Metabolic Control In Diabetic Patients Research Articles

Diabetes, periodontitis, and cardiovascular disease: towards equity in diabetes care.

Type 2 diabetes and its associated cardiovascular risk is an escalating epidemic that represents a significant public health burden due to increased morbidity and mortality, disproportionately affecting disadvantaged communities. Poor glycaemic control exacerbates this burden by increasing retinal, renal, and cardiac damage and raising healthcare costs. This predicament underscores the urgent need for research into cost-effective approaches to preventing diabetes complications. An important but often overlooked strategy to improve metabolic control in diabetic patients is the treatment of periodontitis. Our aim is to assess whether the inclusion of periodontitis treatment in diabetes management strategies can effectively improve metabolic control, and to advocate for its inclusion from an equity perspective. We conducted a comprehensive review of the literature from 2000 to 2023. We analyzed the pathophysiological links between periodontitis, diabetes, and atherosclerotic cardiovascular disease, all of which have inflammation as a central component. We also examined the inequalities in health care spending in this context. Our findings suggest that incorporating routine screening and treatment of periodontitis into national health programs, with coordinated efforts between physicians and dentists, is a cost-effective measure to improve metabolic control, reduce complications and improve the overall quality of life of people with diabetes.

Importance of metabolic control in diabetic patients infected by covid-19 from a south american hospital

Importance of metabolic control in diabetic patients infected by covid-19 from a south american hospital

Metabolic control of diabetic patients assisted by private and public health care systems during the COVID-19 pandemic: A retrospective cohort study

AimsWe sought to analyze the impacts of social restriction measures imposed by the pandemic COVID-19 on the control of metabolic parameters in diabetic patients. MethodsWe accessed the medical records of patients who underwent clinical follow-up in the public and private health systems between July 2019 and June 2021. The sample consisted of 288 patients (111 adults and 177 older individuals). A two-way ANOVA mixed model was used to test the effects of intra- (time: baseline and after 24 months) and inter-subject factors. Linear regression analysis was used to predict the difference in body weight considering age, sex, HbA1c, health care system and insulin use. ResultsAmong adults, we observed an increase in body weight and LDL-c levels, especially for insulin users (p ≤ 0.05). Adults assisted by the public health care system showed higher HbA1c levels (p = 0.001). Among older individuals using insulin, blood glucose levels decreased (p = 0.019). Body weight decreased in those assisted by the private system (p = 0.005), while glycemia decreased for patients assisted by both health care systems (p = 0.043). The linear regression model confirmed that the increase in body weight was more pronounced in adults than in older individuals. ConclusionThe social restriction measures imposed by the pandemic affected the metabolic control of diabetic patients, especially adults assisted by the public health care system.

Impact of the COVID-19 Pandemic on the Metabolic Control of Diabetic Patients in Diabetic Retinopathy and Its Screening

(1) Background: Diabetic retinopathy (DR) is a complication of diabetes mellitus (DM), screening programs of which have been affected by the COVID-19 pandemic. The aim of the present study was to determine the impact of the COVID-19 pandemic on the screening of diabetes patients in our healthcare area (HCA). (2) Methods: We carried out a retrospective study of patients with DM who had attended the DR screening program between January 2015 and June 2022. We studied attendance, DM metabolic control and DR incidence. (3) Results: Screening for DR decreased in the first few months of the pandemic. The incidence of mild and moderate DR remained stable throughout the study, and we observed little increase in severe DR, proliferative DR and neovascular glaucoma during 2021 and 2022. (4) Conclusions: The current study shows that during the COVID-19 pandemic, screening program attendance decreased during the year 2020, which then recovered in 2021. Regarding the most severe forms of DR, a slight increase in cases was observed, beginning in the year 2021. Nevertheless, we aimed to improve the telemedicine systems, since the conditions of a significant proportion of the studied patients worsened during the pandemic; these patients are likely those who were already poorly monitored.

The role of appetite-controlling hormones in the development of eating disorders in diabetic 2 patients

Abstract Binge eating disorder (BED) and night eating syndrome (NES) are common eating disorders (EDs) in individuals with diabetes type 2 (DT2). They worsen metabolic control, have a negative impact on physical and mental health and reduce quality of life. The roles of appetite-controlling hormones – leptin and ghrelin – is not clear enough in EDs and need to be investigated in order to establish new approaches and markers of EDs. Aim: To assess the difference in leptin and ghrelin levels in DT2 patients with and without EDs. 57 patients with DT2 were involved in the study. After physical examination and screening for EDs, blood samples for leptin and ghrelin measuring were obtained. Results: 19 participants (33.3%) were screened positively for ED (BE or NES). Leptin levels were higher in participants with ED (p<0.05). Conversely, ghrelin levels were lower in those with BE or NES (p<0.05). Leptin level is increased in DT2 individuals with BED and NES, whereas ghrelin is decreased. Leptin and ghrelin alterations maintain emotional eating, increase the frequency of binge and night eating episodes. In screening for EDs, assessing leptin and ghrelin levels will facilitate obesity reduction and improve metabolic control in diabetic patients.

Dental Caries Prevalence among Diabetics Acrylic Partial Denture Wearer’s- A Review

Introduction: Dental caries is one of the most common oral health conditions affecting 60-90% of the population. The progression of dental caries results in tooth loss if not treated properly. Tooth loss will presumably cause functional impairment which might ultimately affect the quality of life. Removable partial denture is one of the most widely accepted means of tooth replacement. It had been noticed that removable partial dentures increased the likelihood of new or recurrent caries on remaining adjacent natural teeth. Diabetes mellitus is the most routinely encountered disease among various systemic diseases. Studies revealed that dental caries has been more prevalent and even severe in diabetic patients than nondiabetics. Aim: To assess the effect of Acrylic Removable Partial Dentures (RPD) and diabetes in prevalence of dental caries. Materials and Methods: This study was carried out in JSSDCH, JSSAHER, Mysuru, Karnataka in the year July 2017. The duration of conducting literature search was from July 2017 to Dec 2019. Individuals participating in the study should be partially edentulous and aged between 18-64 years either diabetic or nondiabetic. 69 articles were identified from searching electronic data base (Pubmed, Cochrane, Google scholar) and manual searching from July 2017 to December 2019. 19 articles were excluded following an initial screening. 50 articles were included for the further review. Scientific evidence supporting the hypothesis of the study 10 articles where five articles were review and five articles were original research. The main outcome of intervention involved both methodology and assessment tools applied by investigator to assess the effect of RPD and diabetes in terms of prevalence of dental caries. Results: Studies had shown that RPD wearers shows high caries prevalence as compared to nonwearers, Diabetic patients reported high caries prevalence compared to nondiabetic patients. This literature review states that RPD and Diabetes had an impact on prevalence of dental caries. Conclusion: The conclusion from this present review would indicates that good metabolic control in diabetic patients, periodic monitoring of the removable partial denture, oral hygiene, good RPD design framework, following post-insertion instruction of the RPD, following regular recall visits contributes towards prevention of plaque favouring inhibition of caries prevalence among diabetic and nondiabetic patients wearing RPD.

Thyroid Dysfunction and Diabetes Mellitus: Two Closely Associated Disorders.

Thyroid dysfunction and diabetes mellitus are closely linked. Several studies have documented the increased prevalence of thyroid disorders in patients with diabetes mellitus and vice versa. This review critically discusses the different underlying mechanisms linking type 1 and 2 diabetes and thyroid dysfunction to demonstrate that the association of these two common disorders is unlikely a simple coincidence. We assess the current state of knowledge on the central and peripheral control of thyroid hormone on food intake and glucose and lipid metabolism in target tissues (such as liver, white and brown adipose tissue, pancreatic β cells, and skeletal muscle) to explain the mechanism linking overt and subclinical hypothyroidism to type 2 diabetes and metabolic syndrome. We also elucidate the common susceptibility genes and the pathogenetic mechanisms contributing to the autoimmune mechanism involved in the onset of type 1 diabetes mellitus and autoimmune thyroid disorders. An untreated thyroid dysfunction can impair the metabolic control of diabetic patients, and this association can have important repercussions on the outcome of both of these disorders. Therefore, we offer recommendations for the diagnosis, management, and screening of thyroid disorders in patients with diabetes mellitus, including the treatment of diabetic patients planning a pregnancy. We also discuss the major causes of failure to achieve an optimal management of thyroid dysfunction in diabetic patients and provide recommendations for assessing and treating these disorders during therapy with antidiabetic drugs. An algorithm for a correct approach of these disorders when linked is also provided.

Does Telephone Follow-Up and Education Affect Self-Care and Metabolic Control in Diabetic Patients?

The major goal of diabetes control is to assist patients to perform self-care and metabolic control. One possible way to achieve this goal is education and regular monitoring of patients by telephone. Thus, the present study was conducted with the aim of investigating the impact of education and telephone follow-up on self-care and metabolic control in diabetic patients. This experimental study was conducted at a hospital in the Central Anatolia region of Turkey, with 88 diabetic patients including 44 intervention subjects and 44 control subjects. After an initial discussion, patients in the intervention group received education and telephone follow-up for 3 months. Required approvals were obtained before initiation of the study. Data were collected using a questionnaire form and the Diabetes Self-Care Scale. The Diabetes Self-Care Scale scores ranged between 140 and 210, where higher scores indicated increased self-care activities of patients. At the end of the study, the self-care score was found to increase from 61.3 ± 10.9 to 89.9 ± 12.3 in the intervention group (P < .005), but it showed a reduction from 56.5 ± 7.6 to 54.7 ± 9.3 after 3-month period in the control group. Education and telephone follow-up was also found to reduce the values of several variables of metabolic control including hemoglobin A1c, total cholesterol, triglycerides, low-density lipoprotein cholesterol, and systolic blood pressure. In conclusion, education and telephone follow-up of diabetic patients led to increased self-care scores and had a positive impact on metabolic control variables. In light of these findings, we suggest that education and tele-health home monitoring may be provided on a continuous basis to help patients sustain self-care behaviors that they have adopted during the study period.

Effect of A One-Week Balanced Diet on Expression of Genes Related to Zinc Metabolism and Inflammation in Type 2 Diabetic Patients.

To evaluate the effect of diet on metabolic control and zinc metabolism in patients with type 2 diabetes mellitus (T2DM). One-week balanced diet was provided to 10 Brazilians patients with T2DM. Nutritional assessment, laboratorial parameters and expression of zinc transporter and inflammatory genes in peripheral blood mononuclear cells (PBMC) were performed. Healthy non-diabetic subjects of the same demographic were recruited to provide baseline data. Diabetic patients had higher body mass index and greater fasting plasma glucose, plasma tumor necrosis factor α (TNFα) and plasma interleukin 6 (IL6) levels compared with healthy subjects. In addition, the expression of transporters 4 (ZnT4) mRNA was lower and IL6 mRNA was higher in PBMC of these diabetic patients than in healthy subject. One week after a balanced diet was provided, fasting plasma glucose decreased significantly as did TNFα, IL6 and Metallothionein 1 (MT1) mRNAs. No change was observed in zinc transporter expression in PBMC after the dietary intervention. A healthy eating pattern maintained for one week was able to improve metabolic control of diabetic patients by lowering fasting plasma glucose. This metabolic control may be related to down-regulation of zinc-related transcripts from PBMCs, as TNFα, IL6 and MT1 mRNA.

Ramadan and Type 2 Diabetes in Bangladesh

Ramadan is the Holy month of the Muslims when they are required to fast from dawn to sunset. The present study was aimed at exploring the effects of fasting in the Ramadan on body mass index (BMI), waist circumference (WC), total cholesterol, triglyceride (TG), creatinine, and acute complications in patients with type 2 diabetes in Bangladesh. This prospective study was carried out among 92 types 2 diabetes patients (age 47±9 years, mean±SD), selected randomly from a tertiary-care hospital of the Diabetic Association of Bangladesh (BADAS). Significant changes were observed in the pulse rate (p=.001) and BMI (p=.001) in type 2 diabetes during Ramadan. Fasting blood glucose (p=.001), fructosamine (p=.001), TC (p=.003), HDL-C (p=.004), TG (p=.04), and creatinine (p=.01) were significantly higher in all the patients during fasting. Fasting during Ramadan is associated with a deterioration of metabolic control in diabetic patients. However, fasting did not cause any irreversible damage to renal function; so, fasting is safe for type 2 diabetes in Bangladesh during Ramadan.

Vitamins and Type 2 Diabetes Mellitus

The present review evaluates the relationship between type 2 diabetes mellitus and individual or combined vitamins. Antioxidant vitamins A, C and E are found decreased in diabetic subjects, possibly due to an increased need to control the excessive oxidative stress produced by abnormalities in glucose metabolism. On the other hand, retinol binding protein exerts a modulating effect, as it has adipokine functions. With respect to the B group vitamins, thiamin, pyridoxine and biotin have been found decreased but the mechanisms are not clear, however supplementation has shown some improvement of the metabolic control in diabetic patients. The absorption of folic acid and vitamin B12 is importantly decreased by the prolongued use of metformin, which is the first choice drug in uncomplicated diabetes, thus these two nutrients have been found deficient in the disease and most probably need to be supplemented regularly. On the other hand, vitamin D is considered a risk factor for the development of diabetes as well as its complications, particularly cardiovascular ones. Although some studies have found an association of vitamin K intake with glucose metabolism further research is needed. Studies on the use of multivitamin supplements have shown unconclusive results. After reviewing the evidence, no real recommendation on the use of vitamin supplements in type 2 diabetes mellitus can be issued, however patients using metformin during prolongued periods may need folic acid and vitamin B12.

Impacto de un programa personalizado de educación en pacientes diabéticos tipo 2

Los programas de educación en diabetes han logrado demostrar el beneficio en el control metabólico. Objetivo: evaluar el impacto de un programa personalizado de educación para pacientes diabéticos tipo 2 en seguimiento a seis meses, en el Hospital de San José. Bogotá. Metodología: se condujo un estudio descriptivo retrospectivo a partir de los registros de pacientes adultos con diabetes tipo 2, que ingresaron al programa educativo entre enero 2011 y febrero 2012. Se realizaron intervenciones personalizadas y grupales con un equipo multidisciplinario liderado por médico endocrinólogo. Se compara el control metabólico al ingreso al programa y en el seguimiento al sexto mes según las metas propuestas por la ADA y ATP III. Resultados: ingresaron al programa 115 pacientes, edad promedio de 61.1 años (DE 8.7); tiempo mediano de diagnóstico 10.5 años (RIQ 4-17.5), 43.9% de los hombres y 54% de las mujeres tenían más de 10 años de evolución. El 33.3% de los hombres y 55.4% mujeres presentaban obesidad. Los pacientes en metas de hemoglobina glicosilada A1c (HbA1c) en el seguimiento a seis meses, pasó de 10.4% al ingreso a 51%, colesterol LDL de 41.9 a 47.1%, HDL de 46.3 a 62.5% y triglicéridos de 25.6 a 50%. Las pérdidas en el seguimiento fueron de 48.9%. Se documentó asociación entre el tiempo de evolución de la enfermedad (≤ 5 años) y las metas de HbA1c (p 0.005). Conclusión: la experiencia en seguimiento a corto plazo de un programa educativo personalizado guiado por médico endocrinólogo y un equipo multidisciplinario favorece el control metabólico en pacientes diabéticos

Oral Health Problems among Diabetic Patients – Part of Dental Professionals in Diagnostic and Therapy

Diabetes mellitus is a metabolic disease characterized by hyperglycemia. This is the result of a deficiency in insulin secretion or an increased cellular resistance to the actions of insulin, leading to a variety of metabolic abnormalities. Persistent hyperglycemia has been associated with the incidence and progression in diabetes-related complications, including oral health problems such as oral mucosal diseases, dental caries, salivary dysfunction, oral infections, taste and other neurosensory disorders. Dentists play a major role as part of an allied health team in providing oral care to patients with diabetes. Screening for diabetes and prediabetes in the dental office may provide an important benefit to patients. Several studies have demonstrated the beneficial effect of periodontal treatment on metabolic control of diabetic patients. The aim of this article is to present an overview of opinions contained in the contemporary literature and presentation of the results of clinical trials performed in oral health problems among diabetic patients.

Randomized, Controlled Trial of Glucose-Sparing Peritoneal Dialysis in Diabetic Patients

Glucose-containing peritoneal dialysis solutions may exacerbate metabolic abnormalities and increase cardiovascular risk in diabetic patients. Here, we examined whether a low-glucose regimen improves metabolic control in diabetic patients undergoing peritoneal dialysis. Eligible patients were randomly assigned in a 1:1 manner to the control group (dextrose solutions only) or to the low-glucose intervention group (IMPENDIA trial: combination of dextrose-based solution, icodextrin and amino acids; EDEN trial: a different dextrose-based solution, icodextrin and amino acids) and followed for 6 months. Combining both studies, 251 patients were allocated to control (n=127) or intervention (n=124) across 11 countries. The primary endpoint was change in glycated hemoglobin from baseline. Mean glycated hemoglobin at baseline was similar in both groups. In the intention-to-treat population, the mean glycated hemoglobin profile improved in the intervention group but remained unchanged in the control group (0.5% difference between groups; 95% confidence interval, 0.1% to 0.8%; P=0.006). Serum triglyceride, very-low-density lipoprotein, and apolipoprotein B levels also improved in the intervention group. Deaths and serious adverse events, including several related to extracellular fluid volume expansion, increased in the intervention group, however. These data suggest that a low-glucose dialysis regimen improves metabolic indices in diabetic patients receiving peritoneal dialysis but may be associated with an increased risk of extracellular fluid volume expansion. Thus, use of glucose-sparing regimens in peritoneal dialysis patients should be accompanied by close monitoring of fluid volume status.

Biomarkers for the metabolic control of diabetic patients: Criticisms and future trends

Biomarkers for the metabolic control of diabetic patients: Criticisms and future trends

Experiencia de los cuidadores informales en el manejo de la diabetes mellitus tipo II

People with diabetes represent a significant burden to health systems as well as to the informal caregivers at the domiciliary level. At the present time care offered by informal caregivers is recognized as an important element for obtaining and maintaining metabolic control in diabetic patients. The purpose of this study was to

Non‐surgical periodontal therapy affects metabolic control in diabetics: a randomized controlled clinical trial

Periodontal diseases and diabetes are two common diseases with high prevalence. Many clinicians have accepted the relationship between these two diseases. Some investigators have reported that periodontal treatment may enhance the metabolic control of diabetes. The effects of non-surgical periodontal treatment on metabolic control in people with type 2 diabetes mellitus (DM2) were examined. Forty patients with DM2 and chronic periodontitis [mean age = 50.29 years; mean glycated haemoglobin (HbA1c) = 8.72] were randomly assigned to two groups. The treatment group (n = 22) received full-mouth scaling and root planing, whereas the control group (n = 18) received no periodontal treatment. Gingival index (GI), plaque index (PI), probing pocket depth (PPD), clinical attachment level (CAL), fasting plasma glucose (FPG), HbA1c, total cholesterol (TC), triglyceride (TG) and cholesterol levels were recorded at baseline and compared to data collected three months later. The groups did not differ in gender ratio, age or clinical parameters [PPD (p = 0.107), CAL (p = 0.888), PI (p = 0.180)] and biochemical markers at baseline [FPG (p = 0.429), HbA1c (p = 0.304), TG (p = 0.486), TC (p = 0.942), LDL (p = 0.856) and HDL (p = 0.881)]. FPG, HbA1c and clinical parameters differed between the treatment and control groups (p = 0.006, 0.003 and 0, respectively). From baseline to follow-up (after three months), HbA1c levels decreased in the treated group (p = 0.003). In the same time period, FPG, GI, PPD and CAL increased in the control group (p = 0.016, 0.0, 0.0 and 0.004, respectively) but HbA1c did not change significantly. Non-surgical periodontal therapy could improve metabolic control in diabetic patients.

Respuesta al tratamiento periodontal de diabéticos tipo 2 con mal control metabólico y obesos intolerantes a la glucosa, con periodontitis severa

Diabetes Mellitus (DM) is a risk factor for periodontitis, at the same time, the metabolic control of diabetic patients gets more difficult due to the presence of periodontal infection, increasing the risk of chronic complications and possibly, death by diabetes. It is recognized that both diseases are related because the inflammation factors generated by the periodontitis as well as the oral cavity bacteria in the systemic circulation, may act as aggravating factor for insulin resistance and worsen the glycemic control. It is clear that an opportune treatment of PD would improve the quality of life and the metabolic control of diabetic patients. The objectives of the current paper are to evaluate the impact of the periodontal therapy in both clinical and metabolic parameters in type 2 diabetic and prediabetic obese patients and to demonstrate that uncontrolled diabetics can be treated successfully, without increasing their medical risk. Nine DM2 and 7 glucose intolerant obese patients were selected. All of them suffering severe chronic periodontitis. All patients were treated following a protocol designed by us and medical indications were not modified. The DM2 patients showed approximately a 1% decrease in HbAlc after 6 months of the periodontal treatment. No complication was observed and no patient needed major medical assistance. The response to the periodontal treatment was similar in both groups, with a significant improvement in clinical parameters. Although the decrease in HbA1C was not statistically significant, our results are very promising at the clinical setting. Rev. Clin. Periodoncia Implantol. Rehabil. Oral Vol. 4(2); 50-53, 2011.

Preventive Systems for the Late Complications of Diabetes

Aim of this work is to review and characterize methods and systems that are used to prevent onset and to slow down the progression of the late complications of diabetes. Two groups of methods and systems that might be used to prevent or to slow down the progression of the late complications of diabetes are characterized in this paper. Each of these two groups serves a different purpose. The first group is composed of the systems that facilitate a maintenance of strict metabolic control in diabetic patients, i.e. the systems which are used for monitoring and treatment of diabetes. The second group contains systems that are aimed at screening/monitoring or treatment of the risk factors or the early signs of the late complications. Obesity increases risk of diabetes and its complications. Thus, body mass monitoring and control systems are examples of the tools that belong to this group. Other examples include the diabetic retinopathy telescreening systems and the systems for monitoring of the diabetic foot syndrome.

Oral mucosal lesions in non oral habit diabetic patients and association of diabetes mellitus with oral precancerous lesions

Aims This study was aimed to determine the prevalence of oral mucosal lesions (OML) in patients with diabetes mellitus (DM) and non-diabetic subjects without any oral habits and to investigate the association of DM with oral precancerous lesions. Methods This cross-sectional study involved 420 diabetic and 420 non-diabetic control subjects without any oral habits. Detailed oral examination was performed based on international criteria. Results A significantly greater proportion of subjects with DM (45%) had one or more OML in comparison to non-diabetics (38.3%). Patients with DM showed a significantly greater prevalence of geographic tongue, denture stomatitis and angular cheilitis than non-diabetics ( p < 0.05). The results also showed an association between occurrence of one or more OML and metabolic control of diabetic patients ( p < 0.05). For precancerous lesions, lichen planus was found in two diabetic patients while none of controls had any precancerous lesion ( p > 0.05). Conclusions Prevalence of OML was significantly higher in diabetic patients than non-diabetics and this prevalence was associated with the metabolic control of the patients. However, no association was observed between DM and oral precancerous lesions.