Management Of Type 2 Diabetes Mellitus Research Articles

Approach to: Type 2 diabetes management

Type 2 Diabetes Mellitus (T2DM) is a chronic and insidious disease that is on the rise worldwide. Diabetes pharmacotherapy is complex and varied, and recent studies of novel antihyperglycemic drugs have raised important considerations for the management of T2DM. This review provides an overview for the diagnosis of T2DM, glycemic targets for individuals with a T2DM diagnosis, and outlines a general approach to the management of T2DM, with an emphasis on how to select the appropriate pharmacotherapy using a fictional case as an example. Hypoglycemia, a complication of pharmacotherapy, macrovascular and microvascular disease resulting from T2DM, and other forms of diabetes mellitus are also briefly reviewed.

Nitrosodimethylamine Impurities in Metformin Drug Products

Metformin is a high-dose antidiabetic drug and most widely used first-line therapeutic agent for the management of type 2 diabetes mellitus (T2DM). Medicines regulatory agencies discovered contamination of genotoxic nitrosamine impurity in certain medications containing angiotensin receptor blocking (ARB) agents. This resulted in screening for nitrosamine impurities in a number of probable drug products. In November 2019, the Singapore government withdrew metformin drug products, due to the contamination of nitrosamine impurity, called nitrosodimethylamine (NDMA). The regulatory agencies from different geographies started investigation and subsequently, many products withdrew from the international market due to the presence of an unacceptable limit of NDMA in metformin tablets. Both pharmaceutical companies and regulatory agencies responded to mitigate this emerging issue. USV Private Limited (USV) has adopted a proactive quality risk management program to investigate the presence of genotoxic impurities in metformin products. The presence of NDMA impurities were tested in 425 batches of drug substances and drug products. Threshold toxicological concern (TTC) of all the batches was found to be ≤30 ng/day, when compared to the regulatory limit of 96 ng/day. Hence, USV metformin products are safe and can be continuously prescribed for the management of T2DM.

Dietary management practices for type 1 diabetes mellitus by dietitians in KwaZulu-Natal

BackgroundIn South Africa, 5% – 15% of diabetics have type 1 diabetes mellitus (T1DM). Dietitians are an important part of the diabetes management team; however, there is a lack of published data on the dietary management practices for T1DM by dietitians.AimThe aim of this study was to determine the dietary management practices for T1DM by dietitians in KwaZulu-Natal (KZN).SettingThis study was conducted in KZN.MethodsA cross-sectional, descriptive study was conducted using a self-administered electronic questionnaire.ResultsOf the 69 dietitians who participated, 58% (n = 40) used the American Diabetes Association (ADA) guidelines to manage T1DM; just under 35% (n = 24) spent over an hour with new cases; and 87% (n = 60) used face-to-face consultations for follow-up. Dietitians used the glycaemic index, portion control using the healthy eating plate, carbohydrate counting using nutritional labels and household measures and carbohydrate awareness to manage T1DM (p < 0.05). Dietitians also used the healthy eating plate (71%; n = 49) (p < 0.05) and household measures (73.9%; n = 51) (p < 0.05) to manage T1DM. Time constraints, the literacy level of the patient, available resources and language barriers all played a role in determining the dietary management practices used (p < 0.05).ConclusionMost dietitians in KZN used the ADA dietary guidelines to manage T1DM, which highlights the need for South African dietary guidelines for the management of T1DM. Dietitians used a variety of different dietary methods to manage T1DM in practice. This suggests that dietitians are flexible in how they manage T1DM with no one particular method being used. A variety of factors also influenced which dietary management practices were chosen.

Tailored intervention to implement the management of hypertensive and type 2 diabetes mellitus patients in community pharmacies – a pilot study

Abstract Introduction Uncontrolled blood pressure and poor glycaemic control may lead to increased morbidity and mortality (1). A systematic review of 40 studies reported beneficial effects of interventions conducted in community pharmacies in the management of diabetes and cardiovascular diseases (2). Aim To evaluate the impact of a tailored intervention on clinical outcomes in the management of hypertensive and/or type 2 diabetes mellitus (T2DM) patients in community pharmacies in a pilot implementation study. Methods The study (April to July 2019) utilized a mixed-method design. This included a cross-sectional survey among 133 consented community pharmacists and 390 T2DM and/or hypertensive patients at the pharmacies. Thirty-one item (pharmacists) and 29-item (patients) semi-structured questionnaires were used to gather information on their perception of pharmacists’ roles in the management of T2DM and/or hypertension. Barriers to implement identified roles by the pharmacists were documented. Thereafter, a prospective before- and after-intervention study was conducted in four consented pharmacies to address the barriers. Two pharmacists per pharmacy and 34 consented T2DM and/or hypertensive adult patients who had been on medications for ≥3 months participated. Pharmacists were provided with 2-hr one-on-one training on the management of T2DM and hypertension based on standard guidelines pre-intervention and at 4 weeks. Components of the pharmacist’s intervention included patient’s education, medication counselling , lifestyle modifications and self-care use of point of care devices. Systolic and diastolic blood pressure (SBP and DBP), fasting blood glucose (FBG) and body mass index (BMI) of all patients were measured at baseline, 4- and 8-week post-intervention. Weekly patient follow-up visits to the pharmacies were mandatory. Telephone calls and referral were incorporated, when necessary. Failure to show up for two consecutive visits disqualified patients from completing the study. Descriptive statistics (to summarise data), and paired t-test to compare mean differences in the measured parameters at α=0.05. Results Hypertensive and/or T2DM patients (374) and 71 pharmacists participated in the survey. The patients expected pharmacists to provide medication counselling (81;27.1%), education (47;12.6%), follow-up (18;4.8%), health outcomes monitoring (17;4.5%), and collaboration with physicians (12;3.2%). Sixty-nine (97.2%) pharmacists agreed that patients’ follow-up, patient counselling (71;100.0%), therapeutic plan design to achieve goals (67;94.4%) and collaboration with physicians (61;85.9%) were important. Barriers to providing adequate counsel to these patients were time constraints (23;32.4%), unconducive environment (7;9.9%) and patient’s impatience (33;46.5%). For the intervention component, 16 of the 34 patients enrolled were lost to follow-up (one hospitalized, seven failed two consecutive visits, and eight lost to referral). Effects of the tailored intervention on the parameters are in Table 1. Conclusion The patients’ and pharmacists’ perceived roles of the pharmacist in the management of hypertension and T2DM were in tandem. The 8-week tailored pharmacists’ intervention resulted in better control of blood pressure but increased FBG. This pilot study is limited by the small sample size of patients and pharmacists, as well as the lack of appropriate comparator. Future large-scale multi-site study with relevant comparator is required for a far-reaching conclusion on the impact of the tailored pharmacist intervention in the management of diabetes and hypertension.

Suboptimal glycemic control and prevalence of diabetes-related complications in Kenyan population with diabetes: cohort analysis of the seventh wave of the International Diabetes Management Practices Study (IDMPS)

• The 7th wave of the IDMPS is an international, multicenter, non-interventional, cross-sectional, observational study aimed at assessment of current practices in the management of both T1DM and T2DM in 24 countries in Africa, Eurasia, Middle East, and South Asia. It was conducted as a continuation of the previous waves of the IDMPS and data was collected during the period of January to September 2016 • At the time of the study, target HbA1c of <7.0% was reportedly achieved in only 36.6% of subjects with T2DM • The two most cited reasons for not attaining HbA1c targets in insulinized subjects were – lack of appropriate titration of insulin dose and lack of experience among patients in the management of their insulin dose • Diabetes-related complications were reported by 34.6% subjects overall with a predominance of microvascular complications over macrovascular complications. • This study highlights that the achievement of glycemic target in Kenyan subjects with T2DM is suboptimal and further investigations are required to formulate effective health policies to improve rates of glycemic target attainment in Kenya. To identify real-life medical practices in the management of diabetes mellitus (DM) in the Kenyan population. Kenyan subjects with DM were recruited as part of the 7 th wave of the International Diabetes Management and Practices Study in between September and October 2016. Data on demographics; medical history; glycemic control; concomitant anti-diabetic therapy; and hypoglycemic episodes were analyzed using descriptive statistics. Analysis of subjects with type 2 DM (T2DM), representing 96.7% (n/N: 187/194) of evaluable subjects, is presented. Target HbA1c achievement rate and average HbA1c at last measurement were 36.6% (n/N: 68/187) and 8.2% (66 mmol/mol), respectively. Microvascular complications were prevalent in 35.3% (n=65) of subjects, most frequently as neuropathy (n=41, 21.5%) and microalbuminuria (n=27, 14.1%). Most common comorbidities were dyslipidemia (n=125, 73.5%) and hypertension (n=123, 65.8%). Oral antidiabetic drugs, either alone (n=120, 64.2%) or in combination with insulin (n=48, 25.7%), were the preferred treatment. Inability in reaching glycemic targets in insulinized subjects were mostly attributed to lack of appropriate dose titration and lack of experience in management of dose. The achievement of glycemic target in Kenyan subjects with T2DM is suboptimal. Further investigations are required to formulate effective health policies to improve rates of glycemic target attainment in Kenya.

Diabetes type 1: Can it be treated as an autoimmune disorder?

Type 1 Diabetes Mellitus (T1DM) is characterized by progressive autoimmune-mediated destruction of the pancreatic beta-cells leading to insulin deficiency and hyperglycemia. It is associated with significant treatment burden and necessitates life-long insulin therapy. The role of immunotherapy in the prevention and management of T1DM is an evolving area of interest which has the potential to alter the natural history of this disease.In this review, we give insight into recent clinical trials related to the use of immunotherapeutic approaches for T1DM, such as proinflammatory cytokine inhibition, cell-depletion and cell-therapy approaches, autoantigen-specific treatments and stem cell therapies. We highlight the timing of intervention, aspects of therapy including adverse effects and the emergence of a novel lymphocyte crucial in T1DM autoimmunity. We also discuss the role of cardiac autoimmunity and its link to excess CVD risk in T1DM.We conclude that significant advances have been made in development of immunotherapeutic targets and agents for the treatment and prevention of T1DM. These immune-based therapies promise preservation of beta-cells and decreasing insulin dependency. In their current state, immunotherapeutic approaches cannot yet halt the progression from a preclinical state to overt T1DM nor can they replace standard insulin therapy in existing T1DM. It remains to be seen whether immunotherapy will ultimately play a key role in the prevention of progression to overt T1DM and whether it may find a place in our therapeutic armamentarium to improve clinical outcomes and quality of life in established T1DM.

Telemetric Interventions Offer New Opportunities for Managing Type 1 Diabetes Mellitus: Systematic Meta-review.

BackgroundThe prevalence of diabetes mellitus (DM) is increasing rapidly worldwide. Simultaneously, technological advances are offering new opportunities for better management of type 1 diabetes mellitus (T1DM). Telemetry, the remote acquisition of patient data via a telecommunication system, is a promising field of application in eHealth and is rapidly gaining importance.ObjectiveThe aim of this study was to summarize the current evidences available on the effectiveness of telemetric approaches in T1DM management. This systematic meta-review examined different types of interventions of the technologies used in communication between health care professionals and patients as well as the key outcomes.MethodsWe performed a systematic search in Web of Science Core Collection, EMBASE, Cochrane Library, MEDLINE via PubMed, and CINAHL databases in April 2020 with regard to the effectiveness of telemetric interventions for T1DM. We classified the interventions into 4 categories according to the technology used: (1) real-time video communication, (2) real-time audio communication, (3) asynchronous communication, and (4) combined forms of communication (real-time and asynchronous). We considered various study designs such as systematic reviews, clinical trials, meta-analyses, and randomized controlled trials and focused on the key outcomes. Additionally, a funnel plot based on hemoglobin A1c (HbA1c) values and different quality assessments were performed.ResultsWe identified 17 (6 high quality and 9 moderate quality) eligible publications: randomized controlled trials (n=9), systematic reviews and meta-analyses (n=5), cohort studies (n=2), and qualitative publications (n=1). Of 12 studies, 8 (67%) indicated a (significant or nonsignificant) reduction in HbA1c levels; 65% (11/17) of the studies reported overall (mildly) positive effects of telemetric interventions by addressing all the measured outcomes. Asynchronous interventions were the most successful for patients diagnosed with T1DM, but no technology was clearly superior. However, there were many nonsignificant results and not sustained effects, and in some studies, the control group benefited from telemetric support or increased frequency of contacts.ConclusionsBased on the currently available literature, this systematic meta-review shows that telemetric interventions cause significant reduction in HbA1c levels and result in overall positive effects in T1DM management. However, more specified effects of telemetric approaches in T1DM management should be analyzed in detail in larger cohorts.

Modulation of gut microbiota by dietary macronutrients in type 2 diabetes: a review

Dietary interventions have been a first-line strategy in the long-term management and prevention of type 2 diabetes mellitus (T2DM). Recently, low carbohydrate diets and ketogenic diets emerged as common dietary approaches in managing T2DM. Literature suggests macronutrients impose significant impacts on the gut microbiome related to glucose tolerance, insulin resistance and inflammation. Although there is insufficient literature on gut microbiota modulation via dietary macronutrient management, this area of study has been gradually gaining interest amongst researchers. This review describes the current evidence and summarizes specific dietary macronutrients' effects in sculpting the diverse gut microbiome. Potential crucial research concepts could help develop macronutrient-specific diets to modulate gut microbiota beneficial to T2DM management and pathogenesis.

Effect of lifestyle intervention holistic approach on blood glucose levels, health-related quality of life and medical treatment cost in type 2 diabetes mellitus patients

Type 2 Diabetes Mellitus (T2DM) is a costly, lifestyle-related disorder, its management is very critical and challenging hence lifestyle intervention may a cornerstone in the reversal and management of T2DM. This study designed to assess the impact of lifestyle intervention holistic (LIH) Model on blood glucose levels (BGL), Health-Related Quality of Life (HRQOL), and medical treatment cost in T2DM patients. This prospective, quasi-experimental study was conducted among 224 T2DM patients in Delhi Diabetes Research Center (DDRC), New Delhi. The study participants were allocated into two groups-Lifestyle Intervention Counseling (LIC) group received lifestyle-based counseling through the LIH model while the Usual-care group received only standard treatment. Study outcomes were assessed at baseline, 3rd, 6th, and 12th month and data were analyzed through SPSS. Study results revealed that LIC participants had decreased in fasting blood glucose 0.26 mg dL-1 (-4.37 to 4.89), blood glucose postprandial -70.16 mg dL-1 (-85.15 to - 55.16), HbA1C -2.82% (-5.26 to - 0.37), medicine cost (p &lt; 0.004), hospitalization cost (p &lt; 0.011), and cost of surgery (p &lt; 0.0005). A significant improvement also observed in HRQOL and adherence towards a holistic model in LIC group. The study concludes that lifestyle-based counseling and its adherence was cost-effective and significantly improves BGL, HRQoL, and medical treatment in T2DM patients.

Evaluation of efficacy and safety of a polyherbal Unani formulation in diabetes mellitus type 2 (Zayābīṭus Sukkari Qism Sāni) - a randomised controlled clinical study

Diabetes mellitus type 2 (Zayābīṭus Sukkari Qism Sāni) is a major health concern in 21st century. Despite tremendousadvances in modern sciences, there is a lack of relatively safe and effective drug for its management.The primary objective of this study was to evaluate the efficacy and safety of a polyherbal Unani formulation containingGurmar booti (Gymnema sylvestre), Gilo (Tinospora cordifolia) and Jamun (Syzygium cumini) in the management of DiabetesMellitus Type 2 (DMT2). It was a randomised controlled clinical study conducted on 60 participants of DMT2 inadequatelycontrolled by diet and exercise. The test drug was given to group-A participants (n=30) 6 g twice daily orally for 12 weeks andthe standard drug metformin (500 mg) was given twice daily orally to group-B participants (n=30).It was observed that the difference between the Mean (± SD) value of fasting blood glucose (FBG), postprandial bloodglucose (PPBG) and glycosylated haemoglobin (HbA1c) in Test and Control groups at the end of the study in comparison tobaseline was significant (p<0.05). This study concludes that the test drug was effective in reducing FBG and PPBG significantlyin diabetic participants’ at 12 weeks of treatment.

Influence of socio-demographic characteristics on management of type 2 diabetes mellitus among T2DM clients in Nyandarua South Sub-County, Kenya

Background: Diabetes mellitus (DM) is a complex disease with most complications leading to morbidity and mortality amongst population subsets if not managed. In every six seconds, a person dies from DM or DM related complications. Type 2 diabetes mellitus (T2DM) has markedly increased necessitating active development and implementation of efficient management programs addressing sociodemographic characteristics of diabetic clients. The aim of this study was to determine the influence of socio-demographic characteristics on management of T2DM among type 2 diabetic clients in Nyandarua South sub-County, Kenya. Methods: A cross-sectional facility based study design was used. The study population comprised T2DM clients, aged above 18 years. Systematic random sampling technique was used to select the sample of 294 clients who consented to participate in the study. Data was collected by use of a semi-structured researcher administered questionnaire. Data was analysed using SPSS Version 21. Descriptive statistics were computed to generate frequencies, mean, median and standard deviation. Relationship between socio-demographic factors and management of T2DM was examined using chi-square and bivariate analyses. Results: Majority of the participants were females (59.5%). Slightly more than a quarter of the participants (28%) had good knowledge on management of T2DM. College/university education level was found to be significantly associated with participants’ management of T2DM (OR 5.3666 (1.47-19.58), 95% CI, 1.47-19.58, P=0.0109). Conclusions: Level of education significantly influenced participants’ management of T2DM. The study recommends creation of awareness on T2DM management in Nyandarua County so as to improve clients’ knowledge of management interventions for T2DM health education on T2DM management practices to empower clients to effectively manage the condition.

Effect of Telemetric Interventions on Glycated Hemoglobin A1c and Management of Type 2 Diabetes Mellitus: Systematic Meta-Review

BackgroundDiabetes mellitus is a chronic burden, with a prevalence that is increasing worldwide. Telemetric interventions have attracted great interest and may provide effective new therapeutic approaches for improving type 2 diabetes mellitus (T2DM) care.ObjectiveThe objective of this study was to analyze the clinical effectiveness of telemetric interventions on glycated hemoglobin A1c (HbA1c) specifically and T2DM management generally in a systematic meta-review.MethodsA systematic literature search was performed in PubMed, CINAHL, Cochrane Library, Web of Science Core Collection, and EMBASE databases from January 2008 to April 2020. Studies that addressed HbA1c, blood pressure, fasting blood glucose, BMI, diabetes-related and health-related quality of life, cost-effectiveness, time savings, and the clinical effectiveness of telemetric interventions were analyzed. In total, 73 randomized controlled trials (RCTs), 10 systematic reviews/meta-analyses, 9 qualitative studies, 2 cohort studies, 2 nonrandomized controlled studies, 2 observational studies, and 1 noncontrolled intervention study were analyzed.ResultsOverall, 1647 citations were identified. After careful screening, 99 studies (n=15,939 patients; n=82,436 patient cases) were selected by two independent reviewers for inclusion in the review. Telemetric interventions were categorized according to communication channels to health care providers: (1) “real-time video” interventions, (2) “real-time audio” interventions, (3) “asynchronous” interventions, and (4) “combined” interventions. To analyze changes in HbA1c, suitable RCTs were pooled and the average was determined. An HbA1c decrease of –1.15% (95% CI –1.84% to –0.45%), yielding an HbA1c value of 6.95% (SD 0.495), was shown in studies using 6-month “real-time video” interventions.ConclusionsTelemetric interventions clearly improve HbA1c values in both the short term and the long term and contribute to the effective management of T2DM. More studies need to be done in greater detail.

Assessing Scientific Soundness and Translational Value of Animal Studies on DPP4 Inhibitors for Treating Type 2 Diabetes Mellitus.

Simple SummaryThe value of animal models to predict human outcomes has been increasingly challenged due to a low rate of translation between preclinical and clinical trials. However, translational failure has been proposed to be at least partly explained by the poor methodological quality of animal studies. We thus retrospectively assessed the predictive value of animal models in Type-2-diabetes research, comparing the same outcome measure (glycaemia) in response to a currently available class of antidiabetic drugs between published clinical trials and animal studies, and assessed methodological quality of the latter. In our sample, both mice and rats performed similarly to humans in response to dipeptidyl peptidase-4 (DPP4) inhibitors. These results, while on animal models of just one disease treated with one drug class, suggest current criticism of animal models may not be entirely warranted, though we found a margin for improvement in the research quality of animal studies. Although there is a wide range of animal models of type 2 diabetes mellitus (T2DM) used in research; we have limited evidence on their translation value. This paper provides a) a comparison of preclinical animal and clinical results on the effect of five dipeptidyl peptidase-4 (DPP4) inhibitors by comparing the pharmaceutical caused glucose changes, and b) an evaluation of methodological and reporting standards in T2DM preclinical animal studies. DPP4 inhibitors play an important role in the clinical management of T2DM: if metformin alone is not sufficient enough to control the blood sugar levels, DPP4 inhibitors are often used as second-line therapy; additionally, DPP-4 inhibitors are also used in triple therapies with metformin and sodium-glucose co-transporter-2 (SGLT-2) inhibitors or with metformin and insulin. In our analysis of 124 preclinical studies and 47 clinical trials, (1) we found no evidence of species differences in glucose change response to DPP4 inhibitors, which may suggest that, for this drug class, studies in mice and rats may be equally predictive of how well a drug will work in humans; and (2) there is good reporting of group size, sex, age, euthanasia method and self-reported compliance with animal welfare regulations in animal studies but poor reporting of justification of group size, along with a strong bias towards the use of male animals and young animals. Instead of the common non-transparent model selection, we call for a reflective and evidenced-based assessment of predictive validity of the animal models currently available.

Barriers to postpartum diabetes screening: a qualitative synthesis of clinicians’ views

BackgroundGestational diabetes mellitus (GDM) is an important risk factor for developing type 2 diabetes mellitus (T2DM) later in life. Postpartum screening provides an opportunity for early detection and management of T2DM, but uptake is poor.AimTo explore barriers to screening from clinicians’ perspectives to guide future interventions to increase uptake of postpartum screening.Design and settingSystematic review and qualitative synthesis.MethodQualitative studies included in a previous review were assessed, and then five electronic databases were searched from January 2013 to May 2019 for qualitative studies reporting clinicians’ perspectives on postpartum glucose screening after GDM. Study quality was assessed against the Critical Appraisal Skills Programmes checklist. Qualitative data from the studies were analysed using thematic synthesis.ResultsNine studies were included, containing views from 187 clinicians from both community and hospital care. Three main themes were identified: difficulties in handover between primary and secondary care (ambiguous roles and communication difficulties); short-term focus in clinical consultations (underplaying risk so as not to overwhelm patients and competing priorities); and patient-centric barriers such as time pressures.ConclusionBarriers to diabetes screening were identified at both system and individual levels. At the system level, clarification of responsibility for testing among healthcare professionals and better systems for recall are needed. These could be achieved through registers, improved clinical protocols, and automatic flagging and prompts within electronic medical records. At the individual level, clinicians should be supported to prioritise the importance of screening within consultations and better educational resources made available for women. Making it more convenient for women to attend may also facilitate screening.

The thyroid hormone levels and glucose and lipid metabolism in children with type 1 diabetes: a correlation analysis.

BackgroundType 1 diabetes mellitus (T1DM) is common in clinical setting, the relationship between thyroid hormone levels and glucose and lipid metabolism in patients with T1DM remains unclear. We attempted to analyze the correlation of thyroid hormone levels and blood glucose and lipid metabolism in children with normal thyroid function.MethodsChildren with T1DM were selected, and 85 healthy children who underwent physical examinations in our hospital as control group. The characteristics and laboratory testing results were compared, the correlation of thyroid hormone levels with blood glucose and blood lipids was analyzed by Pearson correlation analysis.ResultsA total of 167 participants were included. the low-density lipoprotein-cholesterol (LDL-C), triglyceride (TG), fasting blood glucose (FBG), and glycated hemoglobin (HbAlc) in T1DM patients were higher than those in healthy controls, while the high-density lipoprotein-cholesterol (HDL-C), thyroid stimulating hormone (TSH) and free triiodothyronine (FT3) in T1DM patients were lower than that of healthy children (all P<0.05). TSH was positively correlated with LDL-C (r=0.169, P=0.032), TC (r=0.182, P=0.017) and TG (r=0.197, P=0.008), negatively correlated with FBG (r=−0.196, P=0.023) and HbAlc (r=−0.328, P=0.002). FT3 was negatively correlated with TG (r=−0.182, P=0.011), FBG (r=−0.184, P=0.009) and HbAlc (r=−0.223, P=0.005). TG in the high TSH group and the middle TSH group is higher than that of low TSH group. However, FBG and HbAlc were lower than those in the low TSH group (all P<0.05). Compared with the low FT3 group, the TG, FBG and HbAlc decreased in the high and middle FT3 group (all P<0.05).ConclusionsThe serum TSH are closely associated with FT3 and glycolipid metabolism in children with T1DM, which may be the useful indicators to assess the severity of T1DM in clinical settings to provide insights into the management of T1DM.

The Position of Gliclazide in the Evolving Landscapes and Disease Continuum of T2DM: A Collaborative Delphi Survey-Based Consensus fromIndia.

IntroductionThis Delphi study aims to provide evidence-based expert opinion on the usage and current position of gliclazide in type 2 diabetes mellitus (T2DM) management in India.MethodsThe single interaction modified Delphi-based methodology was used to collect opinions on gliclazide usage and its position in diabetes management from 338 endocrinologists/diabetologists who have had clinical experience with gliclazide. Participants, using a 9-point scale, were asked to rate eight statements comprising a total of 52 items on the related topics.ResultsThe Delphi consensus suggests that in drug-naïve patients with T2DM, intolerant to metformin or in whom metformin is contraindicated, dual therapy of gliclazide/gliclazide-modified release (MR) should be considered along with a dipeptidyl peptidase 4 (DPP4) inhibitor if glycated hemoglobin A1c level is greater than 7.5% and with insulin if the A1c level is greater than 9%. If the patients are inadequately controlled with metformin (A1c greater than 6.5% after 3 months of therapy), gliclazide/gliclazide-MR shall be added on to the treatment regimen to achieve greater and sustained reductions in A1c levels. However, it was not preferred over other antidiabetic classes in such clinical settings except alpha-glucosidase inhibitors (AGI). Early addition of gliclazide/gliclazide-MR shall be preferred over the up-titration of metformin beyond half-maximal dose for effective management of T2DM. Gliclazide/gliclazide-MR can be used safely in patients with diabetes and cardiovascular and chronic kidney disease. It can be used in older patients with T2DM as it does not have active metabolites and has a low risk of hypoglycemia.ConclusionThe expert panel proposed consideration of monotherapy or dual therapy of gliclazide as an ideal choice in patients with T2DM because of its efficacy, long-term glycemic control, favorable renal outcomes, cardiovascular safety, and an optimal safety profile.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13300-021-01002-4.

The vitamin B12 levels in type 2 diabetes mellitus patients on metformin and not on metformin

Background: Type 2 diabetes mellitus (T2DM) is one of the major global public health concerns, metformin is one of the most widely used drugs and considered as first-line therapy for management of T2DM. Vitamin B12 malabsorption is observed in patients on metformin therapy leading to biochemical and clinical vitamin B12 deficiency. The aim of the current study was to assess the relationship between metformin therapy and development of vitamin B12 deficiency.Methods: Current observational cross sectional study was conducted at Madras medical college and Rajiv Gandhi Government general hospital. Serum vitamin B12 and other blood investigation parameters of T2DM patients, on metformin therapy for long duration (6 months or more than 2 years) were measured and correlated with vitamin B12 levels of T2DM patients not on metformin therapy. Patients were given appropriate treatment and were regularly followed up.Results: Results of the current study findings depicted that significant difference was observed in percent haemoglobin, total blood cells, platelet count, mean corpuscular volume (MCV) and albumin values of patients on metformin therapy when compared to patients who were not on metformin therapy. Study findings also revealed that substantial difference in vitamin B12 deficiency was observed in T2DM patients based on the duration of metformin therapy.Conclusions: Current study revealed that, metformin therapy for 2 years or more, can lead to significant vitamin B12 deficiency which is also associated with macrocytosis. It was concluded that longer the duration of metformin therapy, more significant would be vitamin B12 deficiency.

Increased metformin dosage suppresses pro-inflammatory cytokine levels in systemic circulation and might contribute to its beneficial effects

ABSTRACT Type 2 Diabetes Mellitus (T2DM) is a metabolic disorder, characterized by persistent elevation of blood glucose either due to insulin resistance or insulin insufficiency. Metformin is the recommended first choice of drug for the management of T2DM and is known to improve insulin sensitivity and prevents hyperglycemia by reducing chronic inflammation. T-helper type 1 (Th1) and type 17 (Th17) cells, are important pro-inflammatory CD4+ T cell subsets secreting TNF-α, and INF-γ (Th1), and interleukin 17 (Th17). These cytokines have been shown to play a crucial role in inflammation, insulin resistance, and the development of T2DM. Here, we explore the effect of different metformin dosages on pro-inflammatory cytokine (TNF-α, INF-γ, GM-CSF and IL-17) levels in systemic circulation among T2DM patients in Ghana, since inflammatory responses and cytokines play significant roles in the pathogenesis and progression of T2DM patients on metformin. Two hundred and nine (209) consenting T2DM patients receiving treatment at the Diabetic unit of the Komfo Anokye Teaching Hospital (KATH) in the Ashanti region of Ghana were recruited in a hospital-based cross-sectional study design. Blood samples were collected and serum obtained from each participant were analyzed for the concentrations of TNF-α, INF-γ, GM-CSF and IL-17 cytokine levels by solid-phase sandwich ELISA. We observed that participants on 3000 mg/day dose of metformin had significantly lower levels of TNF-α (p < .001) and IFN-γ (p = .014) compared to those on other dosages (1000 mg and 2000 mg/day). However, GM-CSF and IL-17 levels were not affected by increased metformin dosages. After adjusting for age, gender, dose and duration of metformin use, we observed that participants who took higher doses of metformin had significantly reduced levels of TNF-α (β = −0.0297, 95% CI = (−0.005 to −0.002) p < .001. Metformin dosage independently predicted reduced TNF-α levels with 14.4% variations in the metformin dosage levels. Increased metformin dosage suppresses TNF-α levels in systemic circulation and hence might contribute to its beneficial effects.

Social support buffers the impacts of Diabetes distress on health-related quality of life among type 2 diabetic patients.

Diabetes patients experience significant distress. Improving health-related quality of life (HRQoL) is cardinal in the management of all chronic health conditions. We investigated the moderating role of social support (SS) in the relationship between diabetes distress (DD) and HRQoL. Three hundred and ninety-six type 2 diabetes mellitus (T2DM) patients (M age = 57.71 years) completed measures of relevant variables. Results showed that SS moderated DD-HRQoL association. Our findings provided a guide on extent of support for T2DM management behaviors that may be helpful in ameliorating impacts of stress on patients' health.

Type 1 diabetes mellitus in children: experience in Indonesia

.The prevalence of type 1 diabetes mellitus (T1DM) in children in Indonesia is increasing although the real number is unknown due to high rate of misdiagnosis. Public and healthcare awareness on T1DM in children is still low, reflected by the high number of children diagnosed with diabetic ketoacidosis (DKA). The Indonesian Pediatric Society (IPS) had published a guideline on T1DM management, which consists of insulin injection, daily monitoring of blood glucose, nutrition, physical activity, and education. Aside from low awareness, current challenges on T1DM management in Indonesia are funding by the national health insurance, fasting during Ramadan, and inequities on DM care. The involvement of society, healthcare workers, stakeholders, and the government is of importance to ensure optimal management for children with diabetes.