Metabolic Control In Type Research Articles

Relationship between HbA1c and capillary blood glucose self-monitoring in type 2 diabetics.

Diabetes Control and Complications Trial has established the importance of glycemic control in reducing the progression of retinopathy, nephropathy, and neuropathy in type 1 diabetics. There is little literature linking the frequency of glycemic monitoring with glycated hemoglobin A (HbA1c) in type 2 diabetics. The objectives were to assess the influence of glycemic self-monitoring on HbA1c in three groups of patients with type 2 diabetes (with insulin, with oral antidiabetics and with combination therapy). The glucometer capillary surveys of 117 patients were counted in the 30 days prior to the visit to the Integrated Diabetes Unit at Centro Hospitalar Tondela-Viseu. In the three groups considered, sociodemographic characteristics (age, gender, area of residence, household and schooling) were evaluated and compared. There was no statistically significant association between HbA1c and the frequency of capillary glucose in any of the groups. In the evaluation of sociodemographic data, contrary to what was expected, the area of residence and schooling did not influence the value of HbA1c. These results question the role of glycemic monitoring in the metabolic control of type 2 diabetics, highlighting the need to implement therapeutic education programs so that these patients can adequately intervene in the therapeutic adjustment as a function of the information obtained by capillary glycemia.

Assessment of relationship between serum magnesium and serum glucose levels and HOMA-IR in diabetic and prediabetic patients

Aim: In this study, we aimed to investigate the serum magnesium (Mg) levels in diabetic and prediabetic patients and its correlation with age, body-mass index, HOMA-IR, serum fasting glucose, HbA1c, and insulin levels.Methods: In this retrospective study, a total of 130 patients consisted of newly diagnosed prediabetes (Group PD) (n=63) and type 2 diabetes mellitus (Group D) (n=67) were included. Patients' age, body mass index, serum Mg, glucose and insulin, HOMA-IR and HbA1c were recorded. The prediabetes and type 2 diabetes diagnoses had been made according to WHO criteria at the time of diagnosis.Results: In group D, the mean Mg level (1.88 ± 0.17 mg/dl) was significantly lower than group PD (1.96 ± 0.17 mg/dl) (p = 0.007). Correlation analysis showed that there was a significant negative correlation between Mg and glucose (r = -0.390, p = 0.001) and HOMA-IR (r = -0.284; p = 0.022) in the group D. No correlation was found between serum Mg level and serum insulin, HbA1c, age, and body-mass index (p = 0.801, 0.087, 0.611 and 0.691, respectively). In group PD, serum insulin, HbA1c, glucose, HOMA-IR, age, and body-mass index were not corraleted with serum Mg levels (p = 0.801, 0.087, 0.939, 0.998, 0.611 and 0.691, respectively). Conclusıon: We showed that while there was a negative correlation between magnesium levels and HOMA-IR and fasting blood glucose levels in diabetic patients, but this correlation was not present in prediabetic patients. Our results suggest that serum Mg level is associated with metabolic control of type 2 diabetes and thus it can be considered in these patients.

Effect of a multifactorial intervention on the increase in physical activity in subjects with type 2 diabetes mellitus: a randomized clinical trial (EMID Study).

Regular physical activity is essential for metabolic control in type 2 diabetes mellitus. The aim of this study was to assess the short and long-term impact of a multifactorial intervention on physical activity and clinically relevant biochemical parameters in patients with type 2 diabetes mellitus. This randomised, controlled clinical trial (NCT02991079) included two parallel groups aged 25-70 years from a primary care health centre in Salamanca, Spain. The subjects were assigned randomly (1:1) to control and intervention groups, using Epidat 4.0 software. Both were counselled on the importance of physical activity and maintaining a healthy diet. The intervention group also took five low-moderate intensity 4 km nurse-guided walks, received a smartphone application to promote healthy habits and attended a diet workshop. Physical activity was measured objectively using a pedometer and subjectively using a shortened international physical activity questionnaire (at baseline, 3 and 12 months). In total, 204 subjects were included (mean age 60.6 years, 45.6% were women). After 3 months, relative to the control group, the intervention group increased their daily number of steps by 1852, aerobic steps by 1623, distance walked by 994 m, and total metabolic equivalent minutes per week by 1297 and decreased sedentary time by 34.3 minutes per day. Differences from baseline persisted at 12 months, including mean increases of 1141 daily steps, 917 aerobic steps, and 1065 total metabolic equivalent minutes per week in the intervention group relative to the control group ( P<0.05 for all). The success of this multifactorial intervention should help inform future clinical approaches and application designs towards managing type 2 diabetes mellitus and improving patient outcomes.

Značaj određivanja glikohemoglobina u proceni rizika od amputacija kod pacijenata sa sindromom dijabetesnog stopala

Glycosylated hemoglobin (HbA1c) is important parameter for the assessment of long term metabolic control and risk for development of chronic complications in patients with diabetes mellitus (DM). This study investigates associations between achieved metabolic control in type 2 DM with the risk for the development of diabetic foot (DF) and its treatment modalities. The study included 111 patients (80 men and 31 women) with type 2 DM, aged 65.5±9.8 years. In 41 patients DF was treated by a conservative approach, 41 patients underwent a minor limb amputation (foot amputation) and 29 patients underwent a major limb amputation (below-knee amputation). The levels of HbA1c and serum biochemical parameters were measured by standard laboratory methods. The most frequent risk factor for DF in the examined group (82% patients) was poor glycaemic control (HbA1c>8%). The level of HbA1c was significantly higher in surgically treated patients than in the conservatively treated group (P<0.05). The number of patients who underwent surgical treatment were significantly higher in the group with poor glycaemic control (62.8% patients with poor glycaemic control vs. 40% patients with optimal glycaemic control; P<0.05). We found that the patients with poor glycaemic control had 3.2 times higher risk for amputation (OR=3.21; 95%CI:1.18-8.69; P<0.05). In conclusion, our results demonstrated that optimal metabolic control in type 2 DM reduces the risk for DF development, as well as the invasiveness of DF treatment.

Impact of Obesity on the Metabolic Control of Type 2 Diabetes: Results of the Turkish Nationwide Survey of Glycemic and Other Metabolic Parameters of Patients with Diabetes Mellitus (TEMD Obesity Study)

Background: Obesity is the main obstacle for metabolic control in patients with type 2 diabetes. Turkey has the highest prevalence of obesity and type 2 diabetes in Europe. The effect of obesity on the metabolic control, and the macro- and microvascular complications of patients are not apparent. Objectives: This nationwide survey aimed to investigate the prevalence of overweight and obesity among patients with type 2 diabetes and to search for the impact of obesity on the metabolic control of these patients. We also investigated the independent associates of obesity in patients with type 2 diabetes. Methods: We consecutively enrolled patients who were under follow-up for at least 1 year in 69 tertiary healthcare units in 37 cities. The demographic, anthropometric, and clinical data including medications were recorded. Patients were excluded if they were pregnant, younger than 18 years, had decompensated liver disease, psychiatric disorders interfering with cognition or compliance, had bariatric surgery, or were undergoing renal replacement therapy. Results: Only 10% of patients with type 2 diabetes (n = 4,648) had normal body mass indexes (BMI), while the others were affected by overweight (31%) or obesity (59%). Women had a significantly higher prevalence of obesity (53.4 vs. 40%) and severe obesity (16.6 vs. 3.3%). Significant associations were present between high BMI levels and lower education levels, intake of insulin, antihypertensives and statins, poor metabolic control, or the presence of microvascular complications. Age, gender, level of education, smoking, and physical inactivity were the independent associates of obesity in patients with type 2 diabetes. Conclusion: The TEMD Obesity Study shows that obesity is a major determinant of the poor metabolic control in patients with type 2 diabetes. These results underline the importance of prevention and management of obesity to improve health care in patients with type 2 diabetes. Also, the results point out the independent sociodemographic and clinical associates of obesity, which should be the prior targets to overcome, in the national fight with obesity.

Physical Activity, Insulin Sensitivity, and Metabolic Control in Type 1 Diabetes Mellitus

Physical Activity, Insulin Sensitivity, and Metabolic Control in Type 1 Diabetes Mellitus

Effect of Non-surgical Periodontal Therapy With and Without 0.2% Chlorhexidine Rinse on Metabolic Control of Type 2 Diabetic Patients

Background: The prevalence of periodontal diseases in patients with type 2 diabetes and improper glucose control is significantly higher. The aim of this study is to investigate the effect of scaling and root planning and chlorhexidine digluconate rinse on metabolic control in type 2 diabetic patients. Methods: A total of 60 patients with poorly controlled type 2 diabetes and moderate chronic periodontitis were selected, and randomly divided into three groups. We performed scaling and root planning in 2 test groups (T1, T2), with 0.2% chlorhexidine rinse used only for test group 2. Follow-up including one evaluation 3 months later and a visit 6 months later, was to evaluate glycemic control (FBS and HbA1c) and periodontal status (PI and CPI). Data were presented as mean ± standard deviation (SD) and analyzed using Student’s t test and Wilcoxon test in SPSS 20.0. Results: The mean changes in all variables in both test groups except FBS were significantly reduced (P <0.01). T2 group showed better results at 3-month evaluation. Conclusions: Non-surgical periodontal therapy improves periodontal health indicators and metabolic control in type 2 diabetic patients. Chlorhexidine is more effective on periodontal status and metabolic control in the short term.

Metabolic Control in Type 1 Diabetes: Is Adjunctive Therapy the Way Forward?

Despite advances in insulin therapies, patients with type 1 diabetes (T1DM) have a shorter life span due to hyperglycaemia-induced vascular disease and hypoglycaemic complications secondary to insulin therapy. Restricting therapy for T1DM to insulin replacement is perhaps an over-simplistic approach, and we focus in this work on reviewing the role of adjuvant therapy in this population. Current data suggest that adding metformin to insulin therapy in T1DM temporarily lowers HbA1c and reduces weight and insulin requirements, but this treatment fails to show a longer-term glycaemic benefit. Agents in the sodium glucose co-transporter-2 inhibitor (SGLT-2) class demonstrate the greatest promise in correcting hyperglycaemia, but there are safety concerns in relation to the risk of diabetic ketoacidosis. Glucagon-like peptide-1 agonists (GLP-1) show a modest effect on glycaemia, if any, but significantly reduce weight, which may make them suitable for use in overweight T1DM patients. Treatment with pramlintide is not widely available worldwide, although there is evidence to indicate that this agent reduces both HbA1c and weight in T1DM. A criticism of adjuvant studies is the heavy reliance on HbA1c as the primary endpoint while generally ignoring other glycaemic parameters. Moreover, vascular risk markers and measures of insulin resistance—important considerations in individuals with a longer T1DM duration—are yet to be fully investigated following adjuvant therapies. Finally, studies to date have made the assumption that T1DM patients are a homogeneous group of individuals who respond similarly to adjuvant therapies, which is unlikely to be the case. Future longer-term adjuvant studies investigating different glycaemic parameters, surrogate vascular markers and harder clinical outcomes will refine our understanding of the roles of such therapies in various subgroups of T1DM patients.

Nutritional profile of patients with type 2 Diabetes Mellitus in Ribeirão Preto family health units

Objective: To describe the nutritional profile and the metabolic control of type 2 diabetes mellitus patients in family health units of Ribeirão Preto.Materials and Methods: This is a descriptive study, inquiry type, with patients registered in family health units of Ribeirão Preto – SP. The sample was 100 patients, being laboratory data assessed by means of medical records. The sociodemographic and clinical variables, as well as those related to the nutritional profile were obtained through home visits. Furthermore, anthropometric evaluation of the patients was performed. Body fat (%) was assessed by electric bioimpedance. The local Ethics and Research Committee approved this research.Results: The average age of the patients was 66.7 years, 64 % female, predominantly white (78%), married (58%), and with an incomplete basic school level (56%). The self-reported morbidity with the greatest prevalence was systemic arterial hypertension (71%). Concerning the nutritional diagnostic, 75% of the patients were overweight or presented obesity. As regards to glycemic control, it was evidenced that 75 and 60% of the patients, respectively, were with fasting glycemia and glycated hemoglobin (Hb1Ac) values above the recommended. The odds ratio was used to verify the association between the biochemical variables and the fat mass. However, no significant association was found.Conclusion: The majority of patients were overweight or had obesity and inadequate metabolic control.***Perfil nutricional de pacientes com Diabetes Mellitus tipo 2 em unidades de saúde da família de Ribeirão Preto***Objetivo: Descrever o perfil nutricional e o controle metabólico dos pacientes com Diabetes Mellitus, tipo 2 em unidades de saúde da família de Ribeirão Preto.Materiais e Métodos: Trata-se de um estudo descritivo, tipo inquérito, realizado com pacientes cadastrados em unidades de saúde da família de Ribeirão Preto-SP. A amostra foi constituída por 100 participantes, sendo que os dados laboratoriais foram obtidos por meio de registros em prontuários médicos, e as variáveis sociodemograficas, clínicas, e às relacionadas ao perfil nutricional foram obtidas mediante entrevista domiciliar. Além disso, foi realizada a avaliação antropométrica dos pacientes. Para cálculo da massa de gordura corporal (%) foi utilizada a bioimpedância elétrica. Os dados foram digitados no software Epi InfoTM 7 e analisados pelo programa estatístico Stata 9.0. O trabalho foi aprovado pelo Comitê de Ética e Pesquisa.Resultados: A média de idade dos participantes foi de 66,7 anos, sendo 64% do sexo feminino, com predomínio de brancos (78%), casados (58%), com ensino fundamental incompleto (56%). A morbidade auto referida de maior prevalência foi a hipertensão arterial sistêmica (71%). Com relação ao diagnóstico nutricional, observou-se que 75% dos pacientes estavam com excesso de peso ou obesidade. No que se refere ao controle glicêmico, evidenciou-se que 75 e 60% dos pacientes, respectivamente, estavam com a glicemia de jejum e hemoglobina glicada (Hb1Ac) acima dos valores recomendados. Utilizou-se o odds ratio para verificar a associação entre as variáveis bioquímicas e a massa de fato. No entanto, nenhuma associação significativa foi encontrada.Conclusão: A maioria dos pacientes estava com excesso de peso ou obesidade e controle metabólico inadequado.

Current Level of Glycemic Control and Clinical Inertia in Subjects Using Insulin for the Treatment of Type 1 and Type 2 Diabetes in the Czech Republic and the Slovak Republic: Results of a Multinational, Multicenter, Observational Survey (DIAINFORM).

IntroductionThe aim of the study was to determine the level of metabolic control in type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) patients in the Czech and Slovak Republics.MethodsA non-interventional prospective (observational) study was conducted from January 2015 until April 2016 in routine clinical practice settings at 141 centers in the Czech and Slovak Republics. Data were analyzed from a total of 425 patients with T1DM and 1034 patients with T2DM, proportionally corresponding to the number of patients in both countries. The primary objective of the study was to determine the percentage of patients with HbA1c < 7% (53 mmol/mol).ResultsPatients with T1DM: In this group of patients (55.8% males, mean age 45.9 ± 14.83 years, BMI 25.8 ± 4.21 kg/m², diabetes duration 12.1 ± 9.44 years), 29.9% reached HbA1c levels < 53 mmol/mol. Patients with T2DM: In this group of patients (50.3% male, mean age 63.9 ± 9.65 years, BMI 31.0 ± 5.19 kg/m², diabetes duration 12.4 ± 7.47 years, duration of insulin therapy 5.8 ± 4.71 years), 33.4% reached HbA1c levels < 53 mmol/mol.ConclusionThe overall percentage of patients with HbA1c < 53 mmol/mol in the T1DM group was 29.9% and in the T2DM group was 33.4%. Despite an increasing number of treatment options, most patients still fail to reach the recommended HbA1c targets.FundingSanofi, Czech Republic.

Neurophysiological Evidence for a Compensatory Activity during a Simple Oddball Task in Adolescents with Type 1 Diabetes Mellitus.

Objective The poor metabolic control in type 1 diabetes mellitus (T1D) has a negative impact on the developing brain. Hyperglycemia and glycemic fluctuations disrupt mainly executive functions. To assess a hypothesized deficit of the executive functions, we evaluated visual processing and reaction time in an oddball task. Methods Oddball visual event-related potentials (ERPs), reaction time, and pattern-reversal visual evoked potentials (VEPs) were examined in a cohort of twenty-two 12- to 18-year-old T1D patients without diabetic retinopathy at normal glycemia and in nineteen 10- to 21-year-old healthy controls. Results The P100 peak time of the VEPs was significantly prolonged in T1D patients compared with the control group (p < 0.017). In contrast to the deteriorated sensory response, the area under the curve of the P3b component of the ERPs was significantly larger (p = 0.035) in patients, while reaction time in the same task did not differ between groups (p = 0.713). Conclusions The deterioration on a sensory level, enhanced activity during cognitive processing, and balanced behavioral response support the view that neuroplasticity counterbalances the neural impairment by enhanced cognitive processing to achieve normal behavioral performance in T1D adolescents.

Rapid Improvement of Metabolic Control in Type 1 Diabetes after Transition from Paediatric Clinics to an Adult Diabetes Center

Transition from paediatric to adult diabetes clinics for type 1 diabetes (T1D) patients represents a critical phase often characterized by worsening effects on diabetes outcomes as care visit attendance, metabolic control and diabetes related complications. Aim of this study was to evaluate metabolic control of 122 T1D patients [82/40 M / F, mean (SD), age 25.1 ± 5.7 years, disease duration 17.2 ± 8.1 years, HbA1c 7.9% ± 1.4] at time of transition from paediatric clinics to our adult diabetes center. At baseline, 102 patients were on multiple daily insulin injections (MDI) and 20 subjects were on continuous subcutaneous insulin infusion (CSII). The transition process was performed in a specific "transition clinic" according to the protocol of the Consensus Statement of the American Academy of Paediatrics, American Diabetes Association, Academy of Family Physicians and the American College of Physicians. Results after 3 and 6 months follow-up showed a significant improvement in metabolic control with reduction of HbA1c in the whole population [Δ HbA1c 0-3 months: -0.3% (p &amp;lt;0.05), Δ HbA1c 0-6 months: -0.5% (p &amp;lt;0.02)] as well as in the different age groups [15-20, 21-30 (p &amp;lt;0.05, p &amp;lt;0.001, respectively)]. At baseline females showed a worst metabolic control compared to male patients (HbA1c: 8.3% ± 1.5 vs. 7.6% ± 1.1, p = 0.005) and this result was confirmed at the end of the study period (HbA1c: 7.9% ± 1.0 vs. 7.1% ± 0.8, p &amp;lt;0.001). After 6 months since transition 27% of patients were on CSII compared to 16% of patients in the pre-transfer period, however improvement of metabolic control was independent of CSII use. In conclusion, our data showed that transition from paediatric to our adult diabetes center promotes a very fast reduction of HbA1c already detectable after 3 months of follow-up. This unexpected improvement is likely due not only to increased use of technology but to a more proper clinical setting for emerging adults as recommended by different scientific societies. Disclosure A. Maurizi: None. S. Pieralice: None. D. Tuccinardi: None. C. Guglielmi: None. A. Lauria: None. E. Maddaloni: Speaker's Bureau; Self; Merck &amp; Co., Inc.. Research Support; Self; European Foundation for the Study of Diabetes. E. Fioriti: None. S. Manfrini: None. P. Pozzilli: Research Support; Self; Sanofi. Speaker's Bureau; Self; Eli Lilly and Company. Research Support; Self; Merck Sharp &amp; Dohme Corp..

Long-term Effect of Islet Transplantation on Glycemic Variability

Islet transplantation has been reported to restore normoglycemia and the overall metabolic control in type 1 diabetes mellitus (DM). In the most experienced centers, islet transplantation clinical outcome is similar to that of the whole pancreas transplantation. Long-term islet transplantation function remains a very interesting matter worth discussing. A progressive islet function decrease was reported, probably due to islet exhaustion. In 5 islet-transplanted patients with at least 3-yr follow-up and still insulin independent, their glycemic control was characterized by a blinded retrospective continuous glucose monitoring system (CGMS). Islet transplantation restored glycemic control and glucose variability. Data were compared with patients in the waiting list. All the parameters of glycemic variability tested had improved significantly in patients who had islet transplantation compared with those patients who were on the waiting list. In conclusion, islet transplantation is able to maintain a proper glucose control and normalize glycemic variability in selected patients. A blinded retrospective CGMS is a useful method to characterize glucose homeostasis deeply in vivo in islet-transplanted patients.

Metabolic control of type 1 diabetes in youth with autism spectrum disorder: A multicenter Diabetes-Patienten-Verlaufsdokumentation analysis based on 61 749 patients up to 20 years of age.

A paucity of reports in the literature exists concerning the co-existence between autism spectrum disorder (ASD) and type 1 diabetes (T1D). To compare clinical characteristics, diabetes management and metabolic control in youth with T1D and ASD (T1D-ASD) with youth without ASD (T1D-non ASD). Using the German/Austrian diabetes patient follow-up registry, this study analyzed aggregated data from the last available year of observation for each patient with T1D, ages 1-20 with consistent data on insulin regimen and glycated hemoglobin (A1C), between January, 2005 and March, 2017. From 61 749 patients, 150 (0.24%) were identified as T1D-ASD. Non-adjusted comparisons showed similar results for mean age at onset and duration of diabetes, but not for gender (male: T1D-ASD: 85.3%; T1D-non ASD: 52.8%; P < .001). Unadjusted comparisons showed no difference for severe hypoglycemia, diabetic ketoacidosis, insulin doses, insulin pump therapy, and body mass index. A statistical difference was observed for A1C (P-value .01) and in the number of blood glucose (SMBG) tests/day (median [interquartile range]: T1D-ASD 6.0 [4.4-7.0]; T1D-non ASD 5.0 [4.4-7.0]; P-value < .001). After adjusting for age, gender, duration of diabetes, and year of observation, only SMBG remained significant (P-value .003). T1D-ASD used psycho-stimulants (15.3% vs 2.2%; P-value < .001), antipsychotics (10.7% vs 0.6%; P-value < .001), and antidepressive medications (3.6% vs 0.7%; P-value < .001) more frequently. Metabolic control was similar in the T1D-ASD group compared to T1D-non ASD despite their comorbidity. Awareness of ASD remains important in T1D treatment, as both conditions require long-term multi-disciplinary medical follow-up for optimal outcomes.

The effect of saffron (Crocus sativus L.) hydroalcoholic extract on metabolic control in type 2 diabetes mellitus: A triple-blinded randomized clinical trial.

Background:Metabolic control is a major concern in preventing diabetic complications. Saffron as a natural source of antioxidants could play a role in alleviating diabetes insults. The aim of this study was to investigate effect of saffron hydroalcoholic extract on metabolic control in type 2 diabetes (T2D) mellitus.Materials and Methods:This randomized triple blind study was included 54 T2D patients which randomly received either saffron (Group 1) or placebo (Group 2) twice daily other than routine antidiabetic treatments for 8 weeks. Serum concentration of fasting blood sugar (FBS), 2-h plasma glucose, hemoglobin A1c (HbA1c), total cholesterol, triglyceride (TG), low-density lipoprotein, and high-density lipoprotein were measured as the markers of metabolic control. Anthropometric measures and blood pressure were also measured at the baseline, every 2 weeks during the intervention and the end of the study. Data analyzed using repeated measure analysis of variance test.Results:The baseline metabolic parameters were the same in two group (P > 0.01). FBS serum level significantly decreased within 8 weeks in the saffron group (128.84 ± 31.86) as compared to the placebo (153.76 ± 41.23), (P < 0.001). There was no statistical difference in other metabolic parameters such as serum lipids, blood pressure, and HbA1c (P > 0.01).Conclusion:Saffron hydroalcoholic extract may improve blood glucose control by reducing FBS in T2D patients. However, saffron extract has no significant effect on other aspects of diabetic control in diabetic patients.

Vitamin D ratio and glycaemic control in individuals with type 2 diabetes mellitus: A systematic review.

Several studies have suggested a favorable role for vitamin D in glycaemic metabolism and its potential as adjuvant treatment of type 2 diabetes mellitus. This review discusses the role of vitamin D in the glycaemic control of individuals with type 2 diabetes mellitus and evaluates the effect of vitamin D supplementation on glycaemic markers in this population. Literature searches were performed in the BIREME, LILACS, and PubMed databases using the Medical Subject Headings and words related to vitamin D, type 2 diabetes mellitus, and glycaemic control. Interventional and observational studies were considered eligible. The evaluation of the included studies was independently performed by 2 evaluators at all stages of selection, data extraction, and bias risk assessment. The primary outcome was the relationship between vitamin D levels and glucose metabolism markers in type 2 diabetes mellitus individuals. The secondary outcome was the effect of vitamin D supplementation on the glycaemic control markers in individuals with type 2 diabetes mellitus. The inverse relationship between vitamin D and variables of glucose metabolism was verified. Interventional studies revealed that vitamin D supplementation did not alter glycaemic control markers in most studies. Few studies have shown positive effects with a significant reduction in the percentage of glycated haemoglobin, insulin, and glucose concentrations, and changes in homeostatic model assessment-insulin resistance and beta cell, and quantitative insulin sensitivity check index. Therefore, despite the association of vitamin D with glucose metabolism, there is insufficient evidence of the beneficial effects of its supplementation on the metabolic control of type 2 diabetes mellitus.

Dietary program and physical activity impact on biochemical markers in patients with type 2 diabetes: A systematic review

ObjectivesEvaluate the effectiveness of the implementation of independently or combined dietary and physical activity programs on the blood glucose values and lipid profile in patients with type 2 diabetes, including participants aged 60 years and over. DesignSystematic review. Data sourcePubMed/Medline database, with language restrictions. Papers published between 2010 and 2016 were included. Study selectionA total of 30 randomised controlled trials were included that focused on physical activity and dietary interventions in patients with type 2 diabetes mellitus and include participants aged 60 years and over. ResultsThe selected articles have shown that the implementation of physical activity programs (aerobic, resistance, flexibility and combined exercises), and programs based on a higher intake of vegetables, grains, legumes, fruits, unsaturated fatty acids, as well as consumption of foods with low glycaemic index, calorie restriction, intake of probiotics, vitamin D supplementation and educational sessions about diabetes improves blood glucose levels, as well as the lipid profile, in patients with type 2 diabetes. ConclusionsPhysical activity and dietary programs are fundamental in the treatment and metabolic control of type 2 diabetes mellitus.

New technologies and metabolic control in type 1 diabetes mellitus

The introduction of more rigorous criteria of metabolic control, rapid- and long-acting insulin analogues and the advances in diabetes technology (improved insulin deliv­ery systems and blood glucose monitoring) have not been translated into better glycaemic control in patients with type 1 diabetes, which is quite similar to that observed 20–30 years ago in the Diabetes Control and Complica­tions Trial (DCCT). Continuous subcutaneous insulin infusion (CSII) provided by personal insulin pumps may improve glycaemic control; however, observed results are not so good as it has been expected and are only slightly better or similar to these obtained with multiple daily insulin injections (MDII). Real-time continuous glucose monitoring (CGM) seems to be very useful to achieve target glycaemic control and to avoid hypoglycaemia in both CSII and MDII patients. While using CGM, levels of HbA 1c are lower, time spent in hypoglycaemia is shorter and frequency of hypoglycaemia episodes is reduced. To receive optimum benefit, excellent compliance and fre­quent readings of measurements are required. The most common real-time sensors used in Poland are: Medtronic Enlite, Dexcom G4 Platinum and Abbott FreeStyle Libre. Unfortunately, for majority of patients with type 1 diabe­tes CGM devices have no reimbursement. (Clin Diabetol 2017; 6, 3: 111–114)

Multimedia education program and nutrition therapy improves HbA1c, weight, and lipid profile of patients with type 2 diabetes: a randomized clinical trial.

To evaluate the effect of a multimedia education program and nutrition therapy on metabolic control in patients with type 2 diabetes. What is the effect of a multimedia education program and nutritional therapy on metabolic control in type 2 diabetes? A randomized clinical trial was conducted in 351 patients randomly assigned to either an experimental group receiving a multimedia diabetes education program (MDE) and nutrition therapy (NT) (NT + MDE: n = 173), or to a control group who received nutrition therapy only (NT: n = 178). At baseline, 7, 14, and 21 months, the glycated hemoglobin (HbA1c), glucose, cholesterol, triglycerides, LDL-cholesterol, and HDL-cholesterol were measured. Weight, body mass index (BMI), waist circumference (WC), fat percentage, fat and lean mass, systolic blood pressure (SBP), and diastolic (DBP) were also recorded. Glycated hemoglobin decreased in both groups, although the group with NT + MDE had a greater reduction, with a difference of -0.76% (95%CI -1.33 to -0.19) at 7 months and -0.73% (95%CI -1.37 to -0.09) at 21 months. Only in the NT + MDE did the glucose decrease at 7 (-41.2 mg/dL; 95%CI -52.0 to -30.5), 14 (-27.8 mg/dL; 95%CI -32.6 to -23.1), and 21 months (-36.6 mg/dL; 95%CI -46.6 to -26.6). Triglycerides and the atherogenic index decreased in both groups at 7 and 14 months; while only in the NT + MDE group did it decrease at 21 months. (p < 0.05). Weight decreased at 21 months in the NT + MDE group (-1.23, -2.29 at -0.16; p < 0.05). Nutrition therapy and a multimedia diabetes education program have a favorable impact on achieving metabolic control goals in type 2 diabetes.

Systemic Effects of Repeated Intraocular Dexamethasone Intravitreal Implant in Diabetic Patients: A Retrospective Study.

IntroductionThe objective of this study is to evaluate the influence of repeated intraocular dexamethasone implant (Ozurdex) injections on metabolic control in type 2 diabetic patients.MethodsRetrospective study of 165 type 2 diabetic patients starting Ozurdex treatment who received no less than three consecutive injections. Glycated hemoglobin (HbA1c), serum creatinine, total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides (TGs) were evaluated during 15 months of follow-up after Ozurdex treatment onset.ResultsFifty-seven patients met inclusion criteria. Mean baseline values for HbA1c, creatinine, total cholesterol, HDL cholesterol, and TGs before treatment (7.1%, 1.3, 176.7, 51.1, and 125.6 mg/dl, respectively) were similar to mean values after Ozurdex onset (Wilcoxon test p values were 0.68, 0.41, 0.06, 0.87, and 0.33, respectively) and remained stable during the follow-up period. Mean LDL cholesterol levels increased slightly after Ozurdex treatment onset (90.1 vs 88.2 mg/dl, p = 0.04) but after 15 months of follow-up they had returned to baseline values. Transient increase in LDL cholesterol was remarkable in the group of 24 bilaterally treated patients (96.8 vs 88.4 mg/dl, p = 0.03). A third of these patients increased their baseline LDL values by more than 20%. Even with continuous injections of Ozurdex, LDL cholesterol levels also declined back to baseline by month 15.ConclusionOzurdex injections had no influence on HbA1c or renal function. Lipid profile changes were mild and transient. However, a significant temporary increase has been found in LDL cholesterol levels in patients receiving simultaneous bilateral injections. Lipid levels should be monitored in patients starting with bilateral Ozurdex injections especially in those with recent history of acute myocardial infarction.