Diabetes Management Strategies Research Articles

Predictors of Remission and Relapse of Diabetes after Conventional Gastrectomy for Gastric Cancer: Nationwide Population-Based Cohort Study

We investigated whether preoperative clinical parameters predict diabetes remission and relapse after conventional gastrectomy for cancer and whether postoperative weight changes influence diabetes remission and relapse. This study included 5,150 patients with diabetes who underwent gastrectomy for cancer from 2004 to 2014. Diabetes remission was defined in 3 ways, according to postoperative antidiabetic medication and fasting plasma glucose (FPG) levels. Diabetes relapse was defined as reinitiating antidiabetic medication among patients in diabetes remission. Six predictors (higher body mass index [BMI], total gastrectomy, younger age, FPG levels, number of oral hypoglycemic agents [OHAs], and no insulin use) of diabetes remission increased the likelihood of remission by >13-fold (odds ratio [OR], 13.67; 95% confidence interval [CI], 8.65‒19.11). Three factors (younger age, lower FPG levels, and use of only 1 OHA) predicted a 58% decreased likelihood of diabetes relapse (hazard ratio, 0.42; 95% CI 0.35‒0.48). The lowest interval of postoperative BMI decrease (<-20%) showed a >3-fold increased likelihood of diabetes remission than the highest interval (≥-5%; OR 3.14; 95% CI 2.08‒4.75), independent of baseline BMI. Six variables (BMI, type of gastrectomy, age, FPG levels, number of OHAs used, and insulin use/non-use), and 3 variables (age, FPG levels, number of OHAs used) significantly predict diabetes remission and relapse after gastrectomy for cancer, respectively. Greater postoperative weight decrease may increase the likelihood of diabetes remission, independent of baseline weight. Our results may serve as a basis for the establishment of diabetes and weight management strategies after conventional gastrectomy for cancer.

Valuing health states of people with type2 diabetes: Analyses of the nationwide representative linked databases.

Aims/IntroductionTo estimate preference‐based measures of health‐related quality of life associated with sociodemographic and clinical characteristics in type 2 diabetes patients.Materials and MethodsIndividuals with EuroQol‐5 dimensions‐3 levels data were identified from Taiwan’s National Health Interview Survey in 2009 and 2013. Status of diabetes, comorbidities, complications and treatments were ascertained through data linkage to Taiwan’s National Health Insurance Research Database. Multivariable ordinary least squares, Tobit and median regression analyses were used to estimate the coefficients that represented independent impacts of patients’ characteristics on health‐related quality of life.ResultsThe mean health utility score for 2,104 participants was 0.838. Being female, aging, divorced/widowed, never worked or underweight, or having a lower monthly household income, injectable glucose‐lowering therapy, comorbid connective tissue disease or depression were associated with lower health utilities. Having an amputation led to the largest reduction by 0.288 in health utilities, followed by debilitating stroke (0.266), heart failure (0.237), other coronary heart disease (0.185), kidney dialysis/transplant (0.148), coronary revascularizations (0.093), transient ischemic attack/stroke (0.078), diabetic neuropathy (0.062), polyneuropathy (0.055) and other neuropathy (0.043).ConclusionsMajor vascular complications, connective tissue disease and depression are associated with considerably worse health‐related quality of life. These health utility estimates can facilitate health economic evaluations to determine cost‐effective strategies for diabetes management.

Distress and Quality of Life among Type II Diabetic Patients: Role of physical activity

This study measures the distress and Quality of Life (QoL) among people with type II diabetics in relation to physical exercise. The study was conducted using diabetic participants chosen from various hospitals, aerobic centres, playgrounds and gyms in the city of Hyderabad in India. The participants were divided into two groups – group 1 comprising people who did not adopt physical activity as part of their diabetes management strategy and group 2 comprising people who engaged in physical activity. A quasi-experimental study was performed on both groups employing purposive and snowball sampling methods. Pearson r showed that distress is negatively correlated with QoL among type II diabetics in both groups. Independent t-test indicated that participants in group 2 showed better QoL and lower levels of distress compared to their counterparts in group 1.

Current Trends in the Therapeutic Strategies for Diabetes Management.

Diabetes mellitus is one of the fastest-growing non-communicable diseases. Diabetes mellitus is caused due by the destruction of pancreatic β-cell or due to insulin resistance and characterized by hyperglycemia. Diabetes imposes a very serious economic crisis as the diabetic drug market is growing very rapidly. Even after very path-breaking scientific discoveries, the availability of better healthcare infrastructure, and a rise in literacy rates, the diabetes burden is continuously spreading in various sections all over the world but more especially in low- and middle-income countries. The recent developments in scientific discoveries have given several new generations of antidiabetic medicines such as sulphonylurea, biguanides, thiazolidinedione, α-glucosidase inhibitors. All these drugs have proved a significant reduction in blood glucose level. There are some new classes of hypoglycaemic drugs that have also been developed and reported, such as GLP-1 analogous, DPP-IV inhibitors, amylin inhibitors, and peroxisome proliferator- activated receptors. There are some active molecules and bioactive substances that have been purified from herbs and plants, which add value to the war against diabetes. These phytoconstituents have overturned drug development and lead identification for drugs against diabetes. The review also focuses on some critical areas of diabetes with more focus on statin-based diabetes management approach and stem cell therapy based next generation antidiabetic therapy.

English

BACKGROUND Dyslipidaemia has been proposed as a possible risk factor for diabetic retinopathy (DR) but results from previous studies are inconsistent. We designed this study to find the association of abnormal serum lipid levels with diabetic retinopathy and diabetic macular oedema (DME). METHODS This was a single centre observational study conducted at a tertiary care hospital, where patients with type 2 diabetes of more than five years duration were enrolled. A comprehensive ophthalmic evaluation was performed on all study subjects. Detailed fundoscopy was done after obtaining the best possible mydriasis with 1 % tropicamide and 5 % phenylephrine eye drops using direct ophthalmoscopy, indirect ophthalmoscopy with + 20 D lens and stereoscopic slit lamp biomicroscopy of the disc and macula using + 78 D Volk lens. Fundus photographs were taken in patients with any grade of diabetic retinopathy by Topcon fundus camera. DR and DME were diagnosed and classified according to the Early Treatment Diabetic Retinopathy Study (ETDRS) grading system. Fasting blood sugar (FBS), fasting lipid profile and glycated haemoglobin (HbA1c) was assessed for each patient. RESULTS A total of two hundred and twelve participants was enrolled. Mean age of the study group was 63.93 ± 9.52 and the mean duration of diabetes was 13.54 ± 6.07. DR was present in 164 (78.1 %) of whom 71 (43.3 %) had mild non proliferative diabetic retinopathy (NPDR), 42 (25.6 %) had moderate NPDR, 31 (18.9 %) had severe NPDR, and 20 (12.2 %) had proliferative diabetic retinopathy (PDR). Of those with DR, 59 (36 %) had DME. Duration of diabetes (14.62 ± 6.18 vs 9.72 ± 3.68 years, P &lt; 0.001), higher fasting blood glucose (176.79 ± 59.13 vs 138.46 ± 49.44 mg / dL, P &lt; 0.001), higher HbA1c (8.21 ± 1.38 vs. 7.48 ± 1.25 %, P = 0.002), higher total cholesterol (215.04 ± 49.78 vs 184.37 ± 30.84 mg / dL, P &lt; 0.001), higher triglyceride levels (155.23 ± 59.06 vs 125.13 ± 37.3 mg / dL, P = 0.001) and higher low density lipoprotein (LDL) cholesterol levels (139.28 ± 37.38 vs 120.85 ± 22.75 mg / dL, P = 0.002) were significantly associated with the severity of DR. Higher total cholesterol, higher triglyceride levels and higher LDL cholesterol levels were also associated with DME. CONCLUSIONS There is a significant association of abnormal serum lipid levels and hyperglycaemia with the presence and severity of DR and presence of DME. Early identification and intervention to control these modifiable risk factors, hyperglycaemia and dyslipidaemia may delay the development and progression of DR in diabetic patients. These observations also support the current management strategies for diabetes, which include control of dyslipidaemia in addition to hyperglycaemia. KEYWORDS Diabetic Retinopathy, Diabetic Macular Oedema, Dyslipidaemia

An Exploratory Screening Study for Type 2 Diabetes in Hospitalized Adult Medicine Patients

ObjectivesLiterature from stroke and cardiac hospital admissions demonstrate a higher prevalence of undiagnosed type 2 diabetes compared with the general population. Fewer diabetes screening studies exist in the general medicine population, none of which have been based in Canada. Our primary objective in this study was to determine the prevalence of probable undiagnosed diabetes (glycated hemoglobin [A1C]≥6.5%) in hospitalized medicine patients. Secondary objectives were to identify the prevalence of undiagnosed dysglycemia (A1C≥6.0%) and the subsequent management of emergent cases. MethodsIn this prospective cohort study, adult patients admitted to internal medicine at a tertiary hospital in Ontario were screened for diabetes using an A1C test over a 3-month period. Baseline demographics and outcomes were compared using t tests, chi-square tests and Fisher’s exact tests for normoglycemia, undiagnosed dysglycemia and probable undiagnosed diabetes. A regression analysis was performed to identify any relationships between various cardiovascular-related risk factors and A1C. ResultsA total of 53 adult patients were enrolled. The prevalence of probable undiagnosed diabetes and undiagnosed dysglycemia was 7.5% (n=4) and 30.2% (n=16), respectively. Implementation of diabetes management strategies and/or documentation of the finding occurred in 4 of 16 patients. Regression analysis showed no relationship between either cardiovascular-related risk factors or admission glucose with A1C. ConclusionsA broader screening approach may capture previously undiagnosed cases of diabetes that do not belong to traditionally at-risk populations. Future studies should focus on identifying risk factors for undiagnosed dysglycemia in hospitalized patients, including ethnicity and barriers to community access, so that appropriate screening programs can be developed.

Lifestyle modifications: A key to manage diabetes

Diabetes is one of the leading challenges to the health care or`ganization across world. Worldwide, 422 million peoples suffering from diabetes 1. Diabetes mellitus is a metabolic disorder which is characterized by abnormal metabolism of carbohydrates, fats, protein. The main etiological factors contributes in the development of diabetes are sedentary lifestyle, obesity, intake of junk foods. It is mandatory to manage increased blood sugar level (BSL) to prevent microvascular as well as macrovascular complications. To manage diabetes, metformin and insulin play a key role hence these two medications added in the diabetes pharmacotherapy. Diabetes is not a treatable disease hence we have to maintain weight by doing regular exercise and implementation of dietary modifications. It is important to maintain the balance of daily calories intake and their utilization by practicing physical activity remain the primary and most effective prevention strategy for diabetes management. A management strategy basically involves promotion of effective weight loss and physical exercise, but it is compulsory to do exercise and follow dietary modifications regularly. This is a comprehensive review which focuses on lifestyle modifications in diabetes. How lifestyle modification play a key role in the management of both type of diabetes along with pharmacotherapy.

An Innovative Short-Clustered Maltodextrin as Starch Substitute for Ameliorating Postprandial Glucose Homeostasis.

Dietary starch is usually associated with elevated postprandial glycemic response. This is a potential risk factor of type 2 diabetes. Here, a 1,4-α-glucan branching enzyme (GBE) was employed to reassemble α-1,4 and α-1,6 glycosidic bonds in starch molecules. Structural characterization showed that GBE-catalyzed molecular reassembly created an innovative short-clustered maltodextrin (SCMD), which showed a dense internal framework along with shortened external chains. Such short-clustered molecules obstructed digestive enzymes attack and displayed dramatically reduced digestibility. Therefore, SCMD was served as a dietary starch substitute to improve postprandial glucose homeostasis. A 22.3% decrease in glycemic peak was therefore detected in ICR mice following SCMD intake (10.7 mmol/L), compared with that in the control (13.8 mmol/L). Moreover, an attenuated insulin response (40.5% lower than that in control) to SCMD intake was regarded suitable for diabetes management. These novel discoveries demonstrate that enzymatically rebuilding starch molecules may be a meaningful strategy for diabetes management.

Task-sharing interventions for improving control of diabetes in low-income and middle-income countries: a systematic review and meta-analysis

SummaryBackgroundTask-sharing interventions using non-physician health-care workers might be a potential diabetes management strategy in health systems that are constrained by physician shortages, such as those in low-income and middle-income countries (LMICs).MethodsWe did a systematic review and meta-analysis of task-sharing intervention strategies for managing type 2 diabetes in LMICs. We searched PubMed, Embase, and CINAHL from database inception to Sept 25, 2019, for studies that were randomised control trials or cluster randomised trials with task-shifted or task-shared interventions delivered to adults (≥18 years) by non-physician health workers versus usual care, done in LMICs with glycated haemoglobin (HbA1c) or fasting blood sugar (FBS) as outcome measures. The methodological quality of included studies was assessed using the Cochrane risk of bias tool. Random-effects model meta-analysis was used to estimate the population average pooled mean difference for HbA1c and FBS with 95% CIs. Our study protocol was registered in the PROSPERO database (CRD42018081015).FindingsWe found 4213 studies from the literature search, of which 46 (1·1%) were eligible for the narrative synthesis, including a total of 16 973 participants. 16 of these studies were excluded from the meta-analysis due to high risk of bias. 24 studies with a total of 5345 participants were included in the meta-analysis of HbA1c and 18 studies with a total of 3287 participants for FBS. Interventions led to an average reduction in HbA1c when tasks were delivered by nurses (averaged pooled mean difference −0·54% [95% CI −0·89 to −0·18]; I2=80%) and pharmacists (−0·91% [–1·15 to −0·68]; I2=58%), but not when they were delivered by dietitians (−0·50% [–1·10 to 0·09]; I2=54%) or community health workers (0·05% [0·03 to 0·07]; I2=0%). A reduction in average FBS was also observed when interventions were delivered by pharmacists (average pooled mean difference −36·26 mg/dL [–52·60 to −19·92]; I2=78%) but not nurses (−7·46 mg/dL [–18·44 to 3·52]; I2=79%) or community health workers (−5·41 [–12·74 to 1·92]; I2=71%). Only one study reported on FBS when tasks were delivered by dietitians, with a mean difference of −35·00 mg/dL (−65·96 to −4·04).InterpretationTask sharing interventions with non-physician healthcare workers show moderate effectiveness in diabetes management in LMIC settings. Although relatively high heterogeneity limits the interpretation of the overall findings, interventions led by pharmacists and nurses in LMICs with relatively high physician density are effective strategies in the management of diabetes.FundingWellcome Trust–Department of Biotechnology India Alliance.

The diabetes quality of life brief clinical inventory in combination with the management strategies in type 1 diabetes mellitus with or without the use of insulin pump.

The aims of this study are to evaluate any differences in the Quality of life among Continuous Subcutaneous Insulin Infusion (CSII) and Multiple Dose Injection (MDI) insulin delivery, applying the Diabetes Quality of life Brief Clinical Inventory (DQoL-BCI) questionnaire, and assess the diabetes management strategies between the two groups. One hundred and ten adult participants (male/female ratio 1:2.7) with type 1 diabetes were recruited in this online survey. Forty-eight of them were using CSII and the rest 62 (were using) MDI insulin delivery. A 23-item socio-demographic/diabetes management strategies questionnaire and the 15-item DQoL-BCI were administered. CSII users scored statistically, significantly better at the satisfaction treatment subscale (p = 0.032) of the DQoL-BCI and emerged that they were implemented more management strategies such as dietician guidance services (p = 0.002), carbohydrate education seminars (p = 0.03). Predictive factors were also detected regarding the HbA1c < 7% (53mmol/mol) and β-coefficients in relation to DQoL-BCI questionnaire with the subscales of a negative impact and satisfaction treatment. Diabetes self-management education plays a key role to a better compliance with the treatment. Client-centered multidisciplinary centers in T1DM education are essential so that they be applicable for all T1DM patients irrespective of the type of insulin delivery they used.

The Double Whammy of Obesity and Diabetes on Female Reproductive Health.

The rising global prevalence of obesity and diabetes, especially in youth, confers substantial metabolic consequences and increased mortality in affected individuals. While obesity is strongly tied to the development of insulin resistance and type 2 diabetes, emerging evidence shows that obesity rates are also increasing exponentially in those with type 1 diabetes, contributing to insulin resistance and cardiometabolic sequelae. In addition, both obesity and diabetes can exert adverse effects on female reproductive health independently, with the presence of both conditions likely to exacerbate reproductive dysfunction in this cohort. If the current trends in obesity and diabetes incidence persist, it is likely that more women will be at risk of obesity- and diabetes-related reproductive disorders. This review aims to describe the epidemiology and mechanisms of obesity in women with diabetes, and summarize current literature regarding reproductive disorders in diabetes and weight management strategies in this cohort.

Novel Short-Clustered Maltodextrin as a Dietary Starch Substitute Attenuates Metabolic Dysregulation and Restructures Gut Microbiota in db/db Mice.

Molecular structure of starch in daily diet is closely associated with diabetes management. By enzymatically reassembling α-1,4 and α-1,6 glycosidic bonds in starch molecules, we have synthesized an innovative short-clustered maltodextrin (SCMD) which slowly releases glucose during digestion. Here, we investigated the potential benefits of the SCMD-containing diet using diabetic db/db mice. As compared to a diet with normal starch, this dietary style greatly attenuated hyperglycemia and repaired symptoms associated with diabetes. Additionally, in comparison with acarbose (an α-glucosidase inhibitor) administration, the SCMD-containing diet more effectively accelerated brown adipose activation and improved energy metabolism of db/db mice. Furthermore, the SCMD-containing diet was a more suitable approach to improving the intestinal microflora than acarbose administration, especially the proliferation of Mucispirillum, Akkermansia, and Bifidobacterium. These results reveal a novel strategy for diabetes management based on enzymatically rebuilding starch molecules in the daily diet.

Effect of Voluntary Participation on Mobile Health Care in Diabetes Management: Randomized Controlled Open-Label Trial.

BackgroundThe role of mobile health care (mHealth) in glycemic control has been investigated, but its impact on self-management skills and its psychological aspects have not been studied.ObjectiveWe evaluated the efficacy of mHealth-based diabetes self-management education and the effect of voluntary participation on its effects.MethodsThis study was a randomized controlled open-label trial conducted for 6 months at Kangbuk Samsung Hospital. Participants in the control group (n=31) maintained their previous diabetes management strategies. Participants in the intervention group (n=41) additionally received mHealth-based diabetes self-management education through a mobile app and regular individualized feedback from health care professionals. The primary outcome was change in glycated hemoglobin (HbA1c) level over 6 months between the 2 groups (intervention versus control) and within each group (at 6 months versus baseline). The secondary outcomes were changes in body mass index, blood pressure, lipid profile, and questionnaire scores (the Korean version of the Summary of Diabetes Self-Care Activities Questionnaire, an Audit of Diabetes Dependent Quality of Life, the Appraisal of Diabetes Scale, and Problem Areas in Diabetes) over 6 months between groups and within each group.ResultsA total of 66 participants completed this study. HbA1c (P=.04), total cholesterol level (P=.04), and Problem Areas in Diabetes scores (P=.02) significantly decreased; total diet (P=.03) and self-monitoring of blood glucose level scores (P=.01), based on the Summary of Diabetes Self-Care Activities Questionnaire, markedly increased within the intervention group. These significant changes were observed in self-motivated participants who were recruited voluntarily via advertisements.ConclusionsmHealth-based diabetes self-management education was effective at improving glycemic control and diabetes self-management skills and lowering diabetes-related distress in voluntary participants.Trial RegistrationClinicalTrials.gov NCT03468283; http://clinicaltrials.gov/ct2/show/NCT03468283

Opposite Effects of Work-Related Physical Activity and Leisure-Time Physical Activity on the Risk of Diabetes in Korean Adults.

The object of this study was to examine the effects of domestic and work-related physical activity (DWPA) and leisure-time physical activity (LTPA) on the risk of diabetes, by categorizing fasting blood glucose (FBG) levels into normal, Impaired Fasting Glucose (IFG), and diabetes. The sample consisted of 4661 adults aged 30 years or above, and was chosen from the 2017 Korean National Health and Nutrition Examination Survey (KNHANES) data. Of all the subjects, 14.6% engaged in high-intensity DWPA and 6.25% in moderate-intensity DWPA; while 11.68% and 24.80% engaged in high- and moderate-intensity LTPA, respectively. The effects of both types of physical activities on the risk of diabetes were analyzed using a Bayesian ordered probit model. For those with high-intensity DWPA, the probability of the FBG level being normal was 5.10% (SE = 0.25) lower than for those with non-high-intensity DWPA, and the probabilities of IFG and diabetes were 3.30% (SE = 0.15) and 1.79% (SE = 0.09) higher, respectively. However, for those with high-intensity LTPA, the probability of the FBG level being normal was 2.54% (SE = 0.09) higher, and the probabilities of IFG and diabetes were 1.74% (SE = 0.07) and 0.80% (SE = 0.03) lower, respectively, than those with non-high-intensity LTPA. Likewise, for moderate-intensity DWPA and LTPA, the results were the same compared to low-intensity physical activities though the magnitude of the effects were smaller than for high-intensity. Thus, the activities related to work have a negative effect and those related to leisure have a positive effect. The criteria for physical activities to reduce the risk of diabetes should be set by separating these domains of physical activity, and new management strategies for diabetes are needed for people with moderate- or high-intensity DWPA.

Challenges and Strategies for Diabetes Management in Community-Living Older Adults.

The prevalence of diabetes is increasing, especially in older people, mainly because of an increase in life expectancy. The number of comorbidities also increases with increasing age, leading to a unique diabetes phenotype in old age that includes vascular disease, physical and neuropathic complications, and mental dysfunction. These three categories of complications appear to have a synergistic effect that can lead to a vicious cycle of deterioration into disability. Early assessment and appropriate, timely interventions may delay adverse outcomes. However, this complex phenotype constitutes a great challenge for health care professionals. This article reviews the complex diabetes phenotype in old age and explores management strategies that are predominantly based on the overall functional status of patients within this heterogeneous age-group.

Fighting Diabetes Mellitus: Pharmacological and Non-pharmacological Approaches.

The increasing worldwide prevalence of diabetes mellitus confers heavy public health issues and points to a large medical need for effective and novel anti-diabetic approaches with negligible adverse effects. Developing effective and novel anti-diabetic approaches to curb diabetes is one of the most foremost scientific challenges. This article aims to provide an overview of current pharmacological and non-pharmacological approaches available for the management of diabetes mellitus. Research articles that focused on pharmacological and non-pharmacological interventions for diabetes were collected from various search engines such as Science Direct and Scopus, using keywords like diabetes, glucagon-like peptide-1, glucose homeostasis, etc. Results: We review in detail several key pathways and pharmacological targets (e.g., the G protein-coupled receptors- cyclic adenosine monophosphate, 5'-adenosine monophosphate-activated protein kinase, sodium-glucose cotransporters 2, and peroxisome proliferator activated-receptor gamma signaling pathways) that are vital in the regulation of glucose homeostasis. The currently approved diabetes medications, the pharmacological potentials of naturally occurring compounds as promising interventions for diabetes, and the non-pharmacological methods designed to mitigate diabetes are summarized and discussed. Pharmacological-based approaches such as insulin, metformin, sodium-glucose cotransporters 2 inhibitor, sulfonylureas, glucagon-like peptide-1 receptor agonists, and dipeptidyl peptidase IV inhibitors represent the most important strategies in diabetes management. These approved diabetes medications work via targeting the central signaling pathways related to the etiology of diabetes. Non-pharmacological approaches, including dietary modification, increased physical activity, and microbiota-based therapy are the other cornerstones for diabetes treatment. Pharmacological-based approaches may be incorporated when lifestyle modification alone is insufficient to achieve positive outcomes.

Sweet Talking: Voice Technology and Virtual Assistants in Clinical Diabetes Management.

Voice technology offers a range of novel and promising strategies for clinical diabetes management. Incorporation of voice-powered virtual assistants (such as Apple Siri and Microsoft Cortana) into diabetes care programs has the potential to improve patient awareness and adherence; facilitate comprehensive provider-patient integration and data collection; and expedite consultations, procedures, and meal preparations. This study will present a qualitative literature review on existing and speculative applications of voice technology in diabetes care.

Undertreatment of cardiovascular risk factors in the type 1 diabetes exchange clinic network (United States) and the prospective diabetes follow-up (Germany/Austria) registries.

To examine the control of cardiovascular risk factors in type 1 diabetes (T1D) registries from the United States and Germany/Austria. Data on individuals aged ≥12 years with T1D for ≥1 year, from the T1D Exchange Clinic Network (T1DX, United States) and the Prospective Diabetes Follow-up Registry (DPV, Germany/Austria) from 1 January 2016 to 31 March 2018 were analysed. Linear and logistic regression models adjusted for age groups, sex, duration of diabetes and minority status were used to compare clinical characteristics and achievement of diabetes management targets between registries. The cohort consisted of 47 936 patients (T1DX, n = 19 442; DPV, n = 28 494). Achievement of HbA1c goals (<7.0%, ages 18-65 years; all others, <7.5%) was better in the DPV for those aged <65 years (all P < .001). However, more older adults (aged ≥65 years) in the T1DX achieved an HbA1c goal of <7.5% compared with DPV (70% vs. 50%, P < .001). The frequency of patients with overweight (53% vs. 51%, P < .001) and obesity (19% vs. 9%, P < .001) was higher in T1DX. The frequency of meeting blood pressure goals (84% vs. 66%, P < .001) and lipid goals (73% vs. 62%, P < .001) was higher in T1DX; this was observed across all age groups (all P < .001). Few young adults aged <26 years received antihypertensive and lipid-lowering medications, respectively, despite indications in both registries (T1DX: 5% and 3%, DPV: 3% and 1%). A minority of patients with T1D achieve glycaemic targets and the majority are inadequately treated for hypertension and dyslipidaemia. This highlights the need for improved diabetes and cardiovascular risk management strategies in T1D.

Diabetes in adults with intellectual disability: prevalence and associated demographic, lifestyle, independence and health factors.

As people with intellectual disabilities (ID) are now living longer, they are more at risk of developing non-communicable diseases, including type 2 diabetes mellitus. However, understanding of factors associated with diabetes for targeted management and prevention strategies is limited. This study aimed to investigate prevalence of diabetes in adults (aged ≥18years) with ID and its relationship with demographic, lifestyle, independence and health factors. This was a cross-sectional analysis of interview data from 1091 adults with ID from the Leicestershire Learning Disability Register from 1 January 2010 to 31 December 2016. Logistic regression models were used to identify factors associated with diabetes in the study population. The study population did not have healthy lifestyles: just under half reported having lower physical activity levels than people without ID of a similar age; one-quarter consumed fizzy drinks daily; and 20% consumed five or more fruit and/or vegetables per day. Prevalence of carer/self-reported diabetes was 7.3% (95% confidence interval 5.9-9.0). After adjustment, diabetes was positively associated with South Asian ethnicity (P=0.03) and older age groups (P<0.001). Diabetes was less common in people living with family members (P=0.02). We did not find a relationship between any of the lifestyle, independence and health factors investigated. A significant proportion of people with ID are living with diabetes. Diabetes management and prevention strategies should be tailored to individuals' complex needs and include consideration of lifestyle choices. Such strategies may want to focus on adults of South Asian ethnicity and people living in residential homes where prevalence appears to be higher.

Managing diabetes and COVID-19: A national strategic framework

The coronavirus disease (COVID-19) pandemic has been one of the greatest health challenges that humanity has witnessed in recent times. Diabetes mellitus is one of the most common noncommunicable diseases and its prevalence is very high in evlderly people. COVID-19 also has a worse prognosis in elderly people. Hence, most of the data, both nationally and internationally, have shown that people with uncontrolled diabetes have worse outcomes compared to people without diabetes. This article reviews the connection between diabetes and COVID-19 and suggests various precautions to be taken for people with diabetes, the management strategies for diabetes and lays down a strategic framework for managing people with diabetes and COVID-19.