potential roles of GLP-1RA and SGLT2 inhibitors in PTDM prevention and management as well as in pre-existent T2DM, and providing a roadmap for evidence generation on newer antidiabetic drugs for solid organ transplantation.

Effectiveness of mHealth management with an implantable glucose sensor and a mobile application among Chinese adults with type 2 diabetes

Introduction This study aimed to evaluate the effectiveness of mHealth management with an implantable glucose sensor and a mobile application among patients with type 2 diabetes mellitus (T2DM) in China. Methods A randomised controlled trial was carried out to compare the effectiveness of usual health management to mHealth management based on a model that consisted of the network platform, an implantable glucose sensor and a mobile app featuring guidance from general practitioners (GPs) over a four-week period. Patients (N=68) with T2DM were randomly divided into an intervention group and a control group. Before the intervention, there was no difference in body mass index (BMI), fasting blood glucose (FBG), postprandial two-hour blood glucose (2hPG) and glycosylated haemoglobin (HbA1c) between the intervention group and the control group (p>0.05). Patients in the control group received their usual health management, while patients in the intervention group received mHealth management. Results After health management, the mean BMI, FBG, 2hPG and HbA1c of the intervention group patients were all lower than those of the control group patients (p < 0.05), and the quality of life and self-management of the intervention group patients had significantly improved. Discussion mHealth management effectively showed significant reductions in BMI, FBG, 2hPG and HbA1c and improved quality of life and self-management among patients, which may be related to real-time feedback from an implantable glucose sensor and guidance from GPs through a mobile app. mHealth management is a very promising way to promote the health management of T2DM in China, and this study provides a point of reference for mHealth management abroad.

A Comprehensive Review and Perspective on Natural Sources as Dipeptidyl Peptidase-4 Inhibitors for Management of Diabetes.

Type 2 diabetes mellitus (T2DM) is an increasing global public health problem, and its prevalence is expected to rise in coming decades. Dipeptidyl peptidase-4 (DPP-4) is a therapeutic target for the management of T2DM, and its inhibitors prevent the degradation of glucose-dependent insulinotropic peptide and glucagon-like peptide 1, and thus, maintain their endogenous levels and lower blood glucose levels. Various medicinal plant extracts and isolated bioactive compounds exhibit DPP-4 inhibitory activity. In this review, we discussed different natural sources that have been shown to have anti-diabetic efficacy with a particular emphasis on DPP-4 inhibition. Furthermore, the effect of DPP-4 inhibition on pancreatic beta cell function, skeletal muscle function, and the glucose-lowering mechanisms were also discussed. We believe that scientists looking for novel compounds with therapeutic promise against T2DM will be able to develop antidiabetic drugs using these natural sources.

Is Self-Determined Motivation a Useful Agent to Overcome Perceived Exercise Barriers in Patients With Type 2 Diabetes Mellitus?

Background: Devising a program to increase physical activity (PA)/exercise behavior in patients with type 2 diabetes mellitus (T2DM) can meet with limited effectiveness in real-world settings because of the variety of barriers to PA/exercise that individuals need to overcome. An alternative approach is to explore whether targeting motivation as a facilitator may be effective to increase PA/exercise. This study aimed to understand attitudes toward perceived barriers to PA/exercise by examining individual levels of motivation, grounded on self-determination theory, in patients with T2DM. Methods: This study used an integrated approach combining qualitative and quantitative analysis. Sixteen patients with T2DM were grouped (n = 8 for each group) into either a higher self-motivation (HSM) or lower self-motivation (LSM) group via the Relative Autonomy Index. Thematic and deductive analysis were used to identify attitudes based on ten preconceived barrier themes: apathy, dislike, no priority, lack of support, health problems, lack of knowledge, unfavorable environment, tiredness, lack of time, and financial constraints. Quantitative analysis was to assess statistical differences in the volume of PA/exercise across the two groups, and a mixed-methods analysis was employed to highlight unique cases. Results: Patients in the HSM group expressed positive attitudes toward barriers to PA/exercise, while patients in the LSM group expressed a greater degree of hindrance. Although regular PA/exercise is necessary for T2DM management, patients with LSM considered PA/exercise a lesser priority displaying negative attitudes such as apathy and dislike. Conversely, patients with HSM placed greater emphasis on the benefits of PA/exercise regardless of apathy and dislike. Lack of time and health problems were commonly reported in both groups. The volume of PA/exercise corresponded to motivation levels, but there were some unique cases which arose from active commuting habits and severe health problems. Conclusion: These findings provide insights on how attitudes to perceived barriers to PA/exercise differ by levels of motivation. One insight was that examining motivation should be an essential consideration when designing practical strategies to overcome PA/exercise barriers in patients with T2DM. Lack of time and health problems exist regardless of motivation levels. Future research requires a tailored approach to managing barriers to PA/exercise in patients with T2DM.

Exercise, Pharmaceutical Therapies and Type 2 Diabetes: Looking beyond Glycemic Control to Whole Body Health and Function

Exercise, Pharmaceutical Therapies and Type 2 Diabetes: Looking beyond Glycemic Control to Whole Body Health and Function Thomas Yates()1,2, Joseph Henson1,2, Jack Sargeant1,2, James A King2,4, Ehtasham Ahmad1, Francesco Zaccardi1,3 and Melanie J Davies1,2 1Diabetes Research Center, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK 2NIHR Leicester Biomedical Research Center, University Hospitals of Leicester NHS Trust and University of Leicester, UK 3Leicester Real World Evidence Unit, Diabetes Research Center, University of Leicester, Leicester, UK 4National Center for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, UK © The Authors Abstract Exercise is a powerful therapy for improving glycemic control and increasing cardiorespiratory fitness in adults with type 2 diabetes mellitus (T2DM). However, there is a dearth of evidence investigating interactions or synergies between exercise and most pharmaceutical therapies. This is important as exercise is rarely prescribed in isolation of other background medications used to manage T2DM. Therefore understanding which exercise and drug combinations optimize or blunt responses is crucial. This narrative review discusses advances in weight loss management in diabetes and highlights research opportunities and challenges for combining exercise therapies with newer generations of glucose-lowering therapies with weight loss effects, particularly glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2is). We discuss the role of exercise in preserving lean mass and increasing physical function along with other potential areas of synergy. We conclude that until the evidence base investigating areas of interaction or synergy between exercise and other glucose-lowering or weight loss therapies is developed, exercise will remain a generic rather than a tailored therapy in the management of T2DM.

Diagnosis and management of pediatric type 1 diabetes mellitus

Background: In contrast to type 2 diabetes, type 1 diabetes mellitus (T1DM) requires insulin treatment to control blood glucose. As the incidence and prevalence of T1DM have steadily increased; therefore, T1DM is increasingly being diagnosed not only in children and adolescents, but also in adults. Therefore, the importance of accurate diagnosis and optimal management of T1DM is being recognized in clinical practice.Current Concepts: T1DM is caused by insulin deficiency, following the destruction of insulin-producing pancreatic β-cells. Diagnosis of diabetes is based on the following criteria: fasting blood glucose levels ≥126 mg/dL, random blood glucose levels ≥200 mg/dL accompanied by symptoms of hyperglycemia, an abnormal 2-hour oral glucose tolerance test, or glycated hemoglobin ≥6.5%. Accurate diagnosis of T1DM based on patients’ clinical characteristics, serum C-peptide levels, and detection of autoantibodies against β-cell autoantigens is important for optimum care and to avoid complications. A target glycated hemoglobin level is recommended in children, adolescents, and young adults with access to comprehensive care. The availability of insulin analogues and mechanical technologies (insulin pumps and continuous glucose monitors) has improved the management of T1DM, and these are useful for the prevention of microvascular complications. Screening for microvascular complications should commence at puberty or 5 years after diagnosis of T1DM.Discussion and Conclusion: Effective cooperation and coordination between patient, parents, and healthcare providers are necessary to achieve a successful transition from pediatric to adult care in patients with T1DM. Diabetic management for T1DM should be individualized based on patients’ lifestyle, as well as psychosocial, and medical circumstances.

Pengaruh Self-Efficacy Enhancing Intervention Program (SEEIP) Secara Online Terhadap Self-Efficacy Dalam Manajemen Diri Penderita Diabetes Mellitus Tipe II Di Puskesmas Juli I

Objective: The objective of this study was to determine the effect of Self-Efficacy Enhancing Intervention Program (SEEIP) with online method on Self-Efficacy in Self-Management in Type 2 Diabetes Mellitus (T2DM) at Juli I Public Health CentreMethods: This study was a pre-experimental pre-test and post-test with only one group design. The population wasT2DM at Juli I Public Health Center in 2020. The sample size was 22 participants, selected by purposive sampling technique. Diabetes Management Self-Efficacy Scale (DMSES) was used to measure the Self-Efficacy in Self- Management of T2DM patients. Data were analyzed using paired t-testResults: The results of the study showed that the means score of Self- Management of T2DM before receiving SEEIP was 39,00 (SD: 15,455) and 90,23 (SD: 7,571)after receiving the SEEIP. Paired t-test showed that there was a significant difference on Self- Efficacy in Self-Management in T2DM at Juli I Public Health Centre in 2020Conclusion: SEEIP could improve self-efficacy in self-management for Type 2 diabetes mellitus at Juli I Public Health Centre.

The Effects of Alkaline Ionized Water Administration to the Total Cholesterol Levels in Patients with Type 2 Diabetes Mellitus Accompanied by Dyslipidemia

Background: Total cholesterol is a measure of the total amount of cholesterol components including LDL (low-density lipoprotein), HDL (high-density lipoprotein), and VLDL (very low-density lipoprotein). Alkaline ionized water (AIW) is an electrolyzed water with a hydrogen-rich molecule and an alkaline pH. It has a negative oxidation-reduction potential (ORP) and reactive oxygen species (ROS)-scavenging activity, which shows an antioxidant and has beneficial effects on reducing total cholesterol level, but the results still vary. This study was to investigate the effect of AIW to total cholesterol and other lipid profiles level in patients with type-2 diabetes mellitus (T2DM) accompanied by dyslipidemia. Methods: This was a randomized double blind controlled trial performed in December 2017–December 2018. Thirty patients that had been diagnosed with T2DM accompanied by dyslipidemia in Diponegoro National Hospital Semarang and met the inclussion criteria were determined by consecutive sampling. Subjects were randomly divided into two groups: AIW group (n=15) and control group (mineral water, MW) (pH 7) (n=15). Both were administered orally 1 liter per day for 12 days; total cholesterol level and other lipid profiles were measured before and after 12 days treatment. The statistical analysis was using independent t-test, paired t-test, and non-parametric Mann-Whitney test. Result: There were no differences between AIW group and mineral water group in all lipid profiles at before and after treatment, including total cholesterol (pre-treatment: 290.2 ± 41.45 mg/dL vs 282.2 ± 15.81 mg/dL, p=0.575, and post-treatment: 249.8 ± 41.17 vs 268.5 ± 16.73 mg/dL, p=0.097), LDLc (pre-treatment: 167.0 ± 9.17 mg/dL vs 162.2 ± 4.75 mg/dL, p=0.227, and post-treatment: 157.2 ± 8.88 mg/dL vs 157.6 ± 5.39 mg/dL, p=0.518), HDLc (pre-treatment: 43.8 ± 4.16 mg/dL vs 42.8 ± 4.45 mg/dL, p=0.136 and post-treatment: 47.1 ± 3.24 mg/dL vs 45.2 ± 1.98 mg/dL, p=0.142), and triglyceride (pre-treatment: 351.0 ± 119.36 mg/dL vs 381.3 ± 59.38 mg/dL, p=0.934 and post-treatment: 266.4 ± 115.63 mg/dL vs 317.6 ± 70.50 mg/dL, p=0.154), respectively. There was a wider differences between post- and pre-treatment of total cholesterol (Δtotal cholesterol) (40.4 ± 31.57 vs 13.7 ± 10.65, p=0.002), LDLc (ΔLDLc) (9.8 ± 4.29 vs 4.6 ± 1.54, p=0.000), and HDLc (ΔHDLc) (4.3 ± 1.87 vs 3.4 ± 3.11, p=0.031) in AIW group compared to mineral water group. Conclusion: Alkaline ionized water (AIW) decreased total cholesterol and improved other lipid profiles level in patients with T2DM accompanied by dyslipidemia. These findings might have important implications for the management of T2DM accompanied by dyslipidemia. Keywords : alkaline ionized water, total cholesterol level, type 2 diabetes mellitus, T2DM

Human umbilical cord mesenchymal stem cells in type 2 diabetes mellitus: the emerging therapeutic approach.

The umbilical cord has been proved to be an easy-access, reliable, and useful source of mesenchymal stem cells (MSC) for clinical applications due to its primitive, immunomodulatory, non-immunogenic, secretory and paracrine, migratory, proliferative, and multipotent properties. This set of characteristics has recently attracted great research interest in the fields of nanotechnology and regenerative medicine and cellular therapy. Accumulating evidence supports a pronounced therapeutic potential of MSC in many different pathologies, from hematology to immunology, wound-healing, tissue regeneration, and oncology. Diabetes mellitus, branded the epidemic of the century, is considered a chronic metabolic disorder, representing a major burden for health system sustainability and an important public health challenge to modern societies. The available treatments for type 2 diabetes mellitus (T2DM) still rely mainly on combinations of oral antidiabetic agents with lifestyle and nutritional adjustments. Despite the continuous development of novel and better hypoglycemic drugs, their efficacy is limited in the installment and progression of silent T2DM complications. T2DM comorbidities and mortality rates still make it a serious, common, costly, and long-term manageable disease. Recently, experimental models, preclinical observations, and clinical studies have provided some insights and preliminary promising results using umbilical cord MSCs to treat and manage diabetes. This review focuses on the latest research and applications of human-derived umbilical cord MSC in the treatment and management of T2DM, exploring and systematizing the key effects of both umbilical cord MSC and its factor-rich secretome accordingly with the major complications associated to T2DM.

Expert Group Recommendations on the Effective Use of Bolus Insulin in the Management of Type 2 Diabetes Mellitus.

Evidence suggests a major contribution of postprandial glucose (PPG) excursions to the increased risk of micro- and macro-vascular complications in individuals with type 2 diabetes mellitus (T2DM). Administration of bolus insulin remains a very effective therapeutic option for PPG control. The aim of this expert group recommendation document was to provide practical and easy-to-execute guidelines for physicians on the appropriate use of bolus insulin in the management of T2DM. A panel of key opinion leaders from India reviewed and discussed the available clinical evidence and guideline recommendations on the following topics: (1) optimum control of PPG; (2) choice of bolus insulin; and (3) special situations and practical considerations. The expert panel critically analyzed the current literature and clinical practice guidelines and factored their rich clinical experience to develop a set of nine expert group recommendations for the effective use of bolus insulin. These recommendations will not only result in a more evidence-based application of bolus insulin in the clinical setting but also trigger further research and provide a valuable base for the development of future guidelines on the use of bolus insulin in the management of individuals with T2DM.

Proglucagon-Derived Peptides as Therapeutics.

Initially discovered as an impurity in insulin preparations, our understanding of the hyperglycaemic hormone glucagon has evolved markedly over subsequent decades. With description of the precursor proglucagon, we now appreciate that glucagon was just the first proglucagon-derived peptide (PGDP) to be characterised. Other bioactive members of the PGDP family include glucagon-like peptides -1 and -2 (GLP-1 and GLP-2), oxyntomodulin (OXM), glicentin and glicentin-related pancreatic peptide (GRPP), with these being produced via tissue-specific processing of proglucagon by the prohormone convertase (PC) enzymes, PC1/3 and PC2. PGDP peptides exert unique physiological effects that influence metabolism and energy regulation, which has witnessed several of them exploited in the form of long-acting, enzymatically resistant analogues for treatment of various pathologies. As such, intramuscular glucagon is well established in rescue of hypoglycaemia, while GLP-2 analogues are indicated in the management of short bowel syndrome. Furthermore, since approval of the first GLP-1 mimetic for the management of Type 2 diabetes mellitus (T2DM) in 2005, GLP-1 therapeutics have become a mainstay of T2DM management due to multifaceted and sustainable improvements in glycaemia, appetite control and weight loss. More recently, longer-acting PGDP therapeutics have been developed, while newfound benefits on cardioprotection, bone health, renal and liver function and cognition have been uncovered. In the present article, we discuss the physiology of PGDP peptides and their therapeutic applications, with a focus on successful design of analogues including dual and triple PGDP receptor agonists currently in clinical development.

Covid Lockdown Impact on Type 1 Diabetes Health and Well-Being

Introduction: Data on the impact of the COVID-19 lockdown on glycemic control and psychological well-being in individuals with Type 1 Diabetes Mellitus (T1DM) showed mixed results. Some studies showed improvement in glycemic control attributed to more time for self-care and a more regular lifestyle schedule during the lockdown. However, most published data reflects a short duration of 3–5 months. The impact of long-term social isolation and transition to telemedicine on the health of T1DM patients remains unknown. Our study analyzes patient perception surrounding the impact of an 11-month lockdown on glycemic control, well-being, and self-reported depression symptoms. Methods: PHQ-9 was integrated into a 55-question survey created using RedCap, a secure portal for managing surveys. The survey was sent to 160 T1DM patients over the age of 18 to gauge their current diabetes management and overall well-being prior to, and during the pandemic. The survey also inquired about patients’ perceived effectiveness of telemedicine visits. PHQ9 scores were collected and analyzed along with survey responses. Results: Data collection is still ongoing. From the 47 responders, the PHQ9 screening showed 51% were in the minimal depression score, 34% in the range of mild depression, 11% in moderate depression, and 4% scored in moderate to severe depression. No patients scored within severe depression. In a regular week during the pandemic, 40% of patients experienced difficulty with their motivation and diabetes management and 60% reported no concern, as compared to 36% and 64% respectively before the pandemic. Among the 47 of patient respondents, 30 reported both A1c levels prior and during the pandemic of which 46% showed an improved A1c amid the pandemic, 10% had no change, and 44% reported a worsened A1c level. For the telehealth part of the survey, 90% of patients reported feeling “comfortable with the level of care” they receive via telemedicine, whereas the other 10% were not. Whilst 54% of patients preferred in-person visits and 46% indicated a preference for telehealth visits. Conclusion: T1DM management is challenging. The pandemic adds to the complexity and burden to both self-management and healthcare delivery. Staying locked down for a prolonged period of time imposes economical, psychological, and medical constraints to diabetes care, as nearly half of the patients reported worsening of glycemic control. Our comprehensive survey reports the longest duration reported up to date of how the COVID-19 lockdown impacts patient’s perceived changes in their mental health and diabetes management. It helps clinicians understand the connection between mental and physical health during the pandemic and improve time-restricted telehealth visits by understanding patient concerns. Additional larger scale studies are imperative to expand the knowledge in this field.

A clinical study on ziabetus shakri qism doem (Diabetes mellitus type 2) and its management with Unani formulation, A randomized standard controlled study

The word “Diabetes” is derived from the Greek word “Diabanmo”, which means passing through or to run through or siphon. According to Unani literature retrieved from Al Qaanon, Al Hawi, Kamilus Sanaah, diabetes mellitus is called Ziabetus Sakri. The description of ziabetus (Diabetes) in Unani classical literature is available since the time of Hippocrates and Ziabetus was considered as a disease of the kidneys. Arabian physicians have also described Ziabetus by the terms: Moattasha/Atsha, Zalaqul kulliya, Dolab, Dawwarah, Barkar/Barkarya, and Qaramees. Type 2 Diabetes Mellitus is a heterogeneous group of disorders characterized by variable degree of insulin resistance, impaired insulin secretion and excessive hepatic glucose production. Common presenting symptoms of Diabetes Mellitus include polyuria, polydipsia, polyphagia, weight loss, fatigue, weakness, blurred vision, frequent superficial infections and poor wound healing. The chronic hyperglycemia of diabetes is associated with long term complications, dysfunction and failure of various organs, especially the eyes, kidneys, nerves, heart and blood vessels. In conventional system of medicine several classes of drugs are being used to manage Type 2 Diabetes Mellitus, but apart from being effective, most of these drugs have drastic side effects on several organs and body functions, hence, their long term use is not in favour of the wellbeing of the Diabetic patient. In order to overcome the problem of the unwanted effects of the modern drugs, a clinical study with a Unani polyherbal formulation containing Shoneez (Nigella Sativa), Darchini (Cinnamon zeylanicum), Hulba (Trigonella foenum graceum) and Maghz Tukhm-e-Jamun (Syzygium Cuminum) for the management of Diabetes Mellitus Type 2 has been undertaken. At the end of the study the test drug was found efficacious and safe in the treatment of Type 2 Diabetes Mellitus.

Anti-Inflammatory Properties In Vitro and Hypoglycaemic Effects of Phenolics from Cultivated Fruit Body of Phellinus baumii in Type 2 Diabetic Mice.

Dietary intervention in type 2 diabetes mellitus (T2DM) is a hotspot in international research because of potential threats to human health. Phellinus baumii, a wild fungus traditionally used as a food and medicine source, is now cultivated in certain East Asian countries, and is rich in polyphenols, which are effective anti-inflammatory ingredients useful in treatment of T2DM, with fewer side effects than drugs. To examine the hypoglycaemic effects of Phellinus baumii phenolics (PPE), the metabolite profiles of T2DM mice induced by streptozotocin after PPE intervention were systematically analyzed. Here, 10 normal mice were given normal saline as control group, and 50 model mice were randomly assigned to five groups and daily intragastric administrated with saline, metformin (100 mg/kg), and PPE (50, 100, 150 mg/kg of body weight), for 60 days. The pro-inflammatory factor contents of lipopolysaccharide stimulation of RAW 264.7 cells were decreased in a dose-dependent manner after PPE treatment, we propose that PPE could exert anti-inflammatory properties. PPE could also effectively reduce blood glucose levels, increased insulin sensitivity, and improved other glucolipid metabolism. Q-PCR results suggested that the hypoglycemic effects of PPE might be through activating IRS1/PI3K/AKT pathway in diabetic mice. These results suggest that PPE has strong potential as dietary components in the prevention or management of T2DM.

Self Care Application In Improving The Quality Of Care And Management Of Type 2 Diabetes Mellitus Clients

Introduction: Diabetes Mellitus (DM) is a chronic disease (CD) in Indonesia that contributes to high mortality. This disease poses a limitation to self-care. Good self-care prevents complications and improves the quality of life. Self-care application (SCA) is a way to increase understanding of Type 2 Diabetes Mellitus (T2DM) clients and their families to improve the quality of care and good management of T2DM clients. Objective: To determine the effect of SCA on improving the quality of care and management of T2DM clients which include blood sugar levels, nutrition management, activity/ exercise management, self aesthetics, and personal hygiene. Methods: A quasi-experimental design with a non-equivalent control group design. The population of this study was patients with type 2 diabetes with a total sample size of 50 patients with type 2 diabetes who were evenly divided into 2 research groups. The sampling method used was proportional sampling. The interventions are in the form of SCA with training and mentoring patterns of T2DM clients and their families. Data analysis using independent t-test. Result: The application of self-care had no significant impact on blood sugar stability (p 0.540), was able to improve the quality of nutritional management (p 0.018), improve activity/ exercise management (p 0.000), improve self-esthetic behavior (p 0.000), and increase personal hygiene behavior (p 0.000). Conclusion: Improving the quality of care and management of T2DM due to SCA is directly related to the understanding and awareness of T2DM clients.

The Experience of Indonesian Men Living with Type-2 Diabetes Mellitus and Erectile Dysfunction: A Semi-structured Interview Study

Erectile dysfunction (ED) in men living with Type-2 Diabetes Mellitus (T2DM) in Indonesia is rarely discussed. This study explored the lived experiences of young- to middle-aged Indonesian men living with T2DM and ED to identify the related healthcare support they received from their local public health center. A qualitative-descriptive approach was used to elicit the experiences of twelve men with T2DM who were recruited from a public health center in Surabaya. Using guiding questions, individual interviews were audio recorded, transcribed verbatim, translated to English and then thematically analyzed. Most men in this study experienced ED, with participants’ responses to ED ranging from acceptance to feeling afraid to acknowledge ED to their wife or displaying anger towards their wife. Despite reporting they needed information about ED related to T2DM, participants reported an absence of discussion about ED with health professionals during regular T2DM appointments. Men reported not raising the issue themselves as they felt ashamed or embarrassed. Some men engaged in high-risk self-management behaviors, such as using off-street medications to try and fix their ED while others sought other forms of intimacy with their wife. This study’s findings present previously unreported healthcare experiences of Indonesian men with T2DM and ED. Although routinely visiting healthcare professionals in public health settings for T2DM management, the men in this study did not receive assessment or healthcare around ED. The men would have appreciated the opportunity to discuss their ED and explore treatment options. Future studies are recommended to explore how men with T2DM and ED, and their wives, can be supported by healthcare professionals to improve health and wellbeing outcomes.

Knowledge and Experience of Community Health Volunteer (Cadre) on Type 2 Diabetes Mellitus Management in Yogyakarta

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a chronic disease that requires long-term and comprehensive management. People with T2DM play a significant role in managing their condition and day-to-day life adjustment related to T2DM. In the Indonesian context, community health volunteers (cadres) roles are imperative because the community can influence day-to-day health care. AIM: The study aimed to describe the knowledge and experience of cadre on T2DM management in Yogyakarta, Indonesia. METHODS: It was a descriptive study with a cross-sectional approach. Five primary health-care center (Puskesmas) areas in Bantul district were selected based on their high population, including Kasihan 2, Jetis 1, Sedayu 1, Jetis 2, and Imogiri 2 areas. Sixty-eight cadres from those five areas were enrolled in this study through accidental sampling. The data were collected using questionnaires and analyzed using descriptive statistics. RESULTS: The results showed that the average age of cadres was 43 years old (20–64 years), with more than half of them graduating from high school, unemployed (61.8%), and never received education about DM and its management (51.5%). Forty-two cadres (61.8%) had a moderate level of knowledge, and 64.7% had inadequate experience in T2DM management. CONCLUSION: Knowledge and experience of cadre regarding T2DM management in Yogyakarta need to be increased. Further research is needed to examine certain training programs’ effects to improve cadre’s knowledge and experience in T2DM.

The Association between Hba1c- Derived Estimated Average Glucose (Eag) with Fasting Blood Sugar (FBS) and Post Prandial Blood Sugar (PPBS) in Patients with Type 2 Diabetes in A Cohort of Patients in a Tertiary Care Hospital in Sri Lanka

Introduction: Type 2 Diabetes mellitus (T2DM) is a chronic illness, caused due to resistance to insulin or poor production. FBS, PPBS and Glycated Haemoglobin (HbA1c) are the major tests that are used to monitor chronic glycemia worldwide. HbA1c level remains the gold standard test for assessment of glycemic control at follow up and it reflects the mean glucose values in the previous three - month period. HbA1c is expressed as a percentage, whereas the day-to-day monitoring and treatment of diabetes are based on blood glucose levels expressed as milligrams per deciliter (mg/dl) or millimoles per liter (mmol/L). Due to the difference in the denominators of FBS/PPBS with HbA1c, it causes confusion to the patients regards their glycaemic control. “Estimated average glucose” or eAG derived from HbA1c has been promoted by the American Diabetes Association (ADA). American Association of Clinical Chemists concludes that the correlation (r =0.92) is strong enough to justify reporting both HbA1c and eAG which indicate the 3- month control of the average sugar of the patient. This is easy for the patient as both FBS/PPBS and eAG are expressed with the same denominator for daily glucose checks and long-term control respectively, enhancing the glycaemic control.&#x0D; Objectives: To determine the statistical correlation between eAG derived from HBA1C using the Nathan’s regression equation with FBS and PPBS in patients with T2DM. To analyze the significance of eAG as opposed to HbA1C as a marker of long-term glycemic control in T2DM.&#x0D; Methodology: A retrospective analytical study done at the Department of Haematology of the Sri Jayewardenepura General Hospital, Sri Lanka. A simple random sampling technique was used, over a period of one year commencing June 2019 to June 2020, to obtain the laboratory records through laboratory information system of 201 adult patients both males and females who were diagnosed with T2DM. HbA1c, FBS, PPBS done on the same day were recorded. The eAG(mg/dl) was calculated using the Nathan’s regression equation (eAG = 28.7 x HbA1c – 46.7). Three groups were generated according to the patients’ levels of FBS and PPBS.&#x0D; Statistical Analysis: Data were double entered and analyzed using (SPSS) version 20. Descriptive statistical methods were used to calculate the median, mean standard deviation of age, HBA1c, FBS, and PPBS. Correlations between study variables were done with Pearson’s correlation method. The p value, lower than 0.05 was considered as statistically significant. Coefficient of determination (R Sq) was used to a statistical measure of how close the data are to the fitted regression line.&#x0D; Results: The total population of patients in both the FBS and PPBS groups showed a significant statistical correlation with eAG. The individual subgroups did not conform to this correlation. The results reveal no statistical correlation in both FBS and PPBS with eAG in patients with good glycaemic control. There was a significant statistical correlation in both FBS and PPBS with eAG in the groups of patients with moderately poor control. In those with markedly poor control the FBS did not show a statistical correlation with eAG, as opposed to the PPBS.&#x0D; Conclusion: The clinical importance of HbA1C/eAG in diagnosis and management of T2DM can be re-emphasized by this study. HbA1C along with eAG may be added as a test in the management of T2DM, for the better understanding and maintenance of good glycemic control. As eAG values, derived by the Nathan’s regression equation in our study scattered very close to the regression line, it provided a more complete and representative measure of average glucose in past 3 months. We conclude that HbA1c values were reliably translated into eAG measurements which would be easily understood by the patients being of the same denominator as the FBS/PPBS.

Effect of Yoga on Oxidative Stress in Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis

Diabetes mellitus has a significant impact on public health. Oxidative stress plays a major role in the pathophysiology of Type 2 Diabetes Mellitus (T2DM), leading to various complications of T2DM. Yoga is being widely used in the management of T2DM. The primary objective of this systematic review and meta-analysis is to understand the effects of yoga on oxidative stress parameters among adult patients diagnosed with T2DM. Electronic databases such as PubMed, Scopus, Cochrane Library and Science Direct from start of the study till March 2020 were searched to obtain eligible studies. Study designs of all nature were included (except case studies and reviews). The primary outcome was Malondialdehyde (MDA) and secondary outcomes included fasting plasma glucose, HbA1C and Superoxide Dismutase (SOD) levels. A total of four trials with a total of 440 patients met the inclusion criteria. The results of meta-analysis indicated that yoga significantly reduced MDA (SMD: -1.4; 95% CI -2.66 to -0.13; P = 0.03; I2 = 97%), fasting plasma glucose levels (SMD: -1.87: 95% CI -3.83 to -0.09; P = 0.06; I2= 99%), and HbA1c (SMD: -1.92; 95% CI - 3.03 to -0.81; P = 0.0007; I2 = 92%) in patients with T2DM. No such effect was found for SOD (SMD: -1.01; 95% CI -4.41 to 2.38; P = 0.56; I2= 99%). The available evidence suggests that yoga reduces MDA, fasting plasma glucose and HbA1C, and thus would be beneficial in the management of T2DM as a complementary therapy. However, considering the limited number of studies and its heterogeneity, further robust studies are necessary to strengthen our findings and investigate the long-term benefits of yoga.